LAUSR

The Electronic Data Interchange (EDI) medical procedure code is the code used for health insurance claims in Korea. We mapped Korean EDI codes to SNOMED CT to explore the global interoperability of health insurance claims data. We developed rules for mapping based on the mapping guideline provided by SNOMED CT International. The first and second authors mapped 726 EDI codes used to claim reimbursement in five specialty areas to SNOMED CT. Eight subject matter experts reviewed the mapping results. Out of 726 procedure codes, 82.5% were exactly or partially mapped to SNOMED CT. An EDI code was mapped to an average of 2.04 SNOMED CT concepts. Twenty-one attributes were identified in the EDI codes mapped to SNOMED CT concepts. We identified strategies to improve the EDI code in this study. They include introducing hierarchical structures, adding inclusion and exclusion criteria for procedure codes, and improving EDI code labels.