Stream: CARIN BB ExplanationOfBenefit
Topic: EOB IP/OP
Chetana Nayyar (Apr 13 2021 at 16:17):
The EOB IP/OP have item.productOrService which maps to CPT/HCPCS codes though as per the other industry standards these procedure codes can be even received in ICD-9/ICD-10 formats.
In the same EOB profile though for the procedure element the semantics defined are ICD-9/ICD-10.
Any reason to keep these codes different for these elements?
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Corey Spears (Apr 13 2021 at 17:29):
@Pat Taylor @Amol Vyas
Pat Taylor (Apr 14 2021 at 22:42):
@Chetana Nayyar @Amol Vyas @Corey Spears The ICD9 /ICD10 procedure codes map to procedure in the Inpatient Institutional profile, not to item. productOrService. This mapping aligns with the standards adopted by HHS for claims submission standards.
Chetana Nayyar (Apr 15 2021 at 08:53):
@Pat Taylor
The ask was more towards the CPT and HCPCS codes that are mentioned on the item.productOrService. They are also procedure codes. Any specific reason why these also aren't ICD-9/ICD-10?
Pat Taylor (Apr 15 2021 at 18:05):
@Chetana Nayyar Claims submission standards call for the submission of ICD-9 / ICD-10 procedure codes for inpatient institutional claims at the header level. They're mapped to procedure in that profile. The ICD procedure codes are not valid codes for outpatient institutional and professional and non-clinician claims. This is why they're not included in the Value Set for item.productOrService in those profiles.
Last updated: Apr 12 2022 at 19:14 UTC
