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Back  RFI # 833: HIPAA 5010 Service Types

Formal vs. Informal Help Informal Formal

Submitter

Diana Sokolowski

Description

HIPAA 5010 Service Type definitions
May I please have definitions for the following service types ?

* 3 Consultation
* 10 Blood Charges
* 49 Hospital - Room and Board
* 54 Long Term Care
* 56 Medically Related Transportation (how does this differ
from 59 Ambulance)
* 59 License Ambulance (how does this differ from 56
Medically Related Transportation)
* 67 Smoking Cessation
* BN Gastrointestinal

Also. via what Service Type should Plans express Federally mandated
benefits regarding 'Autism' ? Please advise. Thanx...

Response

Definitions do not exist for Service Type Codes, however in many cases the Service Type Code itself should be descriptive enough for most purposes. Since definitions do not currently exist for these codes, only X12 can add definitions to these codes through the X12 Standards process.

The intended distinction between code 56 (Medically Related Transportation) and code 59 (Licensed Ambulance), is that code 56 is be used when the transportation is not by the means identified by codes 57 (Air Transportation), 58 (Cabulance) or 59.

For the other codes listed in this request, we cannot offer definitions.

Recommendation

One of the challenges with the existing code list is that many of the codes are not service types at all, rather they are diagnosis’ which are more appropriately defined by using the diagnosis codes available in the transaction. Future versions of the service type code list will likely remove all service type codes that can be represented by a diagnosis code. You should use the appropriate diagnosis code for Autism, rather than seek a service type code for Autism.

X12, and in particular X12N/TG2/WG1 (Health Care Eligibility) and X12N/TG2/WG10 (Health Services Review) have undertaken the effort to make the Service Type Code an external code list (similar to the Claim Adjustment Reason Codes for example) and the list is being revised with one of the goals being to add definitions to those codes that may lead to multiple interpretations. These revisions are intended for use with future versions of the 270/271 and 278 transactions (beyond 5010).
Submission 8/14/2009
Status Date 10/5/2009
Status F - Final
Primary References
Document 005010X279
SectionSubs
Page3
Set ID270
Loop2110C
Segment PositionEQ03
Segment IDEQ
Element Position03
Industry NameService Type ID