This document provides a 3-sentence summary of the key points: The document discusses ICD-10 fundamentals, including what ICD-10 is, its current usage in Thailand, why it is used, the concept of relative weight for reimbursement, and examples of proper diagnosis and procedure coding. Complete and accurate ICD-10 coding is important for determining reimbursement amounts based on the complexity and severity of a patient's conditions. Principal and secondary diagnoses and procedures must be coded correctly according to established ICD-10 guidelines.

1. ICD Fundamentals
Nawanan Theera-Ampornpunt, M.D.
Medical Informatics Division
Faculty of Medicine Ramathibodi Hospital
18 May 2005
Reproduced Nov. 23, 2008 for publishing on SlideShare.net.
Parts of the presentation may be specific to the use of
ICD-9-CM and ICD-10 in the author’s organization or country
(Thailand) and may not be applicable to other settings.
Some contents are adopted from “ICD-10-TM Standard Coding Guidelines” by
Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of
Public Health, Thailand, 2004

2. What is ICD-10?
International Statistical Classification of
Diseases and Related Health Problems,
Tenth Revision
Effective 1 Jan. 1993
Adopted in Thailand since 1994

3. Current Usage in Thailand
Governmental reimbursement
ICD-10 for diagnoses
ICD-9-CM-2000 for operations
Developed ICD-10-TM based on
international ICD-10 to better categorize
diagnoses of tropical and endemic
diseases
ICD-10-TM has been adopted increasingly
in various institutions, but not yet
supported by reimbursement organizations

4. Why ICD-10?
International cooperation & standard
Accepted standard for national statistics
Governmental reimbursement (DRG)
National Health Security Office
Social Security Office
Central Office for Healthcare Information
Thai DRG uses ICD-10 for calculating
proper RW (Relative Weight) for
reimbursement

5. RW
Relative Weight (for reimbursement)
More RW = More severe = More money
RW calculations are based on
Number of diseases
Complexity and severity of diseases
Principle diagnosis
Operations done
Age, sex, weight
Discharge type

6. Data Completeness and RW
RW depends on
completeness of diagnoses
proper diagnosis entry
Priority (Principal vs. Secondary)
Severity
Specificity

7. A patient with underlying beta thalassemia was admitted due to
Streptococcus pneumoniae pneumonia and during admission had
experienced ARDS and needed ET tube and ventilator support. Later,
pneumothorax occurred and ICD was done. After 1 month, patient
improved and was discharged.
Diagnosis Entry RW
PDx J13 Pneumonia due to Streptococcus pneumoniae 0.7142
PDx J13 Pneumonia due to Streptococcus pneumoniae 1.6884
SDx D561 Beta thalassemia
PDx D561 Beta thalassemia
SDx J13 Pneumonia due to Streptococcus pneumoniae 1.2256
PDx J13 Pneumonia due to Streptococcus pneumoniae
SDx D561 Beta thalassemia 1.6884
J80 Adult respiratory distress syndrome
PDx J13 Pneumonia due to Streptococcus pneumoniae 1.8631
SDx D561 Beta thalassemia
J80 Adult Respiratory Distress Syndrome
POp 9672 Continuous mechanical ventilation for 96 consecutive
hrs. or more

8. A patient with underlying beta thalassemia was admitted due to
Streptococcus pneumoniae pneumonia and during admission had
experienced ARDS and needed ET tube and ventilator support. Later,
pneumothorax occurred and ICD was done. After 1 month, patient
improved and was discharged.
Diagnosis Entry RW
(Previously) 1.8631
PDx J13 Pneumonia due to Streptococcus pneumoniae
SDx D561 Beta thalassemia
J80 Adult Respiratory Distress Syndrome
POp 9672 Continuous mechanical ventilation for 96 consecutive
hrs. or more
PDx J13 Pneumonia due to Streptococcus pneumoniae 2.3146
SDx D561 Beta thalassemia
J80 Adult Respiratory Distress Syndrome
J939 Pneumothorax
POp 9672 Continuous mechanical ventilation for 96 consecutive
hrs. or more
SOp 9604 Insertion of endotracheal tube
3404 Insertion of intercostal catheter for drainage

