Recording: Introduction to ICD-11 — Part 1

Transcript for webinar on Introduction to ICD-11 — Part 1

Slide #1:

Alicia Boxill: Without further ado, it gives me great pleasure to introduce today’s speaker Kristy Mabon. Kristy is a colleague who also works with the Classifications and Terminologies team at CIHI. Kristy is has been working closely with the World Health Organization, providing input into the content of ICD-11 and its supplemental tools and resources. Kristy is one of the staff members at CIHI who serve as a voting member for the WHO ICD-11 Classification and Statistical Advisory Committee and in addition, she serves as the secretariat for the WHO Morbidity Reference Group.

Now over to you Kristy.

Kristy Mabon: Thank you Alicia and hello everyone. I am excited to see the number of participants who have joined today’s webinar “ICD-11 Mortality and Morbidity Statistics – Part 1”.

Slide #2: Agenda

Today’s webinar, will cover some high level background on ICD-11 MMS, highlight some features of ICD-11, introduce you to some new terminology used in ICD-11, show you the ICD-11 classification in a live demonstration and share with you what is in the works/future at CIHI in terms of ICD-11.

Slide #3: ICD-11 MMS

ICD-11 MMS is available now. The decision to revise the ICD for the 21st century was made in 2000 at the World Health Assembly. The launch of ICD-11 revision took place in Tokyo and since then, the WHO has worked with a Joint Task Force to produce a version that can be released to countries.  

On June 18, 2018, you may have seen the announcement that WHO released its new International Classification of Diseases - ICD-11 for Mortality and Morbidity Statistics. The version released is referred to as the 2018 implementation version and its purpose is for countries to have an advance preview of the code structure, new content, etcetera to support countries in preparing for implementation. 

It is anticipated, May 2019, WHO will present ICD-11 MMS to the World Health Assembly for adoption by Member States and, if adopted, it will come into effect on the 1st of January 2022.  This means that countries will be able to use or transition to ICD-11 after this date. However, no decision has been made for the implementation of ICD-11 in Canada.

It is important to note that ICD-11 will replace ICD-10 and as such, this means that WHO will not be updating the base ICD-10 after 2019.  ICD-10 is the international classification whereas, in Canada, as you know, we have the Canadian modification, which we refer to as ICD-10-CA.  ICD-10-CA includes Canadian enhancement codes which are identifiable with the Canadian flag and these codes do not exist in ICD-10.

Slide #4: WHO’s Objectives of the ICD-11 Revision

WHO’s ICD-11 revision included three primary objectives:

The first - to revise the ICD classification in line with scientific advances, to serve multiple purposes including mortality and morbidity statistics as well as clinical use in primary care, specialty care and research

The second -to continue to serve as an international standard in multiple languages and settings to allow for comparable data

And third - to link with computerized health information systems (that is, directly use standard terminologies and other health informatics applications to be “electronic health application ready”).

Slide #5: Features of ICD-11

Some key features of ICD-11 that align with WHO’s three key objectives for revision include:

ICD-11 is designed to be used in electronic health information systems and will better reflect progress in health sciences and medical practice, which have continuously evolved during the lifespan of ICD-10.  ICD-11 will be web-based, free to download online for personal use and will not require the use of printed books. Additionally, the ICD-11 browser and proposal mechanism can be used by anyone thereby providing a more open and transparent revision process than the current ICD-10 update procedure.
ICD-11 has a foundation component which provides the overarching repository from which concepts can be drawn into specific classifications or linearizations such as mortality, morbidity, epidemiology, case mix, primary care, research, function and disability quality, quality and safety.
ICD-11 incorporates new diagnoses and conditions and will provide enhanced coding possibilities due to the way that codes can be grouped to give precise detail.

And another feature of ICD-11 is that it aligns with other classifications and terminologies such as ICD-O, the International Classification of Disease for Oncology and SNOMED CT (Systematized Nomenclature of Medicine—Clinical Terms). Because ICD-11 has been built with the past revisions of ICD in mind, ICD–11 also ensures consistency with earlier ICD versions, so data analysis between revisions will still be possible.

