1 of 38

Mississippi Department of Mental Health (DMH)

Data Warehouse to CDR Crosswalk

Last Revision Date: 8/13/2020

2 of 38

Contents

Version Control .............................................................................................................................................................................................................. 4

1. Admission Type ...................................................................................................................................................................................................... 4

2. ASAM Level of Care ................................................................................................................................................................................................ 4

3. Citizenship .............................................................................................................................................................................................................. 5

4. Code Set Identifier ................................................................................................................................................................................................. 5

5. County .................................................................................................................................................................................................................... 5

6. Detailed Substance Type ....................................................................................................................................................................................... 8

7. Discharge Reason ................................................................................................................................................................................................. 11

8. DUI Offender ........................................................................................................................................................................................................ 11

9. Education Grade Level ......................................................................................................................................................................................... 11

10. Employment Status .............................................................................................................................................................................................. 12

11. Ethnicity ............................................................................................................................................................................................................... 13

12. Frequency Of Use ................................................................................................................................................................................................. 13

13. Functional Assessment Reason ............................................................................................................................................................................ 14

14. Functional Assessment Type................................................................................................................................................................................ 14

15. Health Insurance .................................................................................................................................................................................................. 15

16. Legal Status .......................................................................................................................................................................................................... 15

17. Living Arrangement.............................................................................................................................................................................................. 15

18. Marital Status....................................................................................................................................................................................................... 16

19. Mental Health Treatment Setting ........................................................................................................................................................................ 16

20. Payment Source ................................................................................................................................................................................................... 17

21. Primary Income Source ........................................................................................................................................................................................ 17

22. Program Area ....................................................................................................................................................................................................... 18

23. Provider Client Identifier Type ............................................................................................................................................................................. 18

24. Provider Client Physical Address Type ................................................................................................................................................................. 18

3 of 38

25. Race...................................................................................................................................................................................................................... 18

26. Recovery Group Attendance Frequency .............................................................................................................................................................. 19

27. Referral Source .................................................................................................................................................................................................... 19

28. Route of Administration ...................................................................................................................................................................................... 20

29. School Attendance Status .................................................................................................................................................................................... 21

30. Serious Mental Illness Or Emotional Disturbance ............................................................................................................................................... 21

31. Service .................................................................................................................................................................................................................. 21

32. Service Procedure ................................................................................................................................................................................................ 27

33. Service Procedure Source .................................................................................................................................................................................... 33

34. Sex ........................................................................................................................................................................................................................ 33

35. Sexual Orientation ............................................................................................................................................................................................... 33

36. Smoker Status ...................................................................................................................................................................................................... 33

37. State ..................................................................................................................................................................................................................... 34

38. Substance Type .................................................................................................................................................................................................... 36

39. Veteran Status ..................................................................................................................................................................................................... 37

Shared Vocabulary Codes ............................................................................................................................................................................................ 37

1. No Yes .................................................................................................................................................................................................................. 37

2. No Yes NA ............................................................................................................................................................................................................ 37

3. No Yes Unknown .................................................................................................................................................................................................. 38

4. No Yes Unknown NA ............................................................................................................................................................................................ 38

5. No Yes Refused .................................................................................................................................................................................................... 38

4 of 38

Version Control Date Version Author(s) Brief Description of Change 3/4/2020 1.0 Shelby Maloney Initial Draft

4/8/2020 1.1 Shelby Maloney Removed Other IDD Provider from 6700.3 under Referral Source Added Other IDD Provider to 6700.22 under Referral Source

4/14/2020 1.2 Shelby Maloney Added Citizenship

4/21/2020 1.3 Shelby Maloney Removed Adjudication Actions Added Version Control

4/22/2020 1.4 Shelby Maloney Added two new services

4/28/2020 1.5 James Brockman Updated 5600.6 and removed 5600.9 Added 12000.155, 13600.BHLD, 13600.SUB2MG, 13600.TRRCY

5/29/2020 1.6 Shelby Maloney Added new Referral Sources 6/16/2020 1.7 Shelby Maloney Updated Citizenship Codes 7/9/2020 1.8 Shelby Maloney Added six new ASAM LOC codes

8/13/2020 1.9 Kim Wood Added 5600.9, 5600.10, 5600.11, 12000.156, 12000.157, 13600.BHLD4 and 13600.CMPES. Updated the description for 1200.153 and 13600.BHLD

1. Admission Type DW Code DW Description CDR Field CDR Code CDR Description 1200.1 Initial admission 2 1 Add Admission Record 1200.2 Transfer admission 2 2 Add Transfer Record

2. ASAM Level of Care DW Code DW Description CDR Field CDR Code CDR Description 11700.1 1 - Outpatient Service NA

11700.2 2-WM - Ambulatory Withdrawal Management with Extended On-Site Monitoring NA

11700.3 2.1 - Intensive Outpatient NA 11700.4 2.5 - Partial Hospitalization NA

11700.5 3.1 - Clinically Managed Low-Intensity Residential NA

11700.6 3.7 - Medically Monitored Intensive Inpatient NA

5 of 38

DW Code DW Description CDR Field CDR Code CDR Description

11700.7 3.7-WM - Medically Monitored Inpatient Withdrawal Management NA

11700.8 4-WM - Medically Managed Intensive Inpatient Withdrawal Management NA

11700.9 3.5 - Clinically Managed High-Intensity Residential NA

11700.10 0.5 - Early Intervention NA 11700.11 1-WM - Ambulatory Withdrawal Management

without Extended On-Site Monitoring NA

11700.12 3.2-WM - Clinically Managed Residential Withdrawal Management

NA

11700.13 3.3 - Clinically Managed Population Specific High-Intensity Residential

NA

11700.14 4 - Medically Managed Intensive Inpatient NA 11700.15 Opioid Treatment Program NA

3. Citizenship DW Code DW Description CDR Field CDR Code CDR Description 14400.7 United States Citizenship NA 14400.8 Non United States Citizenship NA

4. Code Set Identifier DW Code DW Description CDR Field CDR Code CDR Description 9500.3 ICD-10 NA

5. County DW Code DW Description CDR Field CDR Code CDR Description 1700.1 Adams 23, 54, 100 01 Adams 1700.2 Alcorn 23, 54, 100 02 Alcorn 1700.3 Amite 23, 54, 100 03 Amite 1700.4 Attala 23, 54, 100 04 Attala

6 of 38

DW Code DW Description CDR Field CDR Code CDR Description 1700.5 Benton 23, 54, 100 05 Benton 1700.6 Bolivar 23, 54, 100 06 Bolivar 1700.7 Calhoun 23, 54, 100 07 Calhoun 1700.8 Carroll 23, 54, 100 08 Carroll 1700.9 Chickasaw 23, 54, 100 09 Chickasaw 1700.10 Choctaw 23, 54, 100 10 Choctaw 1700.11 Claiborne 23, 54, 100 11 Claiborne 1700.12 Clarke 23, 54, 100 12 Clarke 1700.13 Clay 23, 54, 100 13 Clay 1700.14 Coahoma 23, 54, 100 14 Coahoma 1700.15 Copiah 23, 54, 100 15 Copiah 1700.16 Covington 23, 54, 100 16 Covington 1700.17 DeSoto 23, 54, 100 17 DeSoto 1700.18 Forrest 23, 54, 100 18 Forrest 1700.19 Franklin 23, 54, 100 19 Franklin 1700.20 George 23, 54, 100 20 George 1700.21 Greene 23, 54, 100 21 Greene 1700.22 Grenada 23, 54, 100 22 Grenada 1700.23 Hancock 23, 54, 100 23 Hancock 1700.24 Harrison 23, 54, 100 24 Harrison 1700.25 Hinds 23, 54, 100 25 Hinds 1700.26 Holmes 23, 54, 100 26 Holmes 1700.27 Humphreys 23, 54, 100 27 Humphreys 1700.28 Issaquena 23, 54, 100 28 Issaquena 1700.29 Itawamba 23, 54, 100 29 Itawamba 1700.30 Jackson 23, 54, 100 30 Jackson 1700.31 Jasper 23, 54, 100 31 Jasper 1700.32 Jefferson 23, 54, 100 32 Jefferson 1700.33 Jefferson Davis 23, 54, 100 33 Jefferson Davis 1700.34 Jones 23, 54, 100 34 Jones 1700.35 Kemper 23, 54, 100 35 Kemper 1700.36 Lafayette 23, 54, 100 36 Lafayette 1700.37 Lamar 23, 54, 100 37 Lamar 1700.38 Lauderdale 23, 54, 100 38 Lauderdale

