ICD 10 : Basic CodingGuidelines

Dr. M.M. SinghM.D., D.N.B. (SPM), D.N.B (HH Admn.), MAMS

Associate Professor

Maulana Azad Medical College, New Delhi

ICD 10International Statistical Classification of Diseases and Related Realth ProblemsTenth Revision

Volume 1 :

• Introduction

• Tabular list

• Morphology of neoplasms

• Special tabulation lists for mortality and morbidity

• Definitions

• Regulations

Volume 2 :

Instruction manual

Volume 3 :

Alphabetical indexss

ICD 10 : COMPOSITION OF CHAPTERS

Chapter number an designationI Certain infectious and parasitic diseases

II NeoplasmsIII Disease of the blood and blood forming

organs and certain disorders involving the immune mechanism

IV Endocrine, nutritional and metabolic diseases

V Mental and behavioural disordersVI Diseases of the nervous systemVII Diseases of the eye and adnexaVIII Diseases of the ear and mastoid processIX Diseases of the circulatory systemX Diseases of the respiratory system

Range of codesA00-B99C00-D48

D50-D89

E00-E90

F00-F99G00-G99H00-H59H60-H95I00-I99J00-J99

ICD 10 : COMPOSITION OF CHAPTERS

Chapter number an designationXI Diseases of the digestive system

XII Disease of the skin and subcutaneous tissue

XIII Diseases of the musculo-skeletal system and connective tissue

XIV Disease of the genito-urinary system

XV Pregnancy, childbirth and the puerperium

XVI Certain conditions originating in the perinatal period

XVII Congenital malformations, deformations, and chromosomal abnormalities

Range of codesK00-K93

L00-L99

M00-M99

N00-N99

O00-O99

P00-P95

Q00-Q99

ICD 10 : COMPOSITION OF CHAPTERS

Chapter number and designationXVIII Symptoms, signs and abnormal clinical

and laboratory findings, not elsewhere classified

XIX Injury, poisoning and certain other consequences of external causes

XX External causes of morbidity and mortality

XXI Factors influencing health status and contact with health services

Range of codesR00-R99

S00-T98

V01-Y98

Z00-Z98

CHAPTER XXI FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH

HEALTH SERVICES

Persons with potential health hazards related to socio economic circumstances (Z55-Z65)

• Z55 Problems related to education and literacy

• Z55.3 Under achievement in school

• Z56 Problems related to employment and unemployment

• Z56.2 Threat of job loss

• Z60 Problems related to social environment

• Z60.3 Acculturation difficulty

• Z65 Problems related to other psychological circumstances

• Z65.4 Victim of crime and terrorism (Includes victim of torture)

ICD 10 Chapters

• 21 chapters• 1st character – letter, each for a chapter except.• D – both in chap. II, neoplasms & Chap III, diseases of blood &

blood forming organs & certain disorders involving the immune mechanism

• H-Chap VII diseases of the eye & adnexa, & chap. VIII, diseases of the ear and mastoid process

• Four chaps. Use more than one letter – I, II, XIX, XX• I- XVII relate to disease & other morbid conditions• XVIII – symptoms, signs, abnormal clinical & lab. Findings, not

elsewhere classified• XIX – injuries, poisoning & certain other consequences of external

causes

STRUCTURE OF AN ICD 10 CODE

• F20.10 Hebephrenic schizophrenia continuous course

• Mental and Behavioural disorder

20 Schizophrenia

.1 Hebephrenic type

0 Continuous course

5, 6th character – for specific purpose/research

“U” codes – unused codes

Addition of signs/symbols ( ), [ ], † , *, -

STRUCTURE OF AN ICD 10 CODE

• TUBERCULOSIS (A15-A19)• Includes : Infections due to Mycobacterium

tuberculosis and Mycobacterium bovis• Excludes : Congenital tuberculosis (P37.0)• Pneumoconiosis associated with tuberculosis (J65)• Sequelae of tuberculosis (B90.-)• Silicotuberculosis (J65)

