Logical Observation Identifiers Names and Codes (LOINC

)
Users' Guide



Edited by:
Clem McDonald, MD, Stan Huff, MD, Kathy Mercer, Jo Anna Hernandez,
Daniel J. Vreeman, PT, DPT



Please send questions and comments to:

LOINC
c/o Regenstrief Institute, Inc
410 West 10th St. Suite 2000
Indianapolis, IN 46202

or via email:
loinc@regenstrief.org




This and other relevant documents and files are available at
http://loinc.org


List of Files:

Description Format File Name
LOINC table (database) MDB LOINCDB.MDB
LOINC table (database) ASCII LOINCDB.TXT

LOINC Users' Guide PDF LOINCManual.pdf

RELMA Program Setup.exe
RELMA Users Manual PDF RELMAManual.pdf








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Users Guide-December 2010

TableofContents
1 Introduction .......................................................................................................................................... 4
1.1 Successes ......................................................................................................................................................... 4
1.2 What is not part of the name ............................................................................................................................ 5
1.3 Scope of LOINC .............................................................................................................................................. 6
1.4 The LOINC Code Identifier ............................................................................................................................ 7
2 Major Parts of a Test/Observation Name ...................................................................................... 7
2.1.1 Abbreviations in names of component/analyte .......................................................................................................... 8
2.1 General naming conventions ........................................................................................................................... 8
2.1.3 Punctuation in analyte names ................................................................................................................................... 10

.1.4 Case insensitivity ..................................................................................................................................................... 10
2.1.2 General naming rules for the component (analyte) part of the fully specified name. ................................................. 9

.1.5 Roman numerals vs. Arabic numerals ...................................................................................................................... 11

2
2
2.2 Component/analyte (1st part) ........................................................................................................................ 11

2.2.1 Analyte Name (1st subpart) ..................................................................................................................................... 11

.2.3 Adjustments/corrections (3rd subpart) ..................................................................................................................... 17

.2.4 Distinguishing multiple values for any test via the test name (4th subpart) ............................................................. 17
2.2.2 Challenge test (2nd subpart)..................................................................................................................................... 12
2
2
2.3 Kind of Property (also called kind of quantity) (2nd part) ............................................................................ 18
2.4 Time Aspect (Point or moment in time vs. time interval) (3rd part) ............................................................. 21

.4.1 Time Aspect Modifier .............................................................................................................................................. 23

2
2.5 System (Sample) Type (4th part) ................................................................................................................... 24

.5.1 Super system (2nd subpart) ...................................................................................................................................... 26

2.6 Type of Scale (5th part) ................................................................................................................................. 26

2

2.7 Type of Method (6th part) ............................................................................................................................. 28

2.7.1 DNA/RNA probes/measures .................................................................................................................................... 29

2.7.3 Immune Stain ........................................................................................................................................................... 30

2.7.4 Enzyme Immunoassay (EIA) ................................................................................................................................... 30
2.7.2 Immunofluorescence (IF) ......................................................................................................................................... 29
2.7.5 Coagulation .............................................................................................................................................................. 30

2.7.6 Stains ....................................................................................................................................................................... 30

.7.7 Clinical measures ..................................................................................................................................................... 30

.7.8 Imaging studies ........................................................................................................................................................ 30

2
2
2.8 Short Convenient Names ............................................................................................................................... 30
2.9 Long Common Names ................................................................................................................................... 31
2.10 LOINC term names in HL7 messages ......................................................................................................... 31
2.11 Classes ......................................................................................................................................................... 32
3 Special Cases ....................................................................................................................................... 32
.1.1 Value ........................................................................................................................................................................ 32
3.1 Findings viewed as variables or as values ..................................................................................................... 32

.1.2 Variable (Multiple Choice) Approach ...................................................................................................................... 32

3
3
3.2 Blood bank .................................................................................................................................................... 33

.2.1 Panel reporting: ........................................................................................................................................................ 33

ii

.2.2 Multiple answer reporting: ....................................................................................................................................... 34

3
3
3.3 Immunocompetence studies (flow cytometry) .............................................................................................. 34
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Users Guide-December 2010

3.4 General approach to microbiology results ..................................................................................................... 35
3.5 Antimicrobial susceptibilities ........................................................................................................................ 37
3.6 Cell counts ..................................................................................................................................................... 37
3.7 Skin tests........................................................................................................................................................ 38
3.8 Toxicology Drug of Abuse Screening and Confirmation ........................................................................... 38

3.8.1 Toxicology drug groups ........................................................................................................................................... 39

3.8.3 Reporting the method used for screen and confirm .................................................................................................. 41

3.8.4 Individual drug/metabolite test results ..................................................................................................................... 41
3.8.2 Cutoffs ..................................................................................................................................................................... 40
.8.5 Naming issues .......................................................................................................................................................... 42

.8.6 Summary .................................................................................................................................................................. 42

3
3
3.9 Molecular Genetics LOINC Naming ............................................................................................................. 42

3.9.1 Introduction .............................................................................................................................................................. 42

3.9.3 General Molecular genetics naming rules ................................................................................................................ 44

3.9.4 Infectious Diseases ................................................................................................................................................... 45
3.9.2 Terminology............................................................................................................................................................. 43
3.9.5 Genetic Diseases ...................................................................................................................................................... 45

3.9.6 Hematopathology gene re-arrangement. .................................................................................................................. 48

3.9.7 Translocations .......................................................................................................................................................... 48

3.9.8 Identity testing ......................................................................................................................................................... 49

3.9.9 Tumor Relation Tumor Genetics.............................................................................................................................. 50

3.10 Allergy Testing ............................................................................................................................................ 50

4 Clinical observations and measures .................................................................................................. 51
4.1 Introduction ................................................................................................................................................... 51
4.2 Atomic versus molecular (pre-coordinated names) ....................................................................................... 53
4.3 Radiology Reports ......................................................................................................................................... 54

4.3.1 Diagnostic Radiology Reports ................................................................................................................................. 55

4.3.2 Interventional Radiology Reports ............................................................................................................................ 61
5 Tumor registry .................................................................................................................................... 62
6 Claims attachments ............................................................................................................................ 62
7 HL7 LOINC Document Type Vocabulary Domain ......................................................................... 62
7.1 Use of document type codes in HL7 messages .............................................................................................. 62
7.2 Relationship with terminologies .................................................................................................................... 63
7.3 Elements of Document Type codes ............................................................................................................... 64
7.4 Rules for Creating Clinical Notes from Multiple Components ..................................................................... 70
7.5 Future Work .................................................................................................................................................. 71
8 Order Panels (Batteries) .................................................................................................................... 71
8.1 Goals .............................................................................................................................................................. 72
8.2 Reflex tests .................................................................................................................................................... 73
8.3 Calculated or derived results ......................................................................................................................... 73
8.4 Associated observations ................................................................................................................................ 73
iii


8.5 LOINC Rules for representing order panel names ........................................................................................ 73
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9 Evolving principles for naming collections .......................................................................................... 75
9.1 Goals and general approach ........................................................................................................................... 75
9.2 Collections as orders and observations .......................................................................................................... 75
9.3 LOINC SCALE for collections ..................................................................................................................... 76
.4 Examples of proposed changes according to new policy .............................................................................. 76 9
10 Standardized Assessment Measures ................................................................................................... 76
10.1 Introduction ................................................................................................................................................. 77
10.2 Consolidated Health Informatics endorsement ............................................................................................ 77
10.3 LOINC Representation ................................................................................................................................ 77

10.3.1 Naming rules and conventions for survey instrument items in LOINC ................................................................. 77

10.3.2 Structured answer lists ........................................................................................................................................... 78
11 Editorial Policies and Procedures ................................................................................................... 78
11.1 Concept orientation and LOINC name changes .......................................................................................... 78
11.2 Classification of LOINC term status ........................................................................................................... 79
11.3 Concept persistence and term deprecation ................................................................................................... 80
Appendix A - LOINC Database Structure ............................................................................................. 81
Appendix B - Classes ................................................................................................................................ 84
Appendix C - Calculating Mod 10 Check Digits .................................................................................... 90
Appendix D - Procedure for Submitting Additions/Changes to the Database .................................... 91
Appendix E - Examples for LOINC Property Matching ...................................................................... 97
Appendix F - Acronyms used in LOINC .............................................................................................. 101
Appendix G - LOINC Committee Members ........................................................................................ 104

Tables

Table 1: Hierarchical Structure of Fully Specified Analyte Names ........................................................................ 7
Table 2: Example Component Abbreviations ........................................................................................................... 8
Table 3: Example Case Specifying Conventions ..................................................................................................... 11
Table 4: Example Time Delay Post Challenge ........................................................................................................ 12
Table 5: Example Challenge Subparts ..................................................................................................................... 13
Table 6: Example Route Abbreviations for Challenge Part .................................................................................. 14
Table 7: Example Nature of Challenge .................................................................................................................... 15
Table 8: Example LOINC properties ....................................................................................................................... 19
Table 9: Example Duration Categories ................................................................................................................... 23
Table 10: Time Aspect Modifier Codes ................................................................................................................... 23
Table 11: Example Laboratory System/Sample Types .......................................................................................... 25
Table 12: Type of Scale ............................................................................................................................................. 26
Table 13: Examples of Method Abbreviations ........................................................................................................ 28
Table 14A: Examples of specific methods that would be classed as target amplified DNA/RNA ...................... 29
Table 14B: Examples of specific methods that would be defined in LOINC as signal amplification methods . 29
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Table 15: Example Culture Results ......................................................................................................................... 37
Table 16: Drug Susceptibility Methods ................................................................................................................... 37
Table 17: Drug of Abuse Methods............................................................................................................................ 38
Table 18: Three types of nomenclatures for identifying the location of a genetic defect .................................... 44
Table 19: List of single letter amino acid codes ...................................................................................................... 44
Table 20: Subjects covered to date in clinical LOINC ........................................................................................... 52
Table 21: Examples of Pre-Coordinated Names ..................................................................................................... 54
Table 22: Example Clinical Notes ............................................................................................................................ 63
Table 23. Document Ontology LOINC Naming Rules ........................................................................................... 70
Table 24. Example Document Ontology LOINC Codes ......................................................................................... 71
Table 25: Example Order Sets .................................................................................................................................. 71
Table 26: Examples of LOINC Panel Names (Order Set Names) ......................................................................... 74
Table 27: Example of Proposed Changes ................................................................................................................ 76
Table 28: LOINC Database Structure ..................................................................................................................... 81
Table 29: Classes ........................................................................................................................................................ 84
Table 30: Example submission ................................................................................................................................. 92
Table 31a: Access Field Names for Submission ...................................................................................................... 93
Table 31b: Content Added by Regenstrief (Fields left blank in submission) ........... Error! Bookmark not defined.
Table 32: Acronyms used in LOINC ...................................................................................................................... 101


Figures

Figure 1. Submission Created with Microsoft Access 97 ...................................................................................... 93
Figure 2. An Example Excel Submission (first 9 fields only) ................................................................................ 94
Figure 3. Example Submission Using ASCII Tab-Delimited File ......................................................................... 95
Figure 4. The Propose LOINC Form .......................................................................... Error! Bookmark not defined.
Figure 5. The Local Code Section................................................................................ Error! Bookmark not defined.
Figure 6. The Similar LOINC Section ........................................................................ Error! Bookmark not defined.
Figure 7. Propose LOINC form showing Analyte textbox dropped down ........... Error! Bookmark not defined.
Figure 8. Propose LOINC form showing System textbox dropped up ................ Error! Bookmark not defined.
Figure 9. Providing comments ..................................................................................... Error! Bookmark not defined.
Figure 10. Example answers (sample results) ............................................................ Error! Bookmark not defined.
Figure 11. The Answer List Dialog .............................................................................. Error! Bookmark not defined.
Figure 12. Defining a new answer list ......................................................................... Error! Bookmark not defined.
Figure 13. Highlighting an existing LOINC before proposing a new one ................ Error! Bookmark not defined.
Figure 14. Proposing a LOINC based on an existing one. ......................................... Error! Bookmark not defined.
Figure 15. Review Proposed LOINCs Form ............................................................... Error! Bookmark not defined.
Figure 16. Selecting terms the user desires to submit ................................................ Error! Bookmark not defined.
Figure 17. Windows Common Dialog box used to create LOINC submission files Error! Bookmark not defined.
Figure 18. Message displayed after submission file has been created ...................... Error! Bookmark not defined.
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Copyright Notice and License

The LOINC codes, LOINC table (regardless of format), LOINC Release Notes, LOINC Changes
File, and LOINC Users' Guide are copyright 1995-2010, Regenstrief Institute, Inc. and the Logical
Observation Identifiers Names and Codes (LOINC) Committee. All rights reserved.

The RELMA program, RELMA database and associated search index files (subject to the copyright
above with respect to the LOINC codes and LOINC table included therein), RELMA Release Notes,
and RELMA Users' Manual are copyright 1995-2010, Regenstrief Institute, Inc. All rights reserved.

The LOINC panels and forms file and the LOINC hierarchies file (subject to the copyright above with
respect to the LOINC codes and LOINC table to the extent included in the LOINC panels and forms
file and the LOINC hierarchies file), are copyright 1995-2010, Regenstrief Institute, Inc. All rights
reserved.

LOINC and RELMA are registered United States trademarks of Regenstrief Institute, Inc.

Permission is hereby granted in perpetuity, without payment of license fees or royalties, to use, copy, or
distribute the RELMA program, RELMA Users' Manual, RELMA Release Notes, RELMA
database and associated search index files, LOINC codes, LOINC Users' Guide, LOINC table (in all
formats in which it is distributed by Regenstrief Institute, Inc. and the LOINC Committee), LOINC
Release Notes, LOINC Changes File, LOINC panels and forms file, and LOINC hierarchies file
(collectively, the "Licensed Materials") for any commercial or non-commercial purpose, subject to the
following terms and conditions:

1) To prevent the dilution of the purpose of the LOINC codes and LOINC table of
providing a definitive standard for identifying clinical information in electronic reports, users
shall not use any of the Licensed Materials for the purpose of developing or promulgating a
different standard for identifying patient observations, such as laboratory test results; other
diagnostic service test results; clinical observations and measurements; reports produced by
clinicians and diagnostic services about patients; panels, forms and collections that define
aggregations of these observations; and orders for these entities in electronic reports and
messages.
2) If the user elects to utilize the RELMA program, users receive the full RELMA
database and associated search index files with the RELMA program, including the LOINC table
and other database tables comprising the RELMA database. In addition to its use with the
RELMA program, users may use the LOINC table by itself and may modify the LOINC table as
permitted herein. Users may not use or modify the other database tables from the RELMA
database or the associated search index files except in conjunction with their authorized use of
the RELMA program, unless prior written permission is granted by the Regenstrief Institute, Inc.
To request written permission, please contact loinc@regenstrief.org.
3) Users shall not change the meaning of any of the LOINC codes. Users shall not
change the name of, or any contents of, any fields in the LOINC table. Users may add new fields
to the LOINC table to attach additional information to existing LOINC records. Users shall not
change the content or structure of the LOINC panels and forms from the LOINC panels and
forms file, but may notify the Regenstrief Institute of any potential inconsistencies or corrections
needed by contacting loinc@regenstrief.org.
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4) A user may delete records from the LOINC table to deal with the user's local
requirements. A user also may add new records to the LOINC table to deal with the users' local
requirements, provided that if new records are added, any new entry in the LOINC_NUM field
of such new records must contain a leading alphabetic "X" so that the new codes and records
cannot be confused with existing LOINC codes or new LOINC codes as they are defined in later
releases of the LOINC table. Records deleted or added by users to deal with local requirements
are not reflected in the official LOINC table maintained by the Regenstrief Institute and the
LOINC Committee. Users must also make reasonable efforts to submit requests to LOINC for
new records to cover observations that are not found in the LOINC table in order to minimize the
need for X-codes.
5) LOINC codes and other information from the LOINC table may be used in
electronic messages for laboratory test results and clinical observations such as HL7 ORU
messages, without the need to include this Copyright Notice and License or a reference thereto in
the message (and without the need to include all fields required by Section 7 hereof). When the
LOINC code (from the LOINC_NUM field) is included in the message, users are encouraged,
but not required, to include the corresponding LOINC short name (from the SHORTNAME
field) or the LOINC long common name (from the LONG_COMMON_NAME field) in the
message if the message provides a place for a text name representation of the code.
6) Users may make and distribute an unlimited number of copies of the Licensed
Materials. Each copy thereof must include this Copyright Notice and License, and must include
the appropriate version number of the Licensed Materials if the Licensed Materials have a
version number, or the release date if the Licensed Materials do not have a version number. This
Copyright Notice and License must appear on every printed copy of the LOINC table. Where
the Licensed Materials are distributed on a fixed storage medium (such as diskette or CD-ROM),
a printed copy of this Copyright Notice and License must be included on or with the storage
medium, and a text file containing this information also must be stored on the storage medium in
a file called "license.txt". Where the Licensed Materials are distributed via the Internet, this
Copyright Notice and License must be accessible on the same Internet page from which the
Licensed Materials are available for download. This Copyright Notice and License must appear
verbatim on every electronic or printed copy of the RELMA Users' Manual and the LOINC
Users' Guide. The RELMA Users' Manual and the LOINC Users' Guide may not be modified,
nor may derivative works of the RELMA Users' Manual or LOINC Users' Guide be created,
without the prior written permission of the Regenstrief Institute, Inc. To request written
permission, please contact loinc@regenstrief.org. The Regenstrief Institute retains the right to
approve any modification to, or derivative work of, the RELMA Users' Manual or the LOINC
Users' Guide.
7) Subject to Section 1 and the other restrictions hereof, users may incorporate
portions of the LOINC table, LOINC panels and forms file, and LOINC hierarchies file into
another master term dictionary (e.g. laboratory test definition database), or software program for
distribution outside of the user's corporation or organization, provided that any such master term
dictionary or software program includes the following fields reproduced in their entirety from the
LOINC table: LOINC_NUM, COMPONENT, PROPERTY, TIME_ASPCT, SYSTEM,
SCALE_TYP, METHOD_TYP, STATUS, and SHORTNAME. Users are also required to
either: (1) include the EXTERNAL_COPYRIGHT_NOTICE or (2) delete the rows that include
vii

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third party copyrighted content (e.g., third party survey instruments and answers). If third party
content is included, users are required to comply with any such third party copyright license
terms. Users are encouraged, but not required, to also include the RelatedNames2 and the
LONG_COMMON_NAME in any such database. Further description of these fields is provided
in Appendix A of the LOINC Users' Guide. Every copy of the LOINC table, LOINC panels and
forms file, and/or LOINC hierarchies file incorporated into or distributed in conjunction with
another database or software program must include the following notice:

"This product includes all or a portion of the LOINC table, LOINC panels and forms
file, and/or LOINC hierarchies file, or is derived from one or more of the foregoing,
subject to a license from Regenstrief Institute, Inc. Your use of the LOINC table, LOINC
codes, LOINC panels and forms file, and LOINC hierarchies file also is subject to this
license, a copy of which is available at http://loinc.org/terms-of-use. The current
complete LOINC table, LOINC Users' Guide, LOINC panels and forms file, and LOINC
hierarchies file are available for download at http://loinc.org. The LOINC table and
LOINC codes are copyright 1995-2010, Regenstrief Institute, Inc. and the Logical
Observation Identifiers Names and Codes (LOINC) Committee. The LOINC panels and
forms file and LOINC hierarchies file are copyright 1995-2010, Regenstrief Institute,
Inc. All rights reserved. THE LOINC TABLE (IN ALL FORMATS), LOINC PANELS
AND FORMS FILE, AND LOINC HIERARCHIES ARE PROVIDED "AS IS." ANY
EXPRESS OR IMPLIED WARRANTIES ARE DISCLAIMED, INCLUDING, BUT
NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND
FITNESS FOR A PARTICULAR PURPOSE. LOINC is a registered United States
trademark of Regenstrief Institute, Inc. A small portion of the LOINC table may include
content (e.g., survey instruments) that is subject to copyrights owned by third parties.
Such content has been mapped to LOINC terms under applicable copyright and terms of
use. Notice of such third party copyright and license terms would need to be included if
such content is included."

If the master term dictionary or software program containing the LOINC table, LOINC panels and forms
file, and/or LOINC hierarchies file is distributed with a printed license, this statement must appear in the
printed license. Where the master term dictionary or software program containing the LOINC table,
LOINC panels and forms file, and/or LOINC hierarchies file is distributed on a fixed storage medium, a
text file containing this information also must be stored on the storage medium in a file called
"LOINC_short_license.txt". Where the master term dictionary or software program containing the
LOINC table, LOINC panels and forms file, and/or LOINC hierarchies file is distributed via the Internet,
this information must be accessible on the same Internet page from which the product is available for
download.

8) Use and distribution of the Licensed Materials in ways that are not specifically
discussed herein shall always be accompanied by the notice provided in Section 7 hereof. The
guidelines for providing the notice that are contained in the last paragraph of Section 7 also shall
apply. If a user has a question about whether a particular use of any of the Licensed Materials is
permissible, the user is invited to contact the Regenstrief Institute by e-mail at
loinc@regenstrief.org.
9) If the user desires to translate any of the Licensed Materials into a language other
than English, then user shall notify Regenstrief via email at loinc@regenstrief.org. Any such
viii

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translation is a derivative work, and the user agrees and does hereby assign all right, title and
interest in and to such derivative work: (1) to Regenstrief and the LOINC Committee if the
translation is a derivative of the LOINC codes, LOINC Users' Guide, or LOINC table, and (2) to
Regenstrief if the translation is a derivative work of the RELMA program, LOINC panels and
forms file, LOINC hierarchies file, RELMA Users' Manual, RELMA database or associated
search index files. Further, user shall fully cooperate with Regenstrief in the filing and reviewing
of any copyright applications or other legal documents, and signing any documents (such as
declarations, assignments, affidavits, and the like) that are reasonably necessary to the
preparation of any such copyright application. The assignment granted by this paragraph extends
to all proprietary rights both in the United States, and in all foreign countries. No other right to
create a derivative work of any of the Licensed Materials is hereby granted (except the right to
translate into a language other than English granted in this Section Error! Reference source not
found., and Regenstrief and the LOINC Committee respectively reserve all other rights not
specifically granted herein. All such translations shall be electronically transmitted to
Regenstrief, and such translations shall be made available and are subject to the same license
rights and restrictions contained herein. Regenstrief will give credit on its website (and on
screens in RELMA and in its users guides) to the user and/or entity that did the translation.
10) The Regenstrief Institute, Inc. and the LOINC Committee welcome requests for
new LOINC content (terms, codes or associated material such as text descriptions and
synonyms) and suggestions about revisions to existing content within the Licensed Materials.
Any content submitted in conjunction with such a request is subject to the LOINC Submissions
Policy, which is available at http://loinc.org/submissions-policy.
11) The names "Regenstrief," "Regenstrief Foundation," "Regenstrief Institute," and
"LOINC Committee" may not be used in a way which could be interpreted as an endorsement or
a promotion of any product or service without prior written permission of the Regenstrief
Institute, Inc. Further, no right to use the trademarks of Regenstrief is licensed hereunder. To
request written permission, please contact loinc@regenstrief.org.
12) DISCLAIMER: REGENSTRIEF INSTITUTE, INC. AND THE LOINC
COMMITTEE, AS WELL AS ANY CONTRIBUTORS WHO HAVE PROVIDED
TRANSLATIONS OF THE LICENSED MATERIALS, DO NOT ACCEPT LIABILITY
FOR ANY OMISSIONS OR ERRORS IN THE LICENSED MATERIALS OR ANY
OTHER MATERIALS OBTAINED FROM REGENSTRIEF INSTITUTE, INC. AND/OR
THE LOINC COMMITTEE. THE LICENSED MATERIALS AND ALL OTHER
MATERIALS OBTAINED FROM REGENSTRIEF INSTITUTE, INC. AND/OR THE
LOINC COMMITTEE ARE PROVIDED "AS IS," WITHOUT WARRANTY OF ANY
KIND. ANY EXPRESSED OR IMPLIED WARRANTIES ARE HEREBY
DISCLAIMED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES
OF TITLE, NON-INFRINGEMENT, MERCHANTABILITY AND FITNESS FOR A
PARTICULAR PURPOSE AND WARRANTIES ARISING FROM A COURSE OF
DEALING, TRADE USAGE, OR TRADE PRACTICE. FURTHER, NO WARRANTY
OR REPRESENTATION IS MADE CONCERNING THE ACCURACY,
COMPLETENESS, SEQUENCE, TIMELINESS OR AVAILABILITY OF THE
LICENSED MATERIALS OR ANY OTHER MATERIALS OBTAINED FROM
REGENSTRIEF INSTITUTE, INC. AND/OR THE LOINC COMMITTEE, OR ANY
ix

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TRANSLATIONS OR DERIVATIVE WORKS OF ANY OF THE FOREGOING. IN NO
EVENT SHALL REGENSTRIEF INSTITUTE, INC. OR THE LOINC COMMITTEE OR
ITS CONTRIBUTORS BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL,
SPECIAL, EXEMPLARY, RELIANCE, OR CONSEQUENTIAL DAMAGES OR
ATTORNEYS' FEES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF
SUBSTITUTE GOODS OR SERVICES; OPPORTUNITY COSTS; LOSS OF USE,
DATA, SAVINGS OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER
CAUSED AND ON ANY THEORY OF LIABILITY WHETHER IN CONTRACT,
STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE)
ARISING IN ANY WAY OUT OF THE USE OF THE LICENSED MATERIALS OR
ANY OTHER MATERIALS OBTAINED FROM REGENSTRIEF INSTITUTE, INC.
AND/OR THE LOINC COMMITTEE, EVEN IF ADVISED OF THE POSSIBILITY OF
SUCH DAMAGE OR IF SUCH DAMAGES WERE FORESEEABLE. SOME
JURISDICTIONS DO NOT ALLOW THE LIMITATION OR EXCLUSION OF
CERTAIN WARRANTIES OR CONDITIONS, SO SOME OF THE FOREGOING MAY
NOT APPLY TO YOU.
13) This license shall be construed and interpreted in accordance with the laws of the
State of Indiana, United States of America, excluding its conflicts of law rules.


Notice of Third Party Content and Copyright Terms

A small portion of the content of the LOINC table, LOINC panels and forms, LOINC hierarchies,
RELMA database and associated search index files consists of content subject to copyright from third
parties. This third party content is either used with permission or under the applicable terms of use. In all
such cases, we have included the copyright notice. This third party content is highlighted in the program
as follows: When such copyright content appears in the RELMA look-up grid, RELMA will highlight the
row containing that content by printing in a different background color and using italics. It will also
include a link in the (EXT (C)) column. By clicking on that link, users will get to the copyright notice and
to the terms of use for the content of those LOINC-mapped terms. In the case of a LOINC table (e.g. the
tab delimited file or the LOINC Access database) we include the copyright notice (up to 250 characters).

We have included third party content that allows use and distribution at least for clinical, administrative
and research purposes. The third party copyright owners generally ask for attribution of the source, allow
the free use of the content for treatment, health care management, and research purposes. They generally
forbid alteration of their content (e.g., survey questions and/or answers) and use for commercial purpose,
which usually means the direct sale of the survey instruments, but they often do allow use of their content
in commercial software, medical record and other clinical database systems, and the messaging of patient
information collected through the use of these instruments. The details of the notice of copyright for any
third party content can be found in association with the terms when using the RELMA look-up tool or the
LOINC table. The copyright of the LOINC codes per se remain owned by Regenstrief Institute, Inc. and
the LOINC Committee and subject to the LOINC Copyright Notice and License.

In the future, we expect to include many more survey instruments and questionnaires from third parties
with permission (especially those required by the U.S. federal government for payment and
reimbursement) and believe that cataloguing all of these data collection forms in one comprehensive
system (the LOINC table) along with laboratory and other clinical variables will facilitate the use of this
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xi

data in direct clinical care, research and practice management.


Preface

The LOINC database provides a set of universal names and ID codes for identifying laboratory and
clinical test results.
1, 2
LOINC facilitates the exchange and pooling of results, such as blood hemoglobin,
serum potassium, or vital signs, for clinical care, outcomes management, and research. Currently, many
laboratories use ASTM 1238
3
or its sister standard, HL7
4
, to send laboratory results electronically from
production laboratories to clinical care systems in hospitals. Most laboratories identify tests in HL7
messages by means of their internal (and idiosyncratic) code values. Receiving medical informatics
systems cannot fully understand the results they receive unless they either adopt the producer's
laboratory codes (which is impossible if informatics system receives results from multiple source
laboratories, e.g., the hospital lab, the local commercial lab, and a nursing home lab), or invest in the
work to map each laboratory's coding system to their internal code system.
5


If medical information producers who wish to communicate with each other adopt LOINC codes to
identify their results in data transmissions, this problem would disappear. The receiving system with
LOINC codes in its master vocabulary file would be able to understand and properly file HL7 results
messages that identified clinical observations via LOINC codes. Similarly, if test and observation codes
were reported test with the LOINC codes, government agencies would be able to pool results for tests
from many sites for research management and public health purpose. The LOINC codes (and names) for
test observations should be of interest to hospitals, clinical laboratories, doctors' offices, state health
departments, governmental health care providers, third-party payers, and organizations responsible for
quality assurance and utilization review.

The LOINC codes are not intended to transmit all possible information about a test or observation. They
are only intended to identify the test result or clinical observation. Other fields in the message can
transmit the identity of the source laboratory and special details about the sample. (For instance, the
result code may identify a blood culture, but the message source code can be more specific and identify
the sample as pump blood.) The level of detail in the LOINC definitions was intended to distinguish tests
that are usually distinguished as separate test results within the master file of existing laboratory systems.
Indeed, at the outset, we used the master files from seven U.S. laboratories to shape this effort, and
requests from commercial labs and hospitals continue to shape the content of the LOINC effort.

Each LOINC record corresponds to a single test result or panel. The record includes fields for specifying:

1. Component (analyte) - e.g., potassium, hemoglobin, hepatitis C antigen.
2. Property measured - e.g., a mass concentration, enzyme activity (catalytic rate).
3. Timing - i.e., whether the measurement is an observation at a moment of time, or an observation
integrated over an extended duration of time - e.g., 24-hour urine.
4. The type of sample - e.g., urine, blood.
5. The type of scale - e.g., whether the measurement is quantitative (a true measurement) ordinal (a
ranked set of options), nominal (e.g., E. coli; Staphylococcus aureus), or narrative (e.g., dictation
results from x-rays).
6. Where relevant, the method used to produce the result or other observation.

It also contains information about the amount, route, and timing of physiologic or pharmacologic
challenges (e.g., oral glucose tolerance test, which would be expressed in LOINC as GLUCOSE^1H
POST 100 G GLUCOSE PO1). The LOINC identifiers do not usually include the method in the name for
chemistry tests, where tests are more often standardized to normalized methods; they do include methods
for most serological tests and coagulation studies. This same principle is usually reflected in the master
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files of existing laboratories. Of course, the method can always be reported as a separate item of
information in a result message regardless of whether it is part of the test name.

We used many sources for constructing the database, including the Silver Book from the International
Union of Pure and Applied Chemistry (IUPAC) and the International Federation of Clinical Chemistry
(IFCC),
6
textbooks of clinical pathology (e.g., Henry
7
and Tietz
8
), the expertise and work of the LOINC
members, and EUCLIDES. We have also reviewed the master test files of seven sources (Indiana
University/Regenstrief, University of Utah, Association of Regional and University Pathologists (ARUP),
Mayo Medical Laboratories, LDS Hospital in Salt Lake City, the Department of Veterans Affairs, Quest
Diagnostics, and University of Washington). This has been an empirical effort. Our goal is to provide
codes that correspond to the concepts in real world laboratories and clinical departments master files.

The database includes fields for each of the six parts of the name. In addition, it also contains short
names (as of the August 2002 version for laboratory tests), related words, synonyms, and comments for
all observations. Related words (synonyms) are included to facilitate searches for individual laboratory
test and clinical observation results.

We have defined fields in the database for a number of data elements, e.g., typical units, sample normal
ranges, but most of those fields are only partially populated. In a few cases, we have suggested standard
answer lists for tests whose results are usually reported as codes. The database is an ongoing project. We
have established guidelines for users who wish to request additions and changes to LOINC, which are
detailed in Appendix D.

For some kind of tests and observations, the database provides several ways to report values. For
example, blood cell antigens might be presented as a panel with separate tests which report each
possible antigen as present or absent if the test is to establish paternity; for cross matching, the result
would be reported as a list of antigens found. We try to provide for both methods of reporting in the
LOINC databases by including codes for both types of test identifiers.

