Medical Records and the Law

496 CHAPTER 13: ELECTRONIC HEALTH RECORDS• Coordination of benefits• Healthcare claim status• Enrollment and disenrollment in a health plan• Eligibility for a health plan• Health plan premium payments• Referral certification and authorization• First report of injury• Health claims attachments• Other transactions prescribed by DHHS 184Although covered entities may use code sets prescribed for these transactionsin connection with other transactions, they are required to usethe national standard code sets only with the transactions set forth inthe TCS Rule from time to time by DHHS. The TCS Rule applies toelectronic transmissions using most forms of media, including (a) electronicstorage media, such as computer hard drives, and movable digitalmemory media, such as magnetic tapes or disks and digital memorydevices; and (b) transmission media used to exchange information alreadyin electronic form, such as the wide-open Internet, extranet,leased lines, dial-up lines, and private networks. 185A code set is any set of computer codes used to encode data elements,such as diagnosis, demographic information, and medical procedures.Thecode set standards adopted by the TCS Rule establish thecomputer codes that covered entities must use to conduct the coveredtransactions. Each transaction described in the rule has a prescribed setof codes and data elements that must be used. For example, transmissionsof medical information concerning diseases require the use of theInternational Classification of Diseases, 9th Edition, Clinical Modification(ICD-9-CM), Volumes 1 and 2, as published by DHHS. Other standardcode sets are required for the transmission of other types of information(for example, pharmaceuticals, physician services, clinical laboratorytests, and so forth). 186The HIPAA regulations establishing the National Provider Identifieras the standard unique health identifier for healthcare providers18445 C.F.R. § 160.103.185Ibid.18645 C.F.R. § 162.1002.