Draft Website - For Review Purposes Only

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 Code - FT1 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.

HL7 Attribute Table - DG1 - Diagnosis Segment

Seq#	DataElement	Description	Must Implement	Flags	Cardinality	Length	C.LEN	Vocabulary	DataType
DG1
1	00375	Set ID - DG1	SHALL		[1..1]	[1..4]			SI
2	00376	Diagnosis Coding Method	SHALL NOT	W	[0..0]
3	00377	Diagnosis Code - DG1	SHALL		[1..1]			0051	CWE
4	00378	Diagnosis Description	SHALL NOT	W	[0..0]
5	00379	Diagnosis Date/Time			[0..1]				DTM
6	00380	Diagnosis Type	SHALL		[1..1]			0052 Diagnosis Type	CWE
7	00381	Major Diagnostic Category	SHALL NOT	W	[0..0]			0118	CNE
8	00382	Diagnostic Related Group	SHALL NOT	W	[0..0]			0055	CNE
9	00383	DRG Approval Indicator	SHALL NOT	W	[0..0]			0136 Yes/no Indicator	ID
10	00384	DRG Grouper Review Code	SHALL NOT	W	[0..0]			0056	CWE
11	00385	Outlier Type	SHALL NOT	W	[0..0]			0083 Outlier Type	CWE
12	00386	Outlier Days	SHALL NOT	W	[0..0]				NM
13	00387	Outlier Cost	SHALL NOT	W	[0..0]				CP
14	00388	Grouper Version And Type	SHALL NOT	W	[0..0]
15	00389	Diagnosis Priority		=	[0..1]		2	0359 Diagnosis Priority	NM
16	00390	Diagnosing Clinician			[0..*]				XCN
17	00766	Diagnosis Classification			[0..1]			0228 Diagnosis Classification	CWE
18	00767	Confidential Indicator			[0..1]	[1..1]		0136 Yes/no Indicator	ID
19	00768	Attestation Date/Time			[0..1]				DTM
20	01850	Diagnosis Identifier	MAY True: False:	C	[1..1] [0..1]				EI
21	01894	Diagnosis Action Code	MAY True: False:	C	[1..1] [0..1]	[1..1]		0206 Segment Action Code	ID
22	02152	Parent Diagnosis	MAY True: False:	C	[1..1] [0..1]				EI
23	02153	DRG CCL Value Code			[0..1]			0728 CCL Value	CWE
24	02154	DRG Grouping Usage			[0..1]	[1..1]		0136 Yes/no Indicator	ID
25	02155	DRG Diagnosis Determination Status			[0..1]			0731 DRG Diagnosis Determination Status	CWE
26	02288	Present On Admission			[0..1]			0895 Present On Admission (POA) Indicator	CWE

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.

Attention: DG1-2 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6 .

Definition: DG1-3 - Diagnosis Code - DG1 contains the diagnosis code assigned to this diagnosis. Refer to User-defined Table 0051 - Diagnosis Code in Chapter 2C, Code Tables, for suggested values. This field is a CWE data type for compatibility with clinical and ancillary systems. Either DG1-3.1-Identifier or DG1-3.2-Text is required. When a code is used in DG1-3.1-Identifier, a coding system is required in DG1-3.3-Name of Coding System.

Names of various diagnosis coding systems are listed in Chapter 2, Section 2.16.4, "Coding system table."

Attention: DG1-4 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

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

Definition: This field contains a code that identifies the type of diagnosis being sent. Refer to User-defined Table 0052 - Diagnosis Type in Chapter 2C, Code Tables, for suggested values. This field should no longer be used to indicate "DRG" because the DRG fields have moved to the new DRG segment.

(Definition from DG1.7 in Ch. 6)

Attention: DG1-7 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6 .

(Definition from DMI.2 in Ch. 8)

Definition: This field indicates the determined Major Diagnostic Category (MDC) value. Refer to External Table 0118 – Major Diagnostic Category in Chapter 2C, Code Tables, for suggested values.

(Definition from DG1.8 in Ch. 6)

Attention: DG1-8 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

(Definition from DRG.1 in Ch. 6)

Definition: This field contains the DRG for the transaction. Interim DRG's could be determined for an encounter. Refer to Externally-defined Table 0055 – Diagnosis Related Group in Chapter 2C, Code Tables, for suggested values.

(Definition from DMI.1 in Ch. 8)

Definition: This field contains the DRG for the transaction. Interim DRG's could be determined for an encounter. Refer to External Table 0055 – Diagnosis Related Group in Chapter 2C, Code Tables, for suggested values.

