CIP.002.032

DIAGNOSIS-CODE-1

Data Element

DE Number

CIP032

System DE Number

CIP.002.032

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The primary/principal ICD-9/10-CM diagnosis code as reported on the claim.
Size	X(7)
FLF Start Position	191
FLF Stop Position	197
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. When populated, a Diagnosis Code Flag is required 2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL) 3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL) 4. Value must be a minimum of 3 characters 5. Value must not contain a decimal point 6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters 7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters 8. When there is more than one diagnosis code on a claim, each value must be unique 9. Conditional 10. If Type of Claim (CIP.002.100) in [1,3,A,C,U,W] then value must be populated

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Admitting Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes)

Admitting Diagnosis Code List (ICD-10)

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-347	If the first diagnosis code is populated on a non-denied claim from an IP file, then the value for the first diagnosis code must be a valid value from the list of values for diagnosis codes corresponding to the first diagnosis code flag.
RULE-353	If at least two of the 12 diagnosis codes are populated on a non-denied claim from an IP file, then the diagnosis code values reported must be unique values.
RULE-6409	If a claim is a non-denied claim from an IP file, then the first diagnosis code value reported must be compatible with specified T-MSIS picture format: X(7).

Measure ID	Measure Name
MCR-1-004-16	Average # of diagnoses
MIS-79-014-14	% missing: DIAGNOSIS-CODE-1 (CIP00002)
MIS-21-014-14	% missing: DIAGNOSIS-CODE-1 (CIP00002)
RULE-347	% of claim headers with invalid Diagnosis Code 1
MIS-2-013-13	% missing: DIAGNOSIS-CODE-1 (CIP00002)
MCR-3-005-10	% of claim headers with only 1 diagnosis code
MCR-3-004-16	Average # of diagnoses
MCR-3-003-9	% of claim headers with diagnosis codes
MCR-1-005-10	% of claim headers with only 1 diagnosis code
ALL-13-003-5	% of MSIS IDs with alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) with services that are not emergency room or pregnancy-related
MCR-1-003-9	% of claim headers with diagnosis codes
FFS-3-005-10	% of claim headers with only 1 diagnosis code
FFS-3-004-16	Average # of diagnoses
FFS-3-003-9	% of claim headers with diagnosis codes
FFS-1-005-22	% of claim headers with only 1 diagnosis code
FFS-1-004-28	Average # of diagnoses
FFS-1-003-21	% of claim headers with diagnosis codes

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT029	CLT.002.029	DIAGNOSIS-CODE-1	CLT00002	CLAIM-HEADER-RECORD-LT
COT027	COT.002.027	DIAGNOSIS-CODE-1	COT00002	CLAIM-HEADER-RECORD-OT