CIP.002.040

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

DIAGNOSIS-POA-FLAG-3

Data Element

DE Number

CIP040

System DE Number

CIP.002.040

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery. POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. *States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1.
Size	X(1)
FLF Start Position	217
FLF Stop Position	217
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Diagnosis POA Flag List (VVL) 2. Value must be 1 character 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-362	If the diagnosis poa flag 3 is populated on a non-denied claim from an IP file, then the diagnosis poa flag 3 reported must be found in the list of valid values.
RULE-6118	If a claim is a non-denied claim from an IP file, then the diagnosis POA flag 3 value reported must be compatible with specified T-MSIS picture format: X(1)

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT037	CLT.002.037	DIAGNOSIS-POA-FLAG-3	CLT00002	CLAIM-HEADER-RECORD-LT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After