Case #724

WHO emergency code U07.3 and U07.4

Added by Ralph Dahlgren 6 months ago. Updated 3 months ago.

Status:ActiveStart date:2020-09-03
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:-
Initiator:Finland Target year:2022
MDC:GEN Owner / responsible:National organisations
Target Grouper:FIN Old forum status:

Description

2020-09-03 Ralph D
WHO have decided on activating two more emergency codes in the U07X area. This due to COVID-19. These codes are:
U07.3 Personal history of COVID-19
U07.4 for Multisystem inflammatory syndrome temporally related to COVID-19
These codes has to be implemented, if wanted naturally, to the different countries NordDRG system.
WHO has written as follow below in a paper:

Background
Following rounds of discussions with the CSAC (Classification and Statistics Advisory Committee), MbRG (Morbidity Reference Group) and MRG (Mortality Reference Group) and comments received, it is agreed to activate two more emergency codes for use in the context of COVID-19. The relevant updates apply to ICD-10 and ICD-11 equally.
1. U07.3 Personal history of COVID-19 This optional code serves to flag various signs, symptoms, conditions or syndromes clinically described and where a preceding diagnosis.
While there is still uncertainty of the pathophysiological relationships this code will allow the establishment of a link with COVID-19 without making assumptions about a direct relationship to it.
When using this code there are no time limitations to what a ‘history of’ is, it can be used for conditions that occur briefly after or long after COVID-19 episodes. In this way, the coding can be improved when more is known about the course of the disease.
2. U07.4 for Multisystem inflammatory syndrome temporally related to COVID-19. This code relates specifically to the more clearly defined multisystem inflammatory syndrome.

New proposed codes:
Activate emergency code for Personal history of COVID-19

1. Emergency code: U07.3
2. Title: Personal history of COVID-19
3. Description: Optional additional code used to flag cases where the mention of a preceding diagnosis of COVID-19, confirmed or probable (see case definitions) is
seen to be relevant in the context of the current condition.
Coding note: This code is only used after full recovery from COVID-19. This code is not to be used in cases tested positive at some point in time that did not
present any illness.

Activate emergency code for Multisystem Inflammatory Syndrome

1. Emergency code: U07.4
2. Title: Multisystem inflammatory syndrome.
3. Inclusion terms: Cytokine storm
Kawasaki-like syndrome
Paediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 (PIMS-TS)
Multi-System Inflammatory Syndrome in Children (MIS-C)
4. Exclusion terms: Mucocutaneous lymph node syndrome [Kawasaki] (M30.3)
As noted above, these codes might get different code-texts in the end.

Analysis
Department of Health and Welfare Sweden 2020-09-03
At least Sweden has no complete data on how often the two new codes will be used.
As known for now we know U07.3 Personal history of COVID-19 probably will be used much more frequent than U07.4 Multisystem inflammatory syndrome.
As many of you know Sweden has had a lot of patients in the hospital being treated for Covid-19 (SARS-CoV-2).
Very few has gotten that very serious U07.4 Multisystem inflammatory syndrome.
This means naturally that as for now Sweden at least has no cost-data concerning these two codes, has someone else?
We still think that they should get grouping properties so they can be used in our NordDRG system.
We have discussed with the Nordic Casemix Centre and we offered to make suggestions to be discussed at the meeting 2020-09-04.

Suggestion
Department of Health and Welfare Sweden 2020-09-03
Our suggestion is that the code
U07.3 Personal history of COVID-19 gets the same grouping properties as the ICD+ code Z8610 Personal history of infectious and parasitic diseases:
DGCAT 23M99 Other factors influencing health status
MDC 23 Andra och ospecificerade hälsoproblem

U07.4 Multisystem inflammatory syndrome gets the same grouping properties as the ICD+ code M3030 Mucocutaneous lymph node syndrome [Kawasaki] except PDGPRO 08P10 Arthrosis, arthritis or other connective tissue, since this is not really a typical connective tissue disease. The grouping properties would then be:
COMPL 08C02 Arteritis in connective tissue disease
DGCAT 08M23 Vasculitis or systemic connective tissue disease
DGPROP 08X99 Diseases and disorders of the musculoskeletal system and connective tissue
DGPROP 15X98 Other significant problem of neonate
MDC 08 Diseases and disorders of the musculoskeletal system and connective tissue

This above are suggestions to be discussed at the Expertmeeting 2020-09-04

Decided changes
Department of Health and Welfare Sweden 2020-09-03
Sweden wants a discussion around these codes so if possible all involved countries can in the future have the same grouping properties.
Sweden will as it looks right now include the new U07.3, U07.4 in our NordDRG system for 2021.

