A practical strategy to use the ICD-11 for morbidity coding in the United States without a clinical modification.

OBJECTIVE: The aim of this study was to derive and evaluate a practical strategy of replacing ICD-10-CM codes by ICD-11 for morbidity coding in the United States, without the creation of a Clinical Modification. MATERIALS AND METHODS: A stepwise strategy is described, using first the ICD-11 stem codes from the Mortality and Morbidity Statistics (MMS) linearization, followed by exposing Foundation entities, then adding postcoordination (with existing codes and adding new stem codes if necessary), with creating new stem codes as the last resort. The strategy was evaluated by recoding 2 samples of ICD-10-CM codes comprised of frequently used codes and all codes from the digestive diseases chapter. RESULTS: Among the 1725 ICD-10-CM codes examined, the cumulative coverage at the stem code, Foundation, and postcoordination levels are 35.2%, 46.5% and 89.4% respectively. 7.1% of codes require new extension codes and 3.5% require new stem codes. Among the new extension codes, severity scale values and anatomy are the most common categories. 5.5% of codes are not one-to-one matches (1 ICD-10-CM code matched to 1 ICD-11 stem code or Foundation entity) which could be potentially challenging. CONCLUSION: Existing ICD-11 content can achieve full representation of almost 90% of ICD-10-CM codes, provided that postcoordination can be used and the coding guidelines and hierarchical structures of ICD-10-CM and ICD-11 can be harmonized. The various options examined in this study should be carefully considered before embarking on the traditional approach of a full-fledged ICD-11-CM.

Feasibility of replacing the ICD-10-CM with the ICD-11 for morbidity coding: A content analysis.

OBJECTIVE: The study sought to assess the feasibility of replacing the International Classification of Diseases-Tenth Revision-Clinical Modification (ICD-10-CM) with the International Classification of Diseases-11th Revision (ICD-11) for morbidity coding based on content analysis. MATERIALS AND METHODS: The most frequently used ICD-10-CM codes from each chapter covering 60% of patients were identified from Medicare claims and hospital data. Each ICD-10-CM code was recoded in the ICD-11, using postcoordination (combination of codes) if necessary. Recoding was performed by 2 terminologists independently. Failure analysis was done for cases where full representation was not achieved even with postcoordination. After recoding, the coding guidance (inclusions, exclusions, and index) of the ICD-10-CM and ICD-11 codes were reviewed for conflict. RESULTS: Overall, 23.5% of 943 codes could be fully represented by the ICD-11 without postcoordination. Postcoordination is the potential game changer. It supports the full representation of 8.6% of 943 codes. Moreover, with the addition of only 9 extension codes, postcoordination supports the full representation of 35.2% of 943 codes. Coding guidance review identified potential conflicts in 10% of codes, but mostly not affecting recoding. The majority of the conflicts resulted from differences in granularity and default coding assumptions between the ICD-11 and ICD-10-CM. CONCLUSIONS: With some minor enhancements to postcoordination, the ICD-11 can fully represent almost 60% of the most frequently used ICD-10-CM codes. Even without postcoordination, 23.5% full representation is comparable to the 24.3% of ICD-9-CM codes with exact match in the ICD-10-CM, so migrating from the ICD-10-CM to the ICD-11 is not necessarily more disruptive than from the International Classification of Diseases-Ninth Revision-Clinical Modification to the ICD-10-CM. Therefore, the ICD-11 (without a CM) should be considered as a candidate to replace the ICD-10-CM for morbidity coding.

Strategies to improve external cause-of-injury coding in state-based hospital discharge and emergency department data systems: recommendations of the CDC Workgroup for Improvement of External Cause-of-Injury Coding.

Each year, an estimated 50 million persons in the United States experience injuries that require medical attention. A substantial number of these persons are treated in an emergency department (ED) or a hospital, which collects their health-care data for administrative purposes. State-based morbidity data systems permit analysis of information on the mechanism and intent of injury through the use of external cause-of-injury coding (Ecoding). Ecoded state morbidity data can be used to monitor temporal changes and patterns in causes of unintentional injuries, assaults, and self-harm injuries and to set priorities for planning, implementing, and evaluating the effectiveness of injury-prevention programs. However, the quality of Ecoding varies substantially from state to state, which limits the usefulness of these data in certain states. This report discusses the value of using high-quality Ecoding to collect data in state-based morbidity data systems. Recommendations are provided to improve communication regarding Ecoding among stakeholders, enhance the completeness and accuracy of Ecoding, and make Ecoded data more useful for injury surveillance and prevention activities at the local, state, and federal levels. Implementing the recommendations outlined in this report should result in substantial improvements in the quality of external cause-of-injury data collected in hospital discharge and ED data systems in the United States and its territories.

Data Elements for Emergency Department Systems, Release 1.0 (DEEDS): A Summary Report.

See editorial, p 274. Variations in the way that data are entered in emergency department record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product, Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems-such as data incompatibility and high costs of collecting, linking, and using data-can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations. [DEEDS Writing Committee: Data Elements for Emergency Department Systems, Release 1.0 (DEEDS): A summary report. Ann Emerg Med February 1998;31:264-273.].