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.

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.

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.

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.

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.

507 Health Care Claim Status Category Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1271

SOURCE

Health Care Claim Status Category Code

AVAILABLE FROM

Blue Cross and Blue Shield Association Health Information Technology Department 225 N Michigan Avenue Chicago, IL 60601-7680

ABSTRACT

Code used to organize the Health Care Claim Status Codes into logical groupings

508 Health Care Claim Status Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1271, 1270/65

SOURCE

Health Care Claim Status Code

AVAILABLE FROM

Blue Cross and Blue Shield Association Health Information Technology Department 225 N Michigan Avenue Chicago, IL 60601-7680

ABSTRACT

Code identifying the status of an entire claim or service line

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.

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.