The International Classification of Diseases (ICD) is a standardized system used to classify diseases and health conditions. It was created in 1893 and is updated every 10 years by the World Health Organization. The current version is ICD-10, approved in 1990. ICD-10 organizes diseases into 21 chapters based on affected body system or condition. It provides alphanumeric codes to classify diseases for epidemiology, health management, and clinical purposes on an international scale. The next revision, ICD-11, is currently being developed with a draft submitted to WHO by 2017 and final version in 2018.

1. Ms. Amandeep Kaur
Nursing Tutor
Medical Surgical Nursing
MMCON

2. INTERNATIONAL
CLASSIFICATION OF DISEASES
 • International statistical classification of diseases and related
health problems in short “ICD” is the international standard
diagnostic tool for epidemiology, health management and clinical
purposes.
 • ICD is designed as health care classification system which
provides the diagnostic codes for classifying diseases including
classification of wide variety of signs, symptoms, abnormal
findings, complaints, social circumstances and external cause of
injury or disease.

3. Historical synopsis
 In 1860, Florence nightingale →made first model of systemic
collection of hospital data.
 In 1893, French physician, Jacques Bertillon→ introduced
Bertillon classification of cause of death
 In 1898, American public health association→ recommended
revision of ICD system every 10 years.
 The revision followed minor changes until 6th version of
ICD→ morbidity and mortality condition and section on
mental disorders
 WHO →responsibility for preparing and publishing the ICD
revisions every 10 years.

4. •The ICD -10 was formed in 1893, as the Bertillon
classification of international list of causes of death.
• The work on ICD -10 started in 1983 → approved in
1990 at 43rd world health assembly (WHA)

5.  FLORENCE
NIGHTINGALE
 The lady with the lamp

6. JACQUES BERTILLON
(1858 - 1914 )

7. CAUSE OF DEATH
 THE CAUSES OF DEATH to be entered on the medical certificate
are all those diseases, morbid conditions or injuries which are
either resulted or contributed to death and circumstances of
accident or violence , which produced any such injuries.
 UNDERLYING CAUSE OF DEATH
a) Diseases or injury which initiated the sequence of events leading
directly to death
b) The circumstances of the accident or violence which produced the
fatal injury.

9.  Later more scientific approach was adopted in
classifying diseases. According to certain
characteristics of diseases or injuries, such as
1. The part of the body affected
2. The etiological agent
3. The kind of morbid change produced by the disease
or injury .
4. The kind of disturbance of function produced by
disease or injury.

10. Classification (ICD-10)

11. The ICD -10 is arranged in 21 major
chapters
1.Certain Infectious and parasitic diseases.[A00- B99]
2.Neoplasms [C00-D48]
3. Diseases of the blood and blood forming organs and certain
disorders involving the immune mechanism[D50 – D89]
4. Endocrine nutritional and metabolic diseases [E00-E90]
5. Mental and behavioral disorders [F00-F99]
6. Disorders of the nervous system [G00-G99]
7. Diseases of eye and adnexa [H00-H99]

12. The ICD -10 is arranged in 21 major
chapters cont…
8. Diseases of the ear and mastoid process [H60-H95]
9. Diseases of circulatory system [I00-I99]
10. Diseases of respiratory system [J00-J99]
11. Diseases of digestive system [K00-K99]
12. Diseases of the skin and subcutaneous tissue [L00- L99]
13. Diseases the musculoskeletal system and connective
tissue[M00-M99]
14. Diseases of genitourinary system [N00-N99]
15. Pregnancy , childbirth and puerperium [O00-O99]

13. The ICD -10 is arranged in 21 major
chapters cont…
16. Certain conditions originating in perinatal period [P00 P96]
17. Congenital malformations, deformations and chromosomal
abnormalities [Q 00- Q99]
18. Signs, Symptoms and abnormal clinical and laboratory
findings, not elsewhere classified [R00-R99]
19. Injury, poisoning and certain other consequences of external
causes [S00-T98]
20. External causes of morbidity and mortality [V01-Y98]
21. Factors influencing health status and contact with health
services . [Z00-Z99].

