Transcript ICD-11 ICD revision process fTAG ppt

ICD Revision Process
functioning
Topic Advisory Group
fTAG
Cille Kennedy & Gerold Stucki
Co-Chairs
fTAG Members
• Cille Kennedy
USA: Co-Chair
• Solvejg Bang
Denmark
• Cassia Buchalla
Brazil
• Gerold Stucki
Switzerland: Co-Chair
• John Melvin
USA
• Jane Millar
United Kingdom
• Francesco Gongolo • Catherine Sykes
Italy
• Oye Gureje
Nigeria
• Ros Madden
Australia
WFPT (UK)
• Berna Uluğ
Turkey
• José Luis Vazquez-Barquero
Spain
ICD Revision Process
Challenge: Ensure Consistency
Opportunity: Joint use
Health conditions (disease,
injury, disorder) and
associated health problems
Functioning at the level of the
body (impairments), the person
(activities) and the person in
society (participation) as well as
environmental factors
THE CONTENT MODEL
Any Category in ICD is represented by:
TITLE of ENTITY: Name of disease, disorder, or syndrome…
1.
ICD Concept Title
1.1. Fully Specified Name
2.
Classification Properties
2.1. Parents
2.2 Type
2.3. Use and Linearization(s)
3.
4.
Textual Definition(s)
Terms
4.1. Base Index Terms
4.2. Inclusion Terms
4.3. Exclusions
5.
Body Structure Description
5.1. Body System(s)
5.2. Body Part(s) [Anatomical Site(s)]
5.3. Histopathology
6.
Manifestation Properties
6.1. Signs & Symptoms
6.2. Investigation findings
7.
Causal Properties
7.1.
7.2.
7.3.
7.4.
7.5.
Etiology Type
Causal Properties - Agents
Causal Properties - Causal Mechanisms
Genomic Linkages
Risk Factors
8.
Temporal Properties
8.1. Age of Occurrence & Occurrence
Frequency
8.2. Development Course/Stage
9. Severity of Subtypes Properties
10. Functioning Properties
10.1. Impact on Activities and
10.2. Contextual factors
10.3. Body functions
11. Specific Condition Properties
11.1 Biological Sex
11.2. Life-Cycle Properties
12. Treatment Properties
13. Diagnostic Criteria
14. External Causes
Participation
Task 1
Assist in “Populating” the
Functioning Properties
ICD Revision Organizational Structure
WHO
Revision Steering Group (RSG)
Health Informatics and Modelling TAG
(TAG HIM)
Internal Medicine TAG
Dermatology TAG
External Causes and Injuries
TAG
Morbidity TAG
Mortality TAG
Functioning TAG
Gastroenterology WG
Cardiovascular WG
Hepatology and Pacreatobiliary WG
Nephrology WG
Endocrinology WG
Maternal, Neonatal and
Urogenital TAG
Rheumatology WG
Mental Health TAG
Haematology WG
Musculoskeletal TAG
Respiratory WG
Neurology TAG
Ophthalmology TAG
Paediatrics TAG
Rare Diseases TAG
Cross-Sectional TAGs
Content-Specific TAGs
Working Groups
Generic starting point
Value Set applicable across health conditions
 WHODAS II
 World Health Survey (WHS)
 Generic ICF Core Set
 Input ICF-ICD iCAMP 28-29 Jan. 2010
Rheumatoid Arthritis (M05)
Definition
A chronic, systematic
inflammatory disorder
that may affect many
tissues and organs, but
principally attacks
synovial joints and
characterized by
–
–
–
–
–
musculoskeletal pain
fatigue
joint stiffness
joint swelling
loss of range of
motion
– muscular weakness,
and joint damage
Functioning Properties
(selection from 32 functioning properties)
– Mobility:
• Lifting and carrying objects (d430), Fine hand use
(d440), Hand and arm use (d445), Walking (d450),
Vigorous activities (d455, d4303)…
– Self-Care:
• Caring for body parts (d520), Managing one's
health (needs, assistance or oversight) (d570)…
– Interpersonal Relations:
• Maintaining family relationships (d760), Intimate
relationships (d770)…
– Life Activities:
• Carrying out daily routines (d230), Shopping (d620),
Cooking & preparing meals (d630), Engaging in paid
work (d850)...
