Representing Patient Medical Encounter Diagnosis

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Type Standard / Implementation Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Standard
Final
Production
Rating 4
Yes
Free
N/A
Standard
Final
Production
Rating 4
Yes
Free
N/A
Limitations, Dependencies, and Preconditions for Consideration
Applicable Value Set(s) and Starter Set(s)
  • Use of SNOMED CT® codes should generally be chosen from three axes: Clinical finding, Situation with explicit context, and Event.
  • The use of these standards may be further constrained by other standards and implementation specifications found elsewhere in the ISA.
  • Systems should be able to process (or at minimum display) data coded using the older ICD-9-CM standard, as this legacy content still exists and may be used for analysis/decision support/quality measurement needs, where retroactive analysis is often required, but ICD-9 should not be collected for new entries. NLM has maps from ICD-9-CM diagnosis and procedure codes to SNOMED CT to facilitate code translation and integration with newly collected SNOMED CT data:
  • A mapping from SNOMED CT® to ICD-10-CM is available from the National Library of Medicine to support semi-automated generation of ICD-10-CM codes from clinical data encoded in SNOMED CT for reimbursement and statistical purposes.
  • HIPAA mandates the use of ICD-10 for pharmacy claims using NCPDP standards, while SNOMED is optional for this use. 
  • Problem urn:oid:2.16.840.1.113883.3.88.12.3221.7.4 (SNOMED CT® code system)
  • Recommended starter set: CORE Problem List Subset urn:oid: 2.16.840.1.113762.1.4.1018.240

Comment

NCPDP Comment

While use of ICD-10 is limited, when transmitting diagnosis information it is required. HIPAA mandates the use of ICD-10 for pharmacy claims using NCPDP standards. SNOMED is optional. Adoption level for ICD-10 for the pharmacy is 5.