Coding rules for uncertain and "ruled out" diagnoses in ICD-10 and ICD-11.
Classification
ICD-11
International Classification of Diseases
Ruled out
Uncertain diagnoses
Journal
BMC medical informatics and decision making
ISSN: 1472-6947
Titre abrégé: BMC Med Inform Decis Mak
Pays: England
ID NLM: 101088682
Informations de publication
Date de publication:
27 Sep 2024
27 Sep 2024
Historique:
received:
03
05
2023
accepted:
29
08
2024
medline:
28
9
2024
pubmed:
28
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
The International Classification of Diseases, 11th Revision (ICD-11) has significantly improved the ability to navigate coding challenges beyond prior iterations of the ICD. Commonly encountered sources of complexity in clinical documentation include coding of uncertain and "ruled out" diagnoses. Assessing official international guidelines and rules, this paper documents extensive variation across countries in existing practices for coding and reporting unconfirmed and "ruled out" clinical concepts in ICD-10 (and modifications thereof). The design of ICD-11 is intended to mitigate these coding challenges by introducing postcoordination, expanding the range of codable clinical concepts, and offering clearer guidance in the ICD-11 Reference Guide. ICD-11 offers substantial progress towards more precise capture of uncertain and "ruled out" diagnoses, including international consensus on coding rules for these historically challenging clinical concepts. However, we identify the need for further clarification of the concepts of "provisional diagnosis" and "differential diagnosis."
Identifiants
pubmed: 39334213
doi: 10.1186/s12911-024-02661-6
pii: 10.1186/s12911-024-02661-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
386Subventions
Organisme : Agency for Healthcare Research and Quality
ID : R13HS027288
Informations de copyright
© 2024. The Author(s).
Références
World Health Organization. International statistical classification of diseases and related health problems (ICD). https://www.who.int/standards/classifications/classification-of-diseases . Accessed 11 June 2024.
World Health Organization. ICD-11 Reference Guide. 2022. https://icdcdn.who.int/icd11referenceguide/en/html/index.html . Accessed 11 June 2024.
Ghali WA, Pincus HA, Southern DA, Brien SE, Romano PS, Burnand B, Drösler SE, Sundararajan V, Moskal L, Forster AJ, Gurevich Y, Quan H, Colin C, Munier WB, Harrison J. ICD-11 for quality and safety: overview of the WHO Quality and Safety Topic Advisory Group. Int J Qual Health Care. 2013;25(6):621–5.
doi: 10.1093/intqhc/mzt074
pubmed: 24154846
Jetté N, Quan H, Hemmelgarn B, Drosler S, Maass C, Oec DG, Moskal L, Paoin W, Sundararajan W, Gao S, Jakob R, Üstün B, Ghali WA, IMECCHI Investigators. The development, evolution, and modifications of ICD-10: challenges to the international comparability of morbidity data. Med Care. 2010;48(12):1105–10.
doi: 10.1097/MLR.0b013e3181ef9d3e
pubmed: 20978452
Otero Varela L, Doktorchik C, Wiebe N, Quan H, Eastwood CA. Exploring the differences in ICD and hospital morbidity data collection features across countries: an international survey. BMC Health Serv Res. 2021;21(1):308.
doi: 10.1186/s12913-021-06302-w
pubmed: 33827567
pmcid: 8025494
Southern DA, Hall M, White DE, Romano PS, Sundararajan V, Droesler SE, Pincus HA, Ghali WA. Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data. Int J Qual Health Care. 2016;28(1):129–35.
doi: 10.1093/intqhc/mzv096
pubmed: 26660153
Canadian Institute for Health Information. Canadian Coding Standards for Version 2018 ICD-10-CA and CCI. Ottawa, ON: CIHI; 2018. https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf . Accessed 11 June 2024.
Independent health and aged care pricing authority. Products and licenses. https://www.ihacpa.gov.au/health-care/products-and-licenses . Accessed 11 June 2024.
Avila C. Implementing health financing policies to overhaul the healthcare delivery system in Ukraine. J Hosp Manag Health Policy. 2021;5:7.
doi: 10.21037/jhmhp-20-97
Alharbi MA, Isouard G, Tolchard B, Tong K. Health information literature across the cultural evolutionary divide. Cogent Soc Sci. 2020;6:1.
Ministry of public health, bureau of policy and strategy, office of the permanent secretary, Thailand. International statistical classification of diseases and health related problems, 10th Thai modification, Vol 5, standard coding guidelines, 2014. http://thcc.or.th/ebook5/2014/mobile/ . Accessed 11 June 2024.
ICD-10-CM official guidelines for coding and reporting FY 2023 -- UPDATED April 1, 2023 (October 1, 2022 - September 30, 2023). Centers for Medicare & Medicaid Services (U.S.); National Center for Health Statistics (U.S.); April 1, 2023. https://stacks.cdc.gov/view/cdc/126426 . Accessed 11 June 2024.
Coding rule-out diagnosis. American Hospital Association (AHA) Coding Clinic for ICD-10-CM and ICD-10-PCS. 2017 Fourth Quarter;4:102–3.
World Health Organization. International statistical classification of diseases and related health problems, 10th Revision, Vol 2, Instruction Manual, 2016. https://icd.who.int/browse10/Content/statichtml/ICD10Volume2_en_2016.pdf . Accessed 11 June 2024.
The South African ICD-10 morbidity coding standards and guidelines. https://www.health.gov.za/wp-content/uploads/2021/02/sa_icd-10morbiditycodingstandards-1.pdf . Accessed 11 June 2024.
Independent Hospital Pricing Authority. Australian Coding Standards for ICD-10-AM and ACHI. 12
Information and Funding Systems branch of the Hospital and Health Service Performance division of the Victorian State Government, Department of Health. Health data standards and systems: ACS 0012 Suspected conditions. http://remote.health.vic.gov.au/viccdb/view.asp?Query_Number=3398 . Accessed 11 June 2024.
Government of Western Australia Department of Health. ICD-10-AM/ACHI/ACS Summary of Major Tenth Edition Changes. https://www.health.wa.gov.au/~/media/Files/Corporate/general-documents/Clinical-coding/Guides-and-summaries/summ-10thed.pdf . Accessed 11 June 2024.
NHS Digital. National Clinical Coding Standards ICD-10 5th Edition (2022): Accurate data for quality information. https://classbrowser.nhs.uk/ref_books/ICD-10_2023_5th_Ed_NCCS.pdf . Accessed 11 June 2024.
Mabon K, Steinum O, Chute CG. Postcoordination of codes in ICD-11. BMC Med Inform Decis Mak. 2021;21(Suppl 6):379.
doi: 10.1186/s12911-022-01876-9
World Health Organization. ICD-11 Reference Guide. 2.23.9 Coding of suspected conditions or symptoms, abnormal findings and non-illness situations. https://icdcdn.who.int/icd11referenceguide/en/html/index.html#coding-of-suspected-conditions-or-symptoms-abnormal-findings-and-nonillness-situations . Accessed 11 June 2024.
World Health Organization. ICD-11 Reference Guide. 2.23.5.3 Unconfirmed diagnoses. https://icdcdn.who.int/icd11referenceguide/en/html/index.html#unconfirmed-diagnoses . Accessed 11 June 2024.