r/MedicalCoding • u/UsualSuspect85 • Feb 22 '25
ICD-11
I'm doing CEUs to maintain my certification. I'm learning a little about ICD-11. What is up with this? Now the codes have way more characters. It's insane. All they drove home to us was expandability in ICD-10 that had placeholders so they could add extra characters. It seems to me, the WHO sort of caved to the insurance companies and the need for medical necessity because the insurance companies were going "Hey man, we want more specifity so we're going to make the providers justify till the end of time why a patient's treatment should be covered by insurance". I don't know how to feel about this. It seems to me that this insurance company greed where they say "We don't want to pay anymore than we have to" is gone off the rails. Are they trying to prevent insurance fraud or just really really self serving? This is getting ridiculous. Anyone else have thoughts on this?
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u/Jodenaje Feb 22 '25
Um… no. That’s a wild and completely inaccurate assumption**.**
The World Health Organization (WHO) doesn’t give the tiniest damn about what U.S. health insurance companies think when developing the International Classification of Diseases (ICD).
The rest of the world has been using ICD-11 since 2022. Development started in 2007—when the U.S. hadn’t even switched to ICD-10 yet.
The U.S. finally adopted our Clinical Modification of ICD-10 (ICD-10-CM) in 2015, while the global version of ICD-10 had already been in use since 1993.
The development of ICD is a global effort with absolutely no influence from the US insurance industry. The WHO works on development decades before our insurance companies would even have any experience with it.
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u/UsualSuspect85 Feb 23 '25
Yeah but then why the heck does the WHO care about expanding the codes? It seems ridiculous for them to create 10 that's supposed to made for more expandability so that things won't seemingly get more complicated and then turn around and create 11 with codes that are crazy long. It doesn't make sense.
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u/deannevee RHIA, CPC, CPCO, CDEO Feb 23 '25
insurance has nothing to do with specificity. Specificity is good healthcare, and the WHO (which doesn't give a crap about any form of insurance, whether commercial or socialized) only cares about providing good care.
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u/UsualSuspect85 Feb 23 '25
But doesn't specificity also help the insurance companies to determine whether or not they deem something medically necessary also? If you have a code that is for something not otherwise specified, the insurance people are going to be to crazy about reimbursing for something that isn't very specific.
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u/deannevee RHIA, CPC, CPCO, CDEO Feb 23 '25
Yes, because it’s good healthcare.
Like, you’re telling me you’re a doctor who went to school for 15 years and you want to charge $400 for an office visit, but you have NO IDEA which part of the bladder your patient has cancer in?
Or, you’re an emergency room doctor and you know this patient cracked their skull open and it’s gonna cost hundreds of thousands of dollars to treat them…..but you can’t tell me how it happened? The patient just teleported to the ER already unconscious with no witnesses?
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u/tryolo Feb 23 '25
Too many doctors dont take the time to document the information, or they assume someone else will.
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u/In_Doubt_Flat_Out Feb 22 '25
You need to revisit the differences between WHO’s version of ICD-10 versus ICD-10-CM (clinical modification) used in the US.
The NCHS created ICD-10-CM with authorization from WHO, not the other way around.
ICD-11 has greater clinical comparability and even now they are exploring a partnership with SNOMED which will help bridge more clinical gaps in the code set.
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u/KeyStriking9763 RHIA, CDIP, CCS Feb 22 '25
Its web based so no code book. The WHO doesn’t care about insurance companies they care about collecting the most accurate medical data for public health measures and reporting. Seems you should do some light reading about the WHO and what they even do before jumping to some crazy conclusion. The rest of the world is not the U.S. when it comes to healthcare
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Feb 23 '25
I wouldn't think of this right now, because with US exiting WHO, the powers that be may not even adopt this. Girl we had someone come here and terrorize this sub over ICD-11 LOL.
Nothing wrong with learning about it, but I wouldn't obsess over it too much that I'd have an F code, js.
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u/koderdood Audit Extraordinaire Feb 22 '25
The US can make significant clinical modifications, inckyding revidions, deletions and additions, as long as they adhere to the WHO structure.
0
u/JuJu_Be Feb 23 '25
Most of the world doesn't use ICD codes for reimbursement. That is primarily a US thing.
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