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7.1.2 Narrative reports as batteries with many OBX

Narrative reports from services such as Radiology usually consist of a number of subcomponents (e.g., a chest xray report may consist of a description, an impression, and a recommendation). Other studies, such as echocardiograms, contain analogous components, as well as numeric observations (e.g., left ventricular and diastolic diameter). Surgical pathology reports may contain information about multiple specimens and reports: the anatomic source, the gross description, the microscopic description, and a diagnostic impression for each specimen.

The current standard treats each component of a narrative report as a separate "test" or observation. Just as a CHEM12 is transmitted as an order segment (OBR) plus 12 OBX segments, a chest xray would be transmitted as an order (OBR) segment plus three OBX segments, one for the description, one for the impression, and one for the recommendations. Similarly, an EKG report would be transmitted as an order segment (OBR), two OBX segments for the impression and recommendation, and additional OBX segments for each EKG measurement, e.g. the PR interval, QR interval, QRS axis, and so on.

We have defined code suffixes for constructing observation IDs for the common components of narrative reports (see Figure 7-1). The observation identifier for each such component is obtained by concatenating the observation battery ID (the ID in OBR-4-universal service ID of the preceding OBR from any coding system) with the appropriate suffix. The observation ID for a chest X-ray impression, for example, would be the chest X-ray observation ID (if CPT4, it would be 71020), a subcomponent delimiter, and the suffix, IMP, i.e., 71020&IMP.

This same combining rule applies to other coding systems including local and universal procedural codes (see Chapter 4). For example, if a local code for EKG was E793, and the locally agreed upon designation for that local code was EKG, the impression would be identified as E793&IMP^^99EKG.

Note: The "99EKG" in the 3rd component is included to indicate a local code. The EKG's description, in this case, would be E793&GDT^^99EKG.

Although it is strongly discouraged, the sender and receiver may agree to allow the omission of the observation ID component of a result segment when it is the same as the observation ID of the preceding OBR. In this case, only the ampersand and the suffix would have to be sent, e.g., &IMP or &REC, in OBX-3-observation identifier of a result segment. The full code would be assumed as the test identifier (recorded in the order segment) plus the category identifier recorded in the observation segment.

Figure 7-1. Observation ID suffices

Coded Results

Suffix

Type

Diagnostic Impression

IMP

CE

Recommendation

REC

CE

Confirming Procedures

CNP

CE

Procedure Medication

MED

CE

Anatomic Site

ANT

CE

Device/Instrument

DEV

CE

Serial # Device/Instrument

SER

ST




Bulk Text Reports






Gross Or General Description Of The Study

GDT

TX or FT

Microscopic Or Secondary Description

MDT

TX or FT

Technician's Comment

TCM

TX or FT

Addendum Note

ADT

TX or FT




Other






Diagnosis Onset Date/Time

ITM

TS

Diagnosis Resolution Date/Time

RTM

TS

Comparison Study

CMS

CE

Comparison Date/Time

CMT

TS

Comparison Results

CMR

CE

Comparison Change

CMC

CE

Predicted Value

PRD

ST

Percent Predicted

PPR

ST

After Drug Observed

AFD

ST

Predicted Value After Drug

ADP

ST

Percent Predicted After Drug

APP

ST

Timing Information

TIM

TS

Channel Definition Data

CHN

CD

Waveform Digital Data

WAS

NA or MA

Waveform Annotation

ANO

CE

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