MED_INF 405 HIT Technology Integration
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MED_INF 405 HIT Technology Integration, Interoperability, & Standards Session #3 Assignment: Code the Case Komal Kamra ICD-9-CM and ICD-10-CM are the International Statistical Classification of Diseases, 9th and 10th additions are browsers utilized by the World Health Organization to classify diseases for clinical and epidemiological purposes. The next browser, NCI Metathesaurus is a medical terminology database used by National Cancer Institute for clinical care, research and epidemiology. UMLS Metathesaurus is another biomedical terminology browser with a unified modified language system developed by the U.S. National Library of Medicine. Another browser, Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) is a clinical terminology database of the International Health Terminology Standards Development Organization. The final browser, Logical Observation Identifiers Names and Codes (LOINC) is a browser maintained by the Regenstrief Institute and contains terminologies for laboratory results. There were quite a few challenges associated with these browsers in finding appropriate codes. First, the standards for the same disease varied among browsers since each browser emphasized different aspects of clinical care. Second, different browsers provided varied level of detail for each disease. For example, in searching for Serum glucose, LOINC provide nearly 30 pages of description, which would be very difficult to decipher for a non-clinician. Third, the digital format of the codes was quite different and presented its own challenges in downloading relevant data. For example, a browser RxNorm is not included in the table of browsers below since the pertinent codes could not even be downloaded from this browser. Fourth, certain browsers were not comprehensive as they do not provide all relevant codes for a specific disease, lab value or medication. This forces user to navigate multiple browsers to collect the pertinent information. Fifth, there were challenges associated with forms in which medicines were described thus making it difficult to precisely identify appropriate codes. For example, Metformin Oral Tablet with different concentrations was listed under different codes. Sixth, the demographic variations related to sex, age or race (e.g. Caucasian man) were not covered under specific codes within most of the browsers thus creating data gaps. Case Summary Diabetes Diabetes Hypertension and Heart Failure Hypertension and Heart Failure Weakness Weakness Cough Cough Chest pain Chest pain Dyspnea on exertion Dyspnea on exertion Weight loss Code 250.00 E11 402 Code system ICD-9-CM ICD-10-CM ICD-9-CM Code display Name Diabetes Mellitus Type 2 Type 2 diabetes mellitus Hypertensive heart disease I11.0 ICD-10-CM Hypertensive heart disease with heart failure 780.79 R53.1 786.2 R05 786.5 R07 786.09 ICD-9-CM ICD-10-CM ICD-9-CM ICD-10-CM ICD-9-CM ICD-10-CM ICD-9-CM Other malaise and fatigue Weakness Cough Cough Chest pain Pain in throat and chest Other respiratory abnormalities R06.09 ICD-10-CM Other forms of dyspnea 783.21 ICD-9-CM Loss of weight Case Summary Weight loss Code R63.4 Code system ICD-10-CM Code display Name Abnormal weight loss Anorexia Anorexia Diabetes Hypertension Heart Failure Weakness Cough Chest Pain Dyspnea on exertion Weight loss Anorexia Serum glucose White count Metformin oral tablet Enalapril oral tablet Diabetes Hypertension Heart failure Weakness Cough Chest pain Dyspnea on exertion Weight loss Anorexia Serum glucose White count Metformin oral tablet Enalapril oral tablet 10 mg Diabetes Hypertension Heart Failure Weakness 783.0 R63.0 C2985 C3117 C50577 C28132 C37935 C38665 C2998 ICD-9-CM ICD-10-CM NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) Anorexia Anorexia Diabetes Mellitus Hypertensive disease Heart failure Asthenia Coughing Chest pain Dyspnea C3445 C2875 C61027 C51948 C61612 NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) NCI Metathesaurus (NCIm) Body weight decreased Anorexia Glucose measurement, serum White blood count procedure Metformin C62027 NCI Metathesaurus (NCIm) Enalapril C0011849 C0020538 C0018801 C0004093 C0010200 C0008031 C0231807 UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus Diabetes mellitus Hypertensive disease Heart failure Asthenia Coughing Chest pain Dyspnea on exertion C0043096 C0003123 C0202041 C0427512 C0978483 UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus UMLS Metathesausrus Body weight decreased Anorexia Glucose measurement, serum White blood count laboratory result Metformin oral tablet C0976595 UMLS Metathesausrus Enalapril Maleate 10 mg oral tablet 73211009 38341003 84114007 13791008 SNOMED CT SNOMED CT SNOMED CT SNOMED CT Diabetes Mellitus Hypertensive disorder Heart failure Asthenia Case Summary Cough Chest Pain Dyspnea on exertion Weight loss Anorexia Serum Glucose White count Metformin oral tablet 500 mg Enalapril oral tablet 10 mg Diabetes Hypertension Heart failure Serum glucose White count Code 49727002 29857009 60845006 Code system SNOMED CT SNOMED CT SNOMED CT Code display Name Cough Chest pain Dyspnea on exertion 89362005 79890006 22569008 767002 325278007 SNOMED CT SNOMED CT SNOMED CT SNOMED CT SNOMED CT 318853004 SNOMED CT Weight loss finding Loss of appetite Glucose measurement, serum White blood cell count Metformin hydrochloride 500 mg tablet Enalapril maleate 10 mg tablet 45636-8 45643-4 45641-8 49689-3 6690-2 LOINC LOINC LOINC LOINC LOINC Diabetes mellitus Hypertension Congestive heart failure Glucose tolerance in serum Leucocytes in blood automated count
