International classification of diseases ak

What is ICD? Different uses of ICD. Evolution and changes in ICD. New features in ICD 11. How it will help in healthcare.

1. International Classification of Diseases Presented by: Dr Arijit Kundu Guided by: Prof. Sumitra Pattanaik

2. WHO Family of International Classifications The WHO Family of International Classifications (WHO-FIC) is comprised of classifications to describe various aspects of the health and the health system in a consistent manner . The purpose of FIC is to assist the development of reliable statistical systems at local, national and international levels, with the aim of improving health status and health care.

3. Family of International Classification (FIC) I nternational C lassification of D iseases I nternational C lassification of F unctioning , D isability & Health I nternational C lassification of H ealth I nterventions (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 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) ICF, Children & Youth Version (ICF -CY) REFERENCE Classifications

4. Population Health Births Deaths Diseases Disability Risk factors ICD ICF ICHI Classifications Clinical Decision Support Integration of care Outcome Research Administration Scheduling Resources Billing Policy Making Reporting Cost based Needs based Outcome based Applications of Classification

5. International Classification of Diseases is the international "standard  diagnostic  tool for epidemiology ,  health management  and clinical purposes." 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. Introduction

6. 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

7. The International Classification of Diseases (ICD) is a system, developed collaboratively between the World Health Organization (WHO) and 10 international centers so that the medical terms reported by physicians, medical examiners, and coroners on death certificates can be grouped together for statistical purposes. Development of ICD

8. Evolution of ICD First attempts to systematically classify diseases were made in 17 th & 18 th century. During 17 th century, John Graunt recognized the need to organize mortality data into some logical form and therefore developed the first statistical study of disease, called the London Bills of Mortality . In this work, Graunt classified the deaths of all children who were born alive but who died before they reached the age of six . Resulting classifications were considered to be of little utility, due to inconsistencies in nomenclature and poor statistical data.

9. F irst m edical s t a t is t ician of the Gen e ral R e g i ster O f fice of E ng l and and W ales submitted h i s R e port in 1855 on no m enc l ature and statistic a l c l ass i ficat i on of d i seases, in w h ich he i n cl u ded most o f those fa t al d i se a ses that a f fect h e a lth . W i l l i a m Fa r r ( 180 7 - 1883) Evolution of ICD

10. A Beginning of Modern Classification Jac q u e s B e rtill o n(1 8 5 1- 1922 ) Chief of Statistical Services of Paris , prepared classification based on the principle of distinguishing between general diseases and those localized to a particular organ or anatomical site . This was adopted in 1893.

11. ICD: History (cont.)

12. ICD: History (cont.)

13. ICD: History (cont.)

14. 120+ years of ICD History ICD-1 International List of Causes of Death 1893 ICD- 2 International List of Causes of Sickness and Death 1909 1929 ICD- 4 Categories based on etiology ICD- 6 International Classification of Diseases , Injuries and Causes of Death 1948 Mental, Psychoneurotic and Personality Disorders 1975 ICD- 9 Narrative descriptions of Mental & Behavioral disorders 1990 ICD- 10 ICD- 11 2017-2018

15. Primary users Users include   P hysicians ,   Nurses ,   H ealth workers,   Researchers ,   H ealth information managers,   Policy-makers ,   Insurers and   National health program managers

16. Structure and Principles of ICD 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.

17. ICD-9 & 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 where as 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 .

18. Volumes of ICD-10 Volume 1: Tabular list   Volume 2: Instruction manual   Volume 3: Alphabetical Index

19. 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.

20. Volume 2: INSTRUCTION MANUAL It provides 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

21. Volume 3: A lphabetical index Is the comprehensive Alphabetical index of the diseases and conditions found in the tabular list

22. 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 and mortality . Chapter XXI: Factors influencing health status and contact with health services .

23. Chapters of ICD-10 15 of the chapters have a single letter assigned to them and use most of the 100 categories available Chapters have a smaller range of categories assigned to them and share letters 4 chapters use more than one letter in defining the scope of their categories

24. Chapter Chapter Title Codes I Infectious and parasitic diseases A00-B99 II Neoplasms C00-D49 III Diseases of the blood & blood-forming organs & disorders of the immune mechanism D50-D59 IV Endocrine, nutritional and metabolic diseases E00-E99 V Mental and behavioral disorders F00-F99 VI Diseases of the nervous system G00-G99 VII Diseases of the eye and adnexa H00-H59 VIII Diseases of the ear and mastoid process H60-H99 IX Diseases of the circulatory system I00-I99 X Diseases of the respiratory system J00-J99 XI Diseases of the digestive system K00-K99 XII Diseases of the skin and subcutaneous tissue L00-L99 Tabular List of Chapters

