When using code H35. Presumed ocular histoplasmosis syndrome (POHS) occurs secondary to infection with the yeast form of Histoplasma capsulatum. 819 may differ. In conclusion, eyes manifesting neovascular activity by sub-retinal fluid only in a treat & extend anti-VEGF regimen for neovascular AMD seem to exhibit rather low rates of long-term atrophy and. 359 became effective on October 1, 2023. 3210 - H35. Upon examination, her visual acuity decreased to 20/40 in the right eye (OD) and 20/50 in the left eye (OS). ICD-10-CM Code. Knowing the type present in the patient will help you narrow down to the right AMD ICD-10 code. 5- is more specific. 4 became effective on October 1, 2023. A comparison of the new terms with older terms developed during the fluorescein angiography era is shown in Table 2. Purpose: To describe the clinical and multimodal imaging (MMI) features of age-related macular degeneration (AMD) eyes presenting with intraretinal exudation and no evidence of neovascularization or structural alterations of native retinal vessels. The human eye is a wondrous, and wondrously complex, device. It is found in the 2022 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2021 - Sep 30, 2022 . The bottom line: While PCV presents similarly to wet AMD, an early differential diagnosis can save vision. ICD-10 codes not covered for indications listed in the CPB: H35. One hundred fifty-three (83%) eyes had type 1, 19 (10%) eyes had type 2, and 12 (7%. Recent advancements in multimodal ophthalmic imaging,. Risk factors such as age, race,. 3223 is a valid billable ICD-10 diagnosis code for Exudative age-related macular degeneration, left eye, with inactive scar . The incidence of exudation in these eyes ranged from 20% to 80% (over 6 months to 2 years of follow-up). Key: Red numerals (6th position) indicate laterality; green numerals (7th position) indicate staging. Retinal hemorrhage, right eye. 1. Wet (exudative) AMD, with active choroidal neovascularization H35. 3210 contain annotation back-references. 219 - other international versions of ICD-10 H26. H35. 16 should only be used for claims with a date of service on or before September 30, 2015. Although 85% of AMD is dry, 80 to 90% of severe vision loss caused by AMD results from the wet type. 1 - other international versions of ICD-10 H21. Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in people over the age of 50 worldwide []. Although neovascular AMD (nAMD) accounts for only 10% of AMD patients, the majority of severe vision loss associated with AMD is due to nAMD. Right purtscher retinopathy (eye condition) Right retinal nerve fiber layer myelinated. The 2024 edition of ICD-10-CM became effective on October 1, 2023. Age-related macular degeneration (AMD) is a leading cause of degenerative vision loss in elder individuals [1,2,3]. , Fremont, CA) is an epiretinal radiation delivery device developed to treat wet ARMD. There are various cytokine pathways involved in the formation and leakage from CNV. 4, 5 Although neovascular AMD (nAMD) can be successfully treated with VEGF inhibitors, the treatment of GA remains a substantially. 3210 is applicable to adult patients aged 15 - 124 years inclusive. Funduscopy, infrared (IR, 830 nm), and optical coherence tomography (OCT) images of patients with a normal fundus (a–c), intermediate AMD (d–f), late stage non-exudative AMD (g–i, geographic atrophy, GA), and neovascular, exudative AMD (j–l). 3231. Vascular endothelial growth factor (VEGF) is a key. AMD, and especially nAMD, is the main cause of visual impairment and blindness in developed countries [Citation 2, Citation 5,. ICD-9-CM 362. Age-related macular degeneration (AMD) is a leading cause of blindness in elderly people, primarily due to the macular neovascularisation (MNV) and atrophy that can occur during the disease [1, 2Age-related macular degeneration: Extrafoveal neovascular lesions. ]. Eye (Lond). 3233 may differ. Retinal neovascularization, unspecified, left eye. 9% (17 of 874) in the combined group of patients treated with 0. Neovascular AMD is characterized by choroidal neovascularization (CNV. 50 - other international versions of ICD-10 C72. Choroidal degeneration, unspecified, left eye. Rubeosis iridis. Funduscopy ( a ) and fluorescein angiography ( b early phase, c late phase) at baseline indicate risk factors for the development of subretinal fibrosis, including blocked fluorescence. 