ICD-11 is Coming – Take Time to Adjust

The new classification is designed as a database and has up to 13 dimensions.

The World Health Organization (WHO) will be releasing the 11th Revision to the International Classification of Diseases, or ICD-11, this May. The WHO and many of its 194-member countries have been working on this since 2007. As with ICD-10, ICD-11 will have an impact on coding in all specialties.

One of WHO’s goals for ICD-11 is that it will function in an electronic environment and support electronic health records (EHRs). The classification is actually designed as a database, and it has up to 13 dimensions. Many of our EHRs are already equipped with the SNOMED CT foundation, upon which ICD-11 will link with the Nomenclature of Medicine and Clinical Terms. So the way we think about the code list needs to change; it is no longer a single flat dimension, but rather 3-D virtual reality!

ICD-11 will also be multi-purposed, and the structure is defined in linearizations that incorporate properties and attributes with a focus on mortality, morbidity, the degree of primary care, research, and public health. It is translated in English, French, Spanish, Russian, Chinese, and Arabic. Finally, ICD-11 accommodates many specialties, some quite unique.

But the heartache for all the coders reading this article is the codes. Just like with ICD-9, we have coding professionals that have memorized many ICD-10 codes. They know that A and B codes tie to infectious conditions often requiring antibiotics; C is the cancer chapter; E is the endocrine chapter; and obstetrics-related conditions are listed in Chapter O. We all know that the CM diagnosis codes start with a single alphabetical character. Well, poof! Kiss all that goodbye.

There are 28 chapters in ICD-10. The first character is generally the number of the chapter, but when you get to chapter 10, the first character is alphabetical. There is always a letter in the second position to distinguish ICD-11 codes from ICD-10 codes.

Additionally, there are no alpha “I” (sorry, cardiology) and “O” (sorry, obstetrics) codes. Remember the ICD-10 meaning of hypertension? Forget it! In ICD-11, it’s BA00. “Unspecifieds” also will still exist, so our clinicians will be happy.

Codes will have four (not three) characters before the decimal point, and from what I have seen, up to three characters after the decimal point. There are additional codes to help amplify the base code with specificity, laterality, and anatomy, and to describe associated conditions or manifestations (or to further describe an injury like we do today in ICD-10).

An example of the use of an additional code for a manifestation was offered by Donna Pickett of NCHS, who described a patient with type 1 DM and diabetic retinopathy as follows below:

ICD-11 also has several new chapters:

• Chapter 3: Diseases of the Blood and Blood- forming Organs
• Chapter 4: Disorders of the Immune System
• Chapter 6: Conditions related to Sexual Health
• Chapter 8: Sleep-Wake Disorders
• Chapter 26: Traditional Medicine: This chapter refers to disorders and patterns that originated in ancient Chinese Medicine and are still commonly used in China, Japan, Korea, and elsewhere around the world.
• Chapter 27: Supplemental V Codes: There are not like the ones we know. The V codes will be great supplemental codes for HCCs, rehabilitation centers, and skilled nursing care, because these codes describe a patient’s functional status and disabilities.
• Chapter 28: Supplemental Extension codes: These are the X codes that are used as supplementary or additional codes to identify more detail, such as severity, tumor staging, history, injury, and poisonings, as well as attributes such as differential and provisional diagnoses, presence on admission, or how a condition was confirmed. These may be five alphanumeric codes.

See more information from Donna Pickett online at https://www.ncvhs.hhs.gov/wp- content/uploads/2017/06/NCVHS-June-21-2017-ICD-10-and-ICD-11-Presentation-v-6- 21-17.pdf

I suspect that many of the U.S. specialty groups that added a ton of codes to the virgin version of ICD-10 will find that this new classification allows them to build the codes that accurately describe the conditions they are treating for billing purposes, even if they still select an “unspecified” code. However, more important is the fact that it is her-compatible, which will make its implementation in the U.S. easier and maybe shorter than that of ICD-10.

It is worth health information management’s (HIM’s) time to start exposing its coding and clinical documentation staff to some of the ICD-11 concepts to establish a comfort level as we get closer to implementation over the coming years. Several links to the ICD-11 beta version and training videos appear below.

Beta draft: https://icd.who.int/dev11/l-m/en

• This includes the classification listing by chapter, and under the “info” tab there are links to training videos.

Coding Tool: To enter a search term

https://icd.who.int/devct11/icd11_mms/en/current#/