ICD-11 – The Next-Generation Coding System

July 12, 2018
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The International Classification of Diseases (ICD) provides a public global standard platform to organize and classify information about diseases and related health issues. ICD is a member of the World Health Organization’s “Family” of International Classifications (WHO-FIC) that offer the required health information by capturing data from varied interoperable delivery points across the systems and countries using a suite of integrated standard tools.

In order to maintain the scientific accuracy, ICD is scheduled for yearly periodic revisions as per the WHO recommendations. The latest revision, ICD-10, was adopted by the World Health Assembly in 1990.

A systematic revision of the current ICD 10th version will serve the needs of multiple users in a coordinated manner to improve the classification based upon scientific basis, clinical and public health use, by going through the following three stages.

  • Compilation of scientific, clinical and public health evidence for revision, known as ICD-10 Plus.
  • Creation of a draft ICD-11 development and field testing,
  • Creation of a systematic linkage to the available standard health care terminologies to process the information.

Available ICD-10

From October 2015, all healthcare providers and other HIPAA entities have started using ICD-10 codes. ICD-10 upgrade has been provided to the clients at no additional charge. ICD-10 codes facilitate the tracking of mortality rates in conjunction with the specific diagnosis.

The improvements from ICD-9 to ICD-10 transition include the addition of information on ambulatory care, expanded injury codes, combined diagnosis/symptom codes to describe medical conditions with greater specificity. Even the claims will be denied without payment, if HIPAA covered claim management software use ICD-9 codes. ICD-10 codes contain up to seven alpha-numeric characters while ICD-9 codes only contain up to 5 characters. The expanded length of ICD-10 codes (68000) compared to ICD-9 codes (13000) can convey more specific information.

ICD-11

Towards an ICD-11 two major drafts will be developed. The ICD 11 alpha draft will be subjected to KMS portal view by the internal users such as WHO FIC network and experts. The ICD 11-beta draft will be subjected to systematic field trials for the whole world to enhance feasibility, reliability, clinical utility and validity. The work will be mainly carried out by the Revision Steering Group and the Workgroups to coordinate the overall ICD revision and address different aspects of health care.

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The Revision Steering Group will serve as the planning authority in the updation and revision process. They oversee the revision process and give advice for coordination of workgroups. They also identify basic taxonomic and ontological principles and develop plans for transition from ICD-10 to ICD-11. The Revision Steering Group include WHO Member States, the WHO-FIC Network, and multiple professional organizations.

The Topic Advisory Groups (TAG) will serve as the coordinating advisory body for specific issues namely Oncology, Mental Health, etc. They provide advice on topic revision steps, establishment of workgroups, development of drafts of topic segments, establish workgroups and partners for involvement and implementation of field trials. Each TAG will function at two levels as chairs and members, along with a workgroup structure.

The Work Groups will serve as the key functioning unit for the review of evidence and generation of main proposals at a specific topic in the classification. Their core responsibilities include definition of the diagnostic entity as a medical disease, reviewing the empirical evidence, reporting the results and recommendations to the TAG and global community and evaluation of field trials.

ICD-11 beta draft – Revision Field Trials

The Global Health Practice Network (GHPN) include health professionals throughout the world to provide varied information about patient characteristics to inform the ICD update and revision process. The clinician ratings of individual patients and patient self-report questionnaires collected by the participating clinicians will be used in the field surveys.

ICD-11 alpha draft – Knowledge Management and Sharing Portal

The important elements of this KMS Portal will be:

  1. a) The ICD Revision Platform facilitate transparent communication within expert workgroups in the form of blogs for wider participation.
  2. b) A public forum to give feedback to expert groups throughout the development process.
  3. c) Structured field trials focusing on testing of various options for their feasibility and utility.
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ICD-11 is defined as an operational relational model of diseases and related health conditions which will have clear descriptions of each attribute such as entity title, classification property, terms, anatomy, temporal property, severity of subtypes properties, manifestation, casual, functioning, treatment and diagnostic properties. These features were exemplified in a structured computerized framework that captures the knowledge which underpins an ICD entity, with links to ontologies and SNOMED CT.

The final draft of ICD-11 system is expected to be submitted to World Health Assembly in 2019 and come into effect in 2022. The preparation version was released on 18 June 2018. ICD-11 include transition tables from and to ICD-10, ICD-11 transition solutions tool, hospital coding tool, web services, training protocols etc., which are user friendly, multilingual (43 languages) and accessible after registration in maintenance platform.

Around 300 medical specialists from 55 countries organized in 30 working groups have scientifically updated ICD-11 by solving structural problems in ICD-10. Cancer coding, primary care and traditional medicine are included in ICD-11 system. This system can be connected to any electronic health records (EHRs) data source through a standard API and can be used offline also.

ICD-11 simplifies the healthcare and medical coding and billing software solutions to allow healthcare professionals to record the conditions easily, accurately and completely. Even the expert healthcare and medical coding service providers would help physician in reporting diagnosis using ICD-11 medical coding software solutions. In future, all healthcare systems would start using ICD-11 compliance solutions like medical billing software by integrating ICD-11 codes, conduct internal testing and training the staff.