– Participation:
• Taking part in social life (d910), Recreation and
leisure (d920)…
References
Rheumatoid Arthritis
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Stucki G, Cieza A, Geyh S, Battistella L, Lloyd J, Symmons D, Kostanjsek N,
Schouten J. ICF Core Sets for rheumatoid arthrtitis. J Rehabil Med 2004; 44: 87-93..
Kirchberger I, Glaessel A, Stucki G, Cieza A. Validation of the comprehensive
international classification of functioning, disability and health core set for rheumatoid
arthritis: The perspective of physical therapists. Phys Ther. 2007; 87(4): 368-84.
Rauch A, Kirchberger I, Boldt C, Cieza A, Stucki G. Does the comprehensive
international classification of functioning, disability and health (ICF) core set for
rheumatoid arthritis capture nursing practice? A Delphi survey. Int J Nurs Stud.
2009; 46(10):1320-34.
Rauch A, Cieza A, Boonen A, Ewert T, Stucki G. Identification of similarities and
differences in functioning in persons with rheumatoid arthritis and ankylosing
spondylitis using the International Classification of Functioning, Disability and Health
(ICF). Clin Exp Rheumatol. 2009; 27(4 Suppl 55): S92-101.
Uhlig T, Moe RH, Reinsberg S, Kvien TK, Cieza A, Stucki G. Responsiveness of the
ICF core set for rheumatoid arthritis. Ann Rheum Dis. 2009; 68(6): 879-84
Other validation papers…
ICD-11 Revision: Populating with
functioning properties
TAG
Internal Medicine
Working
Group
ICD-10
chapter
Gastroenterology
XI
Inflammatory bowel diseases (Crohn’s Disease)
Cardiovascular
IX
Hepatology &
Pancreatobilary
Nephrology
Endocrinology
Rheumatology
Dermatology
External Causes & Injuries
Maternal, Neonatal &
Urogenital
Mental Health
Neurology
Ophthalmology
Paediatrics
Rare Diseases
Dentistry
Ear, Nose, Throat
Traditional Medicine
IV
XIV
IV
IX
XIII
Haemotology
Respiratory
III
X
Neoplasms/cancer
II
XII
XIX
XV, VI, &
XIV
V
VI
VII
XVII
Disorder
ICD code
Populated
with FP?
K50/K51
X
Stroke (also under Neurology)
I64
X
Chronic ischaemic heart disease
I25
X
I21
K74.3
X
N30.1
E10-E14
E66
E84
M05
M32
X
D50
J44
J45
Possibly C43,
C44, c47
C50
LF160
X
Acute Myocardial Infarction
Cirrhosis
Cystitis
Diabetes Mellitus*
Obesity
Cystic Fibrosis
Rheumatoid Arthritis*
Systemic Lupus Erythematosus
Iron Deficiency Anaemia
COPD
Asthma
Head & Neck cancer
Breast cancer
Vitiligo
Spinal Cord Injury
Traumatic Brain Injury1
X
X
X
X
X
X
X
X
NOT YET
X
X
NOT YET
NOT YET
NOT YET
Sleep1
Depression*
Bipolar disorders
Intellectual developmental disability
ADHD
Stroke (also Cardiovascular)
Multiple Sclerosis
Epilepsy*
Cerebral Palsy*
Migraine
Blindness
Angelman Syndrome*
NOT YET
F33
F31
F70-F79
F90
X
X
NOT YET
X
NOT YET
X
GD
X
NOT YET
G43
H53
X
NOT YET
NOT YET
NOT YET
NOT YET
NOT YET
A guidelines document is being finalized. This will help
guide content TAGs to populate their disease entities
themselves in consultation with fTAG
Task 2
Coding Issues
Coding Issues
Identify where ‘functioning’ is used in ICD concepts
•
•
•
•
Entity (Definition, Inclusions)
Signs/Symptoms
Severity
Diagnostic Criteria
Analyse the nature and scope of overlap between
• existing ICD-10 concepts
• newly proposed ICD-11 concepts
and ICF concepts
H54 Issue 1: The Draft 8 code, H54.0, Deficits of Functional Vision, is
described as how the person lives and estimates the burden of vision
loss.
Rationale for recommendation 1: As described in Draft 8, Deficits of
Functional Vision are not disease categories. This category describes the
impact of visual loss on how the person lives, in other words
how the person performs activities and is involved in life situations
in usual daily life.
