The following coding systems, ICD-9-CM, CPT-4¹ , and HCPCS, were adopted as standard code sets under the Health Insurance Portability and Accountability Act (HIPAA). Effective October 16, 2003, all covered entities are required to use these national coding systems. Additional information about HIPAA is available through CMS at the following links:

• Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• HIPAA Administrative Simplification
• HIPAA Administrative Simplification - Transactions & Code Sets

ICD-9-CM - International Classification of Diseases - 9th Revision - Clinical Modification

ICD-9-CM is the official system of assigning codes to diagnoses and hospital procedures in the United States. Volumes 1 and 2 comprise diagnostic codes, and Volume 3 lists certain hospital procedure codes. ICD-9-CM is maintained jointly by the National Centers for Health Statistics and the Centers for Medicare and Medicaid Services as part of the ICD-9-CM Maintenance Committee. ICD-9-CM is modified annually to accommodate new terminology and procedures, and to update outdated nomenclature. ICD-9-CM will eventually be replaced by ICD-10-CM (diagnostic codes) and ICD-10-PCS (hospital procedure codes).

CPT® - Current Procedural Terminology

CPT® is a systematic coding system for reporting medical services and procedures performed by physicians. CPT is maintained by the American Medical Association and is modified every year. Revisions are usually effective for dates of service on or after January 1 of each year. CPT also represents Level 1 of the Healthcare Common Procedure Coding System. See the HCPCS section below for further information. Click here for additional background about CPT.

HCPCS - Healthcare Common Procedure Coding System

The Healthcare Common Procedure Coding System (pronounced "hick-picks") was originally created for use under the Medicare program. Today, HCPCS is used by virtually every payer in the United States. HCPCS is comprised of three Levels: Level I - CPT® codes (see above) Level II - National Codes (i.e., "J" codes, "A" codes, "Q" codes, "C" codes for OPPS only) Alpha-numeric coding system for healthcare providers and medical suppliers to report certain drugs, medical supplies, and durable medical equipment. These codes are maintained by the HCPCS National Panel which is comprised of the Blue Cross/Blue Shield Association, the Health Insurance Association of America, and CMS. → Click here for a complete list of HCPCS code issued by the HCPCS Alpha-Numeric Editorial Panel. → Click here for list of HCPCS codes which may be used to bill for certain GlaxoSmithKline Drugs.* *GlaxoSmithKline does not guarantee or provide any explicit or implicit warranty of coding, coverage, or reimbursement. Coding, coverage and reimbursement policies vary significantly by payer, patient, and setting of care. The codes listed in this document will not be used or accepted by all payers. Before using any codes, individual patient benefits should be researched to confirm coding requirements associated with each patient's benefits. Level III - Local Codes The HIPAA eliminated the use of local codes effective October 16, 2003. CPT1 is a registered trademark of the American Medical Association. All CPT five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines, and other materials are Copyright American Medical Association. All rights reserved.