International Classification of Diseases 11th Revision The global standard for diagnostic health information

1. ICD-11
Hosna Salmani

2. • The International Classification of Disease, Eleventh Revision
(ICD-11) is a system of medical coding created by the World
Health Organization (WHO) for documenting diagnoses,
diseases, signs and symptoms. It is anticipated that the final
ICD-11 will be approved for release by the World Health Assembly
in 2018.
ICD-11 WHO
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3. Benefits of ICD-11
• ICD-10 was developed more than 20 years ago, and ICD-11
reflects current medical terminology and information needs.
• ICD-11 functions in digital and electronic health record
(EHR) environments. It is more comprehensive for use in
broader clinical settings.
• ICD-11 has linkage to other data standards such as:
International Classification of Functioning, Disability and
Health (ICF)
International Classification of Health Interventions (ICHI)
SNOMED-CT
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4. • Improve usability
• Improve comparability of translations
• Improve index
• Improve incorporation in electronic problems
• Update scientific content
• Linkage to relevant other classifications and
terminologies
Why ICD-11?
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5. New Chapters:
Chapter 3 Diseases of the Blood and Blood forming Organs
Chapter 4 Disorders of the Immune System.
Chapter 5 Conditions related to Sexual Health.
Chapter 8 Sleep-Wake Disorders
Chapter 26 Extension codes
Chapter 27 Traditional Medicine
New Concepts:
Foundation: Everything in ICD
Entity: Each element in the foundation
Linearization: also known as a Classification
Stem code: Category (includes former ‘dagger’ codes)
Extension code: Additional information
Linearization parents: Classification hierarchy, Chapter, Block, Category Content Model
ICD-11 categories have a short and a long definition.
All ICD-11 categories include separate information on anatomy, aetiology, and other aspects. These can
be accessed through searches, or when browsing in the tabular list.
New Coding Scheme
The chapter numbering: now arabic numbers, not roman numerals
The coding scheme for categories: now minimum 4 characters, 2 levels of subcategories
Asterisk codes become Clinical forms or Extension codes. Additional sub-classifications become
The coding scheme always has a letter in the second position to differentiate from the codes of ICD–10.
In ICD–11, the first character of the code always relates to the chapter number.
It may be a number or a letter. The code range of a single chapter always has the same character in the
first position.
Extension codes Terminology
ICD-10 had a range of expressions to describe a causal relationship between conditions in a code title. In
ICD 11, the preferred term is “due to”.
ICD-10 had a range of expressions indicating the coincidence of two conditions in a code title (e.g. “in” or
“with”). In ICD-11, the preferred term is “associated with”
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6. Coding scheme
Content model
Morbidity, main diagnosis:
- Reason for admission, after assessment at the end of the stay
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Properties Valu
Anatomy breast
Morphology invasive ductal
carcinoma
ICD entity: invasive
ductal carcinoma of
breast

