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Code Sets

The 2000 Final Rule names 6 specific medical data code sets for use in the transactions. In addition, the Final Rule points to those code sets named in the implementation specifications of the mandated transaction standards.

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding effective not prior to October 1, 2015, as a result of the signed and enacted “Protecting Access to Medicare Act of 2014” (H.R. 4302).

ICD-9-CM Volume 3, for procedure coding, will be replaced with International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) effective not prior to October 1, 2015, as a result of the signed and enacted “Protecting Access to Medicare Act of 2014” (H.R. 4302).

For more information on ICD-10, please click here.

Standard Medical Data Code Sets

Code Set

Use

Maintained By

Frequency of Update

ICD-9-CM Volumes 1&2

Diagnosis Coding

Department of Health & Humans Services (HHS)

Annually in October

ICD-9 CM Volume 3

Procedure Coding

(In-patient Procedures)

HHS

Annually in October

National Drug Code (NDC)

Universal Identifier for Human Drugs

HHS

As required/quarterly in Mar, Jun, Sep, Dec

Code on Dental Procedures and Nomenclature (CDT)

Dental Procedure Coding

American Dental Association

Every 3-5 years

A combination of Health Care Financing Administration Common Procedure Coding System (HCPCS) and Current Procedure Terminology (CPT)

Physician and other Health Care Services

HHS

 

 

American Medical Association

Annually in January

HCPCS

Substances, Equipment, Supplies or other items used in Health Care Services

HHS

Annually in October

Other Code Sets required by implementation specifications include:

Provider Taxonomy Codes
International Organization of Standards (ISO) 3166
Claim Adjustment Reason Codes
Place of Service Code
Claim Status Code

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