STRUCTURE OF AN ICD 10 CODE• A15 Respiratory tuberculosis bacterilogically and histologically

confirmed• A15.0 Tuberculosis of lung, confirmed by sputum microscopy with or

without culture Tuberculous :Bronchiectasis } (Confirmed by sputum microscopy with or without culture)Fibrosis of lung}Pneumonia}Pneumothorax }• A 18 Tuberculosis of other organs• A 18.1 † Tuberculosis of genitourinary system• Tuberculosis of :• Bladder (N 33.0 *)• N 33 * Bladder disorders in diseases classified elsewhere• N 33.0 * Tuberculous cystitis (A18.1 †)• Male genital organs (N 51.-*)

STRUCTURE OF AN ICD 10 CODE

• Male genital organs (N 51.- *)• N51.* Disorders of male genital organs in diseases classified

elsewhere• N 51.0 * Disorders of prostate in diseases classified elsewhere Prostatitis :• Gonococcal (A 54.2 †)• Trichomonal ( A59.0 †)• Tuberculous (A 18.1 †)• N 51.1 * Disorders of testis and epididymis in diseases classified

elsewhere• Tuberculosis of :• Epididymis (A18.1 †)• Testis (A18.1 †)

Blocks of Categories

• Blocks have three characters e.g. A 31 Infection due to other mycobacterium• Fourth character : after decimal point is

subcategory• If reporting is upto 4th category, and in some cases

if 4th character in not available, then put “X” in the 4th place to make the codes of uniform length for entry.

• Fifth character – supplementary for specific/ research

Morphology of Neoplasms• Additional code for morphology & behaviour• Five digits, first four indicate morphology, fifth is after a

slash indicates behaviour• e.g. M9370/0 Benign chordoma• /0 Benign• /1 Uncertain whether benign or malignant Borderline

malignancy• Low malignant potential• /2 Carcinoma in situ• Intraepithelial• Noninfiltrating• Noninvasive

Morphology of Neoplasms

• /3 Malignant, primary site• /6 Malignant, metastatic site• /9 Malignant, uncertain whether primary or

metastatic site

- Superficial spreading adenocarcinoma (M8143/3)- If described as “noninvasive” code (M8143/2)

To code with morphology :

- Adenoma bile duct (M8160/0) D13.4

Conventions used in Tabular list (Vol.1)• Parentheses ( ) used in :• 1. Enclose supplementary words, NOT affecting code- e.g. I 10 Hypertension (arterial) (essential) (malignant)

(primary) (systemic)- indicates Hypertension alone or qualified by any or

combination• 2. Enclose code referring exclusion- e.g. H01.0 Blepharitis, excludes blepharoconjunctivitis (H10.5)• 3. Block titles, to enclose three character codes of

categories• 4. To enclose the dagger code in an asterisk category or the

asterisk code following a dagger term

Conventions used in Tabular list (Vol.1)Square brackets [ ] used to :1. Enclose synonyms, alternative words- e.g. A30 Leprosy [Hansen’s disease]2. For referring to previous notes- e.g. C00.8 overlapping lesion of lip [see note 5

on p.182]3. For referring to previously stated set of our

character subdivisions common to a no. of categories

- e.g. K27 Peptic ulcer, site unspecified [See page 566 for subdivisions]

Conventions used in Tabular list (Vol.1)Colon :• To list inclusion and exclusion termse.g. K26 Duodenal ulcer Includes : erosion (acute) of duodenum Excludes : peptic ulcer NOS (K27.-) .0 Acute with haemorrhage .1 Acute with perforation• When insertion of modifying words is required in

diagnosise.g. K36 Other appendicitisAppendicitis :. Chronic. recurrent

Conventions used in Tabular list (Vol.1)Brace }• Used in listing inclusion & exclusion terms, to

indicate that neither words preceding nor after it are complete terms. e.g.

• O71.6 Obstetric damage to pelvic joints & ligaments Avulsion of inner symphyseal cartilage } Damage to coccyx} obstetric Traumatic separation of symphysis (pubis) }NOS – Not otherwise specified or unspecified/

unqualified

Conventions used in Tabular list (Vol.1)

• Not elsewhere classified

Serves a warning that certain variants are listed somewhere. e.g.

J16 Pneumonia due to other infectious organisms, not elsewhere classified

Includes J16.0 Chlamydial pneumonia,

J16.8 Pneumonia due to other specified

infectious organisms

Other categories are in Chapter X

Conventions used in Tabular list (Vol.1)

• “And” in titles . for and /orA18.0, Tuberculosis of bone and joints are to be

classified cases of “Tuberculosis of bone” ;“Tuberculosis of joints” and “Tuberculosis of bones

and joints”.• Point dash .-Indicates existence of a fourth charactere.g. Peptic ulcer NOS (K27.-) .0 Acute with haemorrhage .1 Acute with perforation ….