05 contain annotation back-references that may be applicable to H35. H35. This is the American ICD-10-CM version of D31. The following code(s) above H35. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code H35. 61 became effective on October 1, 2023. 34 Multiple randomized clinical trials have demonstrated that intravitreal injections of anti-VEGF agents to treat choroidal neovascularization in neovascular AMD reduced the risk of moderate vision loss (≥ 15 letters = ≥ 3 lines on a standardized eye chart) to less than 10% over a 24-month period, compared to about 50% in the control group. Signs of neovascular activity include retinal haemorrhage, retinal leakage on fundus fluorescein angiography (FFA), hyperfluorescent vascular network on indocyanine green angiography (ICGA. About 85% of people with AMD have only dry AMD. This is the American ICD-10-CM version of H35. 50 may differ. ICD-10 code H44. 329 may differ. 50 may differ. 879 - other international versions of ICD-10 H02. The prevalence of non-neovascular AMD (SRF without neovascularization) is not known as current knowledge has been based only on case reports [8,9,10]. ” Technically, this is called CNV or choroidal (core-oyd-al) neovascularization (nee-oh-vas-kyoo-lar-eye-zay-shun). This condition may respond to treatment, while being incurable. 212 - other international versions of ICD-10 H26. H25. 7% of all blindness worldwide 1. 3120 may differ. In patients with neovascular AMD, early detection and prompt treatment improves the visual outcome. Short description: Retinal neovascular NOS. 9 may differ. The prevalence of subclinical non-exudative neovascular AMD in the fellow eyes of patients with unilateral exudative AMD ranged from 6. The following are the ICD-10 diagnostic codes for various forms of AMD: AMD (ICD 10 macular degeneration) Coding for Laterality You must use the sixth character to indicate laterality when using ICD 10 codes for macular degeneration, dry AMD (H35. 359, E09. Age-related macular degeneration is a potentially progressive maculopathy. AMD is a prevalent condition that constitutes one of the leading causes of irreversible visual impairment in industrialized countries. ICD-10 codes covered if selection criteria are met: H35. All neoplasms are classified in this chapter. 31xx), and wet AMD (H35. H35. H35. 30: Unspecified macular degeneration [age-related] H35. Randomized trial of treat-and-extend versus monthly dosing for neovascular age-related macular degeneration: 2-year results of the TREX-AMD study. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are an effective means to treat nAMD and reduce its impact on vision compared to either sham treatment or photodynamic therapy. Purpose: To describe the clinical and multimodal imaging (MMI) features of age-related macular degeneration (AMD) eyes presenting with intraretinal exudation and no evidence of neovascularization or structural alterations of native retinal vessels. 3223 contain annotation back-references. Retinal pigment epithelial detachment (PED) is defined as a separation of the retinal pigment epithelium (RPE) from the inner collagenous layer of Bruch’s membrane. 121 - other international versions of ICD-10 D22. 84) was added and should be used when. D22. Photocoagulation destroying the invading vascular membrane usually leaves a chorioretinal scar, and a blind spot or scotoma, but. 31), waist to hip ratio (HR per 0. Source ICD-10-CM Code Target ICD-9-CM Code; H35. H00-H59. Neovascular age-related macular degeneration (nAMD) is among the main causes of visual impairment worldwide. Results: Treatment goals for neovascular age-related macular degeneration include improving/maintaining vision by drying the retina, and several analyses have evaluated the relationship between visual. Key Points. 61 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. A Yes. 3110, H35. 1 About 10% of patients with dry AMD will develop subretinal or choroidal neovascular. Wet (exudative) AMD, with active choroidal neovascularization H35. In the United States, AMD occurs in 10% of the population aged between 65 and 74 years and in 25% of population with more than 74 years. Neovascular age-related macular degeneration (nAMD) is a common world-wide cause of visual loss. Approximately 10-15% of the cases of macular degeneration are the “wet” (exudative) type. B. This is the American ICD-10-CM version of H35. 