ICD-11 is the 11th edition of the International Classification of Diseases. ICD provides a worldwide language (code set and regulations) for health professionals to detect and analyze global health trends and statistics.
According to the World Health Organization’s schedule, countries might start submitting health data using ICD-11 on January 1, 2022 (WHO). This comes after the admission of the 194 countries that make up WHO on May 25, 2019.
ICD codes can be of great financial significance since they help allocate resources, such as funding for health programs.
ICD codes are extremely important in the health insurance billing industry. The United States is a prime example of a country with a strong association between ICD, healthcare finances, and provider reimbursement.
In the 1990s, ICD-10 was implemented by the WHO, which is in charge of updating and publishing the ICD. Due to its out-of-date information, ICD-10 adoption was becoming troublesome.
ICD-10 will progressively lose its ability to provide accurate and insightful classification. ICD-10’s last update came out in October 2019. WHO does not continue to monitor it. So, it is now necessary to assess how the globe and the United States will implement the ICD-11.
ICD-11 Updates: Post-Coordination
ICD-11 codes have a different appearance than ICD-10 codes and a more straightforward structure. Extensions and clustering are two other important characteristics included in ICD-11. This will make it possible to link two types of codes together to define an idea and add specific information to coded items.
Both functions can enhance ICD-11 code information. ICD-11 extensions are non-diagnosis codes that add elasticity to the classification. Extensions are not meant to be used independently; they should be attached to a stem code to replace ICD-10 adjunct codes.
Laterality, acuity, intensity, and other parameters of damage and external causes are described by extension codes. Cluster coding uses two or more ICD-11 codes to indicate a clinical notion with supporting documentation. With this method, ICD-11 makes it clear which codes are used together to define the same condition.
Clustering is the ability that makes it possible to link things when a diagnostic statement is broken down into its parts. It makes it possible to connect key diagnostic ideas (concepts in stem codes) to clinical ideas in extension codes.
Cluster coding is a method of organizing diagnostic “sentences” using ICD-11 codes by linking them together using the “with” operator, typically a forward slash (/) or an ampersand (&).
ICD-11 coding illustration
a diagnosis of left hip osteoarthritis with chronic discomfort and swelling
- Osteoarthritis of the hip, nonspecific (FA00.Z)
- Post-coordination:
- Laterality (if necessary, add another code): XK8G Left
- Possesses manifestation (optional additional code): MG30.30 Musculoskeletal pain that comes from inflammation that lasts for a long time
FA00.Z&XK8G/MG30.30 cluster
ICD-11 was designed so that updating will be simpler than in previous editions, potentially removing the need for ICD-12.
Furthermore, its inventors claim that there will be no need for national revisions to ICD-11 due to its flexibility and capacity to provide detailed digital documentation.
ICD-11 Codes: A Comparison to ICD-9 and ICD-10
The evolution of ICD codes can be seen in the following two cases. Observe that the examples employ U.S.-standard ICD-10-CM and ICD-9-CM codes. The ICD-11 codes come from the ICD-11 Coding Tool’s February 2022 release.
- Hypertension is essential, without further elaboration:
- ICD-9-CM 2015: 401.9 essential hypertension of unknown cause
- ICD-10-CM 2021: I10 Primary (essential) high blood pressure
- ICD-11 code BA00.Z Hypertension is essential but not specific
- Type II diabetes mellitus with a diabetic cataract on the left:
- ICD-9-CM 2015: 250.50 Eye problems caused by diabetes, either type II or nonspecific kind, but not indicated as uncontrolled, and 366.41 Diabetic cataract
- ICD-10-CM 2021: E11.36 Diabetes mellitus type II with diabetic cataract
- ICD-11 codes: 9B10.21&XK8G/5A11
- 21 Cataract in diabetics
- Left XK8G
- Diabetes mellitus type 2 5A11
What’s more about ICD-11?
- The ICD-11 consists of 26 chapters relating to groupings of disorders plus a supplemental portion (Chapter V) for functional assessment. The sixth chapter discusses mental, behavioral, and neurodevelopmental disorders.
- ICD-11 contains more than 17000 distinct codes. There are more than 120 000 codable phrases, which are now online.
- ICD-11 adds missing antimicrobial resistance codes from ICD-10 to make it easier to record and analyze data in line with the Global Antimicrobial Resistance Monitoring System (GLASS) of the World Health Organization.
- The smart coding algorithm can now comprehend over 1.6 million terms.
- ICD-11 includes the Clinical Descriptions and Diagnostic Requirements (CDDR) for mental health, equivalent to ICD-10’s Clinical Descriptions and Diagnostic Guidelines (CDDG).
- Due to the increased number of people living longer with HIV, a new categorization allows researchers to relate the virus to malaria, TB, and dementia.
- Complete modifications have been made to the chapter on personality disorders. Due to overlap in clinical practice, there is now only one “personality disorder” diagnosis categorized as mild, moderate, or severe and assessed in six trait domain areas to keep some of the specificity of the diagnosis from before.
- ICD-11 makes words more evident to the general public and makes it easier to code crucial information like the location and kind of fracture and the spread of a tumor.
- Errors are less likely to happen with ICD-11 because it is digital, has a new structure that is easy to use, and is available in multiple languages.
- ICD-11 currently includes information on all uncommon disorders. A couple of these have different codes but share a unique Universal Resource Identifier (URI).
- URIs enable rare illness registries and researchers to link epidemiological data on diseases of interest to other information exchange goods and languages.
ICD-11’s positive aspects
- ICD-11 portrays tumors, gadgets, drugs, substances, severity, and causes of injuries more accurately.
- There are two tiers of subcategories and four characters per category, with codes ranging from 1A00.00 to ZZ9Z.ZZ.
- The computable nature of ICD-11 should allow for more coding automation in response to clinical documentation.
- The new version of the coding system works better with electronic health records and is more up-to-date.
- On WHO’s ICD-11 portal, the coding tool, Implementation or transition guide, reference handbook, and browser will be available online to make ICD-11 user-friendly.
- Along with diseases, ICD-11 lists external causes, disorders, signs and symptoms, anatomy, histology, etc.
- Each section will have four characters instead of three, and there will be two tiers of subdivisions. The possible codes range from 1A00.00 through ZZ9Z.ZZ.
ICD-11’s role in the long run
ICD-11, like previous ICD versions, has the potential to significantly alter care delivery, health financing, and resource allocation. ICD-11’s additional detail, adaptability, and electronic format will enable it to function as a living record suitable for numerous applications, assuring its longevity.
Healthcare providers not ready for ICD-11’s implementation will see their compensation and number of accepted claims decrease. Monitoring ICD-11 preparation and updates are crucial for ensuring a smooth and effective transition to ICD-11 in your medical billing and coding practice.
Conclusion
By adopting ICD-11, society as a whole, and people at risk for or suffering from chronic pain will have access to more accurate and standardized diagnoses.