The Health Insurance Portability and Accountability Act (HIPAA) Transactions, Code Sets and Identifiers (TCS&I) Office facilitates the implementation of nationwide standards of code sets used in the HIPAA-compliant electronic health care transactions for the Military Health System (MHS).
In addition to the Medical Data Code Sets adopted in the Transactions and Code Sets Final Rule, the following are examples of administrative code sets that are also required in the HIPAA Implementation Guides:
- Health Care Provider Taxonomy Codes
- Country Codes (International Organization of Standards [ISO] 3166)
- Claim Adjustment Reason Codes
- Place of Service Codes
- Claim Status Codes
ICD-10 was adopted initially as a code set in January 2009 when the Centers for Medicare and Medicaid Services (CMS) issued the original ICD-10 Final Rule. The MHS enterprise successfully transitioned to the use of ICD-10 on October 1, 2015.
Frequently Asked Questions
View questions and answers about the nationwide standards for code sets used in the HIPAA compliant electronic health care transactions.
Q1:
How do I know how to correctly code my claim?
A:
- For questions on MHS Click to closeDirect CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”Direct Care coding, you may find additional information by emailing the MHS Medical Coding Program Office
- For questions on coding submissions to the TRICARE Health Plan, you may find additional information by reaching out to the applicable TRICARE Regional Contractor
Q4:
Why are code sets used in nationwide electronic health care transactions?
A:
By using standardized code sets, providers across the nation can easily and efficiently communicate with one another in order to serve patients and conduct administrative transactions. In other words, the use of standardized code sets improves the interoperability of health care payers and providers by normalizing the “language” that is used.
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Feb 27, 2024
View questions and answers about the nationwide standards for code sets used in the HIPAA compliant electronic health care transactions.