COT.003.196

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

TOOTH-NUM

Data Element

DE Number

COT196

System DE Number

COT.003.196

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The tooth number serviced based on the tooth numbering system identified in the TOOTH-DESIGNATION-SYSTEM field.
Size	X(2)
FLF Start Position	392
FLF Stop Position	393
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Tooth Number List (VVL) 2. If Tooth Designation System (COT.003.195) is "JP" value must be found in [1-32][51-82][A-T]or [AS-KS] 3. If Tooth Designation System (COT.003.195) is "JO" value must have 1 digit before and after the decimal (N.N) 4. If Tooth Designation System (COT.003.195) is "JO" value must be a first digit of 1-4 and the decimal must be between 1-8 5. Value must be 2 characters or less 6. Conditional 7. When value is in [A-T], the difference between Ending Date of Service (COT.002.034) and Date of Birth (COT.002.108) is less than 15 years

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

RULE ID	RULE Definition
RULE-1675	If the tooth number is populated on a non-denied, non-void claim line from an OT file, then the tooth number must be a valid value from the list of tooth number values.
RULE-6328	If a claim line is a non-denied claim line from an OT file, then the tooth number value reported must be compatible with specified T-MSIS picture format: X(2).

Measure ID	Measure Name
ALL-35-001-1	% of claim lines with a Procedure Code indicating a sealant, filling, or root canal that are missing Tooth Number
ALL-35-002-2	% of claim lines with a Procedure Code indicating a sealant, filling, or root canal that are missing Tooth Number
ALL-35-003-3	% of claim lines with non-missing Tooth Number that do not have a Procedure Code format that indicates a CDT code
ALL-35-004-4	% of claim lines with non-missing Tooth Number that do not have a Procedure Code format that indicates a CDT code

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	COT.003.196	UPDATE	Coding requirement	1. Value must be in Tooth Number List (VVL)2. If Tooth Designation System (COT.003.195) is 'JP' value must be found in [1..32][51-82][A..T]or [AS..KS]3. If Tooth Designation System (COT.003.195) is 'JO' value must have 1 digit before and after the decimal (N.N)4. If Tooth Designation System (COT.003.195) is 'JO' value must be a first digit of 1-4 and the decimal must be between 1-85. Value must be 2 characters or less6. Conditional7. When value is in ['A'-'T'], the difference between Ending Date of Service (COT.002.034) and Date of Birth (COT.002.108) is less than 15 years	1. Value must be in Tooth Number List (VVL)2. If Tooth Designation System (COT.003.195) is "JP" value must be found in [1-32][51-82][A-T]or [AS-KS]3. If Tooth Designation System (COT.003.195) is "JO" value must have 1 digit before and after the decimal (N.N)4. If Tooth Designation System (COT.003.195) is "JO" value must be a first digit of 1-4 and the decimal must be between 1-85. Value must be 2 characters or less6. Conditional7. When value is in [A-T], the difference between Ending Date of Service (COT.002.034) and Date of Birth (COT.002.108) is less than 15 years