ICD-11 Preview: Worth the Wait?


On April 1 of 2014, the President of the United States signed a law which included a few short lines about a delay to the ICD-10 implementation date. For auditors, providers, and payers who have worked hard to be ready, this raised a number of new questions. Whose idea was this? How should we prepare now? Will the new implementation date be one year later or some other time? Will private payers implement sooner than Medicare? Or, is it possible that CMS will give up entirely on ICD-10, and just wait for ICD-11?

Why not just wait for ICD-11?
The American Medical Association has repeatedly pushed for this last scenario, citing statistics that show that it will cost too much time and money for providers to make the transition. After all, the World Health Organization has said that ICD-11 will be ready by 2017, which is just around the corner. It builds upon the structure of ICD-10, which means that the appearance of the codes won't be too foreign to those who are well versed in ICD-10. However, ICD-11 incorporates medical findings and data that have been discovered since the release of ICD-10 way back in the early 90s. The beta version of ICD-11 is already available. In fact, the WHO has asked experts to register to provide input until it is released to the public. Unlike ICD-10, it is web-based, so that it can be updated instantaneously.

This is a major improvement over ICD-9 and 10. This will also facilitate smoother searching of the code set. ICD-10 was released in English, but ICD-11 has already been translated into 43 languages. All of this, combined with the fact that this electronic format is EHR (electronic health record) ready, seems to imply that the jump might just be a good idea.

The United States stands alone amongst developed nations as it clings to the legacy of ICD-9. Expense and bother are the biggest reasons for the foot-dragging. But, just as our nation finally approaches the (ever changing) ICD-10 finish line, ICD-11 is approaching the starting gate. Why not just wait a few more years and make the jump in a single step?

There are several reasons:

  1. Like ICD-10, ICD-11 is alphanumeric. This structure change has been costly and difficult enough from ICD-9 to ICD-10. A later upgrade to ICD-11 may be easier for computer systems to handle.
  2. ICD-9 is too old to accommodate research and the advancement of science. Without ICD-10, we could use something called the United States Disease-Entity Coding System (USDECS). But this would result in a duplication of effort with ICD-11 implementation and a lack on comparability with international data.
  3. Even though the beta phase should be complete in the next few years, the final move to ICD-10-CM (that is the Clinical Modification used in healthcare settings) may take as long as five or six years. There is strong doubt that ICD-9 can live that long, even with proposed patches such as pruning and re-using obsolete codes.

How is ICD-11 different for preventive and integrative medicine?
TheICD-11 code set may, however, allow providers to report information that was not possible, even with ICD-10. It appears that it will favor the holistic healer, especially CAM (complementary and alternative medicine) providers. ICD-11 will be more integrative. Currently, ICD focuses on medical interventions when people die. However, in reality, many co-morbidities exist at the end of life and the interventions can include lifestyle and attitude factors. Counselors, nutritionists, educators, and even spiritualists can intervene with these co-morbidities and ICD-11 designers seem to have taken notice.

ICD-11 will also include more non-traditional vocabulary. Western science is not the only approach to health and wellness. Terms such as "prana" and "qi" (life force in yoga and oriental medicine) may be found alongside things like "blood pressure" in the vocabulary of future code sets since they are considered of equal importance in many parts of the world. The holistic view of health and wellness may finally fit into the code set that has overlooked it for so long.

The general trend in ICD-11 appears to be a focus on disease pre-cursors in addition to the traditional morbidity emphasis of ICD-9. ICD-11 also recognizes disease crises and sequelae which have detectable markers. This view of disease as a continuum may include things like a deficiency of vitamin D or calcium which can set the stage for other health issues, allowing for intervention at these early stages. Perhaps this can help providers to recognize and treat pre-cursors before full blown disease develops.

Is ICD-11 worth the wait?
Just as we don't need to set the clock on our cell phones, ICD-11 will be able to update automatically. Since it is web-based, information can be added to the code set instantaneously. If a researcher discovers a better way to classify a disease, or learns of a natural solution to some long-debated chronic disorder, this data can be included right away. ICD-11 will be like a wiki-page, where experts can make contributions and edits as information becomes available. This data may be integrated into patient care right away since ICD-11 has been built to fit right into EHR systems. Everyone will have the same, current codes.

Regardless, it is too soon to make the jump. It would be a bit like riding a bullet bike motorcycle (ICD-11) when we are just figuring out how to handle a moped (ICD-10). ICD-9 is just a bicycle, and we have mastered it. Indeed, the bicycle can get us from point A to point B, but other methods of transportation are more effective. Perhaps the ICD-11 move can be made as soon as 2020, but for now, ICD-10 gives us plenty to worry about. Until then, payers, consultants, and providers should watch and wait.

ICD-11 FAQ at WHO, http://www.who.int/classifications/icd/revision/icd11faq/en/index.html
Chirocode Complete & Easy ICD-10 Coding For Chiropractic, Second Edition, 2013

Dr. Gwilliam is an MBA, physician, and AAPC certified ICD-10 instructor. He is also a Certified Professional Coder, Medical Compliance Specialist, and a Certified Professional Medical Auditor. He speaks on compliance and coding topics all over the country as the Director of Education for FindACode. He can be reached at DrG@FindACode.com.