Thinking about ICD-11: It’s not too early (Or, at least, it shouldn’t be)

October 12th, 2018 / By Rhonda Butler

I highly recommend watching Donna Pickett’s ICD-11 presentation, given at the September 12 morning session of the ICD-10 Coordination and Maintenance (C&M) meeting in Baltimore. The link to the YouTube video is posted on the CMS website along with the other C&M meeting materials.

The presentation starts just after 2:55:48. After watching, if you want to know more google ICD-11 and check out the resources on the World Health Organization (WHO) website, including online browser, online coding tool, as well as an API for developers.

Here are a few “just the facts, ma’am” tidbits from the presentation:

  • The WHO officially launched ICD-11 on June 18, and the U.S. National Center for Vital and Health Statistics (NCVHS) has been having sessions related to release of ICD-11, since July. This version is considered “implementation ready,” and is available online for member countries to start preparing for implementation. The final approval vote by the WHO Assembly (as distinguished from the “launch” in June of this year) is scheduled for May of 2019.
  • ICD-11-MMS (ICD-11 for Mortality and Morbidity Statistics) is the new name. It reflects a major re-design of the classification in order to be more IT-friendly and to support better data collection on morbidity. Two major features of ICD-11 are Extensions and Clustering. Extensions are what in the ICD-10 world are called adjunct codes. They do not contain diagnoses per se, but describe laterality, acuity and other aspects of disease/health conditions. This eliminates the combinatorial explosion of adding one level of detail across a wide swath of the classification and makes the classification generally more flexible. Of course, when you break a diagnostic statement down into its component parts for simplicity and flexibility, you want to have a way to link them in the coded record, so “clustering” is the feature to enable linking. A “with” operator is used to link ICD-11 codes together to create a diagnostic “sentence,” with special characters like “&” or “|” used to link the diagnosis codes. Both features have some very nice potential for improving what we can get out of ICD-11 coded data.
  • 2023 is the earliest projected date for the U.S. to use ICD-11 for mortality data collection (coded by state health departments). Before that can happen, they will need an IT update of systems and coder training. Luckily for them, no regulatory process is required for coding mortality in ICD-11.
  • It is “too early to tell” whether other countries will find it necessary to create a national modification of ICD-11. (Remember, ICD-10-CM is the U.S. modification of the WHO version of ICD-10). The WHO apparently would like to impose licensing restrictions that limit the creation of national modifications, so they can maintain better control of the classification, but it has not been spelled out yet what countries can and can’t do with national modifications.

For those of you wondering why on earth you should give a rip about ICD-11, since it will likely be many years before it is implemented in the U.S., my response is, probably not enough of us gave a rip about ICD-10 early enough, and now, here we are, just getting comfy with a classification that is 25 years old, when the next version will likely be available for implementation in three years. It would be nice if we learned from the ICD-10 implementation experience, so that we don’t repeat it and find ourselves just getting comfy with ICD-11 three years before ICD-12 is released. Marx was right—history repeats itself, first as tragedy and then as farce. The history of ICD-10 implementation reads like a tragedy; repeating that history for ICD-11 would be a farce.

It takes many years to build the political and technical scaffolding necessary to implement the next version of the ICD. If we have learned from our ICD-10 history, we would do well to start getting ICD-11 scaffolding in place.

Rhonda Butler is a clinical research manager with 3M Health Information Systems.