HEALTH DATA

CLASSIFICATION NOTES I
(HDC106)
Prepared by: Charles Muema
BSC. HRIM
Course outline

 Introduction to ICD, ICPM & Structure of

classification
 Purpose of disease classification
 Major categories of ICD, ICPM & conventions
 Guideline for coding and indexing
Introduction to ICD,ICPM and structures
of classification
 Definition of ICD and ICPM
 Types of classification
 Principles of disease classification
 Historical development of ICD and ICPM
 Current development of ICD and ICPM
 Structure of classification
 General arrangement of ICD and ICPM operations and their application
 Difference between 9th and 10th revisions
 Concept of the family of disease and health related classification
 Diagnosis and non diagnosis classification
Purpose/importance/use of disease
classification
 Standardization
 Management
 Planning
 Research
 Teaching
 Statistical analysis
 Systematic arrangement of health information
 Resource allocation
Major categories of ICD, ICPM and
conventions
 Introduction to major chapters of ICD and ICPM
 Chapters
 Block of categories
 Three character category
 Four character sub categories
 Organization of volume I, II and III of ICD books
 Organization of volume I and II of ICPM
 Supplementary subdivision for use at 5 th or subsequent level
 The unused U codes
 Tabular list of inclusion and 4th character sub categories
 Abbreviations (NOS, NEC, V-Code, M-code, E-code)
 Conventions asterisk, colon, parenthesis, round bracket, dagger, square bracket,
colon, point dash, and in title, cross reference
 Categories with common characteristic
 Inclusion and exclusion terms
Guideline for coding and indexing
 Introduction to morbidity and mortality coding
 Requirement of coding
 discharge summary
 lead term, code number
 primary arrangement
 Use of category code
 Combined category codes
 Use of inclusion and exclusion
 Provisional diagnosis
 Dual classification
 Multiple codes
Introduction to ICD, ICPM & structures of
classification
Definition of terms
ICD – International classification of diseases
ICPM – International classification of procedures in medicine
Medical coding - Refers to the translation of medical terms
for diagnoses and procedures into code numbers from
standardized code sets.
Can also be defined as the process of transforming descriptions
of medical diagnoses and procedures into universal medical code
numbers.
The diagnoses and procedures are usually taken from a variety of
sources within the health care records, such as; the transcription of
the physician's notes, laboratory results, radiologic results among
other records.
Classification of diseases – can be defined as a system of categories
to which morbid entities are assigned according to established
criteria.
WHO-FIC - WHO Family of International Classifications.
CPT - Current Procedural Terminologies
HCPCS – Healthcare Common Procedure Coding system
It is a standardized codes that represent medical procedures,
supplies, products and services
CPT Is a systematic listing of procedures & services performed by
physicians.
Described by Five-digit codes for procedures or services.
CPT is used to describe the physician’s services to a patient for
diagnosis and treatment of the medical condition(s).

Disease - is a particular abnormal condition that affects part or all of

an organism not caused by external force(injury).
A condition in which some abnormality of structure or its function is
present in some parts of the body.

Pathology - The study of disease(s) and their causes

The concept of Family of disease &
health related classification
 Family – a suite of integrated classification products that share similar features
and can be used singularly or jointly to provide information on different aspects of
health and health care system.
 WHO FIC – aims at providing a conceptual framework of information dimensions
which are related to health and health management. This thus ensures a common
language to improve communication and permits comparison of data across
countries health care disciplines, services and time.
 WHO & WHO FIC NETWORK – strive to build a family of classification that is;
i. Based on sound scientific and taxonomic principles
ii. Culturally appropriate and internationally applicable
iii. Focused on multi dimensional aspects of health
 This ensures that it meets the needs of its different users
 It forms the building blocks of health information system
Types of classification
REFERENCE classifications
Cover the main parameters of the health system, such as death,
disease, functioning, disability, health and health interventions.
Product of international agreements that has achieved broad
acceptance and official agreement for use.
Approved and recommended as guidelines for international
reporting on health.
E.g. International Classification of Diseases (ICD), International
Classification of Functioning, Disability and Health (ICF) and
International Classification of Health Interventions (ICHI).
 DERIVED Classifications
Prepared either by; Adopting the reference classification structure, or
Through rearrangement or aggregation of items from one or more
reference classifications.
Provide additional detail beyond that provided by the reference
classification
Often tailored for use at the national or international level.
It include specialty-based adaptations of ICF and ICD, such as;
 International Classification of Diseases for Oncology, Third
Edition(ICD-O-3) ,
 The ICD-10 Classification of Mental and Behavioural Disorders.
 Application of the International Classification of Diseases to Dentistry
and Stomatology, Third Edition (ICD-DA).
 Application of the International Classification of Diseases to
Neurology(ICD-10-NA)
 ICF, Children & Youth Version (ICF -CY).
RELATED Classifications
Are those that partially refer to reference classifications, or that are
associated with the reference classification at specific levels of the
structure only.
For example;
 International Classification of Primary Care (ICPC)
 International Classification of External Causes of Injury (ICECI)
 The Anatomical, Therapeutic, Chemical (ATC) classification
system with Defined Daily Doses (DDD)
 ISO 9999 Technical aids for persons with disabilities –
Classification and Terminology.
Sub types of classification

