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TMSIS Dataguide Medicaid.gov
Version 3.27.0

DIAGNOSIS-RELATED-GROUP

Data Element

DE Number

CIP068

System DE Number

CIP.002.068

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition

A code representing the Diagnosis Related Group (DRG) that is applicable for the inpatient services being rendered. This field is required on FFS claims and encounters records in which diagnosis related groups are used to determine paid amounts.
Size X(4)
FLF Start Position 299
FLF Stop Position 302
Segment Key Field Identifier Not Applicable
Coding Requirements

1. Value must be 4 characters or less
2. Conditional

If the first two characters of the diagnosis related group indicator is 'HG' which indicates a CMS DRG Group code was assigned, then the value for the diagnosis related group must be from the following list of valid values.

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