ICD Coding advice from the WHO for the 2019 novel coronavirus (COVID-19)

The purpose of this post is to share the World Health Organization [WHO] official diagnosis coding guidance update for health care encounters and deaths related to the 2019 novel coronavirus (COVID-19) previously named 2019-nCoV.

Screenshot image from ICD-10

ICD-10 Chapter XXII: Codes for special purposes has a special sub-category called U07 Emergency use of U07. WHO’s recent creation of an emergency ICD-10 code U07.1, is assigned to the disease diagnosis of 2019-nCoV acute respiratory disease. See my screenshot image from ICD-10 to the left.

 

The title of U07 will be changed back to ‘codes for emergency use’.

It is to be noted that the name ‘2019-nCoV’ is temporary and is likely to change (to be independent of date and virus family, and for consistency with international virus taxonomy).

For ICD-11, the code for the illness would be RA01.0

A new and final ICD-10-CM code title for the COVID-19 diagnosis code is now [March 17–18, 2020] been established, and will be implemented effective October 1, 2020, by the Centers for Disease Control and Prevention’s (CDC), USA and the National Center for Health Statistics (NCHS), USA.

References:

  1. Emergency use ICD codes for COVID-19 disease outbreak, Classifications, WHO, <http://www9.who.int/classifications/icd/covid19/en/>
  2. Organizations Developing New Codes for COVID-19, and a Primer on the Virus, Under the Dome, Journal of AHIMA, <https://journal.ahima.org/new-icd-10-cm-code-for-covid-19-becomes-effective-october-1/>

ICD-11 2018 version: Part 2 – The ICD-11 Menu Hierarchy

The ICD-11 Homepage at https://icd.who.int/ (opens in a new tab of this same open window) of the World Health Organisation (WHO) website is a specific point in time when you “Discover” the ICD-11 interface to then “Explore” to both the whole time you are looking for something about ICD-11 and the time you discovered something about ICD-11.

From this Homepage, the reader discovers a top-level menu that brings you to various “places” within the ICD-11 Homepage. Below is a chart (you can view a larger image of this chart by clicking on this chart which will open in a new tab of this same open window) from my discovery of these various “places” and what I found from my exploration.  This chart shows the ICD-11 Menu Hierarchy as I had discovered and explored. In future posts, I shall write more on each individual menu item.

Mortality Disease Coding in Malaysia, Part 1

Mortality-Disease-Coding-in-Malaysia-plaqueIt is my humble aim of publishing this post to provide potential readers among the Health Information Management (HIM) / Medical Records Management (MRM) practitioner community in Malaysia who may come visit this website-blog, as a one-stop centre of information to locate all the various forms and their intended uses of the Malaysian civil registration system. It is also especially so to educate and inform them about the pitfalls of their mortality coding practices using the International Classification of Diseases Tenth Revision (ICD-10) in Malaysia.

I am presenting this post also partly because of a Summit on Mortality Statistics during the 18th International Federation of Health Information Management Associations (IFHIMA) International Congress, taking place from October 12 to October 14, 2016 in Tokyo, Japan. During this planned summit, invited participants from developing countries are due to present their current conditions on mortality statistics collection and coding, discuss ways to improve mortality coding especially in developing countries, and the need for accuracy in this area.

But before I get into the details of worries on mortality coding procedures in Malaysia, I shall present some background knowledge on what a civil registration system is all about.

Many people in any country are born and die each year.

Any such country needs to know and count all births and deaths.  A system must be in place in a country to count as well as track all births and deaths. This is usually done through a civil registration system, which continuously counts and tracks births by age and sex, which also counts and tracks all deaths by age, sex and not forgetting the more important reason that is of accounting for the main causes of their deaths, as well as the registration of marital status of its people. A well-functioning civil registration system of a country is then the most reliable source of statistics on births and deaths, and causes of death in a country and the marital status of individuals in its population.

A country cannot afford to only have approximate ideas of the numbers, the longevity and the health of their population. In countries with no civil registration system, births and deaths go uncounted and the causes of death are also not documented. Their governments cannot then effectively design public health policies or measure the impact of births and deaths on its population.

So why have a civil registration system in the first instance?

