10/8/2012hci571 isabelle bichindaritz1 classification and coding icd-10
TRANSCRIPT
10/8/2012 HCI571 Isabelle Bichindaritz 1
Classification and CodingICD-10
• Define what is the International Classification of Diseases (ICD).
• Explain the difference between classification and coding.
• List the volumes, chapters, groups, and categories in ICD-10.
• Code diseases with ICD-10
Learning Objectives
10/8/2012 HCI571 Isabelle Bichindaritz 2
3
History1893: Jacques BERTILLON death causes International
Nomenclature (mortality)
1900: 1st revision and 10-yearly revision principle
1948: 6th revision, managed by WHO (World Health Organization),
"International Classification of Diseases, Traumas and Death Causes" Broadening to morbidity
1977: 9th revision: ICD-910/8/2012
4
1993: ICD 10 in English
1994: ICD 10 volume 1 (analytical – diagnosis codes)
1995: ICD 10 volume 2 (history and coding rules)
1996: ICD 10 Volume 3 (alphabetical) and ICD 10 numerical
10/8/2012
: ICD 9-CM (« clinical modifications » adding areas of reimbursement, epidemiology, and health sciences research)
5
ICD 10 :Two facets
1°] A Classification
2°] A Coding system10/8/2012
6
A ClassificationThe international statistical Classification of diseases
and associated health problems
Definition of Classification :Scheme for grouping similar things in a logical way
based on common characteristics
Definition of Nomenclature :A systematic listing of names assigned according to
predefines rules
Note : Classification ≠ Nomenclature
10/8/2012
7
ICD 10 Classification Definition
This classification was based on the world frequencies of affections and their importance
in Public Health.
Initially death causes classification, broadening to morbidity from the 6th revision and mostly the 9th revision.
Set of organized groupings for classifying morbid phenomena and all the reasons for seeking care.
10/8/2012
8
ICD10 Classification organization
1°] An Analytical volume (Volume 1)
2°] A user manual (Volume 2) Coding rules and history of the classification
3°] An Alphabetical volume (Volume 3)
A] Three fundamental Volumes
B] WHO updates + Extensions Update Document with Chapter V
NOTE : Coding a morbidity entity requires both volumes 1 and 3 (and the updates) Search in the Alphabetical (V3) => Verification in the Analytical (V1)
10/8/2012
9
3°] Index (Table) of medication and chemical compounds (tables of noxious effects) Codes Chap. XIX in "T" and Chap. XX in "X" and "Y" [Page 625]
1°] An alphabetical index of diseases of traumatic nature [Page 1]
2°] An alphabetical index of external causes of morbidity and mortality (Index Chapter XX : External Causes of morbidity and mortality) [Page 567]
Alphabetical Volume
It contains 3 indexes
10/8/2012
10
It contains the IC10 Classification
C:\ICD 10
Folder Chapter
Folder Group
Folder Sub-group Cha. XIII and XX)
Folder Category
Folder Sub-Category
The data are stored in hierarchical structures (like folders in PC)
Analytical Volume
The Structure is of hierarchical type.
10/8/2012
11
Chapters (I to XXII) (no proper code)Example : Page 111 : Chapter I :Certain infectious and parasitic diseases (A00-B99)
Groups (no proper code)Example :Page 112 : Intestinal infectious diseases (A00-A09)Page 117 : Tuberculosis (A15-A19)
CategoriesExample :Page 112 : A00 Cholera (3 character code)
Sub-CategoriesExample :Page 112 : A00.9 Cholera, NOS (Code of more than 3 characters)
ICD 10
10/8/2012
12
2050 Categories (2045 + 5 in 2006)Codes with 3 characters (Update : Page 1268 bis and ter)
Other national extensions were created bringing the number of possible codes to 6 (Update : Chapter V [Mental and behavioural disorders] : Page 328)
Total :
247 Groups (245 + 2 in 2006; "U00-U99")(Update : Page 1268 bis)
22 Chapters (21 + 1 in 2006; Le "XXII")(Update: Page 1268 bis)
Sous-CategoriesCodes with more than 3 charactersSometimes extensions of ICD 10 codeswith 5 characters (ICD 10 Page 673)
