COT.003.219

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

PROCEDURE-CODE-MOD-4

Data Element

DE Number

COT219

System DE Number

COT.003.219

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 procedure code modifier used with an associated procedure code. For example, some states use modifiers to indicate assistance in surgery or anesthesia services.
Size	X(2)
FLF Start Position	1257
FLF Stop Position	1258
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Must be associated with a Procedure Code 2. Value must be 2 characters 3. Value must be in Procedure Code Mod List (VVL) 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-1706	If the procedure mod 4 is populated on a non-denied claim line from an OT file, then the procedure mod 4 value reported must be in the list of valid values for procedure mod 4.
RULE-6375	If a claim line is a non-denied claim line from an OT file, then the procedure mod 4 value reported must be compatible with specified T-MSIS picture format: X(2).

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
12/04/2020	2.4.0	COT219-0004	UPDATE	Data Dictionary	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-6) was performed, leave blank or space-fill.	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-4) was performed, leave blank or space-fill.