25. Chapter Chapter Title Codes XIII Diseases of the musculoskeletal system & connective tissue M00-M99 XIV Diseases of the genitourinary system N00-N99 XV Pregnancy, childbirth and the puerperium O00-O99 XVI Certain conditions originating in the perinatal period P00-P99 XVII Congenital malformations, deformations, and chromosomal abnormalities Q00-Q99 XVIII Symptoms & abnormal clinical & lab findings, not elsewhere classified R00-R99 XIX Injury, poisoning and certain other consequences of external causes S00-T99 XX External causes of morbidity and mortality V00-Y99 XXI Factors influencing health status & contact with health services Z00-Z99 Tabular List of Chapters

26. 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 position and a number in the second, third and fourth positions .

27. Some three-character categories have been left vacant 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 . Basic coding guidelines

28. The fourth character follows a decimal point . Possible code numbers therefore range from A00.0 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 Basic coding guidelines

29. Structure of ICD-10 Codes The chapters are subdivided into homogeneous "blocks" of three-alphanumeric character categories. Example: Chapter I: (A00-B99): Certain infectious and parasitic disease A00-A09 Intestinal infectious diseases A15-A19 Tuberculosis A20-A28 Certain zoonotic bacterial diseases A30-A49 Other bacterial diseases

30. Structure of ICD-10 Codes The classification itself at the three character level Certain infectious and parasitic diseases (A00-B99 ) Intestinal infectious diseases (A00-A09) A00 Cholera A01 Typhoid and paratyphoid fevers A02 Other salmonella infections A03 Shigellosis A04 Other bacterial intestinal infections A05 Other bacterial foodborne intoxications A06 Amoebiasis A07 Other protozoal intestinal diseases A08 Viral and other specified intestinal infections A09 Diarrhoea & gastroenteritis of presumed infectious origin

31. Classification at the four character level Amoebiasis (A060 to A069) A06.0 Acute amoebic dysentery A06.1 Chronic intestinal dysentery A06.2 Amoebic non-dysenteric colitis A06.3 Amoeboma of intestine A06.4 Amoebic liver abscess A06.5† Amoebic lung abscess (J99.8*) A06.6† Amoebic brain abscess (G07*) A06.7 Cutaneous Amoebiais A06.8 Amoebic infection of other parts of body A06.9 Amoebiais unspecified Structure of ICD-10 Codes

32. Dagger and Asterisk Inclusion Terms Exclusion Terms Parentheses ( ) Square Brackets [ ] Colon : Brace } Not Otherwise Specified NOS Not Elsewhere Classified NEC AND in code titles Point Dash Additional codes Special signs

33. 1. The “dagger and asterisk” system Additional codes for fine tuning Dagger (†) - Used for the underlying disease It points at the root cause/main condition Asterisk (*) - Manifestation of primary disease i.e . it points at the secondary cause The dagger & asterisk code should be used together and the dagger code is preferred as main code. ICD-10 classification suggests that the “Main Condition” can be made more specific by addition of another code. Special signs

34. Example : Amoebiasis (A060 to A069) A06.0 Acute amoebic dysentery A06.1 Chronic intestinal dysentery A06.2 Amoebic nondysenteric colitis A06.3 Amoeboma of intestine A06.4 Amoebic liver abscess A06.5† Amoebic lung abscess (J99.8*) A06.6† Amoebic brain abscess (G07*) A06.7 Cutaneous amoebiasis A06.8 Amoebic infection of other parts A06.9 Amoebiais unspecified Intracranial & intraspinal abscess (G07*) Abscess of Brain Amoebic brain abscess (A06.6 †) Gonococcal abscess (A54.8 †) Tuberculous abscess (A17.8 †) Dagger (†) - Used for the root cause Asterisk (*) – Used for the secondary cause

35. 2. Inclusion Terms Usually listed within the three and four character categories, may also be at block or chapter level Examples of the different conditions or synonyms for the condition coded to that category Not a sub-classification 3 . Exclusion Terms List of conditions that are to be coded elsewhere, not to the code being looked at. The correct code is in parentheses. Special signs

36. Tuberculosis (A15-A19 ) Incl.: Infections due to Mycobacterium tuberculosis and Mycobacterium bovis Excl.: congenital tuberculosis ( P37.0 ) human immunodeficieny [HIV] disease resulting in tuberculosis ( B20.0 ) pneumoconiosis associated with tuberculosis ( J65 ) sequelae of tuberculosis ( B90.- ) silicotuberculosis ( J65 ) Example:

