Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION (MHDO)
Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS
Appendix 590-243-A - Maine Health Data Organization Source Codes
(with references to specific MHDO data elements by file type)
American Dental Association
Current Dental Terminology (CDT) Codes
(MHDO Data Element: DC032, MC055)
SOURCE: Current Dental Terminology (CDT) Manual
AVAILABLE FROM:
American Dental Association
211 East Chicago Avenue
Chicago, IL 60611-2678
ABSTRACT: The CDT contains the American Dental Association's codes for dental procedures and nomenclature and is the nationally accepted set of numeric codes and descriptive terms for reporting dental treatments.
American Medical Association
Current Procedural Terminology (CPT) Codes
(MHDO Data Element: MC055)
SOURCE: Physicians' Current Procedural Terminology (CPT) Manual
AVAILABLE FROM:
American Medical Association
515 North State Street
Chicago, IL 60654
ABSTRACT: A listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians.
Accredited Standards Committee (ASC)
ASC X12 Directories
(MHDO Data Elements: DC003, DC011, DC012, DC021, DC031, MC003, MC011, MC012, MC027, MC038, ME003, ME007, ME012, ME013, PC003, PC025)
SOURCE: Complete ASC X12 005010 Standard
AVAILABLE FROM:
Data Interchange Standards Association, Inc. (DISA)
7600 Leesburg Pike Ste 430
Falls Church, VA 22043
ABSTRACT: The complete standard includes design rules and guidelines, control standards, transaction set tables, data element dictionary, segment directory and code sources. The data element dictionary contains the format and descriptions of data elements used to construct X12 segments. It also contains code lists associated with these data elements. The segment directory contains the format and definitions of the data segments used to construct X12 transaction sets.
Canada Post
Canadian Provinces
(MHDO Data Elements: DC015, DC028, DC049, DC056, MC015, MC083, MC090, ME016, PC015, PC023)
Cities and ZIP Code
(MHDO Data Elements: DC014, DC016, DC027, DC029, DC048, DC050, DC055, DC057, MC014, MC016, MC082, MC084, MC089, MC091, ME015, ME017, PC014, PC016, PC022, PC024)
SOURCE: Canada Post
AVAILABLE FROM:
Centers for Disease Control and Prevention
HL7/CDC Race and Ethnicity Code Set
(MHDO Data Element: ME021, ME022, ME023, ME024, ME025, ME026, ME027)
SOURCE: Race and Ethnicity Code Set
AVAILABLE FROM:
http://www.cdc.gov/nchs/data/dvs/Race_Ethnicity_CodeSet.pdf
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30329-4027
ABSTRACT: The race and ethnicity code set to be used for coding the race and ethnicity of members.
Centers for Medicare and Medicaid Services
Health Care Common Procedural Coding System
(MHDO Data Element: MC055)
SOURCE: Health Care Common Procedural Coding System
AVAILABLE FROM:
www.cms.gov/HCPCSReleaseCodeSets/
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: HCPCS is the Centers for Medicare and Medicaid Services (CMS) coding scheme to group procedures performed for payment to providers.
Health Insurance Prospective Payment System (HIPPS)
(MHDO Data Element: MC055)
SOURCE: Center for Medicare & Medicaid Services
AVAILABLE FROM:
Center for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
ABSTRACT:Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets of patient characteristics (or case-mix groups) on which payment determinations are made under several prospective payment systems. Case-mix groups are developed based on research into utilization patterns among various provider types. For the payment systems that use HIPPS codes, clinical assessment data is the basic input used to determine which case-mix group applies to a particular patient. A standard patient assessment instrument is interpreted by case-mix grouping software algorithms, which assign the case mix group. For payment purposes, at least one HIPPS code is defined to represent each case-mix group. These HIPPS codes are reported on claims to insurers.
Medical Severity Diagnosis Related Group (MS-DRG) / Inpatient Prospective Payment System (IPPS)
(MHDO Data Element: MC071)
SOURCE: Inpatient Prospective Payment System (IPPS)
AVAILABLE FROM:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteinptPPS/index.html
Inpatient Prospective Payment System (IPPS), List of final MS-DRGs (Table 5)
Center for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
ABSTRACT: Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.
National Provider Identifier
(MHDO Data Elements: DC020, DC043, MC026, MC077, MC086, MC108, MC115, MC121, PC021, PC048)
SOURCE: National Provider System
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 as the standard, unique identifier for each health care provider under the Health Insurance Portability and Accountability Act of 1996.
Pass Through Payment Status and New Technology Ambulatory Payment Classification (APC) / Outpatient Prospective Payment System (OPPS)
(MHDO Data Element: MC073)
SOURCE: Outpatient Prospective Payment System (OPPS), Addendum A
AVAILABLE FROM:
Outpatient Prospective Payment System (OPPS), Addendum A
Center for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
ABSTRACT: The APC is the unit of payment under the Outpatient Prospective Payment System (OPPS), Individual services identified in the Healthcare Common Procedure Code System (HCPCS) are assigned codes based on similar clinical characteristics and similar costs.
Place of Service Codes for Professional Claims
(MHDO Data Element: DC030, MC037)
SOURCE: Place of Service Codes for Professional Claims
AVAILABLE FROM:
https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: The place of service code identifies the location where the healthcare service was rendered.
