COT.002.030

DIAGNOSIS-CODE-2

Data Element

DE Number

COT030

System DE Number

COT.002.030

File Name

COT - CLAIM OTHER

File Segment Number

COT00002

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

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	169
FLF Stop Position	175
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. When populated, value cannot equal Diagnosis Code 1 (COT.002.027) 11. When Diagnosis Code 1 (COT.002.027) is not populated, value should not 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-1347	If the second diagnosis code is populated on a non-denied, non-void claim from an OT file, then the value for the second diagnosis code must be a valid value from the list of diagnosis code values corresponding to the second diagnosis code flag.
RULE-1349	If the second diagnosis code is populated on a non-denied, non-void claim from an OT file, then the second diagnosis code value reported must not equal the first diagnosis code value reported.
RULE-6071	If the first diagnosis code is not populated on a non-denied claim from an OT file, then the second diagnosis code must not be populated.
RULE-6550	If a claim is a non-denied claim from an OT file, then the second diagnosis code value reported must be compatible with specified T-MSIS picture format: X(7).

Measure ID	Measure Name
MIS-6-013-13	% missing: DIAGNOSIS-CODE-2 (COT00002)
RULE-1347	% of claim headers with invalid Diagnosis Code 2
MIS-25-012-12	% missing: DIAGNOSIS-CODE-2 (COT00002)
MIS-83-012-12	% missing: DIAGNOSIS-CODE-2 (COT00002)
ALL-13-004-6	% of MSIS IDs with alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) with services that are not emergency room or pregnancy-related

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP035	CIP.002.035	DIAGNOSIS-CODE-2	CIP00002	CLAIM-HEADER-RECORD-IP
CLT032	CLT.002.032	DIAGNOSIS-CODE-2	CLT00002	CLAIM-HEADER-RECORD-LT