Webinar: Using the ICD-11 Coding Tool (MP4)
Transcript
Slide 1: Title page
Welcome to Using the ICD-11 Coding Tool webinar. ICD-11 is the International Classification of Diseases 11th Revision. This webinar will provide an overview on how to use the ICD-11 Coding Tool. As a prerequisite, we recommend taking the Introduction to ICD-11 for Mortality and Morbidity Statistics webinar.
Slide 2: Learning objectives
At the end of this webinar, you will be able to
- Access the ICD-11 Coding Tool and Help content;
- Identify and describe the icons and links used in the Coding Tool;
- Define the “code also” and “use additional code, if desired” instructions;
- Perform a regular and flexible search using the ICD-11 Coding Tool;
- Use the Postcoordination tool within the ICD-11 integrated browser;
- Access the ICD-11 tabular list using the integrated browser; and
- Quick-copy a code.
Slide 3: ICD-11 electronic tools
ICD-11 has 2 online electronic tools: the browser and the Coding Tool. The ICD-11 browser contains the tabular list. It displays the hierarchy of ICD-11 and all associated information about each entity. The Coding Tool serves as an alphabetical index and functions like a web-based search such that the user can type (or copy and paste) a diagnostic statement as recorded without using a lead term and/or secondary term. The Coding Tool is linked to the ICD-11 browser so that you can access further details on a category or code in the classification within the Coding Tool.
Slide 4: Accessing the Coding Tool
The ICD-11 Coding Tool can be accessed 2 different ways: from the World Health Organization ICD-11 website by clicking the Coding Tool hyperlink, or from the ICD-11 browser by clicking the Coding Tool tab.
Slide 5: Coding Tool
The Coding Tool is used to find the correct ICD-11 code for a specific diagnosis. You can select words from the word list, or type or copy and paste a word or diagnosis in the search box. The results of a search are displayed under the heading “Destination Entities.”
Slide 6: ICD-11 Coding Tool Help - Demo
We will not be covering all the functionality of the ICD-11 Coding Tool; however, detailed guidance is available under the Help tab. You can scroll through the content to a particular section or select a section from the hierarchy listed on the left-hand side of the screen. It includes information on searching and on the integrated browser, postcoordination, related categories in the perinatal chapter and much more. To return to the Coding Tool, click the Help tab again.
Slide 7: ICD-11 Coding Tool — Icons and links
In the Coding Tool, different icons may appear in a destination entity search result. Each icon has a different meaning, which we will explore in further detail.
Slide 8: ICD-11 Coding Tool — Icons and links
The icon with an orange circle and a plus sign means that postcoordination is mandatory.
The icon with a white circle and a plus sign means that postcoordination is available.
The icon with a green circle and 3 horizontal lines means that a coding note is available.
The icon with a yellow circle and the letter J means that there is a related category or categories in the maternal chapter.
And lastly, the icon with a purple circle and the letter K means that there is a related category or categories in the perinatal chapter.
There’s also links labelled Details and See in hierarchy for each destination entity result. The Details link reveals additional information on a certain entity — for example, any matching terms and coding notes. It also includes the See in hierarchy link that would open the ICD-11 integrated browser. It is a recommended best practice to review your chosen code in the ICD-11 browser, which we will cover later in this webinar.
Slide 9: ICD-11 conventions
The “code also” and “use additional code, if desired” instructions in ICD-11 have unique meanings.
Slide 10: “Code also” instruction
The “code also” instruction informs you that additional etiological information (“has causing condition”) is mandatory to postcoordinate with the chosen stem code, when applicable. “When applicable” means that when the case being coded includes documentation to support coding the etiology, coding the etiology is mandatory. If the etiology is not documented, then of course the “code also” instruction does not apply. You will find the “code also” instruction in the ICD-11 browser at the chosen stem code under the Postcoordination tool section with the label “Has causing condition (code also).” In the Coding Tool, as we explained in the earlier slides, any destination entity with an orange circle and a plus sign icon indicates that postcoordination for the entity is mandatory.
Slide 11: “Use additional code, if desired” instruction
The “use additional code, if desired” instruction informs you that optional additional detail can be postcoordinated with the chosen stem code, if desired. “If desired” means that when the case being coded includes details such as manifestations resulting from the underlying condition, laterality detail or anatomy site detail, then you can postcoordinate those details optionally. You will find the “use additional code, if desired” instruction in the ICD-11 browser at the chosen stem code under the Postcoordination tool section with the label “Has manifestation (use additional code, if desired)” or with specific labels referring to categories for extension codes. In the Coding Tool, any destination entity with a white circle and a plus sign icon indicates that there is optional postcoordination for this entity.
