Another Revision Is on the Way?
It seems like only yesterday that the ICD-10 (International Classification of Diseases, Tenth Revision) was the new coding kid on the block. Sometime after 2022, however, ICD-10 will be shelved and swapped out for ICD-11.
Before you shake your fist and shout “Not again!” let’s look at why the World Health Organization (WHO) – which created this system of medical coding for documenting diagnoses, diseases, signs and symptoms, and disease patterns – feels this new revision is necessary.
According to the US Centers for Disease Control and Prevention (CDC), ICD-11 – following on the heels of ICD-10, which was released in the United States in 2015 – contains updates to some key clinical elements and allows the coding process to integrate more smoothly with new electronic records technology. These revisions, the CDC says, should allow for better interoperability and coding consistency across different platforms. In 2017, the WHO field-tested the revisions in 31 countries, with a total of 1673 participants running more than 112,000 codes.
For most physicians, both here and abroad, avoiding ICD-11 will be nearly impossible. According to the WHO, ICD codes are tied to payment for roughly 70% of the world’s healthcare expenditures. More than 100 countries already use this health-information standard.
Although ICD-11 is expected to be finalized this year, full implementation is likely to take longer. Here’s what the American Medical Association had to say in an email to Medscape:
There is a long way to go before the World Health Organization finalizes the eleventh edition of the ICD code set. With actual implementation still several years away, now is the time for US physicians to work with their national medical specialty societies and the National Center for Health Statistics at the CDC to shape how ICD-11-CM is developed for the US healthcare system.
To provide a more complete picture of what ICD-11 is likely to mean to you, Medscape Business of Medicine spoke with nationally recognized coding educator and independent consultant Margaret Skurka, who was on the WHO committee in charge of mapping out the revisions.
Changes in ICD-11. ICD-11 has a new chapter on traditional medicine and secual health, among several other additions. Video game addiction is a new code, for example, in the mental disorders section. There are other updates, of course—too numerous to go into detail here. Let’s just say the WHO’s goal was to simplify the coding structure and make it easier to capture correct and consistent data.
There is also a chapter on codes for special purposes, and a supplementary section for functioning assessment. ICD-11 can be viewed now on the WHO website. The United States must begin to address the type of pelatihan that will be needed for ICD-11, with the realization that it is in an electronic format.
Didn’t we just go to ICD-10 in 2015? Yes, we did. But the WHO’s process to implement ICD-10 began way back in 1992. It took the United States 23 years to adopt it; we finally did so in 2015. We were the last country in the world to move to ICD-10. If we follow that same pattern of being the last country to adopt, we won’t have ICD-11 until 2041.
We can’t allow that to happen. Good data are too important. The purpose of ICD and the WHO sponsorship is, in the CDC’s words, to “promote international comparability in the collection, processing, classification, and presentation of mortality statistics.” Revisions to the ICD are implemented periodically so that the classification more accurately reflects current advances in medical science. We need to be on the same system as the rest of the world for data comparability.
This is confusing. How did this come about? The WHO controls the ICD and has done so since 1948. The United States is required to use the ICD for classification of diseases and injuries under an agreement with the WHO. ICD is also used for death certificate reporting in all countries. This permits global data collection on underlying causes of death. In developing this edition of ICD, the WHO has stated that it received and reviewed over 10,000 proposals for revision. It’s promising that ICD-11 will be the best and most comprehensive version of ICD in history.
In the United States, we currently use the ICD-10-CM (ie, clinical modification) for diagnoses and the ICD-10-PCS (ie, procedure coding system) for inpatient procedure coding. Those codes lead us to the diagnosis-related group and, hence, hospital reimbursement for services rendered.
On the physician side, all practices are required to code diagnoses in ICD-10-CM and all procedures in Current Procedural Terminology (CPT) in order to get paid. Each CPT code has a relative value unit that helps determine the reimbursement for the service. Coding in the United States is done for every health encounter at every level of healthcare.
