16 Va. Admin. Code § 30-16-40 - Billing code sets
Billing codes and modifier systems identified in this section are valid codes for the specified workers' compensation transactions, in addition to any code sets defined by the standards in 16VAC30-16-30.
1. "CDT-4 Codes" are codes and nomenclature
prescribed by the American Dental Association.
2. "CPT-4 Codes" are the procedural
terminology and codes contained in the "Current Procedural Terminology, Fourth
Edition," as published by the American Medical Association.
3. "Diagnosis Related Group" or "DRG" is the
inpatient classification scheme used by CMS for hospital inpatient
reimbursement. The DRG system classifies patients based on principal diagnosis,
surgical procedure, age, presence of comorbidities and complications, and other
pertinent data.
4. "Healthcare
Common Procedure Coding System" or "HCPCS" is a coding system that describes
products, supplies, procedures, and health professional services and that
includes the American Medical Association's Physician "Current Procedural
Terminology, Fourth Edition," CPT-4 codes, alphanumeric codes, and related
modifiers.
5. "ICD-10-CM/PCS Codes"
are diagnosis and procedure codes in the International Classification of
Diseases, Tenth Edition, Clinical Modification/Procedure Coding System
maintained and published by the U.S. Department of Health and Human
Services.
6. "NDC" are National
Drug Codes of the U.S. Food and Drug Administration.
7. "Revenue Codes" is the four-digit coding
system developed and maintained by the National Uniform Billing Committee for
billing inpatient and outpatient hospital services, home health services, and
hospice services.
8. "National
Uniform Billing Committee Codes" are a code structure and instructions
established for use by the National Uniform Billing Committee, such as
occurrence codes, condition codes, or prospective payment indicator codes. As
of February 6, 2019, these are known as UB04 codes.
Notes
Statutory Authority: § 65.2-605.1 of the Code of Virginia.
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