CIP.002.069

DIAGNOSIS-RELATED-GROUP-IND

Data Element

DE Number

CIP069

System DE Number

CIP.002.069

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	An indicator identifying the grouping algorithm used to assign Diagnosis Related Group (DRG) values.Values are generated by combining two types of information: Position 1-2, State/Group generating DRG: If state specific system, fill with two digit US postal code representation for state. If CMS Grouper, fill with "HG". If any other system, fill with "XX". Position 3-4, fill with the number that represents the DRG version used (01-98). For example, "HG15" would represent CMS Grouper version 15. If version is unknown, fill with "99".
Size	X(4)
FLF Start Position	303
FLF Stop Position	306
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 4 characters or less 2. The right-most 2 positions must be found in 01-99 3. Conditional 4. Value must be populated, when associated Diagnosis Related Group (CIP.002.068) is populated

Values are generated by combining two types of information: Position 1-2, State/Group generating DRG: If state specific system, fill with two digit US postal code representation for state.

If CMS Grouper, fill with 'HG'.

If any other system, fill with 'XX'.

Position 3-4, fill with the number that represents the DRG version used (01-98).

For example, 'HG15' would represent CMS Grouper version 15. If version is unknown, fill with '99'.

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

RULE ID	RULE Definition
RULE-411	If a non-denied IP claim has a value populated for submitting state and a value populated for diagnosis related group indicator, the diagnosis related group indicator values in positions 1-2 must match the value for submitting state.
RULE-412	If a non-denied IP claim diagnosis related group is populated, then the diagnosis related group indicator must be populated.
RULE-6884	The format for DIAGNOSIS-RELATED-GROUP-IND on a non-denied IP claim was expected to be submitted as X(4).
RULE-7167	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: 'MS-DRG-VERSION-3', 'MS-DRG-VERSION-4', 'MS-DRG-VERSION-5', 'MS-DRG-VERSION-6', 'MS-DRG-VERSION-7', 'MS-DRG-VERSION-8', 'MS-DRG-VERSION-9', 'MS-DRG-VERSION-10', 'MS-DRG-VERSION-11', 'MS-DRG-VERSION-12', 'MS-DRG-VERSION-13', 'MS-DRG-VERSION-14', 'MS-DRG-VERSION-15', 'MS-DRG-VERSION-16', 'MS-DRG-VERSION-17', 'MS-DRG-VERSION-18', 'MS-DRG-VERSION-19', 'MS-DRG-VERSION-20', 'MS-DRG-VERSION-21', 'MS-DRG-VERSION-22', 'MS-DRG-VERSION-23', 'MS-DRG-VERSION-24', or 'MS-DRG-VERSION-25'

Measure ID	Measure Name
FFS-1-014-31	% of claim headers with CMS/MS-DRG
FFS-3-014-19	% of claim headers with CMS/MS-DRG
MCR-1-013-19	% of claim headers with CMS/MS-DRG
MCR-3-014-19	% of claim headers with CMS/MS-DRG

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name