Logical Observation Identifiers Names and Codes (LOINC​®​)

Quick Start Guide for

Mapping to Laboratory LOINC

loinc.org
Download the free LOINC database, access learning resources, ask
questions, request new LOINC terms, and participate in the LOINC
community.

search.loinc.org
Perform searches on the LOINC database using advanced syntax
capabilities.

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Table of Contents
1 Introduction 5
1.1 Scope 5
1.2 Utilizing existing LOINC mappings 6
1.2.1 In vitro diagnostics (IVD) vendors 6
1.2.2 Reference laboratories’ mappings 6
1.2.3 National Health Systems 7
1.3 Mapping tools 7
1.3.1 Regenstrief Electronic LOINC Mapping Assistant (RELMA) 7
1.3.2 Online search application 8
1.4 Formatting notes 8
1.4.1 Part types and names 8
1.4.2 Citations 8
1.5 Feedback and future versions of this Guide 8

2 Choosing the right LOINC term (“mapping”) 9

2.1 Minimum test information necessary to map 9
2.1.1 Analyte, Specimen, and Method 9
2.1.2 Sample results 9
2.1.3 Units of measure 10
2.2 Additional useful data 10
2.2.1 List of abbreviations used by your laboratory in test names 10
2.2.2 Frequency data 10
2.3 General mapping principles 11
2.4 Part-specific mapping principles 12
2.4.1 Component​ 12
2.4.1.1 Structure of LOINC Components 12
2.4.1.2 Operators 13
2.4.1.3 “&” versus “+” 14
2.4.2 Property and Scale 14
2.4.2.1 Quantitative properties 15
2.4.2.1.1 Fraction versus Ratio 16
2.4.2.1.2 Rate versus Ratio 16
2.4.2.2 Property and Units 17
2.4.2.3 Qualitative terms 19
2.4.2.4 Qualitative results versus the interpretation of quantitative results 19
2.4.3 Time Aspect​ 20
2.4.4 System​ 20

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​2

 2.4.5 Method​ 21
2.5 Orders versus Observations 22

3 Efficient searching 23
3.1 Broad → Narrow 23
3.2 Narrow → Broad 24
3.3 Using LOINC panels to find individual test codes 25

4 Mapping an assay approved for multiple specimens and resulting styles 26

5 Mapping Qualitative Result Values 29

5.1 Linking LOINC Answer Lists to LOINC terms 30
5.2 LOINC Answers and SNOMED CT concepts 31
5.3 Ordinal result values 31
5.4 Nominal result values 33
5.5 Uncertain result values 33
5.6 Flavors of null 34

6 Putting it all together - Mapping practice 35

7 Mapping validation, maintenance, and publication 38

7.1 Validating your mappings 38
7.2 Maintaining your mappings 39
7.3 Mapping publication 40
7.3.1 Publishing your mappings 40
7.3.2 LIVD specification for vendor to LOINC mappings 40

8 Resources 42
8.1 About LOINC 42
8.1.1 LOINC Users’ Guide 42
8.1.2 LOINC website 42
8.1.3 Videos to learn more about LOINC 42
8.2 Mapping and Validation 42
8.2.1 Introduction to Mapping 42
8.2.2 RELMA Users’ Manual 43
8.2.3 LOINC Essentials 43
8.2.4 LOINC Premium Membership program 43
8.2.5 Journal Publications 43
8.3 Requesting new LOINCs or edits to existing LOINCs 43
8.4 Related standards 44
8.4.1 UCUM 44
8.4.2 HL7 v2 44

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​3

 8.4.3 HL7 CDA 44
8.4.4 HL7 FHIR 44

Appendix A - Answer Key 45

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​4

1 Introduction
Logical Observation Identifiers Names and Codes (LOINC®) is a freely available international
standard for identifying health measurements, observations, and documents. LOINC facilitates the
storage, exchange, and pooling of results for clinical care, outcomes management, and research by
providing a set of standard names and identifiers that can be used across heterogeneous computing
environments.

At present, LOINC is used in more than 170 countries. Over 30 countries, including the United
States, have adopted LOINC as a national standard. In the U.S., LOINC is specified for several key
areas, including laboratory, in the 2019 U.S. Core Data for Interoperability.1 And in June 2018, the
U.S. Food and Drug Administration (FDA) published Guidance that supports the adoption of
LOINC for in vitro diagnostic (IVD) test results, the distribution of LOINC codes by IVD vendors,
and inclusion of LOINC codes for IVD tests in product labeling.2

You are probably reading this guide because you have been tasked with choosing the correct LOINC
term for one or more laboratory tests. If you are familiar with LOINC and need help selecting the
right codes, continue reading. If, however, you are totally new to LOINC and are wondering, “Is it
pronounced Low-Inc? L-O-I-N-C? Loinc, like oink?”, then we recommend you start by visiting our
website or reading our Users’ Guide to learn a more about LOINC (pronounced “l-oink”).

1.1 Scope
The purpose of this guide is to help users select LOINC terms for laboratory tests according to best
practices. The audience for this guide is vendors of ​in vitro​ diagnostic (IVD) assays, laboratory
professionals, and anyone else needing guidance on choosing the appropriate LOINC term for an
individual assay or lab test catalog.

We describe foundational principles of choosing the correct laboratory LOINC term and mapping
observation result values, regardless of laboratory domain. This guide will not include discussions on
determining order LOINC terms, but it may include order LOINC terms to help identify result
mappings. Specific use cases (e.g., specific chemical tests, culture media used to identify isolates from
a positive blood culture) are described in individual domain guides.

1
https://www.healthit.gov/isa/sites/isa/files/inline-files/USCDIv12019revised.pdf
2
Logical Observation Identifiers Names and Codes for In Vitro Diagnostic Tests. Guidance for Industry and
Food and Drug Administration Staff. Silver Spring, MD: U.S. Food and Drug Administration; 2018.
Available from:
https://www.fda.gov/ucm/groups/fdagov-public/@fdagov-meddev-gen/documents/document/ucm
610636.pdf

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​5

Example HL7 v2 OBX segments are distinguished in a bordered box. HL7 v2 examples, rather than
CDA or FHIR examples, are used given its wide use in laboratory result reporting at the time this
guide was written. Note, these examples are simplified for readability and do not represent the full
OBX structure. For more information, refer to appropriate HL7 v2 and related specifications. The
LOINC code in each example links to the web page with details for that term.

LOINC continues to evolve following changes in laboratory medicine as well as lessons learned
regarding best practices for reporting, storing, and aggregating laboratory data. In some cases,
LOINC terms that represented the preferred way of reporting 15 or 20 years ago may not necessarily
be the best concepts to use today based on current understanding. In such cases, we still present
information about mapping to such concepts, but with a usage note titled “Evolving model”
describing the mapping strategy that is no longer preferred along with recommendations for which
codes to use based on current best practices. Keep in mind some of these older LOINCs may be
mapped to historic laboratory data in information systems.

1.2 Utilizing existing LOINC mappings

Before starting a new mapping effort, investigate whether any resources exist that may help in your
mapping efforts. Some tests in the compendium may already have LOINC codes supplied by the
instrument or assay vendor, and major reference laboratories’ LOINC mappings can be used to help
inform the local mapping for similar tests. Performing an audit of the supplied LOINCs against the
existing assays attributes is a good starting point in the learning to map journey.

1.2.1 In vitro diagnostics (IVD) vendors

Many IVD vendors have mapped, or are in the process of mapping, their orders and test results to
LOINC terms. Some of these mappings are publicly available, but more commonly the specific maps
for a particular device are reserved for customers who purchase that device. Before you begin
mapping or updating your maps, speak to your IVD representative to find out if LOINC mappings
are available. The list provided by the vendor will likely cover all approved uses of the test kit, not
just those implemented in your laboratory. In the future, as IVD vendors begin to more widely
publish and distribute their LOINC mappings in the LOINC for In Vitro Diagnostics (LIVD) format
(see the “​LIVD specification for vendor to LOINC mappings​” section in Chapter 7 for information
about the LIVD format), integrating LOINC mappings from multiple vendors should become more
streamlined as they will all be in the same standard format.

1.2.2 Reference laboratories’ mappings

In the United States, many large reference laboratories, including Mayo Medical Laboratories,
ARUP Laboratories, LabCorp, and Quest Diagnostics, publish LOINC mappings for each test in
their online catalog, typically on the individual page for each lab test or in a downloadable PDF file
or Excel document. Although it is always a good idea to double-check mappings published by other

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​6

organizations, these reference laboratory mappings are a great resource to jump start initial mapping
or to use as a quality check for existing mappings. Keep in mind, however, different laboratories may
not perform the same test or report results in the same way. Be sure to review the test details
provided by the performing laboratory to ensure it matches the test you are mapping.

1.2.3 National Health Systems

In some countries, including Austria, Belgium, Canada, France, Portugal, the Netherlands, and
others, resources are available at a national level. Such resources include databases with constrained
subsets of LOINC terms applicable within the context of that country, and lists of test result
observations and their associated LOINC terms. Several countries also publish mappings from their
national billing codes to LOINC.

LOINC content and documentation has been ​translated​ into many languages, courtesy of volunteer
translators, all which may be helpful resources with country specific usages of LOINC.

1.3 Mapping tools

RELMA and search.loinc.org are two tools to aid in searches for LOINC codes. Each has features
that may be beneficial depending on the needs of the use case.

1.3.1 Regenstrief Electronic LOINC Mapping Assistant

(RELMA)
RELMA​​ is a desktop mapping program created specifically for LOINC mapping and is maintained
by the LOINC software development team. RELMA’s main purpose is to assist users with the task of
mapping local test codes (mnemonics) to LOINC codes. It is a powerful tool with features to import
your catalog, data dictionary, or file of tests and map each to a specific LOINC term. RELMA stores
those mappings and has multiple export options for loading back into your laboratory information
system (LIS), electronic specimen collection manual, or other system.

