Appendix A. External Code Sources

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A.1 External Code Sources

Appendix A is a listing of all external code sources referenced in this implementation guide.

  • Where an external code source is referenced, the implementer is required to use only the codes from that list.

  • Codes must be reported as listed in the code source (e.g. with leading zeroes).

  • Implementers must follow the instructions for code use that are supplied by the code set owner.

5 Countries, Currencies and Funds

SIMPLE DATA ELEMENT/CODE REFERENCES

26, 100, 1715, 66/38, 235/CH, 235/HA, 235/HB, 955/SP

SOURCE

Codes for Representation of Names of Countries, ISO 3166-(Latest Release)

Codes for Representation of Currencies and Funds, ISO 4217-(Latest Release)

AVAILABLE FROM

American National Standards Institute

25 West 43rd Street, 4th Floor

New York, NY 10036

ABSTRACT

Part 1 (Country codes) of the ISO 3166 international standard establishes codes that represent the current names of countries, dependencies, and other areas of special geopolitical interest, on the basis of lists of country names obtained from the United Nations. Part 2 (Country subdivision codes) establishes a code that represents the names of the principal administrative divisions, or similar areas, of the countries, etc. included in Part 1. Part 3 (Codes for formerly used names of countries) establishes a code that represents non-current country names, i.e., the country names deleted from ISO 3166 since its first publication in 1974. Most currencies are those of the geopolitical entities that are listed in ISO 3166 Part 1, Codes for the Representation of Names of Countries. The code may be a three-character alphabetic or three-digit numeric. The two leftmost characters of the alphabetic code identify the currency authority to which the code is assigned (using the two character alphabetic code from ISO 3166 Part 1, if applicable). The rightmost character is a mnemonic derived from the name of the major currency unit or fund. For currencies not associated with a single geographic entity, a specially-allocated two-character alphabetic code, in the range XA to XZ identifies the currency authority. The rightmost character is derived from the name of the geographic area concerned, and is mnemonic to the extent possible. The numeric codes are identical to those assigned to the geographic entities listed in ISO 3166 Part 1. The range 950-998 is reserved for identification of funds and currencies not associated with a single entity listed in ISO 3166 Part 1.

22 States and Provinces

SIMPLE DATA ELEMENT/CODE REFERENCES

156, 66/SJ, 128/PCJ, 128/SOJ, 235/A5, 771/009

SOURCE

U.S. Postal Service or

Canada Post or

Bureau of Transportation Statistics

AVAILABLE FROM

The U.S. state codes may be obtained from:

U.S. Postal Service

National Information Data Center

P.O. Box 2977

Washington, DC 20013

www.usps.gov

The Canadian province codes may be obtained from:

http://www.canadapost.ca

The Mexican state codes may be obtained from:

www.bts.gov/ntda/tbscd/mex-states.html

ABSTRACT

Provides names, abbreviations, and two character codes for the states, provinces and sub-country divisions as defined by the appropriate government agency of the United States, Canada, and Mexico.

51 ZIP Code

SIMPLE DATA ELEMENT/CODE REFERENCES

116, 66/16, 309/PQ, 309/PR, 309/PS, 771/010

SOURCE

National ZIP Code and Post Office Directory, Publication 65

The USPS Domestic Mail Manual

AVAILABLE FROM

U.S Postal Service

Washington, DC 20260

New Orders

Superintendent of Documents

P.O. Box 371954

Pittsburgh, PA 15250-7954

ABSTRACT

The ZIP Code is a geographic identifier of areas within the United States and its territories for purposes of expediting mail distribution by the U.S. Postal Service. It is five or nine numeric digits. The ZIP Code structure divides the U.S. into ten large groups of states. The leftmost digit identifies one of these groups. The next two digits identify a smaller geographic area within the large group. The two rightmost digits identify a local delivery area. In the nine-digit ZIP Code, the four digits that follow the hyphen further subdivide the delivery area. The two leftmost digits identify a sector which may consist of several large buildings, blocks or groups of streets. The rightmost digits divide the sector into segments such as a street, a block, a floor of a building, or a cluster of mailboxes. The USPS Domestics Mail Manual includes information on the use of the new 11-digit zip code.

121 Health Industry Number

SIMPLE DATA ELEMENT/CODE REFERENCES

66/21, 128/HI, 1270/HI, I05/20

SOURCE

Health Industry Number Database

AVAILABLE FROM

Health Industry Business Communications Council

5110 North 40th Street

Phoenix, AZ 85018

ABSTRACT

The HIN is a coding system, developed and administered by the Health Industry Business Communications Council, that assigns a unique code number to hospitals other provider organizations, and manufacturers and distributors.

130 Healthcare Common Procedure Coding System

SIMPLE DATA ELEMENT/CODE REFERENCES

235/HC, 1270/BO, 1270/BP

SOURCE

Healthcare Common Procedure Coding System

AVAILABLE FROM

Centers for Medicare & Medicaid Services (CMS)

7500 Security Boulevard

Baltimore, MD 21244

ABSTRACT

HCPCS is Centers for Medicare & Medicaid Services (CMS) coding scheme to group procedures performed for payment to providers.

131 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)

SIMPLE DATA ELEMENT/CODE REFERENCES

128/ICD, 235/DX, 235/ID, 1270/BF, 1270/BJ, 1270/BK, 1270/BN, 1270/BQ, 1270/BR, 1270/DD, 1270/PR, 1270/SD, 1270/TD, 1270/AAU, 1270/AAV, 1270/AAX

SOURCE

International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volumes I, II and III

AVAILABLE FROM

U.S. Government Printing Office Bookstore

710 North Capitol Street, NW

Washington, DC 20401

ABSTRACT

The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volumes I, II (diagnoses) and III (procedures) describes the classification of morbidity and mortality information for statistical purposes and for the indexing of healthcare records by diseases and procedures.

132 National Uniform Billing Committee (NUBC) Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

235/NU, 235/RB, 1270/BE, 1270/BG, 1270/BH, 1270/BI, 1270/NUB

SOURCE

National Uniform Billing Data Element Specifications

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

Revenue codes are a classification of hospital charges in a standard grouping that is controlled by the National Uniform Billing Committee.

139 Claim Adjustment Reason Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1034

SOURCE

National Health Care Claim Payment/Advice Committee Bulletins

AVAILABLE FROM

Blue Cross and Blue Shield Association

Health Information Technology Department

225 N Michigan Avenue

Chicago, IL 60601-7680

ABSTRACT

Bulletins describe standard codes and messages that detail the reason why an adjustment was made to a health care claim payment by the payer.

229 Diagnosis Related Group Number (DRG)

SIMPLE DATA ELEMENT/CODE REFERENCES

1354, 1270/DR

SOURCE

Federal Register and Health Insurance Manual 15 (HIM 15)

AVAILABLE FROM

Superintendent of Documents

U.S. Government Printing Office

Washington, DC 20402

ABSTRACT

A patient classification scheme that clusters patients into categories on the basis of patient's illness, diseases, and medical problems.

230 Admission Source Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1314

SOURCE

National Uniform Billing Data Element Specifications

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

A variety of codes explaining who recommended admission to a medical facility.

231 Admission Type Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1315

SOURCE

National Uniform Billing Data Element Specifications

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

A variety of codes explaining the priority of the admission to a medical facility.

235 Claim Frequency Type Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1325

SOURCE

National Uniform Billing Data Element Specifications Type of Bill Last Position

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

A variety of codes explaining the frequency of different Types of Bills (for example, Replacement Claims).

236 Uniform Billing Claim Form Bill Type

SIMPLE DATA ELEMENT/CODE REFERENCES

1332/A

SOURCE

National Uniform Billing Data Element Specifications Facility Type Code

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

A variety of codes describing the type of medical facility.

239 Patient Status Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1352

SOURCE

National Uniform Billing Data Element Specifications

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

A variety of codes indicating patient status as of the statement covers through date.

240 National Drug Code by Format

SIMPLE DATA ELEMENT/CODE REFERENCES

235/N1, 235/N2, 235/N3, 235/N4, 235/N5, 235/N6, 1270/NDC

SOURCE

Drug Establishment Registration and Listing Instruction Booklet

AVAILABLE FROM

Federal Drug Listing Branch HFN-315

5600 Fishers Lane

Rockville, MD 20857

ABSTRACT

Publication includes manufacturing and labeling information as well as drug packaging sizes.

411 Remittance Advice Remark Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/HE

SOURCE

Centers for Medicare & Medicaid Services

OIS/BSOG/DDIS, Mail Stop N2-13-16

7500 Security Boulevard

Baltimore MD 21244

AVAILABLE FROM

Washington Publishing Company http://www.wpc-edi.com

ABSTRACT

Remittance Advice Remark Codes (RARC) are used to convey information about claim adjudication. It could provide general information or supplemental explanations to an adjustment already reported by a Claim Adjustment Reason Code.

530 National Council for Prescription Drug Programs Reject Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/RX

SOURCE

National Council for Prescription Drug Programs Data Dictionary

AVAILABLE FROM

NCPDP

9240 East Raintree Drive

Scottsdale, AZ 85260

ABSTRACT

A listing of NCPDPs reject reason codes, the explanation of the code, and the field number in error.

537 National Provider Identifier (NPI)

SIMPLE DATA ELEMENT/CODE REFERENCES

66/XX, 128/HPI

SOURCE

National Plan and Provider Enumeration System (NPPES)

AVAILABLE FROM

NPI Enumerator

P.O. Box 6059

Fargo, ND 58108-6059

ABSTRACT

The National Provider Identifier (NPI) refers to the standard unique health identifier for health care providers in 45 CFR 162 Subpart D.

