Mapping Korean National Health Insurance Reimbursement Claim Codes for Therapeu- tic and Surgical Procedures to SNOMED-CT to Facilitate Data Reuse...18th World Congress of Medical and Health Informatics, MedInfo 2021 - One World, One Health – Global Partnership for Digital Innovation, 2-4 October, 2021.

South Korea has a public and single-payer system for healthcare services based on fee-for-service payments. The National Health Insurance (NHI) reimbursement claim codes are used by all healthcare providers for reimbursement. This study mapped NHI reimbursement claim codes for therapeutic and surgic...

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Publicado en:Studies in Health Technology & Informatics Vol. 290; pp. 101 - 106
Autores principales: Hannah Kang, Hyeoun-Ae Park
Formato: algorithm proceedings research tables/charts Journal Article
Publicado: Sage Publications Inc. 2022
Acceso en línea:Ver este registro en EBSCOhost
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      dt: 2022
      vid: 290
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      pub: Sage Publications Inc.
      place: Thousand Oaks, California
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        atl: Mapping Korean National Health Insurance Reimbursement Claim Codes for Therapeu- tic and Surgical Procedures to SNOMED-CT to Facilitate Data Reuse...18th World Congress of Medical and Health Informatics, MedInfo 2021 - One World, One Health – Global Partnership for Digital Innovation, 2-4 October, 2021.
      aug:
        au:
          Hannah Kang
          Hyeoun-Ae Park
        affil: College of Nursing, Seoul National University, Seoul, South Korea
      sug:
        subj:
          Insurance, Health, Reimbursement
          Billing and Claims
          Coding
          Therapeutics
          Surgery, Operative
          Snomed
          Congresses and Conferences
          Human
          Single-Payer System
          Semantics
          Specialties, Medical
          South Korea
      ab: South Korea has a public and single-payer system for healthcare services based on fee-for-service payments. The National Health Insurance (NHI) reimbursement claim codes are used by all healthcare providers for reimbursement. This study mapped NHI reimbursement claim codes for therapeutic and surgical procedures to the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to facilitate semantic interoperability and data reuse for research. The Source codes for mapping were 2,500 reimbursement claim codes for therapeutic and surgical procedures such as surgery, endoscopic procedures, and interventional radiology. The target terminology for mapping was the 'Procedure' hierarchy of the international edition of SNOMED-CT released in July 2019. We translated Korean terms into English, clarified their meaning, extracted characteristics of the source codes, and mapped them to pre-coordinated concepts. If a source concept was not mapped to a pre-coordinated concept, we mapped it to a postcoordinated expression. The mapping results were validated internally using dual independent mapping and group discussion by trained terminologists, and by two physicians with experience of SNOMED-CT mapping. Out of 2,500 source codes, 1,298 (51.9%) codes were mapped to pre-coordinated concepts, and 1,202 (48.1%) codes were mapped to post-coordinated expressions. The mapping of the NHI reimbursement claim codes for therapeutic and surgical procedures to SNOMED-CT is expected to support clinical research by facilitating the utilization of health insurance claim data.
      pubtype: Academic Journal
      doctype:
        algorithm
        proceedings
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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