ICD 10 : Basic Coding
Guidelines
Dr. M.M. Singh
M.D., D.N.B. (SPM), D.N.B (HH Admn.), MAMS
Associate Professor
Maulana Azad Medical College, New Delhi
ICD 10
International Statistical Classification of Diseases and
Related Realth ProblemsTenth Revision
Volume 1 :
• Introduction
• Tabular list
• Morphology of neoplasms
• Special tabulation lists for mortality and morbidity
• Definitions
• Regulations
Volume 2 :
Instruction manual
Volume 3 :
Alphabetical indexss
ICD 10 : COMPOSITION OF CHAPTERS
Chapter number an designation
I Certain infectious and parasitic diseases
II Neoplasms
III Disease of the blood and blood forming
organs and certain disorders involving the
immune mechanism
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 the circulatory system
X Diseases of the respiratory system
Range of codes
A00-B99
C00-D48
D50-D89
E00-E90
F00-F99
G00-G99
H00-H59
H60-H95
I00-I99
J00-J99
ICD 10 : COMPOSITION OF CHAPTERS
Chapter number an designation
Range of codes
XI Diseases of the digestive system
XII Disease of the skin and subcutaneous tissue
XIII Diseases of the musculo-skeletal system and
connective tissue
XIV Disease of the genito-urinary system
XV Pregnancy, childbirth and the puerperium
XVI Certain conditions originating in the
perinatal period
XVII Congenital malformations, deformations,
and chromosomal abnormalities
K00-K93
L00-L99
M00-M99
N00-N99
O00-O99
P00-P95
Q00-Q99
ICD 10 : COMPOSITION OF CHAPTERS
Chapter number and designation
Range of codes
XVIII Symptoms, signs and abnormal clinical
and laboratory findings, not elsewhere
classified
R00-R99
XIX Injury, poisoning and certain other
consequences of external causes
S00-T98
XX External causes of morbidity and mortality
XXI Factors influencing health status and
contact with health services
V01-Y98
Z00-Z98
CHAPTER XXI FACTORS INFLUENCING
HEALTH STATUS AND CONTACT WITH
HEALTH SERVICES
Persons with potential health hazards related to socio economic
circumstances (Z55-Z65)
• Z55 Problems related to education and literacy
• Z55.3 Under achievement in school
• Z56 Problems related to employment and unemployment
• Z56.2 Threat of job loss
• Z60 Problems related to social environment
• Z60.3 Acculturation difficulty
• Z65 Problems related to other psychological circumstances
• Z65.4 Victim of crime and terrorism (Includes victim of torture)
ICD 10 Chapters
• 21 chapters
• 1st character – letter, each for a chapter except.
• D – both in chap. II, neoplasms & Chap III, diseases of blood &
blood forming organs & certain disorders involving the immune
mechanism
• H-Chap VII diseases of the eye & adnexa, & chap. VIII, diseases of
the ear and mastoid process
• Four chaps. Use more than one letter – I, II, XIX, XX
• I- XVII relate to disease & other morbid conditions
• XVIII – symptoms, signs, abnormal clinical & lab. Findings, not
elsewhere classified
• XIX – injuries, poisoning & certain other consequences of external
causes
STRUCTURE OF AN ICD 10 CODE
• F20.10 Hebephrenic schizophrenia continuous course
• Mental and Behavioural disorder
20 Schizophrenia
.1 Hebephrenic type
0 Continuous course
5, 6th character – for specific purpose/research
“U” codes – unused codes
Addition of signs/symbols ( ), [ ], † , *, -
STRUCTURE OF AN ICD 10 CODE
• TUBERCULOSIS (A15-A19)
• Includes : Infections due to Mycobacterium
tuberculosis and Mycobacterium bovis
• Excludes : Congenital tuberculosis (P37.0)
• Pneumoconiosis associated with tuberculosis (J65)
• Sequelae of tuberculosis (B90.-)
• Silicotuberculosis (J65)
STRUCTURE OF AN ICD 10 CODE
•
A15 Respiratory tuberculosis bacterilogically and histologically
confirmed
• A15.0 Tuberculosis of lung, confirmed by sputum microscopy with or
without culture
Tuberculous :
Bronchiectasis } (Confirmed by sputum microscopy with or without culture)
Fibrosis of lung}
Pneumonia}
Pneumothorax }
• A 18 Tuberculosis of other organs
• A 18.1 † Tuberculosis of genitourinary system
• Tuberculosis of :
• Bladder (N 33.0 *)
• N 33 * Bladder disorders in diseases classified elsewhere
• N 33.0 * Tuberculous cystitis (A18.1 †)
• Male genital organs (N 51.-*)
STRUCTURE OF AN ICD 10 CODE
• Male genital organs (N 51.- *)
• N51.* Disorders of male genital organs in diseases classified
elsewhere
• N 51.0 * Disorders of prostate in diseases classified elsewhere
Prostatitis :
• Gonococcal (A 54.2 †)
• Trichomonal ( A59.0 †)
• Tuberculous (A 18.1 †)
• N 51.1 * Disorders of testis and epididymis in diseases classified
elsewhere
• Tuberculosis of :
• Epididymis (A18.1 †)
• Testis (A18.1 †)
Blocks of Categories
• Blocks have three characters e.g.
