June 19, 2019  — 

Recording: Webinar: Introduction to ICD-11 — Part 2

Introduction to ICD-11 – Part 2

Slide #1:

Alicia Boxill: Hello everyone and welcome to Part 2 of the planned series, which we are now referring to as an Introduction to ICD-11. I am Alicia Boxill, one of the Classification Specialists who works with the Classifications and Terminologies team at CIHI. I will be the moderator for today’s presentation.

I am happy to introduce today’s speaker Kristy Mabon. Kristy is a colleague who also works with the Classifications and Terminologies team at CIHI. Kristy 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 served 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. We are glad to have you join us for today’s webinar “Introduction to ICD-11 – Part 2”.

Slide #2: Agenda

Looking at the agenda for today, we will first provide an overview of the content covered in Part 1 of the webinar held back on March 26.  Then we will move on to new information to sharing some of the main differences between ICD-10-CA and ICD-11, followed by a live demonstration focusing on how to use the ICD-11 Coding tool and then we will end with time for Questions.

Slide #3: Overview of Part 1 – ICD-11 Webinar

It was intended that participants of today’s webinar would have either attended the live Part 1 webinar or have reviewed the recorded session available on CIHI’s codes and classification web page.  Having said that, we will give a quick summary of the content covered in the Part 1.

Part 1 of the webinar series provided a high-level background to ICD-11.  We shared with the audience that the implementation version of ICD-11 was released on June 18, 2018, almost one year ago. We also highlighted some features of ICD-11 such as, it is designed to be used in electronic health information systems and will better reflect progress in health sciences and medical practice, and that ICD-11 will be web-based and free to download. We introduced the audience to some of the new terminology and concepts used in ICD-11, including stem code, extension code, pre-coordination and post-coordination. We performed a live demonstration re-enforcing the new terminology and concepts used in ICD-11 by navigating the browser and showing examples of codes including how post-coordination works. Lastly, we shared that 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.

Slide 4: 72nd World Health Assembly – ICD-11 Adopted

Most recent information to share with you today is that just last week, on May 25, ICD-11 was presented to the 72nd World Health Assembly and member states agreed to adopt the eleventh revision of ICD. ICD-11 is to come into effect on January 1, 2022.  We want to be clear, though, that this does not mean Canada will transition after this date.

Slide #5: Poll Question

Let’s jump right into our first polling question so I will turn it over to Alicia.

Slide #6: Polling Question content

Thanks Kristy. So, today’s first poll question is: 

Which ICD-11 Part 1 webinar did you attend?

  1. Live webinar – March 26, 2019
  2. Recorded version of webinar which is available on the CIHI website OR
  3. Did not attend the live webinar or the recorded version

About 61% attended the live webinar.
20% attended/ listened through the recorded version and 18% did not attend the live webinar or the recorded version.

I’ll pass the presentation back over to you, Kristy.

Thanks Alicia. Those of you who have not listened to the recorded version of Part 1, I encourage you to do so at your next available opportunity.

Slide #7: Main Differences between ICD-10-CA and ICD-11

For today’s webinar, we wanted to share with you some of the main differences between ICD-10-CA and ICD-11. We cannot cover all of the differences in this short webinar, so we are highlighting some of what we feel are the key differences. These being differences in Chapters, Code Scheme, Residual codes and the Index.

Slide #8: Chapters

In this slide and the following slides, we have tried to show you a visual comparison of the difference between ICD-10-CA and ICD-11.

In terms of Chapters, ICD-10-CA chapter numbering is roman numerals, whereas, ICD-11 chapter numbers are Arabic numbering. 

We know ICD-10-CA has 23 chapters, and ICD-11 has 25 chapters of which 4 are considered to be new for ICD-11. These include:

  • Chapter 3 - Diseases of the blood or blood-forming organs and Chapter 4 – Diseases of the immune system. These conditions in ICD-10-CA were combined in Chapter 3, whereas, in ICD-11, conditions affecting the immune system and conditions affecting the blood are now in two separate chapters.
  • Sleep wake disorders have been regrouped into new Chapter 7. And
  • Sexual conditions have been grouped into the new Chapter 17 - Conditions related to sexual health.

The addition of these new chapters in ICD-11 means the numbering of some of the chapters has changed between ICD-10-CA and ICD-11.

As well, ICD-11 has one new supplementary chapter, Traditional Medicine, which is technically Chapter 26. This chapter is for optional use. As well, there are supplementary sections, one titled section V-Functioning assessment and the other is section X-Extension codes. Both of these supplementary sections are also for optional use.

