1. 10/8/2012HCI571 Isabelle Bichindaritz1 Classification and Coding ICD-10

2. 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 10/8/2012HCI571 Isabelle Bichindaritz2

3. 3 History 1893: 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-9 10/8/2012

4. 4 1993:ICD 10 in English 1993: ICD 10 in English 1994:ICD 10 volume 1 (analytical – diagnosis codes) 1994: ICD 10 volume 1 (analytical – diagnosis codes) 1995:ICD 10 volume 2 (history and coding rules) 1995: ICD 10 volume 2 (history and coding rules) 1996:ICD 10 Volume 3 (alphabetical) and ICD 10 numerical 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) : ICD 9-CM (« clinical modifications » adding areas of reimbursement, epidemiology, and health sciences research)

5. 5 ICD 10 : Two facets 1°] A Classification 2°] A Coding system 10/8/2012

6. 6 A Classification The 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. 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. 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. 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. 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. 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) Categories Example : Page 112 : A00 Cholera (3 character code) Sub-Categories Example : Page 112 : A00.9 Cholera, NOS(Code of more than 3 characters) ICD 10 10/8/2012

12. 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-Categories Codes with more than 3 characters Sometimes extensions of ICD 10 codes with 5 characters (ICD 10 Page 673) 10/8/2012

13. 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. 14 A Coding tool Note : 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

15. 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

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17. 17 Coding Examples ICD 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, hand ICD 10 WHO + National extension On 5 th and 6 th F01.242 : subcortical vascular dementia, with other symptoms, mixt, severe ICD 10 WHO + National extension On 6 th M62.890 : Rhabdomyolysis, unspecified site 10/8/2012

18. 18 Example de code format : ICD 10 WHO with 3 characters + Ext. Nat. on the 5 th 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 6 ème character : CNN.N+N Example : I20.0+0 Unstable angina pectoris with elevated biochemical markers (update. 510) Note : When a Dot-Dash : ".-" replaces the 4 th character, the coder must refer to the sub-category to choose this 4 th character Example : " J45.-" Asthm a Page 571 10/8/2012

19. 19 Coding by Chapter In 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. 20 The Chapters ChaptersLettersNb I Certain infectious and parasitic diseasesA-B186 II NeoplasmsC-D144 III Diseases of the blood and blood-forming organs and certain …D37 IV Endocrine, nutritional and metabolic diseasesE78 V Mental and behavioural disordersF99 VI Diseases of the nervous systemG68 VII Diseases of the eye and adnexaH49 VIII Diseases of the ear and mastoid processH24 IX Diseases of teh circulatory systemI81 X Diseases of the respiratory systemJ65 XI Diseases of the digestive systemK73 XII Diseases of the skin and subcutaneous tissueL77 Nb of Categories 10/8/2012

21. 21 The Chapters ChaptersLettersNb XIII Diseases of the musculoskeletal system and connective tissueM 84 XIV Diseases of the genitourinary systemN84 XVPregnancy, childbirth and the puerperiumO79 XVI Certain conditions originating in the perinatal periodP62 XVIICongenital malformations, deformations and chromosomal…Q89 XVIIISymptoms, signs and abnormal clinical and laboratory…R98 XIX Injury, poisoning and certain other consequences of external…S-T196 XX External causes of morbidity and mortalityV-W-X-Y396 XXIFactors influencing health status and contact with health…Z87 XXIICodes of special purposesU2 Nb of Categories 10/8/2012

22. 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. 23 Choice : Dagger / Star Multi-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. 24 Dagger "†" : Initial manifestation is generalized Star "*" : Manifestation localized to one organ, which is in itself a clinical problem The 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. 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.-+)B65.-+ Vol. 1 page 175 then Vol. 3 page 440 10/8/2012

26. 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. 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. 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. 29  Under the Group title Example : Chapter I : Certain infectious and parasitic diseases Page 111 Group : Tuberculosis (A15-A19) Page 117 Includes : infections due to Mycobacterium tuberculosis and Mycobacterium bovis Includes : infections due to Mycobacterium tuberculosis and Mycobacterium bovis Excludes : Excludes : - pneumoconiosis associated with tuberculosis (J65) [Chapter X : Diseases of the respiratory system] [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. 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. 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...] [Chapter XVI : Certain conditions originating in the perinatal period...] 10/8/2012

32. 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] [Chapter VIII : Diseases of the ear and adnexa page 493] Excludes : tuberculous mastoiditis (A18.0†) 10/8/2012

33. 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. 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. 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 4 th character of this code is often an "8"  One must understand entities other than those coded in the same category 10/8/2012

36. 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 disorders Page 386 10/8/2012

37. 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 508 Hypertension (arterial) (benign) (essential) (malignant) (primitive) (systemic) 10/8/2012

38. 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 code Example : Page 458 H01.1 Blepharitis Excluding blepharo-conjonctivitis (H10.5) 10/8/2012

39. 39 Parentheses are also used in :  Chapters or Groups titles Example : Chapter V : Mental and behavioural disorders Group : Disorders of adult personality and behaviour (F60- F69) Page 382 10/8/2012

40. 40 7°] Meaning of "[ ]": 3 uses  To include synonyms or explanatory sentences Example : A30 Leprosis [Hansen disease] Page 126  To send back to prior notes Example : Page 194 C00.8 Overlapping lesion of lip [see note 5 at the beginning of this chapter page 191] 10/8/2012

41. 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. 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. 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. 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