Recording: Webinar: Introduction to ICD-11 — Part 3

Introduction to ICD-11 – Part 3

Slide #1:

Kristy Mabon: Hello everyone. My name is Kristy Mabon, and I am one of the Classification Specialists who works with the Classifications and Terminologies team at CIHI.

The live presentation of Introduction to ICD-11 Part 3 took place on September 25, 2019 and as a result of enhancements to the ICD-11 Coding tool by the World Health Organization the webinar is being re-recorded today to ensure participants have access to the most current information.  If your are reviewing the recorded versions of Part 1 and Part 2 of the ICD-11 webinar series, you will notice some differences from what we will show you in today’s webinar . 

I am happy to introduce today’s speaker Alicia Boxill. Alicia is a colleague who also works with the classifications and terminologies team at CIHI. Alicia is a location independent worker who works from her home in Alberta. She is a certified HIM professional with previous experience as health records technician and a coding specialist. Now over to you Alicia…

Alicia Boxill: Thank you Kristy and hello everyone.

Slide #2: Agenda

For today’s agenda, we will remind you of the topics covered in the Introduction to ICD-11 Webinar series, Part 1 and 2. We will review some of the changes to the ICD-11 coding tool released on September 26, 2019, and we will introduce the ICD-11 Reference Guide, along with reviewing some examples of ICD-11 conventions. Lastly, we will perform a live demonstration where we will go over some coding examples using the coding tool.

Slide #3: Overview of Webinar Series – Part 1 and 2 

So far, we have hosted two webinars in the Introduction to ICD-11 Series. In these two webinars we covered some background on ICD-11, some of the features and new terminology, some of the main differences between ICD-10-CA and ICD-11 and we shared with participants what is in the works for CIHI in regards to ICD-11. As well, we demonstrated using the new classification. In the most recent, Part 2 Webinar, we shared that ICD-11 was adopted at the 72nd annual World Health Assembly in May 2019 and is to come into effect on January 1, 2022. It is important to note that Canada has not yet made a decision on when ICD-11 will be implemented in Canada. 

Slide #4: ICD-11 Coding Tool Changes

As Kristy mentioned in the introduction, an updated version of the ICD-11 Coding tool is available and we are going to highlight some of the changes from the earlier version.

Slide #5: Coding Tool Changes

One of the changes we would like to point out is that the new coding tool must be used in Google Chrome or Microsoft Edge. Internet explorer is no longer being supported.

The view or layout of the content displayed on the coding tool page has also changed and we will go into more detail during the live demonstration portion.

Slide #6: Coding Tool Changes

  • Some of the changes that have been made to the coding tool released in September include the feedback feature has been removed. That is, in Part 2, we showed you that you could submit a request to WHO when you could not locate a diagnostic term using the coding tool.
  • The chapter list distribution is no longer automatically visible.  It has to be turned on. 
  • How to review a code in the browser has changed and there has been the addition of matching terms list, new icons and post-coordination instruction and an integrated browser.

During the live demonstration, we will show you these specific changes discussed in the previous couple slides.

Slide #7: ICD-11 Reference Guide and Conventions

Moving on from the coding tool changes, we will discuss the ICD-11 Reference Guide and introduce you to some examples of conventions used in ICD-11. We do not have time to go over all of the ICD-11 conventions, however we will review the following:

  • ‘Code also’ instruction

and

  • ‘Use additional code if desired’ instruction

Slide #8: ICD-11 Reference Guide

The ICD-11 Reference guide is a guide that the World Health Organization has created to accompany the classification. It can be found at the link provided on this slide. The reference guide is updated and maintained by the World Health Organization, and was last updated in April of 2019.

The reference guide is divided into 3 parts:

Part 1: An Introduction to ICD-11, which provides a general understanding of ICD-11

Part 2: Using ICD-11, which provides information on how        are created and the details and statistics behind ICD-11

Part 3: New in ICD-11, which provides information on what is new, and what has not changed in ICD-11.

Some content that you will find in the reference guide includes:

-           Glossary of terms

-           ICD-11 conventions

and

-           Morbidity coding rules

The ICD-11 Reference guide is a replacement for the ICD-10 Volume 2 Instruction Manual which was written by the World Health Organization to accompany ICD-10.

It is important to note that the Reference Guide is still under going revisions, and is not a finalized document.

Slide #9: ICD-11 Convention – ‘Code also’ Instruction

The ICD-11 Reference Guide, tells us that conventions standardize the way content is presented in the classification. One example of an ICD-11 convention is the “code also” instruction.

Section 2.3 of the reference guide states that the ‘Code also’ instruction is a convention that informs the user of additional etiological information which is mandatory to assign in a cluster within certain categories. The ‘code also’ instruction is an international instruction mandated by the World Health Organization

Slide #10: ICD-11 Convention: “Code also” instruction example

Here we have an example that will demonstrate the code also instruction in ICD-11.  For this example we will code the diagnostic statement diabetic foot ulcer. This screenshot is from the coding tool. After typing in diabetic foot ulcer into the coding tool the first hit we get is BD54 Diabetic foot ulcer.

