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ICD 10 : Basic CodingGuidelines

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

Associate ProfessorMaulana Azad Medical College, New Delhi

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ICD 10International Statistical Classification of Diseases and

Related Realth ProblemsTenth RevisionVolume 1 :

Introduction Tabular list

Morphology of neoplasms Special tabulation lists for mortality and morbidity Definitions RegulationsVolume 2 :

Instruction manualVolume 3 :Alphabetical indexss

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ICD 10 : COMPOSITION OF CHAPTERS

Chapter number an designationI Certain infectious and parasitic diseasesII NeoplasmsIII Disease of the blood and blood forming

organs and certain disorders involving theimmune mechanism

IV Endocrine, nutritional and metabolicdiseases

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

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ICD 10 : COMPOSITION OF CHAPTERS

Chapter number an designationXI Diseases of the digestive systemXII Disease of the skin and subcutaneous tissue

XIII Diseases of the musculo-skeletal system andconnective tissue

XIV 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-L99

M00-M99

N00-N99O00-O99P00-P95

Q00-Q99

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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 otherconsequences of external causes

XX External causes of morbidity and mortality

XXI Factors influencing health status andcontact with health services

Range of codesR00-R99

S00-T98

V01-Y98

Z00-Z98

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CHAPTER XXI FACTORS INFLUENCINGHEALTH STATUS AND CONTACT WITH

HEALTH SERVICESPersons 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)

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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 immunemechanism 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

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STRUCTURE OF AN ICD 10 CODE

F20.10 Hebephrenic schizophrenia continuous course Mental and Behavioural disorder

20 Schizophrenia.1 Hebephrenic type

0 Continuous course5, 6 th character for specific purpose/research

U codes unused codesAddition of signs/symbols ( ), [ ], , *, -

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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)

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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 cultureTuberculous :

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.-*)

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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 )

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Blocks of Categories

Blocks have three characters e.g.A 31 Infection due to other mycobacterium

Fourth character : after decimal point issubcategory If reporting is upto 4 th category, and in some cases

if 4 th character in not available, then put X in the

4th

place to make the codes of uniform length forentry. Fifth character supplementary for specific/

research

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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

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Morphology of Neoplasms

/3 Malignant, primary site /6 Malignant, metastatic site

/9 Malignant, uncertain whether primary ormetastatic site

- Superficial spreading adenocarcinoma (M8143/3)

- If described as noninvasive code (M8143/2)To code with morphology :

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

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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

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Conventions used in Tabular list (Vol.1)

Square brackets [ ] used to :1. Enclose synonyms, alternative words- e.g. A30 Leprosy [Hansens disease]

2. For referring to previous notes- e.g. C00.8 overlapping lesion of lip [see note 5on p.182]

3. For referring to previously stated set of our

character subdivisions common to a no. ofcategories- e.g. K27 Peptic ulcer, site unspecified [See page

566 for subdivisions]

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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 indiagnosis

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

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Conventions used in Tabular list (Vol.1)

Brace } Used in listing inclusion & exclusion terms, to

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

O71.6 Obstetric damage to pelvic joints & ligamentsAvulsion of inner symphyseal cartilage }Damage to coccyx} obstetric

Traumatic separation of symphysis (pubis) }NOS Not otherwise specified or unspecified/

unqualified

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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 classified

Includes J16.0 Chlamydial pneumonia,

J16.8 Pneumonia due to other specifiedinfectious organisms

Other categories are in Chapter X

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Conventions used in Tabular list (Vol.1)

And in titles . for and /or A18.0 , Tuberculosis of bone and joints are to be

classified cases of Tuberculosis of bone ;

Tuberculosis of joints and Tuberculosis of bonesand joints. Point dash .-Indicates existence of a fourth character

e.g. Peptic ulcer NOS (K27.-).0 Acute with haemorrhage.1 Acute with perforation .

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Volume 3 : Alphabetical index

Sections : 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 eachsubstance the codes for poisonings & adverseeffects of drugs classifiable to Chapter XIX, &Chapter XX codes that indicates mode :accidental, deliberate (self-harm), undetermined,or adverse effect of a correct substance

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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

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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 ornewborn

Section II complication, sequelae, suicide, assault, legalintervention, war operations

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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 : Potts disease A 18.0 M 49.0 *

If fourth character is applicable to a group of categories,common 4 th characters presentede.g. Pregnancy with abortive outcome

If complication : coma, diabetic code to E10-E14 with4th character

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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.

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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

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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 )

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Rubrics with mark combinations 1. with * mark in heading denotes dual classification

exists and all have same alternative codeA17.0 Tuberculous meningitis (GOI *)

Tuberculosis of meninges (cerebral) (spinal)Tuberculous leptomeningitis

2. Present in heading without * : dual classification &they have different alternative codesA18.1 Tuberculosis of genitourinary system

Tuberculosis of : bladder (N33.0*)cervix (N74.0 *) .

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Rubrics with mark combinations

3. None ( & *) present in title : not all groupssubject 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 ininfectious diseases classified elsewhereK67.0 * Chlamydial peritonitis (A74.8 ) K67.1 * Gonococcal peritonitis (A54.8 )

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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 identifyorganism.e.g.

B95 Streptococcal and staphylococcus as a cause of diseasesclassified to other chapters

B95.0 Streptococcus, group A, as the cause of diseasesclassified to other chapters

Diagnosis could be J02.8 B95.0

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Other optional dual coding

2. Neoplasms with functional activityCode 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 fornature of injury, code from XX for cause could be added.

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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 oran 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, consideras metastatic from unspecified primary site & coded to C79.5

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

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Coding guidelines 1, 2Steps :

1. Look for diagnosis (Lead term/key words) inthe 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

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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 *

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Coding guidelines 5

5. Follow carefully any cross references (see, seealso) 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

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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 indiseases classified elsewhere

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Coding guidelines 7, 8

7. Be guided by inclusion and exclusion terms underselected code or chapter or block or category heading A32 Listerosis

Includes : listerial foodborne infectionExcludes : neonatal (disseminated) listerosis (P37.2)

A35 Other tetanusTetanus NOSExcludes : tetanus :

. neonatorum (A33)

. obstetrical (A34)8. Assign code

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Thank You