Representing Patient Medical Encounter Diagnosis

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard	SNOMED CT® U.S. Edition	Final	Production		Yes	Free	N/A
Standard	ICD-10-CM	Final	Production		Yes	Free	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
Use of SNOMED CT U.S. Edition 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 U.S. Edition to facilitate code translation and integration with newly collected SNOMED CT U.S. Edition data: ICD-9-CM Diagnostic Codes to SNOMED CT U.S. Edition ICD-9-CM Procedure Codes to SNOMED CT U.S. Edition A mapping from SNOMED CT U.S. Edition 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 U.S. Edition for reimbursement and statistical purposes. HIPAA mandates the use of ICD-10 for pharmacy claims using NCPDP® standards, while SNOMED CT U.S. Edition is optional for this use.	Problem urn:oid:2.16.840.1.113883.3.88.12.3221.7.4 (SNOMED CT U.S. Edition) Recommended starter set: CORE Problem List Subset urn:oid: 2.16.840.1.113762.1.4.1018.240

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

Use of SNOMED CT U.S. Edition 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 U.S. Edition to facilitate code translation and integration with newly collected SNOMED CT U.S. Edition data:
- ICD-9-CM Diagnostic Codes to SNOMED CT U.S. Edition
- ICD-9-CM Procedure Codes to SNOMED CT U.S. Edition
A mapping from SNOMED CT U.S. Edition 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 U.S. Edition for reimbursement and statistical purposes.
HIPAA mandates the use of ICD-10 for pharmacy claims using NCPDP® standards, while SNOMED CT U.S. Edition is optional for this use.

Problem urn:oid:2.16.840.1.113883.3.88.12.3221.7.4 (SNOMED CT U.S. Edition)
Recommended starter set: CORE Problem List Subset urn:oid: 2.16.840.1.113762.1.4.1018.240

Comment

Submitted by pwilson@ncpdp.org on 2021-09-29

NCPDP Comments

NCPDP supports ONC’s recommendations.

Submitted by gldickinson on 2020-10-23

Preserving Clinical Context

General Comments: USCDI specifies lots of clinical data classes and data elements

Resolving to myriad de-coupled fragments
With vanishingly little focus on:
- Clinical context and vital inter-relationships, e.g., between problems, diagnoses, complaints, symptoms, encounters, allergies, medications, vaccinations, assessments, clinical decisions, orders, results, diagnostic procedures, interventions, observations, treatments/therapies, referrals, consults, protocols, care plans and status...
- Elements and context + purpose of capture: e.g., blood pressure, its measurement (systolic, diastolic), its unit of measure (mm/Hg), its reason for capture, its context of capture (sampling site, sampling method, patient position, at rest/during/post exercise...

It is crucial to consider and determine/resolve how clinical content and context are bound together and preserved in USCDI. The ultimate end user (often a clinician) must be able to readily discern context and inter-relationships – otherwise USCDI places an undue (and often unresolvable) burden on this user. Only the source EHR/HIT system can structure clinical content and context properly. Once data is stuffed into the USCDI framework and related exchange artifact (e.g., FHIR resources) this opportunity is forever lost.

Submitted by pwilson@ncpdp.org on 2018-10-01

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.

Submitted by mcpatric on 2017-11-20

NLM ICD9CM to SNOMED CT maps

Regarding the 3rd bullet about handling legacy content, 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:

About the ISA

ISA Content

ISA Sections

Appendices

Specialty Care and Settings

ISA Publications

Recent ISA Updates