Is there a difference between ICD and ICD-10-CM? Yes. ICD is the foundational code system used worldwide to code injuries, diseases, and causes of death. Countries can adapt the basic system for their own needs. The United States does that and calls it “CM”—clinical modification. We can add codes to the base system (and we did so like crazy in the “External Causes of Injury” section of ICD-10), but we can’t delete them. Therefore, we call our current system “ICD-10-CM” (International Classification of Diseases, Tenth Revision, Clinical Modification). Our friends in Canada did their modifications and call their system “ICD-10-CA.” Our colleagues in Australia did the same thing, and theirs is “ICD-10-AU.”
What’s the current status of ICD-11? The WHO released ICD-11 in Geneva, Switzerland, on June 18, 2018. This latest revision, which has been in the works for over 10 years, has approximately 55,000 unique codes for injuries, diseases, and causes of death. The WHO has promised significant improvements over ICD-10. For the first time, it’s completely electronic. The WHO also says that ICD-11 is much more user-friendly.
There are more chapters in ICD-11 than in ICD-10. The codes will look different, too: There will be four characters before the decimal point, rather than three. For example, the new code for an unspecified type of diabetes mellitus will be 5A14.
ICD already has been translated into 43 languages. Now, 117 countries of the world use the system to report mortality data.
What’s the timeline for US physicians? ICD-11 will be presented for adoption at the World Health Assembly in May 2019 and will become effective in 2022. Countries are encouraged to preview this advance release so that efforts can begin to prepare translations, if needed, and train healthcare professionals—including physicians and coders—in the newest version. ICD already has been translated into 43 languages, and 117 countries use the system to report mortality data.
It’s early in the game, and ICD-11 implementation in the United States is several years away. What every physician should be doing now is documenting diagnoses and procedures in language that is as specific as possible, to capture the best and most detailed code in ICD-10-CM. Those good habits will carry over to ICD-11.
For example, your documentation should always specify the type of congestive heart failure the patient has (acute, chronic, or acute on chronic). Detailed codes capture all that specificity. Similarly, document the responsible organism on pneumonia cases. For anemia, list the etiology, if known. It’s important to also specify the type of diabetes: 1 or 2. If you don’t, ICD-10-CM defaults to type 2. With chronic obstructive pulmonary disease, add “acute exacerbation” if that’s being treated, or documentation of acute respiratory failure if that applies. You get the idea. The bottom line is that detail affects revenue!
Indicate whether the patient is obese and additionally specify that it is morbid obesity, if that applies. The coder can then also add the body mass index (BMI)-specific code to show the level of obesity. The coder knows that the patient is morbidly obese if the BMI is > 40 kg/m2 but, as nonclinicians, cannot add the words “morbid obesity.” That’s the physicians’ responsibility.
Much detail on sepsis is needed on a regular basis. Coders are looking for criteria that indicate systemic inflammatory response syndrome, severe sepsis, septic shock, or septicemia. Payers examine this carefully to make certain it is not bacteremia or something else. Coders look for hypertension versus hypertensive heart disease documentation. Coders want to capture any tobacco use, or history of tobacco use. The stages of chronic kidney disease are important also. Physicians need to know that the coder is hanging on every word to try and capture the best and most specific diagnoses for the case.
It’s simple: Quality data have the power to promote better healthcare within the United States and worldwide. It is also a must for correct reimbursement.
Which leads me to my last point: Try to enjoy learning about ICD-11 in the upcoming years. Despite some of the annoyance you may feel at having to learn about a new ICD system, it’s not a beast, but an advanced, updated, and comprehensive coding system that we’ll use through the next generation of healthcare.
Want to learn more about ICD-11? Check out the WHO’s ICD website, which includes a reference guide, introductory video, and coding tool, among other helpful links.
*Source: Margaret Skurka | Medscape – Jul 31, 2018
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