9. Concept of Diagnosis
Principal diagnosis (PDx)
One condition
Diagnosed at the end of care (Final Dx)
Main reason for the admission
In case of more than one main reason, use
the most resource-consuming Dx
In case of no definitive Dx, use most
appropriate signs/symptoms or findings
Some codes may be valid only in specific gender or specific age groups

10. Concept of Diagnosis
Secondary diagnosis (SDx)
Comorbidity
Condition(s) existing before admission
May exist before or at the same time with the
PDx
Includes underlying diseases
Causes more expenses or higher patient risks
Unlimited items
Complication
Condition(s) occurring after admission
Causes more expenses or higher patient risks
May not be related to PDx
Unlimited items

11. Examples – PDx & SDx
A patient with underlying DM, HT, IHD
presents with severe headache and BP =
200/140 mmHg
PDx I10 Essential (malignant) Hypertension
SDx E119 NIDDM without complications
I259 Chronic ischaemic heart disease, unspecified

12. Examples – In case of 2 potential PDx
Use the most resource-consuming
A patient was admitted due to bacterial
pneumonia with respiratory failure.
PDx J960 Acute respiratory failure
SDx (comorbid)
J159 Bacterial pneumonia, unspecified
Note!!
If respiratory failure occurs after admission,
then the PDx must be bacterial pneumonia
and the respiratory failure must be the SDx
(complication)

13. Examples – PDx must be at the end
of care
A patient with acute abdominal pain was
admitted, the provisional diagnosis was
peritonitis. Surgical findings revealed
perforated chronic duodenal ulcer
PDx K265 Duodenal ulcer : chronic or unspecified with
perforation
SDx -

14. Examples – PDx as
signs/symptoms
A patient with RLQ pain was admitted for
observation, later discharged without
definitive diagnosis because the
symptoms finally resolved
PDx R103 Pain localized to other parts of lower
abdomen
SDx -

15. Examples – Complications related
to PDx
A patient with deep vein thrombosis was
admitted. After admission, pulmonary
embolism occurs.
PDx I801 Phlebitis and thrombophlebitis of
femoral vein
SDx (complication)
I269 Pulmonary embolism without mention
of acute cor pulmonale

16. Examples – Complications not
related to PDx
A patient with pneumonia was admitted.
After admission, acute gastroenteritis
occurred.
PDx J159 Bacterial pneumonia, unspecified
SDx (complication)
A09 Diarrhoea and gastroenteritis of
presumed infectious origin

17. Examples – Comorbids vs
complications
A patient with underlying DM and diabetic
retinopathy was admitted due to bacterial
pneumonia. After admission, acute
gastroenteritis that resulted in hypovolemia
occurred.
PDx J159 Bacterial pneumonia, unspecified
SDx (comorbids)
E116 NIDDM with ophthalmic complications
H360 Diabetic retinopathy
SDx (complications)
A09 Diarrhoea and gastroenteritis of presumed
infectious origin
E86 Volume depletion

18. Concept of Diagnosis
Principal Operation (POp)
Procedure/Operation primarily done for the
admission
Mostly done for PDx, but may be done for SDx
Mostly the major operative procedure is done in OR,
but not necessarily (can be a non-OR procedure)
If more than 1 potential procedure, use clinical
judgement for what is the most important procedure
for the admission
One condition allowed
Secondary Operation (SOp)
All other significant procedures/operations
Unlimited items
Avoid insignificant procedures, like IV infusion,
dressings

19. Examples – Principal vs Secondary Ops.
A patient with indirect inguinal hernia was
admitted. Herniorrhaphy was done. After
admission, pleural effusion was found and
subsequent ICD was done.
PDx K409 Unilateral or unspecified inguinal hernia,
without obstruction or gangrene
SDx J90 Pleural effusion, not elsewhere classified
POp 5302 Repair of indirect inguinal hernia
SOp 3404 Insertion of intercostal catheter for
drainage

