CMSgov · alex-dzeda · Feb 13, 2026 · Feb 4, 2026 · Feb 4, 2026 · Feb 5, 2026
@@ -91,18 +91,6 @@
                         "code": "string"
                     }
                 ]
-            },
-            {
-                "id": "DiagnosisComponent.clm_prod_type_cd_map",
-                "path": "DiagnosisComponent.clm_prod_type_cd_map",
-                "label": "Augmented Diagnosis Prod Type Code Map",
-                "min": 0,
-                "max": "*",
-                "type": [
-                    {
-                        "code": "string"
-                    }
-                ]
             }
 
         ]

@@ -725,11 +725,11 @@
                 ]
             },
             {
-                "id": "LineItemComponent.diagnosisRelatedLine",
-                "path": "LineItemComponent.diagnosisRelatedLine",
+                "id": "LineItemComponent.diagnosisSequence",
+                "path": "LineItemComponent.diagnosisSequence",
                 "label": "Corresponding diagnosis sequence number. Computed based upon resource generation.",
                 "min": 0,
-                "max": "1",
+                "max": "*",
                 "type": [
                     {
                         "code": "string"
@@ -1227,7 +1227,7 @@
               "label": "Supporting Info Sequence Number",
               "definition": "Pre-calculated sequence number for supportingInfo reference.",
               "min": 0,
-              "max": "1",
+            "max": "*",
               "type": [
                 {
                   "code": "string"
@@ -1262,4 +1262,4 @@
             }
         ]
     }
-}
+}
@@ -233,46 +233,41 @@ class Diagnosis:
 diagnosis_codes = [
     Diagnosis(
         CLM_DGNS_CD=x.get("CLM_DGNS_CD"),
+        CLM_PROD_TYPE_CD=x.get("CLM_PROD_TYPE_CD"),
         CLM_POA_IND=x.get("CLM_POA_IND"),
         CLM_DGNS_PRCDR_ICD_IND=x.get("CLM_DGNS_PRCDR_ICD_IND"),
         ROW_NUM=x.get("CLM_VAL_SQNC_NUM"),
     )
     for x in cur_sample_data.get("diagnoses", [])
-    if x.get("CLM_PROD_TYPE_CD") == "D"
+    if x.get("CLM_PROD_TYPE_CD") in ["D", "P", "A", "R", "E"]
 ]
 
-# of note, 1 and E appear to always be the same, so we only care about the E code.
-clm_prod_type_cds = ["P", "A", "R", "E"]
-# this loop ensures that 'rogue' (eg principal not present in main list) diagnoses are not missed.
-for clm_prod_type_cd in clm_prod_type_cds:
-    code = [
-        x.get("CLM_DGNS_CD")
-        for x in cur_sample_data.get("diagnoses", [])
-        if x.get("CLM_PROD_TYPE_CD") == clm_prod_type_cd
-    ]
-    if code and code[0] not in [x.CLM_DGNS_CD for x in diagnosis_codes]:
-        diagnosis = Diagnosis(
-            CLM_DGNS_CD=code,
-            CLM_PROD_TYPE_CD=clm_prod_type_cd,
-            CLM_DGNS_PRCDR_ICD_IND=diagnosis_codes[0].CLM_DGNS_PRCDR_ICD_IND,
-            ROW_NUM=str(len(diagnosis_codes) + 1),
-        )
-        diagnosis_codes.append(diagnosis)
-
-for diagnosis_code in diagnosis_codes:
-    for clm_prod_type_cd in clm_prod_type_cds:
-        cur_code = [
-            x.get("CLM_DGNS_CD")
-            for x in cur_sample_data.get("diagnoses", [])
-            if x.get("CLM_PROD_TYPE_CD") == clm_prod_type_cd
-        ]
-        if cur_code and cur_code[0] == diagnosis_code.CLM_DGNS_CD:
-            diagnosis_code.clm_prod_type_cd_map.append(clm_prod_type_cd)
-    if len(diagnosis_code.clm_prod_type_cd_map) == 0:
-        diagnosis_code.clm_prod_type_cd_map.append("D")
+# Sort diagnoses keys
+type_priority = {"P": 1, "A": 2, "R": 3, "E": 4}
+
+# We need to preserve the list but sort it
+diagnosis_codes.sort(key=lambda d: type_priority.get(d.CLM_PROD_TYPE_CD, 99))
+
+# Assign sequential ROW_NUM
+for idx, diag in enumerate(diagnosis_codes, start=1):
+    diag.ROW_NUM = str(idx)
 
 cur_sample_data["diagnoses"] = [asdict(d) for d in diagnosis_codes]
 
