The implementation of the new International Classification of Diseases 11th Revision for Mortality and Morbidity Statistics (ICD-11-MMS) system is coming in the next few years. This author provides a guide to conversion to the new system, which will include new chapters and simplified codes.
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In May of this year, the World Health Assembly (WHA) received the final submission of the International Classification of Diseases 11th Revision for Mortality and Morbidity Statistics (ICD-11-MMS). While there is much work to be done before the new ICD-11 can be implemented in the United States, it is still important to address updates regarding the impending implementation of the updated diagnosis coding system. Many readers have been asking us for an update on what is happening regarding when and how the U.S. will be implementing the new diagnosis coding system.
Why is another version of the International Classification of Disease needed? In the simplest terms, it is outdated. In 1989, WHA approved the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM or ICD-10), making the system 30 years old as of this year. The clinical modification of ICD-10 was finally implemented for morbidity coding in the U.S. in 2015. Although the U.S. had only implemented the system in 2015, ICD-10 is considered to be outdated from both a clinical and classification perspective.
Due to the advancements in medicine and science since ICD-10’s enaction, a decision was made by the World Health Organization in 2007 to begin work on ICD-11; the substantial structural changes needed in some of the chapters cannot be handled through the normal system update mechanism.
There are many classifications that are related to and derived from ICD-11. Some of the revision goals are to ensure that ICD-11 can function in the digital environment, support electronic record systems, and link with multiple terminologies (e.g., Systematized Nomenclature of Medicine or SNOMED) and other classifications, such as the International Classification of Primary Care; International Classification of Functioning, Disability and Health; and International Classification of Diseases for Oncology.
Another goal is to have consistency and interoperability across different areas such as mortality, morbidity, primary care, research, public health, etc.
The revision process for ICD-11 is the largest ever revision enterprise for ICD, consisting of more than 10,000 proposals. More than 90 countries were involved in the production, review, testing and commenting phases. Hundreds of scientist and clinicians have participated in the process and there are 30 Topic Advisory Groups and Working Groups.
A Closer Look at ICD-11-MMS
What is new in ICD-11? There are 27 chapters total. New chapters include Disorders of the Immune System, Diseases of Blood and Blood Forming Organs, Conditions Related to Sexual Health, Sleep-Wake Disorders, Traditional Medicine, and Extension Codes. The tools for the system include new coding, browsing, translation, mapping, and proposal tools.
In brief, some of the major differences between ICD-10 and ICD-11 are:
• The codes will look different with a simplified code structure.
Extension codes will be used to add on severity, dimensions of injury and external causes.
Clusters of codes will be used, meaning that combining 2 or more codes will describe a diagnostic entity.
• Some diseases have changed location in the system. For example, some cerebrovascular diseases were moved from the circulatory to the nervous system.
• Full functionality of the system will be available in the software of choice, and outputs can be in multiple formats. There will also be a print version of the system.
The ICD-11 implementation packages will consist of:
• Advocacy materials
• Training materials
• Quick guides
• Mappings from and to ICD-10
• Training and test platform
• Reference guides
• Translation tools
These tools will be available in multiple formats.
What Is the Timeline for Implementation?
The final submission to the World Health Assembly occurred in May of this year. The earliest possible implementation date for ICD-11-MMS is Jan. 1, 2022.
When will the U.S. implement ICD-11 for Mortality? Of note, it took 7 years to implement ICD-10 from the publication of the tabular list. Assuming the resources for both personnel and changes to the information technology systems are available, it is believed the U.S. will not implement any earlier than 2023. The process for Morbidity will take a while. As with the implementation of ICD-10, it will need a Notice of Proposed Rule Making and a Final Rule mandating the use of ICD-11 by a certain date.
Today’s Wound Clinic will publish periodic updates on the progress of ICD-11 as new information becomes available. Stay tuned.
Donna Cartwright is Senior Director of Health Policy and Reimbursement for Integra LifeSciences Corp., Plainsboro, NJ. She is an approved trainer on ICD-10-CM and ICD-10-PCS by the American Health Information Management Association and has been designated as a fellow of the American Health Information Management Association.
1. Centers for Medicare and Medicaid Services. ICD-10 Coordination and Maintenance Committee Meeting Materials. September 11, 2018. Available at https://tinyurl.com/y5qvd4ac
2. World Health Organization. ICD-11. Available at https://icd.who.int/.
3. Endicott M. Are you ready for ICD-11? AHIMA Codewrite. Available at https://tinyurl.com/y3ydctkn . Published March 2019.