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The purpose of this page is to collect information on the use of ICD to get the overall picture of how deploying countries encode morbidity: including the level of detail (4 or subsequent character codes) employed, the ICD-10 version in place, the frequency for implementing updates, etc.; and, additionally, their plans regarding ICD-11 once published.

This information will support making decisions in the Semantic Task Force around the review of the Value Set that utilises ICD-10 and the update of this Code System in the MVC.

(lightbulb) For background information on the WHO guidelines and rules for coding using ICD-10, check here.

Provide Feedback - Table

Please, provide the information requested in the table below regarding the use of ICD in your country:

Deploying country*

Indicate ICD Edition / modification in use

(e.g. ICD-9 or ICD-10 / German Modification, Swiss Modification, ICD-10-CM)

Frequency of updates to a new version

Indicate the use of ICD and the level of detail in coding**

(e.g. diagnosis for all admissions are coded to highest number of characters available, i.e. at a minimum to a three-character code***)

ICD-9 or ICD-10 Version in use


Future plans regarding ICD-11

(yes/no & comments)

Flag of Austria   Austria

ICD-10-BMSG 2017 (=ICD-10-WHO 2016 translated into German except Chapter XX)According to frequency of WHO Major Updates

ICD-10 is mandatory for morbidity coding for inpatient care, available up to 5 character codes

ICD-10 is mandatory for mortality coding?

ICD-10-WHO 2016Yes, implementation plan will be designed when ICD-11 is translated into German

Flag of Belgium   Belgium


Every 2-3 years

Used in Minimal Clinical Dataset in hospitals (hospital stay and one day) for reimbursement and planning.

Coded at highest granularity level of ICD-10-CM

ICD-10-CM FY2017No. We plan to have SNOMED CT in  the electronic patient files.


Up to 5-character codes


       i. In-patients Discharge Summary: “ICD-10 CY modification (which uses up to 5 characters, if available)” for the codification of Discharge Summary of in-patients (public & private hospitals) and

      ii. Medical Death Certificate: ICD-10 (up to five characters) for the medical causes of Medical Death Certificate.

    iii. Out-patients prescriptions: ICD-10 will be used for outpatients in the public & private sector, when our new Health System will be established (1 Jun 2019).

    iv. Out-patients:  for reason for consultation in Primary Care it will be used International Classification Of Primary Care  II (ICPC II), when our new Health System will be established (1 Jun 2019).

    v. Cross Border eHealth Care: ICD-10, as is used in the current MVC

       i. In-patients Discharge Summary: we use  the 2010 version of ICD-10. In 2019, we will try to update to the 2016 and when the 2017 version will be available we will make the relevant adaptation

      ii. Medical Death Certificate: we use the 2016 version (an update to 2017 will be in place when available).

  i. In-patients Discharge Summary: for the codification of diagnoses on the of in-patients in the hospitals (public and private). Discharge Summary codification of in-patients is performed in the 95% of in-patients in public hospitals and around 25% of in-patients in the private hospitals.

    ii. Medical Death Certificate: Data for deaths and causes of death are based on medical death certificates, collected and coded (based on the ICD-10) by the Health Monitoring Unit. Causes of death are based only on the information written on the medical death certificate, thus any extra information ie the place of occurrence of the external cause may be coded to the highest number of characters available. The codification of the Medical Death Certificate is 100% (every deceased person death certificate is coded)

  iv. Cross Border eHealth Care: ICD-10, as is used in the current MVC (I think is three characters)

   iii. Out-patients: ICD-10 (possibly up to three characters) will be used for outpatients diagnosis  in the public & private sector when our new Universal Health System will be established (1 Jun 2019).

  i.  In-patients Discharge Summary: ICD-10, 2010 version,

    ii. Medical Death Certificate: ICD-10, 2016 version, on Medical Death Certificates. Since 2004 the ICD-9 version was being used for the coding

Cyprus is awaiting the official launch of the ICD-11, in 2019. At this time there is no plan for the implementation of ICD-11, as first changes have to be made to our infrastructure and education must be provided to all the stakeholders. ICD-11 should be adopted for EU mortality statistics only once it is clear that the benefits outweigh the financial costs and the risks to the quality and continuity of statistics

  Czech Republic

MKN-10 - Czech translation of the ICD-10 WHO with slightly modified codes (dots removed).