Laboratories and managers of medical records systems should record the LOINC codes as attributes of
their existing test/observation master files and use the LOINC codes and names in the OBSERVATION
ID field (OBX-3) of the ASTM and HL7 OBX segment and the corresponding CEN TC251 and DICOM
messages to identify laboratory results.

The overall organization of the database is divided first into four categories, lab, clinical,
attachments and surveys. (This split is recorded in CLASSTYPE.) The laboratory portion is further
divided into the usual categories of chemistry, hematology, serology, microbiology (which includes
parasitology and virology), and toxicology. We have separated antibiotic susceptibilities into their own
category. The clinical portion of the LOINC database contains entries for vital signs, hemodynamics,
intake/output, EKG, obstetric ultrasound, cardiac echo, urologic imaging, gastroendoscopic procedures,
pulmonary ventilator management, and other clinical observations. Appendix B lists these classes in more
detail. There is nothing sacred about these categories, and you are free to sort the database by whatever
class is convenient for your application.

The Regenstrief Institute maintains the LOINC database and makes it available in a number of file
formats. In each of them, the first part of the file contains the copyright notice with permission to use the
database for any purpose without charge or written permission. We have copyrighted the databases and
this document to assure that multiple variants of the codes do not emerge. Having many variants would
defeat the purpose of a universal identifier for test results. The LOINC database (which identifies over
34,000 different lab tests and clinical observations), supporting documentation and the RELMA

mapping
program are all available through the Regenstrief Institute web site. (http://loinc.org )
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LOINC ACCESS database:
The official LOINC database is available as an ACCESS file called LOINC.MDB. It was created using
Microsoft Access 2007.

LOINC Tab Delimited ASCII:
Each record of the database is on a separate line. Each record is terminated by CR/LF, and each field is
delimited with a tab character. Non-null text fields are enclosed in double quotes (). This is the format
you will use if you want to import into your own database. This file contains all of the content of the
database and is formatted to be easily imported into a wide variety of database and spreadsheet
applications.

The LOINC Users' Guide (this document) is available as a PDF file. It explains the structure of the
database, its rationale, and the rules we used for naming test results.

RELMA
In addition to the basic LOINC files, we produce a Windows-based mapping utility called the Regenstrief
LOINC Mapping Assistant (RELMA

). This program is also available for free use

The RELMA package includes the LOINC table in the database plus several large index tables.

RELMA Users' Manual
There is a separate Users Manual documenting the RELMA program.

All of the above files are available from the LOINC website http://loinc.org . They are also distributed on
CD.

We welcome corrections or extensions to the database. We are not interested in adding terms that might
be needed in some future situation but we are interested in adding test observations that are actively being
reported today. Appendix D provides instructions for submitting new terms.

Clem McDonald Stan Huff
Chairman, LOINC Committee Co-Chairman, LOINC Committee
Chairman, Laboratory LOINC Committee Chairman, Clinical LOINC Committee

Acknowledgments

We wish to thank Henrik Olesen, Chairman of IUPAC, Commission on Quantities & Units in Clinical
Chemistry, for his very helpful comments and insights about laboratory test coding.

This endeavor was supported in part by Grant Numbers R13/CCR517099 and H75/CCH522778 from the
Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and
do not necessarily represent the official views of the Centers for Disease Control and Prevention. This
work also was supported in part by grants and contracts from the John A. Hartford Foundation of New
York, the National Library of Medicine (Contracts N01-LM-4-3510, N01-LM-6-3546, N01-LM-9-3517
and N01-LM-3-3501), and the Agency for Health Care Policy and Research (AHCPR) (Grants HS 08750
and HS 07719 ). This work was initiated by and performed under the auspices of the Regenstrief
Institute.
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1 Introduction

The goal of the LOINC project is to create universal identifiers (names and codes) used in the context of
existing ASTM E1238, HL7, CEN TC251, and DICOM observation report messages employed in the
various sub-domains of healthcare informatics such as Clinical Laboratory Information Management
Systems and Computer-Based Patient Record Systems.
9,

10
Specifically, the identifiers can be used as the
coded value of the Observation Identifier field (# 3) of the OBX segment of an ORU HL7 (HL7 vs. 2.x
and vs. 3.9 or ASTM 1238-9410) messages, or in a corresponding field in future versions of these HL7
and DICOM standards. LOINC codes identified in HL7 as code system LN provide universal
identifiers. When used in the context of the messaging standards, LOINC codes allow the exchange of
clinical laboratory data between heterogeneous computing environments.

To facilitate this process, each identifier requires a fully specified name created in a standard way so that
users can create long names for their tests that can be linked to the universal test identifier using
semi-automated methods.

We focused our initial effort on creating names for results of reportable tests or clinical measurements
rather than request-able batteries, because the issues involved in naming results of tests are less complex
than those involved in naming the batteries. However, we have also defined codes for some order panels.
It is important to note that LOINC codes for single tests, reports, and observations are equally suitable for
the ordered item in an order record or message, or as the result identifier in a result message.

The LOINC database is a universal master file of standard test names and codes that will cover most
of the entries in these files of operational laboratory systems, so that the terms in these operational master
files could be mapped directly to universal codes and names. The names we create correspond most
closely to the long test descriptions seen in test master files. The LOINC names are fully specified
names. That is, if a person wanted to map her local test dictionary to the LOINC codes, all the
information needed to map a local test name to one of the fully specified names should be present in the
LOINC name.

We aim to achieve a level of detail in the definition of a test that will map one-to-one to the separately
reported observations on a clinical laboratory report. If a test has its own column on a clinical report, or
has a reference range that is significantly different from other tests, or has a different clinical meaning
than other related tests, it will usually be assigned a separate LOINC code and name. We deliver these
fully specified names, their codes, and their related names as a database in which each line corresponds to
a unique test measurement.

1.1 Successes

The LOINC codes have been greeted enthusiastically since they were released to the Internet in April of
1996. Since then we have released thirteen revisions of the LOINC database and it now includes over
30,000 observation concepts. The informatics committee of the College of American Pathologists (CAP)
has endorsed the LOINC codes. The American Clinical Laboratory Association (ACLA), an association
of large referral laboratories whose members are responsible for more than 60% of US outpatient
laboratory test volume, has recommended LOINC for adoption by its members. Quest Diagnostics


(formerly Corning MetPath), LabCorp

, and SmithKline Beecham (now part of Quest Diagnostics), three

of the largest commercial laboratories in the US, have adopted LOINC as their code system for reportable
test results, as has ARUP (Associated Regional and University Pathologists). Mayo Medical Laboratories
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is currently mapping their tests to LOINC. In addition, the University of Colorado, Intermountain Health
Care, Kaiser Permanente

, Clarian Health (Indiana University, Methodist Hospital, and Riley Hospital),

Partners Healthcare System of Boston (Brigham and Women's and Mass General Hospital), Care
Group of Boston

, Mayo Clinic, and the Department of Defense are adopting the LOINC codes for
laboratory reporting. All US veterinary medicine laboratories have committed to the use of LOINC.

HMOs such as Empire Blue Cross

and Aetna

Health Care are also adopting LOINC for internal
purposes. Internationally, LOINC has also met success. Geneva, Switzerland, is adopting LOINC for
quality assurance mandates. The provinces of Ontario and British Columbia, Canada, are adopting
LOINC codes province wide, and Newfoundland is considering following in their footsteps. Most
recently, Germany has adopted LOINC for national use.

The LOINC codes have been incorporated into the National Library of Medicine's Unified Medical
Language System

(UMLS

). They have been incorporated in HCFA's quality assurance testing pilot

programs, and part of the draft Health Insurance Portability and Accountability Act (HIPPA) electronic
attachments specification. They have been adopted by the Centers for Disease Control and
Prevention/Council of State and Territorial Epidemiologists project for electronically
reporting/transmitting communicable disease information
11, 12
and by the North American Association of
Central Cancer Registries (NAACCR) for their tumor registry variables.

On March 21, 2003, the United States Departments of Health and Human Services (HHS), Defense
(DoD) and Veterans Affairs (VA) announced the first set of uniform standards for the electronic exchange
of clinical health information to be adopted across the federal government. As part of this, all federal
agencies that deal with health care data will adopt laboratory Logical Observation Identifiers Name Codes
(LOINC) to standardize the electronic exchange of clinical laboratory orders and results.

1.2 What is not part of the name

Certain parameters and descriptions pertaining to test performance are specifically excluded from the
fully specified test name. These parameters will typically be reported in separate fields (attributes) of a
test/observation report message, not as part of the observation name. Attributes that we explicitly exclude
from the fully specified name are:

the instrument used in testing
fine details about the sample or the site of collection such as right antecubital fossa
the priority of the testing, e.g., whether stat or routine
who verified the result
the size of the sample collected
the place of testing (e.g., home, bedside, clinical lab)

In the case of laboratory tests, the name does include information that identifies the type of sample (or
specimen). However, the sample part of the name is not meant to carry all possible information about
the sample, but only enough to indicate significant differences in the result and to reflect current usage in
test names. For example, laboratories usually define urine sodium, sweat sodium, and serum sodium as
different tests because each of these has a different normal range. But laboratories do not define different
tests to distinguish the concentration of arterial serum sodium from venous serum sodium, though the lab
may report that the sample was venous or arterial in another part of the report. We are guided by the
pragmatics of conventional usage. If laboratories define separate tests for the same measurements done
on different specimens (this usually implies a well-defined normal range difference), we will define
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different result-able tests in our dictionary. If they do not, we will not.

The extent to which we include methods as part of the name is also guided by pragmatics. We distinguish
tests/observations by the type of method used to produce the results only if a given type of method has an
important effect on the interpretation of the result. This is a complex subject and it is difficult to fully
describe our rationale in this report. Where laboratories do not tend to include the method in the name
(e.g., most of chemistry) we do not include the method in the name. Where they tend to (e.g., in
immunochemistry) we do. For some tests, this can be justified by the standardization of methods to
produce equivalent results, and sometimes by the many variables (method, reagent) that one could
never hope to represent fully in a single name. However, even when we do distinguish these cases, we
distinguish by type of method, not the most detailed possible method distinction. (See section 2.7, Type
of Method, for more details.)

The College of American Pathologists produces statistical summaries of the results for measurements of
standard samples broken down by laboratory and by instrument or procedure. (These are called CAP
surveys.) We considered using this CAP survey data to decide empirically when test names should be
distinguished by method, but decided this was not feasible because many of the apparent differences in
method obtained with the standard samples were artifacts of the sample matrix and did not apply to serum
specimens. In addition, the variation among laboratories was often of the same magnitude as the variation
among methods within laboratories for the same method.

We do not mean to underrate the importance of method differences. The result message will still include
information about the normal range for that particular test, the source laboratory and, if the laboratory
wishes, specific information about the method (e.g., OBX 17 can carry very specific method information).
However, such information is reported in separate fields in the HL7 message. It is not embedded in the
names of the test.

1.3 Scope of LOINC

The current scope of the existing laboratory portion of the LOINC database includes all observations
reported by clinical laboratories, including the specialty areas: chemistry, including therapeutic drug
monitoring and toxicology; hematology; serology; blood bank; microbiology; cytology; surgical
pathology; and fertility. A large number of terms used in veterinary medicine have also been included. In
addition, the scope includes those non-test measurements that are commonly required to interpret test
results and are usually included as part of the report with the laboratory observations. Examples include:

for cervical pap smears, the phase of menstrual cycle or use of estrogens
for arterial blood gases, inspired oxygen
for drug concentrations used in pharmacokinetics, the dose
for a blood bank, the number of units dispensed

The June 2000 release contained our first foray into order sets/batteries. Existing LOINC codes could
always be used to order the specific tests observation, but prior to 2000 there was no mechanism to use
LOINC codes to order a set of observations. We have currently only addressed a group of observations
that are either naturally produced as a panel (e.g., urinalysis) or are defined by some national body (e.g.,
Basic metabolic HCFA 2000 panel).

The clinical portion of the LOINC database covers the areas of blood pressure, heart and respiratory rates,
critical care measures, cardiac output, body dimensions, body temperature, intake and output,
electrocardiography, cardiac echo, obstetric ultrasound, urologic ultrasound, gastrointestinal endoscopy,
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ventilator management, dental, Data Elements for Emergency Department Systems (DEEDS) reporting,
radiology study reporting, claims attachment and the major headings of history and physical, discharge
summary, and operative note reports and tumor registry variables. Further work on clinical obstetrics and
nursing observations is ongoing. There are separate sections for Claims Attachments and Survey
Instruments.

1.4 The LOINC Code Identifier

To each name, we have assigned a unique permanent code that we call the LOINC code. This is the code
that systems should use to identify test results in electronic reports. The LOINC code has no intrinsic
structure except that the last character in the code is a mod 10-check digit. The algorithm to calculate this
check digit is given in Appendix C. All of the structure associated with a single LOINC entity is stored in
other fields in the LOINC database.


2 Major Parts of a Test/Observation Name

The fully specified name of a test result or clinical observation has five or six main parts including: the
name of the component or analyte measured (e.g., glucose, propranolol), the property observed (e.g.,
substance concentration, mass, volume), the timing of the measurement (e.g., is it over time or
momentary), the type of sample (e.g., urine, serum), the scale of measurement (e.g., qualitative vs.
quantitative), and where relevant, the method of the measurement (e.g., radioimmunoassay, immune blot).
These can be described formally with the following syntax.

<Analyte/component>:<kind of property of observation or measurement>:<time
aspect>:<system (sample)>:<scale>:<method>

The colon character, :, is part of the name and is used to separate the main parts of the name.

The first part of the name can be further divided up into three subparts, separated by carats (^). The first
subpart can contain multiple levels of increasing taxonomic specification, separated by dots (.). The third
and fourth parts of the name (time aspect and system/sample) can also be modified by a second subpart,
separated from the first by a carat. In the case of time aspect, the modifier can indicate that the
observation is one selected on the basis of the named criterion (maximum, minimum, mean, etc.); in the
case of system, the modifier identifies the origin of the specimen if not the patient (e.g., blood donor,
fetus, and blood product unit). The hierarchical structure is outlined in Table 1, with references to the
section numbers where each item is explained in detail.

Table 1: Hierarchical Structure of Fully Specified Analyte Names
Subpart Name Section
Component/analyte 2.2
Name and modifier 2.2.1
Component/analyte name 2.2.1.1
Component/analyte subname 2.2.1.2
Component/analyte sub-sub-name 2.2.1.3
Information about the challenge (e.g., 1H post 100 gm PO challenge) 2.2.2
Adjustments/corrections 2.2.3
Kind of Property (mass concentration, mass) 2.3
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Time Aspect (point or moment in time vs. time interval) 2.4
System/Sample type (urine, serum) 2.5.1
Super System (patient, donor, blood product unit) 2.5
Type of Scale (nominal, ordinal, quantitative) 2.6
Method Type 2.7


We used Tietz
13
, Henry
14
, IUPAC
15
, EUCLIDES
16
, diagnostic microbiology textbooks, such as Mahon
and Manuselis

names.
2.1
2.1.1
17
, the American Association of Blood Banking
18
, and other sources as well as the
expertise of the individuals or the committee to choose preferred

Examples of fully specified LOINC names:

Sodium:SCnc:Pt:Ser/Plas:Qn

Sodium:SCnc:Pt:Urine:Qn

Sodium:SRat:24H:Urine:Qn

Creatinine renal clearance:VRat:24H:Ur+Ser/Plas:Qn

Glucose^2H post 100 g glucose PO:MCnc:Pt:Ser/Plas:Qn

Gentamicin^trough:MCnc:Pt:Ser/Plas:Qn

ABO group:Type:Pt:Bld^donor:Nom

Body temperature:Temp:8H^max:XXX:Qn

Chief complaint:Find:Pt:^Patient:Nar:Reported

Physical findings:Find:Pt:Abdomen:Nar:Observed

Binocular distance:Len:Pt:Head^fetus:Qn:US.measured




General naming conventions

Abbreviations in names of component/analyte

Except for enumerated exceptions (Table 2), abbreviations should not be used in the component (analyte)
of the name. We require the use of total, not tot, fraction, not frac, Alpha, not A-, Beta not
B- (and so on for any Greek letter), oxygen, not O
2
, and so on.

Table 2: Example Component Abbreviations
Abbreviation Full Name
Ab Antibody
Ag Antigen
DNA deoxyribonucleic acid
HIV human immunodeficiency virus
HLA human histocompatibility complex derived antigens
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HTLV 1 human t-cell lymphotropic virus-1
Ig X immunoglobulins (e.g., IgG for immunoglobulin G, IgM for immunoglobulin M)
NOS not otherwise specified
RNA ribonucleic acid
rRNA ribosomal ribonucleic acid

2.1.2 General naming rules for the component (analyte) part of the fully specified name.
2.1.2.1 Place the identifier of the substance being measured first. This means Hepatitis A antibodies
(Ab)not Antibodies, Hepatitis A.
2.1.2.2 Use the generic name of a drug, not the brand name, when referring to drug concentrations and
antimicrobial susceptibilities, e.g., Propranolol, not Inderal. We will usually include the brand
or trade names in the related names (synonyms) field.
2.1.2.3 Use full taxonomic name of an organism or virus name (not the disease) when describing a test
that diagnoses that disease. Say Rickettsia rickettsii Ab not Rocky Mountain spotted fever
Ab. Say herpes simplex virus Ab not HSV Ab. The disease name should be included as a
synonym in the related name field.
2.1.2.4 Species and groups of species: SP identifies a single species whose identity is not known. SPP
identifies the set of species beneath a genus. We have a third case, however. In some tests,
antibodies apply to different strains of species. In rickettsial diseases, the antibodies are then
against groups of species, e.g., the spotted fever group or the typhus group. In this case we use
Rickettsia spotted fever group and Rickettsia typhus group.
2.1.2.5 When tests include the name of a bacterium (e.g., Neisseria gonorrhoeae DNA probe) for the
formal LOINC name we use the full bacterial name from the International Journal of Systematic
and Evolutionary Microbiology
19
. When it includes the name of a virus (e.g., West Nile Virus
IgM antibodies), we use the viral name as given by Index Virum
20
.
2.1.2.6 When the test measures an antigen to a specific species of organism but cross-reactivity is such
that other organisms are identified, the name should be the principal organism that is targeted by
the test.
2.1.2.7 Avoid direct and indirect except as parts of synonym names. Avoid conjugated and
unconjugated when a more precise term, such as glucuronidated or albumin-bound is
available.
2.1.2.8 Use platelets, not thrombocytes.
2.1.2.9 Name vitamins by the chemical name. For example, use thiamine not Vitamin B1, The name
containing Vitamin will be included as a synonym. This is the only reasonable approach
because all vitamins have a chemical name but not all vitamins have a numbered vitamin
name.
2.1.2.10 Always specify whether serology tests measure the antigen or antibody, using the
abbreviation Ab for antibody and Ag for antigen. Remove the anti from ANTI X Ab.
It is redundant and obscures the most significant word in the name. Thus, anti-smooth muscle
Ab becomes Smooth muscle Ab. Common abbreviations or shortened names, e.g., ANA for
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anti-nuclear antibody, will be found in the related names field.
2.1.2.11 VDRL will be named Reagin Ab because that is what it is. We will have to depend upon
synonyms and aliases to equate our standardized names with the old names.
2.1.2.12 Use the noun form of the target of the antibody, e.g., Myocardium Ab, not Myocardial Ab.
2.1.2.13 Anion vs. acid: Always use the anionic name for chemicals, not the acid name, e.g., lactate,
citrate, and urate, not lactic acid, citric acid, and uric acid. The acid form of the name will be
included in the related names field of the database.
2.1.2.14 Alcohols: Always use the single-word names for alcohols: methanol, not methyl alcohol;
ethanol, not ethyl alcohol, and so on.
2.1.2.15 Always spell out OH as Hydroxy, or as - ol, with no space or hyphen between Hydroxy and the
next word.
2.1.2.16 Greek letters, alpha, beta, gamma, etc., are always spelled out (e.g., alpha tocopherol, not A-
tocopherol), with a space between the spelled out Greek letter and the rest of the chemical name
2.1.2.17 Use pH, not log (H+).
2.1.2.18 Whenever possible, the component will contain the scientific names of allergens. NOTE: This
is a new convention implemented in January 2002.
2.1.2.19 Avoid use of the word total in laboratory test names, except when denoting the denominator of
a fraction. Thus it is Alkaline phosphatase, not Alkaline phosphatase.total, but Alkaline
phosphatase.bone/Alkaline phosphatase.total.
2.1.2.20 For drug metabolites, we will use the nor form rather than desmethyl, e.g., for instance
nordoxepin not desmethyldoxepin.

2.1.3 Punctuation in analyte names

A number of analyte names include punctuation characters such as commas, for example, to identify the
position of multiple alkyl groups in a carbon chain. We will avoid special characters, e.g., commas,
dashes, and parentheses, except where they are included in the name specified by IUPAC, the Chemical
Abstract Service (CAS) convention, or another international convention. So commas will appear in
multiple substitutions of alkyl chains per the CAS standard, dashes will appear in HLA antigen names,
and parentheses (i.e., round brackets) will appear in the names of red blood cell antigens.

2.1.4 Case insensitivity

All names are case insensitive. Prior to December 2006, we used upper case in the database and our
examples, but change to mixed case for easier readability. In electronic messages senders and receivers
can use upper, lower or mixed case. However, the meanings should not be sensitive to case conversions
to avoid any possibility of confusion when the information is sent over networks that may apply case
conversion. To identify parts of the few names that by international convention are case sensitive, such as
red blood cell antigens, we use the word little in front of the letter that is lower case. We use a similar
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convention to indicate superscripts with the word SUPER. See examples in Table 3.


Table 3: Example Case Specifying Conventions
Our conventions Standard mixed case
Lu
a
L little u super little a
little i-1 subtype i-1 Subtype

Roman numerals vs. Arabic numerals 2.1.5
2.2
2.2.1

Whenever possible, numerals shall be represented in their Arabic form. However, when the conventional
name uses Roman numerals as is the case for clotting factors such as factor VIII, the LOINC primary
name will use Roman numerals and we define a synonym containing Arabic numerals.

Component/analyte (1st part)

The first main part consists of three subparts: (1) the principal name (e.g., the name of the analyte or the
measurement); (2) the challenge or provocation, if relevant, including the time delay, substance of
challenge, amount administered, and route of administration; and (3) any standardization or adjustment.

The three subparts of the first part follow this syntax:

<[analyte].[subclass].[sub-subclass]> ^
<[time delay] post [amount] [substance] [route])> ^
<adjustment>

In the above syntax, the carat (^) is a required delimiter and the dot (.) separates the analyte name from
its subspecies.

This convention also implies that dots (.) and carats (^) cannot be a formal part of any of the words that
are connected by these delimiters.

These subparts are described in greater detail below, Sections 2.2.1 through 2.2.3.

Analyte Name (1st subpart)

The first subpart names the analyte, including any relevant sub-classifications, separated from the main
analyte name by dots.

2.2.1.1 Analyte/Subclass

The principal name (the first subpart) can be divided further by subclass (e.g., Calcium by itself is one
component, Calcium.ionized names another test that measures a subclass of calcium.) Subclasses are
separated by dots. Examples of common subclasses include: bound, free, and bioavailable; ionized and
non-ionized; glycated; glucuronidated and non-glucuronidated; IgA, IgD, IgE, IgG, and IgM as modifiers
indicating the subspecies of antibodies. Note that bio-available is distinguished from free by including
both free and partially bound moieties.
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If the antibody is from a particular subclass of antibodies specify the subclass (IgM, IgG, IgA, or IgD)
e.g., Hepatitis A virus Ab.IgG, Hepatitis A virus Ab.IgM

If more than one species is included in the measurement, all are listed in the subclass, e.g., Mumps virus
Ab.IgG+IgM with a plus sign (+) to separate the subspecies. There should be no spaces between the
plus sign and the words it connects. If two constituents are measured as one quantity, both should be
named and the component separated by a plus sign (+), e.g., Cyclosporine+Metabolites.

If analytes are measured separately, such as in a panel, the analytes are separated by an ampersand (&)
surrounded by spaces, e.g., ABO & Rh panels. In panels, each analyte is measured individually.
Impressions provide another use of the ampersand (&), for example, Hepatitis A virus Ab.IgM & total
impression. In the case of the Hepatitis antibody impression, both the IgM antibody and the total
impression are described separately.
2.2.2 Challenge test (2nd subpart)

The second subpart contains information necessary to interpret challenge (or loading or tolerance) tests.
Variables that report the result of a measurement taken a certain amount of time post challenge (e.g.,
glucose after an oral glucose tolerance test) must be distinguished according to the challenge and the time
post challenge. Thus, the second subpart has a substructure that identifies the time interval or time
difference and the challenge, using the following syntax, where the word post (or base line) is required.

<time delay> post <challenge>

where the challenge can be further characterized as

<amount given> <substance/treatment given> <route given>

An example of a challenge that used all parts would be: Aldosterone^1H post 25 mg captopril PO
The time difference follows the syntax: n<S|M|H|D|W> where n is a number (possibly a decimal); S
denotes seconds; M denotes minutes; H denotes hours; D denotes days; and W denotes weeks. The time
delay can be preceded by a 'greater than' (>) sign, e.g., >4H. Table 4 lists some possible values for time
difference, but any time specification that follows the above syntax would be legal.

In addition to specifying a time elapsed since challenge, the time delay slot can be used to name a clock
time when the measurement was taken, e.g., Glucose^10 AM specimen, or to specify the ordering of
specimens, e.g., ^1st specimen , ^2nd specimen. Use this syntax to indicate pre- and post-immunization
specimens, acute and convalescent specimens, or a series of specimens for which no more detailed
information is available.

Table 4: Example Time Delay Post Challenge
BS Baseline (time just before the challenge)
PEAK The time post drug dose at which the highest drug level is reached (differs by drug)
TROUGH The time post drug dose at which the lowest drug level is reached (varies with drug)
RANDOM Time from the challenge, or dose not specified (random)
n minutes/hours/days/weeks/months/etc. after challenge begun:
1M 1 minute post challenge 6H 6 hours post challenge
2M 2 minutes post challenge 7H 7 hours post challenge
3M 3 minutes post challenge 8H 8 hours post challenge
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4M 4 minutes post challenge 8H SHIFT 8 hours aligned on nursing shifts
5M 5 minutes post challenge 12H 12 hours post challenge
6M 6 minutes post challenge 24H 24 hours post challenge
7M 7 minutes post challenge 2D 2 days
8M 8 minutes post challenge 3D 3 days
9M 9 minutes post challenge 4D 4 days
10M 10 minutes post challenge 5D 5 days
15M 15 minutes post challenge 6D 6 days
20M 20 minutes post challenge 7D 7 days
25M 25 minutes post challenge 1W 1 week
30M 30 minutes post challenge 10D 10 days
1H 1 hour post challenge 2W 2 weeks
1.5H 1 hour (90 min) post challenge 3W 3 weeks
2H 2 hours post challenge 4W 4 weeks
2.5H 2hours post challenge 1MO 1 month (30 days) post challenge
3H 3 hours post challenge 2MO 2 months (60 days) post challenge
4H 4 hours post challenge 3MO 3 months (90 days) post challenge
5H 5 hours post challenge




The second subpart is also used to describe measurements taken at a specified point after the beginning of
an ongoing treatment, such as peritoneal dialysis, e.g., Creatinine^12H post peritoneal dialysis. More
generally, this syntax can be used to indicate that observations were recorded, e.g., ^post partum, ^post
surgery, or ^post EDTA therapy.

The syntax of the second subpart can be specified in various ways to indicate challenges of greater or
lesser specificity, corresponding to the amount of detail the lab knows about the challenge specimen.
Examples of the range of possibilities include:


Table 5: Example Challenge Subparts
Analyte ^ Time Post Amount Sub/Treat Route
^
8H post 30 mg/kg Metyrapone PO 11-Deoxycortisol
^
45M
post
dose u/kg Insulin IV Corticotropin
^

post
dose PO Ascorbate
^
2
ND
specimen
post
XXX challenge 11-Deoxycortisol
^
6H
post
XXX challenge 17-Hydroxyprogesterone
^

post
XXX challenge 11-Deoxycortisol
^
12H
post
CFst Calcium
^

post
CFst C peptide

2.2.2.1 Reporting the baseline measure as part of a challenge test

We define one baseline term for different challenge batteries when the challenge is given by the same
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dose and route. So we define one baseline test for the 100 gm oral glucose tolerance test regardless of the
number of separate measurements defined in the battery. For example, the baseline serum glucose for
100 gm oral glucose by mouth would be:

Glucose^pre 100 g glucose PO

A laboratory could use this same test identifier to identify the baseline result of a two hour glucose
tolerance and a three hour glucose tolerance, for example.

We would define different baseline measurements for challenges with different substances. The baseline
serum glucose before a challenge with 50 U insulin challenges would be defined as a different test from
the baseline glucose for an oral glucose tolerance test. These different baseline tests are defined to
accommodate laboratories that conventionally do the same. However, baseline glucose for any challenge
is not affected by the challenge and could in principle be reported as glucose without specifying the
relation to a coming challenge.

We denote the route of the challenge by HL7 Version 2.3 abbreviations for medication routes (Table 6).
An oral route of administration would be denoted by PO,
1
an intravenous route by IV.


Table 6: Example Route Abbreviations for Challenge Part
(from HL7 v.2.3, Chapter 4)
Abbr. Challenge Description Abbr. Challenge Description
AP Apply Externally MM Mucus Membrane
B Buccal NS Nasal
DT Dental NG Nasogastric
EP Epidural NP Nasal Prongs
ET Endotrachial Tube NT Nasotrachial Tube
GTT Gastronomy Tube OP Ophthalmic
GU GU Irrigant OT Otic
IMR Immerse (Soak) Body Part OTH Other/Miscellaneous
IA Intra-arterial PF Perfusion
IB Intrabursal PO Oral
IC Intracardiac PR Rectal
ICN Intracervical (uterus) RM Rebreather Mask
ID Intradermal SD Soaked Dressing
IH Inhalation SC Subcutaneous
IHA Intrahepatic Artery SL Sublingual
IM Intramuscular TRH Thyrotropin-releasing hormone
IN Intranasal TP Topical
IO Intraocular TRA Tracheostomy
IP Intraperitoneal TD Transdermal
IS Intrasynovial TL Translingual
IT Intrathecal UR Urethral
IU Intrauterine VG Vaginal
IV Intravenous VM Ventimask

1
In the United States, PO (an abbreviation for per ora) is used to identify medications taken by mouth.

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MTH Mouth/Throat WND Wound

Examples:

Glucose^pre 100 g glucose PO:MCnc:Pt:Ser/Plas:Qn

Glucose^30M post 100 g glucose PO:MCnc:Pt:Ser/Plas:Qn

Gentamicin^trough:MCnc:Pt:Ser/Plas:Qn

For drug peak (obtained at a time presumed to reflect the highest concentration) and trough (obtained at a
time presumed to reflect the lowest concentration) measures the nature of the substance loaded is the
same as the analyte name, and need not be included.