Slide 12: ICD-11 Coding Tool and integrated browser
Now that you understand the icons and links that you will see in the ICD-11 Coding Tool and the “code also” and “use additional code, if desired” instructions in the browser, let’s review how to use the ICD-11 Coding Tool and how to access the integrated browser from within the Coding Tool.
Slide 13: Regular search
In the Coding Tool, to perform a regular search for an ICD-11 code, which is the default search, you type (or you could copy and paste) the diagnosis. The Coding Tool only returns results (destination entities) that contain all the words that you have used in your search. It accepts different variants or synonyms of the words, but essentially it searches for a result that contains all components of your search.
When the result displays a blue highlight, this means that it is a perfect match to your search term.
To access the integrated ICD-11 browser from a destination entity, click the Details link at the chosen destination entity and then click the See in hierarchy link.
The following 3 examples will demonstrate how to perform a regular search and remind you of the icons and links we discussed earlier.
Slide 14: Regular search — Example 1 - Demo
The diagnosis is simple chronic bronchitis.
You type (or copy and paste) the diagnosis into the search box. The first destination entity search result, CA20.10 Simple chronic bronchitis, is the perfect match to this search as indicated by the stem code highlighted in blue. You can see the icons indicating that postcoordination is available, and the J and K icons indicating that there is a related category in the maternal and perinatal chapter as well as the Details link. Clicking the Details link reveals more information, including the See in hierarchy link that opens the ICD-11 integrated browser. It is a recommended best practice to review your chosen code in the ICD-11 browser.
Slide 15: Regular search — Example 2 - Demo
The diagnosis is acute gastritis.
You type (or copy and paste) the diagnosis into the search box. The first destination entity, DA42.Z Gastritis, unspecified, is the perfect match to your search as indicated by the matching term highlighted in blue. You can see the icon indicating that there is mandatory postcoordination and the J and K icons, as well as the Details link. Clicking the Details link reveals more information, including the See in hierarchy link that opens the ICD-11 integrated browser.
Slide 16: Regular search — Example 3 - Demo
The diagnosis is diabetic retinopathy.
You type the diagnosis (or copy and paste) into the search box. The first destination entity, 9B71.0Z Diabetic retinopathy, unspecified, is the perfect match to your search as indicated by the code title highlighted in blue. You can see the icon indicating that there is mandatory postcoordination and the Coding Note icon, as well as the Details link. Clicking the Details link, you can see the Coding Note, which instructs you to “always assign an additional code for diabetes mellitus,” and the See in hierarchy link. As a best practice, you can open the integrated browser to confirm your code selection. Later in the webinar, we will show you how to add the additional code for diabetes mellitus using the Postcoordination tool.
Slide 17: Flexible search
When the regular search does not return any results, a flexible search is used.
Unlike the regular search, the flexible search returns destination entity results that do not contain all of the words used in your search. The system finds the best matching phrase to the search words entered into the search box. Search results appear the same as they do when a regular search is performed. The “correct” code may not be readily apparent when using a flexible search because the system is finding the best matching phrase rather than looking for all the words used in your search.
Let’s look at an example requiring use of the flexible search.
Slide 18: Flexible search — Example 1
The diagnosis is acute situational crisis.
When you enter the diagnosis into the search box, you can see that the Coding Tool does not find a match, so you click Try flexible search.
The system tells you that flexible search is on and provides results by showing the best matching words from your search. As you look through the destination entities returned by the search, you can see that QE84 Acute stress reaction appears to be where this diagnosis is classified, based on reviewing the matching terms by clicking the Details link and seeing the index terms “acute stress reaction” and “acute situational reaction.” It is a recommended best practice to review your chosen code in the ICD-11 browser.
Slide 19: Postcoordination
Postcoordination is a functional feature of ICD-11. It allows you to link core diagnostic concepts (i.e., stem code plus stem code) and to add additional details captured in extension codes. The linked codes are referred to as a cluster. A cluster is sometimes autogenerated within the Coding Tool functionality, meaning that the destination entities returned as part of the search results show a cluster of codes rather than a single stem code. Sometimes the Coding Tool will not autogenerate a cluster, even though certain detail is included in the search. In these instances, the cluster is created using the Postcoordination tool, when available, at the chosen stem code in the tabular list.
The following 3 examples show how to search using the Coding Tool and the Postcoordination tool in the integrated browser.
Slide 20: Postcoordination — Example 1- Demo
Let’s look at the diabetic retinopathy example that we did earlier.