 Diagnosis related classification

 Non-diagnosis classification
Diagnosis related classification
i. Special tabulation list
ii. Specialty based adaptation
a. Special tabulation list
Derived directly from the core classification
Used in data presentation and in facilitating analysis of health status and trends at
the national and international levels
There are 5 such list recommended for international comparisons and publications and
are included in volume one of ICD 10.(4 for mortality and 1 for morbidity 298 causes)
see ICD 10 volume 1 pg 1167
Mortality list
i. The condensed list (general 103 causes, infant & child mortality 67 causes)
ii. The selected list (general 80 causes, infant & child mortality 51 causes)
iii. Use of prefixes to identify mortality list
iv. Locally designed list
b. Specialty based adaptations
They usually bring together in a single compact volume the sections or categories
of the ICD that are relevant to a particular specialty
Examples of specialty based adaptations

 Oncology (ICD-O-3)
 Dermatology
 Dentistry and stomatology (ICD-DA).
 Neurology (ICD-10-NA)
 Rheumatology and orthopeadics
 Peadiatrics
 Mental disorders
Non-diagnosis classification

1) ICPM
2) ICF
ICPM
Published in 2 volumes by WHO in 1978
Includes procedures for medical diagnosis, prevention therapy, radiology, drugs,
surgical and laboratory procedures
Adopted by some countries and used by other countries to develop their own
No revision of ICPM in conjunction with ICD 10
ICF
Published by WHO IN 2001
Was in all the six WHO languages (English, Arabic, Chinese, French, Russia & Spanish)
Later translated into over 25 languages.
It superseded international classification of impairments, disability and handicaps (ICIDH)
Functioning – a generic term for body functions, structures, activities and participation. It
denotes the positive aspect of interaction between an individual and contextual factors
Disability – term for impairments, activity limitation and participation restrictions. It
demotes the negative aspect of interaction between an individual and contextual factors
Body functions – the physiological and psychological functions of the body systems
Body structures – anatomical structures of the body
Impairments – problems in body function and structure
Activity – execution of a task or function by an individual
Participation – involvement in a life situation
Participation restriction – difficulties in involvement in a life situation
Environmental factors – the physical, social and attitudinal environment in which people
live
ICF used alphanumeric system
I.e. letters b, s, d & e and numeric codes starting with chapter number(1 digit),
then second level(2 digits) and third and fourth levels (1 digit).
b-body function
s- body structures
d- activities and participation
e- environmental factors
Its nested so that broader categories are defined to include more detailed sub
categories
Principles of disease classification
A statistical classification of diseases must be confined to a
limited number of mutually exclusive categories able to
encompass the whole range of morbid conditions. The categories
have to be chosen to facilitate the statistical study of disease
phenomena.
Every diseaseor morbid condition must have a well defined
place in the list of categories. Consequently, throughoutthe
classification, there will be residual categories for other
and miscellaneous conditions thatcannot be allocated to the more
specific categories. As few conditions as possible should
be classified to residual categories.
A statistical classification of diseases should retain the
ability both to identify specific disease entitiesandto allow
statistical presentation of data for broader groups, to enable useful
and understandable information to be obtained.
Types of codes
a. Diagnostic codes
Are used to determine diseases, disorders, and symptoms.
Are usually used to measure morbidity and mortality
For example: ICD-9, ICD-10
b. Procedural codes
They are numbers or alphanumeric codes used to identify specific
health interventions taken by medical professionals.
For example: CPT, Current Procedural Terminologies.
c. Pharmaceutical codes
Are used to identify medications
For examples: NDC, National Drug Codes.
The NDC, or National Drug Code, is a unique 10-digit, 3-segment
number.
It is a universal product identifier for human drugs in the United
States
The code is present on all non-prescription (OTC) and prescription
medication packages and inserts in the US.
RESPONSIBILITIES OF A MEDICAL CODER

