Understanding SNOMED CT and ICD-10-PCS Codes for Medical Procedures

 
MAGPIE – an Interactive Tool to Find
SNOMED CT and ICD-10-PCS Codes for
Medical Procedures
 
Kin Wah Fung
1
,
    
Julia Xu
1 
,
    
Filip Ameye
2 
,
Arturo Romero-Gutiérrez
3 
,
 
Ariel Busquets
4
 
1 U.S. National Library of Medicine
2 National Institute for Health and Disability Insurance, Belgium
3 Ministry of Health, Social Services and Equality, Spain
4 Hospital Privado Universitario de Córdoba, Argentina
 
SNOMED CT Expo
October 2018, Vancouver, Canada
 
ICD-10-PCS
 
Brand-new classification system created by U.S. Centers
for Medicare and Medicaid Services (CMS)
Multi-axial structure. The seven characters in the code
correspond to the seven axes, each describing a
particular aspect of the procedure.
 
2
 
ICD-10-PCS map project group
 
Formed in 2015, bi-weekly conference calls
Members from Belgium, Spain, Argentina and U.S.
T
o explore ways to map between SNOMED CT 
and
 ICD-10-
PCS
Expected benefits of the map:
Improve SNOMED CT and ICD-10-PCS coding efficiency
and accuracy
Promote re-use of clinical data for administrative,
epidemiologic and statistical purposes
Facilitate integration of clinical and administrative data to
support data analytics
 
3
 
ICD-10-PCS coding is difficult
 
Many more codes compared to ICD-9-CM procedure
codes:
ICD-9-CM Volume 3 (2013) – 3,882
ICD-10-PCS (2018) – 78,705
ICD-10-PCS names are not clinically-intuitive
Root operation definitions:
Extraction - Pulling or stripping out or off all or a portion of a
body part by the use of force
Removal - Taking out or off a device from a body part
Extirpation – Taking or cutting out solid matter from a body
part
Cataract removal is extraction, not removal
Wound excision (debridement) is also extraction, not removal or
excision
Extraction of embolus is extirpation
 
 
Root operation definitions:
Excision - Cutting out or off, without replacement, a portion of
a body part
Resection - Cutting out or off, without replacement, all of a
body part
Appendectomy is resection
Partial nephrectomy is excision
ICD-10-PCS index is relatively sparse and not as rich as
ICD-9-CM procedure index
 
ICD-9-CM procedure codes index
 
ICD-9-CM
 
ICD-10-PCS
 
Compared to the ICD-10-PCS index,
ICD-9-CM index is much richer – has
more refinement options and includes
eponyms e.g. Polya gastrectomy
 
ICD-9-CM procedure codes index
 
ICD-9-CM
 
ICD-10-PCS
 
Compared to the ICD-10-PCS index,
ICD-9-CM index is much richer – has
more refinement options and includes
eponyms e.g. Polya gastrectomy
 
General Equivalence Map (GEM)
 
Re-purposing the ICD-9-CM index
 
The original file is in .rtf file format
Index parsed to extract main entry, indented entries, see
references and codes
Generate full name by concatenating main and indented
entries
 
Map ICD-9-CM index to SNOMED CT
Map ICD-9-CM codes to SNOMED CT through UMLS
Map concatenated index terms to UMLS terms after
normalization
Use the forward GEM (General Equivalence Map) to map
ICD-9-CM to ICD-10-PCS
 
Indirect map through the GEM
SNOMED
CT
ICD-9-CM
Index
ICD-10-
PCS
 
‘Gastrectomy Polya’  – 43.7
Partial gastrectomy with
anastomosis to jejunum
 
26565004
Polya operation, gastrectomy
(procedure)
 
0DB60ZZ
 
Excision of Stomach, Open
 
Approach
0D160ZA
 
Bypass Stomach to Jejunum, Open
 
Approach
0DB64ZZ
 
Excision of Stomach, Percutaneous
 
Endoscopic Approach
0D164ZA
 
Bypass Stomach to Jejunum,
 
Percutaneous Endoscopic Approach
 
UMLS, lexical
map
 
GEM
 
MAGPIE
 
M
ap-
A
ssisted 
G
eneration of 
P
rocedure and 
I
ntervention
E
ncoding
A browser to find codes in SNOMED CT and ICD-10-
PCS for medical procedures and interventions
Special features:
Cascading search
Hybrid lexical and map-assisted matching
Semantic filters
 
