ICD and ICF

ICD-10 is a statistical classification, which means that it contains a limited number of mutually exclusive code categories, which describe all disease concepts.

1. International Classification ofDiseases -10
AND
An Introduction to ICF
DrLipilekhaPatnaik
Professor, Community Medicine
Institute of Medical Sciences & SUM Hospital
Siksha‘O’ Anusandhandeemed to be University
Bhubaneswar, Odisha, India
Email: [email protected]

2. Contents
vDefinitionof Classification
vTypes of classification
vICD-10
vDefinition
vPurposeanduses
vEvolution
vStructure
vBasic codingGuidelines
vICD 11 at doorstep

3. Statistical Classificationof
Diseases
•A classification of disease is a system of categories or
groupings to which diseases, injuries, conditions and
procedures assigned according to established criteria.
•ICD-10 is a statistical classification, which means that it
contains a limited number of mutually exclusive code
categories, which describe all disease concepts.

4. WHO Family of International
Classifications
•‘Family’ designates a suite of integrated classification
productsthat share similar features and can be used singularly
or jointly to provide information on different aspects of
health and the health-care system.
•The WHO Family of International Classifications
(WHO-FIC) attempts to serve asthe framework of
international standards to provide the building blocks of health
information systems.

5. Types of classifications in
WHO-FIC
•Reference classifications
•Derived classifications
•Related classifications

6. Reference classifications
•Cover the main parameters of the health system, such as death,
disease, functioning, disability, health and health interventions.
•Approved and recommended as guidelines for
international reporting on health.
•International Classification of Diseases (ICD)
•International Classification of Functioning, Disability and
Health (ICF)
•International Classification of Health Interventions (ICHI)

7. Derived classifications
•It include specialty-based adaptations of ICFand ICD,
such as
•the International Classification of Diseasesfor Oncology
•the ICD-10 for Mental and BehaviouralDisorders and
•the Application of the International Classification of
Diseases to Neurology (ICD-10-NA)
•Provide additional detail beyond that provided by the
reference classification

8. 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.
•International Classification of Primary Care(ICPC-2),
•International Classification of External Causes of Injury
(ICECI),
•Technical aids for persons with disabilities:
Classification and terminology

9. International classification of diseases
•Represents International Statistical Classification of Diseases
and Related Health Problems.
•Can be defined as a system of categories to which morbid
entities are assigned according to established criteria.
•Used to translate diagnoses of diseases and other health
problems from words into an alphanumeric code.

10. Why to use classification ?
•To allow easy storage, retrieval and analysis of data
•To allow systematic recording, analysis, interpretation and
comparison of mortality and morbidity data between hospitals,
provinces and countries
•To allow comparisons in the same location across different time
periods

11. Evolution of ICD
•During 17
th
century, John Grauntrecognisedthe need to
organisemortality data into some logical form and therefore
developed the first statistical study of disease, called the
London Bills of Mortality.
•In this work, Grauntclassified the deaths of all children who
were born alive but who died before they reached the age of
six.

12. EVOLUTION
Sauvagesfirst
attempted to
systematically classify
alldiseases
& published
underthe title
Nosologia
methodica
OFICD
FrancoisBossier deLacroix
(1706-1777)

13. Linnaeus(1707-1778
Linnaeus
(1707-1778)
EVOLUTION
a great
methodologist
and
contemporaryof
Lacroix
published
hisworkunder
the title
Genera morborum
OFICD

14. EVOLUTIONOFICD
simplifiedthe system
for generaluse
& publishedit
under the title
Synopsis
nosologiae
methodicae
WilliamCullen(1710-1790)

15. EVOLUTIONOFICD
firstmedicalstatisticianof
theGeneralRegisterOffice
of EnglandandWales
submittedhisReportin
1855on nomenclatureand
statistical classificationof
diseases,
in which
he includedmostof those
diseasesthataffect health
andthatarefatal.
WilliamFarr
(1807-1883)

16. ABeginningofModern
Classification
Chiefof Statistical Services
ofParis,
preparedclassification
basedon
the principleof distinguishing
between
generaldiseasesand those
localizedto a particular
organor anatomicalsite.
This wasadoptedin 1893.
JacquesBertillon(1851-1922)

17. A Beginning of ModernClassification
•TheFrenchGovernment,calledthefirstInternationalConference
fortheRevisionoftheBertillon,inParisin1900,thusbeginninga
seriesofrevisionconferencesapproximately10yearsapart
•TheSixthDecennialRevisionConferencein1948wasa
significanteventininternationalvitalandhealthstatistics.
•Itrecommendedtheadoptionofacomprehensiveprogrammeof
internationalcooperationinthefieldofvitalandhealthstatistics.

