Frequently Asked Questions About Code Set Standards Adopted Under HIPAA. What code sets have been adopted as HIPAA standards?

09/20/2000

The Secretary has adopted the following code sets as the standard medical data code sets:

International Classification of Diseases, 9th Edition, Clinical Modification, (ICD-9-CM), Volumes 1 and 2 (including The Official ICD-9-CM Guidelines for Coding and Reporting), as updated and distributed by HHS, for the following conditions:

  1. Diseases.
  2. Injuries.
  3. Impairments.
  4. Other health related problems and their manifestations.
  5. Causes of injury, disease, impairment, or other health-related problems.

International Classification of Diseases, 9th Edition, Clinical Modification, (ICD-9-CM), Volume 3 Procedures (including The Official ICD-9-CM Guidelines for Coding and Reporting), as updated and distributed by HHS, for the following procedures or other actions taken for diseases, injuries, and impairments on hospital inpatients reported by hospitals:

  1. Prevention.
  2. Diagnosis.
  3. Treatment.
  4. Management.

National Drug Codes (NDC), as updated and distributed by HHS, in collaboration with drug manufacturers, for the following: [Note that Secretary Thompson has indicated in a letter to the NCVHS that HHS will publish an NPRM in the near future proposing to retract the adoption of NDC for all transactions save those for retail pharmacies.]

  1. Drugs.
  2. Biologics.

Code on Dental Procedures and Nomenclature, as updated and distributed by the American Dental Association, for dental services.

The combination of Centers for Medicare & Medicaid Services (formerly known as Health Care Financing Administration) Common Procedure Coding System (HCPCS), as updated and distributed by HHS; and Current Procedural Terminology, Fourth Edition (CPT-4), as updated and distributed by the American Medical Association, for physician services and other health related services. These services include, but are not limited to, the following:

  1. Physician services.
  2. Physical and occupational therapy services.
  3. Radiological procedures.
  4. Clinical laboratory tests.
  5. Other medical diagnostic procedures.
  6. Hearing and vision services.
  7. Transportation services including ambulance.

The Centers for Medicare & Medicaid Services (formerly known as Health Care Financing Administration) Common Procedure Coding System (HCPCS), as updated and distributed by CMS, HHS, for all other substances, equipment, supplies, or other items used in health care services. These items include, but are not limited to, the following:

  1. Medical supplies.
  2. Orthotic and prosthetic devices.
  3. Durable medical equipment.