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Placing NON-Standard Visit types in CDM

CDM Builders
#1

Good Afternoon Friends:

I am in the process of putting together requirements for a product we are taking from 4.0 to CDM5.0 standards using Ambulatory Outpatient data. I have ran into a wall writing the Visit_Occurrence requirements. I have a few questions listed below and wanted to see if anyone else has encountered the same issue.

  1. We currently have very detailed information regarding patient visits. Based on our source data we get Billing codes (99213,99214,etc.) and we also get Visit Type Values (Office Visit, Nurse Visit, Medication Refill, Oncology Visit, Pediatric Check-UP, etc)…Based on “our” current CDM version 4 data set we had these items placed in PLACE_OF_SERVICE_SOURCE_VALUE (billing codes) & VISIT_TYPE_SOURCE_VALUE (visit types). We absolutely need to keep this granularity within our CDMv5 data set but for the life of me can not figure out how to implement it. Has anyone ran into the same issues?

I understand that there is a visit_concept_id and Visit_type_concept_id but the selections in the “Standard Vocabularies” are very narrow and will not specifically work for us.

The plan right now is to set each of our VISIT_CONCEPT_ID’s is to ‘Outpatient Visit’. We feel okay doing this as ALL of our data is outpatient data. But then our visit_source_value should relate to the same concept and it is not.

I am sure many other questions will come up based on responses I get. Look forward to the converstaion.

Thank you in advance for any insight or help you can give!!

#2

Not sure why you were happy with CDMv4 but now cannot code in CDMv5. Is
the problem that you need to maintain both the Billing codes and Visit Type
Values? If that is the case I would suggest putting the billing codes in
as the visit_source_value and then the visit_source_concept_id will have
the associated concept id. I think it is understood that the ETL has to
implement its own mapping between the visit_source_value and the
visit_concept_id since there is no such mapping in the vocabulary. The
acceptable visit type concept id’s seem to be almost meta data for the data
source, that is, if your source data set is an EHR system, the visit type
concept id will probably be ‘Visit derived from EHR record’ for every visit
occurrence. If it is also necessary to keep the Visit Type Values (Office
Visit, Nurse Visit, Medication Refill, Oncology Visit, Pediatric Check-UP,
etc) I would add an additional column to the Visit Occurrence table to hold
the string.

#3

Thanks for the insight @DTorok.

It is not necessarily that we dont know how to code or build requirements for CDMv5 but rather wanted to check with the community to see if what we plan on doing follows what others have done in the past.

Yes we do need to maintain the billing codes and the visit types provided from our source. We do not mind adding additional columns to V_O but I wanted to utilize this forum to see how others are doing it. You never know, there may be a possibility of not adding new columns based on how others implemented.

#4

Youd want to check all the codes, but assuming the billing codes you are
talking about are cpt4, then most of those are in the PROCEDURE domain and
would be stored in that table, not visit.

#5

You do make a good point there. They are CPT4 codes and therefore we can have them live in the Procedure domain tied back to the visit with the visit_occurrence_id.

t