ICD-11
ICD | |
Predecessor | ICD-10 |
---|---|
Domain | |
License | CC BY-ND 3.0 IGO[5] |
Website | icd |
The ICD-11 is the eleventh revision of the
The ICD-11 is a large ontology consisting of about 85,000 entities, also called classes or nodes. An entity can be anything that is relevant to health care. It usually represents a disease or a
The ICD-11 officially came into effect on 1 January 2022.[11] In February 2022, the WHO stated that 35 countries were actively using the ICD-11.[12] On 14 February 2023, they reported that 64 countries were "in different stages of ICD-11 implementation".[13] According to a JAMA article from July 2023, implementation in the United States would at minimum require 4 to 5 years.[14]
The ICD-11 MMS can be viewed online on the WHO's website. Aside from this, the site offers two maintenance platforms: the ICD-11 Maintenance Platform, and the WHO-FIC Foundation Maintenance Platform. Users can submit evidence-based suggestions for the improvement of the WHO-FIC, i.e. the ICD-11, the
Structure
WHO-FIC
The WHO Family of International Classifications (
The Foundation Component is a multidimensional collection of entities.
The Foundation Component is the common core on which all Reference and Derived Classifications are based.
A classification can be represented as a tabular list, which is a "flat" hierarchical tree of categories. In this tree, all entities can only have a single parent, and therefore must be mutually exclusive of each other.[21] Such a classification is also called a linearization.
ICD-11 MMS
The ICD-11 MMS is the main Reference Classification of the WHO-FIC, and the primary linearization of the Foundation Component. The ICD-11 MMS is commonly referred to as simply "the ICD-11".[10] The "MMS" part was added to differentiate the ICD-11 entities in the Foundation from those in the Classification. The ICD-11 MMS does not contain all classes from the Foundation ICD-11, and also adds some classes from the ICF. MMS stands for Mortality and Morbidity Statistics. The abbreviation is variously written with or without a hyphen between 11 and MMS ("ICD-11 MMS" or "ICD-11-MMS").
The ICD-11 MMS consists of approximately 85,000 entities. Entities can be chapters, blocks or categories. A chapter is a top level entity of the hierarchy; the MMS contains 28 of them (see Chapters section below). A block is used to group related categories or blocks together. A category can be anything that is relevant to health care. Every category has a unique, alphanumeric code called an ICD-11 code, or just ICD code. Chapters and blocks never have ICD-11 codes, and therefore cannot be diagnosed. An ICD-11 code is not the same as an entity id.
The ICD-11 MMS takes the form of a "flat" hierarchical tree. As aforementioned, the entities in this linearization can only have a single parent, and therefore must be mutually exclusive of each other. their purpose, similarly to blocks, is to group other categories, but, unlike blocks, they only group entities that are located elsewhere in the classification, meaning that their only children are gray nodes.
The ICD-11 MMS also contains residual categories, or residual nodes. These are the "Other specified" and "Unspecified" categories. The former can be used to code conditions that do not fit with any of the more specific MMS entities, the latter can be used when necessary information may not be available in the source documentation. The ICD-11 Reference Guide advises that health care workers always aim to include the most specific level of detail possible, either with one code or multiple codes.[24] In the ICD-11 Browser, residual nodes are displayed in a maroon color.[25] Residual categories are not in the Foundation, and therefore don't have an entity ID. Thus, in the MMS, they are the only categories with derivative entity IDs: their IDs are the same as their parent nodes, with "/other" or "/unspecified" tagged at the end. Their ICD codes always end with Y for "Other specified" categories, or Z for "Unspecified" categories (e.g. 1C4Y and 1C4Z).
Health informatics
The ICD-11, both the ICD-11 Foundation and the MMS, can be accessed using a multilingual
The WHO has released spreadsheets that can be used to link and convert
The ICD-11 Foundation, and consequently the MMS, are updated annually, similarly to the ICD-10. Following the initial release of a stable version on 18 June 2018,[3] the Foundation and the MMS have received seven updates as of February 2025[update].[29][30]
Chapters
Below is a table of all chapters of the ICD-11 MMS,[27] the primary linearization of the Foundation Component.[17]
# | Range | Chapter | # | Range | Chapter |
---|---|---|---|---|---|
1 | 1A00–1H0Z | Certain infectious or parasitic diseases | 15 | FA00–FC0Z | Diseases of the musculoskeletal system or connective tissue |
2 | 2A00–2F9Z | Neoplasms | 16 | GA00–GC8Z | Diseases of the genitourinary system |
3 | 3A00–3C0Z | Diseases of the blood or blood-forming organs | 17 | HA00–HA8Z | Conditions related to sexual health |
4 | 4A00–4B4Z | Diseases of the immune system | 18 | JA00–JB6Z | Pregnancy, childbirth or the puerperium |
5 | 5A00–5D46 | Endocrine, nutritional or metabolic diseases | 19 | KA00–KD5Z | Certain conditions originating in the perinatal period |
6 | 6A00–6E8Z | Mental, behavioural or neurodevelopmental disorders | 20 | LA00–LD9Z | Developmental anomalies |
7 | 7A00–7B2Z | Sleep-wake disorders | 21 | MA00–MH2Y | Symptoms, signs or clinical findings, not elsewhere classified |
8 | 8A00–8E7Z | Diseases of the nervous system | 22 | NA00–NF2Z | Injury, poisoning or certain other consequences of external causes |
9 | 9A00–9E1Z | Diseases of the visual system | 23 | PA00–PL2Z | External causes of morbidity or mortality |
10 | AA00–AC0Z | Diseases of the ear or mastoid process | 24 | QA00–QF4Z | Factors influencing health status or contact with health services |
11 | BA00–BE2Z | Diseases of the circulatory system | 25 | RA00–RA26 | Codes for special purposes |
12 | CA00–CB7Z | Diseases of the respiratory system | 26 | SA00–SJ3Z | Supplementary Chapter Traditional Medicine Conditions - Module I |
13 | DA00–DE2Z | Diseases of the digestive system | 27 | VA00–VC50 | Supplementary section for functioning assessment |
14 | EA00–EM0Z | Diseases of the skin | 28 | XA0060–XY9U | Extension Codes |
Unlike the ICD-10 codes, the ICD-11 MMS codes never contain the letters I or O, to prevent confusion with the numbers 1 and 0.[31]
Changes
Below is a summary of notable changes in the ICD-11 MMS compared to the ICD-10.
General
The ICD-11 MMS features a more flexible coding structure. In the ICD-10; every code starts with a letter, followed by a two digit number (e.g. P35)—creating 99 slots, excluding subcategories and blocks. This proved enough for most chapters, but four are so voluminous that their categories span multiple letters: Chapter I (A00–B99), Chapter II (C00.0–D48.9), Chapter XIX (S00–T98), and Chapter XX (V01–Y98). In the ICD-11 MMS, there is a single first character for every chapter. The codes of the first nine chapters begin with the numbers 1 to 9, while the next nineteen chapters start with the letters A to X. The letters I and O are not used, to prevent confusion with the numbers 1 and 0. The chapter character is then followed by a letter, a number, and a fourth character that starts as a number (0–9, e.g. KA80) and may then continue as a letter (A–Z, e.g. KA8A). The WHO opted for a forced number as the third character to prevent the spelling of "undesirable words".[31] In the ICD-10, each entity within a chapter either has a code (e.g. P35) or a code range (e.g. P35–P39). The latter is a block. In the ICD-11 MMS, blocks never have codes, and not every entity necessarily has a code, although each entity does have a unique id.[31]
In the ICD-10, the next level of the hierarchy is indicated in the code by a dot and a single number (e.g. P35.2). This is the lowest available level in the ICD-10 hierarchy, causing an artificial limitation of 10 subcategories per code (.0 to .9).[32] In the ICD-11 MMS, this limitation no longer exists: after 0–9, the list may continue with A–Z (e.g. KA62.0 – KA62.A). Then, following the first character after the dot, a second character may be used in the next level of the hierarchy (e.g. KA40.00 – KA40.08). This level is currently the lowest appearing in the MMS. The large amount of unused coding space in the MMS allows for updates to be made without having to change the other categories, ensuring that codes remain stable.[31]
The ICD-11 features five new chapters. The third chapter of the ICD-10, "Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism", has been split in two: "Diseases of the blood or blood-forming organs" (chapter 3) and "Diseases of the immune system" (chapter 4). The other new chapters are "Sleep-wake disorders" (chapter 7), "Conditions related to sexual health" (chapter 17, see section), and "Supplementary Chapter Traditional Medicine Conditions - Module I" (chapter 26, see section).
