ICD-11: So Close, Yet So Faraway 

Reflections on ICD-11.   

I would like to share some thoughts on ICD-11, for your consideration.

First, ICD-11 is fully electronic; there will be no books.

It has 17,000 diagnostic categories, and more than 100,000 medical diagnostic terms. The index-based search algorithm interprets more than 1.6 million terms. The World Health Organization (WHO) states in the current ICD-11 fact sheet that it is easy to install and use, either online or offline, leveraging free “container” software. It is very comprehensive, and an unknown is whether countries such as the U.S., Canada, Germany, or Australia can accept it as it is, without doing a country-specific modification, as was done with ICD-10. The comment has been made that if there are urgent conditions not currently in ICD-11, the WHO would appreciate hearing about it as soon as possible.

For morbidity coding (done in hospitals, ambulatory surgery centers, physician’s offices, long-term care facilities, and others), the U.S. uses the Clinical Modification to the basic WHO publication, which is ICD. Some countries of the world left it alone and did not choose to add more codes, but Canada, Australia, and the U.S. did modify it, and that became ICD-10-CM, a clinical modification of the system. We did not take anything out, but we added many, many codes. The basic ICD a lot of the world uses has 14,000 codes. After the U.S. modification, it had 70.000+ codes, and our ICD-10-Procedure Classification system has 87,000 codes. So we did it up big!

I have had email discussions with my counterparts in Canada and Australia, and have exchanged ideas exploring what those countries are doing. I believe there are no international plans yet to create modification editions, and that is the hope of many of us in the U.S. also. That is what delayed us in moving to ICD-10-CM, with the addition of a vast number of codes, especially in Chapters 19, Injuries, Poisoning, and Certain Other Consequences of External Causes; and Chapter 20, External Causes of Morbidity. We were the last civilized nation to adopt ICD-10, and other countries were incredulous that we did not do so until 2015. Australia adopted ICD-10-AU for mortality coding in 1998, and for morbidity in 1999. Canada adopted ICD-10-CA in 2000. Germany adopted ICD-10-GM in 2000. Some countries adopted as early as 1994.  

Various countries now have started preparing for implementation of ICD-11, with some translations done; both the English and Spanish versions are online. 

As of last year’s mid-year meeting of the Education and Implementation Committee (EIC) and the Morbidity Reference Group (MbRG), China was almost done with their translation, they reported, and have invested several million dollars in the preparation for transition from ICD-10 to ICD-11.

I will be on the mid-year meeting of the Education and Implementation Committee this year, virtually of course, on April 8-9, 2021, and will report again after that. The MbRG next meets April 7, 2021. I have a voice and vote for the International Health Information Management (HIM) Association on both the EIC and MbRG subcommittees, and have held those seats since 2005.

It is appropriate that discussion continue this year on U.S. implementation. We must transition for underlying cause of death (UCOD, or mortality), and should eventually for morbidity. 

 Programming Note: Listen to Margaret Skurka report on ICD-11 today during Talk Ten Tuesdays, 10 a.m. Eastern.


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