CIP.002.032

DIAGNOSIS-CODE-1

Data Element

DE Number

CIP032

System DE Number

CIP.002.032

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The primary/principal ICD-9/10-CM diagnosis code as reported on the claim.
Size	X(7)
FLF Start Position	191
FLF Stop Position	197
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. When populated, a Diagnosis Code Flag is required 2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL) 3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL) 4. Value must be a minimum of 3 characters 5. Value must not contain a decimal point 6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters 7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters 8. When there is more than one diagnosis code on a claim, each value must be unique 9. Conditional 10. If Type of Claim (CIP.002.100) in ("1", "3", "A", "C", "U", "W") then value must be populated.

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Admitting Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes)

Admitting Diagnosis Code List (ICD-10)

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

RULE ID	RULE Definition
RULE-347	If the first diagnosis code is populated on a non-denied claim from an IP file, then the value for the first diagnosis code must be a valid value from the list of values for diagnosis codes corresponding to the first diagnosis code flag.
RULE-353	If at least two of the 12 diagnosis codes are populated on a non-denied claim from an IP file, then the diagnosis code values reported must be unique values.
RULE-6409	If a claim is a non-denied claim from an IP file, then the first diagnosis code value reported must be compatible with specified T-MSIS picture format: X(7).

Measure ID	Measure Name
MCR-1-004-16	Average # of diagnoses
MIS-79-014-14	% missing: DIAGNOSIS-CODE-1 (CIP00002)
MIS-21-014-14	% missing: DIAGNOSIS-CODE-1 (CIP00002)
RULE-347	% of claim headers with invalid Diagnosis Code 1
MIS-2-013-13	% missing: DIAGNOSIS-CODE-1 (CIP00002)
MCR-3-005-10	% of claim headers with only 1 diagnosis code
MCR-3-004-16	Average # of diagnoses
MCR-3-003-9	% of claim headers with diagnosis codes
MCR-1-005-10	% of claim headers with only 1 diagnosis code
ALL-13-003-5	% of MSIS IDs with alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) with services that are not emergency room or pregnancy-related
MCR-1-003-9	% of claim headers with diagnosis codes
FFS-3-005-10	% of claim headers with only 1 diagnosis code
FFS-3-004-16	Average # of diagnoses
FFS-3-003-9	% of claim headers with diagnosis codes
FFS-1-005-22	% of claim headers with only 1 diagnosis code
FFS-1-004-28	Average # of diagnoses
FFS-1-003-21	% of claim headers with diagnosis codes

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT029	CLT.002.029	DIAGNOSIS-CODE-1	CLT00002	CLAIM-HEADER-RECORD-LT
COT027	COT.002.027	DIAGNOSIS-CODE-1	COT00002	CLAIM-HEADER-RECORD-OT