Volume 3 : Alphabetical indexSections :• I – list of all terms classifiable to Chapters I-XIX,

and XXI, EXCEPT drugs and other chemicals• II – index of external causes of morbidity and

mortality, all terms classifiable to Chapter XX, EXCEPT drugs and other chemicals

• III – table of drugs & chemicals, list for each substance the codes for poisonings & adverse effects of drugs classifiable to Chapter XIX, & Chapter XX codes that indicates mode : accidental, deliberate (self-harm), undetermined, or adverse effect of a correct substance

Structure in Index• Lead terms or key words (extreme left)• Indentations (in right after dash) Erythroblastosis (fetalis) (newborn) P55.9 - due to -- ABO (antibodies) (incompatibility) (isoimmunization) P55.1 -- Rh (antibodies) (incompatibility) (isoimmunization) P55.0

LEAD TERMS : name of disease/pathological conditionIndented : the modifiers – variety, site, etc.Tuberculosis of hip – search under “t”Stomach ulcer – search under ? “S/U”Adjectival disease conditions : puerperal, puerperium/tuberculosis,

tubercular, tuberculous – in NOUN from or both

Structure in Index• Complete listing of modifiers to a given term may NOT be

feasible• Prioritise the modifiers – one over other Abscess – many sites, NOT tuberculous abscess• If problems or circumstances leading to disease listed –

search may be difficult- T Use key words – counselling, examination, history,

observation, pregnancy, problem, screening, status, vaccination

• Labor, puerperal, maternal condition affecting fetus or newborn

• Section II – complication, sequelae, suicide, assault, legal intervention, war operations

Code numbers in Index• Either three or four character or a dash in place of fourth

place indicates a fourth character exists.

• Burn, ankle (and foot) T 25.-

• If dual classification, by etiology & manifestation both codes are given :

Pott’s disease A 18.0 † M 49.0 *

• If fourth character is applicable to a group of categories, common 4th characters presented

e.g. Pregnancy with abortive outcome

• If complication : coma, diabetic – code to E10-E14 with 4th character

Understanding Index• Multiple diagnoses :• Influenza with pneumonia (J11.0)• Underlying cause of death – each condition to be assigned code• Spelling – American Re – er (center), oe – e (edema), ou – o (labor) etc.• Parentheses :• Several terms in parentheses – classified to the given code• Abscess (embolic) (infective) (metastatic) (multiple) (pyogenic) (septic) - brain (any part) G06.0• Brain abscess, any part, regardless of any variety is coded G06.0• Cross references : See, see also, see condition, see also condition• NEC – Not elsewhere classified (unspecified)• Anomaly of aorta (arch) NEC Q 25.4 – only if no more precise description on

medical record.

Certain conditions with two codes• The “dagger and asterisk” system

• Introduced from ICD 9 onwards

• Underlying generalized disease and a manifestation in a particular organ or site

• Primary code for underlying disease marked with dagger (†)

• Optional additional code for manifestation marked with asterisk (*) – for medical care

• For classification – primary dagger code must be used

• Asterisk code should NOT be used alone

Asterisk code• Appears as three-character categories

• Used when particular disease is NOT specified as underlying cause. e.g.

• G 20 & G 21 Parkinsonism not manifestations of other diseases

• G 22 * Parkinsonism in diseases classified elsewhere

• Corresponding dagger codes are given for conditions in asterisk categories viz.

• G22 * Parkinsonism in diseases classified elsewhere Syphilitic parkinsonism (A 52.1 †)

Rubrics with † mark combinations1. † with * mark in heading denotes dual classification

exists and all have same alternative code A17.0 † Tuberculous meningitis (GOI *) Tuberculosis of meninges (cerebral) (spinal) Tuberculous leptomeningitis2. † Present in heading without * : dual classification &

they have different alternative codes A18.1 † Tuberculosis of genitourinary system Tuberculosis of : bladder (N33.0*) cervix (N74.0 *) ….

Rubrics with † mark combinations

3. None († & *) present in title : not all groups

subject to dual classification, but individual inclusion terms may be, terms will be marked and alternative codes are given.