10/8/2012
13
Chapters content
3°] Chapter XXI : Coding of reasons for seeking care (medication, surveillance; administrative aspects, social…) p. 1213 [Code "Z"]
1°] Chapter I to XIX : Diseases descriptions, traumas, syndromes , symptoms
2°] Chapter XX : External causes of morbidity and of mortality p. 1089
4°] Chapter XXII : Codes for particular reasons"U" code (example : Resistant bacterial agents)
5°] Chapter V : Mental and behavioural disorders p.327 [Code "F"]10/8/2012
14
A Coding toolNote : Coding ≠ Encoding
One encodes to protect information from unwanted users
One codes to transform information in a set of pre-established symbols to facilitate information analysis
10/8/2012
• Volume 1: Diagnosis codes– Contain three, four, five numeric digits– First three specify the disease– Fourth digit provides more detail– Fifth digit gives subtypes of the disease
• Volume 2: Alphabetical index for Volume 1• Volume 3: Contains procedure codes
Understanding Terminologies International Classification of Diseases, Ninth Revision
16
10/8/2012
17
Coding ExamplesICD 10 WHO with 3 characters :
F09 : Unspecified organic or symptomatic mental disorder
ICD 10 WHO with 4 characters (most frequent) :
F01.0 : Vascular dementia of acute onset
ICD 10 WHO with 5 characters :
M65.04 : Abscess of tendon sheath, handICD 10 WHO + National extension On 5th and 6th
F01.242 : subcortical vascular dementia, with other symptoms, mixt, severeICD 10 WHO + National extension On 6th
M62.890 : Rhabdomyolysis, unspecified site
10/8/2012
18
Example de code format :
ICD 10 WHO with 3 characters +Ext. Nat. on the 5th
character :
CNN.+N Example : R53.+2 Fatigue (update. 935)
If for a given location in the code the information does not exist, it is replaced by the symbol « + »
ICD 10 WHO with 4 characters + Ext. Nat. on the 6ème
character : CNN.N+N Example : I20.0+0 Unstable angina pectoris with elevated biochemical markers (update. 510)
Note : When a Dot-Dash : ".-" replaces the 4th character, the coder must refer to the sub-category to choose this 4th character
Example : "J45.-" Asthma Page 57110/8/2012
19
Coding by ChapterIn general, we have : One letter = One Chapter
Chapter I (infectious diseases …) Two letters A and B
A few exceptions :
Chapter II (Neoplasms) Two letters, C and part of D (->D49)
Chapter III (Diseases of the blood…) One part of D (after D50)
Chapter XIX (Injury…) Two letters S and T
Chapter XX (External causes…) Four letters V, W, X and Y
Chapter VII (Diseases of the eye …) One part of H (->H59)
Chapter VIII (Diseases of the ear ) One part of H (after H60)
10/8/2012
20
The Chapters
Chapters Letters Nb
I Certain infectious and parasitic diseases A-B 186 II Neoplasms C-D 144III Diseases of the blood and blood-forming organs and certain … D 37IV Endocrine, nutritional and metabolic diseases E 78V Mental and behavioural disorders F 99VI Diseases of the nervous system G 68VII Diseases of the eye and adnexa H 49 VIII Diseases of the ear and mastoid process H 24IX Diseases of teh circulatory system I 81X Diseases of the respiratory system J 65 XI Diseases of the digestive system K 73XII Diseases of the skin and subcutaneous tissue L 77
Nb ofCategories
10/8/2012
21
The Chapters
Chapters Letters Nb
XIII Diseases of the musculoskeletal system and connective tissue M 84XIV Diseases of the genitourinary system N 84XV Pregnancy, childbirth and the puerperium O 79XVI Certain conditions originating in the perinatal period P 62 XVII Congenital malformations, deformations and chromosomal… Q 89XVIII Symptoms, signs and abnormal clinical and laboratory… R 98XIX Injury, poisoning and certain other consequences of external… S-T 196 XX External causes of morbidity and mortality V-W-X-Y 396XXI Factors influencing health status and contact with health… Z 87XXII Codes of special purposes U 2
Nb ofCategories
10/8/2012
22
Chapters Organization