2A9 may differ. H40. Multimodal imaging of a patient with neovascular AMD showing evidence for macular neovascularisation and submacular fibrosis. 11). 3111, H35. 7%. Another study evaluated reduced-fluence PDT in combination with dexamethasone and bevacizumab for choroidal neovascularization secondary to AMD. Clinical Features: The distinguishing feature is the presence of choroidal neovascularization (CNV) in the. It is a common manifestation in both dry and wet types of age-related macular degeneration. 311-E10. The 2024 edition of ICD-10-CM H26. 2 The disorder results from a gradual breakdown of the retinal pigment epithelium (RPE), theRegarding neovascular AMD, a reduction in choriocapillaris blood flow has also been reported . 5%. by 2050. A subretinal hemorrhage in the setting of untreated or undertreated choroidal neovascular membranes (CNVMs) can be a devastating consequence leading to irreversible vision loss. The first 10‐year outcomes data on VEGF inhibitors for nAMD were published using data from the FRB! registry in 2020. The prevalence of GA goes up with age and it is slightly less than that of neovascular AMD. H26. Neovascular AMD . Download PDF. ICD-10-CM Coding Rules. Age-related macular degeneration (AMD) remains a disease with high morbidity and an incompletely understood pathophysiological mechanism. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are an effective means to treat nAMD and reduce its impact on vision compared to either sham treatment or photodynamic therapy. Currently, the approved. Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. 5% in patients older than 75. Choroidal neovascular membranes (CNVM) are new, damaging blood vessels that grow beneath the retina. This is the American ICD-10-CM version of H35. 051 - other international versions of ICD-10 H35. ICD 10 code for Nonexudative age-related macular degeneration,. If you look at 365. Age-related macular degeneration (AMD) is one of the most common causes of vision loss. 342 became effective on October 1, 2023. wet AMD mean? All patients with AMD begin with the non-neovascular, or dry, form. The 2024 edition of ICD-10-CM C72. According to Jung et al. 9 - other international versions of ICD-10 M31. Choroidal neovascularization (CNV) is the hallmark of 'wet' or 'exudative' AMD, and is responsible for approximately 90% of cases of severe vision loss due to AMD. 051 may differ. 1 million adults age 50 years and older in the US had AMD. 309 - other international versions of ICD-10 H33. The AMD population is expected to be 288 million by 2040 [3, 4]. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10. All neoplasms are classified in this chapter. 359, E10. The disease is characterized by atrophic chorioretinal scars, peripapillary atrophy (PPA) , and the absence of vitritis. glaucoma of right eye; Aphakic glaucoma, both eyes; Bilateral glaucoma assoc w other anterior segment anomaly;. Neovascular age-related macular degeneration (exudative or wet AMD) is a prevalent, progressive retinal degenerative macular disease. Patients who present with submacular hemorrhage often have profound vision loss, which can be permanent owing to the toxic effects of heme on the photoreceptors and retinal pigment epithelium. DiseasesDB. Initiation of antiangiogenic treatment halted their growth. In absence of a consensus definition, broadly. 25% to 27%. The CNVM can leak fluid and blood and,. 89 is grouped within Diagnostic Related Group (s) (MS-DRG v41. Methods: A literature review of anatomical measures of disease activity was conducted. ICD-10-CM Coding Rules. The risk of late AMD, including nAMD and geographic atrophy, increases exponentially in advanced age. 50 became effective on October 1, 2023. 30 - other international versions of ICD-10 D31. 29 may differ. Ophthalmologists at UC Davis Health used an experimental gene therapy last month to treat a patient with wet age-related macular degeneration, or wet AMD. 3223 contain annotation back-references. Applicable To. In 10 – 15% of patients with dry AMD, the disease converts to the wet form, which is also an advanced form of AMD. Wiki Neovascular ARMD icd 10. The risk of late AMD, including nAMD and geographic atrophy, increases exponentially in advanced age. 2A1 [convert to ICD-9-CM] Degenerative myopia with choroidal neovascularization, right eye. 389: Degeneration of macula and posterior pole. The final changes were posted on the CDC website on August 22, 2016. 1. 