ICD-10 4th Edition

You should find these extensive FAQs helpful.

Why has it been decided to implement the WHO updates to ICD-10?

The NHS is committed to reporting morbidity information to the Department of Health using the International Statistical Classification of Diseases and Related Health Problems) Tenth revision (ICD-10). As the World Health Organisation (WHO) continues with a regular update cycle of ICD-10 the UK becomes more out of step with its international peers.

In 2010 the Government published the White Paper – ‘Equity and Excellence: Liberating the NHS' reported commitment to ICD-10 changes for NHS implementation on 1 April 2012 to support quality improvements. The updates are referred to as the ICD-10 4^th Edition.

Why was it decided for the ICD-10 4th Edition to only implement WHO updates up to, and including, January 2010?

The ICD-10 4^th Edition is the latest release of the classification by the World Health Organisation (WHO). Whilst the list of future updates is posted on the WHO website, the use of these changes is subject to the implementation date and availability of data files and published volumes from WHO.

When will the ICD-10 4th Edition data files be ready for our suppliers?

The ICD-10 4^th Edition codes and titles and metadata file, tables of equivalences and specifications are available for download from 10 August 2011 via the Technology Reference data Update Distribution (TRUD) service.

Will equivalence maps between the current ICD-10 and ICD-10 4th Edition be made available?

Tables of Coding Equivalences (ToCE) comprising backward and forward maps are available from TRUD. Use the tables with code description in the file name if you want to perform a visual comparison between the two versions.

Will the ICD-10 cross-maps from SNOMED CT be updated?

Yes, the ICD-10 cross-maps will be updated for the April 2012 release. The cross-mapping data files will be available as part of the terminology release and available via the Technology Reference data Update Distribution (TRUD) service.

Has an Information Standards Notice (ISN) been published as the Trust system supplier won't implement the ICD-10 updates without this?

Yes, the ISN (Ref: ISB 0021 Amd 86/2010) mandating implementation of the ICD-10 updates known as ICD-10 4^th Edition

The Advance Notification (Ref: Amd 86/2010) was issued on 4 April 2011. To note the ISN replaces the former Data Set Change Notice (DSCN).

Will the ICD-10 Clinical Coding Instruction Manual be updated?

Yes, the ICD-10 Clinical Coding Instruction Manual (CCIM) will be updated to support implementation of the changes and will be available in January 2012.

The format of the manual is being considered. If the manual is produced as a hard copy it will continue to be provided free to all NHS clinical coders in England that are registered on our database, and initially received the CCIM on the clinical coding foundation course. If you are a clinical coder in England, and in receipt of a Clinical Coding Instruction Manual, it is imperative that you confirm any changes to your current contact details. Please follow the link below to update your details.

The NHS CFH is considering the suggestion from the ICD-10 Focus Groups for the Trust Coding Manager to validate the list for all clinical coders at their own Trust to ensure details are up-to-date. Further information will be provided about this by registering on the clinical coding mailing list in the near future.

What type of training materials will be available to support the ICD-10 updates?

As a result of the feedback from the site visits and the ICD-10 Focus Groups it is anticipated that training on the ICD-10 updates will be a combination of a self-teach PowerPoint presentation package, and classroom training materials of no more than 2 days duration.

This format proved to be a great success for previous classification implementations, and allows Trusts to use whatever format best suits their local requirements.

The feedback from the ICD-10 Focus Groups will be used to inform the content of these materials, and our Frequently Asked Questions as well as other communications will be regularly updated on progress.

How will an organisation be able to access the ICD-10 updates classroom-based training?

Options include the following:

Clinical Coding Academy-based training – see the NCS website for further information
Contact a neighbouring NHS organisation that has an in-house Approved NHS Clinical Coding Trainer, a list of whom can be found on the NCS website. (N3 connection required to access the NHS list)

In-house training provided by Commercial Approved Clinical Coding Trainers, a list of whom can be obtained by emailing datastandards@nhs.net.

Will the national clinical coding training materials be aligned with the ICD-10 updates and continue to be cascaded to NHS CFH Approved Clinical Coding Trainers?

Yes, the NHS Classifications Service will be incorporating all the key learning points for the ICD-10 updates into the national clinical coding training course materials (Clinical Coding Foundation Course, Clinical Coding Refresher Course, Mental Health Foundation Course, Circulatory & Vascular Workshop, Obstetric & Perinatal Workshop, Orthopaedic Workshop and NCCQ (UK) Revision Workshop).

These materials will be released to all Approved Clinical Coding Trainers subject to the usual licence agreement for use from 1 April 2012. The training materials will be available in January 2012 for NHS CFH Approved Clinical Coding Trainers subject to the usual licence agreement.

We intend to hold two dedicated Trainer Forums, one in the North and one in the South, during December 2011 / early January 2012 at the latest to familiarise all Approved Clinical Coding Trainers with the key learning points for ICD-10 4^th Edition before the Clinical Coding Instruction Manual and training materials are released during January 2012. If your organisation is able to provide a venue for one of these Forums that can hold up to 60 people, please contact datastandards@nhs.net by 30 September 2011.

As a coding manager what budget do I need to purchase the ICD-10 Volumes 1-3 for the coding department?

ICD-10 is published by the WHO and costs are published on their website. Currently ICD-10 Volume set costs approximately £350. However, the NHS Classifications Service is currently negotiating a discounted rate for a bulk order on behalf of the NHS with the WHO. It is hoped that this will be at least a 40% discount, but the NCS is aiming for a 60% discount. Trusts will need to meet these costs locally and we recommend coding departments initially plan for a 40% discount, i.e. £210 per set. The NHS Classifications Service will advise late summer via its website on the final discounted costs.

Will the ICD-10 4th Edition volumes be sold separately so we don't have to purchase Volume 2?

No, in discussions with the WHO they have made it clear that they will only be selling the ICD-10 4^th Edition as a three volume set and will not be selling volumes separately.

ICD-10 Volume 2 is an integral part of the classification and clinical coders should be familiar with the information within.

Will the ICD-10 4th Edition Tabular List (Volume 1) be split into two books?

No, WHO have confirmed that the ICD-10 4^th Edition Tabular List (Volume 1) will be printed as one book.

Will the new ICD-10 volumes have different ISBN numbers to the existing ICD-10 volumes?

This will be raised with the World Health Organisation and the response will be updated on the website in due course.

When and how can I order the ICD-10 4th Edition Volumes 1-3?

We are currently working through the details with the World Health Organisation on how best to distribute to the NHS. We anticipate that the ICD-10 4^th Edition will be available at the end of the year (2011). This information will be updated when more details are available.

What staff should we be targeting to attend in-house awareness sessions?

Gaining the best possible data quality from the use of the ICD-10 4^th Edition will be dependent upon the clinical staff within your organisation documenting clearly and concisely accurate information within their source documentation. Therefore within each trust an overall awareness session will benefit all clinical personnel, whilst short ‘targeted' training sessions will benefit those groups of staff whose speciality will be particularly impacted the most with the introduction of the 4^th Edition, for example, oncologists, renal consultants.

It will also be of benefit to hold awareness sessions for information staff, finance staff and other staff groups that use the data to support mandatory data collections, local service planning and delivery.

It is therefore recommended that clinical coding departments create local awareness materials for these staff groups based on the pertinent key learning points contained within the self-teach PowerPoint presentations and Clinical Coding Instruction Manual.

Has the ICD-10 code format changed?

No, clinical coders will find there has been no change to the ICD-10 code structure as found in the ICD-10 Tabular List.

A number of existing or new ICD-10 codes can now have 5^th character codes assigned. The sequencing rule for dagger and asterisk coding will change with ICD-10 4^th Edition implementation and details of these will be provided in the Key Learning Points.

Is there a list of the Tabular List changes in ICD-10?

Yes, there is a Summary of Changes ICD-10 Reprinted (with updates and corrections) 2000 to ICD-10 4^th Edition which you can download from our website. There is a note in the document to advise it is only a summary of the changes and does not represent all the changes including those within the Alphabetical Index. The final summary document(PDF 224kb) will be published in August when the ICD-10 data files are released.

Will Healthcare Resource Groups be affected?

Yes, The NHS Information Centre for health and social care have confirmed that all valid ICD-10 4^th Edition codes will be accommodated, via the Healthcare Resource Groups grouping process, into reference cost and payment groupers. Further information about Healthcare resource Groups or the NHS Information Centre.

What areas in the ICD-10 updates will have the biggest impact for clinical coders?

Fundamental to coding is the 4-step coding process and the numerous ICD-10 4^th Edition changes within the Alphabetical Index (Volume 3) will continue to require the application of this.

There have been a number of deletions, modifications and additions within the Tabular List (Volume 1) and these are available for download here: Summary of Changes ICD-10 Reprinted (with updates and corrections) 2000 to ICD-10 4^th Edition (PDF 224kb)

One of the biggest changes is to the rule currently governing the sequencing of a dagger and asterisk code combination. This rule has been changed to also allow the asterisk code to precede the dagger code when the manifestation (asterisk) is the primary focus of care. Previously this was always expressed in the sequence format "dagger code then asterisk code". The updates (Volume 2) advise that it should be acceptable to put the asterisk code in first place before the dagger code, if it is the major condition treated. This has the advantage of aligning better with the NHS Primary Diagnosis Definition. However this change will have an impact on the validation software used within systems, because currently all asterisk codes are restricted to second or subsequent fields. Coding practice, systems and data analysis will need to take into account this change.

The new Chapter XXII Codes for Special Purposes include a number of additional codes denoting specific agents that are resistant to antibiotics (e.g. "penicillin-resistant").

There are a large number of updates to the neoplasm chapter. Changes to morphology coding have not been included in this assessment. The updates to the morphological listings include the removal from the ICD-10 classification of haematopoietic malignancy morphology codes. Coding of morphology data is not mandatory for admitted patient care coding in England (but is required by Cancer Registries using ICD-0).

Will there be an update to OPCS-4 at the same time as ICD-10 4th Edition implementation?

No, there are no plans to implement updates to OPCS-4.6 in 2012. It is anticipated that the next update to OPCS-4.6 would be 2013 at the earliest.

Will you be publishing an eVersion of ICD-10 4th edition?

There are no plans to publish an eVersion in the short term.

How frequently will ICD-10 be updated?

The release schedule has not yet been determined however it is not anticipated we will release both OPCS-4 and ICD-10 updates in the same year.

ICD-10 4th Edition — NHS Connecting for Health