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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 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] 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] CWE
7 00381 Major Diagnostic Category SHALL NOT W [0..0] CNE
8 00382 Diagnostic Related Group SHALL NOT W [0..0] CNE
9 00383 DRG Approval Indicator SHALL NOT W [0..0] ID
10 00384 DRG Grouper Review Code SHALL NOT W [0..0] CWE
11 00385 Outlier Type SHALL NOT W [0..0] 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 NM
16 00390 Diagnosing Clinician [0..*] XCN
17 00766 Diagnosis Classification [0..1] CWE
18 00767 Confidential Indicator [0..1] [1..1] 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] ID
22

02152 Parent Diagnosis MAY
True:
False:
C
[1..1]
[0..1]
EI
23 02153 DRG CCL Value Code [0..1] CWE
24 02154 DRG Grouping Usage [0..1] [1..1] ID
25 02155 DRG Diagnosis Determination Status [0..1] CWE
26 02288 Present On Admission [0..1] CWE

DG1-1: 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.

DG1-2: Diagnosis Coding Method

Attention: DG1-2 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6 .

DG1-3: Diagnosis Code - DG1 (CWE) 00377

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."

DG1-4: Diagnosis Description

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.

DG1-5: Diagnosis Date/Time (DTM) 00379

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

DG1-6: Diagnosis Type (CWE) 00380

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.

DG1-7: Major Diagnostic Category

(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.

DG1-8: Diagnostic Related Group

(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.

DG1-9: DRG Approval Indicator

(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.

DG1-10: DRG Grouper Review Code

(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.

DG1-11: Outlier Type

(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.

DG1-12: Outlier Days

(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.

DG1-13: Outlier Cost

(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.

DG1-14: Grouper Version And Type

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

DG1-15: Diagnosis Priority (NM) 00389

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.

DG1-16: Diagnosing Clinician (XCN) 00390

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.

DG1-17: Diagnosis Classification (CWE) 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 in Chapter 2C, Code Tables, for suggested values.

DG1-18: Confidential Indicator (ID) 00767

(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.

(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.

DG1-19: Attestation Date/Time (DTM) 00768

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

DG1-20: Diagnosis Identifier (EI) 01850

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.

DG1-21: Diagnosis Action Code (ID) 01894

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.

DG1-22: Parent Diagnosis (EI) 02152

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 ("+").

DG1-23: DRG CCL Value Code (CWE) 02153

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.

DG1-24: DRG Grouping Usage (ID) 02154

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

DG1-25: DRG Diagnosis Determination Status (CWE) 02155

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.

DG1-26: Present On Admission (CWE) 02288

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.