A Appendix A
CDAR1AIS0005R020V24AIM0005R010
Additional Information Specification 0005: Laboratory Results AttachmentAdditional Information Message 0005:
Laboratory Results Attachment
Release 2.0
Based on HL7 HL7 Version 2.4CDA Standard Release 1.0, Release 1.0
with supporting LOINC® Tables
NPRM CDA Draft #1
December 11July 15, 2003, 2001
© Copyright 2000, 2001, 2002, 2003
Health Level Seven, Inc.
Ann Arbor, MI
Table of Contents
1 Introduction 1
1.1 LOINC Codes and Structure 2
1.2 Revision History 2
1.3 Privacy Concerns in Examples 3
1.4 HL7 Attachment-CDA Document Variants 3
1.5 Request for Information versus Request for Service 3
1.6 Specifying Laboratory Observations 3
1.7 Requirements for Sending Laboratory Results 3
2 Use of the CDA for Laboratory Results 4
2.1 Human-Decision Variant, XML Body 4
2.2 Additional Requirements for the Computer-Decision Variant 5
3 LOINC Codes 6
3.1 Laboratory Results Supporting Documentation 6
3.1.2 Requests for individual results 9
3.1.3 Requests for classes of laboratory test results. 9
3.1.4 Requests for all laboratory tests set 10
3.2 Scope Modification Codes 10
3.3 Coding Example 11
3.1.1 Human-Decision Variant 12
3.1.2 Computer-Decision Variant 16
4 Value Tables for Specific Report Structures 20
5 Response Code Sets 20
5.1 iso+: Extended ISO Units Codes 20
5.2 HL70078: Abnormal Flags 29
5.3 HL70085: HL7 Observation results status. 30
5.4 NPI: National Provider ID 30
1 Introduction 1
1.1 LOINC Codes and Structure 2
1.2 Revision History 2
1.3 Request for Information versus Request for Service 2
1.4 Specifying Laboratory Observations 3
Requirements for Sending Laboratory Results 3
2 HL7 Laboratory Results Message 4
2.1 Additional Information Message Variant Error! Bookmark not defined.
2.2 Use of OBX-11, Observ Result Status 6
3 LOINC Codes 6
3.1 Laboratory Results Supporting Documentation 6
3.1.2 Requests for individual results 8
3.1.3 Requests for classes of laboratory test results. 9
3.1.4 Requests for all laboratory tests set 10
3.2 Scope Modification Codes 10
3.3 Coding Example 11
4 Value Tables for Specific Report Structures 21
5 Response Code Sets 21
5.1 ans+: Extended ANSI Units Codes 21
5.2 C4: CPT-4 30
5.3 HL70070: Specimen Source Codes 30
5.4 HL70085: HL7 Observation results status. 33
5.5 HL70103: Processing ID 33
5.6 HL70163: Administrative Site 34
5.7 HL70103: Processing ID Error! Bookmark not defined.
5.8 I9C: ICD-9-CM Error! Bookmark not defined.
5.9 iso+: Extended ISO Units Codes 35
5.10 NPI: National Provider ID 35
Index of Tables
Table 1.1 Relationship of LOINC Codes, X12N Transactions, and HL7 ORU Message 2
Table 3.1 – LOINC Report Subject Identifier Codes 7
Table 3.3.1- First Battery 11
Table 3.3.2 - Second Battery 11
Table 5.5.1 - Status for an observation. 30
Table 1.1 Relationship of LOINC Codes, X12N Transactions, and HL7 ORU Message 2
Table 2.1 – HL7 ORU message segment Error! Bookmark not defined.
Table 2.2 – Describes the status of the information 6
Table 3.1 – LOINC Report Subject Identifier Codes 7
Table 3.3.1- OBR-4 11
Table 3.3.2 - Second OBR 12
Table 5.3.1 - Specimen Source Codes 31
Table 5.4.1 - Status for an observation contained in an OBX segment. 33
Table 5.6.1 - Administrative Site 34
Table 3.1 is copyright, ( 1995-2001 2003 Regenstrief Institute and the LOINC( Attachment Committee. All rights reserved.
Additional Information Specification 0005:
Laboratory Results AttachmentAdditional Information Message 0005
Laboratory Results Attachment
Release 2.0
Based on HL7 CDA Standard Release 1.0,
with supporting LOINC® Tables
HL7 Version 2.4 Standard, Release 1.0
with supporting LOINC® Tables
Introduction
This publication provides the LOINC[1] code values specific to the laboratory results attachment for the following applications.
• Certain codes will be used in transactions defined by the ASC X12N 277 Implementation Guide (004020X104) Health Care Claim Request for Additional Information and the ASC X12N 275 Implementation Guide (004020X107) Additional Information to Support a Health Care Claim or Encounter which are products of the insurance subcommittee, X12N, of Accredited Standards Committee X12.[2],[3]
• All of the codes may be used in HL7 Clinical Document Architecture (CDA) documents designed for inclusion in the BIN segment of the 275 transaction as described in Health Level Seven (HL7) Implementation Guide: Additional Information Message Implementation Guide[4]
• All of the codes may be used in HL7 ORU messages designed for inclusion in the BIN segment of the 275 transaction as described in Health Level Seven (HL7) Implementation Guide for Additional Information to Support a Healthcare Claim or Encounter.[5]
The format of this document (Is this true?} and the methods used to arrive at its contents are prescribed in the HL7 Implementation Guide. Section 2 of this docuent defines the HL7 CDA variants used for laboratory results attachment data. Section 3 defines the LOINC codes used to request laboratory results attachment data and includes full examples of lab results in the human-decision and computer-decision variants.. Section 4 includes the value tables of LOINC codes specific to the data elements of a laboratory results attachment.
The format of this document and the methods used to arrive at its contents are prescribed in the HL7 Implementation Guide. Section 2 defines the HL7 message variant used for attachment data. Section 3 defines the LOINC codes used to request a laboratory results attachment data. Section 4 includes the value tables of LOINC codes specific to the data elements of a laboratory results attachment. Section 3 presents a fully coded example of a laboratory results attachment.
LOINC codes are copyright 1995-2001 2003 Regenstrief Institute and the LOINC® Committee. All rights reserved.
1 LOINC Codes and Structure
LOINC codes are used for several different purposes in the two X12 transactions and HL7 message that are used to request and provide laboratory results. The table below identifies four specific uses of LOINC codes and describes their use within the messages.
Table 1.1 Relationship of LOINC Codes, X12N Transactions, and HL7 ORU Message
| |X12N 277 |X12N 275 |HL7 ORU |
|Purpose of Message |Request for additional information |Additional information to support a|Provide structured content for X12N|
| |to support a health care claim |health care claim or encounter |275 BIN segment |
|LOINC Modifier Codes|Used in the STC segment to limit |Reiterated in the STC segment |Not used |
| |the time frame or scope of the | | |
| |request | | |
|LOINC Attachment or |Used in the STC segment to identify|Reiterated in the STC segment |Used to define the attachment |
|Element Codes |the attachment or portion thereof | |element being addressedUsed in |
| |being requested | |OBR-4 to define the attachment |
| | | |element being addressed |
|LOINC Answer Part |Not used |Not used |Used to define the value component |
|Codes | | |of the attachment elementUsed in |
| | | |OBX-3 to define the value component|
| | | |of the attachment element |
2 Revision History
|Date |Purpose |
|Sept 30, 1998 |Initial release as separate document. |
|Oct 27, 1998 |Revision based on comments. |
|Nov 11, 1998 |Revise title, citations, and format of tables. |
|Aug 7, 2000 |Update contact information. |
|Oct 2000 |Clarification and technical revisions. |
|May 2001 |Version update, title change, concept clarification, and continuity edits |
|Dec 2001 |Revised title and date; reconciled HL7 ballot |
| |responses |
|Dec 2001 |Revised title and date; reconciled HL7 ballot responses |
|May 2002 |Editing changes requested by the balloters |
|Sept 2002 |Revised LOINC e-mail address, LOINC report subject identifier codes and HL7 message examples |
|July 2003 |Revision for CDA |
3 Privacy Concerns in Examples
The names of natural persons that appear in the examples of this book are intentionally fictional. Any resemblance to actual natural persons, living or deceased, is purely coincidental.
4 HL7 Attachment-CDA Document Variants
As described in the HL7 Implementation Guide, there are two variants of a CDA document when used as an attachment under HIPAA.
• The human-decision variant is used solely for information that will be rendered for a person to look at, in order to make a decision. HL7 provides a non-normative style sheet for this purpose.
