1. ICD Revision Process functioning Topic Advisory Group fTAG Cille Kennedy & Gerold Stucki Co-Chairs

2. fTAG Members Cille Kennedy USA: Co-Chair Solvejg Bang Denmark Cassia Buchalla Brazil Francesco Gongolo Italy Oye Gureje Nigeria Ros Madden Australia Gerold Stucki Switzerland: Co-Chair John Melvin USA Jane Millar United Kingdom Catherine Sykes WFPT (UK) Berna Uluğ Turkey José Luis Vazquez-Barquero Spain

3. 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 ICD Revision Process Challenge: Ensure Consistency Opportunity: Joint use

4. 7. Causal Properties 7.1. Etiology Type 7.2. Causal Properties - Agents 7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages 7.5. 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 Participation 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 THE CONTENT MODEL Any Category in ICD is represented by: 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. Textual Definition(s) 4. 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 TITLE of ENTITY: Name of disease, disorder, or syndrome…

5. Task 1 Assist in “Populating” the Functioning Properties

7. 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

8. 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)…

9. 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…

10. ICD-11 Revision: Populating with functioning properties

11. TAGWorking Group ICD-10 chapter DisorderICD codePopulated with FP? Internal MedicineGastroenterologyXIInflammatory bowel diseases (Crohn’s Disease)K50/K51 X CardiovascularIXStroke (also under Neurology)I64 X Chronic ischaemic heart diseaseI25 X Acute Myocardial InfarctionI21 X Hepatology & Pancreatobilary IVCirrhosisK74.3 X NephrologyXIVCystitisN30.1 X EndocrinologyIVDiabetes Mellitus*E10-E14 X ObesityE66 X Cystic FibrosisE84 X RheumatologyIXRheumatoid Arthritis*M05 X XIIISystemic Lupus ErythematosusM32 X HaemotologyIIIIron Deficiency AnaemiaD50 X RespiratoryXCOPDJ44 X AsthmaJ45 X Neoplasms/cancerIIHead & Neck cancerPossibly C43, C44, c47 NOT YET Breast cancerC50 X DermatologyXIIVitiligoLF160 X External Causes & InjuriesXIXSpinal Cord Injury NOT YET Traumatic Brain Injury1 NOT YET Maternal, Neonatal & Urogenital XV, VI, & XIV NOT YET Mental HealthVSleep1 NOT YET Depression*F33 X Bipolar disordersF31 X Intellectual developmental disabilityF70-F79 NOT YET ADHDF90 X NeurologyVIStroke (also Cardiovascular) NOT YET Multiple Sclerosis X Epilepsy*GD X Cerebral Palsy* NOT YET MigraineG43 X OphthalmologyVIIBlindnessH53 NOT YET Paediatrics Rare DiseasesXVIIAngelman Syndrome* NOT YET Dentistry NOT YET Ear, Nose, Throat NOT YET Traditional Medicine NOT YET

12. A guidelines document is being finalized. This will help guide content TAGs to populate their disease entities themselves in consultation with fTAG

13. Task 2 Coding Issues

14. 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

15. 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.

16. 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

17. 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 ICD- 10’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.

18. ICF Activities used as Signs/Symptoms or Severity of Intellectual Developmental Disorders (IDD) ICDIQ Mental Age Impact on Functioning ICF F70 Mild 50 - 699 -12 yrs Learning Work Social relationships Contribute to society d160-179 d850 d730-779 d910-950 F71 Moderate 35 - 496 – 9 yrs Self care Communication Academic skills Domestic life Work d510-570 d310-360 d130-155 d620-650 d850 F72 Severe 20 - 343 to < 6 yrs Continuous need of support(‘Assistance’ is an ICF qualifier) F73 Profound < 20< 3 yrs Self care Continence Communication Mobility d510-570 d530 d310-360 d410-480

19. Task 3 Joint Use “Case = Disease + Disability”

20. 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

21. “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. “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. Joint Use