ICD-11 pilot in West China: feasibility evaluation and implications for future implementation

This study was designed to comprehensively evaluate the feasibility of implementing ICD-11 as a replacement for ICD-10 in West China in terms of morbidity and mortality coding, summarizing practical experiences and providing valuable insights for the transition to ICD-11 in other regions and countries. Coding data for ICD-11 and ICD-10 were collected during a two-month period from the pilot hospital. Additionally, we also conducted a questionnaire survey and focused interviews among 20 coders. After implementing ICD-11 coding, 92.30% of the primary disease codes remained unchanged in terms of chapter allocation. 41.10% of the codes involved postcoordination, with a maximum of eight codes in postcoordination. Topology Scale Value, Anatomy and topography, and Histopathology were the most frequently used extension code dimensions during postcoordination. Most coders believed that ICD-11 more accurately expressed clinical diagnoses in comparison to ICD-10, the pre-assigned postcoordination provided was user-friendly, but a large number of cases required manual postcoordination, the quality of medical record writing did not meet the requirements for implementing ICD-11, and conducting coding audits was challenging. The evolution from ICD-10 to ICD-11 was smoother compared to previous version upgrades. Coders acknowledged the improvements of ICD-11, but overall the coding process was time-consuming and complex, with certain coding obstacles. The implementation of ICD-11 to replace ICD-10 was considered feasible if solid groundwork could be laid for improving the quality of medical records, with proper training and the release of official ICD-11 textbooks of China.