+# add diagnosisSequence where necessary
+for item in cur_sample_data.get("lineItemComponents", []):
+    if "CLM_LINE_DGNS_CD" in item:
+        line_dgns_cd = item.get("CLM_LINE_DGNS_CD")
+        if match := next(
+            (
+                d
+                for d in diagnosis_codes
+                if line_dgns_cd == d.CLM_DGNS_CD and d.CLM_PROD_TYPE_CD == "D"
+            ),
+            None,
+        ):
+            item["diagnosisSequence"] = [int(match.ROW_NUM)]
+
 filename = "out/temporary-sample.json"
 
 with Path(filename).open("w") as f:

@@ -18,7 +18,7 @@ uses "http://hl7.org/fhir/StructureDefinition/ExplanationOfBenefit" alias BFDEOB
 
 imports "https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper" 
 imports "https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-SupportingInfo-Helper" 
-imports "https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Item-Institutional-Helper" 
+imports "https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Item-Helper" 
 
 group createEOBBase(source src: ExplanationOfBenefitBase, target tgt: BFDEOB){
 
@@ -524,8 +524,8 @@ group addInstitutionalAdjudicationElements(source src: ExplanationOfBenefitBase,
 group addDiagnoses(source src: DiagnosisComponent, target tgt: BackboneElement){
   src.ROW_NUM as rowNum -> tgt.sequence = rowNum "set sequence number";
   src -> tgt.type = create('CodeableConcept') as tgtCC then{
-    src.clm_prod_type_cd_map as typeCode where (typeCode = "A" or typeCode = "P") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#HL7_DIAGTYPE','coding') "Add coding";
-    src.clm_prod_type_cd_map as typeCode where (typeCode = "1" or typeCode = "D" or typeCode = "E" or typeCode = "R") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#C4BB_DIAGTYPE','coding') "set coding";
+    src.CLM_PROD_TYPE_CD as typeCode where (typeCode = "A" or typeCode = "P") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#HL7_DIAGTYPE','coding') "Add coding";
+    src.CLM_PROD_TYPE_CD as typeCode where (typeCode = "1" or typeCode = "D" or typeCode = "E" or typeCode = "R") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#C4BB_DIAGTYPE','coding') "set coding";
   } "Add types";
   src.CLM_POA_IND as poaInd where (poaInd != ' ' and poaInd != '~' ) -> tgt.onAdmission = create('CodeableConcept') as tgtPOA,
     tgtPOA.coding = create('Coding') as tgtCoding,
@@ -543,8 +543,8 @@ group addDiagnoses(source src: DiagnosisComponent, target tgt: BackboneElement){
 group addDiagnosesProfessional(source src: DiagnosisComponent, target tgt: BackboneElement){
   src.ROW_NUM as rowNum -> tgt.sequence = rowNum "set sequence number";
   src -> tgt.type = create('CodeableConcept') as tgtCC then{
-    src.clm_prod_type_cd_map as typeCode where (typeCode = "A" or typeCode = "P") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#HL7_DIAGTYPE','coding') "Add coding";
-    src.clm_prod_type_cd_map as typeCode where (typeCode = "1" or typeCode = "D" or typeCode = "E" or typeCode = "R") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#C4BB_DIAGTYPE_PROF','coding') "set coding";
+    src.CLM_PROD_TYPE_CD as typeCode where (typeCode = "A" or typeCode = "P") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#HL7_DIAGTYPE','coding') "Add coding";
+    src.CLM_PROD_TYPE_CD as typeCode where (typeCode = "1" or typeCode = "D" or typeCode = "E" or typeCode = "R") -> tgtCC.coding = translate(typeCode,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#C4BB_DIAGTYPE_PROF','coding') "set coding";
   } "Add types";
   src -> tgt.diagnosis = create('CodeableConcept') as tgtDiagnosis then {
     src -> tgtDiagnosis.coding = create('Coding') as tgtCoding then {

@@ -1,4 +1,4 @@
-map "https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Item-Institutional-Helper" = "BFD-ExplanationOfBenefit-Item-Institutional-Helper-Map"
+map "https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Item-Helper" = "BFD-ExplanationOfBenefit-Item-Helper-Map"
 imports "https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper" 
 
 group addItem(source src: LineItemComponent, target tgt: BackboneElement){
@@ -110,7 +110,7 @@ group addItem(source src: LineItemComponent, target tgt: BackboneElement){
     //In claims data, CLM_LINE_DGNS_CD refers to the diagnosis that supports the given claim line
     //diagnosisRelatedLine is a computed value that is input "for FML purposes" to correspond to the sequence number
     //present on the diagnosis in EoB.diagnosis that corresponds to the value in CLM_LINE_DGNS_CD.
-    src.diagnosisRelatedLine as claimLineDiagnosis -> tgt.diagnosisSequence = cast(claimLineDiagnosis,"positiveInt") "Add diagnosis sequence number";
+    src.diagnosisSequence as claimLineDiagnosis -> tgt.diagnosisSequence = cast(claimLineDiagnosis,"positiveInt") "Add diagnosis sequence number";
     //Care team sequence is generated by the provider script.
     src.careTeamSequence as careTeamSequence -> tgt.careTeamSequence = cast(careTeamSequence,"positiveInt") "Add reference to care team sequence.";
 }

