Inventory of Health Care Information Standards. Perspective on Code Sets Within Transaction Standards


This perspective was presented to the ANSI HISB on December 13, 1996 by Christopher Chute, M.D., co-chairman of the Codes and Vocabulary Sub-committee of the ANSI HISB TCC.

Analysis of Code Sets Within Transaction Standards

Data Standards Roster

Code Sets within Transaction Standards

The Codes and Vocabulary Sub-committee reports the obvious finding that existing Transactions Standards have embedded within their specification scores of implicit and explicit value tables for data elements. Common examples include values for demographic variables such as race, gender, or marital status. More clinically pertinent codes include Admission Type and Condition Codes. Some standards contain large numbers of specified codes, for example the ANSI X12 837 Health Care Claim template includes or references 441 discreet code tables within that single standard.

Two problems present themselves: 1) Cross mapping named fields or elements among transaction standards; and 2) for each cross mapped element, resolving the code set values among embedded codes sets across transaction standards. The Table below simplistically illustrates a result of this process for one of the 441 code tables in X12N 837 - Admission Type.

Admission Type














Labor and Delivery












Table: Code values for fields "Admission Type"

This subcommittee recommends that HHS assume or commission a detailed evaluation of the complex problem of embedded code sets among transactions standards. For the major transaction standards and their clinical systems sources (e.g. X12N, UB-92, NSF, HL/7, and ASTM E-1384) we suggest:

  1. ) Embedded Code Sets be identified and characterized.
  2. ) Code sets should be clustered across standards for similarity on the basis of element name, table content, or semantic function.
  3. ) For each cluster of similar code sets, the values should be tabulated in a way to clearly represent overlap, discord, and union. The Table layout above might provide a practical format.
  4. ) An analysis of content conflict on the basis of these similarity tables should be presented.
  5. ) Recommended resolutions of code table conflicts should be proposed.

The resultant report would be an enormously valuable resource for Standards Developer Organizations and the overall ANSI HISB to review and collaboratively revise. DHHS might then act upon the revised recommendations from the Standards community to adopt common code table standards across transaction records and their clinical source systems.