ICD-10

Prof. Dr. Lutful Kabir SSMU

What is ICD-10: Introduction

ICD stands for International Classification of Disease ICD contains only diagnosis codes Developed by the World Health Organization (WHO) The current version of ICD-10 was adopted by WHO in May 1990 WHO revises the ICD code-set periodically

ICD-10: Introduction contd

There are three volumes of ICD Volume I: providing a tabular list of ICD Volume II: instruction manual on how to use ICD Volume III: Alphabetical list of ICD There are more than 14,400 different codes in ICD-10. using optional subclassifications, the codes can be expanded to over 16,000 codes.

ICD-10: Introduction contd

138 countries have implemented the ICD10 code for mortality and 99 countries have also implemented ICD-10 code set for morbidity Individual country, on permission from WHO, may make modification to ICD-10 to meet individual country specific needs.

Why ICD ?
ICD is used world-wide for morbidity and mortality statistics, reimbursement systems and automated decision support in medicine It promotes international comparability in the collection, processing, classification and presentation of these statistics

Why ICD contd ?

Implementation of ICD will impact the entire chain of healthcare including patient registration, service delivery, patient care, scheduling, customer service, insurance, revenue and reimbursement management, network management and risk management

Advantages of implementing ICD-10

Measuring the quality, safety and efficacy of care Making clinical decisions based on output from multiple systems Conducting research, epidemiological studies and clinical trials Comparability between health facilities, regions and countries Setting health policy Designing health care delivery systems

Advantages of implementing ICD-10 contd

Monitoring resource mobilization Improving clinical, financial and administrative performance Identifying fraudulant or abusive practices Managing care and disease process Tracking public health and risks Providing data to consumers regarding costs and outcomes of treatment options

Why to write the ICD-10 code?

ICD-10 codes will soon be introduced in the Bangladeshi hospitals both public and private Initially, ICD-10 codes will need to be reported for indoor patients The MIS-Health will ask respective hospitals for patient by patient reporting on indoor patients Use of ICD-10 codes will be integral part of patient care management

How to use ICD-10?

It is easy to use a computer software to find ICD codes Those who will not be using computer software, the following are some tips to understand ICD The ICD code is sub-divided into :
chapters blocks 3-digit codes 4-digit codes

How to use ICD-10: Chapters

There are 22 chapters: -Chapters I to XVII list different diagnoses. -Chapters XVIII lists symptpms, signs and abnormal laboratory findings that are not mentioned elsewhere -Chapter XIX lists injury, poisoning and certain other consequences of external causes -Chapter XX lists external causes of morbidity and mortality -Chapter XXI lists factors influencing health status and contact with health services -Chapter XXII keeps provision for inclusion of new codes which are unavailable in the existing ICD

ICD-10: Examples of Chapters

Chapter I: Certain infectious and parasitic diseases A00-A09 A15-A19 B15-B19 B65-B83 Intestinal infectious diseases Tuberculosis Viral hepatitis Helminthiasis

How each ICD block is constituted?

The block is an alphaneumeric character block The first character is a CAPITAL LETTER The next two characters are neumeric

Examples of ICD block codes

Blocks A00 A01 A03 A06 A09 Diseases Cholera Typhoid and paratyphoid fevers Shigellosis Amoebiasis Diarrhoea and gastrointeritis of presumed infectious origin

ICD-10 Chapters, block and diseases: Examples

Chapter Block Title I A00-B99 Certain infectious and parasitic diseases X XV J00-J99 Diseases of the respiratory system

O00-O99 Pregnancy, child birth and the puerperium

3-digit code
Block denotes the group of disease without specificity 3-digit code Name of the disease A00 A01 A02 A06 Cholera Typhoid and paratyphoid fevers Other salmonella infections Amoebiasis

3-digit Vs 4-digit codes

3-digit codes are broadened into 4-digit code to enhance the specificity 4-digit code adds with the 3-digit code a dot (.) plus another numeric character . The (.) mark is not a character Example: A00 is Cholera A00.0 is Cholera classical A00.1 is Cholera el tor