7 of 38

DW Code DW Description CDR Field CDR Code CDR Description 1700.39 Lawrence 23, 54, 100 39 Lawrence 1700.40 Leake 23, 54, 100 40 Leake 1700.41 Lee 23, 54, 100 41 Lee 1700.42 Leflore 23, 54, 100 42 Leflore 1700.43 Lincoln 23, 54, 100 43 Lincoln 1700.44 Lowndes 23, 54, 100 44 Lowndes 1700.45 Madison 23, 54, 100 45 Madison 1700.46 Marion 23, 54, 100 46 Marion 1700.47 Marshall 23, 54, 100 47 Marshall 1700.48 Monroe 23, 54, 100 48 Monroe 1700.49 Montgomery 23, 54, 100 49 Montgomery 1700.50 Neshoba 23, 54, 100 50 Neshoba 1700.51 Newton 23, 54, 100 51 Newton 1700.52 Noxubee 23, 54, 100 52 Noxubee 1700.53 Oktibbeha 23, 54, 100 53 Oktibbeha 1700.54 Panola 23, 54, 100 54 Panola 1700.55 Pearl River 23, 54, 100 55 Pearl River 1700.56 Perry 23, 54, 100 56 Perry 1700.57 Pike 23, 54, 100 57 Pike 1700.58 Pontotoc 23, 54, 100 58 Pontotoc 1700.59 Prentiss 23, 54, 100 59 Prentiss 1700.60 Quitman 23, 54, 100 60 Quitman 1700.61 Rankin 23, 54, 100 61 Rankin 1700.62 Scott 23, 54, 100 62 Scott 1700.63 Sharkey 23, 54, 100 63 Sharkey 1700.64 Simpson 23, 54, 100 64 Simpson 1700.65 Smith 23, 54, 100 65 Smith 1700.66 Stone 23, 54, 100 66 Stone 1700.67 Sunflower 23, 54, 100 67 Sunflower 1700.68 Tallahatchie 23, 54, 100 68 Tallahatchie 1700.69 Tate 23, 54, 100 69 Tate

8 of 38

DW Code DW Description CDR Field CDR Code CDR Description 1700.70 Tippah 23, 54, 100 70 Tippah 1700.71 Tishomingo 23, 54, 100 71 Tishomingo 1700.72 Tunica 23, 54, 100 72 Tunica 1700.73 Union 23, 54, 100 73 Union 1700.74 Walthall 23, 54, 100 74 Walthall 1700.75 Warren 23, 54, 100 75 Warren 1700.76 Washington 23, 54, 100 76 Washington 1700.77 Wayne 23, 54, 100 77 Wayne 1700.78 Webster 23, 54, 100 78 Webster 1700.79 Wilkinson 23, 54, 100 79 Wilkinson 1700.80 Winston 23, 54, 100 80 Winston 1700.81 Yalobusha 23, 54, 100 81 Yalobusha 1700.82 Yazoo 23, 54, 100 82 Yazoo 1700.101 Out of State 23, 54, 100 99

6. Detailed Substance Type DW Code DW Description Field CDR Code CDR Description 12800.1 Alcohol 82, 83, 84 0201 Alcohol 12800.2 Crack 82, 83, 84 0301 Crack 12800.3 Other cocaine 82, 83, 84 0302 Other Cocaine

12800.4 Marijuana/Hashish, THC, and any other cannabis sativa preparations 82, 83, 84 0401 Marijuana/Hashish, THC and any other cannabis

sativa preparations 12800.5 Heroin 82, 83, 84 0501 Heroin 12800.6 Non-prescription methadone 82, 83, 84 0601 Methadone 12800.7 Codeine 82, 83, 84 0701 Codeine 12800.8 Propoxyphene (Darvon) 82, 83, 84 0702 Propoxyphene (Darvon) 12800.9 Oxycodone (Oxycontin) 82, 83, 84 0703 Oxycodone (Oxycontin) 12800.10 Meperidine (Demerol) 82, 83, 84 0704 Meperidine (Demerol) 12800.11 Hydromorphone (Dilaudid) 82, 83, 84 0705 Hydromorphone (Dilaudid)

12800.12 Butorphanol (Stadol), morphine (MS Contin), opium, and other narcotic analgesics, opiates, or synthetics

82, 83, 84 0706 Butorphanol (Stadol), morphine (Mscontin), opium, and other narcotic analgesics, opiates or synthetics

9 of 38

DW Code DW Description Field CDR Code CDR Description 12800.13 Pentazocine (Talwin) 82, 83, 84 0707 Pentazocine (Talwin) 12800.14 Hydrocodone (Vicodin) 82, 83, 84 0708 Hydrocodone (Vicodin) 12800.15 Tramadol (Ultram) 82, 83, 84 0709 Tramadol (Ultram) 12800.16 Buprenorphine (Subutex, Suboxone) 82, 83, 84 0710 Buprenorphine (Subutex, Suboxone) 12800.17 PCP or PCP combination 82, 83, 84 0801 PCP 12800.18 LSD 82, 83, 84 0901 LSD

12800.19 DMT, mescaline, peyote, psilocybin, STP, and other hallucinogens 82, 83, 84 0902 DMT, mescaline, peyote, psilocybin, STD, and

other hallucinogens 12800.20 Methamphetamine/speed 82, 83, 84 1001 Methamphetamine/Speed 12800.21 Amphetamine 82, 83, 84 1101 Amphetamine

12800.22 MDMA, Ecstasy 82, 83, 84 1103 Methylenedioxymethamphetamine (MDMA, Ecstasy)

12800.23 Bath salts, phenmetrazine, and other amines and related drugs 82, 83, 84 1109 "Bath Salts", phenmetrazine, and other amines

and related drugs 12800.24 Other stimulants 82, 83, 84 1201 Other Stimulants 12800.25 Methylphenidate (Ritalin) 82, 83, 84 1202 Methylphenidate (Ritalin) 12800.26 Alprazolam (Xanax) 82, 83, 84 1301 Alprazolam (Xanax) 12800.27 Chlordiazepoxide (Librium) 82, 83, 84 1302 Chlordiazepoxide (Librium) 12800.28 Clorazepate (Tranxene) 82, 83, 84 1303 Clorazepate (Tranzene) 12800.29 Diazepam (Valium) 82, 83, 84 1304 Diazepam (Valium) 12800.30 Flurazepam (Dalmane) 82, 83, 84 1305 Flurazepam (Dalmane) 12800.31 Lorazepam (Ativan) 82, 83, 84 1306 Lorazepam (Ativan) 12800.32 Triazolam (Halcion) 82, 83, 84 1307 Triazolam (Halcion)

12800.33 Other Benzodiazepine 82, 83, 84 1308 Halazepam, oxazepam (Serax), prazepam, temazepam (Restoril), and other Benzodiazepines

12800.34 Flunitrazepam (Rohypnol) 82, 83, 84 1309 Flunitrazepam (Rohypnol) 12800.35 Clonazepam (Klonopin, Rivotril) 82, 83, 84 1310 Clonazepam (Klonopin, Rivotril)

12800.36 Halazepam, oxazepam (Serax), prazepam, temazepam (Restoril), and other benzodiazepines

82, 83, 84 1308 Halazepam, oxazepam (Serax), prazepam, temazepam (Restoril), and other Benzodiazepines

12800.37 Meprobamate (Miltown) 82, 83, 84 1401 Meprobamate (Miltown) 12800.38 Other non-benzodiazepine tranquilizers 82, 83, 84 1403 Other non-benzodiazepine tranquilizers 12800.39 Phenobarbital 82, 83, 84 1501 Phenobarbital 12800.40 Secobarbital/Amobarbital (Tuinal) 82, 83, 84 1502 Secobarbital/Amobarbital (Tuinal)

10 of 38

DW Code DW Description Field CDR Code CDR Description 12800.41 Secobarbital (Seconal) 82, 83, 84 1503 Secobarbital (Seconal)