• The computer-decision variant has the same content as the human-decision variant, but additional coded and structured information is included so that a computer could provide decision support based on the document. Attachments in the computer-decision variant can be rendered for human decisions using the same style sheet that HL7 provides for rendering documents formatted according to the human-decision variant.
5 Request for Information versus Request for Service
This attachment is a “send-what-you-have” attachment. It is asking for laboratory results that have been produced in the course of the care process. It is not asking for any additional data capture efforts. For example, if the request for data is all Hematology test results, it is not asking the provider to run any specific hematology test procedure, rather it is asking for the provider to send those that happen to have been during the time frame of the request.
6 Specifying Laboratory Observations
When a payer sends a request for supporting documentation, the payor does not have to enumerate every specific test result of interest. LOINC provides codes for large classes of laboratory test results (e.g., chemistry tests) as well as codes for individual test results such as serum potassium concentration. Either kind of code can be used as a subject identifier. As of July 2000, there were more than 22,400 LOINC codes identifying various kinds of lab observations. Whereas most laboratory LOINC codes identify very specific test measurements. The categories (sets) defined in the LOINC Report Subject have sufficient breadth to allow the payer to request a useful subset of laboratory tests with a single code.
The provider will respond to these LOINC class code with the set of individual test results contained within these codes that have been performed on the patient.
7 Requirements for Sending Laboratory Results
Laboratory results are transmitted using the HL7 CDA documentORU message. There are a variety of implementation models for the ORU message in sending lab results. In order to describe a workable set of requirements for the receiving systems, the ORU message variant for lab results in claims attachments imposes a specific set of implementation requirements that limit the information and format variations that may be sent as a claims attachment.
The requirements are:
• The patient must be identified.
• Observations must be fully contained in the transmitted CDA documenttransmitted in a single message, without reference to previous or subsequent messages.
• Only the segments MSH, PID, OBR, and OBX may be used.
• Values may only be sent which are correctly characterized by the Observ result status field, OBX-11.
• If a specimen was taken, but results cannot be obtained, it is acceptable to send X in OBX-11 and the reason that results cannot be obtained in OBX-5. In this case the data type in OBX-2 must be ST or TX.
• Other than an exception alternative described above, the data in OBX-5 must represent the information described by the LOINC code in OBX-3.
• Any data that is sent as a OBX-5 in code must include, in its component 2, the textual interpretation of that code.
• When an observation has a numeric value (rather than a coded or textual value) then an appropriate units of measure should be reported in the units field, OBX-6.
• Antimicrobial susceptibility studies are not covered at this time.
Use of the CDA for Laboratory Results
1 Human-Decision Variant, XML Body
When the provider sends a result using the CDA in the human-decision variant with an XML body, all laboratory results shall be presented in the following way:
• Each battery or other logical grouping shall be sent as a element.
• Each such section shall contain a element identifying the battery.
• The element shall include the producer's name for the battery. For example, if an attachment is being prepared in response to a request for LOINC code 18720-3 (coagulation tests), and the local lab calls the battery that was ordered "pre operative coagulation studies," then the element should include the text "pre operative coagulation studies."
• Where the lab attachment is prepared in response to a 277 message from the payer, the elements for a section should contain a element that echoes the LOINC code received in the 277.
• Each such section shall contain a element. Each rows of this table except the header shall contain the individual observation.
• The columns of the table shall be labeled: Result Name, Result Value, Units, Normal Range, Abnormal Flag and Date/Time.
• A table cell in the Result Name column shall have text that identifies the observation in that row. The table cell may contain a element with the LOINC code that identifies the observation.
• A table cell in the Result Value column shall have the result, which may be a numeric value, a code, a string, or text. If the result is a code, the cell should also include the textual interpretation of the code.
• When an observation has a numeric value (rather than a coded or textual value) then an appropriate units of measure should be reported in the Units column. Where units are not appropriate (for example, for a numerical ratio such as specific gravity) no value shall be used in this column.
• Where the laboratory reported a normal range for an observation the normal range shall be included in the Normal Range column.
• Where the laboratory determined that the reported value is abnormal the Abnormal Flag column shall contain a code drawn from table HL70078.
• The Date/Time columns shall include a text value that conveys the clinically relevant date and time for the observation.
• The data in the Result Value column must represent the information described by the CDA caption for the result. IIf a specimen was taken, but results cannot be obtained, it is acceptable to send X in the Status column and the reason that results cannot be obtained in a comment in the following row.
• Comments that apply to an individual row in the table may appear in a separate element following the element that defines a row of observations. Such comments may describe or explain a result but must not alter the meaning of the result.
• Comments that apply to an entire section may appear as CDA content (paragraphs, list, or tables) before or after the element that conveys the results for the section. Such comments may describe or explain a result but must not alter the meaning of the result.
Note to reviewers: Perhaps the most unusual part of this proposal is not providing the equivalent to OBX-11, the observation status. Instead we propose to let them use a comment field to convey the information if the result specimen was obtained but no result was possible.
2 Additional Requirements for the Computer-Decision Variant
Except as described in this sections, the requirements for Human-Decision Variant shall also be followed for lab results reported using CDA documents in the computer-decision variant. The following requirements supplement or modify the above requirements.
• Each element shall contain a element that includes the LOINC code for the caption of the section or individual observation. Example
urine color
STRAW
1995-10-21T18:38
• The entry in the Result Value column shall be encoded according to the specifications for the computer-decision variant in the Additional Information Message Implementation Guide. For numeric, string, or text data this is not different than the representation that would be used for the human-decision variant.
• Entries in the Units column shall be coded as described for the CE data type in the Additional Information Message Implementation Guide. For example
urine urobilinogen
0.2
0.2-1.0
1995-10-21T18:38
• Entries in the Units column shall be coded as described for the CE data type in the Additional Information Message Implementation Guide. For example
• Non-empty entries in the Abnormal Flag column must appear as the CE data type. For example:
monocytes count
1.6
0.0-0.9
1995-10-21T18:38
• Entries in the Date/Time column shall be encoded as described for the TS data type in the HL7 Additional Information Specification Implementation Guide For example
monocytes count
1.6
0.0-0.9
1995-10-21T18:38
HL7 Laboratory Results Message
All data elements for Textual Report Electronic Attachments are sent using the Laboratory Results Message Variant, described below. It is used to transmit textual and structured information.
3 Use of OBX-11, Observ Result Status
In the provider’s information systems environment, HL7 messages are used to send preliminary, partial, updated, final, and corrected results, and to report that no result will be available for an order, because the specimen was unusable or for other reasons. The values available for this field are designed to support these use cases, and to reflect the status of a result at various points in its life cycle.
The use cases for sending supporting documentation do not support updating a result, once it has been sent the payer. The provider must use this data field to describe the status of the information at the time that it was extracted for transmission to the payer. Accordingly, the following values, which are a subset of HL7 Table 0085, may be used.
Table 2.2 – Describes the status of the information
LOINC Codes
1 Laboratory Results Supporting Documentation
Table 3.1 defines the LOINC code used to request a complete attachment data set specific to laboratory results. The use of this code in the 277 STC segment represents an explicit request for the complete set of data elements relevant to the laboratory results.
The provider is expected toshall return all data elements for which data is available. The minimum attachment data set equates to the required elements; those identified in the value table at Section 4 with a cardinality (Card) of {1,1} (element is required and has one and only one occurrence) or {1,n} (element is required and has one or more occurrences). Those data elements with a cardinality of {0,1} (if available has one and only one occurrence) or {0,n} (if available may have one or more occurrences) should shall be sent if available.
Table 3.1 lists the LOINC codes that represent the current major subclasses of laboratory results. The LOINC database includes a tree structure that links the LOINC term, “all laboratory studies” (LOINC 26436-6), to each of its major subclasses (see Table 3.1) and further links each of these subclassclasses to the LOINC codes for the individual laboratory test observations they contain. Any of the LOINC codes in this hierarchy are valid LOINC report subject codes for the 277-request for supporting documentation message. When a requestor asks for 26436-6 (all laboratory studies (set)), the organization answering that request will return all laboratory results related to a given claim that also satisfy the constraints imposed by the modifier codes submitted in the 277. When a requestor asks for a subclassclass of laboratory tests e.g., coagulation tests (set) (LOINC 18720-3) or chemistry tests (set) (LOINC 18719-5), the organization answering that request would return all coagulation tests or all chemistry tests respectively. When a requestor asks for a single LOINC code (e.g., 2974-1 blood sodium concentrate) the organization returns the test results for that sodium value only.
