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RxNorm code mystery

MEL, SQL, Oracle

Last Post by Anonymous 1 second ago

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ronmoses

(@ronmoses)

Posts: 158

Estimable Member

Topic starter

We have a need to report on medications in a similar fashion to the way CQR does it (CMS 164 is a good example). We see many situations where the medication in CPS translates to a patient's QDM data as an RxNorm code and description. In many cases, we can find neither of these values in the Centricity database.

For example, a patient has PLAVIX 75 MG TABS on their med list. This appears in the patient's QDM data as RxNorm 309362, clopidogrel 75 MG Oral Tablet. Clearly there is a translation going on, but we are unable to find it. (This RxNorm code does not appear in DDID_RXNORM.)

We have spent several months trying to trace this linkage through the DDID_RXNORM and MEDINFO tables, and have even investigated the GEMedispan database, but to no avail. Does anyone have an authoritative answer as to how Centricity handles RxNorm codes?

Posted : June 6, 2017 12:00 am

jfitzmd

(@jfitzmd)

Posts: 419

Reputable Member

The generic is identified in the field GENERICMED field of the MEDICATE table.

Posted : June 6, 2017 2:41 am

rwilliams

(@rwilliams)

Posts: 454

Honorable Member

Are you sure you are not looking at an old medication the patient was on?

I show that Plavix 75mg is RXNorm 213169.

Posted : June 6, 2017 2:41 am

ronmoses

(@ronmoses)

Posts: 158

Estimable Member

Topic starter

Genericmed and RxNorm code are two very different things.

Posted : June 6, 2017 10:40 pm

ronmoses

(@ronmoses)

Posts: 158

Estimable Member

Topic starter

I thought the same thing, but CQR's QDM data shows it as 309362, clopidogrel 75 MG Oral Tablet. Definitely the same med, the start date is the same, and that is the generic name for Plavix. So it's doing some kind of translation. Added to that, 213169 does not appear in GE's value set for Measure 164, whereas 309362 does. Very mysterious.

Posted : June 6, 2017 10:43 pm

rwilliams

(@rwilliams)

Posts: 454

Honorable Member

Your comment got me thinking about this. CMS only provides RXNORM codes for generic medications in their measure definitions, even though the brand name medications meet the measures as well.

CQR gets updated via generation of CCDAs which are uploaded to GE. The generated CCDAs use a special CQR web service and the channel does not save the data so it is tough to verify what was sent without changing code in the CQR channel.

What I am able to do is use a more generic web service to generate a CCDA on a patient that has Plavix in their medications list. Doing so runs through all of the GE Data mapping rules just like the CCDAs uploaded to GE. What I found was that the generated CCDA has the Plavix RXNORM code and not the generic RXNORM code.

This leads me to believe that GE has code directly in CQR that replaces RXNORM codes/medications with codes that meet the measures, meaning that you would not have access to this data mapping.

We ran into similar issues when we were writing reports for our reporting to our ACO. We had to lookup ever brand name drug based on the generic RXNORM code and include the brand names in our reports.

Posted : June 7, 2017 2:11 am

ronmoses

(@ronmoses)

Posts: 158

Estimable Member

Topic starter

Well this is interesting. It took quite a bit of sleuthing, I must say. If I run this query against the GEMedispan database, using what we'll call the "CPS RxNorm" of 213169 as our input, the result is the RxNorm value that's shown in CQR...

SELECT
pv.PropertyValue AS [CPS RxNorm],
pv2.PropertyValue AS [CQR RxNorm]
FROM MSC_PV pv
INNER JOIN MSC_CR cr
ON pv.ConceptId = cr.ConceptId
INNER JOIN MSC_A a
ON cr.RoleId = a.Role1RoleId
AND cr.ConceptId = a.Role1ConceptId
INNER JOIN MSC_PV pv2
ON a.Role2ConceptId = pv2.ConceptId
AND pv2.PropertyValue NOT LIKE 'C%'
WHERE pv.PropertyValue = '213169'

I know nothing about this database, but this looks promising. I'm going to try sticking this code into some of my queries to see if it's a reliable way of deriving the CQR RxNorm code.

Posted : June 7, 2017 2:53 am

DavidShower

(@davidshower)

Posts: 1255

Noble Member

It looks like the DDID_RXNORM table is only used for converting incoming medications (like CCD's) to GE's DDID. I suspect they are converting Plavix to its generic for export and that is picking up the generic's RXNORM code for the external system.

Posted : June 7, 2017 3:08 am

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