For this project, value sets containing a collection of ICD-9-CM, ICD-10-CM and SNOMED CT codes that could support a given MDS response have been identified for each item in MDS3.0 Section I (Active Diagnoses). For example, the ICD-9-CM value set for MDS item I0100 (Cancer) includes all codes in the range 140-239. The presence of an ICD-9-CM code within this range in the patient’s EHR could flag the user to assess if response I0100 should be marked on the MDS assessment.
For purposes of this project, SNOMED CT, ICD-9-CM and ICD-10 value sets have been developed for data elements in MDS 3.0 Section I (Active Diagnoses) only. Value sets have not been developed for data elements in other sections of the MDS 3.0 or for the OASIS-C.
General principles guiding the value set mapping for SNOMED CT include the following:
Value sets are developed at the question level only and are mapped to the following SNOMED CT hierarchies
- Clinical finding
- Situation with explicit context
The questions are equivalent to the assertion patterns or question/answers patterns in the Rosetta Stone Model of Meaning tab. The value set consist of variations of the Model of Meaning concepts.
EXAMPLE: MDS 3.0 Data Element I3700 -- Arthritis (e.g., degenerative joint disease (DJD), osteoarthritis, and rheumatoid arthritis (RA)
- Association/Model of meaning: Arthropathy (disorder) Concept ID 399269003
- Value Set: Osteoarthritis (disorder) 396275006
Arthritis (disorder) 3723001
Decedents of Arthropathy (disorder) CID 399269003 within SNOMED CT
The value set mapping for ICD-9-CM and ICD-10-CM identifies relevant codes for the specified conditions found in the 2011 releases of the classification systems.
4.2.1. EHR Observation Tab -- Rules Used for the Development of SNOMED CT Value Sets
The Model of Meaning concept has been imported to the International Health Terminology Standards Development Organization (IHTSDO) Workbench mapping tool with intentional definition rules used to select the appropriate children concept nodes that relate to the Model of Meaning. Those nodes have been extracted and placed into an Access database. The Access database links the MoM to the valueset_name by clicking on the name within the database. The value set consists of the MDS description, MDS code, SNOMED CT concept ID (CID), the Fully Specified Name (FSN) and a comment column.
MDS Section I value set rules used include:
Select ALL concepts that are:
- Descendents of XXXXX
- Descendents of YYYYYY
- NOT Descendents of ZZZZZZ
- Descendents of XXXXX
Concepts come from the following hierarchies:
- Clinical Findings
- Situation with specific context
Any “history of XX” OR “family history of XX” are excluded from the SNOMED CT situation of specific context hierarchy
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