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Webinar: Introduction to ICD-11 for Mortality and Morbidity Statistics (MP4)

Transcript

Slide 1: Title page

Welcome to the Introduction to ICD-11 for Mortality and Morbidity Statistics webinar. ICD-11 is the International Classification of Diseases, 11th Revision. This webinar will provide a brief introduction to ICD-11.

Slide 2: Learning objectives

At the end of this webinar, you will be able to

• Describe the features and benefits of ICD-11 Mortality and Morbidity Statistics (MMS)
• Locate the ICD-11 browser and Coding Tool on the web
• Navigate the ICD-11 browser and Coding Tool
• Explain the functionality of the Coding Tool
• Define the terminology used in ICD-11
• Find resources for help on how to use ICD-11

Slide 3: ICD-11 MMS

• ICD-11 was formally adopted by the World ºìÁì½í¹Ï±¨ Assembly in May 2019 and came into effect on February 11, 2022.
• It is multilingual and available in several different languages such as English, French, Spanish and Arabic.
• Internationally, each member state will make its own decision about adoption and timing of implementation. There’s been no decision yet about implementation in Canada.

Slide 4: ICD-11 key features and benefits

• ICD-11 has many benefits and features. It is designed to be used in electronic health information systems and will better reflect progress in health sciences and medical practice. It is entirely digital with offline functionality, so it is accessible to everyone. New diagnoses and conditions have been incorporated into ICD-11. There are 17,000 statistical categories and codes. There are over 100,000 medical diagnostic index terms, and the index-based search algorithm interprets more than 1.6 million terms. This expanded content enables enhanced coding possibilities.
• A digital Reference Guide is available with instructions on how to use ICD-11. As mentioned before, it is a multilingual browser. It was also built to be interoperable with other classifications and terminologies such as the International Classification of Diseases for Oncology (ICD-O) and Orphanet.
• This allows the classification to be used for multiple use cases such as primary care, quality and safety, mental health, rare diseases coding, perinatal and maternal coding, cancer coding and more.
• The ICD-11 MMS is built from a common foundation. This foundation contains entities and synonyms from which concepts can be drawn into specific classifications (linearizations) such as the ICD-11 MMS. These entities include diseases, disorders, injuries, external causes, signs and symptoms, functional descriptions, interventions and extension codes. For more information on other reference classifications derived from the foundation such as the International Classification of Functioning, Disability and ºìÁì½í¹Ï±¨ (ICF) and International Classification of ºìÁì½í¹Ï±¨ Interventions (ICHI), please visit the World ºìÁì½í¹Ï±¨ Organization (WHO)

Slide 5: ICD-11 home page

• ICD-11 can be accessed from the WHO’s .
• On the ICD-11 home page, there are hyperlinks to the 2 main ICD-11 electronic tools: the ICD-11 browser and the Coding Tool.
• There’s also a link to the ICD-11 Reference Guide, which we will talk more about in this presentation, as well as links to fact sheets and training material.

Slide 6: ICD-11 electronic tools

• The first ICD-11 electronic tool we will explore is the browser. This tool contains the tabular list. It displays the hierarchy of ICD-11 and all associated information about each category or codable entity.
• The second tool is the Coding Tool. It serves as an alphabetical index but acts like a web-based search. There is no need to search for lead terms and secondary terms. The Coding Tool is linked to the ICD-11 browser to access further details on a category or code in the classification.

Slide 7: ICD-11 browser — Demo

• The ICD-11 online browser allows access to the tabular list of ICD-11. There are navigation tabs, including an Info tab. Here you can access a User Guide, the ICD-11 Reference Guide, print versions and more. Clicking the Coding Tool tab will take you directly to the tool.
• The ICD-11 hierarchy is displayed on the left side of the screen. Once you select a code, all the code’s associated information is displayed to the right of the hierarchy.
• In the top right corner of the screen, you can select different languages. The languages list is separated into 2 sections. The first section is for the entire browser and the second section is for the second language. Clicking a language in the second section will display 2 languages side by side for comparison purposes. Or you can change the language for the entire browser and Coding Tool by selecting a language in the first section. To go back to the original language, simply click the language that you want to access.

Slide 8: ICD-11 Coding Tool — Demo

• The Coding Tool is an electronic index that can be searched to help find ICD-11 terms. You can click the Help tab for guidance on how to use the tool. The Coding Tool includes smart search features such as word prediction, so when you start typing in the search field, a list of possible terms will appear on the left. You can select words from the Word list or type in the entire term manually.
• All search results are displayed and referred to as Destination Entities.
• The tool provides synonyms and cross-references to direct to the appropriate code. The tool will show any matching terms that are available and, when appropriate, will also show any inclusions and exclusions for a selected code. If you click See in hierarchy, it will lead to a built-in integrated browser. Here you can see the code details along with postcoordination, which will be explained shortly. You will also see an interactive code hierarchy to the left to ensure you have selected the most specific code available for the clinical term or phrase you are looking for.

Slide 9: ICD-11 terminology

• We will now explore some of the terminology used in ICD-11. We’ll start with stem codes.

Slide 10: Stem codes — Demo

• Stem codes are found in the tabular list of ICD-11.
• These codes are specifically designed to collect a meaningful minimum of information for use cases that require only 1 code per case.
  • These may be entities or groupings of high relevance, or clinical conditions that should always be described as a single category.
• Stem codes can be used alone or linked together with other stem and/or extension codes. For example, looking at the code NC72.5 Fracture of shaft of femur, we can see that all the details in the code title are able to tell us the diagnosis and it does not need further details added.

