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Unified Medical Language System (UMLS)

UMLS Vocabularies

ICD10CM (International Classification of Diseases, Tenth Revision, Clinical Modification) - Metathesaurus Representation


This page lists UMLS Metathesaurus data elements and traces them back to the specific source data that populates them.

VSAB: ICD10CM_2020


Summary of Changes

There have been no changes to the source format, however Metathesaurus source processing has been updated. TTY = AB atoms are now being created for hierarchical terms (HT); previously they were only created for preferred terms (PT) Multiple values of attributes are now concatenated rather than being represented as separate rows in MRSAT.RRF, e.g.:

  • ICD9CM_2019:
    • C41.0|EXCLUDES2|carcinoma, any type except intraosseous or odontogenic of:
    • C41.0|EXCLUDES2|maxillary sinus (C31.0)
    • C41.0|EXCLUDES2|upper jaw (C03.0)
    • C41.0|EXCLUDES2|malignant neoplasm of jaw bone (lower) (C41.1)
  • ICD10CM_2020:
    • C41.0|EXCLUDES2|carcinoma, any type except intraosseous or odontogenic of: maxillary sinus (C31.0); upper jaw (C03.0); malignant neoplasm of jaw bone (lower) (C41.1)

Source Provided Files:

The following files are downloaded and processed from http://www.cdc.gov/nchs/icd/icd10cm.htm:

Documentation:
  • icd10OrderFiles.pdf
  • icd10cm_tabular_2020.pdf
Data:
  • icd10cm_order_2020.txt
  • icd10cm_tabular_2020.xml
The tabular xml file aligns with the order file, and redundant data is not processed.

Identifiers:

Identifiers are assigned as follows:
  • CODE:
    • Diagnoses, chapters: value of "<name>" tag
    • Diagnoses, 7 character codes: value of "<name>" tag" concatenated with "<SevenChrDef> <extension>" tag
    • Sections: value of "id" attribute of "<section>" tag
  • SAUI: Not Applicable
  • SCUI: Not Applicable
  • SDUI: same as CODE

Atoms (MRCONSO):

Term Type Description Origin
AB Abbreviation (Short description) CODE = icd10cm_order_<YYYY>.txt (character positions 7-13)
STR = icd10cm_order_<YYYY>.txt (character positions 17-76)
SDUI = same as CODE
SUPPRESS = "Y"
ET Entry Term CODE: value of "<name>" tag in icd10cm_tabular_<YYYY>.xml
STR: value of "<includes>" or "<inclusionTerm>" tag in icd10cm_tabular_<YYYY>.xml
SDUI: same as CODE
SUPPRESS = "Y"
HT Hierarchical Term CODE:
  • For diagnoses or chapters: value of "<name>" tag
  • For sections: value of "id" attribute of "<section>" tag
STR: value of "<desc>" tag in icd10cm_tabular_<YYYY>.xml
SDUI: same as CODE
SUPPRESS = "N"

Note: Chapters, Sections, and all "non-leaf" nodes are assigned TTY = "HT." In icd10cm_order_<YYYY>.txt, a value of "0" in character position 15 indicates that the code is not valid for submission on a UB04.
PT Preferred Term CODE: Value of "<name>" tag
For 7th character extensions: the "<sevenChrDef extension>" char is appended to the subcategory name value
STR: value of "<desc>" tag in icd10cm_tabular_<YYYY>.xml
For 7th character extensions: The "<sevenChrDef>" value is appended to the desc value
SDUI: same as CODE
SUPPRESS = "N"

Note: All "leaf" nodes are assigned TTY = "PT." In icd10cm_order_<YYYY>.txt, a value of "1" in character position 15 indicates that the code is valid for submission on a UB04.

Attributes (MRSAT):

Most attributes are extracted from "<note>" tags in icd10cm_tabular_<YYYY>.xml.

ATN Note Type Description
CODE_ALSO codeAlso Instructs that 2 codes may be required to fully describe a condition but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the encounter.
CODE_FIRST codeFirst Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code.
EXCLUDES1 excludes1 A pure excludes. It means "NOT CODED HERE!" Indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. Used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
EXCLUDES2 excludes2 Represents "Not included here". Indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. When an Excludes2 note appears under a code it is acceptable to use both the code and the excluded code together.
NOTE notes
ORDER_NO N/A Order number (icd10cm_order_<YYYY>.txt characters 1-5)
USE_ADDITIONAL useAdditionalCode Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.

Definitions (MRDEF):

There are no definitions for ICD10CM.


Relationships (MRREL):

REL RELA
Inverse RELA
Origin
CHD
PAR
(no rela) Hierarchy created from icd10cm_tabular_<YYYY>.xml
RQ (no rela) Connect Entry Terms (TTY = "ET") to their preferred form (TTY = "PT" or TTY = "HT")
SY expanded_form_of
has_expanded_form
Connect short forms (TTY = "AB") to their preferred form (TTY = PT")