Mental disorders
Overview
The following mental disorders have been newly added to the ICD-11, but were already included in the American
The following mental disorders have been newly added to the ICD-11, and are not in the ICD-10-CM:
Other notable changes include:[32]
- Distinct personality disorders have been collapsed into a single Personality disorder diagnosis, using a dimensional (as opposed to categorical) model; see Personality disorders section.
- All subtypes of Cognitive symptoms (6A25.5).
- Persistent mood disorders (F34), which consists of Cyclothymia (F34.0) and Dysthymia (F34.1), have been deleted. Cyclothymia has been categorized under bipolar and related disorders (6A62), while dysthymia has been categorized under depressive disorders (6A72).
- The ICD-10 differentiates between Anxiety or fear-related disorders (1336943699).
- All Autism spectrum disorder (6A02), except for Rett syndrome, which is moved to the developmental anomalies chapter (LD90.4).
- Hyperkinetic disorders (F90) is renamed Attention deficit hyperactivity disorder (6A05), and a distinction in subtypes is made between predominantly inattentive (6A05.0), predominantly hyperactive-impulsive (6A05.1), and combined (6A05.2). Hyperkinetic conduct disorder (F90.1) has been removed.
- Acute stress reaction (F43.0) has been moved out of the mental disorder chapter, and placed in the chapter "Factors influencing health status or contact with health services" (QE84). Thus, in the ICD-11, Acute stress reaction is no longer considered a mental disorder.[33]
ICD-11 CDDR
Following an extensive, years-long revision process involving nearly 15,000 clinicians from 155 countries,[32] the WHO developed the ICD-11 CDDG (Clinical Descriptions and Diagnostic Guidelines),[34][35][36] later renamed the ICD-11 CDDR (Clinical Descriptions and Diagnostic Requirements).[37] The CDDR is a comprehensive diagnostic manual for identifying and measuring mental illnesses with a uniform terminology, similar to the DSM-5.[38][39] The ICD-11 CDDR was developed around the same time as the DSM-5, and the work groups of both projects regularly met to discuss their efforts. The CDDR and the DSM-5 are similar, but not identical.[40] The ICD-11 CDDR is the successor to the ICD-10 CDDG, which was first released in 1992[41] and was also known as the "Blue Book".[34] The CDDR is integrated into the ICD-11, and can be viewed in the ICD-11 Browser.[27] On 8 March 2024,[39] the CDDR was also released in book form. It can be downloaded for free from the WHO's website.[42]
Personality disorder
The
Described as a clinical equivalent to the Big Five model,[43] the five-trait system addresses several problems of the old category-based system. Of the ten PDs in the ICD-10, two were used with a disproportionate high frequency: emotionally unstable personality disorder, borderline type (F60.3) and dissocial (antisocial) personality disorder (F60.2).[a] Many categories overlapped, and individuals with severe disorders often met the requirements for multiple PDs, which Reed et al. (2019) described as "artificial comorbidity".[32] PD was therefore reconceptualized in terms of a general dimension of severity, focusing on five negative personality traits which a person can have to various degrees.[44]
There was considerable debate regarding this new dimensional model, with many believing that categorical diagnosing should not be abandoned. In particular, there was disagreement about the status of borderline personality disorder. Reed (2018) wrote: "Some research suggests that borderline PD is not an independently valid category, but rather a heterogeneous marker for PD severity. Other researchers view borderline PD as a valid and distinct clinical entity, and claim that 50 years of research support the validity of the category. Many – though by no means all – clinicians appear to be aligned with the latter position. In the absence of more definitive data, there seemed to be little hope of accommodating these opposing views. However, the WHO took seriously the concerns being expressed that access to services for patients with borderline PD, which has increasingly been achieved in some countries based on arguments of treatment efficacy, might be seriously undermined."[44] Thus, the WHO believed the inclusion of a borderline pattern category to be a "pragmatic compromise".[45]
The Alternative DSM-5 Model for Personality Disorders (AMPD) included near the end of the DSM-5 is similar to the PD-system of the ICD-11, although much larger and more comprehensive.[46] It was considered for inclusion in the ICD-11, but the WHO decided against it because it was considered "too complicated for implementation in most clinical settings around the world",[44] since an explicit aim of the WHO was to develop a simple and efficient method that could also be used in low-resource settings.[45]
Gaming disorder
Although a majority
In support of the GD category, Lee et al. (2017) agreed that there were major limitations of the existing research, but that this actually necessitates a standardized set of criteria, which would benefit studies more than self-developed instruments for evaluating problematic gaming.
