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Multiple Modifier with Single Procedure


(Tarun Shah) #1

There are multiple modifiers mapped with single procedure. Do we have to insert row for each modifier in PROCEDURE_OCCURRENCE?

(Don Torok) #2

An example of what you are experiencing will help in answering your question.

(Melanie Philofsky) #3

You don’t have to and I would definitely assess the time cost versus the return before adding multiple modifiers to the CDM.
Many of the CPT4 modifiers are not related to the clinical aspect of a Procedure and are instead supplemental facts for billing purposes and/or additional information needed for healthcare workflow. See the list of modifiers. I would critically analyze the data and then make a decision on whether all the modifiers are necessary for your use cases.

(Tarun Shah) #4

Hi, @MPhilofsky
How can we differentiate Modifiers in clinical, supplemental and as additional information. Also what if there are two clinical modifiers are attached?

(Melanie Philofsky) #5

Hi @TMS,

Have a clinical informatician assess the data. I suggest writing some SQL to pull the data into a csv:

count (*)
FROM Your data source
4 desc

I think this will be a rare occurrence. But you can add another row in your Procedure table with procedure_concept_id = 0 (you don’t want to repeat the procedure_concept_id because your Person only got one Procedure) and then the modifier in the modifier_concept_id and link them using the Fact Relationship table. O

(Ajit Londhe) #6

Hi all,

Revisiting this issue. So the options are:

  1. Select the most clinically important modifier for each patient’s procedures
  2. If we want to keep all of them, then insert additional records into procedure occurrence and use fact relationship to tie them to the event

Are there any other methods people are using?