JMIR Publications

ABSTRACT

Background:

The 11th revision of the International Classification of Diseases (ICD-11) improved neoplasm classification.

Objective:

This paper aimed to study the alterations in the ICD-11 compared to the Chinese Clinical Modification of the ICD-10 (ICD-10-CCM) for neoplasm classification and to provide evidence supporting the transition to the ICD-11.

Methods:

Public data files were downloaded from the World Health Organisation (WHO) and the National Health Commission of the People's Republic of China. The ICD-10-CCM neoplasm codes were manually recoded by the ICD-11 coding tool, and an ICD-10-CCM/ICD-11 mapping table was generated. The existing files and the ICD-10-CCM/ICD-11 mapping table were used to compare the coding, classification, and expression features of neoplasms between the ICD-10-CCM and ICD-11.

Results:

The ICD-11 coding structure for neoplasms has dramatically changed. It provides advantages in coding granularity, coding capacity and expression flexibility. In total, 207 (27.4%) ICD-10 codes and 1359 (38.0%) ICD-10-CCM codes underwent grouping changes, which were significantly different (χ²=30.264, P＜.001). Notably, 2424 (67.8%) ICD-10-CCM codes could be fully represented by ICD-11 codes. Another 252 (7.0%) could be fully described by uniform resource identifiers (URIs). The ICD-11 had a significant difference in expression ability among four ICD-10-CCM groups (χ²=93.654, P＜.001), as well as a considerable difference between the changed and unchanged groups (χ²=74.660, P＜.001). Expression ability negatively correlated with grouping changes (r=-.144, P＜.001). In the ICD-10-CCM/ICD-11 mapping table, 2164 (60.5%) codes had postcoordination. The top three postcoordination results were specific anatomy (53.3%), histopathology (5.6%), and alternative severity 2 (2.0%). The expression ability of postcoordination was not fully reflected.

Conclusions:

The ICD-11 includes many improvements in neoplasm classification, especially the new coding system, improved expression ability and good semantic interoperability. The transition to the ICD-11 will inevitably bring challenges for clinicians, coders, policy makers and information technology (IT) technicians, and many preparations will be necessary.