Slide 11: Extension codes — Demo

• Extension codes are another type of code available in ICD-11. They can be found in Chapter X: Extension Codes. They all start with the letter X and are designed to standardize the way additional information is added to stem codes. These codes can be used optionally to add further details to a stem code, such as severity detail and laterality. Extension codes can not be used without a stem code as they do not provide enough detail on their own.
• Looking again at NC72.5 Fracture of shaft of femur — if we want to add more details to this code, such as indicating that the fracture is of the right leg, we can add an extension code. 
• Extension codes that are commonly added are already listed for you. Here we can see that laterality is available at the code, so we can select XK9K Right to indicate that the fracture is of the right leg.

Slide 12: Precoordination

• Precoordination is a term used in ICD-11 to describe codes that contain all pertinent information about a clinical concept in a pre-combined fashion — meaning that no further codes are required if no further details are available. For example, BD50.40 Abdominal aortic aneurysm with perforation is a pre-coordinated code. This code provides enough detail to describe a patient condition.

Slide 13: Postcoordination — Demo

• Postcoordination refers to the use of multiple codes together to fully describe a documented clinical concept.
• Any combination of postcoordinated codes is called a cluster. This can be a combination of 2 or more stem codes, or a stem code linked to an extension code.
• Postcoordination requires the use of a combining syntax (either a forward slash or an ampersand) to show a link between multiple codes describing a documented clinical concept:
  • A forward slash (/) is used between stem codes.
  • An ampersand (&) is used to separate stem codes from extension codes.
• If we look at BD50.40, we can see that the code title simply states abdominal aortic aneurysm with perforation. [Click to play demo.]
• If we want to be more specific and say infrarenal abdominal aorta, we can select the extension code XA2LN9 to provide that extra detail for the original stem code.

Slide 14: ICD-11 resources

• ICD-11 has multiple resources to help users navigate and use both the ICD-11 browser and Coding Tool.

Slide 15: ICD-11 help — Demo

• Under the Info tab, there is a User Guide that provides detail on how to browse the hierarchy and search for terms in the browser. There’s also a Reference Guide, which we will explore shortly.
• As mentioned before, you can also find the Help section for the Coding Tool by clicking the Coding Tool tab and then clicking the Help tab in the top right-hand corner. This Help section provides guidance on navigating and searching the Coding Tool.

Slide 16: ICD-11 Reference Guide — Demo

• The Reference Guide contains an introduction to the diverse components of ICD-11. This guide is not exhaustive; however, it includes information and guidance on context, components and intended use, as well as rules for mortality and morbidity coding.
• It is divided into 3 parts:
  • Part 1 is an introduction to ICD-11.
  • Part 2 describes how to use the classification.
  • Part 3 explores what’s new in ICD-11.

Slide 17: Summary

• Now let’s look at ICD-11 to summarize what we have covered.

Slide 18: Summary demo

• On the ICD-11 home page, we can see direct links to the ICD-11 browser and Coding Tool. You can also access the ICD home page, which provides information on the benefits and features of ICD-11. From there, you can access the Reference Guide, a fact sheet, licensing information and training. Let’s click the browser link to see the main screen of ICD-11.
• You can access the Coding Tool here as well by clicking the Coding Tool tab. From the Info tab, we can again locate the User Guide and Reference Guide.
• To see stem and extension codes in the browser, we can explore the hierarchy to the left of the screen. Once you select a code, you will see all the code’s details to the right of the hierarchy.
• You can compare languages at the same time by clicking the language icon and choosing a second language in the list. Or you can select a language option in the first section of the list to switch the entire browser and Coding Tool to a different language.
• Let’s now navigate to the Coding Tool. This is where we will find the Help section for information on how to navigate the Coding Tool and how to search for clinical concepts. You can either scroll down to search the information or select a specific topic at the left of the screen. If we then type in a term such as congestive heart failure, we can see that the Coding Tool will instantly provide us with Destination Entities and a word list to the left of the screen to help us with our search. We can select extra terms from the word list —decompensated, for example — or type directly in the search bar like a web-based search.
• Once we have our search terms, we can then review any highlighted codes and additional Destination Entities that are displayed. When you click the Details button, you will see all the code details, including matching terms, inclusions and exclusions, and chapter-specific notes. You can then click See in hierarchy to access the integrated browser. This lets you review the code details. You can navigate the hierarchy on the left for more specific codes. You can also review any postcoordination available for the selected code. When applicable, postcoordinated codes will be linked together by a slash and/or an ampersand, depending on the type of code selected.
• Let’s navigate back to the main page of the ICD-11 browser. Under the Info tab, we will now review the ICD-11 Reference Guide. To access the information in this guide, we can directly type in the search bar. If we type the word postcoordination and click Enter, any section that talks about postcoordination will be highlighted. We can also expand or scroll through the sections in the guide for more details on a specific ICD-11 concept.

Slide 19: Resources

• There are lots of resources for ICD-11, but these are the main ones for guidance on how to navigate and use the ICD-11 applications.

Slide 20: Useful links

• As we come to the end of this webinar, we want to share the WHO links we’ve reviewed as well as a link to CIHI’s ICD-11 web page, where you can find the other ICD-11 webinars from this series — Highlights of ICD-11, and Using the ICD-11 Coding Tool.

Slide 21: Contact information

• Thank you for taking the Introduction to ICD-11 webinar. We would like to hear from you! What ICD-11 topic interests you the most? If you would like to learn more about specific ICD-11 features of different use cases, please contact the Classifications and Terminologies ICD-11 team at ICD-11@cihi.ca. You can also email us if you have any general questions or feedback.

Slide 22: End

We hope this webinar provided an interactive introduction to ICD-11. Be sure to visit CIHI’s Codes, Classifications and Terminologies page for more resources on ICD-11. Thank you for joining us.