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Data Element Name:  Condition Information - Special Program (DIS)
Format-Length:  A/N - 2 Required For:  IP
Effective Date:  1/1/94 Revision Date:  September 2003

NOTE: This is a composite data element. Up to 24 Condition Codes can be reported. 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 HI01-1 1270 BG Condition Qualifier
HI01-2 1271 Condition Code

Paper Form Locator Code Qualifier
Institutional - UB-04 18-28 N/A

Definition:

The code which indicates if the patient is entitled to Medicaid benefits due to a specified physical impairment or treatment for a condition of a disabling nature. A disabling condition means the inability to engage in any substantial or gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or has lasted (or can be expected to last) for a continuous period of not less than 12 months.

Codes and Values:

  1. A5 = Disability

Edit Applications:

  1. Must be a valid entry.
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