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Robert Anderson
Robert Anderson

ICD-11 Reference Guide

The Reference Guide contains an introduction to the diverse components of ICD-11. This guide is not exhaustive; however, it includes information and guidance on context, components and intended use, as well as rules for mortality and morbidity coding.

ICD-11 Reference Guide

An assessment of the number of rare clinical entities having a specific code in ICD10 can be derived from the effort carried out by Orphanet to cross-reference Orpha codes with ICD10 codes, starting from the Orphanet list of rare clinical entities defined as a clinically unique, distinct entity, whatever the number and nature of the causes, and following the European definition for rarity, i.e. a prevalence equal of no more than 1 in 2,000 in the general population of Europe. The cross-referencing is based on the 2010 online version of the ICD-10, but takes into account the official WHO updates endorsed in 2011 and 2012. In January 2015, among the over 6,954 clinical entities listed by Orphanet, 355 of them only have a unique specific code in ICD 10 and 162 can be specifically mapped to a set of ICD10 codes.

The strategy adopted by WHO was extremely ambitious and difficult to implement. The advance of knowledge since the 1980s (when the basic structure of ICD-10 was elaborated) makes the need for a general overhaul quite obvious. It is simultaneously necessary to manage the transition from paper to electronic records and to make use of the wide array of new technical possibilities opened by the development of information technology over the last two decades. Hence the project of turning the old ICD-10, primarily thought and used as a reference tool for statistics, into an ICD-11, intended as a versatile reference tool for any setting requiring the use of an interoperable classification of diseases, with features reminiscent (and allowing the derivative development) of an encyclopedia and ontology. Unfortunately, the revision proceeded rather erratically, with very limited means considering its scope, ambition and strategic significance, and experienced significant hurdles and setbacks. The lack of funding impacted the level of professionalism that could be attained. The contrast between the initially declared goals and the currently foreseen final product is disappointing.

A few examples of this late formulation of rules are now given. Information notes formalizing various aspects, were produced only from the end of 2011 to 2013, so two years after the revision process had been launched, and four years after the preliminary discussions in 2007 [13]. Rules for the naming of diseases were not clear for many TAGs, despite the existence of a WHO style guide. In particular, many names were initially created that made sense only in the hierarchical framework the entity was included in, but which would have made little sense in an alphabetical list like the ICD-11 index. A template on how short definitions should be written has formalized by a dedicated WHO team in 2014 only [14].

From the start of the revision, especially during the preliminary discussions from 2007 to 2009, the HIM TAG and RSG appear to have been much impressed by the social networking model on a large scale information project provided by Wikipedia, the free online encyclopedia that anyone can edit. It is definitely a successful model of collaborative work, with more than 4 600 000 articles in the English version to date, though at every possible level of advancement and quality. On the other hand, producing a generic all-public encyclopedia and a consistent reference tool for classification are quite different endeavors: while the former can thrive in a decentralized setting, as topics are highly diverse and consistency not necessarily an issue (with the possibility of cross references by internal links), the latter requires a much more thoroughly formalized framework. The bottom-to-top approach upheld by the RSG, especially in the early phases of the revision, might have been effective to produce a worldwide encyclopedia of diseases; but to produce a consistent classification, build a reference consensus and enable continuity with previous versions of ICD, a complementary top-to-bottom management was inescapable from the start. Nonetheless, the RSG left the TAGs very free (too free) to organize themselves and define the main lines of the structures they were building. An illustration of the result of this lack of direction is the notably different approaches adopted by the various TAGs. While such differing approaches may be commendable when corresponding medical specialties are considered in isolation, the global result appears to lack clearly defined classificatory principles. This makes it more difficult than needed to understand and may be a hurdle in the future for appropriation by coders. For instance, the chapter on diseases of the digestive system is mostly divided along anatomical lines (Table 3), when the chapter for neurology follows a more etiological approach [15] (Table 4). In the chapter for hematology, it was not possible to reach a consensus, so two different views coexist: one by classically described clinical groups (anemias, polycythemias, hemorrhagic diseases, thrombotic diseases etc.), corresponding to the Rare Diseases TAG draft, one based on etiology (iron deficiency, vitamin B12 deficiency, other nutritional and metabolic anemias, hemolytic anemias, etc.), following the requirements of the Hematology Working Group of the Internal Medicine TAG. Most of the entities are shared, but the structures are quite different, which will have consequences later for analysis depending on which one is chosen for aggregating data. According to the ICD revision procedures, a common classification should have been elaborated in the foundation layer of ICD-11; specific views are supposed to be represented at the linearization level, adapted for different use cases. As a final example, the chapter for circulatory diseases uses several approaches simultaneously, which makes it quite difficult to approach as a tree-structure (Table 5).

Currently, only a small fraction of rare diseases have codes in international nomenclatures, especially in ICD10, making it impossible to trace patients with rare diseases in health information systems on a national and international level. Having codes for each and every rare disease would help obtain a better knowledge of healthcare pathways and of their impact on specialized health care services and on budgets. The existence of specific codes for rare diseases are key to evaluate the performance of the European reference networks of centres of expertise for rare diseases which are about to be implemented.

Chapter 10 of the 7th ed. APA Manual provides many more reference examples for numerous types of reference materials. This guide provides only a few of the citations. For more examples, see the manual.

A citation or reference includes all the information needed for someone to identify and find the resource. Elements will change depending on the resource (a blog, article, legal materials, etc.). Depending on the citation style, a citation may include any of the following: title, author, date, page numbers, publisher, place of publication, link, doi, etc.

EasyBib's barcode scanner pulls citation information and formats it in APA, MLA or Chicago style. You can then e-mail the citation to yourself to copy and paste into your reference list. Available for iOS, Android, and Google Apps.

For most guidelines posted through AHRQ and National Guideline Clearinghouse ( you will cite these documents like websites and web reports. In other words, you need the same 4 major components discussed earlier on this page: author, year, title, and source. After the title of the work, provide any number or identifier for the standard (if any) in parentheses without italics. Below is an example of a guideline found on

Some confusing and ambiguity may arise for works with same author(s) and dates. To distinguish between these works, put a lowercase letter after the year in both the in-text citation and the reference list.

For additional tips on creating stories about transgender people, please see In Focus: Transgender People If you are seeking information about how to create transgender and nonbinary characters for film, TV, theater, video games, etc., please read GLAAD's TRANSform Hollywood guide or contact the GLAAD Media Institute via More resources for content creators may be found at

TransUsed as shorthand for transgender, and on second reference after first using the word transgender. If you use trans without defining it, or without the first reference of transgender, mainstream audiences may not understand its meaning or what you are referencing.

Briefly the trans and nonbinary community did use this phrase. However, it began to seem as if cisgender people had pronouns, while trans people had "preferred pronouns." Everyone uses pronouns and they are a fact, not a preference.

The World Health Organization (WHO) released a preliminary version of the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in June 2018. The ICD-11 is scheduled to go into effect in the year 2022. Among the major innovations introduced in the update of this fundamental, now fully electronic, reference for health statistics is a systematic classification of clinical conditions associated with chronic pain. The classification was developed by an interdisciplinary task force of the International Association for the Study of Pain (IASP) to remedy gaps and errors in the prior version, ICD-10. The new list of diagnostic codes covers the most common painful clinical entities and divides them into subgroups defined by etiology or affected organ system. The classification further includes a subgroup of conditions primarily characterized by pain whose underlying cause is incompletely understood. With the implementation of this systematic classification, ICD-11 takes a decisive step to better reflect the significance of chronic pain as a health problem of enormous epidemiological, economic, and sociological impact. 041b061a72


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