Code Maintenance is a category that contains information about all codes that are required on a claim in order for it to be considered for payment.
Code Maintenance covers the following code sets:
Diagnosis Codes - ICD (International Classification of Diseases) diagnosis codes and related information are maintained to support claims processing and Diagnostic Related Groupings (DRG) assignment. Diagnosis information can be edited online and through a batch CMS interface.
DRG Codes - Diagnosis Related Group (DRG) information is maintained primarily to support pricing inpatient hospital claims. DRG information is only edited online.
Ambulatory Payment Classification (APC) Codes - The APC information is maintained by the Rules Management function to group outpatient services together that are clinically similar and require comparable resources. APC codes are updated through a batch Centers for Medicare and Medicaid Services (CMS) interface, as well as online.
Procedure and Service Codes - Health Care Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT), American Dental Association (ADA) Dental, and Non-Medicaid procedure or service codes and all associated supporting information to support claims adjudication and pricing are maintained by the Rules Management function. The standard codes are updated through a batch Centers for Medicare and Medicaid Services (CMS) interface as well as online, while the non-Medicaid procedure or service codes are only edited online.
Surgical Procedure Codes - Surgical procedure codes and all associated related information are maintained by the Rules Management function. Surgical procedure code information can also be edited online and through batch CMS interface.
Revenue Codes - Revenue codes are maintained primarily for processing institutional claims. Revenue information is edited online. Because of the limited volume and frequency of revenue code changes, there is no need for a batch update process.
Modifiers - Modifiers are maintained by the Rules Management function for procedure modifiers that are not procedure-code specific. Modifiers are updated through a batch Centers for Medicare and Medicaid Services (CMS) interface, as well as online.
Version as of 5/16/14.
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Diagnosis Codes Information