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CBHI - Module & Work Book - Orientation Training on ICD 10 Efficient Health Intelligence is the key to Healthy & Prosperous India Government of India Module and Work Book Orientation Training On ICD 10 Government of India Central Bureau of Health Intelligence (CBHI) Directorate General of Health Services Ministry of Health & Family Welfare Nirman Bhawan, New Delhi - 110 011 CBHI Website : www.cbhidghs.nic.in CBHI email : [email protected] ia”, d n I y indl n of k o i , t a Form form n n I o i at l th plic Hea p “ A n & io in dar nic. licat . n s b e l h u a g P BHI bhid ng C i c C . e n i r w a Fo ww lcom s, Tr : e t a e w t i ebs t are Form n w g e I n .in i H m ort CB .nic ove f r b r p n u Rep s m i@ for i cbh r s i n d tio ail : ges m g E u r S h ou g u o thr GOVERNMENT OF INDIA MODULE AND WORK BOOK ORIENTATION TRAINING ON ICD 10 Compiled and Edited by : Dr. Ashok Kumar, M.D., Director Smt. S Jeyalakshmi, Joint Director ( NFSG) Sh. P K Mukhopadhyay, Joint Director Ms. Pratima Gupta, Assistant Director Central Bureau of Health Intelligence Directorate General of Health Services Ministry of Health & Family Welfare Nirman Bhavan, New Delhi - 110011 Website - www.cbhidghs.nic.in Email : [email protected] In Collaboration with National Centre for Classification in Health (Brisbane), Australia And World Health Organisation, New Delhi ACKNOWLEDGMENT This Module & Work Book has been prepared using the material developed (and concurred during October/November 2004) by Ms. Sue Waker & Maryann Wood, National Centre for Classification in Health (Brisbane), School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove Q 4059 Australia, which was based on the original work by Luminaire Training Enterprises. The suggestions are also appreciated from Dr. Megha Chander Singh (MAMC), Mr. Shiv Kumar (Dy RGI) and the representatives of twenty study hospitals from Delhi and Rohtak, who participated in case study to improve and strengthen the use of ICD 10 in India, for compilation of this ICD 10 Module & Work Book. The concern and guidance of Dr. S.P. Agarwal, Director General of Health Service and Dr. R. K. Srivastava, Addl. D.G.H.S. Government of India, have been very valuable. Please send your comments and suggestions to : The Director, Central Bureau of Health Intelligence (CBHI) Directorate General of Health Services Ministry of Health & Family Welfare Room No. 401, A Wing, Nirman Bhavan, New Delhi - 110011 Email : [email protected] Fax : 91-011-23017695 91-011-23793175 PREFACE The 10th version of International Classification of Diseases (ICD-10) was introduced by WHO in 1993 and India adopted the same for implementation in the year 2000. Accordingly, the Directors of Health Services of all States/Union Territories were advised to adopt the ICD-10 classification system for coding morbidity and mortality records. As is well known, the hospital morbidity and mortality data are an important component of health information system and their coding ensures a uniform data analysis as well as comparison throughout the country and globally. Central Bureau of Health Intelligence (CBHI) being the national nodal institution for health statistics in the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; has introduced a well designed inservice “Orientation Training Course on ICD-10” of one week duration, in order to appropriately build the capacity amongst the officials engaged in preparation, handling and maintenance of medical and health data. This Module and Work Book is compiled and designed to facilitate the requisite orientation and self-learning on efficient use of ICD-10. Besides containing modules and related practical learning exercises covering all the chapters as contained in WHO's publication on ICD-10 (3 volumes); this Module and Work Book also contains the ready materials on (i) Body parts and their key functions, (ii) Medical Terminologies, (iii) ICD-10 code list of three digit categories, and (iv) special tabulation code lists for mortality and morbidity . We hope that this Module and Work Book will prove to be very handy for all those medical, nursing, paramedical and concerned officials who are involved and keen to develop their skills in efficient use of ICD-10. For further indepth details on ICD-10, kindly refer to the WHO's original publication (three volumes) on ICD-10, namely, International Statistical Classification of Diseases and Related Health Problems (Volume I), International Classification of Diseases (Volume II) and International Statistical Classification of Diseases and Related Health Problems (Volume III); which may be available as reference publication in libraries of medical, nursing and paramedical teaching institutions, inservice health and family welfare training centres, institutions and hospitals, etc. CONTENTS ICD 10 Chapter No. - Module No. Subject Page No. 1 Introduction To ICD-10 Structure and Principles of Classification What is clinical coding? What is a statistical classification? Why use a classification? History of the International Classification of Diseases Overview of the ICD-10 classification Volumes of the ICD-10 Chapters of the ICD-10 Structure of the ICD-10 code 1 - 2 6 - 3 - 4 Volume 1 - Tabular List Important points regarding the Tabular List Chapters using more than one letter: Blocks Three character categories or rubrics Four character categories or rubrics Conventions Inclusion Terms Exclusion Terms Glossary descriptions Dagger and Asterisk convention Parentheses ( ) Square brackets [ ] Co1lon : Brace } Not Otherwise Specified (NOS) N1ot elsewhere classified (NEC) "A1nd" in code titles Point dash Volume 3 - Alphabetic Index Important points regarding the Alphabetic Index Structure of Index entries Conventions Parentheses ( ) Not Elsewhere Classified (NEC) Cross-references Procedure Coding Using ICHI Important points for Coding with the ICHI Conventions used in the Tabular List of Procedures 1st level - anatomical site axis 2nd level - procedural type axis Block number Abbreviations Punctuation Instructional terms Conventions used in the Alphabetic List of Procedures Blocks 13 18 i - 5 6 - 7 I 8 II 9 III 10 Sequence Modifiers Not Elsewhere Classified (NEC) Omit Block Cross References Eponyms BASIC CODING GUIDELINES Overview of Morbidity Coding Sources of morbidity data Uses of morbidity data Central concepts for morbidity coding Why single-condition coding? Rules for reselection of main condition Guidelines for coding of the main condition and other Optional additional codes Overview of Mortality Coding Important points for mortality coding chapter International Form of Medical Certificate of Concept of underlying cause of death: Selecting the underlying cause of death General Principle: Rule 1 Rule 2 Rule 3 Rules for modification: Rule A. Senility and other ill-defined conditions Rule B. Trivial conditions Rule C. Linkage Rule D. Specificity Rule E. Early and late stages of disease Rule F. Sequelae Using the Medical Mortality Data System (MMDS) Assumption of intervening cause Highly improbable Duration Sequelae Rheumatic fever with heart involvement Nature of injury Malignancy: Certain Infectious and Parasitic Diseases Important points for Chapter I Coding exercises for Chapter I Sample Hospital Discharge Summaries for Chapter I Mortality Coding Exercises for Chapter I Neoplasms Important points for Chapter II Coding exercises for Chapter II Sample Hospital Discharge Summaries for Chapter II Mortality Coding Exercises for Chapter II Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving The Immune Mechanism Important points for Chapter III 23 25 36 55 63 72 ii IV 11 V 12 VI 13 VII 14 VIII 15 IX 16 X 17 XI 18 XII 19 XIII 20 Coding exercises for Chapter III Sample Hospital Discharge Summaries for Chapter III Mortality Coding Exercise for Chapter III Endocrine, Nutritional and Metabolic Disorders Important points for Chapter IV Coding exercises for Chapter IV Sample Hospital Discharge Summaries for Chapter IV Mortality Coding Exercises for Chapter IV Mental and Behavioural Disorders Important points for Chapter V Coding exercises for Chapter V Sample Hospital Discharge Summaries for Chapter V Mortality Coding Exercises for Chapter V Diseases of the Nervous System Important points for Chapter VI Coding exercises for Chapter VI Sample Hospital Discharge Summaries for Chapter VI Mortality Coding Exercises for Chapter V Diseases of the Eye and Adnexa Important points for Chapter VII Coding exercises for Chapter VII Sample Hospital Discharge Summary for Chapter VII Diseases of the Ear and Mastoid Process Important points for Chapter VIII Coding exercises for Chapter VIII Sample Hospital Discharge Summary for Chapter VIII Diseases of the Circulatory System Important points for Chapter IX Coding exercises for Chapter IX Sample Hospital Discharge Summaries for Chapter IX Mortality Coding Exercises for Chapter IX Diseases of the Respiratory System Important points for Chapter X Coding exercises for Chapter X Sample Hospital Discharge Summaries for Chapter X Mortality Coding Exercises for Chapter X Diseases of Digestive System Important points for Chapter XI Coding exercises for Chapter XI Sample Hospital Discharge Summaries for Chapter XI Mortality Coding Exercises for Chapter XI Diseases of the Skin and Subcutaneous Tissue Important points for Chapter XII Coding exercises for Chapter XII Sample Hospital Discharge Summaries for Chapter XII Mortality Coding Exercises for Chapter XII Diseases of the Musculoskeletal System & Connective Tissue Important points for Chapter XIII Coding exercises for Chapter XIII Sample Hospital Discharge Summaries for Chapter XIII Mortality Coding Exercises for Chapter XIII 80 88 96 104 108 113 121 129 137 145 iii XIV 21 XV 22 XVI 23 XVII 24 XVIII 25 XX 26 XXI 27 28 Diseases of the Genitourinary System Important points for Chapter XIV Coding exercises for Chapter XIV Sample Hospital Discharge Summaries for Chapter XIV Pregnancy, Childbirth and the Puerperium Important points for Chapter XV Coding exercises for Chapter XV Sample Hospital Discharge Summaries for Chapter XV Mortality Coding Exercises for Chapter XV Certain Conditions Originating in the Perinatal Period Important points for Chapter XVI Coding exercises for Chapter XV Sample Hospital Discharge Summaries for Chapter XVI Mortality Coding Exercises for Chapter XVI Congenital Malformations, Deformations and Chromosomal Abnormalities Important points for Chapter XVII Coding exercises for Chapter XVII Sample Hospital Discharge Summaries for Chapter XVII Mortality Coding Exercises for Chapter XVII Symptoms, Signs and Abnormal Clinical & Laboratory Findings, Not Elsewhere Classified Important points for Chapter XVIII Coding exercises for Chapter XVIII Sample Hospital Discharge Summaries for Chapter XVIII Mortality Coding Exercises for Chapter XVIII Injury, Poisoning and Certain Other Consequences of External Causes (Chapter Xix) & External Causes of Morbidity and Mortality The external cause concept Important points for Chapter XIX Important points for Chapter XX Coding exercises for Chapters XIX and XX Sample Hospital Discharge Summaries for Chapter XIX & XX Mortality Coding Exercises for Chapter XIX & Chapter XX Factors Influencing Health Status and Contact With Health Services Important points for Chapter XXI Coding exercises for Chapter XXI Procedure Coding Exercises 153 161 169 177 184 193 207 211 APPENDIX 1 Human Body Structure and Their Key Functions……………………. 216 APPENDIX 2 Medical Terminologies……………………………………………….. 239 APPENDIX 3 ICD 10 List of Three Digit Categories……………………………….. 244 APPENDIX 4 Special Tabulation Lists for Mortality & Morbidity (ICD-10)……… 297 iv MODULE 1 Introduction to ICD-10 Structure and Principles of Classification CBHI ICD 10 Student Workbook December 2004 Page 1 Module 1: Introduction to ICD-10 Structure And Principles of Classification What Is Clinical Coding? Clinical coding is the translation of diagnoses of diseases, health related problems and procedural concepts from text to alphabetic/numeric codes for easy storage, retrieval and analysis. What is a statistical classification of diseases? A classification of diseases is a system of categories or groupings to which diseases, injuries, conditions and procedures are assigned according to established criteria. It is the element of grouping similar terms, which distinguishes a statistical classification from a nomenclature. A nomenclature requires a separate name or title for each disease or procedure concept. ICD-10 is a statistical classification, which means that it contains a limited number of mutually exclusive code categories, which describe all disease concepts. The classification is hierarchical in structure with subdivisions to identify broad groups and specific entities. The classification includes specific rules to guide its use. Why use a classification? • To allow easy storage, retrieval and analysis of data. • To allow systematic recording, analysis, interpretation and comparisons of mortality and morbidity data between hospitals, provinces or countries. • To allow comparisons in the same location across different time periods. History of the International Classification of Diseases The theory of disease classification began in the 17th Century when John Graunt recognised the need to organise mortality data into some logical form and therefore developed the first statistical study of disease, called the London Bills of Mortality. In this work, Graunt classified the deaths of all children who were born alive but who died before they reached the age of six. Death were classified as due to thrush, convulsions, rickets, teeth and worms, chrysomes, livergrown, smallpox, swine pox, measles and worms without convulsions. It was hoped that clues regarding the nature and aetiology of these diseases would be brought to light and that this understanding would ultimately lead to better treatments. During the 18th Century, Sauvages first attempted to systematically classify all diseases in a work called "Nosologia Methodica". William Farr, the first medical statistician, who worked in the newly formed General Register Office of England and Wales in the mid-1800s, further developed the work of both of these men. Farr's work formed the basis of a recommendation to create the International List of Causes of Death, which was presented to the first International Statistical Congress, held in Brussels in 1853. Although modified in 1874, 1880 and 1886 to suit the needs of the time, Farr's classification did not receive universal acceptance, despite his best efforts to promote it. The general arrangement of the classification which included the principle of classifying diseases according to body site - became the basis for work carried out by Dr Jacques Bertillon from Paris. Bertillon developed a classification that distinguished between diseases that affected the body as a whole (systemic diseases) and those that were localised to a particular body site. The Bertillon Classification of Causes of Death received general approval and was adopted for use by several countries. When the American Public Health Association recommended its use for Canada, Mexico and the USA, it also developed plans for the updating of the classification every ten years. At this time, in the very early 1900s, there were only 179 groups of causes of death! In 1920, the Health Organization of the League of Nations, which had taken an active role in the collection and classification of death statistics, determined that it would take over the management of CBHI ICD 10 Student Workbook December 2004 Page 2 the Causes of Death classification. When revising the classification for the fourth and fifth times, in 1929 and 1938, this organisation included classifications for non-fatal conditions for the first time. In 1946, the Interim Commission of the World Health Organization was charged with the responsibility for the continued revision of the classification. The sixth revision conference marked a milestone in the collection of health and vital statistics. A new publication entitled "International Classification of Diseases, Injuries and Causes of Death" was issued in 1948, based on the previous work but including recommendations for the collection of morbidity data, as well as mortality statistics. This classification underwent minor amendment in 1955 and 1965 but mainly to correct errors of fact and inconsistencies. The 1965 revision included, for the first time, two volumes - a tabular list and an alphabetical index. In 1975, the 46 member states of the WHO convened in Geneva to begin development of the ninth revision of the ICD, as it came to be known. In addition to the member states, a number of medical specialty groups sent representatives, due to the now almost universal interest in using the classification for medical record coding and indexing, monitoring and evaluation of health services and epidemiological research. The next year, the World Health Assembly agreed to the revision of the classification and to the development, on a trial basis, of a procedure classification as an accompaniment to the disease classification. Thus the ICD-9 and ICPM (International Classification of Procedures in Medicine) were introduced. Work on the tenth revision of the International Classification of Diseases began in September 1983 when a preparatory meeting on ICD-10 was convened by the World Health Organisation in Geneva. This was followed by several meetings of an expert committee in 1984 and 1987 to make decisions on the direction the work should take and the form of the final proposal. In addition to the technical contribution provided by the expert committees, a large number of comments and suggestions were received from WHO member states and regional offices as a result of the worldwide circulation of the draft proposals for revision and review. It became clear that many users wished the ICD to encompass types of data other than simply diagnostic information. Even if it was restructured, the ICD could not cope with the extremes of the requirements. The concept was therefore developed of a "family" of classifications, with the main ICD as the core, covering the traditional mortality and morbidity statistics, while the needs for more detailed or different classifications would be dealt with by other members of the family such as the International Classification of Functioning (ICF) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Several alternative models for the restructure of the main ICD were investigated, and the final decision was to use an alphanumeric system, which would give a better balance to the chapters and allow sufficient space for future additions and changes without disrupting the codes. The alphanumeric coding scheme uses one letter followed by three numbers, at the fourth character level. This has more than doubled the size of the coding frame in comparison with the ninth revision and has enabled the vast majority of chapters to be assigned a unique letter or group of letters, each capable of providing 100 three character categories. Of the 26 available letters, 25 have been used the letter U having been left vacant for future additions and changes and for possible interim classifications to solve difficulties arising between revisions. ICD-10 is part of the ICD family of classification systems, which also includes: • International Classification of Functioning, Disability and Health (ICF) • International Classification of Diseases for Oncology (ICD-O) • Application of the International Classification of Diseases to Dentistry and Stomatology (ICD-DA) CBHI ICD 10 Student Workbook December 2004 Page 3 • Application of the International Classification of Diseases to Rheumatology and Orthopaedics (ICD-R&O), including the International Classification of Musculoskeletal Disorders (ICMSD). Overview of the ICD-10 classification ICD-10 is a variable-axis classification - meaning the epidemiological data and statistical data coded to it may be grouped as follows: • epidemic diseases • constitutional or general diseases • local diseases arranged by site • developmental diseases • injuries There are three (3) main elements to the structure of the ICD-10. They are: 1. there are 3 volumes 2. there are 21 chapters 3. the structure of the code is alphanumeric. Volumes of the ICD-10 Volume 1 is the Tabular list, which is an alphanumeric listing of diseases and disease groups, along with inclusion and exclusion notes, some coding rules,special tabulation lists for mortality and morbidity, definitions and regulation. Volume 2 is Instruction Manual.It provides : • an introduction to, and instructions on how to use volumes 1 and 3 • guidelines for certification and rules for mortality coding • guidelines for recording and coding for morbidity coding • Statistical presentation Volume 3 is the comprehensive Alphabetical index of the diseases and conditions found in the Tabular list. Chapters of the ICD-10 The ICD-10 contains 21 chapters, each of which is identified by a Roman Numeral i.e. I, II, III, IV, V etc. When referring to a chapter, you should call it by its chapter number and not by the letters of the codes associated with it. i.e. refer to Diseases of the Digestive System as Chapter XI and not as the K chapter. This is because some chapters contain more than one letter and some letters are used in more than one chapter. Structure of the ICD-10 code The first character of the code is an alpha character, followed by two, three or four numeric characters. CBHI ICD 10 Student Workbook December 2004 Page 4 The structure of the three-character category is: A37 first character A to Z followed by 2 digits Most three-character categories are further subdivided into sub-categories to enable coding of a disease or condition more specifically. A37.1 first character A-Z followed by 2 digits then a point lastly another digit NOTE: In some countries and data collection systems, the decimal point may not be used, but for the purposes of this course the decimal point should be included in all exercises. CBHI ICD 10 Student Workbook December 2004 Page 5 MODULE 2 Volume 1 Tabular List CBHI ICD 10 Student Workbook December 2004 Page 6 Module 2: Volume 1 - Tabular List Important points regarding the Tabular List • Most chapters are associated with particular body systems, special diseases or external factors. There is, however, one exception which is Chapter XVIII “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified”. • The number of categories assigned to a chapter is influenced by the number of diseases and conditions that fall within the scope of the chapter. • Fourteen of the chapters have a single letter assigned to them and use most of the 100 categories available. For example, Chapter XI contains codes ranging from K00 to K93. The codes K94 to K99 have not been used at this stage and have been left vacant for future additions to the classification. • Three chapters have a smaller range of categories assigned to them and share letters. • Four chapters use more than one letter in defining categories. e.g. Chapter II contains codes beginning with C and D. Exercise 1: 1. What is the range of 3-character categories used in Chapter III? 2. Two letters are split between a multiple chapters. Which are they? 3. How many letters does Chapter XX use? Chapters using more than one letter: Chapter I Certain infectious and parasitic diseases Chapter II Neoplasms Chapter XIX Injury, poisoning and certain other consequences of external causes Chapter XX External causes of morbidity and mortality Chapters using same letter Chapters II & III – ‘D’ ; Chapters VII & VIII – ‘H’ A,B C,D S,T V,W,X,Y Look at titles of the chapters of the ICD-10. The chapter titles indicate that the conditions included are wide ranging, therefore a large number of codes are required to cover all the conditions. Using an alpha character at the beginning of the code has allowed for 2,600 available 3-character codes. This in turn allows for a large number of 4 character subcategories. Each 3-character code can have up to 10 subcategories. Blocks Each chapter has been divided into blocks of related conditions. The blocks are then divided into three, four and five digit categories. Three character categories or rubrics Some blocks have three character categories for single conditions. Other blocks contain groups of diseases. Four character categories or rubrics These are not mandatory for reporting at international level but the use of fourth characters adds detail and specificity to the coded data. The use of fourth characters allows up to ten subcategories. The fourth character ‘8 is generally used for “ other” conditions belonging to the three character CBHI ICD 10 Student Workbook December 2004 Page 7 category, and ‘9 conveys similar meaning as the three character category title, without adding any additional information. Conventions The ICD-10 Tabular List (Volume I) makes use of certain abbreviations, punctuations, symbols and instructional terms which must be clearly understood. These are referred to as the coding conventions. Inclusion Terms Within the three and four character rubrics there are usually listed a number of other diagnostic terms in addition to the code title. These are known as "inclusion terms" and are given as examples of diagnostic statements to be classified to that rubric. They may refer to different conditions or be synonyms. They are not a subclassification of the rubric. They are to be used as a guide to the content of the rubric, keeping in mind that the list is not exhaustive. e.g. G91 Hydrocephalus includes acquired hydrocephalus Exercise 2: 1. Does the code L03.0 Cellulitis of finger and toe include paronychia? Exclusion Terms Certain rubrics contain lists of conditions preceded by the word "Excludes". These terms are to be coded elsewhere, not within this category as the code may suggest. The correct code that should be assigned is in parentheses following the term. e.g. Q74 Other congenital malformations of limb(s) excludes polydactyly (Q69.-), reduction defect of limb (Q71-Q73), syndactyly (Q70.-) Exercise 3: 1. Should reduction defects of the feet be coded within the 3-character category Q66? If not, where should they be coded? Glossary descriptions Chapter V Mental and Behavioural Disorders, uses glossary descriptions to indicate the content of rubrics. This device is used because the terminology of mental disorders varies greatly, particularly between different countries and the same name may be used to describe quite different conditions. The glossary is not intended for use by coding staff to make a diagnosis but is intended as a guide for clinicians to indicate the content of the rubric. Dagger and Asterisk convention The dual coding system of creating combinations of codes through attachment of daggers (†) and asterisks (*) has been used in ICD-10, thus allowing the description of a condition in terms of its underlying cause or aetiology (†) and current manifestation (*). This enables a better description of the medical care provided and resources used in its treatment to be given. Using this convention, two codes are assigned for diagnostic statements that contain information about both an underlying generalised disease and a manifestation in a particular organ or site, which is a clinical problem in its own right. The primary code is for the underlying disease and is marked with a dagger (†). An optional code for the manifestation is marked with an asterisk (*). CBHI ICD 10 Student Workbook December 2004 Page 8 It is a basic principle of the ICD that the dagger code is the primary code and must always be used for single condition coding. An asterisk code should never be used alone. When coding underlying cause of death for mortality purposes, the dagger code should be used, never an asterisk code. Dagger and asterisk codes convey different meanings in combinations depending upon the circumstances of placing the signs. ‘+’ with * mark in headin gdenotes same code used for the conditions listed below it. e.g. A 170+ Tuberclulosis memingeo (areoral) (spinal) tuberenlons upto memingitis + without * in the heading but mentioned in codes in parespests below it denotes that different codes are available for the conditions following the dianosis in the heading e.g A 18.1 + Tuberonlosis of genitourinary system Tuberculosis of: Bladder (N 33.0*) Cervix (or 74.0*) None of the symbols ‘+’ & * present in title/heading indicates that there are individual terms with alternative codes. e.g. A 54.8 other gonococcnl infections Gonococcal: Peritonitis + (K 67.1*) Pneumonia + (J17.0*) Septicasmia There are 83 asterisk categories in ICD-10 (listed at the start of relevant chapters) which may be used in conjunction with a dagger code, but must not be used alone. Asterisk categories are listed at the beginning of each chapter, block and rubric where appropriate. Exercise 4: 1. How many asterisk categories are there in Chapter IX, Diseases of the Circulatory System? Parentheses ( ) Parentheses are used in four ways in Volume 1: 1. To enclose supplementary words, which may follow a diagnostic term without affecting the code number to which the words outside the parentheses would be assigned. e.g. G11.1 Early-onset cerebellar ataxia Friedrich’s ataxia (autosomal recessive) 2. To enclose the code to which an exclusion term refers. e.g. B25 Cytomegaloviral disease excludes congenital cytomegalovirus infection (P35.1) 3. To enclose the three-character codes of categories in a particular block. e.g. Diseases of peritoneum (K65-K67) 4. To enclose the dagger code in an asterisk category or the asterisk code in a dagger term. e.g. K77.0* Liver disorders in infectious and parasitic diseases classified elsewhere Hepatitis - cytomegaloviral (B25.1†) CBHI ICD 10 Student Workbook December 2004 Page 9 Exercise 5: 1. Is N13.0 the correct code for Hydronephrosis with ureteropelvic junction obstruction and infection? If not, what is the correct code? Square brackets [ ] Square brackets are used: For enclosing synonyms, alternative words or explanatory phrases. e.g. A84.0 Far Eastern tick-borne encephalitis [Russian spring-summer encephalitis] 2. For referring to notes. e.g. C21.8 Overlapping lesion of rectum, anus and anal canal [see note 5 on page 182] 3. For referring to a previously stated set of fourth character subdivisions common to a number of categories. e.g. F10.- Mental and behavioural disorders due to use of alcohol [see pages 321323 for subdivisions] Exercise 6: 1. What does the note in [ ] tell us for codes in the M79 rubric? Colon : The colon [:] is used in listings of inclusion and exclusion terms when the words that precede it are not complete terms for assignment of the diagnosis to that rubric. In other words, the words require one or more of the modifying or qualifying words indented under the lead term before the diagnosis can be assigned to the rubric. e.g. G71.0 Muscular dystrophy: autosomal recessive benign distal … Brace } A brace is used in listings of inclusion and exclusion terms to indicate that neither the words that precede it nor the words after it are complete terms. In other words, one or more of the terms that follow the brace should be part of the diagnosis, to qualify any of the terms before the brace. e.g. E10.1 Insulin dependent diabetes mellitus with ketoacidosis See the brace under the entry for the relevant fourth character 1. With ketoacidosis Diabetic: Acidosis Ketoacidosis } without mention of coma } CBHI ICD 10 Student Workbook December 2004 Page 10 Not Otherwise Specified (NOS) NOS is an abbreviation for 'not otherwise specified', implying 'unspecified' or 'unqualified'. Coders should be careful not to code a term as unqualified unless it is quite clear that no other information is available that would permit a more specific code assignment from elsewhere in the classification. e.g. K14.9 Disease of tongue, unspecified Glossopathy NOS Not elsewhere classified (NEC) NEC stands for not elsewhere classified. When used in a three-character category title, NEC serves as a warning that certain specified types of the listed conditions may appear in other parts of the classification. e.g. K73 Chronic hepatitis, not elsewhere classified "And" in code titles In Volume 1 of ICD-10, "and" stands for "and/or". e.g. S49.9 Unspecified injury of shoulder and upper arm means Unspecified injury of shoulder or unspecified injury of upper arm or unspecified injury of shoulder and upper arm. Point dash .When used as a replacement for the fourth character of a subcategory, a point dash [.-] indicates to the coder that a fourth character exists and should be sought in the appropriate category in the Tabular list. e.g. D59.1 Other autoimmune haemolytic anaemias Excludes haemolytic disease of fetus and newborn (P55.-) Corrections: There have been some corrections to the Tabular list which have been included in a corrigendum at the back of volume 3.. As noted earlier, as part of the updating process for ICD-10, addenda of changes and updates to the classification are also released. A copy of the updates made to the classification since 1996 are included as an appendix to this manual or is available at http://www3.fhs.usyd.edu.au/ncchwww/site/3.2.htm#10 Coders should ensure that the changes outlined in the corrigenda and the addenda are made before commencing coding. This will assist in maintaining comparability with statistical reporting in other countries, and will ensure that the classification reflects current clinical practice. CBHI ICD 10 Student Workbook December 2004 Page 11 MODULE 2 - ANSWERS Volume 1 Tabular List Exercise 1 1. What is the range of 3-character categories used in Chapter III? D50 to D89. Only some of the codes are used however - have a look through the chapter. Now look at other chapters and compare them. 2. Two letters are split between multiple chapters - which are they? D is used in chapters 2 and 3; H is used in chapters 7 and 8. 3. How many letters does Chapter XX use? 4 letters - V, W, X, Y Exercise 2 1. Does the code L03.0, Cellulitis of finger and toe include paronychia? Yes - it is listed as an inclusion term. Exercise 3 1. Should reduction defects of the feet be coded within the three-character category Q66? No - the exclusion note directs the coder to Q72.Exercise 4 1. How many asterisk categories are there in Chapter IX? 8 - they are listed at the beginning of the chapter. Exercise 5 1. Is N13.0 the correct code for Hydronephrosis with ureteropelvic junction obstruction and infection? If not, what is the correct code? No - the exclusion note under N13.0 excludes hydronephrosis that occurs with infection. The correct code is N13.6. Exercise 6 1. What does the note in [ ] tell us for codes in the M79 category? The coder should refer to pages 628 - 629 for site codes for this category. CBHI ICD 10 Student Workbook December 2004 Page 12 MODULE 3 Volume 3 Alphabetical Index CBHI ICD 10 Student Workbook December 2004 Page 13 Module 3: Volume 3 - Alphabetic Index Important points regarding the Alphabetic Index • Volume 3 is an alphabetic index to the Tabular Listing of Volume 1. As such, it contains far more diagnostic terms than the tabular list, reflecting the many and varied ways that doctors and other clinical staff describe diseases. • Volume 3 consists of: • an Introduction, explaining the purpose of the index, its general arrangement and conventions used in the index • Section I which is an alphabetic listing of terms relating to diseases, nature of injury, reasons for contact with health services and factors influencing a person’s health • Section II which is an alphabetic listing of external causes of injury, morbidity and mortality • Section III, which is an alphabetically arranged table of drugs and chemicals. Structure of Index entries Index entries contain: • Lead terms (usually nouns, sometimes adjectives e.g. carious, tuberculous etc) to the far left of each column, in bold. They refer mainly to the names of diseases or conditions. • Modifiers at different levels of indentation to the right. They usually refer to varieties of sites or circumstances that affect coding. Modifiers which do not affect code assignment appear in parentheses ( ) after the condition. All modifiers appear in alphabetical order except “with” which always appears first. e.g. to code a bilateral inguinal hernia with gangrene and obstruction, firstly identify the lead term (hernia), then follow the series of indentations in the Index until all of the diagnosis description has been covered. Hernia - inguinal - - bilateral - - - with - - - - gangrene (and obstruction) K40.1 Note that there are often many entries at each level of indentation and it is necessary to be careful in following the trail of relevant entries for your diagnosis under each lead term. • Code numbers follow the terms in the index and may appear as a 3-character category or be subdivided with either the appropriate 4th digit or a dash (.-). Where the dual system of coding († and *) applies, both codes are given in the index. The dagger is always mentioned first, followed by the asterisk code. • If you cannot identify the lead term in the Index, there are a number of standard ways that codes can be found. Try using one of the following ‘generic’ lead terms: disease complication syndrome pregnancy labour delivery CBHI ICD 10 Student Workbook December 2004 Page 14 puerperal maternal condition affecting fetus or newborn injury sequelae suicide assault legal intervention war operations counselling observation examination history problem screening status vaccination Exercise 1: Identify the lead term and the modifier in the diagnosis Chronic Bronchitis. Exercise 2: Look up the following conditions in Volume 3 (Alphabetical Index): Laryngotracheobronchitis Hippel’s Disease Anesthesia overdose Mumps with orchitis NOTE: American spelling is used throughout Volume 3, with cross-references diphthongs appear at the beginning of a term wherever eg. Oesophag(o) ... - see Esophag(o) ... However, in Volume 1 so-called English spelling is used. For example: look up Haemochromatosis with refractory anaemia Conventions Parentheses ( ) Parentheses are used in the same way as in Volume 1, to enclose non-essential modifiers which do not affect code assignment. e.g. Deafness (acquired)(complete)(hereditary)(partial) H91.9 Not Elsewhere Classified (NEC) "Not elsewhere classified" indicates that specified variants or types of the disease are classified elsewhere, and that where appropriate, a more precise term should be looked for in the Index. If the specific diagnostic term cannot be found in the Index, then the NEC code can be used indicating that the condition does not have a unique code elsewhere in the classification. CBHI ICD 10 Student Workbook December 2004 Page 15 e.g. Mastoiditis (coalescent)(haemorrhagic)(suppurative) H70.9 - acute, subacute H70.0 - chronic (necrotic)(recurrent) H70.1 - specified NEC H70.8 Cross-references Cross references are used to avoid unnecessary duplication of terms in the Index. "See" requires the coder to refer to the other term. This is a mandatory instruction. e.g. Ingestion - chemical - see Table of Drugs and Chemicals "See also" directs the coder to refer elsewhere in the Index if the statement being coded contains other information that is not found indented under the term to which "see also" is attached. This helps the coders to find the most specific code possible for the diagnosis being coded. e.g. Injury (see also specified injury type) It is imperative that Volumes 1 and 3 be used together in locating codes to accurately describe each clinical case - coders should not fall into the trap of coding straight from the Alphabetical Index or browsing around the Tabular List looking for a code that seems to fit the case being coded. Exercise 3: Assign codes for the following conditions firstly just from Volume 3 (column 1) and then again after completing the coding process through Volume 1 (column 2): ICD-10 Codes Index Tabular Patient diagnosed with: Aortic stenosis _______ _______ and Mitral Insufficiency _______ _______ CBHI ICD 10 Student Workbook December 2004 Page 16 MODULE 3 - ANSWERS Volume 3 Alphabetical Index Exercise 1 1. Identify the lead term and the modifier in the diagnosis Chronic Bronchitis. Lead term - Bronchitis Modifier - Chronic - this is an essential modifier Exercise 2 1. Look up the following conditions in Volume 3, Alphabetical Index: Laryngotracheobronchitis J40 Hippel's Disease Q85.8 Anesthesia overdose T41.- Mumps with orchitis B26.0 † N51.1* Exercise 3 1. Assign codes for the following conditions firstly just from Volume 3 (see column 1) and then again after completing the coding process also using Volume 1 (see column 2): Col 1 Col 2 Aortic stenosis I35.0 I08.0 Mitral insufficiency I34.0 I08.0 CBHI ICD 10 Student Workbook December 2004 Page 17 MODULE 4 Procedure Coding Using the ICHI CBHI ICD 10 Student Workbook December 2004 Page 18 Module 4 : Procedure Coding Using ICHI Important points for Coding with the ICHI ICHI stands for the International Classification of Health Interventions. It was developed by the NCCH in 2002 and is a subset of the Australian procedure classification, the Australian Classification of Health Interventions (ACHI). The ACHI is based on an Australian fee schedule known as the Medicare Benefits Schedule, or MBS. ICHI includes codes for surgical and medical procedures, allied health interventions and dental procedures. The ICHI was created to provide a short and simple classification of procedures and interventions, specifically for countries which have previously used the International Classification of Procedures in Medicine (WHO:1978) and which wish to migrate to a more current classification. It is also for those countries that have not used a procedure classification in the past. The Australian Classification of Health Interventions (ACHI), which is the source of the ICHI, is updated biennially by the National Centre for Classification in Health. The classification has been accepted as a member of the Family of International Health Classifications and consideration is being given to having it published by WHO. ICHI includes an extensive Index and a Tabular list, both published within the one volume. Code numbers are between 1-4 characters in length and are in sequential numerical order in the tabular list. More information about ICHI is available at http://www3.fhs.usyd.edu.au/ncchwww/site/4.1.4.htm Conventions used in the Tabular List of Procedures 1st level - anatomical site axis The principal axis of classification in the ICHI is anatomical site. Within each chapter, the anatomical site has been structured using a superior to inferior, or head to toe, approach. 