The document provides an overview of the International Classification of Diseases (ICD) including: 1) A brief history of disease classification systems leading to the development of the ICD by the World Health Organization. 2) An explanation that the ICD-10 is the current international standard for morbidity and mortality statistics and coding of diseases and health problems. 3) A summary of the structure of ICD-10 including its 3 volumes, 22 chapters and alphanumeric coding system.

1. Presenter
Dr. Jai Parkash
JR 2
Moderator
Dr. R.B. Jain
Professor
Department of Community Medicine, PGIMS Rohtak

2. Contents
• Introduction
• Historical background
• Types of classification
• Purpose & Application
• ICD 10
I. Volumes
II. Chapters
III. Basic coding guidelines
• ICD 11 at a glance
• PGIMS Scenario
• References

3. • The International Statistical Classification of Diseases and
Related Health Problems 10th version (ICD 10) is the
international standard prescribed by WHO.
Introduction
Why do we need this?
• So that the morbidity & mortality databases are comparable
within the various region/states of the country and between
countries of region/world.

4. • Such reliable information is essential for meaningful
conclusion on the health status of the population and for
planning the development of facilities for medical and health
care and their efficient functioning.
• ICD 10 coding was introduced by WHO in the year 1993 and
India adopted the same in the year 2000
Introduction (Contd..)

5.  Francois Bossier de Lacroix (1706–1777),
better known as Sauvages did the first attempt
to classify diseases systematically
 Sauvages’ comprehensive treatise was
published under the title “Nosologia methodica”.
Historical background
 A contemporary of Sauvages was the great
methodologist Linnaeus (1707–1778), one
of whose treatises was entitled “Genera
morborum”.

6.  At the beginning of the 19th century, the
classification of disease in most general
use was one by William Cullen (1710–
1790), of Edinburgh, which was
published in 1785 under the title
“Synopsis nosologiae methodicae”.
 At the first International Statistical
Congress, held in Brussels in 1853,the
congress requested William Farr and
Marc d’Espine, of Geneva, for the
formulation of an internationally
applicable, uniform classification of
causes of death.

7. • At the next congress, in Paris in 1855, Farr and d’Espine
submitted two separate lists, which were based on very
different principles.
• Farr’s classification was arranged under five groups:
1. epidemic diseases,
2. constitutional (general) diseases,
3. local diseases arranged according to anatomical site,
4. Developmental diseases and
5. diseases that are the direct result of violence
• d’Espine classified diseases according to their nature (gouty,
herpetic, haematic, etc.).
• The congress adopted a compromise list of 139 rubrics

8. • In 1864, this classification was revised in Paris, on the basis
of Farr’s model, and was subsequently further revised in
1874, 1880 and 1886.
• Although this classification was never universally accepted,
the general arrangement proposed by Farr, including the
principle of classifying diseases by anatomical site, survived
as the basis of the International list of causes of death.
• Jacques Bertillon (1851–1922), Chief of Statistical Services of
the City of Paris prepared a classification of causes of death.
• This classification was based on the principle, adopted by Farr,
of distinguishing between general diseases and those localized
to a particular organ or anatomical site.

9. • The French Government therefore
convoked in Paris, in August 1900,
the first International Conference
for the Revision of the Bertillon or
International list of causes of death.
• Bertillon continued to be the
guiding force in the promotion of
the International list of causes of
death, and the revisions of 1900,
1910 and 1920 were carried out
under his leadership.

10. • The 2nd conference was held in 1909, and the Government of
France called succeeding conferences in 1920, 1929 and 1938.
• ‘Mixed Commission’, was created with an equal number of
representatives from the International Statistical Institute
and the Health Organization of the League of Nations.
• This commission drafted the proposals for the Fourth (1929)
and the Fifth (1938) revisions of the International list of
causes of death.

11. • Sixth revision of the International lists of causes of death
was held in New York City in June and July 1946.
• The conference approved the International form of medical
certificate of cause of death, accepted the underlying cause
of death as the main cause to be tabulated, and endorsed the
rules for selecting the underlying cause of death, as well as
the special lists for tabulation of morbidity and mortality data

14. • The International Conference for the Seventh Revision of
the International Classification of Diseases was held in
Paris under the auspices of WHO, in February 1955.
• The Eighth Revision Conference convened by WHO met in
Geneva, from 6 to 12 July 1965.
• The International Conference for the Ninth Revision
convened by WHO in Geneva from 30 September to 6
October 1975.

15. • For the benefit of users, the ninth revision included an
optional alternative method of classifying diagnostic
statements, including information about both an underlying
general disease and a manifestation in a particular organ or
site.
• This system became known as the dagger and asterisk system
and is retained in the 10th revision.

