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ICD-11Education ToolUnit 6Chapter 08 Diseases of the nervous system

Chapter 11 Diseases of the circulatory system

Chapter 12 Diseases of the respiratory system

Chapter 13 Diseases of the digestive system

Chapter 15 Diseases of the musculoskeletal system or connective tissue

Unit 6 – Chapters 08, 11, 12, 13 and 15 Learning Outcomes1. Understand the structure, conventions and content of Chapters 08, 11, 12, 13 and

15.

2. Understand the chapter-specific notes for Chapters 08, 11, 12, 13 and 15, if applicable.

3. Apply the structure, conventions, content and chapter-specific notes to classify common clinical concepts from Chapters 08, 11, 12, 13 and 15.

Chapter 08Diseases of the nervous systemChapter 08 StructureChapter 08 Diseases of the nervous system contains these top level blocks:

Movement disorders

Disorders with neurocognitive impairment as a major feature

Multiple sclerosis or other white matter disorders

Epilepsy or seizures

Headache disorders

Cerebrovascular diseases

Spinal cord disorders excluding trauma

Motor neuron diseases or related disorders

Disorders of nerve root, plexus or peripheral nerves

Chapter 08 StructureTop level blocks – continued

Diseases of neuromuscular junction or muscle

Cerebral palsy

Nutritional or toxic disorders of the nervous system

Disorders of cerebrospinal fluid pressure or flow

Disorders of autonomic nervous system

Human prion diseases

Disorders of consciousness

Other disorders of the nervous system

Postprocedural disorders of the nervous system

Structure DemonstrationInteractive Activity: Open the ICD-11 Browser. A link to the ICD-11 Coding Tool and Browser (blue) can

be found on the EIC Education Tool platform.

Select Chapter 08 Diseases of the nervous system on the hierarchy tree of ICD-11.

Expand Chapter 08 Diseases of the nervous system by using the grey arrow to view the list of top-level blocks. Information about the block will be displayed on the right side panel.

Chapter 08 Medical InformationThe nervous system is a very complex system through which all parts of the body are controlled and actions are coordinated.

It acts as a communication network through which the sense organs (such as the eyes, ears and taste buds) receive messages from within the body and from the outside world that are converted into impulses that are transmitted to the brain.

Chapter 08 Medical InformationThe brain is responsible for interpreting the stimuli it receives and controlling the body's responses through the nervous system.

This results in speech, action and movement, feeling and sensation, memory and thoughts.

Chapter 08 Medical InformationThe nervous system is divided into two major parts.

The central nervous system consists of the brain and the spinal cord. It is effectively the centre of the nervous system - the part that processes the information received from the peripheral nervous system.

It is responsible for receiving and interpreting signals from the peripheral nervous system and also sends out signals, either consciously or unconsciously.

Chapter 08 Medical InformationThe peripheral nervous system consists of the nerves outside of the brain and spinal cord that connect the rest of the body to the central nervous system.

There are 12 pairs of cranial nerves and 31 pairs of spinal nerves.

The functions of the cranial and spinal nerves are mainly voluntary and are involved with the sensations of smell, taste, sight, hearing and muscle movement.

Chapter 08 Medical InformationThe peripheral nervous system is divided into two major parts.

The somatic nervous system controls voluntary body (muscular) movements.

The autonomic nervous system is a large group of nerves that function involuntarily or automatically, without conscious control. This connects with glands and internal organs like the heart, lungs, stomach, intestines, liver, kidneys and adrenal glands, bladder and reproductive organs that work without us having to consciously do anything.

Chapter 08 Medical InformationThe basic structural and functional unit of the nervous system is the nerve cell or neuron. All neurons have a cell body.

Most neurons have processes called dendrites, which act like antennae, in that they receive input to the cell.

Most neurons also have a single long process called an axon, which is capable of transmitting a pulse of electricity from the cell body to some distant target either in the brain or the periphery (the other areas of the body). These axons may be quite long, for example up to a metre or more for the axons connecting the spinal cord to the foot.

Chapter 08 Medical Information

Chapter 08 Medical InformationThe junction between two neurons is called a synapse.

There are three types of neuron:

sensory neurons, which receive signals from sense organs and carry them to the central nervous system

motor neurons, which carry signals from the central nervous system to the muscles

interneurons, which communicate between the sensory and motor neurons.

Chapter 08 Medical InformationThe brain is divided into three parts - the forebrain, midbrain, and hindbrain.

The forebrain includes the lobes of the cerebral cortex that control higher functions (i.e. those that are voluntary). The midbrain and hindbrain are more involved with unconscious, autonomic functions.

Chapter 08 Medical InformationThe spinal cord is a long, thin, tubular bundle of nerves that is an extension of the central nervous system from the brain. It is enclosed in and protected by the bony vertebral column. The main function of the spinal cord is to transmit inputs from the brain to the periphery nerves.

Chapter 08 Medical InformationDiseases of the nervous systemAtaxia is a condition where there are grossly uncoordinated muscle movements. It often indicates a problem with the part of the brain that coordinates movement. If the problem arises in the cerebellum (or hindbrain), it is known as cerebellar ataxia.

Two other forms of ataxia are:

sensory ataxia, a loss of sensitivity to joint and body part position, which can result from a dysfunction of either the spinal cord or the parts of the brain which receive sensory signals.

vestibular ataxia, which is caused by dysfunction of the vestibular system (the balance system in the inner ear) which is associated with prominent vertigo, nausea, vomiting and disequilibrium (loss of balance).

Chapter 08 Medical InformationDiseases of the nervous systemHemiplegia is a condition where there is paralysis of one half of the body.

Hemiparesis is a less severe condition where one half of the body is weakened rather than paralysed.

Paraplegia is a condition where the lower extremities are paralysed. Paraplegia can be caused by injury to the spinal cord or a congenital condition such as spina bifida.

Quadriplegia, also known as tetraplegia, is a condition where the paralysis affects all four limbs.

Chapter 08 Medical InformationDiseases of the nervous systemTwo types of inflammatory disease which affect the nervous system are meningitis and encephalitis.

Meningitis is the inflammation of the meninges, which are the protective membranes covering the brain and spinal cord. Meningitis has various causes such as bacteria, viruses or other pathogens, physical injury, cancer or certain drugs. Microorganisms invade the blood or cerebral spinal fluid (CSF) which leads to development of meningitis. The severity of the disease ranges from mild to severe and can be a potentially life-threatening condition because the inflammation is so close to the brain and spinal cord.


Diseases of the nervous systemEncephalitis is an inflammation of the brain. It may be caused by a number of different factors, the most common being the direct infection of the brain by a virus or bacterium such as bacterial meningitis. Inflammation can also occur as a complication of some other disorder, such as mumps or herpes simplex. Encephalitis can cause brain damage as the brain swells inside the skull. This may result in, or worsen, the symptoms of a developmental disorder or mental illness.

Chapter 08 Medical InformationDiseases of the nervous systemThere is also a variety of disorders which usually result from nerve damage. These are called neuropathies.

Mononeuropathies Bell palsy is a condition where there is a paralysis of the facial nerve. This leads to an inability to control the facial muscles on the affected side. Bell palsy is a very common mononeuropathy.

Trigeminal neuralgia (TN), or Tic Douloureux is a disorder of the trigeminal nerve that causes episodes of intense pain in various areas of the face such as the scalp, forehead, eyes, nose, lips and jaw.

Chapter 08 Medical InformationMononeuropathiesCarpal tunnel syndrome (CTS), is a condition where the median nerve is compressed at the wrist where it passes through the carpal tunnel in the wrist ligaments. The entrapment/compression typically causes pain, abnormal sensation (paraesthesia) and muscle weakness in the forearm and parts of the hand.

Chapter 08 Medical InformationPolyneuropathyPolyneuropathy affects many nerves at the same time (from the Greek ‘poly-‘, meaning ‘many’). It may be acute and sudden, or chronic and gradual. Polyneuropathies affect both movement and sensation and some forms also affect the autonomic functions. These conditions often affect the body symmetrically (e.g. both arms) and frequently involve the extremities i.e. the fingers or toes.

Chapter 08 Medical InformationAutonomic neuropathyAutonomic neuropathy affects parts of the autonomic nervous system, usually internal organs such as the bladder, the cardiovascular system or the digestive system.

Peripheral neuropathyIn peripheral neuropathy the nerves of the peripheral nervous system are damaged. Causes of damage include disease of the nerves, the side-effects of another condition, injury or drugs. Peripheral neuropathies vary in their presentation and origin, including numbness, tingling, tremor and loss of balance.

Chapter 08 Medical InformationOther diseases of the nervous systemMuscular dystrophy (MD) is a group of hereditary muscle diseases where there is progressive skeletal muscle weakness as the muscle cells gradually break down and die. There are many types of MD. Most are multisystem disorders, affecting for example the heart, gastrointestinal and nervous systems, endocrine glands, skin, eyes and other organs.