2nd level - procedural type axis The secondary axis, within the site chapters, relates to procedure type, beginning with the least invasive procedure through to the most invasive procedure. The standard procedural axes are: Examination Application, insertion or removal Incision Destruction Excision Reduction (only applicable to the musculoskeletal chapter) Repair Reconstruction Revision Re-operation Other procedures Block number The block numbers represent the codes in the ICHI and are numbered sequentially to assist coders to locate specific codes. CBHI ICD 10 Student Workbook December 2004 Page 19 There are certain chapters which contains exceptions to the general format of the ICHI. These are: Dental Services This chapter is based on 'An Australian Schedule of Dental Services and Glossary, Sixth Edition, 2000' which is published by the Australian Dental Association Incorporated. In line with its parent schedule, the Dental Services chapter is structured on a service basis e.g. diagnostic services, preventive services, periodontics, oral surgery, etc. Secondary axes generally relate to procedure types. Obstetric Procedures The principal axis of classification in this chapter relates to the pregnancy cycle e.g. antepartum procedures, procedures associated with labour and delivery, postnatal procedures, etc. Secondary axes relate to the type of procedure. Chemotherapeutic and radiation oncology procedures This chapter has, as its principal axis, procedures relating to chemotherapeutic treatment and radiation oncology. Secondary axes within the radiation oncology axis relate to the type of radiation e.g. external beam therapy, brachytherapy, etc. Non-invasive, cognitive and interventions NEC The principal axis of classification in this chapter refers to the purpose of the intervention (diagnostic, therapeutic or administrative/clinical/client support). The secondary axis relates to the type of procedure or the body system. For example, within the primary axis of Diagnostic Interventions, the secondary axes are Assessment, Consultation, Interview, Examination, Evaluation or Diagnostic tests/measures/investigations. In the axis of Therapeutic Interventions, the secondary axes are Counselling, Education, Nutritional Support, Interventions, Immunisation, Injections, Perfusions or Therapeutic interventions. Imaging Services The type of imaging service performed forms the primary (and only) axis of this chapter - e.g. ultrasound, tomography, radiotherapy, etc. Abbreviations NEC is used in the same way as in the ICD-10 to indicate that other specified variants or types of the condition being coded appear in other parts of the classification and should be used if the coder has sufficient information to assign one of the more specific codes. Punctuation Colon : Colons are also used in the same way as the ICD-10 to indicate to the coder that the terms to the left of the colon are incomplete and require a modifier from the terms to the right of the colon for assignment of the code. Instructional terms There are two instructions that are used in the ICHI. These are Code also and Code also when performed. These may be found at the chapter level or at the level of the first or second axis or at the block level. The two instructions indicate to the coder that an additional block code is to be used when certain associated procedures are also performed or where a certain type of equipment is employed. CBHI ICD 10 Student Workbook December 2004 Page 20 Conventions used in the Alphabetic List of Procedures Blocks Block numbers appear in the Index in bold and are located to the right of the text. Sequence Main terms are sequenced alphabetically with hyphens, spaces and symbols preceding numbers and letters of the alphabet. For example: Amnio-infusion 1330 Amniocentesis - diagnostic 1330 - therapeutic 1330 Diathermy - bladder (endoscopic) 1097 - - tumour (single)(solitary)(with resection) 1097 - - - >2cm dia. 1097 - - - - multiple 1097 Numbers, whether Arabic or Roman, are sequenced numerically before alphabetic characters. For example: Suture - obstetric laceration, current (tear) 1344 - - 1st degree 1344 - - 2nd degree 1344 - - - 3rd degree 1344 - - - - 4th degree 1344 - - bladder (and urethra) 1344 - - cervix 1344 The prepositions 'as', 'by', 'for', 'with' and 'without' immediately follow the main term or subterm to which they relate. When the description of a procedure includes both a description beginning with a preposition, and also an alphabetic subterm, the prepositional term takes precedence. For example: Arthoplasty (see also Repair, joint) 1571 - by osseointegration (implantation of titanium fixture) - - digit (finger)(toe) 1698 - for hallux valgus (hallux rigidus)(unilateral) 1547 - - with prosthesis 1547 - - bilateral 1547 - - - with prosthesis 1547 - ankle - - for joint replacement (total) 1544 - Austin Moore, hip 1489 CBHI ICD 10 Student Workbook December 2004 Page 21 Modifiers A main term or a subterm may be followed by a series of terms in parentheses. The presence or absence of these terms makes no difference to the selection of the block code. These terms are called non-essential modifiers. A term may also be followed by subterms, which do have an effect on selection of the appropriate block code. These are called essential modifiers and are found on individual lines at different levels of indentation following the lead term and are preceded by hyphens. Each line represents an essential difference in site or surgical technique. Not Elsewhere Classified (NEC) In the ICHI the NEC convention is used in two ways: ° With ill-defined terms, to serve as a warning that specific forms of the procedure being coded are classified differently. The only time such codes should be used in where more specific information is unavailable. ° Terms for which a more specific category is not provided by the classification and no amount of additional information will alter the selection of the block code. Omit Block This convention may refer to terms that identify incisions that are listed as main terms in the alphabetic list of procedures. If the incision is made only for the purposes of performing further surgery, the instruction 'omit block' is given. For example: Arthrotomy 1555 - as operative approach - omit block - ankle 1529 - elbow 1410 - hip 1481 Omit block may also be used to apply to certain procedures which, when performed with other procedures, should not be coded. For example: Cardioversion 1890 - in conjunction with cardiac surgery - omit block Cross References Cross references point the coder to possible synonyms or modifiers for a term. There are three types of cross references in ICHI. See is an explicit direction to look elsewhere in the classification. See also directs the coder to another lead term for use where the entries under the first term do not provide an appropriate block. See block xxxx indicates that the tabular list should be consulted for further information or specific site references. Eponyms Procedures named after persons are called eponyms. These are listed both as main terms in the appropriate alphabetical sequence and also under the main term 'procedure'. A description of the procedure or the anatomical site usually follows the eponym. CBHI ICD 10 Student Workbook December 2004 Page 22 MODULE 5 Basic Coding Guidelines CBHI ICD 10 Student Workbook December 2004 Page 23 Module 5: Basic Coding Guidelines When coding you must use the Alphabetical Index as well as the Tabular List. These guidelines should be followed when coding using ICD-10 and the ICHI. 1. Identify the type of statement to be coded and refer to the appropriate section of the Alphabetical Index. (If the Statement is a disease or injury or other condition classifiable to Chapters I-XIX or XXI, consult Section I of the Index. If the statement is the external cause of an injury or other event classifiable to Chapter XX, consult Section II. If the statement is a procedure, surgery or other intervention, refer to ICHI) 2. Locate the lead term. For diseases and injuries this is usually a noun for the pathological condition. However, some conditions expressed as adjectives or eponyms are included in the Index as lead terms. 3. Read and be guided by any note that appears under the lead term. 4. Read any terms enclosed in parentheses after the lead term, as well as any terms indented under the lead term, until all the words in the diagnostic term have been accounted for. 5. Follow carefully any cross-references ("see" and "see also") found in the Index. 6. Refer to the Tabular List to verify the suitability of the code number selected. 7. Be guided by any inclusion or exclusion terms under the selected code or under the chapter, block or category heading. 8. Assign the code. CBHI ICD 10 Student Workbook December 2004 Page 24 MODULE 6 Overview of Morbidity Coding CBHI ICD 10 Student Workbook December 2004 Page 25 Module 6: Overview of Morbidity Coding This section covers the coding of diagnoses and other reasons for contact with health services. Prior to 1948, the International Classification of Diseases was used only for mortality coding. With the 6th revision of ICD in 1948 came the recognition of its potential for morbidity coding. The 6th revision then became an expanded version that included codes for non-fatal conditions. This expansion has continued ever since - there has been a steady increase in the number of categories for coding non-fatal conditions and other health-related circumstances. For the purposes of ICD, the term morbidity covers illness, injuries and reasons for contact with health services including screening and preventive care. Coding usually relates to an episode of health care in a health institution but may also apply to surveys or other diagnostic data. Morbidity usually relates to a single episode of health care. An episode of health care may be defined as: • A period of inpatient care; or • a contact (or series of contacts in a specific time period) with a health care practitioner in relation to the same condition or its immediate consequences. Sources of morbidity data Sources of data for morbidity coding include: • • • • • • • • • • • Hospital records School medical records Death certificates Armed services records Occupational medical records Health surveys Outpatient records (ambulatory care) Maternal and child health services records Disease surveillance records e.g. vaccine preventable diseases, HIV etc. Cancer and chronic disease registry records Other Uses of morbidity data Morbidity data may be used, among other things, to provide clues to causes of disease, and it may form the basis on which decisions are made about previous measures or the allocation of resources or priorities for disease prevention programs. Central concepts for morbidity coding • At the end of an episode of care, the clinician should record all conditions which affected the patient in that period. CBHI ICD 10 Student Workbook December 2004 Page 26 • Practice may vary from establishment to establishment or health authority to health authority in some places, one diagnosis will be singled out for coding (single-condition coding) while in other places, all diagnoses will be coded for each episode of care (multi-condition coding). Coders need to be aware of the policy of their establishments in this regard. Why single-condition coding? Some establishments may implement this policy because of lack of resources (e.g. coding, administrative) or because the resultant simpler data may be more appropriate for its needs. With single-condition coding, there is the need to choose the main condition from the set of diagnoses so that it can then be coded. Section 4.4 of Volume 2 (page 96) concerns the rules and guidelines adopted by the World Health Assembly regarding the selection of a single cause or condition for routine tabulation from morbidity records, and also guidelines for the application of the rules and for coding of the condition selected for tabulation. The following is an excerpt from this section - you should read the entire section to ensure you understand the WHO requirements for morbidity coding. The condition to be used for single-condition morbidity analysis is the main condition treated or investigated during the relevant episode of health care. The main condition is defined as the condition, diagnosed at the end of the episode of health care, primarily responsible for the patient’s need for treatment or investigation. If there is more than one such condition, the one held most responsible for the greatest use of resources should be selected. If no diagnosis was made, the main symptom, abnormal finding or problem should be selected as the main condition…By limiting the analysis to a single condition for each episode, some available information may be lost. It is therefore recommended, where practicable, to carry out multiple condition coding and analysis to supplement the routine data. Clinicians and coders will have no trouble in choosing a main condition if the patient is treated for only one condition during an episode of care but many cases are not that simple. What distinguishes the main condition (MC) from the rest of the recorded conditions? • The main condition is the diagnosis established at the end of the episode of health care to be the condition primarily responsible for the patient receiving treatment or being investigated i.e. that condition which is determined as being mainly responsible for the episode of health care. What then are other conditions (OC) which might be coded? • Other conditions are defined as those that coexist or develop during the episode of health care and affect the management of the patient. For coding purposes, other conditions (also known as additional diagnoses) should be interpreted as conditions that affect patient management in terms of requiring any of the following: • • • therapeutic treatment diagnostic procedures increased nursing care and/or monitoring One or more of the above factors will generally result in an extended length of hospital stay. CBHI ICD 10 Student Workbook December 2004 Page 27 Rules for reselection of main condition In some instances, the Main Condition recorded by the clinician may not be consistent with the WHO definition. Alternatively, no Main Condition may have been specified. WHO has developed a set of rules that can be used to ensure that the Main Condition selected and coded reflects the condition mainly responsible for the episode of care. Coders need to be familiar with these rules and be able to apply them. More information and examples of the rules is available in volume 2 of ICD-10. MB1. Minor condition recorded as main condition, more significant condition recorded as other condition. • Where a minor or longstanding condition, or an incidental problem, is recorded as the main condition, and a more significant condition, relevant to the treatment given and/or the specialty that cares for the patient, is recorded as an other condition, reselect the latter as the main condition. Exercise 1: MC Gastritis OC Carcinoma of the intestine Proc Colectomy LOS 5 weeks MC = ICD-10 code = Exercise 2: MC Impacted wisdom tooth OC Hypertensive heart disease Neuralgia Halitosis Proc Dental extraction Spec Dentistry LOS 2 days MC = ICD-10 code = Review the examples for applying MB1 on page 107-108 of Volume 2. MB2. Several conditions recorded as main condition. • If several conditions that cannot be coded together are recorded as the main condition, and other details on the record point to one of them as the main condition for which the patient received care, select that condition. Otherwise select the condition first mentioned. Exercise 3: MC Bilateral bunions Secondary lesion, lymph node Cancer of breast Proc Mastectomy MC = ICD-10 code = CBHI ICD 10 Student Workbook December 2004 Page 28 Exercise 4: MC Premature rupture of membranes Breech presentation Anaemia of pregnancy Proc Spontaneous Vaginal Delivery MC = ICD-10 code = Review the examples for MB2 on pages 108-110 of Volume 2. MB3. Condition recorded as main condition is presenting symptom of diagnosed, treated condition • If a symptom or sign (usually classifiable to Chapter XVIII), or a problem classifiable to Chapter XXI, is recorded as the main condition and this is obviously the presenting sign, symptom or problem of a diagnosed condition recorded elsewhere and care was given for the latter, reselect the diagnosed condition as the main condition. Exercise 5: MC Abdominal pain OC Acute appendicitis Proc Appendicectomy MC = ICD-10 code = Exercise 6: MC Faecal incontinence OC Angina Crohn’s Disease, large intestine Proc Partial excision, colon MC = ICD-10 code = Review the examples of MB3 on pages 110-111 of Volume 2. MB4. Specificity • Where the diagnosis recorded as the main condition describes a condition in general terms, and a term that provides more precise information about the site or nature of the condition is recorded elsewhere, reselect the latter as the main condition. Exercise 7: MC Congenital heart disease OC Ventricular septal defect MC = ICD-10 code = Review the examples of MB4 on page 111 of Volume 2. CBHI ICD 10 Student Workbook December 2004 Page 29 MB5. Alternative main diagnoses • Where a symptom or sign is recorded as the main condition with an indication that it may be due to either one condition or another, select the symptom as the main condition. Where two or more conditions are recorded as diagnostic options for the main condition, select the first condition recorded. Exercise 8: MC Nausea and vomiting due to food poisoning or appendicitis OC MC = ICD-10 code = Exercise 9: MC Abdominal pain due to acute cholecystitis or acute pancreatitis OC MC = ICD-10 code = Exercise 10: MC Gastroenteritis due to Salmonella or gastroenteritis due to Yersinia OC MC = ICD-10 code = Guidelines for coding of the main condition and other conditions • Selection of the main condition should be done by the clinician caring for the patient or may, if necessary, be identified at the time of coding, by application of the rules for reselection. • Once the main condition has been selected correctly, you may then code the case, following normal procedures. • For guidelines to selection of the correct code for MC, see Volume 2, section 4.4. • The sequence to follow for morbidity coding is as follows: All cases Single-condition coding Multi-condition coding Multi-condition coding Selection of MC Code MC Code other conditions • Where practicable, other conditions should be recorded, even when single-cause coding is to be performed. This provides the coder with a fuller picture of the case, thus making it easier to assign a more specific ICD code for the main condition or to verify the main diagnosis using the rules. Optional additional codes Before continuing further, you should read Section 4.4.2 of Volume 2. The ICD-10 classification itself sometimes indicates when a "main condition" can be made more specific by the addition of another code. CBHI ICD 10 Student Workbook December 2004 Page 30 Example: Acute pulmonary oedema due to exposure to sulphur dioxide fumes MC = Acute pulmonary oedema OC = Accidental poisoning by and exposure to other gases and vapours ICD-10 code = J68.1 ICD-10 code = X47.9 Instruction under J68 states “use additional external cause code (Chapter XX), if desired, to identify cause. • Coding of conditions to which the dagger and asterisk system applies (dual system) Example: MC = Post chickenpox encephalitis ICD-10 code = B01.1† G05.1* The dagger and asterisk codes should be used together, wherever possible, because they describe different aspects of the condition. The dagger code is the preferred main condition. See page 100 of Volume 2 for further details. • External causes of morbidity and injuries Injuries may be classified by their nature (Chapter XIX) and by the external cause that led to the injury (Chapter XX). Both codes should be used but the nature of the injury code is the preferred main condition for morbidity coding. Example: Fracture of skull - motorcycle passenger in head-on collision with pick-up truck. MC = Fractured skull ICD-10 code = S02.9 OC = Circumstances of accident ICD-10 code = V23.5 See page 103 of Volume 2 for further details. • Sequelae (late effects) of certain conditions A number of categories entitled “ sequelae of …..”( B90-B94, E64.-,G09, I69.-, 097, T90-T98, Y85=Y89) are available which enable the coding of a past condition which is itself no longer present, but which is the cause of a present problem. In such a case, the current condition is the preferred main condition. However, where a past condition is responsible for the presence of multiple current conditions and not one of the current conditions can be identified as predominant, then the sequela code (for past condition) may be used as the preferred main condition and followed by codes for each of the current conditions. CBHI ICD 10 Student Workbook December 2004 Page 31 Example: Entropion due to old inactive trachoma MC = Entropion OC = Sequela of trachoma ICD-10 code = H02.0 ICD-10 code = B94.0 See page 104 of Volume 2 for further details. • Coding of suspected conditions, unexplained symptoms and abnormal findings and nonillness situations Codes from Chapters XVIII and XXI should only be used if the clinician is unable to describe the case more specifically. If the final diagnosis is “suspected” or “questionable” or if it is documented with a question mark (?), it should be coded as if it is a certain diagnosis. Example: Suspected intracranial space-occupying lesion (abnormal Skull X-Ray) - not yet diagnosed MC = Abnormal findings on diagnostic imaging of central nervous system - intracranial space-occupying lesion ICD-10 code = R90.0 See page 100 of volume 2 for further details. • Multiple conditions Categories exist which allow indication of multiple conditions within one code (this mainly applies mainly to conditions associated with HIV). Where appropriate, a multiple code can be used as main condition, and additional codes may appear to describe each of the conditions specifically. This is only an issue if no one single condition is indicated by the clinician as the MC or if none can be stated as the predominant focus of treatment. Example: Pneumocystis carinii pneumonia, Tuberculosis, Dementia due to HIV Single condition coding MC= HIV resulting in multiple disease classified elsewhere ICD-10 code = B22.7 Multiple condition coding MC = HIV resulting in multiple disease classified elsewhere OC = Pneumocystis carinii pneumonia due to HIV Tuberculosis resulting from HIV Dementia (non-organic) resulting from HIV ICD-10 code = B22.7 ICD-10 code = B20.6 ICD-10 code = B20.0 ICD-10 code = B22.0 CBHI ICD 10 Student Workbook December 2004 Page 32 Example: Fractures of multiple bones in right lower leg and forearm Single condition coding MC = Fractures involving multiple regions of upper limbs with lower limbs ICD-10 code = T02.6 Multiple condition coding MC = Fractures involving multiple regions of upper limbs with lower limbs OC = Multiple fractures of lower leg OC = Multiple fractures of forearm ICD-10 code = T02.6 ICD-10 code = S82.7(0) ICD-10 code = S52.7(0) See page 101 of Volume 2 for further details. • Combination categories This is where the presence of two or more conditions (or a condition plus associated conditions) can be represented by one code. Example: Viral hepatitis B with hepatic coma MC = Acute hepatitis B without delta-agent with hepatic coma ICD-10 code = B16.2 Kyphoscoliosis with related heart disease MC = Kyphoscoliotic heart disease ICD-10 code = I27.1 See page 101 of Volume 2 for further details. • Acute (or subacute) on chronic conditions Where the patient is suffering an acute exacerbation of a chronic illness and there is no combination category available, the acute aspect of the condition should be assigned as the preferred main condition, with the chronic aspect as an optional additional code. Example: Acute on chronic appendicitis MC = acute appendicitis OC = chronic appendicitis ICD-code = K35.9 ICD-code = K36 See page 104 of volume 2 for further details. • Postprocedural conditions and complications The code range T80-T88 (Chapter XIX) is available to classify certain complications relating to surgical and other procedures. Complications coded here generally affect the whole body. Other categories are also provided near the end of most body system chapters for conditions which occur either as a consequence of specific procedures and techniques or as a result of the absence of an organ or postprocedural conditions which affect a specific body system. CBHI ICD 10 Student Workbook December 2004 Page 33 Postprocedural conditions or complications are defined as: • conditions caused by acquired absence of an organ; • any conditions resulting from surgical procedures; • the after-effect of radiotherapy or similar treatment. Some conditions are common post procedurally. They are coded in the normal way but an additional code may be used to identify the relationship of the condition to a previous procedure. The additional code would be assigned from Chapter XX, External causes of morbidity and mortality (Y83 and Y84). When a postprocedural condition or complication is recorded as the main condition, it is essential that the coder refers to modifiers in the Index to ensure arrival at the correct code. Example: Postgastrectomy dumping syndrome MC = Postgastric surgery syndromes ICD-code = K91.1 SPECIFIC NOTES Section 4.4.4 on p.112 of Volume 2, contains specific guidance notes to each chapter of ICD-10. The Tabular List and the Index refer the coder to these notes where they apply to a code. When the coder comes across such a reference, he/she should read the relevant note in 4.4.4 before assigning the code. The general guidelines and rules as discussed previously apply to all chapters unless a specific chapter note states otherwise. CBHI ICD 10 Student Workbook December 2004 Page 34 MODULE 6 - ANSWERS Overview of morbidity coding Exercise 1 MC Carcinoma of Intestine ICD-10 code C26.0 Exercise 2 MC Impacted Wisdom tooth ICD-10 code K01.1 Exercise 3 MC Cancer of Breast ICD-10 code C50.9 Exercise 4 MC Premature Rupture of Membranes ICD-10 code O42.9 Exercise 5 MC Acute Appendicitis ICD-10 code K35.9 Exercise 6 MC Crohn's disease, large intestine ICD-10 code K50.1 Exercise 7 MC Ventricular Septal Defect ICD-10 code Q21.0 Exercise 8 MC Nausea and Vomiting ICD-10 code R11 Exercise 9 MC Acute cholecystitis ICD-10 code K81.0 Exercise 10 MC Gastroenteritis due to Salmonella ICD-10 code A02.0 CBHI ICD 10 Student Workbook December 2004 Page 35 MODULE 7 Overview of Mortality Coding CBHI ICD 10 Student Workbook December 2004 Page 36 Module 7: Overview Of Mortality Coding Important points for mortality coding chapter • The International Classification of Diseases has its origins in the preparation of mortality statistics. • Death certificates are the main source of mortality data. Information on death certificates may be provided by either a health practitioner or in the case of accidents or violent deaths, a coroner. In some jurisdictions, another official (who may not be medically trained) is responsible for the completion of the medical certificate of cause of death. • The person certifying the cause of death will enter the sequence of events leading to the death on the death certificate in the international format specified by WHO. See page 31 of Volume 2 for further information. International Form of Medical Certificate of Cause of Death Cause of Death I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…………………………….. due to or as a consequence of Approximate interval between onset and death (b)…………………………… due to or as a consequence of …………………... (c)……………………………… due to or as a consequence of …………………... (d)……………………………. …………………... II Other significant conditions contributing to the death, but not related to the disease or condition causing it …………………… ………………………………………… …………………… ………………………………………… …………………… ………………………........................… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. • WHO recommends that, where practicable, a separate certificate should be used to record perinatal death. An international format is also recommended for this certificate. See page 90 of volume 2 for a sample of the Certificate of Cause of Perinatal Death and further information about coding perinatal deaths. CBHI ICD 10 Student Workbook December 2004 Page 37 Exercise 1: Mortality data, in the form of ICD codes, is mainly used for a particular purpose. Is it: 1. Analysis of current causes of death ? 2. Management of public health ? 3. Prevention of major causes of death ? Concept of underlying cause of death: Many Death Certificates give only a single cause of death. These are relatively simple to deal with and all you have to do is code the single cause. However, in many other cases, two or more morbid conditions contribute to death. These must all be recorded on the certificate. In such cases it has been the practice in vital statistics to select one of the causes of death for coding and reporting purposes. This single cause is called the Underlying Cause of Death. The concept of the underlying cause of death is central to mortality coding. WHO has defined the underlying cause of death as: • the disease or injury which initiated the train of morbid events leading directly to death; or • the circumstances of the accident or violence which produced the fatal injury. Therefore, the underlying cause of death is the condition, event or circumstances without which the patient would not have died. For example, a cancer patient dies and the immediate cause of death was heart failure resulting from carcinomatosis. However, the original neoplasm site was colon. The sequence would be malignant neoplasm resulting in carcinomatosis resulting in heart failure. In this example, the heart failure was the final morbid event in the sequence, starting with cancer of the colon. The malignant neoplasm of the colon is the condition to be coded as the underlying cause of death. Exercise 2: What would be the underlying cause of death in this case? Coma resulting from subdural haematoma after a fall from a ladder at work. By the time the death certificate reaches you for coding, the health care practitioner or certifier should have recorded: • • the sequence of morbid events leading to death the original cause of the sequence Preferably the death certificate used should be the international form recommended by the WHO. This has 2 parts. • Part I - is used for diseases related to the sequence of events leading directly to the death. • Part II - is used for unrelated conditions which have no direct connection with the events leading to death but which, by their nature, contributed to death. Part I of the form has 3 - 4 lines, depending on the local practice, to record the sequence of events leading to death. CBHI ICD 10 Student Workbook December 2004 Page 38 Exercise 3: Where do you think the underlying cause of death should be entered on the death certificate shown on the first page of this module? Where two or more conditions must be recorded, the certifying practitioner should record the sequence of events leading to death. Each event in the sequence should be recorded on a separate line, in reverse order. • • • The direct cause of death is entered on the first line The underlying cause of death is entered on the lowest used line Any intervening causes are entered on the lines between the first line and the lowest used line. The completed certificate therefore contains the following information: I(a) Direct cause (b) Intervening Cause of (a) (c) Intervening cause of (b) (d) Originating cause of (c) In terms of the previous example of heart failure, carcinomatosis and cancer of the colon, the completed certificate would look like this: I(a) Heart failure (b) Carcinomatosis (c) Cancer of the colon II There are two ways of classifying injuries: • By their nature (chapter XIX) • By the external cause resulting in the injury (chapter XX) For mortality purposes it is the external cause that should be used for single cause coding and tabulating underlying cause. You should note that whilst most of the ICD is used for coding underlying cause of death, there are particular sections and codes that should NOT be used for this purpose. For example asterisk codes should not be used to classify underlying cause of death. Exercise 4: Find the following examples of codes that are not used to code underlying cause of death. Why do you think that they are not used? B95-B97 Bacterial, viral and other infectious agents G97,H95, N99 Post procedural disorders (Note the cross reference to Section 4.2.6 “Operations” on page 71) O80 -O84 Method of delivery S00 - T98 Injury, poisoning and certain other consequences of external causes. CBHI ICD 10 Student Workbook December 2004 Page 39 Selecting the underlying cause of death The World Health Organisation has defined a set of procedures or coding rules to be followed for coding the underlying cause of death. This series of steps will be outlined in the following pages. When coding, for each case the rules should be applied in a logical sequence beginning with the General Principle. General Principle: When more than one condition is entered on the certificate, the condition entered alone on the lowest used line of part I should be selected only if it could have given rise to all the conditions entered above it. • Example: I(a) Abscess of lung (b) Lobar pneumonia Select lobar pneumonia (J18.1) as the underlying cause as the lung abscess could have been the result of the lobar pneumonia . Exercise 5: Select the underlying cause, applying the general principle: I (a) Hepatic failure (b) Bile duct obstruction (c) Carcinoma of head of pancreas In about 25% of cases the General Principle cannot be applied for some reason. Rules 1, 2 and 3 then need to be applied. Rule 1 If the General Principle does not apply and there is a reported sequence terminating in the condition first entered on the certificate, select the originating cause of this sequence. If there is more than one sequence terminating in the condition mentioned first, select the originating cause of the first-mentioned sequence. In other words, Rule 1 applies when there is a reported sequence but the General Principle cannot be applied. For example, rule 1 may be applied when there is more than one condition entered on the lowest used line Example: I(a) Bronchopneumonia (b) Cerebral infarction and hypertensive heart disease Select cerebral infarction. There are two reported sequences terminating in the condition first entered on the certificate; bronchopneumonia due to cerebral infarction, and bronchopneumonia due to hypertensive heart disease. The originating cause of the first-mentioned sequence is selected. Rule 1 is also invoked if the single condition entered on the lowest used line on the certificate could not have resulted in all of the conditions listed above. CBHI ICD 10 Student Workbook December 2004 Page 40 Example: I(a) Acute myocardial infarction (b) Atherosclerotic heart disease (c) Influenza Select atherosclerotic heart disease. The reported sequence terminating in the condition first mentioned on the certificate is acute myocardial infarction due to atherosclerotic heart disease. Influenza could not have caused the atherosclerotic heart disease or the myocardial infarction. Exercise 6: Select the underlying cause: I(a) Pericarditis (b) Uraemia and pneumonia If there is no logical sequence, Rule 2 should be applied. Rule 2 If there is no reported sequence terminating in the condition first entered on the certificate, select this first-mentioned condition. Example: I(a) Pernicious anaemia and gangrene of foot (b) Atherosclerosis Select pernicious anaemia (D51.0). There is no reported sequence terminating in the pernicious anaemia, which is the first mentioned condition. Exercise 7: Select the underlying cause of death: I(a) Fibrocystic disease of the pancreas (b) Bronchitis and bronchiectasis In some cases there is a condition reported in Part I or II that has not been selected using the General rule or Rule 1 or 2, but which could have obviously caused the other conditions on the certificate. In these cases rule 3 is applied. Rule 3 If the condition selected by the General Principle or by Rule 1 or Rule 2 is obviously a direct consequence of another reported condition, whether in Part I or Part II, select this primary condition. Note that there is a lot of information about assumed consequences of other reported conditions in Volume 2. This information should be read carefully. Example: I(a) Bronchopneumonia II Secondary anaemia and chronic lymphatic leukaemia CBHI ICD 10 Student Workbook December 2004 Page 41 Select chronic lymphatic leukaemia (C91.1). Bronchopneumonia, selected by the General Principle, and secondary anaemia can both be considered direct sequels of chronic lymphatic leukaemia. Exercise 8: Select the underlying cause of death. I(a) Nephrectomy II Clear Cell carcinoma of kidney Some conditions are assumed to be direct consequences of another condition such as: Burkitt’s tumour, Kaposi’s sarcoma, malignant neoplasms of lymphoid, Aaematopoietic and related tissue – considered to be a direct consequence of HIV disease. Any infection classifiable to Aoo-B19, B25-B49, B58-B64, B-99 or J12-J18 – considered as direct consequence of HIV disease. Pnenmonia, from chopnenmomia – acceptable as complication of any disease such as malnutrition, matignant neoplasm, paralysis, injuries etc. Rules for modification: In some cases the underlying cause that has been selected using the above rules is not the most useful or informative for public health or prevention purposes, e.g. senility or a general disease process such as atherosclerosis. In such cases modification rules may need to be applied after the General Principle, Rule 1, Rule 2 and Rule 3 have been applied. There are 6 modification rules (A-F). Rule A. Senility and other ill-defined conditions Where the selected cause is ill-defined and a condition classified elsewhere is reported on the certificate, reselect the cause of death as if the ill-defined condition had not been reported, except to take account of that condition if it modifies the coding. The following conditions are considered ill-defined: I46.9 (Cardiac arrest, unspecified), I95.9 (Hypotension unspecified), I99 (Other and unspecified disorders of circulatory system), J96.0 (Acute respiratory failure), J96.9 (Respiratory failure unspecified), P28.5 (Respiratory failure of newborn), R00-R94 or R96-R99 (Symptoms, sings and laboratory findings, not elsewhere classified). Note that R95 (Sudden Infant Death Syndrome) is not regarded as ill-defined. Example: I(a) Senility and hypostatic pneumonia (b) Rheumatoid arthritis Code to rheumatoid arthritis(M06.9). Senility, selected by Rule 2, is ignored and the General Principle applied. Exercise 9: Select the underlying cause of death. I(a) Myocardial degeneration and emphysema (b) Senility CBHI ICD 10 Student Workbook December 2004 Page 42 Rule B. Trivial conditions Where the selected cause is a trivial condition unlikely to cause death, and a more serious condition (any condition except an ill-defined or another trivial condition) is reported, reselect the underlying cause as if the trivial condition had not been reported. If the death was the result of an adverse reaction to treatment of the trivial condition, select the adverse reaction. When a trivial condition is reported as causing any other condition, the trivial condition is not discarded, i.e. Rule B is not applicable. Example: I(a) Dental caries II Diabetes Code to diabetes (E14.9). Dental caries, selected by the General Principle is ignored, as it may be considered a trivial condition. Example: I(a) Septicaemia (b) Impetigo Code to impetigo (L01.0). The trivial condition selected by the General Principle is not discarded since it is reported as the cause of another condition, in this case the cause of the septicaemia. Exercise 10: Select the underlying cause of death. I(a) Ingrowing toenail and acute renal failure Rule C. Linkage Where the selected cause is linked by a provision in the classification or in the notes for use in underlying cause mortality coding with one or more of the other conditions on the certificate, code the combination. Where the linkage provision is only for the combination of one condition specified as due to another, code the combination only when the correct causal relationship is stated or can be inferred from application of the selection rules. Where a conflict in linkage occurs, link with the condition that would have been selected if the cause initially selected had not been reported. Make any further linkage that is applicable. See Section 4.1.11 and 4.1.12 of Volume 2 for Notes for use in underlying cause mortality coding for detailed instruction on linkages to be applied by the classification. These linkages are given in description and code tables, and indicate how to code cases where one condition is reported as the originating antecedent cause of another condition, or if a condition is reported with mention of another condition elsewhere on the death certificate. Example: I(a) Intestinal obstruction (b) Femoral hernia Code to femoral hernia with obstruction (K41.3). CBHI ICD 10 Student Workbook December 2004 Page 43 Example: I(a) Acute myocardial infarction (b) Atherosclerotic heart disease (c) Influenza Code to acute myocardial infarction (I21.9). Atherosclerotic heart disease, selected by Rule 1, links with acute myocardial infarction (see Section 4.1.11, Volume 2). Exercise 11: Select the underlying cause of death. I(a) Cerebral infarction (b) Hypertension (c ) Atherosclerosis Rule D. Specificity Where the selected cause describes a condition in general terms and a term that provides more precise information about the site or nature of this condition is reported on the certificate, prefer the more informative term. This rule will often apply when the general term becomes an adjective qualifying the more precise term. Example: I(a) Meningitis (b) Tuberculosis Code to tuberculous meningitis (A17.0). The conditions are stated in the correct causal relationship. Exercise 12: Select the underlying cause of death. I(a) Rheumatic heart disease, mitral stenosis Rule E. Early and late stages of disease Where the selected cause is an early stage of a disease and a more advanced stage of the same disease is reported on the certificate, code to the more advanced stage. This rule does not apply to a "chronic" form reported as due to an "acute" form unless the classification gives special instructions to that effect. Example: I(a) Tertiary syphilis (b) Primary syphilis Code to tertiary syphilis (A52.9). Example 13: Select the underlying cause of death. I(a) Chronic myocarditis (b) Acute myocarditis CBHI ICD 10 Student Workbook December 2004 Page 44 Rule F. Sequelae Where the selected cause is an early form of a condition for which the classification provides a separate "Sequelae of …" category, and there is evidence that death occurred from residual effects of this condition rather than from those of its active phase, code to the appropriate "Sequelae of …" category. Example: I(a) Pulmonary fibrosis (b) Old pulmonary tuberculosis Code to sequelae of respiratory tuberculosis (B90.9). Exercise 14: Select the underlying cause of death. I(a) Hydrocephalus (b) Tuberculosis meningitis Using the Medical Mortality Data System (MMDS) Decision Tables to select the Underlying Cause of Death (UCOD) 1 The MMDS Decision Tables are used to assist with the allocation of the correct UCOD and assignment of valid multiple cause codes. The Decision Tables are a collection of lists which provide guidance and direction in the application of the selection and modification rules published in Volume 2 of ICD-10. Although originally designed for use with the automated coding software available from the National Center for Health Statistics in the USA, they are also useful for assisting coders with decisions about acceptable and non-acceptable sequences. Details regarding the use of each of the tables are outlined below. Table A lists each ICD-10 code that is valid for use in both multiple and underlying cause coding Table B lists those codes valid for use in multiple cause coding but NOT underlying cause coding Table C lists all ICD-10 codes that are invalid for BOTH multiple and underlying cause coding. Table D is used to determine the causal relationships of conditions listed on the medical certificate of cause of death. The ‘address