Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Revenue Cycle of Various Health Care Enterprises
Slide content:HIPAA Code Sets ICD-10-CM (Diagnosis codes) ICD-10-PCS (Procedure codes) NCHS & CMS respectively Current Procedural Terminology (CPT) AMA National Drug Codes (NDC) FDA and drug manufacturers Code on DentalProcedures and Nomenclature (CDT) ADA 18
Slide notes:The Health Insurance Portability and Accountability Act, or HIPAA, of 1996 requires that providers use specific code sets when submitting claims. This slide lists some of the code sets used to report medical services. The list also includes the organizations responsible for each code set. Two of these deserve further discussion here, the ICD-10-CM and the current procedural terminology, or CPT. ICD-10-CM is based on the World Health Organization's, or WHOs International Classification of Diseases, Tenth Revision, or ICD-10. ICD-10-CM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the U.S. The National Center for Health Statistics, or NCHS, and the Centers for Medicare and Medicaid Services, or CMS, are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-10-CM. ICD-10-CM for medical diagnoses is based on WHOs ICD-10. CMS also developed a new Procedure Coding System, ICD-10-PCS, for inpatient procedures. ICD-10-CM replaces ICD-9-CM, volumes 1 and 2, and ICD-10-PCS replaces ICD-9-CM, volume 3. The Current Procedural Terminology, or CPT, code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payors for administrative, financial, and analytical purposes. The National Drug Codes, or NDC, are developed by the Federal Drug Administration, or FDA, and drug manufacturers. Also, the American Dental Association develops specific codes for dental procedures called the Code on DentalProcedures and Nomenclature, or CDT. 18