Why a Medical Billing Company Must Understand ICD-11

As the healthcare industry continues to evolve, so do the systems used to classify and code diseases, treatments, and procedures. The International Classification of Diseases (ICD) is the global standard used for health reporting and billing. While most countries, including the United States, have long relied on ICD-10, the World Health Organization (WHO) has developed the next iteration: ICD-11.

For any medical billing company, understanding ICD-11 is not just a technical requirement—it’s a strategic necessity. The shift from ICD-10 to ICD-11 brings with it significant changes in structure, logic, and implementation. Healthcare providers will increasingly rely on their billing partners to manage this transition smoothly, ensuring coding accuracy, compliance, and optimized revenue cycles.

In this article, we explore why it is essential for a medical billing company to have in-depth knowledge of ICD-11, what changes ICD-11 introduces, and how Thrive Medical Billing is preparing for the future of medical coding.

What Is ICD-11?

The International Classification of Diseases, 11th Revision (ICD-11), is the latest version of the global coding system developed by the WHO. Released in 2019 and adopted by many countries for implementation starting in 2022, ICD-11 is designed to reflect advances in medicine and digital health technologies.

ICD-11 improves upon ICD-10 in the following ways:

• More clinical detail and specificity

• Improved digital integration for electronic health records (EHRs)

• Enhanced coding logic to reduce ambiguity

• Support for modern healthcare systems, including telemedicine and genomics

Although the United States has not officially transitioned to ICD-11 as of 2025, preparation is underway—and any forward-thinking medical billing company must already be developing expertise in ICD-11.

Why ICD-11 Knowledge Is Critical for a Medical Billing Company

1. Future-Proofing Medical Billing Services

The transition to ICD-11 is inevitable. Countries around the world are already adopting the new system, and the U.S. is expected to follow suit. A medical billing company that invests early in ICD-11 training and system upgrades will be prepared to help clients make a smooth transition without revenue disruption.

Thrive Medical Billing is already preparing its teams and software to accommodate ICD-11 coding structures. This proactive approach ensures that clients won’t face last-minute confusion or costly errors when the shift occurs.

2. Ensuring Coding Accuracy and Reduced Denials

ICD-11 introduces over 55,000 codes—more than double those in ICD-10. These codes offer deeper specificity and context, which can greatly reduce coding errors when used correctly.

Incorrect or outdated coding leads to:

• Increased claim denials

• Compliance violations

• Reduced reimbursement

• Audit risk

A medical billing company like Thrive Medical Billing that is trained in ICD-11 will be able to code accurately, reducing denials and accelerating payments.

3. Supporting Specialty Practices

Specialty practices—such as cardiology, neurology, oncology, and mental health—will benefit from the expanded and more precise coding available in ICD-11. To take advantage of this, your billing partner must be fluent in the system.

Thrive Medical Billing serves a wide range of specialties and is already aligning its coding protocols with ICD-11 where applicable. This ensures that specialists can document and bill with greater accuracy and receive appropriate reimbursement for complex cases.

4. Improving Data Reporting and Clinical Insights

One of ICD-11’s major advantages is its improved ability to support data-driven healthcare. By offering more detailed classification, ICD-11 enables better clinical research, population health tracking, and performance analytics.

A tech-savvy medical billing company that understands ICD-11 can help providers:

• Report on patient outcomes

• Meet public health reporting requirements

• Optimize treatment plans based on coded data

• Identify revenue opportunities through data trends

Thrive Medical Billing integrates its coding systems with data analytics tools to help practices extract meaningful insights from ICD-coded data.

Key Differences Between ICD-10 and ICD-11

These differences make ICD-11 more dynamic but also more complex—requiring that a medical billing company thoroughly understands how to apply the codes properly.

Challenges of Transitioning to ICD-11

While the benefits of ICD-11 are clear, the transition itself presents challenges that only an experienced medical billing company can effectively manage:

1. Training and Education

Coders must learn a completely new structure and logic. This takes time, resources, and ongoing support. Thrive Medical Billing invests in continual training to ensure that its certified coders are prepared for the complexities of ICD-11.

2. Software Updates

Billing and EHR systems must be compatible with ICD-11. This may require significant upgrades and testing. Thrive Medical Billing uses scalable, cloud-based systems that can be updated seamlessly to integrate ICD-11 capabilities.

3. Workflow Adjustments

ICD-11’s cluster coding and extension codes will change how documentation and billing workflows function. Thrive Medical Billing works closely with providers to redesign workflows, minimizing disruptions during the transition.

4. Dual Coding Periods

During the transition, both ICD-10 and ICD-11 may be in use depending on the payer or region. A competent medical billing company must be able to navigate this hybrid environment without compromising accuracy.

How Thrive Medical Billing Is Leading the ICD-11 Transition

Thrive Medical Billing has always prioritized innovation and compliance. As part of its ICD-11 readiness strategy, the company offers:

ICD-11 Training for Coders and Staff

All coders are undergoing phased training modules that cover ICD-11 structure, coding rules, and specialty-specific scenarios.

Dual-System Compatibility

Billing platforms used by Thrive Medical Billing are being tested for compatibility with both ICD-10 and ICD-11 to ensure continuity.

Provider Education and Support

Thrive Medical Billing assists healthcare providers with documentation best practices that align with ICD-11 requirements, helping to improve claim accuracy and reduce rework.

Data Mapping and Reporting Upgrades

The company is enhancing its analytics tools to leverage the improved granularity of ICD-11-coded data, offering deeper insights into patient outcomes and financial performance.

Final Thoughts

The shift to ICD-11 is a transformative moment in medical billing. It demands not only technical expertise but also forward-thinking strategy, investment in training, and system modernization. Practices that fail to prepare may face compliance issues, delayed payments, and operational chaos.

That’s why choosing a future-ready medical billing company is crucial.

Thrive Medical Billing is committed to helping healthcare providers not just survive the transition—but thrive through it. By combining expert coders, cutting-edge technology, and provider-focused support, Thrive Medical Billing ensures your practice stays ahead of regulatory changes and continues to collect maximum revenue with minimal disruption.