The Canadian Institute for Health Information (CIHI) has established a public submission process so that all who are involved or interested in Canadian health care data have access to the classifications update process.

The purpose of this process is to ensure that the classifications are updated to meet the data collection needs for quality, accurate and comparable clinical data in Canada.

Enhancements to ICD-10-CA and CCI are based on input from the following sources:

  • World Health Organization (WHO) modifications to ICD-10 (will be updated for the last time in 2019 due to the release of ICD-11 in June 2018);
  • CIHI’s eQuery service;
  • Clinical experts (internal/external);
  • Special interest groups; and
  • Public submissions.


WHO is the official publisher of ICD-10 (in English and French) and holds the international copyright. WHO has granted CIHI the licence to enhance the classification to meet Canadian needs for collection of morbidity data through ICD-10-CA. ICD-10-CA is a variable-axis classification that uses an alphanumeric code.


CCI was developed and is maintained solely by CIHI. CCI is a multi-axial and hierarchical classification that uses an alphanumeric code.

Note: Typographical errors or errors in functionality of the electronic code books are excluded from this process. The public submission process is to be used only to request new codes/notes or deletions. Any typographical errors can be sent to classifications@cihi.ca. Functionality issues can be sent to help@cihi.ca.

Rules governing maintenance and enhancement of ICD-10-CA and CCI

Additions or modifications to codes in the classifications and/or indices must follow the code structure and conventions outlined in ICD-10-CA and CCI. The updating process includes consultation with and feedback from internal and external advisors, including various experts and clinicians across Canada.

CIHI follows the general rules and principles below when updating ICD-10-CA and CCI.

  • Consistent with purpose of classification
    The purpose of ICD-10-CA and CCI is to permit the systematic recording, analysis, interpretation and comparison of morbidity statistics.
    This statistical classification of diseases should retain the ability both to identify specific disease entities and to allow for aggregation and statistical presentation of data in broader groups.
    CCI provides comprehensive coverage of diagnostic, therapeutic and other associated health care interventions across a broad spectrum of health care services.
  • Clinical relevancy
    Enhancements to ICD-10-CA and CCI need to demonstrate that important details about a particular disease, related health problem or health intervention are clinically significant in Canada (e.g., the intervention is an accepted practice in Canada and is performed in a Canadian health care setting).
  • Specificity
    Increased specificity contributes to more relevant data for epidemiology, research and decision-support purposes. However, a statistical classification of diseases must be confined to a limited number of mutually exclusive categories able to encompass the whole range of morbid conditions. A specific disease entity that is of particular public importance or that occurs frequently should have its own category. Otherwise, concepts will be assigned to groups of separate but related conditions/interventions.

The generic nature of CCI will, in some instances, group multiple interventions on a particular anatomy site. The detail available in the descriptive qualifiers (part of the CCI code) and intervention attributes allows more distinct identification of the specific site or intervention.

Public submission process

What are the criteria for submitting a proposed update?

Any submission to CIHI for enhancements or modifications to ICD-10-CA and CCI must clearly demonstrate compliance with one of the following criteria:

  • The enhancement addresses a gap in the classifications related to a new disease or health problem, or a new intervention or technique performed in Canada that is evidence-demonstrated.
  • An existing code is outdated and lacks clinical relevancy due to advances in health care technology.
  • The enhancement (e.g., includes or excludes note) provides clarification where there is ambiguity in the classification to guide the coder to a correct code.
  • The enhancement introduces new terminology and clinical concepts that give the classification a higher level of clinical credibility and acceptance to users.
  • The requested change will assist in care planning, data collection for funding, outcome measurement, research or case-mix grouping on a topic of public interest and/or is a health priority.

How to proceed with your submission

Enhancement requests must be submitted using the public submission request form for enhancement of ICD-10-CA and CCI. All supporting documentation relevant to the request must be included. All submissions must include detailed contact information.

Who can submit proposed updates?

Anyone can request an enhancement to the classifications.

What will happen with your submission?

All proposals will be considered. Submissions are first analyzed by CIHI’s classifications specialists for comprehensiveness and compliance with the submission criteria. Appropriate submissions are then compiled for review and may require review by our expert resources.  Enhancements that are approved will be included in the next version of ICD-10-CA or CCI.

Deadline for public submissions

The deadline for public submission for the next version of the classifications can be found at the top of the public submission request form for enhancement of ICD-10-CA and CCI.