ICD-10-GM as an Adaptation of ICD-10-WHO
ICD-10-GM is a version of ICD-10-WHO adapted to the specific requirements of the German health care system. Until and including 2003, it was known as ICD-10-SBG-V. The adaptation process took place in two steps. Compatibility with ICD-10-WHO was maintained. In currently annual revisions, ICD-10-GM is updated in line with updates to ICD-10-WHO and further developed in line with the requirements of its application.
The SGB-V version of ICD-10, known as ICD-10-SGB-V, was developed on the basis of a framework agreement between Central Federal Association of Statutory Health Insurance Funds, the National Association of Statutory Health Insurance Physicians and the German Hospital Association. According to the agreement, the official edition of ICD-10 by the WHO was to be simplified for the concerns of Volume V of the German Social Code in order to use it for the encoding of diagnoses.
- in surgeries in outpatient care in accordance with § 295 SGB V (incapacity certificates and billing documents) and
- in inpatient areas in accordance with § 301 SGB V (billing).
This legal stipulation by § 295 SGB V has been in place since 1995.
ICD-10-SGB-V version 1.3 as a simplified version
Examination of the index showed that some parts of the classification were not needed for the purposes of SGB-V. These are:
- four-character codes for diseases that are very rare in Central Europe (e.g. pneumonic plague A20.2)
- the major part of Chapter XX: External causes of morbidity and mortality"
- a large number of codes from Chapter XXI: "Factors influencing health status and contact with health services"
For that reason, the simplified ICD-10-SGB-V version contains only three-digit codes for diagnoses that are rare in Central Europe (such as plague: A20.-); the four-digit codes have been removed from the Tabular List and listed in an appendix. Chapters XX and XXI only include codes required for the purposes of SGB V.
In addition, the encoding depth of ICD-10-SGB-V was reduced to the level required to meet legal stipulations. For many rare diseases, specific encoding using available diagnostic procedures is no longer possible or irrelevant in terms of treatment decisions. In some cases, though, differentiated encoding is essential because of the resulting different consequences for the accounting of medical services.
A gradation of the required encoding depth was adopted in reflection of the different diagnostic opportunities in GP surgeries and those of medical specialists. This minimum standard defines the encoding depth deemed sufficient for the provision of services in GP surgeries, organised emergency care and care provided by medical specialists outside of their specialist field. The codes for the minimum standard are specifically marked, e.g. highlighted in grey.
This simplified version of ICD-10 was used as ICD-10-SGB-V version 1.3 from 1 January 2000 to encode diagnoses in the outpatient sector in accordance § 295 SGB V and in the inpatient sector in accordance with § 301 SGB V.
ICD-10-SGB-V version 2.0 as a considerably extended version for the inpatient sector
Version 2.0 represents a considerable expansion of ICD-10-SGB-V in order to facilitate the introduction of the AR-DRG (Australian Refined Diagnoses Related Groups) remuneration system in the inpatient sector in Germany. To that end, Chapters I to XIX were expanded largely on the basis of the Australian ICD-10-AM, and the differentiated codes from the list of exotic diseases reintegrated. In this version, too, only those codes from Chapters XX and XXI were included that are required for the purposes of SGB V. The minimal standard was kept and marked accordingly.
Version 2.0 was used from 1 January 2001 until 31 December 2001 for diagnostic encoding in the inpatient sector in accordance with § 301 SGB V; in the outpatient sector, version 1.3 including the minimum standard continued to apply.
ICD-10-GM from version 2004
In 2004, both SGB-V versions were replaced with the German Modification, i.e. ICD-10-GM version 2004, applicable both in the outpatient and the inpatient sector. The minimum standard for care in GP surgeries was abandoned with this version as it had not proven useful in practice. Instead, it is permissible in the outpatient sector to do without five-digit encoding.
In currently annual revisions, ICD-10-GM is updated in line with updates to ICD-10-WHO and further developed in line with the requirements of its application. Compatibility with ICD-10-WHO is maintained.