(Definition from DG1.9 in Ch. 6)

Attention: DG1-9 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.3 in Ch. 6)

Definition: This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 Table 0136 - Yes/no Indicator for valid values.

• Y    the DRG has been approved by a reviewing entity

• N    the DRG has not been approved

(Definition from DG1.10 in Ch. 6)

Attention: DG1-10 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.4 in Ch. 6)

Definition: This code indicates that the grouper results have been reviewed and approved. Refer to User-defined Table 0056 - DRG Grouper Review Code in Chapter 2C, Code Tables, for suggested values.

(Definition from DG1.11 in Ch. 6)

Attention: DG1-11 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.5 in Ch. 6)

Definition: Refers to the type of outlier (i.e., period of care beyond DRG-standard stay in facility) that has been paid. Refer to User-defined Table 0083 - Outlier Type in Chapter 2C, code Tables, for suggested values.

(Definition from DG1.12 in Ch. 6)

Attention: DG1-12 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.6 in Ch. 6)

Definition: This field contains the number of days that have been approved as an outlier payment.

(Definition from DG1.13 in Ch. 6)

Attention: DG1-13 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.7 in Ch. 6)

Definition: This field contains the amount of money that has been approved for an outlier payment.

(Definition from GP1.5 in Ch. 6)

Definition: This field contains the amount that exceeds the outlier limitation as defined by APC regulations. This field is analogous to DRG-7 - Outlier Cost; however, the definition in this field note supersedes the DRG-7 definition.

Attention: DG1-14 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

Definition: This field contains the number that identifies the significance or priority of the diagnosis code. Refer to HL7 Table 0359 - Diagnosis Priority in Chapter 2C, Code Tables, for suggested values.

Note: As of v 2.7, the data type has been changed to numeric. The meaning of the values remains the same as those in HL7 Table 0418 – Procedure Priority, The value 0 conveys that this procedure is not included in the ranking. The value 1 means that this is the primary procedure. Values 2-99 convey ranked secondary procedures.

Definition: This field contains the individual responsible for generating the diagnosis information. As of v 2.7, if XCN.1 - ID Number is populated, then the XCN.13 - Identifier Type Code and the XCN.9 - Assigning Authority or XCN.22 - Assigning Jurisdiction or XCN.23 - Assigning Agency or Department are required. If XCN.2 - Family Name is populated, then the XCN.10 - Name Type Code is required. No assumptions can be safely made based on position or sequence. Specification of meaning based on sequence is deprecated.

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 in Chapter 2C, Code Tables, for suggested values.

(Definition from DG1.18 in Ch. 6)

Definition: This field indicates whether the diagnosis is confidential. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, "Code Tables", for valid values.

• Y    the diagnosis is a confidential diagnosis

• N    the diagnosis does not contain a confidential diagnosis

(Definition from DRG.10 in Ch. 6)

Definition: This field indicates if the DRG contains a confidential diagnosis. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    the DRG contains a confidential diagnosis

• N    the DRG does not contain a confidential diagnosis

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

Definition: This field contains a value that uniquely identifies a single diagnosis for an encounter. It is unique across all segments and messages for an encounter. This field is required in all implementations employing Update Diagnosis/Procedures (P12) messages.

Definition: This field defines the action to be taken for this diagnosis. Refer to HL7 Table 0206 - Segment Action Code in Chapter 2C, "Code Tables", for valid values. This field is required for the update diagnosis/procedures (P12) message. In all other events it is optional.

Definition: This field contains the entity identifier for the parent diagnosis. This field links the "current" manifestation diagnosis ("*") to the entity identifier of the "parent" etiological diagnosis ("+").

Definition: This field indicates the CCL value for the determined DRG for this diagnosis. Refer to Externally-defined Table 0728 - CCL Value in Chapter 2C, Code Tables, for suggested values.

Definition: This field identifies whether this particular diagnosis has been used for the DRG determination. Refer to HL7 Table 0136 – Yes/No Indicator in Chapter 2C, Code Tables, for suggested values. The values have the following meaning for this field:

Y    Yes - Indicates that the diagnosis has been used for the DRG determination

N    No – Indicates that the diagnosis has not been used for the DRG determination

Definition: This field contains the status of this particular diagnosis for the DRG determination. Refer to User-defined Table 0731 – DRG Diagnosis Determination Status in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the present on admission indicator for this particular diagnosis. US reimbursement formulas for some states and Medicare have mandated that each diagnosis code be flagged as to whether it was present on admission or not. Refer to User-defined Table 0895 – Present On Admission (POA) Indicator in Chapter 2C, Code Tables, for suggested values.