An exact match has to mean the same thing.
We call an external concept an exact map only when its meaning, scope, context, and intended use match. Broader, narrower, related, and safety concepts remain linked relationships, not substitutes.
See where today’s clinical codes stop.
Most of an interventional mental health record already fits established standards. Experiences such as the ‘aha’ moment are where the map starts to break down.
What we reviewed
Start with what existing standards can already describe.
The coding landscape is the set of standards used to describe an episode of interventional mental health care. Many parts of the record already have established coding systems. This page examines where those systems become less precise when the record reaches the subjective treatment experience.
It covers ketamine and esketamine, transcranial magnetic stimulation, electroconvulsive therapy, and psychedelic-assisted therapy. Each layer is mapped to the standard that governs it and marked usable or not.
It does not create or modify any external standard. External identifiers remain governed by their respective standards-development organizations.
The stack
Each standard solves a different part of the record.
The established standards cover much of the record. The experiential layer remains the gap examined here.
| Layer | Standard | Steward / jurisdiction | What it identifies | Maturity |
|---|---|---|---|---|
| Drug or molecule | RxNorm, with SNOMED CT | NLM (US) | Drug ingredient, clinical drug, and branded drug identity | Usable |
| Medical device | UDI / GUDID, with SNOMED CT | FDA (US) | Device identity and device classes | Usable |
| Units | UCUM | Regenstrief | Units of measure | Usable |
| Diagnosis (US) | ICD-10-CM, with SNOMED CT | NCHS and CMS (US) | The condition treated, for US records and billing | Mature |
| Diagnosis (international) | ICD-11 | WHO | The condition treated, as a global classification | Mature |
| Procedure reporting | CPT Category III | AMA (US) | Emerging-service reporting, not coverage or payment | Emerging |
| Instruments and observations | LOINC, with SNOMED CT | Regenstrief; SNOMED International | Questionnaire panels, items, calculated scores, and observations | Mixed |
| Safety | MedDRA; CTCAE where applicable | ICH / MedDRA MSSO; NCI for CTCAE | Adverse-event terminology; severity grading in applicable clinical-trial contexts | Mature |
| Exchange | HL7 FHIR and implementation guides | HL7 International and profile sponsors | Exchange format and profiles | Emerging |
| US behavioral-health data | USCDI+ Behavioral Health | ASTP/ONC and SAMHSA | US behavioral-health data elements | Emerging |
| Experience | No broadly adopted, non-pathologizing terminology identified | Proposed below | The subjective treatment arc | Gap |
Jurisdiction matters. The United States currently uses ICD-10-CM for diagnosis coding, while ICD-11 is the WHO global classification. CPT Category III provides temporary codes for emerging technologies, services, and procedures. These standards solve different parts of the record and should not be treated as interchangeable.
Explore the gap
See exactly where the mappings become less precise.
Filter the map, search the concepts, or isolate the gap. Select a marker to see its relationship to existing standards. The tables above remain the plain-text reference.
Uncoded (circle) Adjacent, not equivalent (diamond) Instrument-anchored (triangle) Officially coded (square) size shows priority
Coding
Class
Tier
Showing 26 of 26, 18 in the gap
Coding
Priority
Anchor
Nearest code
Safety rule
List view: every concept and its coding status
Positions are illustrative, not measured percentages. Class, coding status, priority, anchor, and safety rule are real values from the review. No patient data, internal identifiers, or code numbers appear here.
Keep the meanings separate
Keep experience, physical effects, and harm separate.
These records answer different questions. Keeping them separate prevents an experience from automatically becoming a symptom and prevents an acute physical effect from automatically becoming an adverse event.
What happened
Record what the patient experienced in its own terms. An experiential observation does not become a disorder, diagnosis, or adverse event by default.
What the body did
Record a physical effect, such as nausea during a session, separately. An acute effect does not become an adverse event unless it independently meets the criteria for one.
Whether harm occurred
Record the safety event separately when an adverse event actually occurred. Use the appropriate safety terminology for the applicable clinical or research context rather than treating the experience itself as harm.
The gap
The missing layer is the treatment experience.
Medication, diagnosis, measurement, and safety already have established coding systems. A discrete treatment experience may not have an exact equivalent. Forcing a nearby clinical or safety concept to stand in for it can change the meaning of what was recorded. That is the gap the Standards Initiative is examining.
Validated instruments and research methods measure many related experiential domains. A measurement, however, is not the same thing as a standardized code for a discrete event during treatment.
