CLT.002.029

DIAGNOSIS-CODE-1

Data Element

DE Number

CLT029

System DE Number

CLT.002.029

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105".
Size	X(7)
FLF Start Position	168
FLF Stop Position	174
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 (CLT.002.052) 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-6836	If a claim is a non-denied claim from an LT file, then the first diagnosis code value reported must be compatible with specified T-MSIS picture format: X(7).
RULE-892	If the first diagnosis code is populated on a non-denied claim from an LT 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-898	If at least two of the 6 diagnosis codes are populated on a non-denied, non-void claim from an LT file, then the diagnosis code values reported must be unique values.

Measure ID	Measure Name
FFS-5-003-27	% of claim headers with diagnosis codes
FFS-5-004-28	Average # of diagnoses
FFS-7-003-17	% of claim headers with diagnosis codes
FFS-7-004-18	Average # of diagnoses
MCR-5-003-18	% of claim headers with diagnosis codes
MCR-5-004-19	Average # of diagnoses
MCR-7-003-17	% of claim headers with diagnosis codes
MCR-7-004-18	Average # of diagnoses
MIS-4-012-12	% missing: DIAGNOSIS-CODE-1 (CLT00002)
RULE-896	% of claim headers with invalid Diagnosis Code 2
MIS-23-013-13	% missing: DIAGNOSIS-CODE-1 (CLT00002)
MIS-81-013-13	% missing: DIAGNOSIS-CODE-1 (CLT00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP032	CIP.002.032	DIAGNOSIS-CODE-1	CIP00002	CLAIM-HEADER-RECORD-IP
COT027	COT.002.027	DIAGNOSIS-CODE-1	COT00002	CLAIM-HEADER-RECORD-OT