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13. The ICD Foundation Component
• Foundation Component is a collection of ALL ICD entities like diseases, disorders... It represents
the whole ICD universe.
• In a simple way, the foundation component is similar to a “store” of books or songs. From these
elements we build a selection as a linearization. This analogy may however be misleading
because there are many links between the ICD entities (like parent-child relations and other).
1. The ICD entities in the Foundation Component: are not necessarily mutually exclusive
2. allow multiple parenting ( i.e. an entity may be in more than one branch, for example tuberculosis
meningitis is both an infection and a brain disease)
The ICD Linearizations
1. A linearization is a subset of the foundation component, that is:Fit for a particular purpose:
reporting mortality, morbidity, or other uses
2. Jointly Exhaustive of ICD Universe (Foundation Component)
3. Composed of entities that are Mutually Exclusive of each other
4. Each entity is given a single parent
• Linearizations are similar to the classical print versions of ICD Tabular List (e.g. volume I of ICD-
10 or other previous editions).
• Various linearizations could be built at different granularity, use case or other purposes such as
for Primary Care, Clinical Care or Research. The linkage from the foundation component to a
particular linearization will ensure consistent use of the ICD
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14. • Chapter 01 – Infectious diseases
• Chapter 02 – Neoplasms
• Chapter 03 – Diseases of the blood and bloodforming organs
• Chapter 04 – Disorders of the immune system
• Chapter 05 – Conditions related to sexual health
• Chapter 06 – Endocrine, nutritional and metabolic diseases
• Chapter 07 – Mental and behavioural disorders
• Chapter 08 – Sleep – Wake disorders
• Chapter 09 – Diseases of the nervous system
• Chapter 10 – Diseases of the eye and adnexa
• Chapter 11 - Diseases of the ear and mastoid process
• Chapter 12 – Diseases of the circulatory system
• Chapter 13 – Diseases of the respiratory system
• Chapter 14 – Diseases of the digestive system
• Chapter 15 – Diseases of the skin
• Chapter 16 – Diseases of the musculoskeletal system and connective tissue
• Chapter 17 – Diseases of the genitourinary system
• Chapter 18 – Pregnancy, childbirth and the puerperium
• Chapter 19 – Certain conditions originating in the perinatal period
• Chapter 20 – Developmental anomalies
• Chapter 21 – Symptoms, signs, clinical forms, and abnormal clinical and laboratory findings, not elsewhere
classified
• Chapter 22 – Injury, poisoning and certain other consequences of external causes
• Chapter 23 – External causes of morbidity and mortality
• Chapter 24 – Factors influencing health status and contact with health services
• Chapter 25 – Codes for special purposes
• Chapter 26 –Extension Codes
• Chapter 27 – Traditional Medicine
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15. Volumes of ICD-11
Volume 1:
• Tabular List, Special Tabulation Lists, Qualifiers, and Modifiers
• Volume 1 contains the Tabular list, which is an alphanumeric listing of diseases
and disease groups, inclusion and exclusion notes, and some coding rules.
• The ICD has 25 chapters, and approximately 15 000 entities at the 4, 5 or 6-
character level. In addition, there is a section on extension codes and one on
traditional medicine.
Volume 2:
• Reference Guide The Reference Guide contains an introduction to the context,
components, and intended use of the ICD.
• It describes the diverse components of ICD–11, provides guidelines for
certification, recording, rules for mortality coding (i.e. causes of death) and
morbidity coding (e.g. hospital statistics) and lists for tabulation of statistical data.
Volume 3:
• Index The Alphabetical Index is a list of approximately 120 000 clinical terms
(including synonyms or phrases).
• The Index is used to find the relevant ICD codes or code combinations for terms
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16. The Use of ICD-11
- Mortality
- Morbidity
- Epidemiology
- Casemix
- Quality and safety
- Primary care
- Scientifically up to date
- Suitable for electronic environments
- Multilingual
- Smooth transition – simpler use
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17. Aetiology
• 6A30 Type 1 diabetes mellitus
• 6A31 Type 2 diabetes mellitus
• 6A32 Diabetes mellitus, other specified type
• 6A33 Diabetes mellitus, type unspecified
Manifestation
• MB10 Diabetic acidosis
• MF20 Diabetic coma
• MH01 Diabetic cataract
• ML40 Diabetic bullae
• ML41 Diabetic cheiroarthropathy
• ML43 Diabetic dermopathy
• MG50 Diabetic foot
• …… other complications
Hierarchy of ‘Diabetes’ is simpler
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Cluster coding example
Patient with type 1 DM with diabetic retinopathy
6A10 -Type 1 diabetes mellitus
MG45 -Diabetic retinopathy
6A10/MG45 = type 1 DM with diabetic retinopathy