540 Health Plan Identifier (HPID)

SIMPLE DATA ELEMENT/CODE REFERENCES

66/OE, 66/XV, 128/ABY, 128/OEI

SOURCE

Health Plan and Other Entity Enumeration System (HPOES) housed within CMSҠHealth Insurance Oversight System (HIOS)

AVAILABLE FROM

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

ABSTRACT

The Centers for Medicare and Medicaid Services has joined with other payers to develop a unique national provider identifier. The Centers for Medicare and Medicaid Services is the authorizing agent for enumerating payers through the services of a PlanID Registrar. It may also be used by other payers on a voluntary basis.

576 Workers Compensation Specific Procedure and Supply Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

235/ER

SOURCE

IAIABC Jurisdiction Medical Bill Report Implementation Guide

AVAILABLE FROM

IAIABC EDI Implementation Manager

International Association of Industrial Accident Boards and Commissions

8643 Hauses - Suite 200

87th Parkway

Shawnee Mission, KS 66215

ABSTRACT

The IAIABC Jurisdiction Medical Bill Report Implementation Guide describes the requirements for submitting and the data contained within a jurisdiction medical report. The Implementation Guide includes: Reporting scenarios, data definitions, trading partner requirements tables, reference to industry codes, and IAIABC maintained code lists.

682 Health Care Provider Taxonomy

SIMPLE DATA ELEMENT/CODE REFERENCES

128/PXC, 1270/68

SOURCE

The National Uniform Claim Committee

AVAILABLE FROM

The National Uniform Claim Committee

c/o American Medical Association

515 North State Street

Chicago, IL 60610

ABSTRACT

Codes defining the health care service provider type, classification, and area of specialization.

716 Health Insurance Prospective Payment System (HIPPS) Rate Code

SIMPLE DATA ELEMENT/CODE REFERENCES

235/HP

SOURCE

Health Insurance Prospective Payment System (HIPPS) Rate Code

AVAILABLE FROM

Division of Institutional Claims Processing

Centers for Medicare & Medicaid Services

C4-10-07

7500 Security Boulevard

Baltimore, MD 21244-1850

ABSTRACT

The Centers for Medicare & Medicaid Services develops and publishes the HIPPS codes to establish a coding system for claims submission and claims payment under prospective payment systems. These codes represent the case mix classification groups that are used to determine payment rates under prospective payment systems. Case mix classification groups include, but may not be limited to , resource utilization groups (RUGs) for skilled nursing facilities, home health resource groups (HHRGs) for home health agencies, and case mix groups (CMGs) for inpatient rehabilitation facilities.

881 Version / Release / Industry Identifier Code

SIMPLE DATA ELEMENT/CODE REFERENCES

480

SOURCE

Data Interchange Standards Association

AVAILABLE FROM

Data Interchange Standards Association

7600 Leesburg Pike, Suite 430

Falls Church, VA 22043

ABSTRACT

Code indicating the version, release, sub-release, and industry identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and sub-release, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed.

896 International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS)

SIMPLE DATA ELEMENT/CODE REFERENCES

128/PCS, 235/IP, 1270/BBQ, 1270/BBR

SOURCE

International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS)

AVAILABLE FROM

CMM, HAPG, Division of Acute Care

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

ABSTRACT

The International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS), describes the classification of inpatient procedures for statistical purposes and for the indexing of healthcare records by procedures.

897 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)

SIMPLE DATA ELEMENT/CODE REFERENCES

128/I10, 235/DC, 1270/ABF, 1270/ABJ, 1270/ABK, 1270/ABN, 1270/ABU, 1270/ABV, 1270/ADD, 1270/APR, 1270/ASD, 1270/ATD

SOURCE

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)

AVAILABLE FROM

OCD/Classifications and Public Health Data Standards

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

ABSTRACT

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), describes the classification of morbidity and mortality information for statistical purposes and for the indexing of healthcare records by diseases.

932 Universal Postal Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

116

SOURCE

Universal Postal Union website

AVAILABLE FROM

International Bureau of the Universal Postal Union

POST*CODE

Case postale 13

3000 BERNE 15 Switzerland

ABSTRACT

The postcode is the fundamental, essential element of an address. A unique, universal identifier, it unambiguously identifies the addressee's locality and assists in the transmission and sorting of mail items. At present, 105 UPU member countries use postcodes as part of their addressing systems.

959 Present On Admission Indicator

SIMPLE DATA ELEMENT/CODE REFERENCES

1271

SOURCE

National Uniform Billing Committee Official UBO4 Data Specifications Manual

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

The Present On Admission Indicator is a code indicating whether a diagnosis or external cause of injury, poisoning, or adverse event was present on admission.

973 Insurance Industry Specific Remark Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/RM

SOURCE

Insurance Industry Specific Remark Codes List

AVAILABLE FROM

ASC X12

201 East Fourth Street, Suite 202

Frederick, MD 2170

ABSTRACT

The code set represents a list of Industry Specific Remark Codes that will be used to supplement the Claim Adjustment Reason Codes.

974 Claim Adjustment Group Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

1785

SOURCE

Claim Adjustment Group Code

AVAILABLE FROM

ASC X12

201 East Fourth Street, Suite 202

Frederick, MD 2170

ABSTRACT

The code set represents the list of group codes that supplement the adjustment reason codes and remark codes.