One of our affiliates pointed out that SCTID 32908001 Assessment and interpretation of higher cerebral function (procedure), comprise two procedures, assessment AND interpretation. Do these always go together like an entity in other languages? Or should we request that this concept is split into two?
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Our current editorial guidance allows for some combined procedures:
The potential for an endless number of combined procedures that may be performed in the same encounter requires more stringent criteria for addition. Combined procedures acceptable for precoordination are those that represent multiple individual procedures done in sequence or in combination, related to the same focal condition, and performed within the same encounter. These procedures must be sufficiently defined to be added.
In this particular instance, 32908001 Assessment and interpretation of higher cerebral function (procedure) is a legacy concept that has not been reviewed for conformance to the editorial guidance. We would be interested in hearing from members their opinion on these combined procedures.
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I think many real-world use cases sit in this grey area. For instance, in the Dutch hospital thesaurus of procedures I found 12 concepts for open/laparoscopic repair of some kind of hernia combined with a bowel resection. I assume the bowel resection shares the hernia as focal condition, the procedures are performed in the same surgery - but permitting these has led us to a thesaurus which may have 95% SNOMED coverage, but 60% of those we had to create as new SNOMED concepts in the Dutch extension - where they now pose a problem towards cross-border exchange.
It’s clearly not feasible, or scalable at any rate, to allow these combinations unchecked. But I doubt it’s feasible either to prohibit all combinations: some standard procedures simply involve multiple actions. Making the end user record these as separate elements would not be very user-friendly.
Can we identify procedure groups which should obviously be split? And on the other hand procedure groups which should obviously be allowed as precoordination? Relating to the same focal condition and performed within the same encounter is a start; can we be even more strict? Or should we look toward frequency of use instead?
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I am doing the Authoring 1 course now and just read this:
“The potential for an endless number of combined procedures that may be performed in the same encounter requires more stringent criteria for addition. Combined procedures acceptable for precoordination are those that represent multiple individual procedures done in sequence or in combination, related to the same focal condition, and performed within the same encounter. These procedures must be sufficiently defined to be added.”
So the question seems to be if these two procedures are always combined during the same encounter or could be done during different encounters? And that was exactly the initial query.