Civil registration brings multiple benefits. Benefits of a civil registration system include:

  1. an individual’s right to be counted at both extremes of life, i.e. at birth and at death;
  2. provides the basis for individual legal identity for social inclusion;
  3. a birth certificate is needed as a basic legal document – consistent with the Convention on the Rights of the Child proclaimed by The Office of the United Nations High Commissioner for Human Rights (OHCHR) that states that every child should be registered immediately after birth, that gives identity to a child, and automatically bestows a number of rights such as the right to health care, nationality, schooling, passport, property ownership, voting, formal employment, or access to banking services;
  4. death registration and certification with a death certificate for the family of the deceased are often required prerequisites for burial, remarriage, the resolution of criminal cases, ensures their right to inherit property, to access business and financial entitlements, and to claim any available insurance benefits; and
  5. for national planning, death registration helps identify a population’s most pressing health issues in order to have well-functioning health systems – (i) like what type of essential services to provide, (ii) the cause of death data from civil registration systems are vital for pinpointing the diseases and injuries that are cutting lives short and for planning preventive services to avoid premature mortality, and (iii) cause of death data that will be useful to inform governments about outbreaks of fatal disease, e.g. the recent Ebola outbreak.

The availability up-to-date and continuous vital statistics from a reliable and solid civil registration system depends on the level of development of the civil registration system. Lack of such a system and without such data, policy-makers of governments lack reliable evidence to design policies and tend to (OHCHR 2016) “fly blind, often making policy on the basis of ideology, anecdotes or for political considerations, rather than on evidence”.

What then is the situation in Malaysia to have a civil registration system?

Malaysia has a well-functioning civil registration system because it has the necessary law – Act 152 Registration Of Births And Deaths (Special Provisions) Act 1975 Incorporating all amendments up to 1 January 2006 to make it obligatory to register births and deaths, and the infrastructure – a National Registration Department (NRD) that has branches in all capital cities of each District and in all capital cities of all States in Malaysia, unlike in some countries, where it is likely that only people who live in cities have access to registration services.  The NRD is known nationally known as “Jabatan Pendaftaran Negara (JPN)”, is the Malay [Bahasa Malaysia] translation for this department’s official name.

For private hospitals settings in Malaysia, Act 586 Private Healthcare Facilities And Services Act 1998 Incorporating all amendments up to 1 May 2006, Regulation 107 (2) (v) stipulates that a private healthcare facility or service are  “to require notification be given of any births or deaths occurring in a private healthcare facility or service”.

The Malaysian NRD website (this link opens in a new tab of your current window) is an excellent website that provides its readers how-to-guides to register births and deaths under the Malaysian civil registration system.

As most births and deaths occur in public and private hospitals in Malaysia, this website however does not provide HIM / MRM practitioners in their respective place of work in Malaysia enough information on the purpose and workflows of the various forms for births and deaths that are used in a public or a private hospital.

The following are the various forms issued by the NRD, with the Bahasa Malaysia title given inside square brackets. Each link for the forms and exhibits listed below will open in a new tab of your current browser:

Forms used for birth registration

  1. Birth / Stillbirth Registration [Daftar Kelahiran / Kelahiran Mati] JPN.LM01
  2. Birth Certificate [Sijil Kelahiran] JPN.LM05; (no sample available; the reader can view the exhibit of a completed form below)

Forms used for death registration

  1. Death Registration [Dafter Kematian] JPN.LM02 – previous version
  2. Death Registration [Dafter Kematian] JPN.LM02 (Pin. 1/11) – current version
    This is the current form for death registration. It is a combination form of death registration and burial permit. The burial permit incorporated in this form replaces the burial permit form (Am 138-Pin. 178) used since 1978, and now discontinued since form JPN.LM02 (Pin. 1/11)  was first implemented for Peninsular Malaysia from 1st December 2011.
  3. Burial Permit [Permit Menguburkan] (Am 138-Pin. 178) – discontinued, and used since 1978
  4. Death Certificate [Sijil Kematian] JPN.LM03; (no sample available; the reader can view the exhibit of a completed form below)
  5. Certification of Causes of Death by Medical Officer [Perakuan Pegawai Perubatan Mengenai Sebab-sebab Kematian] JPN.LM09
  6. Certification of Causes of Death by Medical Officer (Post-Mortem) [Perakuan Pegawai Perubatan Mengenai Sebab-sebab Kematian (Post-Mortem)] JPN.LM10

The following are exhibits of completed forms, found on the Internet:

  1. Exhibit 1 Birth Certificate [Sijil Kelahiran] JPN.LM05
  2. Exhibit 2 Death Certificate [Sijil Kematian] JPN.LM03
  3. Burial Permit [Permit Menguburkan] (Am 138-Pin. 178)

The reader can browse the NRD website for details among others on (i) normal registration of birth registration that must be made within 14 days of the birth of a child in Malaysia, (ii) persons who can apply for registration of a child, (iii) the application procedure, (iv) required documents for registration, (v) payment, (vi) the methods of applying for extracts of births and/or death certificates to obtain a copy of the birth register by paying a prescribed fee and the various forms used, and (vii) late registration.