Another hereditary disease of the nervous system is Huntington Disease (HD), also known as Huntington chorea. The condition is marked by lack of coordination and abnormal body movements called chorea. It also affects behaviour and mental abilities.

Chapter 08 Medical InformationMotor neuron disease (MND) is a group of progressive disorders that destroy motor neurons, which are the nerve cells that control voluntary activities including movement, walking, breathing, swallowing and speaking.

Multiple sclerosis (MS) is an autoimmune condition where the patient’s immune system attacks the central nervous system, causing demyelination (damage to the myelin sheath of the neurons) and destroying the nerves’ ability to carry signals. MS is the most common condition that causes demyelination and it specifically attacks the areas of the brain and spinal cord known as the white matter.

Chapter 08 Medical InformationParkinson disease (PD) is a condition that progressively affects the person’s motor skills, speech and certain other functions such as mood and sleep. Typical symptoms include tremor, impaired balance often resulting in falls, shuffling, stooped gait, muscle rigidity, slow movement and problems with speech and swallowing.

Patients may also suffer from depression, anxiety and memory problems, and may go on to develop dementia.

Chapter 08 Medical InformationAlzheimer disease is a physical disease which attacks the brain causing the development of neuron tangles and protein plaque deposits. These tangles and deposits disrupt signals within the brain and lead to the death of brain cells. The damage results progressively in impaired memory and thinking, and affects the person’s behaviour. Short-term memory is affected first but eventually long-term memory is also lost. The disease also affects many of the brain's other functions resulting in physical problems with daily living, mood problems and communication difficulties.

In the advanced stages the patient is usually unable to communicate, respond, move or even feed themselves, and death often results from another condition such as pneumonia.

Chapter 08 Medical InformationCerebral palsy is a term used to describe a group of chronic conditions affecting body movements and muscle coordination. The conditions are caused by damage to one or more specific areas of the brain, usually occurring during fetal development, or during infancy.

There are three main types of cerebral palsy:

spastic cerebral palsy – stiff and difficult movement

athetoid cerebral palsy – involuntary and uncontrolled movement

ataxic cerebral palsy – disturbed sense of balance and depth perception.

When a patient has a combination of these three types, this is known as mixed cerebral palsy.

Chapter 08 Medical InformationEpilepsy is a chronic condition of the nervous system where a person experiences recurring seizures, caused by abnormal activity in the brain.

Epilepsy can be in the form of either partial or general seizures.

Generalised seizures include:

generalised tonic-clonic seizure (also called grand mal seizure). Grand mal seizures typically start with the tonic phase, when the limbs stiffen, followed by the clonic phase when the limbs and face jerk uncontrollably.

absence seizures (also called petit mal seizures) are lapses of awareness, sometimes with staring, that begins and ends abruptly, lasting only a few seconds.

Chapter 08 Medical InformationGeneralised seizures atonic seizures produce an abrupt loss of muscle tone. They produce head drops,

loss of posture or sudden collapse.

myoclonic seizures produce rapid, brief contractions of body muscles, which usually occur at the same time on both sides of the body. Occasionally, they involve one arm or a foot.

Partial or focal onset seizures come from a localised source in the brain. In a simple partial seizure there is no loss of consciousness, but in a complex partial seizure the person will lose consciousness.

Chapter 08 Medical InformationHydrocephalus (‘water on the brain’) is a condition where there is an abnormal accumulation of cerebrospinal fluid (CSF) in the brain’s ventricles or in the subarachnoid space between the brain and the skull. This is usually caused by a blockage where CSF would normally drain away from these areas.

Hydrocephalus can cause increased pressure inside the skull, leading to convulsions, mental disability and enlargement of the skull.

Chapter 08 Medical InformationMyasthenia gravis is an autoimmune disorder which causes defects in the transmission of nerve impulses to muscles. Muscle weakness of the skeletal (voluntary) muscles increases during periods of activity and improves after periods of rest. Certain muscles such as those that control the eye and eyelid movement, facial expression, chewing, talking and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected.

Migraine is a neurological syndrome characterised by painful headaches, nausea, vomiting and a heightened sensitivity to bright lights and noise.

Chapter 08 Medical InformationTransient ischaemic attack (TIA) occurs when the blood flow to part of the brain is temporarily interrupted, causing temporary stroke-like symptoms. It is sometimes called a ‘mini-stroke’.

Cerebrovascular accident (CVA) or stroke. This is the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired.

A CVA can result from a thrombosis or embolism, or a haemorrhage. Subarachnoid haemorrhage and intracerebral haemorrhage occur as a result of a burst blood vessel.

Chapter 08 Medical InformationCerebrovascular accident (CVA)Depending on the region of the brain affected, a CVA may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death.

Chapter 08 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there are two chapter-specific notes.

Late effect of cerebrovascular disease

Paralytic symptoms

Chapter 08 Chapter-specific notesLate effect of cerebrovascular diseaseThese codes are not to be assigned as main condition if the residual condition is documented. See also ICD-11 Reference Guide Section Coding of conditions documented as a sequelae (late effect).

As per the ICD-11 Tabular List Coding Note:Use of the code ”Late effects of cerebrovascular disease” requires that there are residual (still persisting) symptoms or signs after a previous cerebrovascular event. Codes for neurological symptoms may be added. Codes for acute stroke should be exclusively used for the acute stroke and immediately related hospitalisation episodes.

Chapter 08 Chapter-specific notesParalytic symptomsThese codes are not to be assigned as main condition if a current cause is documented, unless the episode of care was for treatment of the paralysis itself.

Chapter 08 Coding examplesExample 1A male patient with multiple sclerosis presents for review of disease progression and medication dosages.

8A40.Z Multiple sclerosis, unspecified

Chapter 08 Coding examplesExample 1Interactive Activity: Open the ICD-11 Coding Tool. A link to the ICD-11 Coding Tool and Browser (blue)

can be found on the EIC Education Tool platform

Enter the diagnostic statement – multiple sclerosis

Open the code 8A40.Z Multiple sclerosis, unspecified in the browser window using the icon in the coding tool display

Note the postcoordination option for has manifestation.

Chapter 08 Coding examplesExample 2A 30-year-old male presented with a ventriculoperitoneal (VP) shunt leak following an insertion of a VP shunt 3 months ago.

8E60 Post ventricular shunting leak

Note: for the purposes of this example (i.e. to demonstrate content of Chapter 08) external cause codes have not been assigned.



Enter the diagnostic statement – shunt leak

Open the code 8E60 Post ventricular shunting leak in the browser window using the icon in the coding tool display

Note there are no postcoordination options for this code.

Chapter 08 Coding examplesExample 3A patient suffers from a cerebral infarction due to occlusion of the middle cerebral artery (MCA) with flaccid hemiplegia and aphasia (evidencing middle cerebral artery syndrome).

8B11.51 Cerebral ischaemic stroke due to unspecified occlusion or stenosis of intracranial large artery

XA2JH8 Middle cerebral artery

8B26.2 Middle cerebral artery syndrome

MB53.1 Flaccid hemiplegia

MA80.0 Aphasia

Cluster: 8B11.51&XA2JH8/8B26.2/MB53.1**/MA80.0**

Underlined text indicates optional extension code**manual postcoordination



Enter the diagnostic statement – cerebral infarction middle

Open the code 8B11.51 Cerebral ischaemic stroke due to unspecified occlusion or stenosis of intracranial large artery in the browser window using the icon in the coding tool display

Note the postcoordination option for specific anatomy and associated with

Chapter 08 Coding examplesExample 3Interactive Activity:

Using the postcoordination assign XA2JH8 Middle cerebral artery and 8B26.2 Middle cerebral artery syndrome. To add the specificity of the manifestations (flaccid hemiplegia and aphasia), return to the Coding Tool and enter the manifestations to assign MB53.1 Flaccid hemiplegia and MA80.0 Aphasia

Cluster: 8B11.51&XA2JH8/8B26.2/MB53.1/MA80.0

Chapter 08 Coding exercisesUsing the ICD-11 Coding Tool and Browser code the exercises to demonstrate chapter content and code structure. Exercises range from easy to more complex.

A link to the ICD-11 Coding Tool and Browser (blue) can be found on the EIC Education Tool platform.

Ensure that the ‘Extension Codes’ box is ticked in the Chapter distribution/filter in the Coding Tool.

Leave Coding Tool Tab open until all exercises for this unit are completed.

Chapter 08 Coding exercisesAssign codes for the following diseases:

1. Ataxia due to alcoholic cerebellar degeneration

____________________________________________________________

2. Acute disseminated encephalomyelitis

____________________________________________________________

3. Post traumatic epilepsy due to head injury

____________________________________________________________

4. A patient with spastic quadriplegic cerebral palsy was admitted for Botox injections in the muscles of his legs. Procedure went well and patient was discharged home on the day.

