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Data Element Name:  Admitting Diagnosis Code
Format-Length:  A/N - 6 Required For:  IP
Effective Date:  1/1/94 Revision Date:  July 2007

NOTE: This is a composite data element, for mapping guidelines refer to the Inpatient 837 Addendum.
National Standard Mapping:

Electronic - 837I
X12 Loop
Ref. Des.
Data Element
Code
Description
Version 4050R 2300 HI02-1 1270 BJ Admitting Diagnosis Qualifier
1271 Admitting Diagnosis Code
Paper Form Locator Code Qualifier
Institutional - UB-04 69 N/A

Definition:

The diagnosis provided by the physician at the time of admission which describes the patient's condition upon admission to the hospital. Since the Admitting Diagnosis is formulated before all tests and examinations are complete, it may be stated in the form of a problem or symptom and it may differ from any of the final diagnoses recorded in the medical record.

Codes and Values:

  1. Must be a valid ICD-9-CM code. To be valid, ICD-9-CM codes must be entered at the most specific level to which they are classified in the ICD-9-CM Tabular List. Three-digit codes further divided at the four-digit level must be entered using all four digits. Four-digit codes further subclassified at the five-digit level must be entered using all five digits. Failure to enter all required digits in the diagnosis codes will cause the record to be rejected.

  2. Must be entered exactly as shown in the ICD-9-CM coding reference.

  3. E-codes are not valid as Admitting Diagnosis Codes. E-codes are reported in External Cause-of-Injury Code and Place-of-Injury Code.

Example: HI*BK:63491*BJ:63491~

Edit Applications:

  1. Edits pertaining to ICD-9-CM codes are validated on the basis of the Statement-Covers-Thru Date and Expected Principal Reimbursement depending on conditions described in Appendix N, which include age-specific and sex-specific diagnosis code conditions.

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