By Mary H. Stanfill, MBI, RHIA, CCS, CCS-P, FAHIMA

For both the 9th and 10th versions of the WHO’s International Classification of Diseases, the US clinically modified ICD, significantly expanding the code set to address classification needs in the US. The ICD-10-CM code set, though based on and compatible with the WHO’s ICD-10, includes thousands more codes with much greater detail. And the US isn’t the only country to modify ICD. Other developed countries, such as Canada and Australia, also found it necessary to add additional details and create their own country-specific version.

But creating a modified version of ICD is a significant undertaking, requiring substantial time and expense. In addition, according to IFHIMA, it has resulted in multiple different versions used throughout the world, making it difficult to compare data internationally. In creating ICD-11, the WHO sought to solve these problems by changing the structure and broadening the content.

At the core of ICD-11 is the Foundation Component, which is the data source for an index and tabular created for a particular use. The Foundation contains approximately 80,000 entities, which is hopefully sufficient content for a country to identify a subset that meets their specific needs. Indeed, WHO expects that this ICD-11 structure negates the need for separate clinical modifications. Whether or not that holds true remains to be seen.

Countries around the world are evaluating ICD-11 to determine whether and how they will transition. In the US, the NCVHS is calling for research to inform our evaluation of ICD-11 and the top priority is an assessment of whether ICD-11 can fully support morbidity classification in the US without development of a US clinical modification. So the notion of building ICD-11-CM has not yet been ruled out.

Investigation is just beginning, but the decision on this is critical to implementation planning and timelines. It took several years to create the clinical modification of ICD-10. If we have to do that with ICD-11, it will delay implementation by years. But, if we can (for the first time) simply identify a subset of ICD-11 entities from the Foundation to develop an index and tabular for use in the US (what the WHO calls a “linearization”) that could speed up adoption by several years. Visit the UASI website for other factors impacting when ICD-11 will be implemented.

About the author:

Mary H. Stanfill is currently Vice President of Consulting for United Audit Systems, Inc. and was recently appointed as the official representative of the IFHIMA to the WHO Family of International Classifications Education and Implementation (EIC) and Morbidity Reference Group (MbRG) workgroups. She has over 35 years of experience in the health information profession, primarily focused on clinical classification of healthcare data. She holds a masters in biomedical informatics and is currently pursuing a doctorate in health informatics. Email: [email protected]



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