16. Differences between
ICD-9 & ICD-10
ICD 9
• 17 Chapters
• Numeric codes ( 001-999 )
• Diagnosis code 3-5
characters in length
• Approximately 13000
diagnosis codes
• Limited space for adding
new codes
• Lacks detail
• Lacks laterality
ICD 10
• 22 chapters
• alphanumeric coding,
(A00-Z99)
• Diagnosis code 3-7
characters in length
• Approximately 68000
diagnosis codes
• Flexible for adding new
codes
• Very specific
• Has laterality

17. Comparisons of procedurecode
ICD 9
• 3-4 numbers in length
• Approximately 3,000 codes
• Lacks descriptions of
methodology and approach
for procedures
• Lacks precision to adequately
define procedures
• Lacks detail, laterality
• Based on outdated
technology
ICD 10
• 7 alpha-numeric characters in
length
• Approximately 87,000 available
codes
• Provides detailed descriptions
of methodology and approach
for procedures
• Precisely defines procedures
with detail regarding body part,
approach, any device used, and
qualifying information
• Very specific & has laterality
• Reflects current usage of
medical terminology and
devices

18. • systematic recording,
• analysis, interpretation and
• comparison of mortality and morbidity data collected in
different countries or areas and at different times.
Purpose & Applicability
• 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.
• 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.

19. TYPES OF
CLASSIFICATION
Reference classifications
Derived classifications
Related classifications

20. • Cover the main parameters of the health system, such as
death, disease, functioning, disability, health and health
interventions.
• Product of international agreements.
• Have achieved broad acceptance and official agreement for
use
• Approved and recommended as guidelines for international
reporting on health e.g.
 International Classification of Diseases (ICD)
 International Classification of Functioning, Disability and Health (ICF)
 International Classification of Health Interventions (ICHI) (under
development)
Reference classifications

21. • Based upon reference classifications.
• May be prepared by adopting the reference classification
structure and classes.
or
• Providing additional detail beyond that provided by the
reference classification.
Derived classifications

22. • May be prepared through rearrangement or aggregation of
items from one or more reference classifications.
• Tailored for use at the national or international level.
e.g.
 International Classification of Diseases for Oncology, (ICD-O)
 The ICD-10 classification of mental and behavioural disorders
 Application of the ICD to dentistry and stomatology
 Application of the ICD to neurology (ICD-NA)
 Application of the ICD to dermatology
 Application of the ICD to paediatrics
 Application of the ICD to rheumatology and orthopaedics (ICD-R & 0)
Cont..

23. • Partially refer to reference classifications,
or
• Associated with the reference classification at specific levels
of the structure only e.g.
 International Classification of Primary Care (ICPC)
 International Classification of External Causes of Injury (ICECI)
 The Anatomical therapeutic chemical classification (ATC) with defined
daily doses (ATC/DDD)
 Technical aids for persons with disabilities: classification and terminology
(ISO9999)
Related classifications

24. ICD-10
3VOLUMES

25. • Volume 1. Tabular List. This contains the report of the
International Conference, the classification itself at the three-
and four-character levels, morphology of neoplasms, special
tabulation lists for mortality and morbidity, definitions, and
the nomenclature regulations.
• Volume 2. Instruction Manual. Contains notes on certification
and classification with a good deal of new background and
instructional matter and guidance on the use of Volume 1, on
tabulations, and on planning for the use of ICD.
• It also includes the historical material formerly presented in
the introduction to Volume 1.

26. • Volume 3. Alphabetical Index. This presents the index itself
with an introduction and expanded instructions on its use.
Volume 3
Section I Section II Section III
all the terms
classifiable to
Chapters I–XIX and
Chapter XXI,
index of external
causes of morbidity
and mortality and
contains all the terms
classifiable to Chapter
XX
Table of drugs and
chemicals
except drugs and other chemicals

27. ICD-10
22CHAPTERS

28. • The first character of the ICD code is a letter, and each letter is
associated with a particular chapter, except for the letter D,
which is used in both Chapter II (Neoplasms ) and Chapter III
(Diseases of the blood and blood-forming organs and certain
disorders involving the immune mechanism)
• The letter H, used in both Chapter VII (Diseases of the eye and
adnexa) and Chapter VIII (Diseases of the ear and mastoid
process).
Four chapters (Chapters I, II, XIX and XX) use more than one
letter in the first position of their codes.

