ICD-11 frequently asked questions and resources

As a WHO Member State, Australia endorsed the eleventh revision of the International Classification of Diseases (ICD-11) at the World Health Assembly in 2019, but no decision has been made yet for its use in Australia. The AIHW is the World Health Organization (WHO) Collaborating Centre for the Family of International Classifications (WHO-FIC) in Australia. In this role, we actively collaborate with various agencies through the Australian ICD-11 Task Force (AITF) to develop and then do a multi-year Roadmap of activities to inform decision-makers in Commonwealth, state and territory agencies about the potential costs and benefits of implementation of ICD-11 in Australia in a range of contexts. This Roadmap will produce the evidence base to shape decisions regarding implementation, timelines required, and relative costs involved.

The decision to use ICD-11 in use cases where Activity Based Funding classifications are used lies with the Independent Health and Aged Care Pricing Authority (IHACPA). IHACPA have developed a framework for implementing ICD-11 as a replacement for ICD-10-AM. More information regarding this framework will be forthcoming.

The decision to use ICD-11 in use cases relating to mortality statistics or cause of death reporting lies with the Australian Bureau of Statistics.

The work on ICD-11 in Australia generally is a collaborative effort between Commonwealth agencies, state and territory health departments, universities and other organisations. As the WHO Collaborating Centre in Australia, the AIHW is convening the Australian ICD-11 Task Force (AITF), coordinating work to provide decision makers with information on the potential costs and benefits of implementing ICD-11 in Australia. More information about the AITF is available on International Classification of Diseases 11th Revision.

The Independent Health and Aged Care Pricing Authority (IHACPA) is responsible for the decision to use ICD-11 in use cases where Activity Based Funding classifications are used. IHACPA have developed a framework for implementing ICD-11 as a replacement for ICD-10-AM. More information regarding this framework will be forthcoming.

The Australian Bureau of Statistics is responsible for the decision to use ICD-11 for classification of causes of death.

ICD-11 is a fully digital product, with capabilities to integrate into and support digital health infrastructure. ICD-11 is therefore a technological advancement on ICD-10 and is anticipated to support and extract greater benefit from the enhanced digital health/interoperability agenda being implemented across health systems. ICD-11 has more advanced clinical content than ICD-10, reflecting the latest clinical research and practice.

ICD-11 has multiple use cases; it has been developed for application in other areas of the health sector such as primary care, ambulance and cancer registries. If implemented across these use cases, ICD-11 would facilitate and support data sharing using a common language across the continuum of care. Consequently, ICD-11 should support improved and more efficient cross-jurisdictional and national data sharing and improve patient outcomes.

More information regarding ICD-11 use cases is available from the World Health Organization ICD page.

WHO sets the update schedule for the global ICD-11 for Mortality and Morbidity Statistics (MMS) product. It is then up to the individual country to determine how frequently they will apply these updates at the local level.

Section 3.12 Annex A of the ICD-11 Reference Guide outlines the WHO update and maintenance cycle for ICD-11. In general, updates are expected to occur as follows:

1. A new version of the ICD-11 MMS containing minor updates is released by WHO annually. These releases generally do not affect codes at the four- or five-character levels so that the impact on international reporting is minimised.
2. Releases that do affect the core structure (that is, new or retired codes) will be issued on a five-year cycle to ensure data stability. These are referred to as ‘major’ updates.
3. Updates to mortality and morbidity coding rules in the ICD-11 Reference Guide will follow a ten-year update cycle. This does not mean that rules for application at the local level cannot be created and applied more frequently.

As ICD-11 is a fully digital product. To access it, users will need digital technology (such as computer or tablet) and an internet connection. ICD-11 can also operate offline. Local implementations and usage will be determined by the use case and respective business requirements of those with the responsibility to do so. For Activity Based Funding classifications, this is the Independent Health and Aged Care Pricing Authority. For cause of death classification, this is the Australian Bureau of Statistics.

WHO provides technical support and tooling via its ICD-11 Application Programming Interface (API) which is also FHIR (Fast Healthcare Interoperability Resource) compliant. Mappings are also available between ICD-11 and other classifications and terminologies, making it an interoperable classification.

Stem codes are 4-digit codes similar to the 3-digit codes used in ICD-10. A fourth digit has been added to allow for a greater number of codes to be created, future-proofing ICD-11 and ensuring it can be used for many years. Stem codes are mandatory; at least one stem code must be used in classification.

Extension codes are 5-to-6-digit codes contained in Chapter X Extension Codes in ICD-11. Extension codes are supplementary, for use when additional detail (when available) is required. Extension codes are also optional; it will be a use case by use case decision as to which and how many extension codes are required for use for Australian purposes.

Postcoordination is a new feature for ICD-11. It is a function where users can link relevant codes together in one ‘string’ of codes, to more fully describe a health care condition. In the past, codes were used as a ‘standalone’ – there was no way to exactly associate multiple codes assigned without making assumptions that they were related.

Two or more codes can be postcoordinated together. Consider the following example of a fractured hip:

It is too early to tell, but it is anticipated that there may be Australian specific coding standards over and above WHO’s global ICD-11 Coding Rules outlined in the ICD-11 Reference Guide. This will be a decision for the Independent Health and Aged Care Pricing Authority, who has responsibility for the ICD-10-AM/ACHI/ACS Classification System for use in Activity Based Funding.

There may be other Australian coding standards developed for other use cases, where relevant.

Classification users can begin to learn about ICD-11 now. AIHW and the Independent Health and Aged Care Pricing Authority have web pages published, or in development, with information about ICD-11 and its potential application in Australia.

In addition, WHO has published education materials and multiple short videos on ICD-11 which are freely available. ICD-11 tooling, such as the ICD-11 MMS 2024 version and Coding Tool are also publicly available.

Our ICD-11 information on the AIHW website provides an important source of information about ICD-11. You can also access information directly from the ICD-11 pages of the WHO.

Our ICD-11 Newsletter also provides updates twice a year. You can sign up for the newsletter at our subscription page.

The latest newsletter can be found on our page about International Classification of Diseases 11th revision.

You can also keep updated on what the Independent Health and Aged Care Pricing Authority is doing in relation to ICD-10-AM/ACHI/ACS and AR-DRGs and what they are doing to prepare for a potential implementation of ICD-11 by subscribing to receive updates.

For ICD-11-related questions, please contact us and we will direct your query to the appropriate organisation.

• ‘ICD-11 Education Workshop' at the joint 20th IFHIMA congress and 40th HIMAA conference
  
• ‘ICD-11 Planning in Australia’ at the joint 20th IFHIMA congress & 40th HIMAA conference
• WHO International Classification of Diseases 11th Revision
• ICD-11 workshop (part 1): Introduction to ICD-11 coding
• ICD-11 workshop (Part 2): Introduction to multiple parenting, residual categories & the foundation
• Information for health: the roles of the International Classification of Diseases (ICD)
• Webinar: Introduction to ICD-11 for mortality and morbidity statistics
• Webinar: Using the ICD-11 coding tool