code’ is displayed at the top of lists of codes and code ranges (‘sub addresses’) that have a valid causal relationship appear below the address code. The address code is the code listed on the UPPER line of Part I. The sub address codes identify conditions which can give rise to, or cause, that condition. Conditions for which codes are not listed cannot cause the condition specified by the address code – in other words, they are non-acceptable sequences. This table is used to determine the causal relationships when applying the General Principle and Selection Rules 1 and 2. Table D ambivalent causal relationships There are some ICD-10 code sub addresses that have an ambivalent causal relationship to the condition listed in the address code. That is, they may or they may not have an acceptable causal relationship. This applies to all sub addresses marked with the letter “M”. When the MMDS encounters such a code, the system assumes the relationship to be acceptable but the record is listed for nosological review in case the relationship is, in fact, unacceptable. A coder is required to make the final decision about the use of the code. CBHI ICD 10 Student Workbook December 2004 Page 45 In order to minimise the size of Table D those codes which are infrequently used in mortality coding have not been included as addresses. Therefore certain codes listed in Table A are not found as address codes in Table D and the use of these codes will require further review by the coder to confirm the diagnosis. Table E is the Modification Table and is used for application of Selection Rule 3, Modification Rule A Senility and ill-defined conditions, Modification Rule C Linkage and Modification Rule D Specificity. Modification Rules E Early and late stages of disease and F Sequelae are also integrated into Table E. The address code in Table E is the tentative underlying cause code. That is, the code selected after the application of the General Principle and Selection Rules 1 and 2. This code may be modified a number of times before determination of the final underlying cause. The ICD-10 sub address codes identify conditions which will either combine with the tentative UCOD code or direct the coder to use a preferred code. In either case, the new code becomes the address code. This process may be repeated several times before assignment of the final UCOD code. The use of Table E requires the understanding of a number of symbols and acronyms that alert coders to special conditions and circumstances that must be met before assigning individual sub address codes as the underlying cause. Table E Symbols The symbol ‘M’, as for Table D, denotes an ambivalent relationship and should be processed in the same way as for Table D. The symbol “#” denotes special considerations in the application of Modification Rule C Linkage. Where a condition listed in ICD-10 categories C000 to D489 Neoplasms, is marked with the # symbol, the address may be reported in Part I and the sub address may be reported in Part II or vice versa. Normally, to apply Rule C to neoplasm codes both conditions must be reported TOGETHER in Part I, or TOGETHER in Part II. To apply Rule C to categories F03, F09 and F29, certain sub addresses must be reported on the same line as the address code in order to be selected by Rule C. These subaddresses are flagged with the “#” in Table E. Table E Acronyms DS: (Selection Rule 3) When the tentative underlying cause is considered a direct sequel (DS) of another condition on the certificate in Part I because it is reported on the same or a lower line as the tentative underlying cause, or if is reported in Part II, the code for that other condition is preferred over the code for the tentative underlying cause. DSC: (Selection Rule 3) When the tentative underlying cause is considered a direct sequel of another condition on the certificate in Part I (must be on the same or lower line as tentative underlying cause) or in Part II, and the codes for the tentative underlying cause and the other condition combine into a third code. IDDC: (Modification Rule A) When the tentative underlying cause is an ill-defined condition in the due to position to another condition, and the codes for the tentative underlying cause and the other condition combine into a third code. CBHI ICD 10 Student Workbook December 2004 Page 46 SENMC: (Modification Rule A) When the tentative underlying cause is senility (R54), and this condition is reported with mention of another condition on the certificate, and the codes for the tentative underlying cause and the other condition combine into a third code. SENDC: (Modification Rule A) When the tentative underlying cause is senility (R54), and is reported in a due to position to another condition, and the codes for the tentative underlying cause and the other condition combine into a third code. LMP: (Modification Rule C) When the tentative underlying cause is reported with mention of another condition in Part I or Part II of the certificate, and the code for the other condition is preferred over the code for the tentative underlying cause. LMC: (Modification Rule C) When the tentative underlying cause is reported with mention of another condition, in Part I or Part II of the certificate, and the codes for the tentative underlying cause and the other condition combine into a third code. LDP: (Modification Rule C) When the tentative underlying cause is reported in the due to position to another condition, and the code for the other condition is preferred over the code for the tentative underlying cause. LDC: (Modification Rule C) When the tentative underlying cause is reported in the due to position to another condition, and the codes for the tentative underlying cause and the other condition combine into a third code. SMP: (Modification Rule D) When the tentative underlying cause describes a condition in general terms, and a condition which provides more precise information about the site or nature of this condition is reported anywhere on the certificate, the code for the more precise condition is preferred over the code for the tentative underlying cause. SMC: (Modification Rule D) When the tentative underlying cause describes a condition in general terms, and a condition which provides more precise information about the site or nature of this condition is reported anywhere on the certificate, and the codes for the tentative underlying cause and the other condition combine into a third code. SDC: (Modification Rule D) When the tentative underlying cause is reported in the due to position to another condition, and can be regarded as an adjective modifying this condition, and the codes for the tentative underlying cause and the other condition combine into a third code. Table F explains most ambivalent (‘M’) entries found in Tables D and E. Table F provides further guidance in selection of the most appropriate underlying cause of death. If the conditions laid out in Table F can be met, the code or combination code is selected as the underlying cause of death. This code may be further modified by further application of rules. Table G is the list of codes created to assist the MMDS software to distinguish between certain conditions which are coded to the same category. The table contains conversions to change the created ICD-10 categories back to the original ICD-10 codes. CBHI ICD 10 Student Workbook December 2004 Page 47 Table H contains the list of codes considered to be trivial when assigning the underlying cause of death. If a selected underlying cause is on the list, Modification Rule B is applied to establish the appropriate course of action. This may involve selecting a non-trivial condition as the underlying cause of death. The process of using the Decision Tables goes hand in hand with application of the selection and modification rules. Remember that the process of selection of tentative underlying cause may need to be repeated a number of times before a final underlying cause can be determined. Copies of the Decision Tables, and regular updates, can be obtained from the National Center for Health Statistics. The tables can be downloaded from http://www.cdc.gov/nchs/about/major/dvs/im.htm or can be requested by contacting Dawn King on [email protected] . (1 Reference: National Center for Health Statistics. Instruction Manual Part 2C: ICD-10 ACME Decision Tables for Classifying Underlying Causes of Death. NCHS: Hyattsville, Maryland; 2004) Assumption of intervening cause On some medical certificates, one condition may be indicated as due to another, but the first one is not a direct sequel of the other. In such cases it may be possible to assume that there are intervening causes that have not been reported but which, if understood by the coder, will enable the 'construction' of a correct sequence of events. When making an assumption about intervening causes, you should only assume an intervening cause for the purpose of interpreting the sequence not for modifying the coding of the death. Example: I(a) Cerebral haemorrhage (b) Chronic nephritis Code to chronic nephritis (N03.9). It is necessary to assume hypertension as a condition intervening between cerebral haemorrhage as a condition and the underlying cause, chronic nephritis. Exercise 15: Select the underlying cause of death. I(a) Mental retardation (b) Premature separation of placenta Highly improbable Sometimes the recorded sequence is highly improbable. The words ‘highly improbable’ are used to describe a non-acceptable sequence. See page 67 of Volume 2, for examples of several situations considered highly improbable and how the certificates should be interpreted. Exercise 16: Using the list, decide whether each of the following sequences is acceptable or not: • Tetanus due to malignant neoplasm of the lung • Diabetes due to malignant neoplasm of the pancreas • Intracranial haemorrhage due to endocarditis CBHI ICD 10 Student Workbook December 2004 Page 48 NOTE: acute or terminal circulatory disease which are reported as being due to: malignant neoplasm asthma or diabetes are acceptable as possible sequences when they occur in PART I of the certificate. Duration The stated time factor (or duration) in a sequence should be considered. This is important when you are considering whether one condition was caused by another. However, this is often a poorly completed item on a death certificate and this should be taken into account when interpreting entries. Exercise 17: When can malformation, deformation or chromosomal abnormality be considered to be congenital? (a) only when it is stated to be congenital by the certifier (b) when it is clear that the condition existed from birth Sequelae The terms sequelae or late effects are used to describe a certain group of conditions where a considerable amount of time might elapse between cause and effect. The aetiology or originating condition is often no longer present when the late effect occurs. Certain categories in ICD-10 have been designated for use in coding sequelae as the underlying cause of death. They are: B90-B94; E64.-; E68; G09; I69.-; O97; Y85-89 Exercise 18: Which modification rule applies to sequelae? Does the interval between the original disease and its sequelae matter, for the purposes of underlying cause coding? Rheumatic fever with heart involvement If there is no statement that the rheumatic process was active at the time of death, assume activity if the heart condition (other than terminal conditions and bacterial endocarditis) that is specified as rheumatic, or stated to be due to rheumatic fever, is described as acute or subacute. In the absence of such description, the terms carditis, endocarditis, heart disease, myocarditis and pancarditis can be regarded as acute if either the interval between onset and death is less than one year or, if no interval is stated, the age at death is under 15 years. Pericarditis can be regarded as acute at any age. Exercise 19: Terms such as carditis, endocarditis, heart disease, myocarditis and pancarditis can be regarded as acute if : (a) at least one of the factors listed below applies (b) both factors listed below apply (c) neither factors listed below apply 1. The interval between onset and death is less than one year 2. No interval is stated and the age at death is under 15 years CBHI ICD 10 Student Workbook December 2004 Page 49 Nature of injury Although the external cause of an injury or injuries should be coded as the underlying cause of death, WHO also recommends that the nature of injury is also classified. When more than one kind of injury to a single body region is recorded, and there is no clear indication as to which caused death, you must apply the General Principle and selection rules in the usual way. This relates to categories: S00-S99 T08-T35 T66-T79 Malignancy: When malignancy is given as the underlying cause of death three factors must be taken into consideration when assigning a code. These are the: Site Morphology Behaviour of the neoplasm. If there are 3 factors associated with recording malignant neoplasms as a cause of death then it is not surprising that problems can arise with the way the certificate has been completed. You may be coding a certificate where malignancy is implied but not explicitly stated. Metastases or secondaries are recorded but malignancy itself is not mentioned. Example: I(a) Metastatic involvement of lymph node (b) Carcinoma-in-situ of breast Code to malignant neoplasm of breast (C50.9). If a neoplasm has given rise to metastases or secondaries it means that the neoplasm is malignant. Sometimes the site of a neoplasm may be stated imprecisely. You may find sites prefixed with words like: peri-, para-, pre-, supra-, or infra-. Example: I(a) Fibrosarcoma in the region of the leg Code to malignant neoplasm of connective and soft tissue of lower limb (C49.2). You may find a site stated to be “in the region of”. If such a description is indexed in the classification then you will be able to code it by looking for the site documented. You will find guidance on this sort of problem in paragraph B, page 72, Volume 2. You should not assume the site of a malignancy from other conditions reported on the certificate if the site of the primary neoplasm is not mentioned. Example: I(a) Obstruction of intestine (b) Carcinoma Code to malignant neoplasm without specification of site (C80). CBHI ICD 10 Student Workbook December 2004 Page 50 When a malignancy is entered on the certificate and the primary site is indicated, you should always select the primary site as the underlying cause of death and not any recorded metastatic sites. Do this regardless of the position of the primary site on the certificate. There are 3 ways the site may be indicated: • • • when one site is specified as primary in either part I or part II when other sites may be described as secondary or metastatic when the morphology itself may indicate a primary malignancy. You may encounter cases where the primary site is stated to be unknown. In such cases, do not make any assumptions about the primary site from any other conditions, which are specified. Instead, you should look at the morphology of the neoplasm or code to C80 Malignant neoplasm without specification of site. Refer to volume 2 section 4.2.7 paragraph E for further details. In some cases of malignancy there may be more than one primary site. [ If the sites are not in the same organ system and there is no indication that any is primary or secondary, code to malignant neoplasms of independent (primary) multiple sites (C97)]. A special category has been created for these cases at C97 Malignant neoplasms of independent (primary) multiple sites. A malignancy may spread to another site. This is called metastasis. The adjective ‘metastatic’ is frequently used ambiguously - sometimes meaning a secondary FROM a primary elsewhere and sometimes meaning a primary which has given rise TO metastases. It is very difficult to resolve this situation as there are no specific rules and usage varies between countries and language. However, there are some guidelines set out in section G of 4.2.7 (Volume 2, page 75) that can be followed. In some cases multiple sites may be recorded with no indication as to which is the primary site. Guidance on selection of the underlying cause is given in paragraph H(Volume 2, page 81). You may find that an infectious disease has been given as a consequence of a malignancy. This is an acceptable sequence. Malignant neoplasms can also cause certain types of circulatory diseases. The underlying cause of death will be malignancy. CBHI ICD 10 Student Workbook December 2004 Page 51 MODULE 7 - ANSWERS OVERVIEW OF MORTALITY CODING Exercise 1 Mortality data, in the form of ICD codes, is mainly used for a particular purpose. What is it? 1. It is part of the overall process that leads to 3. In fact, once the data has been collected it is used like this: data analysis → resource management → prevention Exercise 2 What would be the underlying cause of death (UCOD) in this case? Coma resulting from subdural hematoma after a fall at work. Since the rest of the sequence started due to the fall at work, that is the UCOD. Exercise 3 Where do you think underlying cause of death should be entered on the death certificate shown on page 52? On the lowest used line in Part 1. (This answer covers cases where there are not 4 recorded conditions. Where there is a single cause of death this is recorded on the first line, if two conditions are reported the UCOD is on the second line, etc.) Exercise 5 Select the underlying cause of death, applying the general principle. I(a) Hepatic failure (b) Bile duct obstruction (c) Carcinoma of head of pancreas Carcinoma of head of pancreas would be the underlying cause of death. It is the condition entered on the lowest used line in part I and could have given rise to the conditions entered above it. Exercise 6 Select the underlying cause of death. I(a) Pericarditis (b) Uraemia and pneumonia Select uraemia. There are two reported sequences terminating in the condition first entered on the certificate. The underlying cause of the first mentioned sequence is selected. Exercise 7 Select the underlying cause of death. I(a) Fibrocystic disease of the pancreas (b) Bronchitis and bronchiectasis Select fibrocystic disease of the pancreas. There is no reported sequence of events leading to fibrocystic disease of the pancreas, so the first mentioned condition is selected. CBHI ICD 10 Student Workbook December 2004 Page 52 Exercise 8 Select the underlying cause of death. I(a) Nephrectomy II Clear Cell carcinoma of the kidney Select Clear Cell Carcinoma of the kidney. There is no doubt that the nephrectomy was performed for the carcinoma. Exercise 9 Select the underlying cause of death I(a) Myocardial degeneration and emphysema (b) Senility Code the myocardial degeneration. The senility is ignored and rule 2 applied to select the first mentioned condition. Exercise 10 Select the underlying cause of death. I(a) Ingrowing toenail and acute renal failure Code to acute renal failure. Ingrowing toenail as selected by rule 2, is ignored because it is a trivial condition. Exercise 11 Select the underlying cause of death I(a) Cerebral infarction (b) Hypertension (c) Atherosclerosis Code to cerebral infarction. Atherosclerosis, selected by Rule 1, links with hypertension, which itself links with cerebral infarction. See the linkage table on pages 62-65 of volume 2. Exercise 12 Select the underlying cause of death. I(a) Rheumatic heart disease, mitral stenosis Code to rheumatic mitral stenosis. This is known as a combination code. Exercise 13 Select the underlying cause of death I(a) Chronic myocarditis (b) Acute myocarditis Code to acute myocarditis. There is no code for acute on chronic myocarditis and the classification does not indicate that chronic myocarditis should be preferred over the code for the acute form of the disease. Exercise 14 Select the underlying cause of death I(a) Hydrocephalus (b) Tuberculosis meningitis Code to sequelae of tuberculous meningitis. CBHI ICD 10 Student Workbook December 2004 Page 53 Exercise 15 Select the underlying cause of death. I(a) Mental retardation (b) Premature rupture of placenta Code to premature separation of placenta affecting fetus or newborn. It is necessary to assume birth trauma, anoxia or hypoxia as a condition intervening between mental retardation and the underlying cause, premature separation of placenta. Exercise 16 Using the list, decide whether each of the following sequences is acceptable or not: Tetanus due to malignant neoplasm of the lung. Highly improbable (a) Diabetes due to malignant neoplasm of the pancreas. Acceptable sequence (d) Intracranial hemorrhage due to endocarditis. Acceptable sequence (h) Exercise 17 When can malformation, deformation or chromosomal abnormality be considered to be congenital? (a) Only when it is stated to be congenital by the certifier. (b) When it is clear the condition existed from birth. (b) provided there is no indication that the condition was acquired after birth. The duration field may assist with determining this. Exercise 18 Which modification rule applies to sequelae? Modification rule F Does the interval between the original disease and its sequelae matter, for the underlying cause coding? No. Guidance about coding of sequelae for mortality purposes is given in most of the appropriate categories in the tabular listing. Exercise 19 Terms such as carditis, endocarditis, heart disease, myocarditis and pancarditis can be regarded as acute if: (a) at least one of the factors listed below applies. (b) both factors listed below apply. (c) Neither factor listed below applies. 1. The interval between onset and death is less than one year. 2. No interval is stated and the age at death is under 15 years. (a) - at least one of the factors applies to the case being coded. CBHI ICD 10 Student Workbook December 2004 Page 54 MODULE 8 Infectious And Parasitic Diseases CBHI ICD 10 Student Workbook December 2004 Page 55 Module 8: Certain Infectious and Parasitic Diseases (Chapter I) This chapter includes diseases generally recognised as communicable or transmissible. Important points for Chapter I • Categories range from A00 to B99. In fact, this is one of the largest chapters in ICD-10. • 171 of the 200 available categories have been allocated. • The chapter is divided into 21 blocks. • The use of the modifier “Certain” in the title indicates that some infectious and parasitic diseases are classified elsewhere – it is necessary to carefully read inclusion and exclusion notes. • Chapter I has five exclusions listed at chapter level. • It should also be noted that there are some exceptions to the exclusions - they are related to obstetrical and neonatal tetanus, congenital syphilis, perinatal gonococcal information and obstetric and perinatal HIV disease -which are included in Chapter I. • A rule exists in relation to the presumption of infectious or noninfectious origin of gastroenteritis or diarrhoea dependent on the country in which the patient contracted the condition. This rule only applies where there is no specification as to whether the diarrhoea is infectious or non-infectious. If the diarrhoea is presumed to be non-infectious, it should be coded to K52.9 (in the Diseases of Digestive System chapter). If the diarrhoea is presumed infectious, it is coded to Chapter I. The decision about which code to use should be made by each individual country – but be aware that this rule only applies to cases which are not specified as infectious or non-infectious. • When coding tuberculosis, categories A15-A16 identify whether the tuberculosis was confirmed and what method was used for the confirmation e.g. sputum microscopy, chest x-ray. • Block B20-B23 has a note at the beginning concerning the use of the fourth character subcategory. The categories have been provided for optional use when it is not possible to multiple code. • Block B50- B64 provides guidance by the use of exclusion and inclusion notes on how mixed plasmodium infections are to be coded. • B90-B94 codes are to be used when the condition being treated is a sequelae of an infectious disease. • B95-B97 is a block of additional codes that enables infectious organisms to be recorded as the cause of conditions primarily classified to other chapters. These codes should never be used for primary/main condition coding; they are additional or supplementary codes. CBHI ICD 10 Student Workbook December 2004 Page 56 Coding exercises for Chapter I 1. Chronic viral hepatitis C 2. Congenital syphilis in an 18-month old child 3. Non-infective diarrhoea in a 3-week old infant 4. Tuberculosis of lung, confirmed 5. Axillary cutaneous abscess CBHI ICD 10 Student Workbook December 2004 Page 57 Sample Hospital Discharge Summaries for Chapter I Summary 1 ADMISSION DATE : 19-2-2004 DISCHARGE DATE : 28-2-2004 AGE : 40 years SEX male A 40-year-old male who is HIV positive, was admitted with a history of shortness of breath, profuse sweating and elevated temperatures. A bronchoscopy with biopsy was performed and diagnosis on discharge was tuberculosis, which was associated with his HIV. The patient is also being currently treated for Cytomegaloviral (CMV) retinitis. Dx ICD-10 Code Main Condition: Other Conditions: Summary 2 ADMISSION DATE : 14-9-2003 DISCHARGE DATE : 16-9-2003 AGE : 68 years SEX : male A 68-year-old male was admitted with retrosternal dysphagia. A gastroscopy with biopsy was performed, which indicated that he was suffering from Candida oesophagitis as well as gastric erosions. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 58 Mortality Coding Exercises for Chapter I Exercise 1 I Disease or condition directly leading to death* (a)…Septic shock………. due to or as a consequence of Duration between onset and death …days…… Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)…Staphylococcus aureus sepsis…….. due to or as a consequence of … days …… (c)… Staphylococcus aureus meningitis………. due to or as a consequence of … days ……… (d)………………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …renal transplant, NIDDM… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 59 Exercise 2 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Duration between onset and death (a)…SARS ………. due to or as a consequence of …days…… (b)…………………. due to or as a consequence of …………….. (c)………………….. …………….. due to or as a consequence of ……………… (d)…………………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …………………………….. .…………………………… …………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 60 MODULE 8 - ANSWERS Chapter I Certain infectious and parasitic diseases 1. Chronic viral hepatitis C Look up hepatitis in the Index (Volume 3, page 263). Hepatitis - viral - - chronic - - - type - - - - C -> B18.2 Note that WHO has introduced a new entry in the Index, effective from January 2005, to clarify the duration of a disease before it is considered chronic. The new index entry is: Hepatitis - viral - - type - - -C - - - - chronic (duration six months or longer) -> B18.2 2. Congenital syphilis in an 18-month old child Look up syphilis in the Index (Volume 3, page 524). Syphilis - congenital - - early or less than two years after birth -> A50.2 Note that no symptoms are specified and the syphilis is not specified as being latent. A50.2 is described in volume 1 as Early congenital syphilis, unspecified. 3. Non-infective diarrhoea in a 3-week old infant Look up diarrhoea in the Index (see Volume 3, page 158) - note that the terms in parentheses indicate that diarrhoea not otherwise specified is presumed infectious and coded to Chapter 1. Because this case is specified as non-infectious, look up Diarrhoea - neonatal (non infective) -> P78.3. Note that the age of the patient modifies the selection of the code. If the patient was not a neonate, the code would be K52.9 - diarrhoea, non-infective. 4. Tuberculosis of lung, confirmed Look up tuberculosis in the Index (Volume 3, page 545). Tuberculosis - lung - see Tuberculosis, pulmonary. - pulmonary - - confirmed (by) - - - unspecified means -> A15.3. CBHI ICD 10 Student Workbook December 2004 Page 61 5. Axillary cutaneous abscess Look up Abscess in the Index (Volume 3, page 17) Abscess - axilla (region) -> L02.4. Note that if you look up Abscess, cutaneous the Index suggests to see also Abscess, by site. This indicates that there are other, more specific, codes available for body sites. There is also a code for the axillary lymph node under Abscess, axilla but the diagnosis here is for a cutaneous abscess. The exclusion notes on page 107 of volume 3 indicate that certain localised infections, such as this one, are coded to the relevant body system chapter and not to chapter 1. Hospital Discharge Summaries Summary 1: Main Condition: Other conditions: B20.0 HIV disease resulting in mycobacterial infection B20.2 HIV disease resulting in cytomegaloviral disease H32.0 Chorioretinal inflammation in infectious & parasitic diseases classified elsewhere Note that if you are only coding single conditions, you might choose to select B20.7 HIV disease resulting in multiple infections as your main condition. Summary 2: Main Condition: Other Conditions: K20 Oesophagitis B37.8 Candidiasis of other sites K25.9 Gastric ulcer (includes erosions) Mortality Coding Exercises Exercise 1: Underlying cause of death: G00.3 Staphylococcal meningitis Which rule applied: General principle Exercise 2: Underlying cause of death: U04.9 Which rule applied: General principle CBHI ICD 10 Student Workbook December 2004 Page 62 MODULE 9 Neoplasms CBHI ICD 10 Student Workbook December 2004 Page 63 Module 9: Neoplasms (Chapter II) This chapter covers the coding of all neoplastic tumours, both malignant and benign and also cases where there is some uncertainty about the behaviour of a tumour. Important points for Chapter II • Categories range from C00 to D48. • 136 of the 149 available categories have been allocated. • The chapter is divided into 7 blocks, with the block of primary malignancy codes subdivided into 12 further sub-blocks. • It is especially important when coding neoplasms to use both Volume 1 and Volume 3 in identifying the correct set of codes • The three specific aspects to take into account when coding neoplasms are • the site of the tumour • the nature of the tumour (also known as the morphology or histological type), • and the behaviour of the tumour. • Chapter II is organised by tumour site and grouped in terms of the behaviour of neoplasms. The behaviour may be coded using the morphology codes – further information is provided below. D10-D36 D37-D48 D00-D07 C00-C75 & C81-C97 C76-C80 /0 benign neoplasms /1 neoplasms of uncertain and unknown behaviour /2 in situ neoplasms /3 malignant neoplasms, stated or presumed to be primary lesions /6 malignant neoplasms, stated or presumed to be secondary lesions. • Morphology describes the structure and type of cells or tissues as seen under the microscope. The tissue of origin and the type of cells that make up a malignant neoplasm often determine the expected rate of growth, the severity and the type of treatment given. Morphology is described by an additional coding system found in the ICD-10. The morphology code numbers are 6 digits long, including the prefix “M”. • Behaviour indicates how the tumour will behave ie. malignant (primary or secondary), in situ, of uncertain or unknown behaviour or benign. The behaviour is the final digit of the morphology code. Sometimes the ICD-10 Index indicates the behaviour of a neoplasm (because the histological type always acts in a certain pattern) but, when coding, if the clinician overrides the expected behaviour then accept the override in that particular case e.g. adenoma is usually benign, but if clinician documents a case as malignant adenoma, code the case as such. The behaviour code is changed from the expected /0 to /3 to indicate malignant primary. • The Table of Neoplasms is included in Volume 3 and includes the Chapter II codes for each anatomical site of tumour. For each site, there are five possible code numbers according to the behaviour of the tumour. If the diagnosis you are coding does not describe the behaviour of the tumour, you should look up the morphology description in the rest of the Index for guidance as to how the tumour should be coded. E.g. Mesonephroma - see Neoplasm, malignant. You would therefore use the code for malignant primary tumour or malignant secondary tumour, depending on the diagnosis. CBHI ICD 10 Student Workbook December 2004 Page 64 Check the Table of Neoplasms on pages 370-401 of the Alphabetical Index and look at how it is structured. Read also the notes on page 369. • In Chapter II, the 4th digit .9 is for unspecified site and .8 is for overlapping lesions of contiguous sites. • At the back of the Tabular List, is a Table of Morphology of Neoplasms. This table consists of a comprehensive but not exhaustive list of morphological types of neoplasms; the coder should be aware that if the behaviour type being sought is not listed with the histological type then the final digit can be changed (if this is clinically correct). For example, many malignant neoplasms are listed only with the morphology code for the primary lesion; if a secondary lesion needs to be coded, change the final “3” to “6” and the code is correct. Example: To find the correct site and morphology codes for a female patient suffering from lobular carcinoma arising in the lower outer quadrant of the left breast. Step 1: Look up the lead term, carcinoma, in the Alphabetical Index. Carcinoma - lobular (infiltrating) (M8520/3) - - specified site - see Neoplasm, malignant Step 2: The morphology you are given is M8520/3. Confirm that the behaviour (/3) is appropriate for the tumour being described. /3 indicates a primary malignancy and is therefore appropriate for this case because our diagnosis specifies that the tumour arose from the breast. Step 3: Check the morphology (M8520) in the Table of Morphology of Neoplasms in Volume 1. The morphology is correct for this case. Step 4: Look up the Table of Neoplasms in volume 3. Use the alphabetic listing of anatomical sites to find the entry for ‘breast’. Note the subdivisions under the lead term for different parts of the breast. Find the section for the lower outer quadrant. Step 5: Find the code in the column Malignant primary tumour by looking across the row for lower outer quadrant of the breast. We are told that the tumour arose in the patient’s breast; it is therefore a primary tumour and not a metastasis. The correct site or Chapter II code is therefore C50.5. Step 6: Confirm your code selection in Volume 1 of the ICD-10. Check whether there are any relevant exclusion notes. Step 7: The codes for this case are C50.5, M8520/3 Pages 71-85 of Volume 2 provide a large amount of information and direction for the coder in dealing with neoplasms. Read these notes now. CBHI ICD 10 Student Workbook December 2004 Page 65 Coding exercises for Chapter II 1. Malignant bronchial adenoma 2. Cholangiocarcinoma 3. Acute myelomonocytic leukaemia 4. Squamous cell carcinoma of cervix uteri 5. Bilateral synchronous Wilm's tumour (in a patient who is four years old) Sample Hospital Discharge Summaries for Chapter II Summary 1 ADMISSION DATE : 26-8-2003 DISCHARGE DATE : 4-9-2003 AGE : 15 years SEX : female This young girl was admitted for investigation of lethargy. She had complained of increasing tiredness over the past six months, accompanied by dyspnoea and frequent headaches. She had also noticed a lot of spontaneous bruising. On examination, she appeared pale with dark circles under her eyes, her spleen was palpable and hepatomegaly was present. Haematological investigations showed a decreased platelet count, very low haemoglobin (Hb) and an abnormal white cell count (WCC). A bone marrow biopsy was performed under local anaesthetic. This confirmed a diagnosis of acute lymphoblastic leukaemia. Chemotherapy was started immediately. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 66 Summary 2 ADMISSION DATE : 9-10-2003 DISCHARGE DATE : 1-11-2003 AGE : 76 years SEX : female FINAL DIAGNOSIS: Superficial spreading melanoma HISTORY This is a 76 year old lady who was admitted from Gynaecology OPD for radical vulvectomy and bilateral groin dissections for a melanoma of the vulva. She gave a two month history of a pigmented lesion on the right side of the vulva which had been getting larger and became itchy. She reported a 4kg weight loss over the last two months but was otherwise in good health. EXAMINATION She was a very spritely 76 year old lady who had a 2 cm lesion on the lower posterior aspect of the right labia. There was superficial thickening of the lesion, otherwise atrophy only of the vulva and vagina. There were no palpable nodes. MANAGEMENT A radical vulvectomy and bilateral groin dissection were performed on 12-10-2003. Postoperatively she had significant bruising over the mons and around the buttocks and vulva but otherwise had an essentially uncomplicated course. Redivac drains were removed on 19-10-2003 from the bilateral groin incisions. The vulval wound was a little moist but settled with salt baths and she was discharged home on 1-11-2003 to be seen at the Radiotherapy Clinic in four weeks time. HISTOLOGY Histology showed a superficial spreading melanoma as reported on the frozen section at the time of the operation. There was involvement of two inguinal nodes. All excision margins were clear. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 67 Mortality Coding Exercises for Chapter II Exercise 1 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Metastatic abdominal carcinoma, primary of pancreas. due to or as a consequence of Duration between onset and death …4 months… (b)……… due to or as a consequence of ……………… (c)… due to or as a consequence of ……………… (d)………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 68 Exercise 2 I Disease or condition directly leading to death* (a)…Small cell carcinoma, unknown primary. due to or as a consequence of Duration between onset and death …13 Months Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)……………………………. due to or as a consequence of …………...… (c)……………………… due to or as a consequence of ……………… (d)……………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 69 MODULE 9 - ANSWERS Chapter II Neoplasms 1. Malignant bronchial adenoma Look up adenoma in the Index (see Volume 3, page 31) Adenoma - bronchial (M8140/1) D38.1 In this case, the behaviour code (/1) indicates that an adenoma is generally a tumour of uncertain or unspecified nature. Remember that it is possible to change the behaviour (that is the fifth digit of the morphology code) to suit the diagnosis you have been given. Our diagnosis states that, in this case, the tumour is malignant and we can assume it is a primary cancer. Therefore we can change the morphology code to M8140/3. The /3 behaviour code indicates a malignant primary tumour. To find the Chapter 2 code for a primary cancer of the bronchus, we need to look up the Neoplasms table (Volume 3, page 374). Look up Neoplasm - bronchus - see under Malignant primary -> C34.9. 2. Cholangiocarcinoma Look up cholangiocarcinoma in the Index (see Volume 3, page 96) Cholangiocarcinoma -> (M8160/3) - unspecified site -> C22.1 Note that even though a site for the cancer is not specified, the morphological description indicates that the tumour is in the intrahepatic bile ducts - check the code description in Volume 1, page 193. 3. Acute myelomonocytic leukaemia Look up leukemia in the Index (Volume 3, page 334) Leukemia - myelomonocytic - - acute (M9867/3) -> C92.5. Note that it is important to look up the complete morphological description first - in this case, myelomonocytic leukemia - before looking up the modifiers "acute" or "chronic". 4. Squamous cell carcinoma cervix uteri Look up carcinoma in the Index (Volume 3, page 89) Carcinoma - squamous cell -> (M8070/3). Read the note under "Carcinoma" in the Index on page 85, which states that, except where otherwise indicated, carcinomas of any site should be coded to a malignant neoplasm of that site. If you are coding multiple diagnoses, to find the sites you should look up the Neoplasms table. Neoplasm - cervix (uteri) -> C53.9 CBHI ICD 10 Student Workbook December 2004 Page 70 5. Bilateral synchronous Wilm's tumour (patient is four years old) Look up either tumor or Wilm's in the Index (Volume 3, page 552 or 566) Tumor - Wilm's (M8960/3) -> C64. You will note that the code description in the Tabular list is "Malignant neoplasm of kidney, except renal pelvis". A Wilm's tumor is a cancer of the kidney, mainly occurring in children. Remember that the spelling used in the Index is usually American whilst in the Tabular list, it is English. Hospital Discharge Summaries Summary 1: Main Condition: C91.0 Acute lymphoblastic leukaemia Other conditions: M9821/3 Acute lymphoblastic leukaemia NOS Summary 2: Main Condition: C51.9 Malignant neoplasm of vulva, unspecified Other Conditions: M8743/3 Superficial spreading melanoma, primary site C77.4 Secondary & unspecified neoplasm of inguinal & lower limb lymph nodes M8743/6 Superficial spreading melanoma, secondary site T81.0 Haemorrhage & haematoma complicating a procedure, NEC Y83.6 Surgical operation as cause of abnormal reaction of patient or of later complication, without mention of misadventure at time of procedure; removal of other organ Mortality Coding Exercises Exercise 1: Underlying cause of death: C25.9 Malignant neoplasm of pancreas, unspecified Which rule applied: Rule 1, sequence terminating in the condition first entered on death certificate (primary carcinoma causing metastases) Exercise 2: Underlying cause of death: C80 Which rule applied: Malignant neoplasm without specification of site General principle CBHI ICD 10 Student Workbook December 2004 Page 71 MODULE 10 Diseases of the Blood and Blood-forming Organs and Certain Disorders involving the Immune Mechanism CBHI ICD 10 Student Workbook December 2004 Page 72 MODULE 10: Diseases of The Blood And BloodForming Organs And Certain Disorders Involving The Immune Mechanism (CHAPTER III) Important points for Chapter III • Categories range from D50 to D89. • 34 of the available 40 categories have been used. • The chapter is divided into 6 blocks, 3 of which relate to anaemia. • There are 2 asterisk categories in this chapter. • Note that the exclusions remind the coder that HIV disease is coded to Chapter I (see Chapter I - B20-B24). CBHI ICD 10 Student Workbook December 2004 Page 73 Coding exercises for Chapter III 1. Hypogammaglobulinaemia 2. Thalassaemia major 3. Hypochromic-microcytic anaemia 4. Hyperimmunoglobulin E(Hyper-IgE) syndrome 5. Thrombotic thrombocytopenic purpura CBHI ICD 10 Student Workbook December 2004 Page 74 Sample Hospital Discharge Summaries for Chapter III Summary 1 ADMISSION DATE : 15-4-2004 DISCHARGE DATE: 19-4-2004 AGE: 44 years SEX: male This patient was admitted with post-haemorrhagic anaemia due to acute blood loss following perforation of a chronic duodenal ulcer. The ulcer was oversewn and the patient was given a blood transfusion. Dx ICD-10 Code Main Condition: Other Conditions: Summary 2 ADMISSION DATE : 15-4-2004 DISCHARGE DATE : 18-4-2004 AGE : 2 years SEX: female This 2-year-old child was admitted with microangiopathic haemolytic anaemia and an E Coli urinary tract infection. An intravenous pyelogram (IVP) suggested a duplex left ureter. She was started on antibiotics and responded well, but her haemolytic anaemia persists. