The document provides information about the International Classification of Diseases (ICD) including: ICD is the global standard for diagnostic classification and coding of diseases, injuries, and causes of death. It allows for consistent recording and comparison of health data worldwide. ICD-10 provides greater specificity than previous versions with over 68,000 codes to capture detailed clinical information. The document outlines the purpose, history, and structure of ICD codes as well as differences between ICD-9 and ICD-10.

1. .
METTU UNIVERSITY
COLLAGE OF HEALTH SCIENCE
DEPARTMENT OF HEALTH INFORMATICS
CHAPTER TWO
HEALTHCARE CODE SET AND CLASSIFICATION :ICD
NAOL G.(BSC HI)
2013 E.C

2. Objective
• At the end of this lesson student will understand
 definition of ICD
Purpose and limitation of ICD
Different version of ICD
Comparison between different versions of ICD
Nomenclature of ICD-10
ICD-10 chapters and blocks

3. What is ICD

4. What is ICD?
• ICD stands for the International Classification of Disease.
• The ICD provides a method of classifying diseases, injuries, and
causes of death.
• It is the diagnostic classification standard for all clinical and research
purposes.
• The World Health Organization (WHO) publishes the ICDs to
standardize the methods of recording and tracking instances of
diagnosed disease all over the world, making it possible to conduct
research on diseases, their causes, and their treatments.

5. What is ICD?
• ICD is an international uniform standard for reporting diseases and
health conditions.
• ICD incorporates different factors influencing health, including
external causes of morbidity and mortality.
• ICD defines the various patterns of infectious, communicable, and
non-communicable diseases followed by disorders, injuries and
numerous health disability in a systematic way.
• Determining the risk factors that have negative impacts on health.

6. Different Versions of ICD
• ICD has a different version from first until ICD-11.
• The first version of International Statistical Classification of Diseases,
Injuries and Causes of Death (ICD) was produced in 1940.
• WHO published the 6th version of ICD i.e. ICD-6 in 1948, which
included morbidity for the 1st.
• Currently, ICD-10 is in practice. It was endorsed in 1990 by 43rd
World Health Assembly (WHA).
• In near future, ICD-11 will be in practice.
• ICD-11 was recently released on 18 June 2018. However, reporting
using ICD-11 will only start from 1 January 2022.

7. Why ICD classification is needed?
• Classification or Sorting of disease is needed due to the following
facts:
Determines the natural cause of the disease mechanism in a human
body.
Determines the exact problem and solution of the disease.
Determines the normal stages and the critical stage of the disease
Formulation of health statistics. ICD is the bedrock for health
statistics.

8. Cont.…
• Concludes the risk factors of the illness.
• Calculates the prevalence and incidence rate, which ultimately helps to
develop mitigating measures against the disease.
• Helps to categorize vulnerable disease.
• Determines the health cost and resources required to combat disease.
• Critical analysis of the disease based on the severity.

9. How are Diseases Classified in ICD?
• The diseases are categorized:
On the basis of Disease
Body system or region Abdominal disease ,Gastrointestinal
disease
Anatomic Lung disease ,Liver disease
Function Metabolic disease
Pathological/ nature of the disease process Inflammatory disease Tumors formation
Etiologic/ cause Bacterial infection
Epidemiology Epidemic disease
Statistical High prevalence and incidence rate
disease.

10. Purpose of ICD
• International Classification of Disease has multi-dimensional purpose
and usage.
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.
is to permit the systematic recording, analysis, interpretation and
comparison of mortality and morbidity data collected in different
countries or areas and at different times.
ICD is the world’s standard tool to capture mortality and morbidity
data.

11. Purpose of ICD
It organizes health information that is used for statistics and
epidemiology, health care management, allocation of resources,
monitoring and evaluation, research, primary care, prevention and
treatment.
It helps to provide a picture of the general health situation of the
country and population.
ICD is used world-wide for morbidity and mortality statistics,
reimbursement systems and automated decision support in medicine.

12. Limitation of ICD
Escalation of code:
• The rapid growth of ICD codes has made people puzzled, as there are;
intense variations and many people are unaware of all codes due to the
formulation of excessive codes in every interval.
Denials:
• The cost-saving measures with ICD-10 have a provision of paying less
to a health provider.
• Therefore, it can lead to physicians spending more time on coding,
and eventually less time on actually being paid.