12800.42 Amobarbital, pentobarbital (Nembutal), and other barbiturate sedatives 82, 83, 84 1509 Amobarbital, pentobarbital (Nembutal) and

other barbiturate sedatives 12800.43 Ethchlorvynol (Placidyl) 82, 83, 84 1601 Ethchlorvynol (Placidyl) 12800.44 Glutethimide (Doriden) 82, 83, 84 1602 Glutethimide (Doriden) 12800.45 Methaqualone (Quaalude) 82, 83, 84 1603 Methaqualone (Quaalude)

12800.46 Chloral hydrate and other non-barbiturate sedatives/hypnotics 82, 83, 84 1604 Chloral hydrate and other Non-Barbiturate

Sedatives/hypnotics 12800.47 Aerosols 82, 83, 84 1701 Aerosols 12800.48 Nitrites 82, 83, 84 1702 Nitrites

12800.49 Gasoline, glue, and other inappropriately inhaled products 82, 83, 84 1703 Gasoline, glue, and other inappropriately

inhaled products 12800.50 Solvents (paint thinner and other solvents) 82, 83, 84 1704 Solvents (paint thinner and other solvents)

12800.51 Anesthetics (chloroform, ether, nitrous oxide, and other anesthetics) 82, 83, 84 1705 Anesthetics (chloroform, ether, nitrous oxide,

and other anesthetics) 12800.53 Diphenhydramine 82, 83, 84 1801 Diphenhydramine

12800.54

Other antihistamines, aspirin, Dextromethorphan (DXM) and other cough syrups, ephedrine, sleep aids, and any other legally obtained, non-prescription medication

82, 83, 84 1809

Other anti-histamines, aspirin, Dextromethorphan (DXM) and other cough syrups, Ephedrine, sleep aids, and any other legally obtained, non-prescription medication

12800.55 Diphenylhydantoin/Phenytoin (Dilantin) 82, 83, 84 2001 Diphenylhydantoin/Phenytoin (Dilantin)

12800.56 Synthetic Cannabinoid (Spice), Carisoprodol (Soma) & Other Drugs 82, 83, 84 2002 "Spice", Carisoprodol (Soma) and other drugs

12800.57 GHB/GBL (gamma-hydroxybutyrate, gamma-butyrolactone) 82, 83, 84 2003 GHB/GBL (gamma-hydroxybutyrate, gamma-

butyrolactone) 12800.58 Ketamine (Special K) 82, 83, 84 2004 Ketamine (Special K) 12800.59 Other sedatives

12800.60 Not applicable 82, 83, 84 9999 Not applicable – Use when the value in "Substance Abuse Problem is 01 None

12800.61 Unknown 82, 83, 84 9998 Unknown

11 of 38

7. Discharge Reason DW Code DW Description CDR Field CDR Code CDR Description

5600.1 Program Decision to Discharge Client for Non-Compliance with Program Rules 51, 101 3 Therapist terminated treatment

5600.2 Died 51, 101 7 Client deceased 5600.3 Incarcerated

5600.4 Client Left Before Completing Treatment 51, 101 5 8

Client terminated treatment No contact with client within specified time frame/ client eloped

5600.5 Referred Outside Agency for Continued Services 51, 101 4 Client referred elsewhere

5600.6 Transfer to Program Within Agency for Continued Services 51, 101 4 Client referred elsewhere

5600.7 Completed Treatment. No Substance Use 51, 101 2 Treatment Completed 5600.8 Completed Treatment. Some Substance Use 51, 101 2 Treatment Completed 5600.9 Transfer to Non-CDS Program within Agency for

Continued Services 51, 101 4 Client referred elsewhere

5600.10 Evaluation Only 51, 101 1 Evaluation Only 5600.11 Client Moved from Region 51, 101 6 Client moved from region

8. DUI Offender DW Code DW Description CDR Field CDR Code CDR Description 13200.1 First time offend 76 1 First time DUI 13200.2 2 or more DUI, Assessed 76 2 2 or more DUI, Assessed 13200.3 2 or more DUI, Not assessed 76 3 2 or more DUI, Not assessed 2100.1 Not applicable 76 9 Not applicable

9. Education Grade Level DW Code DW Description CDR Field CDR Code CDR Description 2700.0 None, never attended school 21, 115 99 Never attended school 2700.1 First Grade 21, 115 01 First Grade 2700.2 Second Grade 21, 115 02 Second Grade 2700.3 Third Grade 21, 115 03 Third Grade

12 of 38

DW Code DW Description CDR Field CDR Code CDR Description 2700.4 Fourth Grade 21, 115 04 Fourth Grade 2700.5 Fifth Grade 21, 115 05 Fifth Grade 2700.6 Sixth Grade 21, 115 06 Sixth Grade 2700.7 Seventh Grade 21, 115 07 Seventh Grade 2700.8 Eighth Grade 21, 115 08 Eighth Grade 2700.9 Ninth Grade 21, 115 09 Ninth Grade 2700.10 Tenth Grade 21, 115 10 Tenth Grade 2700.11 Eleventh Grade 21, 115 11 Eleventh Grade

2700.12 Twelfth Grade, High School Graduate or GED 21, 115 12 13

Twelfth Grade GED

2700.13 One Year of College 21, 115 15 Some College, No Degree 2700.14 Two Years of College or Associates Degree 21, 115 16 Associates Degree 2700.15 Three Years of College 2700.16 Bachelor's Degree 21, 115 17 Bachelors Degree 2700.17 Some Post Graduate Study 2700.18 Master's Degree 21, 115 18 Master's Degree

2700.19 Graduate or Professional School - Doctoral Study, Med School, Law School, etc. 21, 115 19 Ph.D

2700.20 Technical trade school 21, 115 14 Technical School/Trade School 2700.21 Kindergarten 21, 115 51 Pre-School/Kindergarten 2700.22 Special Education Class 21, 115 52 Special Education 2100.4 Unknown 21, 115 98 Unknown

10. Employment Status DW Code DW Description CDR Field CDR Code CDR Description 2900.10 Full time 26, 116 01 Employed Full-Time 2900.20 Part time 26, 116 02 Employed Part-Time

2900.30 Unemployed 26, 116 05 06

Unemployed - seeking work Unemployed - not seeking

2900.50 Not in labor force - Homemaker 26, 116 07 Homemaker 2900.51 Not in labor force - Student 26, 116 08 Student or Person under 17

13 of 38

DW Code DW Description CDR Field CDR Code CDR Description 2900.52 Not in labor force - Retired 26, 116 09 Retired 2900.53 Not in labor force - Disabled 26, 116 10 Disabled 2900.54 Not in labor force - Resident of institution 26, 116 11 Correctional inmate 2900.55 Not in labor force - Other 26, 116 97 Other

2900.56 Not in labor force - Sheltered/Non-competitive employment

26, 116 97 Other

2900.57 Not in labor force - Not Applicable 2100.4 Unknown 26, 116 98 Unknown

11. Ethnicity DW Code DW Description CDR Field CDR Code CDR Description 6900.1 Puerto Rican 20 P Puerto Rican 6900.2 Mexican 20 M Mexican 6900.3 Cuban 20 C Cuban 6900.4 Other specific Hispanic or Latino 20 O Other Hispanic 6900.5 Not of Hispanic or Latino origin 20 N Not of Hispanic Origin 6900.6 Hispanic or Latino - Specific origin not specified 20 U Unknown 2100.4 Unknown 20 U Unknown

12. Frequency Of Use DW Code DW Description CDR Field CDR Code CDR Description 3500.1 No use in the past month 88, 89, 90

110, 111, 112 1 No use in past month

3500.2 1-3 days in the past month 88, 89, 90 110, 111, 112

2 1-3 times past month

3500.3 1-2 days in the past week 88, 89, 90 110, 111, 112

3 1-2 times/wk past month

14 of 38

DW Code DW Description CDR Field CDR Code CDR Description 3500.4 3-6 days in the past week 88, 89, 90

110, 111, 112 4 3-6 times/wk past month

3500.5 Daily 88, 89, 90 110, 111, 112

5 Daily past month

2100.1 Not applicable 88, 89, 90 110, 111, 112

9 Not applicable

2100.4 Unknown 88, 89, 90 110, 111, 112

8 Unknown

13. Functional Assessment Reason DW Code DW Description CDR Field CDR Code CDR Description 14200.1 Initial Assessment 48 01 Initial Assessment 14200.2 Ninety (90) day assessment 48 02 Ninety (90) day assessment 14200.3 Six (6) month assessment 48 03 Six (6) month assessment 14200.4 Twelve (12) month assessment 48 04 Twelve (12) month assessment

