CIP.002.072

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide

Medicaid.gov

Version 3.38.0

PROCEDURE-CODE-FLAG-1

Data Element

DE Number

CIP072

System DE Number

CIP.002.072

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A flag that identifies the coding system used for an associated procedure code.
Size	X(2)
FLF Start Position	315
FLF Stop Position	316
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. When populated, there must be a corresponding Procedure Code 2. Value must be in Procedure Code Flag List (VVL) 3. Value must be 2 characters 4. Conditional 5. If Procedure Code 1 (CIP.002.070) is populated, Procedure Code Flag 1 (CIP.002.072) must be "02" (ICD-9 CM) or "07" (ICD-10-CM PCS).

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-418	If the procedure code flag 1 is populated on a non-denied claim from an IP file, then the procedure code flag 1 reported must be found in the list of valid values.
RULE-6248	If a claim is a non-denied claim from an IP file, then the procedure code flag 1 value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-7287	#N/A

Measure ID	Measure Name
MIS-2-045-45	% missing: PROCEDURE-CODE-FLAG-1 (CIP00002)
MIS-21-048-48	% missing: PROCEDURE-CODE-FLAG-1 (CIP00002)
MIS-79-048-48	% missing: PROCEDURE-CODE-FLAG-1 (CIP00002)

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CIP.002.072	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code2. Value must be in Procedure Code Flag List (VVL)3. Value must be 2 characters4. Conditional5. If Procedure Code 1 (CIP.002.070) is populated, Procedure Code Flag 1 (CIP.002.072) must be '02' (ICD-9 CM) or '07' (ICD-10 - CM PCS).	1. When populated, there must be a corresponding Procedure Code2. Value must be in Procedure Code Flag List (VVL)3. Value must be 2 characters4. Conditional5. If Procedure Code 1 (CIP.002.070) is populated, Procedure Code Flag 1 (CIP.002.072) must be "02" (ICD-9 CM) or "07" (ICD-10-CM PCS).