The coder is primarily responsible for abstracting and assigning the

appropriate coding on the claims.
i. The Coder checks a variety of sources within the patient’s
medical record, (i.e. the transcription of the doctor’s notes,
ordered laboratory tests, requested imaging studies and other
sources) to verify the work that was done.
ii. He/she the assign CPT codes, ICD-10/11 codes and HCPCS
codes to both report the procedures that were performed.
iii. They also provide the medical biller with the information
necessary to process a claim for reimbursement by the
appropriate insurance agency.
IMPORTANCE OF MEDICAL CODING
1. Coding presents standardized codes which accurately report
medical services and facilitate payment.
E.g. of information coded from; Diagnosis codes: International
statistical Classification of Diseases, ICD-10.
Procedure codes: Current Procedural Terminology (CPT), Facility
Procedures. Supplies: Healthcare Common Procedures Coding
System (HCPCS).

2. Correct code assignment is important and plays a significant role

in: Resource utilization, Reimbursement
3. Correct code assignment permits access to
medical records by diagnoses and procedures for
use in: Clinical care ,Research, Education

4. Correct code assignment is beneficial to health

policy development and planning.
Historical development of ICD
 In the 17th century John Graunt tried to classify mortality data into some
logical form. As a result he came up with London Bill of Mortality. He made
an attempt to estimatethe proportion of liveborn children who died
before reaching the age of six years, no records of age at death
being available.
 1706-1777 Australian statistician known as Sauvages. His comprehensive
treatise was published under the title Methodica Nosolagia
 1707- 1778 Linnaeus who was a great Methodologist developed a
classification and one of his treatise entitled Genora Morborum
 In the 19th century 1710-1790 William Cullen is credited for his contribution
in a document published in 1785 under Synopsis Nosologiae Methodicae
 1807-1883 a medical statistician known as William Farr. This man not only
made the best possible use of the imperfect classifications of
disease available at the time, but labouredto secure better
classifications and international uniformity in their use
Adoption ofthe International List of
Causes ofDeath
 TheInternational Statistical Institute, the successor to the
International Statistical Congress, at its meeting in Vienna in
1891, charged a committee, chaired by Jacques Bertillon (1851–
1922), Chief of Statistical Services of the City of Paris, with
the preparation of a classification of causes of death
 The report of this committee was presented by Bertillon at the
meeting of the International Statistical Institute in Chicago in 1893
and adopted by it. The classification prepared by Bertillon’s
committee was based on the classification of causes of death
used by the City of Paris, which, since its revision in 1885,
represented a synthesis of English, German, and Swiss
classifications. The classification was based on the principle,
adopted by Farr, of distinguishing between general diseases and
those localized to a particular organ or anatomical site
 Bertillon included three classifications: the first, an abridged
classification of 44 titles; the second, a classification of 99 titles;
and the third, a classification of 161 titles.
 The Bertillon Classificationof Causes of Death, as it was first
called, received general approval and was adopted by several countries,
as well as by many cities.
 In 1898, the American Public Health Association, at its meeting
in Ottawa, Canada, recommended the adoption of the Bertillon
Classificationby registrars of Canada, Mexico, and the United States
of America. The Association further suggested that the
classification should be revised every ten years.
 August 1900, the first International Conference for the Revision of
the Bertillon or International List of Causes of Death. Delegates
from 26 countries attended this Conference. A detailed
classification of causes of death consisting of 179 groups and
an abridged classification of 35 groups were adopted on 21
August 1900. The desirability of decennial revisions was
recognized, and the French Government was requested to call the
next meeting in 1910. In fact the next conference was held in 1909, and the
Government of France called succeeding conferences in 1920,
1929 and 1938.
 Bertillon continued to be the guiding force in the promotion
of the International List of Causes of Death, and the revisions of
1900, 1910 and 1920 were carried out under his
leadership. As Secretary-General of the International Conference,
he sent out the provisional revision for 1920 to more than 500
people, asking for comments. His death in 1922 left the International
Conference without a guiding hand.
The Fifth Decennial Revision
Conference
 The Fifth International Conference for the Revision of the
International List of Causes of Death, like the preceding
conferences, was convened by the Government of France and was
heldin Paris in October 1938. The Conference approved three
lists: a detailed list of 200 titles, an intermediate list of 87
titles and an abridged list of 44 titles
 The Sixth Decennial Revision Conference in 1948 was a significant event in
international vital and health statistics. It recommended the adoption of a
comprehensive programme of international cooperation in the field of vital
and health statistics.
 The Seventh Revision Conference was held in Paris in 1955 and, the revision
was limited to essential changes.
 The Eighth Revision Conference was convened by WHO in Geneva in1965. The
Eighth Revision was much more extensive.
 The International Conference for the Ninth Revision was convened by WHO in
Geneva in 1975 and it came into effect from1979.
 ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990
and came into use in WHO Member States as from 1994. India adopted this
classification in the year2000.
PURPOSE OF ICD
 The ICD is the foundation for the identification of health trends and statistics globally.
 The ICD provides a common language for the classification of diseases, injuries and causes of
death, and for the standardized reporting and monitoring of health conditions.
 It is the international standard for defining and reporting diseases and health conditions.
 These entities are listed in a comprehensive way so that everything is covered.
 ICD allows the counting of deaths as well as diseases, injuries, symptoms, reasons for
encounter, factors that influence health status, and external causes of disease.
 It organizes information into standard groupings of diseases, which allows for:
a. Easy storage, retrieval and analysis of health information for evidence-based decision making
b. Sharing and comparing health information between hospitals, regions, settings and countries
c. Data comparisons in the same location across different time periods.
 It is the diagnostic classification standard for all clinical and research purposes. These
include; Monitoring of the incidence and prevalence of diseases, Observing reimbursements
and resource allocation trends and Keeping track of safety and quality guidelines.
 To permit systematic recording, analysis, interpretation and comparison of
mortality and morbidity data
 Translates diagnoses of diseases and other health problems from words to
alphanumeric code thus enabling easy storage, retrieval and analysis of data
 It is the international standard diagnostic classification for all general
epidemiological and many health management purpose. Eg
i. Analysis of general health situation of population groups
ii. Monitoring of incidence and prevalence of disease and other health
problems
 Can be used to classify data recorded as diagnosis, reason for admission,
condition related and reason for consultation
 Its original use was to classify causes of mortality as recorded at the
registration of death. Later its scope was expanded to include disease in
morbidity
Applicability of ICD

