ICD 10 : Basic CodingGuidelinesDr. M.M. SinghM.D., D.N.B. (SPM), D.N.B (HH Admn.), MAMSAssociate ProfessorMaulana Azad Medical College, New Delhi

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

Volume 1 :IntroductionTabular listMorphology of neoplasmsSpecial tabulation lists for mortality and morbidityDefinitionsRegulationsVolume 2 :Instruction manualVolume 3 :Alphabetical indexss

ICD 10 : COMPOSITION OF CHAPTERSChapter number an designationI Certain infectious and parasitic diseasesII NeoplasmsIII Disease of the blood and blood forming organs and certain disorders involving the immune mechanismIV Endocrine, nutritional and metabolic diseasesV 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 systemRange of codesA00-B99C00-D48

D50-D89

E00-E90

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

ICD 10 : COMPOSITION OF CHAPTERSChapter number an designationXI Diseases of the digestive systemXII Disease of the skin and subcutaneous tissueXIII Diseases of the musculo-skeletal system and connective tissueXIV Disease of the genito-urinary systemXV Pregnancy, childbirth and the puerperiumXVI Certain conditions originating in the perinatal periodXVII Congenital malformations, deformations, and chromosomal abnormalities

Range of codesK00-K93L00-L99M00-M99

N00-N99O00-O99P00-P95

Q00-Q99

ICD 10 : COMPOSITION OF CHAPTERSChapter 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 servicesRange of codesR00-R99

S00-T98

V01-Y98

Z00-Z98

CHAPTER XXI FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICESPersons with potential health hazards related to socio economic circumstances (Z55-Z65)Z55 Problems related to education and literacyZ55.3 Under achievement in schoolZ56 Problems related to employment and unemploymentZ56.2 Threat of job lossZ60 Problems related to social environmentZ60.3 Acculturation difficultyZ65 Problems related to other psychological circumstancesZ65.4 Victim of crime and terrorism (Includes victim of torture)

ICD 10 Chapters21 chapters1st 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 mechanismH-Chap VII diseases of the eye & adnexa, & chap. VIII, diseases of the ear and mastoid processFour chaps. Use more than one letter I, II, XIX, XXI- XVII relate to disease & other morbid conditionsXVIII symptoms, signs, abnormal clinical & lab. Findings, not elsewhere classifiedXIX injuries, poisoning & certain other consequences of external causes

STRUCTURE OF AN ICD 10 CODEF20.10 Hebephrenic schizophrenia continuous courseMental and Behavioural disorder20 Schizophrenia .1 Hebephrenic type 0 Continuous course5, 6th character for specific purpose/researchU codes unused codesAddition of signs/symbols ( ), [ ], , *, -

STRUCTURE OF AN ICD 10 CODETUBERCULOSIS (A15-A19)Includes : Infections due to Mycobacterium tuberculosis and Mycobacterium bovisExcludes : Congenital tuberculosis (P37.0)Pneumoconiosis associated with tuberculosis (J65)Sequelae of tuberculosis (B90.-)Silicotuberculosis (J65)

STRUCTURE OF AN ICD 10 CODEA15 Respiratory tuberculosis bacterilogically and histologically confirmedA15.0 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 organsA 18.1 Tuberculosis of genitourinary systemTuberculosis of :Bladder (N 33.0 *) N 33 * Bladder disorders in diseases classified elsewhereN 33.0 * Tuberculous cystitis (A18.1 )Male genital organs (N 51.-*)

STRUCTURE OF AN ICD 10 CODEMale genital organs (N 51.- *)N51.* Disorders of male genital organs in diseases classified elsewhereN 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 elsewhereTuberculosis of :Epididymis (A18.1 )Testis (A18.1 )

Blocks of CategoriesBlocks have three characters e.g. A 31 Infection due to other mycobacteriumFourth character : after decimal point is subcategoryIf 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 NeoplasmsAdditional code for morphology & behaviourFive digits, first four indicate morphology, fifth is after a slash indicates behavioure.g. M9370/0 Benign chordoma/0 Benign/1 Uncertain whether benign or malignant Borderline malignancyLow malignant potential/2 Carcinoma in situIntraepithelialNoninfiltratingNoninvasive

