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CPT4 to SNOMED standardization: how important is it to preserve billing aspects?

vocabularies
cdm

(Eduard Korchmar) #1

Our team is currently working on procedure standardization between different vocabularies. Some procedure concepts in CPT4 differ only by the way they are billed, e.g. there is a concept that on-site medical coders are expected to use for initial procedure only and separate concept for each subsequential reiteration. While it is important for billing and reimbursements, it is probably meaningless for research. Example:

11730 Avulsion of nail plate, partial or complete, simple; single
11732 Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)

If we decide to treat these concepts the same, they will both made non-standard and receive ‘Maps to’ relationship to SNOMED’s 265698006 Removal of nail plate. Otherwise they’ll remain standard and will be made hierarchical descendants of the said concept instead.

11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less
11921 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm
11922 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure)

Same here: either we use ‘Maps to’ 21357004 Tattooing to correct colour defects of skin for all of these, or make them descendants of said concept. Perhaps in this case it could be important to preserve extent of performed procedure, but SNOMED internal logic poorly accommodates procedure extents in numerical sense.

What would be the best approach in terms of usability and practical application?


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