 Population Health; Births, Deaths, Diseases, Disability, Risk factor.

 Clinical; Decision Support, Integration of care, Outcome, Research.
 Administration; Scheduling, Resources, Billing, Policy Making
 Reporting; Cost based, Needs based, Outcome based.
USES OF ICD

1. To allow easy storage, retrieval and analysis of data.

2. To allow systematic recording, analysis, interpretation and comparison of
mortality and morbidity data between hospitals, provinces and countries.
(statistical analysis)
3. To allow comparisons in the same location across different time periods.
4. To plan health care services
5. To improve patient care
6. To control costs
7. In undertaking legal actions
8. In research studies.
9. Resource allocation
The structure, general arrangement and
application of ICD
The ICD is a variable axis classification with its structure developed out of that
proposed by William Farr. He proposed that a statistical data on diseases should be
grouped in the following ways
 Epidemiological diseases
 Constitutional or general diseases
 Local diseases arranged by site
 Developmental diseases
 Injuries
This pattern as withstood the test of time as identified in ICD 10. Is still regarded as a
more useful structure for general epidemiological purposes than any of the
alternatives tested.
The first 2 and last 2 groups comprise of special groups and the remaining group
includes ICD chapters for each of the main body system
The distinction between the ‘special groups’ chapters and the ‘body systems’
chapters has practical implications for understanding the structure of the
classification, for coding to it, and for interpreting statistics based on it.
It has to be remembered that, in general, conditions are primarily
classified to one of the ‘special groups’ chapters. Where there is
any doubt as to where a condition should be positioned, the
‘special groups’ chapters should take priority.

