This lecture illustrates: -What is classification? -ICD definition. -Importance of ICD -ICD-10 -Coding guidelines in ICD-10 -A brief hint about ICD11

1. INTERNATIONAL CLASSIFICATION OF
DISEASES (ICD)
DR. IMAN EL SAYED
PH.D, ASSOCIATE PROFESSOR OF MEDICAL STATISTICS AND SYSTEMATIC REVIEWS, COCHRANE
AUTHOR, UK.
CANCER EPIDEMIOLOGY FELLOWSHIP, UNIVERSITY OF MILAN, ITALY.
MEDICAL RESEARCH INSTITUTE, ALEXANDRIA UNIVERSITY, ALEXANDRIA, EGYPT.
EMAIL: EMAN.ABD.ELFTAAH@ALEXU.EDU.EG
WWW.LINKEDIN.COM/IN/IMANELSAYED83

2. BY THE END OF
THIS LECTURE:
What is classification?
ICD definition.
Importance of ICD
ICD-10
Coding guidelines in ICD-
ICD11
Thanks to Dr. S.K.Nath

3. WHAT IS CLASSIFICATION ???
Classification is a method of grouping of items
scientifically according to purpose and codifying
them with numerical (or alpha-numerical)
identification according to certain principles.
Dr. S.K.Nath

4. THE MEANING OF CLASSIFICATION
There are many diseases, and one needs to establish a common language for
reporting and data analysis.
Standard grouping of diseases by a set of principles is called classification, and
it allows:
• Easy storage, retrieval and analysis of data
• Comparison and transmission of data between hospitals, provinces and
countries
• Comparison in the same location across different time periods.

5. ICD DEFINITION
• A system of categories to which morbid
entities are assigned according to established
criteria.
Dr. S.K.Nath

6. ICD
• The purpose of the ICD is to permit the
systematic recording, analysis,
and comparison of mortality and morbidity
data collected in different countries or
and at different times.
• The ICD is used to translate diagnoses of
diseases and other health problems from
words into an alphanumeric code, which
permits easy storage, retrieval and analysis of
the data”.

7. ICD
• Internationally endorsed classifications facilitate the
• storage,
• retrieval,
• analysis, and
• interpretation
• of data and their
• comparison
• - within populations over time and
• - between populations at the same point in time as well as the
• - compilation of internationally consistent data.
Populations may be nations, states and territories, regions, minority groups or other
specified groups.

8. WHO Family of
International
Classifications

9. EVOLUTION OF ICD
• Francois Bossier de Lacroix (1706-1777) conceived the idea
of classification of diseases and published it under the title
Nosologia methodica
• William Cullen (1710-1790) simplified the system for general
use and published it under the title Synopsis nosologiae
methodicae
Dr. S.K.Nath

10. William Farr (30 November 1807 - 14
April 1883) British epidemiologist,
regarded as one of the founders of
medical statistics.
Dr. S.K.Nath

11. IMPORTANCE OF ICD ACCORDING TO
WILLIAM FARR VIEW.
• “In many instance vague, inconvenient names of diseases have been
employed, or complications have been registered instead of primary
diseases”.

12. IMPORTANCE (CONTINUE)
• It has become the international standard diagnostic
classification for all general epidemiological and
many health management purposes.
• ICD helps in analysis of the general health situation of
population group
• The monitoring of the incidence and prevalence of
diseases and other health problems recorded on
many types of health and vital records.

