I have been trying to get a response to a question that are HIPAA team has. Martin's question below seems to fall in line with my question since based on the level of editing one does could determine if the V22 code is excepted into the internal processing system or not. My question is below. Perhaps feedback on both Martin's and my question will help many of us. Thanks.
HIPAA ANSI (v4010) Implementation Guides list valid codes or direct you to an external source. When applying edits to transactions that are received how are you addressing the following? 1. The IG provides a specific list of codes. When this data element is REQUIRED: a. Do you edit to validate that a value is there, b. Do you validate that the value is one of the ones allowed, c. Do you validate that the value is valid? (i.e.; 834 - Enrollment, Loop 2000 - Member Level Detail, Data Element 1069 - Individual Relationship Code) d. If the value is invalid, do you reject the transaction or do you accept the transaction into your processing system and apply a business rule (i.e.; suspend for manual correction, etc.)? 2. The IG directs you to external sources for some codes (i.e.; zip codes, ICD9, NDC, etc.). a. Will you edit to verify that the value is valid or will you just check to see if a value is present? b. If the value is invalid, do you reject the transaction or do you accept the transaction into your processing system and apply a business rule (i.e.; suspend for manual correction, etc.)? 3. If the field is REQUIRED (i.e.; 834 - Enrollment, Loop 2100 - Member Residence City, State Zip Code, Data Element 116 - Postal Code) but you do not need it for business processing purposes to what depth of editing do you go before allowing the transaction into your processing system? 4. Is there any risk (penalty for non-compliance) to the payer if a code, that is content compliant but invalid, is passed into the processing system(s)? Your feedback would be appreciated. Noelle Polson Blue Cross Blue Shield of Florida HIPAA-AS Corporate Integration Building DC6-4 4800 Deerwood Campus Parkway Jacksonville, FL 32246 Phone (904) 905 - 0052 / Fax (904) 997-5399 Email [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Wednesday, October 10, 2001 6:07 PM To: [EMAIL PROTECTED] Subject: I can't believe I'm asking this question I am reluctant to pose this question, but need the validation. Here goes... Is "V22" a HIPAA-compliant diagnosis code? { } Yes, you dummy. It's right there in the book! { }No, It's clearly marked "Additional Digits Required" in the 2001 ICD-9 manual. Martin A. Morrison Project Management Consultant HIPAA <http://aspe.os.dhhs.gov/admnsimp/> Implementation/Coordination Blue Shield of California <http://www.blueshieldca.com/> 4203 Town Center Bl., Ste. 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