Monday, August 7, 2017


ICD-11! ……Wait ….. what?

The World Health Organization (WHO) began development on ICD-11 in 2007 and is set to be finalized in 2018.  What does this mean for the U.S.?  At this point it is estimated that “11” will be implemented by 2023 or after.  I think I just heard a collective sigh of relief.  I know what you are thinking so I’ll give you a moment to “do the math” and see if your retirement supersedes this timeframe; if it does not -read on.

What needs to happen to “11” before we adopt? 

ICD-11 will need to be evaluated and customized to meet the U.S. needs for formal updating as required by Congress and U.S. stakeholders.  A procedural coding system will need to be developed and as part of HIPAA regulations “11” will need to undergo a rulemaking process before adoption.  Now, historically speaking, it took 8 years to modify “10” and 19 years to implement.  I personally do not feel “11” will take that long as “10” has already started us on the path to computerization; but rest assured it will take an estimated 10 years or more before we see “11” in the states.  For all of you reading this with sweaty palms and racing heartbeats – you may breathe now.

What does ‘11” look like?  For all you coding geeks out there, me included, I know you’re anxious for a taste.  ICD-11 has 26 chapters, 4-digit categories and the ability to build “code-strings” through something called Post-Coordination.  ICD-11 has also split chapter 3 (Diseases of the blood and blood forming organs and certain disorders involving the immune mechanism) into 2. Chapter 3: Diseases of blood and blood forming organs and Chapter 4: Disorders of the immune system.  There are 4 brand new chapters: Chapter 6 Conditions related to sexual health, Chapter 8 Sleep-wake disorders, Chapter 26 Extension codes, and Chapter 27 Traditional medicine.

Here is a sample diagnosis and codes:     
Hypertensive Chronic Renal Disease, Stage 4
BA02     Hypertensive renal disease
GC11.5  Chronic kidney disease stage 4

For those of you wishing to poke around a little more go to:  

Do keep in mind that the above comparisons are between ICD-10-CM as it is modified for the U.S. and the World Health’s ICD-11 version which is not modified. One thing is for sure; ICD-11-CM will be designed to better communicate with computers as the objective of “11” is to form a modern terminology optimized for clinical information systems.  This is so it may be easily utilized by electronic health applications.  Some features of “10” will be preserved but “11” will have some similarities with SNOMED-CT (a computer-friendly terminology).

Blogger opinion:  What does this mean for me? A coding lifer?  My personal thoughts:  The “bar” for coders has continually been raised since the 80’s when codes were required for reimbursement through DRG’s and CPT codes for outpatient procedures.  Then along came Present on Admission (POA) indicators and an increased importance of coding severity of illness (SOI) and risk of mortality (ROM).  More recently coders are working with clinical documentation improvement (CDI) efforts and computerized assisted coding applications (CAC).  The traditional role of a coder will become more automated and the coder will once again be elevated to the higher level - that being a coding auditor.  We have rolled with the punches before and we will continue to do so.  My advice is to embrace the challenge and seek ways to insert yourself into the future.

In summary, the adoption of “11” will be a massive undertaking for the U.S. and will require system designers, implementers and users who have expertise in SNOMED-CT, ICD-10, and the unique features of ICD-11.  The traditional role of an HIM professional will be impacted by this change.  AHIMA is gently steering members through “HIM re-imagined” so we have a place at the table in the future.  Of course, OHIMA is here to assist our membership through educational opportunities so no one gets left behind.  I recommend reading

Thank you for listening.


About the Author

Dee Mandley, RHIT, CCS, CCS-P is the president and owner of D.Mandley and Associates, LLC.  She currently serves as as the OHIMA 2017-18 Board President.   

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