1 Introduction
SNOMED CT terminology provides a common language that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care. The SNOMED CT US Edition is a combination of the full SNOMED CT International Edition and the US Extension of SNOMED CT. The US Edition eliminates the need for implementers to manually combine the US Extension and International releases. The SNOMED CT to ICD-10-CM map reference set is to support semi-automated generation of ICD-10-CM codes from clinical data encoded in SNOMED CT for reimbursement and statistical purposes.
The International Health Terminology Standards Development Organisation (IHTSDO®), trading as SNOMED International, maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (includes the concepts table, the descriptions table, the relationships table, a history table, and ICD mappings), and related technical documentation. SNOMED CT US Edition is developed and maintained by the United States National Library of Medicine and is available to authorized Unified Medical Language System (UMLS) Metathesaurus Licensees. This material includes SNOMED CT which is used by permission of the IHTSDO. All rights reserved.
SNOMED CT was originally created by the College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of IHTSDO. You must have a UMLS Metathesaurus license to access SNOMED CT US Edition data files. License information is available from NLM (https://www.nlm.nih.gov/healthit/snomedct/snomed_licensing.html).
1.1 Background
This document provides a summarized description of the content changes for the NLM maintained SNOMED CT to ICD-10-CM mapping reference set found in the September 2018 release of the SNOMED Clinical Terms® US Edition. These release notes also include technical notes detailing the known issues which have been identified. These are content or technical issues where the root cause is understood, and the fix has been discussed and agreed, but has yet to be implemented.
This document is available as a web resource as well as alongside the September 2018 US Edition release (https://www.nlm.nih.gov/healthit/snomedct/us_edition.html).
The mapping methodology follows closely that of the SNOMED CT to ICD-10 Crossmap Project, a collaborative project between SNOMED International and the World Health Organization. Dual independent mapping by trained terminology specialists is employed to assure quality and reduce variability. Identical maps created independently are accepted as final, while discordant maps are reviewed by a third expert. Regular team meetings are held to discuss problematic and ambiguous cases.
1.2 Scope
This document covers the characteristics of this release of the map, including concept counts and file format. For details about how the map is created please refer to the technical specifications for SNOMED CT to ICD-10-CM map (https://confluence.ihtsdotools.org/display/RMT/SNOMED+CT+Managed+Service+-+US+Edition+Mapping+SNOMED+CT+to+ICD-10-CM+Technical+Specifications+-+September+2018). The Map corresponds to the September 2018 release of the US Edition of SNOMED CT (https://www.nlm.nih.gov/healthit/snomedct/us_edition.html) and the 2019 version of ICD-10-CM.
1.3 Purpose of the Map
To provide a semi-automated coding of ICD-10-CM statistical classification data from a clinical record which is clinically encoded in SNOMED CT
For development of ICD-10 classification codes from SNOMED CT encoded records for use in registries and diagnosis groupers
Please note - this Map is NOT a completely automated ICD-10-CM coding from a SNOMED CT source.
1.4 Audience
All parties who wish to understand the Map and/or to employ it for semi-automatic translation between SNOMED CT and ICD-10-CM should read this document. This may include vendors of electronic health records, terminology developers and managers.
2 Cross map content overview
2.1 Summary
This September 2018 SNOMED CT US Edition (20180901) publication of the the SNOMED CT to ICD-10-CM map marks the second release with the mapping tooling and map release production provided by SNOMED International Managed Service. Quality assurance of the release was completed by both NLM and SNOMED International.
2.2 Scope of publication
The MAP is a directed set of relationships from SNOMED CT source concepts to ICD-10-CM target classification codes. The SNOMED CT source domains for the MAP are limited to subtypes of 404684003 |clinical finding|, 272379006 |event| and 243796009 |situation with explicit context|.
2.2.1 September 2018 SNOMED CT to ICD-10-CM refset statistics
Total number of SNOMED CT source concepts | 123,260 |
Source concepts could not be assigned a map target due to issues of ambiguity or target scope | 10,416 |
This map release includes a total of 203,097 map records, with a maximum of 26 map records per map group.
2.3 What is a refset?
A Reference Set (refset) is a set of references to SNOMED CT components which may associate additional properties with members of the set. It may also indicate associations between members of the set or between members of the set and content of another nomenclature, classification or knowledge structure. The uses of Reference sets include identification of subsets of SNOMED CT content, representation of alternative hierarchical structures and cross maps to classifications. References Sets are a part of SNOMED CT Release Format 2 that provides a general purpose extensibility mechanism. Refsets are a SNOMED International standard artifact that complies with the technical specifications documented in the document SNOMED CT Release Format 2.0 Reference Set Specifications, accessible on line as part of the Technical Implementation Guide
This publication of the MAP employs a Descriptor refset, an Extended Map refset and a Module Dependency refset as documented in that publication.
