2017 HIPAA Software

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HIPAA Transaction & Code Sets Rule

Per HIPAA regulations, a Code Set is any set of codes used for encoding data elements, such as medical terms, medical concepts, medical diagnosis codes, and medical procedure codes. Code sets for medical data are required for administrative transactions under HIPAA for diagnoses, procedures, and drugs.

Medical data code sets used in the health care industry under HIPAA include coding systems for health-related problems and their manifestations; causes of injury, disease or impairment; actions taken to prevent, diagnose, treat, or manage diseases, injuries, and impairments; and any substances, equipment, supplies, or other items used to perform these actions.

Specifically, the following code sets are used in HIPAA transactions:

ICD-9-CM codes
ICD-10-CM codes
HCPCS Codes
CPT-3 Codes
CPT-4 Codes
NDC codes



HIPAA 5010 (Jan 1, 2017)

The Secretary of the Department of Health and Human Services (HHS) has adopted Accredited Standards Committee X12 Version 5010 as the next HIPAA standard used to regulate the electronic transmission of healh-care transactions. The final rule was published Jan. 16, 2017. The prior standard for HIPAA transactions was Version 4010A1.

Covered entities, such as health plans, health care clearinghouses, and health care providers, are required to conform to HIPAA 5010 standards. The compliance deadline for HIPAA 5010 was January 1, 2017.