Table 3.1 – LOINC Report Subject Identifier Codes
|LOINC Code |Report Subject (or Response Specified) |
|26436-6 ALL LABORATORY STUDIES (SET) |
|18716-1 |ALLERGY TESTS (SET) |
|18717-9 |BLOOD BANK TESTS (SET) |
|18767-4 |BLOOD GAS TESTS (SET) |
|18718-7 |CELL MARKER TESTS (SET) |
|18719-5 |CHEMISTRY TESTS (SET) |
|26437-4 |CHEMISTRY CHALLENGE STUDIES |
|18720-3 |COAGULATION TESTS (SET) |
|26438-2 |CYTOLOGY STUDIES (SET) |
|18722-9 |FERTILITY TESTS (SET) |
|18723-7 |HEMATOLOGY TESTS + CELL COUNTS (SET) |
|18724-5 |HLA TESTS (SET) |
|18725-2 |MICROBIOLOGY TESTS (SET) |
|26435-8 |MOLECULAR PATHOLOGY STUDIES (SET) |
|18727-8 |SEROLOGY TESTS (SET) |
|26439-0 |PATHOLOGY REPORTS SECTIONS + STAINS (SET) |
|18721-1 |TOXICOLOGY + THERAPEUTIC DRUG MONITORING TESTS (SET) |
|18729-4 |URINALYSIS STUDIES (SET) |
|Note: The above table does not include antibiotic susceptibilities because they are not covered in this |
|guide. |
|Table 3.1 Copyright 1998-2001 Regenstrief Institute and the LOINC® Attachment Committee. All rights |
|reserved |
Table 3.1 – LOINC Report Subject Identifier CodesTable 3.1 – LOINC Report Subject Identifier Codes shows the two top levels of the laboratory test hierarchy within LOINC. LOINC 26436-6 (all Laboratory Studies) is at the first level and subclassclasses (such as 18719-5 chemistry tests and 18720-3 coagulation tests) are at the second level in the hierarchy. The LOINC codes for the individual tests within a given subclassclass are listed in the LOINC database, but because there are more than 20,000 such LOINC codes they are not listed in this booklet. Users can view the list of LOINC observation contained within any level of the hierarchy through the “HIPAA attachment” task in ™, a PC LOINC browsing program, available at no cost from the Regenstrief Institute. RELMA™ [6], a PC LOINC browsing program, available at no cost from the Regenstrief Institute. (loinc/ - send questions by email to LOINC@.) (loinc/loinc.htm - send questions by email to LOINC@regenstrief.iupui.edu.)
The Regenstrief Institute and LOINC committee will add more refined subclassclasses within the existing major classes as requested by the industry to provide for more precisely targeted laboratory test subsets (for example, thyroid tests). Furthermore, to serve the needs of laboratory reporting, the Regenstrief Institute and the LOINC committee will also continue to add new laboratory LOINC codes as laboratory technology expands and new tests for biomarkers and biochemicals and other laboratory measurements are introduced. These new laboratory codes would be contained within the laboratory hierarchy (LOINC 26436-6) and would also be valid subject identifiers for report identifiers in 277-request messages.
In standard HL7 report messages, these test results are often delivered grouped as batteries of individual observations ordered as a package. This standard reporting structure is also reflected in the HL7 message returned in the 275 to the requestor. The goal is to keep the messages sent in attachments as close as possible to be equivalent messages used in daily care operations.
1. Contents of Laboratory test classes
The content of the laboratory test classes given in Table 3.1 should be obvious from the name. However some of these need more specification.
Microbiology includes all tests used to identify microorganisms and evidence for infection by specific organisms as well as cultures direct microscopic exams that identify organisms or prove evidence for present or past infection with specific organisms. Microbiology includes tests for antibodies, antigens, DNA and RNA. The serology class does not include measures of antibodies or antigens related to microorganisms. And molecular pathology class does not include RNA or DNA based tests for infectious organisms. (They are all included in microbiology.)
The class blood bank includes all blood bank testing including ABO-Rh testing. Allergies include testing to allergens (cat dander, trees, etc). Serology includes rheumatology autoantibodies, and antigen measures not covered by these two classes.
Hematology, as defined, excludes cell counts and differential counts which will be found in cell, differential counts, and coagulation studies, respectively. Measures of complement activity are included within hematology, not chemistry.
Chemistry does not include challenge tests such as Glucose tolerance, ACTH stimulation, etc. These have their own category, chemistry challenge tests.
3.1.2 Requests for individual results
When the LOINC report codes requested in the 277 is an atomic test result (like blood sodium, or prothrombin time-patient) then one OBR and one OBX segment will be returnedonly a single observation row will be returned in the result table in a the 275. The OBX will carry the result for the individual test result requested. OBR-3 will contain the producer’s unique battery instance identifier (which distinguishes among all of the batteries of results produced within the laboratory). OBR-4 component 1 will contain the LOINC code for the individual test that was requested. OBR 4, component 4 may contain the result producer’s battery code, and OBR-4 component five must contain the result producer’s battery name (under which that test result was ordered). This battery name is required to facilitate human review of these results). In these cases, the OBR segment will be followed by one OBX, and the OBR-4 component 1 and the OBX-3 component 1 will contain the same LOINC code (e.g., 2947-0) as shown in Example 1.
Example 1:
MSH|^~\&||||||199808121425||ORU^R01^ORU_R01|Regenstrief0128765419|P|2.4|||NE|NE
PID|||184569||^John^Henry^^Rev||||||11 Elm^Apt 6^Elmo^UT^98365|||||||
OBR|||9527539462010120|2951-2^^LN^^sodium
OBX||NM|2951-2^serum Sodium^LN||140|mmol/L^iso+|||||F|||199810301253
2 Requests for classes of laboratory test results.
When the 277 request for supporting information asks for a LOINC codes that is a class of laboratory observations, the ORU messageCDA document returned will include a series of OBX segments grouped beneath one or more OBR segments one or more sections, each of which has a table that contains one or more result rows using the same general structure that would have been delivered to the hospital or clinic that ordered those tests in the first place. In this case, the OBR-4 component 1 will contain the LOINC code of caption for the section will identify the LOINC parent class to which the first result (the first OBX segment) in that battery belongs. More specifically this will be the parent LOINC code class per the RELMA™ [7] attachment hierarchy of the first OBX in the report batteryrow. So, if the requested LOINC code in the 275 message was 18720-3 (coagulation tests), then 18720-3 coagulation tests would be reported in the caption of the section component 1 of each coagulation test battery returned because 18720-3 is the immediate parent of the first coagulation tests. The producer’s name for each individual battery must be returned placed in OBR-4, component five.the caption. For example, if an attachment is being prepared in response to a request for LOINC code 18720-3 (coagulation tests), and the local lab calls the battery that was ordered "pre operative coagulation studies," then the element should include the text "pre operative coagulation studies."
So, one OBR segment might contain 18720-3^Coagulation tests^LN^COAG275^pre operative coagulation studies.
When the 277 request is for a class of tests, then the returned 275 will often contain multiple OBR segmentssections each with its own following set of OBX segmentstable of results. For example, if the 277 request was for all coagulation tests (LOINC 18720-3), the 275 table might include rows for the prothrombin time patient (LOINC 6301-6) as well as other coagulation studies such as APPT (LOINC 16631-4).
If chemistry tests (LOINC 18719-5) was requested in the 277 message, then the 275 CDA response might include blood sodium, but in this case, the sodium result would be returned under in the section for a battery that also contained other chemistry tests and the 275 response might also include other chemistry test batteries. Because #18719-5 (chemistry tests) is the immediate parent for all chemistry tests, the sodium result (in its OBX segmentwould be a row) would be introduced by in a an OBR segment table that is within a section that has a caption containing #18719-5 (chemistry tests) in OBR-4 component 1.. If the producer’s name for this battery was “electrolytes panel,” it would contain “electrolytes panel” in OBR-4 component fivethe PCDATA for the element. So, the value stored in the OBR-4 field would look like:
18719-5^chemistry tests^LN^Chem1812^electrolyte panel^L
Under this headerWithin this table we would likely see at least four OBX segmentsrows, one for sodium, potassium, chloride and bicarbonate results respectively, because those chemistry tests are often done together in batteries called “electrolytes” as shown in the following example shown in the human-decision variant.
