ICD-11 is now officially in effect

28 Feb 2022

We would like to draw your attention that the ICD-11 is now officially in effect as from the turn of the year. The ICD-11 was the result of a massive amount of work that lasted for more than 10 years, reflecting the major progress in medicine that has taken place. The final version of the ICD-11 was approved at the 72nd meeting of the World Health Assembly in 2019, and with a decision that the ICD-11 could start to be used in 2022. Whereas WHO recommends the use of the most current version of ICD for recording and reporting mortality and morbidity statistics both nationally and internationally, each country decides when to start using ICD-11 in their own country, as the transition requires quite substantial changes in many parts of the medical administrative systems. 35 countries are currently using ICD-11. There is a detailed manual on what codes in the ICD-11 correspond to in the ICD-10 and earlier ICD versions.

The work on the Cerebrovascular Diseases section of the ICD-11 was chaired by Bo Norrving, with the members Valery Feigin, New Zealand, Padma Gunaratne, Sri Lanka, Vladimir Hachinski, Canada, Michael Hennerici, Germany, Ming Liu, China, Peter Rothwell, UK and Jeffrey Saver, USA. The cerebrovascular diseases group was part of the larger group working with Diseases of the Nervous System (chaired by Raad Shakir)

The “Cerebrovascular diseases” segment was one area of the ICD that changed in several important ways from ICD-10 to ICD-11. These are the main changes:

1 In ICD-11, there is a single block of ”Cerebrovascular Diseases” (rather than different entities being spread across different chapters in the ICD-10)

2 In ICD-11, Cerebrovascular Diseases is placed under Diseases of the Nervous System (rather than stroke being placed under Diseases of the Circulatory System in ICD-10).

3 The Cerebrovascular Diseases block includes TIA, stroke, and cerebrovascular diseases not causing acute neurological dysfunction (silent cerebral infarcts, cerebral microbleeds)

4 ICD-11 includes definitions of all diagnostic codes (including definition of stroke). Stroke is defined as intracerebral haaemorrhage, subarachnoid hemorrhage, cerebral ischaemic stroke, and stroke not known if ischaemic or haemorrhagic. The ”stroke” definition requires presence of acute neurological dysfunction.

Some advantages with the ICD-11 are:

Improved clarity and clinical usefulness
Correctly signals that when stroke happens, it happens in the brain
Stroke is a single entity and no longer in the shadow (subheading) of other cardiovascular diseases
Stroke will have its own statistic line in all official statistics
Placement of stroke settled, in all different circumstances
Definitions and terminology of cerebrovascular diseases settled from the highest global governmental body

For stroke and cerebrovascular diseases, the ICD-11 represents a major step forward in recognizing stroke as a major disease on its own and not a subheading, and placing stroke under Diseases of the Nervous System. The stroke community will benefit from these changes.

For the WSO Global Policy Committee:

Bo Norrving, Michael Brainin and Valery Feigin

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