2.4 RF2 refsets in this publication
The SNOMED CT to ICD-10-CM map is released in RF2 format within the SNOMED CT US Edition (https://www.nlm.nih.gov/healthit/snomedct/us_edition.html). The map is also available in a human readable format (tls_Icd10cmHumanReadableMap_US1000124_20180901.tsv) contained within the documentation folder in both the US Edition release.
The SNOMED CT to ICD-10-CM map is released as Refsetid 6011000124106 | ICD-10-CM extended map reference set (foundation metadata concept)|.
The SNOMED CT to ICD-10-CM map refset data are contained in three separate files:
Extended Map: contains the core of the Map data. There are one or more map records for each source concept mapped, including the ICD-10-CM target codes. Found in the Map folder under Refset in the Full, Snapshot, and Delta Release Type folders: xder2_iisssccRefset_ExtendedMap[Full-Snapshot-Delta]_US1000124_20180901.txt.
Refset Descriptor: contains metadata from the SNOMED CT metadata hierarchy (children of 9000000000000454005 |foundation metadata concept|) which describes the attributes of the publication refsets and their information content
Module Dependency: designates the versions of other SNOMED CT modules upon which this publication of the MAP depends
2.5 Additional Resources
Additional resources have been provided to support the use of the Map.
2.5.1 Browsable Spreadsheet
To support browsing and understandability of the MAP, a tab delimited UTF-8 dataset which can be imported into spreadsheet software such as Microsoft Excel® is included with the release. This can be loaded with the text import features of Excel and most spreadsheets. The spreadsheet data format mimics the exemplar appendices of the technical documentation and is a “readable” version of the Map that can be understood by a non-technical individual. This file is not in RF2 format and can be found in the Documentation directory.
2.5.2 Technical Documentation
Technical documentation which summarizes the rationale, procedures, technical artifacts and project overview is included with the publication as the pdf file: SNOMED CT Managed Service - US Edition Mapping SNOMED CT to ICD-10-CM Technical Specifications - September 2018. Accompanying the technical documentation is a collection of sample maps available as Appendix_icd_10_cm_exemplar_20180301.xlsx.
2.5.3 iMagic Mapper
The I-MAGIC (Interactive Map-Assisted Generation of ICD Codes - https://imagic.nlm.nih.gov/imagic/code/map) Algorithm utilizes the SNOMED CT to ICD-10-CM Map in a real-time, interactive manner to generate ICD-10-CM codes. This demo tool simulates the Problem List of an EHR to illustrate how the healthcare provider can capture clinical problems in SNOMED CT and then derive ICD-10-CM codes for reimbursement and other purposes.
3 Technical Notes
3.1 Summary
This section of the document provides a summary of known technical issues and current changes. Please see the Technical Specifications Documentation for additional information.
3.2 Known Issues
Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented. This can be due to a number of reasons, from lack of capacity within the current map editing cycle, to the risk of impact to the stability of the Map if the fix were to be deployed at that stage in the Product lifecycle. For the SNOMED CT to ICD-10-CM map, the following Known Issues were identified, and agreed to be resolved in the next editing cycle:
Some map advice values are not totally in synch with the 2019 ICD10CM coding notes for the following three kinds of map advice: POSSIBLE REQUIREMENT FOR AN EXTERNAL CAUSE CODE, CONSIDER LATERALITY SPECIFICATION, CONSIDER ADDITIONAL CODE TO IDENTIFY SPECIFIC CONDITION OR DISEASE
In a small number of records (8 records), the concept name in the IFA maprule and mapadvice fields has a minor discrepancy (e.g., "Superficial foreign body of mouth" instead of "Superficial foreign body in mouth")
3.3 Technical Updates
3.3.1 Improved SNOMED CT to ICD-10-CM Reference set data
As reported in section 2.3, starting with the March 2018 US Edition release the 6011000124106 | ICD-10-CM complex map reference set (foundation metadata concept)| data will adhere to SNOMED CT RF2 specifications. The 20180301 US Edition release will act as a baseline and the 6011000124106 | ICD-10-CM complex map reference set (foundation metadata concept)| data are the same in the Full, Snapshot, and Delta releases.
Going forward (starting with the 2018 September SNOMED CT US Edition, 20180901), new 6011000124106 | ICD-10-CM complex map reference set (foundation metadata concept) data will be found in the Delta, current status data in the Snapshot, and a historical record of the refset data in the Full Release.
Previous (historical) map data may be obtained by appending previous standalone map release files.