____________________________________________________________

5. A patient with a cerebral infarction due to atherosclerosis of the vertebral artery. While remaining on the neurology service, the patient continued to receive physiotherapy for hemiplegia and speech pathology for dysphasia.

Diseases:

Cerebral infarction due to atherosclerosis of the vertebral artery

____________________________________________________________

Vertebral artery

____________________________________________________________

Hemiplegia

____________________________________________________________

Dysphasia

____________________________________________________________

You have completed Coding exercises for Chapter 08.Please go to the next section in this unit.Chapter 11 Diseases of the circulatory system

Chapter 11 Diseases of the circulatory systemChapter 11 Structure Chapter 11 classifies the diseases and disorders of the circulatory system. It contains these top-level blocks:

Hypertensive diseases

Hypotension

Ischaemic heart diseases

Diseases of coronary artery

Pulmonary heart disease or diseases of pulmonary circulation

Pericarditis

Acute or subacute endocarditis

Heart valve diseases

Chapter 11 Structure Chronic rheumatic heart diseases, not elsewhere classified

Diseases of the myocardium or cardiac chambers

Cardiac arrhythmia

Heart failure

Diseases of arteries or arterioles

Diseases of veins

Disorders of lymphatic vessels or lymph nodes

Postprocedural disorders of circulatory system



Select Chapter 05 Endocrine, nutritional or metabolic disease on the hierarchy tree of ICD-11.

Expand Chapter 05 Endocrine, nutritional or metabolic disease by using the grey arrow to view the list of top-level blocks. Information about the block will be displayed on the right side panel.

Chapter 11 Medical InformationAnatomy and physiology of the circulatory systemThe circulatory system consists of the vessels and the muscles that assist and regulate the flow of the blood around the body. On average, there is around five litres of blood continually moving through the circulatory system.

The main role of the circulatory system is to supply oxygen and nutrients to the cells in the body and then remove their wastes – including carbon dioxide.

Chapter 11 Medical InformationThe circulatory (or cardiovascular) system may be considered to have two distinct parts:

the pulmonary circulation (lungs) and

the systemic circulation (rest of the body).

The coronary circulation (heart) may be considered as part of the systemic circulation.

Chapter 11 Medical InformationThe heartThe heart pumps the blood around the body. It is located in the chest, in the middle though slightly to the left, in between the lungs.

The heart is made up of four chambers, and it is the contractions of the chambers that create the pulse you can feel in the arteries. The heart sounds originate from the closure of the main heart valves.


The heartThere are four heart valves, each with flaps (called leaflets or cusps). The valves open and close to let the blood flow in only one direction through the heart.

The right atrium (right upper chamber) takes in deoxygenated blood that has come from around the body. The blood is pumped into the right ventricle (lower chamber), via the tricuspid valve.

Chapter 11 Medical InformationBlood vessels – arteriesThe arteries are muscular vessels which carry oxygenated blood from the heart to the rest of the body. The only exception is the pulmonary artery which carries deoxygenated blood to the lungs.

The largest artery is the aorta, through which the oxygenated blood leaves the heart. The arteries gradually divide like branches of a tree from this, and become very small blood vessels called capillaries. It is through the capillaries that oxygen and food nutrients pass to the cells.

Chapter 11 Medical InformationBlood vessels – veinsVeins are the vessels which carry deoxygenated blood from the body to the heart. The exception is the pulmonary vein, which carries oxygenated blood from the lungs to the heart.

Some veins have one-way valves to stop blood from running back the wrong way.

Capillaries are also connected to veins to return the blood to the heart, and take the waste (including carbon dioxide) from the cells.

Chapter 11 Medical InformationBlood Blood consists of red blood cells that carry oxygen, white blood cells that are part of the immune system, platelets that are involved in the clotting of the blood, and plasma that carries the blood cells, nutrients and waste.

Specific disorders of the blood are coded to Chapter 03 of the ICD-11.

Chapter 11 Medical InformationDiseases of the circulatory system Rheumatic fever is an autoimmune inflammatory disease which may develop after infection with Group A streptococcus bacteria (for example conditions commonly known as strep throat or scarlet fever). Rheumatic fever is classified in Chapter 01 of the ICD-11. Its manifestations or sequelae are classified here in Chapter 11.

The disease typically damages the heart valves, but may also affect skin and joints. The mitral valve is the one most often affected, though the aortic valve is also very common. Rheumatic fever results in heart valve deformities including stenosis (narrowing) and insufficiency (also referred to as incompetence, meaning inability to perform function).

It commonly occurs in children aged between 5 and 15.

Chapter 11 Medical InformationDiseases of the circulatory systemWe will now look at conditions with regard to blood pressure. This is the amount of pressure inside the circulatory system as the blood is pumped around.

Hypotension is a condition where the blood pressure is too low. Hypertension is a condition where the blood pressure is too high.

There are two types of hypertension:

primary (also known as essential) where the cause is unknown

secondary where it is a result of another known disorder such as kidney or endocrine gland disorders, or coarctation (narrowing) of the aorta.

Chapter 11 Medical InformationDiseases of the circulatory systemIschaemic heart disease is the general term for a number of disorders that affect the myocardium (the muscle of the heart) due to coronary insufficiency (a decrease in the blood supply to the heart).

Ischaemic heart disease is usually caused by deposits of atheromatous material (fatty plaque) that progressively obstruct the coronary arteries and their branches.

Chapter 11 Medical InformationIschaemic heart diseaseMyocardial infarction (MI) is usually caused by obstruction of a coronary artery. The obstruction cuts off the blood supply to the area of myocardium (heart muscle) supplied by the affected artery, causing the cells in that area to die. The severity of the condition depends on how large a part of the myocardium is involved, and may vary from a moderately serious illness to sudden death.

Angina is chest pain from the heart not getting enough oxygenated blood (cardiac ischaemia). Angina may occur as a result of coronary arteriosclerosis, coronary spasm, severe aortic stenosis or insufficiency, anaemia, paroxysmal tachycardia or in connective tissue disorders such as systemic lupus erythematosus.

Chapter 11 Medical InformationIschaemic heart diseaseStable anginaStable angina is the most common type of angina. There is generally a gradual onset over a few minutes, often during exertion such as walking or due to emotional stress, and it usually lasts only five to fifteen minutes with relief of symptoms given by rest or medication (for example nitroglycerin under the tongue).

Chapter 11 Medical InformationIschaemic heart diseaseUnstable anginaUnstable angina is less common and more serious. It will by definition have at least one of three features:

occurring at rest or minimal exertion and lasting over 20 minutes

being severe or of new onset

having a crescendo pattern of worsening, being more severe, longer lasting or more frequent than previously.

Unstable angina often precedes a heart attack.

Chapter 11 Medical InformationIschaemic heart disease Prinzmetal angina is a syndrome characterised by chest pain, pressure, or tightness (angina) that occurs at rest and in cycles and may occur at odd times during the day or night. It is caused by vasospasm (uncontrollable blood vessel contraction) rather than by atherosclerosis (build up of plaque on the walls of the coronary arteries). It can be associated with acute myocardial infarction, ventricular tachycardia or fibrillation and even sudden death.

Chapter 11 Medical InformationDiseases of the circulatory systemCoronary artery disease (CAD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart.

The narrowing is usually caused by atherosclerosis, which occurs when fatty material and a substance called plaque or atheroma builds up on the walls of the coronary arteries.

Cardiomyopathy is when the heart muscle becomes weakened or has a change in structure leading to inadequate heart pumping or other heart function abnormality. It can be caused by viral infections, heart attacks, alcoholism, severe long-term high blood pressure, nutritional disorders, systemic lupus erythematosus, coeliac disease and end-stage kidney disease.

Chapter 11 Medical InformationCardiomyopathyThere are many types of cardiomyopathy and they are often named according to the cause.

Dilated cardiomyopathy results when the left ventricle is enlarged and does not function adequately.

Ischaemic cardiomyopathy results when the myocardium has a reduced pumping function after ischaemic insults due to coronary artery disease. Scarring of the myocardium may be present.

Idiopathic cardiomyopathy results from an unknown cause.

Hypertensive cardiomyopathy results from high blood pressure.

Chapter 11 Medical InformationCardiomyopathy Infectious cardiomyopathy results from an infection

Alcoholic cardiomyopathy results from sustained and heavy alcohol consumption.

Toxic cardiomyopathy results from drugs.

Hypertrophic cardiomyopathy results when the heart muscle is thickened thus reducing the heart’s ability to pump the blood adequately.

Chapter 11 Medical InformationDiseases of the circulatory systemSometimes a blood clot forms in a blood vessel. This clot is called a thrombus.