20. Examples – Principal Ops. for PDx
A patient with indirect inguinal hernia was
admitted. After admission, pneumonia
occured. Herniorrhaphy was done during
the admission after treatment of pneumonia.
PDx K409 Unilateral or unspecified inguinal hernia,
without obstruction or gangrene
SDx J159 Bacterial pneumonia, unspecified
POp 5302 Repair of indirect inguinal hernia
SOp -

21. Examples – Principal Ops. for SDx
A patient with pneumonia was admitted.
After admission, indirect inguinal hernia was
found and herniorraphy was done during the
admission after treatment of pneumonia.
PDx J159 Bacterial pneumonia, unspecified
SDx K409 Unilateral or unspecified inguinal hernia,
without obstruction or gangrene
POp 5302 Repair of indirect inguinal hernia
SOp -

22. Examples – Principal Ops. Outside OR
A patient with pneumonia and pleural
effusion was admitted. After
admission, ICD was done.
PDx J159 Bacterial pneumonia, unspecified
SDx J90 Pleural effusion, not elsewhere
classified
POp 3404 Insertion of intercostal catheter
for drainage
SOp -

23. Examples – Non-OR Principal Ops.
A patient with pneumonia and pleural
effusion was admitted. After
admission, ICD was done.
PDx J159 Bacterial pneumonia, unspecified
SDx J90 Pleural effusion, not elsewhere
classified
POp 3404 Insertion of intercostal catheter
for drainage
SOp -

24. Examples – Non-OR Principal Ops.
A preterm newborn with respiratory distress
syndrome was admitted. After admission, NEC
occured and small intestine resection with end-to-
end anastomosis was done.
PDx P220 Respiratory distress syndrome of
newborn
SDx (Comorbid) P073 Other preterm infants
SDX (Complication) P77 Necrotizing enterocolitis of fetus
and newborn
POp 4562 Other partial resection of small
intestine
SOp 4591 Small-to-small intestinal
anastomosis

25. ICD-10 Chapters
Certain infectious and parasitic diseases
Neoplasms
Diseases of the blood and blood-forming organs and
certain disorders involving the immune mechanism
Endocrine, nutritional and metabolic diseases
Mental and behavioural disorders
Diseases of the nervous system
Diseases of the eye and adnexa
Diseases of the ear and mastoid process

26. ICD-10 Chapters (Cont.)
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the digestive system
Diseases of the skin and subcutaneous tissue
Diseases of the musculoskeletal system and connective
tissue
Diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
Certain conditions originating in the perinatal period

27. ICD-10 Chapters (Cont.)
Congenital malformations, deformations and
chromosomal abnormalities
Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
Injury, poisoning and certain other consequences of
external causes
External causes of morbidity and mortality
Factors influencing health status and contact with health
services

28. External Causes of Morbidity and
Mortality (E-codes)
External causes of
trauma/injury/poisoning
that results in
morbidity/mortality
Important for national
statistics and prevention
measures
If not specified, it’s
incomplete

29. External Causes of Morbidity and
Mortality (V, W, X, Y)
Classified into
Accidents
Intentional self-harm
Assault
Event of undetermined intent
Legal intervention and operations of war
Complications of medical and surgical care
Sequelae of external causes
Supplementary factors related to causes... (eg.
alcohol level, nosocomial condition, etc.)

30. Accidents as External Causes
Transport accidents
Non-transport

31. Accidents as External Causes
Transport accidents
Pedestrian injured
Pedal cyclist injured
Motorcycle rider injured
Occupant of three-wheeled motor vehicle injured
Car occupant injured
Occupant of pick-up truck or van injured
Occupant of heavy transport vehicle injured
Bus occupant injured
Other land transport accidents
Water transport accidents
Air and space transport accidents
Other and unspecified transport accidents
Non-transport

