EDITOR’S NOTE: Ten Going on Eleven is a month-long series on ICD10monitor and Talk Ten Tuesdays that examine important issues related to the transition to ICD-11. Melanie Endicott with the American Health Information Management Association (AHIMA) appeared as a special guest on a recent edition of Talk Ten Tuesdays and focused on, the transition to ICD-11. This article is a summary of her remarks.
There are some new terms we will see in ICD-11, such as stem codes, extension codes, cluster coding, pre-coordination, and post-coordination.
Stem codes contain all pertinent information in a pre-combined fashion, referred to as “pre-coordination.” When additional detail that pertains to a condition is described by combining multiple codes, this is referred to as “post-coordination.” The mechanism of showing that codes are post-coordinated is called “cluster coding” in ICD-11.
Extension codes may be used to add detail to a stem code, and are not to be used alone, but must be added to a stem code. Not all extension codes can be used with every stem code. I won’t delve any deeper into the definitions and appropriate uses of each of these new terms today, but if you want to learn more about them, I suggest you check out the ICD-11 Reference Guide on the World Health Organization (WHO) website. What I do want to share about this new coding scheme in ICD-11 is that it provides for even more specificity than what we see in ICD-10. When I recall the transition from ICD-9 to ICD-10, a lot of the education focused on the increased documentation specificity that needed to occur to accurately capture ICD-10 codes. I foresee a similar pattern as we transition from to ICD-11.
I think one of the biggest areas ripe for clinical documentation improvement will be in capturing all of the specificity that is available using extension codes. There are two types of extension codes. Type 1 extension codes allow the user to add detail to a stem code, such as severity scale value, temporality, etiology, specific anatomic detail, dimensions of an injury, or external cause, etc. Type 2 extension codes represent diagnosis code descriptors, such as discharge diagnosis types, diagnosis timing, diagnosis timing in relation to the surgical procedure, diagnosis method of confirmation, diagnosis certainty, OB diagnosis timing, and capacity or context. It’s important to note that the actual use of these extension codes will depend on how ICD-11 is used in the United States. It is too early to begin training on ICD-11 because there are still so many unknowns; however, it’s never too early to begin familiarizing yourself with the nuances of ICD-11 and getting a general overview of the new features.
A few of these new features to be aware of are the five new chapters that are present in ICD-11, of which I’ll offer a quick overview:
In closing, the implications of ICD-11 on clinical documentation improvement (CDI) are not 100 percent clear right now. I suggest that CDI professionals stay tuned in to the process of ICD-11 implementation in the U.S. – and be ready once more information is available.
Today, I want to shine a light on something that is often overlooked but is absolutely critical to the financial health of our healthcare system:
I recently came across a denial indicating that a query was noncompliant because it did not include evidence why the query was needed. I was
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
