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 HIPAA
Codes
Understanding
HIPAA
The
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
is a federal law that mandates the use of
national standards
and code sets for health transactions, as well as standards
for privacy and security of health information. HIPAA allows
persons
to qualify immediately for comparable health insurance coverage
when they change their employment. Title II of HIPAA gives
the U.S. Department of Health and Human Services (DHHS) the
authority to:
- Mandate
the use of standards for the electronic exchange of health care
data
- Specify what medical and administrative code sets must be
used within those standards
- Require the use of national identification systems for
health care patients, providers, payers (or plans), and
employers
(or sponsors)
- Specify the types of measures required to protect the security
and privacy of personally identifiable health care information
Code
Sets
HIPAA
mandates national standards for administrative codes and medical
codes. State Medicaid agencies
are required to use standardized
medical code sets for medical diagnoses
and for medical and dental procedures. A number of medical
code sets have
been
selected
by DHHS for use in HIPAA transactions:
- Current
Procedural Terminology, Revision 4 (CPT-4) codes: A medical
code set of
physician and other services, maintained
and copyrighted
by the American Medical Association
(AMA) These codes are
used for non-institutional and non-dental
professional transactions.
- Healthcare
Common Procedural Coding System (HCPCS) codes: A medical code
set that
identifies health care procedures,
equipment, and
supplies for claim submission purposes.
-- HCPCS Level I contains numeric
CPT codes maintained by the AMA.
-- HCPCS Level II contains alphanumeric
codes used to identify various items
and services not included in the
CPT code
set.
-- HCPCS Level III contains alphanumeric
codes assigned by Medicaid state
agencies to identify
additional
items and
services not
included in levels I or II. These
are usually called "local
codes" and must have "W", "X", "Y",
or "Z" in the first position.
HCPCS Procedure Modifier Codes can
be used with
all three levels,
with the WA - ZY range
used for locally assigned procedure
modifiers.
- International
Classification of Diseases, 9th Edition - Clinical
Modifications
(ICD-9) codes: A medical code set
maintained
by the World Health Organization.
A U.S. extension, maintained by
the CDC, identifies morbidity factors
or diagnoses and certain procedures.
- Current
Dental Terminology (CDT) codes: A medical code set, maintained
and
copyrighted by the American Dental
Association.
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