Stream: CARIN IG for Blue Button®
Topic: EOB.item.modifier codesystem
Tushar Nair (Aug 25 2021 at 18:33):
Hello,
The code system URLs for HCPCS Level I procedure code is http://www.ama-assn.org/go/cpt and for Level II procedure codes is http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets . So in principle these two codesystems have been separated by there individual URLs.
But in case of EOB.item.modifier -level I as well as Level -II modifier codes, have been assigned same URLs: http://www.ama-assn.org/go/cpt & http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets. Yes , the modifiers have been assigned an individual valueset URL but while performing lookup on the codesystem common URls clash. Is there a reason to assign the modifiers same URLS? @Corey Spears
Corey Spears (Aug 25 2021 at 18:45):
@Mark Roberts @Pat Taylor @Amol Vyas , We should probably discuss in the core team call.
Daniel Venton (Aug 25 2021 at 18:48):
These rules are probably also wrong:
Include all codes defined in http://www.ama-assn.org/go/cpt
Include all codes defined in http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
Since you don't modify a procedureCode (99200) with a procedureCode (99200), you modify, perhaps, with a subset of the values in those code systems. I would think that the serviceOrProcedure code would be the subset of codes that are the procedure type codes, and the modifier would be the subset of them that are modifier type codes.
Corey Spears (Aug 26 2021 at 01:50):
@Daniel Venton Is there a way to identify this subset, such as a hierarchy that can be pointed to? Is there a ValueSet defined for modifier codes alone? Unfortunately we do not have permission to publish CPT codes, so we can't create a ValueSet of defined codes. Even if we did, maintaining the ValueSet would be a challenge. We would need to point to some sort of authoritative source that maintains them over time. If there is, we are definitely interested in knowing about it so we can consider a tighter binding.
Daniel Venton (Aug 26 2021 at 13:15):
I'm not aware of an already defined value-set or "selector" that could be used to differentiate the codes that are modifiers vs the codes that are procedures. It does seem that modifiers are length 2 while procedure codes are length 5 (or not 2), I don't know as that is good (appropriate) enough to place into the IG.
Pat Taylor (Sep 02 2021 at 21:38):
@Daniel Venton @Tushar Nair Yes, the same urls are used for the procedure codes and the modifiers for both CPT and HCPCS. The urls were provided to the HL7 Terminology Authority by the owning authorities, the AMA and CMS. Unfortunately, the best way to differentiate between a procedure code and a modifiers code is the length of the value; procedure codes are five positions; modifiers are two positions. We can talk within the CARIN team @Corey Spears and @Amol Vyas to determine if additional instructions should be added to each of the Value Sets.
Last updated: Apr 12 2022 at 19:14 UTC
