Attachments

Using LOINC in HIPAA Attachments

Speak LOINC

LOINC helps providers and payers speak the same language

The HIPAA Administrative Simplification provision mandates the adoption of standards for electronic claims attachments. A claims attachment includes the clinical and administrative information often necessary to adjudicate claims such as those for ambulance, rehabilitation, or emergency room services. Regenstrief has worked closely with the HL7 Payer/Provider Information Exchange (PIE) Work Group (formerly called the "Attachments" Work Group) to support the use of LOINC codes in the electronic exchanges of attachments between payers and providers.

The current proposed specifications for attachments use LOINC codes for three main purposes:

  1. To identify the specific kind of information being communicated in both a request and response (e.g., a discharge summary or diagnostic imaging report).
  2. To  specify certain optional modifier variables for fulfilling the request for information (e.g. variables that indicate a modification to the default time period).
  3. In structured attachment responses using HL7 CDA, LOINC codes identify the attachment (document) type, sections, and sometimes the individual entries (tests or observations).

There are 4 ways to identify LOINC codes for valid attachment requests and responses:

1 In the LOINC Table

2 Searching in RELMA or the online searchLOINC application

3 Using the LOINC FHIR terminology services

4 The RELMA HIPAA tab

 

The following table shows you how to find the codes you need using 1, 2, and 3.

(See the RELMA HIPAA tab page for more information about 4.)

 

 

For Attachment Requestors (e.g., Payers)

For Attachment Responders (e.g., Providers)

LOINC table Filter ValidHL7AttachmentRequest column for value "Y"

1. LOINC codes that are valid attachment responses

  • Filter HL7_ATTACHMENT_STRUCTURE column for any (non-null) value

2. Subset of response terms that have associated U.S. Realm C-CDA implementation guides

  • Filter HL7_ATTACHMENT_STRUCTURE column for value "IG exists"

3. Subset of response terms that do NOT have associated C-CDA implementation guides

  • Filter HL7_ATTACHMENT_STRUCTURE column for value "No IG exists"
searchLOINC or RELMA search Search string: ValidHL7AttachmentRequest:Y

1. LOINC codes that are valid attachment responses

2. Subset of response terms that have associated U.S. Realm C-CDA implementation guides

3. Subset of response terms that do NOT have associated C-CDA implementation guides

FHIR terminology services

1. LOINC codes that are valid attachment responses

2. Subset of response terms that have associated U.S. Realm C-CDA implementation guides

3. Subset of response terms that do NOT have associated C-CDA implementation guides