The DSM-5 (2013) features a similar category called Internet Gaming Disorder (IGD).[55] However, due to the controversy over its definition and inclusion, it is not included in its main body of mental diagnoses, but in the additional chapter "Conditions for Further Study". Disorders in this chapter are meant to encourage research and are not intended to be officially diagnosed.[56]
Burn-out
In May 2019, a number of media incorrectly reported that
As with the ICD-10, burn-out is not in the mental disorders chapter, but in the chapter "Factors influencing health status or contact with health services", where it is coded QD85. In response to media attention over its inclusion, the WHO emphasized that the ICD-11 does not define burn-out as a mental disorder or a disease, but as an occupational phenomenon that undermines a person's well-being in the workplace.[61][62]
Sexual health
Conditions related to sexual health is a new chapter in the ICD-11. The WHO decided to put the sexual disorders in a separate chapter due to "the outdated
Sexual dysfunctions
Regarding general sexual dysfunction, the ICD-10 has three main categories:
The ICD-10 contains the categories Vaginismus (N94.2), Nonorganic vaginismus (F52.5), Dyspareunia (N94.1), and Nonorganic dyspareunia (F52.6). As the WHO aimed to steer away from the aforementioned "outdated mind/body split", the organic and nonorganic disorders were merged. Vaginismus has been reclassified as Sexual pain-penetration disorder (HA20). Dyspareunia (GA12) has been retained. A related condition is Vulvodynia, which is in the ICD-9 (625.7), but not in the ICD-10. It has been re-added to the ICD-11 (GA34.02).[64]
Sexual dysfunctions and Sexual pain-penetration disorder can be coded alongside a temporal qualifier, "lifelong" or "acquired", and a situational qualifier, "general" or "situational". Furthermore, the ICD-11 offers five aetiological qualifiers, or "Associated with..." categories, to further specify the diagnosis.[64] For example, a woman who experiences sexual problems due to adverse effects of an SSRI antidepressant may be diagnosed with "Female sexual arousal dysfunction, acquired, generalised" (HA01.02) combined with "Associated with use of psychoactive substance or medication" (HA40.2).
