Provisional Codes in Value Sets
In response to the COVID-19 pandemic, VSAC has adapted to our users' needs for provisional codes that several standard terminologies currently produce and frequently update to account for newly created codes and concepts, outside of official terminology update cycles, for emerging viruses and diseases such as SARS-CoV-2 and COVID-19.The following standard terminologies (CPT®, ICD-10-CM, ICD-10-PCS, LOINC® and SNOMED CT) have added provisional (prerelease) codes in response to the COVID-19 pandemic, based on the most up to date information available at the time of their creation:
|Code System||VSAC Code System Version*||Additional Information|
|CPT||Provisional_2021-02-04||CPT COVID-19 coding and guidance|
|ICD-10-CM||Provisional_2020-12-19||New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), Effective: 01/01/2021|
|ICD-10-PCS||Provisional_2020-10-19||2021 ICD-10-PCS COVID-19 UPDATE
In response to the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) is implementing 12 new procedure codes to describe the introduction or infusion of therapeutics into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective August 01, 2020.
|LOINC||Provisional_2021-03-29||LOINC Prerelease Terms, Special Use Codes Only
A new version of LOINC (2.69) was released by Regenstrief in December, 2020. LOINC 2.69 includes Prerelease Terms created up through December 15, 2020. Any LOINC Prerelease Terms created by LOINC after December 15, 2020 will remain available in VSAC as provisional codes until the next version of LOINC is published in mid-2021, at which point the provisional codes will likely become official codes of the upcoming LOINC release.
|SNOMED CT||Provisional_2021-04-23||Pre-Release COVID-19 Related Content
The SNOMED CT COVID-19 related content below will be available in the July 2021 International Edition of SNOMED CT. Because VSAC hosts only the SNOMED CT US Edition, and not the international edition, these pre-release codes will continue in VSAC as provisional codes until the SNOMED CT US Edition is published in September, 2021, at which point the provisional codes will likely become official codes of the SNOMED CT US Edition.
*The “VSAC Code System Version” designation is a VSAC-created element based on the VSAC acquisition date of the provisional codes. Each provisional code system version contains all provisional codes, cumulatively, until the terminology incorporates their provisional codes into a formal release.
Be aware that downstream users may not be ready to handle prerelease codes until they are published in an official terminology release.
How to Include Provisional Codes in Your Value Set Definitions and Expansions(authoring permissions are a prerequisite)
- Find the provisional codes you want to include in your value set definition and expansion using one of the following methods:
- Query by specific code
- Search all codes then filter the Latest Code Status column by "Active/Provisional"
- Browse Code Systems: select "Code System", select "Code System Version" (Provisional), click Search
- Query by specific code
- Save your value set (author action), and then Submit it to your steward (author action) and Approve it as well (steward action). It is critical that the steward Approves the value set for publication.
This step creates an automatically updated “Latest” published value set expansion calculated with the default “Most Recent Code System Versions in VSAC” expansion profile. VSAC includes provisional code system versions within the “Most Recent Code System Versions in VSAC” default expansion profile calculation.
The major benefit to this “Approve-only” method is that you can use the value set’s consistent “Latest” URL on web pages. This “Latest” URL will always be constant so you will not have to update the URL on your web pages or applications when VSAC performs automatic terminology updates. This ensures that your users always connect to your current value set expansion (code list) as the terminologies update and promote their provisional codes to official codes in official terminology releases. Here is an example of a “Latest” expansion URL: https://vsac.nlm.nih.gov/valueset/2.16.840.1.1137184.108.40.2064.9/expansion/Latest
- If you wish to keep a specific "steward expansion" static expanded code list, in addition to your automatically VSAC-updated "Latest" version, navigate to the Expansion/Publication tab.
CAUTION: We recommend you do not perform a "Steward Expansion" using this Expand/Publish step when you create value sets that include provisional codes, because your steward expansion will not benefit from the "Latest" automatic update when the provisional codes become official in their terminology, and the provisional codes will no longer be current in your static public value set steward expansion. If your organization or application requires you to perform a "Steward Expansion" using the Expand/Publish step, you must remain aware of official terminology releases and update your steward expansion manually as soon as the terminology incorporates the provisional codes in an official release that VSAC includes. The URLs for manually updated steward expansions change every time the author and steward update the definition and perform a new steward expansion. Here is an example of a steward expansion URL: https://vsac.nlm.nih.gov/valueset/2.16.840.1.1137220.127.116.114.9/expansion/20200528
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Last Reviewed: May 7, 2021