2.2.2.2 Physiologic challenges

Some challenges are defined in terms of a physiologic stress, not a dose of a chemical substance. The
LOINC names currently cover calorie fasts (no calorie intake), exercise, and fluid restrictions. These
challenges are denoted by codes given in Table 7.
In the case of such challenges, the syntax also includes the duration of the challenge.
For example:
post <duration><physiologic challenge>
Triglyceride^post 12H CFst

Table 7: Example Nature of Challenge
Type Description
CFst Calorie fast. No caloric intake (food) for the period specified in the time part of the term, e.g., POST 12H CFst
Exercise Exercise undertaken as challenge (can be quantified)
FFst Fluid fast. No fluid intake for the period specified

The naming structure is an exact analogous structure to that of chemical challenges. A test for glucose
after 12 hours of an energy fast would be represented as:

Glucose^post 12H CFst:MCnc:Pt:Ser/Plas:Qn

A test for osmolality after a 12-hour fluid restriction would be:

Osmolality^post 12H FFst:Osmol:Pt:Urine:Qn

A test for triglyceride after 12-hour energy fast would be:

Triglyceride^post 12H CFst:MCnc:Pt:Ser/Plas:Qn


Two durations can appear in one specification, for example:

Cortisol^1.5H post 0.05-0.15 U insulin/kg IV post 12H CFst:MCnc:Pt:Ser/Plas:Qn

Our rules for naming challenge tests work well only when there is a single intervention followed by a test
for one or more components over time. Complex challenge tests involving more than one intervention or
complicated sampling techniques need a unique name, but the name may not provide a complete
description of all of the test parameters.
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2.2.2.3 Reporting characteristics of challenge as separate observations

Because we cannot anticipate every type of challenge and route of administration, and because some
challenge tests have no usual dose, some challenge tests will not contain a dose. Challenge observations
that do not include a specific dose in the name have the word dose where a numeric dose would
otherwise appear. The general form is:

<analyte>^<time> post dose <route>

Examples:

Glucose^1H post dose insulin IV:MCnc:Pt:Ser/Plas:Qn

The actual dose might then be sent as a comment or as a separate test that carries the dose as its value.
To accommodate laboratories that wish to transmit the relevant challenge dose as a separate observation,
we also define separate test names (and codes) for reporting such doses. This dose could then be sent by
the reporting service as a separate result in a separate OBX segment.
The name of the observation that identifies the value of the dose would have the form:

<drug or challenge substance>: <time> post dose <challenge substance>

Examples:

Glucose.PO:Mass:Pt:Dose:Qn

Gentamicin:Mass:Pt:Dose:Qn

Thus we distinguish a drug concentration from the drug dose by means of the system (sample), 4th part,
of the test name (see Section 2.5). You can find the observations that carry the dose of drugs or
challenges grouped in the class DRUGDOSE in the LOINC database. This approach has the advantages
of parsimony and practicality. It also provides an observation ID for the piece of information that must be
transmitted along with the request for the observation.

Another example would be:

Oxygen:PPres:Pt:BldA:Qn

Oxygen inhaled:VRat:Pt:Inhl gas:Qn (liters/minute or milliliters/second)

Oxygen inhaled mechanism:Type:Pt:Dose:Nom (to report kind of delivery mechanism, e.g., nasal cannula)

An analogous approach is used for reporting many kinds of associated variables when the variables are
not conventionally embedded in the name, in part because there are too many levels of the variables and it
is not feasible.

2.2.2.4 Generic challenge specifications

We allow for a range of specificity regarding challenges from fully specified to very generic.

Some challenges will be specified fully as described above, e.g., ^30M post 100 g glucose PO . We will
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also include: challenges without the amount specified, e.g., ^30M post dose glucose ; those that specify a
time elapsed but not a particular challenge, e.g., ^1H post XXX challenge ; those that do not specify the
exact time but provide ordering information, e.g., ^2nd specimen post XXX challenge ; or even more
generic, ^ post XXX challenge . These latter variants are needed to accommodate challenges that do not
fit any common protocol, or referrals to reference laboratories where the study protocol is not reported.

2.2.2.5 Acute and convalescent, pre and post immunization

To assess the efficacy of immunizations, we measure antibody levels before and after the immunization;
similarly, we obtain evidence for acute infection by assessing acute and convalescent screens. Both of
these cases are reported with the 1st specimen, 2nd specimen syntax, for example:

Acute specimen, 1st specimen, pre-immunization specimen:
Streptococcus pneumoniae Ab.IgG^1st specimen:ACnc:Pt:Ser:Qn

Convalescent specimen, 2nd specimen, post-immunization specimen:
Streptococcus pneumoniae Ab.IgG^2nd specimen:ACnc:Pt:Ser:Qn

Adjustments/corrections (3rd subpart) 2.2.3
2.2.4

The third subpart of the data element contains calculations that adjust or correct some measured value.
We use this subpart to distinguish corrected or adjusted values from the uncorrected measurement, e.g.,
corrected cell counts from the raw cell counts. Since these attributes are unique to each measurement,
they will be short phrases of text rather than a controlled vocabulary to define the content of the third
subpart. However when defined, such a test will have a unique LOINC code and the meaning will be
fixed by the text in the third part.

Examples:

Calcium.ionized^^adjusted to pH 7.4:SCnc:Pt:Ser/Plas:Qn

Leukocytes^^corrected for nucleated erythrocytes:NCnc:Pt:Bld:Qn

Distinguishing multiple values for any test via the test name (4th subpart)

HL7 messaging allows for multiple results for one observation. Some systems, however cannot
distinguish separate answers per observation, so they made the test names like organism 1, organism 2 or
substance 1, substance 2 to report multiple organisms or substances identified in samples. We do not
encourage this type of reporting because that distinction can more clearly be accomplished by using one
test name (e.g., organism identified) and the HL7 sub ID to distinguish the multiple
organisms/substances. However, we have created a few terms to accommodate systems that bind the
distinction into their test names. The fourth subpart of the component name will allow reporting of repeat
observations taken at the same time and/or on the same specimen.

Example:

Bacteria identified^^^2:Prid:Pt:Stool:Nom:Culture

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2.3 Kind of Property (also called kind of quantity) (2nd part)

The second part of the fully specified name distinguishes between different kinds of quantities relating to
the same substance, e.g., the mass concentration versus the substance (molar) concentration of sodium in
a urine sample, or the absolute eosinophil count versus the percent of the total white count that is made up
of eosinophils. The type of property (kind of quantity) is an IUPAC concept described in the Silver
Book
21
. We include most of the relevant IUPAC types of property in the LOINC properties table. (See
Appendix F for more detailed examples.)

Main property categories

Mass: Observations reported with mass (milligrams, grams, etc.) in the numerator of their units
of measure have properties that begin with the word mass: mass content, mass concentration, etc.

Substance: Observations reported with moles or milliequivalents in the numerator of their units
of measure have properties that begin with the word substance.

Catalytic activity: Observations that report enzymatic activity have properties that begin with
catalytic, e.g., catalytic concentration, catalytic content.

Arbitrary: Results that report arbitrary units in the numerator of their units of measure have a
property that begins with arbitrary.

Number: Counts are associated with properties that begin with number, e.g., a white blood cell
count reported as number of WBCs divided by volume of blood, would have a property of
Number Concentration.

The pharmaceutical industry has the need for laboratory terms that are not specific as to whether the test
measures a substance (substance concentration or substance rate) or mass (mass concentration or mass
rate). We have created terms with the properties of MSCnc or MSRat to represent these more general test
observations. These will only be displayed in RELMA if the user selects one of two new choices (only
MS* prop, all MS* prop) on the LIMIT SEARCH screen.

Category subtypes: Each of the above major property categories has number of derivatives:
concentration, content, ratio, fraction, and rate (See LOINC properties table).

Concentrations: An amount divided by a volume. These have units such as mg/dL, or gm/L.

Contents: An amount divided by a mass. These have units such as mg/gm sample or mg/total
protein.

Ratios: When a result is reported as one measure divided by another taken from the same system,
the property is a ratio. The ratio of the mass concentration of substance A divided by the mass
concentration of creatinine in a urine sample, for instance, is a mass concentration ratio (MCrto).
The numerator and denominator of a ratio must come from the same system. If the measures
come from different specimens, e.g., PT patient/PT control or creatinine serum vs. creatinine
urine, it is a relative ratio (RelRto). The ratio of times coming from an actual and normal control
(as in some coagulation tests) will be relative time (RelTime), a ratio of mass concentrations
coming from two different specimens will be relative mass concentrate (RelMCnc), and a ratio of
catalytic concentrations from different specimens will have the property of relative catalytic
concentrate (RelCCnc).
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Fractions: Fractions are ratios of a part over a whole: Creatine kinase.MB/Creatine kinase.total,
if measured in grams, is a mass fraction. (Fractions are usually reported as percents.)

Rates: A rate is a measure per a time period, e.g., mg/day would be a mass rate (MRat).
Clearances have the property of volume rate, but Clearance will be included in analyte name to
clarify meaning, e.g., Sodium renal clearance:VRat:24H:Urine:Qn

Some measures do not fit the above schema. For instance, IUPAC describes an entitic quantity. This
refers to measure per entity (e.g., cells, receptors, and molecules). Entitic quantities usually have units
that include the name of some entity, e.g., red blood cells (per 10
6
RBCs).

One must be careful when mapping measures of constituents of red blood cells to LOINC code because
they can be expressed many ways, e.g., as an amount per mass of hemoglobin, per liter of blood or
per red blood cell. The first is a mass content, the second a mass concentration, and the last is an entitic
mass (mass per entity) all different properties.

Some tests report the name of an organism (or initially report the presence of any organism, and later
identify the particular strain), toxic substance, antibody or antigen, as a test result. Use Prid (presence
or identity) as the type of property field for results of this sort.

For example:

Bacteria identified:Prid:Pt:Isolate:Nom:Bacterial subtyping

Barbiturates positive:Prid:Pt:Urine:Nom:Confirm

Correct assignment of properties tends to be the most difficult task for new users of LOINC. Appendix F
provides more explanation and many detailed examples.

NOTE: For order sets/panels, the property field may be populated by a dash (-).







Table 8: Example LOINC properties
Enzymatic Activity Substance Amount (Moles/Milliequivalents)
CAct *Catalytic Activity RelSCnc *Relative Substance Concentration
CCnc Catalytic Concentration Sub *Substance Amount
CCrto Catalytic Concentration Ratio SCnc *Substance Concentration
CCnt *Catalytic Content ScRto *Substance Ratio
CFr *Catalytic Fraction SCnt *Substance Content
CRat Catalytic Rate SFr *Substance Fraction
RelCCnc Relative Catalytic Concentration SRat *Substance Rate
ThrSCnc Threshold Substance Concentration
Entitic SCncDiff Difference in Substance Concentration
EntCat *Entitic Catalytic Activity LsCnc Log substance concentration
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EntLen Entitic Length Volumes
EntMass Entitic Mass Vol *Volume
EntNum *Entitic Number VCnt *Volume Content
EntVol *Entitic Volume VFr *Volume Fraction
EntSub Entitic Substance VRat *Volume Rate
Mass VRatCnt Volume Rate Content
Mass Mass VRatRto Volume Rate Ratio
MAric Mass Aeric VRto *Volume Ratio
MCnc *Mass Concentration RelVol Relative Volume
MCrto Mass Concentration Ratio RelVRat Relative Volume Rate
MCnt Mass Content ArEnrg Energy/Area
MFr *Mass Fraction ArResis Resistance/Area
MRat Mass Rate ArVol Volume/Area
MRto Mass Ratio Time
RelMCnc *Relative Mass Concentration Time Time
ThrMCnc *Threshold Mass Concentration TmStp Time StampDate and Time
TRto Time Ratio
TQ2 Timing Quantity 2
Counts RelTime *Relative Time
Num *Number DateRange Date Range
Naric Number Aeric (number per area) Arbitrary Unit Measures
NCnc *Number Concentration (count/vol) ACnc Arbitrary Concentration
NCnt Number Content = Count/Mass ACnt Arbitrary Content
NFr *Number Fraction ThrACnc Threshold Arbitrary Concentration
NRat Number=Count/Time ARat Arbitrary Rate
NRto Number Ratio LaCnc Log Arbitrary Concentration
LnRto Log Number Ratio RelACnc Relative Arbitrary Concentration
LnCnc Log Number Concentration
Other Properties
Accel Acceleration Hx History
Addr Address Len Length
Anat Anatomy LenFr Length Fraction
Angle Angle LenRto Length Ratio
Aper Appearance Loc Location
Arb *Arbitrary MOM Multiple of the median
Area Area Morph Morphology
Bib Bibliographic Citation OD Optical density
Circ Circumference Osmol *Osmolality
CircFr Circumference Fraction Pn Patient number
Class *Class Prctl Percentile
Compli Compliance Prid Presence or Identity
CompliRto Compliance Ratio PPres *Pressure (partial)
Cmplx Complex Pres Pressure
Desc Description PresRat Pressure Rate
Diam Diameter PressDiff Pressure Difference
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Doc Document PresRto Pressure Ratio
Dosage Dosage Quintile Quintile
Elpot Electrical Potential (Voltage) Ratio Relative Density
ElpotRat Voltage Rate (=Amperage) RelRto Relative Ratio
EmailAddr E-mail Address Resis Resistance
EngCnt Energy Content SatFr *Saturation Fraction
EngFr Energy Fraction Seq Nucleotide sequence
EngRat Power = Energy/Time Shape Shape
EngRatFr Energy Ratio Fraction Susc Susceptibility
EngRto Energy Ratio Temp *Temperature
Enrg Energy Tele Telephone number
Equ Equation Txt Text
Fcn Function Threshold *Threshold
Find Finding Titr Dilution Factor (Titer)
FldResist Fluid Resistance Type Type
Force Mechanical Force Vel *Velocity
Imp Impression/interpretation of study VelRat Velocity Rate
ID Identifier VelRto *Velocity Ratio
Instrct Instructions Visc Viscosity
InvLen Inverse Length
*Starred items are adopted from the IUPAC Silver Book, non-starred items are extensions.

2.4 Time Aspect (Point or moment in time vs. time interval) (3rd part)

One can either measure a property at a moment (point) in time or measure it over a time interval and
integrate, in the mathematical sense, over time. In the latter case, we aggregate a series of physiologic
states into a single scalar value that reflects some average property measured over the specified time
interval. Intervals also have relevance for rate measurements such as excretion (substance rate or mass
rate) or clearances (volume rates). The amount over an interval is often expressed as a mass rate (MRat,
e.g., g/24h) or a substance rate (SRat, e.g., mol/24h). Interval measurements often apply to urine and
stool (e.g., collection over 24 hours and calculation of a concentration, total amount, or clearance). They
also apply to clinical measurements such as urine outputs where we have shift totals and 24-hour totals.
Event counts on physiologic monitors, such as the number of premature ventricular contractions (PVCs)
over 24 hours on a Holter monitor, are also of this type.

The allowed values for non-point time aspect are defined as a syntax exactly like the syntax for the times
in challenge tests, e.g., <numeric value><S|M|H|W> The most common one is 24H. Table 9 gives some
other examples.

For urine collection, 24H is the standard integrated measure and these are almost always reported as
mass rates (MRat), substance rates (SRat), or catalytic (CRat) rates. These would contrast with spot or
random urine tests that are represented as point (PT) measures in our nomenclature and usually reported
as concentrations -- MCnc, CCnc, or SCnc for mass, catalytic, and substance concentrations respectively.
However, we can also report the average concentration on a 24-hour specimen in this case the time
aspect value would be 24H but the property would be MCnc/SCnc/CCnc instead of MRat/SRat/CRat.

The designation of 24H collection is maintained for tests that traditionally have reference ranges based on
amount of substance of a component cleared or excreted in 24 hours. However, a given specimen could
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have a 23-hour collection time and would still be called a 24H study. Depending upon the policies and
procedures of the lab, they might extrapolate the reported value to what it would have been if the
collection continued for the full 24 hours and report it as moles per day.

We also allow indirect specifications of a time window. Stdy identifies the duration of the study (without
specifying an exact time); Enctr identifies the Encounter (ER visit, hospital stay, etc).

Sample volumes reported for timed measurements are carried in other fields or as separate test results in
other OBX segments.
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Table 9: Example Duration Categories
Abbr. Duration Descriptions
To identify measures at a point in time. This is a synonym for spot or random as applied to urine
measurements.
Pt
Stdy Duration of the study
Enctr Duration of an encounter (hospital stay, visit).
Episode Episode
Gt 1H Greater than 1 hour
Ge 1 Hr Greater than or equal to 1 hour
Lt 1H Less than 1 hour
Procedure dur Duration of the procedure (surgery, etc.)
XXX Not specified; time will be reported in another part of the electronic message
* (star) Life of the unit. Used for blood products.
Abbr. Description Abbr. Description Abbr. Description
1M 1 minute 7 hours 2W 7H 2 weeks
5M 5 minutes 8H
8 hours
3W 3 weeks
10M 10 minutes 9H
9 hours
4W 4 weeks
15M 15 minutes 10H
10 hours
1MO 1 month (30 days)
20M 20 minutes 12H
12hours
2MO 2 months
30M 30 minutes 18H
18 hours
3MO 3 months
45M 45 minutes 24H
24 hours

90M 90 minutes 48H
48 hours

1H 1 hour 1D 1 day
2H 2 hours 2D
2 day

2.5H 2.5 hours 3D
3 day

3H 3 hours 4D
4 day

4H 4 hours 5D
5 day

5H 5 hours 6D
6 day

6H 6 hours 1W 1 week

2.4.1 Time Aspect Modifier

The second and optional subpart of the time component allows an indication of some sub-selection or
integration of the measures taken over the defined period of time: 8H^max heart rate would be the highest
heart rate observed over 8H (Shift). Min, max, first, last, mean are the other possible values for this
subpart. When nothing is stored in this subpart, we assume a mean value over the time period in
questions. Valid values for this subpart are listed in table below.

Table 10: Time Aspect Modifier Codes
Time Description
min Minimum value over interval
max Maximum value over interval
frst First value observed during an interval
last Last value observed during an interval
mean Mean of all of the values observed on the interval (This is the default selection.)

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2.5 System (Sample) Type (4th part)

System (sample) type is the fourth part of the fully specified test name. It consists of two subparts; the
first part names the system, the optional second part, delimited with a ^, indicates the super system
source of the sample if it is not the patient, e.g., fetus, blood product unit, donor, etc.

We define different tests for the combination of component (analyte) and type of system (sample) that are
commonly reported. In practice, laboratories include a relatively small range of sample types in their test
names. Chemical tests commonly distinguish between serum, urine, blood, and cerebrospinal fluid.
Microbiology cultures tend to distinguish between greater numbers of sources.

The first part of the system field should be coded using the abbreviations listed in Table 11. Since this list
was defined for reporting sample type in a field of the HL7/ASTM message that is quite independent of
the test/measure name, we do not imply that all such types will find their way into distinct LOINC names.
However, when a distinction by type of system is required in the name, it should be represented by one of
these codes.

For many chemistry tests we have included in the LOINC database a test name for identifying
miscellaneous types of body fluid (Body fld), to provide a way to distinguish tests that are performed on
fluid types that are not explicitly represented in the database. We use the code XXX to identify a material
that is not specified it could be solid or fluid, for example.

When should we lump a variety of specimen types under the nonspecific code Body fld and when we
should give a body material its own unique name for a given component? The decision depends upon the
degree to which laboratories have reported the system-component pair as a separate result and the
degree to which the normal ranges for a given component-system have been standardized. By this rule,
we will always define different tests for serum and for urine, when a component can be measured in both.
We define sweat sodium as a distinct test because it is a standardized test used to diagnose cystic fibrosis.
We did not define duodenal fluid sodium as a separate LOINC code because this measure has not been
standardized. This does not mean that the specifics about the system would be ignored. It just means that
this information would be recorded in another field of the message (the specimen field of the HL7 OBR
segment), not in the name. Generally, we will specify the type of system to distinguish at least among
blood, urine, cerebrospinal fluid, pleural fluid, synovial fluid, and peritoneal fluid.

For many types of tests, the distinction between plasma and serum is irrelevant. When testing on serum
or plasma is clinically equivalent, the system should be recorded as Ser/Plas. Sometimes the test can only
be run on either plasma or serum; the component will then be associated with either Ser or Plas in one
observation. If the test can be run on either but the results are different and standardized (a very rare
circumstance), two separate tests will be defined in our file, one with a system Plas and one with a system
Ser. The current LOINC database includes some Ser tests and some Plas tests that should really be
Ser/Plas. As we determine that a Ser or Plas test really should have been designated Ser/Plas, we will
change the designation.

If the test is run on a combination of types of system (such as a ratio of substance found in CSF and
plasma) the codes are joined with a +: Plas+CSF, Ser+CSF, Isolate+Ser, etc.

Details about the exact source and collection method (e.g., blood drawn from the right arm and
maintained on ice) are not a proper part of the test name and are reported in other parts of the message,
e.g., OBX and OBR of the HL7 message.
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Table 11: Example Laboratory System/Sample Types
Abbr. Name Abbr. Name Abbr. Name
Abs Abscess Fistula Fistula Ser Serum
Amnio fld Amniotic fluid Body fld Body fluid, unsp Skin Skin
Anal Anus Food Food sample Sputum Sputum
Asp Aspirate Gas Gas Sptt Sputum - tracheal aspirate
Bil fld Bile fluid Gast fld Gastric fluid/contents Stool Stool = Fecal
BldA Blood arterial Genital Genital Sweat Sweat
BldL Blood bag Genital fld Genital fluid Synv fld Synovial fluid (Joint fluid)
BldC Blood capillary Genital loc Genital lochia Tear Tears
BldCo Blood cord Genital muc Genital mucus Thrt Throat
BldMV Blood- Mixed Venous Hair Hair Platelets Thrombocyte (platelet)
BldP Blood peripheral Inhl gas Inhaled gas Tiss Tissue, unspecified
BldV Blood venous Isolate Isolate Tlgi Tissue large intestine
Bld.dot Blood filter paper WBC Leukocytes Tsmi Tissue small intestine
Bone Bone Line Line Trachea Trachea
Brain Brain Liver Liver Tube Tube, unspecified
Bronchial Bronchial Lung tiss Lung tissue Ulc Ulcer
Burn Burn Bone mar Marrow (bone) Urethra Urethra
Calculus Calculus (=Stone) Meconium Meconium Urine Urine
Cnl Cannula Milk Milk Urine sed Urine sediment
CTp Catheter tip Nail Nail Unk sub Unknown substance
CSF Cerebral spinal fluid Nose Nose (nasal passage) Vag Vagina
Cvm Cervical mucus Nph Naspopharynx Vitr fld Vitreous Fluid
Cvx Cervix Penile vessels Penile vessels Vomitus Vomitus
Col Colostrum Penis Penis Bld Whole blood
Cnjt Conjunctiva Pericard fld Pericardial fluid Water Water
Crn Cornea Periton fld Peritoneal fluid /ascites Wound Wound
To be specified in another part
of the message
Dentin Dentin Dial fld prt Peritoneal dialysis fluid XXX
Dial fld Dialysis fluid Placent Placenta
Dose Dose med or substance Plas Plasma
Drain Drain Plr fld
Pleural fluid (thoracentesis
fld)

Duod fld Duodenal fluid PPP Platelet poor plasma
Ear Ear PRP Platelet rich plasma
Endomet Endometrium Pus Pus
RBC Erythrocytes RBCCo Red Blood Cells Cord
Eye Eye Saliva Saliva
Exhl gas Exhaled gas (=breath) Semen Seminal fluid
Fibroblasts Fibroblasts

These abbreviations are used in the laboratory LOINC codes. Systems in clinical LOINC terms are
spelled out in full and should be easily understood.

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2.5.1
2.6
Super system (2nd subpart)

The second subpart of the system identifies a super-system when it is not the patient, e.g., a blood
product unit (BPU), a bone marrow donor, or a fetus. When the super system is not included in a name,
patient is the assumed default value. This subpart can take on the values in Table 11. Note: we use the
term fetus broadly to include embryo, placenta and products of conception.

For instance, an example of representing a coagulation study that uses measures on both patient and a
control might be:

Coagulation reptilase induced:Time:Pt:PPP:Qn:Coag

Coagulation reptilase induced:Time:Pt:PPP^control:Qn:Coag

Blood banks often report red blood cell antigens for the patient and for each blood product pack assigned
to that patient. So we have:

A Ag:ACnc:Pt:RBC:Ord

A Ag:ACnc:Pt:RBC^BPU:Ord

Note: The inclusion of the super system as part of the system represents a change from versions of
LOINC prior to Release 1.0K, May 1998. Earlier versions included this information in the (no longer
valued) fourth subpart of the component.

Type of Scale (5th part)

The fifth data part of the test name specifies the scale of the measure, and is a required part. The
abbreviation of the type of scale (previously called precision), given in Table 12, should be used in the
fully specified name. Note that with the release of Version 1.0K, May 1998, we changed the codes for
these from SQ to ORD and from QL to NOM to more accurately identify the meaning.

Table 12: Type of Scale
Scale Type Abbr. Description
Quantitative Qn
The result of the test is a numeric value that relates to a continuous numeric scale.
Reported either as an integer, a ratio, a real number, or a range. The test result value may
optionally contain a relational operator from the set {<=, <, >, >=}. Valid values for a
quantitative test are of the form 7, -7, 7.4, -7.4, 7.8912, 0.125, <10,
<10.15, >12000, 1-10, 1:256
Ordinal Ord
Ordered categorical responses, e.g., 1+, 2+, 3+; positive, negative; reactive,
indeterminate, nonreactive. (Previously named SQ)
OrdQn
Test can be reported as either Ord or Qn, e.g., an antimicrobial susceptibility that can be
reported as resistant, intermediate, susceptible or as the mm diameter of the inhibition
zone. (Previously named SQN) We discourage the use of OrdQn in other circumstances.
Quantitative or Ordinal
Nom
Nominal or categorical responses that do not have a natural ordering. (e.g., names of
bacteria, reported as answers, categories of appearance that do not have a natural
ordering, such as, yellow, clear, bloody. (Previously named QL)
Nominal
Narrative Nar Text narrative, such as the description of a microscopic part of a surgical papule test.
Multi
Many separate results structured as one text glob, and reported as one observation, with
or without imbedded display formatting.
Multi
Document Doc A document which could be in many formats (XML, narrative, etc.)
Set Set Used for clinical attachments

Quantitative (Qn) identifies scales that can be tied to some physical quantity through a linear equation.
This means that if we have two reports for the same quantity one with a value of 5 and the other a value
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of 10 we know that the two are related in amount through the linear equation Y = aX +b. When the
intercept, b, is non-zero, we have a difference scale. (Fahrenheit temperature is a difference scale.) When
it is zero we have a ratio scale (Kelvin temperature is a ratio scale).
22, 23
A Qn value may be reported as a
value for a continuous scale, as is the case for serum sodium, or it may be reported from a series of
discrete values, as is the case for titers, e.g., 1:16, 1:32.

Ordinal (Ord): Some observations have values that are well ordered, e.g., present, absent, 1+, 2+, 3+,
or negative, intermediate, positive, but the values have no linear relationship to one another. We do not
know that positive is two or three times as much as intermediate, we just know that positive is more than
intermediate. These kinds of observations have an ordinal scale (Ord). Tests with yes/no answers are
always ordinal (Ord). Tests reported as negative when less than the detection level but as quantified
values otherwise should be regarded as quantitative (Qn).

Quantitative/Ordinal (OrdQn): Rarely, a result can be reported in either an ordinal or quantitative scale.
The principal example of this scale is a MIC, which can be reported as either
resistant/intermediate/susceptible or by the MIC numeric value. The need for terms with OrdQn as scale
was further obviated by clarification from HL7 that results such as "POS" and "NEG" should go in the
OBX-8 field for normalcy status. Thus, LOINC codes with scale of Qn can be appropriately used in these
cases even if the "values" coming back are coded interpretations of the true numeric result value.

Nominal (Nom): Some observations take on values that have no relative order. Think of the numbers on
football jerseys. These simply identify the players, they do not provide quantitative information or rank
ordering of the players. We refer to these as nominal (Nom) in scale. Blood culture results provide a
good example. Possible values could be Escherichia coli (or a code for E. coli) or Staphylococcus aureus.
Other examples are admission diagnoses and discharge diagnoses. Any test or measure that looks broadly
at patient or specimen and reports the name of what it finds, is a Nom scale. The values of nominal
scaled observations are assumed to be taken from a predefined list of codes or from a restricted
vocabulary (e.g. a menu of choices). These observations would typically be sent in an HL7 message OBX
segment with a Coded Element (CE) data type (in earlier HL7 versions) or its superseding Coded with No
Exceptions (CNE) and Coded With Exceptions (CWE) variants (later HL7 versions). It is important to
note that the CE and CWE data types allow values to be set as codes with their print text or just as their
print text alone. These data types and the Nom scale would not be used for running narrative.

Narrative (Nar): Some observations are reported as free text narrative. The content is not drawn from a
formal vocabulary or code system. A dictated present illness would be an example of a scale of narrative
(Nar). Many clinical LOINC codes will come in two versions: one for the nominal (coded) version and
one for a narrative (free text) version.

We strongly encourage all reporting to be at the most granular level of detail. That is, if three numbers
are reported they would each be reported under a unique LOINC code and transmitted in a separate HL7
OBX segment. Occasionally reporting systems are not able to comply with this dictum. For example
some chromatography instruments can identify chemicals from the entire spectrum of known chemicals
(CAS identifies more than 10 million distinct chemicals) and we may not have specific LOINC codes for
reporting out these details. We have designated the scale of Multi to identify results that include many
separately structured results as one text glob with or without imbedded (display formatting). Some
laboratories report all of the details of many multiple measure tests under such globs with test names that
correspond to their order name. We strongly discourage such reporting. It defeats the very purpose of
individual codes to tag content.
NOTE: Because the individual components of an Order set/Panel often have different scales, the scale for
the order set term may be populated by a dash (-).

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2.7 Type of Method (6th part)

The method by which the test was performed is the sixth part of the test name. Methods need only be
expressed as part of the name when they provide a distinction between tests that measure the same
component (analyte) but which have different clinical significance or have a different clinical reference
ranges. For instance, whole blood glucose tested with a test strip might be distinguished in the method
field.
The list of methods given in Table 13 is not exhaustive; we have included only those methods that are
abbreviated in the database or which otherwise require explanation or clarification. Most methods are
fully spelled out in the database and should be self-explanatory.

Laboratories do not include the method as part of the name for most common chemical and hematological
tests. They often need the freedom to choose the instrument according to time of day, urgency of the
request for service, availability of the instruments and so on, even though the instruments may employ
different methods. The laboratories then adjust each of the interchangeable instruments to produce
equivalent results even though the instruments may use different methods. Therefore, we do not want to
distinguish too finely on the basis of methods. Though method is rarely significant for many chemical
and hematological tests, it is often important to immunochemical/serology testing, because the sensitivity
and specificity of some tests varies greatly with the method. For this reason, you will commonly see
methods included in microbiology tests and coagulation tests within the LOINC database.

This does not mean that information about the method is irrelevant, but that it is not always a meaningful
part of the test name. It is an essential element of the internal quality assurance of laboratories.
Remember that both reference range and method can be sent in other fields of ASTM, HL7, and CEN
TC251 result messages.

Table 13: Examples of Method Abbreviations
Method Abbr. Comment
Agglutination Aggl
Coagulation Assay Coag To distinguish coagulation assays based on clotting methods
Complement Fixation Comp fix
Computerized Tomography CT
Cytology Stain Cyto stain
The staining method used for pap smears, fine needle aspirates and other
cell stains.
DNA Nucleic Acid Probe Probe See section 2.7.1 for more information about probes.
Chromogenic/Enzymatic Assay Chromo
To distinguish coagulation assays based on chromogenic (enzymatic)
activity.
Enzyme Immunoassay EIA Subsumes variants such as ELISA
Flocculation Assay Floc
Hemagglutination Inhibition HAI
Hemagglutination HA Encompasses direct and indirect
Immune Blot IB
Immune Fluorescence IF Encompasses DFA, IFA, FA
Latex Agglutination LA
Leukocyte Histamine Release LHR
Minimum Inhibitory Concentration MIC Antibiotic susceptibilities
Minimum Lethal Concentration MLC Also called MBC (minimum bactericidal concentration)
Molecular Genetics Molgen
General class of methods used to detect genetic attributes on a molecular
basis including RFL, PCR and other methods.
Neutralization Neut
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Radioimmunoassay RIA
Serum Bacterial Titer SBT Determines the serum dilution that is capable of killing microorganisms.
Rapid Plasma Reagin RPR
Microscopic flocculation test, using cardiolipin-lecithin-cholesterol
antigen with carbon particles.
Ultrasound US
Vertical Auto Profile VAP Developed by Atherotech, Inc.
Visual Count VC
Venereal Disease Research
Laboratory
VDRL Microscopic flocculation test

2.7.1 DNA/RNA probes/measures

We distinguish three kinds of DNA probe methods:
1. Probe without amplification (Probe)
2. Probe with target amplification (Probe.amp.tar)
See Table 14A for a list of methods that would be identified as Probe.amp.tar in the method part of
the LOINC term.
3. Probe with signal amplification (Probe.amp.sig)
See Table 14B for a list of methods that would be identified as Probe.amp.sig in the method part of
the LOINC term.