Depending on the size of the blood vessel, a thrombus may decrease the blood flow through it, or may completely cut-off the blood flow, resulting in death of tissue supplied by that vessel. This formation of a blood clot is called thrombosis.

A deep vein thrombosis (DVT) is a clot that forms in deeper veins of the legs or arms. There is a risk of pulmonary embolism from DVT.

Chapter 11 Medical InformationDiseases of the circulatory systemA thrombus may become dislodged to float freely in the blood. An embolus is the name given for a dislodged thrombus or other material that is floating in the blood.

An embolism occurs when a blood clot (embolus) or air bubble, travels through the bloodstream and becomes lodged in a blood vessel, blocking the flow of blood.


Diseases of the circulatory systemA pulmonary embolism (PE) is a sudden blockage (embolism) that occurs in a lung artery. It commonly originates from a blood clot in a vein in the leg, called a deep vein thrombosis, that breaks loose and moves through the bloodstream to the lung. When no blood reaches a section of the lung, that section of lung tissue dies. This is referred to as a pulmonary (or lung) infarct.

Chapter 11 Medical InformationDiseases of the circulatory systemAn aneurysm is a pouch like deformity of a blood vessel that is usually caused by a weak arterial wall. Aneurysms rarely cause symptoms until they burst. They are most likely to burst when blood pressure is very high.

Chapter 11 Medical InformationDiseases of the circulatory systemPeripheral vascular diseases (PVD) are conditions that impair blood vessels outside the heart and brain. This can occur through hardening and obstruction (arteriosclerosis), spasms, or widening (aneurysms).

In peripheral artery disease the narrowing and hardening that is caused by the arteriosclerosis leads to decreased blood flow, which can injure the deficiently supplied tissues. The disease is most frequently seen in the legs, and more rarely also affects the arms.

Gangrene of extremities may be the end result of progressive PVD.

Chapter 11 Medical InformationDiseases of the circulatory systemVarices are veins that have become distended (extended or expanded).

Oesophageal varices are distended veins that develop in the lining of the lower oesophagus near the stomach. They are often caused by liver disease (particularly cirrhosis of the liver) and are similar to varicose veins in the legs. They may rupture and cause bleeding.

Gastric varices are dilated submucosal veins in the stomach, which can cause upper gastrointestinal haemorrhage. They are often associated with portal hypertension or elevated pressure in the portal vein system (the system that supplies blood to the liver).

Chapter 11 Medical InformationDiseases of the circulatory systemIntestinal varices are dilated submucosal veins in the intestine.

Varicocele (scrotal varices) is an abnormal enlargement of the veins in the scrotum draining the testicles.

Varicose veinsVaricose veins (VV) occur when there is a problem with the valves that stop blood from running backwards. The veins become enlarged and twisted. The most common site for VVs is in the lower legs, although they can occur elsewhere.

Chapter 11 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there is one chapter-specific note.

Secondary hypertensionThis code is not to be used as the preferred code for the main condition if the underlying cause is recorded.

When coding to the underlying cause, secondary hypertension is used as an additional code (in a cluster) to indicate that this manifestation has been relevant in the context of a treatment.

Chapter 11 Coding examplesExample 1A patient was admitted due to a blood pressure reading of 185/123. A diagnosis of combined diastolic and systolic hypertension was established.

BA00.0 Combined diastolic and systolic hypertension



Enter the diagnostic statement – combined hypertension

Open the code BA00.0 Combined diastolic and systolic hypertension in the browser window using the icon in the coding tool display


Chapter 11 Coding examplesExample 2A patient was admitted with hypertensive heart disease with congestive heart failure, stage 3. Their medications were adjusted and the patient returned home the following day.

BA01 Hypertensive heart disease

BD10.Z Congestive heart failure, unspecified

XS00 Stage 3

Cluster: BA01/BD10.Z&XS00

Underlined text indicates optional extension code



Enter the diagnostic statement – hypertensive heart disease

Open the code BA01 Hypertensive heart disease in the browser window using the icon in the coding tool display

Note the postcoordination option for has manifestation and associated with.

Using the postcoordination option has manifestation assign BD10.Z Congestive heart failure, unspecified and XS00 Stage 3

Cluster: BA01/BD10.Z&XS00

Chapter 11 Coding examplesExample 3A patient was admitted with dyspnoea and fatigue. It was noted that she had rheumatic fever as a child. An echocardiogram was performed which showed mild regurgitation in both mitral and aortic valves. Patient was referred to a cardiologist on discharge.

BC00 Multiple valve disease

BB61.0 Rheumatic mitral valve insufficiency

XS5W Mild

BB71.0 Rheumatic aortic valve insufficiency

XS5W Mild

Cluster: BC00/BB61.0&XS5W/BB71.0&XS5W




Enter the diagnostic statement – rheumatic multiple valve disease

Open the code BC00 Multiple valve disease in the browser window using the icon in the coding tool display

See the coding note at BC00 which states When specific type of valve disease is known, assign codes for the specific conditions.

Chapter 11 Coding examplesExample 3Interactive Activity Note the postcoordination option for associated with.

Using the postcoordination option associated with assign BB61.0 Rheumatic mitral valve insufficiency, XS5W Mild, BB71.0 Rheumatic aortic valve insufficiency and XS5W Mild

Cluster: BC00/BB61.0&XS5W/BB71.0&XS5W





Chapter 11 Coding exercises1. Would a case of ischaemic cerebral infarction be classified to this chapter?

YES / NO

Assign codes for the following diseases:

2. Dissection of the anterior descending coronary artery

________________________________________________________________

3. Cor pulmonale

________________________________________________________________

Essential hypertension

________________________________________________________________

Tachycardia-bradycardia syndrome

________________________________________________________________

Wolff-Parkinson-White syndrome

________________________________________________________________

4. A patient was admitted with chest pain radiating into the jaw. The patient was also dyspnoeic and had a blood pressure of 180/108. A coronary angiography was undertaken. Diagnoses of acute coronary syndrome (ACS) and hypertensive crisis were made.

Acute coronary syndrome (ACS)

________________________________________________________________

Hypertensive crisis

________________________________________________________________

5. A patient was admitted for a femoropopliteal bypass on a known history of peripheral vascular disease (PVD)with rest pain, and non-healing ulcer on the big toe of the right foot. CT angiogram of the right lower limb revealed total occlusion of the superficial femoral artery due to the PVD. Surgery was successful and the foot ulcer was treated with daily dressing.

____________________________________________

You have completed Coding exercises for Chapter 11.Please go to the next section in this unit.Chapter 12 Diseases of the respiratory system

Chapter 12 Diseases of the respiratory systemChapter 12 Structure Chapter 12 Diseases of the respiratory system contains these top level blocks:

Upper respiratory tract disorders

Certain lower respiratory tract diseases

Lung infections

Lung diseases due to external agents

Respiratory diseases principally affecting the lung interstitium

Pleural, diaphragm or mediastinal disorders

Certain diseases of the respiratory system

Respiratory failure

Postprocedural disorders of the respiratory system



Select Chapter 12 Diseases of the respiratory system on the hierarchy tree of ICD-11.

Expand Chapter 12 Diseases of the respiratory system by using the grey arrow to view the list of top-level blocks. Information about the block will be displayed on the right side panel.

Chapter 12 Medical InformationAnatomy and physiology of the respiratory systemRespirationEvery cell in the human body requires a constant supply of oxygen in order to survive and to carry out its functions.

The process by which the organs and tissues of the body are supplied with oxygen is called respiration.

The lungs breathe in air, which contains a mixture of gases including oxygen. This is called inspiration. The bloodstream then takes the oxygen from the lungs and moves it around the body.

Chapter 12 Medical InformationRespirationAll the cells in the body tissues receive their oxygen by absorbing it from the blood supply. This process is called internal respiration. The blood exchanges the oxygen for waste products, mainly carbon dioxide, which it takes from the cells and carries back to the lungs.

When the waste products reach the lungs, they are removed through a process called expiration.

Inspiration and expiration are the words used to describe the process of breathing in and out. This is also called external respiration.

Chapter 12 Medical InformationUpper respiratory tractAir enters the body via the nose and passes through the nasal cavity. This cavity contains mucous membranes and fine hairs called cilia. These stop the entry of foreign bodies and help to warm and moisten the air that is inspired. The nose is also the organ that senses smell. There are nerve endings in the roof of the nose that can detect smell. These are the olfactory nerves and they carry the impulses to the brain which recognises the smell.

Chapter 12 Medical InformationUpper respiratory tract After passing through the nasal cavity, the air next reaches the pharynx or throat.This has three parts:

the nasopharynx, which contains the pharyngeal tonsils or adenoids, which are collections of lymphatic tissue

the oropharynx which contains the palatine tonsils, two rounded masses of lymphatic tissue

the laryngopharynx, which is a passage for both food from the mouth and air from the nose. It divides into two branches: one is the larynx (voice box). The other branch is the oesophagus which forms part of the upper digestive tract.

