2. INTERNATIONAL
CLASSIFICATION OF DISEASES
• International statistical classification of diseases and
related health problems in short “ICD” is the international
standard diagnostic tool for epidemiology, health
management and clinical purposes.
• ICD is designed as health care classification system which
provides the diagnostic codes for classifying diseases including
classification of wide variety of signs, symptoms, abnormal
findings, complaints, social circumstances and external cause of
injury or disease.
3. Historical synopsis
• In 1860, Florence nightingale →made first model of
systemic collection of hospital data.
• In 1893, French physician, Jacques Bertillon→
introduced Bertillon classification of cause of death
• In 1898, American public health association→
recommended revision of ICD system every 10 years.
• The revision followed minor changes until 6th version
of ICD→ morbidity and mortality condition and
section on mental disorders
• WHO →responsibility for preparing and publishing
the ICD revisions every 10 years.
4. • The ICD -10 was formed in 1893, as the Bertillon
classification of international list of causes of death.
• The work on ICD -10 started in 1983 → approved in 1990
at 43rd world health assembly (WHA)
9. CAUSE OF DEATH
• THE CAUSES OF DEATH to be entered on the medical
certificate are all those diseases, morbid conditions or
injuries which are either resulted or contributed to death
and circumstances of accident or violence , which
produced any such injuries.
UNDERLYING CAUSE OF DEATH
a) Diseases or injury which initiated the sequence of events
leading directly to death
b) The circumstances of the accident or violence which
produced the fatal injury.
10.
11. Later more scientific approach was adopted in
classifying diseases. According to certain
characteristics of diseases or injuries, such as
1. The part of the body affected
2. The etiological agent
3. The kind of morbid change produced by the
disease or injury .
4. The kind of disturbance of function produced
by disease or injury.
13. The ICD -10 is arranged in 21 major chapters
1.Certain Infectious and parasitic diseases.[A00- B99]
2.Neoplasms [C00-D48]
3. Diseases of the blood and blood forming organs and
certain disorders involving the immune mechanism[D50 –
D89]
4. Endocrine nutritional and metabolic diseases [E00-E90]
5. Mental and behavioral disorders [F00-F99]
6. Disorders of the nervous system [G00-G99]
7. Diseases of eye and adnexa [H00-H99]
14. 8. Diseases of the ear and mastoid process [H60-H95]
9. Diseases of circulatory system [I00-I99]
10. Diseases of respiratory system [J00-J99]
11. Diseases of digestive system [K00-K99]
12. Diseases of the skin and subcutaneous tissue [L00-
L99]
13. Diseases the musculoskeletal system and
connective tissue[M00-M99]
14. Diseases of genitourinary system [N00-N99]
15. Pregnancy , childbirth and puerperium [O00-O99]
15. 16. Certain conditions originating in perinatal period [P00-
P96]
17. Congenital malformations, deformations and
chromosomal abnormalities [Q 00- Q99]
18. Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified [R00-R99]
19. Injury, poisoning and certain other consequences of
external causes [S00-T98]
20. External causes of morbidity and mortality [V01-Y98]
21. Factors influencing health status and contact with
health services . [Z00-Z99].
16. THE CODING SYSTEM
• The first character of the ICD -10 code is a letter and
each letter is associated with a particular chapter
except for letter D, which is used in chapter 2 and
chapter 3, and letter H which is used in chapter 7 and
chapter 8.
• Chapter 1, 2, 19, 20 use more than one letter in the
first position of their codes
• Each chapter contains sufficient 3 character categories
to cover its contents
• Most of the 3 character categories are subdivided by
means of a 4th numeric character after a decimal point,
allowing up to 10 subcategories
17. Example :-
_Z 22 –carriers of infectious diseases
• Z22.0 –carrier of thyroid
• Z22.1 –carrier of intestinal infectious diseases
• Z22.2 –carrier of diphtheria
• Z22.3 –carrier of specific bacterial diseases
• Z22.4 –carrier of infections with predominantly sexual mode of transmission
• Z22.5 –carrier of viral hepatitis
• Z22.6 –carrier of human T- lymphotropic virus type -1(HTLV-1) infection
• Z22.8 –carrier of other infectious diseases
• Z22.9 –carrier of infectious disease, unspecified .
