International Statistical Classification Of Diseases And .

IntroductionDevelopment of ICD-10A classification of diseases may be defined as a system of categories to which morbid entities are assigned according to establishedcriteria. There are many possible axes of classification and the one selected will depend upon the use to be made of the statistics tobe compiled. A statistical classification of diseases must encompass the entire range of morbid conditions within a manageablenumber of categories.The Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) is the latest ina series that was formalized in 1893 as the Bertillon Classification or International List of Causes of Death. A complete review ofthe historical background to the classification is given in Volume 2 of ICD-10. While the title has been amended to make clearerthe content and purpose, and to reflect the progressive extension of the scope of the classification beyond diseases and injuries, thefamiliar abbreviation "ICD" has been retained. In the updated classification, conditions have been grouped in a way that was felt tobe most suitable for general epidemiological purposes and the evaluation of health care.Work on the Tenth Revision of the ICD started in September 1983 when a Preparatory Meeting on ICD-10 was convened in Geneva.The programme of work was guided by regular meetings of Heads of World Health Organization (WHO) Collaborating Centres forClassification of Diseases. Policy guidance was provided by a number of special meetings including those of the Expert Committeeon the International Classification of Disease - Tenth Revision, held in 1984 and 1987.In addition to the technical contributions provided by many specialist groups and individual experts, a large number of commentsand suggestions were received from WHO Member States and Regional Offices as a result of the global circulation of draftproposals for revision in 1984 and 1986. From the comments received, it was clear that many users wished the ICD to encompasstypes of data other than the "diagnostic information" (in the broadest sense of the term) that it has always covered. In order toaccommodate the perceived needs of these users, the concept arose of a "family" of classifications centred on the traditional ICDwith its familiar form and structure. The ICD itself would thus meet the requirement for diagnostic information for general purposes,while a variety of other classifications would be used in conjunction with it and would deal either with different approaches to thesame information or with different information (notably medical and surgical procedures and disablement).Following suggestions, at the time of development of the Ninth Revision of the classification, that a different basic structure mightbetter serve the needs of the many and varied users, several alternative models were evaluated. It became clear, however, that thetraditional single-variable-axis design of the classification, and other aspects of its structure that gave emphasis to conditions thatwere frequent, costly or otherwise of public health importance, had withstood the test of time and that many users would be unhappywith any of the models that had been proposed as a possible replacement.Consequently, as study of the Tenth Revision will show, the traditional ICD structure has been retained but an alphanumeric codingscheme replaces the previous numeric one. This provides a larger coding frame and leaves room for future revision withoutdisruption of the numbering system, as has occurred at previous revisions.In order to make optimum use of the available space, certain disorders of the immune mechanism are included with diseases of theblood and blood-forming organs (Chapter III). New chapters have been created for diseases of the eye and adnexa and diseases ofthe ear and mastoid process. The former supplementary classifications of external causes and of factors influencing health statusand contact with health services now form part of the main classification.The dagger and asterisk system of dual classification for certain diagnostic statements, introduced in the Ninth Revision, has beenretained and extended, with the asterisk axis being contained in homogeneous categories at the three-character level.Content of the three volumes of ICD-10(This applies to the WHO version ICD-10. Note ICD-10-CA is limited to the tabular list and alphabetical index. The CanadianCoding standards for ICD-10-CA and CCI incorporate WHO morbidity coding rules from Volume 2 of ICD-10.)The presentation of the ICD-10 classification has been changed and there are now three volumes:Volume 1. Tabular List. This contains the Report of the International Conference for the Tenth Revision, the classification itselfat the three- and four-character levels, the classification of the morphology of neoplasms, special tabulation lists for mortality andmorbidity, definitions, and the nomenclature regulations.Volume 2. Instruction Manual. This brings together the notes on certification and classification formerly included in Volume 1with a good deal of new background and instructional matter and guidance on the use of Volume 1, on tabulations, and on planningfor the use of ICD, which was seen as lacking in earlier revisions. It also includes the historical material formerly presented in theintroduction to Volume 1.9