14. THE CODING SYSTEM
 The first character of the ICD -10 code is a letter and each letter is
associated with a particular chapter except for letter D, which is used
in chapter 2 and chapter 3, and letter H which is used in chapter 7
and chapter 8.
 Chapter 1, 2, 19, 20 use more than one letter in the first position of
their codes
 Each chapter contains sufficient 3 character categories to cover its
contents
 Most of the 3 character categories are subdivided by means of a 4th
numeric character after a decimal point, allowing up to 10
subcategories

15. Example :-
 Chapter 21–factors influencing health status and contact with health
services [Z00 - Z99]
Z 22 –carriers of infectious diseases
 Z22.0 –carrier of thyroid
 Z22.1 –carrier of intestinal infectious diseases
 Z22.2 –carrier of diphtheria
 Z22.3 –carrier of specific bacterial diseases
 Z22.4 –carrier of infections with predominantly sexual mode of
transmission
 Z22.5 –carrier of viral hepatitis
 Z22.6 –carrier of human T- lymphotropic virus type -1(HTLV-1) infection
 Z22.8 –carrier of other infectious diseases
 Z22.9 –carrier of infectious disease, unspecified .

16. Z 72- Problems related to life style
 Z 72.0 – tobacco use
 Z 72.1 – alcohol use
 Z 72.2 – drug use
 Z 72.3 – lack of physical exercise
 Z 72.4 – Inappropriate
 Z 72.5 –high risk sexual behavior
 Z 72.6 –gambling and betting
 Z 72.8 –other problems related to life style
 Z 72.9 –problem related to life style, unspecified

17. Z 22.3-carriers of specified bacterial diseases
 Z 22.31 : carrier of bacterial diseases due to meningococci.
 Z 22.32 : carrier of bacterial diseases due to staphalococci.
 Z 22.33 : carrier of bacterial diseases due to streptococci.
 Z 22.34 : carrier of bacterial other specified bacterial
diseases.

19. ICD - 10
The latest version of ICD -10 which came into force in January
1st 1993, revised in 2003.
The main innovations of ICD 10th Revisions are :
1. Relevant information for ambulatory and managed care
encounter.
2. Expanded injury codes.
3. New combination codes for diagnosis / symptoms to reduce the
number of codes needed to describe a problem fully.

20. 4. Classification refined to increased data
granularity/quality.
5. Replacing numerical system of coding frame with
alphanumerical coding frame.
6. Of 26 available letters 25 have been used , except the
letter “U” being left vacant.

22. ICD -11
 The world health organization is currently revising the
ICD towards ICD-11.
 The development is taking place on an internet based
workspace called " ICAT " platform ,(International Centre
for Automotive Technology)
 The draft of the ICD -11 system → submitted to WHO’s
world health assembly (WHA)→ by 2017 and a final
version → in 2018.

23. Advantages and Limitations of ICD
Advantages:
1) fast aggregation of
health data.
2) To know the real time
information about current
health situation.
3) Wider analysis of
community health.
4) Global health
assessment.
Limitations:
1) Discussion is limited to
classified diseases
2) Common term
descriptions of diseases
3) Covers the most
common diseases
4) Country specific
modifications of certain
diseases

24. International form of medical
certificate of cause of death

25. Example :-
 A 67 year old male admitted with retention of urine in
hospital. The chain of events followed were :
A) Uremia
B) Hydro-nephrosis
C) Retention of urine
D) Hypertrophy of prostate

26. I) immediate cause of death in this case is uremia
II) underlying cause of death was hypertrophy of prostate

27. Example :-
 A 46 year old male admitted in unconscious state in
neurosurgery ICU. The chain of events followed were :
a) Head injury
b) Increased ICP
c) Hypertention
d) Decreased cerebral perfusion pressure

28. I) immediate cause of death in this case is Decreased cerebral
perfusion pressure
II) underlying cause of death was increased ICP

29. Reference :-
 • Park's textbook of preventive and social medicine, 23rd edition
- K.PARK
 • Textbook of preventive and social medicine , 4th edition -
SUNDER LAL, ADARSH, PANKAJ.
 • Textbook of preventive and social medicine , 4th edition -
MAHAJAN AND GUPTA.
 • Textbook of community medicine –KULKARNI. Google
reference :
 • www.cdc.gov/nchs/cd9.htm
 • International classification of diseases (WHO) archived from
the original on 12th feb,2015.Retrived 14th march 2015.
 • ^WHO . List of official ICD updates.
 • ^ICD revision time lines and ICD- coding Tool. Note: ICD -10 in
hospital settings : WHO's ICD -10 online browser located at
http://apps.who.int/classification/icd10/browse/2015/en#/20.0