29. InternationalStatisticalClassificationof Diseases
andRelatedHealthProblems10th Revision
Chapter Blocks Title
I A00–B99 Certain infectious and parasitic diseases
II C00–D48 Neoplasms
III D50–D89
Diseases of the blood and blood-forming
organs and certain disorders involving
the immune mechanism
IV E00–E90
Endocrine, nutritional and metabolic
diseases
V F00–F99 Mental and behavioural disorders
VI G00–G99 Diseases of the nervous system
VII H00–H59 Diseases of the eye and adnexa

30. InternationalStatisticalClassificationofDiseasesand
RelatedHealthProblems10th Revision
Chapter Blocks Title
VIII H60–H95
Diseases of the ear and mastoid
process
IX I00–I99 Diseases of the circulatory system
X J00–J99 Diseases of the respiratory system
XI K00–K93 Diseases of the digestive system
XII L00–L99
Diseases of the skin and
subcutaneous tissue
XIII M00–M99
Diseases of the musculoskeletal
system and connective tissue

31. InternationalStatisticalClassificationofDiseasesand
RelatedHealthProblems10thRevision
Chapter Blocks Title
XIV N00-N99
Disease of the genitourinary system
XV O00–O99 Pregnancy, childbirth and the puerperium
XVI P00–P96
Certain conditions originating in the
perinatal period
XVII Q00–Q99
Congenital malformations, deformations
and chromosomal abnormalities
XVIII R00–R99
Symptoms, signs and abnormal clinical
and laboratory findings, not elsewhere
classified

32. InternationalStatisticalClassificationofDiseasesand
RelatedHealthProblems10th Revision
Chapter Blocks Title
XIX S00–T98
Injury, poisoning and certain other
consequences of external causes
XX V01–Y98
External causes of morbidity and
mortality
XXI Z00–Z99
Factors influencing health status and
contact with health services
XXII U00–U99 Codes for special purposes

33. Blocks of categories
The chapters are subdivided into homogeneous blocks of three-
character categories.
Chapter I- the block titles reflect two axes of classification –
mode of transmission and broad group of infecting organisms.
Chapter II- the first axis is the behaviour of the neoplasm; within
behavior, the axis is mainly by site, although a few three-character
categories are provided for important morphological types (e.g.
leukaemias, lymphomas, melanomas, mesotheliomas, Kaposi
sarcoma).
Four-character subcategories
Where a three-character category is not subdivided, it is
recommended that the letter ‘X’ be used to fill the fourth
position, so that the codes are of a standard length for data-
processing.

34. A00 Cholera
A00.0 Cholera due to Vibrio cholerae01, biovar cholerae
Classical cholera
A00.1 Cholera due to Vibrio cholerae01, biovar eltor
Cholera eltor
A00.9 Cholera, unspecified
A01 Typhoid and paratyphoid fevers
A01.0 Typhoid fever
Infection due to Salmonella typhi
A01.1 Paratyphoid fever A
A01.2 Paratyphoid fever B

35. Supplementary subdivisions for use at the level of the fifth
or subsequent character
The fifth and subsequent character levels are usually
subclassifications along a different axis from the fourth
character. They are found in:
Chapter XIII – subdivisions by anatomical site;
Chapter XIX – subdivisions to indicate open and closed
fractures, as well as
intracranial, intrathoracic and intra-abdominal injuries with
and without open wound;
Chapter XX – former subdivisions to indicate the type of
activity being undertaken at the time of the event have now
become optional additional information that is recorded in a
separate field.

36. The ‘dagger and asterisk’ system
• ICD-9 introduced a system, continued in ICD-10, whereby
there are two codes.
 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 (*).
 It is a principle of the ICD that the dagger code is the primary
code and must always be used.

37. • For coding, the asterisk code must never be used alone.
However, for morbidity coding, the dagger and asterisk
sequence may be reversed when the manifestations of a
disease are the primary focus of care.

38. e.g.:
• A17.0† Tuberculous meningitis (G01*)
• Tuberculosis of meninges (cerebral) (spinal)
• Tuberculous leptomeningitis
• If the symbol (†) and the alternative asterisk code both appear
in the rubric heading, all terms classifiable to that rubric are
subject to dual classification and all have the same alternative
code,

39. (ii) If the symbol appears in the rubric heading but the
alternative asterisk code does not, all terms classifiable to
that rubric are subject to dual classification but they have
different alternative codes (which are listed for each term),
e.g:
• A18.1† Tuberculosis of genitourinary system
• Tuberculosis of:
• bladder (N33.0*)
• cervix (N74.0*)
• kidney (N29.1*)
• male genital organs (N51.-*)
• Tuberculous female pelvic inflammatory disease (N74.1*)

