Guidebook On ICD-10

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Government of the People’s Republic of BangladeshMinistry of Health & Family WelfareGuidebook on ICD-10November 2011Management Information System (MIS-Health)Directorate General of Health Services (DGHS)Mohakhali, Dhaka-1212www.dghs.gov.bdin collaboration withGuidebook on ICD-10 1

Guidebook on ICD-10Prepared by:Professor Dr Abul Kalam AzadAdditional Director General (Planning & Development) &Director, MIS-Health, DGHSProfessor Supten SarbadhikariVisiting Professor in Health InformaticsBangladesh Institute of Health Sciences, Dhaka, BangladeshDr Md Aminul HasanDeputy Program Manager, Training (MCH & SPH)Improved Hospital Services Management Section, DGHSIn accordance with guidelines given in a workshopby participants:Dr Nasima AkhterEx.-Chief (Deputy Director) & Program Manager, WHO, MIS-Health, DGHSProfessor Dr Md Ruhul AminProfessor of Pediatrics, Shishu Hospital, DhakaProfessor Dr ARM Lutful KabirProfessor of Pediatrics, Sir Salimullah Medical College, DhakaProfessor Dr Md Ayub Ali ChowdhuryProfessor of Nephrology, National Institute of Kidney & Urology, DhakaProfessor Dr Shaila HossainHead, Department of Community MedicineNational Institute of Preventive & Social Medicine (NIPSOM), DhakaDr Md Mahmudul HaqueAssistant Professor, NIPSOM, Dhaka2 Guidebook on ICD-10

Table of ContentsSl. No.ContentsPage s of implementing ICD-1015.How to use ICD26.How each ICD block is constituted47.3-digits vs. 4-digits ICD codes48.Why to write the ICD-10 code59.Who to write the ICD-10 code510.How to write ICD-10 code511.How to simplify works – making your own quick reference612.Writing Medical Certification of Death713.International Form of Medical Certification of Death714.How to complete the Standard Medical Certification Form815.Recommendations916.References1017.Appendix - A : Block list of ICD-101118.Appendix-B: International Classification of Diseases, Revision 10 (1990)19iii-ivGuidebook on ICD-10 i

Professor Dr Abul Kalam AzadAdditional Director General (Planning & Development) &Director, Management Information System (MIS)Directorate General of Health Services (DGHS)PrefaceInternational Classification of Diseases (ICD) is a global standard for reporting medicaldiagnoses, procedures and causes of death developed by the World Health Organization. Thisstandard allows to exchange terminologies on medical diagnoses, procedures and causes ofdeaths across all languages in the world and simplifies statistical analysis. The current versionof the classification is ICD-10. We, at the Management Information System (MIS) of the DGHS,were facing enormous problem in processing disease and cause-specific data due to absence ofpractice of ICD-10 in our health facilities. We were in urgent need for introducing use of ICD-10 inmedical practice of Bangladesh, be it public or private setting. However, the immediate limitationwas absence of a suitable Guide Book on ICD-10 customized for local context. Thanks to ourprofessional colleagues, both in home and abroad, who assisted us to develop the Guide Bookfor printing and distribution across hospitals and health facilities of Bangladesh, both in printed aswell as in web-based formats.I deeply believe that our medical practitioners will understand the needs for using ICD-10, andwill fully comply with the guidelines and recommendations given in the Guide Book. I urge uponthe concerned health managers, medical teachers, consultants and institute heads to play theirspecific roles proactively and in innovative ways so that we achieve the goal of fully compliantICD-10 use in a short period of time. Their vigilance and supportive supervision will remain as themost important keys to the success.I am indebted to Acting WHO Representative of Bangladesh Country Office Dr Arun BhadraThapa to accept our request very cordially and respond positively for taking all necessary stepstowards printing this Guide Book.Finally, I express my thanks to all concerned, who directly or indirectly, remained with us to publishthis Guide Book on ICD-10.Professor Dr Abul Kalam Azadii Guidebook on ICD-10