3.3.2. Improved Standalone Reference set naming convention
To maintain SNOMED CT RF2 file naming convention for refset products, in March 2018 (version 20180301) the NLM SNOMED CT to ICD-10-CM standalone release package was updated. The new package will follow the naming convention used for all products and derivatives:
SnomedCT_[Product][Format(optional)]_[Release Status]_[Release date]T[Release time][time zone]
No longer in use:
der2_Refset_ICD10CM_US_YYYYMMDD.zip
The newly named NLM SNOMED CT to ICD-10-CM standalone refset package:
SNOMEDCT_UStoICD10CM_PRODUCTION_YYYYMMDDT120000Z
3.3.3 Updated Release of 2018 March US Edition 6011000124106 | ICD-10-CM complex map reference set
On March 26, 2018, there was an updated version of the map (6011000124106 | ICD-10-CM complex map reference set (foundation metadata concept)| ) was released. This updated included an appending of the previously released mapping refset data, originally pulled from the 20180301 release. The newly released version, which includes all of the previously released data, now includes 260,749 mapped records. This is now considered the baseline for the SNOMED CT to ICD-10-CM map.
4 Quality assurance and maintenance
Mapping procedures as outlined in the technical documentation consist of dual independent mapping of all source concepts with map records sent to publication only after consensus of the independent mappers is reached. The Map will be periodically updated with new versions of SNOMED CT and ICD-10-CM. Future expansion of coverage of SNOMED CT concepts will depend on user feedback and availability of resources.
5 Feedback and suggestions
We welcome questions, comments or suggestions to improve the quality, accuracy and usability of the SNOMED CT US Edition. Please send feedback to NLM Customer Support https://support.nlm.nih.gov.
6 Appendix: File format specifications
6.1 Refset Descriptor refset (xder2_cciRefSet_DescriptorSnapshot_INT_yyyymmdd)
(der2 designates a data file of format RF2; cci denotes a Concept-Concept-Integer refset; INT identifies the international version; yyyymmdd is the year, month and date of publication)
Field | Data type | Purpose | |
id | UUID | A 128 bit unsigned integer, uniquely identifying the map category record | |
effectiveTime | Time | Specifies the inclusive date at which this change becomes effective. | |
active | Boolean | Specifies whether the member’s state was active (=1) or inactive (=0) from the nominal release date specified by the effectiveTime field. | |
moduleId | SctId | Identifies the member version’s module. Set to a child of 900000000000443000|Module| within the metadata hierarchy. | |
refSetId | SctId | Indicates that this is part of a "reference set descriptor"; concept Id 900000000000456007 | Reference set descriptor reference set (foundation metadata concept)| | |
referencedComponentId | SctId | The SCT identification of the refset which is described; a metadata descendant of 9000000000000455006 |Reference Set| | |
attributeDescription | SctId |
| |
attributeType | SctId |
| |
attributeOrder | Integer |
|
6.2 Module Dependency refset (xder2_ssRefSet_ModuleDependencySnapshot_INT_yyyymmdd)
Field | Data type | Purpose |
id | UUID | A 128 bit unsigned integer, uniquely identifying the map category record |
effectiveTime | Time | Specifies the inclusive date at which this change becomes effective. |
active | Boolean | Specifies whether the member’s state was active (=1) or inactive (=0) from the nominal release date specified by the effectiveTime field. |
moduleId | SctId | Identifies the member version’s module. Set to a child of 900000000000443000|Module| within the metadata hierarchy. |
refSetId | SctId | Set to one of the children of the 447250001 |Complex map type| concept in the metadata hierarchy. |
referencedComponentId | SctId | A reference to the module on which this module depends, a descendant of 900000000000443000|Module| in the metadata hierarchy. |
sourceEffectiveTime | String | The effective time of the source module. This allows a specific module version to be selected as having a dependency. The effectiveTime must match exactly. |
targetEffectiveTime | String | The effective time of the target module. This allows a specific module version to be selected as being the subject of a dependency. The effectiveTime must match exactly. |
6.3 Extended Map refset (xder2_iissscRefset_ExtendedMapSnapshot INT_yyyymmdd)
Field | Data type | Purpose |
id | UUID | A 128 bit unsigned integer, uniquely identifying the map record |
effectiveTime | Time | Specifies the inclusive date at which this change becomes effective. |
active | Boolean | Specifies whether the member’s state was active (=1) or inactive (=0) from the nominal release date specified by the effectiveTime field. |
moduleId | SctId | Identifies the member version’s module. Set to a child of 900000000000443000|Module| within the metadata hierarchy. |
