The World Health Organization (WHO) announced the much anticipated release of ICD-11 on 18 June 2018. This preview will give physicians and medical coding companies time to adjust to the new version. As WHO points out, the ICD is also used by health insurers whose reimbursements depend on ICD coding, national health programme managers, data collection specialists, and others who track progress in global health and determine the allocation of health resources. In fact, there is a lot to learn as ICD-11 contains new chapters and changes in the coding scheme and terminology, and also includes around 55,000 unique codes for injuries, diseases and causes of death. ICD-11 is scheduled to take effect on January 1, 2022.
Over a decade in the making, ICD-11 is a vast improvement on ICD-10. The important features of ICD-11 as follows:
- It reflects critical advances in science and medicine.
- The new version is fully electronic and can be well integrated with electronic health applications and information systems.
- As it is fully electronic, ICD-11 is also much easier to implement, will cause fewer errors, and allow more detail to be recorded. This will make this coding tool much more accessible, particularly for low-resource settings.
- WHO states that ICD-11 was produced through a transparent, collaborative manner and that a key motive in this revision was to make the ICD easier to use.
- The new version seeks to capture data on healthcare safety more effectively. Updates have been made to help detect and minimize unsafe workflows in hospitals and other unnecessary events that may pose health risks. ICD-11 is also able to better capture data regarding safety in healthcare. “With ICD-11, patient safety events can be recorded better than ever before and prevented. This is a topic of extreme relevance that has not been possible to document properly with the old ICD. With the new ICD-11, we have a complete system to document events or near misses”, says WHO Classifications Terminologies and Standards Team Leader Dr. Robert Jakob.
- Jakob points out that a key principle of the latest ICD revision was to simplify the coding structure and electronic tooling with the goal to help health care professionals to record conditions more easily and completely.
ICD-11 has several new chapters and code updates which include but are not limited to:
- There is a new chapter for traditional medicine. Millions of people use traditional medicine worldwide and it is for the first time that it has been classified in this system. WHO describes this section as follows: “This chapter refers to disorders and patterns which originated in ancient Chinese Medicine and are commonly used in China, Japan, Korea, and elsewhere around the world. This list represents a union set of harmonized traditional medicine conditions of the Chinese, Japanese, and Korean classifications. For an extended list of traditional medicine conditions, please refer to the International Classification of Traditional Medicine (ICTM)”.
- The new chapter on sexual health brings together conditions that were previously categorized in other ways. For e.g., gender incongruence which had been listed under mental health conditions has been moved into sexual health disorders as evidence is now clear that it is not a mental disorder and classifying it so will cause a great deal of trauma for people who are transgender.
- The classification of personality disorders has been reorganized, and the classification of substance use disorders has been expanded. The section on addictive disorders now includes gaming disorder. Gaming disorder is defined in ICD-11 as a pattern of “digital-gaming” or “video-gaming” behaviour characterized by “impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences”. Gaming disorder has been included in ICD-11 following the development of treatment programmes for people with health conditions identical to those characteristic of gaming disorder in many parts of the world.
Addictions.com reported on a study in the medical journal Pediatrics that evaluated video game usage rates of 3,034 children and teenagers. The research revealed some alarming statistics:
- The average length of time spent playing video games was 20 hours per week
- An estimated 72% of American households play video games
- About nine% of the 3,034 participants in the study showed signs of video game addiction
- Four% of the participants were tagged as extreme users who played video games 50 hours per week on average
The inclusion of gaming disorder as an addictive condition is expected to draw the attention of health professionals to the risks of development of this disorder and, accordingly, to relevant prevention and treatment measures. For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months, according to WHO.
WHO also emphasizes that the significant change in the mental disorders section of ICD-11 is an attempt to simplify the codes as much as possible to allow for coding of mental health conditions by primary health care providers rather than by mental health specialists. This will be a critical move, says WHO, since there is a scarcity of mental health specialists and up to 9 out of 10 people who need mental health care do not receive any treatment.
- Updates to codes related to antimicrobial resistance ensure that they are more closely in line with the Global Antimicrobial Resistance Surveillance System (GLASS). Launched in October 2015, GLASS aims to support global surveillance and research in order to strengthen the evidence base on antimicrobial resistance (AMR) and help informing decision-making and drive national, regional, and global actions.
ICD-10 was released in 1990 but was implemented in the U.S only in 2015. It may take several years before the U.S. moves to ICD-11. Nevertheless, as and when the change happens, expert medical coding service providers will be ready to help physicians report diagnoses using the new code system.