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TMSIS Dataguide Medicaid.gov

Version:

DIAGNOSIS-CODE

Data Element

DE Number

CRX206

System DE Number

CRX.004.206

File Segment Number

CRX00004

File Segment Name

CLAIM-DX-RX

Last updated

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. Conditional
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP332 CIP.004.332 DIAGNOSIS-CODE CIP00004 CLAIM-DX-IP
CLT278 CLT.004.278 DIAGNOSIS-CODE CLT00004 CLAIM-DX-LT
COT284 COT.004.284 DIAGNOSIS-CODE COT00004 CLAIM-DX-OT