|
 HIPAA
Codes
The
Health Insurance Portability and Accountability Act of 1996 (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. Key HIPAA Procedural Codes are listed here. Note
that this is not to be considered a complete list.
Learn
more about HIPAA and the code sets.
The
American Academy of Family Physicians (AAFP) has an excellent
online toolkit of HIPAA
Resources which
includes transactions and code set standards, information on
privacy and security, and links to obtain additional
information.
Well
Child Codes
HIPAA
Procedural Code
(As
of 01/01/04)
|
HIPAA Modifier
(As of 01/01/04) |
Procedure Code Description |
Diagnosis Code |
Reimbursement |
| Preventive
Visits |
99381
(new patient)
99391 (established patient) |
EP |
Preventive
Visit: 0 - 11 months |
V20.2 |
|
99382
(new patient)
99392 (established patient) |
EP |
Preventive
Visit: 1 - 4 years |
V20.2 |
|
99383
(new patient)
99393 (established patient) |
EP |
Preventive
Visit: 5 - 11 years |
V20.2 |
|
99384
(new patient)
99394 (established patient) |
EP |
Preventive
Visit: 12 - 17 years |
V20.2 |
|
99385
(new patient)
99395 (established patient) |
EP |
Preventive
Visit: 18 - 20 years |
V20.2 |
|
| Abnormal
Screenings or Referrals |
99381
(new patient)
99391 (established patient) |
EP |
Abnormal
Screening/Referral: 0 - 11 months |
All
ICD-9 Diagnosis codes excluding V20-V20.2, V70.0 and V70.3-70.9,
V72.0, V72.1, V03.81, V04.8, V03.82, V06.1, V06.5,
V06.4, V06.8, V04.0, V05.4, V74.1, and V82.5 to note that this is
an abnormal screen. |
|
99382
(new patient)
99392 (established patient) |
EP |
Abnormal
Screening/Referral: 1 - 4 years |
|
99383
(new patient)
99393 (established patient) |
EP |
Abnormal
Screening/Referral: 5 - 11 years |
|
99384
(new patient)
99394 (established patient) |
EP |
Abnormal
Screening/Referral: 12 - 17 years |
|
99385
(new patient)
99395 (established patient) |
EP |
Abnormal
Screening/Referral: 18 - 20 years |
|
Select
ICD-9 (International Classification of Diseases, 9th Revision)
Diagnosis
Codes Commonly Used
ICD-9
Diagnosis Code
|
Description |
| V03 |
Need for prophylactic vaccination and inoculation against
bacterial diseases |
| V04 |
Need for prophylactic vaccination and inoculation against
certain viral diseases |
| V05 |
Need for other prophylactic vaccination and inoculation against
single diseases |
| V06 |
Need for prophylactic vaccination and inoculation against
combinations of diseases |
| V20 |
Health
supervision of infant or child |
| V70 |
General
medical examination |
| V72 |
Special investigations and examinations |
| V74 |
Special screening examination for bacterial and spirochetal
diseases |
| V82 |
Special screening for other conditions |
Interperiodic
Vision Only and Hearing Only Procedure Codes
HIPAA
Procedural Code
(As
of 01/01/04)
|
HIPAA
Modifier
(As
of 01/01/04) |
Procedure
Code Description |
Diagnosis
Code |
Reimbursement |
| Vision |
| 99173 |
EP |
Interperiodic
vision, normal |
V72.0 |
|
| 99173 |
EP |
Interperiodic
vision, abnormal |
The appropriate
ICD-9-CM diagnosis code |
|
| Hearing |
| V5008 |
EP |
Interperiodic
hearing, normal |
V72.1 |
|
| 92551 |
EP |
Interperiodic
hearing, normal
screening both ears, pure tone, air only |
V72.1 |
|
| 92552 |
EP |
Interperiodic
hearing, normal
screening both ears, pure tone audiometry (threshold); air only |
V72.1 |
|
| 92553 |
EP |
Interperiodic
hearing, normal
screening both ears, pure tone
audiometry (threshold); air and bone |
V72.1 |
|
| 92555 |
EP |
Interperiodic
hearing, normal
screening both ears, speech
audiometry threshold |
V72.1 |
|
| 92556 |
EP |
Interperiodic
hearing, normal
screening both ears, speech
audiometry threshold with speech recognition |
V72.1 |
|
| V5008 |
EP |
Interperiodic hearing, abnormal |
The appropriate ICD-9-CM diagnosis code |
|
| 92551 |
EP |
Interperiodic
hearing, abnormal
screening both ears, pure tone, air
only |
|
| 92552 |
EP |
Interperiodic
hearing, abnormal
screening both ears, pure tone
audiometry (threshold); air only |
|
| 92553 |
EP |
Interperiodic
hearing, abnormal
screening both ears, pure tone
audiometry (threshold); air and bone |
|
| 92555 |
EP |
Interperiodic
hearing, abnormal
screening both ears, speech audiometry
threshold |
|
| 92556 |
EP |
Interperiodic
hearing, abnormal
screening both ears, speech audiometry
threshold with speech recognition |
|
Immunization,
Tuberculin Skin Test, and Blood Lead Test Procedure Codes
HIPAA
Procedural Code
(As
of 01/01/04)
|
HIPAA
Modifier
(As
of 01/01/04) |
Procedure
Code Description |
Diagnosis
Code |
Reimbursement |
| 90647 |
EP |
Hemophilus
influenza, type B (HIB) |
V03.81 |
|
| 90655 |
EP |
Influenza
(preservative free) |
V04.8 |
|
| 90657 |
EP |
Influenza
ages 0 - 3 years years (split virus) |
V04.8 |
|
| 90658 |
EP |
Influenza
ages 3 - 20 years (split virus) |
V04.8 |
|
| 90659 |
EP |
Influenza
ages 12 - 20 years (whole virus) |
V04.8 |
|
| 90669 |
EP |
(prevnar)
Pneumococcal Conjugate |
V03.82 |
|
| 90700 |
EP |
DTAP |
V06.1 |
|
| 90702 |
EP |
DT |
V06.5 |
|
| 90707 |
EP |
MMR |
V06.4 |
|
| 90713 |
EP |
IPV |
V04.0 |
|
| 90716 |
EP |
Varicella |
V05.4 |
|
| 90718 |
EP |
TD |
V06.5 |
|
| 90723 |
EP |
(DTAP, Hep B, and IPV) |
V06.8 |
|
| 90732 |
EP |
Pneumococcal Polysaccharide |
V03.82 |
|
| 90744 |
EP |
Hepatitis B |
V05.3 |
|
| 90748 |
EP |
Combination HEP B and HIB |
V06.8 |
|
| 86580 |
EP |
TB Skin Test |
V74.1 |
|
| 36415 |
EP |
Blood Lead Test |
V82.5 |
|
|