Searching for diabetic retinopathy, you arrive at 9B71.0Z. In reviewing the code in the tabular list, you can see the Coding Note that instructs you to “always assign an additional code for diabetes mellitus.” Under the heading “Postcoordination” is a “has causing condition (code also)” instruction and the stem codes available to capture the type of diabetes. For the purpose of this demonstration, we know that the patient has type 2 diabetes mellitus. Click 5A11 Type 2 diabetes mellitus, and you can see that 5A11 has been postcoordinated with 9B71.0Z. After confirming your code selection, quick-copy the code by clicking the Select icon. This will copy the code into the clipboard and return you to the Coding Tool, where the selected code appears at the top of the Coding Tool. Since the code has been copied into the clipboard, it can then be pasted elsewhere, if necessary.
Slide 21: Postcoordination — Example 2 - Demo
The diagnosis is third-degree burn, left thigh.
The regular search returns destination entity results. The first destination entity displayed is ND96.3 Burn of hip or leg, except ankle or foot, full thickness burn, with extension codes for left and thigh. It contains all the words in your search, and you can see it is an example of the Coding Tool returning an autogenerated cluster that includes 2 extension codes, one identifying the laterality of “left” and the other identifying the anatomy site of “thigh.” To the right of the code title, you see the “postcoordination is available” icon. Clicking the Details link, you can see from the matching terms list that a third-degree burn is indexed to the code for “full thickness burn.” Since it is a recommended best practice to always review your code selection in the tabular list, click the See in hierarchy link, which opens the integrated browser.
In the integrated browser, under the heading “Postcoordination,” you can see the autogenerated postcoordination detail that was created when you performed your Coding Tool search. As you scroll down in the Postcoordination tool section, you can also see several “use additional code, if desired” instructions with various labels. Since this example is an injury (burn), per normal coding practice, you need to also assign an external cause of injury code. You can find the external cause code by using the Postcoordination tool search box available under the heading “Associated with.” Typing “burn” into the search box reveals that “burning NOS [not otherwise specified]” is indexed to PB1Z Unintentional exposure to unspecified thermal mechanism. Select this code by clicking PB1Z and you can see that it has been added to the code cluster. Scrolling back up to the top of the Postcoordination tool section, you can see the codes that are postcoordinated with the stem code. After confirming your code selection, quick-copy the code by clicking the Select button. The code appears at the top of the Coding Tool.
Slide 22: Postcoordination — Example 3- Demo
The diagnosis is acute esophageal varices with bleeding.
The regular search returns destination entity results. You can see that the first destination entity displayed — DA26.00 Oesophageal varices with bleeding, with the extension code detail of acute — is the perfect match to the search words entered.
To the right of the code title, you can see the icon indicating that there is mandatory postcoordination. The J and K icons are not relevant to this example. By clicking the Details link, you can review the “matching terms.” You also must consider the mandatory postcoordination and confirm your code selection in the tabular list by clicking the See in hierarchy link. In the integrated browser, in the Postcoordination tool section, you can see the mandatory “code also” instruction. However, you don’t know the causing condition in this example; therefore, no additional code can be assigned. The other postcoordination options suggested are not applicable as you have no additional detail available in the diagnosis. After confirming your code selection, click the Select icon to quick-copy the code.
Slide 23: Postcoordination — Example 4 - Demo
The diagnosis is closed fracture of the left elbow.
The regular search does not return any destination entity results. Trying a flexible search, the first destination entity returned is NC32.0 Fracture of upper end of ulna with the laterality extension code XK8G for “left.” The first destination entity result appears to be the correct code per the matching term “fracture of elbow [left].”
To the right of the code title, you can see the icon indicating that postcoordination is available and the Details link. Click the Details link to access and find the See in hierarchy link, where you can confirm the code selection in the tabular list and review the postcoordination options that are available.
In the integrated browser, under the “Postcoordination” heading, you can see the autogenerated postcoordination for the laterality of left (XK8G) that was created when you performed your Coding Tool search. Scrolling down in the Postcoordination section, you can see several “use additional code, if desired” instructions, one of which is labelled, “Fracture open or closed.” The diagnosis includes the additional detail of “closed fracture.” For the purposes of this webinar, although optional, you will code to the greatest degree of specificity and postcoordinate the detail of a closed fracture (XJ44E). Click XJ44E in the Postcoordination tool section. You will see that the system automatically adds the extension code to the ICD-11 cluster at the top of the page. When you scroll back up the page, you can see the code title for each extension code chosen directly under the heading “Postcoordination.” After confirming your code selection, click the Select icon to quick-copy the code.
