Global Experience of ICD-10

The International Classification of Disease (ICD) is used for classifying diseases and other health problems recorded on many types of vital records including death certificates and hospital records.  The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10-WHO) is maintained by the World Health Organization and was endorsed by the 43rd World Health Assembly in May 1990.  Many countries around the world began implementing ICD-10 for mortality statistics in 1994. In the natural progression of coding medical records, various countries around the world began to contemplate the idea of using ICD-10 for morbidity data.

Since the World Health Organization (WHO) holds the copyright to ICD-10, those countries seeking to modify the system had to request permission to do so. All modifications must be approved by WHO to keep certain standards and conventions in place. By imposing standards and restrictions the coding integrity is maintained allowing for comparative analysis between counties on global conditions and diseases.

Countries that have sought and gained approval to create their own ICD-10 include Australia (ICD-10-AM), Thailand (ICD-10-TM), Germany (ICD-10-GM), Canada (ICD-10-CA) and the United States (ICD-10-CM).

Of particular interest to the United States is the experience Canada had in the implementation of ICD-10. Our neighboring country, Canada sought approval to modify ICD 10 from WHO in 1995, began work to modify the codes in 1999 and commenced adoption in April 2001.

The rollout of the new code set in Canada was different in some respects from the anticipated rollout in the United States. Canada’s universal, single-payer system is funded and regulated at the federal level but coordinated at the provincial level. In the Canadian ICD-10 rollout, each province had the ability to determine the date for their specific implementation. As a result, provincial implementation of ICD-10-CA was staggered beginning in 2001 with completion by April 2005.  We do not have a single-payer system nor do our states have the same control as the Canadian provinces; as such, our implementation effort will not be staggered.

A somewhat interesting challenge that Canada had was that when they rolled out the ICD 10 system, Windows-based computer software was just making the scene. Not only were Canadian coders faced with a new code set, but they were also faced with the challenge of changing from using hardbound books to desktop Windows-based applications for their reference materials.

What they did implement that we should take note of as we embark on this journey is focused attention to planning and early commitment from industry stake holders including government leaders and agencies, professional associations, colleges and universities, providers and vendors.

The Canadian experience suggests three key points to remember:

  • Planning and preparation are keys to success
  • Education is a must
  • Network and reach out to others to learn from their experiences

Whether you work for a provider or payer, keep this in mind as we move to the October 1, 2013 compliance date.

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