Example
CapabilityStatement/messagedefinition
(JSON)
Vocabulary
FHIR
Infrastructure
Work
Group
|
Maturity
Level
:
2
N/A
|
Standards
Status
:
Trial
Use
Informative
|
ICD
is
a
family
of
code
systems
maintained
by
WHO
,
with
many
countries
publishing
their
own
variants.
There
are
two
principal
revisions
of
ICD
in
use
-
ICD-10
and
ICD-9
(note
that
while
US
usage
has
recently
updated
to
ICD-10,
there
is
still
a
lot
of
legacy
data
coded
in
ICD-9).
Though
these
can
be
referred
to
as
different
versions
of
ICD,
they
are
entirely
distinct
sets
of
codes,
with
significant
differences
in
organization
and
coding
rules.
Plus,
if
period
('.')
characters
are
disregarded
(as
occurs
in
some
systems),
a
few
of
the
codes
are
overlapping
between
ICD-9
and
ICD-10.
Given
these
considerations,
ICD-9
and
ICD-10
are
represented
as
entirely
separate
code
systems.
The
next
revision,
ICD-11,
is
scheduled
for
release
in
2017.
4.3.11.1
Summary
ICD-10
ICD-9
Source
WHO
or
see
below
Compartments
:
Not
linked
to
any
defined
compartments
|
(
CDC
)
System
http://hl7.org/fhir/sid/icd-10
and
http://hl7.org/fhir/sid/icd-10-[x]
(see
below)
http://hl7.org/fhir/sid/icd-9-cm
OID
2.16.840.1.113883.6.3
2.16.840.1.113883.6.42
Version
The
versioning
convention
and
frequency
may
vary
between
the
various
ICD
revisions
and
variants.
WHO
publishes
a
new
version
of
ICD-10
annually
in
October
(with
minor
updates
annually,
and
major
updates,
if
required,
every
3
years
-
the
versions
are
identified
as
'YYYY',
e.g.
'2016').
The
national
variants
(which
in
some
cases
are
used
multi-nationally)
are
also
typically
published
on
an
annual
basis
(refer
to
the
documentation
for
a
particular
variant
for
details).
Code
Either
an
ICD-10
or
ICD-9
code,
or
a
dual
(multiple)
coding
expression
-
see
below.
ICD
codes
SHALL
be
represented
with
the
period
included,
e.g.
123.4
Display
There
are
no
specific
conventions
required
or
described
for
obtaining
the
complete
display
string
for
use
for
each
code.
Inactive
ICD-9
and
ICD-10
do
not
have
codes
that
are
identified
as
inactive
(although
in
some
cases
previously
included
codes
may
have
been
removed
or
changed
in
meaning
in
subsequent
versions).
Hierarchy
The
tabular
representations
are
organized
with
headings
and
multiple
levels
of
codes
(typically
based
on
the
numbers
of
digits
contained
in
each
code),
but
an
explicit
hierarchy
is
not
defined.
Filter
Properties
None
are
described
yet.
4.3.11.2
ICD-10
variants
-
Narrative
Variants
(other
variants
exist
which
are
not
listed
here):
Germany
http://fhir.de/CodeSystem/dimdi/icd-10-gm
see
HL7
Germany
page
-
XML
Netherlands
http://hl7.org/fhir/sid/icd-10-nl
2.16.840.1.113883.6.3.2
United
States
http://hl7.org/fhir/sid/icd-10-cm
2.16.840.1.113883.6.90
-
JSON
4.3.11.3
Multiple
Coding
-
TTL
4.3.11.3.1
Raw
JSON
Dual
Coding
(“dagger
and
asterisk”
system)
(
canonical
form
For
dual
("two
code",
“dagger
and
asterisk”)
coding
+
also
see
volume
2
ICD-10
Manual
JSON
Format
Specification
),
section
3.1.3
Two
codes
for
certain
conditions
.
In
cases
where
two
codes
are
required,
the
primary
recommendation
for
representing
this
coding
in
FHIR
(in
Coding.code)
is
to
simply
use
the
two
ICD-10
codes
separated
by
a
space,
e.g.