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 codee.g. I 10 Hypertension (arterial) (essential) (malignant) (primary) (systemic)indicates Hypertension alone or qualified by any or combination2. Enclose code referring exclusione.g. H01.0 Blepharitis, excludes blepharoconjunctivitis (H10.5)3. Block titles, to enclose three character codes of categories4. 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 :Enclose synonyms, alternative wordse.g. A30 Leprosy [Hansens disease]2. For referring to previous notese.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 categoriese.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 perforationWhen 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 classifiedServes a warning that certain variants are listed somewhere. e.g.J16 Pneumonia due to other infectious organisms, not elsewhere classifiedIncludes J16.0 Chlamydial pneumonia, J16.8 Pneumonia due to other specified infectious organismsOther 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 chemicalsII index of external causes of morbidity and mortality, all terms classifiable to Chapter XX, EXCEPT drugs and other chemicalsIII 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 IndexLead 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 tStomach ulcer search under ? S/UAdjectival disease conditions : puerperal, puerperium/tuberculosis, tubercular, tuberculous in NOUN from or both

Structure in IndexComplete listing of modifiers to a given term may NOT be feasiblePrioritise the modifiers one over other Abscess many sites, NOT tuberculous abscessIf problems or circumstances leading to disease listed search may be difficultT Use key words counselling, examination, history, observation, pregnancy, problem, screening, status, vaccinationLabor, puerperal, maternal condition affecting fetus or newbornSection II complication, sequelae, suicide, assault, legal intervention, war operations

Code numbers in IndexEither 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 : Potts 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 outcomeIf complication : coma, diabetic code to E10-E14 with 4th character

Understanding IndexMultiple diagnoses :Influenza with pneumonia (J11.0)Underlying cause of death each condition to be assigned codeSpelling American Re er (center), oe e (edema), ou o (labor) etc.Parentheses :Several terms in parentheses classified to the given codeAbscess (embolic) (infective) (metastatic) (multiple) (pyogenic) (septic) - brain (any part) G06.0Brain abscess, any part, regardless of any variety is coded G06.0Cross references : See, see also, see condition, see also conditionNEC 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 codesThe dagger and asterisk systemIntroduced from ICD 9 onwardsUnderlying generalized disease and a manifestation in a particular organ or sitePrimary code for underlying disease marked with dagger ()Optional additional code for manifestation marked with asterisk (*) for medical careFor classification primary dagger code must be usedAsterisk code should NOT be used alone

Asterisk codeAppears as three-character categoriesUsed when particular disease is NOT specified as underlying cause. e.g.G 20 & G 21 Parkinsonism not manifestations of other diseasesG 22 * Parkinsonism in diseases classified elsewhereCorresponding 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 combinations3. 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 *) septicaemiaLOOK -> 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 codingBesides dagger, asterisk system other dual coding exists in certain situations.Note in the list Use additional code, if desired1. Infections, codes from Chap. I may be added to identify organismJ02.8 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 chaptersB95.0 Streptococcus, group A, as the cause of diseases classified to other chaptersDiagnosis could be J02.8 B95.0

Other optional dual coding2. 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 added6. 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 79.5Neoplasm, neoplastic - acromion (process) (C79.5.)

Coding guidelines 1, 2Steps :1. Look for diagnosis (Lead term/key words) in the recordAsthma, 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, XXISection 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 55. Follow carefully any cross references (see, see also) in the indexDegeneration, degenerativeAmyloidosis (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.1Degeneration, degenerative - brain (cortical) (progressive) G31.9 --- lipidosis -----cerebral E75.4 G32.8*IN VOL. 1 Page 93 :E75.4 Neuronal ceroid lipofuscinosis Disease :BattenBielschowsky JanskyKufs 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 headingA32 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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