Oct 12, 2021

ICD-11: What to Expect in the U.S. for the Upcoming Coding Standard

Updated May 24, 2022  |  Published October 12, 2021 by Hannah Orlousky


The History and Development of ICD-10 Standard

The International Classification of Diseases (ICD) system was created to track morbidity and diseases within the population. In 1898, the Bertillon Classification of Causes of Death was the first attempt at an international registration of vital statistics, which was later adopted by the American Public Health Association and the Conference of State and Provincial Boards of Health of North America. This classification and the later  Statistical Classification of Diseases, Injuries and Causes of Death were the precursors to today’s ICD standard which continues to be published by the WHO. 

Over the years, along with the Current Procedural Terminology (CPT) code set, ICD has become the most widely used statistical classification system in the world, making up the payment infrastructure of the US health system. However, as knowledge of diseases and treatments advances, so must the ICD system. The tenth edition, ICD-10, is the current system. The development of ICD-10 began in 1983 and the standard was endorsed by the WHO’s World Health Assembly (WHA) in 1990. It was first used by member countries in 1994. ICD-10 was mandated by the United States in 2015. 

ICD-10 is based on a classification logic that utilizes seven alphanumeric characters with the mathematical potential to generate a significantly higher number of codes than its previous version, ICD-9. According to the CDC, there are over 70,000 ICD-10 PCS procedure codes and over 69,000 ICD-10-CM diagnosis codes compared to only about 3,800 procedure codes and 14,000 diagnosis codes in the previous ICD-9-CM, roughly 50 times as many as ICD-9. Developed by CMS and NCHS, ICD-10-CM (Clinical Modification) and ICD-10-PCS (Procedure Coding System) are specific to the U.S. This capability significantly increased the level of specificity and included new standards and discoveries in medicine.

What Are the Differences Between ICD-10 and ICD-11?

The preliminary version of ICD-11 was released on June 18, 2018, and was presented at the WHA in May 2019. The official classification system will take effect globally on January 1, 2022. This new version will address gaps in ICD-10 and incorporate updates, including new discoveries, methods, and ways of thinking that have become normalized in modern-day healthcare. 

How will ICD-11 be different from ICD-10? Here are the key differences in the upcoming ICD-11 system: 

  • Coding Structure: ICD-11 will have a more sophisticated categorization and coding structure than ICD-10. It will offer an even finer level of specificity that can be used in a broader range of classifications for diseases, disorders, injuries, and causes of death. This includes the ability to dual code traditional medicine diagnoses alongside mainstream medicine and generates a functioning score.  

  • Global Applicability: ICD 11 will have more international usage offering guidance for different cultures (see dual coding above) and providing translations into 43 different languages. This will create more standardization and ability for collaboration and interoperability. 

  • Digital-Readiness: ICD-11 was designed to be electronic and intuitive for a global audience in the digital age, including easy integration with electronic health applications and the ability to capture more complex data. 

  • Dimensional Approach: ICD-11 is based on a dimensional approach allowing categories of severity, course, and specific symptoms to be added to diagnoses. These dimensional expansions make it better at capturing change over time.

  • Emergency Pandemic Codes Built: In response to the COVID-19 pandemic, member states requested that emergency codes be built into ICD-11. These codes confirm the diagnosis of COVID-19, classify post-COVID-19 conditions, establish COVID-19 as the cause of death, and record COVID-19 vaccinations and any adverse reactions to vaccinations.

When Can The U.S. Expect ICD-11 Adoption?

While ICD-11 has been developed, endorsed, and takes effect on January 1, 2022, U.S. adoption of the new system may take a while. The official timeline remains to be finalized, but it is expected to be adopted as early as 2025 (2027 if a Clinical Modification set is needed).  The 11th edition of ICD is overdue, with the development of the 10th edition beginning almost 40 years ago! The previous decade-long process of ICD-10 adoption indicates that there is a multi-phase approach to the implementation of a new system. However, the technological advances of ICD-11 should create a more seamless transition and shorter timeline.

It’s never too early to start preparing for this transition. Nearly 30 percent of codes impact all specialties. Therefore, it’s important for coding managers and administrative professionals to familiarize themselves with the upcoming ICD-11 revisions. Taking proactive steps to develop and integrate medical practice tools will be critical to quicker adoption and shorter timelines for reimbursement. 

Powerful practice tools will help equip billing departments for code set changes, and RXNT’s software will enable a streamlined transition. With ICD and CPT billing code databases built directly into RXNT’s technology thanks to our partnership with IMO, your practice can perform a variety of keyword searches using natural language to enable the highest level of detail. This integrated capability will allow your practice to provide accuracy, minimize errors, maximize reimbursements, and speed up the adoption of the new standard. To learn more about how RXNT can streamline your transition, contact our team today.

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