Welcome to the sixth edition of our Classifications and Terminologies e-newsletter. It aims to promote Classifications and Terminologies activities, upcoming education courses, coding questions, topical data quality initiatives and more!

Classifications and Terminologies highlights

eQuery client survey

From August 12 to September 16, 2016, CIHI surveyed clients to better understand their experience using eQuery and related support services to address their coding and data-related questions. We are in the midst of analyzing the data and reviewing all the comments we received. In the coming months, we will share a summary of the findings with you.

Results from the survey will be used to identify areas for improvement to eQuery and related support services.

We sincerely thank all our clients who took part in the survey.

Alternate level of care coding

In January 2015, at the request of the Western Healthcare CEO Forum and in collaboration with the Western Patient Flow Collaborative, CIHI launched a 2-year project to develop and implement alternate level of care (ALC) designation standards in acute inpatient care.

This work also resulted in changes to the list of ICD-10-CA Z-codes that are allowable with ALC Patient Service 99, as well as guidelines to support ALC designation.

The term “alternate level of care” is used in hospital settings to describe patients who occupy a bed in a facility and do not require the intensity of services provided in that care setting. ALC information is typically captured at the inpatient unit level to facilitate discharge planning. At the facility level, ALC data is used to manage inpatient resources and analyze patient flow. At the health authority and jurisdiction levels, ALC information can be used to inform policy and planning around community-based health services and continuing care.

Having accurate and comparable data to improve patient flow in the western regions is the project’s overall goal, and CIHI continues to promote these ALC designation standards in other jurisdictions.

The following resources provide more information on the changes to the Z-codes allowable with ALC and related ALC designation guidelines:

Coders: Job aids


Clinician-friendly short titles for CCI

Clinician-friendly short titles for CCI are available for facility-level reports! The Classifications and Terminologies team created these titles in response to client feedback. They reflect common medical terminology and will improve understanding of the reports. These short titles are provided in a stand-alone table to be used by vendors and facility-level personnel.

CED-DxS pick-list

Requests for additions/enhancements to the v2018 CED-DxS pick-list must be submitted no later than April 30, 2017.

Please complete the CED-DxS Request form in Excel to submit a request for an addition/enhancement to the v2018 CED-DxS pick-list. Visit the NACRS metadata web page, scroll down to the heading “Classification” and then click the request form link.

Education and related resources

Education opportunities

The following new education offerings will be available later this year:

  • Web conference, March 2017 — In the Spotlight: Diagnosis Clusters, Sepsis, Alternate Level of Care (ALC): This interactive session will address coding issues and concerns, with a focus on improving data quality for the topics that are “in the spotlight.”
  • eLearning, spring 2017 — Hip Replacements: This course will include information on related anatomy, components and devices used, as well as answers to common questions in the application of codes and attributes at CCI rubric 1.VA.53.^^ Implantation of internal device, hip joint.

To register for CIHI education sessions, please visit CIHI’s Learning Centre.


In our last e-newsletter, we included some information on the basic architecture and key features of ICD-11. In this edition, we’d like to share more on the field trials and the revision conference:

Field trials for ICD-11: Line coding

It is anticipated that the final version of ICD-11 will be approved for release by the World Health Assembly in 2018. As part of the ICD-11 readiness assessment and in an effort to better understand the differences between ICD-10 and ICD-11, the World Health Organization (WHO) is conducting field trials. The purpose of these field trials is to assess ICD-11 for reliability (consistency), fitness (accuracy and specificity) and feasibility (usability) for basic coding, and to assess comparability between ICD-10 and ICD-11. This is something that was not done with previous versions of ICD, and CIHI’s Classifications and Terminologies team is significantly involved.

We are currently participating in field testing exercises called “line coding.” This includes case-controlled pilot testing of selected ICD-11 components using a pre-established set of diagnostic terms or statements. The diagnostic term set being tested is identified by the WHO. The set is representative of frequently used morbidity codes; all diagnostic terms and statements were pre-coded in both ICD-11 and ICD-10 by an expert group to establish the gold standard.

