DXA & DXD - Diagnosis

Clinical diagnoses at admission and discharge

Record Types: DXA (Admission), DXD (Discharge) | Version: CoBHRM 2026-Q3 | Parent: ADMISSION

Overview

The DIAGNOSIS schema captures clinical diagnoses using ICD-10-CM codes and SMI/SED status. There are two record types:

• DXA - Diagnosis at Admission: Diagnoses assigned at the start of treatment
• DXD - Diagnosis at Discharge: Diagnoses confirmed or updated at end of treatment

Unlike a repeating-record model, the Diagnosis record uses named slots: up to three mental health diagnosis fields and one SUD diagnosis field per record.

Transaction Types: All record types support Add (A), Update (U), and Replace (R) transactions. See Transaction Types for details.

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1. Schema Reference

Identifier Fields

BHA Column Name	Field Name	Format	Required	Valid Values	Notes
RECORD_TYPE	Record Type	x(3)	Y	DXA or DXD	DXA = Diagnosis at Admission, DXD = Diagnosis at Discharge
TRANSACTION_TYPE	Transaction Type	x(1)	Y	A, U, R	See Transaction Types
BHASO_ADMISSION_IDENTIFIER	Admission Identifier	x(-)	Y	Alphanumeric	Must exist in ADMISSION
EFFECTIVE_DATE	Effective Date	date	Y	YYYY-MM-DD

Diagnosis Fields

BHA Column Name	Field Name	Format	Required	Valid Values	Notes
MH_DIAGNOSIS_ID_1	MH Diagnosis 1	x(8)	Conditional	ICD-10-CM code	Required for MH or co-occurring admissions. Primary mental health diagnosis
MH_DIAGNOSIS_ID_2	MH Diagnosis 2	x(8)	N	ICD-10-CM code	Secondary mental health diagnosis
MH_DIAGNOSIS_ID_3	MH Diagnosis 3	x(8)	N	ICD-10-CM code	Tertiary mental health diagnosis
SUD_DIAGNOSIS_ID	SUD Diagnosis	x(8)	Conditional	ICD-10-CM code	Required for SUD or co-occurring admissions
SMI_SED_STATUS	SMI/SED Status	9(2)	Y	See SMI/SED Status	Code 08 (Not Collected) is valid only for SUD-only clients

ICD-10 code validation approach: BHA recommends that ICD-10 codes belong to the State Behavioral Health Services Billing Manual and/or BHA CCAR User Manual, but does not impose a hard restriction at launch. Non-behavioral health codes will be flagged for future provider training rather than rejected.

System Metadata Fields

These fields are required in every submission and track record creation and modification:

BHA Column Name	Field Name	Format	Required	Notes
CREATED_DATE	Created Date	yyyy-mm-dd HH24:MI:SS.FF	Y	Date/time record was created
CREATED_BY	Created By	x(100)	Y	User/system that created the record
LAST_UPDATED_DATE	Last Updated Date	yyyy-mm-dd HH24:MI:SS.FF	Y	If TRANSACTION_TYPE = A, must equal CREATED_DATE

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2. Examples

Minimal Valid Example (DXA - Admission)

Single MH diagnosis with a co-occurring SUD diagnosis at admission.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|MH_DIAGNOSIS_ID_1|MH_DIAGNOSIS_ID_2|MH_DIAGNOSIS_ID_3|SUD_DIAGNOSIS_ID|SMI_SED_STATUS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
DXA|A|ADM-000001|2024-01-15|F32.1|||F10.20|01|2024-01-15 10:00:00|system|2024-01-15 10:00:00

Minimal Valid Example (DXD - Discharge)

Corresponding discharge diagnosis showing improvement — MH diagnosis severity reduced and SUD in early remission.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|MH_DIAGNOSIS_ID_1|MH_DIAGNOSIS_ID_2|MH_DIAGNOSIS_ID_3|SUD_DIAGNOSIS_ID|SMI_SED_STATUS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
DXD|A|ADM-000001|2024-06-15|F32.0|||F10.10|01|2024-06-15 10:00:00|system|2024-06-15 10:00:00

Complete Example: Multiple MH Diagnoses with SUD

All three MH diagnosis slots populated (Major Depressive Disorder recurrent, Generalized Anxiety, Adjustment Disorder) plus opioid use disorder.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|MH_DIAGNOSIS_ID_1|MH_DIAGNOSIS_ID_2|MH_DIAGNOSIS_ID_3|SUD_DIAGNOSIS_ID|SMI_SED_STATUS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
DXA|A|ADM-000002|2024-02-10|F33.1|F41.1|F43.10|F11.20|01|2024-02-10 09:30:00|jdoe|2024-02-10 09:30:00

Edge Case: SUD-Only Client

Client receiving SUD services only, no mental health diagnosis. SMI_SED_STATUS = 08 (Not Collected) is valid for SUD-only clients.

RECORD_TYPE|TRANSACTION_TYPE|BHASO_ADMISSION_IDENTIFIER|EFFECTIVE_DATE|MH_DIAGNOSIS_ID_1|MH_DIAGNOSIS_ID_2|MH_DIAGNOSIS_ID_3|SUD_DIAGNOSIS_ID|SMI_SED_STATUS|CREATED_DATE|CREATED_BY|LAST_UPDATED_DATE
DXA|A|ADM-000003|2024-03-01||||F10.20|08|2024-03-01 14:00:00|system|2024-03-01 14:00:00

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3. Template

View DIAGNOSIS Template

DIAGNOSIS schema template with headers and sample row

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4. Parsing Rules

CSV Parsing Rules

Property	Value
Encoding	UTF-8
Delimiter	Pipe (|)
Quote Character	Double quote (")
Escape	Backslash (\)
Date Format	YYYY-MM-DD
Timestamp Format	YYYY-MM-DD HH24:MI:SS.FF (Mountain Time)
Null Representation	Empty field (||)

See File Format Requirements for full details on encoding, quoting, data types, and null handling.

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5. Update Semantics

Primary Key

RECORD_TYPE + BHASO_ADMISSION_IDENTIFIER

Transaction Types

Type	Code	Behavior
Add	A	Creates new diagnosis record
Update	U	Updates existing diagnosis (new effective date)
Replace	R	Overwrites most recent diagnosis record

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Related Schemas

Schema	Relationship	Key Field
ADMISSION	Parent	BHASO_ADMISSION_IDENTIFIER
CLIENT	Grandparent	BHASO_CLIENT_IDENTIFIER

DXD records are filled out when a discharge occurs, but they link directly to the Admission via BHASO_ADMISSION_IDENTIFIER — not to the Discharge record.