13. Types of classification
• The WHO Family of International Classifications(WHO-FIC) attempts
to serve as the framework of international standards to provide the
building blocks of health information systems.
The types of classifications in the WHO-FIC.
1.Reference classifications
2.Derived classifications
3.Related classifications

14. 1.Reference classifications
• These are the classifications that cover the main parameters of the
health system, such as death, disease, functioning, disability, health
and health interventions.
• WHO reference classifications are a product of international
agreements.
• They have achieved broad acceptance and official agreement for use
and are approved and recommended as guidelines for international
reporting on health.
• They may be used as models for the development or revision of other
classifications with respect to both the structure and the character and
definition of the classes.

15. 2.Derived classifications
• Derived classifications are based upon reference classifications.
• Derived classifications may be prepared either by adopting the
reference classification structure and classes.
• provide additional detail beyond that provided by the reference
classification, or they may be prepared through rearrangement or
aggregation of items from one or more reference classifications.

16. 3.Related classifications
Related classifications are those that partially refer to reference
classifications, or that are associated with the reference classification
at specific levels of the structure only.
With in the WHO-FIC the related classifications include:
 The International Classification of Primary Care (ICPC-2)
The International Classification of External Causes of Injury(ICECI)
Technical aids for persons with disabilities:(ISO9999)
The Anatomical Therapeutic Chemical Classification with Defined
Daily Doses(ATC/DDD).

17. Introduction to ICD-9 And ICD-10

18. ICD-9
• International Classification of Diseases, 9th Edition
• The International Classification of Diseases (ICD) is designed to
promote international comparability in the collection processing,
classification, and presentation of mortality statistics.
• Originally designed for the purpose of comparing mortality data
internationally.
• ICD-9-CM (clinical modification) codes classify diseases, injuries,
health encounters and inpatient procedures.

19. International Classification of Diseases, Ninth
Revision, Clinical Modification (ICD-9-CM)
• ICD-9-CM is based on the World H Organization’s Ninth Revision, International
Classification of Diseases (ICD-9).
• ICD-9-CM is the official system of assigning codes to diagnoses and procedures
associated with hospital utilization.
• The ICD-9 was used to classify mortality data from death certificates until 1999,
when use of ICD-10 for mortality coding started.
• The ICD-9-CM consists of:
 a tabular list containing a numerical list of the disease code numbers in tabular
form
 an alphabetical index to the disease entries and
a classification system for surgical, diagnostic, and therapeutic procedures
(alphabetic index and tabular list)

20. Why ICD-9 changed?
• ICD-9 is old.
• The U.S. has used ICD-9 since 1979 and many terms are now
outdated.
• There have been many changes within medical and health care fields.
• Available codes do not always allow for the capture of clinically
accurate data.
• The structure of ICD-9 codes limits the number of new codes that can
be created.
• Most developed countries have already transitioned to ICD-10 codes.

21. ICD-10
The WHO revises the ICD code-set periodically, and it is currently in its
11th edition.
• ICD-10 contains additional features of the previous ICD-9 coding
system. The volume of ICD-10 codes as compared to ICD-9 codes is
significant.
why?
1. the code size has been expanded.
2. code values and interpretations have been redefined.
3. specificity has been further improved.

22. ICD-10-CM
• ICD-10-CM is a clinical modification of the World Health
Organization’s ICD-10, which consists of a diagnostic system.
• ICD-10-CM includes the level of detail needed for morbidity
classification and diagnostic specificity.
• It also provides code titles and language that complement accepted
clinical practice.
• As with ICD-9-CM, ICD-10-CM is maintained by the National Center
for Health Statistics.

23. Importance of ICD-10
Measuring the quality, safety (or medical errors) and efficacy of care
Making clinical decisions based on output from multiple systems
Conducting research, epidemiological studies and clinical trials
Comparability between health facilities, regions and countries
Setting health policy
Designing healthcare delivery systems

24. cont.…
 Monitoring resource utilization.
Improving clinical, financial and administrative performance.
Managing care and disease processes.
Tracking public health and risks.
Providing data to consumers regarding costs and outcomes of
treatment options.

25. Cont.…
• The system consists of more than 68,000 codes, compared to
approximately 13,000 ICD-9-CM codes.
• ICD-10-CM codes have the potential to reveal more about quality of
care
• ICD-10-CM incorporates greater specificity and clinical detail to
provide information for clinical decision making and outcomes
research.

