CIP.002.041

DIAGNOSIS-CODE-4

Data Element

DE Number

CIP041

System DE Number

CIP.002.041

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105".
Size	X(7)
FLF Start Position	218
FLF Stop Position	224
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. Value must not be populated when Diagnosis Code 3 (CIP.002.038) is not 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-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-363	If the fourth diagnosis code is populated and the fourth diagnosis code flag is for ICD-9 or ICD-10 codes on a non-denied claim from an IP file, then the value for the fourth diagnosis code must be a valid value from the list of values for ICD-9 or ICD-10 codes, respectively.
RULE-366	If the third diagnosis code is not populated on a non-denied claim from an IP file, then the fourth diagnosis code must not be populated.
RULE-6416	If a claim is a non-denied claim from an IP file, then the diagnosis code 4 value reported must be compatible with specified T-MSIS picture format: X(7).

Measure ID	Measure Name
MIS-2-019-19	% missing: DIAGNOSIS-CODE-4 (CIP00002)
RULE-363	% of claim headers with invalid Diagnosis Code 4
MIS-21-020-20	% missing: DIAGNOSIS-CODE-4 (CIP00002)
MIS-79-020-20	% missing: DIAGNOSIS-CODE-4 (CIP00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT038	CLT.002.038	DIAGNOSIS-CODE-4	CLT00002	CLAIM-HEADER-RECORD-LT