ICD coding for COVID-19

The WHO provided some recommendations and guidance to countries on ICD coding of COVID-19, which was declared a pandemic in March 2020. This resulted in updates of the Tabular List and the Alphabetical List to include the following new ICD codes for COVID-19. Click here for update 3 of the guidance and to learn more about the coding of COVID-19 in ICD-10 and ICD-11.

Post COVID-19 codes (25 September 2020)

Activating post COVID-19 codes in ICD-10

Rapid Mortality Surveillance for COVID-19

Revealing the Toll of COVID-19: A Technical Package for Rapid Mortality Surveillance and Epidemic Response

Medical Certification

South African Guideline for Medical Certification of COVID-19 related deaths

Guideline for medical certification of death in the COVID-19 era - SAMJ - 20 July 2020

Medical certification of deaths due to COVID-19 

CDC video on how to correctly certify COVID-19 deaths

How to add Covid-19 as cause of death on a death certificate

Download the WHO’s International guidelines for certification and classification (coding) of Covid-19 as cause of death based on ICD (International Statistical Classification of Diseases) (16 April 2020). 

Feedback from Annual WHO-FIC Meeting 2019

Delegates from AFRO region who attended the WHO-FIC Annual meeting in Banff, Canada. Back: Dr Warrick Sive (SA), Dr Hillary Kipruto (AFRO-WHO), Dr Anthony Ofuso (Ghana), Mr Samuel Cheburet (Kenya), Prof Soraya Maart (SA), Dr Oluwatoyin Awotiwon (SA), Ms Emmy Else Ndevaetela (Namibia), Mr Nenad Kostanjsek (WHO). Front: Prof Debbie Bradshaw (SA), Dr Robert Jakob (WHO).

Join via Zoom on 13 November @14h00 (UHC +2h)

The Annual WHO-FIC meeting and conference took place form 5-11 October in Banff, Canada. Debbie Bradshaw, Oluwatoyin Awotiwon, Soraya Maart and Warrick Sive from the Collaborating Centre attended the meeting. On 13 November at 1400 – 15:00 they will give feedback of the meeting via Zoom.
Click here to join the feedback session.

Click here to download the highlights of the meeting.

Highlights regarding the reference classifications

International Classification of Diseases (ICD)

• ICD-11 was adopted by the World Health Assembly in May 2019 and plans are underway for implementation with the finalisation of the 2020 version.
• Reference guides are being checked and finalised.
• The Education and Implementation sub-committee has created a website carrying various tools for training and will be launched soon.
• The licensing agreement is being formulated for open access and WHO will request the Ministry/Department of Health in each country to disseminate.
• Updating of ICD continues. A total of 116 proposals were considered for voting (from more than 1000 submissions). A further phone meeting will be needed to complete these.
• Compiling diagnostic term set for enhancement of ICD-11 index and ICD-FiT for primary care settings and developing ICD-FiT for international use
• The ICD-11 coding tool is currently under testing by WHO. Post-coordination is available and can point to related conditions.
• The WHO Academy is being set up as an adult learning platform with verifiable credentials. WHO-FIC training is being considered for this platform. Countries will be invited to give input on an expression of interest.

International Classification of Health Interventions (ICHI)

• ICHI version 2 is currently being field-tested and the content coverage needs to be assessed against lists used in different countries. The public health interventions were difficult to code.
• Version 3 is to be completed in 2020.
• South Africa might be an early adopter and can seek assistance from WHO.

International Classification of Functioning (ICF)

• ICF work is currently focused on platforms and updates.
• A phone meeting for remaining CSAC-ICF updates is planned before the end of year.
• The linearisation of the ICF is continuing.
• Development of the Kids Disability Assessment Survey (KIDDAS) is in progress.

Highlights from committee and reference group meetings

Family Development Committee (FDC)

• South Africa’s contribution to ICHI beta 2 testing was noted in a report submitted to the FDC. Plans are to complete the testing and have a revised version available late 2020.
• Progress has been made on the development of a comprehensive framework of the classifications to develop a framework for digital environment.
• Discussions are underway with WONCA on the Primary Health Care linerisation of ICD for better alignment.
• LOINC (which stands for Logical Observation Identifiers Names and Codes) is being considered as a related set of codes for laboratory data.
• Initial work on a mapping of the UHC/SDG indicators for coded data was presented by Dr Warrick Sive. This was well received, and a next version will be developed.

