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World Health Organization (WHO) ICD-10 Revision

The World Health Organization (WHO) produces international classification systems for health that provide a consensual common language for governments, providers and consumers. These systems are used to facilitate the compilation of nationally consistent health data, to conduct research on health and to form the basis of diagnostic categorization for providers and consumers. These systems include the International Classification of Diseases (ICD), the International Classification of Functioning Disability and Health (ICF) and the International Classification of Health Interventions (ICHI).

About the ICD

The International Classification of Diseases (ICD) is the global standard for reporting and categorizing diseases, health-related conditions and external causes of disease and injury. In addition to clinical diagnosis, the classification is also used in the development of health programs, prevention, reimbursement and treatment. Individual countries use the ICD to compile basic health statistics and to monitor spending, while researchers and practitioners use it to compare health status across countries. The WHO mandates publication of the ICD and heads each revision process. For more information about the ICD, please visit the WHO website.

How is the ICD Relevant to U.S. Psychologists?

The U.S. government has published adaptations of ICD as the framework for official morbidity and mortality statistics in the United States for more than 50 years. The current U.S. version, called ICD-9-CM (Clinical Modification), was adapted from the ninth revision of the ICD by the National Center for Health Statistics (NCHS) and the Health Care Financing Administration (now the Center for Medicare and Medicaid Services). U.S. adaptations have largely included additional information in order to meet hospitals’ indexing needs and to enable coding of morbidity and utilization data from inpatient and outpatient records.

Long after its adoption by the rest of the world, NCHS now plans to implement the ICD-10-CM in the United States, effective Oct. 1, 2014. The structure and coding for the mental and behavioral disorders classification in ICD-10-CM are based on WHO’s ICD-10 and are substantially different from those in the ICD-9 and the DSM-IV.

How Do U.S. Clinical Psychologists Use the ICD?

Right now, for billing purposes, all providers are expected to report diagnostic codes using ICD-9-CM. The “CM” indicates that it is the clinical modification produced by the United States through the Centers for Disease Control and Prevention. Many psychologists are not aware of this requirement because the DSM-IV-TR and ICD-9-CM are rather closely “harmonized,” and the codes are similar or equivalent. So, if a psychologist uses the DSM-IV-TR to record a diagnosis, insurance companies receive that information as an ICD-9-CM code. In addition, there is a crosswalk that shows equivalent codes between the two systems (also see Appendix F in the DSM-IV-TR).

HIPAA requires that all diagnostic codes be reported via ICD-10-CM codes effective Oct. 1, 2014. Appendix H in DSM-IV-TR provides a crosswalk to ICD-10. Additional materials will be developed prior to October 2014 to educate psychologists about ICD-10-CM and provide guidance for diagnostic classification. 

After consulting legal regulations and officials at insurance companies, APA understands that providers will not be reimbursed if they are not using an ICD code. APA will be providing CE courses on IDC10-CM and will be publishing other related educational material for psychologists.

Information ICD-10-CM:

New Development: ICD-11 (Revision of ICD-10)

The 10th version of the International Classification of Disease and Related Health Problems (ICD-10) was available to WHO member states in 1995. In 2009, WHO began to revise the ICD-10 to reflect the many changes in the landscape of global disease, scientific developments, service delivery advancements and health information systems. The final ICD-11 is expected by 2015. WHO has organized this revision process to improve clinical utility and to make the ICD compatible with new health information system technology. The revision process is coordinated with a number of Topic Advisory Groups (TAGs) selected by WHO.

APA’s Role in the Revision

The development of those parts of ICD-11 most relevant to psychology is guided by the WHO Department of Mental Health and Substance Abuse, with input from the Topic Advisory Group for Mental Health and associated workgroups. In support of this endeavor, APA is providing a grant to the International Union of Psychological Science (IUPsyS, the representation for psychology within the WHO) to support a psychologist in the role of Senior Program Officer for the revision process.

Articles on the ICD-11 Development:

Annual Reports to APA on the ICD-11 development:

APA has also put out a call to clinical psychologists to participate in the Global Clinical Practice Network (GCPN) to review materials, offer feedback and access other information on the development of ICD-11.

ICD-11 and Diagnostic Codes in the United States

WHO will be completing the preparation of ICD-11 at about the same time that NCHS will be implementing ICD-10-CM. This raises the question of why the current ICD revision is relevant to U.S. psychologists if it is going to be another 20 years before it is implemented in the United States. There are several reasons.

First, it is highly unlikely that there will be a similar delay in ICD-11 implementation. Implementation of ICD-11 is a responsibility of the U.S. government as a WHO member state, and officials at NCHS now occupy prominent positions within the WHO Family of International Classification Network. This makes it more likely that the United States’ will adopt the system adopted as the standard by the rest of the world.

What do psychologists need to know?

It is likely that the United States will attempt to bring the ICD-10-CM gradually in line with ICD-11 through a series of annual updates over the first few years following ICD-10-CM implementation. During this process, compatibility with WHO’s ICD-11 would be the most important consideration in the updates. At this point it is not clear how the DSM-V, which is currently under revision, will compare with ICD11. It is likely that psychologists will come to rely less on DSM for coding purposes. The ICD10-CM classification codes, as well as ICD-11 codes will be freely available from WHO. (See Reed, G.M. (2010). Toward ICD-11: Improving the clinical utility of WHO’s international classification of mental disorders. Professional Psychology: Research and Practice, 41, 457-464.)

The ICD and Research

As the primary federal research agency funding mental health research in the United States, the National Institute of Mental Health (NIMH) is also interested in diagnostic criteria for use in research. At present, NIMH is working with WHO to develop a work plan for integrating ICD-11 with its own project to reconceptualize diagnostic criteria for research.

NIMH has launched a new initiative termed the Research Domain Criteria (RDoC) project. The goal is to shift the research enterprise in a new direction that builds a classification of mental disorders based on discoveries in genomics and neuroscience as well as clinical observation. RDoC acknowledges the limitations of current classification systems of mental disorders as a basis for research, and wants to encourage conceptualizing mental disorders as brain disorders related to identifiable brain circuits that are shaped by genetic variation and experience and related to individual patterns of cognition and behavior. NIMH has provided funding to WHO to produce a work plan for developing Research Diagnostic Criteria based on ICD-11 but incorporating RDoC findings for use in global research. (See National Institute of Mental Health (2013). Research Domain Criteria (RDoC). Retrieved January 8, 2013.)