Slide #6: Poll Question

At this point, we would like to do a quick polling question to get a sense of how much exposure our participants have had with ICD-11 prior to this webinar.  I’ll pass it over to Alicia who will open the poll question.

Slide #7: Polling Question content

Thank you Kristy. Today’s polling question is:  Prior to today’s webinar, have you accessed ICD-11 classification?  Answer Yes or No.  We will give you approximately 30 seconds to answer the question and then we will close the poll and share the results.

It looks like most of the participants have answered the poll. So, I’m going to close the poll. And it looks like the majority haven’t access the classification, ICD-11.

I’ll hand it back over to you, Kristy.

Thank you for those results. That’s not a problem that participants haven’t. That’s the purpose of our webinar today is to introduce you to it and give you that high level background. So, you’re at the right place.

Slide #8: ICD-11 New Terminology

So, one of the early challenges I personally had with learning about ICD-11 was being unfamiliar with the new terminology/language used when WHO spoke about ICD-11.  New terms/language, such as:

Stem Code
Extension Code

Over the next few slides, we will share with you the definitions of these new terms and how they relate to ICD-11.

Slide #9: Foundation Component of ICD-11

As mentioned earlier, ICD-11 has a foundation component which provides the overarching repository from which concepts can be drawn into specific classifications or linearizations such as mortality, morbidity, primary care, research, functioning and disability and quality and safety.  More specifically, the foundation component of ICD-11 is a multidimensional collection of all ICD entities, the diseases, disorders, injuries, external causes, signs and symptoms.  It includes information on where and how a certain entity is represented in a tabular list, whether it becomes a grouping, a category with a stem code, or whether it is mentioned as an inclusion term in a particular category.  The foundation essentially is an underlying database holding content that is needed to generate specialty versions of ICD-11 and country specific modifications. And it includes instructions on how to combine certain codes in a tabular list to achieve more detail in coding

Slide #10: Stem Codes

Unlike ICD-10-CA or ICD-10, when we talk about a code, we typically just say “code” or sometimes we might say “external cause code” or “place of occurrence code”.  In ICD-11, when referring to a code that exists in Chapter 1 to 24, often the code will be referred to as a “stem code”.  Stem Codes are found in the tabular list of ICD-11 MMS – Chapters 1 to 24.  The design of a stem code in ICD-11 makes sure that in use cases that require only one code per case, a meaningful minimum of information is collected.

An example of a stem code from Chapter 22 Injury, poisoning or certain other consequences of external causes is: NC72.5 Fracture of shaft of femur.

Slide #11: Extension Codes

We discussed the meaning of a stem code and here this slide describes extension codes which are very different from stem codes.

Extension codes are codes that can be used optionally to add additional information or detail to a stem code.
An extension code can never be assigned without a stem code and are always joined to a stem code with an ampersand preceding the extension code.
Chapter X – Extension Codes are where all the various optional extension codes reside in the classification. 
All extension codes start with the letter “X”. Therefore, they are easily identifiable in the coded data.
Building on the previous example, here is the example of fracture shaft of femur, except now we have added the detail of “laterality” to the diagnosis so that it’s fracture shaft of femur, right leg.

NC72.5 represents the stem code for “fracture shaft of femur

XJ7YM represents the laterality of “right”

Putting the stem code and extension code together in a post-coordinated cluster, it will appear as NC72.5&XJ7YM

Slide #12: Pre-coordination

Pre-coordination refers to stem codes that contain all pertinent information about a clinical concept in a pre-combined fashion.

For example: BD50.40 Abdominal aortic aneurysm with perforation

You can see that the “with perforation” is included in the stem code. This is an example of “pre-coordination” of a clinical concept.

Conversely, the opposite of pre-coordination is post-coordination. 

