INTRODUCTION

This Classification is intended to present in a systematic fashion

the many procedures used in different branches of medicine, a task which
the World Health Organization is undertaking for the first time.

The difficulties and problems encountered in preparing a

Classific-
ation of Procedures in Medicine are similar to those experienced for the
International Classification of Diseases, aggravated by the absence of
international experience in the fields to be covered. Although certain
countries have experience in these fields, especially in the classific-
ation of Surgical procedures, their views and methods of approach are
divergent enough to make the task of harmonizing their classifications a
complicated one.

Probably these coasiderations motivated the cautious approach

taken
in the report of the International Conference for the Ninth Revision of
the International Classification of Diseases, convened by the word
Health
Organization at WHO headquarters in Geneva from 30 September to 6
October
1975:
"2. Classification of Procedures in Medicine

In response to requests from a number of Member States, the

Organization had drafted a classification of therapeutic,
diagnostic
and prophylactic procedures in medicine, covering surgery,
radiology,
laboratory and other procedures. Various national classifications
of this kind had been studied and advice sought from hospital
associ-
ations in a number of countries. The intention was to provide a
tool for use in the analysis of health services provided to
patients
in hospitals, clinics, outpatient departments, etc.

The Conference Congratulates tile Secretariat on this

important
development and

Recommends that the provisional procedures classifications

should be published as supplements to, and not as integral parts
of,
the Ninth Revision of the International Classification of
Diseases.
They should be published in some inexpensive form and, after two
or
three years' experience, revised in the light of users' Comments."

Subsequently the Twenty-ninth World Health Assembly, meeting in

May
1976, endorsed this recommendation in resolution WHA29.35, in which it
approved "the publication, for trial purposes, of supplementary
classific-
ations of Impairments and Handicaps and of Procedures in Medicine, as
supplements to, but not as integral parts of, the International
Classific-
ation of Diseases."

The present provisional edition of the Classification of

Procedures
in Medicine has been prepared by WH0 in compliance with this resolution,
in the hope that it will serve as a basis for further collaboration and
development.

Preparation of the Classification

Activities for the preparation of the proposals for the
International
Classification of procedures in Medicine began at about the same time as
those for the Ninth Revision of the International Classification of
Diseases and were carried out in parallel.

Scope and form

At a meeting of a working party convened in April 1971 in Chicago,
USA, under the auspices of the American Hospital Association, the
following
consensus was reached on certain requisites to be fulfilled by the
classi-
fication:
(a) it should be susceptible of expansion for those who need
greater
detail, but it should also offer the possibility of use in a
condensed form;

(b) it should be applicable to inpatients and outpatients;

(c) it should include all types of procedures to be recorded for

statistical, administrative, clinical or research purposes,
encompassing exploratory, radiological, surgical and other
procedures of a diagnostic, prophylactic or therapeutic
nature.

In accordance with these recommendations, the present provisional

Classification consists of nine chapterS:

1. Procedures for medica1 diagnosis
2. Laboratory procedures
3. Radiology and certain other applications of physics in medicine
4. Preventive procedures
5. Surgical operations
6 and 7. Drugs, medicaments and biological agents
8. Other therapeutic procedures
9. Ancillary procedures

Structure
The International Classification of Procedures in Medicine has a
structure similar to that of the International Classification of
Diseases.
Each volume will contain a tabular list and an alphabetical index.
 The complete series of categories for the nine chapters are
numbered
from 1-1OO to 9-823, the first digit denoting the chapter number. The
Classification is significant at the three-digit level; the fourth digit
provides for greater detail and precision. Optional fifth-digit sub-
divisions are provided for in some categories.

Sources
Chapter 1, on "Procedures for medical diagnosis", is based mainly
on
Physicians' current procedural terminology (American Medical
Association),
but other sources have been also used, such as Canada's Schedule of unit
values, the Ontario Medical Association list of fees and the
nomenclature
des actes professiones (France).

The classification of laboratory procedures (chapter 2) is based

largely on a French project which was modified in order to take into
account the ever growing number of new techniques.

The chapter on "Radiology and certain other applications of

physics
in medicine" (chapter 3) was originally based on a Swedish
classification,
a French proposal and the classification used in Switzerland by the
Bureau
national de la Sante et du Bien-Etre. and later modified by the WHO
Radi-
ation Hedicine unit in order to take into consideration the opinion of
specialists from the International Radiological Society.

Chapter 4, on "Preventive procedures',, is based on reports of

health
centres in several countries and includes mainly methods and techniques
traditionally considered as preventive andl susceptible of application
to
individuals.

