Using the International Classification of Functioning, Disability and Health in Social Work Settings

Functional status information has become increasingly important in health care policy and health care systems. As indicated by the National Committee on Vital and Health Statistics (NCVHS) (2001), "achieving optimal health and well-being for Americans requires an understanding across the life span of the effects of people's health conditions on their ability to do basic activities and participate in life situations--in other words, their functional status" (p. 1). There is a need to track functional status information within and across health settings to facilitate greater understanding of the impact of health conditions as well as improved clinical treatment and services. Unfortunately, systematic performance information is not available regarding the health care system across patient populations and delivery settings to improve the health and functioning of individuals (Iezzoni & Greenberg, 2003). The International Classification of Functioning, Disability and Health, or ICE has been recommended by the NCVHS (2001) as the only viable candidate for coding functional status information. As the complementary classification to the ICD, or International Statistical Classification of Diseases and Related Health Problems, which classifies diagnosis information (World Health Organization [WHO], 1990), the ICF can provide important functional status data beyond diagnosis (Ustun, Chatterji, Kostanjsek, & Bickenbach, 2003). Specifically, the ICF classification and codes enable clinicians to describe the functional status of individuals with any given diagnosis, to compare functional status between individuals with the same diagnosis, and to track functional outcomes of any given individual at different encounters during the treatment process (hospital intake, hospital discharge, postdischarge). In fact, the ICF's structure and content facilitates the ability of clinicians to identify and track the effectiveness of health-related interventions. The ICF allows professionals "to compare functional levels before and after intentions designed to increase the client's functional capacities in specified domains" (Ustun, Chatterji, Bickenbach, Kostanjsek, & Schneider, 2003, p. 567). Moreover, the ICF contains a section of environmental factors, which permits professionals to determine aspects in a client's environment that affect his or her functioning and to monitor interventions that may involve environmental changes. Clinical health professionals, including social workers, collect functional status information in various settings. There are numerous "place of service codes" or locations where services are rendered (Centers for Medicare and Medicaid Services, 2010). A significant portion of these places where social workers practice include health care settings, such as inpatient and outpatient hospitals, skilled-nursing facilities, assisted-living facilities, custodial care settings, substance abuse treatment facilities, psychiatric facilities, military treatment facilities, group homes, and private offices (Coleman, 2004). Because social workers use place of service codes as well as other code sets--including the ICD-CM, or Clinical Modification (U.S. Department of Health and Human Services, 2010), and the CPT, or current procedural technology (American Medical Association,2009) codes--it is important that social workers become familiar with the ICF classification and code set as well as its potential application in clinical health practice (Saleeby, 2004, 2007). BACKGROUND AND SIGNIFICANCE TO HEALTH AND SOCIAL WORK The ICF is considered both a health-related classification and a standardized framework for describing health (WHO, 2001). It is designed for multiple uses across disciplines, and it is applicable across age groups, cultures, and gender. As the complementary classification to the ICD, considered the international standard diagnostic classification, the ICF provides valuable information by describing functioning and disability associated with diagnosed health conditions. …