CIP.002.070

PROCEDURE-CODE-1

Data Element

DE Number

CIP070

System DE Number

CIP.002.070

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	A procedure code based on ICD-9 and ICD-10 used by the state to identify the procedures performed during the hospital stay referenced by this claim. The principal procedure and related info should be recorded in Procedure Code1, Procedure Code Date-1, and Procedure Code Flag 1. The principal procedure is performed for definitive treatment rather than for diagnostic or exploratory purposes. It is closely related to either the principal diagnosis or to complications that arise during other treatments. Use Procedure Code 2 through Procedure Code 6 (and related data elements) to record secondary, tertiary, etc. procedures.
Size	X(8)
FLF Start Position	307
FLF Stop Position	314
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. When populated, there must be a corresponding Procedure Code Flag 2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code 3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code 4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code 5. Value must be 8 characters or less 6. Value must be in Procedure Code List (VVL) 7. Conditional

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.

Procedure Code List

Procedure Code List 2

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

RULE ID	RULE Definition
RULE-413	If the first procedure code is populated on a non-denied claim from an IP file, then the first procedure code must be a valid value from the list of procedure code values corresponding to the first procedure code flag.
RULE-414	If the first procedure code flag is populated on a non-denied claim from an IP file, then the first procedure code must be populated.
RULE-6142	If a claim is a non-denied claim from an IP file, then the first procedure code value reported must be compatible with specified T-MSIS picture format: X(8).

Measure ID	Measure Name
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
FFS-1-006-23	% of claim headers with principal Procedure Code
FFS-1-007-29	Average # of procedures
FFS-3-006-11	% of claim headers with principal Procedure Code
FFS-3-007-17	Average # of procedures
MCR-1-006-11	% of claim headers with principal Procedure Code
MCR-1-007-17	Average # of procedures
MCR-3-006-11	% of claim headers with principal Procedure Code
MCR-3-007-17	Average # of procedures
MIS-2-041-41	% missing: PROCEDURE-CODE-1 (CIP00002)
MIS-21-044-44	% missing: PROCEDURE-CODE-1 (CIP00002)
MIS-79-044-44	% missing: PROCEDURE-CODE-1 (CIP00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name