32. Accidents as External Causes
Transport accidents
Non-transport
Falls
Exposure to inanimate mechanical forces (includes GSW)
Exposure to animate mechanical forces
Accidental drowning and submersion
Other accidental threats to breathing
Exposure to electric current, radiation and extreme ambient air
temperature and pressure
Exposure to smoke, fire and flames
Contact with heat and hot substances
Contact with venomous animals and plants
Exposure to forces of nature
Accidental poisoning by and exposure to noxious substances
Overexertion, travel and privation
Accidental exposure to other and unspecified factors

33. Transport Accidents
Any accident involving device designed
primarily for conveying persons or goods from
one place to another
Classified into
Traffic accident
Any vehicle accident occuring on the public
highway (e.g. originating on, terminating on,
involving a vehicle partially on the highway)
Nontraffic accident
occurs entirely in any place other than a public
highway, e.g. off-road motor vehicle accidents

34. Transport Accidents
Pedestrian = any person involved in the accident that is not in any
vehicle or animal
Includes:
person changing wheel of vehicle
making adjustment to motor of vehicle
on foot
person with baby carriage
ice-skaters
person with push-cart or push-chair
Roller-skaters
Scooter rider, skateboard rider, skier, person with (powered)
wheelchair
Driver = occupant of a transport vehicle who is operating or
intending to operate it
Passenger is other person than driver
Person on outside of vehicle = any person being transported by a
vehicle but not occupying the space normally reserved for driver &
passengers
Includes: person travelling on bodywork (ตัวถังรถ), bumper (กันชน),
hanging outside, on roof, etc.

35. Transport Accidents
Pedal cycle = bicycle & tricycle
Pedal cyclist = any person riding on pedal cycle or
in a sidecar attached to it
Motorcycle includes:
Motor scooter
Motorcycle with sidecar
Motorized bicycle
Excludes motor-driven tricycle
Motorcycle rider includes person riding on or in a
sidecar
Three-wheeled motor vehicle includes:
motor-driven tricycle, three-wheeled motor car
Car = 4 wheeled motor vehicle, including minibus

36. Transport Accidents
Pick-up Truck or van = 4 or 6 wheeled motor
vehicle designed primarily for carrying property,
weighing less than local limit for classification as
heavy goods vehicle, not requiring special driver’s
license
Heavy transport vehicle = over pick-up truck,
usually carrying above 3,500 kg), requiring special
driver’s license
Bus = motor vehicle designed for carrying > 10
persons, requiring special driver’s license
Railway train includes BTS and Subway
Streetcar includes tram (รถราง)

37. Transport Accidents
Other types of vehicles
Special vehicle mainly used on
industrial premises
Special vehicle mainly used in agriculture
Special construction vehicle
Special all-terrain vehicle
Watercraft
Aircraft

38. Transport Accident Coding
Instructions
If event is unspecified whether traffic or nontraffic
accident, it is:
Trafffic accident if occurred with vehicles normally
used for traffic
Nontraffic accident if occurred with special vehicles
If can’t specify the victim as vehicle occupant and
the victim is
crushed/dragged/hit/injured/killed/knocked
down/run over by vehicles, classify the victim as
pedestrian

39. Transport Accident Coding
Instructions
In transport accident involving vehicle
collision/accident/crash/wreck, if can’t
specify the victim’s role, classify the victim
as occupant or rider of vehicle specified
If more than one vehicle is mentioned, do
not make assumption which vehicle was
occupied by victim unless vehicles are the
same, but use codes with “Victim’s mode of
transport unknown” instead

40. Transport Accident Coding Instructions
Collision
Includes collision after
breakage of any part
explosion of any part
fire starting in vehicle
hit by object thrown into or onto vehicle
object falling in or on
etc.
Includes collision between vehicle and vehicle or vehicle and:
animal (สัตว์ที่อยูเ่ ฉยๆ ในทางจราจร)
nonmotor vehicle
animal-driven vehicle
ํ
animal being ridden (สัตว์ที่กาลังถูกขี่)
bridge
fallen stone
fence
inter-highway divider
landslide
object thrown in front of motor vehicle
safety island (เกาะกลางถนน)
tree
traffic sign
other object - either fixed/movable/moving
Noncollision
fall or thrown away from vehicle without prior collision
overturning without collision