Verbal Autopsy Reference Group (VARG)

• This is a new group that is working towards improving the WHO VA instruments.
• Planned revision of 2016 WHO VA instrument.
• Work is ongoing on guidelines to give more clarity on what.
• Group workshop of countries suggested to do what.
• Prof Debbie Bradshaw made a presentation on the South African experience with the use of the 2016 WHO VA instrument. This was very well received and there were interests expressed for collaboration.

Traditional Medicine Reference Group (TMRG)

• ICD-11, with inclusion of the Traditional Medicine (TM) chapter has been adopted by the WHA.
• The TM Chapter is a supplementary to ICD-11 and not mandatory for international reporting of morbidity and mortality data. It is designed for optional use.
• The aim is to facilitate the counting of encounters in order to aggregate the information, and also the effectiveness and non-effectiveness of the services.
• Not about intervention but diagnosis.

WHO AFRO

• There is no strategic plan for implementation of WHO-FIC in the region. However, efforts to strengthen CRVS are prompting the implementation of ICD.
• Advocacy and training are needed.

ICHI Testing

Testing of the beta draft of ICHI, the International Classification of Health Interventions, is under way throughout the world.  Dr Lyn Hanmer, co-head of the Collaborating Centre, is the Field Trial Centre Coordinator for this region.  Documentation and other resources for ICHI testing have been developed by WHO and the Collaborating Centre, and are made available to all testers.

The significant contributions of colleagues in multiple countries in our Region who have already participated in the testing are acknowledged and appreciated.

The testing period has been extended, so there is time for any colleagues who still wish to participate to register as testers.  Please send an email to lyn.hanmer@mrc.ac.za so that an invitation can be initiated.

Read more.

Alignment of WHO-FIC content within a unifying model: preliminary steps

At the Seoul WHO-FIC Network Meeting in 2018, a discussion was held on the possibility of developing a generalized Content Model and Foundation that encompass all WHO-FIC core classifications. After that, a working group has been started of which Warrick Sive, Luisa Whitelaw, and Soraya Maart of the South African-based Collaborating Centre have been part. The working group pursue the following vision:

• Development of one single Foundation from which all variants of WHO-FIC classifications are derived as linearisations;
• The Foundation should be based on a core WHO-FIC Content Model shared and extended by different classifications;
• The Foundation content should be harmonized, without duplicates and with mutual references, that serves the requirements of all classifications;
• There should be a clear relationship to underlying ontologies, i.e., concepts represented in classifications should be well-defined;
• Finally, there will be a need for integrated tools that facilitate the development, maintenance, versioning, and publication of all WHO-FIC classifications.

Two main lines of work have been identified: one dealing with the model and the other addressing the harmonization of the content. This latter group will concentrate on the existing entities now represented in the three reference classifications.
The working group meets regularly by teleconference and had also an in-presence meeting in Conegliano, Italy. In the latter, the basis for the first concrete steps have been set, starting from a preliminary work about the content models of the current classifications, to find similarities and differences at the present time and suggest further developments.

WHO-FIC Primary Health Care Linearisation

Lyn Hanmer, Soraya Maart, Warrick Sive, and Luisa Whitelaw of the WHO-FIC Collaborating Centre for Africa was co-authors on a poster presented at 2018 WHO-FIC Network meeting in Banff, describing the work done on this linearisation to date.

To assist health professionals in recording disease, functioning loss and performed interventions in all primary health care domains, a WHO-FIC primary health care linearisation is envisioned. This WHO-FIC primary health care linearisation propagates joint use of the WHO-FIC reference classifications, as well as the integration of relevant elements from related or derived classifications.

Cross mapping ICHI to hospital interventions in Nigeria, Uganda and Zambia

Warrick Sive and Chris Cockett from the University of the Witwatersrand presented a poster at 2018 WHO-FIC Network meeting in Banff. The study used a dataset of Procedure Descriptors to assess the mapping of such descriptors to ICHI codes. Data was extracted from completely anonymous claims data emanating from Nigeria, Uganda and Zambia.

Data was mappable to ICHI codes in 79% of the Descriptors tested. The variability in Procedure Descriptors for the same Intervention was noted. It is suggested that ICHI has the potential to improve the quality of data in the setting of this study.