@@ -114,7 +114,25 @@
         {"ROW_NUM":"33","CLM_FI_ACTN_CD":"1"}
     ],
     "lineItemComponents":[
-        {"PRVDR_RNDRNG_PRVDR_NPI_NUM":"1942945159","CLM_LINE_ADD_ON_PYMT_AMT":"11.11","CLM_LINE_NON_EHR_RDCTN_AMT":"11.12","CLM_REV_CTR_TDAPA_AMT":"11.13","CLM_LINE_NUM":"1","CLM_LINE_ALOWD_CHRG_AMT":"9194.22","CLM_LINE_HCPCS_CD":"99213","CLM_REV_APC_HIPPS_CD":"","CLM_LINE_NDC_CD":"","CLM_LINE_NDC_QTY":"","CLM_LINE_SRVC_UNIT_QTY":"3.000","CLM_LINE_REV_CTR_CD":"0636","CLM_DDCTBL_COINSRNC_CD":"M","GEO_FAC_SSA_STATE_CD":"01","CLM_LINE_PRVDR_PMT_AMT":"11.15","CLM_LINE_SBMT_CHRG_AMT":"50.11"},
+        {
+            "CLM_LINE_DGNS_CD": "M48.062",
+            "PRVDR_RNDRNG_PRVDR_NPI_NUM": "1942945159",
+            "CLM_LINE_ADD_ON_PYMT_AMT": "11.11",
+            "CLM_LINE_NON_EHR_RDCTN_AMT": "11.12",
+            "CLM_REV_CTR_TDAPA_AMT": "11.13",
+            "CLM_LINE_NUM": "1",
+            "CLM_LINE_ALOWD_CHRG_AMT": "9194.22",
+            "CLM_LINE_HCPCS_CD": "99213",
+            "CLM_REV_APC_HIPPS_CD": "",
+            "CLM_LINE_NDC_CD": "",
+            "CLM_LINE_NDC_QTY": "",
+            "CLM_LINE_SRVC_UNIT_QTY": "3.000",
+            "CLM_LINE_REV_CTR_CD": "0636",
+            "CLM_DDCTBL_COINSRNC_CD": "M",
+            "GEO_FAC_SSA_STATE_CD": "01",
+            "CLM_LINE_PRVDR_PMT_AMT": "11.15",
+            "CLM_LINE_SBMT_CHRG_AMT": "50.11"
+        },
         {"CLM_LINE_NUM":"2","CLM_LINE_HCPCS_CD":"99453","CLM_REV_APC_HIPPS_CD":"","CLM_LINE_NDC_CD":"","CLM_LINE_NDC_QTY":"","CLM_LINE_SRVC_UNIT_QTY":"3.000","CLM_LINE_REV_CTR_CD":"0771","HCPCS_1_MDFR_CD":"A2","CLM_LINE_NCVRD_CHRG_AMT":"0.10","CLM_LINE_PRVDR_PMT_AMT":"-91.0","CLM_LINE_BENE_PMT_AMT":"17.99","CLM_LINE_BENE_PD_AMT":"13.22","CLM_LINE_CVRD_PD_AMT":"11.14","CLM_LINE_BLOOD_DDCTBL_AMT":"17.11","CLM_LINE_MDCR_DDCTBL_AMT":"3.50"},
         {"CLM_LINE_NUM":"3","CLM_LINE_HCPCS_CD":"","CLM_REV_APC_HIPPS_CD":"","CLM_LINE_NDC_CD":"","CLM_LINE_NDC_QTY":"2348.87","CLM_LINE_SRVC_UNIT_QTY":"","CLM_LINE_REV_CTR_CD":"0001","HCPCS_1_MDFR_CD":"99","CLM_LINE_NCVRD_CHRG_AMT":"","CLM_LINE_INSTNL_REV_CTR_DT":"2025-01-01","CLM_LINE_PRVDR_PMT_AMT":"14.11"},
         {"CLM_LINE_NUM":"4","CLM_LINE_HCPCS_CD":"J2270","CLM_REV_APC_HIPPS_CD":"","CLM_LINE_NDC_CD":"00409189001","CLM_LINE_NDC_QTY":"1000.0","CLM_LINE_NDC_QTY_QLFYR_CD":"GR","CLM_LINE_SRVC_UNIT_QTY":"3.000","CLM_LINE_REV_CTR_CD":"0636","CLM_LINE_INSTNL_ADJSTD_AMT":"4.50","CLM_LINE_PRVDR_PMT_AMT":"11.11","CLM_LINE_INSTNL_RDCD_AMT":"11.11","CLM_LINE_INSTNL_MSP1_PD_AMT":"17.00","CLM_LINE_INSTNL_MSP2_PD_AMT":"14.21","CLM_LINE_INSTNL_RATE_AMT":"0.85","CLM_LINE_BLOOD_DDCTBL_AMT":"1234.0"}