41. Intentional Self-Harm
Suicide and suicidal attempt
Non-suicidal but intentional self- injury/poisoning
Intentional self-poisoning
Hanging, strangulation & suffocation
Drowning & submersion
GSW
Sharp object
Blunt object
Jumping from high place
Jumping or lying before moving objects
Crashing of motor vehicle

42. Assault
Drugs and biological substance
Chemical or noxious substances
Hanging, strangulation & suffocation
drowning and submersion
GSW
Explosive material
Smoke, fire and flames
Steam, hot vapours and hot objects
Sharp object
Blunt object
Pushing from high place
Pushing or placing victim before moving object
Crashing of motor vehicle
By bodily force (Unarmed fight)
Sexual assault by bodily force
Neglect and abandonment
Other maltreatment syndromes

43. Event of Undetermined Intent
Similar to intentional
self-harms and
assaults
Legal Intervention and Operations of War
Legal actions
Legal execution
(ประหารชีวต)
ิ
War operations

44. Complications of Medical and Surgical Care
Includes
Complications of medical devices
Correct drug administered in therapeutic dosage but
cause adverse effect
Misadventures to patients during surgical/medical
care
Surgical and medical procedures causing abnormal
reaction or immediate or later complication
Excludes
Accidental drug over-dosage
Wrong drug given or taken

45. Adverse Drug Effects in Therapeutic Use
Systemic antibiotics (Y40)
Penicillins
Cefalosporins & other beta-lactams
Chloramphenicol
Macrolides
Tetracyclines
Aminoglycosides
Rifamycins
Systemic antifungal antibiotics
Other systemic anti-infectives
Other systemic anti-infectives (Y41)
Sulfonamides
Anti-TB
Antimalarials & drugs acting on blood protozoa
Other antiprotozoal
Anthelminthics
Antiviral drugs
Others

46. Adverse Drug Effects in Therapeutic Use
Hormones & Antagonists (Y42)
Glucocorticoids
Thyroid hormones
Antithyroid drugs
Insulin and oral hypoglycemic drugs
etc.
Primarily systemic agents (Y43)
Antiallergic & antiemetic drugs
Antineoplastic drugs
Immunosuppressive agents
Acidifying & alkalizing agents
etc.

47. Adverse Drug Effects in Therapeutic Use
Agents primarily affecting blood constituents (Y44)
Iron and other anti-hypochromic anemia preparations
Anti-megaloblastic anemia preparations
Anticoagulants
Vit. K & coagulants
Thrombolytic drugs
etc.
Analgesics, antipyretics, anti-inflammatory (Y45)
Antiepileptics & antiparkinsonism (Y46)
Sedatives, hypnotics & antianxiety drugs (Y47)
Anesthetics & therapeutic gases (Y48)
Psychotropic drugs NEC (Y49)
TCA, MAOI, antipsychotics, neuroleptics
CNS stimulants NEC (Y50)
Drugs affecting ANS (Y51)

48. Adverse Drug Effects in Therapeutic Use
Agents affecting CVS (Y52)
Agents affecting GI (Y53)
Agents affecting water-balance & mineral & uric acid metabolism
(Y54)
Agents acting on smooth & skeletal muscles and respiratory
system (Y55)
Oxytocins
Muscle relaxants
Antitussives
Expectorants
Anti-common-cold drugs
Antiasthmatics NEC
Topical agents on skin, eye, ENT & dental drugs (Y56)
Others (Y57)
Antidotes & chelating agents NEC
X-ray contrast media
Bacterial vaccines (Y58)
Other vaccines & biological substances (Y59)
Immunoglobulin

49. Misadventures to patients during
surgical and medical care
Unintentional cut, puncture, perforation or hemorrhage during
surgical and medical care (Y60)
Foreign object accidentally left in body during surgical and medical
care (Y61)
Failure of sterile precautions during surgical and medical care
(Y62)
Failure in dosage during surgical and medical care (Y63)
Excludes accidental overdose of drug or wrong drug given in error
(X40-X44)
Contaminated medical or biological substances (Y64)
Others (Y65)
Mismatched blood used in transfusion
Wrong fluid used in infusion
Failure in suture or ligature during surgical operation
ET Tube wrongly placed during anesthetic procedure
Failure to introduce or to remove other instruments
Performance of inappropriate operation
Nonadministration of surgical and medical care (Y66)

