WHO Wanted ICD-11, Part 1April 21, 2019
On 18 June 2018, 18 years after the launch of ICD-10 and over the course of a decade of development, the World Health Organization (WHO) released a version of ICD-11. This version of ICD-11 will be presented to the World Health Assembly in May 2019 to allow the WHO Member States, including the United States, time to plan for adoption and implementation.
Since implementation in the US is likely years away, there is no pressure at this time to learn much or even anything about ICD-11, but it is interesting to some coding professionals to see an early glimpse of “what’s next.” ICD-11 bears little resemblance to ICD-10, just as ICD-10 bears little resemblance to ICD-9.
To begin, we recommend visiting the WHO website https://www.who.int/classifications/icd/en/ to learn more, for example, about the history of the International Classification of Diseases (ICD), why codes are revised every ten years, and how countries around the world use the ICD. See the section “ICD-11: Classifying Disease to Map the Way We Live and Die.”
The WHO explains, “There are few truer snapshots of a country’s wellbeing than its health statistics. While broad economic indicators such as Gross Domestic Product may skew impressions of individual prosperity, data on disease and death reveal how a population is truly faring. The International Statistical Classification of Diseases and Related Health Problems (ICD) is the bedrock for health statistics. It maps the human condition from birth to death: any injury or disease we encounter in life − and anything we might die of − is coded.”
The WHO website is user-friendly, readable and even includes YouTube videos.
Is the WHO a Real Place with Real People?
Yes! Health information management professionals may envision a place something akin to Oz, including the wizard surrounded by belching balls of fire and appearing in a great hall every ten years to haughtily issue new versions of the ICD. In reality the WHO headquarters is a normal building complex situated on the outskirts of Geneva, Switzerland. There is a library, a bank, a cafeteria and snack counter and, of course, a cyber café and wi-fi access. No balls of fire.
The WHO’s reach, mission and purpose is global, and the ICD is only one aspect – albeit a very important one. What the WHO does overall is explained here. The WHO website includes a link to careers at WHO. Do not expect to find an open coding position.
The Overall Purpose and Uses of the ICD and Its Place in the Universe
The WHO asserts that, “ICD is the foundation for the identification of health trends and statistics globally, and the international standard for reporting diseases and health conditions. It is the diagnostic classification standard for all clinical and research purposes.”
ICD defines the universe of diseases, disorders, injuries and other related health conditions, listed in a comprehensive, hierarchical fashion that allows for:
- Easy storage, retrieval and analysis of health information for evidenced-based decision-making
- Sharing and comparing health information between hospitals, regions, settings and countries
- Data comparisons in the same location across different time periods
- Monitoring of the incidence and prevalence of diseases
- Observing reimbursements and resource allocation trends
- keeping track of safety and quality guidelines.
They also include the “counting of deaths as well as diseases, injuries, symptoms, reasons for encounter, factors that influence health status and external causes of disease.” Notice that this last sentence corresponds for the most part with the ICD-10 chapters we are familiar with and, as you will soon see, the chapters in ICD-11.
Why “Switch” to ICD-11?
The WHO asserts that ICD-11 is “a vast improvement on ICD-10” because it
- has been updated for the 21st century and reflects critical advances in science and medicine
- can now be well integrated with electronic health applications and information systems
- is fully electronic
- will be significantly easier to implement, which will lead to fewer mistakes
- allows more detail to be recorded, all of which will make the tool much more accessible
- has been produced through a transparent, collaborative manner, the scope of which is unprecedented in its history
An overriding motive in this revision was to make the ICD easier to use.
WHO Responds to the Question What “Shelf Life” Will ICD-11 Have?
Raise your virtual hand if it would be fine with you to stick with ICD-10-CM for the remainder of your coding career. Why, you may ask, do we have to transition to ICD-11 when we just became accustomed to ICD-10-CM, and so appreciative of its many virtues as compared to ICD-9-CM?