A 31 Infection due to other mycobacterium
• Fourth character : after decimal point is
subcategory
• If reporting is upto 4th category, and in some cases
if 4th character in not available, then put “X” in the
4th place to make the codes of uniform length for
entry.
• Fifth character – supplementary for specific/
research
Morphology of Neoplasms
• Additional code for morphology & behaviour
• Five digits, first four indicate morphology, fifth is after a
slash indicates behaviour
• e.g. M9370/0 Benign chordoma
• /0 Benign
• /1 Uncertain whether benign or malignant Borderline
malignancy
• Low malignant potential
• /2 Carcinoma in situ
• Intraepithelial
• Noninfiltrating
• Noninvasive
Morphology of Neoplasms
• /3 Malignant, primary site
• /6 Malignant, metastatic site
• /9 Malignant, uncertain whether primary or
metastatic site
- Superficial spreading adenocarcinoma (M8143/3)
- If described as “noninvasive” code (M8143/2)
To code with morphology :
- Adenoma bile duct (M8160/0) D13.4
Conventions used in Tabular list (Vol.1)
• Parentheses ( ) used in :
• 1. Enclose supplementary words, NOT affecting code
- e.g. I 10 Hypertension (arterial) (essential) (malignant)
(primary) (systemic)
- indicates Hypertension alone or qualified by any or
combination
• 2. Enclose code referring exclusion
- e.g. H01.0 Blepharitis, excludes
blepharoconjunctivitis (H10.5)
• 3. Block titles, to enclose three character codes of
categories
• 4. To enclose the dagger code in an asterisk category or the
asterisk code following a dagger term
Conventions used in Tabular list (Vol.1)
Square brackets [ ] used to :
1. Enclose synonyms, alternative words
- e.g. A30 Leprosy [Hansen’s disease]
2. For referring to previous notes
- e.g. C00.8 overlapping lesion of lip [see note 5
on p.182]
3.
For referring to previously stated set of our
character subdivisions common to a no. of
categories
- e.g. K27 Peptic ulcer, site unspecified [See page
566 for subdivisions]
Conventions used in Tabular list (Vol.1)
Colon :
• To list inclusion and exclusion terms
e.g. K26 Duodenal ulcer
Includes : erosion (acute) of duodenum
Excludes : peptic ulcer NOS (K27.-)
.0 Acute with haemorrhage
.1 Acute with perforation
• When insertion of modifying words is required in
diagnosis
e.g. K36 Other appendicitis
Appendicitis :
. Chronic
. recurrent
Conventions used in Tabular list (Vol.1)
Brace }
• Used in listing inclusion & exclusion terms, to
indicate that neither words preceding nor after it are
complete terms. e.g.
• O71.6 Obstetric damage to pelvic joints & ligaments
Avulsion of inner symphyseal cartilage }
Damage to coccyx}
obstetric
Traumatic separation of symphysis (pubis) }
NOS – Not otherwise specified or unspecified/
unqualified
Conventions used in Tabular list (Vol.1)
• Not elsewhere classified
Serves a warning that certain variants are listed
somewhere. e.g.
J16 Pneumonia due to other infectious organisms,
not elsewhere classified
Includes J16.0 Chlamydial pneumonia,
J16.8 Pneumonia due to other specified
infectious organisms
Other categories are in Chapter X
Conventions used in Tabular list (Vol.1)
• “And” in titles . for and /or
A18.0, Tuberculosis of bone and joints are to be
classified cases of “Tuberculosis of bone” ;
“Tuberculosis of joints” and “Tuberculosis of bones
and joints”.
