Health Insurance Reform: Standards for Electronic Transactions. 1. Code Set Standards

10/16/2000

Proposal Summary: We proposed in subpart J the following: In § 142.1002 (now §162.1000), we stated that health plans, health care clearinghouses, and certain health care providers would have to use the diagnosis and procedure code sets as prescribed by the Secretary for electronic transactions. The proposed standard medical code sets of these diagnosis and procedure code sets were identified in the preamble, and the implementation specifications for the transaction standards in part 142 (now part 162), Subparts K through R, specified which of the standard medical data code sets should be used in individual data elements within those transaction standards.

In §142.1004, we specified that the code sets in the implementation specification for each transaction standard in part 142, subparts K through R, would be the standard for the coded nonmedical data elements present in that transaction standard.

In § 142.1010, the requirements sections of part 142, subparts K through R, specified that those who transmit electronic transactions covered by the transaction standards must use the appropriate transaction standard, including the code sets that are required by that standard. These sections would further specify that those who receive electronic transactions covered by the transaction standards must be able to receive and process all standard codes.

We proposed code sets for various types of services and diagnoses.