RELMA is highly recommended for cases where a single person is mapping more than a few terms,
as it stores your data and provides features that help with the mapping process. RELMA’s main
limitation is that it only runs on the Microsoft Windows operating system for an individual user.
Mac or Linux users will have to configure a virtual machine with Windows to use RELMA.
(Instructions for how to do this are​ available on the LOINC website​)​. A new version of RELMA is
released twice a year, in June and December, and must be downloaded after each release in order to
stay current. Best practice has LOINC users update their LOINC content within 90 days of a LOINC
release.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​7

1.3.2 Online search application
Our online search application (​h
​ ttps://search.loinc.org​​) is fast, easy to use, and runs from an Internet
browser without any installation necessary. It does not have all the mapping features of RELMA, but
is useful for quick LOINC searches and is also updated twice yearly with each LOINC release.

1.4 Formatting notes

1.4.1 Part types and names
The types of LOINC ​P​ arts​, such as ​C
​ omponent​ and ​P​ roperty​,​ are capitalized and italicized. The names
of LOINC ​​Parts​ that appear in LOINC term names, such as ​U ​ rine​​ and ​​Ord​,​ are capitalized and set in
a bold typeface. For more information regarding the relationship between LOINC terms and LOINC
​Parts​, refer to the “Major Parts of a LOINC term” chapter in the LOINC Users’ Guide.

1.4.2 Citations
All citations and URLs referenced in this guide were verified at the time of publishing. Scientific
articles are referenced by PubMed identification numbers and linked to the entry at P​ ubMed.gov​​.

1.5 Feedback and future versions of this Guide

As laboratory testing evolves over time, we anticipate publishing new versions of this guide with
new LOINC content and updates to mapping best practices. Comments, proposed edits, or other
suggestions for future versions of this guide, are welcome through ou​r​ ​dedicated feedback site​.​ ​ For
questions or help unrelated to this guide, please contact us via the​ ​Contact LOINC​ page.​

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​8

2 Choosing the right LOINC term
(“mapping”)
Although choosing the correct LOINC term for a given laboratory test can seem daunting, with a
systematic approach and use of available resources, mapping can be straightforward for the majority
of concepts. Keep in mind, mapping from the perspective of an end-user is different from mapping
as an IVD vendor. A vendor should map to all of the LOINC codes that support the range of
specimens and reporting options approved for a single test kit, while end-users should map to the set
of LOINC codes that are appropriate for a particular implementation. For additional information
about mapping from the vendor perspective and examples of the differences between vendor and
end-user mappings, refer to the specific guide for the laboratory domain being mapped.

2.1 Minimum test information necessary to map

Starting with all the data needed, and having the whole test catalog for reference as you are mapping,
is helpful to compare similar tests and determine the appropriate mapping for each. While it is not
necessary to map all of your tests at the same time, it is more efficient. Working with your
Information Technology team on obtaining the full test list and also getting their input on the
format of final product for them to load up will keep rework at bay.

Package inserts (PI) and Standard Operating Procedures (SOP) for commercially- and
laboratory-developed tests, respectively, provide invaluable information for mapping tests to LOINC
codes. These documents typically include the specific analyte being measured, the units of measure,
how the results are reported, what specimens can be used to measure the analyte, and other
information needed to map to a specific LOINC.

2.1.1 Analyte, Specimen, and Method

Key information necessary for choosing the correct LOINC term includes the name of the analyte
(​Component)​ , the specimen type (​System​), and if relevant, the ​M
​ ethod.​ ​This information is usually
found in the PI or SOP, or, if working primarily from a laboratory catalog or LIS system, the test
name. The test ​​Method​ may only be specified for certain terms in which the particular method​ is
significant for interpreting the result. If working with test names that do not include analyte or
specimen type, you must locate that information before beginning.

2.1.2 Sample results

Sample results and associated information, such as average values and reference ranges, are
extremely useful for differentiating tests that seem identical or similar based on test name alone. For
example, sample results can help distinguish between tests that have qualitative results that are

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​9

ranked, such as 1+, 2+, 3+ (LOINC​ S​ cale​ ​​Ord​​) from those that cannot be ranked, such as type of
Adenovirus (LOINC ​S​ cale​ ​​Nom​)​ . If sample results are unavailable, other useful information is the
result type or data type, indicating whether the expected results are quantitative, based on an answer
list, free text, etc. A single assay may be approved for multiple reporting options; these will be
described in the package insert.

2.1.3 Units of measure

Units of measure are critical for mapping to the correct LOINC term. For quantitative results,
LOINC has different terms for results reported in mass units versus molar units such as mass
concentration (mg/dL) and substance (molar) concentration (mol/L). Without units of measure,
you may not know which quantitative LOINC term is appropriate.

KEY POINTS

1. The PI and SOP are excellent sources of information.

2. The following data are essential for choosing the correct LOINC term:
● Analyte
● Specimen(s) analyzed
● Qualitative sample results
● Units of measure for quantitative results
● Method​​ of analysis, if relevant

2.2 Additional useful data

2.2.1 List of abbreviations used by your laboratory in test
names
Each organization tends to use its own conventions for abbreviations in local test names or
mnemonics. Many abbreviations are self-explanatory, but inevitably there are a few ambiguous ones.
If those abbreviations are recorded in a central place, having that list available will save time and
frustration during the mapping process.

2.2.2 Frequency data

Usage frequency of tests when mapping can be helpful for prioritizing work and give some context
about the LOINC terms you are looking for. For example, a test associated with 50,000 results in a
database of 3 million results is more likely to match a commonly used LOINC term compared to a
test that only appears three times. A small number of tests usually represent a relatively high
percentage of the test volume in a typical lab, and such high-volume tests should probably be given
higher mapping priority. Test results important for public health and safety and/or those required to

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​10

be reported under local regulations should also be prioritized. With increasing requirements and
adoption of LOINC, many laboratories are focusing on the priority items first, and also working to
encode most if not all of their test results and orders.

2.3 General mapping principles

The two most important overarching principles are:

1. Map to the most specific LOINC term possible based on the available information; and
2. Do not overspecify by assuming information that is not known.

For example, if you are mapping a test named “Rotavirus Ab IgG Ser IA Titer” and you search for
“Rotavirus Ab Titer”, you will see a short list of candidate terms:

Which LOINC term is most appropriate? Notice that your test name specifies IgG as well as
immunoassay (IA) as the methodology. Armed with those two pieces of information, you can feel
confident that ​71703-3​ ​Rotavirus IgG Ab [Titer] in Serum by Immunoassay​ is the best LOINC for your
test.

Equally important, however, is not to overspecify by guessing about information you do not have.
As seen in the previous example, LOINC has many seemingly similar terms for the same analyte that
vary by subtle distinctions. These distinctions are important because they reflect the differences in
clinical utility for each test, for example, IgG antibodies indicate past infection, while IgM antibodies
indicate current or more recent infection. Mapping accurately requires attention to those details and
not making assumptions about the test being mapped.

For example, if you have a test named “Rotavirus Ab Ser IA Titer”, you will have three potential
LOINC candidates:

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​11

Which LOINC term to choose?

If all other microorganism antibody titer tests in the group being mapped are for IgG (and say so in
the name), it may be tempting to map to the IgG term. But, since IgG is NOT specified in your
Rotavirus test name (or in the PI or SOP), mapping to the IgG term would be overspecifying based
on the information available. In this case, 7​ 1764-5​ Rotavirus Ab [Titer] in Serum by Immunoassay is
the best match based on the available information.

KEY POINT

Use all available information.

Do not make assumptions about test characteristic information you do not have.

2.4 Part-specific mapping principles

2.4.1 ​Component​
The ​​Component​ is the most important axis for mapping because it describes the specific analyte being
measured. Use caution when looking at the ​C ​ omponent​, as terms with seemingly similar ​Components​
could potentially represent very different concepts. For example, the ​C ​ omponents​ ​inFLIXimab​​ and
​inFLIXimab Ab​​ look very similar, even though the first represents the drug, and the second
represents antibodies to the drug. These two concepts are related in that exposure to the drug could
lead to an immune response and production of antibodies against the drug. However, a given test
only measures one analyte, and it is important to choose the LOINC term with the C ​ omponent​ that
reflects what is being measured. Blood banking terms can be similarly confusing in that there are a
parallel set of C
​ omponents​ that represent red blood cell antigens and antibodies to those antigens,
such as B​ Ag​ and B​ Ab​. Map to what is being tested for, and not by the reagent name. The B antisera
reagent is testing for the B antigen on the patient’s cells. Be careful when mapping to such terms. If
you are unsure about whether you are selecting the correct term, ask for help early in the process.

2.4.1.1 Structure of LOINC ​Components

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A single LOINC C ​ omponent​ may actually have multiple subparts. What you see in RELMA or the
online search application in the C ​ omponent​ field is the primary ​Component,​ which we sometimes refer
to as the “full” Component. In some cases there are no subparts, and the primary C ​ omponent​ is the
same as the core C ​ omponent​. However, in other cases, the primary C ​ omponent​ consists of a core
Component​ plus additional subparts, such as a ​Challenge,​ ​Adjustment​, or D
​ ivisor​. The same core
Component​ can be used with a variety of additional subparts to create unique analytes.

The following table illustrates the structure of a variety of a few laboratory C ​ omponents​. Please see
Sections 2.2.2 (​Challenge​), 2.2.3 (​Adjustment)​ and 2.2.1.2 (​Divisor​) of the LOINC User’s Guide for
further discussion of these structures.

Primary ​Component Core ​Component Challenge Adjustment Divisor

Ketones Ketones - - -

Ketones^1H post 50 g glucose Ketones 1H post 50 g - -

PO (measured 1 hour after a 50 glucose PO
gram oral glucose challenge)

Calcium.ionized^^adjust Calcium.ionized - adjusted to -

ed to pH 7.4 pH 7.4
(ionized calcium result is
adjusted for a pH of 7.4)

Glutamate/Amino acids.total Glutamate - Amino acids.total

(fraction of glutamate out of
total amino acids)

Glucose^1H post meal Glucose 1H post meal -

(glucose 1 hour after a meal)

2.4.1.2 Operators
You may have noticed in the examples above, specific operators are used to differentiate certain
Component​ subparts:

● Slash (/): separates numerator from denominator. Note that ​Components​ with a slash are
usually associated with a fraction or ratio Property.
● Carat (^): separates the core ​Component​ from the Challenge (after the first carat), Adjustment
(after the second carat, rarely used), and Count (after the third carat, even more rare).
● Dot (.): What follows the dot in a ​Component​ represents a subclass or further detail about the
analyte that precedes the dot. So ​Beta-N-acetylhexosaminidase.B​ means the B isozyme of
Beta-N-acetylhexosaminidase. Note that the dot does not separate different subparts, but
rather is part of the core ​Component​ structure.

