ISDS Annual Conference Proceedings 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution,  
and reproduction in any medium, provided the original work is properly cited.

ISDS 2016 Conference Abstracts

Evaluation of DoD Syndrome Mapping and Baseline 
for ICD-9-CM to ICD-10-CM Transition
Jessica F. Deerin*, Jean-Paul Chretien and Paul E. Lewis
Armed Forces Health Surveillance Branch, Arlington, VA, USA

Objective
The transition from ICD-9-CM to ICD-10-CM requires evaluation 

of syndrome mappings to obtain a baseline for syndromic surveillance 
purposes. Two syndrome mappings are evaluated in this report.

Introduction
The Department of Defense conducts syndromic surveillance 

of health encounter visits of Military Health System (MHS) 
beneficiaries. Providers within the MHS assign up to 10 diagnosis 
codes to each health encounter visit. The diagnosis codes are grouped 
into syndrome and sub-syndrome categories. On October 1, 2015, 
the Health and Human Services-mandated transition from ICD-
9-CM to ICD-10-CM required evaluation of the syndrome mappings 
to establish a baseline of syndrome rates within the DoD. The DoD 
data within the BioSense system currently utilizes DoD ESSENCE 
syndrome mappings. The Master Mapping Reference Table (MMRT) 
was developed by the CDC to translate diagnostic codes across the 
ICD-9-CM and ICD-10-CM encoding systems to prepare for the 
transition. The DoD ESSENCE and MMRT syndrome definitions are 
presented in this analysis for comparison.

Methods
DoD data was pulled from the BioSense Platform through a 

RStudio server on October 11, 2016, querying data from October 
1, 2014 to September 30, 2016. This time period provides twelve 
months of ICD-9-CM data and twelve months of ICD-10-CM data. 
The ICD codes were binned to both DoD ESSENCE syndromes and 
MMRT macro syndromes for comparison. Although a patient visit 
may contain up to 10 ICD codes, only the first four were included 
for this analysis. Providers are trained to prioritize diagnosis codes 
by position. Only 2.2% of visits had greater than 4 diagnostic codes. 
Each ICD code in a visit is binned to an applicable syndrome. The 
total number of visits includes visits that binned and did not bin to 
a syndrome. Multiple syndromes may be assigned to one patient’s 
health encounter visit if multiple ICD codes are binned. Additionally, 
more than one code per visit may bin to the same syndrome; however, 
only unique syndromes are counted in the total syndrome rate. The 
total syndrome rate was calculated by total unique syndrome visits 
as the numerator and total number of visits during the ICD-9-CM or 
ICD-10-CM time period as the denominator. The rates per 1000 total 
visits were calculated.

Results
Among the DoD ESSENCE syndromes, the ICD-9-CM rate  

for ILI was 36.3 per 1,000 compared to the ICD-10-CM rate of  
38.6 per 1,000. The ICD-9-CM rate for neurological was 18.1 per 
1,000 compared to the ICD-10-CM rate of 0.2 per 1,000.

Among the MMRT syndromes, the ICD-9-CM rate for ILI was 
16.7 per 1,000 compared to the ICD-10-CM rate of 38.4 per 1,000. 
The ICD-9-CM rate for mental disorders was 73.8 per 1,000 compared 
to the ICD-10-CM rate of 73.2 per 1,000.

Conclusions
This analysis provides baseline rates of MMRT syndromes and 

sub-syndromes for syndromic surveillance during the ICD-9-CM to 

ICD-10-CM transition. These data will serve for future comparison 
and tracking of syndrome-specific trends for military-relevant health 
threats.

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e1, 2017 
Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e1, 2017 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e16, 2017 



ISDS Annual Conference Proceedings 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution,  
and reproduction in any medium, provided the original work is properly cited.

ISDS 2016 Conference Abstracts

Figure 1. Frequency of visits of DoD ESSENCE syndromes by coding system, 
October 1, 2014 - September 30, 2016

Keywords
syndromic surveillance; syndrome mappings; DoD ESSENCE; 
MMRT

Acknowledgments
The authors thank Devin Hunt for SAS coding assistance.

*Jessica F. Deerin
E-mail: jessica.deerin@gmail.com

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e16, 2017 


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