The new classification is designed as a database and has up to 13 dimensions.
The World Health Organization (WHO) will be releasing the 11th Revision to the International Classification of Diseases, or ICD-11, this May. The WHO and many of its 194-member countries have been working on this since 2007. As with ICD-10, ICD-11 will have an impact on coding in all specialties.
One of WHO’s goals for ICD-11 is that it will function in an electronic environment and support electronic health records (EHRs). The classification is actually designed as a database, and it has up to 13 dimensions. Many of our EHRs are already equipped with the SNOMED CT foundation, upon which ICD-11 will link with the Nomenclature of Medicine and Clinical Terms. So the way we think about the code list needs to change; it is no longer a single flat dimension, but rather 3-D virtual reality!
ICD-11 will also be multi-purposed, and the structure is defined in linearizations that incorporate properties and attributes with a focus on mortality, morbidity, the degree of primary care, research, and public health. It is translated in English, French, Spanish, Russian, Chinese, and Arabic. Finally, ICD-11 accommodates many specialties, some quite unique.
But the heartache for all the coders reading this article is the codes. Just like with ICD-9, we have coding professionals that have memorized many ICD-10 codes. They know that A and B codes tie to infectious conditions often requiring antibiotics; C is the cancer chapter; E is the endocrine chapter; and obstetrics-related conditions are listed in Chapter O. We all know that the CM diagnosis codes start with a single alphabetical character. Well, poof! Kiss all that goodbye.
There are 28 chapters in ICD-10. The first character is generally the number of the chapter, but when you get to chapter 10, the first character is alphabetical. There is always a letter in the second position to distinguish ICD-11 codes from ICD-10 codes.
Additionally, there are no alpha “I” (sorry, cardiology) and “O” (sorry, obstetrics) codes. Remember the ICD-10 meaning of hypertension? Forget it! In ICD-11, it’s BA00. “Unspecifieds” also will still exist, so our clinicians will be happy.
Codes will have four (not three) characters before the decimal point, and from what I have seen, up to three characters after the decimal point. There are additional codes to help amplify the base code with specificity, laterality, and anatomy, and to describe associated conditions or manifestations (or to further describe an injury like we do today in ICD-10).
An example of the use of an additional code for a manifestation was offered by Donna Pickett of NCHS, who described a patient with type 1 DM and diabetic retinopathy as follows below:
|
6A10 Type 1 diabetes mellitus MG45 Diabetic retinopathy 6A10/MG45 = type 1 DM with |
ICD-11 also has several new chapters:
See more information from Donna Pickett online at https://www.ncvhs.hhs.gov/wp- content/uploads/2017/06/NCVHS-June-21-2017-ICD-10-and-ICD-11-Presentation-v-6- 21-17.pdf
I suspect that many of the U.S. specialty groups that added a ton of codes to the virgin version of ICD-10 will find that this new classification allows them to build the codes that accurately describe the conditions they are treating for billing purposes, even if they still select an “unspecified” code. However, more important is the fact that it is her-compatible, which will make its implementation in the U.S. easier and maybe shorter than that of ICD-10.
It is worth health information management’s (HIM’s) time to start exposing its coding and clinical documentation staff to some of the ICD-11 concepts to establish a comfort level as we get closer to implementation over the coming years. Several links to the ICD-11 beta version and training videos appear below.
Beta draft: https://icd.who.int/dev11/l-m/en
Coding Tool: To enter a search term
https://icd.who.int/devct11/icd11_mms/en/current#/
Last week I read a research letter dealing with family physician burnout published in the Journal of the American Medical Association (JAMA) Internal Medicine. It
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
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