How were the PrimaryCancerCondition diagnoses codes determined?
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 acceptsICD-O-3codes.
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 includepersonal history of (e.g. Z85.3) orfamily history ofcodes (e.g.: Z80.3)
Inclusion of pre-coordinated codes that indicate laterality and gender (e.g.: C50.811- Malignantneoplasm 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 thatCondition.bodySite.mcode-lateralitywill 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 184.108.40.206,Representing Cancer Diagnosis.
Cancer diagnosis code representation
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