18. ICD Revisions
•The Seventh Revision Conference was held in Paris in 1955 and, the
revision was limited to essential changes.
•The Eighth Revision Conference was convened by WHO in
Geneva in 1965. The Eighth Revision was much more extensive.
•The International Conference for the NinthRevision was
convened by WHO in Geneva in1975 and it came into effect from
1979.
•ICD-10 was endorsed by the Forty-third World Health Assembly in
May 1990 and came into use in WHO Member States as from 1994.
•India adopted this classification in the year2000.

19. ICD-9 & ICD-10
•Much larger than ICD-9
•ICD-10 has 21chapters against 17 Chapters inICD-9
•Numeric codes ( 001-999 ) were used in ICD-9 where as an
alphanumeric coding, (A00-Z99) has been adopted in ICD-10.
•It enlarged the number of categories availablefor the
classification.
•Further detail by means of decimal numeric subdivisions
at the four character level.

20. Primary users
Users include
•Physicians,
•Nurses,
•Health workers,
•Researchers,
•Health information managers,
•Policy-makers,
•Insurers and
•National health programme managers

21. Structure and Principles ofICD
•Originally conceived by William Farr
•The Classification is grouped as below:
•Epidemic diseases
•Constitutional or general diseases
•Local diseases arranged by site
•Developmental diseases
•Injuries.

22. Volumes of ICD-10
vVolume 1: Tabular list
vVolume 2: Instruction
manual
vVolume 3: Alphabetical
Index
The image part with relationship ID rId2 was not found in
the file.

23. Volume 1: Tabular list
An alphanumeric listing of diseases and
disease groups, along with inclusion
and exclusion notes, some coding rules,
special tabulation lists for mortality and
morbidity, definition and regulation.
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found in the file.

24. Volume 2: Instruction manual
It provides
•An introduction to and instructions
on how to use volume 1 and 3.
•Guidelines for certification and rules
for mortality coding
•Guidelines for recording and coding
for morbidity coding
•Statistical presentation
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not found in the file.

25. Volume 3: Alphabetical index
•Is the comprehensive
Alphabetical index of the
diseases and conditions
found in the tabular list
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not found in the file.

26. Chapters of ICD-10
•The ICD-10 contains 21 chapters, each of which identified by a
Roman numeral.
•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 andmortality,
•Chapter XXI: Factors influencing health status and contact with health
services

27. Chapters of ICD-10
•The chapters are subdivided into homogeneous
"blocks" of three-alphanumeric character categories. E.g.,
•Chapter I: (A00-B99): Certain infectious andparasitic disease
•A00-A09Intestinal infectious diseases
•A15-A19Tuberculosis
•A20-A28Certain zoonotic bacterial diseases
•A30-A49Other bacterial diseases

28. The image part with relationship ID rId2 was not found in the file.
InternationalStatisticalClassificationofDiseases
and RelatedHealthProblems10
th
Revision
Chapter Blocks
Title
I A00–B99
Certaininfectiousandparasiticdiseases
II C00–D48 Neoplasms
III D50–D89
Diseasesofthe bloodandblood-forming
organsandcertain disordersinvolvingthe
immunemechanism
IV E00–E90 Endocrine,nutritionalandmetabolicdiseases
V F00–F99 Mentaland behaviouraldisorders
VI G00–G99 Diseasesofthe nervoussystem
VII H00–H59 Diseasesofthe eyeandadnexa

29. The image part with relationship ID rId2 was not found in the file.
InternationalStatisticalClassificationof
DiseasesandRelatedHealthProblems10thRevision
tissue
andconnectivetissue
Chapter Blocks
Title
VIII H60–H95 Diseasesof theear andmastoidprocess
IX I00–I99 Diseasesof thecirculatorysystem
X J00–J99 Diseasesof therespiratorysystem
XI K00–K93 Diseasesofthedigestivesystem
XII L00–L99
Diseasesof theskin andsubcutaneous
XIII M00–M99
Diseasesof themusculoskeletalsystem
XIV N00–N99 Diseasesof thegenitourinarysystem

30. The image part with relationship ID rId2 was not found in the file.
InternationalStatistical Classificationof
DiseasesandRelatedHealthProblems10
th
Revision
period
chromosomalabnormalities
laboratoryfindings,notelsewhereclassified
consequencesof externalcauses
withhealthservices
Chapter BlocksTitle
XV O00–O99 Pregnancy,childbirthand thepuerperium
XVI P00–P96
Certainconditionsoriginatinginthe perinatal
XVII Q00–Q99
Congenitalmalformations,deformationsand
XVIII R00–R99
Symptoms,signs andabnormalclinicaland
XIX S00–T98
Injury,poisoningandcertainother
XX V01–Y98 Externalcauses ofmorbidityandmortality
XXI Z00–Z99
Factors influencinghealthstatus and contact
XXII U00–U99 Codesfor specialpurposes

31. Basic coding guidelines
•The basic ICD is a single coded list of three-character
categories, each of which can be further divided into up to 10 four-
character subcategories.
•Three-character categories is mandatory level of coding for
international reporting to the WHO mortality database and for
general international comparisons.
•Tenth Revision uses an alphanumeric code with a letter in the first
positionand a number in the second, third and fourth positions.

