Classification and Coding
ICD-10
10/8/2012
HCI571 Isabelle Bichindaritz
1
Learning Objectives
• 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
10/8/2012
HCI571 Isabelle Bichindaritz
2
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
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: ICD 9-CM (« clinical modifications » adding areas
of reimbursement, epidemiology, and health
sciences research)
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
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ICD 10 :
Two facets
1°] A Classification
2°] A Coding system
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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
Note : Classification ≠ Nomenclature
Definition of Nomenclature :
A systematic listing of names assigned according to
predefines rules
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ICD 10 Classification Definition
Set of organized groupings for classifying morbid
phenomena and all the reasons for seeking care.
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.
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ICD10 Classification
organization
A] Three fundamental Volumes
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)
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)
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Alphabetical Volume
It contains 3 indexes
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]
3°] Index (Table) of medication and chemical
compounds (tables of noxious effects) Codes Chap.
XIX
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in "T" and Chap. XX in "X" and "Y" [Page 625]
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Analytical Volume
It contains the IC10 Classification
The Structure is of hierarchical type.
The data are stored in hierarchical structures
(like folders in PC)
C:\ICD 10
Folder Chapter
Folder Group
Folder Sub-group Cha. XIII and XX)
Folder Category
Folder Sub-Category
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ICD 10
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
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Example :
Page 112 : A00.9 Cholera, NOS (Code of more than
3 characters)
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Total :
 22 Chapters (21 + 1 in 2006; Le "XXII")
(Update: Page 1268 bis)
 247 Groups (245 + 2 in 2006; "U00-U99")
(Update : Page 1268 bis)
 2050 Categories (2045 + 5 in 2006)
Codes with 3 characters (Update : Page 1268 bis and ter)
 Sous-Categories
Codes with more than 3 characters
Sometimes extensions of ICD 10 codes
with 5 characters (ICD 10 Page 673)
Other national extensions were created bringing the number of
possible
10/8/2012codes to 6 (Update : Chapter V [Mental and behavioural disorders] : Page
328)
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Chapters content
1°] Chapter I to XIX : Diseases descriptions,
traumas, syndromes , symptoms
2°] Chapter XX : External causes of morbidity and of
mortality p. 1089
3°] Chapter XXI : Coding of reasons for seeking care
(medication, surveillance; administrative aspects, social…) p.
1213 [Code "Z"]
4°] Chapter XXII : Codes for particular reasons
"U" code (example : Resistant bacterial agents)
5°] Chapter V : Mental and behavioural disorders
p.327
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[Code "F"]
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A Coding tool
Note : Coding ≠ Encoding
One encodes to protect information from unwanted
users
One codes to transform information in a set of preestablished symbols to facilitate information analysis
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Understanding Terminologies
International Classification of Diseases, Ninth Revision
• 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
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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 5th and 6th
F01.242 : subcortical vascular dementia, with
other symptoms, mixt, severe
ICD 10 WHO + National extension On 6th
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M62.890
: Rhabdomyolysis, unspecified site
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If for a given location in the code the
information does not exist, it is replaced by
the symbol « + »
Example de code format :
ICD 10 WHO with 3 characters +Ext. Nat. on the 5th character :
CNN.+N Example : R53.+2
Fatigue (update. 935)
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
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Example : "J45.-" Asthma Page 571
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Coding by Chapter
In general, we have : One letter = One Chapter
A few exceptions :
Chapter I (infectious diseases …) Two letters A and B
Chapter II (Neoplasms) Two letters, C and part of
D (->D49)
Chapter III (Diseases of the blood…) One part of D (after D50)
Chapter VII (Diseases of the eye …) One part of H (->H59)
Chapter VIII (Diseases of the ear ) One part of H (after H60)
Chapter XIX (Injury…) Two
letters S and T
10/8/2012 XX (External causes…) Four letters V, W, X and Y
Chapter
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The Chapters
Nb of
Categories
Chapters
Letters
Nb
I
Certain infectious and parasitic diseases
II
Neoplasms
III Diseases of the blood and blood-forming organs and certain …
IV Endocrine, nutritional and metabolic diseases
V
Mental and behavioural disorders
VI Diseases of the nervous system
VII Diseases of the eye and adnexa
VIII Diseases of the ear and mastoid process
IX Diseases of teh circulatory system
X
Diseases of the respiratory system
XI Diseases of the digestive system
XII Diseases of the skin and subcutaneous tissue
A-B
C-D
D
E
F
G
H
H
I
J
K
L
186
144
37
78
99
68
49
24
81
65
73
77
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The Chapters
Nb of
Categories
Chapters
Letters
Nb
XIII
XIV
XV
XVI
XVII
XVIII
XIX
XX
XXI
XXII
M
N
O
P
Q
R
S-T
V-W-X-Y
Z
U
84
84
79
62
89
98
196
396
87
2
Diseases of the musculoskeletal system and connective tissue
Diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
Certain conditions originating in the perinatal period
Congenital malformations, deformations and chromosomal…
Symptoms, signs and abnormal clinical and laboratory…
Injury, poisoning and certain other consequences of external…
External causes of morbidity and mortality
Factors influencing health status and contact with health…
Codes of special purposes
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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
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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
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The couple Dagger / Star can also be described as
:
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)
Dagger "†" : Initial manifestation is generalized
NOTE : Many "double coding" are absent from the analytical
volume (Vol. 1) They are indicated only in the alphabetic index
(Vol. 3)
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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 …
Group :
(D50-D89) Page 261
Other diseases of the blood and blood-forming organs (D70D77) 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
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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
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Other Rules
1°] Inclusions : « Includes"

Pathological entities to code with the code under
which they are inscribed

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
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Inclusions and Exclusions Locations

Under the Chapter title
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
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
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
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)
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[Chapter XVI : Certain conditions originating in the perinatal period ...]
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
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.-)
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
Under the code and the title of the Category
Example 2 :
Chapter I : Certain infectious and parasitic diseases Page
111
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 ...]
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
Under the code and the title of the SubCategory
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†)
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3°] Meaning of "and" in the titles
In ICD "and" means "or"
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
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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
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Page 180
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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
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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
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6°] Meaning of "( )" : 4 uses

The term in parentheses must be understood as
« specified or not" its presence 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)
To use the I10 code, the presence of words in parenthesis is
complementary
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Parentheses are also used to:

Specify a code
Example : Page 458
H01.1 Blepharitis
Excluding blepharo-conjonctivitis (H10.5)

Dagger code specification in a Category or SubCategory 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
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Parentheses are also used in :

Chapters or Groups titles
Example :
Chapter V : Mental and behavioural disorders
Group : Disorders of adult personality and behaviour (F60F69) Page 382
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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]
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
To refer to a subdivision group with 4 characters
previously mentioned which are common to a certain
number of categories
Example : Page 604 : K26 Duodenum ulcer
[See subdivisions page 603]
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
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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
»
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9°] Meaning of « NOS"
« NOS" means : « Not Other Specified"
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.
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10°] Meaning of « NEC"
"NEC" means : « Not elsewhere classified"
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
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