One main contention is the documentation of the cause of death and the identification process for the underlying cause of death in the death certificate. This is the missing link and misinformation to accurate mortality coding in Malaysia.

According to the ICD-10, Volume 2 Instruction Manual, accurate collection of mortality statistics and their ICD-10 coding are deemed as necessary to break the chain of events or to effect a cure at some point in preventable deaths in a country as the most effective public health objective to prevent the precipitating cause from operating.

HIM / MRM practitioners in Malaysia using ICD-10 for coding of disease are however, generally aware of guidelines included in the ICD-10, Volume 2 Instruction Manual to select the cause of death for tabulation and notification to the World Health Organisation (WHO) for international comparison of mortality statistics.

The causes of death to be entered on the medical death certificate of cause of death is defined (ICD-10, Vol 2 p.31) as “all those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries”. The purpose of the definition (ICD-10, Vol 2 p.31) “is to ensure that all the relevant information is recorded and that the certifier does not select some conditions for entry and reject others. The definition does not include symptoms and modes of dying, such as heart failure or respiratory failure.”

When only one cause of death is recorded in the medical death certificate, this cause is usually selected for tabulation.

But sometimes more than one cause of death is recorded. The selection should be made in accordance with specific rules given in the ICD-10 Volume mentioned above. The rules are based on the concept of the underlying cause of death.

The underlying cause of death is defined (ICD-10, Vol 2 p.31) as “(a) the disease or injury which initiated the train of morbid events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury”.

It is not the HIM / MRM practitioner who identifies the cause of death or the underlying cause of death, rather it is the medical practitioner signing the death certificate who is responsible (ICD-10, Vol 2 p.32) to indicate which morbid conditions that led directly to death and to state any antecedent conditions giving rise to this cause.

The WHO recommends (ICD-10, Vol 2 p.32) that the medical practitioner signing the death certificate use The International Form Of Medical Certificate Of Cause Of Death (IFMCCD) which is designed to facilitate the selection of the underlying cause of death when two or more causes are recorded. I am aware that the IFMCCD is not implemented in Malaysia.

Thus, in the absence of the IFMCCD and general lack of its usefulness, a medical practitioner signing the death certificate in Malaysia is most likely is not aware of the guidelines to facilitate the selection of the underlying cause of death when two or more causes are recorded using the IFMCC. A medical practitioner or other qualified certifier in Malaysia then uses his or her clinical judgement in completing the death certificate form JPN.LM09 (for all deaths excluding for post-mortem) or JPN.LM10 (only used for post-mortem), and states the “cause of death” in the allocated space on these two forms.

Apparently, medical practitioners also state the same cause of death in the discharge summary and the Inpatient Face Sheet (Admission Form) for an inpatient.

HIM / MRM practitioners in their respective place of work in Malaysia are mostly unaware of the process how and when the cause of death is reported and stated by the medical practitioner in the forms JPN.LM09 and JPN.LM10.

HIM / MRM practitioners also vary in their understanding and practice on how mortality coding using ICD-10 is to applied to a reported cause of death. Some say mortality coding is assigned from the diagnostic statement in the discharge summary and while others claim to use the diagnostic statement found in the Inpatient Face Sheet (Admission Form).

In my opinion and to conclude the first part of this subject on mortality disease coding, the absence of a procedure or procedures to identify the underlying cause of death when more than one cause of death is recorded by a medical practitioner using IFMCCD, and the job of the HIM / MRM ICD-10 coder to assign ICD10 codes to a death, is highly inaccurate and not desirable in current day mortality disease coding practices using ICD-10 in Malaysia.