International Country Codes
(MHDO Data Elements: ME109, MC093, MC094, MC329, PC024A, PC109, DC109)
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 Council for Prescription Drug Programs
National Association of Boards of Pharmacy Number
(MHDO Data Element: PC018)
SOURCE: National Association of Boards of Pharmacy Database and Listings
AVAILABLE FROM:
National Council for Prescription Drug Programs
9240 East Raintree Drive
Scottsdale, AZ 85260-7518
ABSTRACT: A unique number assigned in the U.S. and its territories to individual clinic, hospital, chain, and independent pharmacy locations that conduct business at retail by billing third-party drug benefit payers. The National Council for Prescription Drug Programs (NCPDP) maintains this database under contract from the National Association of Boards of Pharmacy. The National Association of Boards of Pharmacy is a seven-digit numeric number with the following format SSNNNNC, where SS=NCPDP assigned state code number, NNNN=NCPDP assigned pharmacy location number, and C=check digit calculated by algorithm from previous six digits.
Uniform Healthcare Payer Data
(MHDO Data Elements: PC011, PC012, PC030)
SOURCE: NCPDP Uniform Healthcare Payer Data Standard Implementation Guide
AVAILABLE FROM:
National Council for Prescription Drug Programs
9240 East Raintree Drive
Scottsdale, AZ 85260
ABSTRACT: This standard is intended to meet an industry need to supply detailed drug or utilization claim information from adjudicated claims that processors/payers or their clients report to States or their Agents.
National Uniform Billing Committee (NUBC)
NUBC Codes
(MHDO Data Elements: MC020, MC021, MC023, MC036, MC054, MC201, MC207, MC209, MC211, MC213, MC215, MC217, MC219, MC221, MC223, MC225, MC227, MC229, MC231, MC233, MC235, MC237, MC239, MC241, MC243, MC245, MC247, MC249, MC251, MC255, MC257, MC259, MC261, MC263, MC265, MC267, MC269, MC271, MC273, MC275, MC277, MC279, MC281, MC283, MC285, MC287, MC289, MC291, MC293, MC295, MC297, MC299, MC301)
SOURCE: National Uniform Billing Committee Official Data Specifications Manual
AVAILABLE FROM:
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.
National Uniform Claim Committee
Healthcare Provider Taxonomy Code Set
(MHDO Data Element: DC026, MC032, MC113)
SOURCE: Washington Publishing Company
MAINTAINED BY: National Uniform Claim Committee https://www.cms.gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll/taxonomy.html
AVAILABLE FROM: Washington Publishing Company www.wpc-edi.com/products/code-lists/
ABSTRACT: The Healthcare Provider Taxonomy Code Set is a hierarchical code set that consists of codes, descriptions, and definitions. Healthcare Provider Taxonomy Codes are designed to categorize the type, classification, and/or specialization of health care providers. The Code Set consists of two sections: Individuals and Groups of Individuals, and Non-Individual.
United States Food and Drug Administration
National Drug Codes
(MHDO Data Element: PC026, MC075)
SOURCE: National Drug Data File
AVAILABLE FROM:
www.fda.gov or http://www.accessdata.fda.gov/scripts/cder/ndc/default.cfm
U.S. Food and Drug Administration
Center for Drug Evaluation and Research
Division of Data Management and Services
10903 New Hampshire Avenue
Silver Spring, MD 20993
ABSTRACT: The National Drug Code is a coding convention established by the Food and Drug Administration to identify the labeler, product number, and package sizes of FDA-approved prescription drugs. There are over 170,000 National Drug Codes on file.
United States Postal Service
States and Outlying Areas of the U.S.
(MHDO Data Elements: DC015, DC028, DC049, DC056, MC015, MC083, MC090, ME016, PC015, PC023)
ZIP Code
(MHDO Data Elements: DC014, DC016, DC027, DC029, DC048, DC050, DC055, DC057, MC014, MC016, MC082, MC084, MC089, MC091, ME015, ME017, PC014, PC016, PC022, PC024)
SOURCE: United States Postal Service
AVAILABLE FROM:
U.S. Postal Service
National Information Data Center
P.O. Box 9408
Gaithersburg, MD 20898-9408
Or
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 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 9-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.
World Health Organization (WHO)
International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure and Diagnosis
(MHDO Data Elements: MC039, MC040, MC041, MC042, MC043, MC044, MC045, MC046, MC047, MC048, MC049, MC050, MC051, MC052, MC053, MC058)
SOURCE: International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
AVAILABLE FROM:
http://www.cdc.gov/nchs/icd/icd9cm.htm
WHO Publications Center AUS
49 Sheridan Avenue
Albany, NY 12210
ABSTRACT: The International Classification of Diseases, 9th Revision, Clinical Modification, describes the classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations.
International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD- 10 -CM/PCS)
(MHDO Data Elements: MC200, MC202, MC203, MC204, MC205, MC206, MC208, MC210, MC212, MC214, MC216, MC218, MC220, MC222, MC224, MC226, MC228, MC230, MC232, MC234, MC236, MC238, MC240, MC242, MC244. MC246, MC248, MC250, MC252, MC254, MC256, MC258, MC260, MC262, MC264, MC266, MC268, MC270, MC272, MC274, MC276, MC278, MC280, MC282, MC284, MC286, MC288, MC290, MC292, MC294, MC296, MC298, MC300, MC302, MC303, MC304, MC305, MC306, MC307, MC308, MC309, MC310, MC311, MC312, MC313, MC314, MC315, MC316, MC317, MC318, MC319, MC320, MC321, MC322, MC323, MC324, MC325, MC326
SOURCE: International Classification of Diseases, 10th Revision, (ICD-10-CM/PCS)
AVAILABLE FROM:
www.cdc.gov/nchs/icd/icd10cm.htm#9update
WHO Publications Center AUS
49 Sheridan Avenue
Albany, NY 12210
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.
