10/8/2012 HCI571 Isabelle Bichindaritz 1

Classification and CodingICD-10

• Define what is the International Classification of Diseases (ICD).

• Explain the difference between classification and coding.

• List the volumes, chapters, groups, and categories in ICD-10.

• Code diseases with ICD-10

Learning Objectives

10/8/2012 HCI571 Isabelle Bichindaritz 2

3

History1893: Jacques BERTILLON death causes International

Nomenclature (mortality)

1900: 1st revision and 10-yearly revision principle

1948: 6th revision, managed by WHO (World Health Organization),

"International Classification of Diseases, Traumas and Death Causes" Broadening to morbidity

1977: 9th revision: ICD-910/8/2012

4

1993: ICD 10 in English

1994: ICD 10 volume 1 (analytical – diagnosis codes)

1995: ICD 10 volume 2 (history and coding rules)

1996: ICD 10 Volume 3 (alphabetical) and ICD 10 numerical

10/8/2012

: ICD 9-CM (« clinical modifications » adding areas of reimbursement, epidemiology, and health sciences research)

5

ICD 10 :Two facets

1°] A Classification

2°] A Coding system10/8/2012

6

A ClassificationThe international statistical Classification of diseases

and associated health problems

Definition of Classification :Scheme for grouping similar things in a logical way

based on common characteristics

Definition of Nomenclature :A systematic listing of names assigned according to

predefines rules

Note : Classification ≠ Nomenclature

10/8/2012

7

ICD 10 Classification Definition

This classification was based on the world frequencies of affections and their importance

in Public Health.

Initially death causes classification, broadening to morbidity from the 6th revision and mostly the 9th revision.

Set of organized groupings for classifying morbid phenomena and all the reasons for seeking care.

10/8/2012

8

ICD10 Classification organization

1°] An Analytical volume (Volume 1)

2°] A user manual (Volume 2) Coding rules and history of the classification

3°] An Alphabetical volume (Volume 3)

A] Three fundamental Volumes

B] WHO updates + Extensions Update Document with Chapter V

NOTE : Coding a morbidity entity requires both volumes 1 and 3 (and the updates) Search in the Alphabetical (V3) => Verification in the Analytical (V1)

10/8/2012

9

3°] Index (Table) of medication and chemical compounds (tables of noxious effects) Codes Chap. XIX in "T" and Chap. XX in "X" and "Y" [Page 625]

1°] An alphabetical index of diseases of traumatic nature [Page 1]

2°] An alphabetical index of external causes of morbidity and mortality (Index Chapter XX : External Causes of morbidity and mortality) [Page 567]

Alphabetical Volume

It contains 3 indexes

10/8/2012

10

It contains the IC10 Classification

C:\ICD 10

Folder Chapter

Folder Group

Folder Sub-group Cha. XIII and XX)

Folder Category

Folder Sub-Category

The data are stored in hierarchical structures (like folders in PC)

Analytical Volume

The Structure is of hierarchical type.

10/8/2012

11

Chapters (I to XXII) (no proper code)Example : Page 111 : Chapter I :Certain infectious and parasitic diseases (A00-B99)

Groups (no proper code)Example :Page 112 : Intestinal infectious diseases (A00-A09)Page 117 : Tuberculosis (A15-A19)

CategoriesExample :Page 112 : A00 Cholera (3 character code)

Sub-CategoriesExample :Page 112 : A00.9 Cholera, NOS (Code of more than 3 characters)

ICD 10

10/8/2012

12

2050 Categories (2045 + 5 in 2006)Codes with 3 characters (Update : Page 1268 bis and ter)

Other national extensions were created bringing the number of possible codes to 6 (Update : Chapter V [Mental and behavioural disorders] : Page 328)

Total :

247 Groups (245 + 2 in 2006; "U00-U99")(Update : Page 1268 bis)

22 Chapters (21 + 1 in 2006; Le "XXII")(Update: Page 1268 bis)

Sous-CategoriesCodes with more than 3 charactersSometimes extensions of ICD 10 codeswith 5 characters (ICD 10 Page 673)

10/8/2012

13

Chapters content

3°] Chapter XXI : Coding of reasons for seeking care (medication, surveillance; administrative aspects, social…) p. 1213 [Code "Z"]

1°] Chapter I to XIX : Diseases descriptions, traumas, syndromes , symptoms

2°] Chapter XX : External causes of morbidity and of mortality p. 1089

4°] Chapter XXII : Codes for particular reasons"U" code (example : Resistant bacterial agents)

