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documentation:vocabulary:cpt4

CPT4

CPT4 is a coding system for the reimbursement of ambulatory services in the US healthcare system. Note: CPT4 is called Common Procedural Terminology, but it does not just contain medical procedures.

Sources

All CPT4 codes are sourced from the NLM, as are maps from MeSH and relationships to LOINC. Relationships to SNOMED and RxNorm (see below for Procedure Drugs) are provided by OHDSI.

Standard Concepts

All valid CPT4 Concepts are Standard Concepts, with the exception of CPT4 section or subsection heading codes (CPT4 Hierarchy Concepts), which are Classification Concepts.

Concept Classes

Concepts are assigned Concept Class as following:

SourceConcept Class
CPT4 codesCPT4
CPT4 modifiersCPT4 Modifier
CPT4 section and subsection headingsCPT4 Hierarchy

Domains

Domains are manually assigned to CPT4 Hierarchy Concepts and propagated down to the CPT4 Concepts.

Relationships, Hierarchy

Relationships are defined within CPT4 and to the following other vocabularies:

Internal CPT4 relationships

  1. There are “Is a” relationships from CPT4 Concepts and CPT4 Modifier Concepts to CPT4 Hierarchy Concepts
  2. There are “Is a” relationships amongst CPT4 Hierarchy Concepts
  3. There are “Is a” relationships between CPT4 Concepts that refer to other CPT4 Concepts. These relationships are very few.

CPT4 to LOINC relationships

These relationships are defined as “CPT4 - LOINC eq”. Note that these relationships are currently defined for drug (pharmaceutical ingredient, not illicit drug) testing procedures.

CPT4 to SNOMED relationships

These relationships are defined as “CPT4 - SNOMED cat” and “CPT4 - SNOMED eq” for categorical (“uphill”) and equivalent relationships. These relationships embed the CPT4 system in a larger hierarchy for procedures, measurements, observations and devices.

Hierarchy

CPT4 contributes to the hierarchies of the Procedure, Measurement and Observation Domains. SNOMED provides the higher hierarchical concepts, while CPT4 are connected as descendents all the way down to leaf nodes.

Maps

All valid CPT4 codes are Standard Concepts and therefore map to themselves. In addition, there are mappings to RxNorm Drug concepts for Procedure Drugs.

CPT4 to RxNorm map

In CPT4, only vaccinations are recorded in sufficient detail that the administered drug can be inferred. Other Procedure Drugs, such as chemotherapies, are only mentioned as general Procedures, without mentioning any specific Drug Product. The Vaccine Concepts are between concept_code 90281 and 90749. They are also descendants of the CPT4 hierarchical term 1012602 “Vaccines, Toxoids”.

Procedure Drugs are Standard Concepts of the domain_id = “Procedure”. However, for each unambiguously mapped CPT4 Concept there is a record in the CONCEPT_RELATIONSHIP table mapping it to the corresponding RxNorm Concept. Depending on how precisely the CPT4 Concept describes the exact Drug Product, the mapping will attempt pick the most detailed RxNorm entity in the following order of precedence:

  • Branded Drug
  • Branded Drug Form or Branded Drug Component
  • Clinical Drug
  • Clinical Drug Form
  • List of Ingredients. Note that the OMOP Standard Vocabularies currently do not support the notion of Ingredient combinations. Therefore, a single CPT4 Concept will be mapped to all individual Ingredients. The consequence of that is that for each CPT4 record there are as many DRUG_EXPOSURE records as there are Ingredients.

Ambiguous CPT4 Procedure Drug Concepts

The following CPT4 Concepts cannot be unambiguously assigned to RxNorm. The reason is that there is more than one type of Vaccine availabe to immunize against a certain infectious disease, but CPT4 does not distinguish between them. For exampe, for Botulinum Antitoxin, there are human and equine antibodies or sera against the Botulinum Toxin variants A to F, and different combinations of antitoxins are on the market against these variants.

Concept IDCPT4 CodeConcept Name
221339890287Botulinum antitoxin, equine, any route
221342590585Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use
221342690586Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use
221342790632Hepatitis A vaccine, adult dosage, for intramuscular use
221342890633Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use
221342990634Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use
221344990675Rabies vaccine, for intramuscular use
221345090676Rabies vaccine, for intradermal use

Influenza Vaccines

Influenza A virusses are very volatile and each year a new product is developed by the pharmaceutical industry for use during the flu season. That means that the same CPT4 Concept will be mapped to different Drugs dependent on the year. The following table contains all Influenza virus vaccines. At a later point, a mechanism for the correct mapping will be provided here that takes the administration date into account.

Concept IDCPT4 CodeConcept Name
4352798090653Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use
4274249990654Influenza virus vaccine, split virus, preservative-free, for intradermal use
221343790655Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
221343890656Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
221343990657Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
221344090658Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
221344290660Influenza virus vaccine, trivalent, live, for intranasal use
221344390661Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
221344490662Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
4075688790664Influenza virus vaccine, pandemic formulation, live, for intranasal use
4075687490666Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
4075696090667Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
4075709790668Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use
4352798190672Influenza virus vaccine, quadrivalent, live, for intranasal use
4481644390673Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
4481652190685Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
4481652090686Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use
4481651990687Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
4481651890688Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use

CPT4 vaccines that do not correspond to a marketed Drug Product

Certain CPT4 Concepts describe vaccination using a Drug that is not or no longer approved by the FDA and marketed by a manufacturer for general use. Some of them are strictly for military use, some of them have been out of circulation before RxNorm started:

Concept IDCPT4 CodeConcept Name
221345590692Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use
221345690693Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)
221347090712Poliovirus vaccine, (any type[s]) (OPV), live, for oral use
221349590749Unlisted vaccine/toxoid
documentation/vocabulary/cpt4.txt · Last modified: 2015/10/06 16:37 by cgreich