Compulsive sexual behaviour disorder
There was debate on whether CSBD should be considered a (behavioral) addiction. It has been claimed that neuroimaging shows overlap between compulsive sexual behavior and substance-use disorder through common neurotransmitter systems.[68] Nonetheless, it was ultimately decided to place the disorder in the Impulse control disorders group. Kraus et al. wrote that, for the ICD-11, "a relatively conservative position has been recommended, recognizing that we do not yet have definitive information on whether the processes involved in the development and maintenance of [CSBD] are equivalent to those observed in substance use disorders, gambling and gaming".[67]
Paraphilic disorders
Gender incongruence
In the ICD-10, the Gender identity disorders were placed in the mental disorders chapter, following what was customary at the time. Throughout the 20th century, both the ICD and the
Antimicrobial resistance and GLASS
The group related to coding
Traditional medicine
"Supplementary Chapter Traditional Medicine Conditions - Module I" is an additional chapter in the ICD-11. It consists of concepts that are commonly referred to as traditional Chinese medicine (TCM), although the WHO prefers to use the more general and neutral sounding term traditional medicine (TM). Many of the traditional therapies and medicines that originally came from China also have long histories of usage and development in Japan (Kampo), Korea (TKM), and Vietnam (TVM).[75] Medical procedures that can be labeled as "traditional" continue to be used all over the world, and are an integral part of health services in some countries. A 2008 survey by the WHO found that "[i]n some Asian and African countries, 80% of the population depend on traditional medicine for primary health care". Also, "[i]n many developed countries, 70% to 80% of the population has used some form of alternative or complementary medicine (e.g. acupuncture)".[76]
From approximately 2003 to 2007,[77] a group of experts from various countries developed the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region, or simply IST.[b][78] In the following years, based on this nomenclature, the group created the International Classification of Traditional Medicine, or ICTM.[c][77][80] As of February 2023[update], Module I, also called TM1,[81][82] is the only module of the ICTM to have been released. Morris, Gomes, & Allen (2012) have stated that Module II will cover ayurveda, that Module III will cover homeopathy, and that Module IV will cover "other TM systems with independent diagnostic conditions in a similar fashion".[77] However, these modules have yet to be made public, and Singh & Rastogi (2018) noted that this "keeps the speculations open for what actually is encompassing under the current domain [of the ICTM]".[83]
The decision to include T(C)M in the ICD-11 has been criticized, because it is often alleged to be
Other changes
Other notable changes in the ICD-11 include:
- Stroke is now classified as a neurological disorder instead of a disease of the circulatory system.[87]
- Allergies are now coded under diseases of the immune system.[87]
- In the ICD-10, a distinction was made between Sleep disorders (G47), included in nervous system diseases chapter, and Nonorganic sleep disorders (F51), included in the mental disorders chapter. In the ICD-11, they are merged and placed into a new chapter called sleep-wake disorders, since the separation between organic (physical) and non-organic (mental) disorders is considered obsolete.[65]
- "Supplementary section for functioning assessment" is an additional chapter that provides codes for use in the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0),[88] the model disability survey (MDS),[89] and the ICF.
Footnotes
- Other specific personality disorders (ICD-9: 301.8; ICD-10: F60.8). Patients who might have NPD are sometimes also diagnosed with Dissocial/Antisocial personality disorder (ICD-9: 301.7; ICD-10: F60.2).
- ^ The abbreviation "IST" is used in official WHO documentation.[78] Other abbreviations that have been used are "WHO-IST"[77] and "WHO ISTT".[75]
- ^ Morris, Gomes, & Allen (2012) also used the term "International Classification of Traditional Medicine-China, Japan, Korea" (ICTM-CJK).[77] This term does not appear in official WHO documentation, and has only limited use.[citation needed] Also, Choi (2020) have used the term "ICD-11-26" to refer to the TM-chapter.[79]
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In this regard, ICD-11 and DSM-5 are quite similar to one another, though not identical, and substantially different from ICD10 and DSM-IV.
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Their arguments led to a series of commentaries, most of which were in favor of including the new diagnosis of GD in the ICD-11.
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The use of the proposed GD criteria in ICD-11 is expected to promote a higher quality of research than the current use of unstandardized, mostly self-developed instruments for evaluating problematic gaming.
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Both diagnostic manuals (i.e., the DSM and the ICD) are regularly revised, thus characterized by permanent change. (...) Moral panics and stigmatization related to video games are mostly induced and maintained by media scaremongering and the differences in mentality of the younger and older generations (i.e., generation gap) and not the existence of a formal diagnosis.
- ^ Rumpf et al. (2018): "The argument of potential stigmatization is not specific to GD but relates to many other well-established mental disorders. (...) Health insurance companies and other financers of treatment may adopt the arguments raised by non-clinical researchers (e.g., "gaming is a normal lifestyle activity"); so that, those in need of treatment and with limited funds are unable to get professional help."
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- ^ DSM-5: "These proposed criteria sets are not intended for clinical use; only the criteria sets and disorders in Section II of DSM-5 are officially recognized and can be used for clinical purposes." (p. 783).
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The ICD-10 classification of Sexual dysfunctions (F52) is based on a Cartesian separation of "organic" and "non-organic" conditions.
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The World Professional Association for Transgender Health (WPATH), for example, defined GD as "discomfort or distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)"
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