Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 241 - UNIFORM REPORTING SYSTEM FOR HOSPITAL INPATIENT DATA SETS AND HOSPITAL OUTPATIENT DATA SETS › Appendix 590-241-A - Maine Health Data Organization Source Codes (with references to specific MHDO data elements by file type)

Current through 2024-29, July 17, 2024
Accredited Standards Committee (ASC)
ASC X12N Electronic Data Interchange Transaction Set
				  Implementation Guide
Health Care Claim: Institutional and Professional
				  (837)
(Used for all Mapping of HIPAA Reference - Transaction
				  Set/Loop/Segment Qualifier/Data Elements)
AVAILABLE FROM:
http://store.x12.org/store
Accredited Standards Committee
8300 Greensboro Drive, Suite 800
McLean, VA 22102
ABSTRACT: The data implementation guide provides standardized
				  data requirements and content for all users of the ANSI ASC X12N 837 Health
				  Care Claims transaction.
American Medical Association
Current Procedural Terminology (CPT)
				  Codes
(MHDO Data Elements: OP6105, OP6106, OP6107, OP6112,
				  OP6113, OP6114, OP6119, OP6120, OP6121)
SOURCE: Physicians' Current Procedural Terminology (CPT)
				  Manual AVAILABLE FROM:
https://www.ama-assn.org/
American Medical Association
AMA Plaza
330 N. Wabash Ave., Suite 39300
Chicago, IL 60611
ABSTRACT: A listing of descriptive terms and identifying
				  codes for reporting medical services and procedures performed by physicians in
				  an outpatient setting.
International Country Codes
(MHDO Data Elements: IP2021, OP2018)
SOURCE:
www.nationsonline.org/oneworld/country_code_list.htm
ABSTRACT: The ISO country codes are internationally
				  recognized codes that designate each country and most of the dependent areas
				  with a two- or three-letter combination or a numeric code.
National Uniform Billing Committee (NUBC)
National Uniform Billing Data Element Specifications as
				  Developed by NUBC. (All MHDO Data Elements except for the following: Diagnosis
				  Codes, Procedure Codes, Payer Identification Number, Social Security Number,
				  HCPCS Procedure Codes, HCPCS Procedure Modifiers, Race/Ethnicity, Present on
				  Admission Indicator, Filler)
SOURCE: UB-04 Data Specifications Manual.
AVAILABLE FROM:
https://www.nubc.org/ub-04-products
National Uniform Billing Committee
American Hospital Association
155 N Wacker Drive
Chicago, IL 60606
ABSTRACT: This serves as the official source of information
				  for institutional health care billing. It contains all billing conventions and
				  codes, including form locators, data element descriptions, definitions,
				  reporting requirements, field attributes, approval and effective dates, and
				  revenue, condition, occurrence, and value codes.
U.S. Department of Health and Human Services, Centers
				  for Medicare and Medicaid Services
Ambulance Modifiers
(MHDO Data Element: OP6106, OP6107, OP6113, OP6114,
				  OP6120, OP6121)
SOURCE: Medicare Claims Processing Manual
AVAILABLE FROM:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html
U.S. Department of Health and Human Services, Centers for
				  Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: Ambulance Modifiers are HCPCS modifier codes
				  available for use with Ambulance services.
U.S. Department of Health and Human Services, Centers
				  for Medicare and Medicaid Services
Health Care Common Procedural Coding
				  System
(MHDO Data Elements: OP6105, OP6106, OP6107, OP6112,
				  OP6113, OP6114, OP6119, OP6120, OP6121)
SOURCE: Health Care Common Procedural Coding System
AVAILABLE FROM:
www.cms.gov/HCPCSReleaseCodeSets/
U.S. Department of Health and Human Services, Centers for
				  Medicare and Medicaid Services
Center for Health Plans and Providers
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: HCPCS is the U.S. Department of Health and Human
				  Services, Centers for Medicare and Medicaid Services (CMS) coding scheme to
				  group procedures performed for payment to providers.
U.S. Department of Health and Human Services, Centers
				  for Medicare and Medicaid Services
National Provider Identifier (NPI)
(MHDO Data Elements: OP6126, OP6128, OP6130, OP8004, OP8005,
				  OP8012, IP8004, IP8005, IP8012)
SOURCE: National Plan and Provider Enumeration System
				  (NPPES)
AVAILABLE FROM:
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: The Centers for Medicare and Medicaid Services
				  developed the National Provider Identifier (NPI) as the standard, unique
				  identifier for each health care provider under the Health Insurance Portability
				  and Accountability Act of 1996 and the NPI Final Rule was implemented May 23,
				  2008.