5°] Chapter V : Mental and behavioural disorders p.327 [Code "F"]10/8/2012

14

A Coding toolNote : Coding ≠ Encoding

One encodes to protect information from unwanted users

One codes to transform information in a set of pre-established symbols to facilitate information analysis

10/8/2012

• Volume 1: Diagnosis codes– Contain three, four, five numeric digits– First three specify the disease– Fourth digit provides more detail– Fifth digit gives subtypes of the disease

• Volume 2: Alphabetical index for Volume 1• Volume 3: Contains procedure codes

Understanding Terminologies International Classification of Diseases, Ninth Revision

16

10/8/2012

17

Coding ExamplesICD 10 WHO with 3 characters :

F09 : Unspecified organic or symptomatic mental disorder

ICD 10 WHO with 4 characters (most frequent) :

F01.0 : Vascular dementia of acute onset

ICD 10 WHO with 5 characters :

M65.04 : Abscess of tendon sheath, handICD 10 WHO + National extension On 5th and 6th

F01.242 : subcortical vascular dementia, with other symptoms, mixt, severeICD 10 WHO + National extension On 6th

M62.890 : Rhabdomyolysis, unspecified site

10/8/2012

18

Example de code format :

ICD 10 WHO with 3 characters +Ext. Nat. on the 5th

character :

CNN.+N Example : R53.+2 Fatigue (update. 935)

If for a given location in the code the information does not exist, it is replaced by the symbol « + »

ICD 10 WHO with 4 characters + Ext. Nat. on the 6ème

character : CNN.N+N Example : I20.0+0 Unstable angina pectoris with elevated biochemical markers (update. 510)

Note : When a Dot-Dash : ".-" replaces the 4th character, the coder must refer to the sub-category to choose this 4th character

Example : "J45.-" Asthma Page 57110/8/2012

19

Coding by ChapterIn general, we have : One letter = One Chapter

Chapter I (infectious diseases …) Two letters A and B

A few exceptions :

Chapter II (Neoplasms) Two letters, C and part of D (->D49)

Chapter III (Diseases of the blood…) One part of D (after D50)

Chapter XIX (Injury…) Two letters S and T

Chapter XX (External causes…) Four letters V, W, X and Y

Chapter VII (Diseases of the eye …) One part of H (->H59)

Chapter VIII (Diseases of the ear ) One part of H (after H60)

10/8/2012

20

The Chapters

Chapters Letters Nb

I Certain infectious and parasitic diseases A-B 186 II Neoplasms C-D 144III Diseases of the blood and blood-forming organs and certain … D 37IV Endocrine, nutritional and metabolic diseases E 78V Mental and behavioural disorders F 99VI Diseases of the nervous system G 68VII Diseases of the eye and adnexa H 49 VIII Diseases of the ear and mastoid process H 24IX Diseases of teh circulatory system I 81X Diseases of the respiratory system J 65 XI Diseases of the digestive system K 73XII Diseases of the skin and subcutaneous tissue L 77

Nb ofCategories

10/8/2012

21

The Chapters

Chapters Letters Nb

XIII Diseases of the musculoskeletal system and connective tissue M 84XIV Diseases of the genitourinary system N 84XV Pregnancy, childbirth and the puerperium O 79XVI Certain conditions originating in the perinatal period P 62 XVII Congenital malformations, deformations and chromosomal… Q 89XVIII Symptoms, signs and abnormal clinical and laboratory… R 98XIX Injury, poisoning and certain other consequences of external… S-T 196 XX External causes of morbidity and mortality V-W-X-Y 396XXI Factors influencing health status and contact with health… Z 87XXII Codes of special purposes U 2

Nb ofCategories

10/8/2012

22

Chapters Organization

1°] Beginning: the most severe pathologies or the most frequent on the world scale

2°] Next : from the most severe to the least severe, or from the most precise to the least precise

10/8/2012

23

Choice : Dagger / StarMulti-axial coding (dual / multiple classification):Star "*" : Manifestation Axis : (associated diagnosis)

Dagger "†" : Etiological Axis : (primary diagnosis)

Example : Page 476

H36.0* Diabetic Retinopathy (E10-E14† with the fourth digit .3)

Ex : E10.3† Diabetes mellitus insulin dependent, with ocular complications (Page 292)

