ICD-11 Prep: Examining Prominent Changes in Preparation for the Transition

The transition to ICD-11 takes time – and understanding the new concepts being introduced is a key starting point.

Since the World Health Organization (WHO) announced the release of the International Classification of Diseases, Eleventh Edition (ICD-11) in 2019, the opinion among industry insiders regarding U.S. adoption of the new codes have been consistent – in that it’s going to take a while. Based on the tremendous undertaking of the implementation of ICD-10, understandably, one might happily push yet another implementation to a later date. However, projecting timeframes for ICD-11 implementation on past experiences of ICD-10 may be misleading.  

The good news is, it is unlikely that hospitals will experience the same challenges as they did with ICD-10. This time around will likely be far less daunting. However, this should not translate to any concession on pre-planning and preparation. Though there is no definite ICD-11 implementation timeline yet established, lessons learned from the ICD-10 transition show that there are numerous steps needed to move toward ICD-11 implementation.

This latest version of the coding set was designed with the direct intent of addressing previous challenges, primarily through a more seamless integration process with electronic health records. ICD-10, though only recently implemented in the U.S., has been in use for decades – before the developments made in today’s electronic environment.

Revisions to accommodate technological advancements were necessary and are incorporated into ICD-11. This newest edition also demonstrates the significant progress made in science and medicine over the past 30 years, and revolutionizes the way conditions are classified and coded in the clinical setting. The overall coding improvements in ICD-11 will provide for more precise and more detailed data recording and collection.

New Concepts for Consideration
By way of comparison, ICD-11 contains 80,000 entries that point to 17,000 codes in 26 chapters, compared to the 14,000 codes in 21 chapters in ICD-10. Additionally, the classification system in ICD-11 has been redesigned, and is now structured as a database that includes up to 13 dimensions, with multiple changes making it more IT-compatible than ICD-10.  

The structure ICD-11 is built on is called the Foundation Component, which contains all ICD concepts and the information needed to construct tabular lists. One tabular list that has been developed from this foundation is Mortality and Morbidity Statistics (ICD-11 MMS). The ICD-11 MMS Tabular List is similar to the ICD-10 Tabular List, organized primarily according to the body systems, but with new content. 

In addition to the ICD Foundation Component, the unique architecture of ICD-11 provides the ability to define a linearization, which will ensure that ICD-11 can support diverse uses.

ICD–11 has five new chapters, and as a result, the numbering of the chapters has changed. The new chapters are:

• Chapter 03: Diseases of the blood or blood-forming organs; Chapter 04: Disorders of the immune system (conditions affecting the immune system and conditions affecting the blood are now in two separate chapters);
• Chapter 07: Sleep-Wake disorders;
• Chapter 17: Conditions related to sexual health; and
• Chapter 27: Traditional Medicine.

In reference to the new chapter, traditional medicine: although people across the globe use traditional medicine, it has never before been classified in this system. Also, a new chapter on sexual health brings together conditions that were previously categorized in other ways (for example, gender incongruence was listed under mental health conditions) or described differently.

In addition to the United States, other countries have built upon the WHO ICD by creating their own code sets. However, with ICD-11, countries can define a specific linearization for their unique needs instead of creating a unique code set, which may save years and sizable cost in the implementation. This is one reason to be optimistic about the timeline and anticipate a “sooner” rather than a “later” start date.

Many of the issues experienced with ICD-10 are proposed to be solved with ICD-11. As an example, ICD-11 includes HIV subdivisions, simplified diabetes coding, melanoma types, and better classification of valve diseases, to name a few changes. ICD-11 will also affect extension codes indicating temporality, severity, dimensions of injury, and external causes. Another new concept of ICD-11 is the function of clustering of codes that combines two or more codes to describe a diagnostic entity.

Is it Start Time? 
The soonest any country may begin using ICD-11 is Jan. 1, 2022 (not too far in the future), although it is up to each country to decide when to adopt. There is no deadline to complete implementation, but considering improvement in efficiencies and technological advances, the implementation date for America’s hospitals may be more expeditious than initially projected. 

Though all necessary pieces for the US ICD-11 transition have not been finalized, it is never too soon to begin planning. 

With a nearly 30-percent increase of codes impacting all specialties, it is important for coding managers and health information management (HIM) professionals to familiarize themselves with the new ICD-11 concepts. Taking proactive measures and developing training plans will ensure a successful transition as the implementation date approaches. Assigning someone to monitor updates and communicate ICD-11 status to management is an excellent place to start. Identify someone to maintain awareness and keep up to date on news and announcements from the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), the American Health Information Management Association (AHIMA), the American Medical Association (AMA), and other industry organizations that provide updates on the move to ICD-11.

In particular, AHIMA has been intricately involved in the development of ICD-11, and provides members with valuable high-level overviews of ICD-11 and how it differs from ICD-10-CM. As the time approaches, look to AHIMA communication and information on tools to assist with adoption.  

Training will be paramount, and must be well-thought out in advance of implementation. It may require a reassessment of internal training processes to better equip coding departments for the many ICD-11 changes.

Another consideration for healthcare organizations will involve what ICD-11 will present in terms of budget implications, education, and software requirements. There are several resources, including the WHO browser, where individuals and organizations can begin to familiarize themselves with the content changes and review the transition guide for ICD-11. This is a valuable exercise for coders, managers, and especially IT staff for assessing requirements and starting to work with revenue cycle software providers to develop project plans and timelines in preparation for the transition. 

It is still undetermined whether the U.S. will create a modification of ICD-11, as it did with ICD-10 CM, which may be another factor in a possible delay. Additionally, the COVID-19 global pandemic has had an impact on a potential pushback of the date. Though some predict it will be 3-4 years before an implementation day is released, pre-planning and preparation are still important.

Programming Note: Listen to Susan Gatehouse report this story live today on Talk Ten Tuesdays, 10 a.m. Eastern.