The Lowdown on Healthcare Provider Taxonomy Codes

Much hubbub surrounds the ICD-10 implementation taking effect in October 2014, and rightfully so. Yet, that doesn’t mean we should ignore the other code sets required for proper billing.

Healthcare Provider Taxonomy Codes fall under this category. To help keep the coding process running smoothly at your practice, let’s take a refresher course on taxonomy codes and their uses.

What are Taxonomy Codes?
Taxonomy codes are the primary components of the Health Care Provider Taxonomy Code Set. They are designed to categorize healthcare providers into two sections: Individuals/Groups of Individuals and Non-Individuals.

The codes are made available by the Washington Publishing Company and maintained by the National Uniform Claim Committee (NUCC).

The Purpose of Taxonomy Codes
Taxonomy codes are designed for use in an electronic environment, primarily within ASC X12N Health Care transactions and certain HIPAA mandated transactions.

Taxonomy codes are also used when applying for a National Patient Identifier (NPI) with the National Plan and Provider Enumeration System (NPPES).

Taxonomy codes are structured into three separate levels. The higher the code level is, the more specific classification your practice receives.

Level 1, Provider Type
This level is the most general of the three. It places providers under a broad umbrella of services and occupations, such as Allopathic & Osteopathic Physicians. Categorization at this level is a starting point and comes without a corresponding code.

Level 2, Classification
Specificity of service or occupation is increased at this level. For example, Family Medicine (207Q00000X) is a code falling under the Allopathic & Osteopathic Physicians category.

Level 3, Area of Specialization
This level provides the most specific categories. For instance, Geriatric Medicine (207QG0300X) falls under the broader Level 2 Family Medicine category.

Code Structure
Taxonomy codes are ten characters in length, alphanumeric in nature, and always end with the letter X. The first four characters of a taxonomy code indicate its Level 2 Classification. The middle five characters vary depending on the Level 3 Area of Specialization.

Let’s take the code for Pediatric Cardiology (2080P0202X) as an example. The “2080” indicates it falls under the Pediatrics classification (208000000X). The “P0202” then differentiates it from specialties like Pediatric Endocrinology (2080P0205X) or Pediatric Nephrology (2080P0210X).

Proceed With Caution
Capitalization – This specific code set only uses capital letters. If you submit claims using lower case letters, the taxonomy code will not be recognized.

Multi-Specialty vs. Single Specialty – These Level 2 codes are very similar, 193400000X for Single Specialty and 193200000X for Multi-Specialty. A mistake on the fourth character will misclassify your practice.

Updates – Taxonomy codes are updated twice a year. The first updates are published in January and go into effect on April 1. The second updates are published in July and are implemented in October. Make sure you’re using the most current coding sets.

Valuable Resources
The Health Care Provider Taxonomy Code Set
More Information About Taxonomy Codes
Crosswalk: Medicare Provider Description to Provider Taxonomy Codes

Remember, although your practice should already be preparing for ICD-10 it doesn’t mean you should be ignoring other coding areas. Always stay vigilant of all of the various code sets to keep your practice’s billing process running like a well-oiled machine.

A practice management system can improve coding at your practice. Our checklist will help you choose one.

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