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Posted: Jun 3, 2022

ICD-11 Fast Facts for Skilled Nursing, Home Healthcare, and Hospice

The World Health Organization’s (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD) is a globally-recognized diagnostic tool for epidemiology, health management, and clinical purposes. ICD provides a systematic approach to coding, reporting, analysis, interpretation, and comparison of mortality and morbidity data.

As of January of this year, the WHO began accepting codes for the 11th revision of the ICD, or ICD-11. This updated version helps address gaps in ICD-10 and incorporates updates that have become standard practice in modern-day healthcare. 

As with ICD-10, ICD-11 will impact medical coding and billing in all specialties. There will be added complexities for some, while others will find consolidated operational enhancements.

Let’s begin by breaking down the purpose of ICD-11, the key differences from ICD-10, and when ICD-11 will be released in the U.S. 

Why Did The WHO Revise ICD-10?

ICD-10 was initially accepted by the WHO in 1989 but was not fully implemented in the U.S. until 2015. Despite several updates, ICD-10 had become clinically outdated, and many of the chapters required structural changes. 

Additionally, ICD-10 presented limitations in enhanced electronic environments and limited information for some morbidity-use cases.

To address the issues with ICD-10, the WHO included the following goals for ICD-11:

1. Ensure ICD-11 functions in an electronic environment by:

  • Providing a digital product
  • Outlining linkage with terminologies such as SNOMED
  • Defining ICD Categories by “logical operational rules” on their associations and details

2. Provide a multi-purpose, coherent classification for mortality, morbidity, primary care, clinical care, research, and public health with consistency and interoperability.

3. Deliver an international, multilingual standard for scientific comparability in English, French, Spanish, Russian, Chinese, and Arabic.

What Are the Differences Between ICD-10 and ICD-11?

According to the WHO, ICD-11 is a scientifically rigorous product representing modern-day health and medical practices. 

What are the differences between ICD-10 and ICD-11? Here are a few of the main differences:

Coding Structure: ICD-11 increases specificity and flexibility with a more sophisticated categorization and coding structure than ICD-10. 

Increased Diagnoses and Conditions: ICD-11 includes more diagnoses and conditions permitting categories of severity, course, and specific symptoms to be added to diagnoses. 

Digital Readiness: ICD-11 was designed to be electronic to help streamline processes and increase operational efficiencies utilizing the latest technologies.

Global Application: ICD-11 offers guidance for different cultures and has been translated into 43 other languages to increase standardization and collaboration internationally.

ICD-11 Basic Code Structure

ICD-11 has added a significant number of diagnoses and chapters so medical billers can become more granular and accurate in their submissions. The ICD-11 diagnostic codes are alphanumeric with a letter in the second position to differentiate them from the ICD-10 codes. In addition, the first character indicates the chapter. For example, 2A00 is a code in Chapter 2. 

One of the most significant updates from ICD-10 to ICD-11 is cluster coding. Cluster coding allows coding professionals to link codes together to fully describe a clinical condition. 

The following example shows the difference for Diabetes mellitus, type II, with left diabetic cataract for ICD-10 and ICD-11. 

ICD-10-CM 2021: E11.36 Type II diabetes mellitus with diabetic cataract

ICD-11: 9B10.21&XK8G/5A11

9B10.21 Diabetic cataract

XK8G Left

5A11 Type 2 diabetes mellitus

When Can The U.S. Expect a Release Date for ICD-11?

Don’t panic yet! Even though ICD-11 took effect on January 1, 2022, the National Committee on Vital Health and Statistics (NCVHS) has not finalized an official rollout timeline for ICD-11 in the U.S. The NCVHS expects that ICD-11 will be released in the U.S. as early as 2025 or delayed to 2027 if a Clinical Modification set is required.

ICD-11 Fast Facts

ICD-11 provides an up-to-date and clinically relevant classification system that results in data that can design effective public health policies, measure policy impacts, or for clinical recording.

The following are 10 ICD-11 Fast Facts

1. ICD-11 includes 17,000 unique codes and more than 120,000 codable terms. 

2. ICD-11 contains 26 chapters, five more than ICD-10

3. ICD-11 is built as a database accessible via a web platform (no more books) to support the use of electronic health records. This allows for the flexibility to grow and change the online content with medical advances. 

4. ICD-11 will create changes in the coding systems for most healthcare organizations because it will connect with various EHRs through the SNOMED CT Foundation.

5. ICD-11 includes a proposal platform that allows users to suggest changes or additions to ICD-11.

6. Codes for patient safety documentation are in line with the WHO patient safety framework.

7. Necessary detail for cancer registration is fully embedded in ICD011.

8. ICD-11 provides more clinically relevant coding for complications of diabetes.

9. In response to the COVID-19 pandemic, emergency codes were added to ICD-11 to confirm the diagnosis of COVID-19, classify post-COVID-19 conditions, establish COVID-19 as the cause of death, and record COVID-19 vaccinations and any adverse reactions.

10. ICD-11 can be used online or offline using free container software. 

How MCA Can Help You Prepare for ICD-11

Our unique combination of highly-skilled billers, long-standing SNF billing experience, and proprietary technology makes MCA a reliable partner for your transition to ICD-11

Drop us a note or call us at 866-609-5880 to learn how MCA can help your skilled nursing, home health, or hospice facility manage the upcoming ICD-11 transition.

About MCA Medical Billing Solutions

MCA is a full-service revenue cycle management company dedicated to helping skilled nursing facilities advance their revenue cycle management. We provide claims creation, submission, and follow-up to Medicare, Medicaid, and all commercial insurers.

When choosing MCA, you can expect experienced business insight, skilled billing intelligence, data extraction and management, and cloud-based documentation. MCA is here to help you streamline your revenue cycle process to produce consistent, high-quality outcomes. 


WHO ICD-11 Fact Sheet

WHO ICD-11 2022 Release Updates

WHO Classification of Disease (ICD)

National Committee on Vital and Health Statistics