1X9 became effective on October 1, 2023. 101 became effective on October 1, 2023. The following code (s) above H35. The 2024 edition of ICD-10-CM H34. 323 - other international versions of ICD-10 H35. Patients receiving SYFOVRE should be monitored for signs of neovascular AMD. Neovascular AMD is characterized by choroidal neovascularization (CNV), which leads to a cascade of complications, including. 2 Another study showed prevalence of exudative AMD in the population older than 52 years to be 1. 819 - other international versions of ICD-10 H43. The management of neovascular age-related macular degeneration (nAMD) has taken a major stride forward with the advent of anti-VEGF agents. Patients with neovascular AMD in one eye have a 4 – 12% per year cumulative risk of developing neovascular AMD in the fellow eye. This is the American ICD-10-CM version of H40. . 3. CNV is diagnosed by an eye specialist, an ophthalmologist, who. Put the anti-VEGF medicine into your eye with a very small needle. Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in people over the age of 50 worldwide. Myopic Macular Degeneration. It can be painless, but can lead to macular degeneration, a major cause of vision loss. Kyoko Ohno-Matsui,. When FA and OCT are combined, type 1 and type 3 neovascular membranes are the most frequent subtypes of neovascular AMD, accounting for about 40% and 34% of instances, respectively. Age-related macular degeneration (AMD) is the most common cause of CNV in the elderly 2. 879 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 052 became effective on October 1, 2023. The following code(s) above H35. The 2024 edition of ICD-10-CM D22. The 2024 edition of ICD-10-CM H31. H35. Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years of age, accounting for 8. EYENET MAGAZINE • 61 Table 2: Wet Age-Related Macular Degeneration (AMD) Right Eye Left Eye Bilateral. To compare the change in lesion area over 4 years of follow-up in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents. The ICD-10 codes for age-related macular degeneration (AMD) involve both laterality and staging. Neovascular AMD comprises 10% of all cases and can lead to devastating visual loss due to choroidal neovascularization (CNV). Neovascular ARMD icd 10's Wiki. The implication of vascular endothelial growth factor (VEGF) in the pathogen-esis of nAMD and the introduction of. Results Consensus Definitions. 2. Neovascular or “wet” AMD (nAMD), characterized by macular neovascularization, intra- or subretinal exudation and hemorrhage,. 32 may differ. This is the American ICD-10-CM version of H33. The prevalence of. The ICD-10 codes for age-related macular degeneration (AMD) involve both laterality and staging. In addition to code changes, some tabular instructions were revised to provide. In March 2016, the Centers for Disease Control released proposed ICD-10 changes for October 1, 2016. AMD is more common among White people and is the leading cause of permanent vision loss in older adults. This is the American ICD-10-CM version of H35. Short description: Exudative age-rel mclr degn, right eye, with inactive scar The 2024 edition of ICD-10-CM H35. 52X0 - other international versions of ICD-10 H40. It’s caused by the growth of abnormal blood vessels between the iris and the cornea. 1 became effective on October 1, 2023. Abstract. Introduction. This is the American ICD-10-CM version of H40. 9 letters. The Epi-Rad90 Ophthalmic System™ (NeoVista, Inc. 25% to 27%. 1-3 It is estimated that approximately half of all causes of severe vision loss (20/200 or worse) in US individuals living over the age of 40 are. Although these lesions were not associated with a significant decrease in visual acuity, the presence of non-exudative MNV seems to be an important predictor of exudative disease. Wet or neovascular AMD (nAMD) is characterised by choroidal neovascularization (CNV), resulting in macular haemorrhage, effusion and fibrosis . In early AMD, there is usually no vision loss, and there are small or few medium-sized drusen, which are about the thickness of a human hair. The 2024 edition of ICD-10-CM H35. 61 - other international versions of ICD-10 H35. Neovascular glaucoma is an aggressive form of secondary glaucoma. While healthy. 3233 became effective on October 1, 2023. The 2024 edition of ICD-10-CM H35. Your eye doctor will then use a special. doi: 10. 