13. IS THERE ICD-9?
• World Health Organization (WHO) developed ICD-9 for use
worldwide
• U.S. developed clinical modification (ICD-9-CM) Implemented in
1979 in U.S.
• Expanded number of diagnosis codes
• Developed procedure coding system
Pat Brooks, CMS

14. WHY IS ICD-9 OUTDATED?
• Old –technology has changed
• Many categories full
• Not descriptive enough
Pat Brooks, CMS

15. WHAT IS ICD-10?
• ICD-10 is a diagnostic coding system
developed by the World Health Organization
in 1993 to replace ICD-9-CM.
American Association of clinical endocrinologists

16. WHAT ARE ICD-10 CODES USED FOR?
• ICD-10 codes report diagnoses, signs, and or symptoms
documented in a patient’s chart or medical record.
• These codes are used to gather, store, and analyze data for
• Reimbursement–would enhance accurate payment for services rendered
• Quality–would facilitate evaluation of medical processes and outcomes
American Association of clinical endocrinologists

17. ARRANGEMENT OF VOLUMES OF ICD-10
• Volume 1: Main classifications (The Tabular List)
• Volume 2: Instruction manual/ Guidance to users
• Volume 3: Alphabetical Index

18. ICD-10: VOLUME 1
Main classifications
• Has 21 chapters (against 17 Chapters in ICD-9)
• Volume 1, the Tabular List, is an alphanumeric listing of
diseases, disease groups and health related problems.
• It contains inclusion and exclusion notes and some coding
rules.

19. CHAPTERS OF
VOLUME1:
Chapters I to XVII: Diseases and other morbid
conditions
Chapter XVIII: Symptoms, signs and abnormal clinical
and laboratory findings, not elsewhere classified.
Chapter XIX: Injuries, poisoning and certain other
consequences of external causes.
Chapter XX: External causes of morbidity and mortality,
Chapter XXI: Factors influencing health status and
contact with health services.

21. ICD-10: VOLUME 1I
• The Instruction Manual,
• Contains an introduction to the
classification and instructions
regarding how to use the
classification to code death
certificates, hospital medical
records and other forms of health
information.

22. ICD-10:
VOLUME 3
(ALPHABETICAL
INDEX)
Volume 3 is divided into three sections as follows:
Section-I lists all the terms classifiable to Chapters I-
XIX and Chapter XXI, except drugs and other
chemicals.
• Section II is the index of external causes of morbidity
and mortality and contains all the terms classifiable to
Chapter XX, except drugs and other chemicals.
• Section III gives the Table of Drugs and Chemicals, lists
for each substance the codes for poisonings and adverse
effects of drugs classifiable to Chapter XIX, and the
Chapter XX codes that indicate whether the poisoning
was accidental, deliberate (self-harm), undetermined, or
an adverse effect of a correct substance properly
administered.

23. ICD-10:
VOLUME 3
(ALPHABETICAL
INDEX)

24. ICD-10-CM CODE STRUCTURE
24
Category
first three
characters
Etiology, anatomic site,
severity, fourth, fifth,
sixth characters (if
applicable)
Extension
seventh
character
(if applicable)
M84 Disorder of continuity
of bone
M84.311- Stress fracture,
right shoulder
M84.311A Stress fracture, right
shoulder; initial encounter

25. BASIC CODING GUIDELINES
Are 3–7 digits;
•Digit 1 is alpha;
•Digit 2 is numeric;
•Digits 3–7 are alpha or numeric
•A decimal is used after the third character.
Examples:
• A78 – Q fever;
• A69.21 – Meningitis due to Lyme disease; and
• S52.131A – Displaced fracture of neck of right radius, initial encounter for closed
fracture.
2013 Webinar Series #6 –
ICD-10 Coding Questions & Answers
August 20, 2013

26. • The “core” classification of ICD-10 is the three-character code,
which is the mandatory level of coding for international reporting
to the WHO database and for general international comparisons.
• The four-character subcategories are recommended for many
purposes and form an integral part of the ICD.
BASIC CODING GUIDELINES

27. BASIC CODING GUIDELINES
• “ A00._” :
• “ ._ “ means that there is a 4th figure.
• “ .-” means not mentioned
• “ .*” means this condition is classified else where.

28. CODING: STEPS IN USING ICD 10
• 1- Locate the “Lead Term” ( usually a noun)
• 2- Go to Alphabetic Index ( vol 3).{ if the statement is
a disease or injury consult section I, if it is external
cause of an injury consult section II, for drugs and
poisons go to section III}
• 3- Read and be guided by any note that appears
under the lead term.
• 4 - Refer to the tabular list ( vol 1) to verify the
chosen code.