Detailed mapping of the global reference list of 100 core health indicators to the 3 reference WHO classifications

Soraya Maart, Luisa Whitelaw and Warrick Sive from the WHO-FIC Collaborating Centre based in South Africa participated in a study which was presented at the 2018 WHO-FIC Network meeting in Canada.
Sustainable development Goal (SDG) 3 (Better Health for all at all ages) is a central pillar among the UN SDGs. A reasonable representation of SDG3 includes Universal Health Coverage (UHC), one of the main targets of SDG3. The global reference list of 100 Core Health Indicators published by WHO and recently revised (WHO 2018) should function as a normative guide for the selection of standard indicators and their definition that “stakeholders and countries can use for monitoring in accordance with their respective heath priorities and capacity”. Among the 100 Core Health Indicators many, especially those grouped under the “Health Status” headline already incorporate the appropriate method of measurement chosen from the WHO-FIC codes (e.g. NCD mortality: ICD codes 100-199, C00-C97, E10-E14, J30-J98). Others however, especially those grouped among under Risk Factors, Health Coverage and Health Systems, lack such specific indication.
Both ICF and ICHI can provide categories and items useful to capture and summarize indicators within those groups. A group of FDC members ran an experiment of manually mapping items from the WHO-FIC to Core Health Indicators.

Capacity building in Nairobi

Debbie Bradshaw, Stefanus Snyman and Lyn Hanmer represented the WHO-FIC Collaborating Centre at the Second Interprofessional Education and Collaborative Practice for Africa conference in Nairobi

The WHO-FIC Collaborating Centre partnered with various other organisations to host the Second Interprofessional Education and Collaborative Practice for Africa conference that took place at the Amref International University, Nairobi, Kenya from July 30 to August 2 2019. The conference was a collaboration between the WHO Regional Office for Africa, the Africa Interprofessional Education Network (AfrIPEN), Sigma Theta Tau’s International Tau Lambda at-Large Chapter, Anglophone Africa APN Coalition, WONCA Africa, Amref International University and our collaborating centre.

The conference is driven by the conviction that concerted action to improve working together will effect change, enhance quality of care, ensure safety, and optimise deployment of human resources on the continent.

Interprofessional collaboration to improve cause of death statistics: Crucial to improve systems for health

Benson Droti and Hillary Kipruto from the WHO Regional Office for Africa co-presented the pre-conference workshop with Debbie Bradshaw and Lyn Hanmer.

WHO Office for the African Region and the Collaborating Centre facilitated a well-attended pre-conference workshop with the aim to stress the crucial role of interprofessional collaboration to improve cause of death statistics

Participants gained an understanding of the double inequity lens on health information in Africa, noting existing initiatives in the WHO African Region to strengthen civil registration and vital statistics

We also explored why cause of death statistics are pivotal to health service delivery and shared experiences with verbal autopsy to fill the gap.

The crucial role Interprofessional collaboration between community health workers, nurses, medical practitioners and health administrators to improve the cause of death statistics were emphasised, as well as their role to build a Civil Registration and Vital Statistics system in Africa.

Participants were also alluded to the use of Verbal Autopsy and were orientated on ICD mortality/cause of death coding.

ICF Education

Stefanus Snyman conducted an ICF Facilitators’ Training Course two days prior to the start of the conference. The course was developed by the Dutch WHO-FIC Collaborating Centres to help meet the increasing need for information and education on ICF.

Since August 2018 three ICF Facilitator Training Course were presented, in Cape Town, Pretoria and Nairobi. 16 persons from 7 countries completed the training.

This course was developed to meet the increasing need for information and education on ICF, especially its application in practice, education and research. The training is aimed at a broad audience with special attention to the care sector.

During the conference Stefanus also presented an in-conference workshop on the ICF as catalyst for interprofessional collaborative practice.

4th International Symposium: ICF Education

Stefanus Snyman from the WHO-FIC Collaborating Centre for the African region helped to organise the 4th International Symposium: ICF Education that was held in Kuwait City on 6 & 7 April 2019. A multidisciplinary group of 80 persons from 29 nations in all 6 WHO regions attended the symposium. This unexpectedly large and diverse turn-out underscores the interest in the ICF and its implementation all around the world.

• Download the poster on ICF Education that was presented at the annual WHO-FIC meeting in 2019.
• Download the Poster Booklet of the 4th International Symposium: ICF Education
• Visit www.ICFeducation.org to find or share ICF-related education resources, research findings, events or news. You can also register on the site as ICF educator or advisor and contribute to the forum.