The World Health Organization (WHO) recently released the 11th edition of the International Classification of Diseases (ICD-11). This release was presented at the World Health Assembly on May 25, 2019 for adoption by member states, and will come into effect on January 1, 2022. However, before we all go into panic mode, note that it is still unknown when ICD-11 will be ready for implementation in the United States. But, it is not too early to review where we’ve been and overview what’s in store for the future!
Background review on ICD revisions
The table below displays the various revisions of ICD timelines. It is important to note that ICD-10 was adopted by the WHO and the World Health Assembly in 1989. But, ICD-10-CM was not fully implemented in the United States until 2015.
Why did the WHO move on from ICD-10?
Unfortunately, despite the updating process, ICD-10 is clinically outdated, and structural changes were needed in some chapters. There is also an increasing need to operate in an electronic environment, as well as the need to capture more information for morbidity-use cases. ICD is the international standard for systematic recording, reporting, analysis, interpretation, and comparison of mortality and morbidity data. According to the WHO, the 11th revision is the result of a collaboration with clinicians, statisticians, epidemiologists, coders, classification, and IT experts from around the world. ICD-11 is a scientifically rigorous product that accurately reflects contemporary health and medical practice, and represents a significant upgrade from earlier revisions.
The WHO ICD-11 revision goals included to:
1. Ensure that ICD-11 will function in an electronic environment by:
• Presenting a digital product
• Providing linkage with terminologies (e.g., SNOMED)
• Defining ICD Categories by “logical operational rules” on their associations and details
• Supporting electronic health records & information systems
2. Provide a multi-purpose and coherent classification for:
• Mortality, morbidity, primary care, clinical care, research, public health
• Consistency & interoperability across different uses
3. Deliver an international, multilingual reference standard for scientific comparability:
• English, French, Spanish, Russian, Chinese, Arabic
Basic Code Structure of ICD-11
The diagnostic codes of ICD-11 are alphanumeric and cover the range from 1A00.00 to ZZ9Z.ZZ. The coding scheme always has a letter in the second position to differentiate from the codes of ICD-10. Chapters are indicated by the first character. For example, 1A00 is a code in Chapter 1, and BA00 is a code in Chapter 11.
ICD-11 has an explicit way of marking codes that are post coordinated to describe one condition, called cluster coding. This is a notable new feature in ICD-11 that creates an ability to link core diagnostic concepts (i.e. stem code concepts) when desired, and/or to add clinical concepts captured in extension codes to primary stem code concepts. Either way, it should be emphasized that the clustering ability inherent to ICD-11 is one of the significant changes relative to ICD-10. And the WHO is indicating that there may not be a need for an ICD-12 version, as ICD-11 is comprehensive and very expandable.
In addition, for the first time, ICD-11 will be fully electronic, providing access to 17,000 diagnostic categories, with over 100,000 medical diagnostic index terms. The index-based search algorithm interprets more than 1.6 million terms. Per the WHO, ICD-11 is easy to install and use online or offline, using free “container” software.
Implementation in the U.S.
There is no definite ICD-11 implementation timeline established yet. However, the National Center for Vital and Health Statistics (NCVHS) notes that there are numerous steps needed to move towards ICD-11 implementation including:
• Evaluation of ICD-11 for U.S. purposes (2018 – 2021? 2022?)
• NCVHS Hearings (2021-2027?)
• Notice of Proposed Rulemaking (NPRM) from HHS published in the Federal Register (? date unknown)
• Final Rule published in the Federal Register (? Date unknown)
It is also very important to note that ICD-11 is only for diagnoses. ICD-10-PCS is completely separate from ICD-10 and will not be updated with the transition of ICD-10 to ICD-11. ICD-10-PCS is not a WHO-developed or maintained vocabulary. ICD-10-PCS is a procedure classification system designed by CMS for coding hospital-based procedures. This development was undertaken, because the WHO retired its procedure coding system with the 10th revision of ICD. The ICD rubric was attached to the new U.S. system. Updates to the U.S. procedure classification system do not need to be tied to updates to ICD and vice versa.
While we wait for the 2022 implementation of the 11th edition, read up on the 2020 ICD-10-PCS Guideline Changes for Coding and Reporting.
YES HIM Consulting, Inc. will keep up-to-date on any and all changes to the implementation dates. In the meantime, if you wish to review the online ICD-11 coding tool, please refer to: