The process is tedious when writing a proposal to amend the ICD-11 classification.
ICD-11 was released by the World Health Organization (WHO) in February 2022. It is important to learn about the new classification, as preparation for its adoption by the United States at some point in the future.
In the fall of 2020, I was engaged to assist a client through the Coordination and Maintenance Committee code amendment process with a new code proposal for ICD-10-CM. I worked with the client to develop the proposal on PTEN Hamartoma Tumor Syndrome and provide education on the new code process. After the completion of the ICD-10-CM proposal, we discussed the classification in ICD-11.
My client, who is based in England, was not aware of ICD-11. I shared the website, and we began our journey. I do not have a deep knowledge of ICD-11 (I had taken the ICD-11 workshop during the American Health Information Management Association/AHIMA Convention in 2021), but I was able to walk them through the code set. The good news is that their topic, PTEN Hamartoma Tumor Syndrome, which is caused by genetic mutation in the PTEN gene, was present in ICD-11, but it was misclassified. In ICD-11, the syndrome was classified as a gastrointestinal disorder.
We decided to write a proposal to amend the ICD-11 classification. As they wrote the clinical portion of the proposal, I worked on the submission process. The submission process is not the same as that of the Coordination and Maintenance Committee, but there was information available on the ICD-11 website. There is also a coding tool that allows the user to code conditions in ICD-11. The WHO and AHIMA also have had education sessions on the classification.
My client and I developed the code alternatives based on similar conditions and how they are classified. The proposal was submitted in May 2021. As the proposal is reviewed, I receive emails whenever there is a change in the proposal status. The proposal has now moved through a couple of WHO committees.
I am happy to report that the Medical and Scientific Committee (MSC) recommended to support the proposal on March 9, 2022, and the Classification and Statistics Advisory Committee (CSAC) Small Group has agreed with the recommendation to move it forward on April 12. This Committee recommended approval with changes. The Committee did not recommend a specific code for PTEN Hamartoma Tumor Syndrome, but it would group the condition with similar conditions. This change does not accomplish the goal of having a specific code for the Syndrome so that the data could be tracked. We are now investigating if we can respond to the suggested changes and request a specific code for the condition.
If adopted, the change would be effective Jan. 1, 2023. While this will be great news, the length of time to amend the classification raises concerns. In the United States, the code proposals are presented twice per year, and we have new ICD-10-CM codes introduced twice per year.
Based on my experience with ICD-11, it could potentially take two years to make changes.
Programming Note: Listen to Laurie Johnson and the Talk Ten Tuesdays Coding Report today and every Tuesday on Talk Ten Tuesday with Chuck Buck at 10 Eastern.
In the ever-evolving world of health information, few transitions generate as much anticipation and uncertainty as the adoption of a new international classification system. The
EDITOR’S NOTE: Ms. Fernandes is the immediate Past President and Communications Chair for the International Federation of Health Information Management Associations (IFHIMA), and will be
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
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. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
