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Question

How were the PrimaryCancerCondition diagnoses codes determined? 

Answer

In researching how cancer diagnoses are captured and exchanged, we considered the following assumptions:

  • Conformance with the US Core Condition profile required SNOMED-CT.
  • EHRs which capture and exchange ICD-10-CM codes for billing purposes. Historical data for meaningful use stage 2 (prior to Promoting Interoperability) accepted ICD-10-CM instead of SNOMED-CT.
  • Cancer Registries like SEER, which accepts ICD-O-3 codes.

Since the FHIR IG only accepts one value set binding to Condition.code, we determined the most comprehensive approach to cover all 3 coding systems (SNOMED-CT, ICD-10-CM, ICD-O-3) was to create one value set containing the relevant primary cancer condition codes from each coding system.

The value set terms further made the following assumptions:

  • Does not include personal history of (e.g. Z85.3) or family history of codes (e.g.: Z80.3)
  • Inclusion of pre-coordinated codes that indicate laterality and gender (e.g.: C50.811 Malignant neoplasm of overlapping sites of right female breast).

  • It is assumed that the creator of the FHIR instance will ensure consistency of any supporting elements with a pre-coordinated Condition.code.  For example, for C50.811, the implementer will ensure that Condition.bodySite.mcode-laterality will contain a code indicating right-side laterality (SNOMED-CT code 24028007 - Right), if such data is available.

A summary of how to populate PrimaryCancerCondition diagnosis codes is illustrated below and further documented in the mCODE FHIR IG section 1.2.2.1, Representing Cancer Diagnosis


Cancer diagnosis code representation

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