"J21.8
B95.6",
as
the
code
value
(string).
This
is
a
simple
form
of
post-coordination
syntax.
Alternatively,
another
possible
syntax
that
may
be
used
(which
may
be
desirable
or
required
in
some
situations)
is
to
include
the
characters
of
the
dagger
(represented
as
†
or
+)
for
the
primary
code
and
the
asterisk
(*)
for
the
secondary
code
as
part
of
the
post-coordinated
code
value,
e.g.
"J21.8+
B95.6*".
In
either
case,
it
is
recommended
that
the
primary
(+)
code
for
the
underlying
generalized
disease
is
listed
first,
followed
by
the
secondary
(*)
code
for
the
specific
manifestation
in
a
particular
organ
or
site.
)
Dual
coding
in
ICD-10
is
used
for
the
following
(and
potentially
other)
reasons:
Showing
new
message
definition
structure
Coding
for
diagnostic
statements
containing
information
about
both
(1)
an
underlying
generalized
disease
and
(2)
a
manifestation
in
a
particular
organ
or
site
which
is
a
clinical
problem
in
its
own
right.
This
is
referred
to
as
the
"dagger
and
asterisk"
system,
as
it
marks
the
primary
code
for
the
underlying
disease
with
a
dagger
(†)
and
an
optional
additional
code
for
the
manifestation
with
an
asterisk
(*).
Other
optional
dual
coding
(noted
in
the
tabular
representation
as
“Use
additional
code,
if
desired
...”)
For
local
infections,
classifiable
to
the
“body
systems”
chapters,
codes
from
Chapter
I
may
be
added
to
identify
the
infecting
organism,
where
this
information
does
not
appear
in
the
title
of
the
rubric.
For
neoplasms
with
functional
activity.
To
the
code
from
Chapter
II
may
be
added
the
appropriate
code
from
Chapter
IV
to
indicate
the
type
of
functional
activity.
For
neoplasms,
the
morphology
code
from
Volume
1,
although
not
part
of
the
main
ICD,
may
be
added
to
the
Chapter
II
code
to
identify
the
morphological
type
of
the
tumour.
For
conditions
classifiable
to
F00-F09
(Organic,
including
symptomatic,
mental
disorders)
in
Chapter
V,
where
a
code
from
another
chapter
may
be
added
to
indicate
the
cause,
i.e.
the
underlying
disease,
injury
or
other
insult
to
the
brain.
Where
a
condition
is
caused
by
a
toxic
agent,
a
code
from
Chapter
XX
may
be
added
to
identify
that
agent.
Where
two
codes
can
be
used
to
describe
an
injury,
poisoning
or
other
adverse
effect:
a
code
from
Chapter
XIX,
which
describes
the
nature
of
the
injury,
and
a
code
from
Chapter
XX,
which
describes
the
cause.
Dual
Coding
Example:
"Staph
aureus
bronchiolitis"
is
coded
using
ICD-10
codes
J21.8
"Acute
bronchiolitis
due
to
other
specified
organisms"
and
B95.6
"Staphylococcus
aureus
as
the
cause
of
diseases
classified
to
other
chapters"
as:
<coding>
<system value="http://hl7.org/fhir/sid/icd-10"/>
<code value="J21.8 B95.6"/>
</coding>
or,
with
the
+
and
*
characters
included:
<coding>
<system value="http://hl7.org/fhir/sid/icd-10"/>
<code value="J21.8+ B95.6*"/>
</coding>
{
"resourceType" : "CapabilityStatement",
"id" : "messagedefinition",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <h2/>\n <div>\n <p>Sample capability statement showing new MessageDefinition structure</p>\n\n </div>\n </div>"
},
"status" : "draft",
"experimental" : true,
"date" : "2012-01-04",
"publisher" : "ACME Corporation",
"contact" : [{
"name" : "System Administrator",
"telecom" : [{
"system" : "email",
"value" : "wile@acme.org"
}]
}],
"description" : "Sample capability statement showing new MessageDefinition structure",
"kind" : "instance",
"software" : {
"name" : "EHR"
},
"implementation" : {
"description" : "Acme Message endpoint",
"url" : "http://acem.com/fhir/message-drop"
},
"fhirVersion" : "5.0.0-snapshot3",
"format" : ["xml",
"json"],
"messaging" : [{
"endpoint" : [{
"protocol" : {
"system" : "http://hl7.org/fhir/message-transport",
"code" : "mllp"
},
"address" : "mllp:10.1.1.10:9234"
}],
"reliableCache" : 30,
"documentation" : "ADT A08 equivalent for external system notifications",
"supportedMessage" : [{
"mode" : "receiver",
"definition" : "http://hl7.org/fhir/MessageDefinition/example"
}]
}]
}
4.3.11.3.2
Additional
Characters
Some
jurisdictions
(e.g.