26. Comparing ICD-9-CM and ICD-10-CM

27. Code structure

28. Nomenclatures of ICD 10
• There are three (3) main elements to the structure of the ICD-10.
They are:
Three (3) volumes
21 chapters (1 additional chapter for new codes).
structure of the code (alphanumeric.)
c
c
c

29. Volumes
ICD-10 comprises three volumes:
- Volume 1 contains the main classifications.
-Volume 2 provides instruction/guidance to users of the ICD.
-Volume 3 is the Alphabetical Index to the classification.

30. Volume
• Volume 1 is the Tabular list, which is an alphanumeric listing of
diseases and disease groups.
• Volume 2 is Instruction Manual. It provides:
-An introduction to, and instructions on how to use volumes 1 and 3;
-Guidelines for certification and rules for mortality coding;
-Guidelines for recording and coding for morbidity coding,
statistical presentation.
• Volume 3 is the comprehensive Alphabetical index of the diseases and
conditions found in the Tabular list and have 3 section.

31. Structure of the ICD-10 code:
• The first character of the code is an alpha character (letter), followed
by two, three or four numeric characters.
• The structure of the three-character category is:
A37
first character A to Z followed by two digit
• three-character categories are further subdivided into sub-categories to
enable coding of a disease or condition more specifically.

32. Chapters
• The classification is divided into 21 chapters. The first character of the
ICD code is a letter, and each letter is associated with a particular
chapter, except for;
• -letter D, which is used in both Chapter II Neoplasms, and Chapter III
Diseases of the blood and blood-forming organs and certain disorders.
• -letter H, which is used in both Chapter VII Diseases of the eye and
adnexa and Chapter VIII Diseases of the ear and mastoid process.
• The chapters are subdivided into homogeneous "blocks" of three-
alphanumeric character categories. E.g. Chapter I: (A00-B99)

33. Cont..
• Chapter 1 to 17 related with disease and other conditions
• Chapter 18 consists of sign, symptom, and abnormal clinical and
laboratory findings
• Chapter 19 consists of injuries, poisoning and certain other
consequence of external injuries
• Chapter 20 external cause of mortality and morbidity, was traditionally
used to classify injury and poisoning.
• Chapter 21 factor influencing health status and contact with health
service

34. Chapter…

35. Cont.…

36. The unused “U-code”
• U00-U49 are to be used for the provisional assignment of new disease
of uncertain etiology
• U50-U99 may be used in research.

37. General principles of disease classification
• Classification is method of generalization.
• A statistical classification of diseases must be confined to a limited
number of mutually exclusive categories.
• The categories have to be chosen to facilitate the statistical study of
disease phenomena
• A specific disease entity that is of particular public health importance
or that occurs frequently should have its own category.
• Every disease or morbid condition must have a well defined place in
the list of categories.

38. Rules and guidelines for mortality & morbidity
coding

39. Guidelines for morbidity coding
Morbidity usually relates to a single episode of health care. An episode of health
care may be defined as:
i. A period of inpatient care; or
ii. A contact (or series of contacts in a specific time period) with a health care
practitioner in relation to the same condition or its immediate consequences.
concepts for morbidity coding
At the end of an episode of care,
• the clinician should record all conditions which affected the patient in that period.
• Practice may vary from health authority to health authority - in some places, one
diagnosis will be singled out for coding (single-condition coding) while in other
places, all diagnoses will be coded for each episode of care (multi-condition
coding).
• Coders need to be aware of the policy of their establishments in this regard.

40. Cont.…
When to write the coding ;
• At the end of establishing a diagnosis the attending clinician will write
the code.
• If coding is not done earlier, the doctor writing the discharge
certificate/ death certificate will write the code (if needed he or she
may consult with the supervisor about the final coding).

41. ICD-11 the new version
• The global standard for health data, clinical documentation, and
statistical aggregation
• Multiple uses, including primary care
• Scientifically up-to-date
• Designed for use in a digital world
• State-of-the-art technology reduces the costs of training and
implementation
• Multilingual design facilitates global use
• Proposal platform allows stakeholder participation in keeping ICD–11
up-to-date.

42. Galaatooma !!!

43. Quiz (5%)
• Define ICD ?
• What is the difference between ICD-9 and ICD – 10?(2%)
• What is the importance of ICD-10?
• Why ICD-9 is changed ?