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Primary vs. Secondary Condition Type

Vocabulary Users
#1

Hi! If someone could share some knowledge regarding Primary vs. Secondary Condition Type, I would greatly appreciate it. I read the following thread:

http://forums.ohdsi.org/t/primary-dx-vs-secondary-dx/

But it was a relatively wide-ranging conversation and I’m not sure I understood what transpired.

I’m simply looking for the diagnosis code that the patient was given after being seen by the emergency room attending physician. This should not be confused with the diagnosis code that billing assigns to the patient or that insurance claims assign to the patient for that visit as these are often not the same diagnosis codes that ED attendings attach to their patients.

What condition type would reflect the “true reason for the ED visit” as assessed by the ED attending after seeing the patient? The encounter diagnosis as mentioned here: Primary dx vs Secondary dx seems to be the most relevant but how does that relate to some of the diagnostic codes that I am seeing in our data (for example):

44786627: Primary Condition
38000245: EHR Problem List Entry
44786629: Secondary Condition

Is 44786627 the condition type attached to the diagnostic code given by the attending physician after first encounter?

Thanks as always for your advice!

#2

Most of the ‘Condition type’ concepts are concerned with claims data and where the Dx occurred on the claim form. If you are ETL’ing an EHR system I would pick the most appropriate from the list below:

  • 42894222 EHR Chief Complaint
  • 45754805 EHR Episode Entry
  • 32019 EHR billing diagnosis
  • 32020 EHR encounter diagnosis
  • 38000245 EHR problem list entry
  • 45905770 Patient Self-Reported Condition
#3

Thank you @DTorok! To clarify: I’d like to only select those asthma diagnoses (for example) where the primary reason for the visit (as determined by the attending physician) is asthma. Each asthma diagnosis at a particular visit is attached to one and only one condition_type concept_id. Per your post, I can assume that an asthma diagnosis entered on a particular visit with a condition_type_id of 44786627: Primary Condition would not be the reason for the visit (as assessed by the attending who entered that diagnosis code into the EHR during that visit)?

This is surprising to me because most of our records use either 44786627 or 38000245 where 38000245 seems to indicate fairly clearly that it’s simply a problem list entry with no specification of whether this diagnosis is important or unimportant.

In the fairly common situation where someone is taken to the ED for an MI but has a history of asthma. Asthma will certainly be on the EHR problem list, but the reason for the visit is obviously an MI. In this example, can I assume that the condition_concept_type_id should be 38000245? Similarly, if someone visits the ED for an asthma exacerbation but also has DM2, DM2 will be on the EHR problem list but the asthma diagnosis should have what condition_type_id?

Thanks again!

#4

I was providing more a history of the Condition Type concept id with the thought that you were beginning an ETL. There is nothing wrong, no rules broken, by using 44786627: Primary Condition to indicate the the diagnosis is the primary reason for the visit. I think 42894222 EHR Chief Complaint would be analogous to Primary Condition.

#5

Thanks @DTorok! I suppose the real question is: Does using 44786627 indicate the primary reason for the visit? How does the concept_type_id become attached to particular diagnosis during a visit? Does the billing department add it / does the attending add it / who decides which concept_type_id is appropriate for the diagnosis code?

#6

All _type_concept_ids are assigned to the data during the ETL. I’d check the specifications for the conversion or ask the data owner.

t