We are trying to decide what to do with procedure modifiers in our data.
The problem (as usual) is that the corresponding procedure codes map to different domains, but only Procedure_occurrence table has the place for a modifier (modifier_concept_id).
Usually we solve this problem by mapping modifiers separately from procedure codes and then linking them in fact_relationship. But it looks really complicated for the end-user of data. Most likely no one will use fact_relationship to look for the related records.
Now we would like to go another way.
We looked at the pairs (procedure code - modifier) with top counts for each of the domain and we would like to do the following solutions:
Procedure - map all modifiers to modifier_concept_id field
Observation - ignore modifier data
Top examples:
Hospital outpatient clinic visit for assessment and management of a patient - Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
Ground mileage, per statute mile - Bachelors degree level
Lipoprotein, direct measurement; LDL cholesterol - Distinct Procedural Service
Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin … - Provider attestation that the hospital laboratory test(s) is not packaged under the hospital opps
Drug - map modifiers meaning route of administration to route_concept_id and ignore other modifiers
Top examples:
Injection, epoetin alfa, 100 units (for esrd on dialysis) - Administered intravenously
Injection, epoetin alfa, (for non-esrd use), 1000 units - Erythropoetic stimulating agent (esa) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy
Albuterol, inhalation solution, fda-approved final product … - Single drug unit dose formulation
Injection, epoetin alfa, 100 units (for esrd on dialysis) - Administered subcutaneously
Device - ignore modifier data
Top examples:
Oxygen concentrator, single delivery port, capable of… - Rental (use the ‘rr’ modifier when dme is to be rented)
Filter, disposable, used with positive airway pressure device - New equipment
@nzvyagina,
A CDM module to support cancer research (accepted last week) includes extension of the MEASUREMENT table to support modifiers for multiple domains:
To explicitly link cancer diagnosis, treatment, or episode record to its modifier, we propose to add the following fields to the Measurement table:
Field
Required
Type
Description
modifier_of_event_id
No
integer
A foreign key identifier to the event (e.g. condition, procedure, episode) record for which the modifier is recorded.
modifier_of_field_concept_id
No
integer
The concept representing the table field concept that contains the value of the event id for which the modifier is recorded (e.g. Condition_Occurrence.condition_occurrence_id).
For cancer use case, we are planning to use this extension to modify conditions (e.g. modifier grade of breast carcinoma diagnosis), procedures (e.g. modifier dose of radiotherapy procedure), and episodes (for one “vetted” set of episode modifiers).
I think this approach is applicable to the general procedure modifier use case you have described. Moreover, it supports more complex scenarios like multiple modifiers for one procedure. It’s also applicable to other domains.
Option 2: Nothing stops you from adding columns to a table. Add a column to each table for the modifier_value and modifier_concept_id. OHDSI tools will not use it, but easier than trying to follow fact_relationship
@rimma: these are modifiers for claims. Nothing to do with the cancer modifiers. @DTorok: Non-standard. Can’t be utilized by any tool. Don’t encourage people to step out of line.
Exactly. And your idea is head on: We discussed something like this previously. Let’s do what you are suggesting and put it into THEMIS as well. Can you ping them?
@Christian_Reich
Modifiers are modifiers whether they modify procedures, diagnoses, or other events or whether they modify cancer-specific or other events. Why not apply the generic modifier approach to multiple use cases?
@rimma: No. Because the modifiers are defined by the CMS to characterize the claims. Has nothing to do with the type of clinical modifiers (attributes) that you are looking at. We define that.
