International Classification of Diseases
(Tenth revision)
(ICD-10)
Dr. Ashraf Hussain. Msc, PhD/ Com. Med.
The concept of ICD
A classification of diseases can be defined as a system of categories to which morbid
entities are assigned according to established criteria.
The purpose of the ICD 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.
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.
Practice and Applicability
In practice, the ICD has become the international standard diagnostic classification
for all general epidemiological and many health management purposes.
These include the analysis of the general health situation of population groups.
The 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.
It can be used to classify data recorded under headings such as ‘diagnosis’, ‘reason
for admission’, ‘conditions treated’ and ‘reason for consultation’.
All WHO members states having committed to report causes of death and illness to
WHO Using the ICD since 1967 (Nomenclature regula ons).
The ICD (International StatisticalClassification of Diseases and Related Health
Problems) being used in 194 countries.
It has been developed interna onally since 1893.
There have been ten major revisions with the most recent being ICD-10
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Criticism
ICD is neither intended nor suitable for indexing distinct clinical entities.
There are also some constraints on the use of the ICD for studies of financial aspects.
History
Original use was to classify causes of mortality as recorded at the registration of
death.
Later, its scope was extended to include diagnoses in morbidity.
Consequently, the ICD provides for a wide variety of signs, symptoms, abnormal
findings, complaints and social circumstances that may stand in place of a diagnosis
on health-related records.
Then, the French Government, hold the first international conference for the
revision of the bertilon classification in 1900.
A detailed classifica on of causes of death consis ng of 179 groups and an abridged
classifica on of 35 groups were adopted.
Government of France called for succeeding conferences in1909, 1920, 1929, and
1938 ended by holding the sixth Decennial revision Conference in1948 which been a
significant event in the international health and vital statistics.
The International Conference for the Seventh Revision and the Eighth Revision
Conference were convened by the WHO and held in Paris,1955 and in Geneva, 1965
respectively.
Then the Interna onal Conference for the ninth revision hold by the WHO in 1979.
Lastly, an extensive work followed which culminated by the Tenth Revision of the
ICD presented in 1989
ICD-9 and ICD-10
Much larger than ICD-9
ICD -10 has 21 chapters against 17 chapters in ICD-9.
Numeric codes (001- 999) were used in ICD-9 whereas an alphanumeric coding,
(A00- Z99) has been adopted in ICD-10.
It enlarged the number of categories available for the classification.
Further detail by means of decimal numeric subdivisions at the four character level
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The concept of a ‘family’ of disease and health-related classifications
Then the WHO Family of International Classifications (WHO-FIC) developed to
provide the building blocks of health information systems.
Figure 1 represents the types of classifica ons in the WHO-FIC ( )ﻟﻼطﻼع
Derived Classifications
International Classification
of Diseases for Oncology,
Third Edition (ICD-O-3)
The ICD-10 Classification of
Mental and Behavioural
Disorders
Application of the
International Classification
of Diseases to Dentistry and
Stomatology, Third Edition
(ICD-DA)
Application of the
International Classification
of Diseases to Neurology
(ICD-10-NA)
International Classification
of Functioning, Disability
and Health, Children &
Youth Version (ICF-CY)
Reference Classifications
International Classification
of Diseases (ICD)
International Classification
of Functioning, Disability
and Health (ICF)
International Classification
of Health Interventions
(ICHI)
under development
Related Classifications
International Classification
of Primary Care (ICPC)
International Classification
of External Causes of Injury
(ICECI)
The Anatomical,
Therapeutic, Chemical (ATC)
classification system with
Defined Daily Doses (DDD)
ISO 9999 Technical aids for
persons with disabilities –
Classification and
Terminology
International Classification
for Patient Safety (ICPS)
International Classification
of Nursing Practice (ICNP)
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.
Derived classifications
are based upon reference classifications
prepared either by adopting the reference classification structure and classes,
providing additional detail beyond that provided by the reference classification.
Or through rearrangement or aggregation of items from one or more reference
classifications.
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.
