Questions Submitted by the Public, by Date Posted to the Website. Standard code sets for service prior to 10/16/2002


Can non-standard medical codes (codes such as J codes for drugs and home grown or local codes) be sent on electronic transactions submitted after the compliance date of 10/16/02 for dates of service prior to 10/16/02?


For dates of service prior to 10/16/2002, the compliance date for the adopted standard medical data code sets would not have been reached. Therefore non-standard codes may be used for dates of service prior to 10/16/2002 on transactions submitted after 10/16/2002. Section 162.1000(a) requires covered entities to use the applicable medical data code sets "valid at the time the health care is furnished" for transactions they conduct after 10/16/2002. To determine which code set was valid at the time of service, the covered entity has to determine the validity dates "specified by the organization responsible for maintaining that code set" and determine whether the date of service falls within those dates.