SODIUM
142
mmol/L
135-145
1 Nov 2000 2:25 PM
POTASSIUM
4.0
mmol/L
3.5-4.5
1 Nov 2000 2:25 PM
CHLORIDE
100
mmol/L
95-105
1 Nov 2000 2:25 PM
BICARBONATE
26
mmol/L
22-26
1 Nov 2000 2:25 PM
3 Requests for all laboratory tests set
When the report subject code in the 277 is LOINC 26436-6 “all laboratory tests” the LOINC code or descriptive phraseor descriptive phrase returned in the caption for each section caption for each section will still be the one that is the immediate parent of the LOINC code for the test reported in the first data row of the tablefirst data row of the table, e.g., the code for chemistry tests, hematology tests, or one of the other class codes in Table 3.1 It will not be all laboratory tests because that is not the immediate parent for any OBX level codespecific result. As is true for coagulation tests, we might see more than one battery containing 18719-5 in the OBR-4 component onesection caption, assuming the patient had more than one chemistry battery performed that satisfied the query scope modifiers. Section 3.3 gives a complete example for a patient who had two batteries performed at one encounter.
2 Scope Modification Codes
The LOINC publication LOINC Modifier Codes as used in the ASC X12N 277 Implementation Guide (004020X104) Health Care Claim Request for Additional Information provides code values for further defining the specificity of a request for additional information. Both time window and item selection modifier codes are defined.
3 Coding Example
Scenario: A payer was reviewing a claim for a male patient named Patient H. Sample who was born on 24 September 1932 who was born on 24 September 1932 for an encounter with George F. Carson, MD that occurred on October 2, 1995. The payer sends a 277 requesting information for LOINC codes 26436-6 (all laboratory tests). The request message included modifier codes that restrict the request to the last result for any laboratory test obtained during the relevant encounter.
Assume that patient has had only two test batteries performed during the encounter, a urinalysis and an automated blood count. Assume also that a response message was created on October 22, 1995 at 6:38:00 PM and that the patient's medical record ID at the sending institution is 6910828 and the billing account number for this encounter is 773789090.
The response includes results from the complete urinalysis and an automated blood count that was ordered for the patient. The two batteries are each identified by one OBR segmentn separate sections, and each such segment is followed by a group of OBX segmentssection contains a table carrying the results for thewith a row for each individual measurements that are part of their respective battery.
In the first OBRsection the caption includes the producer's name for the battery, "Urinalysis complete." In the computer-decision variant the producer's name is supplemented with the, the Universal Service ID, has the LOINC code 18729-4 (urinalysis tests) in the element. and the producers name for the test battery as ordered in component 4-6: 3500500^URINALYSIS COMPLETE^L. The OBXs table rows convey the information shown in the following table.
Table 3.3.1- OBR-4First Battery
|LOINC Code |Result name |Result |Units |Normal |Ab-normal |Clinically relevant|
| | |value | |Range |flag |date/time |
|5778-6 |urine color |STRAW | | | |10/2/1995 |
| | | | | | |6:38 PM |
|5767-9 |urine appearance |CLEAR | | | |10/2/1995 |
| | | | | | |6:38 PM |
|5792-7 |urine glucose (test strip) |1+ | |NEG |A |10/2/1995 |
| | | | | | |6:38 PM |
|5770-3 |urine bilirubin (test strip) |NEG | |NEG | |10/2/1995 |
| | | | | | |6:38 PM |
|5797-6 |urine ketones (test strip) |NEG | |NEG | |10/2/1995 |
| | | | | | |6:38 PM |
|5811-5 |urine specific gravity (test strip) |1.007 | |1.005-1.030 | |10/2/1995 |
| | | | | | |6:38 PM |
|5803-2 |urine pH (test strip) |6 | |5.0-8.0 | |10/2/1995 |
| | | | | | |6:38 PM |
|20405-7 |urine urobilinogen |0.2 |mg/dL |0.2-1.0 | |10/2/1995 |
| | | | | | |6:38 PM |
|13945-1 |urine erythrocytes |1 |/(hpf) |0-3 | |10/2/1995 |
| | | | | | |6:38 PM |
In the second OBR section the caption is "Hematology Tests + Cell Counts" and, in the computer-decision variant the element contains (the one that heads up the complete blood count), the Universal Service ID has the LOINC code 18723-7 (Hematology Tests + Cell Counts)18768-2 (cell counts and differential studies). The next three components of this OBR-3 contain the producer’s code and name for the battery as reported locally, i.e. 2010120^AUTO BLOOD CT WITH AUTO DIFF^L. The OBX that follow this OBR contain the following information.
Table 3.3.2 - Second OBRSecond Battery
|LOINC Code |Result name |Result |Units |Normal |Ab-normal |Clinically relevant|
| | |value | |Range |flag |date/time |
|4544-3 |hematocrit |45 | |39-49 | |10/2/1995 |
| | | | | | |6:38 PM |
|789-8 |erythrocytes count |4.94 |10*6/mm3 |4.30-5.90 | |10/2/1995 |
| | | | | | |6:38 PM |
|787-2 |mean corpuscular volume |91 |fl |90-98 | |10/2/1995 |
| | | | | | |6:38 PM |
|777-3 |platelets count |233 |10*3/mm3 |150-450 | |10/2/1995 |
| | | | | | |6:38 PM |
|6690-2 |leukocytes count |25 |10*3/mm3 |3.2-9.8 |H |10/2/1995 |
| | | | | | |6:38 PM |
|770-8 |neutrophils/100 leukocytes |83.1 |% |37.0-80.0 |H |10/2/1995 |
| | | | | | |6:38 PM |
|706-2 |basophils/100 leukocytes |10.1 |% |10.0-50.0 | |10/2/1995 |
| | | | | | |6:38 PM |
|5905-5 |monocytes/100 leukocytes |6.3 |% |0.0-12.0 | |10/2/1995 |
| | | | | | |6:38 PM |
|713-8 |eosinophils/100 leukocytes |0.3 |% |0.0-7.0 | |10/2/1995 |
| | | | | | |6:38 PM |
|706-2 |basophils/100 leukocytes |0.2 |% |0.0-2.0 | |10/2/1995 |
| | | | | | |6:38 PM |
|751-8 |neutrophils count |20.8 |10*3/mm3 |2.0-7.0 |H |10/2/1995 |
| | | | | | |6:38 PM |
|731-0 |lymphocytes count |2.5 |10*3/mm3 |0.6-3.5 | |10/2/1995 |
| | | | | | |6:38 PM |
|742-7 |monocytes count |1.6 |10*3/mm3 |0.0-0.9 |H |10/2/1995 |
| | | | | | |6:38 PM |
|711-2 |eosinophils count |0.08 |10*3/mm3 |0.00-0.70 | |10/2/1995 |
| | | | | | |6:38 PM |
|704-7 |basophils count |0.04 |10*3/mm3 |0.00-0.20 | |10/2/1995 |
| | | | | | |6:38 PM |
The HL7 messageCDA document that will be included within the 275 response message is shown in the following sample messagebelow.