[see subdivisions pages 291-292]

When the Dagger and Star symbols are present, they must be both recorded

10/8/2012

24

Dagger "†" : Initial manifestation is generalized

Star "*" : Manifestation localized to one organ, which is in itself a clinical problemThe star code allows to classify the manifestation in the chapter corresponding to the organ (coding in the specialty)

The couple Dagger / Star can also be described as :

NOTE : Many "double coding" are absent from the analytical volume (Vol. 1) They are indicated only in the alphabetic index (Vol. 3)

10/8/2012

25

Particular Categories Of 2 types, in most Chapters

and in certain Groups

1°] Other affections of ...., in diseases classified elsewhere (star codes)

Chapter III : Diseases of the blood … (D50-D89) Page 261

Group : Other diseases of the blood and blood-forming organs (D70-D77) Page 275

Category : D77* Other disorders of blood and blood-forming organs in diseases classified elsewhere Page 279

Fibrosis of spleen in schistosomiasis [bilharziasis] (B65.-+)

Vol. 1 page 175 then Vol. 3 page 440

10/8/2012

26

2°] Disorders .... After an act meant to diagnose and treat , not classified elsewhere (iatrogenic pathology)

Chapter IX : Diseases of the circulatory system (I00-I99) Page 503

Group : Other and unspecified disorders of the circulatory system (I95-I99) Page 547

Category : I97 Post procedural disorders of circulatory system, not elsewhere classified Page 547

10/8/2012

27

Other Rules

Pathological entities to code with the code under which they are inscribed

1°] Inclusions : « Includes"

The lists are never exhaustive(The alphabetical index contains more and others)

2°] Exclusions : « Excludes"

Pathological entities which do not have to be coded with this code

10/8/2012

28

Inclusions and Exclusions Locations

Example : Page 327

Chapter V : Mental and behavioural disorders

Include : psychological development disorder

Exclude : symptoms, signs, and abnormal clinical and laboratory results, not elsewhere classified Chapter XVIII (R00-R99) page 915

Under the Chapter title

10/8/2012

29

Under the Group titleExample :

Chapter I : Certain infectious and parasitic diseases Page 111

Group : Tuberculosis (A15-A19) Page 117

Includes : infections due to Mycobacterium tuberculosis and Mycobacterium bovis

Excludes :

- pneumoconiosis associated with tuberculosis (J65)

[Chapter X : Diseases of the respiratory system]

- sequelae of tuberculosis (B90.-)

- silico-tuberculosis (J65)

- congenital tuberculosis c(P37.0)

[Chapter XVI : Certain conditions originating in the perinatal period ...]

10/8/2012

30

Under the code and the title of the Category

Example 1 :

Chapter V : Mental and behavioural disorders Page 327

Group : Mood [affective] disorders (F30-F39) Page 351

Category : F31 Bipolar affective disorder Page 353

Includes : disease, psychosis, and manioc-depressive reaction

Excludes :

- cyclothymia (F34.0)

- bipolar disorder, isolated maniac episode (F30.-)

10/8/2012

31

Example 2 :

Chapter I : Certain infectious and parasitic diseases Page 111

Under the code and the title of the Category

Group : Other bacterial diseases (A30-A49) Page 126

Category : A32 Listeriosis Page 127

Includes : listerial foodborne infection

Excludes :

neonatal (disseminated) listeriosis (P37.2)

[Chapter XVI : Certain conditions originating in the perinatal period ...]

10/8/2012

32

Under the code and the title of the Sub-Category

Example :

Chapter I : Certain infectious and parasitic diseases Page 111

Group : Tuberculosis (A15-A19) Page 117

Category : A18 Tuberculosis other organs Page 121

Sub-Category : A18.6 † Tuberculosis of the ear Page 122(includes) Tuberculous otitis media+ (H67.0*) [Chapter VIII : Diseases of the ear and adnexa page 493]

Excludes :

tuberculous mastoiditis (A18.0†)10/8/2012

33

In ICD "and" means "or"

3°] Meaning of "and" in the titles

Example :

Chapter I : Certain infectious and parasitic diseases Page 111

Group : Infections with a predominantly sexual mode of transmission (A50-A64) Page 134

Category : A60 Anogenital herpesviral [herpes simplex] infection Page 141

Sub-Category : A60.0 Herpesviral infection of genitalia and urogenital tract Page 141

Means : Infection of genital organs or of the urogenital tract by herpes virus

10/8/2012

34

4°] Meaning of "with"To signify the association of two entities in ICD, one uses the word "with"

Example :

Chapter I : Certain infectious and parasitic diseases Page 111

Group : Protozoal diseases (B50-B64) Page 171

Category : B77 Ascariasis Page 180

Sub-Category : B77.0 Ascariasis with intestinal complications Page 180

10/8/2012

35

5°] Meaning of « Others"

In each category there is a code with a label starting with « other » and which takes back afterwards the category label

The 4th  character of this code is often an "8"

One must understand entities other than those coded in the same category

10/8/2012

36

Example :

Chapter V : Mental and behavioural disorders (F00-F99) Page 327

Group : Disorders of adult personality and behaviour (F60-F69) Page 382

Category : F60 Specific personality disorders Page 382

Sub-Category : F60.8 Other specific personality disordersPage 386

10/8/2012

37

6°] Meaning of "( )" : 4 uses The term in parentheses must be understood as

« specified or not" its presence is complementary

To use the I10 code, the presence of words in parenthesis is complementary

Example :

Chapter IX : Diseases of the circulatory system (I00-I99) Page 503

Group : Hypertension diseases (I10-I15) Page 508

Category : I10 Essential (Primitive) hypertension Page 508Hypertension (arterial) (benign) (essential) (malignant)

(primitive) (systemic)

10/8/2012

38

Dagger code specification in a Category or Sub-Category with Stars (or the contrary)

Example : Page 329

Sub-Category : F00.1* Dementia in Alzheimer disease with late onset (G30.1†)G30.1 Chapter VI, P. 430 : Alzheimer disease with late onset

Note : here the Dagger is not present in volume 1 See Volume 3 Page 35

Parentheses are also used to:

Specify a codeExample : Page 458

H01.1 Blepharitis

Excluding blepharo-conjonctivitis (H10.5)

10/8/2012

39

Parentheses are also used in :

Chapters or Groups titlesExample :

Chapter V : Mental and behavioural disorders

Group : Disorders of adult personality and behaviour (F60-F69) Page 382

10/8/2012

40

7°] Meaning of "[ ]": 3 uses

To include synonyms or explanatory sentences Example : A30 Leprosis [Hansen disease] Page 126

To send back to prior notesExample : Page 194C00.8 Overlapping lesion of lip[see note 5 at the beginning of this chapter page 191]

10/8/2012

41

Example : Page 604 : K26 Duodenum ulcer[See subdivisions page 603]

To refer to a subdivision group with 4 characters previously mentioned which are common to a certain number of categories

Following subdivisions may be used as fourth digit with categories K25-K28 :.0 Acute with haemorrhage

.1 Acute with perforation

.2 Acute with haemorrhage and perforation

.3 Acute without haemorrhage nor perforation

.4 Chronic or not other specified, with haemorrhage

.5 Chronic or not other specified, with perforation

.6 Chronic or not other specified, with haemorrhage and perforation

.7 Chronic without haemorrhage nor perforation

.9 Not other specified as acute or chronic, without haemorrhage nor perforation

10/8/2012

42

8°] Meaning of ":"Colon is used to enumerate the terms to be included or excluded, if the words preceding them are not sufficiently complete

Example : Page 607

K36 Other forms of appendicitis

Appendicitis :

. Chronic

. Recurrent

The "Appendicitis" diagnosis can only be placed there if it is accompanied by the words :chronic » or « recurrent »

10/8/2012

43

« NOS" means : « Not Other Specified"

9°] Meaning of « NOS"

Sometimes a term « NOS" is classified under a code corresponding to a type more specific of the ailment

This is due to the fact that the most frequent form of the ailment is often called by the name of the ailment

Example : Page 553

J04.2 Acute laryngotracheitis

Laryngotracheitis NOS

The laryngotracheitis NOS is coded J04.2 because the acute laryngotracheitis is the most frequent.

10/8/2012

44

"NEC" means : « Not elsewhere classified"

10°] Meaning of « NEC"

Used in the title of a category :Some precise varieties of ailments may appear elsewhere in the classification (As a matter of fact certain precise varieties are « classified elsewhere »)

Example : Page 557

J16 Pneumonia due to other infectious organisms, not elsewhere classified

Some other Pneumopathies are classified elsewhere, for example:

Chapter XVI P23 Congenital pneumonia Page 835

10/8/2012