ICD-11 — What’s Happening?

April 20th, 2021 - Wyn Staheli, Director of Research

Categories: Coding

That’s not a typo. This article really is about what is happening with the ICD-11 code set which was released by the World Health Organization (WHO) back in May 2019 and is scheduled to go into effect on January 1, 2022. However, before we break out anti-anxiety medication it should be noted that HIPAA regulations require notification through the rulemaking process before any changes are made to the HIPAA-approved diagnosis code set AND at this point, we don’t know if the “powers that be” plan on making any “clinical modification” to what has been released by the WHO. That said, recently there was a meeting by the Education and Implementation Committee so let’s discuss what we do know.

Historically, it has been the “clinical modification” for use within the United States that has contributed to the delay when it comes to implementation of the WHO’s ICD code set. It appears that the WHO has taken note of how the US and other nations have made modifications and have already incorporated some of those modifications into ICD-11, which hopefully will streamline official adoption of it. For example, cancer registries have been using ICD-O-3 for reporting cancer hisotopathology and according to the WHO website, that information is included within ICD-11.

Two interesting new concepts included in ICD-11 are the addition of “extension codes” and “cluster coding.” Extension codes are 4-6 character codes beginning with the letter “X” and represent groups of codes such as anatomy, severity, and substances. They are reported in conjunction with a “stem code” in order to provide additional granularity to the condition(s). Cluster coding is a little different and may include one or more stem code(s) and/or extension code(s). According to the ICD-11 Reference Guide, cluster coding is “an explicit way of marking a cluster of codes that are postcoordinated or jointly used to code one condition.”

Note: For more comprehensive information on ICD-11 including the ability to search, and a section on the differences between ICD-10 and ICD-11 (including examples of cluster coding), click HERE.

It seems like the WHO has already done the work to make this code set more flexible in order to meet the needs of other nations which in turn should translate to less time trying to get it implemented for use within the United States. It sounds like there are those who feel like it should happen sooner rather than later, so it will be interesting to see what happens in the next year or so.

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