Multiple Targets

Poisonings

Source concepts representing a poisoning from a drug or noxious substance may be mapped to one, two, or three target classification codes depending upon the specificity of the source concept. The poisoning code for the drug or substance will be designated as the primary target code (mapGroup = 1), ICD-10 codes T36–T50. WHO guidance dictates that the sole exception to this rule occurs when the manifestation is a neoplastic disorder. Neoplasms are always mapped as the first target code.

Should the source concept specify the symptoms or findings resulting from the poisoning, the appropriate target code will be mapped as the second map (mapGroup = 2) except in cases of neoplastic complications when the poisoning code will occur second.

When the SNOMED CT concept specifies the action intent/site of injury involved within the event, a specific ICD classification code from range X40–X49, X60–X84, Y10–Y34, or Y40–Y59 will be employed as the second or third target code (mapGroup = 2 or 3). If the source concept does not specify intent, WHO guidance will be reviewed for a default map which will be assigned a mapCategoryId of "Properly classified" with mapAdvice of "MAPPED FOLLOWING WHO GUIDANCE".

Poisoning Examples

Example 1

767146004 | Toxic effect of arsenic and its compounds (disorder)| maps to

• T57.0 Toxic effects of arsenic compounds. No symptoms are specified. WHO guidance specifies the default intent as accidental poisoning.

  mapGroup = 1, mapCategoryId="Properly classified", mapRule=TRUE. mapAdvice is "ALWAYS T57.0". Map Target = "T57.0"

• X48 Accidental poisoning by and exposure to pesticides.

  mapGroup = 2, mapCategoryId = "Properly classified", mapRule = TRUE, Map Target =X48 "Accidental poisoning by and exposure to pesticides". mapAdvice will be "ALWAYS X48" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" and "MAPPED FOLLOWING WHO GUIDANCE"

Example 2

296934007 | Accidental warfarin overdose (disorder)| maps to:

• T45.5 Poisoning by anticoagulant

  (mapGroup 1, mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice= "ALWAYS T45.5", Map Target = "T45.5"

• X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

  (mapGroup 2, mapRule=TRUE. mapAdvice is "ALWAYS X44" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE", Map Target = "X44".

Example 3

403742006 | Arsenic-induced skin malignancy (disorder)| maps to:

• C44.9 Malignant neoplasm of skin unspecified

  (mapGroup 1, mapCategoryId="Properly classified", mapRule=TRUE. mapAdvice is "ALWAYS C44.9" and "POSSIBLE REQUIREMENT FOR MORPHOLOGY CODE". Map Target = "C44.9"

This code is mapped first since the manifestation is a neoplasm.

• T57.0 Toxic effects of arsenic compounds

  (mapGroup 2, mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice is "ALWAYS T57.0" Map Target ="T57.0"

• X48 Accidental poisoning by and exposure to pesticides

  (mapGroup 3, mapCategoryId = "Properly classified", mapRule = TRUE. mapAdvice is "ALWAYS X48" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" and "MAPPED FOLLOWING WHO GUIDANCE" Map Target = "X48"

Example 4

7248001 | Poisoning by salicylate (disorder)| maps to:

• T39.0 Toxic effects of salicylates

  (mapGroup 1), mapCategoryId="Properly classified", Map Rule=TRUE; MapAdvice= "ALWAYS T39.0" Map Target = "T39.0"

• X40 Accidental poisoning by non-opioids

  (mapGroup 2), mapCategoryId = "Properly classified", Map Rule = TRUE. MapAdvice is "ALWAYS X40" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" and "MAPPED FOLLOWING WHO GUIDANCE" Map Target = " X40"

Example 5

216471009 | Accidental poisoning by salicylates (disorder)| maps to:

• T39.0 Toxic effects of salicylates

  (mapGroup 1) mapCategoryId="Properly classified", Map Rule=TRUE; MapAdvice= "ALWAYS T39.0" Map Target = "T39.0"

• X40 Accidental poisoning by non-opioids

  (mapGroup 2) mapCategoryId = "Properly classified", Map Rule = TRUE. MapAdvice is "ALWAYS X40" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" Map Target = " X40"

Example 6

295830007 | Overdose of antidepressant drug (disorder)| maps to:

• T43.2 Poisoning by other and unspecified antidepressants as the default target code. The alphabetic reference for poisoning by antidepressants lists three essential modifiers for subclasses of antidepressants which are found as descendants of the source concept and qualify for mapping but this is a high level concept and so these exclusions are not mapped. mapAdvice is "ALWAYS T43.2" Map Target = "T43.2"

• X41 Accidental poisoning by psychotropic drug

  (mapGroup 2), mapCategoryId = "Properly classified", Map Rule = TRUE. mapAdvice is "ALWAYS X41" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" and "MAPPED FOLLOWING WHO GUIDANCE" Map Target = "X41"

External Causes

External causes can be found within multiple hierarchies including the event, disorder, and situation hierarchies. The corresponding maps vary according to the hierarchy in which the external causes are found and any other conditions represented within the SNOMED concept. Below are a few ways external causes may be mapped.