29. First, check the Index for a code representing your diseases. Then, confirm your choice in the Tabular
List.

30. EXAMPLE
• Anna has ruptured her spleen during a skiing
accident.
• Which volume will you refer to first to find a code
representing her problem?
• Answer: Volume 3

32. NOTES ON USING ICD 10
• N.B1:
Although it is possible to arrive the correct code using
VOL 1 alone, this could be time consuming and could
lead to errors in assignment.

33. NOTES ON USING ICD 10
N.B.2:
• When the diagnosis include systemic disease and
organ affection, coding is leaded by the systemic
disease.
• E.g “Lung Cancer”. Search for code under Cancer ( as
a systemic disease), not under Lung ( organ disease).

34. • Li has a neoplasm of the lung
• Would her illness be coded under:
Chapter II Neoplasms or
Chapter X Diseases of the Respiratory System?

35. NOTES ON USING ICD 10
N.B3:
• Usually the “lead Term” is the name of disease, while the
indented beneath it ( the modifier) refers to anatomical
sites or circumstances that affect its coding.
• E.g. Tuberculosis of hip-- Go under T “ tuberculosis”
not under H “ hip”
• E.g. Stomach ulcer - the Lead term is ulcer not
stomach

36. NOTES ON USING ICD 10
N.B(4)
• The “dagger and asterisk” system
• The primary code is for the underlying disease and is marked with a dagger
(†);
• an optional additional code for the manifestation is marked with an asterisk
(*).
(This is necessary to distinguish underlying generalized disease and a
manifestation in a particular organ or site which is a clinical problem in its
own right )
• E.G., For Syphilitic parkinsonism in G22*, the dagger code is A52.l † -
Symptomatic neurosyphillis

37. PLACEHOLDER “X” CHARACTER
N.B(5)
Placeholder character
The ICD-10-CM utilizes a placeholder character “X”. The “X” is used as a
placeholder at certain codes to allow for future expansion. An example of this is
at the poisoning, adverse effect and underdosing codes, categories T36-T50.
Where a placeholder exists, the X must be used in order for the code to be
considered a valid code.
Example:
H40.11X1 Mild stage primary open-angle glaucoma
NOTES ON USING ICD 10

38. 7th Characters
Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th
character is required for all codes within the category, or as the notes in the Tabular
instruct. The 7th character must always be the 7th character in the data field. If a code
that requires a 7th character is not 6 characters, a placeholder X must be used to fill in
the empty characters.
Example 1:
Some codes have even more!
Example 2:
T79.0XXA Initial encounter for a traumatic air embolism
W06.XXXD Subsequent encounter for a fall from a bed

40. EXAMPLE
• A patient is represented with glaucoma, Rt side, due to
amyloidosis

41. VOLUME 1
VOLUME III

42. • Turn to Chapter XIII, the Musculoskeletal chapter.
NOTES ON USING ICD 10

43. EXAMPLE 1:
Look up the category A37 in your Volume 1.
Condition:………

44. EXAMPLE 2:
Main condition: Cutaneous diphtheria
Code:………

45. EXAMPLE 3:
• Main condition: Severe epistaxis

46. ICD-11
• ICD-11 has been adopted by the Seventy-second
World Health Assembly in May 2019 and comes into
effect on 1 January 2022.

47. Centers for Disease Control and Prevention

48. Centers for Disease Control and Prevention

49. Centers for Disease Control and Prevention

50. Centers for Disease Control and Prevention

51. REFERENCES& RESOURCES:
1. ICD-10 Interactive Self Learning Tool:
• https://icd.who.int/training/icd10training/ICD-
10%20training/Start/index.html
2. ICD11
https://www.who.int/standards/classifications/classificati
on-of-diseases
3. https://www.accreditedschoolsonline.org/medical-
and-health/medical-billing-coding/icd-10/