ABOUT ADMINISTRATIVE SIMPLIFICATION

Code Sets Basics

What is a Medical or Non-Medical Code Set? Administrative Simplifcation A code set is a shared list of codes Code Sets that is used in place of longer HHS adopted specific code sets to reduce confusion about which names or explanations. codes should be used in electronic health care transactions. These code sets are used in a range of health care functions, such as: Health care transactions use medical code sets to quickly • Billing identify: • Tracking public health trends Research • Diagnoses • • Treatments, procedures, and tests Widespread use of standard transactions—where everyone uses • Medical equipment and supplies the same , format, and codes—can lead to and cost • Medications savings across the health care industry. Health care transactions use Below is a list of health care activities and items commonly non-medical code sets to quickly referenced in standard transactions and the code sets used to identify: identify each code set.

• Organizational routing Health Care Activity/Item Adopted Code Set • Claim payment adjustment information Diagnoses (ICD-10-CM) ICD-10 – International Classifcation Procedures (ICD-10-PCS) of Diseases, 10th edition • Claim status information • ZIP code information Outpatient services/procedures CPT – Current Procedure Terminology Using adopted code sets in Health care equipment and supplies standard transactions streamlines Health Care Common Procedure the administrative process by Services not covered by CPT Coding System (HCPCS) reducing time spent translating codes CDT – Code on Dental Procedures and information into different formats. Dental procedures Nomenclature Drug products NDC – National Drug Codes

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