1°] Beginning: the most severe pathologies or the most frequent on the world scale
2°] Next : from the most severe to the least severe, or from the most precise to the least precise
10/8/2012
23
Choice : Dagger / StarMulti-axial coding (dual / multiple classification):Star "*" : Manifestation Axis : (associated diagnosis)
Dagger "†" : Etiological Axis : (primary diagnosis)
Example : Page 476
H36.0* Diabetic Retinopathy (E10-E14† with the fourth digit .3)
Ex : E10.3† Diabetes mellitus insulin dependent, with ocular complications (Page 292)
[see subdivisions pages 291-292]
When the Dagger and Star symbols are present, they must be both recorded
10/8/2012
24
Dagger "†" : Initial manifestation is generalized
Star "*" : Manifestation localized to one organ, which is in itself a clinical problemThe star code allows to classify the manifestation in the chapter corresponding to the organ (coding in the specialty)
The couple Dagger / Star can also be described as :
NOTE : Many "double coding" are absent from the analytical volume (Vol. 1) They are indicated only in the alphabetic index (Vol. 3)
10/8/2012
25
Particular Categories Of 2 types, in most Chapters
and in certain Groups
1°] Other affections of ...., in diseases classified elsewhere (star codes)
Chapter III : Diseases of the blood … (D50-D89) Page 261
Group : Other diseases of the blood and blood-forming organs (D70-D77) Page 275
Category : D77* Other disorders of blood and blood-forming organs in diseases classified elsewhere Page 279
Fibrosis of spleen in schistosomiasis [bilharziasis] (B65.-+)
Vol. 1 page 175 then Vol. 3 page 440
10/8/2012
26
2°] Disorders .... After an act meant to diagnose and treat , not classified elsewhere (iatrogenic pathology)
Chapter IX : Diseases of the circulatory system (I00-I99) Page 503
Group : Other and unspecified disorders of the circulatory system (I95-I99) Page 547
Category : I97 Post procedural disorders of circulatory system, not elsewhere classified Page 547
10/8/2012
27
Other Rules
Pathological entities to code with the code under which they are inscribed
1°] Inclusions : « Includes"
The lists are never exhaustive(The alphabetical index contains more and others)
2°] Exclusions : « Excludes"
Pathological entities which do not have to be coded with this code
10/8/2012
28
Inclusions and Exclusions Locations
Example : Page 327
Chapter V : Mental and behavioural disorders
Include : psychological development disorder
Exclude : symptoms, signs, and abnormal clinical and laboratory results, not elsewhere classified Chapter XVIII (R00-R99) page 915
Under the Chapter title
10/8/2012
29
Under the Group titleExample :
Chapter I : Certain infectious and parasitic diseases Page 111
Group : Tuberculosis (A15-A19) Page 117
Includes : infections due to Mycobacterium tuberculosis and Mycobacterium bovis
Excludes :
- pneumoconiosis associated with tuberculosis (J65)
[Chapter X : Diseases of the respiratory system]
- sequelae of tuberculosis (B90.-)
- silico-tuberculosis (J65)
- congenital tuberculosis c(P37.0)
[Chapter XVI : Certain conditions originating in the perinatal period ...]
10/8/2012
30
Under the code and the title of the Category
Example 1 :
Chapter V : Mental and behavioural disorders Page 327
Group : Mood [affective] disorders (F30-F39) Page 351
Category : F31 Bipolar affective disorder Page 353
Includes : disease, psychosis, and manioc-depressive reaction
Excludes :
- cyclothymia (F34.0)
- bipolar disorder, isolated maniac episode (F30.-)
10/8/2012
31
Example 2 :
Chapter I : Certain infectious and parasitic diseases Page 111
Under the code and the title of the Category
Group : Other bacterial diseases (A30-A49) Page 126
Category : A32 Listeriosis Page 127
Includes : listerial foodborne infection
Excludes :
neonatal (disseminated) listeriosis (P37.2)
[Chapter XVI : Certain conditions originating in the perinatal period ...]
