> ## Documentation Index
> Fetch the complete documentation index at: https://coloradobehavioralhealthadministration.mintlify.site/llms.txt
> Use this file to discover all available pages before exploring further.

# DXA & DXD - Diagnosis

> Clinical diagnoses at admission and discharge

> [!NOTE]
>
> **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.

> [!NOTE]
>
> **Transaction Types:** All record types support Add (`A`), Update (`U`), and Replace (`R`) transactions. See [Transaction Types](https://coloradobehavioralhealthadministration.mintlify.site/getting-started/transaction-types.md) for details.

***

## 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](https://coloradobehavioralhealthadministration.mintlify.site/getting-started/transaction-types.md) |
| `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](https://coloradobehavioralhealthadministration.mintlify.site/reference/appendix-a/clinical/smi-sed-status.md) | Code `08` (Not Collected) is valid only for SUD-only clients |

> [!NOTE]
>
> **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` |

***

## 2. Examples

### Minimal Valid Example (DXA - Admission)

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

```csv theme={null}
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.

```csv theme={null}
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.

```csv theme={null}
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.

```csv theme={null}
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
```

***

## 3. Template

> **[View DIAGNOSIS Template](https://coloradobehavioralhealthadministration.mintlify.site/reference/templates/downloads.md#diagnosis-template-dxa-dxd)**
>
> DIAGNOSIS schema template with headers and sample row

***

## 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](https://coloradobehavioralhealthadministration.mintlify.site/getting-started/file-format-requirements.md) for full details on encoding, quoting, data types, and null handling.

***

## 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 |

***

## Related Schemas

| Schema | Relationship | Key Field |
| - | - | - |
| [ADMISSION](https://coloradobehavioralhealthadministration.mintlify.site/schemas/admission.md) | Parent | `BHASO_ADMISSION_IDENTIFIER` |
| [CLIENT](https://coloradobehavioralhealthadministration.mintlify.site/schemas/client.md) | Grandparent | `BHASO_CLIENT_IDENTIFIER` |

> [!NOTE]
>
> 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.


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