Line coding helps to identify where ICD-10 and ICD-11 align and where there are gaps and/or where a more specific code is required. The process involves a couple of steps. The first step is to find the respective ICD-11 and ICD-10 code for the diagnostic term or statement using an online coding tool developed by the WHO. The second step is to determine whether or not the assigned code is optimal. That is, the coder identifies whether or not there is a match between the detail in the diagnostic term or statement and the detail in the code that is assigned for both ICD-10 and ICD-11.

The data is submitted directly to the WHO and will be analyzed to identify the distribution of agreement between different coders and between coders and the expert group (or gold standard) for each diagnostic term or statement.

CIHI also benefits from the pilot testing! Those doing the testing have the opportunity to build their ICD-11 knowledge and coding skills and to test the process and instruments to identify where improvements can be made prior to starting more comprehensive testing in 2017.

Classifications and Terminologies recently completed phases 1 and 2 of the line coding exercise. We will soon begin phase 3, which will include post-coordination, a new concept that was described in the June 2016 e-newsletter.

ICD-11 Revision Conference

Members of the Classifications and Terminologies team recently participated in the ICD-11 Revision Conference in Tokyo, Japan. Our involvement in these meetings is critical to CIHI staying abreast of and contributing to the development of ICD-11. A wide representation of member states was present, including Asia–Pacific, Africa, the Americas, Europe and the Middle East. At this conference, the WHO released ICD-11 for member state comments. The feedback received will help to refine ICD-11 for use by the various countries around the globe and lead to a formal release of ICD-11 in 2018. Various presentations throughout the 2 days focused on the ICD revision process, advances in and uses for ICD-11 and the tools for ICD-11, which include a coding tool developed by the WHO.

View the ICD-11 release for member state comments and the newly developed coding tool.

The document ICD-11 2016 Edition for Member State Comment High Level Overview provides some instruction on how to use the browser and the coding tool, descriptions of the new terminology and concepts in ICD-11, and an outline of the chapters and blocks.

Coding questions

Personal health information in coding questions

When submitting a question to eQuery, CIHI’s coding question service, please ensure there is no personal health information in the body of your question or in the supplementary documentation that is attached or sent by fax.

Personal health information is health information about an individual that

  • Identifies that specific individual; or
  • May be used or manipulated by a reasonably foreseeable method to identify the individual; or
  • May be linked by a reasonably foreseeable method to other information that identifies the individual.

Examples of personal health information are the patient’s name, date of birth, health card number and address including full postal code. Other types of information that could lead to the re-identification of individuals are names of health care providers and names of third-party facilities (e.g., facility transferred from/facility transferred to).

Please note that some information may be included in the supplementary documentation that cannot be submitted in the body of the question in eQuery. This is because the information provided in the body of the question is viewable by all clients but the supplementary documentation remains confidential and is viewable by CIHI only.

The following can be included in the supplementary documentation but not in the body of the question:

  • Details such as the patient’s age in years and gender.
  • Dates and times of admission and discharge as well as intervention dates and times. These dates and times can aid in understanding the patient’s course of treatment and length of hospital stay.

To further mitigate the risk of inadvertent disclosure of personal health information, please do not copy and paste portions of the supplementary documentation into the eQuery question.

Submitting supplementary information

One of eQuery’s functions is the secure and seamless ability to electronically attach a copy of the supplementary documentation when you submit a question. Whenever possible, CIHI recommends using this feature to send additional documentation rather than sending it by fax.

Coding questions: Updated coding questions

On occasion, a coding question is reopened to revise the answer. This is done when an error is identified, there is new information or there is a change of direction and there is value in revising the answer.

The following coding questions have been revised and updated since June 2016. Log in to eQuery now to review them.
























Note: The tagline ******* Updated on YYYY.MM.DD ********* identifies the date the answer was revised; a brief description of the change, in square brackets, immediately follows the tagline.

Coders’ Resource Page

The Coders’ Resource Page was designed as a one-stop shop, where you will find resources that support your work in the coding and abstracting of data for the DAD and NACRS data holdings.

Since the release of last e-newsletter in June 2016, the following tips for coders have been posted on the Coders’ Resource Page:

  • Coding 101: Back to Basics
  • The Case of the Missing T-Codes and PP-Codes
  • “Admissions Solely for . . . “

The next tip is scheduled to be posted on March, 2017!

Get in touch

For additional information about content in this e-newsletter, please contact us at or visit the Classifications and Terminologies web page.