The basic ICD is a single coded list of three-character categories, each of which
can be further divided into up to 10 four-character subcategories.
In place of the purely numeric coding system of previous revisions, the
Tenth Revision uses an alphanumeric code witha letter in the
first position and a number in the second, third and fourth positions.
The fourth character follows a decimal point. Possible code numbers therefore
range from A00.0 to Z99.9. The letter U is not used
Arrangement of ICD 10
Comprises 3 volumes.
Volume 1 – tabular list (main/core classification)
Volume 2 – instructional manual (guilds users of ICD)
Volume 3 – alphabetical index
Volume 1
Is a list of three-character categories
Composed of the list of three-character categories and the list of inclusions and
four character subcategories
The mandatory level for reporting to the WHO mortality database and general
international comparisons
It lists chapters and block titles
Also contains the following;
 Morphology of neoplasm (codes same as ICD-O)
 Special tabulation list (list 1 and 2 for general mortality, 3&4 for infant and
child mortality (0-4 yrs)
 Definitions
 Nomenclature regulations
Chapters of ICD 10
CHAPTER BLOCKS TITLE

I A00-B99 Certain infectious and parasitic diseases

II C00-D48 Neoplasm

III D50-D89 Diseases of the blood and blood forming organs

and certain disorders involving immune
mechanism

IV E00-E90 Endocrine, nutrition and metabolic diseases

V F00-F99 Mental and behavioural diseases

VI G00-G99 Diseases of the nervous system

VII H00-H59 Diseases of eye and adnexa

VIII H60-H95 Diseases of the ear and mastoid process

IX I00-I99 Diseases of circulatory system

X J00-J99 Diseases of respiratory system

XI K00-K93 Diseases of digestive system

XII L00-L99 Diseases of the skin and subcutaneous tissue

XIII M00-M99 Diseases of the musculoskeletal system and
connective tissue

XIV N00-N99 Diseases of the genitourinary system

XV O00-O99 Pregnancy, child birth and peurperium

XVI P00-P96 Certain conditions originating in the perinatal

period

XVII Q00-Q99 Congenital malformations, deformations and

chromosomal abnormalities
XVIII R00-R99 Symptoms, signs and abnormal clinical findings
not elsewhere classified.

XIX S00-T98 Injury, poisoning and certain other

consequences of external causes

XX V01-Y98 External causes of morbidity and mortality

XXI Z00-Z99 Factor influencing health status and contact

with health services

XXII U00-U99 Codes for special purposes

 Chapters of ICD 10
volume 1
The first character is a letter associated with a particular chapter except for D (chapter II & III)
and H in ( chapter VII & VIII)
4 chapters use more than one letter. (chapters I, II, XIX & XX)
Not all available codes are used. This is to allow space for future revisions and expansion.
ChaptersI–XVII relate to diseases and other morbid conditions,
Chapter XIX to injuries, poisoning and certain other consequences of external causes. The
remaining chapters complete the range of subject matter nowadays included in diagnostic data.
Chapter XVIII coversSymptoms, signs and abnormal clinical and laboratory findings, not
elsewhere classified.
Chapter XX, External causesof morbidity and mortality, was traditionally used to classify causes
of injury and poisoning, but, since the Ninth Revision, has alsoprovided for any recorded external
cause of diseases and other morbid conditions.
Chapter XXI, Factors influencing health status and contact with health services, is intended for
the classification of data explaining the reasonfor contact with health-care servicesof aperson
not currently sick, or the circumstances in which the patient is receivingcare at that
particular time or otherwise havingsomebearing onthat person’s care
Blocks of categories
The chapters are subdivided into homogeneous(same kind) ‘blocks’ of three-character
categories.
The blocks are based on
1) Topography—anatomical site
2) Aetiology—causative factor
3) Morphology—histology, form, structure; malignant, benign
4) Function

In Chapter I, theblock titles reflect two axes of classification – mode of transmission and
broad group of infecting organisms.
In Chapter II, the first axis is the behavior of theneoplasm; within behavior, theaxis is
mainly bysite, although afew three-character categories are provided for important
morphologicaltypes (e.g. leukemia, lymphomas, melanomas, mesotheliomas, Kaposi
sarcoma).

The range of categories is given in parentheses after eachblock title.

Three-character categories

 Within each block, some of the three-character categories are for single
conditions, selected because of their frequency, severity or susceptibility to
public health intervention, while others are for groups of diseases with some
common characteristic.
 There is usually provision for ‘other’ conditions to be classified, allowing
many different but rarer conditions, as well as ‘unspecified’ conditions, to be
included.
Four-character subcategories

Although not mandatory for reporting at the international level,

mostof the three character categories are subdivided by means of a
fourth numeric character after a decimal point, allowing up to 10
subcategories.
Where a three-character category isnotsubdivided, itisrecommended that
theletter ‘X’ be used to fill the fourth position so that the codes are of a
standard length for data-processing.
The fourth character .8 is generally used for ‘other’ conditions belonging to
the three-character category, and .9 is mostly used to convey the same
meaning as the three-character category title, without adding any additional
information.
When thesame fourth-charactersubdivisions apply to a range of three-
character categories, they are listed once only, at the start of the range.
Supplementary subdivisions for use at
the fifth or subsequent character level
The fifthand subsequent character levels areusually subclassifications along a
different axis from thefourth character. They arefound in:

