HI

Dependent Diagnosis

Pos: 080

Max: 1

Detail - Optional

Loop: 2000D

Elements: 12


User Option (Usage): Situational
To supply information related to the delivery of health care

Element Summary:

 

Ref

Id

Element Name

Req

Type

Min/Max

Usage

 

HI01

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 1

M

Comp

 

Required

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

BJ

Admitting Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

BK

Principal Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI02

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 2
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

BJ

Admitting Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI03

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 3
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI04

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 4
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI05

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 5
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI06

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 6
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI07

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 7
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI08

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 8
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI09

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 9
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI10

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 10
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI11

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 11
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational

 

HI12

C022

Health Care Code Information
Description: To send health care codes and their associated dates, amounts and quantities
Alias: Diagnosis 12
Required only if there are additional diagnoses to communicate.

O

Comp

 

Situational

 

 

1270

Code List Qualifier Code
Description: Code identifying a specific industry code list
Industry: Diagnosis Type Code

M

ID

1/3

Required

 

Code

Name

 

BF

Diagnosis

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1271

Industry Code
Description: Code indicating a code from a specific industry code list
Industry: Diagnosis Code

M

AN

1/30

Required

 

ExternalCodeList

 

Name: 131

 

Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

 

 

1250

Date Time Period Format Qualifier
Description: Code indicating the date format, time format, or date and time format
Required if X12N syntax conditions apply.

C

ID

2/3

Situational

 

Code

Name

 

D8

Date Expressed in Format CCYYMMDD

 

 

1251

Date Time Period
Description: Expression of a date, a time, or range of dates, times or dates and times
Industry: Diagnosis Date
Use only when the date diagnosed is known.

C

AN

1/35

Situational



Notes:

1. Use this segment to convey dependent diagnosis information.
2. Required if known by the requester.
3. Required on requests for authorization of home health care. Each home health care request must report a principal diagnosis and principal diagnosis date.

Example:

HI*BF:41090:D8:19980908~


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