14200.5 End of Service/Discharge 48

05 06 07 08 09 10

End of Service/Discharge from Primary Residential Treatment End of Service/Discharge from Transitional Residential Services End of Service/Discharge from Intensive Outpatient Program End of Service/Discharge from Partial Hospitalization Program End of Service/Discharge from Recovery Support Service End of Service/Discharge from Outpatient Service

2100.3 Other 48 99 Incomplete/No Assessment

14. Functional Assessment Type DW Code DW Description CDR Field CDR Code CDR Description 14100.1 Daily Living Activities-20 45 1 DLA-20

15 of 38

DW Code DW Description CDR Field CDR Code CDR Description 14100.2 Daily Living Activities-20 : Alcohol-Drug 45 2 DLA-20:A/D

14100.3 Child and Adolescent Functional Assessment Scale 45 3 CAFAS

14100.4 Incomplete/No Assessment 45 9 Incomplete/No Assessment

15. Health Insurance DW Code DW Description CDR Field CDR Code CDR Description 2200.1 Private insurance 68, 69 01 Private Insurance 2200.2 Blue Cross/Blue Shield 68, 69 02 Blue Cross/Blue Shield 2200.20 Other (e.g. TRICARE) 68, 69 97 Other (eg CHAMPUS) 2200.21 None 68, 69 99 None 2200.3 Medicare 68, 69 03 Medicare 2200.4 Medicaid 68, 69 04 Medicaid 2200.6 Health Maintenance Organization (HMO) 68, 69 05 Health Maintenance Organization (HMO) 2100.4 Unknown 68, 69 98 Unknown

16. Legal Status DW Code DW Description CDR Field CDR Code CDR Description 4900.1 Voluntary-self 11 1 Voluntary (referral) 4900.2 Voluntary-others (by parents, guardians, etc) 11 1 Voluntary (referral)

4900.3 Involuntary-civil 11 2 3

Involuntary - civil - adult psychiatric Involuntary - civil - adult chemical dep.

4900.4 Involuntary-criminal 11 5 Involuntary - criminal 4900.5 Involuntary-juvenile justice 11 4 Involuntary - youth court 4900.6 Involuntary-civil-sexual 2100.1 Not applicable 2100.4 Unknown

17. Living Arrangement DW Code DW Description CDR Field CDR Code CDR Description 3000.01 Homeless 25, 114 03 Homeless/Shelter

16 of 38

DW Code DW Description CDR Field CDR Code CDR Description

3000.02 Dependent living 25, 114

04 05 06 08 09 10 11

Institution Community Program Correctional Facility Foster Care Residential Care Crisis Residence Children’s Residential Treatment

3000.09 Independent living 25, 114 01 02

Private residence Other Independent

2100.4 Unknown 25, 114 99 Unknown

18. Marital Status DW Code DW Description CDR Field CDR Code CDR Description 1500.1 Never married 22 S Single 1500.2 Now married 22 M Married 1500.3 Widowed 22 W Widowed 1500.4 Divorced 22 D Divorced 1500.5 Separated 22 P Separated 2100.4 Unknown 22 U Unknown

19. Mental Health Treatment Setting DW Code DW Description CDR Field CDR Code CDR Description 11600.1 Psychiatric NA 11600.2 Crisis Residential NA 11600.3 IDD Outpatient NA 11600.4 MH Outpatient NA 11600.5 IDD Residential NA 11600.6 Crisis Diversion/Community Transition NA 11600.7 CY Outpatient NA

17 of 38

DW Code DW Description CDR Field CDR Code CDR Description 11600.8 CY Residential NA

20. Payment Source DW Code DW Description CDR Field CDR Code CDR Description 1900.1 Self-pay 32 02 Personal Resources 2100.4 Unknown 1900.2 Blue Cross/Blue Shield 32 04 Blue Cross/Blue Shield 1900.3 Medicare 32 07 Medicare 1900.4 Medicaid 32 08 Medicaid

1900.5 Other government payments 32

03 09 11 12

Service Contract Veteran's Administration Other Public (Government) Sources CHIP (Childrens Health Ins Prg)

1900.6 Worker's compensation 32 10 Workman's Comp

1900.7 Other health insurance companies 32 05 06

CHAMPUS Other Commercial Health Insurance

1900.8 No charge (free, charity, special research, or teaching) 32 01 None

2100.3 Other 32 97 Other Payment Source

21. Primary Income Source DW Code DW Description CDR Field CDR Code CDR Description 1800.1 Wages/Salary 27 1 Wages/Salary 1800.2 Public assistance 27 2 Public Assistance 1800.3 Retirement/Pension 27 3 Retirement/Pension 1800.4 Disability 27 4 Disability 2100.3 Other 27 7 Other 1800.6 None 27 9 None 2100.4 Unknown 27 8 Unknown

18 of 38

22. Program Area DW Code DW Description CDR Field CDR Code CDR Description 11400.1 Mental health (ORG_CODE) D

I Mental Health Core Client data Intellectual and Developmental Disabilities data

11400.2 Substance use disorder (ORG_CODE) A Alcohol and Drug data

23. Provider Client Identifier Type DW Code DW Description CDR Field CDR Code CDR Description 8400.1 Social security number 15 Social Security number

24. Provider Client Physical Address Type DW Code DW Description CDR Field CDR Code CDR Description 8600.1 Work address NA 8600.2 Home address NA 8600.3 Mailing address NA 8600.4 Previous NA

25. Race DW Code DW Description CDR Field CDR Code CDR Description 6800.1 White 19 W White/Caucasian 6800.2 Black or African-American 19 B Black/African American 6800.3 American Indian 19 I Native American Indian 2100.3 Other 19 O Other 6800.5 Alaska Native 19 K Alaskan Native (Aluet, Eskimo, Indian) 6800.7 Asian 19 A Asian 6800.8 Native Hawaiian or other Pacific Islander 19 P Native Hawaiian or other Pacific Islander 6800.9 Multi-Racial 19 M Reporting multiple race categories 2100.4 Unknown 19 U Unknown or not available

19 of 38

26. Recovery Group Attendance Frequency DW Code DW Description CDR Field CDR Code CDR Description 13100.1 No attendance NA

13100.2 Less than once a week - 1 to 3 times in the past 30 days NA

13100.3 About once a week - 4 to 7 times in the past 30 days NA

13100.4 2 to 3 times per week - 8 to 15 times in the past 30 days NA

13100.5 At least 4 times a week - 16 to 30 times in the past 30 days NA

13100.6 Some attendance - number of times and frequency is unknown NA

2100.4 Unknown NA

27. Referral Source DW Code DW Description CDR Field CDR Code CDR Description 6700.01 Individual (includes self-referral) 9 09 Self 6700.02 Alcohol/Drug Abuse Care Provider 9 07 Other SA Care Provider 6700.03 Other Health Care Provider 9 05 Other MH care provider 6700.04 School (Educational) 9 11 School/Education Agency 6700.05 Employer/EAP 9 12 Employer/EAP 6700.06 Other Community Referral 9 97 Other 6700.07 Court/Criminal Justice - State/Federal Court 77 01 State/Federal Court

6700.08 Court/Criminal Justice - Other Court 77 02 Formal adjudication process (other than state/federal)

6700.09 Court/Criminal Justice - Probation/Parole 77 03 Probation/Parole

6700.10 Court/Criminal Justice - Other Recognized Legal Entity 77 04 Other Legal Entity

6700.11 Court/Criminal Justice - Diversionary Program 77 05 Diversionary Program 6700.12 Court/Criminal Justice - Prison 77 06 Prison