United States Postal Service
States and Outlying Areas and Zip Codes of the
				  U.S.
(MHDO Data Elements: IP0106, IP2009, OP0106, OP2009,
				  IP0107, IP2010, OP0107, OP2010)
SOURCE: National Zip Code and Post Office Directory
The USPS Domestic Mail Manual
AVAILABLE FROM:
https://www.usps.com
U.S. Postal Service
National Information Data Center
P.O. Box 9408
Gaithersburg, MD 20898-9408
Or
https://ribbs.usps.gov/index.cfm?page=address_manage_quality
Address Information Systems Products
National Customer Support Center
U.S. Postal Service
6060 Primacy Pkwy Ste 231
Memphis, TN 38119-5772
ABSTRACT: Provides names, abbreviations, and codes for the
				  50 states, the District of Columbia, and the outlying areas of the U.S. The
				  entities listed are considered to be the first order divisions of the U.S.
				  Microfiche AVAILABLE FROM: NTIS (same as address above). The Canadian Post
				  Office lists the following as "official" codes for Canadian Provinces:
AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NF - Newfoundland
NS - Nova Scotia
NT - North West Territories
ON - Ontario
PE - Prince Edward Island
PQ - Quebec
SK - Saskatchewan
YT - Yukon
The ZIP Code is a geographic identifier of areas within the
				  United States and its territories for purposes of expediting mail distribution
				  by the U.S. Postal Service. It is five or nine numeric digits. The ZIP Code
				  structure divides the U.S. into ten large groups of states. The leftmost digit
				  identifies one of these groups. The next two digits identify a smaller
				  geographic area within the large group. The two right-most digits identify a
				  local delivery area. In the nine-digit ZIP Code, the four digits that follow
				  the hyphen further subdivide the delivery area. The two leftmost digits
				  identify a sector which may consist of several large buildings, blocks or
				  groups of streets. The rightmost digits divide the sector into segments such as
				  a street, a block, a floor of a building, or a cluster of mailboxes. The USPS
				  Domestics Mail Manual includes information on the use of the new 11-digit zip
				  code.
World Health Organization (WHO)
International Classification of Diseases Clinical
				  Modification (ICD-10-CM)
(MHDO Data Elements: IP7104, IP7106 IP7110, IP7204,
				  IP7206, IP7208, IP7210, IP7212, IP7214, IP7216, IP7218, IP7304, IP7306, IP7308,
				  IP7310, IP7312, IP7314, IP7316, IP7318, IP7320, IP7322, IP7324, IP7326, IP7404,
				  IP7406, IP7408, IP7410, IP7412, IP7414, IP7416, IP7418, IP7420, IP7422, IP7424,
				  IP7426, OP7104, OP7107, OP7108, OP7109, OP7110, OP7204, OP7206, OP7208, OP7210,
				  OP7212, OP7214, OP7216, OP7218, OP7304, OP7306, OP7308, OP7310, OP7312, OP7314,
				  OP7316, OP7318, OP7320, OP7322, OP7324, OP7326, OP7404, OP7406, OP7408, OP7410,
				  OP7412, OP7414, OP7416, OP7418, OP7420, OP7422, OP7424, OP7426)
SOURCE: International Classification of Diseases, 10th
				  Revision, Clinical Modification (ICD-10-CM)
AVAILABLE FROM:
http://www.who.int/classifications/icd/en/
World Health Organization (WHO)
Regional Office for the Americas
525, 23rd Street, N.W.
Washington, DC 20037
USA OR
www.cdc.gov/nchs/icd/icd10cm.htm#9update
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA
30329-4027
ABSTRACT: The International Classification of Diseases, 10th
				  Revision, is used to report medical diagnosis and inpatient procedures.
				  ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under
				  ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM,
				  but the format of the code sets is similar. ICD-10-PCS is for use in U.S.
				  inpatient hospital settings only. ICD-10­PCS uses 7 alphanumeric digits
				  instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding.
				  Coding under ICD-10-PCS is much more specific and substantially different from
				  ICD-9-CM procedure coding. The transition to ICD-10 is occurring because ICD-9
				  produces limited data about patients' medical conditions and hospital inpatient
				  procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with
				  current medical practice. Also, the structure of ICD-9 limits the number of new
				  codes that can be created, and many ICD-9 categories are
				  full.