CLT.004.278

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TMSIS Dataguide

Medicaid.gov

Version:

DIAGNOSIS-CODE

Data Element

DE Number

CLT278

System DE Number

CLT.004.278

File Name

CLT - CLAIM LONG-TERM CARE

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 '2105'.
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-8924	If a claim is a non-denied claim from an LT file, then the diagnosis code value reported must be compatible with the specified T-MSIS picture format: X(7).
RULE-9099	If the diagnosis type is populated on a non-denied claim header from a LT file, then the diagnosis id reported must be found in the list of valid values for 'DIAGNOSIS-CODE'
RULE-9192	if the CLAIM-DX-LT segment is populated from a CLT file, then the DIAGNOSIS-CODE must be populated for non-denied claim

Measure ID	Measure Name
FFS-5-003-27	% of claim headers with diagnosis codes
FFS-5-004-28	Average # of diagnoses
FFS-7-003-17	% of claim headers with diagnosis codes
FFS-7-004-18	Average # of diagnoses
MCR-5-003-18	% of claim headers with diagnosis codes
MCR-5-004-19	Average # of diagnoses
MCR-7-003-17	% of claim headers with diagnosis codes
MCR-7-004-18	Average # of diagnoses
MIS-92-001-1	% missing: DIAGNOSIS-CODE (CLT00004)
MIS-96-001-1	% missing: DIAGNOSIS-CODE (CLT00004)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP332	CIP.004.332	DIAGNOSIS-CODE	CIP00004	CLAIM-DX-IP
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	CLT.004.278	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.278	ADD	N/A		Created