In a follow through article, I will prescribe some suggestions which could be instituted in Malaysia’s public and private hospitals, particularly in the ICD-10 disease coding for mortality

References:

  1. Act 152 Registration Of Births And Deaths (Special Provisions) Act 1975 Incorporating all amendments up to 1 January 2006
  2. Act 586 Private Healthcare Facilities And Services Act 1998 Incorporating all amendments up to 1 May 2006
  3. International Federation of Health Information Management Associations, 2016. Scholarship Program for Developing Countries [online] Available at http://www.ifhima2016.com/scholarship.html [Acessed 1 May 2016]
  4. The Office of the United Nations High Commissioner for Human Rights (OHCHR), 2016. Convention on the Rights of the Child [online] Available at http://www.ohchr.org/en/professionalinterest/pages/crc.aspx [Acessed 1 May 2016]
  5. World Health Organization 2011, Volume 2 Instruction Manual, International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010 edn, Geneva, Switzerland

8 strange ICD codes

Sometimes we encounter morbidity and mortality conditions that are amusingly unconventional and idiosyncratic to apply the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code or the 2015 American International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

Let’s delve into the infographic below (click on the infographic to view a larger image in a new tab of your current window) from Healthcare IT News  (a publication of  HIMSS Media which is a media organisation serving today’s healthcare industry, including all major healthcare organisations), and hope to find appropriate ICD-10 codes for them.

On verifying the codes given in the infographic, I found them to have similar variations in ICD-10 when compared to the ICD-10-CM codes. Let’s look in detail each of these 8 zaniest codes using the ICD-10-CM and how the differ when using ICD-10.

The first code from the infographic is Z63.1

It was not quiet easy to find an equivalent code for Z63.1 in ICD-10. In ICD-10 there is Z63 but you will need to cross reference with other codes to find hints for lead terms found among other codes belonging under a three-digit category. For example, Z63.1 is one of the several four-digit categories belonging under the three-digit category Z63.

Since “Family discord NOS” is classified to “Other specified problems related to primary support group” with code Z63.8; but when a family discord in relation to or with parents and in-laws is the situation with a presenting patient, then Z63.1 is the appropriate code.

Another example would be when the patient is a “Dependent relative needing care at home”. If the dependent relative is a parent and in-law(s), then code Z63.1 is the appropriate code since this code qualifies with specificity who the dependent relative is, since the parent or the in-law would be an elder or aged. So rather than using code Z63.6 which is for “Dependent relative needing care at home”, use Z63.1 when the dependent relative is a parent or an in-law.

Asphyxiation due to being trapped in a (discarded) refrigerator, accidental has the ICD-10-CM Diagnosis Code T71.231D, which differs from ICD-10.

ICD-10 differs from ICD-10-CM when two codes for asphyxiation due to being trapped in a refrigerator which may be accidental, one from Chapter IX Injury, poisoning and certain other consequences of external causes  and the other from the Chapter XX External causes of morbidity and mortality.

The ICD-10 code T71 from Chapter IX is used for the asphyxiation from systemic oxygen deficiency due to low oxygen content in ambient air. The ICD-10 code W81 from Chapter XX  is used fo describe the circumstances when the patient was found confined to or trapped in a low-oxygen environment including accidentally shut in or trapped in refrigerator. No mention of “discarded” is found for the ICD-10 code W81 if the refrigerator was indeed discarded.

ICD-10 code V97.3 only specifies if the person on ground injured in air transport got sucked into jet unlike ICD-10-CM which has a unique code when person sucked into jet engine with code V97.33XD, “engine” as the addition qualifying term used here.

The exclusion note for “Falls“ includes falls into water (with drowning or submersion) in ICD-10 is classifiable to codes ranging from W65 to W74 which are conditions due to accidental drowning and submersion. There is no code found for accidental drowning and submersion from a fall into a bucket under codes W65 to W74. So we are left only with using the code W74 “Unspecified drowning and submersion” which includes “fall into water NOS”.

This differs greatly from the ICD-10-CM code W16.221 which is for “Fall in (into) bucket of water causing drowning and submersion”, which could happen if the patient was a toddler.

V91.7 applying the fourth-character subdivision “.7” is the most likely ICD-10 code to use for an accident to watercraft for example a burn to water-skis (which is a watercraft) causing other injury (in this case a burn), when compared to ICD-10-CM V91.07XD for a burn due to water-skis on fire.

Walking into a stationary object is to say “striking against or struck by other objects” describing the ICD-10 code W22. From the infographic, the stationary object is a lamp post. ICD-10-CM uses the code W22.02XD in this instance.

Hair causing external constriction is the cause when an item like hair is causing the external constriction. The ICD-10-CM code W49.01XD is for a subsequent encounter when hair is causing an external constriction. In ICD-10, the equivalent would be to use the code W49 for “Exposure to other and unspecified inanimate mechanical forces”. Here the inanimate mechanical force (the constriction) is from the hair.

