I recently stumbled into an issue regarding the mappings from ICD10 heart device observations to SNOMED (a query I had used a few years back was no longer returning plausible results). In short, the goal is to accurately query for “patients with a heart device”.
ICD10 has a section, Z95 - presence of cardiac and vascular implants and grafts, which are observations of a device being present at the time of being coded. SNOMED seems to account for these under the umbrella of “device in situ” .
The mappings in ATHENA from the ICD10 group to standard mappings are not consistent. While there seems to be 1:1 mappings available, most are mapped to concept pairs (concept_id + value_as_concept_id) which are difficult to account for. Specifically, the most common pattern is an observation of “History of a procedure” with “Implantation to cardiovascular system” (a concept within procedure domain) stored in value_as_concept_id.
e.g.
| Maps to | Maps to value | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| icd_code | icd_desc | relationship_id | domain_id | concept_name | concept_id | concept_class_id | relationship_id | domain_id | concept_name | concept_id | concept_class_id |
| Z95 | Presence of cardiac and vascular implants and grafts | Maps to | Observation | Past history of procedure | 4215685 | Context-dependent | Maps to value | Procedure | Implantation to cardiovascular system | 1576286 | Procedure |
| Z95.1 | Presence of aortocoronary bypass graft | Maps to | Observation | Past history of procedure | 4215685 | Context-dependent | Maps to value | Procedure | Aortocoronary bypass grafting | 35225414 | Procedure |
| Z95.8 | Presence of other cardiac and vascular implants and grafts | Maps to | Observation | Past history of procedure | 4215685 | Context-dependent | Maps to value | Procedure | Implantation to cardiovascular system | 1576287 | Procedure |
| Z95.81 | Presence of other cardiac implants and grafts | Maps to | Observation | History of cardiovascular surgery | 4323360 | Context-dependent | Maps to value | Procedure | Implantation to cardiovascular system | 1576288 | Procedure |
Additionally, the handful that are mapped directly to a single SNOMED concept, which I’d argue is the simpler representation, vary on which portion of the SNOMED hierarchy they are mapped to, some within “device in situ” (observations) while others fall under “cardiac finding” (conditions).
| Maps to | ||||||
|---|---|---|---|---|---|---|
| icd_code | icd_desc | relationship_id | domain_id | concept_name | concept_id | concept_class_id |
| Z95.0 | Presence of cardiac pacemaker | Maps to | Observation | Cardiac implant in situ | 45766277 | Clinical Finding |
| Z95.2 | Presence of prosthetic heart valve | Maps to | Condition | Transplanted heart valve present | 42538119 | Clinical Finding |
| Z95.3 | Presence of xenogenic heart valve | Maps to | Observation | Biologic cardiac valve prosthesis in situ | 42709971 | Clinical Finding |
| Z95.4 | Presence of other heart-valve replacement | Maps to | Condition | Transplanted heart valve present | 42538119 | Clinical Finding |
| Z95.5 | Presence of coronary angioplasty implant and graft | Maps to | Condition | Coronary artery graft present | 42537730 | Clinical Finding |
Would there be a downside to remapping these ICD10 codes to the concepts within SNOMED’s “device in situ” hierarchy? At a glance most seem accounted for, those that don’t have a direct mapping could map to the more general “cardiac device in situ” which would seemingly make them a lot easier to query for, removing the requirement of looking for procedure concepts in observation.value_as_concept_id as is currently the case.