Chapter 12 Medical InformationUpper respiratory tractThe larynx contains the vocal cords. These are enclosed in pieces of cartilage which provide support. As air is expired it moves through the vocal cords, causing them to vibrate and produce sounds.

Food from the mouth and air from the nose both pass through the pharynx. The epiglottis is a flap of cartilage which prevents choking or aspiration of food into the lungs by working like a lid over the opening of the larynx. When food travels through the throat, the epiglottis closes over the top of the larynx.

Chapter 12 Medical InformationLower respiratory tract Moving down the system, the air then moves from the larynx to the trachea. This is a tube containing rings of cartilage and connective tissue that keep it open.

When the trachea reaches the mediastinum, which is the central compartment of the chest, it divides at the carina into two tubes, called bronchial tubes, or bronchi.

Chapter 12 Medical InformationLower respiratory tractAt the end of the bronchi are the smallest branches, called bronchioles. These end in bunches of air sacs called alveoli. Each alveolus has a lining which is made up of a one-cell layer of epithelium. This very thin wall is where the exchange of gases occurs. Oxygen is delivered to the bloodstream and carbon dioxide is collected for removal.

Erythrocytes or red blood cells are the cells which carry the oxygen to all parts of the body and the carbon dioxide back to the lungs for expiration.


Chapter 12 Medical InformationLower respiratory tractThe bronchi, bronchioles and alveoli are contained within the two lungs. These are covered by a membrane called the pleura. The layer of the pleura lining the chest cavity is the parietal pleura and the inner layer covering the lungs is the visceral pleura. The pleura is moistened with a serous secretion, which is a thin, watery fluid that helps the lungs move within the chest (thorax).

The two lungs are not quite the same. The right lung is the larger of the two, and is divided into three lobes. The left lung is smaller and has only two lobes.

Chapter 12 Medical InformationDiseases of the respiratory tractCommon cold (also called a coryza) is a viral infection of the nasal passages and pharynx which causes generalised symptoms (malaise, tiredness) and rhinitis (an inflammation of the nasal passages).

Croup is a viral infection of the throat and trachea causing a hoarse voice, noisy breathing and a harsh, barking cough. Croup usually occurs in young children.

Diphtheria is a bacterial infection of the throat, tonsils and nose. A white or grey-looking membrane (which initially looks like a spider web) forms on the back of the throat or in the nose causing an obstruction and difficulty breathing.

Chapter 12 Medical InformationDiseases of the respiratory tractPertussis (also known as whooping cough) is a highly infectious bacterial respiratory infection. Children with pertussis have a characteristic paroxysmal cough with inspiratory whoop.

Tonsillitis involves infection of the pharyngeal tonsils (at the back of the throat) caused by a viral or bacterial infection. It causes a sore throat.

URTI stands for Upper Respiratory Tract Infection. This is an acute viral inflammatory disease which affects the nose, paranasal sinuses, pharynx, larynx, trachea and bronchi.

Chapter 12 Medical InformationDiseases of the respiratory tractChronic obstructive lung disease (COLD) (also known as chronic obstructive pulmonary disease (COPD)) is the collective term for a number of respiratory diseases that prevent the lungs from breathing properly. Two of the most common types of COPD are emphysema and chronic bronchitis.

Asthma occurs in people who have very sensitive airways that narrow in response to certain "triggers". This leads to difficulty in breathing. The airway narrowing is caused by inflammation and swelling of the airway lining, the tightening of the airway muscles, and the production of excess mucus. This reduces the airflow in and out of the lungs and results in a characteristic wheezing sound when the person breathes.

Chapter 12 Medical InformationDiseases of the respiratory tractBronchiectasis is a relatively rare condition affecting the bronchi and lungs. The bronchi become enlarged, forming areas where infection may gather. The walls of the bronchi are damaged and the cilia, which work to keep the respiratory system clean, are destroyed. Without the cilia, germs and foreign material accumulate, causing infection.

Acute bronchitis occurs when the linings of the trachea and bronchi become red and swollen and excessive mucus is produced. This causes wheezing and coughing.

Chronic bronchitis is a progressive inflammatory disease caused by extended exposure to irritants such as tobacco smoke or atmospheric pollutants. It can lead to more severe breathing disorders.

Chapter 12 Medical InformationDiseases of the respiratory tractEmphysema occurs when the alveoli and the narrow passages leading to these air sacs become permanently swollen and lose their elasticity, which makes breathing difficult.

Pneumoconioses are a group of lung diseases that are caused by people breathing polluted gases. Fibrosis of the lung tissue occurs. Examples are silicosis and asbestosis.

Pneumonia is an infection of the lungs, caused by bacteria or viruses. People with pneumonia usually get short of breath because the infection blocks airways in the lungs, interfering with the movement of oxygen from the air into the blood.

Chapter 12 Medical InformationDiseases of the respiratory tract Pneumothorax is another name for a collapsed lung. This occurs when air collects in the pleural space between the lung and the chest wall. The pressure of the air inside and outside the lung determines the extent of lung collapse.

Spontaneous pneumothorax occurs when there is no penetrating wound and may be caused by physical activities, such as scuba diving, high-altitude flying, vigorous stretching or from the rupture of an air sac in the lung caused by a lung disease such as asthma. Pneumothorax may also be due to trauma, when there is a wound to the chest and air leaks into the pleural space and causes the lung to collapse.


Diseases of the respiratory tractTuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis, commonly affecting the lungs. In some cases the disease affects other parts of the body, such as lymph glands, bones, or kidneys.

Initial infection of the lung often occurs during childhood and goes unnoticed. However, a few bacteria continue to survive at the site of infection. Later in life, the infection can reactivate and a serious lung infection occurs.

Chapter 12 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there are no chapter-specific notes for Chapter 12 Diseases of the respiratory system.

Chapter 12 Coding examplesExample 1A patient was admitted with shortness of breath, coughing and a fever. Chest X-ray demonstrated pneumonia and sputum culture indicated that the patient had Pseudomonas pneumonia.

CA40.05 Pneumonia due to Pseudomonas aeruginosa



Enter the diagnostic statement – pseudomonas pneumonia

Open the code CA40.05 Pneumonia due to Pseudomonas aeruginosa in the browser window using the icon in the coding tool display

Note the postcoordination option for laterality. Where the causative agent is precoordinated in the code title, it is not necessary to postcoordinate them from Chapter X Extension codes.

Chapter 12 Coding examplesExample 2A patient was admitted with a shortness of breath, sharp pain on inhalation and increased heart rate.

A chest x-ray showed a spontaneous tension pneumothorax.

CB21.0 Spontaneous tension pneumothorax



Enter the diagnostic statement – spontaneous tension pneumothorax

Open the code CB21.0 Spontaneous tension pneumothorax in the browser window using the icon in the coding tool display

Note the postcoordination option for laterality.

Chapter 12 Coding examplesExample 3A patient was admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD).

CA22.0 Chronic obstructive pulmonary disease with acute exacerbation, unspecified



Enter the diagnostic statement – exacerbation COPD

Open the code CA22.0 Chronic obstructive pulmonary disease with acute exacerbation, unspecified in the browser window using the icon in the coding tool display






Chapter 12 Coding exercisesAssign codes to the following diseases:

Idiopathic pulmonary fibrosis.

______________________________________

Type I chronic respiratory failure.

______________________________________

Chronic bronchitis secondary to tobacco harmful use.

______________________________________

A patient was admitted with a cough, dyspnoea, and haemoptysis. Chest x-ray showed tracheal and bronchial wall thickening, with a small degree of atelectasis. CT confirmed the presence of interstitial lung disease, with AL amyloidosis.

______________________________________

A patient was admitted with shortness of breath on exertion and became tachypnoeic in the recumbent position. A chest x-ray confirmed a diagnosis of diaphragm paralysis.

______________________________________

You have completed Coding exercises for Chapter 12.Please go to the next section in this unit.Chapter 13 Diseases of the digestive system

Chapter 13 Diseases of the digestive systemChapter 13 Structure Chapter 13 Diseases of the digestive system contains these top level blocks

Diseases or disorders of orofacial complex

Diseases of oesophagus

Diseases of the stomach or the duodenum

Diseases of small intestine

Diseases of appendix

Diseases of large intestine

Diseases of anal canal

Diseases of liver

Chapter 13 Structure Diseases of gallbladder or biliary tract

Diseases of pancreas

Diseases of peritoneum

Diverticular disease of intestine

Ischaemic vascular disorders of intestine

Hernias

Inflammatory bowel diseases

Functional gastrointestinal disorders

Postprocedural disorders of digestive system

Chapter 13 StructureThis chapter has very detailed anatomical groups that follow the hierarchy for the digestive tract, according to rostral-caudal order.

