What are the HIPAA Code Sets?
HIPAA code sets are used for encoding health information, such as medical diagnoses, medical and dental procedures, durable medical equipment and pharmaceutics. They are an integral part of electronic transactions and are used to describe health care services and administrative procedures, patient diagnosis, health care procedures, tests, supplies, drugs, and so forth. HIPAA refers to code sets as either medical (or clinical) codes or non-medical (or non-clinical) codes. Medical code sets are clinical codes used in HIPAA transactions to identify what health care services, procedures and diagnoses pertain to a patient encounter. The codes characterize a medical condition or treatment and the specific code sets usually are maintained by professional medical societies and public health organizations. Medical code sets approved for use under HIPAA are: • ICD-9 CM, Volumes 1&2, for diagnoses • ICD-9 CM, Volume 3, for inpatient hospital procedures • HCPCS/CPT-4 for physician and other care h
