DPS - Diagnosis And Procedure Code Segment

The Technical Steward for the DPS segment is Orders and Observations.

For the payer defined in PM1-1 and the service provider defined in MFE-4 and the Producer's Service/Test/Observation ID in MCP-2 these are the Diagnosis and Procedure that impact coverage requirements as defined by:

• When MFI-1 is MLCP (Medical Limited Coverage Process) this segment is identifing what is in limited coverage.

• When MFI-1 is MACP (Medical Approved Coverage Process) this segment is identifing what is approved. This segment defines the test that are approved for a given Diagnosis Code based on the Procedure Code.

HL7 Attribute Table - DPS - Diagnosis and Procedure Code Segment

Seq#	Data Element Name	DataType	Usage	Vocabulary	Cardinality	Item #	Length	C.LEN	Flags
DPS
1	Diagnosis Code - MCP	CWE	R	0051 Diagnosis Code	[1..1]	03472
2	Procedure Code	CWE	R	0941 Procedure Code	[1..*]	03484
3	Effective Date/Time	DTM	O		[0..1]	00662
4	Expiration Date/Time	DTM	O		[0..1]	03473
5	Type of Limitation	CNE	O	0940(R) Limitation Type Codes(Required)	[0..1]	03474

DPS-1: Diagnosis Code - MCP (CWE) 03472

Definition: DPS-1 contains the diagnosis code assigned to this diagnosis. Refer to User-defined Table 0051 - Diagnosis Code for suggested values. This field is a CWE data type for compatibility with clinical and ancillary systems. Either DPS-1.1-Identifier or DPS-1.2-Text is required. When a code is used in DPS-1.1-Identifier, a coding system is required in DPS-1.3-Name of Coding System.

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

DPS-2: Procedure Code (CWE) 03484

Definition: This field contains the procedure code for procedure, if any, associated with this charge description. Repeating field allows for different procedure coding systems such as CPT4, ASTM, ICD9. Coded entry made up of code plus coding schema. See Externally Defined Table 0941 – Procedure Code.

DPS-3: Effective Date/Time (DTM) 00662

Definition: An optional effective date/time can be included for the record-level action specified. It is the date/time the originating system expects that the event is to have been completed on the receiving system. If this field is not present, the effective date/time should default to the current date/time (when the message is received).

DPS-4: Expiration Date/Time (DTM) 03473

Definition: An optional expiration date/time can be included for the record-level action specified. It is the date/time the originating system expects that the event is to have been completed on the receiving system.

DPS-5: Type of Limitation (CNE) 03474

Definition: This field contains the type of limitations as determined by the Payer. This field has a defined value set that may need to be extended. See HL7 Table 0940 - Limitation Type Codes, in Chapter 2C, Code Tables for valid values.