CRX.004.205

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TMSIS Dataguide

Medicaid.gov

Version:

DIAGNOSIS-CODE-FLAG

Data Element

DE Number

CRX205

System DE Number

CRX.004.205

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Flag used to identify wither the associated Diagnosis Code value is a ICD-9 or ICD-10 code.
Size	X(1)
FLF Start Position	134
FLF Stop Position	134
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 1 character 2. Value must be in Diagnosis Code Flag List (VVL) 3. 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-9050	If a claim is a non-denied claim from a RX file, then the diagnosis code flag value reported must be compatible with the specified T-MSIS picture format: X(1).
RULE-9155	If the diagnosis code flag is populated on a non-denied claim header from a RX file, then the diagnosis code flag reported must be found in the list of valid values for 'DIAGNOSIS-CODE-FLAG'.
RULE-9224	if the CLAIM-DX-RX segment is populated from a CRX file, then the DIAGNOSIS-CODE-FLAG must be populated for non-denied claim

Measure ID	Measure Name
MIS-94-001-2	% missing: DIAGNOSIS-CODE-FLAG (CRX00004)
MIS-98-001-2	% missing: DIAGNOSIS-CODE-FLAG (CRX00004)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP331	CIP.004.331	DIAGNOSIS-CODE-FLAG	CIP00004	CLAIM-DX-IP
CLT277	CLT.004.277	DIAGNOSIS-CODE-FLAG	CLT00004	CLAIM-DX-LT
COT283	COT.004.283	DIAGNOSIS-CODE-FLAG	COT00004	CLAIM-DX-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
02/27/2025	4.0.3	CRX.004.205	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	CRX.004.205	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory	1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Conditional
09/16/2024	4.0.0	CRX.004.205	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.205	ADD	N/A		Created