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Frequently Asked Questions for Code Sets

View questions and answers about the nationwide standards for code sets used in the HIPAA compliant electronic health care transactions.

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Code Sets
Q1:

How do I know how to correctly code my claim?

A:

Q2:

What organization developed the ICD-10 code set?

A:

The World Health Organization (WHO), a specialized agency of the United Nations, owns and publishes the ICD code sets (including ICD-10).

Q3:

Where can interested parties find the current (valid 1 October 2017 through 30 September 2018) ICD-10 code set revisions and updates?

A:

Interested parties may find ICD-10 code list file(s) here:

CM: 2018 ICD-10-CM and GEMs

PCS: 2018 ICD-10-PCS and GEMs

Q4:

Why are code sets used in nationwide electronic health care transactions?

A:

By using standardized code sets, providers across the nation can easily and efficiently communicate with one another in order to serve patients and conduct administrative transactions.  In other words, the use of standardized code sets improves the interoperability of health care payers and providers by normalizing the “language” that is used.

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