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Procedures

An activity that is performed with or on a patient as part of the provision of care.

Data Element

Applicable Standard(s)

Procedures

USCDI v1

  • Health Care Financing Administration Common Procedure Coding System (HCPCS)
  • Current Procedural Terminology, Fourth Edition (CPT-4)
  • Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, September 2019 Release

Optional:

  • USCDI v1 - International Classification of Diseases ICD-10-PCS 2020

Optional for technology which records dental procedures:

  • Code on Dental Procedures and Nomenclature (CDT), maintained and distributed by the American Dental Association, for dental services.

Draft USCDI v2

  • Health Care Financing Administration Common Procedure Coding System (HCPCS)
  • Current Procedural Terminology (CPT), 2021
  • Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, September 2020 Release

Optional:

  • International Classification of Diseases ICD-10-PCS 2021

Optional for technology which records dental procedures:

  • Code on Dental Procedures and Nomenclature (CDT), maintained and distributed by the American Dental Association, for dental services.

Data Element

Applicable Standard(s)

Procedures

USCDI v1

  • Health Care Financing Administration Common Procedure Coding System (HCPCS)
  • Current Procedural Terminology, Fourth Edition (CPT-4)
  • Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, September 2019 Release

Optional:

  • USCDI v1 - International Classification of Diseases ICD-10-PCS 2020

Optional for technology which records dental procedures:

  • Code on Dental Procedures and Nomenclature (CDT), maintained and distributed by the American Dental Association, for dental services.

Draft USCDI v2

  • Health Care Financing Administration Common Procedure Coding System (HCPCS)
  • Current Procedural Terminology (CPT), 2021
  • Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, September 2020 Release

Optional:

  • International Classification of Diseases ICD-10-PCS 2021

Optional for technology which records dental procedures:

  • Code on Dental Procedures and Nomenclature (CDT), maintained and distributed by the American Dental Association, for dental services.

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