Representing Immunizations

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Standard	Clinical Vaccines Administered (CVX)	Final	Production	Yes	Free	N/A
Standard	National Drug Code (NDC)	Final	Production	Yes	Free	N/A
Standard	Manufacturing Vaccine Formulation (MVX)	Final	Production	No	Free	N/A
Standard	Current Procedural Terminology (CPT®)	Final	Production	No	$	No
Standard	RxNorm	Final	Production	No	Free	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
General considerations: The list above includes any vocabulary used to record immunizations in any health IT system including IIS, pharmacy, billing, etc. NDC has been used by pharmacies to report historical doses for billing purposes, so it is included here in that context. The CDC's National Center for Immunization and Respiratory Diseases (NCIRD) developed and maintains the CVX and MVX code systems, and developed and maintains the NDC vaccine tables based on information published by the FDA. RxNorm is an acceptable alternative code set for use at the local level. RxNorm is utilized for immunization analytics. RxNorm is not utilized for reporting of previous dispensing but can be employed to specify the drug being prescribed. For Immunization Information System (IIS) consideration: The CDC's National Center for Immunization and Respiratory Diseases (NCIRD) developed and maintains the CVX and MVX code systems, and developed and maintains the NDC vaccine tables based on information published by the FDA. CVX codes are designed to represent administered and historical immunizations and will not contain manufacturer-specific information. If an MVX code is paired with a CVX (vaccine administered) code, the specific trade named vaccine may be indicated providing further specificity as to the vaccines administered. There is a potential issue with use of the National Drug Code regarding which code to use when there are multiple active ingredients in a single package or multiple separate ingredients that need to be mixed together. CDC has published guidance on NDC Unit of Use and Unit of Sale; it can be found at: https://www.cdc.gov/vaccines/programs/iis/2d-barcodes/downloads/guidance-documenting-ndc.pdf. The lot number is used in conjunction with the NDC when reporting immunizations to IIS. There is no standard codification for lot numbers. The IIS community does not utilize RxNorm as a code set and thus it may have limitations for interoperability across systems.	CVX: Vaccines Administered MVX: entire code set NDC concepts used to represent vaccines NDC to CVX, MVX, and CPT: Consolidated Lookup Crosswalk NDC to Units: Table Access with NDC Unit of Use and NDC Unit of Sale CPT®: CPT® Codes Mapped to CVX Codes

Limitations, Dependencies, and Preconditions for Consideration

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

General considerations:

The list above includes any vocabulary used to record immunizations in any health IT system including IIS, pharmacy, billing, etc.
NDC has been used by pharmacies to report historical doses for billing purposes, so it is included here in that context.
The CDC's National Center for Immunization and Respiratory Diseases (NCIRD) developed and maintains the CVX and MVX code systems, and developed and maintains the NDC vaccine tables based on information published by the FDA.
RxNorm is an acceptable alternative code set for use at the local level.
RxNorm is utilized for immunization analytics.
RxNorm is not utilized for reporting of previous dispensing but can be employed to specify the drug being prescribed.

For Immunization Information System (IIS) consideration:

The CDC's National Center for Immunization and Respiratory Diseases (NCIRD) developed and maintains the CVX and MVX code systems, and developed and maintains the NDC vaccine tables based on information published by the FDA.
CVX codes are designed to represent administered and historical immunizations and will not contain manufacturer-specific information.
If an MVX code is paired with a CVX (vaccine administered) code, the specific trade named vaccine may be indicated providing further specificity as to the vaccines administered.
There is a potential issue with use of the National Drug Code regarding which code to use when there are multiple active ingredients in a single package or multiple separate ingredients that need to be mixed together. CDC has published guidance on NDC Unit of Use and Unit of Sale; it can be found at: https://www.cdc.gov/vaccines/programs/iis/2d-barcodes/downloads/guidance-documenting-ndc.pdf.
The lot number is used in conjunction with the NDC when reporting immunizations to IIS. There is no standard codification for lot numbers.
The IIS community does not utilize RxNorm as a code set and thus it may have limitations for interoperability across systems.

Comment

Submitted by kwboone on 2017-11-20

This is clearly the right…

This is clearly the right value set for historical data, as that is the value set used.

Submitted by rmcclure on 2017-10-04

Agree with the code system…

Agree with the code system and value set identified. The VSAC direct url for this value set is https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.6/expansion.

I would like to also have the ISA include RxNorm as an additional code system to describe vaccines. That value set is Vaccine Clinical Drug 2.16.840.1.113762.1.4.1010.8 https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.8/expansion

Submitted by Albert Taylor on 2017-12-11

added value of RxNorm

Given the uptake of CVX/MVX standards, what would the added value of RxNorm be in representing vaccines over CVX/MVX along?