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(Editor's note: this is the third part of a three-part series on LOINC, SMOMED, and ICD-10. See 'Related Content' for parts 1 and 2.)
We have journeyed so far down the road of reimbursement in this new world of HITECH Stages 1 and 2, and their friend ACA. Our companions on this journey are LOINC and SNOMED CT.
They have defined the tests we have performed and the results of that focused, detailed work. Only one thing remains; explaining why we performed testing. Think this has nothing to do with the Lab? Perhaps not, but Lab is the gatekeeper. No test may be performed without a "diagnosis code," or ICD.
ICD, the International Classification of Diseases, is a comprehensive list of physical presentations, clinical symptoms, and known diseases. It is the key, and final companion on the road to reimbursement. Like the Tin Man, it's all business and a bit mechanical. In the beginning, ICD was small and very general.
With each growth the number behind the name defines its version. Many healthcare organizations and providers are currently using ICD-9 and facing the required advancement to ICD-10. Is there really a difference? Oh yes! Our rusty old Tin Man is about to leap forward to become sleek, shiny and almost a real man. The current ICD-9 contains approximately 18,000 codes.
 The new ICD-10 contains more than 140,000. Can there really be that many different clinical presentations, symptoms, or diseases? Flipping through the index is fascinating and somewhat humorous. Who would have thought we'd need the code, W5922XA, "Injury from being struck by a turtle for the first time"? There must also be another code for "Injury from being struck by a turtle for a second time", but I have yet to locate it. Who says interoperability coding is boring and without humor? But we digress.
Up to this point in our journey, LOINC has coded the testing method and basic results. SNOMED has coded the more complex test results. Now ICD brings it home with the reason for the testing. In the Oz of interoperability coding, the order arrives out of thin air as a binary message decoded by our Lab Information System (LIS). It instructs and informs us what testing to perform and why. Upon completion of the testing, the LIS applies the codes we have defined and entered to the test results.
The whole package of information is bundled and shipped out to the EMR/EHR (Electronic Medical/Health Record), and out to the HIE (Health Information Exchange) where it will sit in wait for someone to request it. At that time, it is transmitted to its new home in a second EMR/EHR. In the time it took for you to read the description, the whole process has happened.
Once upon a time, not so long ago, we would travel far and wide carrying most of our basic needs with us. Our luggage was packed with clothes and other personal items needed for the trip, except our critical health information. It remained behind. If we were injured during the trip, all our personal health information was locked away on pieces of paper scattered about and not easily retrieved. ARRA HITECH and ACA have created the requirement for all that information be electronic, portable, and available in real time.
To accomplish this task, interoperability coding standardizes our language and understanding. The concept is not new or foreign. Most European countries have been using this model for nearly a decade. It is as strange as Oz to the USA. However, like Dorothy, we have companions who are there to help us navigate the road of interoperability and reach the safe home of reimbursement for services.
Since the draft of this article and completion of her LOINC/SNOMED CT coding project, Baker has joined BITAC MAP SL as the Head of USA Business Development in addition to her duties as the Laboratory Operations Manager of St Peter's Hospital in Helena, Montana, and her other professional activities. She did so out of a desire to share with others the alternatives to struggling through this process alone.
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