The International Classification of Diseases (ICD) was introduced by the World Health Organization (WHO) to simplify and standardize the language of health and medical diagnoses worldwide. It provides a universal framework for healthcare professionals to accurately document and communicate patient conditions, promoting data interoperability across countries and healthcare systems.

ICD-11, the eleventh revision of the International Classification of Diseases, came into effect on January 1, 2022, and has already been adopted by more than 60 countries. The new version is designed to keep up with the latest advancements in healthcare, offering more detailed and precise codes than its predecessor. Notably, ICD-11 includes coding for over 5,500 rare diseases, along with enhanced support for perinatal and maternal conditions, as well as mental health disorders. This updated version significantly improves diagnostic specificity and broadens the system's coverage, making it a more powerful tool for healthcare professionals.

The goal is to improve care, streamline billing, and make the clinical documentation process much smoother and more efficient.

Let’s decode what this means for medical practices in 2025 and beyond.

What Makes ICD-11 Different From ICD-10?

ICD-11 introduces numerous updates to ICD-10, making it more suited for today’s healthcare landscape. Here’s a look at some of the key differences:

• Built for the Digital Era — ICD-11 is the first version designed for the digital era. Unlike ICD-10, ICD-11 is built to work seamlessly with electronic health records (EHRs). It promotes the digitalization of healthcare, making coding, documentation, claim submission, and data exchange smoother and faster.
• Enhanced Granularity — One of the standout features of ICD-11 is its granularity. It allows for more detailed coding, enabling healthcare providers to document medical conditions accurately. The number of available codes has expanded significantly, giving more options to specify unique diagnoses and treatments. This additional flexibility leads to fewer unspecified codes, which means better reimbursement and clearer communication with insurance companies.
• User-Friendly — ICD-11 has an intuitive design, and its coding tool uses advanced features like partial word-matching, word-order independence, synonym management, hierarchy traversal, and more. These features boost productivity and enable faster and more accurate claim submissions.
• Interoperability — ICD-11 seamlessly integrates with other classification systems, such as SNOMED CT (Systematized Nomenclature of Medicine — Clinical Terms), making it easier to exchange health information and compare statistics across various healthcare platforms and even internationally. 
• Flexible and Future-Proof — One of the most convenient features of ICD-11 is its structure, which can accommodate emerging health issues through annual updates. This makes it much more adaptable than previous versions, which required revisions to incorporate new conditions or treatments. With ICD-11, keeping up with evolving medical knowledge is much easier.

Impacts of ICD-11 on Medical Billing Practices

Shifting from the ICD-10 to the ICD-11 system can impact your billing practices in the following ways:

1. Refined Coding

ICD-11 offers improved precision in medical billing with its innovative cluster code structure and extensions that allow healthcare providers to capture the complexities and nuances of multifaceted health conditions more effectively than ever before. It comprehensively covers rare diseases and emerging health challenges like gaming disorders. Moreover, the coding structure enables a detailed representation of health conditions by combining relevant codes. This increased specificity improves data quality and allows physicians to accurately reflect the complexity of a patient’s condition, reducing the chances of coding errors, claim denials, or requests for additional documentation.

2. Streamlined Coding Process

ICD-11 features an intuitive design with enhanced search functions that streamline medical coding, saving valuable time and ensuring accuracy. With over 55,000 codes, this efficient design boosts productivity, enabling faster and more accurate claim submissions. 

Moreover, its seamless compatibility with electronic health records (EHR) and modern billing platforms reduces manual coding errors and simplifies the billing workflow, accelerating reimbursement timelines and improving overall practice efficiency.

3. Enhanced Health Data Analysis

The granularity of the ICD-11 system allows the capture of intricate health information, improving healthcare analytics and advanced epidemiological research. Medical practices can leverage this data to gain deeper insights, track patient outcomes, and optimize resource allocation. It also empowers practices to participate more effectively in quality improvement initiatives. With ICD-11's enhanced coding, providers can identify trends across various health domains, including chronic diseases, maternal and neonatal health disorders, infectious diseases, and behavioral health conditions. This enhanced diagnostic accuracy promotes personalized patient care and elevates patient experience.

4. Improved Reimbursement Opportunities

The enhanced granularity of ICD-11 allows practices to accurately document and bill for the full scope of care, particularly in complex clinical conditions, high-risk pregnancies, and rare diseases. The comprehensive and unique coding in ICD-11 captures the complexity of the healthcare provided, giving insurers a clearer understanding of the care rendered. This level of detail helps mitigate the risk of claim denials and increases the likelihood of higher reimbursement rates, ensuring practices are compensated appropriately for their services.

5. Harmonized Global Health Coding

ICD-11 standardizes health diagnosis and reporting across countries, which is great news for organizations operating internationally or working with international patients. It facilitates cross-border healthcare, making the claim submission process more efficient and consistent across different healthcare systems.

Additionally, it enhances research and fosters international collaborations in women’s health by improving global communication and data sharing. This standardized approach contributes to more effective public health strategies and advances maternal and reproductive health research, benefiting patients and healthcare providers worldwide.

Challenges in Implementing ICD-11 and Strategies to Surmount Them

Every change involves challenges. A study found that only 23.5% of ICD-10 stem codes map directly to a single ICD-11 code, indicating that physicians and coders must perform post-coordination to achieve the same depth of information.

Medical practices must anticipate the following challenges associated with ICD-11 implementation:

• Learning Curve — ICD-11 introduces a more comprehensive and detailed coding system, which will involve a learning curve. Clinicians and coders will need extensive training to become proficient with the new codes and workflows. Invest in structured training programs and provide continuous education to flatten the learning curve, keep your team up to date, and minimize errors.
• Implementation Costs — Transitioning to ICD-11 involves upfront costs, including system upgrades and temporary drops in productivity as staff learn the new system. Assess your current EHR and RCM systems for ICD-11 compatibility. Budget for possible upgrades and replacements in advance and phase the implementation to minimize disruption. Consider rolling out the changes gradually to help staff adapt without overwhelming them.
• Data Privacy Concerns — As ICD-11 offers more detailed and integrated digital coding, data security becomes even more crucial. Prioritize robust security measures to protect sensitive patient information during transition. Strengthen your cybersecurity protocols, update software to the latest HIPAA standards, and train your staff on best practices for data protection to safeguard patient privacy.

Make Your Switch to ICD-11 Smoother and Easier

ICD-11 can impact practices in multiple ways, influencing aspects like coding, reimbursement, compliance, and health analytics. The transition to ICD-11 requires providers to adapt their coding practices and ensure all staff are adept at the new guidelines.

Glenwood's efficient EMR and RCM systems — GlaceEMR and GlaceRCM — facilitate ICD-11 compatibility, streamline workflows, improve billing accuracy, and enhance overall operational efficiency. Furthermore, it ensures your practice is HIPAA compliant, protecting patient data while optimizing reimbursement processes. 

Invest in robust technology solutions for a smooth drive to excellence.