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Updating the International Classification of Diseases and related health problems, tenth revision (ICD-10).

The Tenth Revision of ICD-10 was endorsed by the Forty-third World Health Assembly (WHA) in May 1990. Prior to ICD-10, updates to the classification were not made between revisions. In its report, the WHO International Conference for the Tenth Revision of the ICD, held in Geneva from 26 September to 2 October 1989, recommended that 'WHO should endorse the concept of an updating process between revisions and give consideration as to how an effective updating mechanism could be put in place'. (1) Consequently, mechanisms for updating ICD-10 were established in 1997 and became operational in 1999. The managing body is the Update and Revision Committee (URC), previously known as the Update Reference Committee. Membership of the URC is comprised of representatives from national WHO Family of International Classification (WHO-FIC) Collaborating Centres, who have knowledge and expertise in ICD. In addition, there are representatives from Mortality, Morbidity and Functioning and Disability Reference Groups.(2)

The Australian Collaborating Centre (ACC), through the National Centre for Classification in Health (NCCH) was instrumental in the development of the updating process, with the NCCH providing chair and secretariat duties for the URC in the first five years after inception. Although these roles have now been handed over to our Canadian colleagues, the ACC is still an active participant, submitting around 10 to 15 proposals for ICD-10 update and commenting and voting on up to another 200 annually. Recommendations for change to ICD-10 are separated into two groups:

* minor changes: improvements to the tabular list, alphabetic index and coding rules that do not change code assignment, including minor corrections or clarifications

* major changes: addition, deletion and movement of codes, movement of terms and changes to rules and guidelines that affect code assignment.

From an Australian perspective, as we produce a national modification of ICD-10, our proposals for change are often twofold:

* changes driven by our national public submission process, where there is a need to alter code structure and assignment at the higher levels of ICD-10, for example, the changes required for chronic kidney disease

* enhancements as a result of our development of ICD-10-AM, which are considered beneficial for the parent classification.

Work on this exercise starts early in the year at NCCH, with a March deadline for proposals to be submitted to the URC. All work is now processed via the ICD Update and Revision web platform, which is hosted by WHO and maintained by the URC secretariat. Proposals may be viewed, and commented on by all URC members. There are two rounds of voting (end of June and end of August) in order to reach consensus on as many proposals as possible prior to the annual WHO-FIC network meeting in October. Most years, with editing and revisions, the majority of proposals are accepted prior to the meeting. Others may be rejected, withdrawn, held over for further work or forwarded to the Topic Advisory Groups for the ICD-11 revision process.

At the annual WHO-FIC network meeting, the remaining, and usually more complex proposals, are discussed and if required, a vote is taken. The URC secretariat then prepares a list of recommendations for change to ICD-10 for WHO-FIC council approval at the meeting. Following the meeting, all agreed recommendations for change to ICD-10 are checked by URC members though an iterative process and the final versions are incorporated into the official ICD-10 updates (yearly and cumulative), which are posted on the WHO website by the end of the following January.

(1) WHO ICD-10 Volume 1, p27 (1989)

(2) Further information on the WHO-FIC network and in particular, the various committees and workflow may be found on the WHO-FIC website: http://

Julie Rust

Manager, International Classification Development National Centre for Classification in Health

Faculty of Health Sciences, The University of Sydney


Tel: +61 2 9351 9719

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Title Annotation:Reports
Author:Rust, Julie
Publication:Health Information Management Journal
Geographic Code:8AUST
Date:Jun 1, 2010
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