Updating ICD-10

WORLD HEALTH ORGANIZATION
Last Updated: December 2007
 This webpage is maintained by the NCCH on behalf of the World Health Organization and will be updated each year following the October meeting of the WHO Network for the Family of International Classifications (WHO-FIC)

WHO Update Reference Committee

  1. WHO Update Reference Committee
  2. Background to the ICD-10 update process
  3. WHO Official Updates to ICD-10

Mortality Reference Group

  1. Mortality Reference Group
  2. MRG Terms of Reference
  3. MRG membership
  4. MRG structure
  5. MRG policies
  6. MRG work program
  7. Mortality Forum

Morbidity Reference Group

  1. Morbidity Reference Group
  2. MbRG Terms of Reference
  3. MbRG membership (.doc 56kb)

WHO Update Reference Committee

Maintaining the currency of a health classification is an enormous but necessary task. Credible health classifications must:

  • provide a common language for clinicians and administrators
  • be receptive to new disease processes, and
  • accommodate emerging evidence of aetiologies of known diseases, new technologies and surgical procedures.

The World Health Organization (WHO) Update Reference Committee (URC) recommends mortality and morbidity changes to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) to the Heads of WHO Collaborating Centres for the Family of International Classifications each year. The URC also develops policies to manage the update process.

The URC was established in March 2000 and the Chair/Secretariat for the URC is Mea Renehan and Lori Moskal respectively, from the North American Collaborating Centre.

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Background to the ICD-10 update process

The ICD-10 in its hard copy version was published by WHO in 1992 (Tabular list), 1993 (Instruction manual) and 1994 (Alphabetical index). It resulted from work begun in 1983 that culminated in the International Conference for the Tenth Revision of the ICD in 1989.

Prior to ICD-10, updates were not made between revisions. In its report the WHO ICD-10 International Conference (1989) 1 recommended that "? WHO should endorse the concept of an updating process between revisions and give consideration as to how an effective updating mechanism could be put in place". Mechanisms for updating ICD-10 were established in 1997 and became operational in 1999.

Two separate bodies were established to manage the updating process: the Mortality Reference Group (MRG) and the URC. The concept for the MRG was developed in 1997, and it began making decisions regarding the application and interpretation of ICD to mortality in 1998. The MRG also makes recommendations on proposed ICD updates to the URC. The URC was established in 2000 and receives proposals from the MRG and members through the WHO Collaborating Centres for the Family of International Classifications. The URC considers the proposals and submits recommendations on proposed ICD updates for mortality and morbidity to the Heads of Collaborating Centres.

The Heads of Collaborating Centres have agreed that the function of the URC should reinforce the process of updating ICD-10 rather than creating the foundation of an ICD-11. The relationship between the MRG, URC, WHO Collaborating Centres, Heads of WHO Collaborating Centres and the WHO Secretariat is shown in Figure 1.

1 WHO ICD-10 Volume 1, p.27 (1989)

Figure 1: Relationships between URC, MRG, WHO Collaborating Centres and WHO Secretariat/Head of Collaborating Centres

For further information on the Update Reference Committee, including structure, policies, membership and submission guidelines, please refer to the World Health Organization.

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WHO Official Updates to ICD-10

The Official Updates to the published volumes of ICD-10 are produced in two formats:

  1. A cumulative list of all changes made to ICD-10 from 1996 onwards. This list includes the Corrigenda to Volume 1 (see Volume 3, pp 747 ? 750)
  2. An annual list of changes made to ICD-10 since 1996.


Contained within each list is the source of recommendation and implementation date. Date of approval has been indicated for all changes except the corrigenda.

These updates are approved annually at the October meeting of Heads of WHO Collaborating Centres for the Family of International Classifications.

Relevant changes in other language versions of ICD-10 and in related tools will also have to be made and disseminated by the appropriate authority.

 

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Mortality Reference Group

The Mortality Reference Group (MRG) makes decisions regarding the application and interpretation of ICD to mortality and makes recommendations on proposed ICD updates to the URC.

The MRG was established at the 1997 meeting of Heads of Collaborating Centres as part of an updating mechanism for the ICD.