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 75 Mortality Coding Exercise for Chapter III Exercise 1 I Disease or condition directly leading to death* (a)…Anaemia…………………………. due to or as a consequence of Duration between onset and death …2 years … Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)…Splenomegaly ….. due to or as a consequence of (c)… …………. due to or as a consequence of …1 year…… (d)……… ……………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 76 Exercise 2 Age 34 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex M (a)… HIV disease with Kaposi’s sarcoma due to or as a consequence of Duration between onset and death …18 months… (b)…Iron deficiency anaemia …….. due to or as a consequence of (c)…. …………. due to or as a consequence of …Years (d)…………………. …… … ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …………………………..… .……………………………. ……………………………… ……………………………… ………….… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 77 MODULE 10 - ANSWERS Chapter III Blood and blood-forming organs and immune mechanism 1. Hypogammaglobulinemia Look up hypogammaglobulinemia in the Index (Volume 3, page 280). Hypogammaglobulinemia -> D80.1 2. Thalassemia major Look up Thalassemia in the Index (Volume 3, page 532). Thalassemia -major ->D56.1 3. Hypochromic-microcytic anemia Look up anemia in the Index (Volume 3, page 44). Anemia -hypochromic - - microcytic ->D50.8 4. Hyperimmunoglobulin E (Hyper-IgE) syndrome Look up Syndrome in the Index (Volume 3, page 520). Syndrome -hyperimmunoglobulin E (IgE) ->D82.4 5. Thrombotic thrombocytopenic purpura Look up Purpura in the Index (Volume 3, page 467). Purpura -thrombocytopenic - - thrombotic -> M31.1 Hospital Discharge Summaries Summary 1: Main Condition: K26.6 Duodenal ulcer, chronic or unspecified with both haemorrhage and perforation Other conditions: D62 Summary 2: Main Condition: D59.4 Other nonautoimmune haemolytic anaemia Other Conditions: Acute posthaemorrhagic anaemia N39.0 Urinary tract infection, site not specified B96.2 E coli as cause of diseases classified to other chapters Q62.5 Duplication of ureter Mortality Coding Exercises Exercise 1: CBHI ICD 10 Student Workbook December 2004 Page 78 Underlying cause of death: D64.9 Anaemia, unspecified Which rule applied: Entries rearranged according to Durations, then General Principle Exercise 2: Underlying cause of death: B21.0 HIV disease resulting in Kaposi’s sarcoma Which rule applied: Rule 2 – no sequence is recorded, so first mentioned condition is selected CBHI ICD 10 Student Workbook December 2004 Page 79 MODULE 11 Endocrine, Nutritional and Metabolic Diseases CBHI ICD 10 Student Workbook December 2004 Page 80 MODULE 11: Endocrine, Nutritional and Metabolic Disorders (Chapter IV) This chapter includes disorders of the endocrine glands, nutritional disorders and metabolic disorders. Important points for Chapter IV • Categories in this chapter range from E00 to E90. • 73 of the available 91 categories have been allocated. • The chapter is divided into 8 blocks. • There are 2 asterisk categories. • Included are disorders of the endocrine glands (E00-E35), nutritional disorders (E40-E64) and metabolic disorders (E65-E90). • The disorders of endocrine glands are grouped anatomically. • Some of the codes in this chapter can be used as additional codes to indicate the functional activity of neoplasms. • An additional code can be assigned to indicate presence of mental retardation associated with iodine deficiency. The ‘Use additional code’ instruction is utilised. • E10-E14, the block on diabetes mellitus, uses insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) as preferred terminology, although it does include reference to Types I and II diabetes mellitus (among others) within the categories. Type I diabetes is equivalent to IDDM, Type II is equivalent to NIDDM. • Insulin dependent diabetes mellitus, non-insulin dependent diabetes mellitus and malnutritionrelated varieties of diabetes are identified at the 3 character level and complications of the diabetes are identified at the fourth character level. Example: Non-insulin dependent diabetes mellitus (NIDDM) with diabetic nephropathy. The correct code would be: E11.2 Indicates the type of diabetes (NIDDM) at the 3rd character level. Indicates the complication (nephropathy) at the 4th character level. • Block E40-E46 (Malnutrition) is principally associated with chronic insufficiency/ inappropriateness of diet and is usually measured in terms of variation in weight from a reference standard that is specific to each country. ICD-10 provides explanatory notes at the beginning of the block to assist in the correct classification of malnutrition. CBHI ICD 10 Student Workbook December 2004 Page 81 Coding exercises for Chapter IV 1. Type II diabetes mellitus with (related) peripheral angiopathy, left foot 2. Cystic fibrosis, admitted because of chronic pseudomonas bronchitis 3. Obesity associated with Prader-Willi Syndrome 4. Medullary carcinoma of the thyroid with hyperparathyroidism 5. Gouty arthropathy, left ankle and knee Sample Hospital Discharge Summaries for Chapter IV Summary 1 ADMISSION DATE : 20-11-2003 DISCHARGE DATE : 8-12-2003 AGE : 50 years SEX : female DISCHARGE DIAGNOSIS: Insulin dependent diabetes PRESENTATION: Mrs X. presented with an episode of uncontrolled diabetes with hypoglycaemia. Once again she had presented in unusual circumstances having had quite some warning of the episode and having called a taxi from her home address. The patient then arrived at the hospital for her second episode of severe hypoglycaemia within a 3 week period. Management on this occasion consisted of supplementation of the patient’s low sugar level by both oral and intravenous supplements. Examination demonstrated signs of severe diabetic retinopathy. The patient has been referred to the Diabetes clinic. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 82 Summary 2 ADMISSION DATE : 8-7-04 DISCHARGE DATE : 12-7-04 AGE : 38 years SEX : female DISCHARGE DIAGNOSIS: Papillary carcinoma thyroid gland PRESENTATION: This 38 year old woman was admitted for a total thyroidectomy for a multi-nodular goitre. She also has hypertension. The procedure was performed uneventfully, but unfortunately the histology showed a poorly differentiated papillary carcinoma of the thyroid gland with invasion and spread into the parathyroid gland. She will be readmitted in 4 weeks for radioactive iodine treatment Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 83 Mortality Coding Exercises for Chapter IV Exercise 1 Age: 69 I Disease or condition directly leading to death* Sex: Female (a)…Acute on chronic renal failure due to or as a consequence of Duration between onset and death …12 days… Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)…Glomerulonephritis….. due to or as a consequence of (c)….Diabetic nephropathy… due to or as a consequence of …1 year (d)…Diabetes Type II… …5 years …… …10 years… II Other significant conditions fracture contributing to the death, but not related to the disease or condition causing it Femoral neck fracture, femoral repair, Post operative; haematoma ……………………………… ……………………………… 1 month ……………… ……………… …………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 84 Exercise 2 Age: 92 Sex: Female I Disease or condition directly leading to death* (a)…Dental caries due to or as a consequence of Duration between onset and death …months Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)… …………………….. due to or as a consequence of (c)………………………………… due to or as a consequence of …… (d)…………………………… ……………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Diabetes…………………………… 30 years…… .…………………………… ……………………………… ……………………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 85 MODULE 11 - ANSWERS Chapter IV Endocrine, nutritional and metabolic diseases 1. Type II diabetes mellitus with (related) peripheral angiopathy, left foot Look up diabetes in the Index (Volume 3, page 158). Diabetes - type II (nonobese)(obese) E11.Refer to page 278 in the Tabular list for E11. You will find a note referring you to page 277 for a fourth character subdivision. The patient has peripheral angiopathy, a peripheral circulatory complication. Therefore .5 is the appropriate fourth character to use. Note also that peripheral angiopathy is listed as an inclusion term beneath .5 and that an asterisk code is listed with it. Therefore the codes to use would be E11.5 † and I79.2* 2. Cystic fibrosis, admitted because of chronic pseudomonas bronchitis Look up bronchitis in the Index (Volume 3, page 77). Bronchitis -chronic ->J42 As the type of organism is given but not listed under bronchitis we have to code the organism as well. Look up infection in the Index (Volume 3, page 296). Infection -pseudomonas - - as cause of diseases classified elsewhere ->B96.5 When multiple coding, the Cystic Fibrosis should be coded as well. Look up fibrosis in the Index (Volume 3, page 226). Fibrosis -cystic - - with - - - pulmonary manifestations -> E84.0 3. Obesity associated with Prader-Willi Syndrome Look up obesity in the Index (Volume 3, page 411). Obesity - specified E66.8 Refer to the exclusion note for E66 in the Tabular list, which states that if the obesity occurs with Prader-Willi Syndrome the code Q87.1 should be used instead. 4. Medullary carcinoma of the thyroid with hyperparathyroidism Look up carcinoma in the Index (Volume 3, page 87). Carcinoma -medullary ->(M8510/3) CBHI ICD 10 Student Workbook December 2004 Page 86 A site code needs to be obtained from the neoplasms section of the Index (Volume 3, page 399). Neoplasm -thyroid -> C73 When multiple coding, the hyperparathyroidism should be coded as well. Look up hyperparathyroidism in the Index (Volume 3, page 275). Hyperparathyroidism -secondary ->E21.1 5. Gouty arthropathy, left ankle and knee Look up arthropathy in the Index (Volume 3, page 60). Arthropathy -gouty M10.0 Refer to page 634 of Volume 1 for the M10 category. You will see a note referring you to pages 628-629 for site codes. These codes are to be added as a fifth character for the M10.0 category to indicate the site of the gouty arthropathy. The appropriate fifth characters to be used would be .6 for the knee and .7 for the ankle. Therefore the codes to be used would be M10.06 and M10.07. Hospital Discharge Summaries Summary 1: Main Condition: E10.3† Insulin dependent diabetes mellitus with ophthalmic complications Other conditions: H36.0* Diabetic retinopathy Summary 2: Main Condition: C73 Malignant neoplasm of thyroid gland Other Conditions: M8050/3 Papillary carcinoma NOS, primary site C79.8 Malignant neoplasm of other secondary sites M8050/6 Papillary carcinoma NOS, secondary site Mortality Coding Exercises Exercise 1: Underlying cause of death: E11.2 Non insulin dependent diabetes mellitus with Renal complications Which rule applied: General Principle, then Rule D Specificity Exercise 2: Underlying cause of death: E14.9 Unspecified diabetes mellitus, without complications Which rule applied: General principle, then rule B Trivial conditions CBHI ICD 10 Student Workbook December 2004 Page 87 MODULE 12 Mental and Behavioural Disorders CBHI ICD 10 Student Workbook December 2004 Page 88 MODULE 12: Mental and Behavioural Disorders (Chapter V) This chapter deals with mental and behavioural disorders of all origins. Important points for Chapter V • Categories range from F00 to F99. • Of the 100 available categories, 78 have been allocated. • The chapter is divided into 11 blocks. • There are 2 asterisk categories, relating to dementia in Alzheimer’s disease and in other diseases classified elsewhere. • Each category is prefaced by a comprehensive description of the disorders it contains. • There is emphasis on behavioural disorders as well as mental disorders. • Block F00-F09 covers organic mental disorder. That is, those disorders resulting from a physical cause e.g. dementia in Alzheimer’s disease. • Block F10-F19 covers disorders due to the use of psychoactive or other substances. The third character indicates the substance involved and the fourth character indicates the clinical state of the patient. Example: F12.2 Indicates that the substance involved is a cannabinoid Indicates that the patient is clinically dependent on the drug CBHI ICD 10 Student Workbook December 2004 Page 89 Coding exercises for Chapter V 1. Trichotillomania 2. Psychogenic impotence 3. Korsakov's psychosis 4. Huntington's disease with dementia 5. Bipolar disorder, currently severely depressed but not psychotic Sample Hospital Discharge Summaries for Chapter V Summary 1 ADMISSION DATE : 3-4-2004 DISCHARGE DATE: 5-4-2004 AGE : 34 years SEX : female DIAGNOSIS: Chronic schizophrenia SUMMARY OF ADMISSION: This thirty-four year old lady was brought in by police following verbal abuse and physical threats against customers and staff at the local shopping mall. Aggressive and violent towards police, punching cell walls at police station. Known to police and admitted to this unit on 2 previous occasions. First diagnosed with schizophrenia 5 years ago and has had multiple admissions to this and other mental health units. Non-compliant with medications. Moved to this area 2 years ago. Unemployed with a 9 year old daughter being cared for by patient’s sister. Difficult two hour evaluation. Patient abusive and threatening to staff. Complained of auditory and visual hallucinations. Paranoid delusions regarding staff intentions to harm her. When questioned about behaviour at shopping mall stated that she "yelled at them because staff were selling the things I wanted to buy to other customers". Stated she hadn't been taking her medications because "they" were trying to poison her. Agreed to voluntary admission for assessment. 10mg haloperidol given orally with good effect. Maintain on 5mg haloperidol nocte. Abrasions and swelling to the back of both hands from punching cell wall at police station were cleaned and dressed. Patient discharged into care of her sister. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 90 Summary 2 ADMISSION DATE : 10-01-04 DISCHARGE DATE : 14-02-04 AGE : 43 years SEX : female DIAGNOSIS: Overdose of Diazepam, chronic depression SUMMARY OF ADMISSION: This 43 year old woman was admitted to this unit via Accident & Emergency department following a deliberate overdose of Diazepam. She claimed she felt depressed and wanted to stay in hospital for a while. She stated that she had felt depressed some months prior to admission, but felt worse in past month. Mental state examination revealed an overweight lady who was pleasant and co-operative. She appeared depressed at interview and felt somewhat helpless in her situation. There was no formal thought disorder or psychotic features. Cognitive testing was intact. The patient was discharged and seemed reasonably well. She is to visit the outpatient department in two weeks. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 91 Mortality Coding Exercises for Chapter V Exercise 1 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Alcoholic amnesic syndrome due to or as a consequence of Duration between onset and death …hours… (b)… Alcoholic liver cirrhosis due to or as a consequence of (c)……Chronic alcoholism due to or as a consequence of …years… (d)…………………………… …years.. ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 92 Exercise 2 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Suicide by gunshot wound to head due to or as a consequence of Duration between onset and death …instant (b)…Severe depression due to or as a consequence of …Years… (c)… ……………………………. due to or as a consequence of .........…… (d)……………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 93 MODULE 12 - ANSWERS Chapter V Mental and behavioural disorders 1. Trichotillomania Look up trichotillomania in the Index (Volume 3, page 541). Trichotillomania ->F63.3 2. Psychogenic impotence Look up impotence in the Index (Volume 3, page 287). Impotence(sexual)(psychogenic) -> F52.2 3. Korsakov's psychosis Look up psychosis in the Index (Volume 3, page 464). Psychosis -Korsakov's(alcoholic) F10.6 If you refer to page 323 of the Tabular List for F10, you will see a note telling you to look at pages 321-323 for a fourth character subdivision. However when we have already been given a fourth character by the Index. We should still confirm that the .6 is the correct code to use. By reading the notes under .6 (Volume 1, page 322) we can see Korsakov's psychosis listed there. Therefore the correct code is F10.6. 4. Huntington's disease with dementia Look up Huntington's disease or chorea in the Index (Volume 3, page 270). Huntington's disease or chorea - with dementia -> G10† F02.2* 5. Bipolar disorder, currently severely depressed but not psychotic Look up disorder in the Index (Volume 3, page 174). Disorder -bipolar F31.9 Refer to page 335 of the Tabular List (Volume 1) for F31.9. F31.9 is unspecified bipolar affective disorder. We now know that bipolar disorder and bipolar affective disorder are the same. Therefore we can look in the F31 category to see if we can find a more specific code as we has been told that this person is severely depressed but not psychotic. The correct code is F31.4. Hospital Discharge Summaries Summary 1: Main Condition: Other conditions: F25.9 Schizoaffective disorder, unspecified Z91.1 Personal history of non compliance with medical treatment and regimen S60.7 Multiple superficial injuries of wrist and hand W22.29 Striking against or struck by other objects, police cell, unspecified activity X83.29 Intentional self-harm by other specified means, police cell, unspecified activity CBHI ICD 10 Student Workbook December 2004 Page 94 Summary 2: Main Condition: T42.4 Poisoning by benzodiazepines Other Conditions: X61.99 Intentional self-poisoning by antiepileptic, sedative- hypnotic, antiparkinsonism and psychotropic drugs NEC, unspecified site, unspecified activity F32.9 Depressive episode, unspecified Mortality Coding Exercises Exercise 1: Underlying cause of death: X73.98 Intentional self-harm by rifle, shotgun and larger firearm discharge, unspecified site, other specified activity Which rule applied: General Principle, then 4.2.2 in Volume 2 Highly Improbable Exercise 2: Underlying cause of death: F10.6 Mental and behavioural disorders due to use of alcohol, amnesic syndrome Which rule applied: General principle, with rule C Linkage (alcoholism (F10,2) links with alcoholic amnesic syndrome (F10.6), code to amnesic syndrome) CBHI ICD 10 Student Workbook December 2004 Page 95 MODULE 13 Diseases of the Nervous System CBHI ICD 10 Student Workbook December 2004 Page 96 Module 13: Diseases of The Nervous System (Chapter VI) This chapter provides codes for diseases and disorders of the nervous system. Important points for Chapter VI • The categories in this chapter range from G00 to G99. • 67 of the 100 available categories have been used. • There are 16 asterisk categories. • The chapter relates to both the central and peripheral nervous systems. • G00-G09 classifies disease where the nerve tissue is attacked by different organisms. All meningoencephalitis and meningomyelitis are included here, as are encephalitis, myelitis and encephalomyelitis. • G40-G47 is for the coding of disorders that occur episodically, e.g. epilepsy, migraines and sleep disorders. • The exclusion note at the beginning of block G50-G59 should be clearly understood. Current injuries to nerves should be classified under injury of the particular body region. There are a number of exclusions within this block which direct the coder to Chapter XIII, Diseases of the Musculoskeletal System and Connective Tissue. CBHI ICD 10 Student Workbook December 2004 Page 97 Coding exercises for Chapter VI 1. Diabetic polyneuropathy 2. Herpesviral encephalitis 3. Congenital muscular dystrophy 4. Carpal tunnel syndrome 5. Chronic fatigue syndrome Sample Hospital Discharge Summaries for Chapter VI Summary 1 ADMISSION DATE : 30-11-03 DISCHARGE DATE : 8-12-03 AGE :75 years SEX: female This elderly lady has a history of bouts of severe facial pain. The pain is often set off when she is eating or brushing her teeth. She was diagnosed as having trigeminal neuralgia and a surgical division of the fifth cranial nerve was carried out. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 98 Summary 2 ADMISSION DATE : 3-4-04 DISCHARGE DATE : 7-4-04 AGE : 39 years SEX : female FINAL DIAGNOSIS: Migraine, hypertension HISTORY: This thirty-nine year old lady was admitted for investigation of headache. She had a sudden onset of bifrontal headache followed by collapse, possible right focal fitting. She was noted to be confused afterwards. At the local doctor's surgery she was noted to be hypertensive with a BP of 180/120. There was no associated fever, cough, nausea, vomiting, diplopia or focal weakness. There is no past history of migraine or other headache. She had a head injury at the age of eighteen but there had been no problems since then. EXAMINATION: On examination she was noted to be obese. She had a blood pressure of 140/90 in both arms, pulse of 90/min and regular. She was afebrile. Auscultation of her heart sounds was normal and chest was clear. Abdominal examination was unremarkable. Cranial nerves were normal. Power and tone in upper and lower limbs were normal. There were no cerebellar signs. Sensation was normal. INVESTIGATIONS: Due to the suspicion of a subarachnoid haemorrhage, contrast CT head scan was performed. This was normal. She then proceeded to a lumbar puncture which was normal and showed normal biochemistry. Full blood count did show some neutrophilia, normal coagulation profile. ECG was normal. MANAGEMENT: Admitted to ward where she was observed. Headache resolved and there was no further evidence of fitting. Neurological signs returned to normal. Blood pressure continued to be erratic, ranging from 140/100 to 170/110. It was elected to commence antihypertensive drug treatment. Further investigations for an underlying cause for her hypertension were undertaken. Microurine was negative. Was very keen to return home. Outstanding investigations include - renal ultrasound and EEG. She has also been referred to the dietician for weight loss. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 99 Mortality Coding Exercises for Chapter VI Exercise 1 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Occipital fracture………. due to or as a consequence of Duration between onset and death …1 week…… (b)…Fall following epileptic fit due to or as a consequence of …1 week…… (c)…Hypertension……………… due to or as a consequence of …10 years… (d)……………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Asthma…… .…………………………… ……………………………… ……………………………… …………………… …………………… …………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 100 Exercise 2 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Chronic renal failure due to or as a consequence of Duration between onset and death …2 years…… (b)…Quadriplegia due to or as a consequence of (c)…MVA……………………. due to or as a consequence of …10 years (d)……………………………… …10 years… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Smoking .Heroin addiction ……………………………… ……………………………… …20 years …10 years …………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 101 MODULE 13 - ANSWERS Chapter VI Diseases of the nervous system 1. Diabetic polyneuropathy Look up polyneuropathy in the Index (Volume 3, page 448). Polyneuropathy -diabetic (see also E10-E14 with fourth character .4) -> E14.4† G63.2* You should always refer to the E10-E14 categories to determine that you have the correct code for the type of diabetes. In this case the diabetes is unspecified, therefore the E14 is the code to use. 2. Herpesviral encephalitis Look up encephalitis in the Index (Volume 3, page 204). Encephalitis -herpesviral -> B00.4† G05.1* 3. Congenital muscular dystrophy Look up dystrophy in the Index (Volume 3, page 194). Dystrophy -muscular - - congenital -> G71.2 4. Carpal tunnel syndrome Look up syndrome in the Index (Volume 3, page 519). Syndrome -carpal tunnel -> G56. 5. Chronic fatigue syndrome Look up syndrome in the Index (Volume 3, page 520). Syndrome -fatigue - - chronic -> G93.3 Hospital Discharge Summaries Summary 1: Main Condition: G50.0 Trigeminal neuralgia Other conditions: Summary 2: Main Condition: Other Conditions: G43.9 Migraine, unspecified I10 Essential Hypertension E66.9 Obesity, unspecified CBHI ICD 10 Student Workbook December 2004 Page 102 Mortality Coding Exercises Exercise 1: Underlying cause of death: G40.9 Epilepsy, unspecified Which rule applied: Rule 1, Sequence terminating in condition first mentioned on certificate (epileptic fit causing fall, causing fracture) Exercise 2: Underlying cause of death: Y85.0 Sequelae of motor vehicle accident Which rule applied: General principle, then rule F Sequelae CBHI ICD 10 Student Workbook December 2004 Page 103 MODULE 14 Diseases of the Eye and Adnexa CBHI ICD 10 Student Workbook December 2004 Page 104 Module 14: Diseases of The Eye and Adnexa (Chapter VII) This is chapter deals exclusively with diseases of the eye and its adnexa. Important points for Chapter VII • The categories in this chapter range from H00 to H59. • 47 of the available 60 categories have been used. • The chapter is divided into 11 blocks. • There are 12 asterisk categories. • Note the use of additional/optional codes for H40.3, H40.4, H40.5 and H40.6 to identify the cause of glaucoma. • H54 blindness and low vision is an important category, which has a table detailing impairment categories. Check page 457 of the Tabular List for this table. CBHI ICD 10 Student Workbook December 2004 Page 105 Coding exercises for Chapter VII 1. Juvenile cataract 2. Tuberculous chorioretinitis 3. Progressive external ophthalmoplegia 4. Blindness right eye, with concurrent low vision left eye 5. Chronic simple glaucoma, both eyes Sample Hospital Discharge Summary for Chapter VII Summary 1 ADMISSION DATE : 28-4-04 DISCHARGE DATE : 29-4-04 AGE : 83 years SEX : female FINAL DIAGNOSIS: Conjunctivitis due to Chlamydia trachomatis This elderly woman was admitted for investigation of acute pain, burning and purulent discharge from her left eye and redness and lacrimation of the right eye. She stated that the left eye had been sore and “itchy” for the last two days. On awakening this morning, the pain had intensified in the left eye and had “spread” to the right eye. EXAMINATION: This thin elderly lady presented with suppurative discharge from left eye, redness in right eye. Examination of the left eye showed superficial hyperaemia of the eyelids and globe, vision slightly impaired, intraocular pressure normal, cornea clear and light reactions normal. Right eye showed slight reddening of the eyelids. Vision, intraocular pressure and the cornea were all normal. INVESTIGATIONS: Swabs from both eyes showed Chlamydia trachomatis infection MANAGEMENT: Patient was admitted to ward and started on Sulfacetamide eye drops and Achromycin, to which she responded well. She was keen to return home and was discharged the following day for follow-up by her local GP. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 106 MODULE 14 - ANSWERS Chapter VII Diseases of the eye and adnexa 1. Juvenile cataract Look up cataract in the Index (Volume 3, page 91). Cataract - juvenile -> H26.0 Note that the Tabular list indicates that juvenile = infantile = presenile. 2. Tuberculous chorioretinitis Look up chorioretinitis in the Index (Volume 3, page 98) Chorioretinitis - tuberculous -> A18.5† H32.0 * If you are only coding single conditions, use the A18.5 to indicate the underlying cause. Also note in the Tabular list on page 117, that there are bullet points to indicate the various manifestations of the tuberculosis of the eye. 3. Progressive external ophthalmoplegia Look up ophthalmoplegia in the Index (Volume 3, page 417) Ophthalmoplegia - progressive external -> H49.4 The Tabular list indicates that this is a form of paralytic strabismus. 4. Blindness right eye, with concurrent low vision left eye Look up blindness (Volume 3, page 74) OR vision (Volume 3, page 563) Blindness - one eye (other eye normal) - - low vision, other eye -> H54.1 Note the Table on page 457, which indicates the levels of visual impairment which are used to determine the appropriate H54.- code. 5. Chronic simple glaucoma, both eyes Look up glaucoma (Volume 3, page 245) Glaucoma - chronic - - simple -> H40.1 OR Glaucoma - simple (chronic) -> H40.1 Hospital Discharge Summary Summary 1: Main Condition: A74.0† Chlamydial conjunctivitis Other conditions: H13.1* Conjunctivitis in infectious and parasitic diseases classified elsewhere CBHI ICD 10 Student Workbook December 2004 Page 107 MODULE 15 Diseases of the Ear and Mastoid Process CBHI ICD 10 Student Workbook December 2004 Page 108 Module 15: Diseases of The Ear and Mastoid Process (Chapter VIII) This chapter deals exclusively with diseases of the ear and mastoid process. Important points for Chapter VIII • The categories in this chapter range from H60 to H95. • 24 of the available 36 categories have been used. • The chapter is divided into 4 blocks. • There are 5 asterisk categories. • The blocks are divided anatomically: external ear, middle ear and mastoid, and inner ear. The final block (H90-H95) contains codes relating to hearing loss, symptom-type conditions, disorders of the acoustic nerve and postprocedural problems. • H90 classifies conductive and sensorineural hearing loss by unilateral and bilateral impairment. CBHI ICD 10 Student Workbook December 2004 Page 109 Coding exercises for Chapter VIII 1. Acute purulent otitis media 2. Mixed conductive and sensorineural hearing loss, bilateral 3. Glue ear 4. Aspergillosis in otitis externa 5. Malignant chemodectoma, right middle ear Sample Hospital Discharge Summary for Chapter VIII Summary 1 ADMISSION DATE : 22-4-04 DISCHARGE DATE : 23-4-04 AGE : 23 years SEX : male FINAL DIAGNOSIS: Acute myringitis due to Streptococcal pneumoniae HISTORY: This 23 year old fit male presented complaining of acute pain in the left ear. Patient has had the pain for the last 24 hours and had taken aspirin with minimal relief. Patient stated he had recently recovered from a chest infection. EXAMINATION: Aural examination revealed inflammation of the tympanic membrane of the left ear with multiple small vesicles. MANAGEMENT: Myringotomy with aspiration of vesicle fluid for pathology showed streptococcal pneumoniae bacteria. Patient commenced on erythromycin 250mg qid. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 110 MODULE 15 - ANSWERS Chapter VIII Diseases of the ear and mastoid process 1. Acute purulent otitis media Look up otitis (Volume 3, page 421) Otitis - media - - acute or subacute - - - purulent -> H66.0 Note that you need to go to three levels of indentation to find the correct code in the Index. 2. Mixed conductive and sensorineural hearing loss, bilateral Look up Loss in the Index (Volume 3, page 337) Loss - hearing - see also Deafness. Deafness - mixed conductive and sensorineural - - bilateral -> H90.6 3. Glue ear Look up glue in the Index (Volume 3, page 247) Glue - ear -> H65.3. 4. Aspergillosis in otitis externa Look up otitis in the Index (Volume 3, page 421) Otitis - externa - - in (due to) - - - aspergillosis -> B44.8 † H62.2 * Remember, for single condition coding, use the underlying cause only (B44.8, Other forms of aspergillosis). 5. Malignant chemodectoma, right middle ear Look up chemodectoma (Volume 3, page 95) Chemodectoma (M8693/1) see Paraganglioma, nonchromaffin Paraganglioma - nonchromaffin - - malignant -> (M8693/3) - - - specified site - see Neoplasm, malignant. Look up the Neoplasm Table in the Index (Volume 3, page 379). CBHI ICD 10 Student Workbook December 2004 Page 111 Neoplasm - ear - - middle - see under Malignant, primary -> C30.1 This is the code to use for single condition coding - add the morphology code if you are coding multiple conditions. Hospital Discharge Summary Summary 1: Main Condition: Other conditions: H73.0 Acute myringitis B95.3 Streptococcus pneumoniae as cause of diseases classified to other chapters CBHI ICD 10 Student Workbook December 2004 Page 112 MODULE 16 Diseases of the Circulatory System CBHI ICD 10 Student Workbook December 2004 Page 113 Module 16: Diseases of the Circulatory System (Chapter IX) Chapter IX covers the organs and systems involved in the circulation of blood and lymph, but not the blood itself. Blood is covered in Chapter III. Important points for Chapter IX • Categories I00 to I99 make up this chapter. • Of the 100 categories available, 77 have been allocated. • The chapter is divided into 10 blocks. • There are 8 asterisk categories. • Care should be taken with this chapter because the prefix "I" looks like a "1", when written or typed, and this can be confusing. • I05-I09 includes most valvular disease whether they are specified as rheumatic or not. Be aware of the exceptions though: valvular diseases of the aortic valve are classified to this block only if they are specified as rheumatic. • I10-I15 Hypertensive disorders have no distinction between malignant and benign types as was the case in ICD-9. • I20-I25 has a note which provides guidance for coders in establishing duration of ischaemic heart diseases. This makes a distinction between morbidity and mortality coding in the application of the codes. Read the note on page 477 of the Tabular List and ensure you understand the distinction. CBHI ICD 10 Student Workbook December 2004 Page 114 Coding exercises for Chapter IX 1. Syphilitic aneurysm of aorta 2. Acute cor pulmonale 3. Biventricular failure 4. Dissection of abdominal aorta 5. Strangulated internal haemorrhoids CBHI ICD 10 Student Workbook December 2004 Page 115 Sample Hospital Discharge Summaries for Chapter IX Summary 1 ADMISSION DATE : 10-11-03 DISCHARGE DATE : 18-11-03 AGE : 75 years SEX : female This 75-year-old female was admitted with incapacitating angina on exertion. An electrocardiogram (ECG) showed cardiac changes consistent with subendocardial acute myocardial infarction. He was treated with medication for his unstable angina and rapidly improved over the next few days. He will be followed up by his cardiac surgeon. Dx ICD-10 Code Main Condition: Other Conditions: Summary 2 ADMISSION DATE : 2-10-03 DISCHARGE DATE : 12-10-03 AGE : 58 years SEX : male This patient presented to hospital with severe congestive cardiac failure. During his stay in hospital, he developed sweats and leukocytosis. This was determined to be due to bacterial endocarditis. Treatment with antibiotics was provided and the patient responded well. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 116 Mortality Coding Exercises for Chapter IX Exercise 1 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Acute myocardial infarction… due to or as a consequence of Duration between onset and death Minutes… (b)…Ischaemic heart disease… due to or as a consequence of …Years… (c)………………………….. due to or as a consequence of …………. (d)………………………….…. ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Alcoholism………… .…………………………… ……………………………… ……………………………… …………………… …………………… …………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 117 Exercise 2 I Disease or condition directly leading to death* (a)…Hypertensive heart disease due to or as a consequence of Duration between onset and death …years…… Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)…Ischaemic heart disease……….. due to or as a consequence of (c)……………………………. due to or as a consequence of …years…… (d)………………………………… …….…… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 118 MODULE 16 - ANSWERS Chapter IX Diseases of the circulatory system 1. Syphilitic aneurysm of aorta Look up aneurysm in the Index (Volume 3, page 45) Aneurysm -aorta - - syphilitic -> A52.0† I79.0* If you only code one condition then only the A52.0† will be recorded. The asterisk code should never be your main condition. 2. Acute cor pulmonale Look up Cor in the Index (Volume 3, page 118) Cor -pulmonale - - acute -> I26.0 3. Biventricular failure Look up Failure in the Index (Volume 3, page 219). Failure - biventricular -> I50.9 4. Dissection of abdominal aorta Look up Dissection in the Index (Volume 3, page 185). Dissection -aorta (any part)(ruptured) -> I71.0 5. Strangulated internal haemorrhoids Look up Hemorrhoids in the Index (Volume 3, page 262). Hemorrhoids -internal - - bleeding, prolapsed, strangulated or ulcerated -> I84.1 Hospital Discharge Summaries Summary 1: Main Condition: I21.4 Acute subendocardial myocardial infarction Other conditions: Summary 2: Main Condition: I50.0 Congestive heart failure Other Conditions: I33.0 Acute and subacute infective endocarditis CBHI ICD 10 Student Workbook December 2004 Page 119 Mortality Coding Exercises Exercise 1: Underlying cause of death: I21.9 Acute myocardial infarction, unspecified Which rule applied: General principle, then rule C linkage (ischaemic heart disease NOS (I25.9) with mention of acute myocardial infarction (I21.9), code to AMI) Exercise 2: Underlying cause of death: I25.9 Chronic ischaemic heart disease, unspecified Which rule applied: General principle CBHI ICD 10 Student Workbook December 2004 Page 120 MODULE 17 Diseases of the Respiratory System CBHI ICD 10 Student Workbook December 2004 Page 121 Module 17: Diseases of the Respiratory System (Chapter X) Chapter X is concerned with diseases and disorders of the respiratory organs including those caused by infection and some external agents, such as in occupational exposure. Important points for Chapter X • This chapter includes categories J00 to J99. • 63 of the available 100 categories have been allocated. • The chapter is divided into 10 blocks. • There are 3 asterisk categories in the chapter. • When a respiratory condition is described as occurring in more than one site and the condition is not specified in the Index, it should be classified to the lower anatomical site eg. tracheobronchitis is coded to bronchitis (J40), not tracheitis plus bronchitis (J04.1 + J40). This coding rule is to be found at the beginning of the chapter. In practice, however, the Index includes many of the possible combinations (eg. pharyngotracheitis (J06.8), laryngotracheobronchitis (J40), tracheobronchopneumonitis (J12-J18)) and directs the coder to the appropriate code. • The section concerning acute upper respiratory infections (J00-J06) is arranged anatomically, from nose down to larynx. • Bronchitis not specified as acute or chronic is assumed to be acute if the person is under 15 years and is coded as J20.9. • Abscess of lung with pneumonia where the causative organism is not specified, is coded to J85.1. If the causative organism is specified, the condition is classified to block J10-J16. • Pleurisy without mention of effusion or current tuberculosis is classified to the symptoms chapter (R09.1). Pleurisy with pleural effusion is classified to J90 Pleural effusion, not elsewhere classified. CBHI ICD 10 Student Workbook December 2004 Page 122 Coding exercises for Chapter X 1. Subglottic edema 2. Bronchitis (in a 10 year old female) 3. Aspiration pneumonitis after inhaling food whilst eating in restaurant 4. Anthracosis and Tuberculosis of lung (confirmed by x-ray and sputum microscopy) 5. Nasopharyngeal polyp Sample Hospital Discharge Summaries for Chapter X Summary 1 ADMISSION DATE : 18-3-04 DISCHARGE DATE : 20-3-04 AGE : 22 months SEX : male FINAL DIAGNOSIS: Croup and chronic asthma HISTORY: This patient is a 22 month old boy with a background of chronic persistent asthma, who was admitted with acute croup and an acute exacerbation of asthma. He has had a history of wheezing and coughing, occurring with exercise and also nocturnally. He has needed his Ventolin every one to two days. This episode of asthma was precipitated by upper respiratory tract infection which is still evident. Nil allergies, normal development and vaccinations are up to date. PAST MEDICAL HISTORY: Chronic persistent asthma. EXAMINATION: He was alert and his respiratory rate was 40/min. His heart rate was 150/min. He had moderate intercostal recession and audible inspiratory stridor and expiratory wheeze. On chest examination he had good air entry. ENT examination revealed tonsillitis and pharyngitis. The ear examination was normal. Dual heart sounds were heard, no murmurs. Abdominal examination was normal. The impression was acute croup and an acute exacerbation of chronic asthma precipitated by URTI. MANAGEMENT: He was admitted for observation and overnight monitoring and started on regular nebulised Ventolin and Pulmicort; and given oral Prednisone. His inspiratory stridor resolved overnight. He is for follow up at OPD in four weeks time. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 123 Summary 2 ADMISSION DATE : 10-11-03 DISCHARGE DATE : 13-11-03 AGE : 64 years SEX : female On admission, this patient’s chest examination revealed signs consistent with bilateral bronchopneumonia and a left pleural effusion. There was marked respiratory failure. She continued to deteriorate and died three days after admission. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 124 Mortality Coding Exercises for Chapter X Exercise 1 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Bronchitis…………. due to or as a consequence of Duration between onset and death …Hours… (b)…Emphysema …………….. due to or as a consequence of (c) Chronic obstructive pulmonary … disease due to or as a consequence of …Years…… …10 years… (d)…………………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it Peripheral vascular disease .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 125 Exercise 2 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)……Terminal hypostatic pneumonia due to or as a consequence of Duration between onset and death …2 days…… (b)… Right hemiplegia ……… due to or as a consequence of …Years.. (c)……………………. ……………. due to or as a consequence of ……… … (d)…………….. ……… …….…… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……CVA………………………… .…………………………… ……………………………… ……………………………… …1992………… ………………… ………………… …………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 126 MODULE 17 - ANSWERS Chapter X Diseases of the respiratory system 1. Subglottic edema Look up Edema in the Index (Volume 3, page 198) Edema -subglottic (see also Edema, glottis) -> J38.4 2. Bronchitis (in a 10 year old female) Look up Bronchitis in the Index (Volume 3, pages 77 & 78) As we know this patient is a child we need to look for a modifier that refers to children or ages. Bronchitis -under 15 years of age - see also Bronchitis, acute or subacute Bronchitis -acute or subacute (with bronchospasm or obstruction) -> J20.9 3. Aspiration pneumonitis after inhaling food whilst eating in a restaurant Look up Pneumonitis in the Index (Volume 3, page 445) Pneumonitis -aspiration -> J69.0 When we refer to J69.0 in the Tabular List, Volume 1 page 540 there is a note at the beginning of the J69 category advising coders to use an additional external cause code from Chapter XX if desired. We would use this code when multiple coding. We know that the patient’s pneumonitis has been caused by the aspiration of food, therefore we need to look for aspiration in the external causes of injury section of the Index (Volume 3, page 581). Aspiration -food W79.Remember that the .- means that there is a fourth digit required to complete the code. When we look up W79 in Volume 1 (page 1071) we note that at the beginning of the section on page 1070 there is a note directing the coder to pages 1013-1017 for the fourth character subdivisions for place of occurrence. As this incident occurred in a restaurant (a trade and service area), the fourth character subdivision will be 5. The activity is eating, thus an Activity code of .4 is appropriate. Therefore our complete code is W79.54. 