California Cancer Reporting System Standards Volume I: Abstracting and Coding Procedures
The National Provider Identifier (NPI) is a unique identification number for health care providers. It is scheduled for 2007 implementation by the Centers for Medicare and Medicaid Services (CMS) as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Health care providers have started the process of obtaining NPI codes, and hospitals have until May 2007 to meet the HIPAA deadline. NPI numbers are being distributed by CMS to all health care providers in the United States. CMS has mandated use of the assigned NPI in all administrative and financial transactions between "large" health plans and CMS starting in May 2007. For billing purposes, these providers will be required to use NPI codes by May 2007, but indications are that some health care facilities will start using these codes in advance of this deadline. If a facility starts to use the NPI codes, that information should be available from the provider's billing department.
NPI numbers are only assigned to health care providers who meet the definition of a "covered entity," and this only includes individuals and entities licensed to provide health care. NPI's are not being issued to physicians who have opted out of government programs; entities that bill or are paid for health care services furnished by other health care providers; or clearing houses, vendors, administrative, and billing services (Federal Register [Friday, January 23, 2004]).
Registries should be able to record the NPI for their hospital or individual physicians with January 1, 2007, diagnoses. It is necessary, however, to be aware that NPI's may not have been assigned to all eligible parties by January 1, 2007. Historic facilities or physicians may no longer be in business or licensed and therefore, may not have an NPI assigned.
The NPI is a 10 byte numeric data item. The NPI consists of 9 numeric digits followed by one numeric check digit. The NPI will not have embedded intelligence. The NPI format and check digit calculation will be compatible with the card issuer identifier on a standard health identification card. The card standard was developed by the National Committee for Information Technology Standards (NCITS), which is accredited by the American National Standards Institute. NPI's will be issued initially with the first digit equal to 1 or 2. NPIs with the first digit equal to 1 are assigned to individual health care providers (i.e., physicians); hospitals or other entities that provide health care services will be assigned the first digit of NPI equal to 2. These digits will not be used as the first digits for other card issuer identifiers. NPI numbers will be generated using a scattering algorithm that has the capability to use all possible numeric combinations beginning with 1 or 2. Each NPI generated will be unique, without requiring database access for verification.
When a facility starts to use the NPI codes, that information should be entered and transmitted in the appropriate NPI data item fields. It is anticipated that the implementation of the NPI will vary by facility, provider, and data collection reporting software. Hospital registries should become aware of how the NPI will be implemented in their specific software.
To search NPI numbers for a registry or reporting facility, please see: https://nppes.cms.hhs.gov/NPPESRegistry/NPIRegistrySearch.do
The following data items are all components of the NPI implementation effort:
NPI--Registry ID (NAACCR #45)
The National Provider Identifier (NPI) code that represents the data transmission source. This item stores the NPI of the facility registry that transmits the record.
NPI--Reporting Facility (NAACCR #545)
The NPI code for the facility submitting the data in the record.
NPI--Inst Referred From (NAACCR #2415)
The NPI code that identifies the facility that referred the patient to the reporting facility.
NPI--Inst Referred To (NAACCR #2425)
The NPI code that identifies the facility to which the patient was referred for further care after discharge from the reporting facility.
NPI--Following Registry (NAACCR # 2445)
The NPI code that records the registry responsible for following the patient.
NPI--Physician—Managing (NAACCR # 2465)
The NPI code that identifies the physician who is responsible for the overall management of the patient during diagnosis and/or treatment for this cancer.
NPI--Physician--Follow-Up (NAACCR # 2475)
The NPI code for the physician currently responsible for the patient’s medical care.
NPI--Physician--Primary Surg (NAACCR # 2485)
The NPI code for physician who performed the most definitive surgical procedure.
NPI--Physician 3 (NAACCR # 2495)
The NPI code for another physician involved in the care of the patient.
NPI--Physician 4 (NAACCR # 2505)
The NPI code for another physician involved in the care of the patient.