What ICD-11 Means for Medical Billing and Coding

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By DeVry University

December 7, 2021
5 min read

The International Classification of Diseases (ICD) was created by the World Health Organization (WHO) as a globally-recognized diagnostic tool for epidemiology, health management and clinical purposes. Currently, U.S. healthcare organizations follow the tenth edition (ICD-10). While WHO will begin accepting codes for ICD-11 starting January 1st, 2022, U.S. organizations have not determined when they will begin transitioning to ICD-11 What will change with ICD-11 and medical billing and coding?

The medical billing and coding industry will need to adapt to the many changes in the new edition. Some may add complexity to the billing and coding process, while others can help streamline operations.

How Does ICD-11 Change Medical Billing and Coding?

Here's how ICD-11 has evolved and what it means for medical coders and billers:

Include More Diagnoses and Conditions

ICD-11 has added a significant number of diagnoses, increasing from 14,000 to over 55,000 unique codes. The addition recognizes conditions not included in ICD-10, so medical coders and billers can become more granular and accurate in their submissions.

The new ICD-11 contains 26 chapters, five more than ICD-10. New sections cover diseases of the blood or blood-forming organs, disorders of the immune system, sleep-wake disorders, conditions related to sexual health and traditional medicine.

While some of the content is new (e.g., traditional medicine,) others were developed from existing chapters. For instance, many conditions in the sexual health chapter were previously classified under different categories. This means medical coders will need to take care to ensure that they're using the correct codes even for conditions they're familiar with.

Increase Specificity and Flexibility

Medical codes will have four characters before the decimal point, instead of three like in ICD-10, and may contain up to three characters after the decimal point. The second position is always a letter, and additional codes will add specificity to the base code (e.g., associated conditions.) ICD-11 also excludes the letters "O" and "I" to avoid confusion with the numbers "1" and "0."

Medical coders and billers who work with specialty groups had to add a lot of codes to ICD-10. The new classification system in ICD-11 will allow them to build codes that can accurately describe the conditions patients are being treated for, even if they still need to select an “unspecified” code.

Meanwhile, the alphanumeric coding structure allows more flexibility in diagnostic groupings. They are also updated to become more consistent with scientific evidence and align with clinical practice needs.

Support the Latest Technologies

ICD-11 enables healthcare organizations to streamline processes and increase operational efficiencies with the latest technologies. Instead of a static publication, it's built as a database and accessed as a web platform to support the use of electronic health records (EHRs). 

As such, it has the flexibility to grow and change as new scientific and medical discoveries emerge. The online content will evolve from the same basic structure so medical coders and billers won't have to adapt to yet another new version as the information is updated.

The ICD-11 platform also includes a robust search feature. For example, physicians can look up diagnoses using natural or preferred terminology. The system will then automatically match it with the correct technical code. This helps streamline workflows while increasing the accuracy of the coding process.

ICD-11 is designed to support interoperability. Healthcare organizations can use API to integrate the new database with their systems and software seamlessly. You can also link the digitalized platform with various medical libraries to enhance its functionality.

Since ICD-11 will connect with most EHR systems through the Systematic Nomenclature of Medicine and Clinical Terms (SNOMED CT) Foundation, it will create changes in the coding system for most healthcare organizations.

To support the use of various e-health technologies, ICD-11 comes with many digital tools to help facilitate the medical coding and billing process. For instance, the implementation package includes a coding tool, a reference guide, a browser tool and transition tables. 

How To Prepare for ICD-11 Medical Coding and Billing Changes 

Medical coding and health information management (HIM) professionals must take the time to become familiar with the new ICD-11 concepts and prepare for the transition thanks to the large number of diagnoses added to this edition, along with the new coding system.

While the expanded features will ultimately give medical coders and billers more advanced tools to do their jobs, they will change the coding process and require training to get comfortable with the new features.

Healthcare organizations should proactively support their medical coders and billers by developing training plans and supporting their staff to learn the new coding system before the transition. You may need to reassess training processes to ensure that your coding team has the resources it needs to adapt to the ICD-11 changes.

Meanwhile, the medical coding and billing department should work with IT to update all your systems and applications (e.g., EHR, practice management, revenue cycle management software) to versions that support integration with the ICD-11 database.

Also, you may want to work with experienced coding specialists to evaluate how you can make changes to the current coding and billing practice to optimize revenue cycle management, reduce coding errors, and improve patient outcomes based on the new ICD-11.

Assign a dedicated resource to monitor updates and communicate ICD-11 status to stakeholders. This person should stay current with ICD-11 news and announcements from the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), the American Health Information Management Association (AHIMA), the American Medical Association (AMA) and other industry organizations.

ICD-11's improved system and technology integration will help medical coders and billers become more accurate and efficient in their jobs. The expanded scope of the new version means that it will take even more experience and knowledge to navigate the database effectively and code accurately.

Get to Know Medical Billing and Coding

If you want to explore a career in medical billing and coding, start with DeVry’s Undergraduate Certificate in Medical Billing and Coding. This certificate program is 100% online, allowing you to study wherever and whenever it works for you. Classes start every 8 weeks. Contact us today to talk with our admissions team.

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