The U.S. Department of Health and Human Services (HHS) has set a goal for the nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care. Achieving this goal will require that key clinical data elements are captured or recorded in detailed, standardized form (using standard vocabularies, codes, and formats) as close to their original sources (patients, health care providers, laboratories, diagnostic devices, etc.) as possible. If these standardized clinical data can also be used to generate HIPAA- compliant billing transactions automatically, this will provide another incentive for adoption of clinical data standards. For automated generation of bills from clinical data to become a reality, robust mappings from standard clinical terminologies to the HIPAA code sets must be created.
HHS has given the National Library of Medicine the responsibility for funding, coordinating, and/or performing official mappings between standard clinical terminologies and HIPAA code sets. Several mappings are in various stages of development and technical validation following a set of basic mapping project assumptions. The draft “SNOMED CT to ICD-9-CM Rules Based Mapping to Support Reimbursement ” is one such map. It relates the July 2008 International Release of SNOMED Clinicial Terms (SNOMED CT) to the 2008 version of the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM). The use case for the mapping assumes that SNOMED CT is used for clinical descriptions and that ICD-9-CM will be used for administrative and reimbursement purposes. The map is thus unidirectional from descriptive SNOMED CT codes to ICD-9-CM codes.