Transitioning from ICD-9 to ICD-10 has presented practices with challenges, including temporary disruptions in workflow and productivity. To avoid repeating past hurdles, many practices are looking at ways to prepare for an ICD-11 transition despite lacking a set implementation date.

The new coding system introduces updated and expanded code sets. These features enable healthcare professionals to create more detailed patient charts covering diagnoses, procedures, and treatments.

The new codes improve coding accuracy, which, in turn, ensures proper reimbursement. In this blog, we look into the impact of ICD-11 on electronic health records (EHRs). Also, we outline actionable steps to help your practice prepare for a seamless transition into this new coding framework.

Understanding ICD-11

ICD-11 is short for the 11th Revision of the International Classification of Diseases. It was updated by the World Health Organization (WHO) and used by practices worldwide. ICD-11 is a standardized classification of diseases and related factors, which allows providers, coders, and billers to document and track health data.

The new coding system consists of alphanumeric codes. Each code corresponds to a specific diagnosis or medical condition. This structure facilitates uniformity and consistency in healthcare documentation and reporting.

The developers structure the new codes into chapters, sections, and categories. The latter is based on disease etiology, anatomy, and other factors. This structure allows codes to capture variations in disease manifestations and severity.

Besides primary diagnosis codes, ICD-11 includes codes for:

• Secondary diagnoses
• External causes of injury
• Factors influencing health status

This coverage lets healthcare providers document relevant comorbidities, complications, and contributing factors. Medical coders and billers use ICD-11 in billing and reimbursement, while researchers apply it in epidemiological surveillance, health policy development, and research.

Differences between ICD-11 and ICD-10

ICD-11 and ICD-10 are classifications of diseases, but they differ in four aspects: 

Structure and Organization

• ICD-11: The ICD-11 structure is more flexible and user-friendly compared to ICD-10. The coding system accommodates changes and updates through its modular structure. This means easier maintenance and adaptation to evolving healthcare needs.

• ICD-10: The ICD-10 structure is more rigid and hierarchical. The developers organize codes into chapters, sections, and subsections. This makes it less adaptable and requires extensive updates to accommodate new health conditions.

Coding System

• ICD-11: ICD-11 codes include more detailed codes compared to ICD-10. It also provides greater granularity in coding. This is valuable for more precise documentation of diseases, conditions, and health-related factors.

• ICD-10: While ICD-10 provides a broad classification, it lacks the level of detail found in ICD-11. This can result in ambiguity when documenting certain health conditions.

Clinical Documentation and Coding

• ICD-11: ICD-11 emphasizes the importance of clinical documentation. This system aims to improve coding accuracy and specificity through detailed documentation guidelines. It encourages providers to record patient diagnoses, procedures, and health encounters in depth.

• ICD-10: The ICD-10 code requires thorough documentation but cannot always support this rule. Its structure and coding conventions limit the provider’s capability to do so.

Technology and Integration

• ICD-11: The ICD Panel designed ICD-11 to be more compatible with modern technology. It offers support for interoperability with EHRs and health information systems. This means the new code makes it easier for providers to manage patient data.

• ICD-10: Providers also use ICD-10 in EHRs and healthcare information systems. However, its older coding conventions present integration challenges for newer digital health technologies.

Impact of ICD-11 on EHR Systems

ICD-11 improves the providers’ level of specificity in documenting patient diagnoses. Adapting to these coding guidelines allows them to capture correct patient information. Furthermore, EHR providers must upgrade the software system to align with ICD-11’s detailed coding. 

Benefits and Challenges of Using ICD-11 in EHR

Implementing ICD-11 in EHR systems offers several benefits for practices. The coding system provides a standardized approach to capturing patient diagnoses and procedures. This leads to accurate clinical documentation and better patient outcomes.

Additionally, ICD-11 integration facilitates information exchange across healthcare settings. However, there are challenges associated with adopting ICD-11 in EHR systems. These hurdles include the following:

• Time-consuming. Healthcare providers and staff will need training.

• Resource-intensive. EHR systems need customization and upgrades to support ICD-11.

• Technical challenges. Practices must ensure the compatibility between ICD-11 and the current EHR and other digital platforms.

Despite these challenges, the benefits of implementing ICD-11 outweigh the initial hurdles. EHR implementation and coding upgrades lead to efficient healthcare delivery.

Preparation for ICD-11 Transition

As the healthcare industry evolves, professionals must stay up-to-date with ICD-11. Here are some key points to remember to ensure your practice is ready for the coding update.

Training for Healthcare Providers, Coders, and Billers

Healthcare professionals need training to familiarize themselves with the new coding framework. These learning opportunities allow them to understand the system’s clinical documentation requirements. 

Coders’ training focuses on translating documentation into new codes. For billers, learning ICD-11 codes promotes the accurate processing of claims. Training and access to coding resources help professionals to be confident with ICD coding.

Upgrading EHR Systems to Support ICD-11

Practices work with their EHR vendors to upgrade their software to ICD-11. To align with the new coding structure, providers must update the following tools:

• Code sets
• Templates
• Clinical decision support tools

Collaborating with vendors helps practices ensure complete ICD-11 integration into current workflows. They can perform testing and validation processes to check for coding accuracy.

Timeline for Implementation

Setting a clear timeline for applying ICD-11 is essential for healthcare organizations. This information allows clinics to plan and execute the transition. A standard timeline should cover the following:

• Training sessions
• System upgrades
• Testing phases
• Roll-out schedules

It is vital to allow enough time for staff to adapt to the new coding system. Practices must address any issues that may arise during the transition period. Providers, coders, and billers must stay informed on coding updates to adjust their workflows.

Takeaway

ICD-11 promises a more adaptable classification system compared to its predecessor, ICD-10. The new coding framework offers potential enhancements in coding accuracy and healthcare standards.

However, achieving a smooth transition requires collaborative efforts. By implementing robust planning strategies, practices can confidently navigate the transition while ensuring continued efficiency in clinical documentation and billing processes.

Choose the Top EMR/EHR Software

Discover the power of EMR-EHRs, your trusted partner in healthcare technology. Teaming up with 1st Providers Choice, we deliver cutting-edge EHR and practice management solutions tailored to meet medical coding standards. 

Our software ensures accurate claims processing and coding precision through testing and verification. Partner with us to improve your practice’s coding compliance and become ICD-11-ready. 

To learn how we can support your practice, contact us at (480)782-1116 or complete our form.

Sources:

• Chute, C.G., Çelik, C. Overview of ICD-11 architecture and structure. BMC Med Inform Decis Mak 21 (Suppl 6), 378 (2021). https://doi.org/10.1186/s12911-021-01539-1

• Feinstein, James A, et al. “Preparing for the International Classification of Diseases, 11th Revision (ICD-11) in the US Health Care System.” JAMA Health Forum vol. 4,7 e232253. 7 Jul. 2023, doi:10.1001/jamahealthforum.2023.2253

• NCVHS ICD-11 Workgroup. ICD-11 Overview Key Facts, History, and References. National Committee on Vital and Health Statistics, Sept. 2023, ncvhs.hhs.gov/wp-content/uploads/2023/09/ICD-11-Overview-September-2023-508.pdf.