Procedure code mapping is one of many code set mappings that may need to be completed in order to successfully interface a healthcare provider with an imaging center via the HL7 standard. Procedure mapping has an impact on radiology workflow.
An imaging center has a defined set of procedures they can perform. In their Radiology Information System (RIS), each procedure has its own internal code. For example, a left-side chest x-ray may be coded as 9999. While these codes are standard within the internal RIS, they are not the same procedure codes that external healthcare providers will be sending them. Hospital 1 may have the left-side chest x-ray coded as ‘R777? in their system, and Hospital 2 may have a code of ‘12345?.
Complicating this issue even further is the use of procedure modifiers. A third hospital may have a procedure code of ‘CX123? in their system for a left-side chest x-ray, and they would use the same procedure code in their system when ordering a right side chest x-ray. They would, however, send a procedure modifier value of ‘L’ or ‘R’ as part of their HL7 order message.
The examples below illustrate the format of the OBR segment of an HL7 order message (ORM^O01) that each sending system would send to an imaging center:
Hospital 1:
OBR||0606290001|060629001RAD|R777^Left Side Chest||…Hospital 2:
OBR||0606290001|060629001RAD|12345^Chest X-RAY Left Side|||…Hospital 3:
OBR||0606290001|060629001RAD|CX123^Left Side Chest^^^L|||…
These messages need to be restructured so that the imaging centers RIS can accept them, and create an order for the correct procedure in their system.Imaging Center:
OBR||0606290001|060629001RAD|9999^Left Side Chest X-RAY|||…
This mapping can take place in 1 of 3 instances:
- The mapping can be accomplished using an interface engine.
- The imaging center may require that the external system do the mapping in their system prior to sending the HL7 order messages to them.
- The imaging center may choose to set up the mapping in their RIS for ‘each’ healthcare provider that they interface with.
There are pros and cons to each approach. If you are an imaging center that plans on interfacing via HL7 with a large number of healthcare providers, creating custom mapping for each HL7 interface within your RIS may be possible but, at the very least, extremely time consuming. On the other hand, if you are an imaging center that requires external systems to do their own mapping, you may lose business to more flexible imaging centers that are willing to do the mapping in their system. HL7 integration engines allow you to take the mapping out of the clinical applications, and gives you the ability to create the mapping in a system that is designed specifically for the manipulation and routing of HL7 messages.
Keep in mind that when the report is sent back to the ordering healthcare provider, a similar mapping may have to take place in order to map the procedure code back to the external procedure code value … Receiving the order is only half the battle!
