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Data Element Name:  Other Diagnosis Code 1 - 14
Format-Length:  A/N - 6 Required For:  AS, ED, IP
Effective Date:  1/1/95 AS, 10/1/95 IP Revision Date:  September 2003

NOTE: This is a composite data element, for mapping guidelines refer to the Inpatient and Outpatient 837 Addenda.

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2300 HI01-1 1270 BF Diagnosis Qualifier
HI01-2 1271 Other Diagnosis Code

Paper Form Locator Code Qualifier
Institutional - UB-04 67A-Q N/A

Definition:

Other Diagnoses include all conditions that coexist at the time of inpatient admission or ambulatory surgical service, or develop subsequently, which affect the treatment received and/or length of stay. Diagnoses that relate to an earlier episode which have no bearing on the current stay are to be excluded.

Conditions should be coded that affect patient care in terms of requiring: clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of stay, or increased nursing care and/or monitoring.

Codes and Values:

  1. Must be 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. E-codes are valid as Other Diagnosis Codes.

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

  4. Inpatient Only (prior to 1/1/99):
    Only E-codes in the range of E930.0 - E949.9 are valid as Other Diagnosis Codes. Other E-codes are to be reported in External Cause-of-Injury Code and Place-of-Injury Code.

  5. If this field is not applicable it must contain blanks.

Example HI01 thru HI06: HI*BF:99591:::::::N*BF:5789:::::::N*BF:2851:::::::N*BF:5849:::::::N*BF:40391:::::::Y*BF:4538:::::::Y~

Edit Applications:

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

  2. When the edit flag on the ICD-9-CM reference file for an "unacceptable principal/primary diagnosis without a secondary diagnosis" is applicable for the Principal/Primary Diagnosis Code, an Other Diagnosis Code 1-14 must also be reported.

  3. Diagnosis codes reported in the range of 800.00-999.99 require the reporting of a valid External Cause-of-Injury Code unless listed as an exception in Appendix N.

  4. Inpatient Only:
    If an Other Diagnosis Code 1-14 is reported, the corresponding Present on Admission Indicator must also be reported except for E-codes.
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