CIP.004.332

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TMSIS Dataguide

Medicaid.gov

Version:

DIAGNOSIS-CODE

Data Element

DE Number

CIP332

System DE Number

CIP.004.332

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

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 '21051'.
Size	X(7)
FLF Start Position	135
FLF Stop Position	141
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be a minimum of 3 characters 2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL) 3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL) 4. Value must not contain a decimal point 5. Mandatory

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

RULE ID	RULE Definition
RULE-8963	If a claim is a non-denied claim from an IP file, then the diagnosis code value reported must be compatible with the specified T-MSIS picture format: X(7).
RULE-9075	If the diagnosis type is populated on a non-denied claim header from a IP file, then the diagnosis id reported must be found in the list of valid values for 'DIAGNOSIS-CODE'.
RULE-9174	if the CLAIM-DX-IP segment is populated from a CIP file, then the DIAGNOSIS-CODE must be populated for non-denied claim

Measure ID	Measure Name
FFS-1-003-21	% of claim headers with diagnosis codes
FFS-1-004-28	Average # of diagnoses
FFS-1-005-22	% of claim headers with only 1 diagnosis code
FFS-3-003-9	% of claim headers with diagnosis codes
FFS-3-004-16	Average # of diagnoses
FFS-3-005-10	% of claim headers with only 1 diagnosis code
MCR-1-003-9	% of claim headers with diagnosis codes
MCR-1-004-16	Average # of diagnoses
MCR-1-005-10	% of claim headers with only 1 diagnosis code
MCR-3-003-9	% of claim headers with diagnosis codes
MCR-3-004-16	Average # of diagnoses
MCR-3-005-10	% 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
MIS-91-001-1	% missing: DIAGNOSIS-CODE (CIP00004)
MIS-95-001-1	% missing: DIAGNOSIS-CODE (CIP00004)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT278	CLT.004.278	DIAGNOSIS-CODE	CLT00004	CLAIM-DX-LT
COT284	COT.004.284	DIAGNOSIS-CODE	COT00004	CLAIM-DX-OT
CRX206	CRX.004.206	DIAGNOSIS-CODE	CRX00004	CLAIM-DX-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CIP.004.332	UPDATE	File segment	None	27
09/16/2024	4.0.0	CIP.004.332	ADD	N/A		Created