Health care procedures.

Background: ICD is used for coding medical diagnoses across the world, but there is no globally accepted coding system for health care procedures. The need for the introduction of a common international medical procedure classification has been addressed by the Australian NCCH, which proposed the International Classification of Health Interventions (ICHI) as the basis of an international procedure classification. In parallel, the French multiaxial Classification Commune des Actes Médicaux (CCAM) has been established.

Objectives: The aim is to compare ICHI to the CCAM architecture and to assess their appropriateness for supporting international comparability of procedure data and give a recommendation for the further development of international procedure classifications.

Methods: The architecture of both ICHI and CCAM was thoroughly analyzed. ICHI classes were mapped to the classes of the multiaxial CCAM basic coding tables. This was done manually by domain experts, which analyzed the exact wording of each ICHI title. The result was assessed in terms of representability and granularity.

Results: 78.4% of ICHI classes could be mapped directly to CCAM. The anatomical site could be represented in 99.3%. Numerous ICHI classes combined anatomical sites requiring more than one CCAM code. Problems arouse due to imprecise ICHI descriptions.

Conclusions: CCAM appeared as the more elaborate and mature system whereas ICHI had some drawback regarding ambiguity and varying granularity. It is recommended to improve the structure of ICHI by the beneficial aspects of the CCAM and to avoid semantic ambiguities by applying ontological principles and logic-based representation languages.