• Point dash .Indicates existence of a fourth character
e.g.
Peptic ulcer NOS (K27.-)
.0 Acute with haemorrhage
.1 Acute with perforation ….
Volume 3 : Alphabetical index
Sections :
• I – list of all terms classifiable to Chapters I-XIX,
and XXI, EXCEPT drugs and other chemicals
• II – index of external causes of morbidity and
mortality, all terms classifiable to Chapter XX,
EXCEPT drugs and other chemicals
• III – table of drugs & chemicals, list for each
substance the codes for poisonings & adverse
effects of drugs classifiable to Chapter XIX, &
Chapter XX codes that indicates mode :
accidental, deliberate (self-harm), undetermined,
or adverse effect of a correct substance
Structure in Index
• Lead terms or key words (extreme left)
• Indentations (in right after dash)
Erythroblastosis (fetalis) (newborn) P55.9
- due to
-- ABO (antibodies) (incompatibility) (isoimmunization) P55.1
-- Rh (antibodies) (incompatibility) (isoimmunization) P55.0
LEAD TERMS : name of disease/pathological condition
Indented : the modifiers – variety, site, etc.
Tuberculosis of hip – search under “t”
Stomach ulcer – search under ? “S/U”
Adjectival disease conditions : puerperal, puerperium/tuberculosis,
tubercular, tuberculous – in NOUN from or both
Structure in Index
• Complete listing of modifiers to a given term may NOT be
feasible
• Prioritise the modifiers – one over other
Abscess – many sites, NOT tuberculous abscess
• If problems or circumstances leading to disease listed –
search may be difficult
- T Use key words – counselling, examination, history,
observation, pregnancy, problem, screening, status,
vaccination
• Labor, puerperal, maternal condition affecting fetus or
newborn
• Section II – complication, sequelae, suicide, assault, legal
intervention, war operations
Code numbers in Index
• Either three or four character or a dash in place of fourth
place indicates a fourth character exists.
• Burn, ankle (and foot) T 25.• If dual classification, by etiology & manifestation both
codes are given :
Pott’s disease A 18.0 † M 49.0 *
• If fourth character is applicable to a group of categories,
common 4th characters presented
e.g. Pregnancy with abortive outcome
• If complication : coma, diabetic – code to E10-E14 with
4th character
Understanding Index
•
•
•
•
Multiple diagnoses :
Influenza with pneumonia (J11.0)
Underlying cause of death – each condition to be assigned code
Spelling – American
Re – er (center), oe – e (edema), ou – o (labor) etc.
• Parentheses :
• Several terms in parentheses – classified to the given code
• Abscess (embolic) (infective) (metastatic) (multiple) (pyogenic) (septic)
- brain (any part) G06.0
• Brain abscess, any part, regardless of any variety is coded G06.0
• Cross references :
See, see also, see condition, see also condition
• NEC – Not elsewhere classified (unspecified)
• Anomaly of aorta (arch) NEC Q 25.4 – only if no more precise description on
medical record.
Certain conditions with two codes
• The “dagger and asterisk” system
• Introduced from ICD 9 onwards
• Underlying generalized disease and a manifestation in a
particular organ or site
• Primary code for underlying disease marked with dagger
(†)
• Optional additional code for manifestation marked with
asterisk (*) – for medical care
• For classification – primary dagger code must be used
• Asterisk code should NOT be used alone
Asterisk code
• Appears as three-character categories
• Used when particular disease is NOT specified as
underlying cause. e.g.
• G 20 & G 21 Parkinsonism not manifestations of other
diseases
• G 22 * Parkinsonism in diseases classified elsewhere
• Corresponding dagger codes are given for conditions in
asterisk categories viz.
• G22 * Parkinsonism in diseases classified elsewhere
Syphilitic parkinsonism (A 52.1 †)
Rubrics with † mark combinations
1. † with * mark in heading denotes dual classification
exists and all have same alternative code
A17.0 † Tuberculous meningitis (GOI *)
Tuberculosis of meninges (cerebral) (spinal)
Tuberculous leptomeningitis
2. † Present in heading without * : dual classification &
they have different alternative codes
A18.1 † Tuberculosis of genitourinary system
Tuberculosis of :
bladder (N33.0*)
cervix (N74.0 *) ….
Rubrics with † mark combinations
3. None († & *) present in title : not all groups
subject to dual classification, but individual inclusion terms may be,
terms will be marked and alternative codes are given.
