3 Major Changes to Look for with ICD-11

The World Health Organization (WHO) updates ICD codes every few years to improve clinical use and acknowledge innovation in healthcare. In the past, transitioning to a new ICD version resulted in confusion and stress for clinicians everywhere. Those caught unprepared saw an increase in rejected claims and a drop in reimbursements. In this article, we’ll go over some key changes to be aware of with ICD-11.

What is ICD-11?

The ICD refers to the International Classification of Diseases, an attempt to use one set of diagnoses internationally. In January 2022, healthcare providers in the United States are expected to start using the 11th edition.  

This is the most significant change to disease classification since ICD-9 was retired in 2015. Currently, ICD-10 represents about 14,000 distinct diagnoses. ICD-11 has 55,000+ unique codes to represent a more comprehensive list of diagnoses. This update is a game-changer for the health and wellness industry because it recognizes several common diagnoses that were previously overlooked in ICD-10. 

While these changes affect professionals in most healthcare specialties, special attention is given to mental health providers. The addition of over 40,000 new codes means you have a more complex system to learn and implement. Luckily, you have until January 2022, when this change is slated to go into effect in the United States, to prepare your practice and avoid difficulties processing claims and assigning diagnosis.

Changes for Mental Health Providers

Change 1. New chapters on sexual health and sleep-wake disorders

There are two new chapters related to mental health in the ICD-11. The first, Conditions Related to Sexual Health, includes: 

• Sexual dysfunctions
• Sexual pain disorders
• Sexually transmitted infections
• Contraceptive management
• Changes to the male and female sexual anatomy 

Some of these conditions were previously classified under other groups. For example, gender identity disorders (now renamed gender incongruence) had, until now, been classified as mental disorders. 

“There have been substantial advances in health-related knowledge as well as social understanding of sexual disorders and sexual health. This has implications for the related categories currently in the Mental and Behavioral Disorders section in the ICD-10,” The WHO says of its motivation to create this chapter. 

The second new mental health chapter, Sleep-wake Disorders, includes:

• Insomnia disorders
• Hypersomnolence disorders
• Sleep-related breathing disorders
• Circadian rhythm sleep-wake disorders
• Sleep-related movement disorders 
• Parasomnia disorders

Change 2. New mental, behavioral and neurodevelopmental conditions

There are many new conditions added to the chapter on mental, behavioral, and neurodevelopmental disorders. Some noteworthy ones include:

• Compulsive sexual behavior disorder. Characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. Classified under impulse control disorders.
• Body integrity dysphoria. Characterized by an intense and persistent desire to become physically disabled in a significant way. Classified under disorders of bodily distress or bodily experience
• Gaming disorder. Characterized by a pattern of persistent or recurrent gaming behavior (‘digital gaming’ or ‘video-gaming’), which may be online (i.e., over the internet) or offline. 

Other new conditions of interest in ICD-11 include:

• Avoidant/restrictive food intake disorder
• Binge eating disorder
• Premenstrual dysphoric disorder
• Bipolar type II disorder
• Body dysmorphic disorder
• Intermittent explosive disorder 
• Olfactory reference disorder

Change 3. Harmonization with the DSM

The structure of the ICD has changed from the decimal coding system. Before, this limited groupings of mental health disorders to 10 major ones, despite its incompatibility with clinical utility and evidence.

ICD-11 uses an alphanumeric coding structure which brings flexibility for more diagnostic groupings. These groupings are more consistent with scientific evidence and meet clinical practice needs.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is ONLY for mental health, whereas ICD (international classification of disease) represents all types of medical diagnoses. Some codes in DSM-5 are not valid ICD codes. ICD-11 will attempt to bridge that gap. This change is largely due to the joint efforts of the WHO and the American Psychiatric Association (APA) to harmonize the structures of the DSM-5 and ICD-11.

How will this affect my practice?

You have ample time to become acquainted with implementing ICD-11 in your practice, as it luckily doesn’t go into effect until after January 2022. Additionally, ICD-11 comes with many tools to help you, including a coding tool, a reference guide, a browser tool, and transition tables in its implementation package. Also, ICD-11 is e-health (digital health) compatible. 

***The provisions of ICD-11 may still undergo modifications before it is due to be implemented/adopted in the U.S.

Want to learn more about ICD codes?

1. The Most Frequently Used ICD-10 Codes of 2022
2. The 20 Most Common ICD-10 Codes for Behavioral Health
3. Top 20 ICD-10 Codes of 2022 (Year-to-Date)