Preparing for the Inevitable – ICD-11

The new code set could be implemented in the U.S. as early as 2023.

It may be a while before the U.S. implements ICD-11 for coding morbidity and mortality, but now is the time to prepare to make the inevitable transition less stressful.

Even as other countries worldwide roll out the updated code set, the United States has not yet reached the milestone. If the introduction of ICD-10 in the U.S. offers any indication, we may be in for a years-long wait ahead, but proactive preparation is always best.

In the following article, we’ll provide an update on ICD-11 in the U.S. and a brief history of the ICD-11 code set, exploring critical differences between ICD-10 and ICD-11 and an overview of tools for implementation, as well as offer key takeaways.

ICD, or the International Classification of Disease, is the international standard for the systematic recording, reporting, analysis, interpretation, and comparison of mortality and morbidity data. While ICD-10 continues to be used for procedure coding on facility claims in the U.S., the WHO released the 11^th edition of ICD in January 2022 for diagnostic coding.

ICD-11 allows health professionals worldwide to share information better and more precisely, and it is now the global standard for coding health information.

This coding system serves a broad range of uses and provides critical information on the global causes, extent, and consequences of human disease and death. The data and statistics coded in ICD support payment systems, quality and safety programs, service planning, and health services research, and it is the basis for comparing statistics on the causes of morbidity and mortality between places and over time. It ensures the reusability of data by sources around the globe beyond just health statistics, extending to resource allocation, decision support, and reimbursement guidelines.

ICD-11 is the integration of terminology and classification, using up-to-date scientific knowledge that can be more easily shared. It is accessible to everyone, distributed under the Creative Commons Attribution-NoDerivs 3.0 IGO license, and enables, for the first time, the tabulation of traditional medicine services and encounters.

Each country decides independently when to adopt ICD-11, and while there are varying opinions, it appears that it will be implemented in the U.S. as early as 2023.

A Brief History of ICD

ICD was initially adopted in 1900 and has morphed into a comprehensive classification system for morbidity, mortality, patient safety, and more. It is also used for primary and secondary care and research. However, its most widespread use is for the cause of death statistics, research, public health monitoring, planning, and provision of follow-up healthcare.

ICD-10 is now 25 years old – and outdated. The U.S. implemented it in 1999, but widespread use was put off for several years. ICD-11 is fully electronic and available in English, French, Chinese, Russian, and Arabic. In addition, it underwent a significant modification to make it more electronically available, include more meaningful clinical content, and be more user-friendly.

Steps Still to Come

ICD-11 has been in the works for a decade, but a lot still needs to happen before it is fully implemented in the U.S. Computer systems must be updated, coders trained, and the entire staff educated. Also, the National Committee on Vital and Health Statistics (NCVHS) states that there still must be hearings for revisions, and the rulemaking must be posted in the Federal Register. Finally, the Final Rule must be published.

The system features five new chapters, with the core chapters of diseases of the immune system, sleep-wake disorders, and conditions related to sexual health. Codes are alphanumeric and provide access to 17,000 diagnostic categories, with more than 100,000 medical diagnostic index terms. A component also allows for creating defined tabular lists for reporting mortality and morbidity codes.

One new feature is stem and extension codes, which are organized into 26 chapters related to such topics as essential hypertension, unspecified, and hyperkalemia. These extension codes are designed to add meaning to a stem code in a standardized manner. For example, extension codes may include aging-related or adenoid basal carcinoma. Other examples with more precision include:

• Complications of diabetes;
• Coding for traffic accidents and causes of injuries;
• Detail for cancer registries;
• Code for antimicrobial resistance;
• Specific coding for clinical stages of HIV; and
• Classification of pulmonary hypertension.

Some significant changes include putting chapters in Arabic, rather than roman numerals. ICD-11 codes also look different than those in ICD-10, with a simplified structure. ICD-11 introduces two features in particular – extensions and clustering – that enable two kinds of post-coordination and the addition of specific detail to coded entities.

An ICD-11 extension is a non-diagnosis code that adds flexibility to the classification. Extensions cannot be used alone, but rather are intended to be added to a stem code, replacing ICD-10 adjunct codes. Extension codes are appended to describe laterality, acuity, severity, and other dimensions of injury and external causes.

Cluster coding is combining two or more ICD-11 codes to describe a documented clinical concept. This approach is how ICD-11 explicitly marks codes that are post-coordinated to describe one condition.

Next Steps for ICD-11

Healthcare companies must make several changes before ICD-11 is adopted in the U.S.:

• Ensure quality and usefulness of data;
• Identify someone to monitor industry updates;
• Adopt lifelong professional learning to ensure everyone is up-to-date on ICD-11;
• Promote the need for continuing education, training, and workforce development; and
• Develop a solid understanding of ICD-11.

Taking such steps will ensure that healthcare organizations are prepared when the U.S. inevitably adopts ICD-11.

About the author

With more than 20 years of coding experience, Leigh Poland is dedicated to providing education globally to ensure medical coders are equipped to do their job accurately and with excellence. As the vice president of coding services at AGS Health, Leigh leads the company’s internal training and continuing education programs.

Contact the author: Leigh.Poland@agshealth.com