Table 14A: Examples of specific methods that would be classed as target amplified DNA/RNA
Probe.amp.tar (includes nucleic acid target amplification and probe)
Applies to: DNA, RNA
PCR* Polymerase Chain Reaction Roche Molecular Systems (thermal cycler)
Requires repeated cycles of heating and cooling-each cycle doubles the target
Applies to DNA, RNA
TMA Transcription Mediated Amplification
Gen-Probe, Inc. (isothermal)
NASBA Nucleic Acid Sequence Based Analysis
Applies to RNA, DNA
Organon-Tenika Corp (isothermal)
SDA Strand Displacement Amplification
Applies to DNA
Becton Dickinson (isothermal)
LAT Ligation-Activated Transcription
3SR SR 3 Self-Sustaining Sequence Replication
Applies to RNA, DNA
Bartel's Diagnostic (isothermal)
LCR Ligase Chain Reaction
Also probe amplification category method
Abbott Laboratories (thermal cycler)
QBR
Q-Beta Replicase or probe amplification
category method
Applies to DNA RNA
Gene Track Systems. (isothermal)
Table 14B: Examples of specific methods that would be defined in LOINC as signal amplification methods
Probe.amp.sig (includes nucleic acid signal amplification and probe)
HPA Hybridization Protection Assay
Applies to RNA
Gen-Probe Accuprobe
BdnA Branched Chain DNA
Applies to DNA, RNA
Chiron Corp (isothermal)
---------
Hybrid Capture
*The items in the first column of the above table are not meant to be used as methods in LOINC terms.

2.7.2 Immunofluorescence (IF)

We do not distinguish among many variants of immunofluorescent tests. DFA, ACIF, are all classed as
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immunofluorescence (IF).


2.7.3
2.7.4
2.7.5
2.7.6
2.8
Immune Stain

We classify peroxidase and all other immune stains of tissue under the method category immune stain.

Enzyme Immunoassay (EIA)

We classify many variants of enzymes under EIA, including ELISA, CEIA, etc.

Coagulation

We distinguish among three kinds of coagulation method: coagulation (Coag), which measures the
coagulation activity, immune (Imm), which measures the amount of the coagulant protein, not its activity,
and chromogenic (Chromo), which measures the coagulation factor via enzyme rate (also called
enzymatic).

Stains

We provide very detailed distinctions among various tissue stains, naming them in full. Stain methods
that are modifications of a basic method are named using a <basic>. <modification> syntax, e.g.,
Methenamine silver stain.Jones

2.7.7 Clinical measures

We distinguish reported from estimated and measured values; so reported body weight would be the
stated weight from a patient or surrogate. Estimated would be the body weight estimated by an observer,
and measured body weight.

2.7.8 Imaging studies

We distinguish among the major imaging modalities for most measures derived from such imaging
studies (e.g., cardiac outputs from a MUGA scan, angiography, 2D Echo, Doppler, etc.).


Short Convenient Names

As of the August 2002 release of LOINC we have included a new field in the LOINC database called
SHORTNAME. This field will carry a short, mixed case name for the LOINC concept. We have
populated these fields for all laboratory and radiology tests. Our goal was to produce names no longer
than 30 characters in order to fit within the space allocated by most laboratory reporting systems. In
contrast to the formal LOINC name case is significant in the LOINC short name. When possible, we
have used common acronyms and common names rather than the more formal name rules of the full
LOINC name. For example, we used the English names of allergens in the short names rather than the
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formal Latin species names (in part because they were shorter). The LOINC short names are subject to
change and should not be used as identifying keys in any database.

These names have been created via a table driven algorithmic process. We have used all upper case to
represent acronyms, and mixed case in organism names as specified in naming conventions (e.g., genus is
capitalized, species is not). For virus names we used the acronym assigned by Index Virum where
available.

2.9
2.10
Long Common Names

LOINC has received periodic requests from users to produce pretty display names that could be used in
user interfaces, etc. While systematically created names (like the standard LOINC short names) can be
guaranteed to be unique, they are sometimes not the most user-friendly. We have always expected that
users would link their own local preferred names to LOINC terms for use in reports and displays. In
contrast to systematically-created names, user-friendly names are often ambiguous.

After collecting and reviewing display names from several sources, we decided to create a new
algorithmically-generated Long Common Name based on patterns we observed. As of the January 2009
release, we have included a new field in the LOINC database called LONG_COMMON_NAME.
These names have been created by an algorithmic process and are checked for uniqueness. Most
abbreviations and acronyms that are used in the LOINC database have been fully spelled out in English.
For allergens, the common English names are used instead of the more formal Latin species names. For
coagulation, the more commonly used phrases such as Prothrombin time have been used.

We started creating long common names first for laboratory terms, but are now producing them for all
terms. The text strings for the long common names are subject to change over time as we continue to
refine the algorithmic process and collect feedback from users. In particular, many of the long common
names for clinical terms have not had as intense focus as the laboratory terms have, so we expect these to
be refined over time.

LOINC term names in HL7 messages

Messaging standards like HL7 typically use a triplet <identifier code>^<descriptive text>^<coding
system> for fields that contain coded entries, such as the OBX-3 Observation Identifier field. Given that
LOINC now produces at least 3 names for each term (i.e., the six-part Fully-Specified Name, Short
Name, and Long Common Name), users have wondered which LOINC name they should use in the
<descriptive text> part of that field (or the equivalent displayName attribute in HL7 V3). In general, we
recommend the use of the Long Common Name because they are probably the most understandable to
human readers. However, the Long Common Names can be quite long and some systems may not be able
to accommodate them. In these cases, we would recommend the use of the Short Name because they
would fit within the space allocated by most reporting systems, could potentially work as a column name
on a flow sheet, and mostly use common acronyms. Using the Fully-Specified Name (e.g. a colon-
separated aggregate of the six part name) is generally not recommended because they are not as human
friendly and contain more instances of reserved characters like ^ and &, which would need to be
properly escaped in the message.

Furthermore, we recommend the simultaneous communication of the senders local code and local name
(in addition to the LOINC code and name) as allowed in the messaging structure to facilitate debugging
and detection of mis-mappings.
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2.11
3.1.1
3.1.2
Classes

We assign each LOINC term to a general category called a Class. These categories are relatively broad
and are intended to make it easier to sort and browse the database. They are not intended to be binding
definitional characteristics of the term, and we may refine them over time. A more detailed listing of the
Classes is presented in Appendix B. Throughout this document many of the naming conventions and
approaches are described in reference to a Class of terms. Here we provide a bit of explanation about
some of the laboratory term classes.

The class of Microbiology includes all tests used to identify microorganisms and evidence for infection
by specific organisms as well as cultures direct microscopic exams that identify organisms or prove
evidence for present or past infection with specific organisms. Microbiology includes tests for antibodies,
antigens, DNA and RNA. The Serology class does not include measures antibodies or antigens related to
microorganisms. Molecular pathology class does not include RNA or DNA based tests for infectious
organisms. (They are all included in Microbiology.)

The class Blood bank includes all blood bank testing including ABO-Rh testing. Allergy class includes
testing for antibodies to allergens (cat dander, trees, etc). Serology includes rheumatological, and
autoantibodies, and antigen measures not covered by these two classes. Hematology/cell counts excludes
coagulation studies that are found in a separate class. Measures of complement activity are included
within Hematology, not Chemistry. Chemistry does not include challenge tests such as Glucose tolerance,
ACTH stimulation, etc; these are in a separate category called Challenge tests.


3 Special Cases

3.1 Findings viewed as variables or as values

For some complex tests there are two ways to organize the results into a report.
Value

Assume a set X is made up of five results that can have a scale of (absent present) or (0 1). These
results could be reported as:

Finding 1 = Present - or - 1
Finding 2 = Absent - or - 0
Finding 3 = Present - or - 1
Finding 4 = Absent - or - 0
Finding 5 = Absent - or - 0

Each finding is then considered a binary variable. This is sometimes called a panel approach.

Variable (Multiple Choice) Approach

The alternative would be to report this information as a single variable (or multiple-choice question) with
many possible values:

Variable X - Finding 1, Finding 3

In this case the findings are the values of a variable called Variable X; only the positive findings are
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reported as values. Many laboratory tests, e.g., those that test for HLA antigens, red blood cell antigens,
or screens for toxic substances, could in theory be presented either way. The microscopic part of the
differential count and urinalysis could also be described either way. History and physical findings and
(given a real stretch) even culture results could be structured in the panel or multiple choice/multiple
answer format.

A single lab may report red blood cell antigens in either way, as a binary panel or a multiple-choice result,
depending upon the purpose of the test. The routine cross and type are reported out in the multiple choice
pattern format (only positives from a modest fixed set of tested antigens are reported). But if the tests are
being used to prove fatherhood, the results are usually reported as a binary panel.

Blood cultures could in theory be regarded as panels:

Test Name Value
Escherichia coli absent
Staphylococcus aureus present
Diphtheroids absent
Streptococcus pneumoniae absent
Pseudomonas aeruginosa present

Although in practice such tests are almost always reported in the multiple choice/multiple answer format,
as follows:

Test Name Values
Blood culture P. aeruginosa, S. aureus

We bring up these issues to explain why we use a somewhat different data format for some types of tests,
and why we sometimes provide for both reporting methods (e.g., HLA blood cell antigen tests) in the
LOINC database. When a binary scale is used, the kind of property will usually be arbitrary
concentration (ACnc) and the scale ordinal (Ord). When the multiple-choice multiple-answer approach is
used, the scale will be nominal (Nom) and the type of property will be presence or identification (Prid).

3.2
3.2.1
Blood bank



Red cell antigens will be named in accordance with the American Association of Blood Banking (AABB)
naming standards.
24
In addition to the antigen or antibody, a modifier would be included in the super-
system (the second subfield of the SYSTEM field); to indicate whether testing was performed on the
patient, donor, or blood pack. Unless explicitly stated, testing is assumed to have been on a material
collected from a patient. Additional information about the person identified in the fourth subpart, such as
the donor's name or relationship to patient, should be placed in other OBX segments, or comment
segments of the message, and would not be part of the test name.

Blood bank reporting illustrates the need for a method of reporting by panel and by multiple-answer
mechanism. The LOINC database provides observation names for both kinds of reporting.

Panel reporting:

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Each reportable antigen must have its own test, so that each element in a full set of binary tests could be
reported as (negative, positive) or (0, 1).

The fully specified names of A, AB, B, and O blood types (as observations) would be as follows:

Measure of serum antibody against type A blood of donor:

A Ab:ACnc:Pt:Ser/Plas^donor:Ord

Presence of A antigen on donor's red blood cells:

A Ag:ACnc:Pt:RBC^donor:Ord

Presence of A antigen on the blood cells in a pack of blood given to the patient:

A Ag:ACnc:Pt:RBC^BPU:Ord


3.2.2
3.3
3.3.1
3.3.2
Multiple answer reporting:

All blood antibodies found (or not found) can also be reported in one result term:

Antigens absent:Prid:Pt:BBL^BPU:Nom
Antibodies identified:Prid:Pt:Ser/Plas:Nom

The LOINC database provides other observations for reporting: the status of each blood pack (e.g.,
held, given, discarded), and for reporting that information when HIS and medical records systems want it;
how much of each type of blood product was given at a moment in time; the type of each pack; any
adverse reaction to that pack; and the pack number to accommodate laboratories that send this
information as discrete observations.

Blood product disposition:Type:Pt:^BPU:Nom

Blood product type:Type:Pt:^BPU:Nom

Immunocompetence studies (flow cytometry)

The CD (Cluster of Differentiation) markers in the LOINC database include all of the single markers and
the most commonly reported combinations, e.g., CD11C+CD20C+. Most of these are really measuring
the number or percent of cells that bear the specific T-cell marker pattern, in which case they should be
specified as a subtype of a lymphocyte, e.g., CELLS.CDx. There are other possibilities, and these cell
types can also be named; for instance Blasts.CD2 or Abnormal blood cells.CD5.

Two kinds of measures are of interest.

The absolute number of such cells per cubic millimeter is represented as number
concentrations, for example:

Cells.CD16C+CD56+:NCnc:Pt:Bld:Qn


Percent of cells containing the named marker per 100 cells of that type is represented as number
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fraction, for example:

Cells.CD16C+CD56+/100 cells:NFr:Pt:Bld:Qn

The database also includes fully specified names for all of the commonly reported HLA antigens. These
are grouped in the class HLA. Experimental methods can define many subtypes of many antigens, so this
list is not exhaustive, and is also likely to expand over time.

Example:

HLA-A1:ACnc:Pt:Bld:Ord

3.4 General approach to microbiology results

The inherently complex structure of the results of microbiological cultures presents unique challenges for
the goal of standardized observation names.

Result Status (Preliminary, Final) should not be reported as a separate observation or as part of the name.
It should be reported in the Result Status field (OBR-25) of the HL7 OBR segment.

Specimen Type (Serum, Blood, Urine, etc.) will be indicated in the HL7 OBR segment with the
Specimen Source field (OBR-15), but may also be represented in the name.

Details of specimen collection will usually be noted as OBX segments or comment segments that
accompany the culture result message. The observation identifier for the OBX segment will have the
fully specified name of SPECIMEN COLLECTION DESCRIPTION:FIND:Pt:*:NOM and the
Observation Sub-ID field will be used to order or group sets of observations. That is, if the material was
collected by swabbing a wound of the right upper arm, multiple OBX segments would be created, each
with the name SPECIMEN COLLECTION DESCRIPTION:FIND:Pt:*:NOM and the Observation
Results fields of the OBX segments would contain respectively Swab, Right, Arm, and Wound.
(The granularity of the actual terms used in the specimen description is at the discretion of the user. Thus,
Right Arm Wound as the value of a single OBX segment could be used in place of the three codes
described in the previous sentence.)

Descriptions of measurement and culture growth will be noted as separate OBX segments that
accompany the culture result message. The name of the observation identifier will provide the context of
the observation. For instance, the name for a quantitative test of bacteria in a specimen would be:

Colony count:Num:Pt:XXX:Qn:VC

Descriptions of Gram stain findings will be noted as OBX segments that accompany the culture result
message. The name of the observation identifier will be:

Microscopic observation:Prid:Pt:XXX:Nom:Gram stain

The result values that could be reported with this test (which is a multiple-choice, multiple answer type or
observation) might include one or more of the following:


Epithelial cells
Gram-positive cocci in chains
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Many Gram-negative diplococci

The organisms identified in a culture will be sent as result values in OBX segments. A separate table
of allowable organism names and/or codes is necessary if these are to be sent as understated results.
Euzbys list of bacterial names approximately 20 other authoritative sources (SNOMED is an
appropriate source for these organism concepts) may be used as the standard. While Throat Culture is
the source of the culture inoculum, it is also a label that indicates what kind of media was inoculated and
the other techniques used in the laboratory. So, it is a short hand for a kind of method and such will be
recorded as the method part of the name. Thus, Throat Culture, Blood Culture, and Clostridium
difficile Culture all represent labels for how a culture was performed. Examples of names of culture
results are:

Bacteria identified:Prid:Pt:Bld:Nom:Culture

Bacteria identified:Prid:Pt:Brn:Nom:Culture

Bacteria identified:Prid:Pt:Stool:Nom:Culture

Names of methods of staining directly on a sample/material (where many descriptive observations are
possible):

Microscopic observation:Prid:Pt:XXX:Nom:Gram stain

Microscopic observation:Prid:Pt:XXX:Nom:Dry mount

Microscopic observation:Prid:Pt:XXX:Nom:India ink preparation

Microscopic observation:Prid:Pt:XXX:Nom:Trichrome stain

Microscopic observation:Prid:Pt:XXX:Nom:Giemsa stain

Names for results of staining procedures performed on organisms that are growing in culture will use
Isolate as the system/sample type. For example:

Fungus identified:Prid:Pt:Isolate:Nom:Fungal subtyping

Names for organism-specific cultures:

Brucella sp identified:Prid:Pt:Bld:Nom:Organism specific culture

Bordetella pertussis identified:ACnc:Pt:Thrt:Ord:Organism specific culture

Chlamydia sp identified:Prid:Pt:Gen:Nom:Organism specific culture

Legionella sp identified:Prid:Pt:Sputum:Nom:Organism specific culture

Note if a test applies to a specific species of organism, the component should include the genus AND
species (at least). If the measure applies to a series of species in the same family the string sp must be
included. If it applies to as subgroup of the genus, then that subgroup should be named.

Names for method for general class of organism:

Fungus identified:Prid:Pt:Wound:Nom:Culture

Bacteria identified:Prid:Pt:CSF:Nom:Culture

Again, the Result Value of these tests would be either organism names or other statements of culture
outcome. The table below contains valid values of the culture result from the HL7 OBX segment:
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Table 15: Example Culture Results
No growth
Gram-positive cocci
Small Gram negative rod
Escherichia coli
Normal flora
Candida albicans

Presence or Identity (Prid) as a property should be used when the value of a test can identify one set of
alternative infectious agents. If the culture is for herpes virus and the culture can have results of herpes
virus 1, herpes virus 2, etc., then Prid is the right property. If the culture is for herpes virus and the
answer is positive/negative or yes/no, then the property should be arbitrary concentration (ACnc) and the
scale ordinal (Ord).


3.5 Antimicrobial susceptibilities

The drug susceptibility tests are grouped together in the LOINC database under the class ABXBACT.

Antimicrobial susceptibility tests are named according to the generic name of the drug tested and the
methodology used in testing, with property of susceptibility (Susc), and with scale of quantitative (Qn),
ordinal (Ord), or OrdQn. Thus, appropriate names would be:

Ampicillin:Susc:Pt:Isolate:OrdQn:MIC

Ampicillin:Susc:Pt:Isolate:OrdQn:Agar diffusion

Ticarcillin+clavulanate:Susc:Pt:Isolate:Qn:MLC

Table 16 lists methods in drug-susceptibility tests.

Table 16: Drug Susceptibility Methods
Method Description
Agar diffusion Bacterial sensitivity via agar diffusion (Kirby-Bauer)
MIC Minimum inhibitory concentration
MLC Minimum lethal concentration
SBT Serum bactericidal titer
Gradient strip Susceptible by E-Test or gradient strip method

Methodless codes also exist for each antimicrobial agent.

3.6 Cell counts

Quantitative counts of various entities and cells in blood, urine, CSF, and other body fluids may be
performed and reported in one of three ways. Cell counts in blood are often reported as absolute counts
per unit volume (property number concentration, NCnc), or percents of a general cell type, e.g., percent
eosinophils, (property number fraction, NFr). Blood cells are usually reported in such a manner, via
either a manual or automated count method. Counts on urine and other body fluids can also be done as
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direct counts and reported as NCnc or NFr. However, they are more often reported as the number of
entities or cells per microscopic high power or low power field, e.g., 5-10 cells per high power field.
These are really numbers per area (property Naric). For example, the number of erythrocytes casts per
low power field would be reported as:

Erythrocyte casts:Naric:Pt:Urine sed:Qn:Microscopy.light.LPF

Note that even though the values are reported as a range, the scale is still quantitative (Qn), because the
values can be related through a ratio. We use HPF or LPF to identify high power and low power fields
respectively. Large entities (such as casts) are usually reported per low power fields, smaller entities per
high power fields.

One other way such entities are reported is as a pure ordinal, e.g., none, few, moderate, loaded. These
would be specified as arbitrary concentration (ACnc) properties with ordinal scale, for example:

Erythrocytes:ACnc:Pt:Semen:Ord:Microscopy.light

3.7
3.8
Skin tests

These follow the pattern of a challenge test. For a TB skin test it would be:

Tuberculosis reaction wheal^3D post 25 TU ID:Diam:Pt:Skin:Qn

Where TU means tuberculin units, ID means intradermal, Diam indicates a measure of the diameter of the
wheal and so on.

Toxicology Drug of Abuse Screening and Confirmation

Many kinds of test methods are used in toxicology:
Screening tests include HPLC, EIA, TLC, RIA, GC, and GCMS (rarely).
Confirmation tests are GCMS, LCMS, GC, and HPLC.

Table 17: Drug of Abuse Methods
Abbr. Description
HPLC high pressure liquid chromatography
TLC thin layer chromatography
GC gas chromatography
EIA enzyme immunoassay
RIA radioimmunoassay
GCMS gas chromatography/mass spectrometry
LCMS liquid chromatography/mass spectrometry

Many laboratories use GCMS to signal that the test is a confirmation of a previous screening test, but
other methods are also used to confirm, and a given method can be used to screen or to confirm a test.
However, it is important that two different methods be used for screen and for confirm and that they both
be applied with techniques appropriate to the mode (screen or confirm). So the LOINC committee has
determined it is better to distinguish the screening from the confirming procedure by the use of the words
screen or confirm, in the method part of the name, rather than by naming a specific method. Hence
LOINC will distinguish toxicology method by Screen and Confirm but not by particular methods.

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Toxicology tests can also be performed on a group of drugs/substances or on individual drugs/
metabolites/ substances. We will develop LOINC names and codes for both categories: groups of
analytes, e.g., barbiturates and individual analytes, e.g., phenobarbital.

Group test results are usually reported as ordinal (present /absent) but can also be reported as mass
concentrations when the numerator is the total mass of the detectable substances in the group. Group tests
at the screening level may also be followed by a confirmation at the group level or by confirms of the
individual drug/substance tests at the confirmatory level. Individual drugs/substances may be reported as
present/absent (Ord) or as mass (or substance) concentrations (Qn).

When individual drugs/substances are reported ordinally, the reporting threshold (the threshold at which a
test level is considered positive) may also be reported as a separate result. Thus we have separate
LOINC codes to report the cutoff used for defining a positive or negative value.


3.8.1 Toxicology drug groups

General principles: for each group of drugs (amphetamines, benzodiazepines, opiates, etc.) we will
define the following kinds of LOINC observations:

3.8.1.1 Screen for a group of drugs/ toxic substances

X: ACnc:Pt:Ord:SYS:Screen for the group as a whole
(Answer = present/absent)

For example, Amphetamines:ACnc:Pt:Urine:Ord:Screen
Example answer: present

Identify the set of drugs/substances screened for by the group test. The answer will be a list
of discrete drug/substance names or codes.

X tested for:Prid:Pt:SYS:Nom:Screen
(Answers = individual drugs that this screening test could detect, from a fixed list)

For example, Amphetamines tested for:Prid:Pt:Urine:Nom:Screen (nominal)
Example answer = amphetamine, methamphetamine, dextroamphetamine, levoamphetamine, pseudoephedrine

3.8.1.2 Identify the drugs substances screened for (and perhaps other information). The answer will be
a glob of narrative text.

X tested for:Prid:Pt:SYS:Nar:Screen
(Answers = individual drugs that this screening test could detect, as a blob of text or canned comment)

For example, Amphetamines tested for:Prid:Pt:Urine:Nar:Screen (narrative)
Example answer = The EMIT urine screen for amphetamines detects amphetamine, methamphetamine, dextroamphetamine,
levoamphetamine as indications of methamphetamine abuse. It is also reactive with a component present in
over-the-counter nasal decongestant inhalers, and a positive result must be confirmed by a quantitative method that
rules out the non-abuse situation

When a screen is reported as negative, confirmatory testing is not performed. When a screening test is
reported as positive, the result must be confirmed by an independent testing method.

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3.8.1.3 Confirmatory testing for the presence of one or more members of the group represented as a
single observation.

X:ACnc:Pt:SYS:Ord:Confirm
(Answers = present/absent)

For example, Amphetamines:ACnc:Pt:Urine:Ord:Confirm
Example answer: present

3.8.1.4 List of the actual drug/substances confirmed.

X positive:Prid:Pt:SYS:Nom:Confirm
(Answers = list of analytes detected)

For example, Amphetamines positive:Prid:Pt:Urine:Nom:Confirm
Example answer: dextroamphetamine, methamphetamine

3.8.1.5 More commonly, confirmatory testing is reported as a set of observations, one to report
the presence (or quantitative amount detected) of each analyte in the group.

X:ACnc:Pt:SYS:Ord:Confirm
(Answers = present/absent)
or
X:MCnc:Pt:SYS:Qn:Confirm
(Answers = quantitative amount)

For example:

Amphetamine:ACnc:Pt:Urine:Ord:Confirm [present]
Dextroamphetamine:ACnc:Pt:Urine:Ord:Confirm [present]
Methamphetamine:ACnc:Pt:Urine:Ord:Confirm [present]
Levomethamphetamine:ACnc:Pt:Urine:Ord:Confirm [present]

Cutoffs 3.8.2

The cutoff levels for screens and confirms of a given substance or group of substances will usually differ.
There are three ways to indicate specific cutoffs in LOINC.

3.8.2.1 We provide separate LOINC terms for reporting the cutoff levels of a number of commonly
abused substances and substance groups.

X cutoff:MCnc:Pt:Urine:Qn:Screen
X cutoff:MCnc:Pt:Urine:Qn:Confirm

For example, Amphetamines cutoff:MCnc:Pt:Urine:Qn:Screen
Example answer: 1000 ng/ml

For example, Methamphetamine cutoff:MCnc:Pt:Urine:Qn:Confirm
Example answer: 500 ng/ml

3.8.2.2 Two general cutoff terms, one for screen and one for confirm, can be applied to any substance
whether or not a pre-coordinated term exists.

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XXX cutoff:MCnc:Pt:SYS:Qn:Screen
XXX cutoff:MCnc:Pt:SYS:Qn:Confirm

3.8.2.3 For commonly used cutoffs, such as those mandated by regulatory agencies, we provided
precoordinated terms for reporting a present/absent result with the cutoff specified in the
method field:

X:ACnc:Pt:SYS:Ord:Screen>N
X:ACnc:Pt:SYS:Ord:Confirm>N

For example, Amphetamines:ACnc:Pt:Urine:Ord:Screen>1000 ng/mL
Example answer: not detected

3.8.3
3.8.4
Reporting the method used for screen and confirm

We provide terms for reporting the method used for screen and confirm tests:

X screen method:Prid:Pt:SYS:Nom:*
X confirm method:Prid:Pt:SYS:Nom:*

These would normally be reported in conjunction with terms reporting levels and possibly cutoffs, as in
the following example:

Amphetamines:ACnc:Pt:Urine:Ord:Confirm
[Answer = positive]
Amphetamines cutoff:MCnc:Pt:Urine:Qn:Screen
[Answer = 1000 ng/ml]
Amphetamines screen method:Prid:Pt:Urine:Nom:*
[Answer = EIA]
Amphetamines positive:Prid:Pt:Urine:Nom:Confirm
[Answer = amphetamine, methamphetamine]
Amphetamine cutoff:MCnc:Pt:Urine:Qn:Confirm
[Answer = 500 ng/ml]
Methamphetamine cutoff:MCnc:Pt:Urine:Qn:Confirm
[Answer = 500 ng/ml]
Amphetamines confirm method:Prid:Pt:Urine:Nom:*
[Answer = GC/MS]

Individual drug/metabolite test results

Individual substances can be reported as screens (ordinal), confirms (ordinal) or confirms (quantitative --
usually mass or substance concentrations).

Group test screens may be confirmed by group confirms (as described above) or by individual confirms
(Either ordinal or quantitative-depending upon the laboratory's preference)

3.8.4.1 Individual test screen (ordinal)

Methamphetamine:ACnc:Pt:Urine:Ord:Screen
Example answer: present

3.8.4.2 Individual test confirm (ordinal)

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Methamphetamine:ACnc:Pt:Urine:Ord:Confirm
Example answer: present

3.8.4.3 Individual test confirm (quantitative)

Methamphetamine:MCnc:Pt:Urine:Qn:Confirm
Example answer: 250 ng/ml

Individual tests may also be reported as simple quantitative (without confirm or screen), as is the case for
therapeutic drug level monitoring.

3.8.4.4 Individual substance measured quantitatively; screen/confirm is not relevant

Digoxin:MCnc:Pt:Ser/Plas:Qn
Example answer: 1.2 ng/ml

3.8.5 Naming issues

For confirms, would always be looking for specific analytes. For example, you would never look for
tetrahydrocannabinol, but would look for delta-9-tetrahydrocannabinol, 11-hydroxycannabinol, etc.

3.8.6
3.9
3.9.1
Summary

For each group LOINC defines the following set of terms:

Analyte group:ACnc:Pt:Urine:Ord:Screen
Analyte group:ACnc:Pt:Urine:Ord:Confirm
Analyte group:MCnc:Pt:Urine:Qn:Confirm
Analyte group tested for:Prid:Pt:Urine:Nom:Screen
Analyte group tested for:Prid:Pt:Urine:Nar:Screen
Analyte group positive:Prid:Pt:Urine:Nom:Confirm
Analyte group screen method:Prid:Pt:Urine:Nom:*
Analyte group confirm method:Prid:Pt:Urine:Nom:*

For each individual analyte LOINC now defines the following set of terms:

Analyte:ACnc:Pt:Urine:Ord:Screen
Analyte:ACnc:Pt:Urine:Ord:Confirm
Analyte:MCnc:Pt:Urine:Qn:Confirm
Analyte:MCnc:Pt:Urine:Qn
Analyte cutoff:MCnc:Pt:Urine:Qn:Screen
Analyte cutoff:MCnc:Pt:Urine:Qn:Confirm



Molecular Genetics LOINC Naming

Introduction

Molecular pathology testing can be used for many purposes. In infectious disease testing to identify
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organisms and mutations in organisms; in genetic analysis to identify mutations including substitutions,
deletions/ insertions, frame shifts and trinucleotide repeats; to identify specific chromosomal translocation
and clonality in leukemia and lymphomas; to identify various tumor associated genes and gene deletions;
in paternity testing to determine the probability that a person is the parent of a child; and in forensic
testing to determine the probability that a criminal is associated with genetic material he/she left as
evidence.
25

Terminology 3.9.2

The main methods used are Southern Blot which applies hybridization to selected DNA chopped up by
restriction enzymes; Northern Blot which applies hybridization to all cellular RNA (which comes
naturally in smaller segments) and Restriction Fragment Length Polymorphism (RFLP). RFLP depends
on the Variable Number of Tandem Repeats (VNTR) which are normal, but specific variants of each
persons DNA. Southern Blot may be combined with RFLP to target mutations whose exact gene
molecular chemistry is not known. For completeness sake, we mention Western Blot, which applies an
analogous blot method to protein analysis.

In situ hybridization is a method that applies probes to intact tissue. The cellular patterns of the
homologies can then be read microscopically. There are a variety of methods for detecting such in situ
probes. One popular method is Fluorescent In-Situ Hybridization (FISH). This technique is analogous to
an immune stain except that the molecular binding is based on DNA/RNA homologous instead of
antigen-antibody binding.

DNA chips provide a radical new way to identify DNA and RNA sequences. In the patented
AFYMETRIX

technique, the nucleoside chains are grown using lithography-like methods. Target
DNA is tagged with a detector and washed over the chip in steps. The locations of the tags on the chip
identify the DNA (RNA) in the sample.

Identity testing is used to identify relationships among people and has special complexity. In paternity
testing, it can be helpful to have DNA from the child, the putative father and the mother when possible to
distinguish the alleles that come from the father.

Blood is the most common specimen for molecular pathology studies. The DNA comes from the
leukocytes, bone marrow, tumors, products of conception and forensic specimens are also important
specimens.

Forensic testing has special requirements of stringency and often mixes blood antigen testing with RFLP
testing. The results are usually reported as a probability.

Genetic changes that occur during the life of the patient such as tumor mutation are called somatic and
those that are inherited are referred to as germ line. The nature of the specimen and the testing usually
distinguishes these two, so it is not necessary to include this distinction in the test names.

Alleles refer to different forms of a gene. Alleles are distinguished at the phenotype level. Locus refers
to a specific DNA (or RNA) codon or the corresponding amino acid in the protein produced by this
codon.

The term mutation is usually applied to a genetic variant that causes a functional change in the gene and
results in disease. An allele, the term is usually applied to a genetic variant that does not cause a disease.

The string of DNA that codes for a protein is usually interrupted by DNA segments called introns that do
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not contribute to the protein definition. Typically the DNA that defines a protein is interrupted by several
introns. The coding sequences of DNA between the exons are called introns. Linked together, the exons
provide the instructions for creating the specific protein. Exons may be numbered e.g., exon 1, exon 2,
etc. Exon numbers sometimes appear in the names of DNA mutations, but for a number of reasons,
identifying codon locations relative to an exon is unreliable and we will try to avoid such nomenclature
when possible in LOINC names.

A codon refers to the sequence of three nucleotides that code for one amino acid. Codons are numbered
from the first codon participating in the protein (in humans the codon for Methionine) starting with codon
number 1.

Defects in genes can be coded in one of three different nomenclatures as described in Table 18.