37. 4. Parentheses ( ) Enclose supplementary words Enclose the code for the exclusion term Enclose the three character codes of categories in a block Enclose the dagger code in an asterisk category or the asterisk code in a dagger term Special signs

38. 5. Square Brackets [ ] For enclosing synonyms, alternative words or explanatory phrases For referring to notes For referring to fourth character subdivisions common to a number of categories Special signs

39. 6. Colon : Used in lead terms and listings of inclusion and exclusion terms when the words in the list need an essential modifier to allow assignment of the specified code Example: G71.0 Muscular dystrophy : autosomal recessive benign [Becker] distal Special signs

40. 7. Brace } Used to link a series of terms Each term on the left of the brace must be modified by at least one of the terms to the right of the brace before the specific code can be assigned Special signs

41. 8. Not Otherwise Specified (NOS) Means unspecified or unqualified Only used if no other information exists to allow assignment of a more specific code Example: K14.9 Disease of tongue, unspecified Glossopathy NOS Special signs

42. 9. Not Elsewhere Classified (NEC) Used as a warning that specific types of the condition being coded appear elsewhere in the classification If more specific information is available, a different code may be selected Example : K73.2 Chronic hepatitis, not elsewhere classified Special signs

43. 10. “AND” in code titles " and" stands for "and/or” in code titles Example : S49.9 Unspecified injury of shoulder and upper arm Means that here we can code the following: unspecified injury of shoulder unspecified injury of upper arm unspecified injury of shoulder and upper arm Special signs

44. 11. Point Dash .- Indicates to the coder that a fourth character exists and should be sought at category, block or chapter level Example: D59.1 Other autoimmune haemolytic anaemias Excludes : haemolytic disease of fetus and newborn (P55 .-) Tabular List Conventions

45. 12. Additional codes ICD-10 sometimes indicates when coding can be made more specific by the addition of another code instructions such as use additional external cause code, if desired, to identify cause use additional code (B95-B97) to identify infectious agent Tabular List Conventions

46. Volume 3 (Alphabetical index) Volume 3 is divided into three sections as follows: Section-I lists all the terms classifiable to Chapters I-XIX and Chapter XXI, except drugs and other chemicals . Section II is the index of external causes of morbidity and mortality and contains all the terms classifiable to Chapter XX, except drugs and other chemicals . Section III gives Table of Drugs and Chemicals lists for substance the codes for poisonings & adverse effects of drugs (under Chapter XIX )

47. 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 Problem encountered

48. ICD - 11 Need for an 11th Revision ICD-10 , despite the updating process, ICD-10 was clinically outdated Structural changes were needed to some chapters Increasing need to operate in an electronic environment Need to capture more information for morbidity Launched on 18 th June, 2018.

49. ICD-11: Features About 300 specialists of 55 countries, organized in 30 main working groups have provided their input to make ICD-11 scientifically up-to-date, and structural problems that became apparent using ICD-10 have been solved. ICD-11 is much easier to use than ICD-10. The systematic reliance on the use of code combinations and extension codes makes ICD finally clinically relevant. Primary care, cancer coding, traditional medicine and a section for assessment of functioning are now included .

50. ICD-11: Features Special versions, as for mental health, primary care, or dermatology are produced. ICD-11 is truly multilingual. ICD-11 is based on the electronic foundation component that contains all content, structural information, references in a machine readable format. The content is then rendered for machine or human use, electronically or in print. ICD-11 is digital health: The system allows connection of any software through a standard API. The same package is also prepared for offline use.

51. ICD-11: Features In ICD-11, each disease entity has a description that give key descriptions and guidance in meaning of the entity/category is in human-readable terms, to guide users. Definitions have a standard structure according to a template with standard definition templates and further features exemplified in a "Content Model". The Content Model is a structured framework that captures the knowledge that reinforces the definition of an ICD entity . Each ICD entity can be seen from different dimensions or "parameters".

52. For example, there are currently 13 defined main parameters in the Content Model to describe a category in ICD : ICD Entity Title - Fully Specified Name Classification Properties - disease, disorder, injury, etc. Textual Definitions - short standard description Terms - synonyms, other inclusion and exclusions Body System/Structure Description - anatomy and physiology Temporal Properties - acute, chronic or other ICD-11: Features

53. Severity of Subtypes Properties - mild, moderate, severe, or other scales Manifestation Properties - signs, symptoms Causal Properties - etiology: infectious, external cause, etc. Functioning Properties - impact on daily life: activities and participation Specific Condition Properties - relates to pregnancy etc. Treatment Properties - specific treatment considerations: e.g. resistance Diagnostic Criteria - operational definitions for assessment ICD-11: Features

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