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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

ABR

Assigned by Receiver

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

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

CODE SOURCE:

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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.

 

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

 

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

 

ExternalCodeList

 

Name: 663

 

Description: Logical Observation Identifier Names and Codes (LOINC)

 

 

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 UMO has approved the health care service with monetary limitations.

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 for specific services and procedures.
2. Required if the UMO authorizes specific procedure codes.
3. The UMO can use each occurrence of the Health Care Code Information composite (C022) to specify codes that identify the specific information that the UMO requires from the provider to complete the medical review. In the C022 composite, data elements 1270 and 1271 support the use of codes supplied from the Logical Observation Identifier Names and Codes (LOINC®) List. These codes identify high-level health care information groupings, specific data elements, and associated modifiers.
The Logical Observation Identifier Names and Codes (LOINC®) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
4. If this segment is used to request additional information associated with a specific procedure, place the specific procedure code in the HI C022 composite that precedes the HI C022 composite(s) containing the LOINC. If the original request contained more than six procedure codes and you are using LOINC to request additional information for each of these procedure codes or if you need to specify multiple questions/LOINC codes per procedure you cannot exceed the limit of 12 occurrences of the C022 composite in this HI segment. If necessary, use additional occurrences of Loop 2000F.
Refer to Section 2.2.5 of this guide for more information on requesting additional information.

Example:

HI*BO:490000:D8:19980121::1~


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