Table 18: Three types of nomenclatures for identifying the location of a genetic defect
Designation Explanation
Identify the defect by codon by counting the amino acids in the protein produced by the gene counting the
first amino acid.
p
Identify the defect by counting nucleotides from the messenger RNA used to produce the protein with intron
excluded. These will produce numbers 3x as large as those in the first method.
c
Identify the defect by counting from the first nucleotide in the DNA as it exists as a gene natively in the
chromosome with introns included.
g

General Molecular genetics naming rules 3.9.3

When possible, the LOINC component of a molecular pathologic mutation will be named according to the
gene name and information about the particular defect (e.g., deleted alanine from position 47). LOINC
will resort to the use of the disease name only when the gene has no name and/or the genetic defect is not
yet fully specified. We will always include the genetic disease name in the related name field of the
database, when the disease is not part of the component; so that users of the database can easily find the
LOINC term by the disease name as well.

We use the nomenclature for human gene mutations proposed by Beaudet
26
in the component (when the
mutation name belongs in the test name) or as an answer when it belongs as an answer. This
nomenclature system recommends that missense mutations be named using single letter amino acid (p-
notated - not nucleotide) abbreviations. A list of single letter amino acid codes is given in Table 19.







Table 19: List of single letter amino acid codes
Amino Acid Code Amino Acid Code
Alanine A Leucine L
Arginine R Lysine K
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Asparagine N Methionine M
Aspartic acid D Phenylalanine F
Cysteine C Proline P
Glutamic acid E Serine S
Glutamine Q Threonine T
Glycine G Tryptophan W
Histidine H Tyrosine Y
Isoleucine I Valine V


The system (specimen) used in the LOINC name for genetic testing will usually be BLD/TISS since the
distinction between these two specimens is rarely important to the result of a molecular pathology test.
We will split this further to accommodate fetal specimens in a later release.

We did not create separate variables for each kind of molecular genetics method, i.e., we will not make up
separate variables for measurements done via Southern Blot, PCR, restriction fragment length
polymorphism (RFLP) because different methods are only used when they provide the same answer, and
the difference is rarely important. Further, a plethora of method variants exists, and we could never hope
to keep up with all of these minor variants. Instead, we will use the generic method of MOLGEN (for
molecular genetics method) to indicate that a result of the analysis is based on a molecular genetics
method rather than some chemical or antigen method.

3.9.4
3.9.5
Infectious Diseases

For most infections disease reporting, the existing LOINC nomenclature (e.g., detecting a particular
species of organism by detecting DNA homology) works fine. The word DNA is included as part of the
component name and we distinguish the type of method used for detecting the microorganisms (Probe,
Probe.amp.tar, Probe.amp.sig). See the Microbiology section for more information.

Genetic Diseases

3.9.5.1 DNA diagnostic assays for the detection of specific disease gene mutations.

In most of these cases we require the gene name, the specification of the nomenclature (p, g, or, c) and the
mutation name. A LOINC term that identifies a specific mutation will start with the gene name followed
by the specification of the mutation in that mutation using Beaudets syntax. A dot will separate the gene
name and the mutation identifier. In general, the form of the component (first part) of the LOINC name
will be:

<gene name> gene.<mutation nomenclature><mutation and its location>

For example, Factor V Leiden mutation would be represented as F5 gene.p.R506Q. Where F5
identifies the gene, gene is a fixed part, p identifies the kind of mutation nomenclature (protein) and
R506Q indicates that the amino acid arginine (R) is replaced by glutamine (Q) (see Table 19) at codon
#506.

Some examples of fully specified LOINC names for tests of specific mutation are:

F5 gene.p.R506Q:Arb:Pt:Bld/Tiss:Ord:Molgen
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Synonyms = Factor V Leiden, Factor V resistance, APC resistance gene

HFE gene.p.C282Y:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonyms = HLA-H gene, hemochromatosis gene

CFTR gene.p.F508 del:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonyms = Cystic Fibrosis Transmembrane Regulator

The scale used for LOINC codes of this type is Ord. Test procedures that identify single mutations use
two DNA probes: one for the normal locus and the other for the abnormal locus. When only the normal
probe reacts, the laboratory reports no mutation. When both the normal and mutation probes react, the
laboratory reports heterozygous. When only the mutation probe reacts it reports homozygous.
Consequently, such single mutation testing produces one of three ordinal answers:

a) no mutation
b) heterozygous mutation (the mutation found in one gene)
c) homozygous mutation (the mutation was found in both genes in the gene pair)

Specific testing such as this is only possible when the molecular pathology of the gene is very well known
and only one defect is being reported.

3.9.5.1 DNA diagnostic assays for the detection of multiple disease gene mutations (alleles).

Multiple testing can be reported in 4 styles: a single observation for each pair, two separate observations,
gene mutation analysis and narrative.

a) A separate observation for each pair of genes

This style of reporting is identical to the style used in 3.9.5.1 with each tested mutation having a separate
LOINC code. For example:

HFE gene.p.C282Y:Arb:Pt:Bld/Tiss:Ord:Molgen

HFE gene.p.H63D:Arb:Pt:Bld/Tiss:Ord:Molgen

b) Two separate observations.

One observation reports the kind of mutation (allele) found in the first chromosome and another for
reporting the kind of mutation for the paired chromosome. In this case, the identity of the allele is
reported in the answer. For example

APOE gene allele 1:Prid:Pt:Bld/Tiss:Nom:Molgen
Answers = E1, E2, E3, or E4

APOE gene allele 2:Prid:Pt:Bld/Tiss:Nom:Molgen
Answers = E1, E2, E3, or E4




c) Gene Mutation Analysis

This is really an extension of the above case. The general name is <genetic disease> mutation
analysis:Prid:Pt:Bld/Tiss:Nom:Molgen. The answers are the names of the genes detected. Examples
follow:
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CFTR gene mutation analysis:Prid:Pt:Bld/Tiss:Nom:Molgen
Synonyms = Cystic fibrosis transmembrane regulator

BRCA1 gene mutation analysis:Prid:PT:Bld/Tiss:Nom:Molgen
Synonyms = breast cancer risk gene

Answers for these could be Identifiable Mutation Not Identifiable Mutation

With this type of reporting, a separate observation is usually required to report what alleles or mutations
were tested for, so that the person receiving the report will know how to interpret a negative report. In
this style of reporting, we may use the disorder name to identify the domain of interest because it covers
more than one mutation. The report provides information about multiple possible mutations.

The general form will be

<allele class or disease name> gene mutations tested for:Prid:Pt:Bld/Tiss:Nom:Molgen.

For example:

CFTR gene mutations tested for:Prid:Pt:Bld/Tiss:Nom:Molgen
The answers could include Delta F508, G542X, R553X, W1282X, N1303K, etc.
d) Narrative report

In this case, the information is provided as a bulk narrative report like a visit note and without computer
accessible structure. We discourage the use of this approach because it is not useful for automatic
analysis.

3.9.6 Trinucleotide repeats

A number of diseases, most of which manifest as neurologic disorders are caused by excessive repeats of
specific trinucleotides, and the age of onset of the disease is inversely proportional to the number of
excess repeats. Examples of these disorders include:

Fragile X syndrome
Huntington disease
Spinocerebellar ataxia (SCA1)

We name the component of these terms by the gene when the gene is well defined or the disease, and the
name of the trinucleotide that repeats plus the word repeats.

<disease name> <trinucleotide> repeats

For example, Huntington disease would be represented as HD gene.CAG repeats

Examples of some fully specified LOINC names are:

FRAXE gene.CGG repeats:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonym = Fragile x syndrome

HD gene.CAG repeats:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonym = Huntington Disease, It15, Hd, Huntington Chorea

Spinocerebellar ataxia genes.CAG repeats:Arb:Pt:Bld/Tiss:Ord:Molgen

DMPK gene.CTG repeats:Arb:Pt:Bld/Tiss:Ord:Molgen
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Synonym = Myotonic Dystrophy

These are usually reported not expanded, indeterminate or expanded, so the scale is Ord.

If the actual number of trinucleotide repeats were reported, the property would be entitic number
(EntNum) and the scale would be quantitative (Qn). We are not aware of any labs that currently report
the actual number. We will define these quantitative variants when they are requested.

3.9.6
3.9.7
Hematopathology gene re-arrangement.

Immunocells have an innate genetic variability due to rearrangement. The unique rearrangement can be
used to identify the development of a clone of one cell type as occurs in many lymph cell tumors (e.g.,
lymphoma). We use the following format to identify clonal excess.

Immunoglobulin heavy chain gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen

Immunoglobulin kappa light chain gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen

Immunoglobulin lambda light chain gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen

TCRB gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonym = T cell receptor beta chain

TCRD gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonym = T cell receptor delta chain

TCRG gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonym = T cell receptor gamma chain

These would be reported as clonal, or not clonal.

Translocations

Tests to detect gene-specific translocation breakpoints (with known partner genes) should be designated
as follows:

T(<breakpoint gene 1>,<breakpoint gene 2>)(<gene1>,<gene2>)gene translocation

For example:

T(9,22)(ABL1,BCR) gene translocation:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonyms = Philadelphia chromosome, BCR1, chronic myeloid leukemia, CML

T(14,18)(IGH,BCL2) gene translocation:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonyms = Follicular B cell lymphoma, oncogene B-cell leukemia 2, CLL, chronic lymphatic leukemia, follicular
lymphoma

T(15,17)(PML,RARA) gene translocation:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonyms = RAR, promyelocytic leukemia, myelogenous, retinoic acid receptor, acute promyelocytic leukemia, APL

These can also be expressed as a fraction of cells that have the rearrangement versus total cells of interest:

Cells.t(9,22)(ABL1,BCR)/Cells.total:NFr:Pt:Bld/Tiss:Qn:Molgen

If specific partner genes are not known, use:

CCND1 gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen
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Synonyms = Lymphoma 1

BCL2 gene rearrangements:Arb:Pt:Bld/Tiss:Ord:Molgen
Synonyms = Lymphoma 2

The specificity for major or minor breakpoints should also be designated:

T(9,22)(ABL1,BCR) gene translocation major break points:Arb:Pt:Bld/Tiss:Ord:Molgen

T(9,22)(ABL1,BCR) gene translocation minor break points:Arb:Pt:Bld/Tiss:Ord:Molgen

Identity testing 3.9.8

The identity testers usually look at 4 genetic loci (each locus is polymorphic enough that any one match
has a 10% error of being incorrect). The loci are independent so if all 4 probes match (including all
exclusions and inclusions) the probability of an erroneously match is .0001 (one out of 10,000). They
may use more than four depending upon the degree of confidence required by the circumstances of the
testing. The forensic community chooses from a set of about 20 probes.

We propose two styles for reporting identity testing: atomic and pre-coordinated definitions

3.9.8.1 Atomic style

This style uses a series of LOINC names to report the kind of index case, the kind of comparison case, the
results of the identity testing, and all of the other separate components of the testing. It includes an
observation for reporting the actual probes used, and another observation for reporting the population that
the probes assume. The method will be MOLGEN.IDENTITY.TESTING. For example:

DNA probes used:Prid:Pt:Index case^comparison case:Nom: Molgen.identity.testing

Population base:Prid:Pt:Probes:Nom: Molgen.identity.testing

Relationship:Type:Pt:index case:Nom: Molgen.identity.testing
Answers = child, victim, suspect

Relationship:Type:Pt:^comparison case:Nom: Molgen.identity.testing
Answers = mother, alleged mother, father, alleged father, evidence
(external to victim)

Confidence of relationship:likelihood:Pt:Index case^comparison case:QN: Molgen.identity.testing
(this gives the statistical confidence in the conclusion)

Conclusion:Imp:Pt:index case^comparison case:Nar: Molgen.identity.testing
(this gives summary statement of the conclusion about identity of relatedness)

3.9.8.2 Pre-coordinated definitions alternative

Some of the above atomic terms (e.g., DNA probes used) could also be reported with the pre-coordinated
results.

Relationship:likelihood: child^alleged mother:Qn:Molgen.identity.testing
Synonyms= maternity testing
(gives the likelihood that the alleged mother is the mother of the index child)

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Relationship:likelihood:child^alleged father:Qn:Molgen.identity.testing
Synonyms = paternity testing
(gives the likelihood that the alleged father is the father of the index child)

Relationship:likelihood: victim^suspect:Qn:Molgen.identity.testing
(gives the likelihood that the either the genetic material on the victim is that of the suspect)

Relationship:likelihood: suspect^victim:Qn:Molgen.identity.testing
(gives the likelihood that the genetic material on the suspect is that of the victim)

Identity:likelihood:Evidence^suspect:Qn:Molgen.identity.testing
(gives the likelihood that the genetic material on the evidence is that of the suspect)

Identity:likelihood:evidence^victim:Qn:Molgen.identity.testing
(gives the likelihood that the genetic material on the evidence is that of the victim)


3.9.9
3.10

Tumor Relation Tumor Genetics

Looking at copy number of N-Myc gene (Growth control gene)

N-Myc gene amplification: EntNum:Pt:Bld/Tiss:Qn:Ord:Molgen

N-Myc gene amplification: ArbEnt:Pt:Bld/Tiss:Ord:Molgen
Answers = Non-amplified, indeterminant, amplified

(Comment: these are numbers of excess copies resulting from biologic events, not the true measuring
process)

Gene loss

p gene loss:Arb:Pt:tumor:Ord:Molgen
Answer: gene loss, no gene loss

Compare signal from tumor with normal tissue adjusted for total DNA.

Allergy Testing

The allergy testing industry provides tests for more than 450 different allergens today. Most testing looks
for IgE antibodies against these allergens. For some allergens testing for IgG and IgA antibodies are
available, as well.

For LOINC terms that represent allergen testing, the component is the allergen name plus the type of the
antibody (mostly IgE). Most allergens relate to animals, plants or derivatives of such entities. In the past
(prior to LOINC vs. 2.04), we used the common name, rather than the scientific name to identify the
allergen. However, this approach led to some duplicate term definitions, because two different companies
would name the same allergen differently. It also led to ambiguity because two different species of
animal or plant would sometimes have the same common name. As of version 2.04, we corrected these
problems. To help reduce the ambiguity we now use the Latin name of the species of the biologic entity
that causes the allergy.

Some background: First, most allergens can also be identified with a special 2-5 character code assigned
by Pharmacia
27
that most allergy testing companies reference in their catalogue of testing. We used
these codes to identify duplicate and ambiguous LOINC allergy test terms. These Pharmacia codes are
also included in the related names field of the database. Second, allergen tests are often reported in two
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styles: a quantitative raw measure and an ordinal (0-6) severity rank (RAST class). LOINC defines
separate terms for each of these reporting styles. For example, the two LOINC codes for reporting IgE
antibodies to Japanese Millet are:
4.1

Echinochloa crus-galli Ab.IgE:ACnc:Pt:Ser:Qn
Echinochloa crus-galli Ab.IgE.RAST class:ACnc:Pt:Ser:Ord

The RAST class is a categorization of the raw measurement based on specific allergy criteria. The
specific IgE class result values (0, 1, 2, 3, 4, 5, or 6) are an ordered categorical response rather than a
continuous numeric scale, therefore RAST class terms have an ordinal (ORD) scale.

Laboratories also test mixtures of allergens to produce one result. These will be represented in LOINC as
follows:

(Acer negundo+Quercus alba+Ulmus americana+Populus deltoides+Carya pecan) Ab.IgE:ACnc:Pt:Ser:Ord:Multidisk
Related name = tx2

There may be more than one type of allergen for each plant. For instance, IgE antibodies can develop
towards tree pollen and the fruit of the same tree. Similarly, antibodies exist for grain and for grain
pollen. In these cases, the LOINC component will contain the word POLLEN to distinguish the pollen
allergen from the food allergen. For example, the LOINC term for corn (maize) IgE antibody would be:

Zea mays Ab.IgE:ACnc:Pt:Ser:Qn:
Related names = f8; cultivated corn; maize

Zea mays pollen Ab.IgE:ACnc:Pt:Ser:Qn
Related names: g202: cultivated corn; maize




4 Clinical observations and measures

Introduction

For most of the measures we include separate observations for summary data, e.g., shift and 24-hour urine
output totals. We also provide varying degrees of pre-coordination for the observation, the body site at
which it was obtained, and the method. For example, a cardiac output based on the Fick method is
distinguished from a cardiac output computed from 2D cardiac echo data.

Physiologic measures are often monitored continuously over time and the instrument reports summary
statistics over that reporting period. For vital signs these can include minimum, maximum, and mean
value over a time period. For intake and output the total is the summary statistic usually reported. When
we address measures taken over time, we usually include 1 hour, 8 hour, 10 hour, 12 hour, and 24 hour
intervals to cover the varying lengths of work shifts within and across institutions. The LOINC names of
these correspond to the form of a 24-hour urine specimen. The times are recorded in the duration (third
part) of the name.

The parts of clinical measurement names are largely the same as for laboratory measures, with some
subtle differences that are detailed below.

Parts 2, 3, 5 and 6 (type of property, timing, scale, and method) correspond exactly in meaning between
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laboratory and clinical LOINC codes.

System: Part 4, body system, has the same general meaning for clinical and laboratory measures, but
whereas in the case of laboratory tests the system usually identifies a fluid and a body compartment by
implication (e.g., serum, cerebral spinal fluid), for clinical terms, the system is usually a body part (e.g.,
chest), organ (e.g., heart), or part of an organ (e.g., heart.ventricle). In some cases the system may be an
instrument or device attached to the system (e.g., OB ultrasound imaging device).

Component: In the case of laboratory test observations, the component (part 1) usually identifies some
chemical moiety that is distributed in the system (glucose, or HIV antibodies). In the case of clinical
terms, the component usually identifies a particular projection of a three or four dimension space to a
measure of a particular feature (e.g., QRS interval, systolic) of a time changing measure
(ventricle.left.outflow tract). In addition, the component is used to distinguish the various ranges or
inflections of a physiologic tracing, or to define precisely the section in three-dimensional space in which
an area or range is being measured.

The component includes such things as the special kinds of length (e.g., circumference, diameter, or
radius) when length is the property, and the specific level and axis on which a measurement of a body part
is taken, e.g., circumference taken at the nipple line. The component should remove all ambiguity as to
what projection or axis or specific sub-time frame is being measured. So if one is measuring the diameter
of the kidney, the system would have to specify kidney.right (or kidney.left), and the component would
identify the axis and level at which the diameter was measured (e.g., cross-sectional at level of pelvis).
For a measure of chest circumference the system = chest, the component = circumference at nipple line,
and the property = length. Areas, lengths, and volumes of organs all have to be specified enough in the
component to distinguish a particular area or length that is being measured. When a measure changes
over some cycle (e.g., inspiration, expiration, diastole, and systole), then that should also be specified in
the component. (Duration is used to identify the duration of an overall study.)

For most clinical measurements, the component is an attribute of a patient or an organ system within a
patient. However, attributes of non-patient systems are also often of interest. For example, we might
want to know the class of instrument used to obtain the measurement: i.e., the vendor model number or
institutional inventory number of an endoscopy. Such identification numbers have a property of ID.
Infection control might want the latter reported in order to track nosocomial infections.

When attributes of an instrument or device are being reported, the system is the name of instrument. The
same is true when we report characteristics of tubes used to move fluid in and out of body cavities. For
example, we might want to report the size and type of a nasogastric tube.


Table 20: Subjects covered to date in clinical LOINC
Body pressure (systolic, diastolic, and mean)
Body measurements
Body weight (and measures used to estimate ideal body weight)
Cardiac ultrasound
Cardiac output, resistance, stroke work, ejection, fraction, etc.
Circumference of chest, thighs, legs
Critical care measures
Dental
Electrocardiographic measures
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Emergency department case reports (CDC DEEDS)
Gastroenterology endoscopy
Heart rate (and character of the pulse wave)
Intake and output
Major headings in operative note
Major headings in discharge summary
Major headings of history and physical
Obstetric ultrasound imaging
Ophthalmology measurements
Pathology protocols
Pulmonary ventilator management
Radiology reports
Respiratory rate
Standardization survey instruments
Urology ultrasound imaging


To accommodate the special dimensions of clinical observations we have introduced new options for the
kind of property. The new kinds of property are what you might expect from the new kinds of
dimensions being measured (e.g., resistance, voltage, work per beat). However, we have also introduced
three important new properties:

Anat Anatomic is a special case of Prid that identifies anatomic sites.

Imp Impression is a diagnostic statement, always an interpretation or abstraction of some
other observation (a series of test results, an image, or a total patient), and almost always
generated by a professional. (We could also consider the EKG cart's automated
diagnoses as impressions.) Impressions are used in laboratory medicine as well as
clinical medicine, so you will see them appearing there as well.

Find Finding is an atomic clinical observation, not a summary statement as an impression.
Physical, historical, review of systems and other such observations have a property of
Finding. These may have a scale of Nom for coded findings, Nar for findings reported in
narrative text or Ord for ordinal findings.

In clinical measures, super systems (the second subpart of the system component) may be required. For
example, we distinguish head measures of a patient versus a fetus as follows:

Circumference.occipital-frontal:Len:Pt:Head:Qn

Diameter.biparietal:Len:Pt:Head^fetus:Qn

4.2 Atomic versus molecular (pre-coordinated names)

With clinical terms we almost always have two ways of reporting. Using the first, we can report an
observation by reporting a number of atomic variables which together fully describe the observation. For
example, we have the following atomic observations for circumference measures. These variables let us
deal with all of the unique kinds of circumferences for which we have not yet defined a pre-coordinated
term.
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Table 21: Examples of Pre-Coordinated Names
Code Description
Circumference:Len:Pt:XXX:Qn The actual measure of some circumference
Identifies the body part measured
Circumference site:Anat:Pt:*:Nom
(specifies the system)
Identifies the measuring technique used to obtain
the circumference Circumference method:Type:Pt:XXX:Nom:*
(answers = tape measure, derived, imaging)


We also provide pre-coordinated terms that combine some of the atomic variables into one LOINC code.
For example, we have:

8279-2 Circumference.at nipple line:Len:Pt:Chest:Qn

and

8293-3 Circumference^inspiration:Len:Pt:Chest:Qn

which provide more specificity and permit the key components of the measure to be expressed as one
variable as is the convention in many clinical systems. We call these pre-coordinated codes molecular
variables.

Within the LOINC database molecular variables will vary with respect to how many atomic components
are aggregated. As is true in some laboratory areas, methods often are not included as part of a name, nor
are they always reported. The most common molecular aggregation is between functional measure and a
particular site of measurement. (e.g., the many different intravascular sites for blood pressure
measurements.) But in some cases the molecular variables represent combinations of specific measures
and particular methods (e.g., the cardiac output measures). Please note that most molecular variables
could also be accompanied by one or more atomic measures to provide special information about the
measure, e.g., special circumstances of the measure, or the vendor model number or institutional
inventory number of the measuring instrument.

When we have a variable that really reports what would have been contained in the name in a fully
pre-coordinated term, we will place an asterisk in the part that will be reported as a value. For example, a
variable that is used to report the anatomic site as an atomic variable, would have an asterisk (*) in the
system part of the name. The variable used to report the method of a particular measure would have an
asterisk (*) in the method part of the name.

4.3 Radiology Reports

The creation of LOINC codes for naming radiology reports began with a special subgroup of committee
members and a collection of report names from a variety of clinical sites. Radiology LOINC codes were
first released in 2000. A bolus of over 2,000 new codes were added in December 2004, and the Radiology
section of LOINC continues to be an active area of growth.

LOINC names for radiology reports follow the general pattern of other clinical observations and
measures, with some subtle differences noted below. Parts, 2, 3, and 5 (type of property, timing, and
scale) correspond exactly in meaning to other clinical and laboratory LOINC codes.

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4.3.1 Diagnostic Radiology Reports

4.3.1.1 Component

Like other clinical LOINC codes, the component identifies a particular projection of a three dimensional
space. The component should remove all ambiguity about what projection is being measured.

a) Component/Analyte name

The first subpart of the component field delineates the projections and spatial conditions that are present
during image acquisition. The first subpart is named using the syntax:

<descriptor> [<number of views>] [<projection beam orientation>] [<body position>]

The <descriptor> identifies the type of images in the report. For diagnostic x-ray and mammography
studies, the <descriptor> is either View or Views. For diagnostic ultrasound, MRI, CT, and tomography
studies, the <descriptor> is Multisection. The descriptor is the only required field in the component.

Where it is appropriate, additional words are added to the first subpart of the component to clarify the
focus of the exam (e.g., Multisection limited, or Multisection for pyloric stenosis).

The <number of views> is an optional parameter to describe a specific integer number of views in the
projection. Many radiology report names do not specify the actual projections taken, but rather only the
number of views. Some report names describe the number of views in relative terms like minimum of 3
views or less than 4 views. Where necessary to specify these relative qualifications, we use the
following expressions:

* Gt = greater than
* Ge = greater than or equal to
* Lt = less than
* Le = less than or equal to

The <projection beam orientation> is an optional parameter that specifies the orientation(s) of the beam
with respect to the patient. Widely used abbreviations with unambiguous meanings are employed where
appropriate (e.g., PA, AP, etc). Multiple images with different orientations are combined using &.

The <body position> is an optional parameter to remove ambiguity about the subjects body position with
respect to gravity. Examples positions include prone, upright, supine, for example:

View PA prone:Find:Pt:Abdomen:Nar:XR

In order to accommodate special groupings of views and challenges, where necessary, we will make an
exception to the principle of not using parentheses in the component for radiology studies (see section
2.1.3). For example:

Views (AP^standing) & (lateral^W hyperextension):Find:Pt:Knee:Nar:XR

b) Report names for portable studies
In general, we do not make names for reports of portable studies, except when the image produced by a
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portable study is different than the normal study. For example, portable chest x-ray studies are typically
taken at a shorter distance than those taken in the radiology department, and thus we create separate
LOINC codes for them:

Views AP portable:Find:Pt:Chest:Nar:XR

c) Eponyms and colloquial expressions

Radiology tests are often commonly referred to by eponyms or colloquial expressions. When they are
widely used and understood, these names can represent a concise way to communicate the test(s) being
reported. In many cases, these expressions convey meaning that spans multiple parameters or even
multiple LOINC axes (e.g., COMPONENT, METHOD, and SYSTEM). LOINC names typically employ
these expressions only when their meaning is unambiguous, and confine the use of these expressions
within one axis. For example:

View Merchants:Find:Pt:Knee:Nar:XR

d) Challenge tests

The second subpart of the component is chemical, physical, and/or functional challenges. The naming
convention for chemical challenges (e.g., administration of contrast agents) follows the previously
described pattern, including abbreviations for route of administration. For example:

Multisection^W & WO contrast IV:Find:Pt:Kidney.bilateral+Collecting system:Nar:XR.tomo

When describing administration of contrast into specific spaces for which abbreviations do not exist, the
space is spelled out in full, and preceded by intra or via according to these guidelines:

We use intra: when the contrast injected goes directly into this anatomic space, and this space is what is
visualized in the study. For example:

Views^W contrast intra lymphatic:Find:Pt:Lymphatics:Nar:XR.fluor

We use via when the contrast injected goes through this device (e.g., catheter) and into the anatomic
space being visualized. For example:

Views^W contrast via T-tube:Find:Pt:Biliary ducts+Gallbladder:Nar:XR.fluor

Views^W contrast via colostomy:Find:Pt:Colon:Nar:XR.fluor

Physical challenges that are present during imaging are denoted using a similar pattern:

[<existence>] <challenge>

where existence is denoted W, WO, or W & WO. The existence of W & WO denotes separate views, with
and without the challenge. For example:

Views^W & WO weight:Find:Pt:Acromioclavicular joint:Nar:XR

4.3.1.1.1 Ambiguity related to decubitus in radiology projections and positions

This section describes several issues surrounding radiology naming conventions involving the term
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decubitus in abdomen and chest x-ray terms, and to describe an LOINCs accepted naming
conventions. The primary point of confusion concerns an ambiguous naming convention that mixes
projection and body position.

4.3.1.1.1.1 Accepted Term Definitions

Excerpts from Merrills Atlas of Radiographic Positions and Radiologic Procedures
28
:

a) Decubitus

Indicates that the patient is lying down and that the central ray is horizontal and parallel with the floor.

Three decubitus positions are named according to the body surface on which the patient is lying:

(i) Lateral decubitus (left or right)

In a lateral decubitus position, the patient is side-lying. The position is named left or right by the side of
the patient lying on the table.

If the patients back is closest to the IR (image receptor, e.g., unexposed x-ray film), this resulting
projection is AP. If the patients ventral surface (stomach) is closest to the IR, the resulting projection is
PA.

The AP projection in the left lateral decubitus position is the most common (and perhaps implied)
decubitus view.

However, it is also possible to do a lateral projection in a right or left lateral decubitus (recumbent)
position. (Figure 16-17, Merrill, Vol. 3)

The lateral decubitus position is most often used to demonstrate the presence of air-fluid levels or free air
in the chest or abdomen because air rises to the right side and views, are not obliterated by air that may be
in the stomach.

ii) Dorsal decubitus

In a dorsal decubitus position, the patient is supine. The central ray provides a lateral projection. The
position can be named left or right by the side of the patient that is closest to the IR.

This is also called a cross-table lateral view (abdomen).

This type of position is commonly used in lateral x rays of the spine when the patient cannot be moved
into a standard lateral position and premature infants that cannot be positioned easily.

iii) Ventral decubitus

In a ventral decubitus position, the patient is prone; rarely performed, usually in cases of trauma when the
patient cannot be moved. The central ray provides a lateral projection. The position can be named left or
right by the side of the patient that is closest to the IR.

b) KUB
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The Kidneys, Ureters, Bladder (KUB) imaging technique is an Abdomen AP projection, often with the
patient in the supine position. The KUB view includes anatomical structures from the diaphragm to the
symphysis pubis.
4.3.1.1.1.2 Radiology Naming Conventions

In Radiology, LOINC has typically allowed several levels of granularity to accommodate differences in
naming conventions (e.g., specifying laterality or not, explicitly specifying contrast use or not). Different
levels of granularity have been observed in this domain as well.

Example local term names:

Abd R Lat Debub XR
Abd R Decub Port XR
Abdomen Debuitus
Chest Decub XR
Chest L Decub XR
Xray Chest Decubitus

4.3.1.1.1.2.1 Decubitus is a body position, not a projection. To add clarity to the names, we will use
decubitus only to refer to the lateral decubitus position.

a) When using decubitus to specify body position, we will explicitly say L-lateral-decubitus or R-
lateral-decubitus. Including the word lateral adds clarity as to which projection we are talking
about, and the dashes - help link the words together.

(i) Where the intent is to not name a side, we will use lateral-decubitus, rather than the more
ambiguous, naked decubitus.

4.3.1.1.1.2.2 We will not use the term dorsal decubitus to refer to the supine position. Supine will be
used as a valid body position where needed.

a) Because it is common and clear, we use lateral crosstable to mean a lateral projection (rightor left) in
the supine position, thus encompassing both a projection and body position.

4.3.1.1.1.2.3 The term ventral decubitus will not be used to refer to the prone position. Instead, we use
prone as a valid body position where needed.

4.3.1.1.1.2.4 Historically, we created some terms in which there was an implied projection (e.g., AP).
Through careful review, we revised or deprecated these ambiguous terms so as to make the
particular projection explicit include in the name.

a) When a particular projection is not named, it is implied that any potential projection could be
done/reported with this code (e.g., AP, PA, or lateral).
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b) An AP L-lateral-decubitus and AP R-lateral-decubitus are considered distinct views in our naming
conventions. Thus, use plural views and not the singular view in such terms.

c) A naked lateral in the component means a lateral projection (in any body position).

d) Historically, LOINC included some terms with the abbreviation KUB as a named view. Through
careful review, we have discontinued its use in favor of simply using the projection (AP) and a
specified patient position (e.g., supine or upright) where necessary. This avoids the ambiguity about
what KUB means with respect to the patient position.

e) As in other areas tricky spots of Radiology names, parentheses will clarify which projections are
being done in which body positions.

