ICD-10 ushered in a new era of diagnostic coding. The transition to from ICD-9 codes to the ICD-10 codes took place on October 1, 2015. ICD-10 is the tenth edition of the International Classification of Diseases and allows for a greater level of specificity with detailed classifications of patients’ conditions, injuries, and diseases. ICD-10 codes allow medical billing and coding companies to report anatomic sites, etiologies, and comorbidities and complications. As ICD-10 codes are very granular, they improve the physician’s ability to demonstrate severity of illness.
The medical industry is now gearing up for a new official reporting system – ICD-11. Officially released on June 18, 2018, ICD-11 will replace ICD-10 beginning January 1, 2022. Implementation in the U.S. may take longer but it’s time to take a look at how ICD-10 changed medical coding, whether it made things more complicated, and what differences ICD-11 will bring.
There is no doubt that ICD-10 offers higher quality data for assessing service quality, outcomes, safety, and efficiency.
- Higher level of granularity: With ICD-10, there was a four-fold increase in the number of available codes over the ICD-9 version. The number of ICD-10 codes stood at 72,616 in FY 2021. This indicates the scale of detail available to denote real-world clinical practice and medical technology advances.
- Increased specificity: With increased specificity for screening encounters, ICD-10 supports enhanced study of utilization and health system effects. When physician documentation indicates the most specific clinical diagnosis, medical coding service providers can assign highly specific diagnosis codes that align with the documentation.
- Laterality: One of the most distinct features of ICD-10 codes is laterality. There are specific codes that can be used to signify laterality and distinguish right, left, and bilateral. This is important for pain management billing and coding.
- Extensions to identify encounter type: For injuries, ICD-10 offers an expanded category with a seventh character extension to identify the encounter type: “A” for the initial encounter, “D” for the subsequent encounter for fracture with routine healing, “G” for subsequent encounter for fracture with delayed healing, and “S” for sequela of fracture.
- Other Specified and Unspecified: There may be an “other specified” or “other” code and an “unspecified” code within a category of codes. An “other” code denotes there are codes for some diagnoses, but there is no one specific for the patient’s condition. An “unspecified” code indicates that the condition is unknown at the time of coding. If more information is obtained about the patient’s condition at a later time, an “unspecified” diagnosis can be assigned a specific code.
ICD-10: Predictions that failed to Materialize
While it offers all of these features and benefits, it was predicted at the time of implementation that ICD-10 would make things more complicated. An AHIMA article noted that some healthcare industry stakeholders predicted the following:
- Financial disruptions caused by claims denials and more
- Administrative problems
- Adverse impact on coding accuracy
- Burdensome clinical documentation requirements
- Complexity caused by an increased number of codes, such as
- impossible to learn, and difficult to use
- Complications caused by expanded specificity in ICD-10 external cause codes
- Level of detail in ICD-10-CM not supported by the medical community
- increase in the number of miscoded and rejected claims due to code complexity and number
- Medically unnecessary tests would be need to assign ICD-10 codes
- Widespread denials related to “unspecified” ICD-10 codes
- Adverse impact on coding productivity and clinician productivity due to increased documentation requirements
- ICD-10 transition would be expensive, especially for small practices
- There would be major disruptions in operations of healthcare entities
- Delays in ICD-10 transition
- ICD-10 would not be implemented
The AHIMA article notes that most these dire predictions failed to materialize and that most of the healthcare industry transition to ICD-10 implementation smoothly:
- ICD-10 included new concepts that provide a better understanding of severity, risk, comorbidities, causation, and other important parameters related to proper healthcare assessment and treatment.
- Clinical documentation improvement efforts and EHR documentation tools eased documentation capture.
- A 2016 study from the AHIMA Foundation reported only a 0.65% decline in coding accuracy following ICD-10 implementation. Training on ICD-10 actually improved coding accuracy to a higher level than before ICD-10.
As with any major transition, there were some problems but these have been minor or limited in nature, resolved quickly, and have not caused widespread disruption. Also, some reported issues were related to EHR design and functionality problems, and not ICD-10. Healthcare providers could overcome claims submission challenges by outsourcing medical billing and coding. Certified medical coders who are well-trained in their field communicate with providers to clarify clinical documentation to assign the most accurate ICD-10 and CPT codes on a claim. Now, it’s time for ICD-11 and medical billing and coding companies are well into the learning process.
ICD-11: Changes and Improvements
The International Classification of Disease, Eleventh Revision (ICD-11) comprises codes for documenting diagnoses, diseases, signs and symptoms and social circumstances. ICD-11 builds upon its predecessor and offers improvements that are intended to address gaps in the ICD-10.
Key changes include:
- ICD-11 will be entirely electronic and easy to install. The coding system has been reconstructed to adapt ICD to digital use.
- ICD-11 has around 55,000 unique codes for classifying diseases, disorders, injuries, and causes of death in greater detail as well as several new chapters.
- It incorporates medical updates, discoveries, or changes in thinking
- Revisions have been made to categorization and coding structure, international usage, and user-friendliness
- Introduction of cluster coding supports more comprehensive alphanumeric coding of complex clinical situations
- Updating of the chapter on mental disorders has been done to account for new information on mental disorders. Each mental, behavioral, and neuro developmental disorder listed includes a description with guidance on meaning that can be accessed on the site.
- Added diagnosis include attention deficit disorder, complex PTSD, compulsive sexual behavior, gaming disorder and prolonged grief disorder.
- The revised system offers a common coding language for use globally, including guidance for use with different cultures and translations into 43 languages.
- The dimensional approach of the new system makes it better at capturing change over time.
When implemented, ICD-11 will involve significant changes over ICD-10. The number and specificity of the new code set will be a game changer for coding and patient care, according to experts (fortherecordmag,com). Healthcare organizations can make the transition to ICD-11 easier and less stressful by reaching out to experts. In medical billing and coding companies, teams have started efforts to get familiar with the underlying structure and organization of the ICD-11 code set, and understand the new concepts and how to classify diagnosis.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.