4. Anthracosis and Tuberculosis of lung (confirmed by chest x-ray and sputum microscopy) Look up Anthracosis in the Index (Volume 3, page 54). Anthracosis -> J60 If we look up J60 there is an exclusion note excluding anthracosis with tuberculosis. (J65). Therefore the code J65 should be used for this condition. We then need to find a code for the tuberculosis as well. CBHI ICD 10 Student Workbook December 2004 Page 127 Look up Tuberculosis in the Index (Volume 3, page 547). Tuberculosis -pulmonary - - confirmed(by) - - - sputum microscopy with or without culture -> A15.0 5. Nasopharyngeal polyp Look up polyp in the Index (Volume 3, page 449). Polyp -nasopharyngeal -> J33.0 Hospital Discharge Summaries Summary 1: Main Condition: Other conditions: J05.0 Acute obstructive laryngitis [Croup] J45.9 Asthma, unspecified J06.8 Other acute upper respiratory infections of multiple sites Summary 2: Main Condition: J18.0 Bronchopneumonia, unspecified Other Conditions: J90 Pleural effusion, NEC Mortality Coding Exercises Exercise 1: Underlying cause of death: J44.8 Other specified chronic obstructive pulmonary disease Which rule applied: General principle with rule D Specificity Exercise 2: Underlying cause of death: I64 Which rule applied: Stroke, not specified as haemorrhage or infarction General principle, then rule 3 – other condition (CVA) obvious cause of condition selected by general principle (right hemiplegia) CBHI ICD 10 Student Workbook December 2004 Page 128 MODULE 18 Diseases of the Digestive System CBHI ICD 10 Student Workbook December 2004 Page 129 Module 18: Diseases of Digestive System (Chapter XI) Chapter XI involves diseases and disorders of the alimentary tract or digestive system. Important points for Chapter XI • Categories K00 to K93 comprise this chapter. • 71 of the available 94 categories have been used. • The chapter is divided into 10 blocks. • Except for block K40-K46 (Hernias), the codes in the range K00-K63 are arranged anatomically from mouth to anus. These are then followed by blocks concerning disorders of the other main organs associated with digestion. • There are 5 asterisk categories. • Block K25-K29 has a fourth character subdivision to identify if haemorrhage or perforation occurred. • For block K40-K46 there is a note which states that if a hernia is described as both gangrenous and obstructed, only the gangrene need be coded (specified at 4th digit level). This is because the gangrene is the result of the obstruction. • Block K57 Diverticular disease of the intestine includes diverticulosis, diverticulum and diverticulitis. The fourth character level is used to specify if there is perforation or an abscess present. CBHI ICD 10 Student Workbook December 2004 Page 130 Coding exercises for Chapter XI 1. Adenomatous rectal polyp 2. Chronic gastrojejunal ulcer 3. Obstructed left inguinal hernia 4. Diverticulitis of jejunum and ileum with perforation 5. Postgastrectomy dumping syndrome Sample Hospital Discharge Summaries for Chapter XI Summary 1 ADMISSION DATE : 20-1-04 DISCHARGE DATE : 8-2-04 AGE : 49 years SEX : female FINAL DIAGNOSIS: Multiple stones in Common Bile Duct HISTORY: This was a routine admission of a 49-year-old woman for open cholecystectomy. She had a twelve-month history of epigastric pains associated with nausea and sweating. She was admitted in December 2003 with probable gallstone pancreatitis. An ultrasound scan at this time revealed gallstones. The common bile duct was not dilated. EXAMINATION: Examination on admission was unremarkable and the patient was not jaundiced at this stage. OPERATION: Open cholecystectomy was performed on 21.1.04 via a Kocher's incision. An operative cholangiogram at this time revealed filling defects with no flow into the duodenum. Subsequently the common bile duct was explored and multiple stones were removed from the common bile duct. Post-operatively Mrs. X suffered some pain at the site of her operative wound. She also had some transient fevers. This was not thought to be a cholangitis or wound infection. The patient was discharged home with review in Surgical Outpatients planned. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 131 Summary 2 ADMISSION DATE : 8-4-04 DISCHARGE DATE : 17-4-04 AGE : 27 years SEX : female This patient is a 27-year-old hospital worker with recently diagnosed Crohn’s disease of the ileum. During this admission, a segmental resection of her terminal ileum was performed, following colonoscopy. She was also found to have a perianal abscess which was drained. The patient was discharged eight days post-operatively having suffered no significant complications. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 132 Mortality Coding Exercises for Chapter XI Exercise 1 Age: 29 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex: Male (a)…Gastrointestinal haemorrhage…… due to or as a consequence of Duration between onset and death ……………… (b)…Cirrhosis of liver…………….. due to or as a consequence of (c)… Alcoholism ……..……………. due to or as a consequence of ……………… (d)……………………………… ……………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it … …………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 133 Exercise 2 Age: 49 I Disease or condition haemorrhage…… directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex: Male (a)…Gastrointestinal Duration between onset and death due to or as a consequence of ……day…… (b)….Perforated duodenal ulcer…… due to or as a consequence of ……years…… (c)…… due to or as a consequence of ……………… (d)……………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 134 MODULE 18 - ANSWERS Chapter XI Diseases of the digestive system 1. Adenomatous rectal polyp Look up polyp in the Index (Volume 3, page 448). Polyp -adenomatous (M8210/0) see also Neoplasm benign Look up Neoplasm in the Index (Volume 3, page 394) Neoplasm -rectum -> D12.8 Therefore the correct codes will be D12.8, M8210/0 2. Chronic gastrojejunal ulcer Look up ulcer in the Index (Volume 3, page 554). Ulcer -gastrojejunal - - chronic -> K28.7 3. Obstructed left inguinal hernia Look up hernia in the Index (Volume 3page 264). Hernia -inguinal - - unilateral - - - with - - - - obstruction-> K40.3 Note that as the hernia is specified as on the left side only, the unilateral code is the appropriate one. 4. Diverticulitis of jejunum and ileum with perforation Look up Diverticulitis in the Index (Volume 3, page 188). Diverticula, diverticulitis -jejunum (see also Diverticula, small intestine) Diverticula, diverticulitis -ileum (see also Diverticula, small intestine) As both of these modifiers have no mention of perforation we need to look under Diverticula, small intestine for the modifier for perforation. Diverticula -intestine - - small - - - with abscess, perforation or peritonitis -> K57.0 5. Postgastrectomy dumping syndrome Look under Postgastrectomy dumping syndrome in the Index (Volume 3, page 450). Post gastrectomy dumping syndrome -> K91.1 CBHI ICD 10 Student Workbook December 2004 Page 135 Hospital Discharge Summaries Summary 1: Main Condition: K80.5 Calculus of bile duct without cholangitis or cholecystitis Other conditions: Summary 2: Main Condition: K50.0 Crohn’s disease of small intestine Other Conditions: K61.0 Anal abscess Mortality Coding Exercises Exercise 1: Underlying cause of death: K70.3 Alcoholic cirrhosis of liver Which rule applied: General principle, then rule C linkage (alcoholism links with cirrhosis of liver, code to alcoholic liver cirrhosis) Exercise 2: Underlying cause of death: K26.6 Duodenal ulcer, chronic or unspecified with Haemorrhage and perforation Which rule applied: General principle, then rule D Specificity CBHI ICD 10 Student Workbook December 2004 Page 136 MODULE 19 Diseases of the Skin and Subcutaneous Tissue CBHI ICD 10 Student Workbook December 2004 Page 137 Module 19: Diseases of the Skin And Subcutaneous Tissue (Chapter XII) This chapter covers diseases of the skin and subcutaneous tissue. Important points for Chapter XII • Categories range from L00 to L99. • 72 of the 100 available categories have been allocated. • There are 10 exclusions listed at the start of the chapter. • 8 of the exclusions listed are at chapter level, one at block level and at one at code level. • There are 8 blocks. • There are 6 asterisk categories. • This chapter has many exclusions and inclusions, listed at the beginning of many of the blocks and categories, in addition to those at the start of the chapter. The exclusion notes identify elements of codes that are classified elsewhere. • The terms dermatitis and eczema are used synonymously and interchangeably. • Contact dermatitis is classified according to whether it is allergic, irritant or unspecified. The three categories do not have the same fourth character subdivisions, so care must be taken when assigning codes. Take special note of the exclusions and cross references within these codes. • L55 sunburn is classified according to the depth of skin which is affected: • First degree/erythema - affecting epidermis only • Second degree/partial thickness - affecting both epidermis and dermis causing possible blistering • Third degree/ full thickness - affecting epidermis, dermis and subcutaneous layers, usually causing extensive damage. CBHI ICD 10 Student Workbook December 2004 Page 138 Coding exercises for Chapter XII 1. Trichorrhexis invaginata 2. Drug induced androgenic alopecia 3. Contact dermatitis due to cosmetics 4. Arthropathic psoriasis 5. Perforating granuloma annulare Sample Hospital Discharge Summaries for Chapter XII Summary 1 ADMISSION DATE :30-4-04 DISCHARGE DATE : 2-5-04 AGE : 63 years SEX : female FINAL DIAGNOSIS: Basal Cell Carcinoma (BCC) of nose and forehead Squamous Cell Carcinoma (SCC) lip and forearm Non Insulin Dependent Diabetes Mellitus (NIDDM) PROCEDURE: Excision and biopsy of multiple skin lesions. Flap graft to nose. SUMMARY OF ADMISSION: This 63 year old female was admitted after being referred by her local doctor for removal of skin lesions from her left forearm, nose, forehead and upper lip. She went to surgery on 1/5/04, following stabilisation of her diabetes. The surgery was unremarkable with the excision of 3 skin lesions and wide excision of 1 skin lesion from her nose with flap graft. Biopsies showed SCC of the left forearm and upper lip and BCC from her nose and forehead. The graft to her nose appeared to have taken well and she was discharged the following day. She will be followed up in outpatients. Previously diet controlled NIDDM was unstable on admission, and she was prescribed Diabex 500mg bd. While in hospital she was seen by the diabetic educator on three occasions for nutritional education and self-monitoring techniques. Booked to attend diabetic clinic and will continue review of her diabetes with her local doctor. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 139 Summary 2 ADMISSION DATE : 10-01-03 DISCHARGE DATE : 25-02-03 AGE : 34 years SEX :male FINAL DIAGNOSIS: Infected foreign body left calf. PROCEDURE: Incision and drainage of staphylococcal abscess left calf. Removal of foreign body and excisional debridement of wound 11/01/03 SUMMARY OF ADMISSION: Patient presented to Accident & Emergency department complaining of pain and swelling in left calf. Patient reported having multiple scratches, splinters and abrasions of left calf 2 weeks ago following a motor cycle accident while competing in motorcross competition. At the time the patient’s protective clothing had been torn by a broken branch after collision with a tree. Multiple splinters were removed at the time and the wound was cleaned and dressed by the First Aid Officer. The patient now has a large abscess, 4cm x 6cm inflamed area, to left calf. Patient was admitted for incision and drainage of abscess of calf. Incision and drainage with removal of 2cm sliver of wood was conducted. Pus++ drained from wound. Necrosis of surrounding muscle tissue debrided. The wound was left open to heal. A Split skin graft was subsequently applied from donor site of left hip with good result. Patient discharged 25/02/03 and will be followed up in outpatients department. EXAMINATION FINDINGS: Histology – wound swab left calf showed staphylococcus aureus infection Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 140 Mortality Coding Exercises for Chapter XII Exercise 1 Age: 68 Sex: Male I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Pneumonia…………………………. due to or as a consequence of Duration between onset and death ……………… (b)…………………………………… due to or as a consequence of ……………… (c)………………………………… due to or as a consequence of ……………… (d)……………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Cutaneous T-Cell lymphoma… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 141 Exercise 2 Age: 56 Sex: Female I Disease or condition directly leading to death* (a)…Systemic lupus erythematosus due to or as a consequence of Duration between onset and death ……………… Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)…………………………………… due to or as a consequence of (c)………………………………… due to or as a consequence of ……………… (d)……………………………… ……………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Alcoholic… .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 142 MODULE 19 - ANSWERS Chapter XII Diseases of the skin and subcutaneous tissue 1. Trichorrhexis invaginata Look up trichorrhexis in the Index (Volume 3, page 541). Trichorrhexis (nodosa)(invaginata) ->L67.0 2. Drug induced androgenic alopecia Look up Alopecia in the Index (Volume 3, page 38). Alopecia -androgenic - - drug induced -> L64.0 A note under L64.0 states to use an external cause code to identify the drug if known. If you know what drug is causing the alopecia, then you would identify it by using the table of drugs and chemicals in the Index. 3. Contact dermatitis due to cosmetics Look up dermatitis in the Index (Volume 3, page 153). Dermatitis -contact (see also Dermatitis, due to) As we know the dermatitis is due to cosmetics, we should follow the instruction and look under Dermatitis, due to. Dermatitis -due to - - cosmetics (contact) -> L25.0 4. Arthropathic psoriasis Look up psoriasis in the Index (Volume 3, page 463). Psoriasis -arthropathic ->L40.5† M07.3* 5. Perforating granuloma annulare Look up granuloma in the Index (Volume 3, page 249). Granuloma -annulare (perforating) ->L92.0 CBHI ICD 10 Student Workbook December 2004 Page 143 Hospital Discharge Summaries Summary 1: Main Condition: C44.0 Other malignant neoplasm of skin of lip Other conditions: M8070/3 C44.6 M8070/3 C44.3 M8090/3 E11.9 Squamous cell carcinoma Other malignant neoplasm of upper limb Squamous cell carcinoma Other malignant neoplasm of other and unspecified parts of face Basal cell carcinoma Non insulin dependent diabetes mellitus Summary 2: Main Condition: Open wound of other parts of lower leg S81.8 Other Conditions: T79.3 B95.6 R02 V27.00 Post-traumatic wound infection NEC Staphylococcus aureus as cause of diseases classified to other chapters Gangrene, NEC Motorcycle rider injured in collision with fixed or stationary object, driver injured in non traffic accident while engaged in sports activity Mortality Coding Exercises Exercise 1: Underlying cause of death: C84.5 Other and unspecified T cell lymphoma Which rule applied: General principle, then rule 3 – selected condition an obvious consequence of another condition reported elsewhere Exercise 2: Underlying cause of death: M32.9 Systemic lupus erythematosus, unspecified Which rule applied: General principle CBHI ICD 10 Student Workbook December 2004 Page 144 MODULE 20 Diseases of the Musculoskeletal System and Connective Tissue CBHI ICD 10 Student Workbook December 2004 Page 145 Module 20: Diseases of the Musculoskeletal System & Connective Tissue (Chapter XIII) This chapter covers diseases and conditions relating to the spine, joint, muscles and connective tissue of the body. It also covers deformities acquired after birth. Important points for Chapter XIII • Categories range from M00 to M99. • 79 of the 100 available categories have been allocated. • 12 of the categories have asterisk codes. • The Site of Musculoskeletal Involvement is an additional optional subclassification (located at the beginning of the chapter) provided to indicate the site of involvement of a condition where this is appropriate. Valid fifth digits are indicated in square brackets [ ] after each code to which they apply. The use of these optional codes is a matter for decision by each country as they are not a mandatory part of the codes. • Supplementary classifications for optional use are also given for the following conditions: M23 Internal derangement of knee M40-M54 Dorsopathies (except M50 & M51) M99 Biomechanical lesions NEC. • There are 6 major blocks in this chapter, 4 of which are broken down into smaller blocks making 15 blocks in total. • M00-M03 begins with a note explaining an important distinction that is made between the causes (direct or indirect aetiological relationship) of the various disorders. This is the basis of the classification used for this block. Read the Note on page 629 of the Tabular list now. • M15-M19 Arthrosis. The term arthrosis is synonymous with osteoarthritis and osteoarthrosis. • M40-M54 Dorsopathies, has a second supplementary subclassification to indicate the site of involvement. This is set for optional use for all categories in this block, except M50 and M51. CBHI ICD 10 Student Workbook December 2004 Page 146 Coding exercises for Chapter XIII 1. Rubella arthritis 2. Gout of the big toe 3. Bilateral post-traumatic coxarthrosis 4. Osteolysis 5. Tuberculous arthritis Sample Hospital Discharge Summaries for Chapter XIII Summary 1 ADMISSION DATE : 20-3-04 DISCHARGE DATE :21-3-04 AGE : 32 years SEX : male This male patient was admitted for investigation of pain in his left knee. He stated the pain had begun during a soccer game yesterday. He was taken to theatre for an arthroscopy which showed a bucket handle tear of his left medial meniscus. A meniscectomy was performed without complication and he was discharged the following day. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 147 Summary 2 ADMISSION DATE : 28-4-04 DISCHARGE DATE :5-6-04 AGE : 83 years SEX : female FINAL DIAGNOSIS: Osteoarthritis L) knee Total knee replacement This elderly woman was admitted for a left total knee replacement. She had severe osteoarthritis of this joint. The procedure went well but the post-operative period was problematic. On 14.5.04, approximately two weeks post procedure, she collapsed. The cause of collapse was uncertain but thought to be due to orthostatic hypotension. No cause could be identified. She required an ICU admission for several days. Her recovery from this event was slow but on 5.6.04 she was discharged to Mount Hospital for rehabilitation. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 148 Mortality Coding Exercises for Chapter XIII Exercise 1 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Pathological osteoporotic femoral fracture…………. due to or as a consequence of Duration between onset and death …1 week…… (b)…Vision impairment……………… due to or as a consequence of (c)…General debility; dementia; Osteoporosis……. due to or as a consequence of …10 years… ……………… (d)………………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Postural hypotension… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 149 Exercise 2 I Disease or condition directly leading to death* (a)…Gangrene left foot due to peripheral vascular disease (PVD) Duration between onset and death …2 weeks… due to or as a consequence of Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (b)………………………………… due to or as a consequence of ……………… (c)………………………………… due to or as a consequence of ……………… (d)……………………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 150 MODULE 20 - ANSWERS Chapter XIII Diseases of the musculoskeletal system & connective tissue 1. Rubella arthritis Look up arthritis in the Index (Volume 3, page 59). Arthritis -rubella -> B06.8† M01.4* Refer to M01.4 in the Tabular List (Volume 1, page 630). The note at the beginning of the M01 block directs the coder to pages 628-629 for a site code. On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision. The appropriate code would be .9 as no site has been specified. The correct codes for rubella arthritis site unspecified are B06.8† and M01.49*. 2. Gout of the big toe Look up gout in the Index (Volume 3, page 249). Gout, gouty -> M10.9 Refer to M10.9 in the Tabular List (Volume 1 page 634). The note at the beginning of M10 directs the coder to pages 628-629 for a site code. On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision. The appropriate code for the big toe would be 7. The correct code for gout of the big toe is M10.97. 3. Bilateral post-traumatic coxarthrosis Look up coxarthrosis in the Index (Volume 3, page 120). Coxarthrosis -post-traumatic(unilateral) - - bilateral -> M16.4 4. Osteolysis Look up osteolysis in the Index (Volume 3, page 419) Osteolysis -> M89.5 Refer to M89.5 in the Tabular List (Volume 1 page 671) a note at the beginning of M89 directs the coder to pages 628-629 for a site code. On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision. The appropriate code for this condition would be unspecified as no site has been given in our diagnosis. Therefore the code for osteolysis, unspecified is M89.59. 5. Tuberculous arthritis Look up arthritis in the Index (Volume 3, page 59). Arthritis -tuberculous -> A18.0† M01.1* CBHI ICD 10 Student Workbook December 2004 Page 151 Refer to M01.1 in the Tabular List (Volume 1 page 630) a note at the beginning of M01 directs the coder to pages 628-629 for a site code. On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision. The appropriate code would be .9 as no site has been specified. The correct codes for tuberculous arthritis site unspecified are A18.0† and M01.19*. Hospital Discharge Summaries Summary 1: Main Condition: S83.2 Tear of meniscus, current Other conditions: X59.90 Exposure to unspecified factor, unspecified place of occurrence, while engaged in sports activity Summary 2: Main Condition: M17.9 Gonarthosis, unspecified Other Conditions: I95.1 Orthostatic hypotension Mortality Coding Exercises Exercise 1: Underlying cause of death: M80.95 Unspecified osteoporosis with pathological fracture Which rule applied: Rule 1, sequence terminating in first mentioned Condition, then rule D specificity Exercise 2: Underlying cause of death: I73.9 Peripheral vascular disease, unspecified Which rule applied: Rule 1, sequence terminating in condition first mentioned CBHI ICD 10 Student Workbook December 2004 Page 152 MODULE 21 Diseases of the Genitourinary System CBHI ICD 10 Student Workbook December 2004 Page 153 Module 21: Diseases of the Genitourinary System (Chapter XIV) This chapter comprises the urinary system and the male and female reproductive systems. Important points for Chapter XIV • Categories range from N00 to N99. • 82 of the 100 available categories have been allocated. • 9 of the categories have asterisk codes. • Chapter XVI has 8 exclusions listed at chapter level. • There are 11 blocks. • N00-N08 Glomerular disease The three character categories relate to clinical syndromes (e.g. chronic nephrotic syndrome) and the fourth characters allow the coding of morphological changes (e.g. focal and segmental glomerular lesions). • An additional code from N17-N19 Renal Failure may be used with a code from another chapter, if desired, to identify the presence of renal failure. • N70-N77 Inflammatory disease of female pelvic organs consists of eight categories organised to follow the structure of the female reproductive system, starting with the ovary and fallopian tube. • Dysplasia of the cervix, vagina and vulva are classified by severity in categories N87, N89 and N90 Note that CINI, VINI and VAINI are equivalent to mild dysplasia CINII, VINII and VAINII are the same as moderate dysplasia CINIII, VINIII, VAINIII are equivalent to severe dysplasia or carcinoma in situ CBHI ICD 10 Student Workbook December 2004 Page 154 Coding exercises for Chapter XIV 1. Renal tubulo-interstitial disorder due to brucellosis 2. Acute diffuse membranous glomerulonephritis 3. Acute cystitis with urolithiasis 4. Incomplete uterovaginal prolapse 5. Glomerulitis in diabetes mellitus Sample Hospital Discharge Summaries for Chapter XIV Summary 1 ADMISSION DATE : 15-9-03 DISCHARGE DATE : 22-9-03 AGE : 62 years SEX : female FINAL DIAGNOSIS: Chronic cystitis PRESENTATION: This 62 year old lady, who is an insulin dependent diabetic, has a history of on-going cystitis. This manifests itself mainly with frequency and discomfort in the retropubic region. On several occasions in the past, gram negative organisms have been cultured from her urine. Despite treatment with sensitive oral antibiotics, she has had no reduction in symptoms. A previous seven day course of intravenous Gentamyacin was successful in clearing her of her problem for a lengthy period. MANAGEMENT: It was therefore elected to admit her for seven days for intravenous antibiotic treatment. This was carried out between 15.9.03 - 22.9.03 with intravenous Gentamyacin at a dose of 120 mgs each 24 hours. At discharge the patient felt that there may have been some improvement of her bladder symptoms although this was slight. She was discharged on antibiotics twice a day for seven days until review by her urologist. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 155 Summary 2 ADMISSION DATE : 11-9-03 DISCHARGE DATE : 16-9-03 AGE : 89 years SEX : male FINAL DIAGNOSIS: Proteus UTI PRESENTATION: This patient was admitted via Urology Outpatients’ Clinic for investigation of a recent onset of urinary incontinence and haematuria. EXAMINATION: This 89-year-old man had a six-month history of a poor stream with dribbling ++. He had night time and day time incontinence. He had one episode of frank haematuria three months prior and a further episode just prior to his admission. MANAGEMENT: On admission a urine specimen was collected which showed a heavy growth of Proteus mirabilis. He was treated with intravenous Gentamicin in hospital and discharged on Augmentin. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 156 Mortality Coding Exercises for Chapter XIV Exercise 1 Age: 62 Sex: Female I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Uraemia…………………………. due to or as a consequence of Duration between onset and death …2 days… (b)…Acute on chronic renal failure….. due to or as a consequence of …1 week…… (c)…Klebsiella UTI/anaemia…………. due to or as a consequence of …1 week…… (d)………………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 157 Exercise 2 Age: 59 Sex: Female I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Acute renal failure, Chronic renal.. failure due to or as a consequence of Duration between onset and death ……Month… (b)…cardiogenic shock…….. due to or as a consequence of ……Week… (c)………sepsis……….. due to or as a consequence of …3 Weeks… (d)……UTI…………………………………. ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 158 MODULE 21 - ANSWERS Chapter XIV Diseases of the genitourinary system 1. Renal tubulo-interstitial disorder due to brucellosis Look up disorder in the Index (Volume 3, page 183). Disorder -tubulo-interstitial(in) - - brucellosis -> A23._ † N16.0* Refer to pages 119 and 120 of Volume 1 to find the correct code in the A23 category for brucellosis. The .- means a further digit is required to complete the code. As the brucellosis is unspecified then the correct should be A23.9†. 2. Acute diffuse membranous glomerulonephritis Look up glomerulonephritis in the Index (Volume 3, page 247). Glomerulonephritis -membranous(diffuse)NEC code to N00-N07 with a fourth character of .2 Refer to pages 681-682 to determine which is the correct code to use from the range N00-N07. We are looking for a code that includes acute glomerulonephritis. The code we are looking for is N00 Acute nephrotic syndrome - which includes acute glomerulonephritis. The Index has already indicated that the fourth character should be a .2. Therefore our code is N00.2. 3. Acute cystitis with urolithiasis Look up cystitis in the Index (Volume 3, page 129). Cystitis -acute -> N30.0 If we refer to page 693, at the beginning of the block there is an exclusion note stating if the conditions in this block occur with urolithiasis then the coder should refer to the block N20-N23. If we check this section we note that the correct code is N20.9 as no site of calculus is given. 4. Incomplete uterovaginal prolapse Look up prolapse in the Index (Volume 3, page 460). Prolapse -uterovaginal - - incomplete -> N81.2 5. Glomerulitis in diabetes mellitus Look up glomerulitis in the Index (Volume 3, page 246). Glomerulitis (see also Glomerulonephritis) N05._ As there is no modifier for "in diabetes mellitus" we should look up glomerulonephritis in the Index (Volume 3, page 246). Glomerulonephritis -in(due to) - - diabetes mellitus (see also E10-E14 with fourth character of .2) -> E14.2† N08.3* CBHI ICD 10 Student Workbook December 2004 Page 159 As the diabetes is unspecified we can use the codes that the Index has indicated are appropriate for this condition. Hospital Discharge Summaries Summary 1: Main Condition: N30.2 Other chronic cystitis Other conditions: E10.9 Insulin dependent diabetes mellitus Summary 2: Main Condition: N39.0 Urinary tract infection, site not specified Other Conditions: B96.4 Proteus mirabilis as cause of disease classified to other Chapters Mortality Coding Exercises Exercise 1: Underlying cause of death: N39.0 Urinary tract infection, site not specified Which rule applied: Rule 1, more than one sequence terminating in first reported condition – first sequence used to select underlying cause Exercise 2: Underlying cause of death: N39.0 Urinary tract infection, site not specified Which rule applied: General principle CBHI ICD 10 Student Workbook December 2004 Page 160 MODULE 22 Pregnancy, Childbirth and the Puerperium CBHI ICD 10 Student Workbook December 2004 Page 161 MODULE 22: Pregnancy, Childbirth and the Puerperium (Chapter XV) This chapter covers disorders and complications that arise during pregnancy, childbirth and the puerperium. Important points for Chapter XV • Coders should be very careful in distinguishing the letter “O” from the number “0” in this chapter. • Categories range from O00 to O99. • 75 of the 100 available categories have been allocated. • The chapter starts with a list of 8 exclusions. • There are 8 blocks. • The first 3 blocks are mostly concerned with pregnancy. • Inclusion and exclusions are found at the beginning of each block or category. • Throughout this chapter there are quite a few notes, some of which refer you to either morbidity or mortality guidelines in Volume 2. Make sure you read these before you assign a code from this chapter. • O00-O08 Pregnancy with abortive outcome, covers all abortions, but excludes continuing pregnancy in multiple gestation after abortion of one fetus or more. Complications related to abortions are specified by fourth character subdivisions. Category O08 also has a note to indicate that this category is primarily for morbidity coding. • O20-O29 Other maternal disorders predominantly related to pregnancy, contains many varied conditions associated with pregnancy, e.g.: • O20 Haemorrhage in early pregnancy • O21 Excessive vomiting in pregnancy • O22 Venous complication in pregnancy • O60-O75 Complications of Labour and delivery is structured to follow the progress of labour. • O80-O84 Delivery, is a block which allows for single deliveries to be classified at the three character level. The codes are primarily for morbidity purposes. Guidelines are provided in Volume 2 and should be referred to before assigning codes from this block. Read the notes on page 121 of Volume 2 which indicate how to select Main Condition for obstetric cases. • O85-O92 covers the puerperium and includes problems with lactation. • O95-O99 includes maternal health. • There are time limits associated with O96 Death from any obstetric cause occurring more than 42 days but less than 1 year after delivery, and O97 Death from sequelae of direct obstetric cause (one year or more). • Coders should refer to pages 1235-1238 of Volume 1 for definitions related to obstetric deaths prior to beginning coding. CBHI ICD 10 Student Workbook December 2004 Page 162 Coding exercises for Chapter XV 1. Spontaneous abortion 2. Live twin delivery 3. Cardiomyopathy in the puerperium 4. Fetal distress affecting labour and delivery 5. Premature separation of the placenta CBHI ICD 10 Student Workbook December 2004 Page 163 Sample Hospital Discharge Summaries for Chapter XV Summary 1 ADMISSION DATE : 13-11-03 DISCHARGE DATE : 19-11-03 AGE : 27 years SEX : female This 27-year-old primigravida was admitted at full term. Her delivery was complicated by placenta praevia which, fortunately, had not caused a haemorrhage. Because of this, an emergency classical caesarean section was performed. A single healthy female infant weighing 3980 grams was delivered. Dx ICD-10 Code Main Condition: Other Conditions: Summary 2 ADMISSION DATE : 16-11-03 DISCHARGE DATE : 20-11-03 AGE : 31 years SEX : female An artificial rupture of membranes was performed on this lady at 39 weeks gestation, because of pregnancy-induced hypertension. Labour was obstructed due to shoulder presentation of the fetus. Neville Barnes forceps with episiotomy were used to help delivery of a live male infant. Manual removal of a retained placenta was performed. Mother and baby were discharged well. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 164 Mortality Coding Exercises for Chapter XV Exercise 1 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Massive Haemorrhage due to or as a consequence of Duration between onset and death …3 hours… (b)…Placenta praevia due to or as a consequence of (c)……………… due to or as a consequence of …3 hours (d)…………………… ……………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it Gestational Diabetes .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 165 Exercise 2 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last (a)…Pelvic trauma……….. due to or as a consequence of Duration between onset and death …2 hours…… (b)…Obstructed delivery due to or as a consequence of ……………… (c)…Breech presentation…. due to or as a consequence of ……………… (d)………………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Home birth .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 166 MODULE 22 - ANSWERS Chapter XV Pregnancy, childbirth and the puerperium 1. Spontaneous abortion Look up abortion in the Index, (Volume 3, page 16). Abortion -spontaneous -> O03._ Refer to page 724 of volume 1 for the fourth character subdivision. The list of fourth character subdivisions is listed above the O03 category as indicated in the note for O03. As the abortion is unspecified with no mention of complications, the fourth character code will be .9. Therefore the correct code will be O03.9. 2. Live twin delivery Don't forget that you are coding the mother's record here. Look up delivery in the Index (Volume 3, page 148). Delivery -multiple -> O84.9 As there is no index entry to indicate twins, we have to think of another word to describe twins. Therefore we look for multiple delivery. 3. Cardiomyopathy in the puerperium The puerperium is also known as the postpartum period. Look up cardiomyopathy in the Index (Volume 3, page 90). Cardiomyopathy -postpartum -> O90.3 4. Fetal distress affecting labour and delivery Look up distress in the Index (Volume 3, page 186). Distress -fetal(syndrome) - - affecting - - - labour and delivery -> O68._ Refer to page 748 of Volume 1 to determine which code from the O68 category is appropriate for this patient. As the type of fetal distress is not specified, the code O68.9 should be used. 5. Premature separation of the placenta Look up separation in the Index (Volume 3, page 492). Separation -placenta(normally implanted)(premature)(see also Abruptio placentae) --> O45.9 As we do not have further details to code, we can accept this code and do not have to refer to Abruptio placentae as the Index suggests. CBHI ICD 10 Student Workbook December 2004 Page 167 Hospital Discharge Summaries Summary 1: Main Condition: O82.1 Delivery by emergency caesarean section Other conditions: O44.0 Placenta praevia specified as without haemorrhage Z37.0 Single live birth Summary 2: Main Condition: O13 Other Conditions: O64.4 O81.0 O73.0 Z37.0 Gestational (Pregnancy induced) hypertension without significant proteinuria Obstructed labour due to shoulder presentation Low forceps delivery Retained placenta without haemorrhage Single live birth Mortality Coding Exercises Exercise 1: Underlying cause of death: O44.1 Placenta praevia with haemorrhage Which rule applied: General principle, then rule C Linkage Exercise 2: Underlying cause of death: O64.1 Obstructed labour due to breech presentation Which rule applied: General principle and table on page 66 of volume 2 CBHI ICD 10 Student Workbook December 2004 Page 168 MODULE 23 Certain Conditions Originating in the Perinatal Period CBHI ICD 10 Student Workbook December 2004 Page 169 Module 23: Certain Conditions Originating in the Perinatal Period (Chapter XVI) This chapter is concerned with conditions affecting the fetus and the newborn baby, originating in the perinatal period. Important points for Chapter XVI • Categories range from P00 to P96. • Of the 100 available categories 59 have been allocated. • There is one inclusion at the beginning of this chapter, and 5 exclusions. • For disorders related to length of gestation and foetal growth, birth weight takes priority over gestational age as evidence of maturity of the baby. This is because birth weight is a more objective measure than gestational age, which might be miscalculated. For example, P07 Disorders related to short gestation and low birth weight, not elsewhere classified, has a note at the beginning of the category to give guidance on the assignment of this code if both birth weight and gestational age are specified. • P10-P15 birth trauma is classified to six categories which are arranged according to the physical effect of the injury, e.g. P10.2 Intraventricular haemorrhage due to birth injury. • P35-P39 Infections specific to the perinatal period, includes only congenital infections and parasitic disease and those infections acquired in utero or which are present at birth. There are some exceptions to this and these are clearly noted in the appropriate category. • Coders should refer to pages 1235-1238 of Volume 1 for definitions related to perinatal deaths prior to beginning coding. CBHI ICD 10 Student Workbook December 2004 Page 170 Coding exercises for Chapter XVI (Remember it is the baby's record you are coding in these exercises) 1. Low birth weight - baby weighed 900g 2. Fetal death 3. Congenital hydrocele 4. Feeding problems of newborn 5. Birth injury to spine CBHI ICD 10 Student Workbook December 2004 Page 171 Sample Hospital Discharge Summaries for Chapter XVI Summary 1 ADMISSION DATE : 15-8-03 DISCHARGE DATE : 28-8-03 AGE at discharge : 18 days SEX : male This baby was born on 28-7-03 at 34 weeks gestation. His birthweight was 2150 grams and birth head circumference was 31cm. His weight had dropped to 1990g in the week following delivery. His blood group was A positive. He had been a cephalic occipito-anterior (OA) presentation delivered by urgent caesarean section because of fetal distress. DIAGNOSES: prematurity jaundice – non-haemolytic –requiring phototherapy for 72 hours Dx ICD-10 Code Main Condition: Other Conditions: Summary 2 ADMISSION DATE : 8-4-04 DISCHARGE DATE : 3-7-04 AGE at discharge : 86 days SEX : female This 3400 gram female infant was admitted to Special Care Nursery after being delivered at term by forceps delivery. The baby had suffered meconium aspiration during stage 1 of labour. The cord was prolapsed. The baby also had atelectasis of the left lung and was mildly distressed on admission. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 172 Mortality Coding Exercises for Chapter XVI Exercise 1 Age: 30 mins I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex: Male (a)…Asphyxia due to or as a consequence of Duration between onset and death ……………… (b)…Umbilical cord around neck due to or as a consequence of ……………… (c)… Birth due to or as a consequence of ……………… (d)……………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Chorioamnionitis… .…………………………… ……………………………… ……………………………… …………………… …………………… …………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 173 Exercise 2 Age : 3 hours I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex : Female (a)…Pulmonary haemorrhage due to or as a consequence of Duration between onset and death …1 hour… (b)……………………………. due to or as a consequence of (c)… ………………. due to or as a consequence of ……………… (d)………………………………… ……………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Meconium aspiration… .…………………………… ……………………………… ……………………………… ……………………… ……………………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 174 Chapter XVI Certain conditions originating in the perinatal period 1. Low birth weight - baby weighed 900 grams Look up low in the Index (Volume 3, page 338). Low -birthweight - - extreme (999 grams or less) -> P07.0 2. Fetal death Look up death in the Index (Volume 3, page 132). Death -fetus, fetal(cause not stated)(intrauterine) -> P95 This is a really poor diagnosis - you should try to get more information about why the baby died. 3. Congenital hydrocele Look up hydrocele in the Index (Volume 3, page 271). Hydrocele -congenital -> P83.5 4. Feeding problems of newborn Look up feeding in the Index (Volume 3, page 222). Feeding -problem - - newborn -> P92.9 5. Birth injury to spine Look up injury in the Index (Volume 3, page 304). Injury -birth(see also Birth injury) P15.9 As we have an injury of the spine specified we should look for a more specific code. Therefore we can look up Birth injury in the Index, page 72. Birth -injury - - spine -> P11.5 CBHI ICD 10 Student Workbook December 2004 Page 175 Hospital Discharge Summaries Summary 1: Main Condition: P07.1 Other low birth weight Other conditions: P59.0 Neonatal jaundice associated with preterm delivery Summary 2: Main Condition: P24.0 Neonatal aspiration of meconium Other Conditions: P02.4 Fetus and newborn affected by prolapsed cord P28.1 Other and unspecified atelectasis of newborn Mortality Coding Exercises Exercise 1: Underlying cause of death: P02.5 Fetus and newborn affected by other compression of umbilical cord Which rule applied: Rule 1 - sequence terminating in the condition first entered on death certificate (cord around neck causing asphyxia) Exercise 2: Underlying cause of death: P26.9 Unspecified pulmonary haemorrhage originating in perinatal period Which rule applied: General principle CBHI ICD 10 Student Workbook December 2004 Page 176 MODULE 24 Congenital Malformations, Deformations and Chromosomal Abnormalities CBHI ICD 10 Student Workbook December 2004 Page 177 MODULE 24: Congenital Malformations, Deformations and Chromosomal Abnormalities (Chapter XVII) This chapter covers congenital malformations, deformations and chromosomal anomalies. Important points for Chapter XVII • Categories range from Q00 to Q99. • 87 of the available 100 categories have been allocated. • No asterisk categories are found in this chapter. CBHI ICD 10 Student Workbook December 2004 Page 178 Coding exercises for Chapter XVII 1. Patent ductus arteriosus 2. Cervical spina bifida with hydrocephalus 3. Von Recklinghausen's disease 4. Pentalogy of Fallot 5. Laryngocele Sample Hospital Discharge Summaries for Chapter XVII Summary 1 ADMISSION DATE : 18-8-03 DISCHARGE DATE : 18-8-03 AGE : 3 years SEX: male This 3-year-old boy was admitted with pain in the left upper arm. He had been diagnosed with osteogenesis imperfecta at birth. He had suffered multiple fractures since. An X-ray of his upper arm revealed a pathological fracture of the shaft of his left humerus. An open reduction with internal fixation was performed in theatre. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 179 Summary 2 ADMISSION DATE : 4-7-04 DISCHARGE DATE : 16-7-04 AGE : 3 months SEX : male DIAGNOSIS: Ventricular Septal Defect Relevant History: Breathless at times, especially during feeding, failure to thrive, and a heart murmur. Relevant Clinical Evidence: hepatomegaly. Alert child. Pansystolic murmur at left sternal edge. No Relevant Investigations And Results: Cardiac catheter/coronary angiogram revealed a large perimembranous ventricular septal defect. Chest x-ray showed cardiomegaly. Treatment In Hospital: A tissue patch closure of ventricular septal defect was performed under GA with cardiopulmonary bypass. The post-operative period was uncomplicated and the patient was discharged home to his parents. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 180 Mortality Coding Exercises for Chapter XVII Exercise 1 Age: 1 day I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex : M (a)… Aortic and mitral valve atresia due to or as a consequence of Duration between onset and death …1 day… (b)…Congenital malformation…….. due to or as a consequence of (c)………………………….. due to or as a consequence of …1 day.. (d)……………………………. II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……. Prematurity (32/40) .…………………………… ……………………………… ……………………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 181 Exercise 2 Age: 5 minutes I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex : M (a)… Anencephaly due to or as a consequence of Duration between onset and death …1 day… (b)…Birth defect…….. due to or as a consequence of (c)……………………………….. due to or as a consequence of (d)……………………………….. II Other significant conditions contributing to the death, but not related to the disease or condition causing it ………………………….. .………………………….. ……………………………… ……………………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 182 MODULE 24 - ANSWERS Chapter XVII Congenital malformations, deformations and chromosomal abnormalities 1. Patent ductus arteriosus Look up patent in the Index (Volume 3, page 431). Patent - ductus arteriosus or botalli -> Q25.0 2. Cervical spina bifida with hydrocephalus Look up spina bifida in the Index (Volume 3, page 503). Spina bifida - cervical - - with hydrocephalus -> Q05.0 3. Von Recklinghausen's disease Look up Von Recklinghausen's in the Index (Volume 3, page 563). Von Recklinghausen's - disease (neurofibromatosis) -> Q85.0 4. Pentalogy of Fallot Look up Pentalogy of Fallot in the Index (Volume 3, page 432). Pentalogy of Fallot -> Q21.8 5. Laryngocele Look up laryngocele in the Index (Volume 3, page 330). Laryngocele (congenital)(ventricular) -> Q31.3 Hospital Discharge Summaries Summary 1: Main Condition: Q78.0 Osteogenesis imperfecta Other conditions: M84.42 Pathological fracture NEC, upper arm Summary 2: Main Condition: Q21.0 Ventricular septal defect Other Conditions: Mortality Coding Exercises Exercise 1: Underlying cause of death: Q23.0 Congenital stenosis of aortic valve Which rule applied: General principle, then rule 3 (selected condition an obvious consequence of another reported condition), then rule 2 (first mentioned condition) Exercise 2: Underlying cause of death: Q00.0 Anencephaly Which rule applied: General principle, then rule D Specificity CBHI ICD 10 Student Workbook December 2004 Page 183 MODULE 25 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified CBHI ICD 10 Student Workbook December 2004 Page 184 Module 25: Symptoms, Signs And Abnormal Clinical & Laboratory Findings, Not Elsewhere Classified (Chapter XVIII) This chapter covers: • symptoms • signs • abnormal results of clinical or other investigative procedures and • ill defined conditions regarding which no diagnosis classifiable elsewhere is recorded Important points for Chapter XVIII • Categories range from R00 to R99 • 90 of the available 100 categories have been allocated • A group has been created for symptoms involving cognition perception, emotional state and behaviour at R40 -R46 and speech and voice at R47-R49 • Blocks are listed after 2 exclusions for the chapter • Any exclusions from a block or category are given and the category or subcategory to which the exclusion belongs is always specified. • There are no asterisk categories in this chapter • The Alphabetical Index (Volume 2) should always be used to clarify which signs and symptoms are to be assigned to chapter XVIII and which to other chapters. • R10 Abdominal and pelvic pain is subdivided according to the site of the pain, e.g. Pain localised to the upper abdomen. • R47-R49 classifies symptoms and signs involving speech and voice, and conditions such as speech disturbance not elsewhere classified, and voice disturbance. • R70-R94 deals with abnormal findings. These codes are to be used when no clear diagnosis has been given and a person is having follow-up of an examination indicating abnormal findings. • R95-R99 Ill-defined and unknown causes of mortality, as the titles suggest, are to be used for mortality coding. They are only to be used if no other specific code can be assigned. CBHI ICD 10 Student Workbook December 2004 Page 185 Coding exercises for Chapter XVIII 1. Pyrexia of unknown origin 2. False-positive Wassermann reaction for syphilis 3. Hyperglycaemia 4. Petechiae 5. Hallucinations (visual) CBHI ICD 10 Student Workbook December 2004 Page 186 Sample Hospital Discharge Summaries for Chapter XVIII Summary 1 ADMISSION DATE : 26-12-03 DISCHARGE DATE : 28-12-03 AGE : 65 years SEX : male FINAL DIAGNOSIS: Chest pain SUMMARY OF ADMISSION: This 65 year old aged pensioner was admitted to hospital with a prolonged episode of central chest pain. At the time of admission this had been present for eleven hours without any significant electrocardiographic change or cardiac enzyme rise. The pain had begun whilst he was having a glass of beer in the afternoon, although there were no gastrointestinal features. The pain was described as a central heaviness which radiated to the right hand. It was atypical in nature with pleuritic and positional elements and also exacerbation with posture and use of the arms. There was no associated sweating, nausea or presyncope. There had been one episode of similar chest pain six years previously. There was no ongoing exertional chest pain or dyspnoea however. EXAMINATION FINDINGS: There was a sinus tachycardia of 110/min and blood pressure of 150/100. Pulses were symmetric and blood pressure equal in both upper arms. Heart sounds were dual, chest was clear, carotids were decreased in volume, but there were no associated bruits. Femoral pulses were also decreased in volume. There were well maintained peripheral pulses. Abdomen was soft to examine. There was marked chest wall tenderness which reproduced some of the pain. INVESTIGATIONS: ECG and chest x-ray were normal. Full Blood Count and Cardiac enzymes were normal. BSL was normal. ASSESSMENT & MANAGEMENT: The impression of the pain was that it was atypical in nature and related to the chest wall. There were no obvious rib fractures on x-ray. Thyroid function was also checked and found to be normal. Serial ECGs and cardiac enzymes failed to demonstrate evidence of myocardial infarction. The patient is to attend follow up with his local medical officer Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 187 Summary 2 ADMISSION DATE : 20-1-04 DISCHARGE DATE : 21-1-04 AGE : 49 years SEX female FINAL DIAGNOSIS: Epigastric pain HISTORY: This 49-year-old woman admitted for investigation. She had a two-day history of epigastric pains associated with nausea and sweating. EXAMINATION: Examination on admission was unremarkable and the patient was not jaundiced at this stage. OPERATION: Ultrasound revealed no abnormality and the pain eased The patient was discharged home with review in Surgical Outpatients planned. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 188 Mortality Coding Exercises for Chapter XVIII Exercise 1 Age: 91 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex: F (a)…Natural causes… due to or as a consequence of Approximate Duration between onset and death ……………… (b)………………………………… due to or as a consequence of ……………… (c)………………………………… due to or as a consequence of ……………… (d)…………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ………………… ………………… ………………… ……… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 189 Exercise 2 Age: 77 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex: Male (a)… Old age due to or as a consequence of Duration between onset and death ……………… (b)……Frailty …… due to or as a consequence of (c)…… Debility … due to or as a consequence of ……………… (d)……………….. ……………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 190 MODULE 25 - ANSWERS Chapter XVIII Symptoms, signs and abnormal clinical & laboratory findings, not elsewhere classified 1. Pyrexia of unknown origin Look up pyrexia in the Index (Volume 3, page 469). Pyrexia (of unknown origin) -> R50.9 Note that there are more specific codes shown in the Index and as Exclusion notes in the Tabular list for pyrexia occurring in conjunction with different conditions, but our diagnosis is pyrexia of unknown origin. 2. False-positive Wassermann reaction for syphilis Look up false in the Index (Volume 3, page 221). False - positive serological test for syphilis (Wassermann reaction) -> R76.2 3. Hyperglycaemia Look up hyperglycemia in the Index (Volume 3, page 274). Hyperglycemia, hyperglycemic -> R73.9 Again, note that there are more specific codes to use if you know the cause of the hyperglycemia. 4. Petechiae Look up Petechiae in the Index (Volume 3, page 437). Petechia, petechiae -> R23.3 If the petechiae had been occurring in a newborn baby, we would use code P54.5 from the Perinatal Conditions chapter. 5. Hallucinations (visual) Look up hallucinations in the Index (Volume 3, page 252). Hallucinations - visual -> R44.1 There are individual codes for the differing types of hallucinations - visual, auditory and other hallucinations. CBHI ICD 10 Student Workbook December 2004 Page 191 Hospital Discharge Summaries Summary 1: Main Condition: R07.4 Chest pain unspecified R10.1 Pain localised to upper abdomen R99 Other ill-defined and unspecified causes of mortality Other conditions: Summary 2: Main Condition: Other Conditions: Mortality Coding Exercises Exercise 1: Underlying cause of death: Which rule applied: Exercise 2: Underlying cause of death: Which rule applied: General principle R54 Senility Rule 2 – no reported sequence, so select first mentioned condition. Note Rule A Senility does not apply because all reported conditions are coded to chapter XVIII. CBHI ICD 10 Student Workbook December 2004 Page 192 MODULE 26 Injury, Poisoning and Certain Other Consequences of External Causes & External Causes of Morbidity and Mortality CBHI ICD 10 Student Workbook December 2004 Page 193 Module 26: Injury, Poisoning And Certain Other Consequences Of External Causes (Chapter Xix) & External Causes Of Morbidity And Mortality (Chapter XX) These two chapters cover injury, poisoning and certain other consequences of external causes and the classification of environmental events and circumstances as the cause of injury, poisoning and other adverse effects. The external cause concept • The use of Chapter XX codes permits the classification of environmental events, circumstances and conditions as the cause of injury, poisoning and other adverse effects. The use of Chapter XX codes along with Chapter XIX codes provides additional information of particular concern to industrial medicine, national safety programs and national health agencies. Injury prevention programs are often based on the information coded to this Chapter. • When multiple coding, a Chapter XX code should always be assigned with a Chapter XIX code. That is, a code describing how the injury(s) occurred as well as the injury code(s) will be assigned. When coding underlying cause of death, the code for the external cause takes priority. Conversely, when coding morbidity records, the main condition will be the nature of the most severe injury. Important points for Chapter XIX • Categories range from S00 to T98. • Of the 199 available categories 195 have been allocated. • There are 21 blocks. • Blocks S00-S99, at the three-character level are classified by site of injury, e.g. head, arms. The fourth character level indicates the type of injury that occurred, e.g. fracture, open wound. • Codes in the range T00-T98 are used to code all other trauma, e.g. burns, complications of surgery, poisonings. • When multiple coding, all injuries should be coded, avoid the use of 'multiple' type codes. Multiple codes are useful for single condition coding. eg T06.- can be used to code fractures of multiple regions of upper limb(s) in association with lower limb(s). Important points for Chapter XX • Four letters of the alphabet - V,W,X.and Y - have been assigned to this chapter, making it the largest in ICD-10. • Categories range from V01 to Y98. • Of the 400 available categories 372 have been used. • 8 major blocks CBHI ICD 10 Student Workbook December 2004 Page 194 • The Chapter includes Place of occurrence codes, which are fourth character subdivisions used to identify the place where an injury occurred. They are to be used with categories W00 - Y34 (except Y06 and Y07). .0 .1 .2 .3 .4 .5 .6 .7 .8 .9 Home Residential institution School, other institution, public administrative area Sports and athletics area Street and highway Trade and Service area Industrial and construction area Farm Other specified places Unspecified place See pages 1013 - 1017 of Volume 1 for the detailed breakdown of Place of Occurrence codes. • An Activity code is also provided for optional use in a supplementary character position with categories V01-Y34 to indicate the activity the injured person was involved in at the time of the injury. This code should not be confused with, or be used instead of, the place of occurrence code. 0 1 2 3 4 8 9 while engaged in sports activity while engaged in leisure activity while working for income while engaged in other types of work while resting, sleeping, eating or engaging in other vital activities while engaged in other specified activities while engaged in unspecified activities The codes can be found on pages 1018-1019 of Volume 1. Note that if an activity falls into more than one of the categories, select the code that is higher on the list (i.e. the lower number). • Chapter XX codes can also be assigned with codes from Chapter I-XVII to identify the external cause of a condition, e.g. dermatitis due to solvents. • Chapter XX codes are never assigned as the main condition code for morbidity coding. For mortality coding the Chapter XX code is the code assigned for the underlying cause of death. • V01-V79 Motor vehicle transport accidents, are classified at the three character level by the mode of transport of the injured person and at the fourth character level according to the position of the person in the motor vehicle. Read the notes and definitions on pages 1018-1025 of the Tabular List. These notes refer to the classification of transport accidents and need to be understood before assigning codes from Chapter XX. The table on page 576 of Volume 3 is useful as a guide to finding the correct code for transport accidents. • X60-X80 Intentional self harm, are incidents determined as being suicide or self-inflicted injuries. CBHI ICD 10 Student Workbook December 2004 Page 195 • The Table of Drugs and Chemicals, found at the back of the Alphabetical Index, guides the coder to the correct codes to describe poisonings by drugs and chemicals. To use the Table, first of all look up the name of the drug in the alphabetical list. The first column indicates the nature of injury code from Chapter XIX that is appropriate for the specific drug. Check the Tabular list to confirm this code selection. The other four columns in the Table give the External Cause codes to describe the circumstances of the poisoning e.g. accidental, intentional self-harm, undetermined intent and adverse effect in therapeutic use. Select the appropriate code and confirm it in the Tabular list. Add the Place of Occurrence and/or Activity codes as required. • Y10-Y34 Event of undetermined intent, includes occurrences where it is not clear whether the person was accidentally injured or the injury was purposely inflicted. • Terms to be aware of when searching the index for the external cause are ‘exposure’ and ‘contact’ if the person comes in contact with an object or instrument; or is exposed to an element. CBHI ICD 10 Student Workbook December 2004 Page 196 Coding exercises for Chapters XIX and XX 1. Multiple lacerations to abdomen, inflicted by a knife during a fight in a bar. The victim was a bar attendant working in the bar at the time. 2. Cerebral contusion due to fall from bed onto floor, whilst sleeping, at home. 3. Adverse reaction to anaesthetic given prior to surgical operation 4. The final diagnosis for this 24-year motor cycle rider who was involved in a collision with a car was a closed fracture mid shaft right femur, compound fracture mid shaft right tibia. 5. Second degree burn to leg sustained from uncontrolled house fire. Sample Hospital Discharge Summaries for Chapter XIX and XX Summary 1 ADMISSION DATE : 24-4-03 DISCHARGE DATE : 23-5-03 AGE : 24 years SEX : male FINAL DIAGNOSIS: trail bike accident Mr X. had been riding his trail bike on a country track when he lost control and the bike went down a 10 metre embankment. Mr X. sustained an open fracture of the left tibia and fibula and a dislocation of the right ankle. On admission the patient was taken to theatre where the ankle dislocation was reduced and the fracture site underwent debridement and lavage. A fracture reduction was performed on day five with fixation using two nails. Unfortunately the wound became infected and grew pseudomonas. He was managed on oral antibiotic treatment. At discharge he was placed in a short leg plaster of Paris. He is for continuing follow up in outpatients. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 197 Summary 2 ADMISSION DATE : 10-11-02 DISCHARGE DATE : 16-11-02 AGE : 47 years SEX : male FINAL DIAGNOSIS: Mr X. is a sailor who suffered a fractured zygoma and mandible after falling down stairs at work. He was mildly concussed on arrival at hospital. X-rays showed that the fracture to the zygoma was not displaced but the mandibular fracture would require wiring. CT scan of the brain was clear. He was taken to theatre on the day of admission where the mandible was wired. Three days after surgery Mr X. became drowsy then unresponsive. A second CT scan of the brain identified a subdural haematoma. He was taken back to theatre where a craniotomy was performed to evacuate the haematoma. He has recovered quite well from his accident. He remains on a liquid diet until the wires are removed from his mandible, which will be in another three weeks. He seems to have had no residual effects from the subdural haematoma. He is presently continuing management in outpatients and we expect him to make a complete recovery. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 198 Summary 3 ADMISSION DATE : 10-1-04 DISCHARGE DATE: 22-1-04 AGE : 91 years SEX : female FINAL DIAGNOSIS: fractured neck of femur, requiring open reduction of fracture Mrs X. is a charming elderly lady who was admitted with an intertrochanteric fracture of her left neck of femur. She sustained this when she slipped on a wet path in the garden at her home. The fracture was reduced and internally fixed with a pin and plate. Post-operatively she progressed slowly but on day 3 she fell out of bed and dislocated her right shoulder and sustained a laceration to her right forearm. She was taken back to theatre where the shoulder dislocation was reduced and her forearm sutured under a light GA. There were no further complications but re-mobilisation was slow. At discharge she was mobile with the assistance of a walking frame and was discharged home into the care of her daughter. Dx ICD-10 Code Main Condition: Other Conditions: CBHI ICD 10 Student Workbook December 2004 Page 199 Mortality Coding Exercises for Chapter XIX and Chapter XX Exercise 1 Age I Disease or condition directly leading to death* Sex (a)…Shock; haemorrhage………. due to or as a consequence of Antecedent causes (b)…Multiple rib fractures, lacerated Morbid conditions lungs and spleen . . . . . . . giving rise to the above due to or as a consequence of cause, stating the underlying condition last (c)…MVA due to or as a consequence of (d)………………………………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it Driver, of car Vs semi trailer .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… …………………… …………………… …………………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 200 Exercise 2 Age : 45 I Disease or condition directly leading to death* Antecedent causes Morbid conditions giving rise to the above cause, stating the underlying condition last Sex : Male (a)…Hanging………………. due to or as a consequence of ……………… (b)..Successful suicide… due to or as a consequence of ……………… (c)………………………………… due to or as a consequence of ……………… (d)……………………………… ……………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it ……………………………… .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 201 Exercise 3 Age : 34 I Disease or condition directly leading to death* Antecedent causes conditions giving rise to the above cause, stating the underlying condition last Sex : Female (a)…Subdural haemorrhage due to or as a consequence of …1 hour… (b)..Fracture of base of skull and Morbid orbital floor… due to or as a consequence of …1 hour…… (c)…Fall from gangplank of cruise ship onto wharf due to or as a consequence of …1 hour… (d)……………………… ………… II Other significant conditions contributing to the death, but not related to the disease or condition causing it …Acute alcohol intoxication… .…………………………… ……………………………… ……………………………… ……………… ……………… ……………… ……………… *This does not mean the mode of dying e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. Selected Underlying Cause of Death: ICD-10 Code: Which rule applied: Explanation: CBHI ICD 10 Student Workbook December 2004 Page 202 MODULE 26 - ANSWERS Chapter XIX Injury, poisoning and certain other consequences of external causes & Chapter XX External causes of morbidity and mortality 1. Multiple lacerations to abdomen, inflicted by a knife during a fight in a bar. The victim was a bar attendant working in the bar at the time. Look up laceration in the Index (Volume 3, page 328). Laceration (see also Wound, open) As there is no listing under Laceration for abdomen, we need to refer to Wound, open in the Index (Volume 3, page 567). Wound, open - multiple - - abdomen, lower back and pelvis -> S31.7 We can now code the external cause of the injury (that is, how the injury occurred). In this case the wounds were 'inflicted by a knife in a fight in a bar'. Look up fight in the Index under External Causes of Injury section (Volume 3, page 599). Fight (hand)(fists)(foot) (see also Assault, fight) Y04.Y04 does not cover fight with a knife, therefore we need to refer to Assault, fight in the External Causes of injury section,(Volume 3, page 582), to find fight with a knife. Assault - fight - - with weapon - - - cutting or piercing -> X99.The .- at the end of the code indicates that the coder must assign a fourth digit. At the beginning of the X85-Y09 section there is a note referring the coder to pages 1013-1017 for the fourth character subdivision. These pages list the places of occurrence for injuries - in other words, where they happened. We need to select from this section an appropriate code for bar. We will select .5 Trade and service area. As well, X99.- is in the range of codes that require an activity code to be selected. Turn to page 1017-1018 of Volume when and determine the correct activity code. We know the victim was a bar attendant at the time of the incident, and we assume he was working at the time of the injury, so the correct activity code is .2. The complete external cause code for this case is X99.52. 2. Cerebral contusion due to fall from bed onto floor, whilst sleeping, at home. Look up contusion in the Index (Volume 3, page 116). Contusion - cerebral -> S06.2 CBHI ICD 10 Student Workbook December 2004 Page 203 Refer to page 900 of the Tabular List (Volume 1). At the beginning of the S06 rubric is a list of optional fifth character subdivisions to indicate if the contusion occurred with or without open intracranial wound. As there is no mention of open intracranial wound in our diagnosis, we would use 0 in the fifth character position. Our code for cerebral contusion would be S06.20. For the external cause of the injury, we look up fall in the Index (Volume 3, page 597). Fall - bed -> W06.The .- indicates that more digits are required to complete this code. The additional codes are the activity code and the place of occurrence code. Refer to page 1013-1017 for the place of occurrence code first. The correct code would be .0 for home. Refer to page 1017-1018 for the activity code. The person was sleeping at the time of the accident, so the code to use would be a 4. Therefore the complete external cause code for this case would be W06.04. 3. Adverse reaction to anaesthetic Look up Reaction in the Index (Volume 3, page 472) Reaction - anesthesia - see Anesthesia, complication Anesthesia - complication or reaction NEC (see also Complications, anesthesia) -> T88.5 Complications - anesthesia NEC -> T88.5 Because we do not know any more information about the nature of the adverse reaction or the type of operation being performed we cannot use a more specific injury code. It is possible to add an external cause code to specify that the patient had an abnormal reaction to an anesthetic agent. Look up the Table of Drugs and Chemicals (volume 3, page 633). Anesthetic NEC - see under adverse effect in therapeutic use -> Y48.4. If you refer to page 1013 for Place of occurrence you will note that a place of occurrence code is not required for this code. 4. The final diagnosis for this 24-year-old motor cycle rider, who was involved in a collision with a car, was a closed fracture mid shaft right femur, compound fracture mid shaft right tibia. Look up fracture in the Index (Volume 3, page 235). Fracture -femur - - shaft(lower third)(middle third)(upper third) -> S72.3 Refer to page 932 Tabular List for S72.3. At the beginning of the S72 category is a note providing fifth character subdivisions for use with this category. They are used to indicate whether a fracture is open or closed. We have been told that the fracture is closed, there we would use the 0. The full code for the fractured femur is S72.30. CBHI ICD 10 Student Workbook December 2004 Page 204 As the patient has two fractures, we need to code the other fracture as well. Look up fracture in the Index (Volume 3, page 238). Fracture -tibia(shaft)(with fibula) -> S82.2 Refer to page 936 of the Tabular List. At the beginning of the S82 section on page 935 is a note providing a fifth character subdivision for use with this section to indicate whether the fracture is open or closed. The fractured tibia is described as a compound fracture, which is an open fracture, therefore we would use a 1. The complete code for the fractured tibia is S82.21. To find the correct external cause code refer to the transport accident table in Volume 3, page 576. The first column indicates the type of transport the person who was injured was using and the list across the top indicates what they collided with, or how the accident happened. We need to match up the motor cycle rider with the collision with a car. This will give us code V23.-. If we refer to Volume we note that a fourth digit is required to indicate the person's status in the vehicle and whether it was a traffic accident or not. The correct digit to assign is a 4. You will note that no place of occurrence code is required for this code, but an activity code needs to be assigned. Although we can refer to page 1017-1018, we do not know what activity the patient was involved in at the time. Assign 9 for the activity code to complete external cause code, V23.49. 5. Second degree burns to leg from an uncontrolled house fire. Look up burn in the Index (Volume 3, page 80). Burn - legs - see limb, lower Burn - limb - - lower -> T24.Refer to Volume 1 page 962 for the fourth character, which will be .2 for our case. The correct code for the leg burns is therefore T24.2. To code the external cause, look up Fire in the Index (Volume 3, page 599). Fire (see also Exposure fire) Exposure - fire - - uncontrolled - - - in building or structure -> X00.Refer to page 1075 of the Tabular list for X00.- which refers the coder to pages 1013-1017 for the appropriate fourth digit to indicate the place of occurrence. We will use .0 to indicate home. Then refer to pages 1017-1018 for the correct activity code. As no indication is given as to the activity the person was involved in at the time of the house fire, the correct fifth digit would be 9. The final correct code is X00.09. CBHI ICD 10 Student Workbook December 2004 Page 205 Hospital Discharge Summaries Summary 1: Main Condition: Other conditions: S82.21 Fracture of shaft of tibia, open fracture S93.0 V28.09 Dislocation of ankle joint Motorcycle rider in non collision transport accident, driver injured in non traffic accident, activity not specified Infection following a procedure, NEC Pseudomonas as cause of disease classified to other chapters Surgical operation with implant of artificial internal device T81.4 B96.5 Y83.1 Summary 2: Main Condition: Other Conditions: Summary 3: Main condition: Other conditions: S06.50 Traumatic subdural haematoma, without open intracranial wound S02.60 S02.40 W10.92 Fracture of mandible, closed Fracture of malar and maxillary bones, closed Fall on and from stairs and steps, place of occurrence unspecified, activity whilst working for income S72.10 Pertrochanteric fracture W01.09 S43.0 S51.9 W06.24 Fall on same level from slipping, tripping and stumbling Dislocation of shoulder joint Open wound of forearm, part unspecified Fall involving bed, in hospital, while resting or sleeping Mortality Coding Exercises Exercise 1: Underlying cause of death: V44.59 Which rule applied: Exercise 2: Underlying cause of death: General principle, then rule D Specificity X70.98 Which rule applied: Exercise 3: Underlying cause of death: Which rule applied: Car occupant involved in collision with heavy transport vehicle, driver involved in traffic accident, activity unspecified Intentional self-harm by hanging, strangulation and suffocation, place of occurrence unspecified, other specified activity General principle V93.19 Accident on board watercraft without accident to watercraft, not causing drowning and submersion, place of occurrence residential institution, activity not specified General principle CBHI ICD 10 Student Workbook December 2004 Page 206 MODULE 27 Factors Influencing Health Status and Contact with Health Services CBHI ICD 10 Student Workbook December 2004 Page 207 Module 27: Factors Influencing Health Status and Contact with Health Services (CHAPTER XXI) This chapter is for use for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as “diagnoses” or “problems”. Important points for Chapter XXI • Categories range from Z00 to Z99 • 84 of the available 100 categories have been used. • There are 7 blocks. • A code for asymptomatic HIV is provided in this chapter. • Codes for contact with or exposure to HIV infection are also part of Chapter XXI. • Z00-Z13 Persons encountering health services for examination and investigation, has many exclusions throughout the block, both to other categories within the block and other categories outside of the block. For example Z02 and Z09 have exclusions to categories within this block as well as exclusions to other categories within this chapter. • Z30-Z39 Person encountering health services in circumstances related to, covers all aspects of reproduction, including contraceptive management, procreative management and pregnancy and antenatal care. Of particular note is the use of Z37 Outcome of delivery, which can be used as an additional code to identify the outcome of delivery on the mother's record. Z38 Liveborn infants, according to place of birth is used to code health infants who are occupying a cot, but are not sick. CBHI ICD 10 Student Workbook December 2004 Page 208 Coding exercises for Chapter XXI 1. Incidental pregnancy 2. Convalescence following surgery 3. Reversal of vasectomy (also known as vasoplasty) 4. Patient "has been in contact with cholera" 5. Outcome of delivery: single live birth (coding mother’s record) 6. Routine follow-up after surgery for malignant bladder papilloma 7. Chemotherapy session 8. Fitting and adjustment of external breast prosthesis CBHI ICD 10 Student Workbook December 2004 Page 209 MODULE 27 - Answers Chapter XXI Factors influencing health status and contact with health services 1. Incidental pregnancy Look up pregnancy in the Index (Volume 3, page 454). Pregnancy -incidental finding -> Z33 2. Convalescence following surgery Look up convalescence in the Index (Volume 3, page 117). Convalescence(following) -surgery NEC -> Z54.0 3. Reversal of vasectomy (also known as vasoplasty). Look up vasoplasty in the Index (Volume 3, page 561). Vasoplasty, after previous sterilisation -> Z31.0 4. Patient "has been in contact with cholera" Look up contact in the Index (Volume 3, page 114). Contact(with) - cholera -> Z20.0 5. Outcome of delivery: single live birth (code the mother's record) Look up outcome in the Index (Volume 3, page 421). Outcome of delivery -single - - liveborn -> Z37.0 6. Routine follow-up after surgery for malignant bladder papilloma Look up examination in the Index (Volume 3, page 215). Examination -follow-up(routine)(following) - - malignant neoplasm - - -surgery -> Z08.0 7. Chemotherapy session Look up chemotherapy in the Index (Volume 3, page 95). Chemotherapy (session)(for) -> Z51.2 8. Fitting and adjustment of external breast prosthesis Look up fitting(of) in the Index (Volume 3, page 232). Fitting (of) -prosthesis(external) - - breast -> Z44.3 CBHI ICD 10 Student Workbook December 2004 Page 210 MODULE 28 Procedure Coding Exercises CBHI ICD 10 Student Workbook December 2004 Page 211 Module 28: Procedure Coding Exercises 1. Appendicectomy 2. Assisted breech delivery with forceps to aftercoming head 3. Control of arterial haemorrhage by ligation 4. Repair of broncho-oesophageal fistula with oesophageal atresia 5. Closed biopsy of stomach with endoscopic brushings 6. Lobectomy of lung 7. Excision of squamous cell carcinoma from eyelid 8. Substernal bilateral thyroidectomy, complete 9. Repair of myelomeningocoele 10. Total abdominal hysterectomy with unilateral salpingo-oophorectomy CBHI ICD 10 Student Workbook December 2004 Page 212 MODULE 28 - ANSWERS Procedure coding with ICHI Appendicectomy Look up appendicectomy in the Procedures Index. Appendicectomy (incidental)(open) -> 926 If the appendicectomy was performed laparoscopically, note the block code is the same. The laparoscopy could also be coded to indicate the approach. Assisted breech delivery with forceps to aftercoming head Look up delivery in the Procedures Index. Delivery - breech - - assisted - - - with forceps to aftercoming head (FACH) -> 1339 Control of haemorrhage by ligation Note that it is difficult to code this procedure without knowing the site of, or reason for, the haemorrhage - this information should always be provided. Control - haemorrhage - - artery NEC -> 767 Repair of broncho-oesophageal fistula Look up Repair in the Procedures Index. Repair - fistula - see also Closure, fistula Closure - fistula - - broncho-oesophageal - - -with repair of oesophageal atresia -> 866 Closed biopsy of stomach with endoscopic brushings Look up Biopsy in the Procedures Index. Biopsy - stomach - - closed -> 1008 It is not necessary to separately code the brushings. Lobectomy of lung Look up Lobectomy in the Procedures Index. Lobectomy - lung (complete) -> 552 CBHI ICD 10 Student Workbook December 2004 Page 213 Excision of squamous cell carcinoma from eyelid Look up Excision, tumour Excision - tumour - - skin - see excision, lesion, skin Excision - lesion - - skin - - - specified site - - - - eyelid -> 1620 Substernal bilateral thyroidectomy, complete Look up thyroidectomy in the Procedures Index. Thyroidectomy - complete - - bilateral - see Thyroidectomy, bilateral Thyroidectomy - bilateral - - substernal -> 115 Repair of myelomeningocoele Look up Repair in the Procedures Index. Repair - myelomeningocoele (with excision) -> 55 10. Total abdominal hysterectomy with unilateral salpingo-oophorectomy Look up hysterectomy in the Procedures Index. Hysterectomy - abdominal - - with - - - salpingo-oophorectomy - - - - unilateral -> 1268 CBHI ICD 10 Student Workbook December 2004 Page 214 References 1. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). WHO: Geneva; 1992 2. Meads, M. Sue & Brown, Faye. ICD-10 Coding Fundamentals: A comprehensive coding guide for healthcare professionals. PMIC: Los Angeles; 1997 3. National Centre for Classification in Health. International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10AM) 3rd Ed. NCCH: Sydney; 2002 4. World Health Organization Collaborating Centre for the Classification of Diseases, London. TENDON: ICD-10 computer based training. OPCS: London; 1996 5. National Centre for Classification in Health. International Classification of Health Interventions, 2nd edition. NCCH : Sydney; 2004 6. Berkhow, Robert & Fletcher, J. Andrew (Eds). The Merck Manual of Diagnosis and Therapy 16th Ed. Merck Research Laboratories: New Jersey; 1992 7. Pan American Health Organization. Intercod ICD-10 computer based interactive training. PAHO: Washington; 2002 8. National Center for Health Statistics. Instruction Manual Part 2C: ICD-10 ACME Decision Tables for Classifying Underlying Causes of Death. NCHS: Hyattsville, Maryland; 2004 CBHI ICD 10 Student Workbook December 2004 Page 215 APPENDIX 1 Human Body Structure and Functions CBHI ICD 10 Student Workbook December 2004 Page 216 Human Body Structure and Functions CELL DEFINITION The cell is the smallest structure unit of our body. The cell is capable of independent functioning. A cell membrane surrounds each cell and allows material to leave and enter the cell. The nucleous contains chromosomes which carrier characteristic of the parents to the next generation. Each normal body, normal cells contains 23 pairs of chromosomes which carries characteristic of the parents to the next generation. Each normal body, normal cells contains 23 pair of chromosomes in a cell. Genes in the chromosomes are hereditary units of the body. DNA (Deoxyribonucleic acid) in the genes in the transmeter of hereditary characteristics. The nuclei in the nucleous contain ribonucleic acid or RNA which controls the manufacturer of protein. Cytoplasm :- It carries out the functions of the cell e.g. It maintains the structure of the cells. It removes the waste product from the cell and maintains nutrition of the cell. FUNCTIONS OF THE CELL Digestion :- Proper digestion and absorption of nutrients. Excretion :- Elimination of the waste of the body. Respiration :- Inhaling oxygen and using it and giving out CO2 (carbondioxide) Growth & Repair :Reproduction :- Each cell simply divided into tissues. TISSUES Tissues are materials composed of cells and intercellular or interstitial fluid. Many tissues unite together forms organs. Types of Tissues I. Epithelial tissue II. Connective tissue III. Muscle tissue IV. Nervous tissue I. Epithelial tissue Epithelial tissues form covering like skin or epidermis, glands, inner living of blood vessels and lines of digestive, respiratory and genitourinary tracts. Functions epithelial tissues : 1. This group of tissues is found in covering of the body and living cavities and tubes and also found in glands. They epithelial tissues protects the underlying organs. 2. Secretion and absorption. CBHI ICD 10 Student Workbook December 2004 Page 217 Types of epithelial tissues : 1. Simple epithelium 2. Cuboidal epithelium 3. Ciliated epithelium 4. Transitional epithelium II. Connective tissue It helps in connection, protection and supporting the different parts together and helping and holding them in place. The cells forming the connective tissues are more widely separated from each other than those forming the epithelium e.g. bone, cartilage, ligaments, blood and lymph etc. Functions of connective tissues: 1. Binding and support 2. Protection 3. Transport Insulation (maintains body temperature) Types of connective tissues 1. Fibroblast 2. Macrophages 3. Plasma cells 4. Mast cells 5. Fat cells III. Muscle tissue It has power of contraction movement. There are three types of muscle tissues. 1. Skeletal muscle tissue 2. Cardiac muscle tissue* 3. Smooth muscle tissue *Voluntary muscles or involuntary muscles or cardiac muscles. Functions of muscle tissue : Contraction and relaxation. IV. Nervous tissue Nervous tissue conduct nerve impulses between body structure and controls body function. It consists of two kinds of cells. Nerve cell or neurons and supporting cells called neurolgia. Functions of nervous tissues : Excitable cells - They initiate, receive, conduct and transmit information. Non-excitable cells - They support the neurons. MEMBRANES Membranes are sheets of epithelial tissues and their basement membranes that cover or line internal structures of cavities. The main membranes are mucous membranes, serous membranes and synovial membranes. Mucous membranes disease the moist living of the elementary tract, respiratory tract and genito urinary tracts and sometimes it is also called mucosa. Serous membranes or srosa secreta serous watery fluid, they are found in the thoracic cavity, the pleura surround the lungs and the pericardium surrounds the heart. Peritonium surrounds the abdominal organs. CBHI ICD 10 Student Workbook December 2004 Page 218 Functions of serous membranes :- There are two living end two layers in the serous membranes visceral and parietal layer filled with serous fluid which protects the organs from friction rub or jerky movements. Synovial membranes : This membrane is found lining the joint cavities and surrounding the tendous which could be injured by rubbing against bones. This membrane is found over wrist joint and knee joints. Synovial membranes secretes clear sticky oily synovial fluid which helps the joints from any injury. ANATOMICAL TERMS 1. Anatomical position :- Anatomical position is the body in the upright position with the head facing forward, the arms at the sites with the palms of the hands facing forward and the feet together. 2. Median plane :- When the body in the anatomical position is divided longitudinally into right and left halves. It has been divided in the median plane. 3. Medial and lateral :- Any structure which is median to another is nearer to the midline and any structure lateral to another is farther from the midline or at the side of the body. 4. Proximal and distal :- These terms are used when describing the bones of the limbs, the proximal end of a bone is the one nearest to the point of attachment of the limb and the distal end is farthest away. 5. Anterior or ventral :- This indicates that the part being described is nearer the front of the body. 6. Posterior or dorsal :- This means that part being described is nearer to the back of the body. 7. Superior :- This indicates our structure nearer the head. 8. Inferior :- This indicate our structure farther away from the head. 9. Border :- This is a ridge of bone which separates two surfaces. 10. Spine, spinous process or crest :- This is a sharp ride of a bone. 11. Trochanter, tuberosity and tubercle :- These are rough ended bony projections usually for the attachment of muscles or ligaments. The different names are used according to the size of the projection. Trochanters are the largest and tubercles are the smallest. 12. Styloid process :- This is a sharp downward projection of bone which gives attachment to muscles and ligaments. 13. Fossa (Pleural – Fossae) :- This is a hollow or depression. 14. Foramen (Foramana – Pleural) :- This is a whole in a structure. 15. Bony sinus :- This is a hollow cavity within a bone. 16. Meatus :- This indicates a tube shaped cavity within a bone. 17. Articulation :- This is a joint between two or more bones. 18. Suture :- This is the name given to an immovable joint e.g. between the bones of skull. 19. Articulating surface :- This is the part of the bones which enters into the formation of a joint. 20. Facet :- This is a small generally rather flat, articulating surface. 21. Condyle :- This is a smooth rounded projection of the bone which takes part in a joint. 22. Septum :- This is a partition separating two cavities. 23. Fissure or cleft :- This indicates a narrow slit. 24. Supination :- It means superior or above. 25. Pronation :- It means downward. 26. Flexion :- Bending 27. Abduction :- Away from the midline. 28. Adduction :- Nearer to the midline 29. Circumduction :- Moving the limb in a circular way. CBHI ICD 10 Student Workbook December 2004 Page 219 DIGESTIVE SYSTEM Definition: It prepares food for consumption by the cells through 5 basic activities. i) Ingestion = taking food into the body. ii) Peristalsis = the movement of food along the digestive tract. iii) Digestion = break-down of food by both chemical & mechanical processes. iv) Absorption = the passage of digested food from the digestive tract into the cardiovascular & lymphatic systems for distribution to cells. v) Defaecation = the elimination of indigestible substances from the body. I. ORGANS /PARTS: i) Mouth Tongue Teeth Salivary Glands (3 pairs) Palate cheeks Pharynx Oesophagus Stomach Small Intestine Deudenum Jejunum Ileum Large Intestine (colon) Ascending Colon Transverse Colon Descending Colon Rectum & Anus Mouth / Oral Cavity: The mouth is formed by cheeks, palates, lips, tongue, parotid glands, salivary glands, submandibular glands and sublingual glands. Pharynx : - It helps in swallowing the food. Oesophagus : - It is a hollow tube extends from pharynx to stomach. It is about 10 inches long. It helps in passage of food & liquids. Stomach: - It lies in epigastric region and left hypochondriac region of the abdomen cavity. It digests food and secretes gastric juices like Hydrochloric Acid, intrinsic factor and stomach gastrin. It serve food reservoir. It secrete antianaemic factor. It helps in absorption of food, water, alcohol and drugs (in limited amount). Stomach secretes hormone, gastrin. Small Intestine :- It is about 6 mt. long and its diameter is about 2.5 cms. Parts are (i) duodenum, (ii) jejunum & (iii) ileum. Functions :- Complete digestion of food, absorption of food and water. It It secretes hormone. Large Intestine : - It is 1.8 meters long and 6 cm in diameter. Parts of large intestine are cecum, rectum, colon & anal canal. Functions 1. Absorption of water 2. Elimination of food product. CBHI ICD 10 Student Workbook December 2004 Page 220 vii) Rectum and anus :- Elimination of food products. ACCESSORY ORGANS: Salivary Glands (3 pairs) Pancreas Liver Gall Bladder i) Salivary Glands (3 pairs) : There are 3 pairs of salivary glands. The parotid, mandibular gland & two sublingual glands. It secretes ptylin (saliva). ii) Pancreas : a) Pancreas is a pale grey gland weighing about 60 gms. b) It is about 12-15 cms long and is situated in the epigastric and left hypochondriac region of the abdominal cavity. c) It consists of a broad head, a body and a narrow tail. d) The head lies in the curve of the body of duodenum, the body behind the stomach and the tail lies in front of the left kidney. Functions :a) It secrete pancreatic juices by acinar cells b) It secretes insulin by β cells (Islets of langerhans) c) It secretes glucagon by α cells. iii) Liver : It is situated in right hypo-chondrium. It is the largest gland in our body. Its approximate weight is about 1.5 kg. It is divided in three lobes (right-lobe, left lobe and posterior caudate lobe). It consist of hepatic duct, cystic duct and common bile duct. Functions:a) It secrete bile juices. b) It plays essential role in metabolism of carbohydrates, proteins and fats. c) It also metabolises drugs and alcohol. iv) Gall Bladder : The size and shape of gallbladders is like a pear. It lies under surface of liver. Functions :a. Concentration and storage of bile during digestion. b. It ejects bile into ampulla / duodenum. CBHI ICD 10 Student Workbook December 2004 Page 221 URINARY / EXCRETORY SYSTEM Organs of urinary system :Right and left Kidneys – Glands (supra renal glands) Right and left Ureters – The ducts of kidney The Urinary Bladder – The reservoir of urine The Urethra – The passage from bladder to the outside FUNCTIONS OF URINARY SYSTEM 1. Primary function of urinary system is to regulate the concentration and volume of blood by removing and restoring selected amount of water and solutes. 2. Excretion of waste products from the body. i) Kidneys: There are two kidneys (left and right) situated in posterior abdominal wall. They are bean shaped. Each kidney consists of thousands of nephrons. [Basic unit of the kidney is nephron which does filteration]. They are about 11.25 cms. long and 5 to 7.5 cms. wide and 2.5 cms. thick. Right kidney is slightly lower then the left kidney due to liver. Functions : a) To drain urine and waste product from the body. b) Nephron is the functioning unit of the kidney. ii) Ureters : There are 2 ureters in human body. Functions: a) To drain urine from kidney to the urinary bladder. b) Ureters are situated posterior to the peritonium. iii) Urinary Bladder: It is situated behind posterior to the symphysis to the pubis. Functions: It stores urine prior to micturation (passing of urine). Urethra : Urethra is the tube extended from the urinary bladder to the exterior. Functions : - To discharge urine from the body. The normal quantity of urine in a normal adult person in 24 hrs. is 1500 ml. Blood supply of adrenal vein is controlled by the autonomic nerves system. CBHI ICD 10 Student Workbook December 2004 Page 222 THE LYMPHATIC SYSTEM Lymph is a fluid like plasma and the tissue fluid, but in cases of infection it may contain bacteria. Lymphatic system composed of The Lymph The Lymphatic Vessels The Lymph glands or nodes Lymphathic organs are:Tonsils, Thumus and Spleen LYMPHATIC VESSELS ARE :The Thoracic Duct :It collects lymph from legs, trunk, left arms, left side of chest and left side of head. Right Lymphatic Duct :It collects lymph from right arm, right side of chest and right side of head. Functions of Lymph:Lymph glands help to protect the body from infection. Producing new lymphocytes for the blood. Spleen is a largest lymphatic gland It is 12½ cm long and 8cm broad and it is protected by lower ribs. Functions of Spleen It produces new lymphocytes for the blood. It helps to fight the infection. It acts as a reservoir of RBC. Lymph nodes e.g. Cervical Lymph Nodes Axillary Lymph Nodes Submaxillary Nodes Intestinal Nodes Iliac Nodes CBHI ICD 10 Student Workbook December 2004 Page 223 CIRCULATORY SYSTEM / CARDIOVASCULAR SYSTEM Organs: Heart Arteries Veins Lungs Heart: The heart is roughly cone-shaped hollow muscular organ. It is approximately10 cm long and weight is about 225 gms in females and 310 gms in male. The size of the heart is equal to the owner’s fist. The heart is situated in thoracic cavity in the medium stinum between the 2 lungs. It lies obliquely little more to the left then the right. Structure of the Heart: Heart is composed of 3 layers of tissues: i) Pericardium - Outermost layer – 2 – Pericardial fluid. ii) Myocardium - Muscular layer – Middle. iii) Endocardium - Innermost layer of the heart Internal Organs of the Heart: The heart is divided into right and left side by the septum. Each side upper and lower chambers are divided by an artio-ventricular valve. Upper chamber are called Atrium and Lower chamber are ventricles. The right artio-ventricular is called ’Tricuspid Valve’. The left artioventricular is called ‘Bicuspid Mitral’. The largest veins of the body is superior and inferior vena cava. These veins empty their blood into right atrium then blood is pushed into right ventricle by the right atrioventricular valve and from their it is pumped into the pulmonary arteries(Pulmonary arteries are the only arteries which carries de-oxygenated (impure) blood. Pulmonary arteries carries impure blood to the lungs for purification or exchange of gases. After purification of blood pulmonary veins carries oxygenated (pure) blood to the left side of the heart in the left atrium then it is pushed to the left ventricle. From left ventricle it is pushed into the aorta then it is passed on to various parts of the body. Blood supply to the heart :The heart is supplied by coronary arteries. Sinoatrial Node (Pace maker) It initiate impulse of the heart. Nerve supply to the heart Sympathetic fibers-Cardiac nerve Parasympathetic fibers-Vagus nerve Cardiac cycle: Each cardiac cycle consists of systole, diastole, pause. One cardiac cycle completes in – 0.8 seconds. Arteries It breakdown in arterioles and these becomes capillaries. Veins It breakdown in veinioles and these becomes capillaries. CBHI ICD 10 Student Workbook December 2004 Page 224 RESPIRATORY SYSTEM Respiratory centre is situated in the brain. Following are the organs of the respiratory system :Nose Pharynx Larynx Trachia Bronchia Lungs i) Nose : 1. Contains two nostrils 2. These nostrils are covered with ciliated nucous membrane 3. Nose serves as passage way for the air 4. Filtering, moistering and worming of the air occurs in the nose. 5. Nose helps in smelling good and bad odour. ii) Pharynx : 1. It is located behind the nose. 2. It serves passage way for air, food and liquids. iii) Larynx: 1. It is located between pharynx and trachea. 2. It helps in producing voice. Trachea : 1. It is situated in the chest cavity. 2. Walls of trachea is made-up of smooth muscles and C-shaped rings of cartilage at intervals which keeps the tube opened all the time. 3. Trachea is also covered with ciliated mucous membrane 4. Trachea is about 4½” long 5. It helps in passage of air. Bronchi : 1. There are two bronchus (right and left). 2. Right bronchus is slightly larger than left bronchus. 3. Bronchus have same structure like trachea. 4. These also help in passage way of air. vi) Lungs: Right lung :- It contains 3 lobes – Upper, middle and lower lobe. Left lung :- It contains 2 lobes – Upper and lower lobe. 1. Lungs are two in number (right and left). 2. There are three lobes in right lung. 3. There are two lobes in left lung. 4. Each lung consist of air sacs (alveoli). In these air sacs exchange of gases takes place CO2 is taken in and CO2 is expelled out). Cycle of respiration Inspiration, expiration and pause. Normal respiration in an adult person is 12-16 times/minute. CBHI ICD 10 Student Workbook December 2004 Page 225 BLOOD CELL Definition: The blood is composed of a strew-coloured transparent fluid in which different types of cells are suspended. Blood contains 55% plasma, and 45% blood cells. Types of blood cells There are 3 types of cells present in blood : i. Erythrocytes (R.B.C.) [ 4.5 to 5.5 per mm3 ] ii. Leucocytes (W.B.C.) [ 5,000 to 11,000 per mm3 ] a. Granular Leucocytes 1. Neutrophils (40 to 75%) 2. Eosinophils ( 1 to 6% ) 3. Basophils (<1%) b. Agranulocytes 1. Monocytes (2-10%) 2. Lymphocytes (20-50%) iii. Platelets or Thrombocytes [ 150,000 to 350,000 per mm3 ] Functions of blood : Blood is a complex liquid. Its functions are as under: i. It transports oxygen from the lungs to all cells (parts) of the body. ii. It transports carbondioxide from cells to the lungs. iii. It transports nutrients from the digestive organs to the cell. iv. It transports waste products from cell to kidneys, lungs and sweat glands. v. It transports hormones from endocrine glands to the cell. vi. It transports enzymes to various cells. vii. It regulates body pH (Hydrogen Ion Concentration) through buffers and amino acids. viii. It maintains the normal body temperature i.e. 37°C. ix. It maintains fluid and water balance. x. It protects our body from toxins, foreign microbes and destroying and engulfing them. xi. It protects our body from fluid and blood loss by clotting mechanisms. Rh Factor When Rh antigen is present in the RBCs, it is Rh+ve blood. When Rh antigen is not present in the RBCs, it is Rh-ve blood. Blood forming Organs: - Red Bone Marrow & Liver. Life Span R.B.C. W.B.C. Platelets Function R.B.C. W.B.C. 120 days. Few hours to few days. 5 to 9 days. - To transport Oxygen & Carbon Dioxide 1. They are Soldiers of the body (phagocytocis) 2. Prevention of allergies. Platelets - Helps blood clotting. (Thrombocytes) CBHI ICD 10 Student Workbook December 2004 Page 226 Branches of Blood Vessels Artery - Arteioles Vein - Veinuoles - Capillary Capillary Types of Blood Group Blood Group Can Receive Blood A A, O B AB B, O A, B, AB, O (Universal recipient) O (Self recipient) O Can Donate Blood A, AB B, AB AB A, B, AB, O (Universal donor) Plasma Plasma is the liquid portion of blood. It consists of 91.5% water and 8.5% solutes. These solutes are proteins (albumins, globulins, fibrinogen substances, foods, enzymes, hormones, respiratory gases and electrolytes). CBHI ICD 10 Student Workbook December 2004 Page 227 ENDOCRINE SYSTEM Endocrine system consist of glands. These glands are ductless glands. They pour their hormones directly into the blood stream. DEFINITION OF HORMONE It is a chemical messenger which is secreted by endocrine glands. TYPES OF ENDOCRINE GLANDS 1. Pituitary gland (master gland of our body) 2. Thyroid gland 3. Parathyroid glands 4. Adrenal or supra renal glands 5. Pancreas 6. Pineal gland 7. Thymus gland 8. Ovaries (female gonad) 9. Testis (male gonad) 10. Placenta (temporary endocrine gland) in females only -1 -1 -4 -2 -1 -1 -1 -1 -2 - As per number of babies 1. Pituitary gland (master gland of our body) Situated in skull cavity. Location : a) In sella Turcica of sphenoid bone b) It consist of two endocrine glands – Anterior lobe and posterior lobe Anterior lobe : Secrete growth hormone (STH). Follicle stimulating hormone (FSH), prolactin hormone, lactogenic hormone, leucotropic hormones (LTH). Posterior lobe : Secrete anti-diuretic hormone and oxytocin hormone (ADH). 2. Thyroid gland It is located in neck just below larynx. It secretes thyroid hormones i.e. T3, T4, TSH, calcitonin. 3. Parathyroid glands These are situated in the posterior surface of thyroid gland. These are small in size like peas. They are 4-5 in number. They secrete parathormone (parathyroid hormone). 4. Adrenal or supra renal glands Located at the top of kidneys. They secrete epinephrin, nor-epinephrin, mineralo corticoids, glucocorticoid hormones. 5. Pancreas Located in abdomen cavity. It secretes insulin and glucagon hormone. 6. Pineal gland It is situated in the skull cavity. It secretes Milatorun adrenoglomerulotropin hormone. 7. Thymus gland It is situated in chest. It secrete thymosin. 8. Ovaries (female gonad) It is situated in lower abdomen in females. They secrete progestrone and estrogen hormones. 9. Testis (male gonad) They secrete testosteron. 10. Placenta (temporary endocrine gland) in females only It is temporary endocrine gland. It secrete estrogen, progesteron chorionic gonadotropin hormone. CBHI ICD 10 Student Workbook December 2004 Page 228 REPRODUCTIVE SYSTEM FEMALE REPRODUCTIVE ORGANS 1. Ovaries -2 2. Uterus -1 3. Breast -2 4. Vagina -1 STRUCTURE OF UTERUS Uterus is a pear shaped organ situated in the lower abdomen. Size :- Size of uterus is 3x2x1 inch. It consists of body, cervix and fallopian tubes. Walls of the uterus :- There are three layers in uterus – Outermost layer is perimetrium, middle layer is myometrium, inner layer is endometrium. FUNCTIONS OF UTERUS 1. Menstruation 2. Pregnancy 3. Labour and expulsion of fetus Blood supply Blood supply is done by ovarian arteries. Venous drainage Venous drainage into internal iliac veins. Fallopian tubes (uterus tubes) They are 10 cms long and attached to uterus at upper, out angles. Fallopian tubes have same three layers like uterus. Parts of fallopian tubes 1. Isthmus – Attached to the uterus 2. Ampulla – Intermediate dilated portion 3. Infuindibulum – Funnel shaped terminal component. Functions of fallopian tube 1. Serve as ducts for ovaries 2. Gives passage way by which ova can reach uterus 3. Fertilization occurs in the fallopian tubes Ovaries (Female Gonads) Size 1. Size and shape of large donads. 2. Lie behind and below uterine tube (i.e. fallopian tube). 3. Attached to uterus and broad ligaments. Functions of ovaries 1. Oogenesis – formation of mature female gametes (Ova) 2. Secretion of hormones – Estrogens and progesterone Vagina Location It is located between rectum and urethra. CBHI ICD 10 Student Workbook December 2004 Page 229 Functions of Vagina 1. Receive seminal fluid 2. It is excretory duct for uterine secretion and menstrual flow. 3. It is the lower part of the birth canal Internal Organs Uterus, fallopian tubes, ovaries, cervix, vagina External organs Vulva and perineum THE BREAST They are two in numbers. It is located under skin over peritoneal muscles. Structure : Niples, areola, lactiferus Functions : It secrete milk for infant MALE REPRODUCTIVE ORGANS 1. A pair of testes – Function – To produce sperms 2. Epididymis – They store sperms 3. Vas diferens – They carry sperms from the testes to the penis 4. Penis – Used for injecting sperms into females. CBHI ICD 10 Student Workbook December 2004 Page 230 SPECIAL SENSES i) ii) iii) iv) v) Eyes Ear Nose Tongue Skin - Sight Hearing Smell Taste Touch There are 5 special senses in our body, which gives us awareness of surroundings through the senses. I. EYES Eyes are the sense organs of sight. They give us visual sensation. The structures of the eyes are eyebrows, eyelids, eyelashes and the lachrimal apparatus. Eyes are situated in the orbital cavity on both sides of the nose. There are 3 layers of tissues in the eyes, first / outermost layer is sclera made up of fibrous tissues; second layer is choroid made up of vascular tissue and the third is retina (inner most layer) made up of nervous tissue. The anterior cavity contains aqueous humor and the posterior cavity contains viterous humor. Optic nerve supplies sensation to the eyes. II. EAR Ears are the sense organs of hearing. They give us auditory sensation. The structures of the ears are: a) External Ear (Outer Ear) : It consists of pinna auricles. b) Auditory Canal (Meatus) : It consists of 3 bones called Ossicles (MIS – Malleus, Incus & Stapes), Eustacian Tube & Ear Drum (tympunum). c) Internal Ear : It consists of Vestibule, Chochlea, Bony Labyrinth & Semi-circular Canals. III. NOSE It is the sensitive organ of smell. Olfactory nerve endings are found in the nose. There are 2 naries, which is divided by a septum. Olfactory cells convey impulses to olfactory nerves for the sensation, for example, sweet, good, bad… There are small hairs found in the nose and the nose is covered by celliated mucus membrane. These prevents entrance of foreign body into the nose. IV. TONGUE Tongue is a voluntary muscular structure, which occupies the floor of the mouth. It consists of little projections called papilae and these papilae containing nerve endings of the sense of taste called taste-buds. Blood supply to the tongue is by the lingual branch of external carotid artery. And the venous drainage is by the lingual vein. Nerves supply by 12 cranial nerve called hypoglossal nerve. Functions of the Tongue Mastication Swallowing Speech Taste Chewing Deglutition CBHI ICD 10 Student Workbook December 2004 Page 231 V. SKIN It is one of the largest organs of the body. It contains glands, hair & nails. The principal parts of the skin are, 1. Epidermis (outer portion), & 2. Dermis (inner portion). Dermis contains blood vessels, nerves, hair follicles, oil glands and ducts of sweat glands. The colour of the skin is due to melanin, carotine & blood-in-capillaries in the dermis. FUNCTIONS OF EPIDERMIS 1. Skin protects us against various factors like micro-organisms, sun-light and chemicals. 2. Epidermis is the covering of our body, which protects us from all the above things. 3. Skin maintains the normal temperature of the body. 4. It protects our body from heat loss. 5. It helps in formation of Vit. D with the sun-light. 6. It also absorbs some drugs, which are applied on the skin. 7. It is made from stratific squamous epithelial tissues. FUNCTIONS OF DERMIS 1. It maintains body temperature 2. It protects from bacterial invasion 3. It gives beauty / structure to the skin 4. It maintains fluid & electrolytic balance Dermis is made of fibrous connective tissues. It has blood vessels, which gives nourishment to the skin; sweat glands excretes waste product from the body; oil glands excretes oil, which gives moisturisation to the skin. CBHI ICD 10 Student Workbook December 2004 Page 232 SKELETON SYSTEM BONE Bone is a hardest tissue in the body when fully developed. It is composed of water, organic materials and inorganic materials. TYPES OF BONES (as per formation) 1. Compact bone :- It appears to be solid. Microscopic structure shows large numbers of haversian system. 2. Calcillous bone :- It looks spongy. Microscopically the haversian canals are much larger than in compact bone. TYPES OF BONES (as per structure) 1. Long bones e.g. femur, radius, ulna, humerus, tibia, fibula. 2. Short bones e.g. Corpals (wrist bones), tarsals (ankle bones), phalangese. 3. Flat bones e.g. skull bones, rib bones, shoulder and hip bones. 4. Irregular bones e.g. Vertebrae, some skull bones, sphenoid, ethmoid bones and mandible bones. FUNCTIONS OF BONES 1. Bones provide framework (shape) to the body. 2. Bones gives attachment to muscles and ligaments 3. Bones helps in movement of the body. 4. Bones protect delicate (vital) organs of our body e.g. brain, heart, lungs and female reproductive organs. 5. Blood cells are formed in the bone marrow (hemopoiesis) 6. Bones serve as a major reservoir for calcium (deposit and withdrawal). 7. Bones help in locomotion (movement). DIVISION OF SKELETAL SYSTEM Total bones in our body are 206. Skeleton system is divided into two parts :1. Axial skeleton (80 bones) 2. Appendicular skeleton (126 bones) 1. Axial skeleton :- Bones that form upright axis of the body and ear bones (6 bones) are included in the axial skeleton system. There are 80 bones (including 6 ear bones) in axial skeleton system. Breakup of bones I. Axial Skeleton = 80 bones 1. Cranium bones =8 Frontal bones Parietal bone Temporal bone Occipital bone Sphenoid bone Ethmoid bone -1 -2 -2 -1 -1 -1 CBHI ICD 10 Student Workbook December 2004 Page 233 2. Face bones = 14 3. Ear bones =6 Malleus (3x3) Incus Stapes 4. Hyoid bone (neck) = 1 5. Vertebral column = 26 6. Chest sternum =1 7. Ribs = 24 II. Nasal bones Maxillary bones Zygomatic (molar) bones Mandible Lacrimal bones Palat (soft and hard) Vomer bone Inferior chonche or forbinates -2 -2 -2 -1 -2 -2 -1 -2 -2 -2 -2 Cervical vertebrae Thoracic vertebrae Lumbar vertebrae Sacrum vertebrae Coccyx vertebrae -7 - 12 -5 -1 -1 True ribs False fibs - 7 pairs - 5 pairs Appendicular skeleton = 126 bones It consists of upper and lower extremities. 1. Upper extremities = 64 Clavicle bones Scapula bones Humerus bones Radium bones Ulna bones Carpals bones Metacarpals bones Phalanges bones -2 -2 -2 -2 -2 - 16 - 10 - 28 2. Lower extremities = 62 Hip or innominate bones Femur bones Patella (knee bones) Tibia bones Fibula bones Tarsals Metatarsals Phalanges -2 -2 -2 -2 -2 - 14 - 10 - 28 CBHI ICD 10 Student Workbook December 2004 Page 234 JOINTS Joint is the site at which any two or more bones comes together. TYPES OF JOINTS 1. Fibrous of joints :- They have no movement e.g. skull between teeth maxilla and mandible. 2. Cartilaginous joints – They have slight movements e.g. between body of vertibrae and symphysis pubis. 3. Synovial joints – They are freely movable joints. They are classified according to there range of movements. Types of synovial joints are as under :a) Ball and Socket joints e.g. Shoulder and hip joints. b) Hinge joints e.g. elbow joint, knee joints, ankle joints, interphalangeal joints between atlas and axis. c) Gliding joints e.g. sternoclavicular joint, acramioclavicular joint, joint between capal and tarsal bones. d) Pivot joint e.g. radio-ulner joint between atlas and axis. e) Condyloid and saddle joint e.g. wrist tempremandibular, metacarpo-phalangeal joints, metalarso-phalangeal joints. NERVOUS SYSTEM Basic unit of nervous system is nerve cells or neuron PARTS OF NEURON a) The cell body or cyton b) The dendrites c) The tail of axon which is long tube like part Nerve cells are found in the brain and spinal cord. Nerve cells are joined end to end forming long nerve fibres. These nerve fibres forming a nerve. TYPES OF NEURONS 1. Sensory neuron :- It carry impulses from the sense organs to the spinal cord and brain e.g. optic nerve of the eyes. 2. Motor neuron : It carry impulses from the brain to spinal cord and then to the muscles or glands. FUNCTIONS OF NEURON To conduct messages from one part of the body to the other. The message that travels along a neuron is called an impulse. TYPES OF NERVOUS SYSTEM Nervous system has two parts : 1. Central Nervous System – Consisting brain and spinal cord. 2. Peripheral Nervous System – Consisting nerves (spinal cord) and brain (cranial nerves). There are 31 pairs of spinal nerves and 12 pairs of cranial nerves. Autonomic Nervous System – It consists of nerve cells called ganglia. It contgrols the involuntary muscles (which are not under control of our will) and vital functions of the heart, lungs and makes them work harmoniously. This system always functions whether we sleep or awake. CBHI ICD 10 Student Workbook December 2004 Page 235 MUSCLES TYPES OF MUSCLES : 1. Voluntary muscles or skeletal muscles 2. Involuntary muscles or smooth or visceral muscles. 3. Cardiac muscles (found in heart only) FUNCTIONS OF MUSCLES 1. Muscles give shape to our body. 2. By contraction and retraction they help in locomotion. 3. They help in storage of calcium, glucose and nutritional materials. 4. They help in lifting of weight (by stored energy in the muscles). BRAIN The brain is the main central centre of nervous system. It consists of 3 main centres cerebrum, cerebellum and brain stem. I. CEREBRUM a) It is uppermost and largest part of the brain. b) Its surface is thrown into grooves and ridges. c) It is divided into right and left halves called right and left cerebral hemiphereses. Functions of cerebrum a) Controls mental activities like thinking and reasoning. b) Centre for intelligence and memory. c) Centre for perceiving pain, sound, touch, taste, smell etc. II. CEREBELLUM It is a small area located just under the cerebrum at the back of the head. Functions : a) Maintains balance of the body. b) Coordinates musclar activity. III. BRAIN STEM It is the lowest part of the brain and joins the brain to the spinal cord. It has three parts i.e. Medulla, Pons and Mid brain. Functions Controls the activity of internal organs like heartbeat, breathing etc. VERTICLES OF BRAIN (Total = 14) 1. Two lateral verticles 2. Third lateral verticles 3. Fourth lateral verticles Cerebrospinal fluid (CSF) is formed in ventricles. SPINAL CORD Spinal cord extends from the medulla of the brain and runs down through the whole length of the vertebral column. A section through the spinal cord shows the following structure. CBHI ICD 10 Student Workbook December 2004 Page 236 Functions a) To conduct messages from the skin and muscles to the brain. b) To conduct messages or commands from the brain to the muscles of the body trunk and limbs. Covering of the brain and spinal cord - Meningese Meningese 1. Dura Mater – Outer layer 2. Arachnoid Mater – Middle layer 5. Pia Mater – Inner layer BURSAE Bursae are small connective tissue sacs lined with synovial membrane and containing synovial fluid e.g. – between skin and bone - between tendon and bone head of the humerous and acromion process and deltoid muscles between patella and skin Functions of the Bursae 1. They act as cushion 2. They relieve pressure between moving parts LIGAMENTS Ligaments are strong band of fibrous tissue. They give additional stability to the joints. Ligaments of vertebrae 1. Anterior longitudinal ligament 2. Posterior longitudinal ligament 3. The ligamenta flova 4. Inter spinous ligaments 5. Supra spinous ligaments 6. Ligamentum Nuchae 7. Transverse ligaments Ligaments of knee 1. Anterior cruciate ligament 2. Posterior cruciate ligament 3. Tibial collateral ligament 4. Fibular collateral ligament CBHI ICD 10 Student Workbook December 2004 Page 237 MAMMARY GLANDS Breasts: Breasts are accessory glands of female reproductive system. There are 2 breasts situated on chest cavity. Each breast consists of about 20 lobes and these lobes being made up of lobules, consisting of cluster of Alveoli. These alveoli open into lactiferous duct, which opens into the nipple. This nipple is the projected part of the breast and is surrounded by pigmented area, which is called areola and areola has sebaceous glands, which lubricate the nipple during lactation. [ 20 lobes = lobules = alveoli = open into lactiferous duct = open into nipple = projected part ] Blood supplies by the branches of axillary arteries to the nipple, venous drainage by axillary & mammary veins. Nerve supply by 4th, 5th & 6th Thoracic Nerves. Function After birth of baby, breast produce milk. CBHI ICD 10 Student Workbook December 2004 Page 238 APPENDIX 2 Medical Terminology CBHI ICD 10 Student Workbook December 2004 Page 239 MEDICAL TERMINOLOGY 1. DEFINITION, OBJECTIVES & VALUES The Principle or fundamental method of building medical vocabulary consists breaking down a word into three parts i.e. prefix, root and suffix. Each component has a distinct meaning. a) Prefix:- In a word “Intercostal”, ‘Inter’ Means between and ‘Costa’ means ‘ribs’. Inter is the prefix and costa is the root. b) Suffix:- In the word “Rhinitis”, ‘Rhin’ means nose, is the root and ‘it is’ means inflammation is the suffix’. c) Root:- There may be one unit in a word. If its meaning is complete without the addition of prefix or suffix, it is a root word. Medical Terminology may be defined as “study of Medical Terms”. 2. SCIENCE DEVOTED TO THE STUDY OF THE BODY a) Anatomy: It is the study of structure of body and relationship of its parts. b) Physiology: It is the study of normal functions and activities of the body. c) Pathology: It is the study of the changes caused by disease in the structure or functions of the body. d) Embryology: It is the study of the development of the body from the ovum (female reproductive cell) after union with the sperm (male reproductive cell) e) Histology: It is the microscopic study of the minute structure, composition and function of the normal cells and tissues. f) Biology: It is the study of all forms of life. 3. MEDICAL SPECIALTIES a) Pediatrics b) Gynecology c) Obstetrics . d) Surgery e) Otology f) Laryngology 4. COLOURS & NUMBERS S.No. Term ALBUS, LEUCO, LEUKO CHLOROS CIRRHOS CYANO ERYTHRO, RHODO, RUBER MELANO POLIO PORPHYRO XANTHO Meaning White Green Orange - yellow Blue Red Black Gray – particularly relating to the gray matter of the nervous system Purple Yellow CBHI ICD 10 Student Workbook December 2004 Page 240 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. UNI, MONO PRIMUS, PROTO, PROCT SESQUI SEMI, HEMI DEUTERO, DEUTO, SECUNDUS DUO DIS, DI TRI TERTIUS, TRITOS TETRA, QUADRI PENT, PENTA, QUINQUE, QUINTUS HEX, HEXA, SEX HEPT, HEPTA, SEPTEM OCTO NONUS CENTI HEC, HECTO MILLI KILO One, Single First One and a half One half Second Two Twice or duplicate Three or thrice Third Four or four folds Five, Fifth Six Seven Eight Nine or Ninth Hundred or Hundredth part One Hundred One Thousand part One Thousand 5. PREFIXES (Few examples) S.No. Prefix Meaning Medical Term A (AN BEFORE VOWEL Without, lack of Anemia Apnea Meaning of Medical Term Lack of blood Without breath AB, APO Away from ANTE Before, forward ANTI CONTRA against Opposite Against Across, Through, beyond Beyond, In excess Aboral Aponeurosis Antecubital Ante flexion Anti sepsis Contraception Away from mouth Away from tendon Before elbow Forward bending Against infection Prevention of conception Transectin Cut across Ultraviolet Beyond violet End of spectrum TRANS ULTRA CBHI ICD 10 Student Workbook December 2004 Page 241 6. PREFIXES (Few examples) S. No. 1. Prefix AGO, IGO Meaning Disease Medical Term Lumbago Impetigo Hematuria Osteonecrosis Osteosclerosis Meaning of Medical Term Lumber disease Acute inflammatory Skin disease Inflammation of the appendix Pathological Drinking of alcohol Presence of blood in the urine Death of a bone Hardening of bone 2. 3. IT IS MANIA Inflammation Madness Appendicitis Dipsomania 4. 5. 6. URIA In the urine NECROSIS Death SCLEROSIS Hardening Medical Term Hymenotomy Meaning of Medical Term Incision of Hymen Rhinoplasty Plastic repair of nose Myostasis Stretching of muscles 7. OPERATIVE SUFFIXES (Few examples) S.No. 1. Prefix OTOMY 2. PLASTY 3. TASIS Meaning Incision Cutting up Repair Plastic repair stretching 8. ROOTS a) SKELETAL SYSTEM: (Few examples) S.No. 1. 2. 3. 4. 5. Root ARTHRON CARPUS MYO MYELOS SPONDYLOS, RACHI Meaning Joints Wrist Muscles Marrow of spine Vertebra (Spinal bone) Integumentary System (skin, breast, sweat gland, mammary gland, hair and nail) (Few examples) S.No. 1. DERMA (IN GREEK) CUTIS (IN LATIN) 2. MAMMA, MAST Skin Nipple Respiratory System S.No. 1. PNEUMON 2. RHIN Lungs Nose CBHI ICD 10 Student Workbook December 2004 Page 242 Gastro Intestinal System S.No. 1. STOMA 2. HEPAT 3. GINGIVA Mouth Liver Gum Endocrine System S.No. 1. GOITER Thyroid Genito Urinary System S.No. 1. RENAL, NEPHR Kidney Nervous System S.No. 1. Neuron nerve Special senses System S.No. 1. OPSIS 2. OTO Vision Ear Circulatory & Lymphatic System S.No. 1. ANGION 2. HEM Vessal Blood CBHI ICD 10 Student Workbook December 2004 Page 243 APPENDIX 3 List of Three Character Categories CBHI ICD 10 Student Workbook December 2004 Page 244 Chapter I Certain infectious and parasitic diseases (A00?B99) Intestinal infectious diseases (A00?A09) A00 Cholera A01 Typhoid and paratyphoid fevers A02 Other salmonella infections A03 Shigellosis A04 Other bacterial intestinal infections A05 Other bacterial foodborne intoxications A06 Amoebiasis A07 Other protozoal intestinal diseases A08 Viral and other specified intestinal infections A09 Diarrhoea and gastroenteritis of presumed infectious origin Tuberculosis (A15?A19) A15 Respiratory tuberculosis, bacteriologically and histologically confirmed A16 Respiratory tuberculosis, not confirmed bacteriologically or histologically A17† Tuberculosis of nervous system A18 Tuberculosis of other organs A19 Miliary tuberculosis Certain zoonotic bacterial diseases (A20?A28) A20 Plague A21 Tularaemia A22 Anthrax A23 Brucellosis A24 Glanders and melioidosis A25 Rat-bite fevers A26 Erysipeloid A27 Leptospirosis A28 Other zoonotic bacterial diseases, not elsewhere classified Other bacterial diseases (A30?A49) A30 Leprosy [Hansen's disease] A31 Infection due to other mycobacteria A32 Listeriosis A33 Tetanus neonatorum A34 Obstetrical tetanus A35 Other tetanus A36 Diphtheria A37 Whooping cough A38 Scarlet fever A39 Meningococcal infection A40 Streptococcal septicaemia A41 Other septicaemia A42 Actinomycosis A43 Nocardiosis A44 Bartonellosis A46 Erysipelas A48 Other bacterial diseases, not elsewhere classified A49 Bacterial infection of unspecified site CBHI ICD 10 Student Workbook December 2004 Page 245 Infections with a predominantly sexual mode of transmission (A50?A64) A50 Congenital syphilis A51 Early syphilis A52 Late syphilis A53 Other and unspecified syphilis A54 Gonococcal infection A55 Chlamydial lymphogranuloma (venereum) A56 Other sexually transmitted chlamydial diseases A57 Chancroid A58 Granuloma inguinale A59 Trichomoniasis A60 Anogenital herpesviral [herpes simplex] infection A63 Other predominantly sexually transmitted diseases, not elsewhere classified A64 Unspecified sexually transmitted disease Other spirochaetal diseases (A65?A69) A65 Nonvenereal syphilis A66 Yaws A67 Pinta [carate] A68 Relapsing fevers A69 Other spirochaetal infections Other diseases caused by chlamydiae (A70?A74) A70 Chlamydia psittaci infection A71 Trachoma A74 Other diseases caused by chlamydiae Rickettsioses (A75?A79) A75 Typhus fever A77 Spotted fever [tick-borne rickettsioses] A78 Q fever A79 Other rickettsioses Viral infections of the central nervous system (A80?A89) A80 Acute poliomyelitis A81 Atypical virus infections of central nervous system A82 Rabies A83 Mosquito-borne viral encephalitis A84 Tick-borne viral encephalitis A85 Other viral encephalitis, not elsewhere classified A86 Unspecified viral encephalitis A87 Viral meningitis A88 Other viral infections of central nervous system, not elsewhere classified A89 Unspecified viral infection of central nervous system Arthropod-borne viral fevers and viral haemorrhagic fevers (A90?A99) A90 Dengue fever [classical dengue] A91 Dengue haemorrhagic fever A92 Other mosquito-borne viral fevers A93 Other arthropod-borne viral fevers, not elsewhere classified A94 Unspecified arthropod-borne viral fever A95 Yellow fever A96 Arenaviral haemorrhagic fever CBHI ICD 10 Student Workbook December 2004 Page 246 A98 A99 Other viral haemorrhagic fevers, not elsewhere classified Unspecified viral haemorrhagic fever Viral infections characterized by skin and mucous membrane lesions (B00?B09) B00 Herpesviral [herpes simplex] infections B01 Varicella [chickenpox] B02 Zoster [herpes zoster] B03 Smallpox B04 Monkeypox B05 Measles B06 Rubella [German measles] B07 Viral warts B08 Other viral infections characterized by skin and mucous membrane lesions, not elsewhere classified B09 Unspecified viral infection characterized by skin and mucous membrane lesions Viral hepatitis (B15?B19) B15 Acute hepatitis A B16 Acute hepatitis B B17 Other acute viral hepatitis B18 Chronic viral hepatitis B19 Unspecified viral hepatitis Human immunodeficiency virus [HIV] disease (B20?B24) B20 Human immunodeficiency virus [HIV] disease resulting in infectious and parasitic diseases B21 Human immunodeficiency virus [HIV] disease resulting in malignant neoplasms B22 Human immunodeficiency virus [HIV] disease resulting in other specified diseases B23 Human immunodeficiency virus [HIV] disease resulting in other conditions B24 Unspecified human immunodeficiency virus [HIV] disease Other viral diseases (B25?B34) B25 Cytomegaloviral disease B26 Mumps B27 Infectious mononucleosis B30 Viral conjunctivitis B33 Other viral diseases, not elsewhere classified B34 Viral infection of unspecified site Mycoses (B35?B49) B35 Dermatophytosis B36 Other superficial mycoses B37 Candidiasis B38 Coccidioidomycosis B39 Histoplasmosis B40 Blastomycosis B41 Paracoccidioidomycosis B42 Sporotrichosis B43 Chromomycosis and phaeomycotic abscess B44 Aspergillosis B45 Cryptococcosis B46 Zygomycosis B47 Mycetoma CBHI ICD 10 Student Workbook December 2004 Page 247 B48 B49 Other mycoses, not elsewhere classified Unspecified mycosis Protozoal diseases (B50?B64) B50 Plasmodium falciparum malaria B51 Plasmodium vivax malaria B52 Plasmodium malariae malaria B53 Other parasitologically confirmed malaria B54 Unspecified malaria B55 Leishmaniasis B56 African trypanosomiasis B57 Chagas' disease B58 Toxoplasmosis B59† Pneumocystosis B60 Other protozoal diseases, not elsewhere classified B64 Unspecified protozoal disease Helminthiases (B65?B83) B65 Schistosomiasis [bilharziasis] B66 Other fluke infections B67 Echinococcosis B68 Taeniasis B69 Cysticercosis B70 Diphyllobothriasis and sparganosis B71 Other cestode infections B72 Dracunculiasis B73 Onchocerciasis B74 Filariasis B75 Trichinellosis B76 Hookworm diseases B77 Ascariasis B78 Strongyloidiasis B79 Trichuriasis B80 Enterobiasis B81 Other intestinal helminthiases, not elsewhere classified B82 Unspecified intestinal parasitism B83 Other helminthiases Pediculosis, acariasis and other infestations (B85?B89) B85 Pediculosis and phthiriasis B86 Scabies B87 Myiasis B88 Other infestations B89 Unspecified parasitic disease Sequelae of infectious and parasitic diseases (B90?B94) B90 Sequelae of tuberculosis B91 Sequelae of poliomyelitis B92 Sequelae of leprosy B94 Sequelae of other and unspecified infectious and parasitic diseases CBHI ICD 10 Student Workbook December 2004 Page 248 Bacterial, viral and other infectious agents (B95?B97) B95 Streptococcus and staphylococcus as the cause of diseases classified to other chapters B96 Other bacterial agents as the cause of diseases classified to other chapters B97 Viral agents as the cause of diseases classified to other chapters Other infectious diseases (B99) B99 Other and unspecified infectious diseases Chapter II Neoplasms (C00?D48) Malignant neoplasms (C00?C97) Malignant neoplasms of lip, oral cavity and pharynx (C00?C14) C00 Malignant neoplasm of lip C01 Malignant neoplasm of base of tongue C02 Malignant neoplasm of other and unspecified parts of tongue C03 Malignant neoplasm of gum C04 Malignant neoplasm of floor of mouth C05 Malignant neoplasm of palate C06 Malignant neoplasm of other and unspecified parts of mouth C07 Malignant neoplasm of parotid gland C08 Malignant neoplasm of other and unspecified major salivary glands C09 Malignant neoplasm of tonsil C10 Malignant neoplasm of oropharynx C11 Malignant neoplasm of nasopharynx C12 Malignant neoplasm of piriform sinus C13 Malignant neoplasm of hypopharynx C14 Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx Malignant neoplasms of digestive organs (C15?C26) C15 Malignant neoplasm of oesophagus C16 Malignant neoplasm of stomach C17 Malignant neoplasm of small intestine C18 Malignant neoplasm of colon C19 Malignant neoplasm of rectosigmoid junction C20 Malignant neoplasm of rectum C21 Malignant neoplasm of anus and anal canal C22 Malignant neoplasm of liver and intrahepatic bile ducts C23 Malignant neoplasm of gallbladder C24 Malignant neoplasm of other and unspecified parts of biliary tract C25 Malignant neoplasm of pancreas C26 Malignant neoplasm of other and ill-defined digestive organs Malignant neoplasms of respiratory and intrathoracic organs (C30?C39) C30 Malignant neoplasm of nasal cavity and middle ear C31 Malignant neoplasm of accessory sinuses C32 Malignant neoplasm of larynx C33 Malignant neoplasm of trachea C34 Malignant neoplasm of bronchus and lung C37 Malignant neoplasm of thymus CBHI ICD 10 Student Workbook December 2004 Page 249 C38 C39 Malignant neoplasm of heart, mediastinum and pleura Malignant neoplasm of other and ill-defined sites in the respiratory system and intrathoracic organs Malignant neoplasms of bone and articular cartilage (C40?C41) C40 Malignant neoplasm of bone and articular cartilage of limbs C41 Malignant neoplasm of bone and articular cartilage of other and unspecified sites Melanoma and other malignant neoplasms of skin (C43?C44) C43 Malignant melanoma of skin C44 Other malignant neoplasms of skin Malignant neoplasms of mesothelial and soft tissue (C45?C49) C45 Mesothelioma C46 Kaposi's sarcoma C47 Malignant neoplasm