4.3.1.2 Timing

Most radiology reports will have a time aspect of point in time (PT). A few reports indicate a specific
time window (e.g., timed fluoroscopy imaging), and these are named in the usual manner, e.g., <numeric
value><S|M|H|W>. Where qualifiers are needed to indicate a relative time frame, we use the following
conventions:

Gt = greater than
Ge = greater than or equal to
Lt = less than
Le = less than or equal to

For example, Le 1H

4.3.1.3 System

For all clinical LOINC terms, the system is spelled out in full and should not be ambiguous. For most
radiology reports, the system describes what is being viewed, not only the anatomic area of interest. For
example, a common study to identify anterior glenoid pathology is the West Point view x-ray. Because
this view demonstrates the entire shoulder, not just the glenoid rim, the system is Shoulder:

View West Point:Find:Pt:Shoulder:Nar:XR

We name systems that encompass multiple organ systems by joining them with a plus (+). The
individual parameters are arranged in cephalocaudal and/or proximodistal order:

Views:Find:Pt:Spine.cervical+Spine.thoracic+Spine.lumbar:Nar:XR

Views:Find:Pt:Spine.lumbar+Sacrum+Coccyx:Nar:XR

While the system describes what is being viewed, it is not an exhaustive list of all structures in the view.
For example, in practice, a standard lateral view x-ray of the radius and ulna shows these bones in their
entirety as well as the proximal row of carpal bones and the elbow joint. Yet, the system for this report
would simply be Radius+Ulna.

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4.3.1.3.1 Vessels

For reports of vascular studies, if the system contains multiple vessels, each vessel is named separately
and connected by a plus (+), (e.g., Celiac artery+Superior mesenteric artery+Inferior mesenteric artery). If
the vessel(s) being viewed is part of a common root, it is named with the common part first, then a dot (.)
separator, and then the division (e.g., Vena cava.inferior). If the vessel(s) are independent branches, then
they are named independently and connected by a plus (+), (e.g., Superior mesenteric artery+Inferior
mesenteric artery).

For studies that view all the vessels in an area, the SYSTEM is typically named in plural form (e.g.,
Lower extremity vessels, Lower extremity veins). The rationale for this is that most angiography studies
demonstrate some vessel branches, not just a single vessel.

4.3.1.3.2 Brain, head, cerebral, and skull

There is presently much variation in radiology system naming patterns pertaining to the anatomical area
of the head. We have modeled our naming patterns largely after prevailing conventions. We generally use
a system containing Head for reports of MRA, CTA, CT, and US studies. We use the system of Brain
with reports of MRI and nuclear medicine studies, and Skull with plain film study reports. For
conventional fluoroscopic angiography reports, we use a system containing Cerebral when not specifying
a particular artery.

4.3.1.3.3 Extremities

Test names for studies of the extremities often vary in their terminology. The term arm technically
means the part of the upper limb from shoulder to elbow, but is also commonly used to refer to the entire
upper limb, and the term leg technically means the part of the lower limb between the knee and ankle,
but is also commonly used to refer to the entire lower limb (Dorlands Illustrated Medical Dictionary
29
).
In lieu of this, we have included arm and leg as broad synonyms, but do not use them as a system.
We use Upper extremity and Lower extremity to refer to the limbs in their entirety or when the
visualized region of the limb is not specified. For more specific regions, we name the system based on the
anatomy visualized with that particular method. For example, we name an x-ray of the upper arm as:

Views:Find:Pt:Humerus:Nar:XR

4.3.1.3.4 Laterality

For most bilaterally symmetric entities, we create separate LOINC codes for radiology reports
differentiated by laterality. Thus, for many studies we have LOINC codes that differ only by the laterality
of the system (e.g., Shoulder, Shoulder.left, Shoulder.right, Shoulder.unilateral, and Shoulder.bilateral).

4.3.1.3.5 Series projections with multiple systems

For radiology reports on a series of projections that include multiple systems (e.g., Ribs+Chest), the order
the projections are listed in the COMPONENT corresponds with the order of the anatomical sites in the
system. In addition, the secondary anatomical site is added to the COMPONENT to clarify which views
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were for which anatomical region. For example:

Views lateral & PA chest:Find:Pt:Ribs+Chest:Nar:XR

4.3.1.3.6 Use of dot (.) in system

Using a dot (.) in the SYSTEM signifies that the modifier is a subdivision or component of the main
word. No dot (.) is used when the modifier is just an adjective used for clarification. So, we have:
Chest.pleura, but Superficial tissue.



4.3.1.3.7 Method

In general, the method for radiology reports corresponds to the method for other LOINC terms. The
pattern for naming a radiology method is:

<modality>.[submodality]
4.3.1.3.7.1 Method for angiography terms

LOINC terms use the methods of XR.fluor.angio, MRI.angio, and CT.angio to describe angiography
study reports. Radiology systems often use the abbreviations MRA, MRV, CTA, and CTV in test names
of angiography studies. Because MRA and CTA can refer to studies of arteries, veins, or both, they are
equivalent synonyms to the LOINC methods MRI.angio and CT.angio and are included in the database as
synonyms. MRV and CTV are added as synonyms only to terms where the method is MRI.angio or
CT.angio and the system contains the word Vein or Veins.

4.3.2 Interventional Radiology Reports

4.3.2.1 Component

Radiology reports for interventional studies under imaging guidance typically contain a component of the
form: Guidance for <indication>, where <indication> is description of the nature of the guidance. For
example:

Guidance for biopsy:Find:Pt:Breast:Nar:Mam

Guidance for drainage:Find:Pt:Kidney:Nar:US
4.3.2.2 System

The system for interventional radiology reports is named for the anatomical structures being viewed,
similar to the pattern for systems of diagnostic radiology reports.
4.3.2.3 Method

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In general, the method for interventional radiology reports corresponds to the method for diagnostic
radiology and other LOINC terms. The pattern for naming the method is:

<modality>.[submodality]



5 Tumor registry

In collaboration with North American Association of Central Cancer Registries, Inc (NAACCR, Inc), we
have developed a set of LOINC codes that can be used to communicate tumor registry variables from
clinical institutions to tumor registries and among tumor registries. These LOINC terms map to the
content of NAACCR data set, and include variables for such things as the hospital at which the tumor was
first diagnosed, the primary anatomic site of the tumor, it size, its degree of spread at the time of
diagnoses, and a host of other variables of interest to the tumor registries. The NAACCR data set and
other cancer-related demographics are identified by the class TUMRRGT.

The NAACCR standards and an implementation guide for transmitting these LOINC tumor registry
variables within HL7 messages are available from the NAACCR website: http://naaccr.org/ .




6 Claims attachments

For more information see HIPAA Attachments display in RELMA, the HIPPA Attachment section in
RELMA Users Manual and the respective Claims Attachment books published by HL7 Attachments
SIG.



7 HL7 LOINC Document Type Vocabulary Domain

This section describes our approach to creating a set of document type codes. This work has been
collaboration between the LOINC committee and the HL7 document ontology task force, with initial
contributions from Stan Huff, Pavla Frazier, Bob Dolin, Clem McDonald, and continued refinements
from many others.

7.1 Use of document type codes in HL7 messages

In creating and maintaining document type codes it is important to distinguish between the purpose of
local document names and the names represented by the document type code. Document type codes are
created to provide consistent semantics for the names of documents when they are shared or exchanged
between independent facilities or enterprises. The names and codes that are used locally within an
enterprise are entirely under the control of the local enterprise, and these names are valuable to the work
flow and access of information within the enterprise. It is assumed that the exact local name for the
document will be retained in the system that created the document and that the local name can be sent
along with the document type code when the document is sent to an external organization. The document
type code should only express the meaning in a document name that can be shared between independent
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organizations.

For example, it is appropriate to have local document names like Dr. Smiths Tuesday Pain Clinic Note
or Albuquerque VA General Medicine Consult Note for use within an enterprise. However, some parts
of these very specific local names are not meaningful outside of the originating enterprise Thus, proper
document type codes would have names like Outpatient Pain Clinic Note, or General Internal
Medicine Consult Note.







Table 22: Example Clinical Notes
Possible local terms Document type codes
Dr. Smiths Tuesday Pain Clinic Note Outpatient Pain Clinic Note
Albuquerque VA General Medicine Consult Note General Internal Medicine Consult Note

7.2 Relationship with terminologies

LOINC
HL7 will use LOINC codes for clinical document codes, and will not develop an independent document
code system for clinical documents. At its option, HL7 may choose to limit its domain to a subset of
LOINC codes. HL7 can incorporate any LOINC document code into the HL7 domain.

The naming rules in this document only apply to clinical notes. For purpose of this Users Guide, a
clinical note is a clinical document (as defined by the HL7 CDA Standard), where clinical professionals
and trainees produced the document either spontaneously (e.g., I write my admitting note) or in response
to a request for consultation. Clinical Notes provides a better description of the process.

Clinical Notes are to be distinguished from patient reports such as radiology reports, pathology reports,
laboratory reports, cardiac catheterization reports, etc., that are generated in response to an order for a
specific procedure. Names for most of these later concepts are accommodated well by the clinical LOINC
naming structure, and many such codes already exist within the LOINC database.

Relationship with HL7 V2.x values
The HL7 document type code domain will overlap with similar concepts found in HL7 V2.x (user defined
table 0270 Document Types; user defined table 0496 Consent Types). Our approach to manage this
overlap is:

Create a mapping from LOINC codes to HL7 V2.x document codes.
Continue to develop LOINC codes to meet the needs of the HL7 V3 domain that are not present
in the V2.x tables.

Relationship to a reference terminology
As soon as possible, the component terms used in the creation of the names of document type codes will
be mapped to either the UMLS Metathesaurus or SNOMED CT. This mapping will help to establish the
meaning of the terms and will allow aggregation and classification of document type codes based on
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definitions, computable relationships, and subsumption hierarchies that exist in the reference terminology.

7.3 Elements of Document Type codes

In the following, synonymy or equivalent terms are designated by parenthesis. Document codes are
defined by their component parts. The first list of axis values was published in 2003, and served as the
basis for an initial set of LOINC codes.

Through both empiric analysis and expert review, we have continued evaluating and refining this list. The
following listing contains the current set of axis values for the elements of document type codes that have
been vetted by the LOINC Committee. We are in the process of carefully harmonizing our existing
Document terms with these new values.


Kind of Document
Description: Characterizes the general structure of the document at a macro level. Document types are
differentiated based on the need to define distinct document headers.

Allowed Values:

1. Note
Description: Clinical Note (also known as Clinical Document). Documents generated by
clinicians as part of patient care, which includes notes written at the initiative of individual clinic and
consulting clinicians. It does not include clinical reports such as, radiology, pathology, and cardiac
catheter reports that are usually stimulated by a particular order. Clinical documents meet five
criteria, as defined in CDA 1.0: wholeness, stewardship, authentication, persistence, and human
readability.

2. Working draft of additional values for Kind of Document:

Work is presently underway to more fully define the other potential values for Kind of Document.
The following list shows the working draft of these values:

1. Administrative note
a. Against medical advice note
b. Agreement
c. Certificate
d. Consent
e. Contract
2. Advance directive
a. Do not resuscitate
1. Rescinded do not resuscitate
b. Living will
c. Rescinded advance directive
3. Diagram
4. Flowsheet
5. Legal
6. Letter
7. Note
a. Adverse event note
b. Alert
8. Report

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Type of Service
Description: Characterizes the kind of service or activity provided to/for the patient (or other subject of
the service) as described in the note. Common subclasses of service would be examinations, evaluations,
and management. The notion of time sequence, e.g., at the beginning (admission) at the end (discharge)
is subsumed in this axis.
1. Communication
2. Conference
a. Case Conference
3. Consultation
1. Confirmatory Consultation
4. Individual Counseling
5. Group Counseling
6. Daily or End of Shift Signout
7. Diagnostic Study
8. Education
a. Discharge Instructions
b. Discharge Teaching
c. Preoperative Teaching
9. Evaluation and Management
a. Annual Evaluation
b. Assessment
c. Crisis Intervention (Psychosocial Crisis Intervention)
d. Disease Staging
e. Disability Examination
1. Social Security Administration Compensation Examination
2. Compensation and Pension Examination
1. VA Compensation and Pension Acromegaly
2. VA Compensation and Pension Aid and Attendance or Housebound Exam
3. VA Compensation and Pension Arrhythmias
4. VA Compensation and Pension Arteries Veins and Miscellaneous (Misc)
5. VA Compensation and Pension Audio
6. VA Compensation and Pension Bones
7. VA Compensation and Pension Brain and Spinal Cord
8. VA Compensation and Pension Chronic Fatigue Syndrome
9. VA Compensation and Pension Cold Injury Protocol
10. VA Compensation and Pension Cranial Nerves
11. VA Compensation and Pension Cushing's Syndrome
12. VA Compensation and Pension Dental and Oral
13. VA Compensation and Pension Diabetes Mellitus
14. VA Compensation and Pension Digestive Conditions
15. VA Compensation and Pension Ear Disease
16. VA Compensation and Pension Eating Disorders
17. VA Compensation and Pension Endocrine Diseases
18. VA Compensation and Pension Epilepsy and Narcolepsy
19. VA Compensation and Pension Esophagus and Hiatal Hernia
20. VA Compensation and Pension Eye
21. VA Compensation and Pension Feet
22. VA Compensation and Pension Fibromyalgia
23. VA Compensation and Pension General Medical
24. VA Compensation and Pension Genitourinary
25. VA Compensation and Pension Gulf War Protocol
26. VA Compensation and Pension Gynecological Conditions and Disorders of the Breast
27. VA Compensation and Pension Hand Thumb and Fingers
28. VA Compensation and Pension Heart
29. VA Compensation and Pension Hemic Disorders
30. VA Compensation and Pension Human Immunodeficiency Virus (HIV)-Related Illness
31. VA Compensation and Pension Hypertension
32. VA Compensation and Pension Infectious Immune and Nutritional Disabilities
33. VA Compensation and Pension Intestines
34. VA Compensation and Pension Joints (Shoulder Elbow Wrist Hip Knee Ankle)
35. VA Compensation and Pension Liver Gall Bladder and Pancreas
36. VA Compensation and Pension Lymphatic Disorders
37. VA Compensation and Pension Mental Disorders
38. VA Compensation and Pension Mouth Lips and Tongue
39. VA Compensation and Pension Multiple Exam
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40. VA Compensation and Pension Muscles
41. VA Compensation and Pension Neurological Disorders
42. VA Compensation and Pension Nose Sinus Larynx and Pharynx
43. VA Compensation and Pension Peripheral Nerves
44. VA Compensation and Pension Post Traumatic Stress Disorder (PTSD) Initial Evaluation
45. VA Compensation and Pension Post Traumatic Stress Disorder (PTSD) Review
46. VA Compensation and Pension Prisoner of War Protocol
47. VA Compensation and Pension Pulmonary Tuberculosis and Mycobacterial Diseases
48. VA Compensation and Pension Rectum and Anus
49. VA Compensation and Pension Residuals of Amputations
50. VA Compensation and Pension Respiratory Diseases
51. VA Compensation and Pension Respiratory - Obstructive Restrictive and Interstitial
52. VA Compensation and Pension Scars
53. VA Compensation and Pension Sense of Smell and Taste
54. VA Compensation and Pension Skin Diseases
55. VA Compensation and Pension Spine
56. VA Compensation and Pension Stomach Duodenum and Peritoneal Adhesions
57. VA Compensation and Pension Thyroid and Parathyroid Diseases
f. Evaluation and Management of a Specific Problem
1. Evaluation and Management of Anticoagulation
2. Evaluation and Management of Hyperlipidemia
3. Evaluation and Management of Hypertension
4. Evaluation and Management of Smoking Cessation
5. Evaluation and Management of Overweight and Obesity
g. History and Physical
1. Annual History and Physical
2. Admission History and Physical
3. Comprehensive History and Physical
4. Targeted History and Physical
h. Initial Evaluation
1. Admission Evaluation
2. Admission History and Physical
i. Plan
1. Treatment Plan
j. Risk Assessment and Screening
1. Fall Risk Assessment
k. Subsequent Evaluation
1. Progress Note
l. Surgical Operation
1. Postoperative Evaluation and Management
2. Preoperative Evaluation and Management
m. Summarization
1. Transfer Summarization
2. Summary of Death
3. Discharge Note
4. Discharge Plan
5. Discharge Summary
n. Transplant Candidate Evaluation
o. Transplant Donor Evaluation
p. Well Child Visit
10. Medication Management
a. Medication Reconciliation
11. Outreach
12. Pathology Procedure
a. Autopsy
13. Procedure
14. Referral
15. Respite
16. Supervisory Direction
17. Triage

Setting
Description: Setting is a modest extension of CMSs (also known as HCFA) coarse definition of settings,
which have well defined meanings. Setting is not equivalent to location, which typically has more locally
defined meanings and is reported in other parts of the message. Setting would be limited to one of the
following categories (with some future extensions possible).
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Most clinical report names would include a setting (at least at the top level) to avoid confusion between
important classes of reports. For example, The Admission H&P is usually taken to be the Hospital
Admission H&P, but it could be confused with the nursing home H&P if not distinguished by the setting.
Setting is not a required component of the name.
1. Ambulance
2. Birthing Center
3. Emergency Department
4. Inpatient Hospital
5. Intensive Care Unit
6. Long Term Care Facility
1. Custodial Care Facility
2. Nursing Facility
1. Skilled Nursing Facility
7. Outpatient
1. Ambulatory Surgical Center
2. Office
3. Outpatient Hospital
4. Urgent Care Center
8. Patient's Home
9. Rehabilitation Hospital
10. Telehealth
11. Telephone Encounter

Subject Matter Domain (SMD)
Description: Characterizes the subject matter domain of a note.
1. Acupuncture
2. Aerospace Medicine
3. Allergy and Immunology
a. Clinical and Laboratory Immunology
4. Anesthesiology
a. Pain Medicine
5. Audiology
6. Chiropractic Medicine
7. Critical Care Medicine
8. Dentistry
9. Dermatology
a. Clinical and Laboratory Dermatological Immunology
b. Dermatopathology
c. Pediatric Dermatology
10. Emergency Medicine
a. Medical Toxicology
b. Pediatric Emergency Medicine
c. Sports Medicine
d. Undersea and Hyperbaric Medicine
11. Ethics
12. Family Medicine
a. Adolescent Medicine
b. Geriatric Medicine
c. Sports Medicine
13. General Medicine
14. Internal Medicine
a. Adolescent Medicine
b. Cardiovascular Disease
1. Clinical Cardiac Electrophysiology
2. Interventional Cardiology
c. Endocrinology
1. Diabetology
2. Thyroidology
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d. Gastroenterology
1. Hepatology
e. Geriatric Medicine
f. Hematology and Oncology
g. Infectious Disease
h. Nephrology
i. Pulmonary Disease
j. Rheumatology
k. Sports Medicine
15. Medical Genetics
a. Clinical Biochemical Genetics
b. Clinical Cytogenetics
c. Clinical Genetics
d. Clinical Molecular Genetics
e. Molecular Genetic Pathology
16. Mental Health
a. Psychiatry
1. Addiction Psychiatry
2. Child and Adolescent Psychiatry
3. Forensic Psychiatry
4. Geriatric Psychiatry
5. Psychosomatic Medicine
b. Psychology
16. Multi-specialty Program
17. Neurological Surgery
18. Neurology
a. Clinical Neurophysiology
b. Neurology Neurodevelopmental Disabilities
c. Neurology with Special Qualifications In Child Neurology
d. Pain Medicine
e. Vascular Neurology
19. Nuclear Medicine
20. Nutrition Dietetics
21. Obstetrics and Gynecology
a. Maternal and Fetal Medicine
b. Reproductive Endocrinology
22. Occupational Therapy
23. Ophthalmology
24. Optometry
25. Oral Surgery
26. Orthopedic Surgery
a. Orthopedic Sports Medicine
b. Surgery of the Hand
27. Orthotics Prosthetics
28. Otolaryngology
a. Neurotology
b. Pediatric Otolaryngology
c. Plastic Surgery within the Head and Neck
29. Palliative Care
30. Pastoral Care
31. Pathology
a. Anatomic and Clinical Pathology
1. Blood Banking Transfusion
2. Dermatopathology
32. Pediatrics
a. Adolescent Medicine
b. Child and Adolescent Psychiatry
c. Hepatology
d. Medical Toxicology
e. Neonatal Perinatal Medicine
f. Pediatric Cardiology
g. Pediatric Critical Care Medicine
h. Pediatric Dermatology
i. Pediatric Endocrinology
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j. Pediatric Emergency Medicine
k. Pediatric Gastroenterology
l. Pediatric Hematology-Oncology
m. Pediatric Infectious Diseases
n. Pediatric Nephrology
o. Pediatric Otolaryngology
p. Pediatric Pulmonology
q. Pediatric Radiology
r. Pediatric Rehabilitation Medicine
s. Pediatric Rheumatology
t. Pediatric Surgery
u. Sports Medicine
33. Pharmacy
34. Physical Medicine and Rehabilitation
a. Kinesiotherapy
b. Pain Medicine
c. Pediatric Rehabilitation Medicine
d. Spinal Cord Injury Medicine
e. Vocational Rehabilitation
35. Physical Therapy
36. Plastic Surgery
a. Plastic Surgery within the Head and Neck
b. Surgery of the Hand
37. Podiatry
38. Preventive Medicine
a. Medical Toxicology
b. Occupational Medicine
c. Undersea and Hyperbaric Medicine
39. Primary Care
40. Public Health
41. Radiology
a. Diagnostic Radiology
b. Nuclear Radiology
c. Pediatric Radiology
d. Radiation Oncology
e. Radiological Physics
f. Vascular and Interventional Radiology
42. Recreational Therapy
43. Research
44. Respiratory Therapy
45. Social Work
46. Speech Pathology
47. Surgery
a. Colon and Rectal Surgery
b. Pediatric Surgery
c. Surgery of the Hand
d. Surgical Critical Care
e. Thoracic Surgery
f. Transplant Surgery
g. Vascular Surgery
48. Tumor Board
49. Urology

Role
Description: Characterizes the training or professional level of the author of the document, but does not
break down to specialty or subspecialty.
1. Assistant
2. Case Manager
3. Clerical
4. Counselor
5. Fiduciary
6. Interdisciplinary
a. Team
7. Medical Assistant
8. Nursing
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a. CRNA
b. Certified Nursing Assistant
c. Clinical Nurse Specialist
d. Nurse Midwife
e. Nurse Practitioner
f. Licensed Practical Nurse
g. Registered Nurse
9. Patient
10. Physician
a. Attending
b. Fellow
c. Intern
d. Resident
11. Physician Assistant
12. Student
a. Sub Intern
13. Technician
14. Therapist
* Physician subsumes medical physicians and osteopathic physicians.

7.4 Rules for Creating Clinical Notes from Multiple Components

Names for required clinical notes would be constructed by picking entries from the Kind of Document
axis and at least one of the other four axes. The LOINC committee will create LOINC codes for all
required combinations (not all possible combinations).

The original document ontology terms were created only for the document type of note and with the
general naming pattern:

<Subject Matter Domain> : <Training / Professional Level>: <Setting>: <Type> : Note

As we have revised and refined the elemental axes in the document ontology, simple names would be
constructed and ordered as follows:


Table 23. Document Ontology LOINC Naming Rules
Component
Property Time System Scale
Method
Class
<Type of Service> <Kind of Document> Find Pt <Setting> Doc <SMD>.<Role> DOC.CLINRPT


In general, combinations from within an axis are allowed in a term name where they make sense (SMD,
Service), but are disallowed where they do not (Role, Setting). Combinations will be represented with a
plus (+), so as to distinguish from elements containing and or &. Where a particular element is not
defined for a given term and leaves a LOINC axis blank, the LOINC name will include the {} naming
convention. For example, if a Setting is not designated, the System will be {Setting}.

LOINC codes for clinical notes designed according to this model and are assigned a class of
DOC.CLINRPT.

Example LOINC codes in the Document Ontology include:



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Table 24. Example Document Ontology LOINC Codes
Component Property Time System Scale Method Class
Group counseling note Find Pt Hospital Doc {Provider} DOC.CLINRPT
Evaluation and management note Find Pt Outpatient Doc {Provider} DOC.CLINRPT
Evaluation and management note Find Pt {Setting} Doc {Provider} DOC.CLINRPT
History and physical note Find Pt {Setting} Doc {Provider} DOC.CLINRPT

7.5 Future Work

We continue active development and refinement of the Kind of Document axis. As we continue this work,
we intend to develop equally specific definitive documents for other kinds of health case associated
documents.





8 Order Panels (Batteries)

Beginning with version 1.0o, the LOINC database was expanded to include order sets/panels. These have
been identified with the word PANEL in the component name. Since the property type will vary
depending on the panel elements, the second part of the LOINC name may be populated by a dash (-).
The scale (5th part of the LOINC name) will be populated by a dash (-) if the panel elements could have
different scales.

If a government authority recognizes the order set, it will include the year that an order set took effect.
For example:

Comprehensive metabolic 2000 panel.

Using RELMA, you can view the list of the individual test components included in each panel (order set).
The elements will be accompanied by a flag that will denote the expected appearance of the panel element
in the panel when resulted. A flag is always one of three states:
R - Required. The panel element is always expected to be reported when the panel is resulted.
O - Optional. The panel element may not be reported with a panel result depending upon
institutional policy or capabilities of the reporting lab.
C - Conditional. The panel element is a key finding in the panel report and should be assumed to
be negative, absent or not present if the panel result does not include data for this element.

Some example order sets:


Table 25: Example Order Sets
24358-4 Hemogram WO platelets panel - Pt Bld Qn R
26464-8 Leukocytes NCnc Pt Bld Qn R
26453-1 Erythrocytes NCnc Pt Bld Qn R
718-7 Hemoglobin MCnc Pt Bld Qn R
20570-8 Hematocrit VFr Pt Bld Qn R
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30428-7 Mean corpuscular volume EntVol Pt RBC Qn R
28539-5 Erythrocyte mean corpuscular hemoglobin EntMass Pt RBC Qn R
28540-3 Erythrocyte mean hemoglobin concentration MCnc Pt RBC Qn R
30384-2 Erythrocyte distribution width EntVol Pt RBC Qn O
30385-9 Erythrocyte distribution width Ratio Pt RBC Qn O
24326-1 Electrolytes 1998 panel - Pt Ser/Plas Qn R
2951-2 Sodium SCnc Pt Ser/Plas Qn R
2823-3 Potassium SCnc Pt Ser/Plas Qn R
2075-0 Chloride SCnc Pt Ser/Plas Qn R
2028-9 Carbon dioxide SCnc Pt Ser/Plas Qn R
330373 Anion gap SCnc Pt Ser/Plas Qn O


LOINC has created a series of spreadsheets that contains sets of related panels. These spreadsheets may
include information on multiple panels or just a single panel. Each spreadsheet contains three
worksheets: list of LOINC terms within the union of the panels in the package, a table that defines the
nesting of the panels within a given panel, and a table that defines all of the answer lists in the panel. This
content can be easily used to load a database, but every panel in LOINC is not yet represented this way.
You can also get to the panels content by going to the panel screen in RELMA. You can look at the
content of every panel on this screen in report format. You can also pick any panel in the grid of a search,
right click, and then export.

8.1 Goals

We have gotten many requests for a standard set of test order codes from Medical Information System
vendors. They want standard codes for the common orders so they can install their system with a set of
usable starter set of order codes. They also want them to ease the cross communications among merging
hospitals.

LOINC codes have been defined for most individual laboratory observations and for many clinical
observations, and claims attachments. Obviously, these same LOINC codes can be used to order
individual laboratory and clinical observations, as well as to report the LOINC code for Blood
Hemoglobin (LOINC # 718-7) could as easily be used to order a Blood Hemoglobin, as well as to report
the result of that test. Pre-existing LOINC codes could also be used to order more complex observations.
The Urinary Creatinine Clearance (LOINC # 2164-2) could also be used order code Creatinine Clearance.
Since the calculation of creatinine clearance requires two distinct measures (serum creatinine and 24-hour
urine creatinine), an order for creatinine clearance implies an order for these two other measures.
However, the existing single value LOINC codes could not be used to order many laboratory and clinical
procedures that are ordered as a single-named test (battery), such as CBC, urine dipsticks, blood
differential count, LDH isoenzymes. Similarly physicians order Blood pressure measures and expect to
get (at least) the diastolic blood pressure and the systolic blood pressure. Though these are separate
observations, for practical purposes one is never measured without the other.
Initially, we created LOINC codes for the common fixed observation packages. By fixed, we mean that
certain kinds of measures will always be part of the battery, and the production of that particular set of
measurements is tightly bound to the procedure or instruments that produce the values and or by a
government mandate (e.g., LOINC # 24325-3: Hepatic function HCFA 2000 panel). Other types of order
codes have evolved.

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Background on kinds of results found in order sets
To understand the rules about creating order sets, we distinguish several kinds of results in orderable test
batteries (or sets).

8.2
8.3
8.4
8.5
Reflex tests

Testing can be done in steps. A certain number of analyses are done at the first step, then depending upon
the values of those analytes different analyses (observations) are performed. For example, a TSH test
might be done first and depending upon its value, other confirmatory tests would be done. We have not
yet addressed the naming of Panels with reflex components in LOINC. This is work for the future.

Calculated or derived results

The results in an order set often include results that simple calculations based on the primary
measurements. For example, it might include the absolute concentration and the percent concentration of
a given element, such as basophils. In the information theoretic sense these do not provide additional
information. So we will usually use one order panel name regardless of how many values were calculated
from the primary measurement.

Associated observations

Some sets consist of a set of measures produced by the laboratory and a set of observations obtained by
the placer and sent along with the request. For example, placers will usually report the percent inspired
O2 when they request an arterial blood gas and the laboratory reports that value along with the values it
measures directly. We call these associated observations and count the volumes and times of collection
in this category for the purpose of this discussion. We will not define distinct order panels that vary with
the number of clinical variables (not measured by the lab) that are included in the report.

LOINC Rules for representing order panel names

We will use most of the same general LOINC naming rules for Batteries of Observations (Panels) as for
individual observations.
Component Name: For orders sets consisting of three or more constituent tests, the component name will
be a concatenation of:

(1) A name (e.g., Hemogram, Differential count, Vital Signs) to convey the content of the panel
(2) The word Panel included to unambiguously identify that this LOINC term refers to a panel or
battery

In the case that a well-defined panel exists but has no conventional name, we will include each of the
distinct measured entities separated by ampersand (&) in the component name. So for example, when a
creatinine is measured along with sodium in a 24-hour urine, we will use this convention to build up
panels from other panels. We may also use a more efficiently syntax, which implies repeat of the first
part of the name, e.g., Chlamydia Ab IgM & IgG Panel.

Any of these batteries may variously include in the report a variety of other values derived from the
reported measures, information sent along with the request (e.g., inspired O2 for blood gases). In most
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cases we will not make up different names for the same set of tests done by different methods. Because
of the possible mixtures of methods within a panel, representing these distinctions would cause an
explosion of the distinct Panel, which would (usually) be a burden on the ordering provider. Further, in a
given setting the ordering provider can only order the methods that are provided by his usual producer.
Implied in the order is Give me the battery produced by your usual methods. In special circumstances,
we might provide method specific observation panels, e.g., when blood pressure is usually done by
automated methods, the provider might want the option of obtaining a blood pressure by manual methods
as a double check.

Property, Timing, Scale and Method: We will not usually value the property type (the second part of a
LOINC name) of an order panel because the property varies within the measures included in a battery.
But since this field cannot be null in a LOINC name, we will include a dash (-) in this field, but we will
usually value the timing and the system and the scale field.