1 Human-Decision Variant
|Document Header | |
|identifies all lab | |
|studies. | |
| | |
|Patient encounter | |
|identified with | |
|provider account | |
|number. | |
|George Carson, MD, | |
|identified as the | |
|provider MD. | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|Patient Identification | |
| | |
|Includes name, date of | |
|birth and gender. | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|Begin Body, first | |
|Section and table | |
|heading. |URINALYSIS COMPLETE |
| | |
| | |
| | |
| |Result name |
| |Result value |
| |Units |
| |Normal Range |
| |Abnormal flag |
| |date/time |
| | |
| | |
|urine color | |
| | |
| |urine color |
| |STRAW |
| | |
| | |
| | |
| |10/2/1995 6:38 PM |
| | |
|urine appearance, with | |
|comment |urine appearanceCLEAR |
| |10/2/1995 6:38 PM |
| | |
| | |
| | |
| |This is a comment that applies to the urine appearance observation. |
| | |
|urine glucose, urine | urine glucose (test strip) |
|bilirubin, urine |1+NEGA |
|ketones, urine pH, |10/2/1995 6:38 PM |
|urine urobilinogen, | |
|urine erythrocytes |urine bilirubin (test strip)NEG |
| |NEG10/2/1995 6:38 PM |
| | |
| |urine ketones (test strip)NEG |
| |NEG10/2/1995 6:38 PM |
| | |
| |urine specific gravity (test strip) |
| |1.0071.005-1.030 |
| |10/2/1995 6:38 PM |
| | |
| |urine pH (test strip)6 |
| |5.0-8.0 |
| |10/2/1995 6:38 PM |
| | |
| |urine urobilinogen0.2 |
| |mg/dL0.2-1.0 |
| |10/2/1995 6:38 PM |
| | |
| |urine erythrocytes1 |
| |/(hpf)0-3 |
| |10/2/1995 6:38 PM |
| | |
| | |
| | |
|Comment that applies to| |
|entire battery. |Comment |
| |This is a comment that applies to the entire urinalysis complete battery. |
| | |
| | |
|Second Battery | |
| |AUTO BLOOD CT WITH AUTO DIFF |
| | |
| | |
| |Result name |
| |Result value |
| |Units |
| |Normal Range |
| |Abnormal flag |
| |date/time |
| | |
| | |
| | |
| |hematocrit45 |
| |39-49 |
| |10/2/1995 6:38 PM |
| | |
| |erythrocytes count |
| |4.9410*6/mm3 |
| |4.30-5.90 |
| |10/2/1995 6:38 PM |
| | |
| |mean corpuscular volume91 |
| |fl90-98 |
| |10/2/1995 6:38 PM |
| | |
| |platelets count |
| |23310*3/mm3 |
| |150-45010/2/1995 6:38 PM |
| | |
| |leukocytes count |
| |2510*3/mm33.2-9.8 |
| |H10/2/1995 6:38 PM |
| | |
| |neutrophils/100 leukocytes |
| |83.1%37.0-80.0 |
| |H10/2/1995 6:38 PM |
| | |
| |basophils/100 leukocytes |
| |10.1%10.0-50.0 |
| |10/2/1995 6:38 PM |
| | |
| |monocytes/100 leukocytes |
| |6.3%0.0-12.0 |
| |10/2/1995 6:38 PM |
| | |
| |eosinophils/100 leukocytes |
| |0.3%0.0-7.0 |
| |10/2/1995 6:38 PM |
| | |
| |basophils/100 leukocytes |
| |0.2%0.0-2.0 |
| |10/2/1995 6:38 PM |
| | |
| |neutrophils count |
| |20.810*3/mm3 |
| |2.0-7.0H |
| |10/2/1995 6:38 PM |
| | |
| |lymphocytes count |
| |2.510*3/mm3 |
| |0.6-3.5 |
| |10/2/1995 6:38 PM |
| | |
| |monocytes count |
| |1.610*3/mm3 |
| |0.0-0.9H |
| |10/2/1995 6:38 PM |
| | |
| |eosinophils count |
| |0.0810*3/mm3 |
| |0.00-0.70 |
| |10/2/1995 6:38 PM |
| | |
| |basophils count |
| |0.0410*3/mm3 |
| |0.00-0.20 |
| |10/2/1995 6:38 PM |
| | |
| | |
| | |
| | |
|Close body and document| |
| | |
2 Computer-Decision Variant
Significant differences when compared to the human-decision variant are shown in boldface.
|Document Header | |
|identifies all lab | |
|studies. | |
| | |
|Patient encounter | |
|identified with | |
|provider account | |
|number. | |
|George Carson, MD, | |
|identified as the | |
|provider MD. | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|Patient Identification | |
| | |
|Includes name, date of | |
|birth and gender. | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|Begin Body, first | |
|Section and table | |
|heading. |URINALYSIS COMPLETE |
| | |
| | |
| | |
| | |
| | |
| |Result name |
| |Result value |
| |Units |
| |Normal Range |
| |Abnormal flag |
| |Date/Time |
| | |
| | |
|urine color | |
| | |
| |urine color |
| | |
| |STRAW |
| | |
| | |
| | |
| | |
| |1995-10-21T18:38 |
| | |
| | |
|urine appearance, urine| urine appearance |
|glucose, urine |CLEAR |
|bilirubin, urine | |
|ketones, urine pH, |1995-10-21T18:38 |
|urine urobilinogen, |urine glucose (test strip) |
|urine erythrocytes | |
| |1+NEG |
| | |
| | |
| | |
| | |
| |1995-10-21T18:38 |
| |urine bilirubin (test strip) |
| |NEGNEG |
| | |
| |1995-10-21T18:38 |
| |urine ketones (test strip) |
| |NEGNEG |
| | |
| |1995-10-21T18:38 |
| |urine specific gravity (test strip) |
| |1.0071.005-1.030 |
| | |
| |1995-10-21T18:38 |
| |urine pH (test strip) |
| |65.0-8.0 |
| | |
| |1995-10-21T18:38 |
| |urine urobilinogen |
| |0.2 |
| | |
| | |
| |0.2-1.0 |
| | |
| |1995-10-21T18:38 |
| |urine erythrocytes |
| |1 |
| | |
| | |
| | |
| |0-3 |
| |1995-10-21T18:38 |
| | |
| | |
| | |
|Second Battery | |
| |Hematology Tests + Cell Counts |
| | |
| | |
| | |
| |Result name |
| |Result value |
| |Units |
| |Normal Range |
| |Abnormal flag |
| |date/time |
| | |
| | |
| |hematocrit |
| |4539-49 |
| | |
| |1995-10-21T18:38 |
| |erythrocytes count |
| |4.94 |
| | |
| |4.30-5.90 |
| |1995-10-21T18:38 |
| |mean corpuscular volume |
| |91 |
| | |
| | |
| |90-98 |
| | |
| |1995-10-21T18:38 |
| |platelets count |
| |233 |
| | |
| | |
| |150-450 |
| | |
| |1995-10-21T18:38 |
| |leukocytes count |
| |25 |
| | |
| | |
| |3.2-9.8 |
| | |
| | |
| | |
| |1995-10-21T18:38 |
| |neutrophils/100 leukocytes |
| |83.1 |
| | |
| | |
| |37.0-80.0 |
| | |
| | |
| | |
| | |
| |1995-10-21T18:38 |
| |basophils/100 leukocytes |
| |10.1 |
| | |
| | |
| |10.0-50.0 |
| | |
| | |
| |1995-10-21T18:38 |
| |monocytes/100 leukocytes |
| |6.3 |
| | |
| | |
| |0.0-12.0 |
| | |
| |1995-10-21T18:38 |
| |eosinophils/100 leukocytes |
| |0.3 |
| | |
| | |
| |0.0-7.0 |
| | |
| |1995-10-21T18:38 |
| |basophils/100 leukocytes |
| |0.2 |
| | |
| | |
| |0.0-2.0 |
| | |
| |1995-10-21T18:38 |
| |neutrophils count |
| |20.8 |
| | |
| |2.0-7.0 |
| | |
| | |
| | |
| | |
| |1995-10-21T18:38 |
| |lymphocytes count |
| |2.5 |
| | |
| | |
| |0.6-3.5 |
| | |
| |1995-10-21T18:38 |
| |monocytes count |
| |1.6 |
| | |
| | |
| | |
| |0.0-0.9 |
| | |
| | |
| | |
| | |
| |1995-10-21T18:38 |
| |eosinophils count |
| |0.08 |
| | |
| | |
| |0.00-0.70 |
| | |
| |1995-10-21T18:38 |
| |basophils count |
| |0.04 |
| | |
| | |
| |0.00-0.20 |
| | |
| |1995-10-21T18:38 |
| | |
| | |
| | |
|Close body and document| |
| | |
MSH|^~\&|LABGL1||DMCRES||19951022183800||ORU^R01^ORU R01|LABGL1199510221838581|P|2.4|||NE|NE
PID|||^^^6910828^Y^C8||Sample^Patient^H|||||||||||||773789090
OBR||UR6164-7^REG_LAB~HOSPITAL||18729-4^URINALYSIS STUDIES (SET) ^LN^3500500^URINALYSIS COMPLETE^L
OBX||TX|5778-6^URINE COLOR^LN||STRAW||||||F|||19951002183800||647
OBX||TX|5767-9^URINE APPEARANCE^LN||CLEAR||||||F|||19951002183800||647
OBX||TX|5792-7^URINE GLUCOSE TEST STRIP^LN||1+||NEG|A|||F|||19951002183800||647
OBX||TX|5770-3^URINE BILIRUBIN TEST STRIP^LN||NEG||NEG||||F|||19951002183800||647
OBX||TX|5797-6^URINE KETONES TEST STRIP^LN||NEG||NEG||||F|||19951002183800||647
OBX||NM|5811-5^URINE SPECIFIC GRAVITY (REFRACTOMETRY) TEST STRIP^LN||1.007||1.005- 1.030||||F|||19951002183800||647