Slide 24: Coding examples using the ICD-11 Coding Tool and integrated browser
Let’s put what you have learned into practice by coding more examples.
Slide 25: Practice — Example 1- Demo
The diagnosis is femoral vein thrombosis in pregnancy.
The regular search does not return any destination entities. Trying a flexible search, you can see the matching term “femoral vein thrombosis” at the first destination entity result BD71.4 Lower limb deep vein thrombosis. As well, you see the J icon, which indicates that there is a related category in the maternal chapter. You know that the diagnosis is specific to pregnancy, so the J icon is applicable.
Click the Details link, where you can see more details on how to code femoral vein thrombosis in pregnancy. Under the heading “Related categories in the maternal chapter,” you see “Deep phlebothrombosis in pregnancy postcoordinated with lower limb deep vein thrombosis.” Click the hyperlink for the ICD cluster of JA61.3/BD71.4. This hyperlink takes you to the integrated browser — namely, to the maternal chapter and more specifically, the stem code JA61.3 Deep phlebothrombosis in pregnancy. You can see the autogenerated ICD-11 cluster. After confirming your code selection, click the Select icon to quick-copy the code.
Slide 26: Practice — Example 2 - Demo
The diagnosis is acute gastritis due to H. pylori.
The regular search did not return any destination entities. Trying a flexible search, you can see that DA42.1&XT5R Helicobacter pylori induced gastritis [Acute] has the same meaning as the diagnosis. Click the Details link to reveal more information, including the See in hierarchy link.
In the integrated browser, we see the ICD-11 cluster because the Coding Tool already autogenerated the ICD-11 cluster with the detail of extension code “XT5R Acute.” There is no additional detail in the diagnosis so the postcoordination options available are not applicable. After confirming your code selection, quick-copy the ICD-11 cluster.
Slide 27: Practice — Example 3 - Demo
The diagnosis is stage 1 chronic kidney disease.
For this example, the regular search returned a perfect match destination entity. That is, GB61.0 Chronic kidney disease, stage 1. You can see there is mandatory postcoordination for this entity. Clicking the Details link reveals more information, including the See in hierarchy link.
In the integrated browser, under the “Postcoordination” heading, you can see the “code also” instruction, meaning that it is mandatory to assign a code when the causing condition is known. For the purpose of demonstrating a “code also” instruction, let’s say that we know the patient’s chronic kidney disease is due to type 2 diabetes mellitus. Click Diabetes mellitus, displayed in the Postcoordination tool, to see drop-down options. Here you will find 5A11 Type 2 diabetes mellitus. Or you can simply type “diabetes type 2” into the search box. Click 5A11 and the system links the code for you so that you have an ICD-11 cluster of GB61.0/5A11. The ICD-11 cluster describes stage 1 chronic kidney disease due to type 2 diabetes mellitus.
Slide 28: Practice — Example 4 - Demo
The last example for practice is a diagnosis of STEMI.
You can see that the regular search returned 3 different destination entities. This is a good example to show you that the first destination will not always be the code you want. It is important to review the matching terms closely at each destination entity and not just the individual words that the Coding Tool bolds.
You can see that the first destination entity displayed, BA42.0, is the code to use when the diagnosis is subsequent myocardial infarction, which is not what you are trying to code. The third destination entity displayed, BA41.1, is the code to use when the diagnosis is non-STEMI. Again, this is not the diagnosis you are trying to code.
It is the second destination entity displayed, BA41.0 Acute ST elevation myocardial infarction, that you want. You can see the matching term “STEMI - [ST elevation myocardial infarction].” Confirm your code selection in the integrated browser and then quick-copy the code.
Slide 29: Resources
We are near the end of this webinar and want to share some resources with you.
Slide 30: Useful links
Here’s the link to the ICD-11 home page. From there, you can find the ICD-11 browser, ICD-11 Coding Tool, ICD-11 Coding Tool Help and the Reference Guide.
And here’s the link to CIHI’s ICD-11 resources page. It provides information on what is in the works for CIHI in relation to ICD-11, as well as the links for the other ICD-11 webinars. If you would like more information about ICD-11, we have provided a direct link to the WHO ICD-11 web page.
Slide 31: CIHI page
If you have any questions about this webinar or about other webinars in the series, or if you wish to give us feedback about any topics or require further information, please email us at ICD-11@cihi.ca using the subject line “ICD-11 webinar,” and we will be happy to respond. Thank you for joining us.