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Friday, April 22, 2011

Trouble Finding HL7 V3 Codes in NQF Quality Measures? I know why...

Are you having trouble finding the codes listed in the spreadsheets supplied by CMS for the NQF Quality Measures?  I was recently contacted by someone who was looking for immunization reason codes from the  spreadsheets in the second download.

The spreadsheet rows affected look something like this:
21703, 21704, 21738, 21745, 21747, 21815, 21990, 22259, 22261, 22855
14880, 15985, 19729, 21708, 21710, 21741, 21743, 21746, 22260, 22851
19730 , 19731, 19733, 19734, 19735, 19736, 19987, 19988, 19989, 19990, 21408, 21493, 21568, 21706, 21707, 21709, 21728, 21729, 21730, 21731, 21732, 21733, 21734, 21735, 21744, 22023, 22024, 22165, 22166, 22167, 22168, 22169, 22857, 22858, 22859, 22865, 22866, 22867, 22907, 22909, 22911, 22912, 22913

Look all you want in HL7 Version 3 Vocabulary and you'll have trouble finding these code values.  Why?  Because those aren't the HL7 Code values nor is the code system correctly identified.  Yes, they do come from HL7 Version 3.0, but which of the umpteen code systems defined in V3?  (Note:  I'm using the HL7 Ballot web-site here for educational purposes, you should really be using an HL7 Normative Edition Publication to view the published codes).

The answer is that it can be found in the HL7 V3 ActReason Code System.

So, where did the numbers come from?  These are the Internal identifiers HL7 uses to maintain the vocabulary, found in the column titled "Definition, Properties and Relationships" rather than the appropriate codes found in the "Concept Code Column".  Look at 21703 for example.  That should actually be INEFFECT in the ActReason code set.

The Standard Taxonomy column should indicate that the vocabulary comes from HL7 ActReason so you know which code set it comes from.  While this is part of the HL7 Version 3.0 standard, the specific version of the code set is NOT 3.0.  I'm assuming that NQF is using the HL7 2010 Normative Edition.  If so, the version should probably be 2010 or something like that.

Now that you know how to do the mapping, there's something else that should also have been done.  The spreadsheets note the copyright for CPT®, LOINC® and SNOMED-CT®, but should also acknowledge the copyright of HL7 on the Version 3 codes that they report, and obtain appropriate permissions to use them.