Slide #13: Post-coordination (Cluster Coding)

Post-coordination requires creating a “cluster” or “cluster coding”.

Most of you, we assume are familiar with the ICD-10-CA concept of “diagnosis cluster”.  Don’t confuse this with the ICD-11 concept of post-coordination or cluster coding.  There are similarities, but “how” cluster coding is performed in ICD-11 is completely different than in ICD-10-CA.

Post-coordination or cluster coding refers to the use of multiple codes, that is, stem codes and/or extension codes) together to fully describe a documented clinical concept.  So in other words the clinical concept cannot be captured in a pre-coordinated stem code.

Post-coordination requires use of a convention, either a forward slash or ampersand, to show more than one ICD-11 code used together to describe a documented clinical concept.

The example shown is a clinical concept/diagnosis recorded as: Duodenal ulcer with acute hemorrhage”. 

Post-coordination is required to fully describe the documented clinical concept.  DA63.Z represents “Duodenal ulcer, unspecified” and the forward slash is the convention used to link the other stem code ME24.90 Acute gastrointestinal bleeding, not elsewhere classified.  You will remember that this is different from the convention of using an ampersand before an extension code when linking it to a stem code.

Slide #14: ICD-11 – Let’s take a look – Live Demonstration

Let’s now take a look at ICD-11.  Access to the implementation version of ICD-11 is found at the link shown on the screen. 

Our goal of performing the live demonstration is to build on the content we have shared to this point regarding the new terms and show you how this content applies when using ICD-11. The live demonstration will not go into too much detail for this particular webinar.

Going back to the presentation, as we come to the end of this webinar you might be wondering…

Slide #15: What’s in the works for CIHI?

What is in the works for CIHI?

As previously mentioned, ICD-11 will be presented to the World Health Assembly in May of this year for adoption by Member States and, if adopted, will come into effect on the 1st of January, 2022. While this means that countries will be able to use or transition to ICD-11 after this date, no decision has been made for the implementation of ICD-11 in Canada.

CIHI is currently working on a number of initiatives to better understand the differences between ICD-10-CA and ICD-11 to help inform the business and statistical implications of adoption.  

CIHI will continue to socialize ICD-11 in Canada through webinars such as this one and through various activities.

We will determine a decision making process Vis a Vis adoption by:

Assessing ICD-11 for Canadian morbidity use through CIHI led field trials
Identify value-add and benefits ICD-11 offers Canada compared to ICD-10-CA
Conduct impact analysis both externally and internally.
As well as participate in French translation and validation of ICD11

We will also be seeking classifications expertise and experience in all areas of healthcare, from primary to acute care.  All of these planned activities will be an excellent opportunity to test the classification, as well as assess and understand the differences from ICD-10-CA and the benefits of, and improvements in ICD-11.

Slide #16: Polling Question #2

We have come to our last polling question, so I’ll pass it over to Alicia who will open the polling question.

Slide #17: Polling Question #2 content

Thank you Kristy. Today’s second poll question is:  Would you be interested in learning more about ICD-11 by volunteering to participate in a CIHI lead field trial, that is, coding examples using ICD-11. Answer yes, no or maybe.

We will give you approximately 30 seconds to answer the question and then we will close the poll and share the results.

And it looks like we have a fair bit of interest from just over a third of participants in participating in ICD-11 field trials.

I’ll hand the presentation back to you, Kristy.

That’s great news and once CIHI establishes a plan for that, certainly, communication will go out and those of you who are willing to participate will be able to opt in at that time. Thank you.

Slide #18: Recorded webinar and more information about ICD-11

So, we would like to remind you that a recorded webinar will be available after April 15th on our web site on the Codes and Classifications page and bring to your attention that more information about ICD-11 can also be found at the following links.  The first two are links are from the WHO website pages and the last are short YouTube Videos about ICD.  These videos were released on June the 18th, 2018 with the 2018 implementation version release of ICD-11. So, those may be sites that you will be curious to check out and learn more about.