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.

135 American Dental Association

SIMPLE DATA ELEMENT/CODE REFERENCES

1361, 235/AD, 1270/JO, 1270/JP, 1270/TQ, 1270/AAY

SOURCE

Current Dental Terminology (CDT) Manual

AVAILABLE FROM

Salable Materials

American Dental Association

211 East Chicago Avenue

Chicago, IL 60611-2678

ABSTRACT

The CDT manual contains the American Dental Association's codes for dental procedures and nomenclature and is the accepted set of numeric codes and descriptive terms for reporting dental treatments and descriptors.

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.

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.

237 Place of Service Codes for Professional Claims

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/POS, 1332/B

SOURCE

Place of Service Codes for Professional Claims

AVAILABLE FROM

Centers for Medicare & Medicaid Services

CMSO, Mail Stop S2-01-16

7500 Security Blvd

Baltimore, MD 21244-1850

ABSTRACT

The Centers for Medicare & Medicaid Services develops place of service codes to identify the location where health care services are performed.

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.

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.

662 SNOMED, Systematized Nomenclature of Medicine

SIMPLE DATA ELEMENT/CODE REFERENCES

128/SNH, 235/LD, 1270/AAA

SOURCE

Systematized Nomenclature of Medicine (SNOMED)

AVAILABLE FROM

College of American Pathologists

325 Waukegan Road

Northfield, IL 60093-2750

ABSTRACT

SNOMED is a comprehensive, multi-axial, concept-based terminology created for indexing the entire medical record, including signs and symptoms, diagnoses and procedures. Its design provides the framework for systems to collect, retrieve, aggregate, and transmit health data across clinical specialities and sites of care in a computer-readable form. Use of the "Concept Code" in Code Source 662 supports accurate indexing/coding of patient data.

663 Logical Observation Identifier Names and Codes (LOINC)

SIMPLE DATA ELEMENT/CODE REFERENCES

128/LOI, 235/LB, 1270/LOI

SOURCE

Logical Observation Identifier Names and Codes (LOINC)

AVAILABLE FROM

Reginstriff Institute

Indiana University School of Medicine

1001 West 10th Street

5th Floor RHC

Indianapolis, IN 46202

ABSTRACT

List of descriptive terms and identifying codes for reporting precise test methods in medicine.

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.

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.

886 Health Care Service Review Decision Reason Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

1271

SOURCE

Health Care Service Review Decision Reason Code List

AVAILABLE FROM

Blue Cross and Blue Shield Association

Health Information Technology Department

225 N Michigan Avenue

Chicago, IL 60601-7680

ABSTRACT

Code identifying the decision of a health care service review as reported by the transaction set sender

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.

958 Service Type

SIMPLE DATA ELEMENT/CODE REFERENCES

1271

SOURCE

Service Type List

AVAILABLE FROM

Washington Publishing Company

747 177th Lane NE

Bellevue, WA 98008

ABSTRACT

Code identifying the classification of health care service.