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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 • • • • • • 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 – – – – – – 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.