32. •Some three-character categories have been leftvacant for
future expansion / Revision
•Codes U00–U49 are to be used by WHO for the provisional
assignment of new diseases of uncertain etiology.
•Codes U50–U99 may be used in research, e.g. when testing an
alternative sub-classification for a special project.

33. •The fourth character follows a decimal point.
•Possible code numbers therefore range fromA00.0 to
Z99.9.
•Fill fourth position with X , when sub-division is not there, so
that the codes are of a standard length for data-processing.
A N N . N

34. •A00 Cholera
•A01 Typhoid and paratyphoid fevers
•A02 Other salmonella infections
•A03 Shigellosis
•A04 Other bacterial intestinal infections
Excl.: Foodborne intoxications elsewhereclassified
Tuberculous enteritis (A18.3)

35. •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
Infectiondue to Salmonella paratyphiNOS

36. •Inclusion terms-Within the three-and four-character
rubrics, there are usually listed a number of other
diagnostic terms.
•These are known as ‘inclusion terms’ andare given, in
addition to the title.
•Rubric -In the context of the ICD, rubric denotes either a
three-character category or a four-character subcategory.

37. •Exclusion terms-Certain rubrics contain lists of conditions
preceded by the word “Excludes”. These are terms which are
classified elsewhere.
•A06 Amoebiasis
Incl.: infection due to Entamoeba histolytica
Excl.: other protozoal intestinaldiseases (A07.-)

38. •Glossary descriptions-Chapter V, Mental and behavioural
disorders, uses glossary descriptions to indicate the content of
rubrics.
•This device is used because the terminology ofmental
disorders varies greatly

39. 2 codes for certainconditions
•The “dagger and asterisk” system
•There are two codes for diagnostic statements containing
information about both
•an underlying generalized disease and
•a manifestationin a particular organ or site which is a
clinical problem in its own right.
•This convention was provided because coding to underlying
disease alone was often unsatisfactory for compiling statistics
relating to particular specialties.

40. •The primary code is for the underlying disease and is marked
with a dagger (†);
•an optional additional code for themanifestationis marked
with an asterisk (*).
•E.g.,
•A17 † Tuberculosis of nervous system
•A17.0 † Tuberculous meningitis (G01*)
•A17.1 † Meningeal tuberculoma(G07*)

41. •ItisaprincipleoftheICDthatthedaggercodeisthe
primarycodeandmustalwaysbeused.
•Forcoding,theasteriskcodemustneverbeusedalone.
•Thereare83asteriskcategoriesinICD-10whichmaybe
usedinconjunctionwithadaggercode.

42. Volume 3
Volume 3 is divided into three sections as
follows:
•Section-I lists all the terms classifiable toChapters
I-XIX and Chapter XXI,except drugs and other
chemicals.
•Section II is the index of external causes of
morbidity and mortality andcontains all the terms
classifiable toChapter XX,except drugs and other
chemicals.

43. Volume 3
•Section III gives Table of Drugs and Chemicals lists for
substance the codes for poisonings & adverse effects of drugs
(under Chapter XIX )
•This volume also includes 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.

44. Problem encountered
•Size of the Classification
•No formal training
•No user-friendly software to guide
•Inadequate staff in MRD
•Use of nonstandard abbreviations
•Delay/ incomplete case sheets
•Procedure (instead of diagnosis) are written
•Manually done –very slow and difficult

45. ICD 11 at Door step
•The 11th version, ICD-11, is now being prepared.
•Nearly 20 years have passed since the tenth revision was
published. Much has changed:
•Subject matter: e.g. due to better understanding of the genetic
basis of some diseases
•Context: e.g. the rise of electronic health records &
terminologies

46. Construction of ICD-11
•Internet-based permanent platform
•All year round
•Open to all people in a structured way
•Content experts focus
•Digital curation
•Wiki enabled collaboration
•Ontology based
•Enhanced discussion & peer review
•TAGs serve as the editorial group
•Electronic copy print version (multiplelanguages)

47. ICD 11
•For the first time, through advances in information
technology, public health users, stakeholders and others
interested can provide input to the beta version of ICD-11 using
an online revision process.
•Peer-reviewed comments and input will be added through
the revision period.
•When finalized, ICD-11 will be ready to use with electronic
health records and information systems.