50. Medical devices associated with adverse
incidents in diagnostic and therapeutic use
Anesthesiology devices (Y70)
CVS devices (Y71)
ENT devices (Y72)
GI & urology devices (Y73)
General hospital and personal-use devices (Y74)
Neurological devices (Y75)
Obstetric & gynecological devices (Y76)
Ophthalmic devices (Y77)
Radiological devices (Y78)
Orthopedic devices (Y79)
Physical medicine devices (Y80)
General surgery and plastic surgery devices (Y81)
Other (Y82)

51. Surgical and other medical procedures as the cause of
abnormal reaction, without mention of misadventure at the
time of procedure
Surgical operation and other surgical procedures (Y83)
Transplant of whole organ
Implant of artificial internal device
Anastomosis, bypass or graft
Formation of external stoma
Other reconstructive surgery
Amputation of limb(s)
Removal of other organ (partial/total)
Other
Other medical procedures (Y84)
Cardiac catheterization
Kidney dialysis
Radiological procedure and radiotherapy
Shock therapy
Aspiration of fluid
Insertion of gastric or duodenal sound
Urinary catheterization
Blood-sampling
Other

52. Notes
If there is any S or T code in PDx or SDx,
there must be external causes
If the diagnosis is drug-induced or
poisoning, there must be external causes
If the diagnosis is trauma-related, there
must be external causes
External causes must not be used as PDx

53. Examples – External causes
A man riding motorcycle was hit by truck
during his way home after work. He
experienced cerebral concussion and close
fracture of Rt. femur, after admission,
aspiration pneumonia occured
PDx S7230 Fracture of shaft of femur : closed
SDx (comorbid)
S0600 Concussion, without open intracranial
wound
SDx (complication)
J690 Pneumonitis due to food and vomit
External cause
V2442 Motorcycle rider injured in collision with
heavy transport vehicle or bus, driver injured in traffic
accident, while working for income

54. Activity Code
While engaged in sports activity
While engaged in leisure activity
Hobby
Leisure-time activities with entertainment element
Voluntary activities
While working for income
Includes during transportation to and from working
While engaged in other types of work
Cleaning, cooking, gardening, etc.
While resting, sleeping, eating or engaging in other
vital activities
Personal hygiene
While engaged in other specified activities
During unspecified activity

55. Examples – External causes
A woman with CA cervix who underwent
radiotherapy came to the hospital due to
radiation cystitis
PDx N304 Irradiation cystitis
SDx C539 Malignant neoplasm of cervix uteri,
unspecified
External cause
Y842 Radiological procedure and radiotherapy
as the cause of abnormal reaction of the
patient, or of later complication, without
mention of misadventure at the time of
the procedure

56. Examples – External causes
A woman with acute pyelonephritis was
admitted to the hospital and was given
Ceftriaxone. After drug administration, she
experienced urticaria and hypotension.
PDx N10 Acute tubulo-interstitial nephritis
SDx L500 Allergic urticaria
T886 Anaphylactic shock due to adverse effect
of correct drug or medicament properly
administered
External cause
Y401 Cefalosporins and other beta-lactam
antibiotics causing adverse effects in
therapeutic use

57. Note!!
In the software in Ramathibodi wards,
some items show only the name of the
drugs causing adverse effects. For
example,
T361 Cefalosporins and other beta-
lactam antibiotics
Y401 Cefalosporins and other beta-
lactam antibiotics
What’s their differences???