Version 2014 in practical use, Version 2016 with updates up to 2018 is ready but not yet in use

Update frequency is more or less biannual

Last update (2018) still not fully implemented

Mandatory for use in inpatient and outpatient care:

- death certificates

- in-patient cases

- out-patient cases

- incapacity for work, disability pensions

All cases are coded  to highest granularity level available (except for incapacity for work and disability pensions - only three character coding).

ICD-10 2014Yes, implementation plan will be designed


ICD-10 Estonian modification with Estonian translationsNo regular update

ICD-10 is mandatory to use for morbidity coding in inpatient and outpatient care.

ICD-10 is also used for mortality coding.

Coded at highest granularity level up to 5 character codes where possible.

2005Implementation preparation project is considered to start in 2019.

Flag of France   France

ICD 10 french ATIH version with national extension



Death registries (CepiDc)

Hospital stay description for budget establishment (ATIH)

Coding of chronic diseases for reimbursement claims


Patient Summary


Various use cases in ambulatory cares as well as hospital

-monitoring of cohorts

-coordination of healthcare professionals

-piloting health care patterns

Coded at highest granularity level


Coordination of WHO collaboration centers for translation in 2018/2019

Flag of Germany   Germany

ICD-10-GM (German Modification)

ICD-10-WHO translated into German

ICD-10-GM: yearly

ICD-10-WHO: according to frequency of WHO Major Updates

ICD-10-GM is mandatory for morbidity coding for inpatient and outpatient care

Level of detail for inpatient: up to 5 character codes, mostly identical to ICD-10-WHO, partially more granular adjusted to the German Reimbursement system (G-DRG).
Level of detail for outpatient: up to 4 character codes.

ICD-10-WHO is mandatory for mortality coding, available up to 5 character codes

ICD-10-GM 2018, 2019 published

ICD-10-WHO 2016, publication of version 2019 in progress (will be last version released by WHO)

Preparations for evaluation for a possible ICD-11 implemementation  have been started, but decision to implement ICD-11 in national reimbursement systems has not been taken yet. These are:

  • Collaboration with WHO for development of ICD-11
  • Participation in Field Testing
  • Translation project started Mid 2018
  • implementation preparation project to start in 2019
  • Analysis project of impact on German Health Care system to start in 2019

ICD-11 is expected to be final mid 2019. From then on it may be used for defined purposes , even before national implementation.

Flag of Greece   Greece

Greek adaption of ICD-10 2008 update
ICD-10 is being used in a five-character code detail level

ICD-10 2008

Flag of Hungary   Hungary

Hungarian adaption of ICD-10

Yearly national update, but WHO updates are not implemented

The Hungarian ICD-10 classification system used for morbidity encoding (mainly for reimbursement) is a national extension of the four-digit ICD-10 classification published by WHO. 5th digit subdivision provided by WHO is not followed.

The subdivision serves mainly reimbursement purposes.

1995No information yet

Flag of Ireland   Ireland

ICD-10 AMEvery 2-3 yearsUsed for Hospital inpatient attendances and is linked to financial reimbursement from paper based recordsICD-10 AM 8th edition, 10th edition due for deployment in 2020No plans for ICD 11 yet

Flag of Italy   Italy


No plans in the short future


ICD-10-CMEvery 2-3 years

Coded at highest granularity level of ICD-10-CM (7-digits)

ICD-10-CM FY2017


ICD-10 Version 2016 (WHO)In line with WHO's own updatesICD-10 is used at national level mainly for classification and coding of mortality and hospital inpatient activity. It is used to the finest level of granularity existing in the published classification.ICD-10 Version 2016 (WHO)There is the intention to transition from ICD-10 to ICD-11, but there is no implementation plan or timeline for this yet.

Flag of Netherlands  Netherlands

ICD-10IrregularNot used for patient record keeping. It is used for administrative purposes and quality assessments. Examples:
Used for morbidity and mortality statistics. Cause of death registries. Hospital admission and discharge registries. Cancer registries. Road traffic accidents.
Coding to the deepest level.
ICD-10 2014Translation of ICD-11 has not started yet. No plans for using ICD-10/ICD-11 for primary care use. Sustainable mappings between SNOMED and ICD are considered valuable in the Netherlands and will accelerate implementation of both systems. 


ICD9CM: portuguese Translation

ICD10CM/PCS: Portuguese translation; it is currently in pilot phase, and it will replace ICD9CM in the EHR.

ICD9CM last update: 2013

ICD10CM/PCS: yearly

ICD9CM: highest level of granularity

ICD10CM/PCS: highest level of granularity.

ICD9CM is mandatory for morbidity coding for inpatient and outpatient care, and is used for billing. ICD10CM/PCS will replace ICD9CM, with the same goals.

ICD9CM: 2013

ICD10CM/PCS is in pilot phase

No plans regarding ICD11.

PT plans are, to implement ICD10CM/PCS nationwide, as soon as possible.

Flag of Slovenia  Slovenia

ICD-10-AM, version 6 (Australian Modification)More than 5 years

In Slovenian hospitals DRG system is implemented. Coding in hospitals is based on Slovenian version of Australian coding standards.

ICD-10, 2nd editionOur plans will be prepared according to the plans of the EU / Eurostat and member states agreement. So far, there are no plans to start with the implementation of ICD-11 before 2021.

Flag of Spain  Spain

Status: Draft under elaboration

Version: 2018/12/18 13:18


  • EHR Electronic Health Records
  • HIS Hospital Information Systems
  • PCIS Primary Care Information System

ICD-9-CM (USA) and ICD-10-CM (USA) in all 14 regions.

ICD-10 (WHO) only in 1/14 regions and only in Primary Care.

In addition to these, we also use:

ICPC-2 for reason for consultation in Primary Care.

SNOMED CT for the coding of problems.

ICD-9-CM (USA): no new versions expected.

ICD-10-CM (USA): every two years.

ICD-10 (WHO): irregular timing.

ICPC-2: irregular timing.

SNOMED CT : continuous maintenance, editions published every six months.

EHR primary sources:

  • ICD-9-CM (USA): coded to highest number of characters available.
  • ICD-10-CM (USA): coded to highest number of characters available.
  • ICPC-2: full codes.
  • SNOMED CT full edition: truncation not applicable.
  • ICD-10-WHO: minimum four characters.

HIS & PCIS sources:

  • ICD-9-CM (USA): coded to highest number of characters available.
  • ICD-10-CM (USA): coded to highest number of characters available.

National standards for: Inpatients; Ambulatory surgery; Daycare hospital; Emergency visits; Ambulatory clinic; Special procedures (e.g. catheterization labs).

HIS and PCIS datasets are built using rule-based secondary indexing and annotation for all disorders, both for inpatient and outpatient care (MBDS).

ICD-9-CM: multiple versions since 1986 until 2014.

ICD-10-CM: 2016, 2018.

ICD-10-WHO: 2008, 2009, 2016.

No plans to adopt ICD-11 (WHO) as national standard.

ICD WHO standards are not adopted as national standards for Spain.

We adopted ICD-CM family and also ICPC-2 and SNOMED CT as national standards for the coding of health problems.


*Currently, included in the table countries aiming to deploy Patient Summary services during Wave 1, 2, 3, and 4.

**Include details such as the use of dual coding (the dagger and asterisk system, for example) or other relevant considerations.

***In ICD-10, Chapters are subdivided into homogeneous blocks of three-character categories. Then, within each block, some of the these three-character categories are assigned to single conditions (selected based on their frequency, severity, or susceptibility to public health intervention); while others represent groups of diseases with a common characteristic. Most of the three-character categories are subdivided by means of a fourth, numeric character after a decimal point. WHO recommends, that when a three-character category is not further subdivided, to fill the fourth position with the letter "X".

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