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  1. FHIR Specification Feedback
  2. FHIR-26891

Replace CARIN BB HCPCS Modifier Codes with AMA CPT / CMS HCPCS Procedure Modifiers

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US CARIN Blue Button (FHIR)
    • 0.1 [deprecated]
    • Financial Mgmt
    • (NA)
    • Terminology
    • Hide

      Delete CARIN Blue Button HCPCS Modifier Codes Value Set.

      Replace with the following Value Set:

      Defining URL: http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes
      Name: AMACPTCMSHCPCSProcedureCodes
      Title: AMA CPT CMS HCPCS Procedure Codes
      Definition: The Value Set is a combination of two Code Systems:  CPT (HCPCS I) and HCPCS II procedure codes. They are submitted by providers to payers to convey the specific procedure performed.  AMA CPT CMS HCPCS Procedure Codes leverage US Core Procedure Codes composition. 
      CPT codes are available by subscription from the AMA at http://www.ama-assn.org/go/cpt.  HCPCS codes are available at http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets.  The link takes one to a list of files.  The target set for this Code System is the procedure codes from this file. 
      Copyright: CPT © Copyright 2019 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.  HCPCS Level II Alphanumeric Codes are maintained by the US Centers for Medicare and Medicaid Services (CMS) and are available for public use. As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change.
      Logical Definition: This value set includes codes from the following code systems:
      ·       Include all procedure codes defined in http://www.ama-assn.org/go/cpt
      ·       Include all procedure codes defined in http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets

      Bind with binding strength Required to item.productOrService in the Inpatient Institutional, Outpatient Institutional and Professional and Non-Clinician Profiles

      Define Code System:

      Defining URL: http://www.ama-assn.org/go/cpt
      Name: AMACPTCodes
      Title: AMA CPT Codes
      Definition: CPT procedure code modifiers help further describe a procedure code without changing its definition.  CPT codes are available by subscription from the AMA at http://www.ama-assn.org/go/cpt
      Copyright: CPT © Copyright 2019 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.  As HL7 is working with the owning authority to finalize the url, this url is subject to change.

       
      Define Code System:

      Defining URL: http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
      Name: CMSHCPCSCodes
      Title: CMS HCPCS Codes
      Definition: HCPCS procedure code modifiers help further describe a procedure code without changing its definition.  HCPCS procedure code modifiers are available at http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
      Copyright: HCPCS Level II Alphanumeric Codes are maintained by the US Centers for Medicare and Medicaid Services (CMS) and are available for public use. As HL7 is working with the owning authority to finalize the url, this url is subject to change.
      Show
      Delete CARIN Blue Button HCPCS Modifier Codes Value Set. Replace with the following Value Set: Defining URL: http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSProcedureCodes Name: AMACPTCMSHCPCSProcedureCodes Title: AMA CPT CMS HCPCS Procedure Codes Definition: The Value Set is a combination of two Code Systems:  CPT (HCPCS I) and HCPCS II procedure codes. They are submitted by providers to payers to convey the specific procedure performed.  AMA CPT CMS HCPCS Procedure Codes leverage US Core Procedure Codes composition.  CPT codes are available by subscription from the AMA at http://www.ama-assn.org/go/cpt .  HCPCS codes are available at http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets .  The link takes one to a list of files.  The target set for this Code System is the procedure codes from this file.  Copyright: CPT © Copyright 2019 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.  HCPCS Level II Alphanumeric Codes are maintained by the US Centers for Medicare and Medicaid Services (CMS) and are available for public use. As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change. Logical Definition: This value set includes codes from the following code systems: ·       Include all procedure codes defined in http://www.ama-assn.org/go/cpt ·       Include all procedure codes defined in http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets Bind with binding strength Required to item.productOrService in the Inpatient Institutional, Outpatient Institutional and Professional and Non-Clinician Profiles Define Code System: Defining URL: http://www.ama-assn.org/go/cpt Name: AMACPTCodes Title: AMA CPT Codes Definition: CPT procedure code modifiers help further describe a procedure code without changing its definition.  CPT codes are available by subscription from the AMA at http://www.ama-assn.org/go/cpt Copyright: CPT © Copyright 2019 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.  As HL7 is working with the owning authority to finalize the url, this url is subject to change.   Define Code System: Defining URL: http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets Name: CMSHCPCSCodes Title: CMS HCPCS Codes Definition: HCPCS procedure code modifiers help further describe a procedure code without changing its definition.  HCPCS procedure code modifiers are available at http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets .  Copyright: HCPCS Level II Alphanumeric Codes are maintained by the US Centers for Medicare and Medicaid Services (CMS) and are available for public use. As HL7 is working with the owning authority to finalize the url, this url is subject to change.
    • Mark Roberts/ Pat Taylor: 16-0-2
    • Correction
    • Compatible, substantive

    Description

      Ballot feedback was that the Terminology Section of the IG requires a major overall, renaming the Value Sets and Code Systems and updating links.  Following is a recommended resolution for the Procedure Code Modifiers:

      1)  Delete Value Set CARINBBHCPCSModifierCodes

      2)  Define AMACPTCMSHCPCSProcedureModifiers

      3)  Title:  AMA CPT CMS HCPCS Procedure Modifiers

      4) Description:  The Value Set is a combination of two Code Systems:  CPT (HCPCS I) and HCPCS II procedure code modifiers.  Modifiers help further describe a procedure code without changing its definition. 

      5) Value Set: http://hl7.org/fhir/us/ValueSet/ama-cpt-cms-hcpcs-procedure-code-modifiers

      6)  Code System URIs: 

      http://www.ama-assn.org/go/cpt-modifiers.  Submit a request to define an OID named CPT Procedure Code Modifiers.

      http://www.cms.gov/hcpcs-level-II-modifiers. Submit a request to define an OID named HCPCS II Procedure Code Modifiers

      7)  Code System Definition:

      CPT modifiers are available by subscription from the AMA at http://www.ama-assn.org/go/cpt. Copyright Statement: CPT copyright 2014 American Medical Association. All rights reserved.  

      HCPCS modifiers are available at https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.  The link takes one to a list of files.  The HCPCS ANWEB files include modifier and procedure codes.    The target set for this Code System is the procedure code modifiers from this file.  The code set is owned by CMS and is available for use.

      8)  Bind the ValueSet to item.modifier in the Inpatient Facility, Outpatient Facility and Professional and Non-Clinician Profiles

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            taylorpatriciab Patricia Taylor
            Patricia Taylor
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