OBX||NM|5803-2^URINE PH TEST STRIP^LN||5.5||5.0-8.0||||F|||19951002183800||647
OBX||TX|20405-7^URINE UROBILINOGEN^LN||0.2|mg/dL|0.2 - 1.0||||F|||19951002183800||647
OBX||NM|13945-1^URINE ERYTHROCYTES (MICROSCOPIC)^LN||1|/(hpf) |0-3||||F|||19951002183800||647
OBR||H7561-2^REG_LAB|9527539462010120|18768-2^CELL COUNTS AND DIFFERENTIAL STUDIES (SET)^LN^2010120^AUTO BLOOD CT WITH AUTO DIFF^L|||19951002180500|||||||19951002182500
OBX||NM|4544-3^HEMATOCRIT (AUTOMATED)^LN||45||39-49||||F|||19951002185800||860
OBX||NM|789-8^ERYTHROCYTES COUNT (AUTOMATED)^LN||4.94|10*12/mm3|4.30-5.90||||F|||
19951002185800||860
OBX||NM|787-2^ERYTHROCYTE MEAN CORPUSCULAR VOLUME (AUTOMATED COUNT)^LN||91|fL|90-98||||F|||19951002185800||860
OBX||NM|777-3^PLATELETS COUNT (AUTOMATED)^LN||233|10*9/mm3|150-450||||F|||
19951002185800||860
OBX||NM|6690-2^LEUKOCYTES COUNT (AUTOMATED)^LN||25|10*9/mm3|3.2-9.8|H|||F|||
19951002185800||860
OBX||NM|770-8^NEUTROPHILS/100 LEUKOCYTES (AUTOMATED)^LN||83.1|%|37.0-80.0|H|||F|||
19951002185800||860
OBX||NM|706-2^BASOPHILS/100 LEUKOCYTES (AUTOMATED)^LN||10.1|%|10.0-50.0||||F|||
19951002185800||860
OBX||NM|5905-5^MONOCYTES/100 LEUKOCYTES (AUTOMATED)^LN||6.3|%|0.0-12.0||||F|||
19951002185800||860
OBX||NM|713-8^EOSINOPHILS/100 LEUKOCYTES (AUTOMATED)^LN||0.3|%|0.0-7.0||||F|||
19951002185800||860
OBX||NM|706-2^BASOPHILS/100 LEUKOCYTES (AUTOMATED)^LN||0.2|%|0.0-2.0||||F|||
19951002185800||860
OBX||NM|751-8^NEUTROPHILS COUNT (AUTOMATED)^LN||20.8|10*9/mm3|2.0-7.0|H|||F|||
19951002185800||860
OBX||NM|731-0^LYMPHOCYTES COUNT (AUTOMATED)^LN||2.5|10*9/mm3|0.6-3.5||||F|||
19951002185800||860
OBX||NM|742-7^MONOCYTES COUNT (AUTOMATED)^LN||1.6|10*9/mm3|0.0-0.9|H|||F|||
19951002185800||860
OBX||NM|711-2^EOSINOPHILS COUNT (AUTOMATED)^LN||0.08|10*9/mm3|0.00-0.70||||F|||
19951002185800||860
OBX||NM|704-7^BASOPHILS COUNT (AUTOMATED)^LN||0.04|10*9/mm3|0.00-0.20||||F|||
19951002185800||860
Value Tables for Specific Report Structures
The set of LOINC codes for laboratory observations is very large. The RELMA HIPAA task can be used to produce reports for all of the elements within the hierarchy as well as the hierarchy of LOINC codes that are described in all of the Attachments booklets.
Response Code Sets
This section describes response codes that may be used in the computer-decision variant in component 3 of OBX-5in the element to transmit a coded result or to send the units for a numerical result. , when OBX-2 indicates a CE data type. These code sets may also be used in component 3 of OBX-6 when OBX-2 indicates a numeric data type and in certain other fields as described in for the HL7 Message Variant in section Error! Reference source not found..
1 iso+: Extended ISO Units Codes
ISO 2955-1983 and extensions as defined in HL7 Version 2.4 Figure 7-13.
|Code/Abbr. |Name |
|/(arb_u) |*1 / arbitrary unit |
|/iu |*1 / international unit |
|/kg |*1 / kilogram |
|/L | 1 / liter |
|1/mL |*1 / milliliter |
|10.L/min |*10 x liter / minute |
|10.L /(min.m2) |*10 x (liter / minute) / meter2 = liter / (minute × meter2) |
|10*3/mm3 |*103 / cubic millimeter (e.g., white blood cell count) |
|10*3/L |*103 / Liter |
|10*3/mL |*103 / milliliter |
|10*6/mm3 |*106 / millimeter3 |
|10*6/L |*106 / Liter |
|10*6/mL |*106 / milliliter |
|10*9/mm3 |*109 / millimeter3 |
|10*9/L |*109 / Liter |
|10*9/mL |*109 / milliliter |
|10*12/L |*1012 / Liter |
|10*3(rbc) |*1000 red blood cells† |
|a/m |Ampere per meter |
|(arb_u) |*Arbitrary unit |
|bar | Bar (pressure; 1 bar = 100 kilopascals) |
|/min | Beats or Other Events Per Minute |
|bq | Becquerel |
|(bdsk_u) |*Bodansky Units |
|(bsa) |*Body surface area |
|(cal) |*Calorie |
|1 |*Catalytic Fraction |
|/L | Cells / Liter |
|cm | Centimeter |
|cm_h20 |* Centimeters of water =H20 (pressure) |
|cm_h20.s/L | Centimeters H20 / (liter / second) = (centimeters H20 × second) / liter (e.g., mean pulmonary |
| |resistance) |
|cm_h20/(s.m) | (Centimeters H20 / second) / meter = centimeters H20 / (second × meter) (e.g., pulmonary pressure |
| |time product) |
|(cfu) |*Colony Forming Units |
|m3/s |Cubic meter per second |
|d | Day |
|db | Decibels |
|dba |*Decibels a Scale |
|cel | Degrees Celsius |
|deg | Degrees of Angle |
|(drop) |Drop |
|10.un.s/cm5 | Dyne × Second / centimeter5 (1 dyne = 10 micronewton = 10 un) (e.g., systemic vascular resistance) |
|10.un.s/(cm5.m2) | ((Dyne × second) / centimeter5) / meter2 = (Dyne × second) / (centimeter5 × meter2) (1 dyne = |
| |10 micronewton = 10 un) (e.g., systemic vascular resistance/body surface area) |
|ev | Electron volts (1 electron volt = 160.217 zeptojoules) |
|eq | Equivalent |
|f | Farad (capacitance) |
|fg | Femtogram |
|fL | Femtoliter |
|fmol | Femtomole |
|/mL |*Fibers / milliliter |
|g | Gram |
|g/d |*Gram / Day |
|g/dL | Gram / Deciliter |
|g/hr | Gram / Hour |
|g/(8.hr) |*Gram / 8 Hour Shift |
|g/kg | Gram / Kilogram (e.g., mass dose of medication per body weight) |
|g/(kg.d) | (Gram / Kilogram) / Day = gram / (kilogram × day) (e.g., mass dose of medication per body weight per |
| |day) |
|g/(kg.hr) | (Gram / Kilogram) / Hour = gram / (kilogram × hour) (e.g., mass dose of medication per body weight |
| |per hour) |
|g/(8.kg.hr) | (Gram / Kilogram) /8 Hour Shift = gram / (kilogram × 8 hour shift) (e.g., mass dose of medication per|
| |body weight per 8 hour shift) |
|g/(kg.min) | (Gram / Kilogram) / Minute = gram / (kilogram × minute) (e.g., mass dose of medication per body |
| |weight per minute) |
|g/L | Gram / Liter |
|g/m2 | Gram / Meter2 (e.g., mass does of medication per body surface area) |
|g/min | Gram / Minute |
|g.m/(hb) | Gram × meter / heart beat (e.g., ventricular stroke work) |
|g.m/((hb).m2) | (Gram × meter/ heartbeat) / meter2 = (gram × meter) / (heartbeat × meter2) |
| |(e.g., ventricular stroke work/body surface area, ventricular stroke work index) |
|g(creat) |*Gram creatinine |
|g(hgb) |*Gram hemoglobin |
|g.m |Gram meter |
|g(tot_nit) |*Gram total nitrogen |
|g(tot_prot) |*Gram total protein |
|g(wet_tis) |*Gram wet weight tissue |
|gy | Grey (absorbed radiation dose) |
|hL | Hectaliter = 102 liter |
|h | Henry |
|in | Inches |
|in_hg | Inches of Mercury (=Hg) |
|iu |*International Unit |
|iu/d |*International Unit / Day |
|iu/hr |*International Unit / Hour |
|iu/kg | International Unit / Kilogram |
|iu/L |*International Unit / Liter |
|iu/mL |*International Unit / Milliliter |
|iu/min |*International Unit / Minute |
|j/L | Joule/liter (e.g., work of breathing) |
|kat |*Katal |
|kat/kg |*Katal / Kilogram |
|kat/L |*Katal / Liter |
|k/watt |Kelvin per watt |
|(kcal) | Kilocalorie (1 kcal = 6.693 kilojoule) |
|(kcal)/d |*Kilocalorie / Day |
|(kcal)/hr |*Kilocalorie / Hour |
|(kcal)/(8.hr) |*Kilocalorie / 8 Hours Shift |
|kg | Kilogram |
|kg(body_wt) |* kilogram body weight |
|kg/m3 |Kilogram per cubic meter |
|kh/h |Kilogram per hour |
|kg/L | Kilogram / liter |
|kg/min |Kilogram per minute |
|kg/mol | Kilogram / mole |
