Insurance companies use of diagnostic and medical treatment codes are regulated by the Health Insurance Portability and Accountability Act, or HIPAA. These treatment codes or "code sets" is referred to any set of codes that is used to encode medical data such as procedures and diagnoses. Various types of code sets have been adopted by the Department of Health and Human Services and are required to be used for electronic transactions.
Electronic Data Interchange
An Electronic Data Interchange, or EDI, is the electronic transfer of information between organizations or trading partners that exchange information or data. HIPAA law includes provisions that has led to the development of a uniform framework or standards for the exchange of electronic transactions such as the use of medical treatment codes. The use of EDI makes processing data faster and eliminates the need to store many types of paper documents.
CPT Codes
CPT stands for Current Procedure Terminology, which are codes that describe a particular type of medical procedure. The American Medical Association updates and maintains these codes to provide uniform information and languagefor heath care providers. There are currently over 7,800 CPT codes being used that consist of five numeric digits. Providers who need these codes can purchase them by contacting the American Medical Association.
HCPCS
HCPCS is the Health Care Common Procedure Coding System which has been established by the Centers for Medicare and Medicaid Services. This code set is used to identify supplies and medical services not provided by a physician that are not covered by the CPT Codes maintained by the American Medical Association.
ICD Codes
These are diagnosis codes that are known as the International Classification of Diseases. The diagnosis system for these codes is referred to ICD-9-CM and ICD-10-CM. ICD codes are used for coding various conditions, injuries, diseases and symptoms. These codes are maintained by the National Center for Health Statistics, Centers for Disease control which is located within the Department of Health and Human Services. The newest codes can be found in the International Classification of Diseases,10th Revision, Clinical Modification reference book.
Provider Requirements
HIPAA law requires health plans and insurance companies to accept a standard medical claim that has been set electronically. They cannot require health care providers to make changes or additions to the medical treatment codes on the claim. The development of code sets under the HIPAA law supersedes any state laws, provider requirements or agreements.
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