At this first phase we have defined batteries for:
Hemograms and differential counts (both automated and manual)
Arterial blood gases
Urinalyses
Isoenzymes
Antibodies for IgG and IgM when they are done in pairs
Common toxicology batteries
Susceptibility testing
Chemical batteries defined by HCFA
A few clinical orders



Description of some LOINC Panels (Order Set Names):

Table 26: Examples of LOINC Panel Names (Order Set Names)
LOINC_NUM LOINC Fully Specified Name Description
24358-4 Hemogram WO platelets panel:-:Pt:Bld:Qn HCT & HGB & WBC & RBC & Indices
Hemogram WO platelets & W manual differential
panel :-:Pt:Bld:Qn
24359-2 Hemogram & Differential Count
24317-0
Hemogram & platelets WO differential panel:-
:Pt:Bld:Qn
HCT & HGB & WBC & RBC & Indices & Platelets
pH & PO2 & PCO2 on blood without specifying whether
arterial, venous, or other source. The report would usually
include an observation about the inspired O2 sent along with the
report. It may include a variety of other patient characteristics
sent by the requester and a variety of computed variables.
24338-6 Gas panel:-:Pt:Bld:Qn
Gas panel:-:Pt:BldA: Qn
pH & PO2 & PCO2 on arterial blood. The report would usually
include an observation about the inspired O2 sent along with the
report. It may include a variety of other patient characteristics
sent by the requester and a variety of computed variables.
24336-0
Gas panel:-:Pt:BldV:Qn
pH & PO2 & PCO2 on venous blood. The report would usually
include an observation about the inspired O2 sent along with the
report. It may include a variety of other patient characteristics
sent by the requester and a variety of computed variables.
24339-4
29274-8 Vital signs measurement:Find:Pt:^Patient^Multi
Diastolic Blood Pressure & Systolic Blood Pressure & Pulse
Rate & Respiratory Rate
24357-6 Urinalysis macro (dipstick) panel:-:Pt:Urine:-
Urinalysis dip stick results. Usually includes Glucose, Bilirubin,
estimate of leukocytes, estimate of RBCs, estimate of bacteria,
Ph, Specific gravity. But we do not make distinctions about the
exact set of measures on the dipstick. The ordering clinician
will not necessarily know what particular dipstick is being used
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and is not able or interested in making those distinctions.
Bacterial susceptibility panel:-:Pt:Isolate:OrdQn
Would include susceptibility results for the antibiotics relevant
to the isolates and the kind of culture.
29576-6


9 Evolving principles for naming collections

9.1
9.2
Goals and general approach
We are in the process of evolving our model for naming collections in LOINC. Our goals in refining this
model are to:

Create names that are consistent across different subject domains within LOINC
Make it easy to create a list of all codes that could be used as document type in CDA
Make it easy to create a list of all codes that could be used as section headings in CDA
Avoid proliferating names

To this end, we are developing rules for naming of collections will apply to both laboratory collections
(CBC, CHEM7) coded and structured clinical collections (Vital Signs), documents (Admit History and
Physical Exam), Apgar scores, Braden Scale, Pain scales, etc. There will be two categories of names for
collections:

Names for panels with enumerated discreet contents, and
Names for general collections of information.

Using the existing panel mechanisms, the LOINC database will record the association between LOINC
collections and individual observations where these associations are known. For example, LOINC
already records the expected contents for CBC, Liver Enzymes, etc. It will also include definitions for
Vital Signs, Cardiac Catheterization, Braden Scale, surveys, etc. We will create a single LOINC code for
any general collection of information where the information content of the collection is the same,
regardless of whether the content is a text document, a scanned image of text, or a sound file of the same
information.

Since collections are named by their real or anticipated contents, the same LOINC code could be used as
either a document type or as a section type.

Collections as orders and observations

The same LOINC code will be used for ordering a procedure, naming the document produced as the
description of the procedure, or naming the structured and coded set of observations from the procedure.

For panels, the same code for CBC would be used as the ordered item in an order record or message, and
as the panel identifier in the OBR segment of a result record or message. The same pattern would be
followed for laboratory procedures and clinical procedures.

For general collections, the same code would be used as the ordered item in an order record or message,
and as the result identifier in a result message. For example, the general collection name could be used in
a result message as the identifier of a document type, as a section label, as the universal identifier in an
OBR segment, or as the identifier in and OBX segment depending on the circumstances. The same pattern
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would be followed for radiology procedures and clinical procedures.

We are not taking away the flexibility of having the ordered code be different from the result code. For
example, it is often desirable for the order code to be less specific and more abstract than the result code.
LOINC would contain codes for something like Exercise EKG with the expectation that the result could
come back as AHA Protocol Stress EKG Result. The point is that when appropriate we would use the
same LOINC code in the contexts of orders and results. We would NOT make LOINC codes that meant
CBC Order and CBC Result, we would use the same LOINC code for CBC in both orders and
results.

Current practice would also continue where a pure procedure is ordered and discreet results would be
returned. For example, Urine Microscopic Exam could be ordered and discreet values for cell types,
casts, amorphous material, etc. would be returned.


9.3
9.4
LOINC SCALE for collections

The SCALE for panels will be Panel. The SCALE for general information collections will be Doc,
short for document, which is used in the most general sense of a text document, image, scanned text
image, etc. Doc would replace the current use of Nar (narrative) or Nom (nominal) for general
information collections in the current LOINC database.

The LOINC committee will review current contents of the LOINC database and modify names
appropriately to conform to the new conventions. We will not implement the name changes until after the
current Attachments NPRM is final.

Examples of proposed changes according to new policy

Table 27: Example of Proposed Changes
LOINC# Component Property Time System Scale Method Class/Type
24358-4 Hemogram panel - Pt Bld Panel PANEL.HEM/BC
24320-4 Basic Metabolic HCFA 98 panel - Pt Ser/Plas Panel PANEL.CHEM
24362-6 Renal Function HCFA 2000 Panel - Pt Ser/Plas Panel PANEL.CHEM
34566-0 Vital signs panel - Pt ^Patient Panel PANEL.VITALS
11488-4 Consultation note Find Pt {Setting} Doc {Provider} ATTACH.CLINRPT
34066-1 Boxed warning section - -
^FDA package
insert
Doc DOC.REF.
35511-5 Background information section - -
^Clinical trial
protocol
Doc DOC.REP.CTP
35660-0
Path report.final diagnosis section
text
Imp Pt Specimen Doc TUMRRGT
24534-0 Multisection Find Pt
Abdominal
vessels
Doc US.doppler RAD





10 Standardized Assessment Measures
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10.1
10.2
10.3
10.3.1
Introduction

The LOINC committee approved inclusion of standardized assessment measures (e.g., survey
instruments) with version 1.0p. Representing the observations in these assessments within LOINC
required a modest extension of the System axis to include aggregate units of analysis, such as family,
and storage of additional attributes within the LOINC database. Bakken
30
provides a detailed description
of the methodology for inclusion and evaluation into LOINC and the extensions to the LOINC axes.

The initial corpus of material represented in LOINC came from standardized nursing assessment
instruments, including: Home Health Care Classification (HHC), Quality Audit Marker (QAM), Signs
and Symptoms Checklist for Persons with HIV (HIV-SSC), Living with HIV, and the Omaha System. We
have since expanded the content to cover standardized assessment instruments in many other domains.



Consolidated Health Informatics endorsement

As national interest in using standards for communicating the results of patient assessment instruments
has increased, we have collaborated with members of the Consolidated Health Informatics (CHI)
Disability Workgroup and many others to more fully develop the content and infrastructure to support
patient assessment instruments. LOINC now contains full representations of CMSs Minimum Data Set
version 2 (MDS) used in nursing homes, CMSs Outcome and Assessment Information Set (OASIS) used
in home health care, and the Social Security Administrations Residual Functional Capacity (RFC)
instrument.

Our work with CHI Disability Workgroup has led to the endorsement of Clinical LOINC as a CHI
standard for federally-required assessment (i) questions and answers, and (ii) assessment form that
include functioning and disability content. The recommendations of the CHI Disability Workgroup were
endorsed by the NCVHS and subsequently the HHS Secretary.

LOINC Representation

The overall organization of the survey instruments are represented in LOINC using a nested panel
structure consistent with the existing model for laboratory panels. LOINC codes are created for the
individual questions/items within an instrument, as well as for the panels/groups of terms representing the
hierarchical nature of the instrument. In addition, the database and RELMA program continue to be
refined to support the definitional elements of the full instrument, including: computational and skip
logic, help and contextual coding content, and structured answer lists.
Naming rules and conventions for survey instrument items in LOINC
As we have expanded our work to represent more and varied patient assessment instruments within
LOINC, we have evolved our model to capture more completely the relevant aspects of various forms. In
particular, we have three fields that can capture the exact display of the question/item on the form in
question. (For some instruments, it can be difficult to determine what exactly is the question text). The
Component of a LOINC term represents the thing or attribute being measured, and is the default for
capturing the item text. However, there are several reasons why the component may not be the exact item
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text. The most important ones include: our LOINC naming conventions do not permit certain characters
(e.g. "/" or "?") because of our internal "Part" parsing rules, that some aspects of the question are modeled
in other parts of the formal LOINC name, or that there is some important aspect to the "thing being
measured" (e.g. a lookback period of the last 7 days) that is not represented explicitly on the form for that
particular item. In general, for purposes of displaying the item text as it appears on the instrument, one
can follow this rule:
1. SURVEY_QUEST_TEXT in the LOINC table [if populated]. This field is populated when the
variable/item is asked as a question. In some cases, the variable has both a question and a label. In
these cases, the SURVEY_QUEST_TEXT field is populated with both, in the pattern of
[Label].[Question text]. For example, for item J0300 on the MDS version 3 we have "Pain
Presence. Ask resident: "Have you had pain or hurting at any time in the last 7 days?"
2. DISPLAY_NAME_FOR_FORM in the FORM_DATA table (RELMA) or FORMS table (CSV
file export) [if populated]. This field provides an override display that is linked to the instance of
the LOINC question code in a particular form. It allows for the same clinical concept to have
slight presentation variances on different forms where those variances have no change in the
concept meaning and accomodates instances where the LOINC naming conventions require some
difference between the item and the LOINC Component. For example, an item might have the
form label of "Body Mass Index (BMI)" but the LOINC Component would simply be "Body
mass index".
3. COMPONENT in the LOINC table. This is the default display.
In addition to these fields, some LOINC codes used in survey instruments may have other LOINC name
fields such as a Short Name, Long Common Name, or our newly created Consumer Name. These
additional names may be useful in some contexts for these items, be we will still use the above rule to
capture the item's representation in the instrument. Some of the original survey instruments modeled in
LOINC may not follow this rule exactly, in part due to the fact that we did not have full survey
representation model as we do presently. Ongoing work includes reviewing where modifications may be
needed.

10.3.2
11.1
Structured answer lists

The questions/items in standardized assessment instruments often have highly specialized, fixed answer
lists. In many contexts, it is the answer list that most completely defines the meaning of concept
represented by the question. Additionally, because many of the answer choices are highly specialized, few
are represented by existing codes in reference terminologies. For these reasons, we have created a
structured representation of the answer lists for the questions in assessment instruments represented in
LOINC. Individual answers are assigned a non-semantic identifier with a LA prefix and a mod-10
check digit. The answer codes LOINC assigns are unique by lexical string (ignoring capitalization), and
by intention do not distinguish between strings that may have different meanings depending on their
contextual use. The LA codes are placeholders for the structured answer lists, not intended as an external
codes system or in the HL7 message.


11 Editorial Policies and Procedures

Concept orientation and LOINC name changes

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LOINC is a concept-based terminology, which means that it provides a way of naming classes of things
that exist in the real world. Each concept (term) is given an identifier and a fully-specified name. Other
attributes, including other names such as a Short Name and Long Common Name, are also provided in
the LOINC database. The concept is anchored by the LOINC code, not by the particular strings in the
formal name we happen to use to explain the code. It is certainly not possible to convey all of the
subtleties that exist in the world with formal machinery alone, which is why we are also working very
hard to include narrative text descriptions with each term that further elaborate and explain the concept.

In a complex, organic terminology like LOINC, name changes and modifications are unavoidable for
many reasons. Since its inception, LOINC has maintained a set of editorial policies that guide our
adherence to this concept-oriented ideal even as the terminology evolves over time. An over-arching
policy is that we can change the name (i.e. the human-readable representation of the concept) in any way
that does not change the meaning of the concept. In other words, a modification is allowable and valid if
it is still an unambiguous reference to a class of things in the real world.

For example, two different numbering systems have been used to identify the serotypes of Streptococcus
pneumoniae, which are important in gauging the coverage of polyvalent pneumonia vaccines. The U.S.
system uses only numbers while the Danish system includes numbers and letters. For a period of time,
LOINC term names were split and used a mixture of the Danish and U.S. identifiers, which was
inconsistent and confusing. To clarify, we converted the few Danish serotype identifiers to their
corresponding U.S. serotype identifiers (and included the Danish identifiers as synonyms). This was not a
fundamental change to the underlying concept, but rather just the particular labels used to express it.

Not all situations are crystal clear, so our general policy is to seek as much input as is feasible, and
typically such cases are brought for discussion to the LOINC Committee.

11.2 Classification of LOINC term status

LOINC development follows best practices for terminology system development by never reusing or
deleting codes. If a LOINC term is identified as erroneous or a duplicate of a previous term it is flagged
as deprecated in the database, but the record is not removed. Changes in concept status are made very
judiciously. Prior to the LOINC version 2.31 release (June 2010), we identified such deprecated terms by
populating the STATUS field of the database with DEL and wherever possible identified superseding
concepts in the MAP_TO field. Active (non-deprecated) records had no value (null) in the STATUS field.
Based on new use cases and input from the LOINC community, LOINC 2.31 implements an expansion to
that classification. The presently supported values for term status, with the definition and implications for
use, are:

ACTIVE Concept is active. Use at will.
TRIAL Concept is experimental in nature. Use with caution as the concept and
associated attributes may change.
DISCOURAGED Concept is not recommended for current use. New mappings to this
concept are discouraged; although existing may mappings may continue
to be valid in context. Wherever possible, the superseding concept is
indicated in the MAP_TO field of the database and should be used
instead.
DEPRECATED Concept is deprecated. Concept should not be used, but it is retained in
LOINC for historical purposes. Wherever possible, the superseding
concept is indicated in the MAP_TO field of the database and should be
used both for new mappings and updating existing implementations.
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Furthermore, we have added two new fields:

STATUS_REASON Classification of the reason for concept status. This field will be Null for
ACTIVE concepts, and optionally populated for terms in other statues
where the reason is clear. DEPRECATED or DISCOURAGED terms
may take values of: AMBIGUOUS, DUPLICATE, or ERRONEOUS.
STATUS_TEXT Explanation of concept status in narrative text. This field will be Null for
ACTIVE concepts, and optionally populated for terms in other statues.

Our initial implementation of these new concept status values populated the STATUS field with
ACTIVE or DEPRECATED based on their existing status and have identified a limited set of terms
that have been designated DISCOURAGED or TRIAL.

The principal reason identifying terms as DISCOURAGED is where we have strong inclinations that a
particular term is no longer valid given current practice. For example, we have flagged as
DISCOURAGED several lutropin terms with Properties consistent with mass or molar units because all
lutropin sources that we could reach report concentrations in international units (IU) per volume and the
drug lutropin is prescribed in terms of international units per volume. To avoid help confusion on the part
of mappers, the DISCOURAGED status steers them away from these terms to the more likely candidates.

The principal reason for identifying terms as TRIAL is a very constrained circumstance, such as when the
source of the term is still equivocating. This has been illustrated in our work to create a LOINC
representation of federally-required patient assessment instruments. Here, the item meaning is defined in
the context of use within that instrument. We have been fortunate to work with assessment developers in
the early stages of instrument development. This is advantageous because it enables the codes to be
included in data specifications and documents as they are developed, but we are in the position of creating
codes and names for data elements whose attributes are still in flux. As the instrument evolves, the
specific representation of the item (question) or answer options on the form may change. Ultimately, the
representation will be settled by an authoritative body (such as CMS) and they are intended for use in one
context the official release of the instrument. Identifying these terms as TRIAL allows us to include
them in the public distribution while clearly flagging their pending status. Once the final concept
representation has been determined, terms initially labeled TRIAL would be reclassified as ACTIVE (or
perhaps in rare circumstances DEPRECATED or even rarer DISCOURAGED).

11.3 Concept persistence and term deprecation

LOINC codes are never reused or deleted, and the concept meaning is persistent over time despite the fact
that there may be modifications to the name (as described above). If we discover that a LOINC terms
meaning is a duplicate of another existing term or it is somehow erroneous, it will be given a status of
DEPRECATED but not removed from the database.

In the past, when we encountered duplicate terms (i.e. terms that had different names but meant the same
thing), our general policy was to deprecate the newest term. Many times, this convention worked well
because the older term was more likely to have been incorporated into users systems through mappings,
etc. However, this was not always the case. Sometimes, the new term had the clearer, more recognizable
label and thus it was most likely the most mapped-to term.

Therefore, our current policy is to make the change to require (in our estimation) the least amount of re-
mapping for existing users.
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Appendix A - LOINC Database Structure

Table 28: LOINC Database Structure
Field Name Type Width Description
1. LOINC_NUM Text 7 The unique LOINC Code is a string in the format of nnnnn-n.
2. COMPONENT Text 255 First major axis-component or analyte
Second major axis-property observed (e.g., mass vs.
substance)
3. PROPERTY Text 30
4. TIME_ASPCT Text 15
Third major axis-timing of the measurement (e.g., point in
time vs 24 hours)
5. SYSTEM Text 100
Fourth major axis-type of specimen or system (e.g., serum vs
urine)
6. SCALE_TYP Text 30
Fifth major axis-scale of measurement (e.g., qualitative vs.
quantitative)
7. METHOD_TYP Text 50 Sixth major axis-method of measurement
8. RELAT_NMS Text 254
This field is no longer being maintained. It has been replaced
by RelatedNames2
9. CLASS Text
An arbitrary classification of the terms for grouping related
observations together. The current classifications are listed in
Table 29. We present the database sorted by the class field
within class type (see field 23). Users of the database should
feel free to re-sort the database in any way they find useful,
and/or to add their own classifying fields to the database.

The content of the laboratory test subclasses should be
obvious from the subclass name.
20
Text 8
This is for our internal use and should be ignored by database
users.
10. SOURCE
11. DT_LAST_CH Text 8 Date last changed, in the format YYYYMMDD
Text 3
Change Type Code
DEL = delete (deprecate)
ADD = add
12. CHNG_TYPE NAM = change to Analyte/Component (field #2);
MAJ = change to name field other than #2 (#3 - #7);
MIN = change to field other than name
UND = undelete
13. COMMENTS Memo - Free-text comments relating to the test result.
14. ANSWERLIST Memo -
The contents of this field have been moved to new structured
lists which can be viewed in the details screen using RELMA.
15. STATUS Text 11
ACTIVE = Concept is active. Use at will.
TRIAL = Concept is experimental in nature. Use with caution
as the concept and associated attributes may change.
DISCOURAGED = Concept is not recommended for current
use. New mappings to this concept are discouraged; although
existing may mappings may continue to be valid in context.
Wherever possible, the superseding concept is indicated in the
MAP_TO field of the database and should be used instead.
DEPRECATED = Concept is deprecated. Concept should not
be used, but it is retained in LOINC for historical purposes.
Wherever possible, the superseding concept is indicated in the
MAP_TO field of the database and should be used both for
new mappings and updating existing implementations.
16. MAP_TO Text 7
Used when a field has been dropped from the active database
(by entering DEL in the Status field) because it has been
replaced by an updated term. In those cases, MAP_TO
contains the LOINC code of the new term that should be used.
17. SCOPE Text 20 Not currently used.
18. CONSUMER_NAME Text 255
An experimental (beta) consumer friendly name for this item.
The intent is to provide a test name that health care consumers
will recognize; it will be similar to the names that might
appear on a lab report and is not guaranteed to be unique
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because some elements of the LOINC name are likely to be
omitted. We will continue to modify these names in future
release, so do not expect it to be stable (or perfect). Feedback
is welcome.
19. IPCC_UNITS Text 30
Units have been moved to a new structure that can be viewed
in the details screen in RELMA.
20. REFERENCE Memo -
Contains references to medical literature, product
announcements, or other written sources of information on the
test or measurement described by the LOINC record.
21. EXACT_CMP_SY Text 50
Exact core component synonym: This field contains an exact
synonym for the core component of the LOINC component
name. We have included the mixed case and superscript
form of blood bank and HLA antigens (e.g., Lua) here. As
there is no ASCII representation for superscript letters, we use
the hat (^) to signify superscripts in this field. (e.g., if the core
component is represented as L little u super little a in the
LOINC component/analyte name field, it is represented in the
Exact Core Synonym field as Lu^a.)
22. MOLAR_MASS Text 13
Molecular weights: This field contains the molecular weights
of chemical moieties when they are provided to us. This
release contains values kindly contributed by IUPAC.
23. CLASSTYPE Int 2
1=Laboratory class; 2=Clinical class; 3=Claims attachments;
4=Surveys
24. FORMULA Text 255 Regression equation details for many OB.US calculated terms.
25. SPECIES Text 20
Codes detailing which non-human species the term applies to.
If blank, human is assumed.
26. EXMPL_ANSWERS Memo -
For some tests and measurements, we have supplied examples
of valid answers, such as 1:64, negative @ 1:16, or 55.
27. ACSSYM Memo -
Chemical name synonyms, alternative name synonyms, and
chemical formulae supplied by the Chemical Abstract Society.
28. BASE_NAME Text 50 Chemical base name from CAS
29. FINAL Text 1 Internal LOINC use field
30. NAACCR_ID Text 20
Maps to North American Association of Central Cancer
Registries Identification Number
31. CODE_TABLE Text 10 Examples on CR0050 Cancer Registry
32. SETROOT Yes/No 1
Currently used for claims attachments. Yes in this field
signifies that this record is the root of a set of LOINC codes.
0=No, 1=Yes
33. PANELELEMENTS Memo -
This field is no longer being maintained. See Viewing
LOINC Details in RELMA.
34. SURVEY_QUEST_TXT Memo - Verbatim question from the survey instrument
35. SURVEY_QUEST_SRC Text 50
Exact name of the survey instrument and the item/question
number
36. UNITSREQUIRED Text 1
Y/N field that indicates that units are required when this
LOINC is included as an OBX segment in a HIPAA
attachment
37. SUBMITTED_UNITS Text 30
Units as received from person who requested this LOINC
term.
38. RELATEDNAMES2 Memo -
This is a new field introduced in version 2.05. It contains
synonyms for each of the parts of the fully specified LOINC
name (component, property, time, system, scale, method). It
replaces #8, Relat_NMS.
39. SHORTNAME Text 40
Introduced in version 2.07, this field is a concatenation of the
fully specified LOINC name. The field width may change in a
future release.
40. ORDER_OBS Text 15
Defines term as order only, observation only, or both. A
fourth category, Subset, is used for terms that are subsets of a
panel but do not represent a package that is known to be
orderable we have defined them only to make it easier to
maintain panels or other sets within the LOINC construct.
41. CDISC_COMMON_TESTS Text 1
Y in this field means that the term is a part of subset of
terms used by CDISC in clinical trials.
42. HL7_FIELD_SUBFIELD_ID Text 50
A value in this field means that the content should be
delivered in the named field/subfield of the HL7 message.
When NULL, the data for this data element should be sent in
an OBX segment with this LOINC code stored in OBX-3 and
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with the value in the OBX-5.
43. EXTERNAL_COPYRIGHT_NOTICE Memo -
External copyright holders copyright notice for this LOINC
code.
44. EXAMPLE_UNITS Text 255
This field is populated with a combination of submitters units
and units that people have sent us. Its purpose is to show users
representative, but not necessarily recommended, units in
which data could be sent for this term.
45. INPC_PERCENTAGE Number -
Percent of overall 13 month result volume within the INPC
(circa 2006). A record with a value > 0 indicates that this code
is one of the common tests that comprise > 99% of the total
INPC result volume. See also PMID: 18693941.
46. LONG_COMMON_NAME Text 255
This field contains the LOINC term in a more readable format
than the fully specified name. The long common names have
been created via a table driven algorithmic process. Most
abbreviations and acronyms that are used in the LOINC
database have been fully spelled out in English.
47. HL7_V2_DATATYPE Text 255
HL7 version 2.x data type that would be sent in OBX-2 when
this data is delivered in an HL7 message.
48. HL7_V3_DATATYPE Text 255
HL7 version 3.0 data type that is compatible with this LOINC
code.
49. CURATED_RANGE_AND_UNITS Memo -
A curated list of normal ranges and associated units
(expressed as near UCUM codes) for physical quantities and
survey scores. Intended as tailorable starter sets for
applications that use LOINC forms as a way to capture data.
Units are separated from normal ranges by XXX and sets of
normal range/units pairs are separated by YYY.
50. DOCUMENT_SECTION Text 255
Classification of whether this LOINC code can be used a full
document, a section of a document, or both. This field was
created in the context of HL7 CDA messaging, and populated
in collaboration with the HL7 Structured Documents
Technical Committee.
51. DEFINITION_DESCRIPTION_HELP Memo -
Field that is similar to the current COMMENTS field that tells
users what the LOINC term is and what to do with it.
52. EXAMPLE_UCUM_UNITS Text 255
The Unified Code for Units of Measure (UCUM) is a code
system intended to include all units of measures being
contemporarily used in international science, engineering, and
business. (www.unitsofmeasure.org ) This field contains
example units of measures for this term expressed as UCUM
units.
53. EXAMPLE_SI_UCUM_UNITS Text 255
The Unified Code for Units of Measure (UCUM) is a code
system intended to include all units of measures being
contemporarily used in international science, engineering, and
business. (www.unitsofmeasure.org) This field contains
example units of measures for this term expressed as SI
UCUM units.
54. STATUS_REASON Text 9
Classification of the reason for concept status. This field will
be Null for ACTIVE concepts, and optionally populated for
terms in other status where the reason is clear.
DEPRECATED or DISCOURAGED terms may take values
of: AMBIGUOUS, DUPLICATE, or ERRONEOUS.
55. STATUS_TEXT Memo -
Explanation of concept status in narrative text. This field will
be Null for ACTIVE concepts, and optionally populated for
terms in other status.
56. SPECIAL_EXPLANATION Memo -
Detailed explanation about special changes to the term over
time.

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Appendix B - Classes
Table 29: Classes

Table 29a: Clinical Term Classes
Abbreviation Clinical Term Class
ART Antiretroviral therapy
BDYCRC.ATOM Body circumference atomic
BDYCRC.MOLEC Body circumference molecular
BDYHGT.ATOM Body height atomic
BDYHGT.MOLEC Body height molecular
BDYSURF.ATOM Body surface atomic
BDYTMP.ATOM Body temperature atomic
BDYTMP.MOLEC Body temperature molecular
BDYTMP.TIMED.MOLEC Body temperature timed molecular
BDYWGT.ATOM Body weight atomic
BDYWGT.MOLEC Body weight molecular
BP.ATOM Blood pressure atomic
BP.CENT.MOLEC Blood pressure central molecular
BP.MOLEC Blood pressure molecular
BP.PSTN.MOLEC Blood pressure positional molecular
BP.TIMED.MOLEC Blood pressure timed molecular
BP.VENOUS.MOLEC Blood pressure venous molecular
CARD.US Cardiac ultrasound (was US.ECHO)
CLIN Clinical NEC (not elsewhere classified)
DENTAL Dental
DEVICES Medical devices
DOC.ADMIN Administrative documents
DOC.CLINRPT Clinical report documentation
DOC.EPSOS Smart Open Services for European Patients (epSOS) documents
DOC.MISC Miscellaneous documentation
DOC.PUBLICHEALTH Public health documentation
DOC.QUALITY Quality documents
DOC.REF Referral documentation
DOC.REF.CTP Clinical trial protocol document
DOCUMENT.REGULATORY Regulatory documentation
ED Emergency (DEEDS)
EKG.ATOM Electrocardiogram atomic
EKG.IMP Electrocardiogram impression
EKG.MEAS Electrocardiogram measures
ENDO.GI Gastrointestinal endoscopy
EYE Eye
EYE.CONTACT_LENS Ophthalmology contact lens
EYE.GLASSES Ophthalmology glasses: Lens manufacturer (LM) & Prescription
EYE.HETEROPHORIA Ophthalmology heterophoria
EYE.OCT Ophthalmology Optical Coherence Tomography (OTC)
EYE.PX Ophthalmology physical findings
EYE.REFRACTION Ophthalmology refraction
EYE.RETINAL_RX Ophthalmology treatments
EYE.TONOMETRY Ophthalmology tonometry
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EYE.US Ophthalmology ultrasound
EYE.VISUAL_FIELD Ophthalmology visual field
FUNCTION Functional status (e.g., Glasgow)
H&P.HX History
H&P.PX Physical
H&P.SURG PROC Surgical procedure
HEMODYN.ATOM Hemodynamics anatomic
HEMODYN.MOLEC Hemodynamics molecular
HRTRATE.ATOM Heart rate atomic
HRTRATE.MOLEC Heart rate molecular
HRTRATE.TIMED.MOL Heart rate timed molecular
IO.TUBE Input/Output of tube
IO_IN.ATOM Input/Output atomic
IO_IN.MOLEC Input/Output molecular
IO_IN.SUMMARY Input/Output summary
IO_IN.TIMED.MOLEC Input/Output timed molecular
IO_IN_SALTS+CALS Input/Output electrolytes and calories
IO_OUT.ATOM Input/Output atomic
IO_OUT.MOLEC Input/Output molecular
IO_OUT.TIMED.MOLE Input/Output timed molecular
NEONAT Neonatal measures
OB.US Obstetric ultrasound
OBGYN Obstetric/Gynecology
PANEL.ART Antiretroviral therapy order set
PANEL.BDYTMP Body temperature order set
PANEL.BP Blood pressure order set
PANEL.CARDIAC Cardiac studies order set
PANEL.CV Cardiovascular order set
PANEL.DEVICES Medical devices order set
PANEL.DOC Documents panels
PANEL.DOC.CLINRPT Clinical report documentation set
PANEL.ED Emergency (DEEDS) order set
PANEL.EYE Ophthalmology panels
PANEL.FUNCTION Function order set
PANEL.H&P History & Physical order set
PANEL.IO Input/Output order set
PANEL.NEONAT Neonatal measures order set
PANEL.OB.US Obstetrical order set
PANEL.PATIENT SAFETY Patient safety order set
PANEL.PHENX PhenX Panel
PANEL.PHR Public health record order set
PANEL.RAD Radiology order set
PANEL.TUMRRGT Tumor registry order set
PANEL.US.URO Urology ultrasound order set
PANEL.VACCIN Vaccination order set
PANEL.VITALS Vital signs order set
PATH.PROTOCOLS.BRST Pathology protocols - breast
PATH.PROTOCOLS.GENER Pathology protocols - general
PATH.PROTOCOLS.PROST Pathology protocols - prostrate
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PATH.PROTOCOLS.SKIN Pathology protocols - skin
PATIENT SAFETY Patient safety
PHENX PhenX
PUBLICHEALTH Public Health
PULM Pulmonary ventilator management
RAD Radiology
RESP.ATOM Respiratory atomic
RESP.MOLEC Respiratory molecular
RESP.TIMED.MOLEC Respiratory timed molecular
SKNFLD.MOLEC Skinfold measurements molecular
TRNSPLNT.ORGAN Organ transplant
TUMRRGT Tumor registry (NAACCR)
US.URO Urological ultrasound
VACCIN Vaccinations
VOLUME.MOLEC Volume (specimen) molecular


Table 29b: Laboratory Term Classes
Abbreviation Laboratory Term Class
ABXBACT Antibiotic susceptibilities
ALLERGY Response to antigens
BLDBK Blood bank
CELLMARK Cell surface models
CHAL Challenge tests
CHALSKIN Skin challenge tests
CHEM Chemistry
COAG Coagulation study
CYTO Cytology
DRUG/TOX Drug levels & Toxicology
DRUGDOSE Drug dose (for transmitting doses for pharmacokinetics)
FERT Fertility
HEM/BC Hematology (coagulation) differential count
HL7.GENETICS Clinical genetic report
HL7.CYTOGENETICS Clinical cytogenetic report
HLA HLA tissue typing antigens and antibodies
HPA HPA typing
LABORDERS Laboratory order codes
MICRO Microbiology
MISC Miscellaneous
MOLPATH Molecular pathology
MOLPATH.DEL Gene deletion
MOLPATH.MISC Gene miscellaneous
MOLPATH.MUT Gene mutation
MOLPATH.REARRANGE Gene rearrangement
MOLPATH.TRINUC Gene trinucleotide repeats
MOLPATH.TRISOMY Gene chromosome trisomy
MOLPATH.TRNLOC Gene translocation
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NR STATS Normal range statistics
PANEL.ABXBACT Susceptibility order sets
PANEL.ALLERGY Allergy order set
PANEL.BLDBK Blood bank order set
PANEL.CELLMARK Cell marker order sets
PANEL.CHAL Challenge order set
PANEL.CHEM Chemistry order set
PANEL.COAG Coagulation order set
PANEL.DRUG/TOX Drug level & Toxicology order set
PANEL.FERT Fertility testing order set
PANEL.HEDIS Healthcare Effectiveness Data and Information Set order set
PANEL.HEM/BC Hematology & blood count order set
PANEL.HL7.GENETICS HL7 genetics panel
PANEL.HL7.CYTOGENETICS HL7 cytogenetics panel
PANEL.HLA HLA order set
PANEL.HPA HPA order set
PANEL.MICRO Microbiology order set
PANEL.MISC Miscellaneous order set
PANEL.MOLPATH Molecular pathology order set
PANEL.OBS Obstetrics order set
PANEL.SERO Serology order set
PANEL.UA Urinalysis order set
PATH Pathology
Serology (antibodies and most antigens except blood bank and infectious
agents)
SERO
SPEC Specimen characteristics
UA Urinalysis



