How is ICD-11 going to Impact Medical Billing Services?

ICD stands for the International Classification of Disease, which is the global standard for clinical and medical research for reporting of disease and related health problems. ICD is a classification system that evolved over the years from its humble beginnings in the second half of the 19th century. It was little known around the world until 1898 when the American Public Health Association (APHA) recommended it for adoption in the USA, Canada, and Mexico. Since then International conferences were conducted every ten years in which physicians and medical researchers set together and revised the classification system. With the formation of the World Health Organization in 1948, the responsibility for the revision was given to the new organization.

According to WHO, there are multiple purposes for ICD. It serves as a mechanism for recording, tracking, analyzing, and interpreting health conditions. However, the most appropriate utilization of ICD has come to be in medical billing services in USA. ICD codes are used all over the world and especially in America for coding of various diagnosis and procedures, to bill the payers accordingly.

Although WHO has released its most recent revision of the coding system, the ICD-11, the version under implementation in most countries around the world is the ICD-10. ICD-10 was initially released by WHO in 1992, however, it was not readily implemented in the United States. Due to resistance from the healthcare industry and complicated regulatory environment, the ICD-10 had to go through a series of iterative amendments, converting it to ICD-10-CM. The version that finally got implemented in the US in 2015 had around 70,000 codes in it. The original ICD-10 only contained 14,400 codes.

Before the implementation of ICD-10-CM, many critics and interest groups proposed that since the next revision was just around the corner, maybe the United States should skip ICD-10 and move directly to ICD-11. However, proponents of ICD-10-CM suggested otherwise, and rightly so.  While ICD-11 is undoubtedly different from ICD-10-CM, it is vastly based on the various modifications made by the American government in ICD-10. Further, it will take at least 5 to 7 years before ICD-11 can be implemented in the United States. Thus it would have been a big mistake not to implement ICD-10-CM. Let us now look into what’s contained in the latest ICD version.

The Need for ICD-11

The WHO has been working for past 70 years or so (almost without pause) on updating the coding system to cater for the new developments in the medical sciences, and for the discovery of newer diseases. The revisions so far have been made every decade, but the pace of medical advancements has grown like never before.  Currently, almost the same number of discoveries is being made in a year or less that used to take ten years or so in the earlier part of the last century. Thus a decennial update of the coding system is no longer suitable. The newest version of the ICD-11 will be updated on a continual basis and will be consistently available online. It also means that there will no need for a complete revamping of ICD-11 to bring forth ICD-12. ICD-11 will continuously stay up-to-date.

Significant Changes that Come with ICD-11

To deal with the requirements of the current century, WHO has brought some significant changes to the coding system. Here are the critical differences between them:

  • ICD-11 is entirely online and comes with an ICD-11 browser, making navigation through the various chapters and various sections much easier.
  • ICD-11 also has a coding tool to help medical billers and coders easily find the most up-to-date codes for various conditions. The coding tool is not only flexible on spelling and also provides related and synonymous terms.
  • To ensure interoperability between internal and external databases, WHO has now incorporated the SNOMED CT terminologies into ICD, by linking them together. Thus the new ICD version is EHR ready. A mapping tool for linking ICD-11 and SNOMED CT is also released.
  • Multilanguage translation support covers not only English but also five other languages including Chines, Russian, Spanish, French and Arabic.

A Detailed Look into ICD-11

The ICD-11 has got significant differences from the previous version. For one, the number of diagnostic codes in ICD-11 is about 55,000, almost four times greater than ICD-10. Furthermore, each entry contains descriptions and definitions that were not present in the previous version. Codes contain four characters before the hyphen instead of three. After the hyphen, there may be up to 4 characters, but not necessarily.

ICD-11 is organized in chapters, and the chapter numbers are changed from the Roman to Arabic numerals. The terms are mapped together through a semantic network around mortality, morbidity, primary care, research, and public health.  Many of the chapters are the same as in the ICD-10, only more codes have been added for newly discovered conditions. These include chapter 1, 2, 8, 10, 11, 12, 13, 15, 16, 18, and 19 according to the ICD-11 chapter numbering. Some chapters were renamed slightly, while additions were made to their codes as well. These include chapter 6, 9, 14, 20, and 21.

Interestingly, chapter 6 contains codes for various gaming disorders as well, to recognize the excessive indulgence in gaming as a behavioral disorder. The chapter III in ICD-10 for the diseases of the blood and the immune system has been divided into two chapters. There are three new chapters – Chapter 7 for sleep-wake disorders; chapter 17 for disorders related to sexual health; and chapter 26 for traditional medicine like the Homeopathic, Chinese, Japanese, Ayurvedic medicine, etc. ICD-11 also contains two additional sections, Section V for functioning assessment and the section X for extension codes.

Implementation of ICD-11 in the USA

As mentioned earlier, the transition from ICD-9 to ICD-10 went through years of delays before being finally implemented in 2015. The delays were the result of many to-and-fro movements of proposed documents between CMS, Washington, and the healthcare industry. Some commentators are expecting similar delays in the ICD 11. However, we believe that the implementation won’t be as difficult this time around. Firstly, ICD-10 codified about five times the diagnostics codes (from 14,000 to 70,000), and about 18 times as many procedure codes as ICD-9 (over 70,000 codes up from about 4,000). ICD-11 already contains 55,000 codes, so the new modification will not be as massive as previously. Secondly, formerly a considerable number of practices had to transition from the paper-based system to a digital system. It is not a major issue this time. And lastly, the industry has learned a lot from its mistakes in the past two decades, and there is a broader acceptance of the need for IT in healthcare.

In light of the above, we expect the following timeline for the ICD-11 implementation:

  • Release by WHO: 2018 (already done)
  • Evaluation by CMS: by 2019
  • Hearings by the National Committee on Vital Health Statistics: by 2022
  • Notice of proposed rulemaking: by 2022
  • Final Rule (2023)
  • Interim Final Rule (?)

What Does It Mean for Medical Billing and Coding?

Modification and implementation of the ICD-11 in the United States are expected to be a gigantic task, as it will involve people with expertise in ICD-10, SNOMED-CT, and system design. Furthermore, medical coding professionals have just started to become accustomed to the ICD-10 codes. They fear they will have to unlearn once again what they learned with huge difficulty and learn the newer codes. Their anxiety may be justified to some extent; however, with the new tools available to the coders and ICD-11 being EHR friendly, memorizing codes is not that much a necessity anymore. Besides, there is still time for the actual implementation. By the time it comes into play, coders will be better prepared for the new system.

As for healthcare practices and hospitals, it is essential for them to make preparations in advance. Yes, the final implementation is not yet clear, they don’t want the same panic as was the case with ICD-10 implementation. I good starting point may be consulting a professional medical billing services provider like P3 Healthcare Solutions. P3Care has years of experience in handling medical billing for numerous practices and hospitals all over the United States. “We are highly capable of advising on implementation, training, and infrastructure requirements for the new system,” says one company official. Get in touch with one of their experts at 1-844-557-3227 or email us them all your questions at