Exceptions are categories for hernia, functional gastrointestinal disorders and inflammatory bowel diseases.

Chapter 13 StructureICD-11 has been improved in structure and content including:

Vascular disorders of GI organs have their own category. However, oesophageal varices, gastric varices and haemorrhoids are classified in Chapter 13.

In ‘Diseases of liver’, there are independent categories for Metabolic and transporter liver disease, Autoimmune liver diseases, Non-alcoholic fatty liver disease and Vascular disorders of the liver.

There are also independent sections for ‘Diseases of gallbladder and biliary duct’ and ‘Diseases of pancreas’.



Select Chapter 13 Diseases of the digestive system on the hierarchy tree of ICD-11.

Expand Chapter 13 Diseases of the digestive system by using the grey arrow to view the list of top-level blocks. Information about the block will be displayed on the right side panel.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe gastrointestinal (GI) (or alimentary) tract starts at the oral cavity and ends at the anus. It is the system that enables the ingestion, digestion, absorption and elimination of food.

The organs that make up the digestive system are the mouth, oesophagus, stomach, small intestines, large intestines, liver, gallbladder and pancreas.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThere are three accessory organs that are related to the alimentary tract. These are the liver, the gallbladder and the pancreas. They are considered part of the digestive system because they also produce chemicals that are necessary for the chemical breakdown of food.

The digestive (or exocrine) pancreas produces digestive enzymes that are secreted into the intestines to help digest food.

The gallbladder stores bile which is produced in the liver. Bile is secreted from the gallbladder into the intestines to help digest fats.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe upper gastrointestinal (GI) tract consists of:

the oral cavity (mouth)

pharynx oesophagus and stomach.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe oral cavity includes the teeth, tongue, salivary glands, jaw and the buccal mucosa (the inner lining of the cheeks and lips). It is in here that the digestion process begins, by the chewing (mastication) of the food and the formation of a food bolus (a small lump of chewed food).

Salivary glands surround the mouth and secrete saliva. Saliva is mainly compromised of water, electrolytes, mucus and salivary amylase and helps with the early phases of chemical digestion and to liquefy food.


Anatomy and physiology of the digestive systemThe pharynx allows the passage of the food bolus into the oesophagus. This organ is also part of the respiratory system as it allows air into the trachea.

The epiglottis is a flap of cartilage which prevents choking or aspiration of food into the lungs. It works like a lid so that when food travels through the throat, the epiglottis closes over the top of the trachea.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe oesophagus is a muscular tube that allows the passage of the food from the pharynx to the stomach. The process of moving the food through the oesophagus is called peristalsis.

Chapter 13 Medical InformationAnatomy and physiology of the digestive system

Further digestion takes place in the stomach where gastric acidic juices break down the food. The cardiac orifice is the opening to the stomach. The rounded upper portion of the stomach is called the fundus, and is above the body of the stomach. The main portion of the stomach is called the body of the stomach and the lower portion of the stomach is called the pyloric antrum. The pyloric sphincter leads to the duodenum.

Some substances resulting from this breakdown are absorbed through the lining of the stomach while the rest of the semi-digested food is passed into the small intestine through the pyloric sphincter.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe lower gastrointestinal (GI) tract consists of:

the small intestine large intestine and the anus.


The small intestine connects the stomach and the large intestine. It is made up of the duodenum, the jejunum and the ileum. This is where the majority of food digestion takes place.

The digestive process is helped by bile (a digestive juice produced in the liver) and different enzymes released by the pancreas, and also by glands in the small intestinal wall.

Once the various nutrients are broken down into a simple state, they are then absorbed through the small intestine.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe large intestine consists of 3 parts: caecum, colon and rectum. The large intestine starts just after the ileocecal valve at the caecum, and the appendix is attached at the bottom of the caecum.

The main function of the large intestine is to absorb the remaining water from indigestible food (substances that cannot be broken down by the body). It also stores the useless nutrients and wastes and flushes them from the body in the form of faeces.


The colon has four portions: ascending, transverse, descending and sigmoid or pelvic colon.

The ascending colon proceeds from the ileocecal valve upward to the hepatic flexure, which is on the right side of the abdomen.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe colon then becomes the transverse colon and then turns downward to become the descending colon at the splenic flexure, on the left side of the abdomen.

The sigmoid colon follows on from the descending colon and then ends at the rectum.


The anus is the external opening of the alimentary tract where the expulsion or defecation of faeces occurs. Internal and external anal sphincters at the terminus of the rectum control the flow of faecal material leaving the body.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe accessory organs consist of:

the biliary system the liver (which is part of the biliary system)

the gallbladder (which is another part of the biliary system)

the pancreas


The biliary system is made up of the liver, gallbladder and various ducts (hepatic, cystic and common bile). It is involved in the production and transportation of bile – which aids digestion.

One of the functions of the liver is to produce bile. The bile is secreted into the small intestine via the common bile duct.

Chapter 13 Medical InformationAnatomy and physiology of the digestive systemThe gallbladder stores the bile produced by the liver.

The pancreas produces pancreatic enzymes that help in the digestive process. These enzymes are passed into the small intestine via the pancreatic duct.

Chapter 13 Medical InformationDiseases of the digestive systemGastro-oesophageal reflux disease (GORD or GERD) is a chronic disease of the lower oesophagus and stomach. Acid reflux occurs when the lower oesophageal sphincter does not close properly. The lower oesophagus becomes inflamed and irritated due to the reflux of food and gastric acid.

Oesophagitis is the inflammation of the oesophagus due to reflux, chemicals and infection.

Chapter 13 Medical InformationDiseases of the digestive system Appendicitis is the inflammation of the vermiform appendix. It is usually caused when the appendiceal lumen is blocked by faecalith, inflammation, a neoplasm or foreign body. The obstruction results in oedema, infection and often infarction of the wall of the appendix.

If diagnosis or treatment is delayed the appendix may rupture resulting in peritonitis (infection of the peritoneum) or abscess formation.

Chapter 13 Medical InformationDiseases of the digestive systemA hernia is formed by the protrusion of part of the abdominal contents (usually fatty tissue or intestine) through a defect or weakness in the abdominal wall or nearby structure. Types of hernia related to the digestive system include:

Hiatus hernias result from a weakness in the diaphragm that allows the protrusion of the stomach or lower oesophagus into the thorax.

Inguinal hernias are located in the groin area just above the thigh and involve the protrusion of intestine or fatty tissue through a weakened area of the abdominal wall.

Femoral hernias occur when intestine protrudes into the femoral canal.

Chapter 13 Medical InformationDiseases of the digestive systemUmbilical hernias are located in the area of the umbilicus (belly button) where there is a weakness in the abdominal wall. These hernias may often be present at birth.

Incisional hernias result from a weakness in the abdominal wall caused by abdominal surgery.

Epigastric hernias occur higher up the abdominal wall and usually only contain fatty tissue. The epigastric region is the upper part of the abdomen, above the stomach.

Chapter 13 Medical InformationDiseases of the digestive systemA peptic ulcer is a hole in the lining (mucous membrane) of the stomach (gastric), duodenum or oesophagus. A peptic ulcer may also be documented as a gastroduodenal, gastrojejunal (including anastomotic), gastrointestinal or marginal ulcer.

While excess acid is considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by bacteria called Helicobacter pylori (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications (NSAIDs (nonsteroidal anti-inflammatory drugs)), including aspirin.

Chapter 13 Medical InformationDiseases of the digestive systemCrohn disease is a chronic inflammatory digestive disorder that most commonly affects the lower small intestine (ileum). The disease is characterised by areas of inflammation with areas of normal lining in between.

The main gastrointestinal symptoms are abdominal pain, diarrhoea (which may be bloody), constipation, vomiting and weight loss or gain. Crohn disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis and inflammation of the eye.

Chapter 13 Medical InformationDiseases of the digestive systemIrritable Bowel Syndrome (IBS) is a chronic disorder of function of the gastrointestinal tract, particularly the large intestine (colon).

Symptoms include abdominal pain or discomfort, mucus in the stools, irregular stools and alternating diarrhoea and constipation.

Diverticular disease is a disease of the colon (and usually the sigmoid colon). Diverticula are little ‘out-pouching’s’ of the wall of the colon, although they can be found in smaller numbers in the stomach or small intestine. Diverticulitis is inflammation of the colon at the site of the diverticula – usually as a result of the diverticula becoming blocked.

Chapter 13 Medical InformationDiseases of the digestive systemParalytic ileus is a functional obstruction of the intestine, usually the colon and is also called adynamic ileus. This is usually due to a neurogenic impairment of peristalsis and can lead to complete intestinal obstruction.