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2.4.1.3 “&” versus “+”
Be careful when mapping to ​Components​ that contain plus (“+”) or ampersand (“&”). In LOINC, the
“+” indicates that the test does NOT differentiate between the two when reporting the result.
Components with an ampersand are used when the test can detect the analytes on either side of the
ampersand and DOES differentiate between the two when reporting the result.

Example: ​​HIV 1+2 Ab​​ indicates a test that can detect antibodies to both HIV 1 and HIV 2 but does
not differentiate between them when reporting the result; a result value of “Detected” means that
antibodies against HIV 1 and/or HIV 2 were detected. In contrast, ​C ​ hlamydia trachomatis &
Neisseria gonorrhoeae DNA​​ indicates a test that can detect both C ​​ hlamydia trachomatis​ and
​Neisseria gonorrhoeae​ AND can distinguish between the two. In these cases, the result distinguishes
the different entities; the answer values might be “Chlamydia trachomatis not detected” and/or
“Neisseria gonorrhoeae detected”.

KEY POINT

An ampersand indicates analytes that can be differentiated, while a plus indicates that
multiple analytes can be detected but not distinguished from each other.

2.4.2 ​Property​ and ​Scale

The LOINC S​​ cale​ and ​P​ roperty​ axes are closely related. The ​​Scale​ represents a higher level
categorization of how the result is reported, such as quantitative (numeric) or qualitative. Property​
describes the specific aspect of the analyte that is being measured, such as its mass concentration or
volume.

Since S​ cale​ represents a broad category, it can be used to quickly narrow down the list of candidate
LOINC terms. For example, if you know the test result is qualitative, you can immediately eliminate
all of the LOINC terms that represent quantitative measurements. Once you have a more
manageable set of terms to look at, you can focus on the fine-grained distinctions in the ​​Property.​

The following table illustrates how ​​Property​ and S​​ cale​ differ for various types of results.

Type of result LOINC LOINC LOINC term examples

value Property Scale

Presence/absence, PrThr Ord 8030-9​ Streptococcus pneumoniae Ab:​

OR graded results PrThr:Pt:Ser:Ord
Example results​: Present, Absent

2514-8​ Ketones:PrThr:Pt:Urine: Ord:Test strip

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​14

 Example results: Negative, Trace, Small, Moderate, Large

Absence or, if Prid Nom 34601-5​ Drugs identified:Prid:Pt:Body fld:Nom

present, the specific Example results:​ None, Amphetamine, Barbiturate,
type or identity of Oxycodone
what is present
90990-3​ Protein.monoclonal
isotype:Prid:Pt:Ser/Plas: Nom:MS.MALDI-TOF
Example results:​ ​No monoclonal protein detected,
Monoclonal IgA lambda, Monoclonal IgG kappa,
Monoclonal IgM kappa

Identification of the Type Nom 882-1​ ABO & Rh group:Type:Pt:Bld:​Nom

type of the analyte Example results​: O pos, O neg, A pos, A neg
that is already
known to be present 86509-7​ Varicella zoster virus clad:Type:Pt:XXX:​
Nom:Molgen
Example results:​ Varicella-zoster virus clade 1,
Varicella-zoster virus clade 2

Quantitative ACnc Qn 80221-5​ N-methyl-D-aspartate receptor Ab.IgG:​

LnCnc Titr:Pt:Ser:Qn:IF
MCnc Example result​: 1:4
NCnc
SCnc 87742-3​ Adalimumab Ab:ACnc:Pt:Ser/Plas:Qn
Thresh Example result​: 8.2 IU/mL
Num
Titr 35072-8​ Basophils:NCnc:Pt:CSF:Qn
Example result:​ 20 cells/uL

86701-0​ Rotavirus A​​ ​RNA:ThreshNum:Pt:XXX:Qn:

Probe.amp.tar
Example result:​ 26 cycles

Impression/ Imp Nom 88700-0​ Babesia microti Ab.IgG &

Interpretation IgM:Imp:Pt:Ser:Nom:
Example results: Ab not detected, Recent infection, Past
infection

57702-3​ Infectious diseases:Imp:Pt:Bld.dot:Nom

Example results: Normal, Borderline, Suspect HIV,
Suspect TOXO

63569-8​ Nuclear Ab pattern:Imp:Pt:CSF:Nom:IF

Example results: Rim, Homogenous, Speckled, Diffuse

2.4.2.1 Quantitative properties

Quantitative properties describe measurable aspects of an analyte (i.e., mass, counts, concentrations,
etc.) A few representative examples are listed below.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​15

 Quantitative ​Property Abbreviation

Mass Concentration MCnc

Substance Ratio SRto

Mass Rate MRat

Volume Fraction VFr

2.4.2.1.1 Fraction versus Ratio

The fraction and ratio P​ roperties​ in LOINC are often confused by users. Both typically have a
numerator and denominator, but there is an easy way to remember the difference: fractions
represent “part of the whole”. So, the analyte in the numerator represents a portion of the analyte in
the denominator. In contrast, ratios represent the comparison of two quantities where one is not a
subset of the other. Following are a few examples of ​Components​ and the type of P​ roperty​ they have.
Note that the specific P​ roperty​ depends on the aspect of the analytes being measured (mass,
substance, volume, etc.).

Component Property type

Glutamate/Amino acids.total Fraction

Glutamate/Creatinine Ratio

Albumin/Protein.total Fraction

Albumin/Globulin Ratio

Coproporphyrin Fraction
3/Porphyrins.total

IgA.kappa/IgA.lambda Ratio

2.4.2.1.2 Rate versus Ratio

Users often confuse LOINC rate and ratio P​ roperties​ because they look very similar. Rate Properties
end with “Rat”, and ratio P​ roperties​ end with “Rto”. Be careful when mapping to these terms and pay
careful attention to the units. Another way to distinguish these is that the C
​ omponent​ for terms
representing ratios will almost always have a divisor, such as /​ Creatinine​ or ​/Carnitine.free​.

Suppose your lab offers a test called “24 hour urine Cortisol” and you have already determined that
the analyte being measured is cortisol and not free cortisol. You search LOINC for that test name
and find several candidate terms as shown below:

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​16

Which term is the correct match? That is impossible to determine from the information given
because you do not know whether the result is reported in mass-based units or substance-based
units, or whether it is a ratio, rate, or concentration. Finally, if the result turns out to be a
concentration, you will also need to know whether the lab is using an immunoassay before choosing
the correct term.

You find out from your lab that this test is resulted as a cortisol to creatinine ratio in mass-based
units. From this information, you can feel confident that ​44310-1​ C ​ ortisol/Creatinine [Mass Ratio] in
24 hour Urine​ is the correct LOINC term for your test.

2.4.2.2 Property and Units

The LOINC P​ roperty​ is closely related to the units of measure; the ​Property​ determines the kind of
units that are reportable with that term. LOINC has different P​ roperties​ for analytes measured in
mass units versus substance units (e.g., milligrams versus millimoles), but does not have different
Properties​ to represent different orders of magnitude, such as milligram versus gram. Thus, when
mapping, users must choose a LOINC term with a P​ roperty​ that is consistent with the reporting
units. The table below provides some examples of common laboratory units of measure and the
corresponding LOINC P​ roperty​ and ​Scale​.

The ​ACnc​ P​ roperty​ represents the number of arbitrary units in a volume (arbitrary concentration).
Immunoassay results that are based on optical densities are commonly represented in LOINC with
this ​Property.​ Because the units are truly arbitrary, they may be represented in a variety of ways by
different laboratories and also within LOINC, as shown in the table below.

Units of measure Property Description Scale

mg/dL; ng/mL MCnc Mass concentration Qn

mmol/L; nmol/dL SCnc Substance Qn

concentration

copies/mL; #/mL NCnc Number concentration Qn

log copies/mL; log #/mL LnCnc Log number Qn

concentration

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​17

#/area; /[HPF]; /[LPF] Naric Number per area Qn

mmol/mol{creatinine} SRto Substance ratio Qn

% NFr Number fraction Qn

mg/(24.h); mg/d; mg/h MRat Mass rate Qn

nmol/g; mol/kg SCnt Substance content Qn

IU/L; IU/mL; index value; EIA units; units/mL ACnc Arbitrary concentration Qn

Adding a P​​ roperty​ to your search query is another easy way to further narrow the list of candidate
LOINC terms. For example, if the test’s units of measure are mg/dL, searching for LOINC terms
with the P​ roperty​ ​M
​ Cnc​​ (mass concentration) will significantly narrow the number of terms
returned.

To illustrate this further, consider the two searches in the images below. The first image shows the
search query “Urine sodium” and the second shows “Urine sodium SCnc”. The second search returns
less than a quarter of the candidate LOINC terms of the first. Although you must still choose
between six candidate terms, the mapping is straightforward if you know the duration of the urine
specimen collection.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​18

2.4.2.3 Qualitative terms
Qualitative properties describe what is being measured for non-quantitative laboratory concepts,
such as whether an analyte is present or the specific type of analyte detected. Three of the most
common qualitative properties seen in laboratory terms are PrThr, Prid, and Imp. Refer to section
2.3.2 Qualitative Properties of the LOINC User’s Guide for further information.

Abbreviation Full name Description

PrThr Presence or Threshold Actual presence or absence of an analyte or that the amount
of analyte detected is over some predetermined threshold

Prid Presence or Identity Whether or not an analyte of a particular kind is present,

and if it is, to identify the specific analyte

Imp Impression/Interpretation A diagnostic statement, an interpretation or abstraction of

some other observation

2.4.2.4 Qualitative results versus the interpretation of quantitative results

It is important to distinguish qualitative results from an ordinal interpretation of a quantitative
result. For example, a rapid test for Streptococcus pyogenes antigen that is routinely done in a
physician’s office yields a true qualitative result, either the antigen is present or not, and there is no
quantitative result that can be reported. There may be a particular concentration at which the test
reads positive, but that information is not part of the reported result. On the other hand, an assay for
which the concentration of a particular analyte is its primary reportable result is fundamentally a
quantitative assay. The quantitative result may be interpreted as positive or negative based on a
particular threshold, but the interpretation of the quantitative result, which would be reported in
OBX-8 of an HL7 version 2 message, is different from a primary qualitative result, which would be
reported in OBX-5.

