Representation and differentiation of audiology interventions within the international classification of health interventions
Alida Naudé, Amisha Kanji, Faheema Mahomed-Asmail, Kutloano Mtimkulu, Sakhile NkosiBackground:
Standardised intervention coding supports service visibility, reimbursement, resource planning and health-system analytics. The International Classification of Health Interventions (ICHIs) provides a standardised framework for representing health interventions, but its ability to capture the breadth and clinical specificity of contemporary audiology practice requires evaluation.
Objective:
To evaluate the extent to which contemporary audiology interventions can be represented and differentiated within ICHI and identify limitations in coding granularity that may affect health information management, service reporting and reimbursement.
Method:
An inventory of audiology interventions was derived from historical and current South African tariff schedules, scope-of-practice documents, university curricula and contemporary clinical practice. A total of 105 interventions spanning hearing and vestibular assessment, electrophysiology, device-related procedures, and counselling and rehabilitation were independently mapped to ICHI using a structured coding rubric aligned with the Target–Action–Means framework. Interrater agreement was calculated for a predefined subset.
Results:
All included interventions could be represented within ICHI. Most (92.3%) demonstrated direct one-to-one alignment with an ICHI stem code. The remainder required approximate (‘best-fit’), postcoordination, or composite coding using multiple descriptors and/or extension codes. Clinically distinct interventions frequently converged under identical stems, particularly within rehabilitation, counselling, device management and tele-audiology. This convergence reduced coding granularity and differentiation of clinical intent, service complexity and resource utilisation.
Conclusion:
ICHI provides broad structural coverage of contemporary audiology interventions; however, limited granularity constrains its utility for detailed health-system reporting, reimbursement modelling and service evaluation. Greater differentiation within rehabilitation- and technology-related categories is warranted to better represent contemporary audiology practice and support person-centred ear and hearing care within universal health coverage frameworks.
Implications for health information management practice:
High-level ICHI stems may obscure clinically meaningful variation in audiology services, reducing data precision for funding, workload measurement, service evaluation and national reporting. Implementation guidance and standardised composite coding protocols may improve specificity where existing stems are insufficient. Identified classification gaps may inform formal submissions to the World Health Organisation Family of International Classifications Network. Improved specificity could strengthen interoperability, secondary data analytics, reimbursement modelling, and evidence-based hearing-care planning.