Animal-rider injured in collision with streetcar or trolley uses the ICD-10-CM code V80.730A for an initial encounter. I think the ICD-10 code V80 Animal-rider or occupant of animal-drawn vehicle injured in transport accident best describes a similar accident. You will also need to find a ICD-10 code for the injury as a consequence of the external cause.

8 Strange-Codes

Infographic credit: http://himt.wisconsin.edu/blog/6-health-information-technology-infographics-need-see-right-now/

Now we have seen how weird some 8 conditions can be, and how we will know exactly which ICD-10 or ICD-10-CM code to use.

References:

  1. World Health Organization 2011, Volume 1 Tabular list, International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010 edn, Geneva, Switzerland
  2. 8 zaniest ICD-10 codes, 25 July 2013, Healthcare IT news, viewed 28 February 2015, <http://www.healthcareitnews.com/infographic/infographic-top-zaniest-icd-10-codes>

Tracking the Ebola outbreak (if any) in Malaysia

Ebola virus disease (EVD) – formerly known as Ebola haemorrhagic fever, its outbreak in West Africa with the first case notified in March 2014, and its effects around the world, continues to get news coverage.

As I write this article, the World Health Organisation (WHO) is investigating reports according to three media outlets that an undisclosed number of Islamic State of Iraq and Syria (ISIS) militants displaying signs of Ebola have been showing up at an Iraqi hospital in the ISIS-held city of Mosul, 250 miles north of Baghdad. Thus, Malaysians who are fighting there alongside other ISIS militants – and when they return, are likely to pose a real danger of exposing the Malaysian public with Ebola. Fortunately, the Ministry of Health Malaysia has in place a comprehensive “Guideline on Ebola Viral Disease (EVD) Management In Malaysia” which includes guidelines for healthcare providers to stay alert for and evaluate any probable case,  for example known persons who are returning from ISIS controlled regions. The guidelines ensures screening of an such an individual as a Person Under Investigation (PUI) since he or she was a contact of an EVD case with either a high or low risk.

The World Health Organisation (WHO) warns that the Ebola virus causes an acute, serious illness which is often fatal if untreated. EVD first appeared in 1976 in two African states, and takes its name when the second case occurred in a village near the Ebola River, in the Democratic Republic of Congo.

The International Classification of Diseases (ICD) Ninth Revision i.e. ICD-9 for morbidity and mortality coding was adopted by Malaysia by 1978. Since the Ebola virus was first discovered in 1976, Health Information Management (HIM) / Medical Records (MR) practitioners in Malaysia who had just started morbidity and mortality coding using ICD-9, would have coded any probable case of Ebola as “078.89, other specified diseases due to viruses”.

As the Ebola outbreak heightened after the West African outbreak in 2014, any eventuality of an outbreak in Malaysia will not impede our ability to track and respond to the virus within its own borders and makes it easier to share information with the rest of the world. Malaysia’s ability to immediately track and respond to the Ebola outbreak from a public health perspective will be possible with the specificity in patient data morbidity and mortality coding for EVD using the Tenth Revision of ICD i.e. ICD 10, as Malaysia would be able to use the ICD-10 code for the Ebola virus – A98.4 to assess the efficacy of treatment and outcomes. Malaysia adopted ICD-10 by 1 January 1999 in our morbidity and mortality reporting systems.

The infographic by the Coalition for ICD-10 below (click to enlarge the infographic which will open in a new tab of your current browser window), presents the public health benefits of using ICD-10 in the fight against Ebola.

EVD Infographic

References :

  1. Ebola virus disease, Fact sheet N°103 Updated September 2014, World Health Organisation (WHO),viewed 3 January 2015, ,< http://www.who.int/mediacentre/factsheets/fs103/en/ >
  2. Guidelines On Ebola, Ministry of Health Malaysia, viewed 3 January 2015, ,< http://www.moh.gov.my/english.php/pages/view/606 >
  3. ICD-10: A Common Language for Public Health, The Coalition for ICD-10,viewed 3 January 2015, ,< http://coalitionforicd10.org/2014/09/04/icd-10-a-common-language-for-public-health/ >
  4. ISIS fighters ‘have contracted Ebola’: World Health Organisation investigating reports militants showed up at Iraqi hospital with lethal disease, Mail Online, Saturday, Jan 3rd 2015, viewed 3 January 2015, < http://www.dailymail.co.uk/news/article-2894154/ISIS-fighters-contracted-Ebola-World-Health-Organisation-investigating-reports-Islamist-militants-disease-showed-Iraqi-hospital.html >