This screenshot demonstrates some of the new features found in the coding tool. The coding tool indicates when a perfect match has been found for your search term by highlighting the code and code title in blue and adding an asterisk next to the code title. We can see here that our code BD54 Diabetic foot ulcer has been highlighted in blue and an asterisks is found at the end of the code title. This indicates that the diagnostic statement diabetic foot ulcer is a perfect match at BD54.

As mentioned previously, one change in the coding tool is the addition of a new feature displayed in the coding tool titled matching terms. Matching terms are synonyms of the code. Here we can see that neuropathic ulceration of foot due to diabetes is a matching term at BD54.

At BD54 Diabetic foot ulcer there is an icon that looks like a green circle with 3 horizontal lines in the middle located to the right of the code title. This icon indicates that there is a coding note at this code. A coding note provides further direction on code assignment.  Another icon that looks like an orange circle with a plus sign is also located to the right of the code title. This orange icon indicates that post-coordination is mandatory at this entity as does the heading  “mandatory post coordination” – click here to open the browser. In other words, the instruction means that when we go to the browser, we will find a code also instruction..

Because there is mandatory postcoordination at this code, we will take a look at a screenshot of the code BD54 in the browser.

Slide #11: ICD-11 Convention - ‘Code also’ Instruction Example

What we seen on the slide is the screenshot of BD54 Diabetic foot ulcer in the browser.

In the postcoordination box we can see that it says Has causing condition, followed by the code also instruction in parentheses. When we see the code also instruction in ICD-11 we know that it is mandatory to follow this instruction, if applicable. The coding tool entity details also informed us of this code also instruction with the orange plus sign icon.

In the context of coding the diagnostic statement of “diabetic foot ulcer” it is mandatory to assign an addition code for the type of “diabetes” since it is clear that diabetes is the causing condition of the foot ulcer.

To select a causing condition you can type in the condition into the search box underneath has causing condition, or your can select one of the codes listed below the search box. Since the example we used does not describe what type of diabetes this patient has, we must select 5A14 Diabetes mellitus, type unspecified.

At the top of the browser, the cluster is created with the codes BD54/5A14. This post-coordinated cluster represents the example “diabetic foot ulcer due to unspecified type of diabetes mellitus”

Slide #12: ICD-11 Convention – ‘Use additional code, if desired’ instruction

Let’s move on to the ‘Use additional code, if desired’ instruction, which is found in Section 2.3 of the reference guide. This instruction is different from “code also” instruction because it informs the user of optional additional detail that may be coded. This means that it is optional to follow when reporting at the international level to the World Health Organization.

Slide #13: ICD-11 Convention - ‘Use additional code, if desired’ instruction example

Here we have an example to demonstrate a ‘use additional code, if desired’ instruction within the classification. This example is demonstrating how to classify a diagnostic statement of “fracture of left femur”

What we see on the slide is a screenshot from the coding tool. The first hit we get when we type fracture of femur into the coding tool is NC72.Z.  The coding tool has indicated that NC72.Z Fracture of femur, unspecified is a perfect match because the code and code title are highlighted blue and an asterisks seen at the end of the code title. As our diagnostic statement does not provide further detail on the specific location or the type of femur fracture we will select this code.

The icon that looks like a grey circle with a plus sign indicates that there is optional postcoordination available for this entity. In other words, this icon indicates that there is a use additional code if desired instruction at this code.

Underneath the code title we see a list of matching terms. Our search, fracture of femur is listed as a matching term. Lastly there is information about postcoordination also located underneath the list of matching terms. We can see the grey circle icon and it states that postcoordination is available at this code. Let’s go to the next slide to see the postcoordination options available at this code in the browser.

Slide #14: ICD-11 Convention – ‘Use additional code, if desired’ instruction example

This screen shot is of the code NC72.Z Fracture of femur, unspecified in the ICD-11 browser. In the post coordination box we see that it says laterality, followed by a use additional code if desired instruction. This means that laterality is optional to capture. In our example we do know that the left femur was fractured. We can add the left extension code to the stem code NC72.Z by selecting the left extension code found in the list of extension codes in the postcoordination box.

Once we have selected the left extension code we can see that it has been populated in the postcoordination box next to laterality and the extension code has been added to the stem code to create a cluster at the top of the browser.

Slide 15: Live demonstration

We have come to the live demonstration portion of today’s webinar so we will go to the ICD-11 implementation version.

This completes the live demonstration portion of this webinar. I’ll return to the slide presentation where we have one more slide to cover.

Slide 16: Codes and Classifications web page

If you are not familiar with our ICD-11 webpage, please visit the link located at the top of the slide. There you will find recorded versions of Part 1 and Part 2 of the Introduction to ICD-11 webinar series. The recorded version of today’s webinar, Part 3, will be available November 15, 2019. The date is to be determined for Part 4.

Thank you. We have now come to the end of this webinar. If you have any questions about this webinar or the Introduction to ICD-11 Part 1 or Part 2, please email us at classifications@cihi.ca using the subject line ICD-11 webinar, and we will be happy to answer your questions.

We hope you have found Part 3 of the “Introduction to ICD-11” informative. Thank you.