ICD-11: Hurry Up and Wait

U.S. adoption of the new codes is not expected until after 2022.

A lot of excitement was generated last week when the World Health Organization (WHO) announced that the International Classification of Diseases, Eleventh Edition (ICD-11) was being released.  But there is a long way to go before the finalization of ICD-11.   

The next milestone is for the World Health Assembly to accept the proposed version, and that organization does not meet until May 2019. The WHO effective date for ICD-11 is Jan. 1, 2022, so the U.S will not be able to implement any earlier than that.

ICD-11 was released at this time to permit members to plan and prepare for implementation. For some, translation of the classification will be a huge undertaking. In the United States, the typical process is for the Centers for Disease Control and Prevention (CDC) to evaluate the classification and clinically modify it. This process takes approximately four to six years to complete. It is important to note that the classification will have electronic and print versions.  

According to the WHO, ICD-11 is a system of medical coding created for documenting diagnoses, diseases, signs and symptoms, and social circumstances. The major changes for ICD-11 include:

1. There are 30 chapters rather than 21.
2. Each category will feature four characters rather than three; for example, 1A00.00.
3. There are two levels of subcategories.
4. The alphanumeric codes have a letter in the second position and a number in the third position. A number will always be in the third position.
5. The range of codes is 1A00.00 to ZZ9Z.ZZ.
6. Extension codes begin with letter “X” and have their own chapter. The extension chapter groups anatomy, agent, histopathology, and other criteria that may be used to add detail to the code.
7. The terminal letter “Y” is reserved for the residual category of “other specified,” and the terminal character “Z” is reserved for residual category of “unspecified.”
8. The linkage of two conditions with causal relationship is “due to.” The linkage of two concurrent conditions is “associated with,” without causal sequence.
9. “Code also” instructions provide additional information that should be coded in conjunction with certain categories because the information is relevant for primary tabulation.
10. Categories will include short (100 words) description and long (unlimited words) description.
11. The code set has three volumes – Index, Reference, and Tabular. All three are required to assign the code correctly.

Some interesting changes include the addition of Internet gaming disorder as a mental health disorder. In the U.S., the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists this condition as meriting further study. Transgender identification is listed as gender incongruence in the chapter titled “Conditions Related to Sexual Health.”  

There are a few new chapters in ICD-11, which include:

1. Chapter 4 – Diseases of the Immune System
2. Chapter 7 – Sleep-Wake Disorders
3. Chapter 17 – Conditions Related to Sexual Health
4. Chapter 20 – Developmental Anomalies (separated from Conditions Arising in the Perinatal Period)
5. Chapter 25 – Codes for Special Purposes
6. Chapter 26 – Traditional Medicine Conditions – Module 1
7. Chapter V – Supplementary Section for Functioning Assessment
8. Chapter X – Extension Codes

The WHO website contains a description of the ICD-11 code development process as well as a code browser and other electronic tools. The site also contains a timeline for ICD-11 introduction. The website is accessible at https://icd.who.int. To learn more in-depth information about ICD-11, please review this site.

It is exciting to see ICD-11 in “print,” but it is also important to understand that the actual implementation and readiness is still several years away. Lessons learned from the ICD-10 implementation include that it is important to provide much education and communication regarding a new code set. At the moment, we are in a hurry-up-and-wait mode.