A54.8 Other gonococcal infections

Gonococcal :

peritonitis † (K67.1 *)

pneumonia † (J17.0 *)

septicaemia

• LOOK -> K67.1 * Disorders of peritoneum in

infectious diseases classified elsewhere

K67.0 * Chlamydial peritonitis (A74.8 †)

K67.1 * Gonococcal peritonitis (A54.8 †)

Other optional dual coding• Besides dagger, asterisk system other dual coding exists in certain situations.• Note in the list “Use additional code, if desired…”• 1. Infections, codes from Chap. I may be added to

identify organism• J02.8 Acute pharyngitis due to other specified organisms Use additional code (B95-97), if desired, to identify

organism. e.g. B95 Streptococcal and staphylococcus as a cause of diseases

classified to other chapters• B95.0 Streptococcus, group A, as the cause of diseases

classified to other chapters• Diagnosis could be J02.8 B95.0

Other optional dual coding

2. Neoplasms with functional activity Code of Chap. IV may be added to Chap. II code for functional

activity3. Neoplasms, the morphology code on p1181-1204 of vol.1,

may be added to chapter II to identify morphological type4. Conditions in F00-F09 (organic, including symptomatic,

mental disorders) in Chap. V, code from other chapters may be added to indicate the cause, i.e. underlying disease, injury, to brain etc.

5. If condition is caused by a toxic agent, a code from Chap. XX may be added

6. For injury, poisioning, adverse effect, code from XIX for nature of injury, code from XX for cause could be added.

Signs in Index• †/* etiology & manifestation code respectively• # Sites marked # to be classified as malignant neoplasm of

Skin in the sites if neoplasm is squamous cell carcinoma or an epidermoid carcinoma, and to benign neoplasm of skin of the sites if it is a papilloma (any type)

• e.g. Face NEC #• Carcinomas & adenocarcinomas, any type other than

intraosseous or odontogenic, of sites with mark, consider as metastatic from unspecified primary site & coded to C 79.5

• Neoplasm, neoplastic - acromion (process) (C79.5.)

Coding guidelines 1, 2Steps :

1. Look for diagnosis (Lead term/key words) in the record

- Asthma, uremia, encephalopathy (noun for diseases, injuries)

- cancerous, bilous, tuberculous, carious tooth (adj.)2. Refer volume 3 (alphabetical index)• Section I of index – Disease/conditions

classifiable in Chap.I – XIX, XXI• Section II – external causes of injury classifiable

in Chap. XX

Coding guidelines 3, 4

3. Read and be guided by any note in the term4. Read terms in parentheses after the lead term (modifiers do NOT affect codes) (terms indented under lead term – modifies code)• Degeneration, degenerative - adrenal (capsule) (fatty) (gland) (hyaline) (infections) E27.8 - amyloid (see also amyloidosis) E85.9• - brain (cortical) (progressive) G31.9 -- alcoholic G31.2 -- in --- alcoholism G31.2 --- beriberi E51.1 † G32.8 * --- lipidosis ----cerebral E75.4 † G32.8 *

Coding guidelines 5

5. Follow carefully any cross – references (“see”, “see also”) in the index

• Degeneration, degenerative

• Amyloidosis (generalized) (primary) E85.9

- with lung involvement E85.4 † J99.8*

- familial E85.2

- genetic E85.2

- localized E85.4

- specified NEC E85.8

Coding guidelines 66. Refer the tabular list (Vol.2), verify the suitability of the code

selected.• Three character code in index with dash indicates a fourth character to

be found in vol.1• Degeneration, degenerative - brain (cortical) (progressive) G31.9 --- lipidosis -----cerebral E75.4 † G32.8*• IN VOL. 1 Page 93 :• E75.4 Neuronal ceroid lipofuscinosis Disease :• Batten• Bielschowsky – Jansky• Kufs G32.8 * Other specified degenerative disorders of nervous system in

diseases classified elsewhere

Coding guidelines 7, 87. Be guided by inclusion and exclusion terms under

selected code or chapter or block or category heading• A32 Listerosis Includes : listerial foodborne infection Excludes : neonatal (disseminated) listerosis (P37.2)• A35 Other tetanus Tetanus NOS Excludes : tetanus : . neonatorum (A33) . obstetrical (A34)8. Assign code

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