Table 29c: Attachment Term Classes
Abbreviation Attachment Term Class
ATTACH Attachment
ATTACH.AMB Ambulance attachment
ATTACH.CARD Cardiac attachment
ATTACH.CLINRPT Clinical report attachment
ATTACH.CPHS Children's Preventative Health System attachment
ATTACH.ED Emergency department attachment
ATTACH.GENERAL General attachment
ATTACH.GI Gastrointestinal attachment
ATTACH.LAB Laboratory attachment
ATTACH.MEDS Medication attachment
ATTACH.MODIFIER Modifier attachment
ATTACH.OBS Obstetrics attachment
ATTACH.REHAB Rehabilitation attachment
ATTACH.REHAB.ABUSE Alcohol/Substance abuse rehabilitation attachment
ATTACH.REHAB.CARDIAC Cardiac rehabilitation attachment
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ATTACH.REHAB.NURS Specialized nursing attachment
ATTACH.REHAB.OT Occupational therapy attachment
ATTACH.REHAB.PSYCH Psychiatric rehabilitation attachment
ATTACH.REHAB.PT Physical rehabilitation attachment
ATTACH.REHAB.PULM Pulmonary rehabilitation attachment
ATTACH.REHAB.RT Respiratory rehabilitation attachment
ATTACH.REHAB.SOCIAL Medical social work attachment
ATTACH.REHAB.SPEECH Speech therapy rehabilitation attachment
ATTACH.RESP Respiratory attachment


Table 29d: Survey Term Classes
Abbreviation Survey Term Class
PANEL.SURVEY.BIMS Brief Interview for Mental Health Status (BIMS) set
PANEL.SURVEY.CARE Continuity Assessment Record and Evaluation (CARE) set
PANEL.SURVEY.CAM Confusion Assessment Method (CAM) set
PANEL.SURVEY.GDS Geriatric Depression Scale (GDS) set
PANEL.SURVEY.HHCC Home Health Care Classification set
PANEL.SURVEY.HIV-SSC Signs and Symptoms checklist for persons living with HIV set
PANEL.SURVEY.HOWRU howRU outcomes instrument set
PANEL.SURVEY.LIV-HIV Living with HIV set
Minimum Data Set for Nursing Home Resident Assessment and Care
Screening set PANEL.SURVEY.MDS
PANEL.SURVEY.MFS Morse Fall Scale set
PANEL.SURVEY.NMMDS Nursing Management Minimum Data set
PANEL.SURVEY.OASIS Outcome and Assessment Information Survey set
PANEL.SURVEY.OMAHA OMAHA survey set
PANEL.SURVEY.PHQ9 Patient Health Questionnaire PHQ-9 set
PANEL.SURVEY.PROMIS Patient Reported Outcomes Measurement System set
PANEL.SURVEY.QAM Quality Audit Marker set
PANEL.SURVEY.QRDA Quality Health Reporting Document Architecture set
PANEL.SURVEY.RFC Residual Functional Capacity set
PANEL.TIMP Test of Infant Motor Performance set
PANEL.SURVEY.USSGFHT United States Surgeon General Family Health Tool set
SURVEY.CARE Continuity Assessment Record and Evaluation (CARE) survey
SURVEY.GDS Geriatric Depression Scale (GDS) survey
SURVEY.HOWRU howRU outcomes instrument survey
Minimum Data Set for Nursing Home Resident Assessment and Care
Screening survey SURVEY.MDS
SURVEY.MFS Morse Fall Scale survey
SURVEY.NMMDS Nursing Management Minimum Data survey
SURVEY.NURSE.HHCC Home Health Care Classification survey
SURVEY.NURSE.HIV-SSC Signs and Symptoms checklist for persons living with HIV survey
SURVEY.NURSE.LIV-HIV Living with HIV survey
SURVEY.NURSE.OMAHA OMAHA survey
SURVEY.NURSE.QAM Quality Audit Marker survey
SURVEY.OASIS Outcome and Assessment Information Survey
SURVEY.PHQ Patient Health Questionnaire
SURVEY.QRDA Quality Health Reporting Document Architecture survey
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SURVEY.PROMIS Patient Reported Outcomes Measurement System survey
SURVEY.RFC Residual Functional Capacity survey
SURVEY.USSGFHT United States Surgeon General Family Health Tool survey
TIMP Test of Infant Motor Performance survey
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Appendix C - Calculating Mod 10 Check Digits


The algorithm for calculating a Mod 10 check digit is as follows:


Instructions



Example

1. Using the number 12345, assign positions to the digits, from right to left.
1st = 5
2nd = 4
3rd = 3
4th = 2
5th = 1

2. Take the odd digit positions counting from the right (1st, 3rd, 5th, etc.) 531


3. Multiply by 2. 1062


4. Take the even digit positions starting from the right (2nd, 4th, etc.). 42


5. Append (4) to the front of the results of (3). 421062


6. Add the digits of (5) together. 4+2+1+0+6+2 = 15


7. Find the next highest multiple of 10. 20


8. Subtract (6) from (7).


Thus, 5 is the Mod 10 check digit for 12345. 20 - 15 = 5.

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Appendix D - Procedure for Submitting Additions/Changes to
the Database
Introduction

The Regenstrief Institute receives two kinds of requests for additions:

(1) The first kind of request deals with (a) an entirely new kind of measurement, e.g., DNA
sequencing or (b) the use of LOINC codes in manners that have not been agreed upon by the LOINC
committee, e.g., the definition of terms to accommodate the organism 1, organism 2, etc., structures that
are present in many laboratory databases.

(2) Other requests are variations on observations that are already in the database. For example, we
have a term for a particular test result with serum as the specimen (system) and a user requests an
identical term for a specimen of gastric contents. Provided that the requestor followed the rules given
below and the number of terms requested at a given time is modest, we will try to respond to these kinds
of requests quickly.

The Institute will only be able to respond quickly to such requests if the requestor provides us with clear
information about the new terms, as detailed below in Table 30, which defines the content that we need to
determine whether a submitted code requires a new LOINC code assignment or not. Before sending a
request, make sure that you have, at a minimum, provided information about the component, property,
timing aspect, system, scale, method and units of measure (when appropriate). It is also very useful for us
to receive example results or answers lists of the test/observation that is being requested. This
information enables us to verify the property, scale, and method.

You have the option of either submitting a file produced solely by you or one generated on your behalf
via the RELMA program. Regardless of which option you choose, your submission file must be sent to
the Regenstrief Institute in one of three file formats.
The preferred format (and the one that RELMA will produce on your behalf) is a Microsoft
Access database (mdb).
The second format is a Microsoft Excel spreadsheet (xls).
The final format is a tab delimited ASCII file (txt).
The example file and field descriptions below will aid you in creating a submission file from scratch
(without the aid of the RELMA program).

A Few Notes before Proceeding

The terms addition, requested term and proposed LOINC are synonymous. All of these terms refer
to a concept created by a user that will be or has been submitted to the Regenstrief Institute for
consideration as an addition to the LOINC database.

Please note that we tend to avoid the use of methods for chemistry tests. We will not routinely accept
requests for method-specific chemistry tests. Only in very special circumstances will we distinguish
among analytic methods in chemistry. We do distinguish microbiology, serology, and coagulation tests
by method type. Even here, however, we do not distinguish every variation in methods. Look in the body
of this guide for information about the kinds of distinctions that we make.

If you find a test in the database that you believe is wrong, please send us a letter or email
(loinc@regenstrief.org) calling attention to the term and the reason you think it is wrong, (e.g., not using
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the standard nomenclature, typographical error, system of serum when it is only valid when performed on
plasma, duplicate of some other concept in the database, etc. We welcome all input from users.

Note that our policy is to allow both method-vague (no method) as well as method-specific measures in
serology (measures of Ab and Ag), and in antibiotic susceptibility testing.

Please pay special attention to requests for submissions that include the system of serum or plasma alone.
For most chemical analyses there is no important clinical difference between the values obtained from
serum and those obtained from plasma, and we would like to represent them in the database as Ser/Plas to
indicate our indifference to the distinction. Unfortunately, many requestors of new terms define their
request in terms of the one that they happen to use (e.g., serum or plasma) without telling us that the
measure can really be done on either serum or plasma. Most such requests should be for Ser/Plas as the
system (sample). If the measurement MUST be done on either serum or plasma, please scientifically
justify your request; otherwise you will greatly delay our response to your submission.

When possible, please provide a full description of the test, its purpose, and procedure. (A copy of
vendors test kit descriptive material or a copy from a textbook describing the procedure and its purpose
would be very helpful.) We often will require a committee discussion to decide how to represent new
subject matter, so response times will be slower.

The requestors also need to supply some evidence that they are familiar with the database and that they
are sure the term is not already represented in LOINC. The major work these requests generate is the
effort to be sure the observation is not already in the database. We can perform this service if the
requestors have done most of this work themselves. For this reason, we request that you identify the
LOINC term that is closest to your request and to flag the difference between the requested test and the
existing test. That is, when a new observation is only a variation on an old one, use an existing LOINC
observation as the template, change the part that is different in the new term and indicate that difference.


An Example Submission and Definition of the Submission File

An example submission (which, because of space limitations, includes columns for only the first few
fields) appears below. Real submissions should have columns for all of the items listed in Table 29.
Additional details are provided in the sections on creating Access Database and Excel submissions
presented later in this appendix.

Table 30: Example submission
Your
test
ID
Analyte/
Row# Property Time System Scale Method Related Etc
Component
1 G23 Glucose^90M post 50g lactose MCnc Pt Urine Ord Test strip
Urine
2 C47 Coproporphyrin 1 isomer MRat 24H Qn
3 I98 Indican MRat 24H
Urine
Qn
4 T51 Thyroxine.free MCnc Pt Urine Qn


The following table contains a description of the fields contained in the submit.mdb template. These
fields should be present in the submission file you submit to Regenstrief. Only some of the fields need to
be populated with data as noted below.


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Table 31a: Access Field Names for Submission
Field Name Type Width Description
1. S_ROW Long 4 Row number of this term in submitters file.
2. S_LOCAL_CD Text 50
The submitters local code used to identify the test/observation in the
submitters master file.
3. S_COMPO Text 150 Submitters Analytes/Component. Mandatory. (User Guide 2.2)
4. S_PROP Text 30
Submitters Kind of Property. Mandatory but we can help if you provide
enough details. (User Guide 2.3)
5. S_TIME Text 15 Submitters Time Aspect. Mandatory. (User Guide 2.4)
6. S_SYS Text 100 Submitters System/Sample Type. Mandatory. (User Guide 2.5)
7. S_SCALE Text 30 Submitters Type of Scale. Mandatory. (User Guide 2.6)
8. S_METH Text 50 Submitters Type of Method. If required. (User Guide 2.7)
9. S_REL_NAM Text 254
Submitters Related Names. Strongly recommended. Common names,
acronyms or synonyms.
10. S_LOINC Text 10
Submitters LOINC number. Strongly recommended. This is the LOINC
number that is similar, but not the same as, the submitters test.
11. S_RESULTS Memo -
Submitters Example Results. Recommended for new analytes. As
reported by your lab.
12. S_UNITS Text 30
Submitters Example Units. Mandatory for quantative results. As reported
by your lab.
13. S_SPECIES Text 20 To be used for veterinary term submissions.
14. S_ID Text 50
If the submitter includes a reference code ID for each unique submission to
LOINC, record that ID here, and this will be returned with questions or an
assigned LOINC number on a returned file.
15. S_COMMENT Memo - Comments the submitter may wish to pass to RI when needed.

Creating a Submission Using Microsoft Access

A blank Microsoft Access database template (.mdb) is available at http://loinc.org/submissions .




Figure 1. Submission Created with Microsoft Access

Creating a Submission Using Microsoft Excel

If you choose to create your submission using Microsoft Excel, you should use the field names as
specified in Table 29. Failure to do so may result in delays in processing the submission. Figure 2 below
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shows an example of what an Excel submission template looks like.
An Excel submission template (.xls) can be downloaded at http://loinc.org/submissions .


Figure 2. An Example Excel Submission (first 9 fields only)

CAUTION: Please take note of the field size indicated in Table 29. Upon receipt of your submission, we
will copy the submission data into a Microsoft Access database as defined above in Table 29. If the cells
in your Excel submission contain too many characters, some data may be lost in the conversion process.


Creating a Submission Using a Tab-Delimited ASCII Text File

If you choose to send your submission in a tab-delimited ASCII text file format, please use the following
format:

S_ROW|S_LOCAL_CD|S_COMPO|S_PROP|S_TIME|S_SYS|S_SCALE|S_METH|S_REL_NAM|S_LO
INC|S_RESULTS|S_UNITS|S_ID|S_SPECIES|S_COMMENT<CRLF>

Each field is separated from the other by a Tab character. That is, each vertical bar above would actually
be a Tab character (i.e., an ASCII 9). A carriage-return/line-feed pair (i.e., the <CRLF> above) terminates
each line. Therefore, each <CRLF>-terminated line in the ASCII file becomes a submission record. Note
that the field lengths presented in 29 still apply to ASCII file submissions because upon receipt of your
submission we copy the ASCII file data you submit into an Access database of the form described above.

Using the previous example, one line might appear as:

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1|G23|GLUCOSE^90m POST 50g LACTOSE PO|MCNC|PT|UR|ORD|TEST STRIP|||6762-9||MG/DL|||

where the vertical bars represent the Tab character. Notice that two vertical bars appear between TEST
STRIP and 6762-9. In this example, this means that the related names field is empty (i.e., a null field
value). The example also shows that fields S_RESULTS, S_ID, and S_COMMENT are also empty.
Without the empty field, the field information would get out of sync and it would appear that the related
names for this submission were actually the closest LOINC number for the submission (i.e., 6762-9).
Therefore, the ordering of the fields and the use of the Tab character to delimit the fields is very
important.

In Figure 3 below, an example submission file is shown with the actual tab characters in lieu of the
vertical bars used above as illustrations. Please note that the first row contains the field names described
in Table 29. Also note that the tab characters are invisible to the human eye and make the text appear
chaotic (this is one reason we recommend the use of Microsoft Access for the creation of submission
files).


Figure 3. Example Submission Using ASCII Tab-Delimited File

Generating a Submission Using RELMA

The RELMA program can aid you in creating submissions by allowing you to create, manage and store
submission terms in a way that is similar to how the program creates, manages and stores local working
sets. With RELMA, you can create terms for submission over time and submit groups of terms in
batches. The program will track when the term was created and the date when you submitted the term.
The program will help you organize the terms that you create and it will automate the process of creating
the submission files.

For detailed instructions on how to use the RELMA propose a term feature, please see Appendix B of the
RELMA manual which can be downloaded at http://loinc.org/downloads/files/RELMAManual.pdf.


Sending Submission Files to Regenstrief Institute

Regardless of the file type, please email to submissions@loinc.org . Note that you may have to zip the
file. If you do not have access to email, you may copy this file onto a CD and mail it to:

Kathy Mercer
The Regenstrief Institute, Inc.
Health Information and Translational Sciences Bldg. (HITS)
410 West 10th Street, Suite 2000
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Indianapolis, IN 46202

Within a day or two of receipt of your file, you will receive a confirmation email and the submission
process will be underway. You may receive additional communication from Regenstrief with requests for
further information if required. Once the submission process has completed, you will receive files
containing your requested codes.
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Appendix E - Examples for LOINC Property Matching

1. Content (CNT) Like concentration except that volume in the denominator is replaced by mass. By
extension:

CCnt Catalytic Content, catalytic activity of a component per unit mass of a sample (system).
24048-1|Alpha galactosidase:CCnt:Pt:Fib:Qn

MCnt Mass Content, mass of component per unit mass of a sample (system).
9435-9|Isopropanol:MCnt:Pt:Tiss:Qn
Note: All of the heavy metal measurements in hair, nails, and tissue should all be mass
contents.
8157-0|Arsenic:MCnt:Pt:Nail:Qn

NCnt Number Content, number of component entities per unit mass of a sample (system).
20771-2|Coliform bacteria:NCnt:Pt:Egg:Qn:Viability count

2. Fraction (FR). Fraction of component A in a group of entities B, C, Y, N in system 1. By extension:

CFr Catalytic Fraction
2536-1|Lactatedehydrogenase1/Lactatedehydrogenase.total:CFr:Pt:Ser/Plas:Qn:Electrophoresis
9642-0|Creatine Kinase.BB/Creatine kinase.total:CFr:Pt:Ser/Plas:Qn

NFr Number Fraction
10602-1|Spermatozoa.abnormal head/100 spermatozoa:NFr:Pt:Semen:Qn
764-1|Neutrophils.band form/100 leukocytes:NFr:Pt:Bld:Qn:Manual count

MFr Mass Fraction
2614-6|Methemoglobin/Hemoglobin.total:MFr:Pt:Bld:Qn

SFr Substance Fraction
4546-8|Hemoglobin A/Hemoglobin.total:MFr:Pt:Bld:Qn

VFr Volume fraction.
4545-0|Hematocrit:VFr:Pt:Bld:Qn:Spun

3. Ratio (RTO). Ratio of component A to component B in system 1. By extension:

CCRto Catalytic Concentration Ratio
2325-9|Gamma glutamyl transferase/Aspartate aminotransferase:CCrto:Pt:Ser/Plas:Qn

SCRto Substance Concentration Ratio
2958-7|Sodium/Potassium:ScRto:Pt:Sweat:Qn

MCRto Mass Concentration Ratio
2768-0|Phenylalanine/Tyrosine:MCrto:Pt:Ser/Plas:Qn

NRto Number Ratio
11138-5|Myeloid cells/Erythroid cells:NRto:Pt:Bone mar:Qn

VelRto Velocity Ratio
12022-0|Resistivity index:VelRto:Pt:Uterine artery.right:Qn:Doppler.calculated

VRatRto Volume Rate Ratio
29462-9|Pulmonic flow/Systemic flow:VRatRto:Pt:Circulatory system.XXX:Qn:US.doppler

Ratio 1811-9|Amylase/Creatinine renal clearance:Ratio:24H:Urine:Qn

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Note:
CSF/Serum Protein calculation is not a ratio, because the measured components are not in the same
system. Its property type is relative mass concentration, RlMCnc (see below).

Note:
If the units of the denominator and numerator are both mass (e.g., mg/g), use MCrto
13719-0|Carnitine/Creatinine:MCrto:Pt:Urine:Qn
If the units of the denominator and numerator are both substance (e.g., mmol/mol) use ScRto
22695-1|Carnitine/Creatinine:ScRto:Pt:Urine:Qn
If the units of the denominator and numerator are different (mmol/g), use Ratio
17866-5|Carnitine/Creatinine:Ratio:Pt:Urine:Qn

4. Relative (REL). Relative amount of component A in system 1 compared to system 0. By extension:

REL should be used anywhere an actual measurement is divided by a measurement on a normal or
control. It should also be used when a quotient is created by dividing a measured substance in Serum
by the same substance measured in CSF, Urine, etc.

RelMCnc Relative Mass Concentration (as noted previously)
2858-9|Protein.CSF/Protein.serum:RelMCnc:Pt:Ser+CSF:Qn
3235-9|Coagulation factor XII Ag actual/Normal:RelMCnc:Pt:PPP:Qn:Imm

RelTime Relative time
3232-6|Coagulation factor XII activity actual/Normal:RelTime:Pt:PPP:Qn:Coag

RelCCnc Relative Catalytic Concentration
28660-9|Plasminogen actual/Normal:RelCCnc:Pt:PPP:Qn:Chromo

RelRto Relative Ratio
20450-3|Alpha-1-fetoprotein multiple of the median:RelRto:Pt:Ser/Plas:Qn

RelVol Relative Volume
19853-1|Capacity.inspiratory.bs/Capacity.inspiratory.preop:RelVol:Pt:Respiratorysystem:Qn:Spirometry

RelVrat Relative Volume Rate
20161-6|Voluntaryventilation.max^postbronchodilator/MVV:predicted:RelVRat:Pt:Respiratory system:Qn

5. Cmplx. Other divisions of one measurement by another that are not covered by the above rules
should be classed as having Complex (Cmplx) properties, and the exact formula for deriving the
quantity should be explicitly stated.


6. ARBITRARY. Arbitrary concentration of items. If we are not measuring the activity of an enzyme
then the units of measure and properties are:

Possible Values Property Scale
Units/mL, IU/mL, etc. ACnc Qn
Units/gm, IU/gm, etc. ACnt Qn
Unit/min, IU/24hr, etc. ARat Qn
Unitless (Patient/Control) AFr Qn

When measuring presence/absence or ordering measures of a component, ACnc is also the correct
property with scale of Ord

NOTE: If we are measuring the activity of an enzyme then the units of measure and properties are:
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Possible Values Property Scale
IU/mL, Units/mL, etc. CCnc Qn
IU/gm, Units/gm, etc. CCnt Qn
IU/24hr, Unit/min, etc. CRat Qn
Unitless (Patient/Control) CFr Qn

7. If the property is Titr then the scale is always Qn.
For any X Ab or Ag:

Possible Values Property Scale
<1:2, 1:4, 1:8... Titr Qn

8. For Any X Ab or Ag:

Possible Values Property Scale
Neg, Indeterminate, Pos ACnc Ord
1+, 2+, 3+... ACnc Ord
<1:2, 1:4, 1:8... Titr Qn
Neg, 1:4, 1:8 ... Titr Qn
Neg, 0.90 ACnc Qn (EIA units)

9. For any intensive evaluation whose value comes from a finite set of unranked (independent)
coded items the property will be Prid (or Type) and scale Nom. Prid is used in cases where the
value set includes the option of reporting none, not present, etc. Type is used in cases where
the result always specifies a value from the finite set. For extensive measures whose value comes
from a finite set of unranked coded items, the property will be the extensive property, and the
scale will be Nom.

Intensive Properties Possible Values (coded) Property Scale
Organism Identified E. coli, S. aureus, etc. Prid Nom
ABO Group A, B, AB, O Prid Nom
Surgery (Dis. Summary) Cholecystectomy, Appendectomy Prid Nom


Extensive Properties Possible Values (coded) Property Scale
Urine Color Amber, straw, etc. Color Nom
Urine Turbidity Hazy, cloudy, opaque Turbidity Nom

10. For any intensive evaluation whose value comes from a finite set of unranked (independent) free text
items (or a paragraph) the property will be Prid, or Find and scale Nar to indicate that the result is free
text narrative. For extensive measures whose value comes from a finite set of unranked text items (or
a paragraph), the property will be the extensive property, and the scale will be Nar.

Intensive Properties Possible Values (text) Property Scale
Organism Identified E. coli, S. aureus, etc. Prid Nar
ABO Group A, B, AB, O Prid Nar
Surgery (Dis. Summary) Cholecystectomy Prid Nar


Extensive Properties Possible Values (text) Property Scale
Urine Color Amber, straw, etc. Color Nar
Urine Turbidity Hazy, cloudy, opaque Turbidity Nar
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11. Imp is used to represent the property when the evaluation is a mental abstraction based on one a
collection of measurements and or data. For example, if several measurements are made relative to
immunoglobin levels in Serum and CSF in a myasthenia gravis panel, and if by examining all of the
evidence a pathologist decided that this pattern of findings represented active disease (which could be
represented as a coded value), the result of the pathologist thought process would be represented as:

Possible Values (text) Property Scale
Myasthenia Evaluation No disease, chronic disease Imp Nom

If the pathologist evaluation is reported free text or a paragraph of information, the representation
would be:

Myasthenia Evaluation No disease, chronic disease Imp Nar

12. Methods are only used to distinguish things that are identical in the other five LOINC fields but may
differ because the sensitivity or specificity is different for the given methods.

13. Need to be careful in distinguishing end point detection method from property. For example, if
sodium is measured using an ion specific electrode, the property is not a voltage difference. The
voltage difference is just a method for indirectly measuring the sodium concentration. Concentration
is the real property. Likewise, many antigens and antibodies are now measured using optical density
as the detection method. However, the property we are really measuring is an arbitrary concentration
(ACnc), not the optical density. If it is a ratio of optical densities (as with Gliadin Ab, Parvovirus
B19 Ab, etc.) that are compared (patient value divided by a standard control), then the property
should be ACRto (arbitrary concentration ratio).

14. ml/min/1.73sqM (Milliliters per min per 1.73 square meters BSA): Similar to the immediately
preceding item. This result has the same property as if it had units of ml/min/sqM. The property of
this measurement should be called areic volume rate (ArVRat).


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Appendix F - Acronyms used in LOINC

Table 32: Acronyms used in LOINC
Acronym Meaning
AC Abdominal Circumference
ADL Activities of Daily Living
AE Anion Exchange protein
AP Anterio-Posterior
APAD AnteroPosterior Diameter of the Abdomen
AUT Automated Ultrasound Testing
B2GP1 Beta 2 Glycoprotein 1
BD Binocular Distance
BOR Brachio-Oto-Renal
BPC Biparietal Circumference
BPD Biparietal diameter
CD Cluster of differentiation
CDA Congenital dyserythropoietic anaemia
CDB Childhood Disability Benefits
cDNA complementary DNA
CFst Calorie Fast
CHAMPUS
Civilian Health and Medical Program of the Uniformed
Services
Cine Cinematographic
CNR1 Cannabinoid receptor 1
COC Commission on Cancer
COPD Chronic Obstructive Pulmonary Disease
CPT Current Procedural Terminology
CRL Crown-Rump Length
CSF Cerebral spinal fluid
CW Continuous wave
CyCD22 Cytoplasmic CD22
DBG Donna Bennett-Goodspeed
DCIS Ductal carcinoma in situ
DISIDA Diisopropyliminodiacetic acid
DRG Diagnostic Related Groups
DTPA Diethylenetriamine pentaacetate
Dx Diagnosis
EBV-LMP Epstein Barr virus latent membrane protein
ED Emergency Department
EDD Estimated Delivery Date
EEG Electroencephalogra
EFW Estimated Fetal Weight
EGD Esophagogastro duodenoscopy
EKG Electrocardiogram
EMS Emergency Medical Service(s)
ENT Ear, Nose Throat
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ERCP Endoscopic Retrograde Cholangiopancreatography
FL Femur Length
FLACC Face Legs Activity Cry Consolability
FNA Fine needle
FTA Fetal Trunk Area
GALOP Gait disorder Autoantibody Late-age Onset Polyneuropathy
GSD Gestational Sac Diameter
GSL Gestatonal Sac Length
HC Head Circumference
HCFA Health Care Financing Administration
HIV Human immunodeficiency virus
HIV-SSC
Sign and Symptom Check-List for Persons with HIV
Disease
HL Humerus Length
HLA Human Leukocyte Antigen
HMPAO Hexamethylpropyleneamine oxime
HTLV Human T-cell Lymphotrophic Virus
HWL Height Width Length
ICD International Classification of Diseases
ICD9 International Classification of Diseases, Ninth Revision
ICD9-CM
International Classification of Diseases, Ninth Revision,
Clinical Modification
ICD-O International Classification of Diseases for Oncology
ID Intradermal
INR International normalized ratio
IOD Inter Ocular Distance
KUB Kidney-Ureter-Bladder
LHON Leber hereditary optic neuropathy
LOINC Logical Observation Identifiers Names and Codes
LVOT Left Ventricular Outflow Tract
LW Landsteiner-Wiener
LWT Length Width Thickness
MAA Microalbumin aggregate albumin
MEMS Medication Event Monitoring System
MERSTH Medical Event Reporting System-Total Health System
MIB-1 Mindbomb homolog 1
MIBG Metaiodobenzylguanidine
MIC Minimum inhibitory concentration
MLC Minimum lethal concentration
MLO Mediolateral oblique
MMA Macro aggregate albumin
MVV Maximum Voluntary Ventilation
NAACCR North American Association of Central Cancer Registries
Ng Nasogastric
NPI National Provider Identifier
OFD Occipital-Frontal Diameter
O-I BPD Outer to Inner Biparietal Diameter
OmpC Outer membrane porin of E coli
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O-O BPD Outer to Outer Biparietal Diameter
O-O TD Outer to Outer Tympanum Diameter
OOD Outer Orbital Diameter
PA Postero-Anterior
PCP Primary Care Physician
PEG Polyethylene Glycol
PHQ Patient Health Questionnaire
PISA Proximal Isovelocity Surface Area
PSR Peridontal Screening and Recording
PYP Pyrophosphate
QAM Quality Audit Marker
QID Four times a day
RAST Radioallergosorbent test
RFC Residual Functional Capacity
RFLP Restriction fragment length polymorphism
RUG Resource Utilization Groups
SAB Streptoavidin-biotin
SBT Sequence based typing
SC Sulphur colloid
SCB Sertoli cell barrier
SCL Scleroderma
SEER Surveillance Epidemiology and End Result
TAD Transverse Abdominal Diameter
TC Thoracic Circumference
TCD Transverse Cerebellar Diameter
TD Transaxial Diameter
TEC Tubingen electric campimetry
TID three times a day
TNM Tumor, node, metastasis
TORCH
Toxoplasma, Rubella. Cytomegalovirus, Herpes Simplex
Virus
TTD Transverse Thoracic Diameter
TU Tuberculin Units
VTI Velocity Time Integral
VWF von Willebrand Factor









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Appendix G - LOINC Committee Members

Name Organization City, State/Province,
Country

Ray Aller University Southern California Pathology Vista, CA
John Baenziger Indiana University Hospital Indianapolis, IN
Suzanne Bakken Columbia School of Nursing New York, NY
Pam Banning 3M West Linn, OR
Rita Barsoum Kaiser Permanente Pasadena, CA
James Barthel H. Lee Moffitt Cancer Center Tampa, FL
Dean Bidgood Duke Medical Center Durham, NC
Bruce Bray University of Utah Salt Lake City, UT
James Campbell University of Nebraska Omaha, NE
Jim Case California Veterinary Diag Labs Davis, CA
Jim Cimino Columbia Presbyterian Med Center New York, NY
Lori Carey Canada Health Infoway Saskatoon, SK, Canada
Robert Dolin Mayo Foundation Rochester, MN
James K Fleming Laboratory Corp of America Burlington, NC
Arden Forrey University of Washington Seattle, WA
Bill Francis Augilent Technologies Andover, MA
Pavla Frazier University of Utah Salt Lake City, UT
Alan Golichowski Indiana Univ. Dept. of Medicine Indianapolis, IN
Barry Gordon C/NET Solutions Berkeley, CA
Brian Griffin Quest Diagnostics Rutherford, NJ
Gil Hill Hospital for Sick Children Toronto, ON, Canada
Stan Huff Intermountain Health Care Salt Lake City, UT
Cindy Johns LabCorp Burlington, NC
William (Bill) Karitis Department of Defense, U.S. Navy Onley, MD
Ted Klein Klein Consulting, Inc Ridge, NY
Jeff Lamothe USAF Biloxi, MS
Lee Min Lau 3M HIS Salt Lake City, UT
Diane Leland Riley Hospital for Children Indianapolis, IN
Pat Maloney Quest Diagnostics Teterboro, NJ
Doug Martin Roudebush VA Medical Center Indianapolis, IN
Susan Matney Intermountain Health Care Salt Lake City, UT
Ken McCaslin Quest Diagnostics Collegeville, PA
Clem McDonald NLM Lister Hill National Center for Bethesda, MD
Biomedical Communications
Kathy Mercer Regenstrief Institute Indianapolis, IN
Deirdre ONeill National Medical Services Association Willow Grove, PA
Judy Ozbolt Vanderbilt University Nashville, TN
Dan Pollock Centers for Disease Control Atlanta, GA
Rick Press Oregon Health Sciences University Portland, OR
Christine Raine Parners Healthcare, Inc. Brookline, MA
Angelo Rossi Mori Instituto Tecnologie Biomediche Rome, Italy
Jon Rosenblatt Mayo Medical Laboratories Rochester, MN
Shawn Shakib 3M HIS Salt Lake City, UT
John Stelling World Health Organization Geneva, Switzerland
Steve Steindel CDC Atlanta, GA
Jeff Suico Eli Lilly & Co. Indianapolis, IN
Anders Thurin University Hospital Linkoping, Sweden
Wayne Tracy Health Patterns, LLC Overland Park, KS Daniel
Vreeman Regenstrief Institute/IUSOM Indianapolis, IN
Larry West ARUP Laboratories Salt Lake City, UT
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Thomas White New York State Office of Mental Health New York, NY
Warren Williams CDC Atlanta, GA
Pat Wilson 3M HIS Salt Lake City, UT
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106


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