COT.002.028

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

DIAGNOSIS-CODE-FLAG-1

Data Element

DE Number

COT028

System DE Number

COT.002.028

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1.
Size	X(1)
FLF Start Position	167
FLF Stop Position	167
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Diagnosis Code Flag List (VVL) 2. Value must be 1 character 3. Conditional 4. Value should not be populated, if the associated diagnosis code is not populated

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

RULE ID	RULE Definition
RULE-1343	If the first diagnosis code is populated on a non-denied, non-void claim from an OT 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-1345	If the diagnosis code flag 1 is populated on a non-denied claim from an OT file, then the diagnosis code flag 1 reported must be found in the list of valid values.
RULE-6199	If a claim is a non-denied claim from an OT file, then the diagnosis code flag 1 value reported must be compatible with specified T-MSIS picture format: X(1).

Measure ID	Measure Name
MIS-6-014-14	% missing: DIAGNOSIS-CODE-FLAG-1 (COT00002)
MIS-25-013-13	% missing: DIAGNOSIS-CODE-FLAG-1 (COT00002)
MIS-83-013-13	% missing: DIAGNOSIS-CODE-FLAG-1 (COT00002)
RULE-7564	% of claim headers with a Procedure Code indicating a dental claim and non-missing Diagnosis Code Flag 1 that have a missing Diagnosis Code 1

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP033	CIP.002.033	DIAGNOSIS-CODE-FLAG-1	CIP00002	CLAIM-HEADER-RECORD-IP
CLT030	CLT.002.030	DIAGNOSIS-CODE-FLAG-1	CLT00002	CLAIM-HEADER-RECORD-LT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After