Draft of Disability Classification Being Tested

VOLUME 30 , NUMBER 9 October 1999

Draft of disability classification being tested

By Kathryn Foxhall
Monitor staff

Field trials are beginning on a new version of the inter- national system of disabil- ity classification that psychologists anticipate will more clearly communicate the services they provide and how those services help patients.

The World Health Organization (WHO) released the "Beta-2 Draft" of the International Classification of Functioning and Disability--known as ICIDH-2--in July. The coding system will go through several sets of real-world tests in the next few months. Release of the final version is expected in 2001.

APA's ICIDH Working Group, which has been involved in redrafting ICIDH over the last three years, is taking a lead in testing the instrument in this country, and will work for the widespread adoption of the final product. APA held two sessions on the ICIDH-2 at its Annual Convention in Boston, Aug. 20 - 24.

Currently health facilities and health professionals, including psychologists, use medical coding as a part of medical records, and specifically on claim forms for reimbursement. Most prominently, the International Classification of Diseases (ICD) coding system, which includes DSM-IV, is used to designate diagnosis. A version of the ICD system, ICD-9-CM, is integral to reimbursement in the United States.

But proponents of the new ICIDH-2 say it will allow psychologists and other health professionals to also code disablement and level of functioning in the body, person and society aspects. In addition, the codes can change over time, reflecting a change in level of functioning.

Practitioners will also be able to code the treatments or interventions that can maximize functioning; the outcomes or effectiveness of the interventions; and the levels at which consumers evaluate their own functioning.

Those capabilities, say proponents, will better allow psychologists to show insurers and others what they do and how it changes patients' conditions. That kind of measurement could be important in understanding what works on a patient-by-patient basis and on a far greater scale within research.

For example, if a patient has breast cancer, the diagnosis will always be the same and that is what current coding reflects. However, if interventions--which might be social or environmental--help the patient to better deal with the condition, the ICIDH-2 will show the intervention and the change in functioning.

"I have no question that in five years we will be using this--that it will be a required part of what we do," says Stanley Berent, PhD, chair of APA's ICIDH Work Group.

He believes the major motivation for using the system will come from third-party payers, including government programs, which will begin to require the ICIDH-2 codes on claim forms. However, the classification will give psychologists an opportunity to "be objective and speak a common language," says Berent, director of the Neuropsychology Division at the University of Michigan Hospital Center.

WHO has developed ICIDH over 30 years as a method of going beyond simple classification of diseases, or diagnoses, so as to classify human function "at the level of the body, the whole person and the person within the complete social and physical environmental context." It is meant to complement the ICD, which is also a WHO system.

Although the first version of ICIDH was not widely used in the United States, the second edition is the focus of considerable interest in government agencies and private groups.

"Diagnosis alone does not predict service needs, length of hospitalization, level of care or outcomes," says a WHO publication on ICIDH.

There's increased recognition, says the organization, that reducing disability involves "changes to the social and physical environment as well as changes in the level of functioning of the person."

According to WHO, ICIDH is a way of recording and measuring those changes.

For psychology in particular, says APA's Practice Directorate, the system may show its strength "in identifying psychologically relevant conditions and in measuring functional outcomes of psychology services."

At an Aug. 23 ICIDH convention session, J.G. Benedict, PhD, a clinical psychologist from Denver, said that the lack of clear, reliable indicators for most aspects of diagnosis makes it difficult for one clinician to describe a condition in the same way another clinician would. The ICIDH-2, he hopes, will allow practitioners to better describe conditions and more accurately evaluate interventions.

Advocates of ICIDH-2 hope that psychologists' reimbursement will some day be tied to the system. Indeed, say officials in APA's Practice Directorate, the ICIDH-2 "may support third-party reimbursement for psychology services not currently covered under medical diagnosis."

Donald Kewman, PhD, a rehabilitation psychologist at the University of Michigan, said in his Aug. 23 presentation that the ICIDH offers hope of freeing psychologists from "haggling with someone who has not been trained in our areas to try to justify what we have been trained to do and what the patient deserves."Y

The "Beta-2 Draft" of ICIDH-2 and information about it are on the WHO web site at www.who.int/ICIDH.

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