Qualifiers for diagnoses

@akanter and all, sorry, this question may be already covered elsewhere, but I am wondering how, if at all, qualifiers (e.g. mild, medium, severe) can be used with particular diagnoses (e.g. Traumatic Brain Injury (TBI)). In the case of TBI, for example, what is the best way to record TBI mild vs TBI moderate vs TBI severe at the diagnosis level. Have 3 separate CIEL #s, one for each, or use the existing CIEL# for TBI and add qualifiers (mild, moderate, severe)? Or is there a 3rd alternative?

For background, we are using this definition summarized in UpToDate for this use case: “TBI has traditionally been classified using injury severity scores; the most commonly used is the Glasgow Coma Scale. A GCS score of 13 to 15 is considered mild injury, 9 to 12 is considered moderate injury, and 8 or less is considered severe TBI.”

Thanks! Steve

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This is a great question. In many cases it makes sense to use a combination of codes to describe the course of a particular disease or treatment. However, in general, if the qualifiers are important to prognosis, or clinical decision support, it is much hard to post-coordinate the terms. I would recommend creating pre-coordinated disease concepts and am happy to do so.