CRX.004.206

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TMSIS Dataguide

Medicaid.gov

Version:

DIAGNOSIS-CODE

Data Element

DE Number

CRX206

System DE Number

CRX.004.206

File Name

CRX - CLAIM PHARMACY

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. 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-9051	If a claim is a non-denied claim from a RX file, then the diagnosis code value reported must be compatible with the specified T-MSIS picture format: X(7).
RULE-9156	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-CODE'.
RULE-9225	if the CLAIM-DX-RX segment is populated from a CRX file, then the DIAGNOSIS-CODE must be populated for non-denied claim

Measure ID	Measure Name
MIS-94-001-1	% missing: DIAGNOSIS-CODE (CRX00004)
MIS-98-001-1	% missing: DIAGNOSIS-CODE (CRX00004)

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
02/27/2025	4.0.3	CRX.004.206	UPDATE	Necessity	Mandatory	Conditional
02/27/2025	4.0.3	CRX.004.206	UPDATE	Coding requirement	1. Value must be a minimum of 3 characters2. 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 point5. Mandatory	1. Value must be a minimum of 3 characters2. 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 point5. Conditional
09/16/2024	4.0.0	CRX.004.206	UPDATE	File segment	None	42
09/16/2024	4.0.0	CRX.004.206	ADD	N/A		Created