The HIPAA coding regulations establish the code sets the health care industry uses to describe medical diagnosis and treatment.
Enacted as part of the Health Insurance Portability and Accountability Act of 1996, the HIPAA medical coding regulations standardize the code sets health care organizations use to process health care data. Hospitals and health plans use codes to represent diagnosis, treatment, drugs and equipment used in a patient's medical care to facilitate billing and administrative reporting. Standardized coding across the industry is designed to encourage electronic commerce in health care, lower administrative costs and improve efficiency and accuracy.
Diagnosis
The HIPAA medical coding regulations establish the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) as the code set hospitals and health plans should use for inpatient hospital diagnosis coding. The codes reference diseases, injuries, impairments, other related health problems and their causes. This code set is maintained by the Centers for Medicaid and Medicare Services (CMS).
Treatment
The regulations establish the International Classification of Diseases, 10th revision, Procedure Coding System (ICD-10-PCS) to reference procedures or other actions that address a patient's disease, injury or impairment. These actions may include prevention, diagnosis, treatment and management. CMS also maintains this code set.
Physician Services
Maintained and distributed by the American Medical Association, the HIPAA code set rules establish the Current Procedural Terminology (CPT) code set for use in describing medical procedures and physician services. These services might include physical and occupational therapy, radiological procedures, clinical laboratory tests and hearing and vision services.
Equipment
The regulations establish the Health Care Common Procedure Coding System (HCPCS) as the code set to represent non-physician services, supplies and medical equipment, such as wheelchairs, prosthetics and orthotics. CMS maintains this code set.
Drugs
HIPAA code set rules establish the National Drug Codes (NDC) to reference drugs and biologics. This code set identifies the manufacturer, product and package size of all drugs and biologics that the U.S. Food and Drug Administration (FDA) recognizes. The FDA maintains this code set in collaboration with drug makers.
Dental Services
Maintained and distributed by the American Dental Association, the regulations establish the Code on Dental Procedures and Nomenclature (CDT) as the code set for dental services.
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