Subscriber Diagnosis

Pos: 080

Max: 1

Detail - Optional

Loop: 2000C

Elements: 12

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

Diagnosis

CODE SOURCE:

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

Admitting Diagnosis

CODE SOURCE:

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

Principal Diagnosis

CODE SOURCE:

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

LOI

Logical Observation Identifier Names and Codes (LOINC) Codes

The Logical Observation Identifier Names and Codes (LOINCŽ) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.
See Section 2.2.5 for information on using LOINC to request additional information.

CODE SOURCE:

663: Logical Observation Identifier Names and Codes (LOINC)

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

Admitting Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

	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

Diagnosis

CODE SOURCE:

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

LOI

1271

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

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.

2/3

Situational

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.

1/35

Situational

Notes:

1. Required if valued on the request and used by the UMO to render a decision. If the response has not been rendered and this segment is used to request additional information associated with a specific diagnosis, place the specific diagnosis code in the HI C022 composite that precedes the HI C022 composite(s) containing the LOINC. If the original request contained more than six diagnosis codes and you are using LOINC to request additional information for each of these diagnosis codes or if you need to specify multiple questions/LOINC codes per diagnosis you cannot exceed the limit of 12 occurrences of the C022 composite.
2. It is recommended that the UMO retain the diagnosis information carried on the request for use in subsequent health care service review inquiries and notifications related to the original request.
3. The UMO can use each occurrence of the Health Care Code Information composite (C022) to specify codes that identify the specific information that the UMO requires from the provider to complete the medical review. In the C022 composite, data elements 1270 and 1271 support the use of codes supplied from the Logical Observation Identifier Names and Codes (LOINCŽ) List. These codes identify high-level health care information groupings, specific data elements, and associated modifiers. The Logical Observation Identifier Names and Codes (LOINCŽ) code set was intended to increase the functionality of the 278 transaction set and it is not mandated by HIPAA and is only used when mutually agreed to by trading partners.

Refer to Section 2.2.5 of this guide for more information on requesting additional information in the 278 response.

Example:

HI*BF:41090~

	ExternalCodeList
	Name: 663
	Description: Logical Observation Identifier Names and Codes (LOINC)

	Code	Name
	D8	Date Expressed in Format CCYYMMDD

	Code	Name
	D8	Date Expressed in Format CCYYMMDD

	Code	Name
	D8	Date Expressed in Format CCYYMMDD