Cascading search
 
Sequential navigation through SNOMED CT and ICD-9-
CM to hone in on ICD-10-PCS tables and codes
MAGPIE has suggestions at each step, but users can
change selections
 
Search
term
SNOMED
CT
concept
ICD-9-CM
term
ICD-10-
PCS tables
ICD-10-
PCS codes
 
Hybrid lexical and map-assisted
matching
 
At each step, optimizing search by a combination of
Lexical matching
Build index tables for SNOMED CT, ICD-9-CM and ICD-10-
PCS
At each step, match search terms to index terms using
Apache Lucene information retrieval library functions
Search terms are enriched by synonyms of the identified
SNOMED CT and ICD-9-CM codes
Map-assisted matching
Maps created between the 3 terminologies
Codes identified in each step will be used to find codes in the
next terminology
 
Index tables generation
 
Mapping tables generation
 
Semantic filters
 
make use of words in search string to hone in on the
ICD-10-PCS tables and codes
Body system and body part filters
“total replacement of 
left hip
Axis2 (body system): Lower joints
Axis4 (body part, body region): Hip Joint, Left
Approach filter
laparoscopic
 excision of 
right ovary
Axis2 (body system): Female reproductive system
Axis4 (body part, body region): Ovary, right
Axis5 (approach): Percutaneous endoscopic
 
Search methods
 
Search
term
SNOMED
CT
concept
ICD-9-CM
term
ICD-10-
PCS tables
ICD-10-
PCS codes
 
lexical
 
map
 
lexical
+ map
 
lexical
+ map
+ filter
 
lexical
+ map
+ filter
 
MAGPIE website
 
magpie.nlm.nih.gov 
– work in progress
We welcome your feedback!
 
 
Questions?
 
kwfung@nlm.nih.gov
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MAGPIE, an interactive tool designed by Kin Wah Fung et al., aids in finding SNOMED CT and ICD-10-PCS codes for medical procedures. The ICD-10-PCS system, introduced by the U.S. CMS, features a multi-axial structure with seven characters representing different aspects of a procedure. The ICD-10-PCS map project group, initiated in 2015, aims to improve coding efficiency and promote data reuse and integration. However, coding with ICD-10-PCS can be challenging due to the vast number of codes and non-intuitive naming conventions. Understanding root operation definitions is essential for accurate coding. The ICD-10-PCS index is noted to be less comprehensive compared to the ICD-9-CM procedure index.


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  1. MAGPIE an Interactive Tool to Find SNOMED CT and ICD-10-PCS Codes for Medical Procedures Kin Wah Fung1, Julia Xu1 , Filip Ameye2 , Arturo Romero-Guti rrez3 ,Ariel Busquets4 1 U.S. National Library of Medicine 2 National Institute for Health and Disability Insurance, Belgium 3 Ministry of Health, Social Services and Equality, Spain 4 Hospital Privado Universitario de C rdoba, Argentina SNOMED CT Expo October 2018, Vancouver, Canada

  2. ICD-10-PCS Brand-new classification system created by U.S. Centers for Medicare and Medicaid Services (CMS) Multi-axial structure. The seven characters in the code correspond to the seven axes, each describing a particular aspect of the procedure. 2

  3. ICD-10-PCS map project group Formed in 2015, bi-weekly conference calls Members from Belgium, Spain, Argentina and U.S. To explore ways to map between SNOMED CT and ICD-10- PCS Expected benefits of the map: Improve SNOMED CT and ICD-10-PCS coding efficiency and accuracy Promote re-use of clinical data for administrative, epidemiologic and statistical purposes Facilitate integration of clinical and administrative data to support data analytics 3

  4. ICD-10-PCS coding is difficult Many more codes compared to ICD-9-CM procedure codes: ICD-9-CM Volume 3 (2013) 3,882 ICD-10-PCS (2018) 78,705 ICD-10-PCS names are not clinically-intuitive Root operation definitions: Extraction - Pulling or stripping out or off all or a portion of a body part by the use of force Removal - Taking out or off a device from a body part Extirpation Taking or cutting out solid matter from a body part Cataract removal is extraction, not removal Wound excision (debridement) is also extraction, not removal or excision Extraction of embolus is extirpation