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22. Problems with ICD-10
1. Used in 117 out of 193 countries for official
statistics
2. Does not interoperate with electronic health
records
3. is not up to todays
4. no definitions
5. No OFFICIAL PRIMARY CARE VERSION
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23. • Antimicrobial resistance - essentially missing
• HIV subdivisions - outdated detail
• Skin cancer - melanoma types missing – basalioma missing-
other
• Valve diseases - outdated structure, need by valve, less
rheumatic
• Chapters 1-18 versus Chapter 19 - clarify when use 19 and
when not
• Regrouping necessary - Allergies and autoimmune diseases
• Problematic combination codes (e.g. alcoholic
cardiomyopathy I42.6 <-> cause alcohol X45)
• External causes - Loosing detail in non-accidents; traffic
accidents
Issues with ICD-10 - examples
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24. Coding tool
• ICD-11 browser
See foundation and tabular list (linearization)
Download versions
See differences
• Proposal and commenting tool
Make suggestions and discuss them
Notifications
• Review tool
• Translation tool
Translate in your language
• Mapping tool
See mapping at detailed level – download maps
Comment mapping to and from ICD-10
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25. Code Structure
• The codes of the ICD–11 are alphanumeric and cover the range
from 1A00.00 to ZZ9Z.ZZ.
• Codes starting with ‘X’ indicate an extension code (see
Extension codes).
• A letter in the 2nd character position allows for clear
distinction between a code from ICD–11 and one from ICD–10.
• The letters ‘O’ and ‘I’ are omitted to prevent confusion with
the numbers ‘0’ and ‘1’.
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26. Code Structure
EDEE.EE
• E corresponds to a 'base 34 number' (0-9 and A-Z; excluding O, I);
• D corresponds to 'base 24 number' (A-Z; excluding O, I); and 1 corresponds to
the 'base 10 integers' (0-9)
• The first E starts with ‘1’ and is allocated for the chapter. (i.e. 1 is for the first
chapter, 2:chapter 2, … A chapter 10, etc.)
• The terminal letter Y is reserved for the residual category ‘other specified’
• the terminal letter ‘Z’ is reserved for the residual category ‘unspecified’.
• For the chapters that have more than 240 blocks,
• ‘F’ (‘other specified’) and ‘G’ (‘unspecified’) are also used to indicate residual
categories (due to problems with the coding space).
• Chapters are indicated by the first character. For example, 1A00 is a code in
chapter 1, and BA00 is a code in chapter 11.
• Groups are not coded within this code structure. However, hierarchical
relations are retained in the 4-digit codes. There is unused coding space
allocated in all blocks to allow for later updates and to keep the codes stable
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• The tool works by searching as the user continues typing.
• It generates (and dynamically updates) three different outputs as the
search continues:
• On the left it shows a list of words:
▫ If you are in the middle of a word the system will try to guess the word
that you are typing.
▫ If you have completed a word the system will show you related
keywords.
• The second output is matched entities.
• The matched words are highlighted in this list. The list shows only the titles
but a button will make more matching index entries visible. A link to the
relevant entity in the ICD-11 browser is also available by using this button
• You may sort the results by the classification order by using the dropdown
box at the top of the list
ICD-11 Coding Tool

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Multiple Coding Equivalent expressions

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Multiple Coding Equivalent expressions

