Updated on: March 14, 2016

ICD-11: Ideal for Holistic Medicine?

Original story posted on: May 24, 2013

In June 2012, the American Medical Association (AMA) proposed that we, as a country, ought to consider skipping ICD-10 and make the jump right to ICD-11 instead. After all, the World Health Organization (WHO) has indicated that ICD-11 will be ready by 2015. It builds upon the structure of ICD-10 but incorporates medical findings and data that have been made available since the release of ICD-10 way back in 1992.


The beta version of ICD-11 is already available, in fact; the WHO has asked experts to register to provide input before it is released to the public. It is also Web-based, meaning it can be updated instantaneously. This is a major improvement over ICD-9 and ICD-10, and it also will facilitate improved searching through the code set. Furthermore, ICD-10 was released in English, but ICD-11 already has been translated into 43 languages. All of this, combined with the fact that this electronic format is EHR- (electronic health record) ready, seems to imply that the move suggested by the AMA just might be a good idea.

The United States currently stands alone among developed nations as it clings to ICD-9. Expenses and bother are the biggest reasons for the foot-dragging. But just as our nation finally approaches the ICD-10 finish line, ICD-11 is approaching the starting gate. Why not just wait a few more years and take a single step? There are several reasons:

  1. Like ICD-10, ICD-11 is alphanumeric. This structure change has been costly and difficult enough going from ICD-9 to ICD-10. A later upgrade to ICD-11 may be easier for computer systems to handle.
  2. ICD-9 is too old to accommodate research and the advancement of science. Without ICD-10, we could use something called the United States Disease-Entity Coding System (USDECS), but this would result in a duplication of efforts with ICD-11 implementation and a lack of comparability with international data.
  3. Even though the ICD-11 beta phase should be complete in 2015, the final move to ICD-10-CM (that is, the clinical modification used in healthcare settings) may take as long as five or six years. There is strong doubt that ICD-9 can last that long, even with proposed patches such as pruning and reusing obsolete codes.

Despite these considerations, here is a sneak peek into how ICD-11 actually might look. It appears that it will favor the holistic healer, especially CAM (complementary and alternative medicine) providers. ICD-11 also will be more integrative. Currently, ICD-9 focuses on medical interventions when people die. However, in reality, many co-morbidities often exist at the end of life, and the interventions can include lifestyle and attitude factors. Counselors, nutritionists, educators and even spiritualists can intervene with these co-morbities, and ICD-11 designers seem to have taken notice.

ICD-11 also will include more non-traditional vocabulary. Western science does not represent the world’s only approach to health and wellness. Terms such as “prana” and “qi” (meaning “life force” in yoga and one form of Asian medicine, respectively) may be found alongside items like “blood pressure” in future code sets, since they are considered to be of equal importance in many parts of the world.

The general trend in ICD-11 appears to feature a focus on disease precursors in addition to the traditional morbidity emphasis of ICD-9. ICD-11 also recognizes disease crises and sequelae, which have detectable markers. This view of disease as a continuum may include issues such as a deficiency of vitamin D or calcium, which can set the stage for other health issues; putting emphasis on those issues may allow for intervention at these early stages. Perhaps this also can help providers recognize and treat precursors before a full-blown disease develops.

Just as we don’t need to set the clock on our cell phones, ICD-11 will be able to update automatically as well. Since it is Web-based, information can be added to the code set simultaneously. If a researcher discovers a better way to classify a disease or learns of a natural solution to some long-debated chronic disorder, this data can be included right away. ICD-11 will be like a Wikipedia page where experts can make contributions and edits as information becomes available. This data may be integrated into patient care right away since ICD-11 has been built to fit right into EHR systems.

It is too soon to make this jump now; that would be a bit like riding a high-powered motorcycle (ICD-11) when we are just figuring out how to handle a moped (ICD-10). ICD-9 is just a bicycle, and we have mastered it. Indeed, the bicycle can get us from point A to point B, but other methods of transportation are more effective.

Perhaps the move to ICD-11 can be made sometime around 2020, but for now, ICD-10 offers plenty about which to worry. Until then, complementary alternative providers should watch and wait.

The holistic view of health and wellness may finally fit into a code after being overlooked it for so long.

About the Author

Dr. Evan Gwilliam is a chiropractic physician, certified professional coder, and medical compliance specialist. He is the director of education and consulting for the ChiroCode Institute.


Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

Evan M. Gwilliam, DC, MBA, BS, CPC, CCPC, CCCPC, NCICS, CPC-I MCS-P, CPMA, executive vice president of ChiroCode and Find-A-Code LLC, graduated from Palmer College of Chiropractic as valedictorian and is a certified professional coding instructor, medical compliance specialist, and professional medical auditor, among other things. He provides expert witness reports, medical record audits, consulting, and online courses for healthcare providers. He also writes books and articles for trade journals and is a sought-after seminar speaker. He has a bachelor’s degree in accounting and a master’s of business administration, and he is one of the few clinicians who is a certified ICD-10 Instructor and certified MACRA/MIPS healthcare professional.