Rules Are Changing: The Impending Transition to ICD-11
Part 3: Start preparing now to ensure a smooth and efficient implementation.
The World Health Organization (WHO) updates ICD codes every 10 years to improve clinical use and acknowledge innovations in healthcare. After the tumultuous transition to the 10th revision of the International Classification of Diseases, simply mentioning the phrase “ICD-11” is liable to strike fear in the hearts of revenue cycle professionals and healthcare providers across the country. But there’s no need to stress or panic, as the changes made to the classification system will likely make your life easier.
Last month, we talked about some distinguishing characteristics of the novel ICD-11 and compared it to previous versions to give you a better idea of how these revisions could impact current practices. In this third part of the three-part series, we’ll examine the advantages of and major concepts developed and included in the 11th revision, moving toward ICD-11, and implementation considerations.
Reasons to Embrace ICD-11
Let’s review some key changes and the advantages they bring to ICD-11:
- Ease of use
- The coding system is more contemporary and more easily integrated with electronic health records.
- ICD-11 will be completely electronic and user-friendly, offering resources such as the online Coding Tool, Implementation or Transition Guide, Reference Guide, and Browser.
- Digital capabilities
- Its digital format enables ICD-11 to be continuously updated, improves coordination with other classifications and terminologies, provides the flexibility to reduce the need for clinical modifications, and improves the comparability of translations.
- ICD-11 is designed to be computable and is expected to facilitate greater auto-generation of codes from clinical documentation.
- Updated structure and content reflecting current scientific knowledge
- A reformulated chapter structure and indexing system require relocation of some existing codes.
- New codes have been added. ICD-11 has roughly 55,000 unique codes to represent a more comprehensive list of diagnoses.
- Besides diseases, ICD-11 includes external causes, disorders, signs and symptoms, anatomy, histopathology, and much more.
- Each category will feature four characters rather than three, and there are two levels of subcategories. The range of codes is 1A00.00 to ZZ9Z.ZZ.
- New and improved
- There are 30 chapters, compared to 21 in ICD-10. Additions include chapters for immune system diseases, sleep-wake disorders, traditional medicine, developmental anomalies, sexual health, and functioning assessment, as well as a better representation of cancers, devices, medications, substances, severity, and causes of injuries.
- ICD-11 allows for multiple applications to meet health system priorities: mortality, morbidity, primary care reporting, clinical recording, research, patient safety, antimicrobial resistance, epidemiology, population health, health system performance, resource allocation, reimbursement, etc.
- Better coding quality
- ICD-11 enables more straightforward coding. Simple coding can be done as well as coding of complex clinical detail.
- The introduction of extensions and clustering allows for the addition of specific detail to coded entities.
- The new coding structure allows for greater flexibility of application than in previous versions; health conditions can be described to any level of detail by combining codes.
Be sure to read Part 1 “The Rules Are Changing: ICD’s Continued Evolution and the Impending Transition to ICD-11” in the July 2020 issue of Healthcare Business Monthly and Part 2 “ICD’s Continued Evolution and Impending Transition to ICD-11” in the August 2020 issue.
Moving Toward ICD-11
While there is an expectation that countries will start planning for the transition, currently, there is no mandatory implementation date. Member states will migrate to ICD-11 at their own pace and according to their needs and resources. Thus, global implementation of the new edition will be a patchy and prolonged process.
WHO will be accepting data reported using both ICD-10 and the new ICD-11 code sets until the majority of member states have transitioned to the latest version. 2023 is the earliest projected date for the United States to use ICD-11 for mortality data collection coded by state health departments. Before that can happen, an IT update of systems and software and coder training is necessary.
Mortality data have been reported in an internationally standardized way for many years, and it is imperative to continue this practice with the transition to ICD-11. In contrast to mortality, morbidity coding has evolved in a divergent manner at the national level in response to emerging needs and local practices in healthcare provision. In the countries where this has occurred, the transition to ICD-11 may require a tailored approach to allow for these differences in reporting rules and coding, but the goal is to ultimately transition toward an internationally consistent output.