58. Note!!
In the ICD search screen, try choose T36, you’ll
see Poisoning by systemic antibiotics, so
T361 is poisoning by cefalosporins and other
beta-lactam antibiotics
Similarly, try choose Y40, you’ll see
Systemic antibiotics
It’s still not understood...
Knowing that Y items are external causes would
be beneficial. In this case, it is the code for drugs
causing adverse effects in therapeutic use

59. Examples – External causes
A woman who previously broke up with
boyfriend intentionally took 30 tablets of
paracetamol. She was then taken to the
hospital.
PDx T391 Poisoning by 4-Aminophenol derivatives
External cause
X600 Intentional self-poisoning by and
exposure to nonopioid analgesics,
antipyretics and antirheumatics at home
Please note that paracetamol is 4-Aminophenol
derivatives

60. Place of Occurrence
Home
Apartment
Farmhouse
Private places, etc.
Residential institution
Children’s home
Dormitory
Home for the sick
Military camp
Nursing home
Old people’s home
Prison

61. Place of Occurrence
School, other institution and public administrative area
Campus, college
Church
Cinema
Court-house
Gallery, museum
Hospital
Library
Public hall
Post office
Sports and athletics area
Street and highway
Freeway, motorway, pavement, sidewalk
Trade and service area
Airport
Bank
Casino
Gas station
Hotel
Restaurant
Market
Shop
Shopping mall
Supermarket
Bus station

62. Place of Occurrence
Industrial and construction area
Farm
Other specified places
Unspecified places

63. Factors Influencing Health Status
and Contact with Health Services
(Code Z)
In some cases, provision of supplemental codes Z would be
beneficial for statistical completeness and medical record
review
Problems related to lifestyle (Z72)
Tobacco use (Z720)
Alcohol use (Z721)
Drug use (Z722)
Inappropriate diet and eating habits (Z724)
High-risk sexual behaviour (Z725)
Family history of diseases (Z80-Z84)
Personal history of diseases (Z85-Z88)
Acquired absence of limb or other organ (Z89-Z90)
Risk factors and personal history of medical treatment
(Z91-Z92)
Personal history of self-harm
Personal history of major surgery
Personal history of irradiation

64. Factors Influencing Health Status
and Contact with Health Services
(Code Z)
Artificial opening status (Z93)
Tracheostomy
Gastrostomy
Ileostomy
Colostomy
Cystostomy
etc.
Transplanted organ and tissue status
Kidney transplant status
Heart transplant status
Lung transplant status
Liver transplant status
Bone transplant status
Bone marrow transplant status (Z948)
etc.
Presence of cardiac and vascular implants and grafts (Z95)
Presence of other functional implants (Z96)
Presence of intraocular lens
Presence of insulin pump (endocrine implants)
Presence of orthopaedic joint implants, etc.

65. Factors Influencing Health Status
and Contact with Health Services
(Code Z)
Presence of other devices (Z97)
Presence of artificial eye
Presence of artificial limb
Presence of intrauterine contraceptive device
Other postsurgical states (Z98)
Intestinal bypass and anastomosis status
Arthrodesis status
Presence of CSF shunt, etc.
Dependence on enabling machines and devices (Z99)
Dependence on aspirator
Dependence on respirator
Dependence on renal dialysis
Dependence on wheelchair, etc.
These codes must not be used as PDx

66. How To Choose The Proper
Code in the Software?
Start search by most relevant keyword(s)
Don’t be too specific, it may have no results
Asthma instead of Acute severe asthma
Don’t be too generic, it may have extensive results
enteritis instead of infection
Avoid uncommon terms, they may have no results
Pneumonia instead of Pulmonary infection
Be aware of incorrect sequence of keywords
Tuberculosis of lung instead of Lung tuberculosis
Use generic form of the words first
Asthma instead of Asthmatic
Anaphyla instead of Anaphylaxis,
Anaphylactic
(because you don’t know what words are
used in ICD-10)
Infection instead of infections

67. How To Choose The Proper
Code in the Software?
Choose most specific and relevant code
(need human decision)
Acute pharyngitis instead of URI
See description for more details
(inclusions, exclusions)
N811 Cystocele
Cystocele with urethrocele
Prolapse of (anterior) vaginal wall NOS
Excludes: cystocele with prolapse of uterus
(N812-N814)
NOS Not Otherwise Specified
NEC Not Elsewhere Classified
Use the most detailed items
Don’t use N81 but use N811