DRG change
There will be no movement of cases between DRG Groups, the codes are new. The cases that will be coded with the codes will be grouped to different DRGs.
When cost data comes to Sweden, in 2021 we can control if they are correctly grouped.

Technical change
For technical description see above.
Suggestion for technical changes has been made, see included Excell-file named ‘Suggested TC for U073 and U074 C855’. Correction might have to be done after the meeting.

Suggested TC for U073 and U074 C855.xlsx (17.8 KB) Ralph Dahlgren, 2020-09-03 14:59

Post-covid activation of three codes.docx (34 KB) Martti Virtanen, 2020-09-08 15:29

Adding post COVID-19 codes in ICD-10.docx (18 KB) Martti Virtanen, 2020-09-17 10:11

Grupperingsegenskaper för nya koder för Covid, nya WHO U-koder 2020-10-15.xlsx (45.9 KB) Ralph Dahlgren, 2020-10-16 08:29

Technical_Changes_Ticket_#724_10122020.xlsx (11 KB) Kristiina Kahur, 2020-12-10 12:19

History

#1 Updated by Martti Virtanen 6 months ago

2020-09-04 Expert group
The topic was dicscussed and it was pointed out thet the proposal is only available as a draft from WHO. However, some solution will come, and the countries may consider to use the is proposal for time beeing.

#2 Updated by Martti Virtanen 6 months ago

2020-09-08 Martti Virtanen
The latest proposal from WHO is attached. There will still be modifications.
Countries may decide to use the U07.x codes and link them later to the WHO codes. Nordcase will any way link the codes the WHO codes.

#3 Updated by Martti Virtanen 6 months ago

2020-09-16 Expert group
The matter was shortly dicsussed.
We will add the new codes proposed by WHO using the U07 subcodes to ICD+. This allows the countries to introduce the new codes if necesary already during this autumn. Before publication of NordDRG 2020 the new codes can easily be added to the national version. The codes may also differ from the codes we are now using as long as the concepts are roughly the same.
After the publication of the 2021 groupers any changes obviously mean that the distributed groupers need to be updated.
The added concepts and codes are:
U0710 'COVID-19, virus identified'
U0720 'COVID-19, virus not identified'
U0730 'Personal history of COVID-19'
U0740 'Post COVID-19 condition'
U0750 'Multisystem inflammatory syndrome associated with COVID-19'
If WHO decides to use 3 chracter codes instead of U0730 to U0750, NCC wil consider changing the ICD+ codes accorgingly. Thr problems can be solve by linkage.
Alread Iceland has sent us the new codes for Iceland The include U07.4 with the concept of U07.5. Therefore the reserve code u07.5 is effectively made un uspable and it has been rmoved from the ICD+ for Iceland.

#4 Updated by Martti Virtanen 6 months ago

2020-09-17 Martti Virtanen
I got today a latest version of the added covid-19 realated codes. See attached file Adding post COVID-19 codes in ICD-10.docx

#5 Updated by Ralph Dahlgren 5 months ago

2020-10-16 Ralph Dahlgren
The file that Martti put up in this case turned out to be the correct codes from WHO.
Sweden has now gotten the codes with Swedish texts from our co-workers.
So now we enclose the swedsih codes with grouping properties that Sweden wants to be included in the Swedish definitiontables for 2021. This file only includes the WHO codes. Sorry for beeing so late.

#6 Updated by Arna Harðardóttir 4 months ago

  • Target Grouper ICE added
  • Initiator Iceland added

Martti Virtanen wrote:

2020-09-17 Martti Virtanen
I got today the latest version of the added covid-19 realated codes. See attached file Adding post COVID-19 codes in ICD-10.docx

Martti will you then exchange these new codes from WHO with the older ones (U07.3 and U07.4) in the national ICD versions? Iceland has this new version in its EMR.

#7 Updated by Martti Virtanen 4 months ago

2020-11-05 Casemix Centre MV
The ICD+ is now changed according to the latest version of WHO ICD-10. The covid-19 codes are
U0710 COVID-19, virus identified
U0720 COVID-19, virus not identified
U0890 Personal history of COVID-19, unspecified (instead of U0740)
U0990 Post COVID-19 condition, unspecified (instead of U0750)
U1090 Multisystem inflammatory syndrome associated with COVID-19, unspecified (instead of U0760).

