How SNOMED CT Can Help in the ICD-10-CM Transition

How SNOMED CT Can Help in the ICD-10-CM Transition

How SNOMED CT can help in the ICD-10-CM transition Kin Wah Fung, MD, FRCSEd, MS, MA National Library of Medicine National Institutes of Health 2010 SNOMED CT Systematized Nomenclature of Medicine - Clinical Terms The most comprehensive, multilingual clinical healthcare terminology in the world

Created by the merging of SNOMED RT (Reference Terminology) with CTV3 (Clinical Terms version 3) in 2002 2 2010 An international standard Owned by IHTSDO (International Health Terminology Standards Development Organisation) 18 member countries so far, including US, UK, Canada, The Netherlands, Spain, Denmark, Australia, New Zealand

SNOMED CT can be used by Anyone with an Affiliate License (free for all member countries) 40 low income countries (defined by the World Bank) Qualifying research/humanitarian/charitable projects 3 2010 Terminology for the EHR As a clinical terminology, SNOMED CT is inherently more suitable than other terminologies/classifications for clinical documentation in the EHR (electronic health record) This is not to say that SNOMED CT is superior to

ICD, since they are designed for different purposes and each should each be used for the purpose for which it was designed 4 2010 Content coverage SNOMED CT has better clinical coverage than ICD Number of codes: SNOMED CT (Clinical finding): 100,000 ICD-9-CM: 14,000 ICD-10-CM: 68,000

ICDs focus is statistical less common diseases get lumped together in catch-all categories e.g. J15.8 Pneumonia due to other specified bacteria, which could result in loss of information SNOMED CT is clinically-based document whatever is needed for patient care 5 2010 ICD-9-CM ICD-10-CM SNOMED CT

Apert syndrome 755.55 Acrocephalosyndactyly Q87.0 Congenital malformation syndromes predominantly affecting facial appearance 205258009 Apert

syndrome Metabolic acidosis 276.2 Acidosis E87.2 Acidosis 59455009 Metabolic acidosis Respiratory acidosis 276.2 Acidosis

E87.2 Acidosis 12326000 Respiratory acidosis Lactic acidosis 276.2 Acidosis E87.2 Acidosis 91273001 Lactic acidosis

299.8 Other specified F84.5 Aspergers 23560001 Aspergers Differences Between ICD-9-CM, ICDpervasive developmental disorder disorder disorders

10-CM and SNOMED CT Aspergers disorder 6 2010 Clinical orientation Different users and usage SNOMED CT - direct use by healthcare providers during the process of care ICD use by coding professionals after the episode of care It may be problematic for healthcare providers to use

ICD directly Some terms are not clinical user-friendly Some contents have little clinical relevance Presumed knowledge of coding rules and conventions 7 2010 Unfriendly terms Apparently awkward names (embedded coding guidelines) E878.2 Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of

misadventure at time of operation (ICD-9-CM) Clinically irrelevant details V30.2xxD Person on outside of three-wheeled motor vehicle injured in collision with pedestrian or animal in nontraffic accident, subsequent encounter (ICD-10-CM) 8 2010 ICD coding rules and conventions Patient admitted with gastrointestional bleeding and found to be anemic. Which is the correct code? 280 Iron deficiency anemias secondary to blood loss (chronic), OR 285.1 Acute posthemorrhagic anemia

There is no general code to cover both cases of acute and chronic blood loss In ICD convention, words in parenthesis e.g. (chronic) are known as non-essential modifiers whether they are present or not doesnt affect coding, so 280 is the correct code if the clinical course is not certain. But clinical users may not be aware of this convention. SNOMED CT: 413532003 Anemia due to blood loss 9 2010 Flexible data entry and retrieval ICD dictates level of granularity of coding NOS (Not otherwise specified) codes - cases with insufficient

information for more specific codes NEC (Not elsewhere classified) codes - cases with more specific information but not covered by existing codes SNOMED CT allows coding at any level of granularity as appropriate for the clinical situation - no need for NOS, NEC codes Flexible data retrieval SNOMED CT has multiple hierarchy (single hierarchy for ICD) SNOMED CT concepts are defined logically by their attributes (only textual rules and definitions in ICD) 10 2010

Clinical guideline for hypertension ICD-9-CM If one uses only codes in the range HYPERTENSIVE DISEASE (401-405), will be missing 410.9 Myocardial infarction with hypertension 642 Hypertension complicating pregnancy, childbirth, and the puerperium SNOMED CT All descendants of 38341003 Hypertensive disorder 11 2010

Data retrieval using attributes Find all diseases caused by occlusion of artery affecting any artery except mesenteric or renal arteries SNOMED CT Find all descendants of 2929001 Occlusion of artery Exclude those with Finding site = Structure of mesenteric artery or Structure of renal artery ICD-9-CM

440 Atherosclerosis and descendants (except 440.1 Of renal artery) 433 Occlusion and stenosis of precerebral arteries and descendants 437.0 Cerebral atherosclerosis 414.0 Coronary atherosclerosis 416.0 Idiopathic pulmonary arteriosclerosis 443.9 Peripheral vascular disease, unspecified List needs to be reviewed with each update 12 2010

Extensibility No single terminology will be complete for every use case - there is always a need for extension ICD no available method for extension provided by the classification SNOMED CT well-defined rules to extend coverage by combining existing concepts (post-coordination) e.g. Left kidney stone can be represented by adding the laterality attribute 7771000 Left to 95570007 Kidney stone Advantages: Can compute equivalence of new concepts to existing concepts The new concept will be recognized as a sub-class of existing concepts

13 2010 Meaningful Use Criteria for EHR Stage1Meaningful Use problem list data should be encoded in either SNOMED CT or ICD-9-CM NPRM (Notice of Proposed Rule Making) for 2014 EHR Certification Criteria (for Stage 2 Meaningful Use) SNOMED CT proposed as the preferred problem list terminology 2010 Direct generation of ICD-10-CM codes

from clinical data Clinical data coded in SNOMED CT can be used to generate ICD-10-CM codes (code once, use multiple times) Implementation of SNOMED CT in the EHR will not only improve the quality of data, but can also help the transition to ICD-10-CM 2010 SNOMED CT to ICD-10-CM Map NLM project with participation from National Center for Health Statistics (NCHS) Re-use of methodology, tools and data from the IHTSDO/WHO

project to map SNOMED CT to ICD-10 Rule-based map because One SNOMED CT concept may need more than one ICD-10-CM codes to fully represent its meaning e.g. etiology and manifestation, injury codes One SNOMED CT concept may have multiple alternative ICD-10-CM target codes Dual independent mapping as built-in quality assurance 2010 Scope of the map Only mapping those SNOMED CT concepts suitable for the problem list: clinical findings, events and situation

Commonly occurring concepts are mapped first CORE Problem List Subset Donated content from Kaiser Permanentes Convergent Medical Terminology (CMT) Preview publication released in February - covers 7,000 concepts Final release in June about 15,000 concepts 2010 Intended uses of the map Embedded in the EHR to find ICD-10-CM codes in realtime the I-MAGIC (Interactive Map-Assisted Generation of ICD Codes) use case

To assist coding professionals by suggesting ICD codes based on SNOMED CT-encoded problems 2010 I-MAGIC demo tool http://imagic.nlm.nih.gov/imagic/code/map 2010 Link to I-MAGIC Demo Tool http://www.nlm.nih.gov/research/umls/ mapping_projects/snomedct_to_icd10cm.html

Link to I-MAGIC demo tool 2010 I-MAGIC Screen Capture - Homepage Information from EHR Problem list entry interface 2010

I-MAGIC Screen Capture Problem List SNOMED CT terms included in the published map 2010 I-MAGIC Screen Capture Get ICD Codes Button Click here to see ICD-10-CM

codes 2010 I-MAGIC Screen Capture Refine ICD10-CM Codes ICD-10-CM codes Options to refine ICD-10-CM codes 2010

I-MAGIC Screen Capture Laterality Refinement Laterality refinement choices 2010 I-MAGIC Screen Capture ICD Coding Notes ICD coding notes

2010 I-MAGIC Screen Capture ICD-10-CM Code for Adult ICD-10-CM code for adult 2010 I-MAGIC Screen Capture ICD-10Code for Child ICD-10-CM code for child

2010 I-MAGIC Screen Capture ICD-10-CM Code for Newborn ICD-10-CM code for newborn 2010 I-MAGIC Screen Capture ICD-10-CM Code for Male

ICD-10-CM code for male 2010 I-MAGIC Screen Capture ICD-10-CM Code for Female ICD-10-CM code for female 2010 I-MAGIC Screen Capture Trimester

and Fetus Specification Trimester specification Fetus specification 2010 I-MAGIC Screen Capture Problem Refinement Different ICD-10-CM codes

if these more specific conditions apply 2010 I-MAGIC Screen Capture Mandatory Refinement Choices No valid default ICD10-CM code Mandatory refinement choices

2010 NLM SNOMED CT resources Subsets

CORE Problem List Subset http://www.nlm.nih.gov/research/umls/Snomed/core_subset.html Convergent Medical Terminology Subsets http://www.nlm.nih.gov/research/umls/Snomed/cmt.html Nursing Problem List Subset http://www.nlm.nih.gov/research/umls/Snomed/nursing_problemlist_subset.html Route of Administration Subset http://www.nlm.nih.gov/research/umls/Snomed/roa_subset.html

Mappings SNOMED CT to ICD-10-CM Map http://www.nlm.nih.gov/research/umls/mapping_projects/snomedct_to_icd10cm.html SNOMED CT to ICD-9-CM Map http://www.nlm.nih.gov/research/umls/mapping_projects/snomedct_to_icd9cm_reimburse.html ICD-9-CM Map to SNOMED CT map (under development)

US Extension http://www.nlm.nih.gov/research/umls/Snomed/us_extension.html US SNOMED CT Content Request System https://uscrs.nlm.nih.gov/ UMLS-enhanced SNOMED CT browser https://uts.nlm.nih.gov/snomedctBrowser.html 2010 Questions? [email protected] 2010

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