|kg/s | Kilogram / second |
|kg/(s.m2) | (Kilogram / second)/ meter2 = kilogram / (second × meter2) |
|kg/ms |Kilogram per square meter |
|kg.m/s |Kilogram meter per second |
|kpa | Kilopascal (1 mmHg = 0.1333 kilopascals) |
|ks | Kilosecond |
|(ka_u) | King-Armstrong Unit |
|(knk_u) |*Kunkel Units |
|L | Liter |
|L/d |*Liter / Day |
|L/hr | Liter / hour |
|L/(8.hr) |*Liter / 8 hour shift |
|L/kg | Liter / kilogram |
|L/min | Liter / minute |
|L/(min.m2) | (Liter / minute) / meter2 = liter / (minute × meter2) |
| |(e.g., cardiac output/body surface area = cardiac index) |
|L/s | Liter / second (e.g., peak expiratory flow) |
|L.s | Liter / second / second2 = liter × second |
|lm | Lumen |
|lm/m2 | Lumen / Meter2 |
|(mclg_u) |*MacLagan Units |
|mas | Megasecond |
|m | Meter |
|m2 | Meter2 (e.g., body surface area) |
|m/s | Meter / Second |
|m/s2 | Meter / Second2 |
|ueq |*Microequivalents |
|ug | Microgram |
|ug/d | Microgram / Day |
|ug/dL | Microgram / Deciliter |
|ug/g | Microgram / Gram |
|ug/hr |*Microgram / Hour |
|ug(8hr) | Microgram / 8 Hour Shift |
|ug/kg | Microgram / Kilogram |
|ug/(kg.d) | (Microgram / Kilogram) /Day = microgram / (kilogram × day) (e.g., mass dose of medication per patient|
| |body weight per day) |
|ug/(kg.hr) | (Microgram / Kilogram) / Hour = microgram / (kilogram × hours) (e.g., mass dose of medication per |
| |patient body weight per hour) |
|ug/(8.hr.kg) | (Microgram / Kilogram) / 8 hour shift = microgram / (kilogram × 8 hour shift) |
| |(e.g., mass dose of medication per patient body weight per 8 hour shift) |
|ug/(kg.min) | (Microgram / Kilogram) / Minute = microgram / (kilogram × minute) |
| |(e.g., mass dose of medication per patient body weight per minute) |
|ug/L | Microgram / Liter |
|ug/m2 | Microgram / Meter2 (e.g., mass dose of medication per patient body surface area) |
|ug/min | Microgram / Minute |
|uiu |*Micro international unit |
|ukat |*Microkatel |
|um | Micrometer (Micron) |
|umol | Micromole |
|umol/d | Micromole / Day |
|umol/L | Micromole / Liter |
|umol/min | Micromole / Minute |
|us | Microsecond |
|uv | Microvolt |
|mbar | Millibar (1 millibar = 100 pascals) |
|mbar.s/L | Millibar / (liter / second) =(millibar × second) / liter (e.g., expiratory resistance) |
|meq |*Milliequivalent |
|meq/d |*Milliequivalent / Day |
|meq/hr |*Milliequivalent / Hour |
|meq/(8.hr) | Milliequivalent / 8 Hour Shift |
|meq/kg | Milliequivalent / Kilogram (e.g., dose of medication in milliequivalents per patient body weight) |
|meq/(kg.d) | (Milliequivalents / Kilogram) / Day = milliequivalents / (kilogram × day) (e.g., dose of medication |
| |in milliequivalents per patient body weight per day) |
|meq/(kg.hr) | (Milliequivalents / Kilogram) / Hour = milliequivalents / (kilogram × hour) (e.g., dose of |
| |medication in milliequivalents per patient body weight per hour) |
|meq/(8.hr.kg) | (Milliequivalents / Kilogram) / 8 Hour Shift = milliequivalents / (kilogram × 8 hour shift) (e.g., |
| |dose of medication in milliequivalents per patient body weight per 8 hour shift) |
|meq/(kg.min) | (Milliequivalents / Kilogram) / Minute = milliequivalents / (kilogram × minute) (e.g., dose of |
| |medication in milliequivalents per patient body weight per minute) |
|meq/L | Milliequivalent / Liter |
| | Milliequivalent / Meter2 (e.g., dose of medication in milliequivalents per patient body surface area)|
|meq/min | Milliequivalent / Minute |
|mg | Milligram |
|mg/m3 | Milligram / Meter3 |
|mg/d | Milligram / Day |
|mg/dL | Milligram / Deciliter |
|mg/hr | Milligram / Hour |
|mg/(8.hr) | Milligram / 8 Hour shift |
|mg/kg | Milligram / Kilogram |
|mg/(kg.d) | (Milligram / Kilogram) / Day = milligram / (kilogram × day) (e.g., mass dose of medication per |
| |patient body weight per day) |
|mg/(kg.hr) | (Milligram / Kilogram) / Hour = milligram/ (kilogram × hour) (e.g., mass dose of medication per |
| |patient body weight per hour) |
|mg/(8.hr.kg) | (Milligram / Kilogram) /8 Hour Shift = milligram / (kilogram × 8 hour shift) (e.g., mass dose of |
| |medication per patient body weight per 8 hour shift) |
|mg/(kg.min) | (Milligram / Kilogram) / Minute = milligram / (kilogram × minute) (e.g., mass dose of medication per|
| |patient body weight per hour) |
|mg/L | Milligram / Liter |
|mg/m2 | Milligram / Meter2 (e.g., mass dose of medication per patient body surface area) |
|mg/min | Milligram / Minute |
|mL | Milliliter |
|mL/cm_h20 | Milliliter / Centimeters of Water (H20) (e.g., dynamic lung compliance) |
|mL/d |*Milliliter / Day |
|mL/(hb) | Milliliter / Heart Beat (e.g., stroke volume) |
|mL/((hb).m2) | (Milliliter / Heart Beat) / Meter2 = Milliliter / (Heart Beat × Meter2) (e.g., ventricular stroke |
| |volume index) |
|mL/hr |*Milliliter / Hour |
|mL/(8.hr) |*Milliliter / 8 Hour Shift |
|mL/kg | Milliliter / Kilogram (e.g., volume dose of medication or treatment per patient body weight) |
|mL/(kg.d) | (Milliliter / Kilogram) / Day = milliliter / (kilogram × day) (e.g., volume dose of medication or |
| |treatment per patient body weight per day) |
|mL/(kg.hr) | (Milliliter / Kilogram) / Hour = milliliter / (kilogram × hour) (e.g., volume dose of medication or |
| |treatment per patient body weight per hour) |
|mL/(8.hr.kg) | (Milliliter / Kilogram) / 8 Hour Shift = milliliter / (kilogram × 8 hour shift) (e.g., volume dose of|
| |medication or treatment per body weight per 8 hour shift) |
|mL/(kg.min) | (Milliliter / Kilogram) / Minute = milliliter / (kilogram × minute) (e.g., volume dose of medication |
| |or treatment per patient body weight per minute) |
|mL/m2 | Milliliter / Meter2 (e.g., volume of medication or other treatment per patient body surface area) |
|mL/mbar | Milliliter / Millibar (e.g., dynamic lung compliance) |
|mL/min | Milliliter / Minute |
|mL/(min.m2) | (Milliliter / Minute) / Meter2 = milliliter / (minute × meter2) (e.g., milliliters of prescribed |
| |infusion per body surface area; oxygen consumption index) |
|mL/s | Milliliter / Second |
|mm | Millimeter |
|mm(hg) |*Millimeter (HG) (1 mm Hg = 133.322 kilopascals) |
|mm/hr | Millimeter/ Hour |
|mmol/kg | Millimole / Kilogram (e.g., molar dose of medication per patient body weight) |
|mmol/(kg.d) | (Millimole / Kilogram) / Day = millimole / (kilogram × day) (e.g., molar dose of medication per |
| |patient body weight per day) |
|mmol/(kg.hr) | (Millimole / Kilogram) / Hour = millimole / (kilogram × hour) (e.g., molar dose of medication per |
| |patient body weight per hour) |
|mmol/(8.hr.kg) | (Millimole / Kilogram) / 8 Hour Shift = millimole / (kilogram × 8 hour shift) (e.g., molar dose of |
| |medication per patient body weight per 8 hour shift) |
|mmol/(kg.min) | (Millimole / Kilogram) / Minute = millimole / (kilogram × minute) (e.g., molar dose of medication per|
| |patient body weight per minute) |
|mmol/L | Millimole / Liter |
|mmol/hr | Millimole / Hour |
|mmol/(8hr) | Millimole / 8 Hour Shift |
|mmol/min | Millimole / Minute |