The package insert will tell you whether a particular assay is approved for quantitative and/or
qualitative reporting; some assays are approved for both and may map to two LOINC codes. For

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​19

assays that map to two LOINC codes, the code that is appropriate for the result being reported in a
particular instance should be used.

KEY POINT

Result: “Positive” or “Negative” → LOINC Scale = Ord

Result: 3 mg/dL → LOINC Scale = Qn; may be interpreted as “Positive” or “Negative”, but
the interpretation is not the primary result

2.4.3 ​Time Aspect​

The ​Time Aspect​ axis of a LOINC term is usually straightforward for mapping. Most laboratory tests
are “point in time” measurements, meaning that they are measuring the amount of analyte present in
a given sample at the time the specimen was collected. This is represented by a value of “Pt” in the
Time Aspect​ of the LOINC term. In other cases, the T​ ime Aspect​ ​is more distinctive. For example,
timed specimen collections, such as 24-hour urine measurements in chemistry, measure the amount
of analyte collected in the urine over 24 hours. The T​ ime Aspect​ ​for such tests is 24H​.

If your implementation uses the same result field for random urine and timed urine collections,
you’ll want to use the XXX T
​ iming​ LOINC terms for those analytes.

2.4.4 ​System​
The LOINC S​ ystem​ represents the specimen being tested. Examples include, but are not limited to:
blood (​Bld​), serum or plasma (​Ser/Plas​), urine, various respiratory specimens, cerebrospinal fluid
(​CSF​), stool, tissue, pleural fluid, and urethral swab.

Some LOINC terms contain a System ​with multiple specimen types separated by a slash (“/”). The
slash indicates that any of these specimen types are suitable for that test. It does NOT mean that a
specific manufacturer’s assay has to be approved for all of the specimens listed; it simply means that
the results are expected to be clinically equivalent regardless of which of the two (or three)
specimens are used, and the assay should be approved for at least one of the given specimens.

For instance, the ​​Ser/Plas​ ​S​ ystem​ in LOINC is used for assays where the analyte can be measured in
either serum or plasma. This is common in antibody tests. LOINC does not make separate terms for
tests on serum and plasma, unless there is a compelling reason to do so. One such example is
ammonia assays, where the preferred specimen is plasma, and the results in serum compared to
plasma are significantly different. LOINC will not have a test with a ​​System​ of S​ er/Plas​ as well as the
exact same test but with a ​S​ ystem​ of ​S​ er​ or ​Plas.​ Over time, as testing methods have evolved, by
policy, LOINC has added ​​Plas​​ to many LOINC terms that originally had a ​System​ of ​S​ er​, and we will
continue to do so moving forward.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​20

 KEY POINT

LOINC ​System​ ​Ser/Plas​ = “Serum OR Plasma”​

Mapping a particular manufacturer’s assay to a ​Ser/Plas​ term does NOT imply that the
specific assay is approved for both specimens. Laboratories do not need to run the test on
both serum and plasma in order to use a LOINC code with a ​System​ of ​Ser/Plas​​.​

LOINC uses a S​​ ystem​ of ​X

​ XX​​ for terms where either the specimen is truly unknown (e.g. a solid or
liquid that is not otherwise identified) or is expected to be specified in a field other than the LOINC
name. The latter situation is common in the context of public health, where public health
laboratories may run the same test on a wide variety of specimens but only have a single order
and/or result code for that test. In these situations, laboratories typically report the specimen by
another mechanism, such as the HL7 SPM segment.

The ​​XXX​​ terms should only be used in the two cases described above. They should NOT be used
when the test you are mapping is always run on a specific specimen, often as designated in the
Intended Use section of the package insert for a particular assay. In some cases, mapping to the more
general “specimen agnostic” ​XXX​ term may be useful, but this practice is discouraged as it results in a
loss of information and a failure to accurately map across institutions. (See the “Special issues related
to XXX as a S​ ystem”​ section in the LOINC Users’ Guide for more information.)

2.4.5 Method​
LOINC includes terms that specify a particular laboratory method as well as those that do not (i.e.,
methodless terms). In general, when the specific method used has a clinically significant impact on
interpreting the results for a particular analyte, LOINC will specify the M​​ ethod​ in its term name. On
the other hand, if the result is the same clinically regardless of the methodology used, then the
LOINC name will generally be methodless.

Even when the ​​Method​ is included in the term name, LOINC specifies the ​M
​ ethod​ at a general level.
For example, Immunoassay (​IA​) includes enzyme immunoassay and chemiluminescence.

The same principle of mapping to the most specific term possible without over-specifying, applies to
choosing LOINC terms with the appropriate ​M ​ ethod.​ If the assay being mapped has a specific
methodology important for interpreting the result, then map to a LOINC term with that specific
​Method​. If such a term does not exist, a new term may be needed (See Section 9.3 “Requesting new
LOINCs”).

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​21

2.5 Orders versus Observations
LOINC terms represent orders, observations, and in many cases, the same term represents both an
order and an observation. LOINC does not create different terms when a concept is being used as an
order or an observation. Rather, the designation of whether a term can be used as an order,
observation, or both is carried in the OrderObs field within the LOINC database.

For example, ​Borrelia burgdorferi IgG+IgM with reflex to immunoblot panel - Serum​ is an order, but it is
not an observation because it does not represent a single test that can be resulted. The OrderObs
value for such a term is O​ rder​. On the other hand, ​Borrelia burgdorferi IgG Ab [Presence] in Serum by
Immunoblot​ is a single test that could be ordered and resulted individually, so in LOINC, its OrderObs
value is B
​ oth​ (meaning that the same term can function as both the order and observation). Finally,
some observations are such that they would never be ordered by themselves, and these have an
OrderObs value of O ​ bservation​. Examples include the presence or absence of IgG antibodies to
various Borrelia protein bands (e.g., 23 kDa), which would not be ordered in isolation.

The concepts of orders and observations are closely related to the panel and panel children
constructs in LOINC. LOINC “panels” are always order-only terms that contain a discrete set of
enumerated child elements (children), corresponding to what is typically called a “Battery” or
“Profile” in the laboratory setting. A given panel term does not represent a single resultable test;
rather, it represents an order for a set of tests. Panel terms often have a dash (-) for the ​Property​ and
Scale​ since the child terms may not all have the same values for these attributes. While in almost all
cases the child elements within a LOINC panel are enumerated, they are not necessarily all required;
rather, some may be optional or conditional, and the same LOINC panel term may be used by
different laboratories or manufacturers whose specific batteries may not be exactly the same. For
more information regarding panels and business rules for mapping local batteries to LOINC panels,
see the LOINC Users’ Guide “Panels (Batteries)” chapter and “Business rules for users mapping their
local panels to LOINC panels” section.

LOINC terms that are observations only are, by definition, children or resultable tests within an
orderable panel and cannot be ordered by themselves. In contrast, those classified as both an order
and an observation may be included in a panel but also have to be orderable (and resultable) on their
own.

KEY POINT

Individual observations should only be be mapped to LOINC codes that have an ​OrderObs
value of ​Observation​ or ​Both
Batteries or panels should only be mapped to LOINC codes that have an ​OrderObs​ value of
Order

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​22

3 Efficient searching
There are many strategies for searching in LOINC, but they are not equally effective. Here we
provide two search strategies we have found to be best for getting to the correct LOINC term more
quickly. You may have, or discover, other techniques that work for you. If that’s the case, please
share so it can be included in future versions of this guide.

3.1 Broad → Narrow

For LOINC beginners or those unfamiliar with the range of content contained in LOINC, we
recommend starting at a high level with the Component and possibly one other key piece of
information such as the ​System​ or ​Method,​ if available. From there, you can hone down the search
results. This will help you gain an understanding of how different lab tests are represented in
LOINC. This is also a useful exercise to help figure out what additional information might be needed
before choosing a LOINC code.

For example, if your lab test name is “Influenza PCR”, that may initially seem like enough
information. However, searching for “Influenza PCR” in LOINC will return more than 130
candidate terms, just a few of which are shown below.

Right away, you can see that you need to get more information from the laboratory. Is the test
looking for Influenza A? B? Haemophilus influenzae? Is the result quantitative? Qualitative? What
specimen is being tested?

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​23

What if the test name is “Influenza PCR Lower respiratory”? You could search for all of those key
words and narrow down your candidate terms right away; however, if you are new to LOINC, you
may not realize that we have different terms with Systems such as ​Respiratory​,
Respiratory.upper​, R ​ espiratory.lower​, and seeing these differences might affect your choice of
LOINC term.

In addition, seeing the range of existing terms will be helpful to decide whether or not a new term
should be requested if a specific match is not found. For example, if your test is specific for a lower
respiratory specimen and you find a nearly matching LOINC term except the S​ ystem​ is
Respiratory.upper​, then you can surmise that Regenstrief would likely create a new term with the
System​ ​Respiratory.lower​. If, however, your test is specific for a specimen taken from the left
lower lobe of the lung, you will see that no LOINC codes exist for such a specific System, and
therefore Regenstrief will be unlikely to create a new LOINC term and will typically recommend
that you use a less specific ​System.​

3.2 Narrow → Broad

If you are fairly familiar with LOINC and the types of terms that it contains, we recommend
focusing your search from the start and including all key information about ​Component,​ T ​ iming​,
Property​, S​ ystem​, and ​Method​ in the search string. If you need a LOINC code for a test named “24 hour
urine glucose” that is reported in mg/dL, include all of that information in the search. If you search
for “glucose” by itself, you will be faced with nearly a thousand LOINC terms, but searching for “24
hour urine glucose” narrows the list to six. Add in the P​ roperty,​ which you know is M ​ Cnc​ based on
the units of measure, and searching for “24 hour urine glucose MCnc” returns the single appropriate
LOINC match.

Don’t want to start with all of the test details? Using C

​ omponent​ plus the ​Property​ or ​Scale​ will still
make the process more efficient by narrowing results. So, while searching for “glucose MCnc” yields
400 terms, it is less than half the results compared to “glucose” alone.