20 of 38

DW Code DW Description CDR Field CDR Code CDR Description 6700.13 Court/Criminal Justice - DUI/DWI 77 07 DUI/DWI 6700.14 Court/Criminal Justice - Other 77 97 Other 6700.15 Court/Criminal Justice - Not Applicable 77 99 Not Applicable 6700.16 Court/Criminal Justice - Unknown 77 98 Unknown 6700.17 Court/Criminal Justice - Not Collected 6700.18 Court/County Justice 6700.19 Crisis/Respite Program 6700.20 Nursing Home 9 18 Nursing Home (non-DMH) 6700.21 Personal Care Home 6700.22 Other IDD Facility 9 06 Other IDD care provider 6700.23 Home 6700.24 Veterans Administration (VA) 6700.25 DMH Psychiatric Hospital 9 01 DMH psychiatric hospital 6700.26 Other MS CMHC 9 02 Other MS CMHC 6700.27 DMH IDD Facility 9 03 DMH IDD Facility 6700.28 Private Psychiatric Hospital 9 04 Private Psychiatric Hospital 6700.29 General Hospital/Other Health Care Provider 9 08 General Hospital/Other Health Care Provider 6700.30 Family/Friend 9 10 Family/Friend 6700.31 Police/Sheriff 9 13 Police/Sheriff 6700.32 Court/Correctional Facility 9 14 Court/Correctional Facility 6700.33 Vocational Rehabilitation/job placement 9 17 Vocational Rehabilitation/job placement 6700.34 Group Home (non-DMH) 9 20 Group Home (non-DMH) 2100.4 Unknown 9 98 Unknown

28. Route of Administration DW Code DW Description CDR Field CDR Code CDR Description 3400.1 Oral 85, 86, 87 1 Oral 3400.2 Smoking 85, 86, 87 2 Smoking 3400.3 Inhalation 85, 86, 87 3 Inhalation

3400.4 Injection (intravenous, intramuscular, intradermal, or subcutaneous) 85, 86, 87 4 Injection (intravenous, intramuscular,

intradermal, or subcutaneous) 2100.3 Other 85, 86, 87 7 Other

21 of 38

DW Code DW Description CDR Field CDR Code CDR Description 2100.4 Unknown 85, 86, 87 8 Unknown

29. School Attendance Status DW Code DW Description CDR Field CDR Code CDR Description 2100.1 Not applicable NA

14000.1 Attending School Regularly: 5 Days or Less Absent

NA

14000.2 Not Attending School Regularly: 6 Days or More Absent

NA

14000.3 Home Schooled NA 14000.4 Not Available NA

30. Serious Mental Illness Or Emotional Disturbance DW Code DW Description CDR Field CDR Code CDR Description

3600.1 SMI 40 Y N U

3600.2 SED 41 Y N U

3600.3 At risk for SED 3600.4 Not SMI/SED 2100.4 Unknown

31. Service DW Code DW Description CDR Field CDR Code CDR Description 12000.1 Psychiatric Services - Acute Treatment 3, 59 101 Psychiatric Services - Acute Treatment 12000.2 Psychiatric Services - Intermediate 3, 59 102 Psychiatric Services - Intermediate 12000.3 Psychiatric Services - Continuing Treatment 3, 59 103 Psychiatric Services - Continuing Treatment

22 of 38

DW Code DW Description CDR Field CDR Code CDR Description

12000.4 Psychiatric Services - Continued Medical Treatment 3, 59 104 Psychiatric Services - Continued Medical

Treatment 12000.5 Psychiatric Services - C/Y - Acute Treatment 3, 59 105 Psychiatric Services - C/Y - Acute Treatment 12000.6 Psychiatric Residential Treatment Facility 3, 59 106 Psychiatric Residential Treatment Facility 12000.7 Crisis Residential 3, 59 110 Crisis Residential 12000.8 Chemical Dependency Units 3, 59 111 Chemical Dependency Units 12000.9 Forensics 3, 59 121 Forensics 12000.10 Nursing Facility 3, 59 122 Nursing Facility 12000.11 Medical Surgical Hospital 3, 59 123 Medical Surgical Hospital 12000.12 Intermediate Care Facility - (ICF/IDD) - Large 3, 59 151 Intermediate Care Facility - (ICF/IDD) - Large 12000.13 Intermediate Care Facility - (ICF/IDD) - Small 3, 59 152 Intermediate Care Facility - (ICF/IDD) - Small 12000.14 ICF/IDD Respite 3, 59 153 ICF/IDD Respite 12000.15 Designated Mental Health Holding facilities 3, 59 162 Designated Mental Health Holding facilities 12000.16 Supported Living 3, 59 205 Supported Living 12000.17 Primary Residential Daily Per Diem (Bundled) 3, 59 206 Primary Residential Daily Per Diem (Bundled) 12000.18 Therapeutic Foster Care 3, 59 208 Therapeutic Foster Care 12000.19 Therapeutic Group Home - C/Y 3, 59 211 Therapeutic Group Home - C/Y 12000.20 Supervised Living 3, 59 215 Supervised Living 12000.21 Supported Employment - Individual 3, 59 304 Supported Employment - Individual 12000.22 Supported Employment - Group 3, 59 305 Supported Employment - Group 12000.23 Therapeutic Day Treatment - Substance Abuse 3, 59 309 Therapeutic Day Treatment - Substance Abuse 12000.24 Adult Day Center Services - Alzheimer's 3, 59 311 Adult Day Center Services - Alzheimer's 12000.25 Acute Partial Hospitalization 3, 59 313 Acute Partial Hospitalization 12000.26 Psychosocial Rehabilitation 3, 59 314 Psychosocial Rehabilitation 12000.27 Work Activity 3, 59 315 Work Activity 12000.28 Day Treatment (Child) 3, 59 318 Day Treatment (Child)

12000.29 Senior Psychosocial Rehabilitation Services - Community 3, 59 319 Senior Psychosocial Rehabilitation Services -

Community

12000.30 Senior Psychosocial Rehabilitation Services - Nursing 3, 59 320 Senior Psychosocial Rehabilitation Services -

Nursing 12000.31 Drop-In Center 3, 59 321 Drop-In Center 12000.32 Prevocational Services 3, 59 323 Prevocational Services 12000.33 Family Therapy (W/O Patient) 3, 59 402 Family Therapy (W/O Patient) 12000.34 Evaluation Only 3, 59 404 Evaluation Only 12000.35 Medication Evaluation and Monitoring 3, 59 406 Medication Evaluation and Monitoring

23 of 38

DW Code DW Description CDR Field CDR Code CDR Description 12000.36 Intake/Biopsycho-Social Assessment 3, 59 416 Intake/Biopsycho-Social Assessment

12000.37 Treatment Plan Development & Review (By Non-Physician) 3, 59 417 Treatment Plan Development & Review (By

Non-Physician) 12000.38 Multi-family Group Therapy 3, 59 418 Multi-family Group Therapy 12000.39 Peer Support, Per 15 Minutes 3, 59 419 Peer Support, Per 15 Minutes 12000.40 Intensive Outpatient - Substance Abuse 3, 59 420 Intensive Outpatient - Substance Abuse 12000.41 Assertive Community Treatment 3, 59 421 Assertive Community Treatment

12000.42 Integrated Treatment for Co-Occurring disorder (MH/SA) 3, 59 424 Integrated Treatment for Co-Occurring disorder

(MH/SA) 12000.43 Group Therapy 3, 59 427 Group Therapy 12000.44 Early Intervention SED 3, 59 429 Early Intervention SED 12000.45 Family Support and Education 3, 59 430 Family Support and Education 12000.46 Medication Injection 3, 59 431 Medication Injection 12000.47 Pre-Evaluation Screening 3, 59 432 Pre-Evaluation Screening 12000.48 Intensive Outpatient Psychiatric Services - C/Y 3, 59 434 Intensive Outpatient Psychiatric Services - C/Y 12000.49 Intensive Case Management 3, 59 502 Intensive Case Management 12000.50 Recovery Support Services 3, 59 503 Recovery Support Services 12000.51 Community Support Services 3, 59 509 Community Support Services 12000.52 Targeted Case Management 3, 59 510 Targeted Case Management 12000.53 Mobile Crisis Services 3, 59 602 Mobile Crisis Services 12000.54 Telephone Emergency/Crisis Response Service 3, 59 603 Telephone Emergency/Crisis Response Service 12000.55 Walk-In Emergency/Crisis Response Service 3, 59 604 Walk-In Emergency/Crisis Response Service 12000.56 Intensive Crisis Intervention Service 3, 59 605 Intensive Crisis Intervention Service 12000.57 Community Crisis Transition 3, 59 610 Community Crisis Transition 12000.58 Alcohol and Drug Prevention 3, 59 704 Alcohol and Drug Prevention 12000.59 Prevention (Children/Youth) 3, 59 705 Prevention (Children/Youth) 12000.60 DUI 3, 59 706 DUI 12000.61 Staffing - No Treatment Plan Review 3, 59 801 Staffing - No Treatment Plan Review 12000.62 No Shows/Cancellations 3, 59 802 No Shows/Cancellations 12000.63 PATH Grant Service 3, 59 803 PATH Grant Service 12000.64 Making a plan (MAP) Team Review meeting 3, 59 804 Making a plan (MAP) Team Review meeting 12000.65 Respite 3, 59 807 Respite 12000.66 Wraparound Facilitation 3, 59 808 Wraparound Facilitation