Intestinal obstruction is a potentially serious condition where the intestines are blocked and can it can affect the small and large intestine (colon). When there is a blockage, food and drink cannot pass through the body and may require surgery.

Volvulus is when a loop of intestine twists around itself and the mesentery that supports it, which causes a bowel obstruction. Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool. Symptoms may appear rapidly or more gradual.


Diseases of the digestive systemHepatitis is the inflammation of the liver. It can be acute (lasts less 6 months) or chronic (when it persists longer).

Hepatitis can be due to toxins (e.g. drugs, alcohol), infections or from autoimmune processes.

A group of viruses known as the hepatitis viruses cause most cases of liver damage worldwide.

Cirrhosis is a result of chronic liver disease characterised by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules. Cirrhosis is most commonly caused by alcoholism and hepatitis C, but has many other possible causes.

Chronic liver failure usually occurs in the context of cirrhosis.

Chapter 13 Medical InformationDiseases of the digestive systemCholecystitis is an infection or inflammation of the gallbladder which occurs most commonly because of an obstruction of the cystic duct from cholelithiasis (gallstones). Inflammation of the ducts (cholangitis) may also occur.

Other causes of cholecystitis include ischaemia (decreased blood flow to the gallbladder) and bacterial infections.

Chapter 13 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there are no chapter-specific notes for Chapter 13 Diseases of the digestive system.

Chapter 13 Coding examplesExample 1A patient was admitted for an oesophagogastroduodenoscopy (EGD) which showed gastro-oesophageal reflux with oesophagitis.

DA22.1 Erosive gastro-oesophageal reflux disease



Enter the diagnostic statement – reflux oesophagitis

Open the code DA22.1 Erosive gastro-oesophageal reflux disease in the browser window using the icon in the coding tool display

Note the postcoordination option for has manifestation.

Chapter 13 Coding examplesExample 2A patient was admitted with gastrointestinal (PR) bleeding for a colonoscopy. The scope demonstrated that the bleeding was due to rectal polyps.

DB35.Y Other specified polyp of large intestineXA4KU2 RectumCluster: DB35.Y&XA4KU2Underlined text indicates optional extension code



Enter the diagnostic statement – rectal polyp

Open the code DB35.Y Other specified polyp of large intestine in the browser window using the icon in the coding tool display

Note the postcoordination options for specific anatomy and has manifestation.

Using the postcoordination option for specific anatomy assign XA4KU2 Rectum

Cluster: DB35.Y&XA4KU2

Chapter 13 Coding examplesExample 3A patient was admitted to hospital with severe abdominal pain. He was diagnosed with an incarcerated inguinal hernia on the right side.

DD51 Inguinal herniaXK9K RightME24.7 Digestive system incarceration

Cluster: DD51&XK9K/ME24.7




Enter the diagnostic statement – inguinal hernia

Open the code DD51 Inguinal hernia in the browser window using the icon in the coding tool display

Note the postcoordination options for laterality and has manifestation.

Using the postcoordination options assign XK9K Right and ME24.7 Digestive system incarceration

Cluster: DD51&XK9K/ME24.7





Chapter 13 Coding exercisesAssign codes to the following diseases:

1. Toxic megacolon due to ulcerative colitis

_____________________________________

2. Temporomandibular joint (TMJ) dysfunction

_____________________________________

3. Liver cirrhosis with associated bleeding oesophageal varices

_____________________________________

4. A patient was admitted for an oesophagogastroduodenoscopy (EGD) for ongoing upper abdominal pain and haematemesis. The EGD demonstrated a sizeable gastric ulcer, due to Helicobacter pylori as the cause of the pain and haematemesis.

Disease: gastric ulcer due to Helicobacter pylori

_____________________________________

5. A patient was admitted to hospital due to two-day history of fever, severe abdominal pain and diarrhoea. On examination, the abdomen was tender to palpation and peritoneal signs were positive. Laboratory investigations showed highly elevated markers of inflammation. He was diagnosed with sepsis due to acute appendicitis. An appendectomy was performed

Disease: sepsis due to acute appendicitis

_____________________________________

You have completed Coding exercises for Chapter 13.Please go to the next section in this unit.Chapter 15 Diseases of the musculoskeletal system and connective tissue

Chapter 15 Diseases of the musculoskeletal system or connective tissueChapter 15 StructureChapter 15 musculoskeletal system or connective tissue contains these top level blocks:

Arthropathies

Conditions associated with the spine

Soft tissue disorders

Osteopathies or chondropathies

Certain specified acquired deformities of musculoskeletal system or connective tissue, not elsewhere classified

Postprocedural disorders of the musculoskeletal system

Chapter 15 Structure A block for autoinflammatory syndromes located in Chapter 04 Disorders of the

immune system is secondarily parented to Chapter 15.

Spinal conditions are grouped together in the section Conditions associated with spine.



Select Chapter 05 Endocrine, nutritional or metabolic disease on the hierarchy tree of ICD-11.

Expand Chapter 05 Endocrine, nutritional or metabolic disease by using the grey arrow to view the list of top-level blocks. Information about the block will be displayed on the right side panel.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal systemThe musculoskeletal system has two parts.

The skeletal system is made up of bones and joints. It is made up of 206 bones, the smallest being the ossicles in the inner ear and the largest being the femur.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal system – continued The muscle system is made up of the voluntary muscles (those we control and use for functions such as walking). These are also known as striated muscles.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal system – continued Connective tissue is made up of fibres and is involved in the structure and support of various body tissues and organs.

Bones are connected to each other at the joints by ligaments. Skeletal muscle is usually attached to bones by tendons.

As well as tendons and ligaments, cartilage, adipose tissue, blood and bone itself are all types of connective tissue.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal system – continued Skull The skull or cranium protects the brain. The bones of the cranium include the frontal, parietal, temporal, occipital, sphenoid and ethmoid.

The mandible and the maxilla form the jaw.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal system – continued Shoulder and thoracic (chest) region There are two bones in the shoulder area, one of which is the clavicle or collar bone. The scapula is also known as the shoulder blade. The thoracic area has the sternum, as well as ribs on both sides of the chest.


Anatomy and physiology of the musculoskeletal system – continued The bones in the armThe three bones in the arm are the humerus in the upper arm, and the radius and ulna in the lower arm.

There are also carpal bones that form the wrist, metacarpals that form the hand and the phalanges which form the fingers.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal system – continued The bones in the leg and footThe three bones in the leg are the femur in the upper leg, and the tibia and fibula in the lower leg.

There are also tarsal bones that form the ankle, metatarsals that form the foot and the phalanges which form the toes.


Anatomy and physiology of the musculoskeletal system – continued The pelvis The pelvis (also referred to as the pelvic girdle) is made up of the hip bone (also called the coxal bone or innominate bone) which has three parts (the ilium, pubis and ischium), sacrum and coccyx.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal system – continued The spine The bones in the spine or vertebral column are called vertebrae and they protect the spinal cord and spinal nerves.

There are seven cervical vertebrae, twelve thoracic vertebrae and five lumbar vertebrae, along with the sacrum and coccyx.

Chapter 15 Medical InformationAnatomy and physiology of the musculoskeletal system – continued

The spine – continued Between the vertebrae there is an intervertebral disc which cushions the joint.

Chapter 15 Medical InformationDiseases of the musculoskeletal systemMyositis is an inflammation of a muscle. Some myositis disorders are thought to be caused by autoimmune conditions, rather than resulting from an infection.

Tendonitis is an inflammation of a tendon. It usually results from an overuse injury, where the tendon is repeatedly strained until tiny tears form. Symptoms include pain and swelling.

Synovitis is an inflammation of a synovial membrane. This type of membrane lines those joints which possess cavities and are called synovial joints. The joint swells due to fluid collection and is painful when moved.

Chapter 15 Medical InformationDiseases of the musculoskeletal systemBursitis is an inflammation of a bursa. Bursae are small sacs located between two adjoining structures, such as muscles, tendons or bones. Bursitis involves inflammation outside the joint unlike arthritis which involves inflammation within the joints.

Arthritis is inflammation of a joint. Osteoarthritis (OA) is the most common form of arthritis. It is a chronic disorder characterised by degeneration of joint cartilage and adjacent bone. It causes joint pain and stiffness. It may also be documented as degenerative arthritis or degenerative joint disease.

Chapter 15 Medical InformationDiseases of the musculoskeletal systemRheumatoid arthritis and psoriatic arthritis are both autoimmune forms of arthritis in which the body attacks itself.

Septic arthritis is caused by an infection in the joint.

Gouty arthritis is caused by deposition of uric acid crystals in the joint, causing inflammation.

Juvenile arthritis is a general term for the different types of arthritis that occur in children. It is diagnosed sometime between birth and 16 years of age.

