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Dataset: ICD-9-CM to SNOMED CT Map
Many existing electronic health record (EHR) systems contain clinical information encoded in ICD-9-CM. To facilitate migration to SNOMED CT as the primary clinical terminology for patient problems (diseases and conditions), it is desirable that the legacy ICD-9-CM data be translated to SNOMED CT. This will make it possible to compare newly collected data with historic data, and will also allow the EHR to make use of SNOMED CT to provide clinical decision support and other functions. The goal of the ICD-9-CM to SNOMED CT Map (herein referred to as “the Map”) is to facilitate the translation of legacy data and the transition to prospective use of SNOMED CT for patient problem lists. Note that this Map is not the same as, and serves different purposes from, the SNOMED CT to ICD-9-CM Map.
The most useful mappings are the one-to-one maps, in which a single SNOMED CT concept can be used to represent the full meaning of an ICD-9-CM code. This allows the automatic translation of ICD-9-CM codes into SNOMED CT codes without loss of meaning. The Map tries to identify as many one-to-one maps as possible, however, due to the differences between the two coding systems, one-to-one maps cannot be found for some ICD-9-CM codes. This difference is usually due to one of two reasons. Firstly, in ICD-9-CM, some codes are “catch-all” codes that encompass heterogeneous diseases or conditions (e.g. pneumonia due to other specified bacteria). These codes, commonly known as “NEC codes” (not elsewhere classified codes), will not have one-to-one maps because of their nature. Secondly, since SNOMED CT is more granular than ICD-9-CM in most disease areas, some ICD-9-CM diseases or conditions are further refined as more specific concepts in SNOMED CT. For such cases, it is not possible to map to a more specific SNOMED CT concept without the input of additional information.
The Map is published in two separate files, one containing the one-to-one maps, and the other the one-to-many maps. Also included in the files are the usage frequency of the ICD-9-CM codes, and the usage frequency of the SNOMED CT concepts from the CORE Problem List Subset data. The latter information can help users to identify the more commonly used SNOMED CT targets in the one-to-many maps.
Two lists were obtained from the Centers for Medicare & Medicaid Services (CMS), covering commonly used ICD-9-CM codes in short-stay and outpatient hospitals respectively, for the year 2009. SNOMED CT maps for the ICD-9-CM codes in the lists were derived primarily from two existing knowledge sources: the synonymy between ICD-9-CM and SNOMED CT terms in the Unified Medical Language System (UMLS), and the SNOMED CT to ICD-9-CM Cross Maps published in the International release of SNOMED CT. The choice of target SNOMED CT codes was limited to concepts in three hierarchies: Clinical finding, Situation with explicit context, and Events. One-to-one maps identified by UMLS synonymy were not manually validated. One-to-many maps that were algorithmically identified which involved less than 5 SNOMED CT targets were manually reviewed, with the intention to reduce them to one-to-one maps if possible. ICD-9-CM codes with no maps, or one-to-many maps involving a large number of targets were not manually reviewed.