This concept is not a disease/disorder but the impact of disease/disorder,
described and classified in the ICF.
Recommendation 1: The fTAG recommends that the description of how the
person lives should not be included in the ICD-11 as a disease category.
The impact of diseases/disorders on how a person lives is included in
more detail in the Content Model under Functioning Properties, 10.1
Activities and Participation. In addition to the generic set of
Functioning Properties, the Content Model can be populated via the iCAT
with additional activities and situations which are likely to be affected by
ocular diseases/disorders.
H53 Issue 3: The Ophthalmology TAG defines Draft 8 H53, Disorders of
Visual Functions, as codes that describe how each eye functions, not
as ocular disease/disorders. The fTAG noted that four of the H53
concept titles are indeed Visual Functions. The codes, as included in
Draft 8 are:
• H53.1, Loss of Contrast vision
• H53.2, Light sensitivity deficiencies
• H53.3, Color vision
• H53.5, Disorders of Binocular vision
Rationale for recommendation 3: These four proposed ICD-11 codes are
not diseases/disorders. They are functions of the eye and there are ICF
codes for these functions. They are:
• ICF b21022, Contrast sensitivity;
• ICF b21020, Light sensitivity;
• ICF b21021, Colour vision; and
• ICF b21000 and b21002, Binocular acuity of distant vision and Binocular
acuity of near vision, respectively.
Recommendation 3: The fTAG suggests that three of the proposed
concept titles H53.1, H53.2 and H53.5 be placed in the Content Model
under Functioning Properties, 10.3 Body functions
H53 Issue 4: The ICD has historically contained a diagnostic code, Colour
vision. As presented in Draft 8, Colour vision, H53.3, is described as an
eye function, which indicates the presence of an eye disease but is not a
disease/disorder. The ICD-10 code contains a list of subtypes of ocular
problems with colour.
Rationale for recommendations under Issue 4: Because the ICD-10 has
both a historical context and includes a list of subtypes of problems
related to color, additional analysis of this proposed Draft 8 ICD-11 code
is suggested.
Recommendation 4: The fTAG suggests that the Ophthalmology TAG
review the subtypes of Colour vision deficiencies listed under the ICD10’s H53.5 and decide whether or not they are:
1. symptoms of ocular diseases/disorders/syndromes
2. ocular diseases/disorders/syndromes that should be classified in the
ICD-11
3. eye functions as labeled in the heading by the Ophthalmology TAG?
Recommendation 4c: If the Ophthalmology TAG intends that Draft 8 H53.3
Color vision reflects functions of the eye (as they stated), then H53.3
belongs under Functioning Properties, 10.3 Body functions.
ICF Activities used as Signs/Symptoms or Severity
of Intellectual Developmental Disorders (IDD)
IQ
Mental
Age
F70
Mild
50 - 69
9 -12 yrs
Learning
Work
Social relationships
Contribute to society
d160-179
d850
d730-779
d910-950
F71
Moderate
35 - 49
6 – 9 yrs
Self care
Communication
Academic skills
Domestic life
Work
d510-570
d310-360
d130-155
d620-650
d850
F72
Severe
20 - 34 3 to < 6 yrs
Continuous need of support
(‘Assistance’ is an ICF
qualifier)
Self care
Continence
Communication
Mobility
d510-570
d530
d310-360
d410-480
ICD
F73
Profound
< 20
< 3 yrs
Impact on
Functioning
ICF
Task 3
Joint Use
“Case = Disease + Disability”
Joint Use
• Examples of how ICD/ICF linkage works for
usual clinical purposes
–
–
–
–
–
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Medical rehabilitation
Palliative Medicine
Geriatrics
Supportive/Assistive Care
Reimbursement
Eligibility determination (disability benefits)
• Coding guidance for joint use of ICD and ICF
Joint Use
“Generic Perspective”
Kostanjsek N, Rubinelli S, Escorpizo R,
Kennedy C, Stucki G, Üstün TB. Assessing
the impact of health conditions using the
ICF. Disability and Rehabilitation 2010, early
online.
“MSK Paper”
Kostanjsek N, Escorpizo R, Boonen A, Walsh N, Üstün TB,
Stucki G. Assessing the impact of musculoskeletal health
using the ICF. Disability and Rehabilitation 2011; 33(13–
14): 1281–1297.