HI

Procedures

Pos: 080

Max: 1

Detail - Optional

Loop: 2000F

Elements: 12


User Option (Usage): Situational
To supply information related to the delivery of health care

Element Summary:

 

Ref

Id

Element Name

Req

Type

Min/Max

Usage

 

HI01

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 1

M

Comp

 

Required

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI01-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI01-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI02

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 2
Use this for the second procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI02-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI02-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI03

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 3
Use this for the third procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI03-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI03-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI04

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 4
Use this for the fourth procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI04-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI04-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI05

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 5
Use this for the fifth procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Required if X12N syntax conditions apply.

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI05-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI05-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI06

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 6
Use this for the sixth procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI06-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI06-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI07

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 7
Use this for the seventh procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI07-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI07-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI08

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 8
Use this for the eighth procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date
Required if proposed or actual procedure date is known.

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity
Required if requesting authorization for more than one occurrence of the procedure identified in HI08-2 for the same time period.

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier
Required if the code list referenced in HI08-1 has a version identifier. Otherwise Not Used.

O

AN

1/30

Situational

 

HI09

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 9
Use this for the ninth procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier

O

AN

1/30

Situational

 

HI10

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 10
Use this for the tenth procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier

O

AN

1/30

Situational

 

HI11

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 11
Use this for the eleventh procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier

O

AN

1/30

Situational

 

HI12

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Procedure Code 12
Use this for the twelfth procedure.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list

M

ID

1/3

Required

 

Code

Name

 

BO

Health Care Financing Administration Common Procedural Coding System

Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under BO.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

BQ

International Classification of Diseases Clinical Modification (ICD-9-CM) Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

JP

National Standard Tooth Numbering System

CODE SOURCE:

135: American Dental Association Codes

 

ZZ

Mutually Defined

Use ZZ for Code Source 513: Home Infusion EDI Coalition (HIEC) Product/Service Code List.

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

 

ABR

Assigned by Receiver

Use ABR for Revenue Codes in Code Source 132: National Uniform Billing Committee (NUBC) codes.

 

NDC

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code
240: National Drug Code by Format

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Procedure Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 130

 

Description: Health Care Financing Administration Common Procedural Coding System

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) codes

 

ExternalCodeList

 

Name: 134

 

Description: National Drug Code

 

ExternalCodeList

 

Name: 135

 

Description: American Dental Association Codes

 

ExternalCodeList

 

Name: 240

 

Description: National Drug Code by Format

 

ExternalCodeList

 

Name: 513

 

Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

RD8

Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Procedure Date

C

AN

1/35

Situational

 

 

782

Monetary Amount
Description: Monetary amount
Industry: Procedure Monetary Amount
Use if the procedure charge amount is needed by the UMO to approve a monetary limitation for the health care services requested.

O

R

1/18

Situational

 

 

380

Quantity
Description: Numeric value of quantity
Industry: Procedure Quantity

O

R

1/15

Situational

 

 

799

Version Identifier
Description: Revision level of a particular format, program, technique or algorithm
Industry: Version, Release, or Industry Identifier

O

AN

1/30

Situational



Notes:

1. Use this segment to request specific services and procedures.
2. Use the most current version of the code list identified in HIxx-1 Code List Qualifier Code (Data Element 1270).

Example:

HI*BO*49000:D8:19950121::1~


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