12000.67 Adult Making A Plan (AMAP) Team Review meeting 3, 59 810 Adult Making A Plan (AMAP) Team Review

meeting

24 of 38

DW Code DW Description CDR Field CDR Code CDR Description 12000.68 Support Coordination - IDD 3, 59 901 Support Coordination - IDD 12000.69 In-Home Nursing Respite Services - IDD 3, 59 903 In-Home Nursing Respite Services - IDD 12000.70 Community Respite - IDD 3, 59 905 Community Respite - IDD 12000.71 Supervised Living - IDD 3, 59 907 Supervised Living - IDD 12000.72 Supported Living - IDD 3, 59 908 Supported Living - IDD 12000.73 Day Services - Adult - IDD 3, 59 909 Day Services - Adult - IDD 12000.74 Prevocational Services - IDD 3, 59 910 Prevocational Services - IDD 12000.75 Behavior Support/Intervention - IDD 3, 59 912 Behavior Support/Intervention - IDD 12000.76 Home & Community Supports - IDD 3, 59 917 Home & Community Supports - IDD 12000.77 Supported Employment - Individual - IDD 3, 59 918 Supported Employment - Individual - IDD 12000.78 Supported Employment - Group - IDD 3, 59 919 Supported Employment - Group - IDD 12000.79 Host Homes - IDD 3, 59 920 Host Homes - IDD 12000.80 Crisis Intervention - IDD 3, 59 921 Crisis Intervention - IDD 12000.81 Job Discovery - IDD 3, 59 922 Job Discovery - IDD 12000.82 Transition Assistance - IDD 3, 59 923 Transition Assistance - IDD 12000.83 Crisis Support Services - IDD 3, 59 924 Crisis Support Services - IDD 12000.84 Shared Supported Living Services - IDD 3, 59 925 Shared Supported Living Services - IDD 12000.85 In-Home Respite Services - IDD 3, 59 926 In-Home Respite Services - IDD

12000.86 Primary Residential Daily Per Diem (Parenting one child) (Bundled) 3, 59 206 Primary Residential Treatment

12000.87 Primary Residential Daily Per Diem (Parenting two children) (Bundled) 3, 59 206 Primary Residential Treatment

12000.88 Primary Residential Daily Per Diem (Parenting three children) (Bundled) 3, 59 206 Primary Residential Treatment

12000.89 Family Therapy (W/Patient) 3, 59 402 Family Therapy 12000.90 Psychotherapy - 30 minutes 3, 59 426 Individual Therapy 12000.91 Psychotherapy - 45 minutes 3, 59 426 Individual Therapy 12000.92 Psychotherapy - 60 minutes 3, 59 426 Individual Therapy 12000.93 Medicaid Eligible Residential per diem 3, 59 206 Primary Residential Treatment 12000.94 Vocational Rehab Daily Per Diem 3, 59 206 Primary Residential Treatment 12000.95 Transitional Residential Daily Per Diem 3, 59 207 Transitional Residential Treatment

12000.96 Transitional Residential Daily Per Diem (Parenting one child) 3, 59 207 Transitional Residential Treatment

12000.97 Transitional Residential Daily Per Diem (Parenting two children) 3, 59 207 Transitional Residential Treatment

25 of 38

DW Code DW Description CDR Field CDR Code CDR Description

12000.98 Transitional Residential Daily Per Diem (Parenting three children) 3, 59 207 Transitional Residential Treatment

12000.99 Vocational Rehab One Child Daily Per Diem 3, 59 206 Primary Residential Treatment 12000.100 Vocational Rehab Two Children Daily Per Diem 3, 59 206 Primary Residential Treatment 12000.101 Vocational Rehab Three Children Daily Per Diem 3, 59 206 Primary Residential Treatment 12000.102 Nursing Assessment 3, 59 428 Nursing Assessment 12000.103 Eval & Mgmt - Current Patients (99211) 3, 59 404 Evaluation Only 12000.104 Eval & Mgmt - Current Patients (99212) 3, 59 404 Evaluation Only 12000.105 Eval & Mgmt - Current Patients (99213) 3, 59 404 Evaluation Only 12000.106 Eval & Mgmt - Current Patients (99214) 3, 59 404 Evaluation Only 12000.107 Eval & Mgmt - Current Patients (99215) 3, 59 404 Evaluation Only 12000.108 Psychiatric Diag Eval w/o Medical Services 12000.109 Psychiatric Diag Eval w/Medical Services 12000.110 Medication Administration 3, 59 431 Medication Injection 12000.111 Vivitrol (naltrexone) injection

12000.112 Suboxone (buprenorphine-nalox) 8 mg (30 film strips)

12000.113 Probuphine (buprenorphine) 6-month implant (all 4 rods)

12000.114 Sublocade (buprenorphine) 100 mg injection

12000.115 Medically Managed Intensive Inpatient WM per diem (max 5 days)

12000.116 Telemedicine 3, 59 12000.117 Eval & Mgmt - New Patients (99201) 3, 59 404 Evaluation Only 12000.118 Eval & Mgmt - New Patients (99202) 3, 59 404 Evaluation Only 12000.119 Eval & Mgmt - New Patients (99203) 3, 59 404 Evaluation Only 12000.120 Eval & Mgmt - New Patients (99204) 3, 59 404 Evaluation Only 12000.121 Eval & Mgmt - New Patients (99205) 3, 59 404 Evaluation Only 12000.122 Withdrawal Management - 1 12000.123 Withdrawal Management - 2 12000.124 Withdrawal Management - 3.2 12000.125 Withdrawal Management - 3.7 12000.126 Withdrawal Management - 4 12000.127 Psychological Evaluation (first hour) 12000.128 Psychological Evaluation (each additional hour)

26 of 38

DW Code DW Description CDR Field CDR Code CDR Description 12000.129 Generic Oral Naltrexone 50 mg (30 tablets)

12000.130 Generic Buprenorphine (Subutex) 8 mg (30 tablets)

12000.131 Zubsolv (buprenorphine-naloxone) 5.7 mg (30 tablets)

12000.132 Generic Buprenorphine-naloxone 8 mg (30 film strips)

12000.133 Methadone 5 mg (30 ml) 12000.134 Methadone 5 mg (60 ml) 12000.135 Methadone 5 mg (120 ml)

12000.136 Medical Withdrawal Room and Board per diem (max 5 days)

12000.137 Medicaid Eligible Residential Daily per diem (1 child) 3, 59 206 Primary Residential Treatment

12000.138 Medicaid Eligible Residential Daily per diem (2 children) 3, 59 206 Primary Residential Treatment

12000.139 Medicaid Eligible Residential Daily per diem (3 children) 3, 59 206 Primary Residential Treatment

12000.140 Brief Behavioral Health Assessment (Screening) (SBIRT) 3, 59 416 Intake/Biopsycho-social Assessment

12000.141 Psychological Evaluation (first 30 minutes)

12000.142 Psychological Evaluation (each additional 30 minutes)

12000.143 Sublocade (buprenorphine) 300 mg injection

12000.144 Generic Buprenorphine-naloxone 8 mg (30 tablets)

12000.145 Insertion of single non-biodegradable implant 12000.146 Ancillary 12000.147 Urine Drug Screens Onsite 3, 59 809 Urine Drug Screens 12000.148 Prolonged Service 30 minutes 12000.149 Prolonged Service 60 minutes 12000.150 Targeted Case Management - IDD 3, 59 510 Targeted Case Management

12000.151 Crisis Diversion/Community Transition Residential

12000.152 ICORT

27 of 38

DW Code DW Description CDR Field CDR Code CDR Description 12000.153 Bed Hold - Labor & Delivery 12000.154 Suboxone (buprenorphine-naloxone) 2 mg (30

film strips)*

12000.155 Transitional Residential/CY 12000.156 Withdrawal Management 4 Bed Hold 12000.157 Community Maintenance – Pre Eval Screening

32. Service Procedure DW Code DW Description CDR Field CDR Code CDR Description 13600.H0039 Assertive Community Treatment, Face-To-