While we Americans may see ICD-11 and think ICD-11-CM, the “clinical modification for use in the United States,” the global perspective of WHO is that the United States of America is just one of many countries that use the ICD. The ICD does not cater to or favor any one country over another, and member countries are expected to follow suit and transition to new versions as, according to the organization, “WHO tweaks the ICD through the years to take into account new understandings of medicine…”
At this time, most member countries use ICD-10; however some countries still use older ICD versions. The WHO notes “All World Health Organization (WHO) Member States are expected to use the most current version of the ICD for reporting death and illness (according to an international treaty, the ‘WHO Nomenclature Regulations’, adopted by the World Health Assembly in 1967).
“ICD–10 has been translated into 43 languages, and ICD–11 has been available in all six official languages since its publication (English, French, Spanish, Russian, Chinese, and Arabic). Most countries (115 in 2017) use the system to report mortality data, a primary indicator of health status.”
The WHO asserts that
“The reason for revising the code every decade or so is this: countries can apply to develop their own adaptations. They are not allowed to change the basic code, but they can add detail – essentially producing more granular versions tailored to their health systems and circumstances.
“Every year, WHO takes slightly incompatible data from countries and makes them comparable. Over the years though, version control slips too far and several slightly varying versions appear all over the world. Thus, a new version becomes necessary to reset the system.
“ICD-11, however, has been produced electronically and therefore should act more as a living document to which everyone has access. Its agility should ensure considerable longevity.”
It appears safe to say that the US will adopt ICD-11; it is a matter of when. Efforts are currently underway to ensure a smoother implementation compared to the implementation of ICD-10-CM.
Meeting minutes of the February 6, 2019 and February 7, 2019 meeting of the Department of Health and Human Services National Committee on Vital and Health Statistics, Full Committee Meeting may shed some light on the implementation timeline. Present for both days was world-renowned health information management professional Linda Kloss, a member of the Full Committee, co-chair of Privacy, Confidentiality and Security Subcommittee and member of the Standards Subcommittee.
A perusal of these minutes is recommended with a focus on comments by Linda Kloss and the ICD-11 work plan as she discussed over the course of both days, as follows: “We outline the timeline. The clock starts ticking in May 2019 when the World Health Organization adopts 11 for worldwide use with an effective date of 2022.
“This starts the clock ticking on when the US is going to start using this for mortality, cause of death reporting and whether ICD-11 is adequate as a morbidity classification system for the US or whether the US needs to develop a clinical modification as it did for ICD-10. But we are suggesting that that go through a formal evaluation process to make those decisions and that we not leave it until sometime in the future, but begin to scope out that project.”
Of note, there are also comments by Linda Kloss about ICD-10-PCS, “…finding a way over time to rename it properly. Maybe not rename. Name it properly. I would just call it procedure coding system. I think it is the ICD tacked on to it that is the problem because it has nothing to do with the World Health Organization. We are going to run into problems down the road if the World Health Organization continues its development of a procedure coding system version. I just think it forestalls problems down the road. I think renaming – I would encourage us to do both.”
In summary, ICD-11-CM is years away from implementation in the US. Efforts are being made to ensure a smoother transition from ICD-10-CM to ICD-11-CM as compared to the transition from ICD-9-CM to ICD-10-CM.
As noted throughout this blog, much information available now and going forward can be obtained from the WHO websites and links. More information from WHO, the Center for Medicare and Medicaid Services (CMS) and the National Committee for Health and Vital Statistics (NCHVS) will likely be available after ICD-11 is presented to the World Health Assembly in May 2019.
Next: WHO Wanted ICD-11, Part 2 provides an overview of the ICD-11 code structure, chapters and rationales, and some examples of common diagnoses as they are currently coded in ICD-11. Bear in mind as we proceed towards eventual implementation that anything we see now is ICD-11, not ICD-11-CM, the version that will eventually be used in the US.
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