What is ICD-11? An Overview

Our "what is ICD-11" discussion would not be complete without examining the purpose of this update. The WHO and its decision-making body, the World Health Assembly, realized that despite the updating process, ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) was clinically and technologically outdated and missing content for several de facto uses of ICD, like primary care or clinical decisions. To bring the system into the 21st century, structural changes were needed, as well as the need to operate in today’s environment of electronic medical records and capture more information for morbidity use cases.

According to the U.S. Centers for Disease Control and Prevention, the goals of this 11^th ICD revision also included ensuring that ICD-11 will be a digital product, functioning in an electronic health records environment and linking with terminologies like SNOMED (Standardized Nomenclature of Medicine).

Simply stated, the classification system has undergone a major makeover. It is now structured as a database that can include more than a dozen dimensions, with changes that range from making it more IT-friendly and better able to better support data collection on morbidity, to lowering cost. There’s also been a name change. Its full name is ICD-11 for Mortality and Morbidity Statistics, or ICD-11-MMS. Several changes have been made to the mental health disorders that are listed, including some that may be considered long overdue in the eyes of clinicians.

A partial list of additions and modifications includes:

What is ICD-11 in relation to the previous revision? According to AAPC, ICD-11 is a game-changer for the healthcare industry because it recognizes several common diagnoses that were overlooked in ICD-10. The addition of more than 40,000 new codes makes it a more complex system, but its advantages are many:

Here's what the adoption of ICD-11 means for medical coders and billers:

ICD-11 has added a significant number of diagnoses, increasing from 14,000 to more than 55,000 unique codes. The addition recognizes conditions not included in ICD-10, so medical coders and billers can become more granular and accurate in their submissions.

The new ICD-11 contains 26 chapters, 5 more than ICD-10. New sections cover diseases of the blood or blood-forming organs, disorders of the immune system, sleep-wake disorders, conditions related to sexual health and traditional medicine.

While some of the content is new, others were developed from existing chapters. For instance, many conditions in the sexual health chapter were previously classified under different categories. This means medical coders will need to take care to ensure that they're using the correct codes even for conditions they're familiar with.

Medical codes will have 4 characters before the decimal point, instead of 3 like in ICD-10 and may contain up to 3 characters after the decimal point. The second position is always a letter, and additional codes add specificity to the base code (e.g., associated conditions). ICD-11 codes also exclude the letters "O" and "I" to avoid confusion with the numbers "1" and "0".

Medical coders and billers who work with specialty groups had to add a lot of codes to ICD-10. The new classification system in ICD-11 allows them to build codes that can accurately describe the conditions patients are being treated for, even if they still need to select an “unspecified” code.

Meanwhile, the alphanumeric coding structure allows more flexibility in diagnostic groupings. They are also updated to become more consistent with scientific evidence and align with clinical practice needs.

ICD-11 enables healthcare organizations to streamline processes and increase operational efficiencies with the latest technologies. Instead of a static publication, it's built as a database and accessed as a web platform to support the use of electronic health records (EHRs). 

As such, it has the flexibility to grow and change as new scientific and medical discoveries emerge. The online content will evolve from the same basic structure so medical coders and billers won't have to adapt to yet another new version as the information is updated.

The ICD-11 platform also includes a robust search feature. For example, physicians can look up diagnoses using natural or preferred terminology. The system will then automatically match it with the correct technical code. This helps streamline workflows while increasing the accuracy of the coding process.

ICD-11 is designed to support interoperability. Healthcare organizations can use API to integrate the new database with their systems and software seamlessly. You can also link the digitized platform with various medical libraries to enhance its functionality.

Since ICD-11 will connect with most EHR systems through the Systematic Nomenclature of Medicine and Clinical Terms (SNOMED CT) Foundation, it will create changes in the coding system for most healthcare organizations.

To support the use of various e-health technologies, ICD-11 comes with many digital tools to help facilitate the medical coding and billing process. For instance, the implementation package includes a coding tool, reference guide, browser tool and transition tables.

The launch of ICD-11 introduced a completely revised structure for the classification of mental and behavioral disorders. The following examples are representative of these updates.

Gaming Disorder (GD) is defined in ICD-11 as a pattern of gaming behavior (digital or video-gaming) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities and the continuation or escalation of gaming despite the occurrence of negative consequences.

The inclusion of GD in ICD-11, while highly debated, was based on reviews of available evidence and the need to standardize the disorder to make prevention and treatment measures readily available.

The established codes for GD are:

Complex post-traumatic stress disorder, or Complex PTSD, is defined as a disorder that may develop following exposure to prolonged or repetitive events of a particularly threatening or horrific nature. This may include things like prolonged domestic violence or repeated childhood abuse. The symptoms of complex PTSD cause substantial impairment in personal, family, social, occupational or other important areas of functioning and include significant and ongoing:

Prolonged Grief Disorder (PGD) is a condition in which, following the death of a person close to the bereaved, such as a spouse, partner, parent or child, there is a persistent and pervasive grief response. This response is characterized by longing for the deceased or a preoccupation with the deceased accompanied by intense emotional pain. Examples of this emotional pain include sadness, guilt, anger, denial, difficulty accepting death and feeling that one has lost a part of one’s self.

The grief response in cases of PGD persists for an atypically long period of time following the loss (more than 6 months at a minimum) and exceeds what is considered a normative period of grieving, taking into account the person’s cultural and religious context. The disorder causes significant impairment in the bereaved individual’s personal, family, social, occupational or other important areas of functioning.

The established code for PGD is 6B42.

Medical coding and health information management (HIM) professionals must take the time to become familiar with the new ICD-11 concepts and prepare for the transition thanks to the large number of diagnoses added to this edition, along with the new coding system. While the expanded features of ICD-11 will ultimately give medical coders and billers more advanced tools with which to do their jobs, they will need training to learn how to use them accurately.

Here are a few ways healthcare organizations can proactively support their staff:

While the ICD and the Diagnostic and Statistical Manual of Mental Disorders (DSM) are both authoritative guidebooks for medical and mental health professionals and share some similarities, there are substantial differences between them. The primary difference is that the ICD is much broader in its scope and authorship. Here’s a breakdown: