Colombia

Healthcare System

SGSSS (Sistema General de Seguridad Social en Salud) — mandatory health insurance system established by Ley 100 de 1993. Two regimes: Contributivo (formal sector workers) and Subsidiado (low-income, funded by government). EPS (Entidades Promotoras de Salud) manage enrollment and benefits. IPS (Instituciones Prestadoras de Servicios de Salud) are the healthcare providers. PBS (Plan de Beneficios en Salud) is the mandatory benefits package.

System Type: Mandatory social health insurance (Bismarck-style)
Regulatory Body: INVIMA (Instituto Nacional de Vigilancia de Medicamentos y Alimentos) — drug, device, and food regulation; MSPS (Ministerio de Salud y Protección Social) — health system oversight
Data Protection: Ley 1581 de 2012 (Estatuto de Protección de Datos Personales); SIC (Superintendencia de Industria y Comercio) enforcement; Decreto 1377 de 2013 implements the law
Currency: COP (Colombian Peso)
Emergency Number: 123 (national emergency — police/fire/ambulance integrated); 125 (Defensa Civil); 119 (Cruz Roja Colombiana — Red Cross)
Languages: es

Coding Systems

diagnosis

CIE-10 (Spanish ICD-10)

Clasificación Internacional de Enfermedades, 10ª revisión — Spanish translation of WHO ICD-10. Adopted by SISPRO (Sistema de Información para la Protección Social) and used universally for all SGSSS claims and RIPS reporting. Same alpha-numeric codes as WHO ICD-10; clinical descriptions in Spanish.

procedures

CUPS (Clasificación Única de Procedimientos en Salud)

National procedure classification maintained by Ministerio de Salud y Protección Social. Established via Resolución 4747 de 2007, updated by Resolución 5851 de 2018 and subsequent updates. Codes are 6-digit numeric in XX.XX.XX format (group.subgroup.procedure). Mandatory for all EPS/IPS claims. ~4,000 codes covering all clinical procedures.

dental

FDI (ISO 3950) + CUPS dental section

FDI two-digit notation is standard dental notation. Dental procedures billed via CUPS section 23.XX.XX (Procedimientos de Odontología). Colombia is a major dental tourism destination.

drugs

INVIMA registry (Registro Sanitario)

INVIMA (Instituto Nacional de Vigilancia de Medicamentos y Alimentos) — Colombian equivalent of FDA. All drugs require Registro Sanitario (RS) number. INVIMA-MED controls controlled substances per Ley 30 de 1986. Formulario Terapéutico Nacional lists PBS-covered medications. Controlled substances: Receta de Control Especial.

lab Reporting

Referencia (RIPS codes)

Laboratory results reported via RIPS (Registro Individual de Prestaciones de Servicios) using CUPS section 90.XX.XX for clinical laboratory procedures.

Translation Corridors

CO→US (Colombian diaspora in Florida, NJ — needs CUPS→CPT, CIE-10→ICD-10-CM) CO→ES (Colombians in Spain — same language, different system: CUPS→CMBD, EPS→SNS context) CO→DE (Colombian professionals in Germany — Spanish→German, CUPS→OPS/DRG) VE→CO (Venezuelan refugees receiving care in Colombia — CIE-10 stays same, different EPS context) Medical tourism TO Colombia: cardiology (Medellín), cosmetic surgery (Bogotá, Cartagena), dental (all cities), bariatric — patients from US, Spain, Venezuela returning home needing records translated

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