10/8/2012
32
Under the code and the title of the Sub-Category
Example :
Chapter I : Certain infectious and parasitic diseases Page 111
Group : Tuberculosis (A15-A19) Page 117
Category : A18 Tuberculosis other organs Page 121
Sub-Category : A18.6 † Tuberculosis of the ear Page 122(includes) Tuberculous otitis media+ (H67.0*) [Chapter VIII : Diseases of the ear and adnexa page 493]
Excludes :
tuberculous mastoiditis (A18.0†)10/8/2012
33
In ICD "and" means "or"
3°] Meaning of "and" in the titles
Example :
Chapter I : Certain infectious and parasitic diseases Page 111
Group : Infections with a predominantly sexual mode of transmission (A50-A64) Page 134
Category : A60 Anogenital herpesviral [herpes simplex] infection Page 141
Sub-Category : A60.0 Herpesviral infection of genitalia and urogenital tract Page 141
Means : Infection of genital organs or of the urogenital tract by herpes virus
10/8/2012
34
4°] Meaning of "with"To signify the association of two entities in ICD, one uses the word "with"
Example :
Chapter I : Certain infectious and parasitic diseases Page 111
Group : Protozoal diseases (B50-B64) Page 171
Category : B77 Ascariasis Page 180
Sub-Category : B77.0 Ascariasis with intestinal complications Page 180
10/8/2012
35
5°] Meaning of « Others"
In each category there is a code with a label starting with « other » and which takes back afterwards the category label
The 4th character of this code is often an "8"
One must understand entities other than those coded in the same category
10/8/2012
36
Example :
Chapter V : Mental and behavioural disorders (F00-F99) Page 327
Group : Disorders of adult personality and behaviour (F60-F69) Page 382
Category : F60 Specific personality disorders Page 382
Sub-Category : F60.8 Other specific personality disordersPage 386
10/8/2012
37
6°] Meaning of "( )" : 4 uses The term in parentheses must be understood as
« specified or not" its presence is complementary
To use the I10 code, the presence of words in parenthesis is complementary
Example :
Chapter IX : Diseases of the circulatory system (I00-I99) Page 503
Group : Hypertension diseases (I10-I15) Page 508
Category : I10 Essential (Primitive) hypertension Page 508Hypertension (arterial) (benign) (essential) (malignant)
(primitive) (systemic)
10/8/2012
38
Dagger code specification in a Category or Sub-Category with Stars (or the contrary)
Example : Page 329
Sub-Category : F00.1* Dementia in Alzheimer disease with late onset (G30.1†)G30.1 Chapter VI, P. 430 : Alzheimer disease with late onset
Note : here the Dagger is not present in volume 1 See Volume 3 Page 35
Parentheses are also used to:
Specify a codeExample : Page 458
H01.1 Blepharitis
Excluding blepharo-conjonctivitis (H10.5)
10/8/2012
39
Parentheses are also used in :
Chapters or Groups titlesExample :
Chapter V : Mental and behavioural disorders
Group : Disorders of adult personality and behaviour (F60-F69) Page 382
10/8/2012
40
7°] Meaning of "[ ]": 3 uses
To include synonyms or explanatory sentences Example : A30 Leprosis [Hansen disease] Page 126
To send back to prior notesExample : Page 194C00.8 Overlapping lesion of lip[see note 5 at the beginning of this chapter page 191]
10/8/2012
41
Example : Page 604 : K26 Duodenum ulcer[See subdivisions page 603]
To refer to a subdivision group with 4 characters previously mentioned which are common to a certain number of categories
Following subdivisions may be used as fourth digit with categories K25-K28 :.0 Acute with haemorrhage
.1 Acute with perforation
.2 Acute with haemorrhage and perforation
.3 Acute without haemorrhage nor perforation
.4 Chronic or not other specified, with haemorrhage
.5 Chronic or not other specified, with perforation
.6 Chronic or not other specified, with haemorrhage and perforation
.7 Chronic without haemorrhage nor perforation
.9 Not other specified as acute or chronic, without haemorrhage nor perforation
10/8/2012
42
8°] Meaning of ":"Colon is used to enumerate the terms to be included or excluded, if the words preceding them are not sufficiently complete
Example : Page 607
K36 Other forms of appendicitis
Appendicitis :
. Chronic
. Recurrent
The "Appendicitis" diagnosis can only be placed there if it is accompanied by the words :chronic » or « recurrent »
10/8/2012
43
« NOS" means : « Not Other Specified"
9°] Meaning of « NOS"
Sometimes a term « NOS" is classified under a code corresponding to a type more specific of the ailment
This is due to the fact that the most frequent form of the ailment is often called by the name of the ailment
Example : Page 553
J04.2 Acute laryngotracheitis
Laryngotracheitis NOS
The laryngotracheitis NOS is coded J04.2 because the acute laryngotracheitis is the most frequent.
10/8/2012
44
"NEC" means : « Not elsewhere classified"
10°] Meaning of « NEC"
Used in the title of a category :Some precise varieties of ailments may appear elsewhere in the classification (As a matter of fact certain precise varieties are « classified elsewhere »)
Example : Page 557
J16 Pneumonia due to other infectious organisms, not elsewhere classified
Some other Pneumopathies are classified elsewhere, for example:
Chapter XVI P23 Congenital pneumonia Page 835
10/8/2012