The ​Class​ value as inclusion or exclusion criteria is also useful, and should not be forgotten. If you
know your glucose test is not a challenge test and know LOINC has numerous glucose challenge
tests, exclude terms that are in the C​ HAL​ C
​ lass​ by searching for “glucose -class:CHAL”. This simple
addition cuts down search results by nearly 80%. Even better, include the C ​ lass​ value for the specific
term you are looking for. The search “glucose class:UA” yields the same 6 terms as the previously
mentioned “24 hour urine glucose”.

There are many other fields in addition to those mentioned above that can be used to focus searches.
For example, if you are only looking for new terms released for the first time in the 2.67 LOINC
release, you can use the VersionFirstReleased field, i.e., “VersionFirstReleased:2.67”, as well as other
search parameters. Refer to the L
​ OINC search help​ for a full list of searchable fields and search
syntax.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​24

3.3 Using LOINC panels to find individual test
codes
The chemistry domain in LOINC includes some of the most common tests performed on patients,
often bundled into panels (also called “batteries”) such as the basic and comprehensive metabolic
panels. Clinicians often order these tests by panel rather than individually, for example, the lab order
will be for a basic metabolic panel rather than individual orders for sodium, potassium, creatinine,
etc.

While mapping panels and lab orders is out of scope for this guide, it may still be helpful to look at
some of the panels in LOINC to see if their children are representative of your local panel of tests.
For example, rather than looking up sodium, potassium, creatinine, and all of the other elements of a
comprehensive metabolic panel one by one, you can use the LOINC comprehensive metabolic panel
as a starting point​. Be careful, though, because you still have to make sure the individual terms match
on all of the Part values. Pay special attention to the Property, because for chemistry panels in
particular, often the terms will match on all of the Part values except for Property.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​25

4 Mapping an assay approved for
multiple specimens and resulting styles
Assays approved for use with multiple specimens and multiple reporting options will map to
multiple LOINC codes. Therefore, mapping from an IVD vendor’s point of view is a little different
from the laboratory end-user’s point of view. When vendors provide a list of LOINC codes to their
clients, they should include ​​all​​ of the appropriate codes based on the information in their package
insert, and laboratories utilizing vendor mappings should pick the subset of codes applicable to their
local implementation of the assay as shown in the table below.

The same mapping principles described earlier apply for each approved specimen and reporting
format. For example, if an assay is approved for use with either serum or CSF, the vendor should
provide two LOINC codes, one with ​S​ ystem​ ​​Ser​​ or ​​Ser/Plas​​, and one with ​CSF​. Similarly, if a single
assay can be configured to result an ordinal qualitative response or a numeric titer, the vendor
should again provide two different LOINC codes, one for each type of result. It is up to each
downstream client to determine the best LOINC codes for their specific implementation of the test.
A lab may also decide to follow another mapping strategy as shown for “Laboratory C” in the table
below, but note the limitation presented in the footnote for that strategy.

KEY POINT

IVD vendors should map to ​all​​ of the LOINC codes that support the range of specimens and​
reporting options approved for a single test kit.

Laboratories should map to the ​subset​​ of LOINC codes appropriate for the specimens and
reporting options they have implemented for that test kit.

The following table illustrates the sets of LOINC codes IVD vendors could provide for various
hypothetical assays based on package insert information and the subset(s) of codes downstream
laboratories would use depending on their individual LIS implementations.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​26

 Package insert assay IVD Vendor provided LOINC codes used by downstream
information LOINC codes clients for individual implementations

Adenovirus DNA 21055-9​ Adenovirus DNA: Laboratory A​:​ only using the assay to
PCR PrThr:​Pt: Ser/Plas: Ord: test CSF specimens
● Approved for Probe.amp.tar​ 38375-2​ Adenovirus DNA: PrThr:
serum, CSF, and 38375-2​ Adenovirus DNA: Pt:​CSF:Ord: Probe.amp.tar
urine PrThr:​Pt:CSF:Ord: Probe.amp.tar
● May only be 86512-1​ Adenovirus DNA: Laboratory B​:​ using the assay for all
reported as a PrThr:​Pt:Urine:Ord: Probe.amp.tar three approved specimens, with three
qualitative individual test builds
ordinal result 21055-9​ Adenovirus DNA:PrThr:Pt:​​
Ser/Plas:Ord:Probe.amp.tar​
38375-2​ Adenovirus DNA: PrThr: Pt:​
CSF: Ord: Probe.amp.tar
86512-1​ Adenovirus DNA: PrThr:
Pt:​Urine: Ord: Probe.amp.tar

Laboratory C​:​ using the assay for all

three specimens, but with a single build
in the LIS that does not specify the
3
specimen
39528-5​ Adenovirus DNA: PrThr:Pt:​​
XXX: Ord: Probe.amp.tar

Adenovirus DNA 38375-2​ Adenovirus DNA: Laboratory D​:​ result built in the LIS as
PCR PrThr:​Pt:CSF:Ord:Probe.amp.tar an ordinal text string
● Approved for CSF 49338-7​ Adenovirus DNA: 38375-2​ Adenovirus DNA:PrThr:
only NCnc:​Pt:CSF:Qn:Probe.amp.tar Pt:​CSF:Ord:Probe.amp.tar
● May be reported 66730-3​ Adenovirus DNA:
as a qualitative LnCnc:​Pt:CSF:Qn:Probe.amp.tar Laboratory E​:​ numeric result
ordinal result or a expressed as # copies/mL
quantitative viral 49338-7​ Adenovirus DNA:NCnc:Pt:
load as CSF:Qn:Probe.amp.tar
copies/volume or
log copies/volume Laboratory F​:​ numeric result
expressed as log copies/mL
66730-3​ Adenovirus DNA:LnCnc:​Pt:
CSF:Qn: Probe.amp.tar

3
Using a single build for a generic specimen is not recommended as it results in a loss of information, and the
list of codes provided by the vendor should not include the generic LOINC code when more specific ones are
available (note that 3​ 9528-5​ is not listed in the second column)

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​27

Adenovirus DNA PCR 21055-9​ Adenovirus DNA: PrThr:​ Laboratory G​:​ only using the assay to
● Approved for Pt: Ser/Plas: Ord: Probe.amp.tar​ test CSF specimens, reporting results as
serum, CSF, and 38375-2​ Adenovirus DNA: PrThr:​ a qualitative ordinal
urine Pt: CSF: Ord: Probe.amp.tar 38375-2​ Adenovirus DNA: PrThr:
● May be reported 86512-1​ Adenovirus DNA: PrThr:​ Pt:​CSF: Ord: Probe.amp.tar
as a qualitative Pt: Urine: Ord: Probe.amp.tar
ordinal result, Laboratory H​:​ testing CSF and urine
quantitative viral 49334-6​ Adenovirus DNA: NCnc:​ specimens, reporting results as
load in Pt: Ser/Plas: Qn: Probe.amp.tar copies/mL
copies/volume or 49338-7​ Adenovirus DNA: NCnc:​ 49338-7​ Adenovirus DNA: NCnc: Pt:​
log Pt: CSF: Qn: Probe.amp.tar CSF: Qn: Probe.amp.tar
copies/volume, or 48609-2​ Adenovirus DNA: NCnc:​ 48609-2​ Adenovirus DNA: NCnc:
both an ordinal Pt: Urine: Qn: Probe.amp.tar Pt:​Urine: Qn: Probe.amp.tar
result and if
positive, a 66723-8​ Adenovirus DNA: LnCnc:​ Laboratory I​:​ testing all three
quantitative viral Pt: Ser/Plas: Qn: Probe.amp.tar specimens specimens, reporting initial
load 66730-3​ Adenovirus DNA: LnCnc:​ results as ordinal, followed by viral load
Pt: CSF: Qn: Probe.amp.tar in log copies/mL if the ordinal result is
66719-6​ Adenovirus DNA: LnCnc:​ “Detected”
Pt: Urine: Qn: Probe.amp.tar 21055-9​ Adenovirus DNA: PrThr:
Pt:​Ser/Plas: Ord: Probe.amp.tar​
38375-2​ Adenovirus DNA: PrThr:
Pt:​CSF: Ord: Probe.amp.tar
86512-1​ Adenovirus DNA: PrThr:
Pt:​Urine: Ord: Probe.amp.tar
66723-8​ Adenovirus DNA: LnCnc:​
Pt: Ser/Plas: Qn: Probe.amp.tar
66730-3​ Adenovirus DNA: LnCnc:​
Pt: CSF: Qn: Probe.amp.tar
66719-6​ Adenovirus DNA: LnCnc:​
Pt: Urine: Qn: Probe.amp.tar

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​28

5 Mapping Qualitative Result Values
Qualitative results are non-numeric values that can be either ordinal or nominal. Ordinal result
values can be ranked, such as Detected/Not detected, Low/Medium/High,
Susceptible/Intermediate/Resistant, or Positive/Negative. Nominal result values cannot be ranked,
and include concepts such as the specific Streptococcus pneumoniae serotype detected, or the species
of bacteria identified in a blood culture. Nominal result values can be thought of as “short answers”
or those coming from a pick-list. Narrative result values (longer, free-text entries) are not drawn
from a formal vocabulary or terminology standard and are out of scope for this guide.

In the context of HL7 v2 data exchange, both the observation and the observation result value(s) are
reported in the OBX segment, with the observation in OBX-3 and the result value(s) in OBX-5.
More specifically, OBX-5.1 contains the code, 5.2 the text, and 5.3 the coding system. In cases where
the P​​ roperty​ is ​​OrdQn​​, such as antimicrobial susceptibility testing, result values can be reported ​as
either:

● a quantitative value in OBX-5 with an interpretation in OBX-8, or

● an ordinal result value in OBX-5 using the same LOINC code.

In this chapter we address the second reporting style; however, example OBX segments for both are
shown below for comparison.​

OBX|1|NM|​6932-​8​^Penicillin [Susceptibility] by Minimum inhibitory

concentration​​ ​(MIC)^LN||​0.05|ug/mL​||S|||F|...

OBX|1|CE|​6932-8​^Penicillin [Susceptibility] by Minimum inhibitory

concentration​​ ​(MIC)^LN||​LA6576-8^Susceptible^LN​||||||F|...