Professor Dr. Khondaker Md. Shefyet UllahDirector GeneralDirectorate General of Health Services (DGHS)MessageIam glad to see that MIS-Health of DGHS is going to publish the Guide Book on ICD-10 for useby the medical practitioners of Bangladesh both in health facilities as well as in private practice.International Classification of Diseases (ICD) is a global standard, which needs to implement forstatistical processing of diagnoses of morbidities and mortalities in easy to understand format sothat health planning and programs can be made based on the country situation. ICD-10 is alsoimportant for comparison of morbidity and mortality data between countries. The health serviceof Bangladesh lacked a suitable guide book on ICD-10, which made difficulties in introducingpractice of using standard medical diagnostic terminologies in the country. I hope that this guidebook will remove these difficulties and our medical practitioners will feel comfortable for usingICD-10. I emphasize on their full compliance with the guidelines and recommendations given inthe Guide Book.I have learnt that WHO-Bangladesh Country Office provided assistance to publish this GuideBook. Let me extend my appreciation to WHO in this opportunity. Finally, I thank Director, MISHealth and his team for taking this laudable initiative of publishing this Guide Book on ICD-10.Professor Dr. Khondaker Md. Shefyet UllahGuidebook on ICD-10 iii

Dr Arun Bhadra ThapaActing WHO Representative to BangladeshMessageIt is my pleasure to know that Bangladesh is publishing the International Classification of Diseases(ICD-10), developed by the World Health Organization (WHO), which is used world-wide formorbidity and mortality statistics, reimbursement systems and automated decision support inmedicine.As we know, ICD is a global standard diagnostic classification for all general epidemiological,many health management purposes and clinical use. The main purpose of ICD is to harmonizemedical recording practices worldwide and medical practitioners of Bangladesh should learn anduse ICD while caring for their patients. ICD-10 was adopted by the World Health Assembly inMay 1990 and all government and private health and medical institutions in the country shouldessentially use this ICD in preparing their records and reports and the same should be ensured byall concerned authorities through well designed guidelines, directives and continued monitoring.All medical and health institutions, including hospitals in the country should equip themselves withWHO publication on ICD-10 as a reference and authorities should formulate a plan for regularorientation on the use of it. I believe, Implementation of ICD-10 will have a positive impact onthe entire value chain of healthcare, including insurance, service delivery, scheduling, patientregistration, patient care, customer service, revenue and reimbursement management, networkmanagement and risk management.With regard to achieving the objective of ICD-10, it is important for the concerned health managers,medical teachers, consultants and institute heads to play their roles proactively. I hope that thisvaluable publication will guide them to perform their roles and responsibilities fruitfully.I would like to extend my sincere appreciation to all those in Directorate General of Health Serviceswho have significantly contributed to the development and publication of this valuable guide.Dr Arun Bhadra ThapaActing WHO Representative to Bangladeshiv Guidebook on ICD-10

IntroductionWhat do we understand by ICDICD stands for International Classification of Diseases. This classification system has beendeveloped by the World Health Organization (WHO). ICD is used world-wide for morbidity andmortality statistics, reimbursement systems and automated decision support in medicine. Thedesign of ICD promotes international comparability in the collection, processing, classification andpresentation of these statistics. The ICD contains only diagnosis codes. The WHO revises the ICDcode-set periodically, and it is currently in its 10th edition. ICD-10 represents a fundamental overhaulof the previous ICD-9 coding system. The volume of ICD-10 codes as compared to ICD-9 codes issignificant because in ICD-10, the code size has been expanded, code values and interpretationshave been redefined and specificity has been further improved.Global ICD-10 adoptionThe current version of ICD is ICD-10, which was adopted by the World Health Assembly in May1990. It is learnt that as of writing this guide book 138 countries have implemented the ICD-10 codeset for mortality, and 99 of them have also implemented ICD-10 for morbidity. Individual country,on permission from WHO, may make modification to ICD-10 to meet individual country-specificneeds. For example, Canada and Australia each has a national version of the ICD-10 code set.Likewise, WHO granted permission to the United States to develop a national clinical modificationof ICD-10. The effort involved the United States National Center for Health Statistics (NCHS) andthe Centers for Medicare and Medicaid Services (CMS). The NCHS created ICD10-CM, whichcontains diagnosis codes. The ICD10-Procedure Coding System (PCS) was developed for CMS,which contains the procedure codes for use in reimbursement of in-patient hospital services. TheICD10-CM code set is five times larger than the code sets being used in other countries.Advantages of implementing ICD-10 Measuring the quality, safety (or medical errors) 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 healthcare delivery systems Monitoring resource utilization Improving clinical, financial and administrative performance Identifying fraudulent or abusive practices Managing care and disease processes Tracking public health and risks Providing data to consumers regarding costs and outcomes of treatment optionsGuidebook on ICD-10 1