Face, Per 15 Minutes NA

13600.H2012 Behavioral Health Day Treatment, Per Hour NA 13600.H0036 Community Psychiatric Supportive

Treatment, Face-To-Face, Per 15 Minutes NA

13600.H0031 Intake/Biopsycho-Social Assessment NA 13600.T1502 Medication Administration NA 13600.H2030 Mental Health Clubhouse Services, Per 15

Minutes NA

13600.T1002 Nursing Assessment NA 13600.T2015 Prevocational Services - IDD NA 13600.J0570 Probuphine (buprenorphine) 6-month

implant (all 4 rods) -J0570 NA

13600.H0038 Self-Help/Peer Services, Per 15 Minutes NA 13600.Q9991 Sublocade 100 mg NA 13600.Q9992 Sublocade 300 mg NA 13600.T1017 Targeted Case Management NA 13600.T2023 Targeted Case Management - IDD NA 13600.H0003 Urine Drug Screens Onsite NA 13600.J2315 Vivitrol (naltrexone) injection J2315 NA 13600.96127 Brief Behavioral Health Assessment

(Screening) (SBIRT) NA

13600.99201 Eval & Mgmt NA 13600.99202 Eval & Mgmt NA

28 of 38

13600.99203 Eval & Mgmt NA 13600.99204 Eval & Mgmt NA 13600.99205 Eval & Mgmt NA 13600.99211 Eval & Mgmt NA 13600.99212 Eval & Mgmt NA 13600.99213 Eval & Mgmt NA 13600.99214 Eval & Mgmt NA 13600.99215 Eval & Mgmt NA 13600.90847 Family Therapy (W/ Patient) NA 13600.90846 Family Therapy (W/O Patient) NA 13600.90853 Group Therapy NA 13600.11981 Insertion of single non-biodegradable

implant NA

13600.96372 Med Admin (96372) NA 13600.90849 Multi-family Group Therapy NA 13600.99304 Nursing Facility NA 13600.99355 Prolonged Service 30 minutes NA 13600.99354 Prolonged Service 60 minutes NA 13600.90791 Psych Diag Eval (90791) NA 13600.90792 Psych Diag Eval (90792) NA 13600.96137 Psychological Evaluation (each additional 30

minutes) NA

13600.96131 Psychological Evaluation (each additional hour)

NA

13600.96136 Psychological Evaluation (first 30 minutes) NA 13600.96130 Psychological Evaluation (first hour) NA 13600.90832 Psychotherapy - 30 minutes NA 13600.90834 Psychotherapy - 45 minutes NA 13600.90837 Psychotherapy - 60 minutes NA 13600.2011 Telephone Emergency/Crisis Response

Service NA

13600.311 Adult Day Center Services - Alzheimer's NA 13600.810 Adult Making A Plan (AMAP) Team Review

meeting NA

13600.704 Alcohol and Drug Prevention NA 13600.ANCIL Ancillary NA

29 of 38

13600.912 Behavior Support/Intervention - IDD NA 13600.111 Chemical Dependency Units NA 13600.610 Community Crisis Transition NA 13600.905 Community Respite - IDD NA 13600.921 Crisis Intervention - IDD NA 13600.110 Crisis Residential NA 13600.924 Crisis Support Services - IDD NA 13600.909 Day Services - Adult - IDD NA 13600.162 Designated Mental Health Holding Facilities NA 13600.321 Drop-In Center NA 13600.706 DUI NA 13600.429 Early Intervention SED NA 13600.404 Evaluation Only NA 13600.430 Family Support and Education NA 13600.121 Forensics NA 13600.GENBUPR Generic Buprenorphine (Subutex) 8 mg (30

tablets) NA

13600.GENBUPRNAL Generic Buprenorphine-naloxone 8 mg (30 film strips)

NA

13600.GENBTAB Generic Buprenorphine-naloxone 8 mg (30 tablets)

NA

13600.GENORNAL Generic Oral Naltrexone 50 mg (30 tablets) NA 13600.917 Home & Community Supports - IDD NA 13600.920 Host Homes - IDD NA 13600.153 ICF/IDD Respite NA 13600.903 In-Home Nursing Respite Services - IDD NA 13600.926 In-Home Respite Services - IDD NA 13600.424 Integrated Treatment for Co-Occurring

disorder (MH/SA) NA

13600.502 Intensive Case Management NA 13600.605 Intensive Crisis Intervention Service NA 13600.420 Intensive Outpatient - Substance Abuse NA 13600.434 Intensive Outpatient Psychiatric Services -

C/Y NA

13600.151 Intermediate Care Facility - (ICF/IDD) - Large NA 13600.152 Intermediate Care Facility - (ICF/IDD) - Small NA

30 of 38

13600.922 Job Discovery - IDD NA 13600.804 Making a plan (MAP) Team Review meeting NA 13600.MEDRES Medicaid Eligible Residential Daily Per Diem NA 13600.MEDRES1CH Medicaid Eligible Residential Daily per diem

(1 child) NA

13600.MEDRES2CH Medicaid Eligible Residential Daily per diem (2 children)

NA

13600.MEDRES3CH Medicaid Eligible Residential Daily per diem (3 children)

NA

13600.123 Medical Surgical Hospital NA 13600.MEDWMN Medical Withdrawal Management per diem

(max 5 days) NA

13600.MWMRB Medical Withdrawal Room and Board per diem (max 5 days)

NA

13600.406 Medication Evaluation and Monitoring NA 13600.METH120 Methadone 5 mg (120 ml) NA 13600.METH30 Methadone 5 mg (30 ml) NA 13600.METH60 Methadone 5 mg (60 ml) NA 13600.602 Mobile Crisis Services NA 13600.802 No Shows/Cancellations NA 13600.803 PATH Grant Service NA 13600.432 Pre-Evaluation Screening NA 13600.705 Prevention (Children/Youth) NA 13600.323 Prevocational Services NA 13600.PRBND Primary Residential Daily Per Diem

(Bundled) NA

13600.PRBDN1 Primary Residential Daily Per Diem (Parenting one child) (Bundled)

NA

13600.PRBDN3 Primary Residential Daily Per Diem (Parenting three children) (Bundled)

NA

13600.PRBDN2 Primary Residential Daily Per Diem (Parenting two children) (Bundled)

NA

13600.106 Psychiatric Residential Treatment Facility NA 13600.101 Psychiatric Services - Acute Treatment NA 13600.105 Psychiatric Services - C/Y - Acute Treatment

31 of 38

13600.104 Psychiatric Services - Continued Medical Treatment

13600.103 Psychiatric Services - Continuing Treatment 13600.102 Psychiatric Services - Intermediate NA 13600.503 Recovery Support Services NA 13600.807 Respite NA 13600.319 Senior Psychosocial Rehabilitation Services -

Community NA

13600.320 Senior Psychosocial Rehabilitation Services - Nursing Facility

NA

13600.925 Shared Supported Living Services - IDD NA 13600.801 Staffing - No Treatment Plan Review NA 13600.SUBFILM Suboxone (buprenorphine-naloxone) 8 mg

(30 film strips) NA

13600.CDCTR Crisis Diversion/Community Transition Residential

NA

13600.215 Supervised Living NA 13600.907 Supervised Living - IDD NA 13600.901 Support Coordination - IDD NA 13600.305 Supported Employment - Group NA 13600.919 Supported Employment - Group - IDD NA 13600.304 Supported Employment - Individual NA 13600.918 Supported Employment - Individual - IDD NA 13600.205 Supported Living NA 13600.908 Supported Living - IDD NA 13600.TELEMED Telemedicine NA 13600.309 Therapeutic Day Treatment - Substance

Abuse NA

13600.208 Therapeutic Foster Care NA 13600.211 Therapeutic Group Home - C/Y NA 13600.923 Transition Assistance - IDD NA 13600.TRRES1 Transitional Residential Daily Per Diem

(Parenting one child) NA

13600.TRRES3 Transitional Residential Daily Per Diem (Parenting three children)

NA

32 of 38

13600.TRRES2 Transitional Residential Daily Per Diem (Parenting two children)

NA

13600.TRRES Transitional Residential Daily Per Diem NA 13600.VOCREH Vocational Rehab Daily Per Diem NA 13600.VOCREH1 Vocational Rehab One Child Daily Per Diem NA 13600.VOCREH3 Vocational Rehab Three Children Daily Per