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MRG structure

Meetings

Much of the work of the MRG is conducted by teleconferences held 3-4 times each year. At least one annual face-to-face meeting is held, usually at the Heads of Collaborating Centres meeting.

Terms of reference

Work of the MRG will cover issues of ICD-10 update for mortality coding, classification and reporting purposes.

  1. Establish ground rules for MRG functioning.
  2. Determine and prioritise problems and issues for review, emanating from the Mortality Forum and from other sources.
  3. Deliberate on updates to the classification itself (eg correction of errors and additions) and on clarifications of application and interpretation (of the classification and its associated rules) to establish international practice.
  4. Make decisions regarding the application and interpretation of ICD-10 for mortality.
  5. Make recommendations through a democratic process, with attempts to achieve consensus.
  6. Once the MRG has discussed and agreed upon a recommendation, MRG members and their Centres will support the recommendation of the MRG.
  7. Provide documentation of discussions and decisions.
  8. Submit recommendations for ICD-10 updates to the Update Reference Committee.
  9. The MRG will work principally electronically, and meet in person when feasible.
  10. The MRG finalises annual recommendations by the end of April.

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MRG policies

  1. Updates suggested should only relate to the ICD-10 and not to national versions (although they may come from national versions).
  2. The Secretariat appoints the chairperson for the MRG.
  3. Decisions from the MRG should be available from the WHO ICD-10 home page (either directly or through a link) using the most suitable accessible technology. The decision may be available from several sites (mirror or replicate sites) but, if so, they should all be updated concurrently.

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MRG work program

  1. Continue to hold periodic meetings (about 3-4 teleconferences per year) and at least one face-to-face meeting. Teleconference meetings will normally be scheduled in November, January/February, April, June and September and a face-to-face meeting will be held at the Heads of Collaborating Centres meeting.
  2. Prioritise issues and problems for review.
  3. Make recommendations to the Update Reference Committee by end of April.
  4. Prepare annual report for Head of Collaborating Centres meeting by end of July.

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MRG Membership list (PDF 12Kb)

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Mortality Forum

A separate discussion group is available to address issues and questions related specifically to mortality coding, classification, definitions, guidelines and decision tables. Questions regarding these topics should be sent to the Mortality Forum. Important mortality issues subsequently will reach the URC by way of the Mortality Reference Group.

To send a query to the Mortality Forum, address e-mail to: mortforum@nordclass.uu.se

Past discussions in the Mortality Forum are posted to the Nordic Collaborating Centre?s web site for the Mortality Forum.

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Morbidity Reference Group

The main purpose of the MbRG is to improve the international comparability of morbidity data and the application of ICD in morbidity by analysing and integrating needs deriving from statistics, casemix and clinical documentation.

Membership is comprised of nominees from collaborating centers and WHO regional offices, together with individuals with morbidity classification expertise from outside the WHO-FIC Network.

The NCCH provides a co-chair (Kerry Innes, Associate Director) and secretariat support (Julie Rust, Project Officer) to the MbRG. The other co-chair is Olafr Steinum (Sweden).

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Morbidity Reference Group (MbRG) - Terms of reference

Purpose:

The objective of the Morbidity Reference Group (MbRG) is to improve international comparability of morbidity data and the application of ICD in morbidity by analysing and integrating needs deriving from statistics (e.g. hospital data), casemix (e.g. DRG systems) and clinical documentation (e.g. clinical terminology and electronic health records).

Functions:

  1. To identify, discuss and solve problems related to the interpretation and application of ICD to coding and classification of morbidity, including the establishment of standardised interpretation of the categories and the development of agreed definitions, coding rules and guidelines.
  2. To develop recommendations for ICD-10 updates for forwarding to the Update and Revision Committee annually, through a democratic process which attempts to achieve consensus.
  3. To support the revision process for ICD by providing advice on morbidity related issues and possible terminology linkage for morbidity coding.
  4. To review possible morbidity applications of WHO derived and related classifications, to inform recommendations for change to ICD.
  5. To consider and support statistical, epidemiological, reimbursement (including casemix) and clinical applications of ICD for morbidity purposes.
  6. To construct a database summarising national applications of ICD for morbidity purposes.
  7. To provide documentation of discussions and decisions in a database that can be used online and offline.

MbRG Membership List (.doc 56kb)

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