Slide #9: Code Scheme

Looking at the code scheme differences between ICD-10-CA and ICD-11, we can see that ICD-10-CA has 3 or 4 character categories which can be further divided up to six character subcategories.  For example, T82.700 is an example of a 6 character Canadian enhancement code.  Whereas, ICD-11 has stem codes that are 4 characters with potentially 2 levels of subcategories. CA02.1 Acute viral pharyngitis is an example of a first level of a subcategory and CA02.10 Pharyngitis due to Adenovirus is an example of a 2nd level subcategory. 

Another difference is, ICD-10-CA codes are alphanumeric with a letter in the 1st position and a number in the 2nd, 3rd, 4th, 5th and up to 6th position.  ICD-11 codes are also alphanumeric, except a letter is in the 2nd position and a number is in the 3rd position.  The ICD-11 code scheme has forced a number at the 3rd character position to prevent spelling undesirable words and the letters “O” and “I” are omitted to prevent confusion with the numbers “zero” and “one”.

Slide #10: Code Scheme cont’d

Continuing with code scheme differences, the ICD-10-CA code scheme with the 1st character of the code being a letter does not have any relationship to the roman numeral chapter numbering. For example, J18.9 is a code in Chapter X Diseases of the respiratory system.  Whereas, the ICD-11 code scheme does have a relationship to the Arabic chapter numbering. For chapters 1 through 9, numbers 1-9 are used as the first character of the code and for chapters 10 through 25, a letter is used for the first character of the code, starting with letter “A” for chapter 10, letter B for Chapter 11, etc. 

For example:

  • AA00 is a stem code in Chapter 10 Diseases of the ear or mastoid process; and
  • QA00.0 is a stem code in Chapter 24 Factors influencing health status or contact with health services.

Another difference is ICD-10-CA’s concept of “diagnosis cluster” compared to ICD-11’s concept of “post-coordination and cluster coding”. As you know, ICD-10-CA uses a data element “diagnosis cluster” to link certain codes together on an abstract. In ICD-11, one of its new features is post-coordination and cluster coding and it’s functionality is built right into the classification itself.  It does not use a data element per se, rather, a forward slash is used to link two stem codes together and an ampersand is used to link an extension code to a stem code or link two or more  extension codes together. Remember, from in Part 1 webinar, we said extension codes cannot be used alone.

Slide #11: Residual Codes

Identifying “residual codes” in ICD-10-CA and ICD-11 is also different.

In ICD-10-CA, the numeric code .8 represents the residual code “other specified”. D50.8 Other iron deficiency anaemias is an example of a “other specified” residual code.

Whereas, in ICD-11, the terminal letter Y or .Y represents the residual code “other specified”. For example, 5C7Y Other specified disorders of fluid electrolyte or acid-base balance and 3A00.Y Other specified iron deficiency anaemia are both examples of “other specified” residual codes.

The unspecified residual in ICD-10-CA is represented by the numeric code .9.  F50.9 Eating disorder, unspecified is an example.  Whereas, in ICD-11, unspecified codes are represented by terminal letter Z or .Z. 6B8Z Feeding or eating disorders, unspecified and  6B60.Z Dissociative neurological symptom disorder, with unspecified symptoms are both examples of an “unspecified” residual code.

Slide #12: Examples

This slide is intended to give you a visual comparison at the code level of some of the differences we just covered in the previous slides.

The first example of ICD-10-CA code I25.13 is highlighting the difference we talked about with code scheme.  We don’t readily know what chapter the ICD-10-CA code I25.13 resides. However, knowing the code scheme used in ICD-11 and looking at the comparable code BA80.1, we know BA80.1 resides in Chapter 11. This is because, as we said earlier, for Chapters 10-25, the 1st character of the code uses a letter starting with the letter “A” for Chapter 10 and letter “B” for Chapter 11, and so on.

The ICD-10-CA code N18.9 Chronic kidney disease, unspecified compared to the stem code in ICD-11 of  GB61.Z is demonstrating the difference between of the ‘unspecified’ character .9 in ICD-10-CA and the “unspecified” character “Z”  in the ICD-11.

And lastly, the ICD-10-CA diagnosis cluster and ICD-11 post-coordination and cluster coding are different.  We can see that ICD-10-CA uses a data element, diagnosis cluster to link the related codes to describe pneumonia due to MRSA.

Whereas, ICD-11, uses a forward slash to link the two stem codes CA40.06 linked together with MG51.00.

The stem code CA40.06 is the ICD-11 code for Pneumonia due to Staphylococcus and the stem code MG51.00 is the code for Methicillin resistant Staphylococcus aureus.