4-digit code
3-digit code
A01 A01.0

4-digit code

Name of the disease

Typhoid and paratyphoid fevers Typhoid fever Infection due to Salmonella typhi

A01.1 A01.2 A01.3

Paratyphoid fever A Paratyphoid fever B Paratyphoid fever C

Who is responsible to write ICD-10 code

The immediate doctor in-charge of the patient will have the primary responsibility to write the ICD-10 code Otherwise, the doctor who is writing the discharge, referral or death certificate of the patient will have to write or complete the ICD-10 code The overall responsibility of writing ICD-10 codes in all case sheets will be the responsibility of the unit head

 The doctor writing the ICD-10 code should write his/her name legibly so that s/he can be traced for clarification or completing the incomplete write up The complete case-sheet on discharge, referral or death of the patient will go to the medical record room for entry into national data base. In time, this will be done through hospital wards where the patient will receive the treatment

ICD-10 code documentation: Accountability and use

ICD-10: How to write ?

It is advisable that each hospital ward will make a seal with the following information from hospitals own local fund Simple clear and legible hand writing will also be allowed

ICD-10 code seal

Chapter No. Block No. 3-digit code Name of the disease 4-digit code Name of the disease Name of the doctor

Bronchiolitis : ICD-10
Chapter No. Block No. 3-digit code Name of the disease J 21 J21 Acute bronchiolitis

4-digit code J21.9 Name of the disease Acute bronchiolitis, unspecified Name of the doctor DR ARM Luthful Kabir

ICD-10 code: Guide book and references

One handbook accommodating only ICD-3 digit and 4-digit codes will be supplied The codes are mentioned in order of block, 3digit codes and 4-digit codes (vide appendix) Websites: DGHS ( www.dghs.gov.bd>document>icd10) WHO (http://int/classification/apps/icd/icd10online)

Writing medical certification of death

It is now a necessity that Bangladeshi Hospitals will conform to the international standards of death certifications and Meet international obligation of death reporting for statistical purposes An Internationally Standard Medical Certification of Death Form needs to be filled up and to be enclosed with the deaseaseds case sheet in case of any death event The doctor writing the death certificate will have to complete the standard medical certificate form

How to complete the Standard Medical Certification of Death

In most of the cases death depends on a chain of events that would follow the exact underlying cause gradually to immediate cause. So, a Standard Medical Certification of Death may have 3 important sections Part I: Statement on causes of death having direct relation Section 1: Disease or conditions directly leading to death Section 2: Antecedent causes, morbid conditions, if any, giving rise to above cause Part II (Section 3) : Statement of conditions that may contribute to death but not directly related to factors causing death The cause of death will be the last line of Part I, and this will be translated into ICD-10 Please see an example of International Form of Medical Certification of Death In the page overleaf.

International Form of Medical Certification of Death

Please put tick appropriately
Causes of death

Main diagnosis

Other diagnosis
Approx. interval between onset and death Minutes______

I. Disease or conditions directly leading to death* Antecedent causes Morbid conditions, if any, giving rise to the abobe causes, stating the underlying condition last II. Other significant conditions contributing to death, but not related to diseases or conditions causing it

Due to or as a consequence of (b) Due to or as a consequence of days________

___________________________

* This does not mean the mode of dying. e,g. heart failure, respiratory failure, injury or complications that caused death

International Form of Medical Certification of Death

Please put tick appropriately
Causes of death

Main diagnosis

Other diagnosis
Approx. interval between onset and death Minutes______ 2 days________

I. Disease or conditions directly leading to death* Antecedent causes Morbid conditions, if any, giving rise to the abobe causes, stating the underlying condition last II. Other significant conditions contributing to death, but not related to diseases or conditions causing it

(a) Hyperkalemia Due to or as a consequence of (b) Acute glomerulonephritis Due to or as a consequence of

___________________________

* This does not mean the mode of dying. e,g. heart failure, respiratory failure, injury or complications that caused death

ICD-10 coding of cause of death

Chapter No. Block No. 3-digit code Name of the disease XIV N00-N99 N00 Acute nephritic syndrome

4-digit code N00.9 Name of the disease Acute nephritic syndrome, unspecified Name of the doctor DR ARM Luthful Kabir