Implementation of ICD-10 will impact the entire value chain of healthcare, including insurance,service delivery, scheduling, patient registration, patient care, customer service, revenue andreimbursement management, network management and risk management.How to use ICDICD is an international standard. To harmonize our medical practice, we should learn and useICD while caring our patients. Although ICD is a classification system and not a coding system, ituses codes to represent different diagnoses, procedures or life events. There are some easy touse software(s) that help to find ICD codes. However, those who will not use computer software,here are some tips for them to understand ICD. Essentially, all medical practitioners need tounderstand the ICD.The WHO has published three important volumes on ICD. The volume I provides a tabular listof ICD. The volume II is the instruction manual on how to use the ICD. The Volume III is thealphabetical list of ICD. In ICD-10, there are more than 14,400 different codes. It allows trackingof many new diagnoses. Using optional sub-classifications, the codes can be expanded to over16,000 codes.The ICD is sub-divided into chapters, blocks, 3-digit codes and 4-digit codes. Further subclassification like 5-digit codes and 6-digit codes also exist. But, we will limit our discussion up to4-digit codes. Below is a listing of Chapters, Block groups and Chapter titles.Chapter BlockTitleIA00-B99Certain infectious and parasitic diseasesIIC00-D48NeoplasmsIIID50-D89Diseases of the blood and blood-forming organs and certain disordersinvolving the immune mechanismIVE00-E90Endocrine, nutritional and metabolic diseasesVF00-F99Mental and behavioral disordersVIG00-G99Diseases of the nervous systemVIIH00-H59Diseases of the eye and adnexaVIIIH60-H95Diseases of the ear and mastoid processIXI00-I99Diseases of the circulatory systemXJ00-J99Diseases of the respiratory systemXIK00-K93Diseases of the digestive systemXIIL00-L99Diseases of the skin and subcutaneous tissueXIIIM00-M99Diseases of the musculoskeletal system and connective tissueXIVN00-N99Diseases of the genitourinary systemXVO00-O99Pregnancy, childbirth and the puerperiumXVIP00-P96Certain conditions originating in the perinatal periodXVIIQ00-Q99Congenital malformations, deformations and chromosomal abnormalities2 Guidebook on ICD-10

XVIIIR00-R99Symptoms, signs and abnormal clinical and laboratory findings, notelsewhere classifiedXIXS00-T98Injury, poisoning and certain other consequences of external causesXXV01-Y98External causes of morbidity and mortalityXXIZ00-Z99Factors influencing health status and contact with health servicesXXIIU00-U99Codes for special purposesChapters I to XVII list different diagnoses. Chapter XVIII lists symptoms, signs and abnormallaboratory findings that are not mentioned elsewhere. Chapter XIX lists injury, poisoning andcertain other consequences of external causes. Chapter XX lists external causes of morbidityand 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.Following list shows different blocks under Chapter I. List of all blocks will be provided in appendix.Please note that each block has a title.Chapter I: Certain infectious and parasitic diseases(A00-B99)A00-A09Intestinal infectious diseasesA15-A19TuberculosisA20-A28Certain zoonotic bacterial diseasesA30-A49Other bacterial diseasesA50-A64Infections with a predominantly sexual mode of transmissionA65-A69Other spirochaetal diseasesA70-A74Other diseases caused by chlamydiaeA75-A79RickettsiosesA80-A89Viral infections of the central nervous systemA90-A99Arthropod-borne viral fevers and viral haemorrhagic feversB00-B09Viral infections characterized by skin and mucous membrane lesionsB15-B19Viral hepatitisB20-B24Human immunodeficiency virus [HIV] diseaseB25-B34Other viral diseasesB35-B49MycosesB50-B64Protozoal diseasesB65-B83HelminthiasesB85-B89Pediculosis, acariasis and other infestationsB90-B94Sequelae of infectious and parasitic diseasesB95-B97Bacterial, viral and other infectious agentsB99Other infectious diseasesGuidebook on ICD-10 3