The LOINC distribution includes structured answer lists of possible result values for nearly every
ordinal qualitative LOINC observation term as well as many nominal terms. These LOINC Answer
Lists are sets that organize a collection of LOINC Answer strings and codes. LOINC Answer Lists
illustrate the ​possible​ result values associated with an observation, and LOINC Answer codes
provide unique identifiers for the strings representing them. A specific LOINC Answer List may be
associated with one or more individual LOINC terms.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​29

 KEY POINT

Local result values for qualitative tests can be mapped to LOINC Answer codes representing
the equivalent string.

Different IVD manufacturers may recommend different result values, such as Detected/Not detected
versus Present/Absent, for similar assays. Always follow local reporting regulations. For example,
report qualitative results according to the IVD vendor’s package insert for the assay used. Ongoing
efforts in the U.S. by the FDA’s Systemic Harmonization and Interoperability Enhancement for Lab
Data (SHIELD) initiative, the ​IVD Industry Connectivity Consortium​​ (IICC), and other
collaborators aim to create constrained, publicly-available lists of answer sets and/or equivalence
mappings for result values that share the same meaning. Such constrained answer sets, once
approved by stakeholders, have the potential to make reporting across different IVD assays more
consistent, or at least comparable by way of equivalence mappings. When SHIELD initiative
participants define such sets, this chapter will be updated to include appropriate use of manufacturer
or public-health recommended coding sets and/or equivalence mappings, their impact on LOINC
Answer Lists, and how they will be made available.

5.1 Linking LOINC Answer Lists to LOINC terms

By and large, laboratory terms with answer lists, use ​​Example​​ type lists. The intent is to give users
an idea of the types of results associated with a particular LOINC observation. For example, a list
that contains result values such as “Detected” and “Not detected” is indicative of an ordinal result
representing the presence or absence of an analyte. ​E ​ xample​​ lists are illustrative of ​possible​ result
values or a “starter set” to which additions or subtractions can be made depending on the use case.
​Preferred​​ lists contain a set of answers that users are strongly encouraged to use. They represent a
recommended set, however, alternate values may be used if necessary. ​N ​ ormative​​ lists are typically
defined by a validated survey questionnaire (e.g., patient-reported outcomes (PRO) instruments),
government form, or other authoritative source. When using LOINC terms bound to ​​Normative
​Answer Lists, only answers in the specified set are allowed. For laboratory terms, ​Normative
answer lists are a rarity, and ​Preferred​ lists are also relatively uncommon.

A LOINC term is typically bound to an Answer List based on information from the package insert
and sample report(s) for the original test the term was created for. When new LOINC terms are
requested, we ask for supporting documentation, in part to understand how the observation is
reported. If such documentation is not provided, we work with the submitter to determine the
appropriate set of result values for a particular assay.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​30

 KEY POINT

Example​ Answer Lists include Answer codes and strings that are meant to be illustrative of​
possible ​result values. Answer Lists are typically bound to a particular LOINC term based on
the IVD test upon which that term was originally modeled. Depending on their reporting
needs, users may add or subtract result values from an ​Example​ LOINC Answer List provided
they remain consistent with that term’s ​Scale ​(i.e., ordinal or nominal).

5.2 LOINC Answers and SNOMED CT concepts

SNOMED CT is an international terminology standard for clinical information, such as symptoms,
diagnoses, anatomy, and microorganism names.4 SNOMED CT provides codes representing
nominal and ordinal values for observations represented by LOINC terms and that are organized by
hierarchies, such as Clinical finding, Organism, and Qualifier value. If appropriate concepts exist in
SNOMED CT, the Regenstrief Institute recommends using SNOMED CT codes for reporting
qualitative laboratory result values if appropriate licensure is granted. In situations where the use of
SNOMED CT is not permitted, LOINC Answer codes or other terminologies could be used.

Some LOINC Answer Lists include a mapping between the LOINC Answer codes and
corresponding SNOMED CT codes. This is ongoing work and a given list may only contain
mappings for a subset of the answers it contains. Mappings are also shown on detailed display pages
associated with each term.

NOTE: Due to licensing restrictions, this guide does not include SNOMED CT codes, though
mappings are available in the LOINC Answer File that is available for​ download from the LOINC
website​​.

5.3 Ordinal result values

LOINC contains a variety of Answer Lists that include sets of ordinal result values. The three
LOINC Answer Lists shown in the table below are the most common lists attached to LOINC
laboratory terms other than terms in the A ​ LLERGY​ ​Class.​ These three lists account for 75% of the
non-allergy terms that have ordinal lists. In the ​ALLERGY​ ​Class​, more than 90% of ordinal terms
are linked to a single Answer list L
​ L1927-4​, which represents the results of RAST testing. The rest
are linked to L
​ L360-9​.

4
SNOMED CT [Internet]. London (England): SNOMED International. Available from:
http://www.snomed.org/snomed-ct

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​31

 Answer List ID Answer string Answer code

LL744-4 Detected LA11882-0

Not detected LA11883-8

LL360-9 Positive LA6576-8

Negative LA6577-6

LL1937-3 Present LA9633-4

Absent LA9634-2

Result value mapping should be done at the level of the Answer code and Answer string, not at the
level of the Answer List. For example, if an IVD manufacturer recommends reporting result values
as either Present or Absent, you would map the Present result value to LA9633-4 and the Absent
result value to LA9634-2; nothing would be mapped to Answer list L ​ L1937-3​. Similarly, if the
recommended result values are Positive and Absent and there is no LOINC Answer list that bundles
those two together, you would still map to the individual answers LA6576-8 and LA9634-2.

KEY POINT

Individual result values should be mapped to the appropriate Answer code and Answer
string pairs, not directly to an Answer list.

Also, recall that the possible result values for a particular assay are defined by the product
information for that assay and not by the ​ list associated with the corresponding LOINC term. For
instance, suppose two different assays, “Assay A” and “Assay B”, produce ordinal result values for
whether or not IgM antibody to Legionella species is present in a serum specimen. The package
insert for Assay A recommends reporting result values as Detected/Not detected, whereas the
package insert for Assay B recommends reporting Present/Equivocal/Absent. Laboratories using
Assay A would use Answer codes LA11882-0 (Detected) and LA11883-8 (Not detected), and
laboratories using Assay B would use LA9633-4 (Present), LA11885-3 (Equivocal), and LA9634-2
(Absent). Both laboratories would map to the same LOINC term:

81118-2​ Legionella sp Ab.IgM:PrThr:Pt:Ser:Ord​​

LCN: ​Legionella sp IgM Ab [Presence] in Serum

The above LOINC term happens to be associated with ​​Example​​ LOINC Answer List L
​ L744-4​,
which contains LA11882-0 (Detected) and LA11883-8 (Not detected), but the same term can be used
with result values LA9633-4 (Present), LA11885-3 (Equivocal), and LA9634-2 (Absent), or any
other ordinal values that have the same meaning.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​32

 KEY POINT

Primary characteristics of an assay should determine which LOINC term to map to, NOT the
Answer List associated with that term. Result value mapping is an independent process.

5.4 Nominal result values

Nominal results include concepts such as the type of microorganism, drug, protein, cell, etc. identified
in a specimen. LOINC contains many more nominal than ordinal lists due to the variety of possible
nominal result values across LOINC terms. However, the general principles of using LOINC Answer
Lists are the same. E
​ xample​​ Answer Lists are representative of the types of results associated with a
given observation. The primary observation should be mapped to a LOINC term first, followed by
mapping the allowable result values.

One difference between nominal and ordinal results is that LOINC Answer strings and codes may not
exist for all reportable results given the breadth of result values possible. If no standard code for a
nominal laboratory result value is available (whether from LOINC, SNOMED CT, or another coding
system), it is possible to send a free text entry as the result value (e.g., in an HL7v2 OBX segment).
However, such unstandardized reporting makes it difficult for receiving systems to aggregate and
process the data.

5.5 Uncertain result values

For both ordinal and nominal types of results, there are instances in which a test may not produce a
definitive result value. These are not the same as “flavors of null” described in the next section,
because a result value is still produced. In many cases, IVD manufacturers specify the value that
should be used in various circumstances. LOINC contains a variety of Answer codes and strings that
represent these uncertain types of results as shown below.

LOINC Answer string LOINC Answer code

Equivocal LA11885-3

Indeterminate LA11884-6

Inconclusive LA9663-1

Invalid LA15841-2

Undetermined LA14100-4

Uncertain LA12719-3

Uncertain significance LA26333-7

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​33

5.6 Flavors of null
LOINC does not make different Answer Lists that vary only by the inclusion or exclusion of certain
null flavors. Thus, our policy is to add specific null flavors as entries in the Answer List only where
we are aware of their specific relevance. However, LOINC Answer codes exist for a variety of null
flavor concepts. Users wishing to communicate such a null flavor concept are free to do that
regardless of its presence in the LOINC Answer List. Examples of LOINC Answer strings and codes
for null flavor result values are shown in the table below.

LOINC Answer string LOINC Answer code

Unknown LA4489-6

Not done LA6630-3

Test not done LA18373-3

Not performed LA7304-4

Equipment failure LA7497-6

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​34

6 Putting it all together - Mapping
practice
Time to put the knowledge gained thus far to the test. Below are ten exercises to help further
illustrate various practical aspects of mapping local terms to LOINC codes. An answer key is
provided at the end of this guide.