The national version of ICD may use the U07 codes or the U07-U10 codes as preferred nationally. You only need to inform us.

Finland is only using U071 and U072 codes
Estonia is not using any of these codes.
For Iceland I understand that U071, U072, U089, U099 and U109 will be used. The Icelandic text are also available and they are used in ICD+.
For Latvia (case #711) I also understand that U071, U072, U089, U099 and U109 will be used. Since Latvian text is not available, the codes are now added with english text. Text will corrected as soon as we get the Latvian text.
Norway has not activated any of these codes.
Sweden has previous created codes:
U071 Covid-19, virus påvisat (COVID-19, virus identified)
U072 Covid-19, virus ej påvisat (COVID-19, virus not identified)
Z861A Covid-19 i den egna sjukhistorien (PPersonal history of COVID-19)

U071 and U072 are linked correctly to U0710 and U0720. Z861A is the same as the new WHO code U089. Therefore although Z861A is subtituted with U089 'Covid-19 i den egna sjukhistorien' linked to U0890. Z861A is removed from ICD+.
U099 'Covid-19 i den egna sjukhistorien' is added to Swe version linked to U0990
U109 'Multisystemiskt inflammatoriskt syndrom associerat med covid-19' is added to Swe version linked to U10990

Properties are given in NDMS as proposed by Sweden.

All emergency codes in the U-chapter that do not have any specific content are linked to U1990 'Code for future use'. ICD+ will have only this one code that will have DGCAT 99M01 'New unspecified diagnosis' and MDC 99 'Unspecific or erroneous information'

When an emergency code is taken in use they are automatically accepted by the NordDRG but will not have properties for any specific purpose. Thus there must be a separate method to deal with these cases at hospital reimbursement system or it is recommended that these codes (linked to U1990) are only used as secondary dx.

#8 Updated by Kristīne Putniņa 4 months ago

The names for new U codes in Latvian:
U08 Covid-19 anamnēzē

U08.9 Covid-19 anamnēzē, bez precizējuma
U09 Stāvoklis pēc pārslimota Covid-19
U09.9 Stāvoklis pēc pārslimota Covid-19, bez precizējuma
U10 Ar Covid-19 saistīts daudzsistēmu iekaisuma sindroms
U10.9 Ar Covid-19 saistīts daudzsistēmu iekaisuma sindroms, bez precizējuma

#9 Updated by Malle Avarsoo 4 months ago

  • Target Grouper EST added
  • Initiator Nordic Casemix Centre added

Martti!
Please be aware, that Estonia has implemented both these codes:U071 and U072 .
Your last comment "Estonia is not using any of these codes " is not true.

#10 Updated by Kristiina Kahur 4 months ago

  • Target year 2022 added

Nordic Casemix Centre/Kristiina Kahur 12-11-2020

Thank you for feedback and clarifications.
This ticket remains open until Expert Group meeting in Spring 2021 in case there will be changes in national version regarding Covid-19 related codes and properties.

#11 Updated by Elina Hermiö 3 months ago

  • Target Grouper FIN added
  • Initiator Finland added

The Finnish ICD10 classification has been updated with three new covid-19 codes U089, U099 and U10.9.

Finland would like to implement these codes to the Finnish version for 2021 grouper.
The properties given already for the Swedish, Icelandic and Latvian covid-19 codes could be used in Finland too.

The Finnish and English names for the following covid-codes

U08 Aiemmin sairastettu COVID-19-virusinfektio; Personal history of COVID-19
U08.9 Aiemmin sairastettu COVID-19-virusinfektio, tarkemmin määrittelemätön; Personal history of COVID-19, unspecified
U09 COVID-19-virusinfektion jälkitila; Post COVID-19 condition
U09.9 COVID-19-virusinfektion jälkitila, tarkemmin määrittelemätön; Post COVID-19 condition, unspecified
U10 COVID-19-virusinfektioon liittyvä usean elinjärjestelmän tulehduksellinen oireyhtymä; Multisystem inflammatory syndrome associated with COVID-19
U10.9 COVID-19-virusinfektioon liittyvä usean elinjärjestelmän tulehduksellinen oireyhtymä, tarkemmin määrittelemätön;Multisystem inflammatory syndrome associated with COVID-19, unspecified

#12 Updated by Kristiina Kahur 3 months ago

Nordic Casemix Centre/Kristiina Kahur 10-12-2020

The required changes have been made in Finnish 2021 tables.
The updated Finnish 2021 tables will be delivered via ticket #709.

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