68. How To Choose The Proper
Code in the Software?
If can’t find the proper specific code, try using related-words
British terms (Diarrhoea, Oedema, Haemorrhage, Centre, Labour,
Programme, Licence)
Other word forms
Amoeba, Amoebic, Amoebiasis
Infection, Infectious, Infective, Inflammation, more specific conditions
Tuberculosis, tuberculous
Try other similar words
LBP -> Dorsalgia
bacteremia -> septicaemia / sepsis
Oral candidiasis -> Candidal stomatitis
Enterocolitis -> Enteritis, colitis, gastroenteritis, etc.
Liver failure -> Hepatic failure
Try other disease/syndrome names
Colle’s fracture -> Fracture of lower end of radius
Try avoid abbreviations
Tuberculosis instead of TB
Upper respiratory tract infection instead of URI
If still can’t find the proper code, use the diagnosis tree
If still can’t find the proper code, use ‘Other’ if the disease is
specific, or use ‘Unspecified’ if non-specific

69. Dual Code System
Appears as dagger (+) and asterisk (*)
Some codes need multiple entry, e.g.
TB Meningitis
A17.0+ Tuberculous meningitis (G01*)
G01* Meningitis in bacterial diseases
classified elsewhere
Notice the + and * sign, if present, consider using the
other code, too
+ must always be present, * is optional
If * is entered, + must first be present

70. Examples – Dual Codes
A patient was admitted due to
cryptococcal meningitis.
PDx B451 Cerebral cryptococcosis (G021*)
SDx (Comorbid)
G021 Meningitis in mycoses classified
elsewhere

71. Examples – Dual Codes
A patient was admitted due to
histoplasmosis with pneumonia.
PDx B394 Histoplasmosis capsulati, unspecified
SDx (Comorbid)
J172 Pneumonia in mycoses

72. Examples – Dual Codes
A patient was admitted due to amoebic
lung abscess.
PDx A065 Amoebic lung abscess (J99.8*)
SDx (Comorbid)
J998 Respiratory disorders in other
diseases classified elsewhere

73. ICD-10 In Particular Diseases
Chemotherapy/Radiotherapy
In OPD case or patients with less than 24 hours
length of stay, use this as PDx
Z511 Chemotherapy session or
Z510 Radiotherapy session
In IPD case with more than 24 hours length of
stay, use Z511 or Z510 as SDx and use proper
diagnosis (e.g. CA colon) as PDx

74. ICD-10 In Particular Diseases
DM
IDDM
Coma
DKA
With renal complications
With ophthalmic complications
With neurological complications
With peripheral circulatory complications
With other specified complications
With multiple complications
With unspecified complications
Without complications
NIDDM
Malnutrition-related DM
Other specified DM
Unspecified DM

75. ICD-9-CM
Used for operations and procedures
Consists of 3- to 4-digit codes
Categorized by systems
Nervous system
Endocrine system
Eye
Ear
Nose, mouth and pharynx
Respiratory system
Cardiovascular system
Hemic and lymphatic system
Digestive system
Urinary system
Male genital organs
Female genital organs
Obstetrical procedures
Musculoskeletal system
Integumentary system
Miscellaneous

76. Commonly Used ICD-9CM
9604 Insertion of endotracheal tube
3322-24 Bronchoscopy
4413 Other gastroscopy
4414 Gastroscopy with biopsy
(Brush biopsy of stomach)
311 Temporary tracheostomy
9671 Continuous mechanical ventilation for
less than 96 consecutive hours
9672 Continuous mechanical ventilation for
96 consecutive hours or more

77. Commonly Used ICD-9-CM
3894 Venous cutdown
3893 Central venous catheterization NEC
8604 Other incision with drainage of skin
and subcutaneous tissue
3404 Insertion of intercostal catheter for
drainage
8872 Diagnostic ultrasound of heart
(echocardiography)
Sometimes, need to use categorized trees to find codes.
If can’t find proper code, use “others”