External cause examples

Example 1

Source concepts denoting a condition with an identifiable cause within scope of ICD-10 Chapter XX will be mapped to two target classification codes. The external cause classification will be assigned to the second target record (mapGroup=2).

242012005 | Thermal burns from lightning (disorder)| maps to:

• T30.0 Burn of unspecified region

  mapGroup 1, mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice= "ALWAYS T30.0", Map Target = "T30.0"

• X33 Victim of lightning

  mapGroup 2, mapCategoryId = "Properly classified", mapRule = TRUE. mapAdvice is "ALWAYS X33" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" Map Target = "X33"

Example 2

If the external cause or location is not explicit in the SNOMED CT concept, the generic external cause code will not be listed as a target ICD-10 code, as illustrated below. mapAdvice will be used instead to communicate to the end user the necessity to add an external cause code.

371162008 | Closed fracture of skull (disorder)| maps to:

• S02.90 Fracture of skull and facial bones, part unspecified – closed

  mapGroup 1, mapCategoryId="Properly classified", mapRule=TRUE. mapAdvice is "ALWAYS S02.90" and "POSSIBLE REQUIREMENT FOR AN EXTERNAL CAUSE CODE" Map Target = "S02.90" The ICD-10 code X59.0, Exposure to unspecified factor causing fracture will not be listed as a second target ICD-10 code.

Example 3

SNOMED CT concepts which are descendants of 272379006 | Event (event)| will be mapped as either External causes or as Factors influencing health status when these are within the scope of ICD-10.

414189000 | Fall down steps (event)| maps to:

• W10 Fall on or from stairs or steps – unspecified place

  mapCategoryId="Properly classified", mapRule=TRUE. mapAdvice is "ALWAYS W10" and "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" and "THIS IS AN EXTERNAL CAUSE CODE FOR USE IN A SECONDARY POSITION" Map Target = "W10"

Example 4

5193003 | Lightning (event)| maps to:

• X33 Victim of lightning

  mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice="ALWAYS X33", "POSSIBLE REQUIREMENT FOR PLACE OF OCCURRENCE" and "THIS IS AN EXTERNAL CAUSE CODE FOR USE IN A SECONDARY POSITION" Map Target = "X33"

Dagger and Asterisk

Source concepts which map to ICD-10 chapters with dagger and asterisk conventions will often be mapped to two target classification codes. The asterisk classification will be the second target record (mapGroup=2). The asterisk code will have applied advice of THIS CODE MAY BE USED IN THE PRIMARY POSITION WHEN THE MANIFESTATION IS THE PRIMARY FOCUS OF CARE.

Dagger codes identified during tabular review which do not have a corresponding asterisk are called "virtual dagger" references. These do not require second target addition.

There may be instances where only an asterisk is provided in a map because the dagger information is unavailable in the SNOMED CT concept. In this instance, mapAdvice THIS MAP REQUIRES A DAGGER CODE AS WELL AS AN ASTERISK CODE is appended to the map to communicate to the end user the need to add an additional corresponding code.

Dagger and asterisk examples

Example 1

111900000 | Pneumonia in aspergillosis (disorder)| maps to :

• B44.1 Other pulmonary aspergillosis

  mapGroup 1, mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice="ALWAYS B44.1", Map Target = "B44.1"

• J17.2 Pneumonia in mycoses

  mapGroup 2, mapCategoryId="Properly classified",mapRule=TRUE, mapAdvice= "ALWAYS J17.2" and "THIS CODE MAY BE USED IN THE PRIMARY POSITION WHEN THE MANIFESTATION IS THE PRIMARY FOCUS OF CARE" Map Target = "J17.2"

Example 2

20735004 | Syphilitic aortitis (disorder)| maps to:

• A52.0 Cardiovascular syphilis

  mapGroup 1, MapPriority 2, mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice="ALWAYS A52.0", Map Target = "A52.0"

• I79.1 Aortitis in disease classified elsewhere

  mapGroup 2, mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice="ALWAYS I79.1" and "THIS CODE MAY BE USED IN THE PRIMARY POSITION WHEN THE MANIFESTATION IS THE PRIMARY FOCUS OF CARE" Map Target = "I79.1"

Example 3

307726001 | Anemia in ovarian carcinoma (disorder)| maps to:

• C56 Malignant neoplasm of ovary

  (mapGroup 1, mapCategoryId="Properly classified", mapRule=TRUE. mapAdvice is "POSSIBLE REQUIREMENT FOR MORPHOLOGY CODE" and MAPPED FOLLOWING WHO GUIDANCE" Map Target = "C56"

• D63.0 Anemia in neoplastic disease

  (mapGroup 2, mapCategoryId="Properly classified", mapRule=TRUE, mapAdvice= "ALWAYS D63.0" and "THIS CODE MAY BE USED IN THE PRIMARY POSITION WHEN THE MANIFESTATION IS THE PRIMARY FOCUS OF CARE", Map Target = "D63.0")