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In ICD-10 the informa on about diseases and condi ons and their causes is grouped
as follows:
• Communicable diseases
• General diseases that affect the whole body
• Local diseases arranged by site
• Developmental diseases
• Injuries
• External causes
Fundamentals of ICD 10
ICD-10 comprises three volumes:
Volume 1 contains the main classifica ons.
Volume 2 provides guidance to users of the ICD
Volume 3 is the Alphabe cal Index to the classification.
2. Chapters
The classifica on 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 the 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.
Chapters of the ICD 10
Chapters I to XVII: Diseases and other morbid conditions
Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not
elsewhere classified.
Chapter XIX: Injury, poisoning and certain other consequences.
Chapter XX: External causes of morbidity and mortality.
Chapter XXI: Factors influencing health status and contact with health services
Chapter XXII: Codes for special purposes
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Chapters of the ICD 10, Cont.
I A00-B99 presents certain infec ous and parasi c diseases
II
C00-D48
Neoplasms
III
D50-D89
Diseases of the blood and blood-forming organs and disorders
of immune mechanism
IV
E00-E90 Endocrine, nutri onal and metabolic dis.
V
F00-F99 Mental and behavioural disorders
VI
G00-G99
Diseases of the nervous system
VII
H00-H59
Diseases of the eye and adnexa
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 diges ve system
XII
L00-L99
Diseases of the skin and subcutaneous tissue
XIII
M00-M99 Diseases of the musculoskeletal system and connec ve
tissue
XIV
N00-N99 Diseases of the genitourinary system
XV
O00-O99 Pregnancy, childbirth and the puerperium
XVI
P00-P96 Certain condi ons origina ng in the perinatal period
XVII Q00-Q99 Congenital malforma ons, deforma ons and chromosomal
abnormalities
3. Blocks of categories
Three-character categories
These chapters are subdivided into homogenous blocks of three alphanumeric
character categories.
This three character division is the least mandatory level for reporting to the WHO
Mortality database.
V01-X59: Accidents
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V01-V99
Transport accidents
V01-V09
Pedestrian injured in transport accident
V10-V19
Pedal cyclist injured in transport accident
V20-V29
Motorcycle rider injured in transport accident
V30-V39
Occupant of three-wheeled motor vehicle injured in transport accident
V40-V49
Car occupant injured in transport accident
V50-V59
Occupant of pick-up truck or van injured in transport accident
V60-V69
Occupant of heavy transport vehicle injured in transport accident
V70-V79
Bus occupant injured in transport accident
V80-V89
Other land transport accidents
V90-V94
Water transport accidents
V95-V97
Air and space transport accidents
V98-V99
Other and unspecified transport accidents
W00-X59
Other external causes of accidental injury
W00-W19
Falls
W20-W49
Exposure to inanimate mechanical forces
W50-W64
Exposure to animate mechanical forces
W65-W74
Accidental drowning and submersion
W75-W84
Other accidental threats to breathing
W85-W99
Exposure to electric current, radiation and extreme ambient air temperature and pressure
X00-X09
Exposure to smoke, fire and flames
X10-X19
Contact with heat and hot substances
X20-X29
Contact with venomous animals and plants
X30-X39
Exposure to forces of nature
X40-X49
Accidental poisoning by and exposure to noxious substances
X50-X57
Overexertion, travel and privation
X58-X59
Accidental exposure to other and unspecified factors
X60-X84
Intentional self-harm
X85-Y09
Assault
Y10-Y34
Event of undetermined intent
Y35-Y36
Legal intervention and operations of war
Y40-Y84
Complications of medical and surgical care
Y85-Y89
Sequelae of external causes of morbidity and mortality
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Y90-Y98
Supplementary factors related to causes of morbidity and mortality classified
elsewhere
Then…
A fourth character comes following a decimal point.
So each category can be further divided into up to 10 four character subcategories.
It gives a range of 0.0 to 0.9.
Total possible code numbers therefore range from A00.0 to Z99.9.
When there is no subdivision, X is placed so that the codes got a standard length of
data processing.
The four-character subcategories are used in the following ways
identifying, for example, different sites or varieties if the three-character category is
for a single disease, or
Individual diseases if the three-character category is for a group of conditions.
