CLT.002.032

DIAGNOSIS-CODE-2

Data Element

DE Number

CLT032

System DE Number

CLT.002.032

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

No Updates

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	177
FLF Stop Position	183
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. Value must not be populated when Diagnosis Code 1 (CLT.002.029) is not 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-6843	The format for DIAGNOSIS-CODE-2 on a non-denied LT claim was expected to be submitted as X(7).
RULE-896	If the second diagnosis code is populated and the second diagnosis code flag is for ICD-9 or ICD-10 codes on a non-denied claim from an LT file, then the value for the second diagnosis code must be a valid value from the list of values for ICD-9 or ICD-10 codes, respectively.
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.
RULE-899	If the first diagnosis code is not populated on a non-denied claim from an LT file, then the second diagnosis code must not be populated.

Measure ID	Measure Name
MIS-4-013-13	% missing: DIAGNOSIS-CODE-2 (CLT00002)
MIS-23-014-14	% missing: DIAGNOSIS-CODE-2 (CLT00002)
MIS-81-014-14	% missing: DIAGNOSIS-CODE-2 (CLT00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP035	CIP.002.035	DIAGNOSIS-CODE-2	CIP00002	CLAIM-HEADER-RECORD-IP
COT030	COT.002.030	DIAGNOSIS-CODE-2	COT00002	CLAIM-HEADER-RECORD-OT