For allergy observation NDFRT and UNII productCoded should RXCUI "integrated" in RxNorm be used?

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    • Type: Terminology
    • Resolution: Answered
    • Priority: Major
    • Component/s: Guidance
    • None
    • George Robinson
    • 3175717390
    • FDB
    • Guidance for proper population of AllergyObservation QRDA productCoded
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      The MU value sets currently do not include medication class concepts, but as is noted in the question, the expectation is to use NDFRT concepts to identify these classes. Even though ONC has stated that RXNORM is the preferred code system for reactants, it has become clear that for drug classes, the proper code system identifier to the expected NDFRT concepts is the NDFRT NUI (NDFRT Unique Identifier) and the NDFRT code system OID. Therefore your option 2 is preferred.
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      The MU value sets currently do not include medication class concepts, but as is noted in the question, the expectation is to use NDFRT concepts to identify these classes. Even though ONC has stated that RXNORM is the preferred code system for reactants, it has become clear that for drug classes, the proper code system identifier to the expected NDFRT concepts is the NDFRT NUI (NDFRT Unique Identifier) and the NDFRT code system OID. Therefore your option 2 is preferred.

      I’m seeking clarification on a debate regarding compilation of the “productCoded” element of the Allergy Observation when the source of the code which has been “integrated” within RxNorm spans FDA UNII (SAB = MTHSPL) or NDFRT on the behalf of one of our customers. One side supports use of the RXCUI, regardless of the code’s source (in keeping with ONC medication allergy constraint of "RxNorm for Medication Allergy", the other side supports use of the RXCUI only when the code spans the source vocabulary of RxNorm (more in keeping with HL7 C-CDA and QRDA specifications). FDB provides both the external code and the RXCUI to our customers within our cross-references.

      Here are a couple of examples:

      Patient drug allergy is to “amoxicillin”… amoxicillin spans the RxNorm precise ingredient “Amoxicillin”… I would expect this representation of the productCoded:

      <code code=”723” displayName = “Amoxicillin”
      codeSystem=2.16.840.1.113883.6.88” codesystemName = “NLM RxNorm”>
      <translation code = “3675” displayName = “Amoxicillin”
      codeSystem = “2.16.840.1.113883.4.65” codesystemName = “FDB Hierarchical Ingredient Code Sequence Number (HIC_SEQN)”
      </code>

      Patient drug allergy is to “Penicillins” … spanning NDFRT N0000011281 “Penicillins” which is integrated in RxNorm with RXCUI 7986

      Option 1 – Use RXCUI assigned to the NDFRT Code

      <code code=”7986” displayName = “Penicillins”
      codeSystem=2.16.840.1.113883.6.88” codesystemName = “NLM RxNorm”>
      <translation code = “476” displayName = “Penicillins”
      codeSystem = “2.16.840.1.113883.4.296” codesystemName = “FDB Specific Allergen Group Code (DAM_ALRGN_GRP)”
      </code>

      Option 2 – use the NDFRT Code and NDFRT OID, as the code does not span an RXNORM value with a SAB (source vocabulary) of “RXNORM

      <code code=”N0000011281” displayName = “Penicillins”
      codeSystem=2.16.840.1.113883.3.26.1.5” codesystemName = “VA NDF-RT”>
      <translation code = “476” displayName = “Penicillins”
      codeSystem = “2.16.840.1.113883.4.296” codesystemName = “FDB Specific Allergen Group Code (DAM_ALRGN_GRP)”
      </code>

      For the Penicillins example, which method is more consistent with ONC/CMS intent? Secondly, would the first option fail NIST validation?

            Assignee:
            Rob McClure
            Reporter:
            George Robinson (Inactive)
            Duc Nguyen (Inactive), Kevin Larsen (Inactive), Maria Michaels (Inactive), Steve Emrick (Inactive)
            Votes:
            1 Vote for this issue
            Watchers:
            6 Start watching this issue

              Created:
              Updated:
              Resolved: