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ICD 10 : Basic Coding Guidelines

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

Associate Professor Maulana Azad Medical College, New Delhi

ICD 10
International 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 designation I Certain infectious and parasitic diseases
II Neoplasms III 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 disorders VI Diseases of the nervous system VII Diseases of the eye and adnexa VIII Diseases of the ear and mastoid process IX Diseases of the circulatory system X Diseases of the respiratory system

Range of codes
A00-B99 C00-D48

D50-D89 E00-E90 F00-F99 G00-G99 H00-H59 H60-H95 I00-I99 J00-J99

deformations. childbirth and the puerperium XVI Certain conditions originating in the perinatal period XVII Congenital malformations.ICD 10 : COMPOSITION OF CHAPTERS Chapter number an designation XI 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. and chromosomal abnormalities Range of codes K00-K93 L00-L99 M00-M99 N00-N99 O00-O99 P00-P95 Q00-Q99 .

not elsewhere classified XIX Injury.ICD 10 : COMPOSITION OF CHAPTERS Chapter number and designation XVIII Symptoms. signs and abnormal clinical and laboratory findings. 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 codes R00-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 • Z60.4 Victim of crime and terrorism (Includes victim of torture) .3 Acculturation difficulty • Z65 Problems related to other psychological circumstances • Z65.

each for a chapter except. poisoning & certain other consequences of external causes .ICD 10 Chapters • 21 chapters • 1st character – letter. abnormal clinical & lab. neoplasms & Chap III. Use more than one letter – I. & chap. diseases of the ear and mastoid process • Four chaps. XIX.XVII relate to disease & other morbid conditions • XVIII – symptoms. VIII. • D – both in chap. signs. II. XX • I. Findings. diseases of blood & blood forming organs & certain disorders involving the immune mechanism • H-Chap VII diseases of the eye & adnexa. not elsewhere classified • XIX – injuries. II.

1 Hebephrenic type 0 Continuous course 5. 6th character – for specific purpose/research “U” codes – unused codes Addition of signs/symbols ( ). [ ]. *. - .10 Hebephrenic schizophrenia continuous course • Mental and Behavioural disorder 20 Schizophrenia .STRUCTURE OF AN ICD 10 CODE • F20. † .

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 • A15.1 † Tuberculosis of genitourinary system • Tuberculosis of : • Bladder (N 33. 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 18.0 *) • N 33 * Bladder disorders in diseases classified elsewhere • N 33.-*) .1 †) • Male genital organs (N 51.0 Tuberculosis of lung.0 * Tuberculous cystitis (A18.

*) • N51..2 †) • Trichomonal ( A59.0 †) • Tuberculous (A 18.0 * Disorders of prostate in diseases classified elsewhere Prostatitis : • Gonococcal (A 54.STRUCTURE OF AN ICD 10 CODE • Male genital organs (N 51.1 †) • Testis (A18.1 †) .1 * Disorders of testis and epididymis in diseases classified elsewhere • Tuberculosis of : • Epididymis (A18.* Disorders of male genital organs in diseases classified elsewhere • N 51.1 †) • N 51.

g. 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. A 31 Infection due to other mycobacterium • Fourth character : after decimal point is subcategory • If reporting is upto 4th category.Blocks of Categories • Blocks have three characters e. • Fifth character – supplementary for specific/ research .

M9370/0 Benign chordoma • /0 Benign • /1 Uncertain whether benign or malignant Borderline malignancy • Low malignant potential • /2 Carcinoma in situ • Intraepithelial • Noninfiltrating • Noninvasive .g. fifth is after a slash indicates behaviour • e.Morphology of Neoplasms • Additional code for morphology & behaviour • Five digits. first four indicate morphology.

Morphology of Neoplasms • /3 Malignant.If described as “noninvasive” code (M8143/2) To code with morphology : .Superficial spreading adenocarcinoma (M8143/3) .Adenoma bile duct (M8160/0) D13.4 . metastatic site • /9 Malignant. primary site • /6 Malignant. uncertain whether primary or metastatic site .

To enclose the dagger code in an asterisk category or the asterisk code following a dagger term . I 10 Hypertension (arterial) (essential) (malignant) (primary) (systemic) .5) • 3.1) • Parentheses ( ) used in : • 1. Enclose code referring exclusion . to enclose three character codes of categories • 4.e.e. excludes blepharoconjunctivitis (H10.Conventions used in Tabular list (Vol.g. NOT affecting code .indicates Hypertension alone or qualified by any or combination • 2. H01. Block titles.g. Enclose supplementary words.0 Blepharitis.

e. For referring to previously stated set of our character subdivisions common to a no.1) Square brackets [ ] used to : 1. site unspecified [See page 566 for subdivisions] . Enclose synonyms.g.e. alternative words . C00.g.8 overlapping lesion of lip [see note 5 on p.g. K27 Peptic ulcer. A30 Leprosy [Hansen’s disease] 2.Conventions used in Tabular list (Vol. For referring to previous notes .e. of categories .182] 3.

K26 Duodenal ulcer Includes : erosion (acute) of duodenum Excludes : peptic ulcer NOS (K27. Chronic . K36 Other appendicitis Appendicitis : .g.g.1 Acute with perforation • When insertion of modifying words is required in diagnosis e.1) Colon : • To list inclusion and exclusion terms e.0 Acute with haemorrhage . recurrent .-) .Conventions used in Tabular list (Vol.

g.1) Brace } • Used in listing inclusion & exclusion terms.Conventions used in Tabular list (Vol. e. to indicate that neither words preceding nor after it are complete terms.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 . • O71.

8 Pneumonia due to other specified infectious organisms Other categories are in Chapter X . not elsewhere classified Includes J16. J16 Pneumonia due to other infectious organisms. J16. e.1) • Not elsewhere classified Serves a warning that certain variants are listed somewhere.0 Chlamydial pneumonia.Conventions used in Tabular list (Vol.g.

g.Conventions used in Tabular list (Vol.1) • “And” in titles .0 Acute with haemorrhage . Peptic ulcer NOS (K27.1 Acute with perforation ….Indicates existence of a fourth character e. for and /or A18. . • Point dash . “Tuberculosis of joints” and “Tuberculosis of bones and joints”.-) .0. Tuberculosis of bone and joints are to be classified cases of “Tuberculosis of bone” .

EXCEPT drugs and other chemicals • II – index of external causes of morbidity and mortality. or adverse effect of a correct substance . undetermined. 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. deliberate (self-harm). & Chapter XX codes that indicates mode : accidental. and XXI.Volume 3 : Alphabetical index Sections : • I – list of all terms classifiable to Chapters I-XIX.

tubercular. Tuberculosis of hip – search under “t” Stomach ulcer – search under ? “S/U” Adjectival disease conditions : puerperal. etc.due to -.Rh (antibodies) (incompatibility) (isoimmunization) P55.1 -. site.0 LEAD TERMS : name of disease/pathological condition Indented : the modifiers – variety.Structure in Index • Lead terms or key words (extreme left) • Indentations (in right after dash) Erythroblastosis (fetalis) (newborn) P55.9 . puerperium/tuberculosis.ABO (antibodies) (incompatibility) (isoimmunization) P55. tuberculous – in NOUN from or both .

legal intervention. observation. puerperal. vaccination • Labor.Structure in Index • Complete listing of modifiers to a given term may NOT be feasible • Prioritise the modifiers – one over other Abscess – many sites. history. war operations . status. sequelae. suicide. examination. maternal condition affecting fetus or newborn • Section II – complication. assault.T Use key words – counselling. NOT tuberculous abscess • If problems or circumstances leading to disease listed – search may be difficult . pregnancy. problem. screening.

ankle (and foot) T 25. Pregnancy with abortive outcome • If complication : coma.• If dual classification.g.0 † M 49.0 * • If fourth character is applicable to a group of categories. • Burn.Code numbers in Index • Either three or four character or a dash in place of fourth place indicates a fourth character exists. common 4th characters presented e. diabetic – code to E10-E14 with 4th character . by etiology & manifestation both codes are given : Pott’s disease A 18.

see condition.4 – only if no more precise description on medical record. . ou – o (labor) etc. see also. any part.brain (any part) G06.0 • Cross references : See.0 • Brain abscess. see also condition • NEC – Not elsewhere classified (unspecified) • Anomaly of aorta (arch) NEC Q 25.0) Underlying cause of death – each condition to be assigned code Spelling – American Re – er (center).Understanding Index • • • • Multiple diagnoses : Influenza with pneumonia (J11. • Parentheses : • Several terms in parentheses – classified to the given code • Abscess (embolic) (infective) (metastatic) (multiple) (pyogenic) (septic) . oe – e (edema). regardless of any variety is coded G06.

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 .

g. • G22 * Parkinsonism in diseases classified elsewhere Syphilitic parkinsonism (A 52.Asterisk code • Appears as three-character categories • Used when particular disease is NOT specified as underlying cause. e. • 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.1 †) .

1 † Tuberculosis of genitourinary system Tuberculosis of : bladder (N33.Rubrics with † mark combinations 1.0*) cervix (N74. † Present in heading without * : dual classification & they have different alternative codes A18.0 † Tuberculous meningitis (GOI *) Tuberculosis of meninges (cerebral) (spinal) Tuberculous leptomeningitis 2. † with * mark in heading denotes dual classification exists and all have same alternative code A17.0 *) …. .

but individual inclusion terms may be.8 Other gonococcal infections Gonococcal : peritonitis † (K67. None († & *) present in title : not all groups subject to dual classification.1 *) pneumonia † (J17.1 * Disorders of peritoneum in infectious diseases classified elsewhere K67.0 * Chlamydial peritonitis (A74.8 †) K67.1 * Gonococcal peritonitis (A54.Rubrics with † mark combinations 3.8 †) .0 *) septicaemia • LOOK -> K67. A54. terms will be marked and alternative codes are given.

asterisk system other dual coding exists in certain situations.Other optional dual coding • Besides dagger.8 Acute pharyngitis due to other specified organisms Use additional code (B95-97).g. group A. • Note in the list “Use additional code. I may be added to identify organism • J02. if desired…” • 1. as the cause of diseases classified to other chapters • Diagnosis could be J02. e.0 Streptococcus.8 B95. if desired.0 . to identify organism. codes from Chap. Infections. B95 Streptococcal and staphylococcus as a cause of diseases classified to other chapters • B95.

Neoplasms. may be added to chapter II to identify morphological type 4. i. XX may be added 6. 5. underlying disease.Other optional dual coding 2. to brain etc. code from XIX for nature of injury. a code from Chap.1. the morphology code on p1181-1204 of vol. adverse effect. code from XX for cause could be added. V.e. code from other chapters may be added to indicate the cause. mental disorders) in Chap. Neoplasms with functional activity Code of Chap. including symptomatic. poisioning. Conditions in F00-F09 (organic. IV may be added to Chap. . injury. If condition is caused by a toxic agent. For injury. II code for functional activity 3.

any type other than intraosseous or odontogenic.) . neoplastic . Face NEC # • Carcinomas & adenocarcinomas.g.acromion (process) (C79.5. consider as metastatic from unspecified primary site & coded to C 79. of sites with mark.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.5 • Neoplasm.

Coding guidelines 1. XXI • Section II – external causes of injury classifiable in Chap.Asthma. Refer volume 3 (alphabetical index) • Section I of index – Disease/conditions classifiable in Chap. encephalopathy (noun for diseases. injuries) . uremia. Look for diagnosis (Lead term/key words) in the record . tuberculous. carious tooth (adj. XX .) 2.I – XIX. bilous. 2 Steps : 1.cancerous.

8 . degenerative .lipidosis ----cerebral E75.1 † G32.amyloid (see also amyloidosis) E85.brain (cortical) (progressive) G31.4 † G32.2 --.adrenal (capsule) (fatty) (gland) (hyaline) (infections) E27.Coding guidelines 3.9 • . Read terms in parentheses after the lead term (modifiers do NOT affect codes) (terms indented under lead term – modifies code) • Degeneration.alcoholism G31.2 -.9 -. Read and be guided by any note in the term 4.8 * .in --.beriberi E51. 4 3.alcoholic G31.8 * --.

2 .8* .Coding guidelines 5 5.with lung involvement E85. “see also”) in the index • Degeneration.genetic E85. degenerative • Amyloidosis (generalized) (primary) E85.4 † J99.2 .8 .9 .familial E85. Follow carefully any cross – references (“see”.localized E85.specified NEC E85.4 .

4 Neuronal ceroid lipofuscinosis Disease : • Batten • Bielschowsky – Jansky • Kufs G32.1 • Degeneration. 1 Page 93 : • E75.4 † G32.2). verify the suitability of the code selected.8 * Other specified degenerative disorders of nervous system in diseases classified elsewhere . degenerative . Refer the tabular list (Vol.lipidosis -----cerebral E75.8* • IN VOL.brain (cortical) (progressive) G31.9 --.Coding guidelines 6 6. • Three character code in index with dash indicates a fourth character to be found in vol.

2) • A35 Other tetanus Tetanus NOS Excludes : tetanus : . neonatorum (A33) . Assign code . 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. obstetrical (A34) 8.Coding guidelines 7. 8 7.

Thank You .