Coding mechanisms for main condition in ICD-11

Countries have been routinely abstracting health data from hospital charts and coding conditions using ICD-10. A main condition must be assigned to each admission. However, the definition of main condition is inconsistent across countries, and may be based on (1) the initial reason for admission; (2) the reason for admission, as understood at the end of the hospital stay; and (3) the condition that consumed the most hospital resources or hospital days. Now, ICD-11 standardizes the coding schema for main condition. This paper describes the ICD-11 coding guidelines for main condition and discusses their implications for data comparability.