From October 2016 US healthcare providers started using ICD-10 codes for documentation of clinical conditions instead of earlier system of ICD-9 codes. Though there have been changes in coding system versions before this, what made this transition different was widespread use of ICD-9 compared to earlier versions and adoption of healthcare IT platforms like EHR and PM systems by most of the healthcare setups in recent years. This was first change instance of ICD version for Health Care IT platforms and it was handled without any major hiccup by most of them.
Now it is time to prepare for transition from ICD-10 to ICD-11. ICD-11 has been in making for last few years and was approved by WHO (World Health Organization) in 2019 and came in to effect from January 2022. It is expected to be implemented in US latest by 2027 (as early as 2025) due to changes required for Clinical Modifications similar to ICD-9-CM or ICD-10-CM codes.
ICD-11 Introduction
ICD-11 is 11th version of International Classification of Diseases. This will be 4 character category codes with 2 levels of sub category. A letter is always present at 2nd position to differentiate it from ICD-10.
Some of the important changes from ICD-10 codes include introduction of new diagnoses, refinement of criteria of existing diagnoses. ICD-11 has 21 groups instead of 11 in ICD-10. It has 55,000 codes against 14000+ codes in ICD-10.
ICD-11 coding system includes post coordination system that allows adding more detail to the entity that is chosen. Different types of information can be added to different elements. For example, Histopathology, manifestation, temporality, severity Etc
ICD-11 also defines extension codes starting with letter “X” which cover areas of Post Coordination like Severity Scale, Temporality, Specific Anatomic Details, Dimension of injury and many other aspects of diagnosis etc.
Advantages of ICD-11 classification
Up-to-date: This version is more comprehensive classification of diseases and is based on current understanding of diseases which was not available when earlier versions were designed. ICD-10 classification is clinically out dated despite regular updates to the codes. ICD-11 includes modern knowledge about diseases to classify them in more accurate manner.
Ease of Use: Unlike previous versions, ICD-11 is first digital classification which improves accuracy.
The coding structure is simplified for primary diagnosis and further explicit post coordination codes can be added to further describe the diagnosis.
Digital classification is also assisted by smart classification tool and API provided by WHO which helps clinicians to search diagnosis using commonly used or natural terminologies.
Example of coding using ICD-11 against ICD-10
Example 1: Closed Fracture of 1st Rib on right side.
ICD-10-CM codes:
You can use S22.31XA which indicates Fracture of 1 rib, right side, initial encounter for closed fracture. Here it just indicates 1 rib but there is no way to identify which Rib whether it is 1st or 2nd or any other.
ICD-11 classification:
With simplified system primary diagnosis of problem is, fracture of Rib
Code NA82.3 indicates fracture of Rib which is primary diagnosis.
But it needs to have more details for better identification of problem. This can be done using Post coordination.
Now here are codes that can be combined with primary diagnosis for post coordination –
Laterality: XK9K – Right
Fracture Open/Closed: XJ44E – Closed Fracture
Specific anatomy: XA98Q1 – First Rib
So combination code with ICD-11 will be – NA82.3&XK9K&XJ44E&XA98Q1
Example 2: Type 2 Diabetes with CKD Stage 1
ICD-10-CM Codes:
You can use E11.22 which indicates Type 2 Diabetes mellitus with diabetic chronic kidney disease. However the code doesn’t indicate the level/stage of CKD caused due to Diabetes.
ICD-11 classification:
With simplified system primary diagnosis is Type2 Diabetes which has manifestation of CKD Stage 1.
Code 5A11 indicates primary diagnosis of Type 2 Diabetes.
In post coordination with can use “has manifestation” code GB61.0 to indicate Chronic Kidney Disease, Stage 1.
So combination code with ICD-11 is 5A11/GB61.0
Conclusion:
Looking at above example you can see identification of primary diagnosis is simple with ICD-11 code and with help of coding tool, you can easily add post coordination codes to document details of diagnosis with more accurate details.
Digital coding of ICD-11 also includes APIs and tools which will help EHR and Billing Systems to integrate them and allow users to easily document diseases with greater accuracy.