WHO recognizes that the use of ICD in the specific context of a country’s healthcare system may require the development of modifications to ICD-11, for example, due to specific settings or reimbursement system requirements. These changes will be subject to the same international process as all other proposed changes to ICD to avoid diverging regional modifications of ICD and instead retain one international classification system.
While arrangements for international morbidity reporting to WHO have yet to be finalized, it’s important to note that ICD-11 is “designed to be flexible and adaptable enough for morbidity coding, to pre-empt the need for national modifications,” according to the Implementation or Transition Guide. Dual coding studies undertaken during the transition will confirm this and verify the completeness of ICD-11. So, it’s too early to tell whether member states will find it necessary to create a national modification of ICD-11.
In the United States, the Department Health and Human Services (HHS) secretary tasked the National Committee on Vital and Health Statistics (NCVHS) with evaluating pathways and making recommendations on the adoption and use of ICD-11 in the U.S. The NCVHS has put forth recommendations and produced a set of research topics for HHS to explore to provide guidance and inform the decision-making process.
The following are some of the main areas and concepts developed and included in ICD-11:
- New primary care concepts for application in settings where simple diagnoses are made.
- Major overhaul of the section on the documentation of patient safety events, allowing for all necessary detail and compliance with the WHO patient safety framework.
- Coding for antimicrobial resistance, which was missing in ICD-10, to enable data documentation and analysis consistent with the WHO Global Antimicrobial Resistance Surveillance System (GLASS).
- A new classification for HIV has been created to account for the growing population of those living longer with the disease, providing the ability to link the virus with conditions, such as malaria, tuberculosis, and dementia, among others.
- The new supplementary section for functioning assessment allows monitoring of functional status via its recording before and after the intervention.
- It permits the calculation of a summary functioning score — both a domain-specific and an overall summary score — using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) or the WHO Model Disability Survey (MDS).
- All rare diseases are now incorporated into ICD-11. Only a few of these have an individual code, but all have their own Uniform Resource Identifier (URI).
- URI use allows rare disease registries and researchers access to detailed epidemiological data on conditions of interest and facilitates linkage with other information interchange products and terminologies.
- The new Supplementary Chapter for Traditional Medicine provides standardized descriptions for data capture and allows for country-level monitoring through dual documentation alongside mainstream practice, as well as international comparison.
- In many countries, such as China, India, Japan, and the Republic of Korea, traditional medicine is an integral part of health services provided. It has not been based on standard classification, nor has it been possible for health authorities to monitor or compare internationally or regionally, until now.
What Does the Future Hold?
Throughout history, efforts have been made to maximize the utility of ICD, which has greatly impacted the provision of care, health financing, and resource allocation. The increased detail and flexibility built into ICD-11, coupled with its electronic format, will help it to serve as a living document applicable to many purposes, ensuring its longevity.
It would be premature to speculate when the United States will be prepared for migration to ICD-11 for mortality, whether ICD-11 will be adequate as a morbidity classification system, or whether NCVHS will need to develop a clinical modification, as was done for ICD-9 and ICD-10. Though timing and many other details remain uncertain, planning for the transition to ICD-11 is definitely underway.
The inevitable truth is that ICD-11 is looming large on the healthcare horizon, and practices that are unprepared for this transition will see an uptick in rejected claims and a drop in reimbursements. It’s imperative to monitor ICD-11 planning and keep an eye on any developments to ensure your practice is equipped for a smooth and efficient implementation of ICD-11.
ICD-11 Implementation or Transition Guide, 2019, WHO, https://icd.who.int/docs/ICD-11%20Implementation%20or%20Transition%20Guide_v105.pdf
ICD-11 Reference Guide, 2019, WHO, https://icd.who.int/icd11refguide/en/index.html