3) or a claim for intravitreal injection [Classification Commune des Actes Médicaux (CCAM) procedure code BGLB001] (Figure 1, Step 1). 3211 H35. Fundus photo and fluorescein angiogram of a classic choroidal neovascular membrane in exudative age-related macular degeneration. 3120 is applicable to adult patients aged 15 - 124 years inclusive. Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in people over the age of 50 worldwide. 90 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Exdtve age-rel mclr degn, right eye, with inact chrdl neovas The 2024 edition of ICD-10-CM H35. The 2024 edition of ICD-10-CM C72. Early AMD. The following code (s) above D22. Ag e-related macular degeneration (AMD) is the third leading cause of blindness worldwide and the leading cause of legal blindness among people aged 65 years and older in the United States. 121 became effective on October 1, 2023. 90 became effective on October 1, 2023. In the wet, or exudative, form of age-related macular degeneration (AMD or ARMD), pathologic choroidal neovascular membranes (CNVM) develop under the retina. AMD is classified as either dry or wet (neovascular), and dry AMD may manifest as early, intermediate, or advanced disease. 212 may differ. H35. While the presence of subretinal fluid often prompts the initiation of intravitreal injections, there are some cases where treatment can be deferred as discussed. Referred to retina for same day evaluation and aflibercept injections. At the initial visit, 19 of the eyes had vision better than 20/200. From a clinical perspective, late-stage AMD can be classified atrophic and neovascular AMD. Rubeosis iridis. 10), and risk of late AMD among female non-smokers with increased with BMI (HR per 2. 729 Serous Detachment of Retinal Pigment Epithelium, unspecified eye. Primary open-angle glaucoma, left eye, moderate stage. Code H35. B. H33. Age-related macular degeneration (AMD) affects one in eight people 60 years of age or older and is the most common cause of irreversible blindness in older persons in developed countries. The 2024 edition of ICD-10-CM H43. This is the American ICD-10-CM version of H34. Aqueous humor gives the eye its shape and nutrients and controls intraocular. ICD-10 codes covered if selection criteria are met: H35. The non-neovascular advanced stage of dry atrophic AMD also known as geographic atrophy involves degeneration of the RPE, retina and the choriocapillaris with well-demarcated borders, resembling the map of a ‘continent’ (Figures 1F–J). Dietary supplements for AMD are widely discussed in the literature. Introduction. 5 mg ranibizumab compared with 1. Answer: The ICD-10-CM Quick Reference Guide for Glaucoma (page 4) includes that information. 1 VEGF inhibitors have revolutionized the management of common ocular diseases such as neovascular age-related macular degeneration (AMD), diabetic macular edema, and macular edema associated with retinal vein occlusion (RVO). Kokame. Randomized trial of treat-and-extend versus monthly dosing for neovascular age-related macular degeneration: 2-year results of the TREX-AMD study. 3222 contain annotation back-references. Macula. Purpose To describe the clinical and multimodal imaging (MMI) features of age-related macular degeneration (AMD) eyes presenting with intraretinal exudation and no evidence of neovascularization or structural alterations of native retinal vessels. In the eye, a healthy, intact retina is key to clear vision. Age-related macular degeneration (AMD) is one of the most common causes of vision loss. There may also be too many of them, even if they’re in the right place. 3223 - other international versions of ICD-10 H35. Geographic Atrophy* / therapy. In the wet form, rapid, severe vision loss can occur due to the development of. 90 may differ. Macular Degeneration is an eye disease that primarily affects the retina and destroys your sharp, central vision. Short description: Exudative age-rel mclr degn, bilateral, with inactive scar The 2024 edition of ICD-10-CM H35. Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in people over the age of 50 worldwide. 32 - other international versions of ICD-10 H35. 3223 may differ. 22 may differ. AimTo investigate the peripapillary and macular microvasculature in neovascular age-related macular degeneration (nAMD) in recently started versus long-term anti-vascular endothelial growth. The following code (s) above M31. 3212 became effective on October 1, 2023. 