ICD-11: Navigating the basics

The transition to ICD-11 is coming and 3M HIS is here to help. We'll debrief the major updates for you and provide an analysis on how the proposed changes could affect your organization. And more importantly, what you can do to prepare for this historic change.

It feels like the health care industry is finally comfortable with ICD-10 and now ICD-11 is on the horizon. The transition from ICD-9 to ICD-10 was an enormous undertaking, with multiple delays, so it feels natural to set aside the thought of ICD-11 for a later time. After all, most of us have other aspects of our job that need to be done now, so why take the time to start reviewing a coding system with no definitive implementation date? While this is a valid question, the answer is, at some point we will move to ICD-11 and now is a great time to get acquainted with the basics.    

Goals of ICD-11

According to the World Health Organization (WHO), the goal of ICD-11 is to enable  health data comparison at an international level. For example, consider these statistics from the WHO:

• Approximately 70 percent of the world’s health care organizations use ICD coding for reimbursement, health initiatives and resource allocation.
• In addition, 110 countries that account for 60 percent of the world’s population use ICD cause-of-death data for health planning and monitoring.
• ICD-10 diagnosis coding has been cited in more than 20,000 scientific articles, which shows the importance of detailed and precise classifications.

What implementing ICD-11 means

The implementation of ICD-11 will have many benefits for health care providers in the U.S. Our diagnosis coding system today includes inconsistent modifications. These variances limit our ability to compare data internationally, develop guidelines and link to knowledge bases. ICD-11 means improved structure and content reflecting contemporary medicine and better coding quality. The updates also mean better tracking and analysis for global health care. 

What’s different in ICD-11?

Besides the structural and content differences, the ICD-11 coding system contains 28 chapters compared to 22 chapters in ICD-10. The additional chapters include developmental anomalies, immune system diseases, sexual health, sleep-wake disorders, traditional medicine and functional assessment. Also, each category contains four characters rather than three and two levels of subcategories.

ICD-11 coding also contains two new terms you will want to know: code extensions and clustering. Code extensions and clustering allow for coding "post-coordination," defined as linking multiple codes to describe a concept. Extensions should not be used alone and are intended to clarify further the severity, laterality, acuity and other aspects of injuries or external causes. On the other hand, cluster codes combine two or more codes to describe a documented clinical concept. Cluster codes will use a forward slash (/) or ampersand (&) to link ICD-11 codes together, creating a diagnostic sentence. For example:

Right shoulder pain FB56.4 & XK9K & XA2ND5

• FB56.4 (pain in limb)
• XK9K (right)
• XA2ND5 (shoulder region)

Future expectations

We don't know yet when ICD-11 will be officially implemented in the U.S. Still, in 2018, the Centers for Disease Control and Prevention (CDC) indicated 2023 would be the earliest date for the adoption of mortality coding. As a result, the Department of Health and Human Services (HHS) secretary requested the National Committee on Vital and Health Statistics (NCVHS) review options and make recommendations for adoption. Subsequently, the committee published a meeting summary (NCVHS Meeting Summary) outlining recommendations and additional exploratory topics for consideration.

 Karla VonEschen is a coding analyst at 3M Health Information Systems.

Contributions to this blog from Benny Ruiz, a clinical development analyst at 3M Health Information Systems.