ICD-11 for Indian Clinics: What Changed from ICD-10 and How to Use It in 2026

What Is ICD-11?

ICD-11 (International Classification of Diseases, 11th Revision) is the WHO's global standard for recording, reporting, and analysing health data. India officially adopted ICD-11 in 2022 for mortality and morbidity reporting under the notification from the Ministry of Health and Family Welfare.

For Indian clinics, ICD codes appear in:

• Insurance and TPA claim submissions
• ABDM health records and ABHA-linked prescriptions
• Government health scheme reporting (PMJAY, CGHS, ESIC)
• Death certificates and discharge summaries
• Hospital MIS and quality reporting

For most outpatient GP consultations, ICD codes are used in the background by your software — you select a diagnosis, and the software assigns the code. Understanding the system helps when you encounter coding errors in insurance rejections.

Key Changes from ICD-10

The biggest practical change for Indian clinics is the new extension code system. For example, in ICD-11 you can code “Type 2 diabetes with moderate diabetic nephropathy affecting the left kidney” as a single extended code — previously this required multiple codes in ICD-10.

Most Common ICD-11 Codes for GPs

Impact on Insurance Claims

This is where the ICD-10 to ICD-11 transition creates real-world complexity for Indian clinics in 2026:

• PMJAY (Ayushman Bharat): Still using ICD-10 codes for claim submission as of mid-2026. ICD-11 migration is planned but not yet mandated.
• Private insurers and TPAs: Mixed — some have adopted ICD-11, most still accept ICD-10. Always check the specific TPA's current requirement.
• ABDM health records: ICD-11 is the standard for ABHA-linked health records from 2023 onwards.
• CGHS and ESIC: Transitioning to ICD-11 — check the latest circular from the respective ministry.

The practical implication: your clinic software should maintain dual-coding capability — ICD-10 for insurance claims where required, ICD-11 for ABDM records. If your software only supports one version, raise it as a support ticket.

For the full picture on ABDM compliance requirements, see our ABDM compliance guide for Indian clinics.

FAQ

Do I need to know ICD codes for daily OPD practice?

Not individually — your software should handle code assignment. However, understanding the structure helps when insurance claims are rejected with “incorrect code” errors. Knowing that hypertension is BA00 (not I10) for an ABDM record lets you quickly identify and fix the issue.

Where can I access the full ICD-11 code list in India?

The WHO provides a free online ICD-11 browser at icd.who.int — fully searchable in English. The Ministry of Health has also published Indian adaptations of ICD-11 for specific contexts like cause-of-death certification.

Is there an official Indian adaptation of ICD-11 like there is for ICD-10-CM in the USA?

India uses the WHO ICD-11 core without a separate national modification (unlike the USA's ICD-10-CM). Chapter 26 (Traditional Medicine) is particularly relevant for India, covering Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Sowa Rigpa conditions.