Chapter XIII – subdivisions by anatomical site (pg 562)

Chapter XIX – subdivisions toindicate open and closed fractures aswell as

intracranial, intrathoracic and intra-abdominal injuries with and without open
wound (pg 827)
Chapter XX – former subdivisions to indicate the type of activity being
undertaken at the time of the event have now become optional additional
information that is recorded in a separate field (pg 895)
The unused ‘U’ codes

Codes U00–U49 are to be used by WHO for the provisional

assignment of new diseases of uncertain etiology. (eg covid 19 ICD10
code is U07.1, U07.2) ICD 11 RA01.0

Codes U50–U99 may be used in research, e.g. when testing an alternative

subclassification for a special project. Currently the range includes Severe
acute respiratory syndrome (SARS), and special codes for bacterial agents
resistant to antibiotics.

Refer to page 1033 of volume 1

 Blocks practicals
Use of tabular list of inclusions and four
character subcategories
Inclusion terms- a listed number of other diagnostic items given in addition to
the tittle, as examples of other diagnostic terms classifiable under that rubric
 In the context of the ICD, ‘rubric’ denotes either a three-character category
or a four-character subcategory
Exclusion terms - These are terms which, although the rubric title might suggest
that they were to be classified there, are in fact classified elsewhere
Glossary descriptions - In addition to inclusion and exclusion terms, Chapter V,
Mental and behavioural disorders, uses glossary descriptions to indicate the
content of rubrics
Two codes for certain conditions

a) Dagger (†)- underlying condition/generalized disease (the primary code)

b) Asterisk (*). – manifestation in a particular organ or site (optional additional
code)
Eg A17.0, A18.1, A54.8
Refer to page 20-23 of ICD volume 2
Conventions used in the tabular list

1) Parentheses ( )
 used to enclose supplementary words, which may follow a
diagnostic term without affecting the code number, (hypertension)
 used to enclose the code to which an exclusion term
refers. (blepharitis-inflammation of eyelids)
 to enclose the three character codes of categories included in that block
 to enclose the dagger code in an asterisk category or the asterisk code
following a dagger term.
2) Square brackets [ ]
 for enclosing synonyms, alternative words or explanatory
phrases (A30)
 for referringto previous notes (C00.8)
 for referringto a previously stated set of fourth character
subdivisions common to a number of categories (K27)
3) Colon :
A colon is used in listings of inclusion and exclusion terms when the words that
precede it are not complete terms for assignment to that rubric (K36)
4) Brace } indicated by a vertical line
is used in listings of inclusionand exclusion terms to indicate that
neither the words that precede it nor the words after it are complete terms
(O71.6)
5) ‘NOS’
abbreviation for “not otherwise specified”, implying “unspecified”
or “unqualified”.
6) “Not elsewhere classified” NEC
The words “not elsewhere classified”, when used in a three-
character category title, serve as a warning that certain specified
variants of the listed conditions may appear in other parts
of the classification. (J16,J18)
7) Point dash.
This indicates to the coder that a fourth character exists and should be sought in
the appropriate category
1. “And” in tiles A18.0+
 V – Code – supplementary classification of factors influencing health status
and contact with health services. Used in a same way as Z code in ICD 10
 M – Code – diseases of musculoskeletal system and connective tissue (M00-
M99). Also refer to morphology of neoplasms in ICD-O
 E – Code – supplementary classification of cause of injury and poisoning
Categories with common characteristics

 Asterisk categories
 Categories limited to one sex
 Sequelae categories (for sequelae of conditions nolonger in an active phase)
 Postprocedural disorders

Refer to pg 26 of instructional manual

Arrangement of the Alphabetical Index
volume 3
Section I lists all the terms classifiable to ChaptersI–XIX and
Chapter XXI, except drugs and other chemicals;
Section II is the index of external causes of morbidity and
mortality and contains all the terms classifiable to Chapter XX,
except drugs and other chemicals;
Section III, the Table of Drugs and Chemicals, lists for each
substance the codes for poisonings and adverse effects of drugs
classifiable to Chapter XIX, and the Chapter XX codes that indicate
whether the poisoning was accidental, deliberate (self-harm),
undetermined, or an adverse effect of a correct substance
properly administered.
Structure