1. Identify the missing pieces necessary for an accurate mapping.

Local test: Leukocyte concentration (10*9/L)

❏ Analyte (Component)
❏ Property
❏ Time Aspect
❏ Specimen type (System)
❏ Units of measure
❏ Method

2. Which LOINC best matches the local test? (​ Answer options follow this model:
LOINC Code: Component:Property:Timing:System:Scale:Method)

Local test: HIV-2 Antibody - Serum - Rapid Immunoassay - Present/Absent

❏ 31073-0: HIV 2 Ab band pattern:Imp:Pt:Ser:Nom:IB

❏ 51786-2: HIV 2 Ab Signal/Cutoff:RelACnc:Pt:Ser/Plas:Qn:IA
❏ 33807-9: HIV 2 Ab.IgG:PrThr:Pt:Ser:Ord:
❏ 81641-3: HIV 2 Ab:PrThr:Pt:Ser/Plas/Bld:Ord:IA.rapid
❏ 5224-1: HIV 2 Ab:ACnc:Pt:Ser/Plas:Ord:IA

3. Why is the LOINC below a poor choice for the local test?

LOINC: 2839-9: Progesterone:MCnc:Pt:Ser/Plas:Qn:

Local test: Progesterone Concentration - Urine (24H)

❏ Analytes are different

❏ Properties do not align
❏ System mismatch
❏ Timing difference

4. What further information is necessary before attempting to map the local term below?

Local test: Vanillylmandelic Acid, 24 hr urine

❏ Analyte (Component)
❏ Property

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​35

 ❏ Time Aspect
❏ Specimen type (System)
❏ Units of measure
❏ Method

5. Which LOINC best matches the local test? (​ Answer options follow this model:​ ​LOINC Code:
Component:Property:Timing:System:Scale:Method)

Local test: Influenza Virus B Ab, IgM concentration - Serum - Immunofluorescence

❏ 17016-7: Influenza virus B Ab.IgM:ACnc:Pt:Ser:Qn:

❏ 86570-9: Influenza virus B Ab.IgM:PrThr:Pt:Ser:Ord:IA
❏ 57328-7: Influenza virus B Ab.IgM^1st specimen:ACnc:Pt:Ser:Qn:IA
❏ 47315-7: Influenza virus B Ab.IgM:ACnc:Pt:Ser:Qn:IA
❏ 49078-9: Influenza virus B Ab.IgM:MCnc:Pt:CSF:Qn:IA

6. Why is the LOINC below a poor choice for the local test?
LOINC: 82062-1 - Beef+Chicken meat+Pork+Turkey meat Ab.IgE RAST class:PrThr:Pt:Ser:
Local test: Beef+Poultry+Pork Allergy in Serum (Presence)

❏ Analytes are different

❏ Properties do not align
❏ System mismatch
❏ Method difference

7. Identify the missing pieces preventing an accurate mapping.

Presence of Bacilliform bacteria

❏ Analyte (Component)
❏ Property
❏ Time Aspect
❏ Specimen type (System)
❏ Units of measure
❏ Method

8. Which of the following LOINC codes should a vendor provide for the local test? (​Answer
options follow this model: LOINC Code:Component:Property:Timing:System:Scale:Method)

Local test: Quantitative screen ​11-Hydroxy delta-9 tetrahydrocannabinol in Serum or Urine

❏ 78752-3: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:Body fld:Ord:Screen

❏ 80111-8: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:Pt:Bld:Qn:Confirm
❏ 70178-9: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:Bld:Ord:
❏ 40864-1: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:Pt:Ser/Plas:Qn:
❏ 80112-6: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:Body fld:Qn:Confirm
❏ 78753-1: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:Ser/Plas:Ord:Screen
❏ 48934-4: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:Pt:XXX:Qn:
❏ 78754-9: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:Urine:Ord:Screen

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​36

 ❏ 48935-1: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:XXX:Ord:
❏ 78751-5: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnt:Pt:Hair:Qn:

9. Match the Property to the unit

Property Answer Unit

A MCnc Example: A-3 1 log copies/mL

B NFr 2 mg/d

C SCnt 3 mg/dL

D Naric 4 umol/mol{creatin
ine}

E LnCnc 5 #/area

F MRat 6 nmol/g

G SRto 7 %

10. Which Component best represents a single test that differentiates between two or more
analytes?

❏ HIV 1+2 Ab+HIV1 p24 Ag

❏ Dengue virus 1 & 2 & 3 & 4 RNA
❏ Foot and mouth disease virus serotype
❏ Dengue virus 1+2+3+4 & Zika virus Ab.IgA+IgG+IgM
❏ HIV 1 & 2 Ab
❏ 11-Dehydro thromboxane beta 2/Creatinine

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​37

7 Mapping validation, maintenance,
and publication
For optimal success, consideration must be given to how mappings will be validated and maintained
over time as both your local testing and the LOINC standard evolve. Plan for how to make mappings
available to the people and systems that need them. Different use cases for mapping have different
requirements. One approach will not satisfy all. In this section, recommendations for addressing
these issues are discussed.

7.1 Validating your mappings

Mapping validation is an important step. Even when highly qualified professionals perform the
mapping, errors and inconsistencies are probable.5 Be sure to take advantage of mappings provided
by reference laboratories and IVD vendors and confirm them for use in your context, keeping in
mind that those mappings are informative and not prescriptive.

For higher confidence in the accuracy and consistency of your mappings, multiple experts should be
involved. To minimize the potential for bias, each expert could independently map each test,
followed by a comparison and reconciliation of discrepancies. Resources may not support this level
of mapping redundancy, in which case we still recommend having at least one other reviewer
confirm the LOINC choices. This review could be across all mappings, or even a subset of tests with
different analytes, methods, and units of measure.

Of special note is a Regenstrief Institute service called the Mapping Validity Checker, which is a
semi-automated algorithm that checks LOINC mappings for each test in a test catalog. The
algorithm looks for inconsistencies and probable errors in the mappings and returns a detailed
report highlighting areas in need of further review. Where possible, the report provides suggestions
for choosing the correct LOINC code. The Mapping Validity Checker is available for a small fee as
part of the L
​ OINC Premium Membership program​​. The detailed feedback and consistency checking
represents an exceptional value, even for expert mappers. (Regenstrief has yet to see a mapping file
completely free of issues.)

Lastly, for the highest degree of confidence in your mappings, consider working directly with
Regenstrief’s LOINC staff on a special project basis. Such an arrangement has been used successfully
by IVD vendors, professional associations, government agencies, and other organizations. With
dedicated resources from Regenstrief, this approach is especially helpful where new LOINC content
is likely needed (e.g., new tests) and a high degree of confidence in the mappings is desired.

5
Lin MC, Vreeman DJ, McDonald CJ, Huff SM. Correctness of Voluntary LOINC Mapping for Laboratory
Tests in Three Large Institutions. AMIA Annu Symp Proc. 2010 Nov 13;2010:447-51. [PMID: ​21347018​]

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​38

7.2 Maintaining your mappings
Mappings of local tests to LOINC terms must be maintained, because both your testing and
LOINC continue to grow. Over time, tests may be added or replaced in your catalog. In addition,
LOINC publishes new releases (at least) twice a year, in June and December. Each LOINC release
includes new LOINC terms and all previously released terms, some of which may have been updated
since the previous release. Users should review each release for changes in status for all LOINC
terms they are using. If a previously active LOINC term you mapped to has now become discouraged
or deprecated, users should review the documented rationale for the status change and update the
mapping to an appropriate LOINC when possible. Regenstrief Institute and the LOINC Committee
recommend users update to the current version of LOINC within 90 days of its publication.

The two main ways to find newly edited LOINC terms are:

1. Filter on the current version number in the VersionLastChanged field in the LOINC table
(either the .csv or .mdb version), available from the L ​ OINC download page​ ​of the LOINC
website​.​ Once you have filtered on this field, the value in the CHNG_TYPE field indicates
whether the term is new, discouraged, deprecated, or updated (see “Appendix A LOINC
Database Structure” in the LOINC Users’ Guide for descriptions of the CHNG_TYPE
values).
2. Download the L ​ OINC Table Changes File​, available as an independent download from the
LOINC website.

For more details regarding term statuses (active, trial, discouraged, and deprecated) as well as other
editorial policies, see the “Editorial policies and procedures” chapter in the LOINC Users’ Guide.

KEY POINT

We recommend updating your local system with the latest version of LOINC within 90 days
of each release, which occurs twice a year in June and December.

From the local database maintenance standpoint, consider the following recommendations:

1. Anytime there is a change in the display name, specimen type, reporting format, units of
measure, workstation assignment or interpretive data, there is a potential for a LOINC
attribute change, so the existing mapping should be reviewed when such a change is
implemented;
2. If instrument downtime or a kit change occurs, the LOINC mappings for the tests run by
the substitute bench or referral lab performing the temporary downtime runs should be
reviewed. If the LOINC is “stamped” on an open result field and a different LOINC is to be

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​39

 used, the predetermined override procedure (which varies from LIS to LIS) will need to be
invoked;
3. If any local tests are mapped to a LOINC term with ​System​​ ​XXX ​or no ​Method ​​(i.e.,
methodless), consider looking for new codes with a more accurate S​ ystem ​o​ r M
​ ethod ​​with
each new LOINC release.

7.3 Mapping publication

7.3.1 Publishing your mappings
After completing your mapping validation, you will be ready to share the output with the people and
systems who will put them into action. Consideration should be given ahead of time to the full
lifecycle of these mappings. Different situations will require different processes, so here we describe
some general approaches.

First, recognize that you will almost inevitably have to inactivate some mappings and update to
superseding codes. Consider where the history logs of those mappings should be stored. (In the
source systems that use them? Offline in your mapping environment?) Next, consider the optimal
communication and approval process for publication to downstream recipients when the mappings
are finalized. You will also want to determine the format of the mapping file, including its structure
and contents (e.g., which data fields). RELMA has a highly configurable set of features for exporting
mappings (See the “Exporting Local Terms and their LOINC Mappings” section in the RELMA
Manual).

If you are an IVD vendor, we strongly recommend publishing the mappings of your test codes to
LOINC codes for your customers using the newly developed LIVD specification (described below).

7.3.2 LIVD specification for vendor to LOINC mappings

LIVD​​ specifies a standard digital format for IVD vendors to publish the LOINC terms associated
with each of their test results. The LIVD specification was published by the I​ VD Industry
Connectivity Consortium​ (IICC). It was created for publishing and exchanging mappings of LOINC
terms for IVD test results as a resource for downstream users such as clinical laboratories. IVD
vendors are well positioned to identify the appropriate LOINC terms for their test results because
they possess all of the relevant information about the test. When paired with expert LOINC
knowledge and review, IVD vendors have the opportunity to create high quality mappings that can
then be used by their customers to achieve more consistent coding choices across the industry. As
IVD vendors make these LIVD format mappings available, the reduced effort and expense of
choosing the correct LOINC term will dramatically boost the ability of labs to implement standard
terminology.

