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6.4.2 DG1 - diagnosis segment

The DG1 segment contains patient diagnosis information of various types, for example, admitting, primary, etc. The DG1 segment is used to send multiple diagnoses (for example, for medical records encoding). It is also used when the FT1-19-diagnosis does not provide sufficient information for a billing system. This diagnosis coding should be distinguished from the clinical problem segment used by caregivers to manage the patient (see Chapter 12, Patient Care). Coding methodologies are also defined.

Figure 6-2. DG1 attributes

SEQ

LEN

DT

OPT

RP/#

TBL#

ITEM#

ELEMENT NAME

1

4

SI

R



00375

Set ID - DG1

2

2

ID

(B) R


0053

00376

Diagnosis Coding Method

3

60

CE

O


0051

00377

Diagnosis Code

4

40

ST

B



00378

Diagnosis Description

5

26

TS

O



00379

Diagnosis Date/Time

6

2

IS

R


0052

00380

Diagnosis Type

7

60

CE

B


0118

00381

Major Diagnostic Category

8

4

IS

B


0055

00382

Diagnostic Related Group

9

2

ID

B


0136

00383

DRG Approval Indicator

10

2

IS

B


0056

00384

DRG Grouper Review Code

11

60

CE

B


0083

00385

Outlier Type

12

3

NM

B



00386

Outlier Days

13

12

NM

B



00387

Outlier Cost

14

4

ST

B



00388

Grouper Version And Type

15

2

NM

B



00389

Diagnosis Priority

16

60

XCN

O

Y


00390

Diagnosing Clinician

17

3

IS

O


0228

00766

Diagnosis Classification

18

1

ID

O


0136

00767

Confidential Indicator

19

26

TS

O



00768

Attestation Date/Time

6.4.2.0 DG1 field definitions

6.4.2.1 Set ID - DG1 (SI) 00375

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.

6.4.2.2 Diagnosis coding method (ID) 00376

Definition: This field has been retained for backward compatibility only. Use the components of DG1-3-diagnosis code instead of this field. When used for backward compatibility, ICD9 is the recommended coding methodology. Refer to HL7 table 0053 - Diagnosis coding method for valid values.

6.4.2.3 Diagnosis code (CE) 00377

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: Use this field instead of DG1-2-coding method and DG1-4-diagnosis description. (Those two fields have been retained for backward compatibility only.) DG1-3-diagnosis code contains the diagnosis code assigned to this diagnosis. Refer to user-defined table 0051- Diagnosis code for suggested values. This field is a CE data type for compatibility with clinical and ancillary systems.

See Chapter 7 for suggested diagnosis codes. For the name of the coding system, refer to Chapter 7, Section 7.14, "Coding schemes," Figure 7-2-Diagnostic Coding Schemes.

6.4.2.4 Diagnosis description (ST) 00378

Definition: This field has been retained for backward compatibility only. Use the components of DG1-3-diagnosis code field instead of this field. When used for backward compatibility, DG1-4-diagnosis description contains a description that best describes the diagnosis.

6.4.2.5 Diagnosis date/time (TS) 00379

Definition: This field contains the date/time that the diagnosis was determined.

6.4.2.6 Diagnosis type (IS) 00380

Definition: This field contains a code that identifies the type of diagnosis being sent. Refer to user-defined table 0052 - Diagnosis type. This field should no longer be used to indicate "DRG" because the DRG fields have moved to the new DRG segment.

User-defined Table 0052 - Diagnosis Type

Values

Description

A

Admitting

W

Working

F

Final

6.4.2.7 Major diagnostic category (CE) 00381

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field has been retained for backward compatibility only. This field should only be used in a master file transaction. Refer to user-defined table 0118 - Major diagnostic category for suggested values.

6.4.2.8 Diagnostic related group (IS) 00382

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. It contains the DRG for the transaction. Interim DRG’s could be determined for an encounter. Refer to user-defined table 0055 - DRG code for suggested values.

6.4.2.9 DRG approval indicator (ID) 00383

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 table - 0136 - Yes/no indicator for valid values.

6.4.2.10 DRG grouper review code (IS) 00384

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. Refer to user-defined table 0056 - DRG grouper review code for suggested values. This code indicates that the grouper results have been reviewed and approved.

6.4.2.11 Outlier type (CE) 00385

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the type of outlier that has been paid. Refer to user-defined table 0083 - Outlier type for suggested values.

6.4.2.12 Outlier days (NM) 00386

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the number of days that have been approved for an outlier payment.

6.4.2.13 Outlier cost (NM) 00387

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the amount of money that has been approved for an outlier payment.

6.4.2.14 Grouper version and type (ST) 00388

Definition: This field has been retained for backward compatibility only. This field has moved to the new DRG segment. When used for backward compatibility, this field contains the grouper version and type.

6.4.2.15 Diagnosis priority (NM) 00389

Definition: This field has been retained for backward compatibility only. This field should no longer be used for DRG priority, because the DRG fields have moved to the new DRG segment.

When used for backward compatibility, DG1-15-diagnosis priority contains the number that identifies the significance or priority of the diagnosis or DRG code. The numbers have the following meanings:

0 the admitting diagnosis

1 the primary diagnosis

2 and higher for ranked secondary diagnoses

6.4.2.16 Diagnosing clinician (XCN) 00390

Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>

Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)

Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)

Definition: This field contains the individual responsible for generating the diagnosis information. Multiple names and identifiers for the same person may be sent in this field, not multiple diagnosing clinicians. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components for this field are described in Chapter 2.

6.4.2.17 Diagnosis classification (IS) 00766

Definition: This field indicates if the patient information is for a diagnosis or a non-diagnosis code. Refer to user-defined table 0228 - Diagnosis classification for suggested values.

User-defined Table 0228 - Diagnosis classification

Value

Description

C

Consultation

D

Diagnosis

M

Medication (antibiotic)

O

Other

R

Radiological scheduling (not using ICDA codes)

S

Sign and symptom

T

Tissue diagnosis

I

Invasive procedure not classified elsewhere (I.V., catheter, etc.)

6.4.2.18 Confidential indicator (ID) 00767

Definition: This field indicates whether the diagnosis is confidential. Refer to HL7 table 0136 - Yes/no indicator for valid values.

Y the diagnosis is a confidential diagnosis

N the diagnosis does not contain a confidential diagnosis

6.4.2.19 Attestation date/time (TS) 00768

Definition: This field contains the time stamp that indicates the date and time that the attestation was signed.

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