What are standard code sets?

What is a code set? Under HIPAA, a “code set” is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.

What are the 5 code sets approved by Hipaa?


  • 837 Health Care Claims.
  • 835 Health Care Claim Payment/Remit Advice.
  • 278 Referral Certification, Authorization, Extensions and Appeals.
  • 131 International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure.
  • 132 National Uniform Billing Committee (NUBC) Codes.
  • 134 National Drug Code.

What are billing codes?

Billing and coding are separate processes, but both are crucial to receiving payment for healthcare services. Medical coding involves extracting billable information from the medical record and clinical documentation, while medical billing uses those codes to create insurance claims and bills for patients.

What is a coding classification set?

Two common medical coding classification systems are in use — the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). ICD codes are alphanumeric designations given to every diagnosis, description of symptoms and cause of death attributed to human beings.

What is a CMS code?

The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry. This standard names the POS code set currently maintained by CMS as the code set to be used for describing sites of service in such claims.

What is the most current code standard?

The NEC is approved as an American national standard by the American National Standards Institute (ANSI). It is formally identified as ANSI/NFPA 70. First published in 1897, the NEC is updated and published every three years, with the 2020 edition being the most current.

What is the unique identifier rule?

Providers – NPI, or National Provider Identifier, is a unique 10-digit number used to identify health care providers. Health plans – There is no longer an adopted standard to identify health plans. Patients – There is no adopted standard to identify patients.

What are the three types of codes?

There are three types of media codes, symbolic codes, technical codes and written codes. Conventions are expected ways in which codes are organised in a product.