Vocab. CPT4

CPT4

CPT4 is a coding system for the reimbursement of ambulatory services in the US healthcare system provided by physicians. It represents Level I of the HCPCS system. Note: CPT4 is called Common Procedural Terminology, but it does not only contain medical procedures. CPT4 is copyright by the American Medical Association. Therefore CPT4 is licensed content and cannot be provided directly. The OHDSI vocabulary download contains only bare codes and relationships to actual OHDSI concepts. All additional information can only be retrieved by download using a UMLS account. For this purpose, a Java tool and respective instructions are provided within the vocabulary download.

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.

Transformation

The procedures for transforming Concepts from the source to the OMOP Standard Vocabularies can be found on the OHDSI GitHub.

Concept Names

All Concepts are assigned the longest of all available names.

Concept Code

The 5 letter alphanumeric CPT4 code is used as concept code. Category I codes consist of 5 digits and category II codes of 4 digits and a letter. Hierarchy entries come as a 7 digit code with a '10' as prefix.

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.

Domains

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

Domain	Notes
Procedure
Measurement
Observation
Drug
Visit
Spec Anatomic Site
Device
Meas Value

Concept Classes

Concepts are assigned a respective Concept Class as follows:

Source	Concept Class
CPT4 codes	CPT4
CPT4 modifiers	CPT4 Modifier
CPT4 section and subsection headings	CPT4 Hierarchy

Concept Relationships

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 level 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.

Maps

Initially all valid CPT4 codes are Standard Concepts and therefore map to themselves. Where applicable, concepts are mapped to Standard vocabularies for the respective domains.

Hierarchy

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

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 {Multiple Ingredients / MIN}. 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 example, 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. Thus, these concepts are mapped to CVX vocabulary.

Concept ID	CPT4 Code	Concept Name
2213398	90287	Botulinum antitoxin, equine, any route
2213425	90585	Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use
2213426	90586	Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use
2213427	90632	Hepatitis A vaccine, adult dosage, for intramuscular use
2213428	90633	Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use
2213429	90634	Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use
2213449	90675	Rabies vaccine, for intramuscular use
2213450	90676	Rabies vaccine, for intradermal use

Influenza Vaccines

Influenza A viruses 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 could be provided that takes the administration date into account.

Concept ID	CPT4 Code	Concept Name
43527980	90653	Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use
42742499	90654	Influenza virus vaccine, split virus, preservative-free, for intradermal use
2213437	90655	Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
2213438	90656	Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for
2213439	90657	Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
2213440	90658	Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
2213442	90660	Influenza virus vaccine, trivalent, live, for intranasal use
2213443	90661	Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
2213444	90662	Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
40756887	90664	Influenza virus vaccine, pandemic formulation, live, for intranasal use
40756874	90666	Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
40756960	90667	Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
40757097	90668	Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use
43527981	90672	Influenza virus vaccine, quadrivalent, live, for intranasal use
44816443	90673	Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
44816521	90685	Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
44816520	90686	Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use
44816519	90687	Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
44816518	90688	Influenza 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 ID	CPT4 Code	Concept Name
2213455	90692	Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use
2213456	90693	Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)
2213470	90712	Poliovirus vaccine, (any type[s]) (OPV), live, for oral use
2213495	90749	Unlisted vaccine/toxoid

Instructions for ETL