COT.003.254

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TMSIS Dataguide

Medicaid.gov

Version:

DIAGNOSIS-CODE-POINTER-1

Data Element

DE Number

COT254

System DE Number

COT.003.254

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A pointer to the diagnosis code in the order of importance to this service.
Size	9(2)
FLF Start Position	796
FLF Stop Position	797
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be numeric 2. Value must be 2 digits or less 3. Value must be between 1 and 12 4. Conditional 5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated

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

RULE ID	RULE Definition
RULE-9198	If a claim is a non-denied claim from an OT file, and is a Medicaid or Medicaid-expansion CHIP FFS or Separate CHIP FFS claim and claim line medicaid paid amt is non-null and not zero, then the claim line Diagnosis Code Pointer 1 must be populated.

Measure ID	Measure Name
RULE-9226	% of claim headers with a Procedure Code indicating a dental claim and non-missing Diagnosis Code Flag that have a missing Diagnosis Code

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/19/2025	4.0.11	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then�value must be populated	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated
05/29/2025	4.0.9	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then�value must be populated
05/07/2025	4.0.8	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If TYPE-OF-CLAIM is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated
04/24/2025	4.0.7	COT.003.254	UPDATE	Necessity	Mandatory	Conditional
04/24/2025	4.0.7	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If TYPE-OF-CLAIM is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated
03/14/2025	4.0.4	COT.003.254	UPDATE	Coding requirement		1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory
12/19/2024	4.0.1	COT.003.254	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory
09/16/2024	4.0.0	COT.003.254	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.254	ADD	N/A		Created