CIP.002.197

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

OUTLIER-CODE

Data Element

DE Number

CIP197

System DE Number

CIP.002.197

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	This code indicates the Type of Outlier Code or DRG Source. The field identifies two mutually exclusive conditions. The first, for PPS providers (codes 0, 1, and 2), classifies stays of exceptional cost or length (outliers). The second, for non-PPS providers (codes 6, 7, 8, and 9), denotes the source for developing the DRG. https://www.resdac.org/cms-data/variables/medpar-drgoutlier-stay-code
Size	X(2)
FLF Start Position	1157
FLF Stop Position	1158
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Outlier Code List (VVL) 2. Value must be 2 characters 3. Value is mandatory if either DRG Outlier Amount (CIP.002.194) or Outlier Days (CIP.002.198) are populated 4. 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-7026	If a claim line is a non-denied claim line from an IP file, then the outlier code value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-714	If the outlier code is populated on a non-denied claim from an IP file, then the outlier code value reported must be in the list of valid values.

Measure ID	Measure Name

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/24/2022	3.0.0	OUTLIER-CODE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| \|CIP197\|OUTLIER-CODE\| This code indicates the Type of Outlier Code or DRG Source. The field identifies two mutually exclusive conditions. The first, for PPS providers(codes 0, 1, and 2), classifies stays of exceptional cost or length (outliers). The second, for non-PPS providers (codes 6, 7, 8, and 9), denotes the source for developing the DRG. https://www.resdac.org/cms-data/variables/medpar-drgoutlier-stay-code 1.(LV) value must be in Outlier Code List (VVL) 2.(FD1) (Day Outlier) If Outlier Code is 01, then Outlier Days (CIP.002.198) must be populated. 3.(S) value must be 2 characters 4.(N) conditional 5.(FD1) if value equals '00' or '09', then DRG Outlier Amount (CIP.002.194) must not be populated\|	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| \|CIP197\|OUTLIER-CODE\| This code indicates the Type of Outlier Code or DRG Source. The field identifies two mutually exclusive conditions. The first, for PPS providers (codes 0, 1, and 2), classifies stays of exceptional cost or length (outliers). The second, for non-PPS providers (codes 6, 7, 8, and 9), denotes thesource for developing the DRG. https://www.resdac.org/cms-data/variables/medpar-drgoutlier-stay-code 1.(LV) value must be in Outlier Code List (VVL) 2.(S) value must be 2 characters 3.(FD1) value is mandatory if either DRG Outlier Amount (CIP.002.194) or Outlier Days (CIP.002.198) are populated 4.(N) conditional\|