The Index contains ‘lead terms’, positioned to the far left of the column,
with other words (‘modifiers’ or‘qualifiers’) atdifferent levels of
indentation under them.
In Section I, these indented modifiers orqualifiers are usually varieties,
sites orcircumstances that affect coding;
in Section II they indicatedifferent types ofaccident oroccurrence,
vehicles involved, etc. Modifiers that do not affect coding appear in
parentheses after the condition.
Code numbers

The code numbers that follow the terms refer to the categories and
subcategories to which theterms should be classified.
If the code has only three characters, it can be assumed that the category has
not been subdivided.
In most instances where thecategory hasbeen subdivided, thecode numberin the
Indexwill give thefourth character.
A dash in thefourth position (e.g. O03.-) This means that the category hasbeen
subdivided and that thefourth character can be found by referring to the
tabular list.
If the dagger and asterisk system applies to the term, bothcodes aregiven.
Conventions used in alphabetical index

Parenthesis (same vol one)

NEC
NEC (not elsewhere classified) indicates that specified variants of
the listed condition are classified elsewhere, and that, where
appropriate, a more precise term should be looked for in the
Index.
Cross references
Cross references are used to avoid unnecessary duplication of
terms in the Index. The word “see” requires the coder to
refer to the other term; “see also” directs the coder to
refer elsewhere in the Index if the statement being coded contains other
information that is not found indented under the term to which “see also”
is attached.
GENERAL ARRANGEMENT OF ICPM
Volume1
 1. PROCEDURES FOR MEDICAL DIAGNOSIS
 2. LABORATORY PROCEDURES
 4. PREVENTIVE PROCEDURES
 5. SURGICAL PROCEDURES
 8. OTHER THERAPEUTIC PROCEDURES
 9. ANCILLARY PROCEDURES
GENERAL ARRANGEMENT OF ICPM
Volume 2
 3. RADIOLOGY AND CERTAIN OTHER
APPLICATIONS OF PHYSICS IN MEDICINE
 6 & 7. DRUGS, MEDICAMENTS, AND
BIOLOGICAL AGENTS
Assignment

1) Read and make notes on general characteristics and content of the prosed
10th revision of the ICD (ref page 15 of volume 1 of ICD 10) (group 1 & 8)

2) Make a list of all category blocks under every chapter (VOL 1, ICD 10) (group 2
& 7)

3) Difference between ICD 9 and ICD 10 (American Medical Association web

page)- No of chapters, structure etc. (group 3 & 6)
4) The concept of Family of disease & health related classification (group 4 & 5)
5) Structure and arrangement of ICPM
GUIDELINES FOR CODING AND INDEXING
Introduction
The Alphabetical Index contains many terms not included in Volume 1, and
codingrequires that both the Index and the Tabular List should be consulted
before a code is assigned.

SOME OF THE REQUIREMENTS FOR CODING

 Discharge summary
 Diagnosis
 Lead term
 ICD books
 Knowledge in Primary arrangement (indices and modifiers)
Indices – the dash (-) that is followed by a word (modifier) after the main entry
or lead term. Used to indicate a sub category of the lead term
Modifier/qualifier- the word after the dash which describes the lead term or the
word above the dash/hyphen.
Eponyms - A person after whom a discovery, invention, place, etc., is named or
thought to be named. E.g.. Downs syndrome after John Langdon Down
Lead term – is the guiding term used in coding which usually is a disease or
condition
Diagnosis - the identification of the nature of an illness or other problem through
examination.
Provisional Dx – is inconclusive diagnosis made before the full diagnosis.
CODING PROCEDURE
1. Identify the type of statement to be coded and refer to the appropriate section
of the Alphabetical Index. (If the statement is a disease or
injury or other condition classifiable to ChaptersI–XIX or
XXI, consult Section I of the Index. If the statement is
the external cause of an injury or other event classifiable
to Chapter XX, consult Section II.)
2. Locate the lead term. For diseases and injuries this is usually a noun for the
pathological condition. However, some conditions expressed
as adjectives or eponyms are included in the Index as lead terms.
3. Read and be guided by any note that appears under the lead term.
CODING PROCEDURE
5. Read any terms enclosed in parentheses after the lead term (these modifiers do
not affect the code number), as well as any terms indented under the lead
term (these modifiers may affect the code number), until allthe words in the
diagnostic expression have been accounted for.
6. Follow carefully any cross-references (“see” and “see also”) found in the
Index.
7. Refer to the tabular list to verify the suitability of the code number
selected.Note that a three-character code in the Index with a dash in the
fourth position means that there is a fourth character to be found in Volume 1.
Further subdivisions to be used in a supplementary character
position are not indexed and, if used, must be located in Volume 1.
8. Be guided by any inclusion or exclusion terms under the selected code or under
the chapter, block or category heading.
9. Assign the code.
 Varicella pneumonia
 B01.2† (J17.1*)
 Gastro-esophageal reflux disease with esophagitis
 K21.0
 Tuberculous meningitis
 A17.0† (G01*)