How each ICD block is constitutedPlease see the first block above. It begins at code A00 and ends at code A09. It titles “IntestinalInfectious Diseases”. The block is an alphanumeric character block, where the first character isa CAPITAL LETTER and the next two characters are numeric. Either A00 or A09 constitutes a3-digit ICD code. All the 3-digit ICD codes for block A00-A09 are mentioned below:A00CholeraA01Typhoid and paratyphoid feversA02Other salmonella infectionsA03ShigellosisA04Other bacterial intestinal infectionsA05Other bacterial foodborne intoxications, not elsewhere classifiedA06AmoebiasisA07Other protozoal intestinal diseasesA08Viral and other specified intestinal infectionsA09Diarrhoea and gastroenteritis of presumed infectious origin3-digit vs. 4-digit ICD codesWe have seen above, example of 3-digit ICD codes. Let us consider A00. It is the 3-digit ICDcode for Cholera. It does not tell specifically, which type of cholera it is, classical or el tor, or unspecified. A 4-digit ICD code answers this question. The table below shows how 3-digit ICD codesare broadened into 4-digit ICD codes to enhance the specificity.3-digit code4-digit codeA00NameCholeraA00.0A00.1A00.9A01Cholera due to Vibrio cholerae 01, biovar choleraeClassical choleraCholera due to Vibrio cholerae 01, biovar eltorCholera eltorCholera, unspecifiedTyphoid and paratyphoid feversA01.0Typhoid feverInfection due to Salmonella typhiA01.1Paratyphoid fever AA01.2Paratyphoid fever BA01.3Paratyphoid fever CA01.44 Guidebook on ICD-10Paratyphoid fever, unspecifiedInfection due to Salmonella paratyphi NOS (not otherwise specified)

It is easy to understand the difference between 3-digit and 4-digit ICD codes. The 3-digit codebegins with a Capital Letter followed by two numeric characters (example: A00 Cholera). The4-digit code, on the other hand, adds with the 3-digit code a dot (.) plus another numeric character(example: A00.0 Cholera classical; A00.1 Cholera el tor). In 4-digit code, the (.) mark is notconsidered as a digit.Why to write the ICD-10 code It has been planned that ICD-10 codes will 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 indoorpatients. Use of ICD-10 codes will be integral part of this system.Who to write the ICD-10 code The doctor in-charge of the patient will have the primary responsibility to write the ICD10 code. Otherwise, the doctor who is writing the discharge, transfer, referral or deathcertificate of the patient will have to write or complete the ICD-10 code. The doctor writing the ICD-10 code should write his/her name legibly so that s/he can betraced for clarification or completing the incomplete write up. The overall responsibility of writing ICD-10 codes in all patient case-sheets will be theresponsibility of the unit head. The completed case-sheet on discharge, transfer, referral or death of patient will go to themedical record room for entry into national database. In time, this will be done throughhospital ward where the patient will receive treatment. In case of incomplete or no ICD-10code, the case-sheet will be returned to the corresponding doctor for completing the job.How to write ICD-10 codeIt is advised that each hospital ward will make a seal with the following information from thehospital’s own local fund. Simple hand writing will also be allowed. However, all hand writingsmust be clear and legible.ICD-10 CodingChapter No.Block No.3-digit Code(Name)4-digit Code(Name)Name of the doctorGuidebook on ICD-10 5

Let us see, how it will look after completing:ICD-10 CodingChapter No.Block No.3-digit Code(Name)4-digit Code(Name)IA00-A09A01Typhoid and paratyphoid feverA01.1Paratyphoid fever AName of the doctor Dr. Shamima RahmanThere may be question, why so many information to provide? Can we not simply go for writing3-digit code or 4-digit code directly? There are two reasons for requesting the information. First,two keep provision for cross-checking so that mistakes are identified and corrected. Second, toguide the doctor to follow the steps in sequence to easily find the correct ICD code. To explainfurther, begin from Chapter Name and identify which chapter the patient’s diagnosis represents.Identify the blocks and go to respective block. Then go to the 3-digit code. Finally, explore the4-digit code, if you could further specify your diagnosis or intervention.If we examine the ICD codes, we will understand that to write 4-digit code, one will need todo specific diagnosis further down from 3-digit code. In primary care setting, even determining3-digit code may appear difficult due to lack of adequate diagnostic facilities. However, we shouldremember that the international obligation is to write at least 3-digit code. In this given context,introduction of ICD-10 coding system will pressurize our policy makers to improve the standardsof health care facilities of Bangladesh.To compromise with the shortcomings of interim period, based on the information available, therespective ICD-10 information boxes may be filled up. For example, only Chapter No. and BlockNo.; up to 3-digit code along with code name; all the information boxes including 4-digit codealong with code name. Doctors should be inquisitive to explore information as finest as possibleto be comfortable to write the 4-digit code. This will improve their clinical abilities.How to simplify works – making

of the previous ICD-9 coding system. The volume of ICD-10 codes as compared to ICD-9 codes is significant because in ICD-10, the code size has been expanded, code values and interpretations have been redefined and specificity has been further improved. Global ICD-10 adoption The current version of ICD is ICD-10, which was adopted by the World .

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