The Eighth Revision of the International Classification of

Diseases
(Adapted} (United States Public Health Service Publication No. 1693)
served as a basis for the classification of surgical operations (chapter
5),
but some items were extracted from other sources, particularly the Dutch
code (Algemene Ziekenfondsen, 1968) and the Classification of the Office
of Population Censuses and Surveys (England and Wales, 1974), as well as
several other lists and working documents issued by hospitals and public
health administrations in all regions of the World. However, the
arrange-
ment of categories is based on topography, not surgical specialty.

Two chapters are provided for the classification of drugs,

medicaments
and biological agents (chapters 6 and 7). They follow as closely as'
possible the Corresponding series of categories in sections 960-979 of
the
Ninth Revision of ICD, which classify the toxic effects of these sub-
stances. The code numbers have been derived by omitting the ICD first
digit "9" and by adding an additional digit for further detail. For
example, the ICD category 960.0 Penicillins becomes 6-00 in the Drugs
classification and the subdivision 6-000 to 6-009 allow for identifi-
cation of the varieties of penicillin.

Chapter 8, on "Other therapeutic procedures, as indicated by its

title, includes medical therapeutic procedures not elsewhere classified.
The axis chosen is the type of intervention instead of the anatomical
system.

The final chapter, "Ancillary procedures" (chapter 9), contains

all
procedures not included in the preceding chapters. it is, therefore, a
collection of marginal activities which might seem to have little
relation-
ship with the aims of most users of this classification. However, they
have been included because they are, or might be, encountered as
recorded
procedures having a bearing on professional clinical activities.

Mode of utilization
The use of the International Classification of Procedures in
Medicine
should not present real problems for coders, since the steps for
assignig
the code numbers are similar to those followed for coding with lCD.

Evidently, the user should carefully review the arrangement of the

tabular lists and the alphabetical indexes in order to become familiar
with the contents and the manner of presentation and especially to
become
familiar with the terminology used in these classifications.

In the tabular lists the categories are numerically ordered, but

some
gaps will be found witich are intended for greater flexibility and
possible
modifications if the need arises. As in ICD the fourth-digit sub,
divisions contain a few inclusion terms to clarify the contents of the
category; exclusion notes are also used for that purpose. The reference:
"Other available codes: ..." indicates to the reader the place where
other related procedures have been classified.

The alphabetical indexes are organized in a way similar to the ICD

Index, and are also based on lead terms which may or may not have
several
levels of indented modifiers, The complete terms are followed by the
four-digit code. Where fourth-digit subdivisions are common for a group
if three-digit categories, the fourth digit is replaced by a dash (-)
and
in these cases the fourth digit must be looked for in the tabular list.
The optional fifth-digit subdivisions are not shown in the indexes.

For some purposes the chapters of the International Classification

of
Procedures in Medicine can be used separately, for example: chapter 3 by
a radiotherapy department, chapter 2 by a laboratory service, chapter 4
by
a preventive unit not offering treatment services, and chapters 6 and 7
by
a pharmacy, Health institutions should, however, strive to use the
complete set of nine chapters.

Since in the majority of circumstances a patient will be subject

to
more than one procedure, the principle of multiple coding appears
essential, within chapters as well as between chapters. Ideally, all
the procedures should be coded. This is especially advisable from the
administrative standpoint (charges, accounting, etc.) and for
statistical
purposes. However, it is for the health institution or administration to
decide how many items should be coded from each chapter and in each
case.

The use of the four-digit codes will provide more precise and accu
rate information. Although the three-digit codes are also significant,
they are less precise and offer less detail; the use of the four-digit
codes is therefore preferable.

The design of the system used for gathering the data, the forms to
enter the code numbers and other aspects of data processing will depend
on the characteristics and needs of institutions; no attempt is there-
fore made here to propose such a system.

Coding with the International Classification of Procedures in

Medicine is simpler than coding with ICD, since there are no special
rules
for coding as is the case for ICD, where we find a set of rules for
single-
condition coding in mortality and morbidity. Coding problems encountered
with these new classifications, if any, should be dealt with in a class-
room situation.

The following abbreviations are used in this volume:

NOS not otherwise specified

NEC not elsewhere classified

Comments and suggestions

Users of the International Classification of Procedures in

Medicine
are requested to forward their comments and suggestions, after an
experience of two or three years, to:

Head, WHO Centre for Classification of Diseases

Office of Population Censuses and Surveys
St Catherine's House
10 Kingsway
London WC2B 6JP
United Kingdom
or

Head, WHO Center for Classification of Diseases for North

America
National Center for Health Statistics
US Public Health Service
Department of Health, Education and Welfare
Washington, DC
United States of America