CRX.004.203

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TMSIS Dataguide

Medicaid.gov

Version:

DIAGNOSIS-TYPE

Data Element

DE Number

CRX203

System DE Number

CRX.004.203

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Indicates the context of the diagnosis code from the provider's claim (i.e., an NCPDP claim can have up to 5 diagnosis codes). The type of diagnosis code (e.g., principal, admitting, external cause of injury, or other) is captured here. The order in which the diagnosis code was reported is captured in the Diagnosis Sequence Number.
Size	X(1)
FLF Start Position	131
FLF Stop Position	131
Segment Key Field Identifier	6
Coding Requirements	1. Value must be 1 character 2. Value must be in Diagnosis Type Code List (VVL) 3. Value must be "D" 4. Conditional

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

RULE ID	RULE Definition
RULE-9048	If a claim is a non-denied claim from a RX file, then the diagnosis type value reported must be compatible with the specified T-MSIS picture format: X(1).
RULE-9154	If the diagnosis type is populated on a non-denied claim header from a RX file, then the diagnosis id reported must be found in the list of valid values for 'DIAGNOSIS-TYPE'.
RULE-9222	if the CLAIM-DX-RX segment is populated from a CRX file, then the DIAGNOSIS-TYPE must be populated for non-denied claim

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP329	CIP.004.329	DIAGNOSIS-TYPE	CIP00004	CLAIM-DX-IP
CLT275	CLT.004.275	DIAGNOSIS-TYPE	CLT00004	CLAIM-DX-LT
COT281	COT.004.281	DIAGNOSIS-TYPE	COT00004	CLAIM-DX-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
05/07/2025	4.0.8	CRX.004.203	UPDATE	Necessity	Mandatory	Conditional
05/07/2025	4.0.8	CRX.004.203	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be "D"4. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be "D"4. Conditional
09/16/2024	4.0.0	CRX.004.203	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.203	ADD	N/A		Created