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 Attachments Work Group (AWG) 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 3 ways to identify LOINC codes for use as valid attachments:

1 In the LOINC Table

For Attachment Requestors (e.g. Payers)

The LOINC Table contains a field called ValidHL7AttachmentRequest. A value of Y in this field indicates that this LOINC code can be sent by a payer as part of an HL7 attachment request for additional information. The set of terms that can be used in requests for additional information include:

  1. The preferred (generic) document codes that have clinically-relevant HL7 implementation guides
  2. The HL7 AWG-approved document codes that don't yet have an implementation guide

For Attachment Responders (e.g. Providers)

The LOINC Table contains a field called HL7_ATTACHMENT_STRUCTURE. For attachments approved by the HL7 AWG, this field will be populated with a value of IG exists (previously STRUCTURED) or No IG exists (previously UNSTRUCTURED) for relevant terms.

The IG exists terms are those that have clinically-relevant HL7 implementation guides that use the U.S. Realm Header. The No IG exists terms are those approved by the HL7 AWG for transmission using the Unstructured Document template of the C-CDA.

2 Using RELMA

Both requestors and responders can easily find appropriate LOINC codes to use in attachments with RELMA. RELMA has a special form for browsing the attachment content. Just look for the HIPAA menu and you'll be on your way.

You can read more about how to browse the attachment content with RELMA.

In RELMA, you can also find attachment content by searching on the HL7_ATTACHMENT_STRUCTURE field with RELMA's easy to use search syntax.

For example, to search for all the LOINC terms containing the word consent that have a value in HL7_ATTACHMENT_STRUCTURE of No IG exists, you could enter this query in the search box:

consent HL7AttachmentStructure:NoIGexists

To find the set of progress note terms that could be used with the HL7 C-CDA implementation guide, you could search:

progress note HL7AttachmentStructure:IGexists

To search for all of the terms that can be used in attachment requests for additional information, you could enter this query:

ValidHL7AttachmentRequest:Y

 

3 Using search.loinc.org

The attachment codes in LOINC can be easily located in search.loinc.org, which uses is the same search syntax as RELMA. This powerful search syntax can find keywords anywhere in the LOINC records or witinh a particular field.

For example, to search for all the LOINC terms with value in HL7_ATTACHMENT_STRUCTURE of No IG exists you can enter this query in the search box:

HL7AttachmentStructure:NoIGexists

You can follow this link to run the above query on search.loinc.org.

Similarly, to search for all of the terms that can be used in attachment requests for additional information, you could enter this query:

ValidHL7AttachmentRequest:Y

Follow this link to run the above query.

Similar to RELMA, the rows in the search results grid of the online search application can be highlighted and then exported to a CSV file.