Chapter 15 Medical InformationDiseases of the musculoskeletal systemOsteoporosis is a condition in which the bones become brittle and fragile. This happens as a result of losing minerals, particularly calcium, more quickly than the body replaces them. Bones then lose their density and become thinner and less able to tolerate minor bumps or accidents that can then cause serious fractures.

Osteomyelitis is an infection of the bone, usually as a result of a bacterial infection. It may be either acute (of recent onset) or chronic (longstanding).

Chapter 15 Medical InformationDiseases of the musculoskeletal systemPaget disease is an example of secondary osteoarthritis. It is the most common form of bone inflammation. The effect of Paget disease is that bone breaks down more quickly than normal, and when it re-grows, it is much softer and weaker than normal bone.

Rotator cuff syndromeThere are two categories of rotator cuff problems:

Tears of the tendons and/or muscles, and inflammation of structures in the joint. The most common is a rotator cuff tear.

Inflammation of the muscle/tendons of the rotator cuff is the second type of problem.

Chapter 15 Medical InformationDiseases of the musculoskeletal systemDorsopathy refers to various diseases of the back and/or spine.

Spondylopathy refers to disorders of the vertebrae, which are the bones making up the spinal column. Examples include:

spondylosis – degeneration of the spine with deformity of the joint(s) of two or more vertebrae, which may result in narrowing

ankylosing spondylitis – a chronic, degenerative inflammatory arthritis of the spine

spinal stenosis – a narrowing of the spinal canal, resulting in compression of the spinal cord and spinal nerves. It may result in radiculopathy.

Chapter 15 Medical InformationDiseases of the musculoskeletal systemMyelopathy refers to any disease of the spinal cord. In cases of intervertebral disc disorders, it means that the disc problem is impacting on the spinal cord and compressing it.

Radiculopathy is where the disc disorder impacts on a spinal nerve root such that the nerve does not work properly. It has symptoms of pain and/or numbness radiating from the affected nerve. Sciatica is the most common type of radiculopathy.

Herniated intervertebral disc (also known as displaced or prolapsed intervertebral disc) is when there is a break in the outer rim of the disc and nuclear tissue is pushed out through the defect and into the spinal canal. Compression of the spinal cord or nerve roots may occur. It occurs most frequently in the lower lumbar region.

Chapter 15 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there is one chapter-specific note for the musculoskeletal system.

General notesMany musculoskeletal conditions are treated without knowing the underlying disease. In such cases only the musculoskeletal condition is coded.

Chapter 15 Coding examplesExample 1A patient was admitted for a decompressive laminectomy for third lumbar vertebra spinal stenosis.

FA82 Spinal stenosis

XA3N97 Third lumbar vertebra

Cluster: FA82&XA3N97




Enter the diagnostic statement – spinal stenosis

Open the code FA82 Spinal stenosis in the browser window using the icon in the coding tool display

Note the postcoordination option for specific anatomy and has manifestation

Using the postcoordination for specific anatomy assign XA3N97 Third lumbar vertebra

Cluster: FA82&XA3N97

Chapter 15 Coding examplesExample 2A patient was admitted for elective total knee replacement for osteoarthritis of the right knee.

FA01.Z Osteoarthritis of knee, unspecified

XK9K Right

Cluster: FA01.Z&XK9K




Enter the diagnostic statement – osteoarthritis knee

Open the code FA01.Z Osteoarthritis of knee, unspecified in the browser window using the icon in the coding tool display

Note the postcoordination option for laterality, specific anatomy and associated with

Using the postcoordination function for laterality assign XK9K Right

Cluster: FA01.Z&XK9K

Chapter 15 Coding examplesExample 3 A patient was admitted to hospital for arthrodesis of the right wrist for a nonunion of distal radius fracture. He had a fall 12 months ago and sustained a closed Colles fracture for which he underwent closed reduction and insertion of a K-wire with plaster cast immobilisation.

FB80.8 Nonunion of fracture

XK9K Right

XA4X32 Lower end of radius not otherwise specified

Cluster: FB80.8&XK9K&XA4X32


Note: for the purposes of this example (i.e. to demonstrate content of Chapter 15) the external cause codes have not been assigned.

Chapter 15 Coding examplesExample 3Interactive Activity: Open the ICD-11 Coding Tool. A link to the ICD-11 Coding Tool and Browser (blue) can be found on the EIC Education Tool platform

Enter the diagnostic statement - nonunion fracture

Open the code FB80.8 Nonunion of fracture in the browser window using the icon in the coding tool display

Note the postcoordination option for laterality, specific anatomy and associated with.

Using the postcoordination function assign XK9K Right and XA4X32 Lower end of radius not otherwise specified

Cluster: FB80.8&XK9K&XA4X32





Chapter 15 Coding exercisesAssign codes for the following diseases:

1. Pathological fracture of the third lumbar spine due to osteoporosis

______________________________________________________________

2. Polymyalgia rheumatica

______________________________________________________________

3. A patient was admitted for a total hip replacement of the left hip due to idiopathic avascular necrosis of the femoral head.

______________________________________________________________

4. A patient was admitted with pain and stiffness in the bottom of the left heel, extending outward from the heel. The pain was worse in the morning, or if the patient had been sitting for a while. A diagnosis of plantar fasciitis was made.

______________________________________________________________

5. A patient was admitted with lower back pain. A spinal CT confirmed a prolapsed L4/5 disc with degenerative disease of the spine in the lumbar area.

______________________________________________________________

You have now completed ICD-11 Education Tool Unit 6Chapter 08 Diseases of the nervous systemChapter 11 Diseases of the circulatory systemChapter 12 Diseases of the respiratory SystemChapter 13 Diseases of the digestive systemChapter 15 Diseases of the musculoskeletal system

and connective tissue

Answers to Unit 6 ExercisesChapter 08 Coding Exercises

1. 8A03.30 Ataxia due to alcoholic cerebellar degeneration

2. 8A42.Z Acute disseminated encephalomyelitis, unspecified

3. 8A60.5 Epilepsy due to injuries to the head

Note: for the purposes of this exercise (i.e. to demonstrate content of Chapter 08) the sequelae codes have not been assigned

4. 8D20.10 Spastic quadriplegic cerebral palsy

5. 8B11.1 Cerebral ischaemic stroke due to intracranial large artery atherosclerosis

XA1XP6 Vertebral artery

MB53.Z Hemiplegia, unspecified

MA80.1 Dysphasia

Chapter 11 Coding exercises1. The correct response is NO

2. BA82&XA7NQ7


BA82 Coronary artery dissection

XA7NQ7 Left anterior descending coronary artery

3. BB01.5 Cor pulmonale BA00.Z Essential hypertension, unspecifiedBC80.20 Tachycardia-bradycardia syndromeBC81.4 Wolff-Parkinson-White syndrome

4. BA4Z Acute ischaemic heart disease, unspecified

BA03 Hypertensive crisis

5. BD40.0Y&XK9K&XA2JF3/EF60


BD4.0Y Other specified lower limb atherosclerosis

XK9K Right

XA2JF3 Femoral artery

EF60 Ischaemic ulceration of skin

Chapter 12 Coding exercises1. CB03.4 Idiopathic pulmonary fibrosis

2. CB41.10 Chronic respiratory failure, Type I

3. CA20.1Z/6C4A.1Z**

**manual postcoordination

CA20.1Z Chronic bronchitis, unspecified

6C4A.1Z Harmful pattern of use of nicotine, unspecified

4. CB05.3/5D00.0

CB05.3 Interstitial lung diseases associated with metabolic disorders

5D00.0 AL amyloidosis

5. CB23 Disorders of diaphragm

Chapter 13 Coding exercises1. DB32.20/DD71.Z

DB32.20 Toxic megacolon

DD71.Z Ulcerative colitis, unspecified

2. DA0E.8 Temporomandibular joint disorders

3. DB93.1 Hepatic cirrhosis

DA26.00 Oesophageal varices with bleeding

4. DA60.1 Helicobacter pylori associated gastric ulcer

5. DB10.02/1G40

DB10.02 Acute appendicitis without localised or generalised peritonitis

1G40 Sepsis without septic shock

Chapter 15 Coding exercises1. FB80.B&XA3N97/FB83.1Z


FB80.B Pathological fracture, not elsewhere classified

XA3N97 Third lumbar vertebra

FB83.1Z Osteoporosis, unspecified

2. FA22 Polymyalgia rheumatica

3. FB81.0&XK8G&XA96S5


FB81.0 Idiopathic aseptic osteonecrosis

XK8G Left

XA96S5 Femoral head

4. FB40.1&XK8G


FB40.1 Plantar fasciitis

XK8G Left

5. FA80.9&XA2N96


FA80.9 Intervertebral disc degeneration of lumbar spine with prolapsed disc

XA2N96 Lumbar intervertebral disc or space L4–L5

hscic.kahootz.com · web viewthe main gastrointestinal symptoms are abdominal pain, diarrhoea...

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