How pharmacists can make best use of health-care and billing codes

March 10, 2008

Here's a primer on healthcare and billing codes, from NDC to CPT.

National Provider Identification (NPI)

One new landmark change in 'coding' requirements for all providers is the move to National Provider Identification (NPI) numbers. These mandates, as provisions of the Health Insurance Portability and Accountability Act (HIPAA) 1996, required the development of 'standard' national identifier numbers for all providers, health plans, and employers. The intent was to improve the efficiency of electronic data interchange-as more than five billion claims are processed by healthcare insurers in the United States each year. Prior to this requirement, claims systems were burdened with the growing amount of information and crosswalk systems needed for successful claims adjudication. Before the use of NPI numbers, every provider was required to have a unique ID number which corresponded to every payer he or she billed to.

A large number of providers did not meet the May 2007 NPI deadline. Therefore, CMS developed an NPI Contingency Plan which extended the date for providers to begin using NPI numbers. Providers must be aware, however, that the contingency plan has the following rigid implementation dates: