As U.S. physicians gear up to put the ICD-10 coding system in place by the upcoming Oct. 1 deadline, work is being done elsewhere on the coding system's next-generation product: ICD-11.
, which coordinates implementation of the coding system, "ICD is currently under revision, through an ongoing Revision Process, and the release date for ICD-11 is 2017."
ICD stands for International Classification of Diseases; the system has been in use since 1948 (although an earlier version known as the International List of Causes of Death was first issued in 1893). The ICD "is the international standard for defining and reporting diseases and health conditions," the WHO says on its website. "It allows the world to compare and share health information using a common language."
Although physicians in the U.S. have gotten used to using ICD-9, the upcoming implementation of ICD-10 has caused controversy because the new version is much more granular, with a different number of digits and many more codes -- 68,000 compared with 13,000.
How much different ICD-11 will be from ICD-10 is hard to say, since it's still in development, explained , senior director for coding policy and compliance at the American Health Information Management Association, in Chicago, in a telephone interview.
"It's similar in that it's alphanumeric," she told 51˶. However, she added, it wouldn't work to skip directly from ICD-9 to ICD-11. "ICD-10 is definitely the path to get to ICD-11; ICD-9 is definitely not the path to get to ICD-11."
The system being implemented here on Oct. 1 is actually ICD-10-CM, with CM standing for "clinical modification," Bowman noted. "We expanded some codes and added detail based on our information needs in the U.S. For example, laterality wasn't in ICD-10, so we added it ... They're actually looking at what we did in the U.S. in our clinical modification to incorporate that into ICD-11."
As for when the U.S. is going to take up ICD-11, that's hard to say, she continued. "The World Health Assembly adopted ICD-10 in 1990 and we still haven't adopted it in the U.S., so I hope it doesn't take that long but it gives you some idea. I think we'll have ICD 10 for a good 15-20 years, at least."
"We wouldn't have been so far behind if we had implemented back when we first started talking about it -- we just have a much more arduous regulatory process" than other places, Bowman said. "Other countries just said [to their providers], 'Here you go and quit complaining.' The U.S. process, with having to undergo public input, makes for a much more complex implementation." The rules for adopting a new coding system are outlined in the regulations for the .
, CEO of Washington-based consulting firm Avalere Health, agreed that a timetable for implementing ICD-11 in the U.S. is hard to figure out. "I'd be hard-pressed to give you a concrete date because I don't see this happening any time soon," he said in a phone interview. "We just switched over to ICD-10 ... and it's possible ICD-11 will be leapfrogged by the time 10 is implemented."
"Coding only becomes more complex; it never gets any simpler," he continued. "ICD-11 is going in in Europe in the not-too-distant future, and it's possible that by 2020 -- which is going to be here before you know it -- that ICD-12 will be out ... By 2018 we'll be thinking about what the next great thing is."
As for how ICD-11 will differ from ICD-10, Mendelson said it wasn't completely clear, but "we've looked at it, and it's substantially more complex."
The Centers for Medicare and Medicaid Services (CMS), which plays a major part in implementing the ICD system in the U.S., issued in February that "it is not feasible to skip directly to ICD-11 because ICD-10 is a foundational building block prior to moving to ICD-11 ... Several prominent industry groups, including the American Medical Association, have issued statements opposing transitioning directly to ICD-11 because of the complexity of the coding system and the best practice to implement ICD-10 to gain experience with that system first." A CMS spokesman said in an email that the agency had no further comment on the subject.