051 - H35. AMD is classified into two forms, a non-neovascular or “dry” form and a neovascular or “wet” form (Fig. POHS is asymptomatic until choroidal neovascularization (CNV) or sequelae such as disciform. Neovascularization refers to the growth of new blood vessels. The following code (s) above D31. The 2024 edition of ICD-10-CM H33. 3221 - Exudative age-related macular degeneration, left eye [with active choroidal neovascularization] was found in ICD-10-CM 2023, trusted medicine information. H35. (ICD-10) code H35. H35. 1 Any stage of dry AMD can turn into wet AMD, which typically causes faster vision loss. According to thorough estimates, 200 million people worldwide are estimated to have AMD, and by 2040, this number is projected to rise to close to 300 million. 89 [convert to ICD-9-CM] Other specified glaucoma. 30 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 31x3 for advanced atrophic dry AMD without subfoveal involvement— geographic atrophy (GA) not involving the center of the fovea. Angiogenesis Inhibitors. This is the American ICD-10-CM version of H35. 351 became effective on October 1, 2023. 52X0 became effective on October 1, 2023. ICD 10 code for Exudative age-related macular degeneration, bilateral, with active choroidal. The macula is the part of the retina with the highest concentration of cones, which are essential for central vision. Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the population over 50 years of age [], and neovascular AMD (NVAMD) is responsible for up to 90% of severe vision loss due to AMD [2, 3]. Age-related macular degeneration (AMD) is one of the leading causes of vision impairment and blindness in the United States, particularly in the elderly. The patient was 81. 2024 ICD-10-CM Diagnosis Code. 89 - other international versions of ICD-10 H25. 1. The 2024 edition of ICD-10-CM H25. Age-related macular degeneration (AMD) constitutes a prevalent, chronic, and progressive retinal degenerative disease of the macula that affects elderly. When the neovascular component is present, it has been suggested the term vascularized PED (15),. At the moment that wet AMD disease activity was detected, median VA was 20/32-1. Age-related macular degeneration (AMD) affects an estimated 14 million people worldwide, and is the leading cause of severe, irreversible vision loss in individuals over the age of 50 years in Western societies. 11). ” The “angle” referred to here is the angle between the iris, which makes up the colored part of your eye, and. The following code (s) above H35. A network of abnormal, leaky blood vessels in the choroid is referred to as a choroidal neovascular membrane (CNVM). H21. 89 would be the best code to use. In industrialized countries, age-related macular degeneration (AMD) is a leading cause of blindness in adults older than 60 years of age. 3220 is applicable to adult patients aged 15 - 124 years inclusive. When you get this treatment, your doctor will: Put numbing medicine in your eye. New vessels associated with serous PED are represented in. Clinical. This is the American ICD-10-CM version of H26. 9 : M00-M99. 329 contain annotation back-referencesThe prevalence of subclinical nonexudative neovascular AMD in the fellow eyes of patients with unilateral exudative AMD ranged from 6. Health and. Choroidal neovascularization (CNV) is the medical term for growth of new blood vessels beneath the eye’s retina (subretinal). This is the American ICD-10-CM version of H21. C72. Introduction: Wet (neovascular, exudative) age-related macular degeneration (AMD) is a leading cause of severe vision loss in the elderly population of developed societies. 3290 is applicable to adult patients aged 15 - 124 years inclusive. 4 became effective on October 1, 2023. Methods: A literature review of anatomical measures of disease activity was conducted. Submacular hemorrhage is a devastating complication of wet age-related macular degeneration (AMD). ICD-10-CM Code for Exudative age-related macular degeneration, unspecified eye, with active choroidal neovascularization H35. 0): 124 Other disorders of the eye with mcc or thrombolytic agent. It is found in the 2022 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2021 - Sep 30, 2022 . H35. Intravitreal injection therapy using anti-vascular endothelial growth factor (VEGF) agents (e. 3231 for Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization is a medical classification as listed by WHO under the.