What are the circumstances where a single ICN can have 38 or more diagnoses as defined in field 35 - Additional Diagnosis Codes - of the MAO-004 report layout?

Field #35 has 38 slots because the MAO-004 will report diagnoses deleted from a prior Internal Control Number (ICN). If, for example, an institutional record was submitted with 25 diagnoses and then replaced with 25 new, unique diagnoses, field #35 would report the 25 diagnoses on the current record as add and the 25 diagnoses removed from the prior record as delete. Since only 38 slots are available, the additional diagnoses would be reported on a second line in the report, with all fields identical to the first line except for the diagnoses and add/delete indicators.