A01 Typhoid and paratyphoid fevers
A01.0 Typhoid fever
Infection due to Salmonella typhi
A01.1 Paratyphoid fever A
A01.2 Paratyphoid fever B
A01.3 Paratyphoid fever C
A01.4 Paratyphoid fever, unspecified
Infection due to Salmonella paratyphi NOS
C15 Malignant neoplasm of oesophagus
•
C15.0 Cervical part of oesophagus
•
C15.1 Thoracic part of oesophagus
•
C15.2 Abdominal part of oesophagus
•
C15.3 Upper third of oesophagus
•
C15.4 Middle third of oesophagus
•
C15.5 Lower third of oesophagus
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•
C15.9 Oesophagus, unspecified
3. Supplementary subdivisions for use at the fifth or subsequent character level
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
S22: Fracture of rib(s), sternum and thoracic spine
The following subdivisions are provided for optional use in a supplementary
character position where it is not possible or not desired to use multiple coding to
identify fracture and open wound; a fracture not indicated as closed or open should
be classified as closed.
0closed
1open
Glossary descriptions
Chapter V, Mental and behavioural disorders, uses glossary descriptions to indicate
the content of rubrics.
This device is used because the terminology of mental disorders varies greatly,
particularly between different countries, and the same name may be used to
describe quite different conditions.
The glossary is not intended for use by coding staff.
F20.0 Paranoid schizophrenia
Paranoid schizophrenia is dominated by relatively stable, often paranoid delusions,
usually accompanied by hallucinations, particularly of the auditory variety, and
perceptual disturbances. Disturbances of affect, volition and speech, and catatonic
symptoms, are either absent or relatively inconspicuous.
Paraphrenic schizophrenia Excl.:involutional paranoid state (
F22.8
)paranoia (
F22.0
)
F20.1 Hebephrenic schizophrenia
A form of schizophrenia in which affective changes are prominent, delusions and
hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable,
and mannerisms common. The mood is shallow and inappropriate, thought is
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disorganized, and speech is incoherent. There is a tendency to social isolation.
Usually the prognosis is poor because of the rapid development of "negative"
symptoms, particularly flattening of affect and loss of volition. Hebephrenia should
normally be diagnosed only in adolescents or young adults.
Disorganized schizophrenia Hebephrenia
Inclusion & Exclusion terms
Inclusion terms: as a guide to the content of the rubrics.
Exclusion terms: These are terms which, although the rubric title might suggest that
they were to be classified there, are in fact classified elsewhere.
The “dagger and asterisk” system
for diagnostic statements containing information about both
an underlying generalized disease and
a manifestation in a particular organ or site which is a clinical problem in its own
right.
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 (*).
For example, categories G20 and G21 are for forms of Parkinsonism that are not
manifestations of other diseases assigned elsewhere,
while category G22* is for “Parkinsonism in diseases classified elsewhere”.
Corresponding dagger codes are given for conditions mentioned in asterisk
categories; for example, for syphili c Parkinsonism in G22*, the dagger code is
A52.1† (Syphili c parkinsonism†
G22*
)
A39.5† Meningococcal heart disease
Meningococcal:
1. carditis NOS (
I52.0*
)
2. endocarditis (
I39.8*
)
3. myocarditis (
I41.0*
)
4. pericarditis (
I32.0*
)
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Notes
Codes U00-U49, are to be used by WHO for the provisional assignment of new
diseases of uncertain aetiology For example, Severe Acute Respiratory Syndrome
(SARS) has been added to Chapter XXII at U04.0 and Zika Virus disease U06.0
Codes in the second half of the chapter may be added by individual countries to
capture details about particular diseases in which they have a particular interest but
which do not have unique codes in the rest of the ICD-10.
However, codes U50-U99 cannot be used for interna onal comparison or repor ng
Golden Coding Rule
The special disease categories take priority over the body system categories.
At the end:…
Volumes 1 and 3 must be used together to correctly find codes for each case (e.g.
cause of death or diagnosis).
The basic process is to firstly check the Index for a code representing your disease.
Then confirm your choice in the Tabular List. The Instruc on Manual (Volume 2)
contains information to help you make your choice.
Trying to find the correct code in Volume 1 without firstly checking the Index, may
result in an incorrect code being assigned.
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