Transaction and Code Set Standard

One of the key goals of the HIPAA regulation is to simplify and streamline the processing of electronic information throughout the healthcare industry.  Currently, it has been estimated, there are over 400 different formats used by healthplans, providers and information clearinghouses to transfer information in electronic media.  The HIPAA regulations have established the following standard transaction codes in conjunction with the American National Standard Institute (ANSI):   

Covered Entities that exchange information in electronic formats will be required to use these standard formats as of the 10/16/02 (or 10/16/03 if an extension is granted) compliance date. 

In order to simplify the classification of member information in electronic information exchanges, HIPAA also requires the use of the following standard code sets: 

• Diagnoses and inpatient hospital services – International Classification of Diseases, ninth edition (ICD-9)
• Institutional Services – ICD-9 and Common Procedural Coding System (HCPCS)
• Physician Services – Current Procedure Terminology (CPT-4)
• Dental Services – Current Dental Terminology (CDT)
• Pharmaceuticals/Drugs – National Drug Code (NDC)