refSetId | SctId | Set to one of the children of the |Complex map type| concept in the metadata hierarchy. |
referencedComponentId | SctId | The SNOMED CT source concept ID that is the subject of the map record. |
mapGroup | Integer | An integer identifying a grouping of complex map records which will designate one map target at the time of map rule evaluation. Source concepts that require two map targets for classification will have two sets of map groups. |
mapPriority | Integer | Within a map group, the mapPriority specifies the order in which complex map records should be evaluated to determine the correct map target. |
mapRule | String | A machine-readable rule, (evaluating to either ‘true’ or ‘false’ at run-time) that indicates whether this map record should be selected within its map group |
mapAdvice | String | Human-readable advice that may be employed by the software vendor to give an end-user advice on selection of the appropriate target code. This includes a) a summary statement of the map rule logic, b) a statement of any limitations of the map record and c) additional classification guidance for the coding professional. |
mapTarget | String | The target ICD-10 classification code of the map record. |
correlationId | SctId | A child of |Map correlation value| in the metadata hierarchy, identifying the correlation between the SNOMED CT concept and the target code. |
mapCategoryId | SctId | Identifies the SNOMED CT concept in the metadata hierarchy which is the MapCategory for the associated map record. This is a subtype of 447634004 |ICD-10 Map Category value|. |
6.4 Map browser spreadsheet (tls_ICD10HumanReadableMap_INT_yyyymmdd)
The browser spreadsheet dataset is the same as the Extended Map Refset with the descriptive names for the SNOMED CT concept, ICD-10-CM code and mapCategoryId added for readability.
Field | Data type | Purpose |
id | UUID | A 128 bit unsigned integer, uniquely identifying the map category record |
effectiveTime | Time | Specifies the inclusive date at which this change becomes effective. |
active | Boolean | Specifies whether the member’s state was active (=1) or inactive (=0) from the nominal release date specified by the effectiveTime field. |
moduleId | SctId | Identifies the member version’s module. Set to a child of 900000000000443000|Module| within the metadata hierarchy. |
refSetId | SctId | Set to one of the children of the |Complex map type| concept in the metadata hierarchy. |
referencedComponentId | SctId | The SNOMED CT identifier of the source concept that is being mapped in this record |
sctName | String | The fully specified name of the SNOMED CT source concept being mapped |
mapGroup | Integer | A collation identifier which specifies one or more map records which are to be evaluated in sequence for determination of at most one ICD-10 target codes for this map |
mapPriority | integer | The sequence number for evaluation of this map record within the map group |
mapRule | string | The map rule for this map record |
mapAdvice | string | The map advice for this map record |
mapTarget | string | Target ICD-10 classification code for this map record |
icdName | string | WHO term assigned to the target ICD-10 code for this record |
correlationId | SctId | A child of |Map correlation value| in the metadata hierarchy, identifying the correlation between the SNOMED CT concept and the target code. |
mapCategoryValueId | SctId | The metadata identifier for the map category assigned to this map record, a child of 447634004 |ICD-10 map category value| |
mapCategoryValue | string | Primary term for the map category metadata assigned to this map record |
Approvals
Final Version | Date | Approver | Comments |
---|---|---|---|
1.0 | Terance Shird | ||
1.0 |
| Rory Davidson | |
1.0 | Kin Wah | ||
1.0 |
| Suzy Roy | Approved |
Draft Amendment History
Version | Date | Editor | Comments |
---|---|---|---|
1.0 | 20120703 | Kin Wah Fung | Final release notes of Phase 1 map |
2.0 | 20130601 | Kin Wah Fung | Release notes of updated map |
3.0 | 20131220 | Kin Wah Fung | Release notes of updated map |
4.0 | 20140901 | Kin Wah Fung | Release notes of updated map |
4.1 | 20150225 | Susan Roy, Kin Wah Fung | Release notes for 2015 March US Edition |
5.0 | 20150630 | Kin Wah Fung | Release notes for 20150901 version of the map |
5.1 | 20150901 | Kin Wah Fung, Susan Roy | Release notes for 2015 September US Edition |
6.0 | 20160624 | Kin Wah Fung | Release notes for 201603 version of the map |
6.1 | 20161006 | Kin Wah Fung | Release notes for 201609 version of the map |
7.0 | 201702 | Kin Wah Fung Susan Roy | Release notes for 201702 version of the map |
7.1 | 201703 | Kin Wah Fung | Release notes for 201703 version of the map |
8.0 | 201709 | Kin Wah Fung | Release notes for 201709 version of the map |
9.0 | 20180301 | Susan Roy, Kin Wah Fung | Release notes for 20180301 version of the map |
10.0 | 20180807 | Susan Roy, Kin Wah Fung | Release notes for 20180901 version of the map |