Slide #13: Index

The last main difference we wanted to cover today is the differences between ICD-10-CA and ICD-11 index functionality. We are familiar with ICD-10-CA electronic alphabetical index using Folio Views, a software product owned by Rocket Software, Inc. Using Folio Views for ICD-10-CA, the alphabetical index is searched by entering  a lead term and secondary term. ICD-11 also uses an electronic index, referred to as the Coding Tool; however, it has a “google-like” search functionality and the coder does not have enter a lead term or secondary term when searching.  The search functionality is intended to be used by typing the diagnosis as it is recorded in the chart documentation.

Slide #14: ICD-11 Coding Tool

Let’s look more closely at ICD-11’s index – the Coding Tool.

The next few slides will cover how to access the coding tool from the ICD-11 browser and explain a simple and flexible search using the coding tool.  We will then move on to a live demonstration.

Slide #15: Accessing the Coding Tool

So here, this slide shows you how to access the Coding Tool from the ICD-11 browser of the implementation version. We can click on the tab titled “Coding Tool” and then you will be taken to a new window. The new window, you can see you’re in the Coding Tool by the blue header, that says “ICD-11 Coding Tool”.

Slide #16: Simple Search

In this slide, we are demonstrating how to perform a simple search which is pretty straightforward. Simply, typing in the diagnosis which is recorded, which in this case is “type 2 diabetes mellitus”. We type that into the search box.

The coding tool finds the best match based on the diagnosis recorded in the coding tool search box. In this case, it’s 5A11 Type 2 diabetes mellitus.

We will look more closely at a simple search when we get to the live demonstration portion of this webinar.

Slide #17: Flexible Search

The diagnosis from the chart documentation in this example was “acute situational crisis. However, when we searched the term, the coding tool does not find a match, so we click on “Try flexible search”.

Slide #18: Try Flexible Search revealed…

After we clicked on “Try flexible search”, our first hit appears to be the code we are looking for and we are basing this decision the fact that we see “acute crisis reaction” and “acute situational reaction” as other index terms under QE84 Acute stress reaction.  These terms are a close match to our search word and looking at the other matches, we don’t see anything closer.  Of note, since the exact term “acute situational crisis” is not found using the coding tool, we could use the “Feedback” feature and submit a request to add “acute situational crisis” to the coding tool and we’ll show you that feedback feature again when we get to our live demonstration.

Slide #19: Simple and Flexible searches

So, a few hints to remember when performing a simple or flexible search using the Coding Tool:

  • Type in the search box, the diagnosis as it is recorded in the chart documentation.
  • Always hit the space bar when you have finished entering the complete diagnosis. This is a sign to the computer that your search term is complete.
  • Don’t search by “lead term” or “secondary term”. No longer does the coder have to think about “lead term” or “secondary term” when using the ICD-11 Coding Tool.

Slide #20: Polling Question

We have come to our second polling question. So, again I will turn it over to Alicia.

Slide #21: Polling Question #2 content

Thank you Kristy. Today’s second poll question is:  When using the coding tool, the coder should type the “lead term” and “secondary term” in the search box as they would do when searching ICD-10-CA using Folio. Answer True or False

And most participants answered false.

So, I will hand it back over to you, Kristy.

Thanks Alicia. So, everybody seemed to have picked up on the tip. The answer was false. So, that’s one of the neat things with the new Coding Tool. We don’t have to think about lead term and secondary term. We’re using this like a Google search and typing in the diagnosis or diagnostic statement as we see it in the chart documentation.

Slide #22: Live Demonstration ICD-11 Coding Tool

So, we have now come to the live portion of the webinar, to do the live demonstration. First, we go to ICD-11 implementation version using the link you see on the screen.

This completes our live demonstration portion of this webinar. I’ll return to the slide presentation where we have just a couple more slides to cover before we take some questions.

Slide #23: ICD-11 Coding Tool – Future Enhancements

So, this slide is to alert you to some possible coding tool enhancements that are coming.  Having just shown you how to use the Coding Tool as it presently exists in the Implementation version of ICD-11, we do want you to be aware that WHO has made enhancements to the coding tool and these enhancements are presently being tested within WHO’s maintenance platform which is at this link that you see on the screen. The maintenance platform is different from the implementation version that we were just using. The classification seen on the maintenance platform is not the released version of the classification and the content in this platform may change on an ongoing basis. If or when the coding tool enhancements will be integrated into the implementation version of ICD-11 is unknown at this time.

Slide #24: Codes and Classifications web page

And lastly, if you are not familiar with our Codes and Classifications web page at www.cihi.ca, please write down the link showing on the bottom of this slide.  On our Codes and Classifications web page, you will find the recorded version of the webinar, “Introduction to ICD-11 – Part 1 and Part 2 will be available June 24th.  Part 3 and Part 4 are tentatively planned for September and December, respectively.  And lastly, if you would like more information about ICD-11, you can also find other resources available on this codes and classifications web page.