For more information regarding the LIVD project, see the L

​ IVD page​ ​on the IICC website.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​40

KEY POINT

If you are an IVD vendor mapping your tests to LOINC, we recommend publishing your
mappings using the LIVD format.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​41

8 Resources
8.1 About LOINC
8.1.1 LOINC Users’ Guide
The LOINC® Users' Guide is the definitive document about LOINC®. It explains the structure of the
table, its rationale, and the rules LOINC® uses for naming test results.
https://loinc.org/download/loinc-users-guide/

8.1.2 LOINC website

The LOINC® website has multiple resources available for new and experienced LOINCers. From the
home page, you can click “Get Started” for a quick tour. Dig a little deeper and you will find domain
specific information, videos, details on available downloads, events and community activities, and
information on submitting new LOINC terms. ​https://loinc.org

8.1.3 Videos to learn more about LOINC

There are three videos available for no cost and several more available through our Premium
Membership program (see below). The three freely available presentations include A ​ n Introduction to
LOINC, LOINC Overview, a​ nd​​ Understanding the Nature of LOINC Names.​ The videos range from 22-65
minutes in duration and are a great way to learn more about LOINC quickly.
https://loinc.org/videos/

Through the Premium Membership program, you can gain access to real-time and archived
LOINCinars (webinars). Past topics have included a tour of the new LOINC artifacts, tips for
searching in LOINC, and the lifecycle of a submission. h
​ ttps://loinc.org/members/webinar/

8.2 Mapping and Validation

8.2.1 Introduction to Mapping
There are a variety of slideshows available on the LOINC website, with three focused specifically on
mapping in LOINC. You will find Using RELMA Tutorial, Advanced LOINC Mapping Topics, and
Top 10 Tips for Mapping to LOINC. Look for these great resources under the header Laboratory
LOINC Mapping with RELMA - Tutorials and Boot Camps. ​https://loinc.org/slideshows/

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​42

8.2.2 RELMA Users’ Manual
This document contains all the ins and outs of the RELMA program, from basics to advanced
mapping topics. h
​ ttps://loinc.org/download/relma-manual/

8.2.3 LOINC Essentials

A thorough, detailed step-by-step guide for getting your local terms mapped to LOINC written by
former LOINC Director, Dr. Daniel Vreeman. Available for $39, this eBook will help you learn
LOINC fast. ​https://danielvreeman.com/loinc-essentials/

8.2.4 LOINC Premium Membership program

In addition to showing their support for LOINC, premium members receive special benefits including access
to LOINCinars, technical support, access to the archive of past releases, a discount on LOINC Essentials
eBook, and automatic delivery of the change file with each release. Additionally, premium members can
purchase the mapping validity check for a small fee. ​https://loinc.org/members/

8.2.5 Journal Publications

Abhyankar S, Demner-Fushman D, McDonald CJ. Standardizing clinical laboratory data for
secondary use. ​​Journal of biomedical informatics.​ 2012;45(4):642-650. doi:10.1016/j.jbi.2012.04.012.
[PMID: 2​ 2561944​]

Vreeman DJ, Hook J, Dixon BE. Learning from the crowd while mapping to LOINC. J Am Med
Inform Assoc. 2015;22(6):1205-11. doi: 10.1093/jamia/ocv098. [PMID: 2​ 6224334​​]

Kim H, El-Kareh R, Goel A, Vineet F, Chapman WW. An Approach to Improve LOINC Mapping
through Augmentation of Local Test Names. Journal of biomedical informatics. 2012;45(4):651-657.
doi:10.1016/j.jbi.2011.12.004. [PMID:​ ​22210167​]

8.3 Requesting new LOINCs or edits to existing

LOINCs
LOINC codes are primarily created based on community (user) requests. If you cannot find an
appropriate LOINC term for your test, check the L ​ OINC pre-release web page​ and the terms
currently in queue. If you do not see the concept you need, you are welcome to submit a request for a
new LOINC term to Regenstrief Institute following the instructions on our ​Submissions​ page.

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​43

Likewise, we rely on the LOINC community to help us keep up with the latest scientific knowledge. If you
are aware of any changes needed to existing terms, such as ​Component​ updates, addition of synonyms, or
updating term or P​ art​ descriptions, you can submit these via the​​ ​Contact LOINC​ page.​

8.4 Related standards

8.4.1 UCUM
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. The
purpose is to facilitate unambiguous electronic communication of quantities together with their
units. ​http://unitsofmeasure.org

8.4.2 HL7 v2
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=185

8.4.3 HL7 CDA

http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7

8.4.4 HL7 FHIR

http://www.hl7.org/implement/standards/product_brief.cfm?product_id=449

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​44

Appendix A - Answer Key
The red underlined text represents the key pieces of information related to the LOINC term that do
NOT match the local test. Correct answers are noted in bold typeface.

1. Identify the missing pieces necessary for an accurate mapping.

Local test: Leukocyte concentration (10*9/L)

❔more
Analyte (Component) - Leukocyte is sufficient, but it is possible this is for a
specific target, e.g., Leukocytes.disintegrated or Leukocytes^^corrected for
nucleated erythrocytes
Property - based on the units provided (10*9/L), we know this is a Number
Concentration (NCnc)
✔ Time Aspect ​- depending on the (missing) specimen, this could be point in
time (Pt) for blood or 24 hour (24H) for urine
✔ Specimen type (System)
Units of measure
✔ Method

(See section 2.1 Minimum test information necessary to map)

2. Which LOINC best matches the local test?

Local test: HIV-2 Antibody - Serum - Rapid Immunoassay - Present/Absent

31073-0: HIV 2 Ab ​band pattern:Imp​:Pt:Ser:Nom:​IB

51786-2: HIV 2 Ab ​Signal/Cutoff:RelACnc​:​Pt:Ser/Plas:Qn:IA
33807-9: HIV 2 Ab.​IgG​:PrThr:Pt:Ser:Ord:
✔81641-3: HIV 2 Ab:PrThr:Pt:Ser/Plas/Bld:Ord:IA.rapid
5224-1: HIV 2 Ab:​ACnc​:Pt:Ser/Plas:Ord:IA

(See Chapter 2 - ​Choosing the right LOINC term (“mapping”)​)

3. Why is the LOINC below a poor choice for the local test?
LOINC: 2839-9: Progesterone:MCnc:Pt:Ser/Plas:Qn:
Local test: Progesterone Concentration - Urine (24H)

Analytes are different

Properties do not align
✔​System mismatch (Serum/Plasma vs. Urine)
✔​Timing difference (Point in time vs. 24 hour collection)

(See section 2.3 General mapping principles)

4. What further information is necessary before attempting to map the local term
below?
Local test: Vanillylmandelic Acid, 24 hr urine

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​45

 Analyte (Component)
✔​Property
Time Aspect
Specimen type (System)
✔​Units of measure
✔​Method - if relevant

(See section 2.1 Minimum test information necessary to map)

5. Which LOINC best matches the local test?

Local test: Influenza Virus B Ab.IgM concentration - Serum - ELISA

17016-7: Influenza virus B Ab.IgM:ACnc:Pt:Ser:Qn:​＿＿

86570-9: Influenza virus B Ab.IgM:​PrThr​:Pt:Ser:Ord:IA
57328-7: Influenza virus B Ab.IgM​^1st specimen​:ACnc:Pt:Ser:Qn:IA
✔47315-7: Influenza virus B Ab.IgM:ACnc:Pt:Ser:Qn:IA
49078-9: Influenza virus B Ab.IgM:MCnc:Pt:​CSF​:Qn:IA

(See section 2.3 General mapping principles)

6. Why is the LOINC below a poor choice for the local test?
LOINC: 82062-1 - Beef+Chicken meat+Pork+Turkey meat Ab.IgE RAST
class:PrThr:Pt:Ser:

Local test: Beef+Poultry+Pork Allergy in Serum (Presence)

✔​Analytes are different (Chicken and Turkey meat vs. Poultry)

Properties do not align
System mismatch
Method difference

(See section 2.4.1 C

​ omponent​​)

7. Identify the missing pieces preventing an accurate mapping.

Presence of Bacilliform bacteria

Analyte (Component) - “Bacilliform bacteria” clearly indicates the target

Property - “Presence” provides the information necessary to know this is PrThr
T
​ ime Aspect - would be nice to have, but not required as part of the minimum
data necessary to accurately map in this case
✔ S​ pecimen type (System)
Units of measure
✔​Method - if relevant

(See section 2.1 Minimum test information necessary to map)

8. Which of the following LOINC codes should a vendor provide for the local test?

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​46

 Local test: Qualitative screen ​11-Hydroxy delta-9 tetrahydrocannabinol in Serum or Urine

78752-3: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:​Body fld​:Ord:Screen

80111-8: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:Pt:​Bld​:Qn:​Confirm
70178-9: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:​Bld​:Ord:​＿＿
4​ 0864-1: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:Pt:Ser/Plas:Qn:​＿＿
80112-6: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:​Body fld​:Qn:Confirm
✔78753-1: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:Ser/Plas:Ord:Screen
48934-4: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnc:Pt:​XXX​:Qn:​＿＿
✔78754-9: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:Urine:Ord:Screen
48935-1: 11-Hydroxy delta-9 tetrahydrocannabinol:PrThr:Pt:​XXX​:Ord:​＿＿
78751-5: 11-Hydroxy delta-9 tetrahydrocannabinol:MCnt:Pt:​Hair​:Qn:​＿＿

(See section 1.2.1 In vitro diagnostics (IVD) vendors)

9. Match the Property to the unit

Property Answer Unit

A MCnc A-3 1 log copies/mL

B NFr B-7 2 mg/d

C SCnt C-6 3 mg/dL

D Naric D-5 4 umol/mol{creatini

ne}

E LnCnc E-1 5 #/area

F MRat F-2 6 nmol/g

G SRto G-4 7 %

(See section 2.4.2 Property​ and Scale​)

10. Which Components best represents a single test differentiation between two or
more analytes?

HIV 1+2 Ab+HIV1 p24 Ag

✔​Dengue virus 1 & 2 & 3 & 4 RNA
Foot and mouth disease virus serotype
Dengue virus 1+2+3+4 & Zika virus Ab.IgA+IgG+IgM
✔​HIV 1 & 2 Ab
11-Dehydro thromboxane beta 2/Creatinine

Remember that analytes separated by ‘&’ CAN be differentiated, while those with ‘+’ cannot.

(See Section 2.4.1.1 “&” versus “+”)

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​47

Quick Start Guide for Mapping to Laboratory LOINC ​•​ ​48