40. (iii) If neither the symbol nor the alternative code appears in the
title, the rubric as a whole is not subject to dual classification
but individual inclusion terms may be; if so, these terms will be
marked with the symbol and their alternative codes given,
e.g.:
• A54.8 Other gonococcal infections
• Gonococcal
• peritonitis† (K67.1*)
• pneumonia† (J17.0*)

41. Conventions used in the Tabular list
Parentheses ( )
• used to enclose supplementary words, which may follow
a diagnostic term without affecting the code number
For example, in I10, the inclusion term, ‘Hypertension
(arterial)(benign)(essential)(malignant) (primary)(systemic)’,
implies that I10 is the code number
• used to enclose the code to which an exclusion term refers.
Square brackets [ ]
• for enclosing synonyms, alternative words or explanatory
phrases; e.g.
A30 Leprosy [Hansen disease]
• for referring to previous notes

42. WHO: Help-Line
• There are nine WHO Collaborating Centres for Classification of
Diseases, who assist countries with problems encountered in
the development and use of health-related classifications and,
in particular, in the use of the ICD
• Australia, England and USA for English knowing countries.
• Besides, there are at France, Russia, China, Venezuela
Sweden, Brazil

44. Revision Process in the 21st Century

46. Chapter 01 – Infectious diseases
Chapter 02 – Neoplasms
Chapter 03 – Diseases of the blood and blood-forming
organs
Chapter 04 – Disorders of the immune system
Chapter 05 – Conditions related to sexual health
Chapter 06 – Endocrine, nutritional and metabolic diseases
Chapter 07 – Mental and behavioral disorders
Chapter 08 – Sleep – Wake disorders
CHAPTERS IN ICD-11

47. Chapter 09 – Diseases of the nervous system
Chapter 10 – Diseases of the eye and adnexa
Chapter 11 - Diseases of the ear and mastoid process
Chapter 12 – Diseases of the circulatory system
Chapter 13 – Diseases of the respiratory system
Chapter 14 – Diseases of the digestive system
Chapter 15 – Diseases of the skin
Chapter 16 – Diseases of the musculoskeletal system and
connective tissue
Chapter 17 – Diseases of the genitourinary system
Chapter 18 – Pregnancy, childbirth and the puerperium
CHAPTERS IN ICD-11..

48. Chapter 19 – Certain conditions originating in the perinatal
period
Chapter 20 – Developmental anomalies
Chapter 21 – Symptoms, signs, clinical forms, and abnormal
clinical and laboratory findings, not elsewhere classified
Chapter 22 – Injury, poisoning and certain other consequences
of external causes
Chapter 23 – External causes of morbidity and mortality
Chapter 24 – Factors influencing health status and contact with
health services
Chapter 25 – Codes for special purposes
Chapter 26 –Extension Codes
Chapter 27 – Traditional Medicine
CHAPTERS IN ICD-11…

49. Highlights of the meeting :
• Gave feedback on the terminology used, a decision was
taken to rename the Joint Linearization for Mortality and
Morbidity statistics as the International Classification of
Diseases, 11th Revision, for Mortality and Morbidity
Statistics (ICD-11-MMS).
In April 2016, the Joint Task Force (JTF) met in Cologne,
Germany to further progress the work on the ICD-11 Tokyo
release.
Joint Task Force Meet
2016

50. • ICD-11 is built for an electronic environment, facilitating
the classification of information in electronic health
records, with technology assistance including coding tools,
browsers, and different web services, focusing on ease of
use and improved specificity and consistency of the coded
data.
• A release of the ICD-11-MMS will take place at the ICD
Revision Conference from 12-14 October 2016 in Tokyo,
Japan.

51. • A multi-lingual coding platform to support translations
Important to note, the Tokyo Release will not be the “final”
version of ICD-11, nor will it be ready for implementation in
countries. This release will represent a high-level overview of
the structure of the ICD-11-MMS to support discussion about
national requirements and support for implementation .

55. PGIMS Scenario
• ICD coding done since 2004
• Done only for indoor files
• In charge- Mr. Shiv Kumar, Department of biostatistics
• Coding on MLC files being done by Mr. Raja Ram
• Coding on Non MLC files being done by Mr. Rakesh
• All entries manually entered in files being computerized by
Mr. Sukhbir

56. References
• International statistical classification of diseases and related
health problems 10th revision, Volume 2, Instruction manual
Fifth edition 2016
• ICD- 10 Volume 1
• ICD- 10 2e Volume 3
• World Health Organization – Health Data Standards and
Informatics June 2016, ICD-11 Update
• http://apps.who.int/classifications/icd11/browse/l-m/en

57. THANK YOU !