ICD-11 is Coming: What Healthcare Professionals Need to Know
With the transition to ICD-11 on the horizon, healthcare professionals—from clinicians to coders and administrators—need to understand the implications of this change. This article explores the upcoming changes and impact associated with ICD-11.
Understanding ICD-11
The International Classification of Diseases (ICD) serves as the global standard for defining and classifying diseases, disorders, injuries, and other related conditions. The World Health Organization (WHO) issues periodic updates to the ICD to reflect advances in medical knowledge and changes in healthcare practices.
The upcoming transition to ICD-11 will bring significant changes to the industry and how conditions and procedures are classified and coded.
According to the WHO “The ICD system is designed to promote international comparability in the collection, processing, classification, and presentation of health statistics, and health information in general.”
This makes possible the aggregation and comparison of data between countries and regions, independent of language.
The ICD also serves as the underpinning of health insurance reimbursement and claims processing, national healthcare administration programs, data collection and research, global health initiatives, and patient quality and safety reporting. According to the WHO, “70 percent of the world’s health expenditures use ICD coding for reimbursement and resource allocation.”
Disease registries and government agencies rely on the codes to track population health data.
The ICD coding system is thoroughly embedded in the healthcare system, from provider documentation to EMR/PM system databases and administrative functions such as billing and reimbursement. Health systems use their ICD volumes and mix to plan and project the need for resources as well.
Key Changes
ICD-11 brings several key changes to improve the accuracy and efficiency of healthcare coding:
Format. For the first time, the new version has been released in a digital format.
New chapters and categories reflect advancements in medical knowledge and technology and emerging public health concerns. For example, ICD-11 includes a chapter devoted to gaming disorders, as well as a section on antimicrobial resistance.
Emphasis on interoperability and integration with EHRs. ICD-11 is designed to be more compatible with digital health platforms.
Traditional medicine “is an integral part of health services provided in many countries, such as China, India, Japan, and the Republic of Korea,” according to the WHO. The new version includes a supplemental chapter to allow standardized descriptions for traditional medicine.
Impact on Healthcare Professionals
ICD-11 will have a significant impact on healthcare professionals, including:
Workflows. Virtually every healthcare workflow will be impacted in some way. Providers can use the new browser as they document. Coders will have an interactive tool at their fingertips, potentially integrated with their EMR. Authorizations staff will interact with new code sets.
Training. Implementation of ICD-11 will require time and resources dedicated to training.
Systems. Both internal systems such as EMR/PM systems, as well as external systems such as grouper software, payer claims processing systems, etc., will be impacted, and therefore the people using them.
Coordination with other stakeholders. Healthcare professionals will need to monitor the timing of implementation and communicate with the government, payers, vendors, and other stakeholders to ensure a smooth transition.
Benefits of Transitioning to ICD-11
The adoption of ICD-11 offers several benefits for the healthcare industry and its stakeholders:
Digitization. The ICD-11 package consists of a browser, coding tool, and APIs. Coding can flow from the browser to the health record.
Ease of use. The new tool is designed to be effective in different settings where coding resources can vary greatly. ICD-11’s design makes it useful for solo practitioners as well as large health systems with professional coders or health insurance companies. It was designed to reduce coding costs and provide better quality data.
Increased specificity. ICD-11 includes more detailed codes for diseases and conditions to improve treatment plans and outcomes.
Technological enhancements. ICD-11 is designed to be simple to embed in any software.
Overall, the adoption of ICD-11 offers a range of benefits that can enhance healthcare delivery, data management, research, public health surveillance, and operational efficiency.
Challenges and Considerations
Technically, ICD-11 has been available since 2022. However, in the United States, implementation is expected to take several years. This is due to the downstream dependencies, effort, and resources involved.
One of the challenges of the ICD system is obsolescence. With tens of thousands of unique codes and the involvement of over 3,500 stakeholders, developing a version update is a massive, sometimes decade-long undertaking. Meanwhile, medical science and technology are evolving more rapidly.
Development of a new version is followed by additional years to implement it, due to how embedded ICD is in virtually every aspect of healthcare operations.
Other challenges include:
Crosswalking. ICD-10 codes do not map neatly to ICD-11 codes, as there is not a one-to-one relationship.
Billing and Reimbursement. The Medicare Inpatient Prospective Payment System, the basis for hospital reimbursement, relies on ICD codes to determine MS-DRGs and case mix. As grouper methodology is updated, reimbursement could be impacted.
Reporting. Organizations must update custom reports and queries used for quality reporting, operations, and other purposes.
Systems. EMR/PM, benchmarking, analytics, and other systems need to be updated with the new codes. Providers involved in risk-based reimbursement models rely on algorithms for predictive analytics. A change to ICD-11 necessitates updates and programming.
Resources. The cost of hours spent on education and training, testing, and implementation are all incremental to day-to-day operations, may not be budgeted, and can put a strain on an already lean workforce.
The WHO recommends 18 months of simultaneous use of ICD-10 and ICD-11 to fully understand and test the impact. Pre-assessment and a formal project management approach are also recommended for a successful transition.
Resources and Support
Healthcare organizations, professionals, and other stakeholders can access a variety of resources and tools to help with the transition.
The World Health Organization
The WHO provides official guidelines, training materials, and updates on ICD-11. For example, the interactive Coding Tool which consists of a search bar that instantly updates results based on words input by the user, and the ICD-11 Browser which allows the user to search for key terms, anatomy, or other elements. Fact sheets and training can also be found on the WHO website.
Professional Associations
Professional associations such as AHIMA and other coding associations offer workshops, webinars, certifications. The Healthcare Financial Management Association (HFMA) and others provide access to white papers, articles, and resources.
Software Vendors and Healthcare IT Companies
Software vendors and health IT companies are proactively developing solutions for their clients.
Online Platforms, Forums, and Communities
Online platforms and communities like LinkedIn and professional association forums help facilitate knowledge sharing and collaboration among healthcare professionals, providing an opportunity to post questions and share insights and lessons learned.
In conclusion, the transition to ICD-11 represents a major milestone in the evolution of healthcare coding and data capture. Healthcare professionals will need to invest in training and adapt their practices and workflows to ensure a smooth transition, and full realization of the benefits offered by ICD-11.