MIAMI BEACH – ICD-11 is a better classification system for skin diseases and dermatologists should take the time now to help shape its final form.
For the 11th revision of the International Classification of Diseases, the chapter on skin diseases has been completely redesigned, said Dr. Robert J. G. Chalmers, co-chair and managing editor of the Dermatology Topic Advisory Group for ICD-11.
Now in its beta version, ICD-11 is assembled as a Wiki-like knowledge base: Its building blocks are "concepts," which may refer to a single disease, disorder or syndrome, or to a group of related disorders.
Each concept will have terms, explicit inclusion and exclusion rules, and hierarchical links to its "parents," "siblings," and "children."
The skin diseases chapter will have 21 major headings, each of which is subdivided into logical groupings and sub-groupings, Dr. Chalmers said at the annual meeting of the American Academy of Dermatology.
Unlike in ICD-10 – slated to be adopted in the United States next year – the web-based view of ICD-11 allows any one concept to have more than one logical parent. For instance, erythema nodosum leprosum can be displayed both as a form of cutaneous vasculitis and as a complication of leprosy. This "polyhierarchy" also enables diseases such as cutaneous infections and neoplasms to be displayed within the skin chapter even though their preferred location may reside within a different chapter.
The revisions will help dermatologists to better document diseases, care for their patients, and assist recruitment for clinical trials. "It’s a better way of capturing information," said Dr. Chalmers.
The ICD was first published in the late 1890s, and included a total of four codes for skin diseases: ulcer, bed-sore; eczema; pemphigus; and other diseases of the skin. But by the 5th edition, eczema and pemphigus had disappeared from the codes, leaving only carbuncle and boils; cellulitis, acute abscess and other diseases of the skin and cellular tissue, Dr. Chalmers said.
ICD-6, which was published in 1948, was entrusted to the newly-formed World Health Organization which continues to publish the code sets.
The 6th edition contained 60 skin diseases, but very little changed from that version until ICD-9, published in 1975.
ICD-9 is still used in the United States, and ICD-10, which was published in 1990 and introduced into clinical practice some 20 years ago in much of the world, is set to replace ICD-9 in the United States next year. The two versions are very similar and "for a dermatologist, ICD-10 remains crude and cumbersome instrument full of bizarre inconsistencies," said Dr. Chalmers, a consultant dermatologist at the University of Manchester, United Kingdom.
Plans for ICD-11 were announced by the WHO in 2007, and the revision is set for release in 2015.
Dr. Chalmers said that it will probably be at least 5 years from now before ICD-11 is available for clinical use. But given the timeline for implementation of ICD-10 in the United States, he said there is no telling when ICD-11 will be available here.
U.S. doctors have challenged the adoption of ICD-10 for several reasons such as having to establish new billing and collection systems, a need for staff training, and an expectation of lower reimbursement.
The American Academy of Dermatology Association, along with the American Medical Association, have urged the Centers for Medicare and Medicaid Services to skip over ICD-10 and wait to update the code set until ICD-11 becomes available. Their request has been declined.
In the meantime, Dr. Chalmers encouraged dermatologists to visit the ICD-11 beta version and share comments, proposals, and definitions, and to participate in field trials.
Dr. Chalmers had no relationships to disclose.