Diem NA

13600.VOCREH2 Vocational Rehab Two Children Daily Per Diem

NA

13600.604 Walk-In Emergency/Crisis Response Service NA 13600.WM-1 Withdrawal Management - 1 NA 13600.WM-2 Withdrawal Management - 2 NA 13600.WM-3.2 Withdrawal Management - 3.2 NA 13600.WM-3.7 Withdrawal Management - 3.7 NA 13600.WM-4 Withdrawal Management - 4 NA 13600.315 Work Activity NA 13600.ZUBSOLV Zubsolv (buprenorphine-naloxone) 5.7 mg

(30 tablets) NA

13600.H0032 Treatment Plan Development & Review (By Non-Physician)

NA

13600.H2021 Wraparound Facilitation NA 13600.ICORT Intensive Community Outreach and

Recovery Team NA

13600.BHLD Bed Hold - Labor & Delivery NA 13600.SUB2MG Suboxone (buprenorphine-naloxone) 2 mg

(30 film strips) NA

13600.TRRCY Transitional Residential/CY NA 13600.BHLD4 Withdrawal Management 4 Bed Hold NA 13600.CMPES Community Maintenance – Pre Eval

Screening NA

33 of 38

33. Service Procedure Source DW Code DW Description CDR Field CDR Code CDR Description 12200.6 HCPCS NA 12200.7 CPT4 NA 12200.8 State Code NA

34. Sex DW Code DW Description CDR Field CDR Code CDR Description 8300.1 Male 18 M Male 8300.2 Female 18 F Female 2100.4 Unknown 18 U Unknown

35. Sexual Orientation DW Code DW Description CDR Field CDR Code CDR Description 11300.1 Heterosexual NA 11300.2 Bisexual NA 11300.3 Homosexual NA

36. Smoker Status DW Code DW Description CDR Field CDR Code CDR Description 13900.1 Former smoker NA 13900.2 Smoker, current status unknown NA 13900.3 Current some day smoker NA 13900.4 Current every day smoker NA 13900.5 Unknown if ever smoked NA 13900.6 Never smoked NA

34 of 38

37. State DW Code DW Description CDR Field CDR Code CDR Description 1600.AK Alaska 66 AK Alaska 1600.AL Alabama 66 AL Alabama 1600.AP Armed Forces-Pacific 66 AZ Armed Forces-Pacific 1600.AR Arkansas 66 AR Arkansas 1600.AS American Samoa 1600.AZ Arizona 66 AZ Arizona 1600.CA California 66 CA California 1600.CO Colorado 66 CO Colorado 1600.CT Connecticut 66 CT Connecticut 1600.DC District of Columbia 66 DC District of Columbia 1600.DE Delaware 66 DE Delaware 1600.FL Florida 66 FL Florida 1600.FM Federated States of Micronesia 1600.GA Georgia 66 GA Georgia 1600.GU Guam 1600.HI Hawaii 66 HI Hawaii 1600.IA Iowa 66 IA Iowa 1600.ID Idaho 66 ID Idaho 1600.IL Illinois 66 IL Illinois 1600.IN Indiana 66 IN Indiana 1600.KS Kansas 66 KS Kansas 1600.KY Kentucky 66 KY Kentucky 1600.LA Louisiana 66 LA Louisiana 1600.MA Massachusetts 66 MA Massachusetts 1600.MD Maryland 66 MD Maryland 1600.ME Maine 66 ME Maine 1600.MH Marshall Islands 1600.MI Michigan 66 MI Michigan 1600.MN Minnesota 66 MN Minnesota 1600.MO Missouri 66 MO Missouri 1600.MP Northern Mariana Islands 1600.MS Mississippi 66 MS Mississippi 1600.MT Montana 66 MT Montana

35 of 38

DW Code DW Description CDR Field CDR Code CDR Description 1600.NC North Carolina 66 NC North Carolina 1600.ND North Dakota 66 ND North Dakota 1600.NE Nebraska 66 NE Nebraska 1600.NH New Hampshire 66 NH New Hampshire 1600.NJ New Jersey 66 NJ New Jersey 1600.NM New Mexico 66 NM New Mexico 1600.NV Nevada 66 NV Nevada 1600.NY New York 66 NY New York 1600.OH Ohio 66 OH Ohio 1600.OK Oklahoma 66 OK Oklahoma 1600.OR Oregon 66 OR Oregon 1600.PA Pennsylvania 66 PA Pennsylvania 1600.PR Puerto Rico 1600.PW Palau 1600.RI Rhode Island 66 RI Rhode Island 1600.SC South Carolina 66 SC South Carolina 1600.SD South Dakota 66 SD South Dakota 1600.TN Tennessee 66 TN Tennessee 1600.TX Texas 66 TX Texas 1600.UT Utah 66 UT Utah 1600.VA Virginia 66 VA Virginia 1600.VI Virgin Islands 1600.VT Vermont 66 VT Vermont 1600.WA Washington 66 WA Washington 1600.WI Wisconsin 66 WI Wisconsin 1600.WV West Virginia 66 WV West Virginia 1600.WY Wyoming 66 WY Wyoming

36 of 38

38. Substance Type DW Code DW Description CDR Field CDR Code CDR Description

12700.1 None 79, 80, 81 107, 108, 109 01 None

12700.2 Alcohol 79, 80, 81 107, 108, 109 02 Alcohol

12700.3 Cocaine/Crack 79, 80, 81 107, 108, 109 03 Cocaine/Crack

12700.4 Marijuana/Hashish 79, 80, 81 107, 108, 109 04 Marijuana/Hashish

12700.5 Heroin 79, 80, 81 107, 108, 109 05 Heroin

12700.6 Non-prescription methadone 79, 80, 81 107, 108, 109 06 Non-prescription Methadone

12700.7 Other opiates and synthetics 79, 80, 81 107, 108, 109 07 Other Opiates and Synthetics

12700.8 PCP-Phencyclidine 79, 80, 81 107, 108, 109 08 PCP-phencyclidine

12700.9 Hallucinogens 79, 80, 81 107, 108, 109 09 Hallucinogens

12700.10 Methamphetamine/speed 79, 80, 81 107, 108, 109 10 Methamphetamine/Speed

12700.11 Other amphetamines 79, 80, 81 107, 108, 109 11 Other Amphetamines

12700.12 Other stimulants 79, 80, 81 107, 108, 109 12 Other Stimulants

12700.13 Benzodiazepines 79, 80, 81 107, 108, 109 13 Benzodiazepine

12700.14 Other tranquilizers 79, 80, 81 107, 108, 109 14 Other Tranquilizers

12700.15 Barbiturates 79, 80, 81 107, 108, 109 15 Barbiturates

12700.16 Other sedatives or hypnotics 79, 80, 81 107, 108, 109 16 Other Sedatives or Hypnotics

12700.17 Inhalants 79, 80, 81 107, 108, 109 17 Inhalants

37 of 38

DW Code DW Description CDR Field CDR Code CDR Description

12700.18 Over-the-counter medications 79, 80, 81 107, 108, 109 18 Over-The-Counter Medications

12700.19 Other drugs 79, 80, 81 107, 108, 109 20 Other Drugs

2100.4 Unknown 79, 80, 81 107, 108, 109 98 Unknown

39. Veteran Status DW Code DW Description CDR Field CDR Code CDR Description 1400.1 Veteran 33 Y Yes 1400.2 Not a veteran 33 N No 2100.4 Unknown 33 U Unknown 2100.5 Not collected

Shared Vocabulary Codes The following codes are used in multiple fields in the Data Warehouse. In the Submission Guides, when the Vocabulary Validation note for a field indicates something like “Must be a valid Vocabulary value from the Mississippi Code System, for the No Yes Refused Value Set”, that means that the codes for that data set are not specific to that field, but are one of the common data sets below:

1. No Yes Code Description 7400.0 No 7400.1 Yes

2. No Yes NA Code Description 7400.0 No 7400.1 Yes 2100.1 Not applicable

38 of 38

3. No Yes Unknown Code Description 7400.0 No 7400.1 Yes 2100.4 Unknown

4. No Yes Unknown NA Code Description 7400.0 No 7400.1 Yes 2100.4 Unknown 2100.1 Not applicable

5. No Yes Refused Code Description 7400.0 No 7400.1 Yes 2100.6 Refused to answer