(January 6, 2010)

NHIA is pleased to announce that the 2010 version of the NHIA National Coding Standard for Home Infusion Claims under HIPAA is now available and still offered to the public at no charge. First published in 2002, this document of procedures and examples for coding home infusion claims is widely used by payers and providers throughout the United States.

The publication presents the HCPCS (Healthcare Common Procedure Coding System) per diem "S-codes" as a comprehensive coding system for home infusion therapy claims and provides procedures for their use, information about what's included in the home infusion per diem, and detailed coding examples for both typical and unusual claims scenarios that payers and providers are likely to encounter when using the per diem coding system. Procedures and claim examples for services provided in the Ambulatory Infusion Suite of the Home Infusion Therapy Provider (AIS) are also included.

As compared to the 2009 version, the new National Coding Standard includes new illustrations for coding of claims on Box 24 of the CMS-1500 claim form with NDC numbers coded for drugs.  We note that the S-coding system for home infusion claims is well established and widely used.  Beyond new coding illustrations, no substantive changes are made to the coding standard for 2010.

• Download the 2010NHIA National Coding Standard for Home Infusion Claims under HIPAA, version 1.09.02a (free, registration required)

• Obtain NHIA's Quick Coding Reference for Home Infusion Therapy.

• Visit the HIEC Resource Center.

A summary of the changes to the National Coding Standard follows.

Box 24 Coding:  For two examples, we added illustrations for coding of claims on Box 24 of the CMS-1500 claim form.  In addition to generally enhancing our claim coding presentation, we are illustrating a coding convention we understand is increasingly being used by payers.  Specifically, we illustrate drug coding using the qualifier “N4” to indicate that what follows is an eleven position NDC number.  Using this qualifier is a convention adopted by the National Uniform Claims Committee in its 1500 instruction manual that is similar to a data requirement within the X12N 837 Professional electronic claim.

Other Enhancements. Changes are made to keep the National Coding Standard current.