Claim Diagnosis Code 1 Diagnosis Version Code (ICD-9 or ICD-10) (Encounter)

SAS Name

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9/ICD-10.


On October 1, 2015 the conversion from the 9th version of the International Classification of Diseases (ICD-9-CM) to version 10 (ICD-10-CM) occurred. ICD-10 has more than 70,000 unique diagnosis codes compared to approximately 14,000 ICD-9 codes, which allows for more detail surrounding diagnoses.

The diagnosis version code applies to all diagnoses on the claim (i.e., diagnoses appear in variables ICD_DGNS_CDX).

This field is not present in the institutional claims (inpatient, skilled nursing, home health) since the cutover occurred exactly on October 1, 2015. Although this cutover date applies to carrier/DME claims, there are some instances where a billing date could straddle the cutoff date (e.g., DME ordered vs. received dates), therefore we include this field to enable verification as to which codes are used.

Source: Medicare Advantage Organizations (MAOs)

Code Code value
Blank ICD-9
9 ICD-9
0 ICD-10