48. ICD Limitations
•ICD does not provide sufficient detail for some specialties and
sometimes information on different attributes of health
conditions may be needed.
•The ICD also is not useful to describe functioning and
disability as aspects of health, anddoes not include a full
array of health interventions or reasons for encounter.

49. An Introduction
to the International
Classification of
Functioning, Disability,
and Health (ICF)

50. What is the ICF?
•Is a classification of health and health-related domains.
•As the functioning and disability of an individual occurs in a context,
ICF also includes a list of environmental factors.
•ICF is the WHO framework for measuring health and disability at both
individual and population levels.
•ICF was officially endorsed by all 191 WHO Member States in the
Fifty-fourth World Health Assembly on 22 May 2001as the
international standard to describe and measure health and disability.

51. •Functioning and disability are viewed as a complex interaction between the
health condition of the individual and the contextual factors of the
environment as well as personal factors. The picture produced by this
combination of factors and dimensions is of "the person in his or her
world".
•The classification treats these dimensions as interactive and dynamic.
•It allows for an assessment of the degree of disability.
•It is applicable to all people, whatever their health condition.
•The language of the ICF is neutral as to etiology, placing the emphasis on
function rather than condition or disease.
•It also is carefully designed to be relevant across cultures as well as age
groups and genders, making it highly appropriate for heterogeneous
populations.

52. The Aims of the ICF
•To provide a scientific basisfor the consequences of health
conditions
•To establish a common languageto improve communications
•To permit comparisonsof data across:
•Countries
•Health care disciplines
•Services
•Time
•To provide a systematic coding schemefor health information
systems

53. ICF Domains
•Body Function and Structures
•Activities (related to tasks and actions by an individual)
•Participation (involvement in a life situation)
•Additional information on severity and environmental
factors

54. Body Function and Structures
•Physiological and psychological function of body systems
•Very specific recording of detailed functional abilities and
impairments
•Not linked to cause.For example, fluency and rhythm of speech
functions–could be from stuttering, stroke, or autism

55. Body FunctionsandStructures
BrokenintoEightChapters
Skin and related structuresFunctions of the skin and related
structures
Structures related to movementNeuromusculoskeletal and
movement-related functions
Structures related to the
genitourinary and reproductive
systems
Genitourinary and reproductive
functions
Structures related to the digestive,
metabolic and endocrine systems
Functionsofthedigestive, metabolic
andendocrinesystems
Structures of the cardiovascular,
immunological and respiratory
systems
Functions of the cardiovascular,
haematological, immunological and
respiratory systems
Structures involved in voice and
speech
Voice and speech functions
The eye, ear and related structuresSensory functions and pain
Structures of the nervous systemMental functions

56. Activities and Participation
•Describes individual’sfunctioning as a whole person, as opposed to
function and structure of his/her body parts
•Range from Basic to Complex
•basic would be, for example, dressing, eating, and bathing
•complex include work, schooling, civic activities
•WHO approach
•Activities –what people can do inherently without assistance or barriers
•Participation –functioning taking into account the impact of barriers and
facilitators in the environment

57. ClassificationofActivitiesandParticipation
1Learning &Applying Knowledge
2General Tasks and Demands
3Communication
4Movement
5Self Care
6Domestic Life Areas
7Interpersonal Interactions
8Major Life Areas
9Community, Social & Civic Life

58. Health Condition
(disorder/disease)
Interaction of Concepts
Environmental
Factors
Personal
Factors
Body
function&structure
(Impairment)
Activities
(Limitation)
Participation
(Restriction)

59. Example: Polio
•May have caused paralysis of legs (Body Function)
•Affects ability to walk or climb stairs (Activity)
•Impedes ability to attend school or find employment
within the current environment (Participation)
BUT….

60. •Mobility related activities, such as getting around the house or
community can be improved with accessible environment and
assistive devices
•Participation can be increased with reduced stigma, accessible
environments and flexible job design
•Disabilityis NOT independent of the environment, and therefore is
not static

61. summary
•ICD-10is a statistical classification containing a limited number of mutually
exclusive code categories, which describe all disease concepts.
•The ICD-10 contains 3 volumes, 21 chapters, each of which identified by a
Roman numeral.
•Vol 1 –Tabular list, Vol 2 –Instruction Manual and Vol 3 –Alphabetical index
•ICD-10 uses an alphanumeric code with a letter in the first positionand a
number in the second, third and fourth positions.
•The fourth character follows a decimal point.
•ICF is a classification of health and health-related domains.
•The domains are Body Function and Structures, Activities, Participation and
additional information on severity and environmental factors

62. Thanks and lets start coding diseases