Chapter 21–factors influencing health status and contact with
health services [Z00 - Z99]
18. Z 72.0 – tobacco use
Z 72.1 – alcohol use
Z 72.2 – drug use
Z 72.3 – lack of physical exercise
Z 72.4 – Inappropriate
Z 72.5 –high risk sexual behavior
Z 72.6 –gambling and betting
Z 72.8 –other problems related to life style
Z 72.9 –problem related to life style, unspecified
Z 72- Problems related to life style
19. EXAMPLE :-
Chapter 21–factors influencing health status and contact with health
services [Z00- Z 99]
Z 22 –carriers of infectious diseases
Z 72.0 – tobacco use
Z 72.1 – alcohol use
Z 72.2 – drug use
Z 72.3 – lack of physical exercise
Z 72.4 – Inappropriate
Z 72.5 –high risk sexual behavior
Z 72.6 –gambling and betting
Z 72.8 –other problems related to lifestyle
Z 72.9 –problem related to life style,
unspecified
Z22.0 –carrier of thyroid
Z22.1 –carrier of intestinal infectious
diseases
Z22.2 –carrier of diphtheria
Z22.3 –carrier of specific bacterial diseases
Z22.4 –carrier of infections with
sexual mode of transmission
Z22.5 –carrier of viral hepatitis
Z22.6 –carrier of human T- lymphotropic
virus type -1 infection
Z22.8 –carrier of other infectious diseases
Z22.9 –carrier of infectious disease,
unspecified .
Z 72- Problems related to life style
20. Z 22.3-carriers of specified bacterial diseases
• Z 22.31 : carrier of bacterial diseases due to
meningococci
• Z 22.32 : carrier of bacterial diseases due to
staphalococci
• Z 22.33 : carrier of bacterial diseases due to
streptococci
• Z 22.34 : carrier of bacterial other specified bacterial
diseases
21.
22. ICD - 10
The latest version of ICD -10 which came into force in
January 1st 1993, revised in 2003.
The main innovations of ICD 10th Revisions are :
1. Relevant information for ambulatory and managed care
encounter
2. Expanded injury codes
3. New combination codes for diagnosis / symptoms to
reduce the number of codes needed to describe a
problem fully .
23. 4. Classification refined to increased data granularity
5. Replacing numerical system of coding frame with
alphanumerical coding frame.
6. Of 26 available letters 25 have been used , except the
letter “U” being left vacant .
24.
25. • The world health organization is currently revising
the ICD towards ICD-11.
• The development is taking place on an internet based
workspace called " icat " platform ,
• The draft of the ICD -11 system → submitted to
WHO’s world health assembly (WHA)→ by 2017
and a final version → in 2018.
ICD -11
26. Advantages:
1) fast aggregation of
health data
2) To know the real time
information about
current health situation
3) Wider analysis of
community health
4) Global health
assessment
Limitations:
1) discussion is limited to
classified diseases
2) common term
descriptions of diseases
3) covers the most
common diseases
4) country specific
modifications of certain
diseases
Advantages and Limitations of ICD
28. Example :-
• A 67 year old male admitted with retention of
urine in hospital. The chain of events followed
were :
a) uremia
b) hydronephrosis
c) retention of urine
d) hypertrophy of prostate
29. I) immediate cause of death in this case is uremia
II) underlying cause of death was hypertrophy of prostate
30. Reference :-
• Park's textbook of preventive and social medicine, 23rd edition
- K.PARK
• Textbook of preventive and social medicine , 4th edition
- SUNDER LAL, ADARSH, PANKAJ.
• Textbook of preventive and social medicine , 4th edition
- MAHAJAN AND GUPTA.
• Textbook of community medicine –KULKARNI.
Google reference :
• www.cdc.gov/nchs/cd9.htm
• International classification of diseases (WHO) archived from the original on 12th
feb,2015.Retrived 14th march 2015.
• ^WHO . List of official ICD updates.
• ^ICD revision time lines and ICD- coding Tool.
Note: ICD -10 in hospital settings : WHO's ICD -10 online browser located at
http://apps.who.int/classification/icd10/browse/2015/en#/20.0
