Telemedicine,Telestroke,and Artificial Intelligence Can Be Coded with the International Classification of Health Interventions

In 2016–2017, an international collaboration between the National Centre for Classification in Health in Australia and several academic teams from France conducted a review of the International Classification of Health Interventions (ICHI) Alpha 2016 version concerning the coding of acute stroke care including telestroke. Telestroke is the provision of acute stroke care through telemedicine. The study found that it was possible to use ICHI to code interventions involved in the acute stroke care process, but highlighted the lack of appropriate coding for telestroke. ¹ It was suggested to add telemedicine to the next version of ICHI.

Different propositions were made to cover this gap and discussed during the Family Development Committee (FDC) midyear meeting held in South Africa in June 2017. It was decided during this meeting to include two extension codes for telehealth. A third extension code was also added later. An extension code in ICHI is used to describe additional information about an intervention and may be used with any ICHI intervention code to which it is applicable.

The beta version of ICHI was released in October 2017, containing >7,000 codes, followed by a Beta-2 in 2018. ^2,3 For the first time, ICHI included dedicated codes for telehealth (including telemedicine). The extension codes defined were XH01, XH02, and XH03. The code XH01 can be used for an intervention “…performed with advice or assistance provided from a distant location” and “should be recorded at the health care facility where the individual receiving the intervention is located.” The code XHO2 can be used for an intervention provided to a person or people in a distant location, and “…should be recorded at the health care facility where the provider is located.” The ICHI guidelines state that:

Where an intervention is provided to a recipient(s) in a distant location, and there is a health care provider co-located with the recipient(s) who is also involved in provision of the intervention, the intervention may be recorded at both locations (e.g., two different hospitals). In such a case extension code XH02 must be used at the location that is distant from the recipient. This provides a mechanism to prevent double counting of the intervention when information across locations is aggregated.

The code XH03 is to be used for “Interventions delivered via technology, without direct involvement of a human provider,” and could include telehealth interventions relying only on artificial intelligence such as automated diabetic retinopathy screening.

Telestroke interventions can thus be coded with ICHI Beta-2 version 2018 telehealth extension codes. As given in Table 1, the neurological assessment can be conducted by the emergency doctor with the support of a remote neurologist (code XH01 by emergency doctor, and XH02 by remote neurologist), or only by the remote neurologist (code AZZ.AA.ZZ and XH02). The radiological examination (in this example CT with intravenous contrast), conducted by the radiographer with support from a remote radiologist, should be coded AAA.BA.BD and XH01 by the radiographer and AAA.BA.BD and XH02 by the radiologist. The thrombolysis performed by the emergency doctor with support from a remote neurologist should be coded IAA.DB.AF and XH01 by the emergency doctor and IAA.DB.AF and XH02 by the remote neurologist.

Enhancing ICHI by adding extension codes for telehealth interventions is a step forward to better describe the reality of health care today and tomorrow across the world.