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Code V70.0


#1

So everywhere I am looking (cms.gov and a google search) is calling this code a route general medication examination. However, it shows up as a traffic accident in the condition domain in the vocabularies. The reason I ask is because users are trying to do reporting off of the OMOP data and the concept name is misleading. Most of the diagnosis records show up as having routine general medication examination in Epic. Has anybody else experienced Epic diagnosis showing as procedures in the vocabularies? Is there a differentiator in Epic that can distinguish whether this code record is a procedure or diagnosis. Trying to avoid hardcoding to filter out these out. Or is this a mistake in the vocabularies?


(Christian Reich) #2

@OHDSI_User:

V70.0 exists in ICD-10 and in ICD-9-CM. In the first it’s the accident (a Condition), in the second it’s the medical examination (a Procedure). Concept codes are generally not unique across vocabularies, only within (and in some not even that). So, your Epic system is probably defaulting to ICD-10-CM.


(Melanie Philofsky) #3

For ICD9CM and ICD10CM, you need to filter by date. October 1, 2015 is when the US changed over to ICD10CM.


#4

Well the issue is that users are logging this as a diagnosis in pat_enc_dx when it is really a procedure. So we will have to filter out ‘diagnoses’ in this table that are really procedures in an observational database. There is a high number which is throwing off reporting numbers e.g. wellness examinations are showing up in condition_occurrence as traffic accidents.


(Melanie Philofsky) #5

Ah, @OHDSI_User, I think I might understand what you are seeing.

First, let me invite you to the EHR WG held every other Friday from 10am to 11am EST. Our next meeting is this Friday, September 20th. We discuss all things EHR & more. The meeting details are also located here. If you give me your email address, I can send you the calendar invite.

This is how it works from a clinical workflow perspective. The Person Visits a Provider at a Care Site (all OMOP language). The Provider records the ICD9CM code (if the visit was before Oct. 1, 2015) or ICD10CM code (if the Visit was on Oct. 1, 2015 to the present) - note, some EHRs recorded an ICD9CM AND an ICD10CM code during the transition from 9 to 10. This code represents why the Person had a Visit that is recorded in the patient encounter diagnosis table. The reason may be for a routine medical examination or because of a car accident, doesn’t matter if it is a Procedure/Condition/Measurement/Observation/etc., this is how it is recorded at the source.

The domain_id signifies where the data should live in the OMOP CDM. If the Visit was before Oct. 1, 2015, v70.0 has domain_id = Condition then you need to ETL it to the Condition table. If the Visit was on or after Oct. 1, 2015, then the domain_id = Procedure and the data ETLs to the Procedure table.

I highly recommend you watch the CDM/Vocabulary tutorial and the ETL tutorial found here. These tutorials will give you the foundation for the CDM and explains the model very well.


#6

Hi Melanie. I missed the meeting today because I thought it was at 11:00 est. So the biggest challenge we are facing is classifying everything in pat_enc_dx according to whether it is a procedure, observation, or diagnosis. To my knowledge, there is no explicit field in Epic that uniquely classifies these fields into these buckets. What I have been able to do so far is classify according to the dx_group. I have had some success reducing the number of procedures showing up as conditions. However, these groups have some significant overlap as well. And there are many instances where there is no dx_group populated (thousands of codes). Can we chat on the phone regarding this since you use Epic? Probably other institutions using Epic are running into this issue.


(Melanie Philofsky) #7

Sure, I’ll reach out via email.


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