  5. Root operation definitions: Excision - Cutting out or off, without replacement, a portion of a body part Resection - Cutting out or off, without replacement, all of a body part Appendectomy is resection Partial nephrectomy is excision ICD-10-PCS index is relatively sparse and not as rich as ICD-9-CM procedure index

  6. ICD-9-CM procedure codes index ICD-9-CM ICD-10-PCS Compared to the ICD-10-PCS index, ICD-9-CM index is much richer has more refinement options and includes eponyms e.g. Polya gastrectomy

  7. ICD-9-CM procedure codes index ICD-9-CM ICD-10-PCS General Equivalence Map (GEM) Compared to the ICD-10-PCS index, ICD-9-CM index is much richer has more refinement options and includes eponyms e.g. Polya gastrectomy

  8. Re-purposing the ICD-9-CM index The original file is in .rtf file format Index parsed to extract main entry, indented entries, see references and codes Generate full name by concatenating main and indented entries

  9. Indirect map through the GEM Map ICD-9-CM index to SNOMED CT Map ICD-9-CM codes to SNOMED CT through UMLS Map concatenated index terms to UMLS terms after normalization Use the forward GEM (General Equivalence Map) to map ICD-9-CM to ICD-10-PCS SNOMED CT ICD-10- PCS ICD-9-CM Index GEM UMLS, lexical map Gastrectomy Polya 43.7 Partial gastrectomy with anastomosis to jejunum 0DB60ZZ Excision of Stomach, Open Approach Bypass Stomach to Jejunum, Open Approach Excision of Stomach, Percutaneous Endoscopic Approach Bypass Stomach to Jejunum, Percutaneous Endoscopic Approach 26565004 Polya operation, gastrectomy (procedure) 0D160ZA 0DB64ZZ 0D164ZA

  10. MAGPIE Map-Assisted Generation of Procedure and Intervention Encoding A browser to find codes in SNOMED CT and ICD-10- PCS for medical procedures and interventions Special features: Cascading search Hybrid lexical and map-assisted matching Semantic filters

  11. Cascading search Sequential navigation through SNOMED CT and ICD-9- CM to hone in on ICD-10-PCS tables and codes MAGPIE has suggestions at each step, but users can change selections SNOMED CT concept Search term ICD-9-CM term ICD-10- PCS tables ICD-10- PCS codes

  12. Hybrid lexical and map-assisted matching At each step, optimizing search by a combination of Lexical matching Build index tables for SNOMED CT, ICD-9-CM and ICD-10- PCS At each step, match search terms to index terms using Apache Lucene information retrieval library functions Search terms are enriched by synonyms of the identified SNOMED CT and ICD-9-CM codes Map-assisted matching Maps created between the 3 terminologies Codes identified in each step will be used to find codes in the next terminology

  13. Index tables generation Terminology Resources used to build index tables SNOMED CT Repurposed I9 index UMLS ICD-9-CM Repurposed I9 index UMLS ICD-10-PCS ICD-10-PCS index UMLS

  14. Mapping tables generation Source terminology Target terminology Resources used to build mapping tables SNOMED CT ICD-9-CM Repurposed I9 index UMLS SNOMED CT ICD-10-PCS Repurposed I9 index UMLS GEM ICD-9-CM ICD-10-PCS GEM

  15. Semantic filters make use of words in search string to hone in on the ICD-10-PCS tables and codes Body system and body part filters total replacement of left hip Axis2 (body system): Lower joints Axis4 (body part, body region): Hip Joint, Left Approach filter laparoscopic excision of right ovary Axis2 (body system): Female reproductive system Axis4 (body part, body region): Ovary, right Axis5 (approach): Percutaneous endoscopic

  16. Search methods lexical + map + filter lexical + map lexical SNOMED CT concept Search term ICD-9-CM term ICD-10- PCS tables lexical + map + filter ICD-10- PCS codes map

  17. MAGPIE website magpie.nlm.nih.gov work in progress We welcome your feedback!

  18. Questions? kwfung@nlm.nih.gov

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