30. Example
Myocardial infarction:
Diabetes mellitus, type 1
BA21
5A10
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31. Example
• A patient was admitted with a fracture of the shaft of
the right radius and contusion scalp after falling off a
ladder.
• Main condition: Fracture of shaft of radius &
right/contusion of scalp/fall on or from ladder
NC32.3 & XK9K/NA00.01 & PA81
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32. Browsing Using the Hierarchy
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33. Linearization Information Icons
• The blue icon shows that the entity
is included in the ICD-11 for
Mortality and Morbidity Statistics
• The yellow icon shows that the
entity is included in the Primary
Care High Resource Setting
Linearization
• The green icon shows that the
entity is included in the Primary
Care Low Resource Setting
Linearization
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34. Browsing Linearizations
• The following are the main differences between
browsing the linearization and browsing the foundation
component
1. When you browse a linearization, only entities that
are in that linearization are visible in the hierarchy
2. In the linearization there is only one parent per entity
where as there may be more than one in the
foundation component
3. an entity may have more children in the foundation
than in the linearization. These additional children
are still visible in the linearization view but show up
as grayed out.
4. All of the content model parameters are not shown
in the linearization view. Only title, synonyms,
definition, inclusions and exclusions are visible
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35. There are several buttons that you can use to decide how the visualizations
appear. You need
• This mode will let you see:
•the selected entity
•its parents
•its children
• This is the default mode and it will let you see:
•the selected entity
•all of its ancestors up to the classification root
•its children
• This mode will let you see:
•the selected entity
•all of its ancestors up to the classification root
•its children
•all ancestors of all children
• This button can be used in conjunction with one of the other buttons.
If used, the system will show you the foundation but highlighting the linearization
within the foundation using various colors and styles so that you can easly see
which entities are in the linearization, which are not, which of the parents is the
linearization parent, etc ICD
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37. Post-coordination
• The post-coordination system allows adding more detail to the
entity that is chosen.
• Different types of information can be added to different
elements. For example, additional 'Histopathology' information
could be added to most of the Neoplasm categories but it cannot
be added to the categories elsewhere in the classification.
• Some categories contain information that is incomplete for the
multiple purposes of ICD. In such cases the note (code
also) indicates that information needs to be added for that axis.
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39. ‫کتاب‬‫فصول‬
1.Certain infectious and parasitic diseases
2.Neoplasms
3.Diseases of the blood and blood-forming organs and certain
disorders involving the immune mechanism
4.Endocrine, nutritional and metabolic diseases
5.Mental, Behavioral and Neurodevelopmental disorders
6.Diseases of the nervous system
7.Diseases of the eye and adnexa
8.Diseases of the ear and mastoid process
9.Diseases of the circulatory system
10.Diseases of the respiratory system
11.Diseases of the digestive system
12.Diseases of the skin and subcutaneous tissue
13.Diseases of the musculoskeletal system and connective
tissue
14.Diseases of the genitourinary system
15.Pregnancy, childbirth and the puerperium
16.Certain conditions originating in the perinatal period
17.Congenital malformations, deformations and chromosomal
abnormalities
18.Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
19.Injury, poisoning and certain other consequences of
external causes
20.External causes of morbidity
21.Factors influencing health status and contact with health
services
Chapter 01 – Infectious diseases
Chapter 02 – Neoplasms
Chapter 03 – Diseases of the blood and bloodforming organs
Chapter 04 – Disorders of the immune system
Chapter 05 – Conditions related to sexual health
Chapter 06 – Endocrine, nutritional and metabolic diseases
Chapter 07 – Mental and behavioural disorders
Chapter 08 – Sleep – Wake disorders
Chapter 09 – Diseases of the nervous system
Chapter 10 – Diseases of the eye and adnexa
Chapter 11 - Diseases of the ear and mastoid process
Chapter 12 – Diseases of the circulatory system
Chapter 13 – Diseases of the respiratory system
Chapter 14 – Diseases of the digestive system
Chapter 15 – Diseases of the skin
Chapter 16 – Diseases of the musculoskeletal system and
connective tissue
Chapter 17 – Diseases of the genitourinary system
Chapter 18 – Pregnancy, childbirth and the puerperium
Chapter 19 – Certain conditions originating in the perinatal
period
Chapter 20 – Developmental anomalies
Chapter 21 – Symptoms, signs, clinical forms, and abnormal
clinical and laboratory findings, not elsewhere classified
Chapter 22 – Injury, poisoning and certain other
consequences of external causes
Chapter 23 – External causes of morbidity and mortality
Chapter 24 – Factors influencing health status and contact
with health services
Chapter 25 – Codes for special purposes
Chapter 26 –Extension Codes
Chapter 27 – Traditional Medicine
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ICD-11 ICD-10

40. Coding Tool
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50. ICD-10CM/ICD-10
• The ICD-10-CM revision includes more than 68,000 diagnostic
codes
• ICD-10-CM diagnosis codes consist of three to seven digits
• The structure of ICD-10-CM codes:
• first character: alpha character
• second and third: numeric
• four through seven: numeric and alpha characters.
• first three characters categorize the injury and the fourth through
sixth characters describe in greater detail, anatomical location and
severity of an injury or illness.
• The seventh character is an extension digit and used to classify an
initial, subsequent or sequela (late effect) treatment encounter
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52. 11/28/2017
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54. References
• http://searchhealthit.techtarget.com/definition/ICD-
10-CM
• http://searchhealthit.techtarget.com/definition/ICD-
11
• https://www.cihi.ca/en/submit-data-and-view-
standards/codes-and-classifications/icd-11
• Who
• icd-11 Guidelines
• ICD-10-CM Field Testing Project AHIMA
• ICD-11 Revision Conference Report Tokyo, Japan,12-
14 October, 2016
• ICD-10-CM Official Guidelines for Coding and
Reporting
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55. Thank you for your attention
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Hosna Salmani
Email: hosnasalmani@gmail.com
LinkedIn: Hosna Salmani
Twitter: hosnasalmani