|mmol/m2 | Millimole / Meter2 (e.g., molar dose of medication per patient body surface area) |
|mosm/L |*Milliosmole / Liter |
|ms | Milliseconds |
|mv | Millivolts |
|miu/mL |*Milliunit / Milliliter |
|mol/m3 |Mole per cubic meter |
|mol/kg | Mole / Kilogram |
|mol/(kg.s) | (Mole / Kilogram) / Second = mole / (kilogram × second) |
|mol/L | Mole / Liter |
|mol/s | Mole / Second |
|ng | Nanogram |
|ng/d | Nanogram / Day |
|ng/hr |*Nanogram / Hour |
|ng/(8.hr) | Nanogram / 8 Hour shift |
|ng/L | Nanogram / Liter |
|ng/kg | Nanogram / Kilogram (e.g., mass dose of medication per patient body weight) |
|ng/(kg.d) | (Nanogram / Kilogram) / Day = nanogram / (kilogram × day) (e.g., mass dose of medication per patient |
| |body weight per day) |
|ng/(kg.hr) | (Nanogram / Kilogram) / Hour = nanogram / (kilogram × hour) (e.g., mass dose of medication per |
| |patient body weight per hour) |
|ng/(8.hr.kg) | (Nanogram / Kilogram) / 8 Hour Shift = nanogram / (kilogram × 8 hour shift) (e.g., mass dose of |
| |medication per patient body weight per 8 hour shift) |
|ng/(kg.min) | (Nanogram / Kilogram) / Minute = nanogram / (kilogram × minute) (e.g., mass dose of medication per |
| |patient body weight per minute) |
|ng/m2 |Nanogram / Meter2 (e.g., mass dose of medication per patient body surface area) |
|ng/mL |Nanogram / Milliliter |
|ng/min |*Nanogram / Minute |
|ng/s |*Nanogram / Second |
|nkat |*Nanokatel |
|nm |Nanometer |
|nmol/s |Nanomole / Second |
|ns |Nanosecond |
|n |Newton (force) |
|n.s |Newton second |
|(od) |*O.D. (optical density) |
|ohm |Ohm (electrical resistance) |
|ohm.m |Ohm meter |
|osmol |Osmole |
|osmol/kg |Osmole per kilogram |
|osmol/L |Osmole per liter |
|/m3 |*Particles / Meter3 |
|/L |*Particles / Liter |
|/(tot) |*Particles / Total Count |
|(ppb) |*Parts Per Billion |
|(ppm) |*Parts Per Million |
|(ppth) |Parts per thousand |
|(ppt) |Parts per trillion (10^12) |
|pal |Pascal (pressure) |
|/(hpf) |*Per High Power Field |
|(ph) |*pH |
|pa | Picoampere |
|pg | Picogram |
|pg/L | Picogram / Liter |
|pg/mL | Picogram / Milliliter |
|pkat |*Picokatel |
|pm | Picometer |
|pmol |*Picomole |
|ps | Picosecond |
|pt | Picotesla |
|(pu) |*P.U. |
|% |Percent |
|dm2/s2 |Rem (roentgen equivalent man) = 10-2 meter2 / second2 = decimeter2 / second2 Dose of ionizing |
| |radiation equivalent to 1 rad of x-ray or gamma ray) [From Dorland's Medical Dictionary] |
|sec |Seconds of arc |
|sie |Siemens (electrical conductance) |
|sv |Sievert |
|m2/s |Square meter / second |
|cm2/s |Square centimeter / second |
|t |Tesla (magnetic flux density) |
|(td_u) |Todd Unit |
|v |Volt (electric potential difference) |
|1 |Volume Fraction |
|wb |Weber (magnetic flux) |
|*Starred items are not genuine ISO, but do not conflict. |
|†This approach to units is discouraged by IUPAC. We leave them solely for backward compatibility |
2 C4: CPT-4
Procedure coding from American Medical Association, P.O. Box 10946, Chicago IL 60610.
3 HL70078: Abnormal Flags
Code set maintained by Health Level 7 2.3 (Table 0078) giving the flag values used for reporting normalcy of a result. Note: flags for susceptibility do not apply to this specification.
|Value |Description |
|L |Below low normal |
|H |Above high normal |
|LL |Below lower panic limits |
|HH |Above upper panic limits |
|< |Below absolute low-off instrument scale |
|> |Above absolute high-off instrument scale |
|N |Normal (applies to non-numeric results) |
|A |Abnormal (applies to non-numeric results) |
|AA |Very abnormal (applies to non-numeric units, analogous to panic limits for numeric units) |
|null |No range defined, or normal ranges don't apply |
|U |Significant change up |
|D |Significant change down |
|B |Better--use when direction not relevant |
|W |Worse--use when direction not relevant |
|S |Susceptible. Indicates for microbiology susceptibilities only. |
|R |Resistant. Indicates for microbiology susceptibilities only. |
|I |Intermediate. Indicates for microbiology susceptibilities only. |
|MS |Moderately susceptible. Indicates for microbiology susceptibilities only. |
|VS |Very susceptible. Indicates for microbiology susceptibilities only. |
4 HL70070: Specimen Source Codes
Code set maintained by Health Level 7 2.3 (Table 0070) giving the source of a specimen for a test.
Table 5.4.1 - Specimen Source Codes
5 HL70085: HL7 Observation results status.
HL7 table describes the status for an observation contained in an OBX segmenta table row.
There is an inconsistency with the discussion in the text.
Table 5.35.5.1 - Status for an observation contained in an OBX segment.
|Code |HL7 Observation results status. |
|C |At some time prior to sending the information to the payer, a correction was posted to the provider’s |
| |database. This value is the corrected value. |
|R |Results entered -- not verified at the time of transmission to the payer |
|S |Partial results |
|F |Final |
|N |Not observed |
|P |Preliminary |
|X |No result can be obtained for this request/specimen |
6 HL70103: Processing ID
Description of whether HL7 messages represent production, testing, or training transactions.
7 HL70163: Administrative Site
Code set maintained by Health Level 7 giving body sites used for administering medications and taking specimens.
Table 5.7.1 - Administrative Site
8 iso+: Extended ISO Units Codes
ISO 2955-1983 and extensions as defined in HL7 Version 2.4 Figure 7-13.
9 NPI: National Provider ID
The NPI is a proposal to meet HIPAA requirements for a national standard to identify providers. The Secretary DHHS has published a notice of proposed rule making (NPRM) specific to the NPI and the public comment period has closed. An NPI final rule is being drafted and will, at some point, be published in the Federal Register. For more information contact the US Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), 7500 Security Blvd., Baltimore, MD 21244.
Do we need to mention this somewhere in the text?
The HHS Administration web site address is .
-----------------------
[1]LOINC® is a registered trademark of Regenstrief Institute and the LOINC Committee. The LOINC database is copyright 1998-2001 Regenstrief Institute and the LOINC Committee and the LOINC database codes and namesis available at no-cost from . Regenstrief Institute, 1050 Wishard Blvd., Indianapolis, IN 46202
Email: LOINC@regenstrief.iupui.edu
[2]Information on this and other X12N/HIPAA-related implementation guides is available from the Washington Publishing Company, Gaithersburg, MD.
[3] Within this Health Level Seven document, references to the transaction defined by these X12N implementation guides will be abbreviated by calling them 275 and 277.
[4] Health Level Seven, Inc. 3300 Washtenaw Ave., Suite 227, Ann Arbor, MI 48104-4250. ()
[5] Health Level Seven, Inc. 3300 Washtenaw Ave., Suite 227, Ann Arbor, MI 48104-4250.
[6] RELMA is a trademark of Regenstrief Institute
[7] RELMA is a trademark of Regenstrief Institute
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