How Soon Will the United States Adopt ICD-11?

February 9th, 2022 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT

The World Health Organization (WHO) is responsible for the creation and maintenance of the International Classification of Diseases (ICD). As of January 1, 2022, ICD-11 or the 11th edition of ICD became effective worldwide, but as of yet has hardly been spoken about in the United states.

“The ICD is a classification system developed by the World Health Organization (WHO) to serve as the foundation for identifying health trends and statistics worldwide and is the international standard for reporting mortality, morbidity and other conditions affecting health.”

Coussoule, Nick. Message to the Honorable Xavier Bacerra, Wash DC, 10 Sept 2021, Letter.

The WHO published ICD-10 in 1992 and made it available to the world. Each country has the option to either adopt the code set as is or customize it to meet the individual needs of their country’s healthcare reporting system. ICD-10 codes are used across the globe for reporting mortality, morbidity and other conditions affecting an individual’s health; however, in the United States, it is customized through the process of clinical modifications (hence the CM in ICD-10-CM) to allow it to be tied to reimbursement. Uniquely enough, the United States is the only nation that actually ties healthcare service reimbursements to medical necessity by linking healthcare services to ICD-10-CM diagnosis codes. For this reason, coupled with the complexities of our free economy and legislative process, it took the U.S. from 1992 - 2015 to complete the ICD-10 customization and finally implement ICD-10-CM.

How Soon Will the United States Adopt ICD-11-CM?

Work on ICD-11 was completed in 2019 and approved for implementation on January 1, 2022, which means that all countries have access to and the ability to implement ICD-11 in accordance with their own time-tables. While the United States has yet to determine whether or not or even if the work of customization and implementation readiness will begin, it is being discussed.

In a letter dated September 10, 2021 to Xavier Becerra, Secretary of the Department of Health and Human Services (HHS), Nick Coussoule, Chair of the National Committee on Vital and Health Statistics identified the reasons why the United States should seriously consider adopting ICD-11 and the customization process.

The letter explains that while ICD-11 has been released to the public for implementation on January 1, 2022, the United States, due to the pandemic has failed to meet the research and other recommendations within the usual 12-18 month timeframe and as such there is an immediate need to begin research and strategic communications planning related to ICD-11 adoption with the following two major recommendations:

“The Department’s delayed action has increased the urgency to commence research and strategic communications and outreach. We put these forward now to avert significant avoidable transition cost and burden to the U.S. healthcare system, including public health, like those experienced in the recent transition from ICD-9 to ICD-10. Therefore, we present the following two recommendations:

Recommendation 1: HHS should conduct research to evaluate the impact of different approaches to the transition to and implementation of ICD-11.
Recommendation 2: HHS should conduct outreach and communicate regularly with the U.S. healthcare industry about the ICD transition.”

How IS ICD-11 Different from ICD-10-CM?

To be ahead of the game and allow subscribers the option to review and play with ICD-11 before implementation, Find-A-Code has uploaded the diagnostic code set and provided some detailed explanations of the differences between ICD-10-CM and ICD-11 (the WHO’s version), some of which include:

Categories increase from 3 digits to four (e.g., Alzheimer disease: G30 (ICD-10-CM) becomes 8A20 (ICD-11).
First digit of the code always relates to the chapter number: 1 - Z.
All codes in the chapter have the same character in the first position (e.g., 1A00 is a code in Chapter 1, and BA00 is a code in Chapter 11).
Codes always have a letter in the second position to distinguish from the codes of ICD-10.
Letters "O" and "I" are NOT used - 1/l is always the number 1, 0/o is always a zero, "L" is used but only in upper-case and all code letters are shown in upper-case.
Chapters are numbered with Arabic numerals (0-9) instead of Roman (I, II, III, etc.). This is a change for WHO’s from ICD-10 to ICD-11 but the United States made that change for the ICD-10-CM version.
Where ICD-10-CM ends in ‘8’ to indicate ‘other specified’, the letter 'Y' is used in ICD-11.
Where ICD-10-CM ends in ‘9’ to indicate ‘unspecified,’ the letter 'Z' is used in ICD-11.

Note: Although Y and Z are used this way (see above) in most chapters, the letters Y and Z do not represent ‘other’ or ‘unspecified’ concepts in the X (Extension) codes that are added at the end of ICD-11 codes.

To explore the ICD-11 codeset and learn more about it, click HERE and enjoy exploring. For additional information on becoming a Find-A-Code subscriber, click on the question mark (?) in the upper right corner of the screen to speak with a customer support agent.

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