.
 Fracture of forearm
 S52
 Fracture of lower end of radius
 S52.5
 Torus fracture of lower end of radius
 S52.53
 Torus fracture of lower end of right radius
 S52.521
 Torus fracture of lower end of right radius, initial encounter for closed fracture
 S52.521A
 In the above example, S52 is the category.
 The fourth and fifth characters of “5” and “2” provide additional clinical
detail and anatomic site.
 The sixth character in this example indicates laterality, i.e., right radius.
 The seventh character, “A”, is an extension that provides additional
information, which means “initial encounter” in this example
1) lobar pneumonia
2) carcinoma of head of pancreas
3) prostatic adenoma
4) pedestrian hit by truck
5) cirrhosis of liver
6) rheumatic heart disease
7) fibrocystic disease of the pancreas
1) (J18.1)
2) (C25.0)
3) (D29.1)
4) (V04.1)
5) (K74.6)
6) (I09.9)
7) (E84.9)
Assignment

Discuss the following

 Difference between 9th and 10th revisions
 Supplementary subdivision for use at 5th or subsequent level
 The unused U codes
 Abbreviations (NOS, NEC, V-Code, M-code, E-code)
 Categories with common characteristic
 Use of category code
 Combined category codes
ICD DECENNIAL REVISIONS
1) 1900 - France (Jacques Bertillon)
2) 1910 - France (Jacques Bertillon)
3) 1920 - France (Jacques Bertillon) Died in 1922
4) 1929 - France
5) 1938 – France (Paris)
6) 1948 – France (Paris)
7) 1955 – Paris auspices of WHO adopted in1956
8) 1965 - Geneva (WHO) adopted in1966
9) 1975 - Geneva (WHO) adopted in1976
10) 1989 - Geneva (WHO) adopted in1990
11) 2016 – Tokyo Japan (WHO) adopted in 2019
HISTORY
1. John Graunt on the London Bills of Mortality
Attempt to estimate the proportion of liveborn children who died before
reaching the age of six years,
2. (1706–1777) François Bossier de Lacroix (Sauvages)- Australian statistician
First attempt to classify diseases systematically
Treatise was published under the title Nosologia methodica
3. (1707–1778) Linnaeus, A contemporary of Sauvages - was a great
methodologist
Treatises was entitled Genera morborum
4. (1710–1790) William Cullen of Edinburgh at the beginning of the 19th century
Synopsis nosologiae methodicae published in 1785
5. (1807–1883) William Farr, first medical statistician of the General Register Office of England
and Wales founded in 1837
Made the best possible use of the imperfect classifications of disease available at the
time
Labored to secure better classifications and international uniformity in their use.
Urged the adoption of a uniform classification
6. (1851–1922) Jacques Bertillon, Chief of Statistical Services of the City of Paris
Charged with the preparation of a classification of causes of death by International
Statistical Institute, the successor to the International Statistical Congress, at its
meeting in Vienna in 1891
Grandson to Achille Guillard, a noted botanist and statistician
Introduced the resolution requesting Farr and d’Espine to prepare a uniform
classification at the first International Statistical Congress in 1853
HISTORY cont…
 The first International Statistical Congress was held in Brussels in 1853,
 The Congress requested William Farr and Marc d’Espine, of Geneva, to prepare an
internationally applicable, uniform classification of causes of death.
 At the next congress, in Paris in 1855, Farr and d’Espine submitted two separate
lists, which were based on very different principles.
 Farr’s classification was arranged under five groups:
1) epidemic diseases,
2) constitutional (general) diseases,
3) local diseases arranged according to anatomical site,
4) developmental diseases and
5) diseases that are the direct result of violence.
 d’Espine classified diseases according to their nature (gouty, herpetic, haematic,
etc.).
 The congress adopted a compromise list of 139 rubrics. In 1864, this classification
was revised in Paris, on the basis of Farr’s model, and was subsequently further
revised in 1874, 1880 and 1886.