INTERNATIONAL CLASSIFICATION OF DISEASESUpdates The official updates to the published volumes of ICD-10 are available as annual lists of changes on the WHO website e updates are approved annually at the meeting of Heads of WHO Collaborating Centres for the Family of InternationalClassifications. The lists indicate the sources of the recommendations and implementation dates. The date of approval has beenindicated for all changes except the corrigenda.Volume 3. Alphabetical Index. This presents the index itself with an introduction and expanded instructions on its use.*******The Forty-third World Health AssemblyThe classification was approved by the International Conference for the Tenth Revision of the International Classification ofDiseases in 1989 and adopted by the Forty-third World Health Assembly in the following resolution:Having considered the report of the International Conference for the Tenth Revision of the International Classification of Diseases;1.ADOPTS the following, recommended by the Conference:(1) the detailed list of three-character categories and optional four-character subcategories with the Short Tabulation Lists forMortality and Morbidity, constituting the Tenth Revision of the International Statistical Classification of Diseases andRelated Health Problems, due to come into effect on 1 January 1993;(2) the definitions, standards and reporting requirements related to maternal, fetal, perinatal, neonatal and infant mortality;(3) the rules and instructions for underlying cause coding for mortality and main condition coding for morbidity;2.REQUESTS the Director-General to issue the Manual of the International Statistical Classification of Diseases and RelatedHealth Problems;ENDORSES the recommendations of the Conference concerning:(1) the concept and implementation of the family of disease and health-related classifications, with the InternationalStatistical Classification of Diseases and Related Health Problems as the core classification surrounded by a number ofrelated and supplementary classifications and the International Nomenclature of Diseases;(2) the establishment of an updating process within the ten-year revision cycle.3.10

Conventions used in the Tabular List of DiseasesIn listing terms in the tabular list, ICD-10-CA uses some special conventions relating to the use of parentheses, square brackets,colons, braces, abbreviations and symbols. These need to be clearly understood by coders and others wishing to interpret statisticsbased on ICD-10-CA.Inclusion termsWithin the three and four-character rubrics, there are usually listed a number of other diagnostic terms. These are known as"inclusion terms" and are given, in addition to the title, as examples of the diagnostic statements to be classified to that rubric. Theymay refer to different conditions or be synonyms. They are not a subclassification of the rubric.Inclusion terms are listed primarily as a guide to the content of the rubrics. Many of the items listed relate to important or commonterms belonging to the rubric. Others are borderline conditions or sites listed to distinguish the boundary between one subcategoryand another. The lists of inclusion terms are by no means exhaustive and alternative names of diagnostic entities are included in theAlphabetical Index, which should be referred to first when coding a given diagnostic statement.It is sometimes necessary to read inclusion terms in conjunction with titles. This usually occurs when the inclusion terms areelaborating lists of sites or pharmaceutical products, where appropriate words from the titles (e.g. "malignant neoplasm of .","injury to .", "poisoning by .") need to be understood.General diagnostic descriptions common to a range of categories, or to all the subcategories in a three-character category, are to befound in notes headed "Includes", immediately following a chapter, block or category title.Exclusion termsCertain rubrics contain lists of conditions preceded by the word "Excludes". These are terms which, although the rubric title mightsuggest that they were to be classified there, are in fact classified elsewhere. An example of this is in category A46, "Erysipelas",where postpartum or puerperal erysipelas is excluded. Following each excluded term, in parentheses, is the category or subcategorycode elsewhere in the classification to which the excluded term should be allocated.General exclusions for a range of categories or for all subcategories in a three-character category are to be found in notes headed"Excludes", immediately following a chapter, block or category title.Glossary descriptionsIn addition to inclusion or exclusion terms, Chapter V, Mental and behavioural disorders, uses glossary descriptions to indicate thecontent of rubrics. This device is used because the terminology of mental disorders varies greatly, particularly between differentcountries, and the same name may be used to describe quite different conditions. The glossary is not intended for use

ICD-10-CA is the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada. ICD-10-CA was developed by the Canadian Institute for Health In