A54.8 Other gonococcal infections
Gonococcal :
peritonitis † (K67.1 *)
pneumonia † (J17.0 *)
septicaemia
• LOOK -> K67.1 * Disorders of peritoneum in
infectious diseases classified elsewhere
K67.0 * Chlamydial peritonitis (A74.8 †)
K67.1 * Gonococcal peritonitis (A54.8 †)
Other optional dual coding
• Besides dagger, asterisk system other dual coding
exists in certain situations.
• Note in the list “Use additional code, if desired…”
• 1. Infections, codes from Chap. I may be added to
identify organism
• J02.8 Acute pharyngitis due to other specified organisms
Use additional code (B95-97), if desired, to identify
organism.
e.g.
B95 Streptococcal and staphylococcus as a cause of diseases
classified to other chapters
• B95.0 Streptococcus, group A, as the cause of diseases
classified to other chapters
• Diagnosis could be J02.8 B95.0
Other optional dual coding
2. Neoplasms with functional activity
Code of Chap. IV may be added to Chap. II code for functional
activity
3. Neoplasms, the morphology code on p1181-1204 of vol.1,
may be added to chapter II to identify morphological type
4. Conditions in F00-F09 (organic, including symptomatic,
mental disorders) in Chap. V, code from other chapters may
be added to indicate the cause, i.e. underlying disease, injury,
to brain etc.
5. If condition is caused by a toxic agent, a code from Chap.
XX may be added
6. For injury, poisioning, adverse effect, code from XIX for
nature of injury, code from XX for cause could be added.
Signs in Index
• †/* etiology & manifestation code respectively
• # Sites marked # to be classified as malignant neoplasm of
Skin in the sites if neoplasm is squamous cell carcinoma or
an epidermoid carcinoma, and to benign neoplasm of skin
of the sites if it is a papilloma (any type)
• e.g. Face NEC #
• Carcinomas & adenocarcinomas, any type other than
intraosseous or odontogenic, of sites with mark, consider
as metastatic from unspecified primary site & coded to C
79.5
• Neoplasm, neoplastic
- acromion (process) (C79.5.)
Coding guidelines 1, 2
Steps :
1. Look for diagnosis (Lead term/key words) in
the record
- Asthma, uremia, encephalopathy (noun for
diseases, injuries)
- cancerous, bilous, tuberculous, carious tooth (adj.)
2. Refer volume 3 (alphabetical index)
• Section I of index – Disease/conditions
classifiable in Chap.I – XIX, XXI
• Section II – external causes of injury classifiable
in Chap. XX
Coding guidelines 3, 4
3. Read and be guided by any note in the term
4. Read terms in parentheses after the lead term
(modifiers do NOT affect codes)
(terms indented under lead term – modifies code)
• Degeneration, degenerative
- adrenal (capsule) (fatty) (gland) (hyaline) (infections) E27.8
- amyloid (see also amyloidosis) E85.9
• - brain (cortical) (progressive) G31.9
-- alcoholic G31.2
-- in
--- alcoholism G31.2
--- beriberi E51.1 † G32.8 *
--- lipidosis
----cerebral E75.4 † G32.8 *
Coding guidelines 5
5. Follow carefully any cross – references (“see”, “see
also”) in the index
• Degeneration, degenerative
• Amyloidosis (generalized) (primary) E85.9
- with lung involvement E85.4 † J99.8*
- familial E85.2
- genetic E85.2
- localized E85.4
- specified NEC E85.8
Coding guidelines 6
6. Refer the tabular list (Vol.2), verify the suitability of the code
selected.
• Three character code in index with dash indicates a fourth character to
be found in vol.1
• Degeneration, degenerative
- brain (cortical) (progressive) G31.9
--- lipidosis
-----cerebral E75.4 † G32.8*
• IN VOL. 1 Page 93 :
• E75.4 Neuronal ceroid lipofuscinosis
Disease :
• Batten
• Bielschowsky – Jansky
• Kufs
G32.8 * Other specified degenerative disorders of nervous system in
diseases classified elsewhere
Coding guidelines 7, 8
7. Be guided by inclusion and exclusion terms under
selected code or chapter or block or category heading
• A32 Listerosis
Includes : listerial foodborne infection
Excludes : neonatal (disseminated) listerosis (P37.2)
• A35 Other tetanus
Tetanus NOS
Excludes : tetanus :
. neonatorum (A33)
. obstetrical (A34)
8. Assign code
Thank You