Explore each concept in the map above to see its instrument anchor, nearest clinical relationship, and when safety coding may apply.
A label records what was described. It does not decide whether the experience was objectively true or turn the description into a diagnosis.
Read why the weeks after dosing get lost, and what goes unmeasured while the vocabulary is missing.
Record the experience
Record the ‘aha’ moment without deciding what it means.
During a session, a practitioner can mark the ‘aha’ moment when it happens. One action places it on the session timeline. The marker records that the practitioner considered the moment worth returning to. It does not interpret the experience.
Practitioners can also choose experiential observations from a governed list rather than typing free text. Acute physical effects remain separate, so recording nausea does not automatically create an adverse event. When a concept allows more than one source, the record also distinguishes what the patient reported from what the practitioner observed.
Interpretation stays with the clinician. Arcametric records the observation without deciding that it was a breakthrough, symptom, or diagnosis. A useful code should preserve meaning, not add an interpretation the practitioner never recorded.
Map without forcing a match
Show the relationship instead of forcing equivalence.
A proposed concept can have several relationships to existing standards. Those relationships stay explicit instead of being collapsed into one code.
- Exact map. Meaning, scope, context, and intended use all match. Only then does an external code substitute for the concept.
- Broader than. The external concept covers more than the proposed concept.
- Narrower than. The external concept covers less than the proposed concept.
- Related to. Conceptually adjacent, kept as a relationship, never a substitute.
- Instrument anchor. The concept is measured by a named instrument domain or item.
- Safety overlay. A clinical or adverse-event code applied only when harm is present.
- No exact mapping identified. No equivalent found in this review. Stated as a finding, not a claim that none can exist.
Each concept has a stable identifier, preferred label, operating definition, default valence, and source history. External codes remain separate mappings, so one concept can carry more than one relationship with its own purpose, confidence, source, and verification date. When the review identifies no exact equivalent, the record says so instead of forcing a near-match.
Read this before citing it
Know what is established, proposed, and still open.
- Builds on prior work. The proposal draws on validated instruments, published phenomenology research, existing medical terminologies, and prior coding-gap analyses. It is not first.
- An open call to the field. What proves useful is offered to the relevant standards-development organizations as change requests.
- A dated snapshot. Standards change. Verify every identifier against its current authoritative release before relying on it.
- Open questions remain. Whether a given instrument's panel or total-score identity fits a specific implementation, instrument licensing for content and scoring, and the final local codes for several experiential concepts are all still under review.
Authorities as of this review. LOINC, Regenstrief, version 2.82; CPT Category III, AMA; ICD-10-CM (current U.S. release), NCHS and CMS; ICD-11, WHO; USCDI+ Behavioral Health, ASTP/ONC and SAMHSA; RxNorm, NLM; SNOMED CT, SNOMED International; MedDRA, MedDRA MSSO / ICH; CTCAE, NCI, in applicable clinical-trial contexts; UCUM, Regenstrief; HL7 FHIR, HL7 International. Last reviewed 2026-08-12.
Questions from the field
Get answers to the questions clinicians and researchers ask about the gap.
What is the coding gap in interventional mental health data?
Most of the record is codable. Substances can map to medication standards such as RxNorm, diagnoses to ICD, many measurements to LOINC, and adverse events to safety terminology such as MedDRA. The gap examined here is the discrete subjective treatment experience, such as insight, unity, or ego dissolution. Related domains can be measured, but that does not necessarily provide a broadly adopted clinical code for the event itself.
Is there a standard code for psychedelic experiences like ego dissolution or the ‘aha moment’?
No broadly adopted, non-pathologizing exact code was identified in this review for discrete experiences such as ego dissolution, unity, or a psychological insight event. Instruments can measure related experiential domains, but measurement and event coding are different functions.
How is a challenging experience coded versus an adverse event?
Keep them separate. Record a challenging or intense experience as an experience in its own terms. Add a safety record when an adverse event actually occurred. This prevents the experience itself from being treated as harm by default while preserving the safety record when harm is present.
Which standards code ketamine and psychedelic therapy records today?
Different standards cover different parts of the record. RxNorm identifies medications, ICD classifications cover diagnoses, LOINC identifies many health measurements and survey instruments, MedDRA supports adverse-event terminology, and HL7 FHIR supports health-data exchange. CPT Category III contains temporary codes for emerging services and procedures. The experiential event layer examined here does not yet have the same broadly adopted coding coverage.