Ten Going on Eleven: Part II

EDITOR’S NOTE: Ten Going on Eleven is a month-long series on ICD10monitor and Talk Ten Tuesdays that examine important issues related to the transition to ICD-11. Melanie Endicott with the American Health Information Management Association (AHIMA) appeared as a special guest on a recent edition of Talk Ten Tuesdays and focused on, the transition to ICD-11. This article is a summary of her remarks.

There are some new terms we will see in ICD-11, such as stem codes, extension codes, cluster coding, pre-coordination, and post-coordination.

Stem codes contain all pertinent information in a pre-combined fashion, referred to as “pre-coordination.” When additional detail that pertains to a condition is described by combining multiple codes, this is referred to as “post-coordination.” The mechanism of showing that codes are post-coordinated is called “cluster coding” in ICD-11.

Extension codes may be used to add detail to a stem code, and are not to be used alone, but must be added to a stem code. Not all extension codes can be used with every stem code. I won’t delve any deeper into the definitions and appropriate uses of each of these new terms today, but if you want to learn more about them, I suggest you check out the ICD-11 Reference Guide on the World Health Organization (WHO) website. What I do want to share about this new coding scheme in ICD-11 is that it provides for even more specificity than what we see in ICD-10. When I recall the transition from ICD-9 to ICD-10, a lot of the education focused on the increased documentation specificity that needed to occur to accurately capture ICD-10 codes. I foresee a similar pattern as we transition from to ICD-11.

I think one of the biggest areas ripe for clinical documentation improvement will be in capturing all of the specificity that is available using extension codes. There are two types of extension codes. Type 1 extension codes allow the user to add detail to a stem code, such as severity scale value, temporality, etiology, specific anatomic detail, dimensions of an injury, or external cause, etc. Type 2 extension codes represent diagnosis code descriptors, such as discharge diagnosis types, diagnosis timing, diagnosis timing in relation to the surgical procedure, diagnosis method of confirmation, diagnosis certainty, OB diagnosis timing, and capacity or context. It’s important to note that the actual use of these extension codes will depend on how ICD-11 is used in the United States. It is too early to begin training on ICD-11 because there are still so many unknowns; however, it’s never too early to begin familiarizing yourself with the nuances of ICD-11 and getting a general overview of the new features.

A few of these new features to be aware of are the five new chapters that are present in ICD-11, of which I’ll offer a quick overview:

• Conditions affecting the immune system and conditions affecting the blood are now two separate chapters.
• There’s a new chapter titled “Sleep-Wake Disorders.”
• “Conditions related to sexual health” are all in one chapter.
• And a new chapter titled “Traditional Medicine” has been added.

In closing, the implications of ICD-11 on clinical documentation improvement (CDI) are not 100 percent clear right now. I suggest that CDI professionals stay tuned in to the process of ICD-11 implementation in the U.S. – and be ready once more information is available.