Germany)
have
additional
coding
requirements
Usage
note:
every
effort
has
been
made
to
ensure
that
go
beyond
the
dual
coding
“dagger
examples
are
correct
and
asterisk”
coding
approach
(syntax).
In
ICD-10-GM
used
in
Germany
the
!
character
is
used
to
indicate
a
secondary
diagnosis.
Primary
diagnosis
S62.32
-
Fracture
of
shaft
of
metacarpal
bone
Secondary
diagnosis
Z33!
-
Pregnancy
as
a
secondary
diagnosis
The
recommended
syntax
for
representing
these
combinations
of
codes
in
FHIR
(in
Coding.code)
is
to
include
the
additional
(+*!)
characters
when
useful,
but
they
are
present
and
to
separate
the
code
groups
with
a
space,
as:
<coding>
<system value="http://fhir.de/CodeSystem/dimdi/icd-10-gm"/>
<version value="2017"/>
<code value="S62.32 Z33!"/>
</coding>
4.3.11.3.3
Three
or
More
Codes
The
coding
also
may
require
three
or
sometimes
more
codes
for
a
complete
representation
of
the
intended
meaning.
A
further
German
coding
example
(from
the
Deutsche
Kodierrichtlinien
manual)
includes
an
additional
secondary
diagnosis
and
a
monitoring
code.
Additional
secondary
diagnosis
and
monitoring
codes
O09.1!
-
Duration
of
pregnancy
between
5
and
13
weeks
Z34
-
Monitoring
of
a
regular
pregnancy
A
proper
interpretation
of
this
extended
example
is:
"A
patient
is
admitted
to
hospital
due
to
not
a
fracture
of
the
metacarpal
shaft.
Since
she
is
six
weeks
pregnant,
the
pregnancy
and
the
monitoring
normative
part
of
the
pregnancy
are
coded
as
secondary
diagnoses."
The
recommended
FHIR
representation
is:
<coding>
<system value="http://fhir.de/CodeSystem/dimdi/icd-10-gm"/>
<version value="2017"/>
<code value="S62.32 Z33! O09.1! Z34"/>
</coding>
Other
jurisdictions
may
have
similar
needs
for
multiple
coding
but
with
different
specific
coding
requirements.
In
those
cases
local
coding
manuals
and
authorities
should
be
consulted
to
determine
the
recommended
or
expected
syntax
to
use
in
a
FHIR
Coding
instance.
4.3.11.4
Copyright/License
Issues
ICD-10
is
©Copyright
World
Health
Organization
(WHO).
WHO
licenses
its
published
material
widely,
in
order
to
encourage
maximum
use
and
dissemination.
See
Licensing
WHO
classifications
for
details.
The
ICD
variants
have
their
own
separate
copyright
and
licensing
(refer
to
the
documentation
for
the
particular
variant
for
details).
4.3.11.5
ICD-X
Filter
Properties
No
need
for
filters
identified
yet.
4.3.11.6
Implicit
Value
Sets
No
need
for
implicit
value
sets
identified
yet.
specification.
Conformance
|
Propose
a
change