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Classification of Diseases


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lecture given to first year med students in their Family and Community Medicine class (some slides were borrowed)

lecture given to first year med students in their Family and Community Medicine class (some slides were borrowed)

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  • 1. Classification of Diseases Lectured by Bien Nillos, MD Faculty Family and Community Medicine University of Saint La Salle
  • 2. Historical perspective
    • ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994.
    • The classification is the latest in a series which has its origins in the 1850s. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893.
    • WHO took over the responsibility for the ICD at its creation in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published.
  • 3.
    • The World Health Assembly adopted in 1967 the WHO Nomenclature Regulations that stipulate use of ICD in its most current revision for mortality and morbidity statistics by all Member States
  • 4. What is ICD
    • The international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use.
    • Include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected, reimbursement, resource allocation, quality and guidelines
  • 5. Uses of ICD
    • classify diseases and other health problems recorded on many types of health and vital records (e.g. death certificates and health records)
    • enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes
    • provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States.
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  • 10. ICD-9
    • are comprised of three characters to the left of a decimal point, and one or two digits to the right of the decimal point. Examples:
      • 250.0 means diabetes with no complications
      • 530.81 means gastro reflux disease (GERD)
      • 079.99 means a virus
  • 11.
    • Some ICD-9 codes have V or E in front of them. A “V” code designates a patient who is accessing the healthcare system for some reason that won't require a diagnosis, usually a preventive reason. Examples:
      • V70.0, the code for a general health check up
      • V58.66 specifies that a patient is a long term aspirin user
      • V76.12 is coded for a healthy person who gets a mammogram
      • V04.81 is the most common code for a flu shot
  • 12.
    • An ICD-9 code with an E specifies that the health problem is the result of an environmental factor such as an injury, accident, a poisoning or others.
    • A car accident code will be preceded by an E, as will a code for a victim of a plane crash or a snake bite or any other health problem caused by outside force. Medical errors are reported using some of these ICD E codes.
  • 13. ICD-10
    • codes are approached differently and are quite different from their ICD-9 counterparts. These codes are broken down into chapters and subchapters. They are comprised of a letter plus two digits to the left of the decimal point, then one digit to the right.
    • The letters group diseases. All codes preceded by a C indicate a malignancy (cancer), codes preceded by a K indicate gastrointestinal problems, etc.
  • 14.
    • Examples are:
      • A02.0 indicates a salmonella infection
      • I21.X refers to myocardial infarction
      • M16.1 is used for arthritis in the hip
      • Q codes represent genetic abnormalities, like Q35 for a baby born with a cleft palate
      • U codes are for new problems that develop over time. Any of the antibiotic resistant "superbugs" that develop over time will fall into the U category.
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  • 44. Break
  • 45. How To Diagnosis
    • The patient is a 63 year-old retired Navy veteran with a history of diabetes mellitus type II who presented to an outside hospital with mental status changes. He suffered clinical deterioration during the first 24 hours of his stay and was referred to our hospital in consideration of possible acute stroke. Presenting symptoms included fluent aphasia, confusion, and speaking gibberish. He also related a recent history of chronic cough, sputum production, and a 15 pound weight loss. As part of his initial stroke evaluation, he underwent CT angiography of the head and neck.
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    • This study was remarkable for pulmonary findings consistent with a large apical cavitary lesion. A high resolution chest CT without contrast was then performed, confirming a large cavitary lesion in the right upper lobe with a relatively thin wall (Figure 2). Sputum was collected for Acid Fast Bacilli (AFB) culture. In addition, a lumbar puncture was performed to collect cerebral spinal fluid (CSF) for analysis, AFB culture, and nucleic acid amplification of  M. tuberculosis  via PCR. Results of both sputum and CSF specimens are listed in the Microbiology and Laboratory sections.
  • 47.
    • Sputum specimenGram stain: Moderate white blood cells present  Many gram positive cocci in chains and pairs  Many "ghost" cells seen suggestive of Acid Fast Bacilli (Figure 3) AFB stain: Many Acid Fast Bacilli found on smear (Figure 4) Culture: Acid Fast Bacilli found on culture (8 days after collection)    Rough, buff colored colonies on LJ slant    Nitrate positive    Niacin positive    DNA probe: Positive for  M. Tuberculosis  Complex      Negative for  M. Avium  Complex
  • 48.
    • Cerebral Spinal Fluid specimen
    • PCR: Negative for Mycobacterium tuberculosis DNA Gram stain: Few white blood cells present. No organisms present. AFB Culture: No mycobacterium isolated
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