of peripheral nerves and autonomic nervous system C48 Malignant neoplasm of retroperitoneum and peritoneum C49 Malignant neoplasm of other connective and soft tissue Malignant neoplasm of breast (C50) C50 Malignant neoplasm of breast Malignant neoplasms of female genital organs (C51?C58) C51 Malignant neoplasm of vulva C52 Malignant neoplasm of vagina C53 Malignant neoplasm of cervix uteri C54 Malignant neoplasm of corpus uteri C55 Malignant neoplasm of uterus, part unspecified C56 Malignant neoplasm of ovary C57 Malignant neoplasm of other and unspecified female genital organs C58 Malignant neoplasm of placenta Malignant neoplasms of male genital organs (C60?C63) C60 Malignant neoplasm of penis C61 Malignant neoplasm of prostate C62 Malignant neoplasm of testis C63 Malignant neoplasm of other and unspecified male genital organs Malignant neoplasms of urinary tract (C64?C68) C64 Malignant neoplasm of kidney, except renal pelvis C65 Malignant neoplasm of renal pelvis C66 Malignant neoplasm of ureter C67 Malignant neoplasm of bladder C68 Malignant neoplasm of other and unspecified urinary organs Malignant neoplasms of eye, brain and other parts of central nervous system (C69?C72) C69 Malignant neoplasm of eye and adnexa C70 Malignant neoplasm of meninges C71 Malignant neoplasm of brain C72 Malignant neoplasm of spinal cord, cranial nerves and other parts of central nervous system CBHI ICD 10 Student Workbook December 2004 Page 250 Malignant neoplasms of thyroid and other endocrine glands (C73?C75) C73 Malignant neoplasm of thyroid gland C74 Malignant neoplasm of adrenal gland C75 Malignant neoplasm of other endocrine glands and related structures Malignant neoplasms of ill-defined, secondary and unspecified sites (C76?C80) C76 Malignant neoplasm of other and ill-defined sites C77 Secondary and unspecified malignant neoplasm of lymph nodes C78 Secondary malignant neoplasm of respiratory and digestive organs C79 Secondary malignant neoplasm of other sites C80 Malignant neoplasm without specification of site Malignant neoplasms of lymphoid, haematopoietic and related tissue (C81?C96) C81 Hodgkin's disease C82 Follicular [nodular] non-Hodgkin's lymphoma C83 Diffuse non-Hodgkin's lymphoma C84 Peripheral and cutaneous T-cell lymphomas C85 Other and unspecified types of non-Hodgkin's lymphoma C88 Malignant immunoproliferative diseases C90 Multiple myeloma and malignant plasma cell neoplasms C91 Lymphoid leukaemia C92 Myeloid leukaemia C93 Monocytic leukaemia C94 Other leukaemias of specified cell type C95 Leukaemia of unspecified cell type C96 Other and unspecified malignant neoplasms of lymphoid, haematopoietic and related tissue Malignant neoplasms of independent (primary) multiple sites (C97) C97 Malignant neoplasms of independent (primary) multiple sites In situ neoplasms (D00?D09) D00 Carcinoma in situ of oral cavity, oesophagus and stomach D01 Carcinoma in situ of other and unspecified digestive organs D02 Carcinoma in situ of middle ear and respiratory system D03 Melanoma in situ D04 Carcinoma in situ of skin D05 Carcinoma in situ of breast D06 Carcinoma in situ of cervix uteri D07 Carcinoma in situ of other and unspecified genital organs D09 Carcinoma in situ of other and unspecified sites Benign neoplasms (D10?D36) D10 Benign neoplasm of mouth and pharynx D11 Benign neoplasm of major salivary glands D12 Benign neoplasm of colon, rectum, anus and anal canal D13 Benign neoplasm of other and ill-defined parts of digestive system D14 Benign neoplasm of middle ear and respiratory system D15 Benign neoplasm of other and unspecified intrathoracic organs D16 Benign neoplasm of bone and articular cartilage D17 Benign lipomatous neoplasm D18 Haemangioma and lymphangioma, any site D19 Benign neoplasm of mesothelial tissue D20 Benign neoplasm of soft tissue of retroperitoneum and peritoneum CBHI ICD 10 Student Workbook December 2004 Page 251 D21 D22 D23 D24 D25 D26 D27 D28 D29 D30 D31 D32 D33 D34 D35 D36 Other benign neoplasms of connective and other soft tissue Melanocytic naevi Other benign neoplasms of skin Benign neoplasm of breast Leiomyoma of uterus Other benign neoplasms of uterus Benign neoplasm of ovary Benign neoplasm of other and unspecified female genital organs Benign neoplasm of male genital organs Benign neoplasm of urinary organs Benign neoplasm of eye and adnexa Benign neoplasm of meninges Benign neoplasm of brain and other parts of central nervous system Benign neoplasm of thyroid gland Benign neoplasm of other and unspecified endocrine glands Benign neoplasm of other and unspecified sites Neoplasms of uncertain or unknown behaviour (D37?D48) D37 Neoplasm of uncertain or unknown behaviour of oral cavity and digestive organs D38 Neoplasm of uncertain or unknown behaviour of middle ear and respiratory and intrathoracic organs D39 Neoplasm of uncertain or unknown behaviour of female genital organs D40 Neoplasm of uncertain or unknown behaviour of male genital organs D41 Neoplasm of uncertain or unknown behaviour of urinary organs D42 Neoplasm of uncertain or unknown behaviour of meninges D43 Neoplasm of uncertain or unknown behaviour of brain and central nervous system D44 Neoplasm of uncertain or unknown behaviour of endocrine glands D45 Polycythaemia vera D46 Myelodysplastic syndromes D47 Other neoplasms of uncertain or unknown behaviour of lymphoid, haematopoietic and related tissue D48 Neoplasm of uncertain or unknown behaviour of other and unspecified sites Chapter III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50?D89) Nutritional anaemias (D50?D53) D50 Iron deficiency anaemia D51 Vitamin B12 deficiency anaemia D52 Folate deficiency anaemia D53 Other nutritional anaemias Haemolytic anaemias (D55?D59) D55 Anaemia due to enzyme disorders D56 Thalassaemia D57 Sickle-cell disorders D58 Other hereditary haemolytic anaemias D59 Acquired haemolytic anaemia CBHI ICD 10 Student Workbook December 2004 Page 252 Aplastic and other anaemias (D60?D64) D60 Acquired pure red cell aplasia [erythroblastopenia] D61 Other aplastic anaemias D62 Acute posthaemorrhagic anaemia D63? Anaemia in chronic diseases classified elsewhere D64 Other anaemias Coagulation defects, purpura and other haemorrhagic conditions (D65?D69) D65 Disseminated intravascular coagulation [defibrination syndrome] D66 Hereditary factor VIII deficiency D67 Hereditary factor IX deficiency D68 Other coagulation defects D69 Purpura and other haemorrhagic conditions Other diseases of blood and blood-forming organs (D70?D77) D70 Agranulocytosis D71 Functional disorders of polymorphonuclear neutrophils D72 Other disorders of white blood cells D73 Diseases of spleen D74 Methaemoglobinaemia D75 Other diseases of blood and blood-forming organs D76 Certain diseases involving lymphoreticular tissue and reticulohistiocytic system D77? Other disorders of blood and blood-forming organs in diseases classified elsewhere Certain disorders involving the immune mechanism (D80?D89) D80 Immunodeficiency with predominantly antibody defects D81 Combined immunodeficiencies D82 Immunodeficiency associated with other major defects D83 Common variable immunodeficiency D84 Other immunodeficiencies D86 Sarcoidosis D89 Other disorders involving the immune mechanism, not elsewhere classified Chapter IV Endocrine, nutritional and metabolic diseases (E00?E90) Disorders of thyroid gland (E00?E07) E00 Congenital iodine-deficiency syndrome E01 Iodine-deficiency-related thyroid disorders and allied conditions E02 Subclinical iodine-deficiency hypothyroidism E03 Other hypothyroidism E04 Other nontoxic goitre E05 Thyrotoxicosis [hyperthyroidism] E06 Thyroiditis E07 Other disorders of thyroid Diabetes mellitus (E10?E14) E10 Insulin-dependent diabetes mellitus E11 Non-insulin-dependent diabetes mellitus E12 Malnutrition-related diabetes mellitus E13 Other specified diabetes mellitus E14 Unspecified diabetes mellitus CBHI ICD 10 Student Workbook December 2004 Page 253 Other disorders of glucose regulation and pancreatic internal secretion (E15?E16) E15 Nondiabetic hypoglycaemic coma E16 Other disorders of pancreatic internal secretion Disorders of other endocrine glands (E20?E35) E20 Hypoparathyroidism E21 Hyperparathyroidism and other disorders of parathyroid gland E22 Hyperfunction of pituitary gland E23 Hypofunction and other disorders of pituitary gland E24 Cushing's syndrome E25 Adrenogenital disorders E26 Hyperaldosteronism E27 Other disorders of adrenal gland E28 Ovarian dysfunction E29 Testicular dysfunction E30 Disorders of puberty, not elsewhere classified E31 Polyglandular dysfunction E32 Diseases of thymus E34 Other endocrine disorders E35? Disorders of endocrine glands in diseases classified elsewhere Malnutrition (E40?E46) E40 Kwashiorkor E41 Nutritional marasmus E42 Marasmic kwashiorkor E43 Unspecified severe protein-energy malnutrition E44 Protein-energy malnutrition of moderate and mild degree E45 Retarded development following protein-energy malnutrition E46 Unspecified protein-energy malnutrition Other nutritional deficiencies (E50?E64) E50 Vitamin A deficiency E51 Thiamine deficiency E52 Niacin deficiency [pellagra] E53 Deficiency of other B group vitamins E54 Ascorbic acid deficiency E55 Vitamin D deficiency E56 Other vitamin deficiencies E58 Dietary calcium deficiency E59 Dietary selenium deficiency E60 Dietary zinc deficiency E61 Deficiency of other nutrient elements E63 Other nutritional deficiencies E64 Sequelae of malnutrition and other nutritional deficiencies Obesity and other hyperalimentation (E65?E68) E65 Localized adiposity E66 Obesity E67 Other hyperalimentation E68 Sequelae of hyperalimentation Metabolic disorders (E70?E90) E70 Disorders of aromatic amino-acid metabolism E71 Disorders of branched-chain amino-acid metabolism and fatty-acid metabolism CBHI ICD 10 Student Workbook December 2004 Page 254 E72 E73 E74 E75 E76 E77 E78 E79 E80 E83 E84 E85 E86 E87 E88 E89 E90? Other disorders of amino-acid metabolism Lactose intolerance Other disorders of carbohydrate metabolism Disorders of sphingolipid metabolism and other lipid storage disorders Disorders of glycosaminoglycan metabolism Disorders of glycoprotein metabolism Disorders of lipoprotein metabolism and other lipidaemias Disorders of purine and pyrimidine metabolism Disorders of porphyrin and bilirubin metabolism Disorders of mineral metabolism Cystic fibrosis Amyloidosis Volume depletion Other disorders of fluid, electrolyte and acid-base balance Other metabolic disorders Postprocedural endocrine and metabolic disorders, not elsewhere classified Nutritional and metabolic disorders in diseases classified elsewhere Chapter V Mental and behavioural disorders (F00?F99) Organic, including symptomatic, mental disorders (F00?F09) F00? Dementia in Alzheimer's disease F01 Vascular dementia F02? Dementia in other diseases classified elsewhere F03 Unspecified dementia F04 Organic amnesic syndrome, not induced by alcohol and other psychoactive substances F05 Delirium, not induced by alcohol and other psychoactive substances F06 Other mental disorders due to brain damage and dysfunction and to physical disease F07 Personality and behavioural disorders due to brain disease, damage and dysfunction F09 Unspecified organic or symptomatic mental disorder Mental and behavioural disorders due to psychoactive substance use (F10?F19) F10 Mental and behavioural disorders due to use of alcohol F11 Mental and behavioural disorders due to use of opioids F12 Mental and behavioural disorders due to use of cannabinoids F13 Mental and behavioural disorders due to use of sedatives or hypnotics F14 Mental and behavioural disorders due to use of cocaine F15 Mental and behavioural disorders due to use of other stimulants, including caffeine F16 Mental and behavioural disorders due to use of hallucinogens F17 Mental and behavioural disorders due to use of tobacco F18 Mental and behavioural disorders due to use of volatile solvents F19 Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances Schizophrenia, schizotypal and delusional disorders (F20?F29) F20 Schizophrenia F21 Schizotypal disorder F22 Persistent delusional disorders F23 Acute and transient psychotic disorders F24 Induced delusional disorder CBHI ICD 10 Student Workbook December 2004 Page 255 F25 F28 F29 Schizoaffective disorders Other nonorganic psychotic disorders Unspecified nonorganic psychosis Mood [affective] disorders (F30?F39) F30 Manic episode F31 Bipolar affective disorder F32 Depressive episode F33 Recurrent depressive disorder F34 Persistent mood [affective] disorders F38 Other mood [affective] disorders F39 Unspecified mood [affective] disorder Neurotic, stress-related and somatoform disorders (F40?F48) F40 Phobic anxiety disorders F41 Other anxiety disorders F42 Obsessive-compulsive disorder F43 Reaction to severe stress, and adjustment disorders F44 Dissociative [conversion] disorders F45 Somatoform disorders F48 Other neurotic disorders Behavioural syndromes associated with physiological disturbances and physical factors (F50?F59) F50 Eating disorders F51 Nonorganic sleep disorders F52 Sexual dysfunction, not caused by organic disorder or disease F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classified F54 Psychological and behavioural factors associated with disorders or diseases classified elsewhere F55 Abuse of non-dependence-producing substances F59 Unspecified behavioural syndromes associated with physiological disturbances and physical factors Disorders of adult personality and behaviour (F60?F69) F60 Specific personality disorders F61 Mixed and other personality disorders F62 Enduring personality changes, not attributable to brain damage and disease F63 Habit and impulse disorders F64 Gender identity disorders F65 Disorders of sexual preference F66 Psychological and behavioural disorders associated with sexual development and orientation F68 Other disorders of adult personality and behaviour F69 Unspecified disorder of adult personality and behaviour Mental retardation (F70?F79) F70 Mild mental retardation F71 Moderate mental retardation F72 Severe mental retardation F73 Profound mental retardation F78 Other mental retardation F79 Unspecified mental retardation CBHI ICD 10 Student Workbook December 2004 Page 256 Disorders of psychological development (F80?F89) F80 Specific developmental disorders of speech and language F81 Specific developmental disorders of scholastic skills F82 Specific developmental disorder of motor function F83 Mixed specific developmental disorders F84 Pervasive developmental disorders F88 Other disorders of psychological development F89 Unspecified disorder of psychological development Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90?F98) F90 Hyperkinetic disorders F91 Conduct disorders F92 Mixed disorders of conduct and emotions F93 Emotional disorders with onset specific to childhood F94 Disorders of social functioning with onset specific to childhood and adolescence F95 Tic disorders F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence Unspecified mental disorder (F99) F99 Mental disorder, not otherwise specified Chapter VI Diseases of the nervous system (G00?G99) Inflammatory diseases of the central nervous system (G00?G09) G00 Bacterial meningitis, not elsewhere classified G01? Meningitis in bacterial diseases classified elsewhere G02? Meningitis in other infectious and parasitic diseases classified elsewhere G03 Meningitis due to other and unspecified causes G04 Encephalitis, myelitis and encephalomyelitis G05? Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere G06 Intracranial and intraspinal abscess and granuloma G07? Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere G08 Intracranial and intraspinal phlebitis and thrombophlebitis G09 Sequelae of inflammatory diseases of central nervous system Systemic atrophies primarily affecting the central nervous system (G10?G13) G10 Huntington's disease G11 Hereditary ataxia G12 Spinal muscular atrophy and related syndromes G13? Systemic atrophies primarily affecting central nervous system in diseases classified elsewhere Extrapyramidal and movement disorders (G20?G26) G20 Parkinson's disease G21 Secondary parkinsonism G22? Parkinsonism in diseases classified elsewhere G23 Other degenerative diseases of basal ganglia G24 Dystonia G25 Other extrapyramidal and movement disorders G26? Extrapyramidal and movement disorders in diseases classified elsewhere CBHI ICD 10 Student Workbook December 2004 Page 257 Other degenerative diseases of the nervous system (G30?G32) G30 Alzheimer's disease G31 Other degenerative diseases of nervous system, not elsewhere classified G32? Other degenerative disorders of nervous system in diseases classified elsewhere Demyelinating diseases of the central nervous system (G35?G37) G35 Multiple sclerosis G36 Other acute disseminated demyelination G37 Other demyelinating diseases of central nervous system Episodic and paroxysmal disorders (G40?G47) G40 Epilepsy G41 Status epilepticus G43 Migraine G44 Other headache syndromes G45 Transient cerebral ischaemic attacks and related syndromes G46? Vascular syndromes of brain in cerebrovascular diseases G47 Sleep disorders Nerve, nerve root and plexus disorders (G50?G59) G50 Disorders of trigeminal nerve G51 Facial nerve disorders G52 Disorders of other cranial nerves G53? Cranial nerve disorders in diseases classified elsewhere G54 Nerve root and plexus disorders G55? Nerve root and plexus compressions in diseases classified elsewhere G56 Mononeuropathies of upper limb G57 Mononeuropathies of lower limb G58 Other mononeuropathies G59? Mononeuropathy in diseases classified elsewhere Polyneuropathies and other disorders of the peripheral nervous system (G60?G64) G60 Hereditary and idiopathic neuropathy G61 Inflammatory polyneuropathy G62 Other polyneuropathies G63? Polyneuropathy in diseases classified elsewhere G64 Other disorders of peripheral nervous system Diseases of myoneural junction and muscle (G70?G73) G70 Myasthenia gravis and other myoneural disorders G71 Primary disorders of muscles G72 Other myopathies G73? Disorders of myoneural junction and muscle in diseases classified elsewhere Cerebral palsy and other paralytic syndromes (G80?G83) G80 Infantile cerebral palsy G81 Hemiplegia G82 Paraplegia and tetraplegia G83 Other paralytic syndromes Other disorders of the nervous system (G90?G99) G90 Disorders of autonomic nervous system G91 Hydrocephalus G92 Toxic encephalopathy CBHI ICD 10 Student Workbook December 2004 Page 258 G93 G94? G95 G96 G97 G98 G99? Other disorders of brain Other disorders of brain in diseases classified elsewhere Other diseases of spinal cord Other disorders of central nervous system Postprocedural disorders of nervous system, not elsewhere classified Other disorders of nervous system, not elsewhere classified Other disorders of nervous system in diseases classified elsewhere Chapter VII Diseases of the eye and adnexa (H00?H59) Disorders of eyelid, lacrimal system and orbit (H00?H06) H00 Hordeolum and chalazion H01 Other inflammation of eyelid H02 Other disorders of eyelid H03? Disorders of eyelid in diseases classified elsewhere H04 Disorders of lacrimal system H05 Disorders of orbit H06? Disorders of lacrimal system and orbit in diseases classified elsewhere Disorders of conjunctiva (H10?H13) H10 Conjunctivitis H11 Other disorders of conjunctiva H13? Disorders of conjunctiva in diseases classified elsewhere Disorders of sclera, cornea, iris and ciliary body (H15?H22) H15 Disorders of sclera H16 Keratitis H17 Corneal scars and opacities H18 Other disorders of cornea H19? Disorders of sclera and cornea in diseases classified elsewhere H20 Iridocyclitis H21 Other disorders of iris and ciliary body H22? Disorders of iris and ciliary body in diseases classified elsewhere Disorders of lens (H25?H28) H25 Senile cataract H26 Other cataract H27 Other disorders of lens H28? Cataract and other disorders of lens in diseases classified elsewhere Disorders of choroid and retina (H30?H36) H30 Chorioretinal inflammation H31 Other disorders of choroid H32? Chorioretinal disorders in diseases classified elsewhere H33 Retinal detachments and breaks H34 Retinal vascular occlusions H35 Other retinal disorders H36? Retinal disorders in diseases classified elsewhere Glaucoma (H40?H42) H40 Glaucoma H42? Glaucoma in diseases classified elsewhere CBHI ICD 10 Student Workbook December 2004 Page 259 Disorders of vitreous body and globe (H43?H45) H43 Disorders of vitreous body H44 Disorders of globe H45? Disorders of vitreous body and globe in diseases classified elsewhere Disorders of optic nerve and visual pathways (H46?H48) H46 Optic neuritis H47 Other disorders of optic [2nd] nerve and visual pathways H48? Disorders of optic [2nd] nerve and visual pathways in diseases classified elsewhere Disorders of ocular muscles, binocular movement, accommodation and refraction (H49?H52) H49 Paralytic strabismus H50 Other strabismus H51 Other disorders of binocular movement H52 Disorders of refraction and accommodation Visual disturbances and blindness (H53?H54) H53 Visual disturbances H54 Blindness and low vision Other disorders of eye and adnexa (H55?H59) H55 Nystagmus and other irregular eye movements H57 Other disorders of eye and adnexa H58? Other disorders of eye and adnexa in diseases classified elsewhere H59 Postprocedural disorders of eye and adnexa, not elsewhere classified Chapter VIII Diseases of the ear and mastoid process (H60?H95) Diseases of external ear (H60?H62) H60 Otitis externa H61 Other disorders of external ear H62? Disorders of external ear in diseases classified elsewhere Diseases of middle ear and mastoid (H65?H75) H65 Nonsuppurative otitis media H66 Suppurative and unspecified otitis media H67? Otitis media in diseases classified elsewhere H68 Eustachian salpingitis and obstruction H69 Other disorders of Eustachian tube H70 Mastoiditis and related conditions H71 Cholesteatoma of middle ear H72 Perforation of tympanic membrane H73 Other disorders of tympanic membrane H74 Other disorders of middle ear and mastoid H75? Other disorders of middle ear and mastoid in diseases classified elsewhere Diseases of inner ear (H80?H83) H80 Otosclerosis H81 Disorders of vestibular function H82? Vertiginous syndromes in diseases classified elsewhere H83 Other diseases of inner ear CBHI ICD 10 Student Workbook December 2004 Page 260 Other disorders of ear (H90?H95) H90 Conductive and sensorineural hearing loss H91 Other hearing loss H92 Otalgia and effusion of ear H93 Other disorders of ear, not elsewhere classified H94? Other disorders of ear in diseases classified elsewhere H95 Postprocedural disorders of ear and mastoid process, not elsewhere classified Chapter IX Diseases of the circulatory system (I00?I99) Acute rheumatic fever (I00?I02) I00 Rheumatic fever without mention of heart involvement I01 Rheumatic fever with heart involvement I02 Rheumatic chorea Chronic rheumatic heart diseases (I05?I09) I05 Rheumatic mitral valve diseases I06 Rheumatic aortic valve diseases I07 Rheumatic tricuspid valve diseases I08 Multiple valve diseases I09 Other rheumatic heart diseases Hypertensive diseases (I10?I15) I10 Essential (primary) hypertension I11 Hypertensive heart disease I12 Hypertensive renal disease I13 Hypertensive heart and renal disease I15 Secondary hypertension Ischaemic heart diseases (I20?I25) I20 Angina pectoris I21 Acute myocardial infarction I22 Subsequent myocardial infarction I23 Certain current complications following acute myocardial infarction I24 Other acute ischaemic heart diseases I25 Chronic ischaemic heart disease Pulmonary heart disease and diseases of pulmonary circulation (I26?I28) I26 Pulmonary embolism I27 Other pulmonary heart diseases I28 Other diseases of pulmonary vessels Other forms of heart disease (I30?I52) I30 Acute pericarditis I31 Other diseases of pericardium I32? Pericarditis in diseases classified elsewhere I33 Acute and subacute endocarditis I34 Nonrheumatic mitral valve disorders I35 Nonrheumatic aortic valve disorders I36 Nonrheumatic tricuspid valve disorders I37 Pulmonary valve disorders I38 Endocarditis, valve unspecified CBHI ICD 10 Student Workbook December 2004 Page 261 I39? I40 I41? I42 I43? I44 I45 I46 I47 I48 I49 I50 I51 I52? Endocarditis and heart valve disorders in diseases classified elsewhere Acute myocarditis Myocarditis in diseases classified elsewhere Cardiomyopathy Cardiomyopathy in diseases classified elsewhere Atrioventricular and left bundle-branch block Other conduction disorders Cardiac arrest Paroxysmal tachycardia Atrial fibrillation and flutter Other cardiac arrhythmias Heart failure Complications and ill-defined descriptions of heart disease Other heart disorders in diseases classified elsewhere Cerebrovascular diseases (I60?I69) I60 Subarachnoid haemorrhage I61 Intracerebral haemorrhage I62 Other nontraumatic intracranial haemorrhage I63 Cerebral infarction I64 Stroke, not specified as haemorrhage or infarction I65 Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction I66 Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction I67 Other cerebrovascular diseases I68? Cerebrovascular disorders in diseases classified elsewhere I69 Sequelae of cerebrovascular disease Diseases of arteries, arterioles and capillaries (I70?I79) I70 Atherosclerosis I71 Aortic aneurysm and dissection I72 Other aneurysm I73 Other peripheral vascular diseases I74 Arterial embolism and thrombosis I77 Other disorders of arteries and arterioles I78 Diseases of capillaries I79? Disorders of arteries, arterioles and capillaries in diseases classified elsewhere Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80?I89) I80 Phlebitis and thrombophlebitis I81 Portal vein thrombosis I82 Other venous embolism and thrombosis I83 Varicose veins of lower extremities I84 Haemorrhoids I85 Oesophageal varices I86 Varicose veins of other sites I87 Other disorders of veins I88 Nonspecific lymphadenitis I89 Other noninfective disorders of lymphatic vessels and lymph nodes Other and unspecified disorders of the circulatory system (I95?I99) I95 Hypotension I97 Postprocedural disorders of circulatory system, not elsewhere classified CBHI ICD 10 Student Workbook December 2004 Page 262 I98 I99 Other disorders of circulatory system in diseases classified elsewhere Other and unspecified disorders of circulatory system Chapter X Diseases of the respiratory system (J00?J99) Acute upper respiratory infections (J00?J06) J00 Acute nasopharyngitis [common cold] J01 Acute sinusitis J02 Acute pharyngitis J03 Acute tonsillitis J04 Acute laryngitis and tracheitis J05 Acute obstructive laryngitis [croup] and epiglottitis J06 Acute upper respiratory infections of multiple and unspecified sites Influenza and pneumonia (J10?J18) J10 Influenza due to identified influenza virus J11 Influenza, virus not identified J12 Viral pneumonia, not elsewhere classified J13 Pneumonia due to Streptococcus pneumoniae J14 Pneumonia due to Haemophilus influenzae J15 Bacterial pneumonia, not elsewhere classified J16 Pneumonia due to other infectious organisms, not elsewhere classified J17? Pneumonia in diseases classified elsewhere J18 Pneumonia, organism unspecified Other acute lower respiratory infections (J20?J22) J20 Acute bronchitis J21 Acute bronchiolitis J22 Unspecified acute lower respiratory infection Other diseases of upper respiratory tract (J30?J39) J30 Vasomotor and allergic rhinitis J31 Chronic rhinitis, nasopharyngitis and pharyngitis J32 Chronic sinusitis J33 Nasal polyp J34 Other disorders of nose and nasal sinuses J35 Chronic diseases of tonsils and adenoids J36 Peritonsillar abscess J37 Chronic laryngitis and laryngotracheitis J38 Diseases of vocal cords and larynx, not elsewhere classified J39 Other diseases of upper respiratory tract Chronic lower respiratory diseases (J40?J47) J40 Bronchitis, not specified as acute or chronic J41 Simple and mucopurulent chronic bronchitis J42 Unspecified chronic bronchitis J43 Emphysema J44 Other chronic obstructive pulmonary disease J45 Asthma J46 Status asthmaticus J47 Bronchiectasis CBHI ICD 10 Student Workbook December 2004 Page 263 Lung diseases due to external agents (J60?J70) J60 Coalworker's pneumoconiosis J61 Pneumoconiosis due to asbestos and other mineral fibres J62 Pneumoconiosis due to dust containing silica J63 Pneumoconiosis due to other inorganic dusts J64 Unspecified pneumoconiosis J65 Pneumoconiosis associated with tuberculosis J66 Airway disease due to specific organic dust J67 Hypersensitivity pneumonitis due to organic dust J68 Respiratory conditions due to inhalation of chemicals, gases, fumes and vapours J69 Pneumonitis due to solids and liquids J70 Respiratory conditions due to other external agents Other respiratory diseases principally affecting the interstitium (J80?J84) J80 Adult respiratory distress syndrome J81 Pulmonary oedema J82 Pulmonary eosinophilia, not elsewhere classified J84 Other interstitial pulmonary diseases Suppurative and necrotic conditions of lower respiratory tract (J85?J86) J85 Abscess of lung and mediastinum J86 Pyothorax Other diseases of pleura (J90?J94) J90 Pleural effusion, not elsewhere classified J91? Pleural effusion in conditions classified elsewhere J92 Pleural plaque J93 Pneumothorax J94 Other pleural conditions Other diseases of the respiratory system (J95?J99) J95 Postprocedural respiratory disorders, not elsewhere classified J96 Respiratory failure, not elsewhere classified J98 Other respiratory disorders J99?Respiratory disorders in diseases classified elsewhere Chapter XI Diseases of the digestive system (K00?K93) Diseases of oral cavity, salivary glands and jaws (K00?K14) K00 Disorders of tooth development and eruption K01 Embedded and impacted teeth K02 Dental caries K03 Other diseases of hard tissues of teeth K04 Diseases of pulp and periapical tissues K05 Gingivitis and periodontal diseases K06 Other disorders of gingiva and edentulous alveolar ridge K07 Dentofacial anomalies [including malocclusion] K08 Other disorders of teeth and supporting structures K09 Cysts of oral region, not elsewhere classified K10 Other diseases of jaws K11 Diseases of salivary glands K12 Stomatitis and related lesions CBHI ICD 10 Student Workbook December 2004 Page 264 K13 K14 Other diseases of lip and oral mucosa Diseases of tongue Diseases of oesophagus, stomach and duodenum (K20?K31) K20 Oesophagitis K21 Gastro-oesophageal reflux disease K22 Other diseases of oesophagus K23? Disorders of oesophagus in diseases classified elsewhere K25 Gastric ulcer K26 Duodenal ulcer K27 Peptic ulcer, site unspecified K28 Gastrojejunal ulcer K29 Gastritis and duodenitis K30 Dyspepsia K31 Other diseases of stomach and duodenum Diseases of appendix (K35?K38) K35 Acute appendicitis K36 Other appendicitis K37 Unspecified appendicitis K38 Other diseases of appendix Hernia (K40?K46) K40 Inguinal hernia K41 Femoral hernia K42 Umbilical hernia K43 Ventral hernia K44 Diaphragmatic hernia K45 Other abdominal hernia K46 Unspecified abdominal hernia Noninfective enteritis and colitis (K50?K52) K50 Crohn's disease [regional enteritis] K51 Ulcerative colitis K52 Other noninfective gastroenteritis and colitis Other diseases of intestines (K55?K63) K55 Vascular disorders of intestine K56 Paralytic ileus and intestinal obstruction without hernia K57 Diverticular disease of intestine K58 Irritable bowel syndrome K59 Other functional intestinal disorders K60 Fissure and fistula of anal and rectal regions K61 Abscess of anal and rectal regions K62 Other diseases of anus and rectum K63 Other diseases of intestine Diseases of peritoneum (K65?K67) K65 Peritonitis K66 Other disorders of peritoneum K67? Disorders of peritoneum in infectious diseases classified elsewhere CBHI ICD 10 Student Workbook December 2004 Page 265 Diseases of liver (K70?K77) K70 Alcoholic liver disease K71 Toxic liver disease K72 Hepatic failure, not elsewhere classified K73 Chronic hepatitis, not elsewhere classified K74 Fibrosis and cirrhosis of liver K75 Other inflammatory liver diseases K76 Other diseases of liver K77? Liver disorders in diseases classified elsewhere Disorders of gallbladder, biliary tract and pancreas (K80?K87) K80 Cholelithiasis K81 Cholecystitis K82 Other diseases of gallbladder K83 Other diseases of biliary tract K85 Acute pancreatitis K86 Other diseases of pancreas K87? Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere Other diseases of the digestive system (K90?K93) K90 Intestinal malabsorption K91 Postprocedural disorders of digestive system, not elsewhere classified K92 Other diseases of digestive system K93? Disorders of other digestive organs in diseases classified elsewhere Chapter XII Diseases of the skin and subcutaneous tissue (L00?L99) Infections of the skin and subcutaneous tissue (L00?L08) L00 L01 L02 L03 L04 L05 L08 Staphylococcal scalded skin syndrome Impetigo Cutaneous abscess, furuncle and carbuncle Cellulitis Acute lymphadenitis Pilonidal cyst Other local infections of skin and subcutaneous tissue Bullous disorders (L10?L14) L10 Pemphigus L11 Other acantholytic disorders L12 Pemphigoid L13 Other bullous disorders L14? Bullous disorders in diseases classified elsewhere Dermatitis and eczema (L20?L30) L20 Atopic dermatitis L21 Seborrhoeic dermatitis L22 Diaper [napkin] dermatitis L23 Allergic contact dermatitis L24 Irritant contact dermatitis L25 Unspecified contact dermatitis L26 Exfoliative dermatitis CBHI ICD 10 Student Workbook December 2004 Page 266 L27 L28 L29 L30 Dermatitis due to substances taken internally Lichen simplex chronicus and prurigo Pruritus Other dermatitis Papulosquamous disorders (L40?L45) L40 Psoriasis L41 Parapsoriasis L42 Pityriasis rosea L43 Lichen planus L44 Other papulosquamous disorders L45? Papulosquamous disorders in diseases classified elsewhere Urticaria and erythema (L50?L54) L50 Urticaria L51 Erythema multiforme L52 Erythema nodosum L53 Other erythematous conditions L54? Erythema in diseases classified elsewhere Radiation-related disorders of the skin and subcutaneous tissue (L55?L59) L55 Sunburn L56 Other acute skin changes due to ultraviolet radiation L57 Skin changes due to chronic exposure to nonionizing radiation L58 Radiodermatitis L59 Other disorders of skin and subcutaneous tissue related to radiation Disorders of skin appendages (L60?L75) L60 Nail disorders L62? Nail disorders in diseases classified elsewhere L63 Alopecia areata L64 Androgenic alopecia L65 Other nonscarring hair loss L66 Cicatricial alopecia [scarring hair loss] L67 Hair colour and hair shaft abnormalities L68 Hypertrichosis L70 Acne L71 Rosacea L72 Follicular cysts of skin and subcutaneous tissue L73 Other follicular disorders L74 Eccrine sweat disorders L75 Apocrine sweat disorders Other disorders of the skin and subcutaneous tissue (L80?L99) L80 Vitiligo L81 Other disorders of pigmentation L82 Seborrhoeic keratosis L83 Acanthosis nigricans L84 Corns and callosities L85 Other epidermal thickening L86? Keratoderma in diseases classified elsewhere L87 Transepidermal elimination disorders L88 Pyoderma gangrenosum L89 Decubitus ulcer CBHI ICD 10 Student Workbook December 2004 Page 267 L90 L91 L92 L93 L94 L95 L97 L98 L99? Atrophic disorders of skin Hypertrophic disorders of skin Granulomatous disorders of skin and subcutaneous tissue Lupus erythematosus Other localized connective tissue disorders Vasculitis limited to skin, not elsewhere classified Ulcer of lower limb, not elsewhere classified Other disorders of skin and subcutaneous tissue, not elsewhere classified Other disorders of skin and subcutaneous tissue in diseases classified elsewhere Chapter XIII Diseases of the musculoskeletal system and connective tissue (M00?M99) Arthropathies (M00?M25) Infectious arthropathies (M00?M03) M00 Pyogenic arthritis M01? Direct infections of joint in infectious and parasitic diseases classified elsewhere M02 Reactive arthropathies M03? Postinfective and reactive arthropathies in diseases classified elsewhere Inflammatory polyarthropathies (M05? M14) M05 Seropositive rheumatoid arthritis M06 Other rheumatoid arthritis M07? Psoriatic and enteropathic arthropathies M08 Juvenile arthritis M09? Juvenile arthritis in diseases classified elsewhere M10 Gout M11 Other crystal arthropathies M12 Other specific arthropathies M13 Other arthritis M14? Arthropathies in other diseases classified elsewhere Arthrosis (M15?M19) M15 Polyarthrosis M16 Coxarthrosis [arthrosis of hip] M17 Gonarthrosis [arthrosis of knee] M18 Arthrosis of first carpometacarpal joint M19 Other arthrosis Other joint disorders (M20?M25) M20 Acquired deformities of fingers and toes M21 Other acquired deformities of limbs M22 Disorders of patella M23 Internal derangement of knee M24 Other specific joint derangements M25 Other joint disorders, not elsewhere classified Systemic connective tissue disorders (M30?M36) M30 Polyarteritis nodosa and related conditions M31 Other necrotizing vasculopathies M32 Systemic lupus erythematosus M33 Dermatopolymyositis CBHI ICD 10 Student Workbook December 2004 Page 268 M34 Systemic sclerosis M35 Other systemic involvement of connective tissue M36? Systemic disorders of connective tissue in diseases classified elsewhere Dorsopathies (M40?M54) Deforming dorsopathies (M40?M43) M40 Kyphosis and lordosis M41 Scoliosis M42 Spinal osteochondrosis M43 Other deforming dorsopathies Spondylopathies (M45?M49) M45 Ankylosing spondylitis M46 Other inflammatory spondylopathies M47 Spondylosis M48 Other spondylopathies M49? Spondylopathies in diseases classified elsewhere Other dorsopathies (M50?M54) M50 Cervical disc disorders M51 Other intervertebral disc disorders M53 Other dorsopathies, not elsewhere classified M54 Dorsalgia Soft tissue disorders (M60?M79) Disorders of muscles (M60?M63) M60 Myositis M61 Calcification and ossification of muscle M62 Other disorders of muscle M63? Disorders of muscle in diseases classified elsewhere Disorders of synovium and tendon (M65?M68) M65 Synovitis and tenosynovitis M66 Spontaneous rupture of synovium and tendon M67 Other disorders of synovium and tendon M68? Disorders of synovium and tendon in diseases classified elsewhere Other soft tissue disorders (M70?M79) M70 Soft tissue disorders related to use, overuse and pressure M71 Other bursopathies M72 Fibroblastic disorders M73? Soft tissue disorders in diseases classified elsewhere M75 Shoulder lesions M76 Enthesopathies of lower limb, excluding foot M77 Other enthesopathies M79 Other soft tissue disorders, not elsewhere classified Osteopathies and chondropathies (M80?M94) Disorders of bone density and structure (M80?M85) M80 Osteoporosis with pathological fracture M81 Osteoporosis without pathological fracture M82? Osteoporosis in diseases classified elsewhere M83 Adult osteomalacia CBHI ICD 10 Student Workbook December 2004 Page 269 M84 M85 Disorders of continuity of bone Other disorders of bone density and structure Other osteopathies (M86?M90) M86 Osteomyelitis M87 Osteonecrosis M88 Paget's disease of bone [osteitis deformans] M89 Other disorders of bone M90? Osteopathies in diseases classified elsewhere Chondropathies (M91?M94) M91 Juvenile osteochondrosis of hip and pelvis M92 Other juvenile osteochondrosis M93 Other osteochondropathies M94 Other disorders of cartilage Other disorders of the musculoskeletal system and connective tissue (M95?M99) M95 Other acquired deformities of musculoskeletal system and connective tissue M96 Postprocedural musculoskeletal disorders, not elsewhere classified M99 Biomechanical lesions, not elsewhere classified Chapter XIV Diseases of the genitourinary system (N00?N99) Glomerular diseases (N00?N08) N00 Acute nephritic syndrome N01 Rapidly progressive nephritic syndrome N02 Recurrent and persistent haematuria N03 Chronic nephritic syndrome N04 Nephrotic syndrome N05 Unspecified nephritic syndrome N06 Isolated proteinuria with specified morphological lesion N07 Hereditary nephropathy, not elsewhere classified N08? Glomerular disorders in diseases classified elsewhere Renal tubulo-interstitial diseases (N10?N16) N10 Acute tubulo-interstitial nephritis N11 Chronic tubulo-interstitial nephritis N12 Tubulo-interstitial nephritis, not specified as acute or chronic N13 Obstructive and reflux uropathy N14 Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions N15 Other renal tubulo-interstitial diseases N16? Renal tubulo-interstitial disorders in diseases classified elsewhere Renal failure (N17?N19) N17 Acute renal failure N18 Chronic renal failure N19 Unspecified renal failure Urolithiasis (N20?N23) N20 Calculus of kidney and ureter N21 Calculus of lower urinary tract CBHI ICD 10 Student Workbook December 2004 Page 270 N22? N23 Calculus of urinary tract in diseases classified elsewhere Unspecified renal colic Other disorders of kidney and ureter (N25?N29) N25 Disorders resulting from impaired renal tubular function N26 Unspecified contracted kidney N27 Small kidney of unknown cause N28 Other disorders of kidney and ureter, not elsewhere classified N29? Other disorders of kidney and ureter in diseases classified elsewhere Other diseases of urinary system (N30?N39) N30 Cystitis N31 Neuromuscular dysfunction of bladder, not elsewhere classified N32 Other disorders of bladder N33? Bladder disorders in diseases classified elsewhere N34 Urethritis and urethral syndrome N35 Urethral stricture N36 Other disorders of urethra N37? Urethral disorders in diseases classified elsewhere N39 Other disorders of urinary system Diseases of male genital organs (N40?N51) N40 Hyperplasia of prostate N41 Inflammatory diseases of prostate N42 Other disorders of prostate N43 Hydrocele and spermatocele N44 Torsion of testis N45 Orchitis and epididymitis N46 Male infertility N47 Redundant prepuce, phimosis and paraphimosis N48 Other disorders of penis N49 Inflammatory disorders of male genital organs, not elsewhere classified N50 Other disorders of male genital organs N51? Disorders of male genital organs in diseases classified elsewhere Disorders of breast (N60?N64) N60 Benign mammary dysplasia N61 Inflammatory disorders of breast N62 Hypertrophy of breast N63 Unspecified lump in breast N64 Other disorders of breast Inflammatory diseases of female pelvic organs (N70?N77) N70 Salpingitis and oophoritis N71 Inflammatory disease of uterus, except cervix N72 Inflammatory disease of cervix uteri N73 Other female pelvic inflammatory diseases N74? Female pelvic inflammatory disorders in diseases classified elsewhere N75 Diseases of Bartholin's gland N76 Other inflammation of vagina and vulva N77? Vulvovaginal ulceration and inflammation in diseases classified elsewhere CBHI ICD 10 Student Workbook December 2004 Page 271 Noninflammatory disorders of female genital tract (N80?N98) N80 Endometriosis N81 Female genital prolapse N82 Fistulae involving female genital tract N83 Noninflammatory disorders of ovary, fallopian tube and broad ligament N84 Polyp of female genital tract N85 Other noninflammatory disorders of uterus, except cervix N86 Erosion and ectropion of cervix uteri N87 Dysplasia of cervix uteri N88 Other noninflammatory disorders of cervix uteri N89 Other noninflammatory disorders of vagina N90 Other noninflammatory disorders of vulva and perineum N91 Absent, scanty and rare menstruation N92 Excessive, frequent and irregular menstruation N93 Other abnormal uterine and vaginal bleeding N94 Pain and other conditions associated with female genital organs and menstrual cycle N95 Menopausal and other perimenopausal disorders N96 Habitual aborter N97 Female infertility N98 Complications associated with artificial fertilization Other disorders of the genitourinary system (N99) N99 Postprocedural disorders of genitourinary system, not elsewhere classified Chapter XV Pregnancy, childbirth and the puerperium (O00?O99) Pregnancy with abortive outcome (O00?O08) O00 Ectopic pregnancy O01 Hydatidiform mole O02 Other abnormal products of conception O03 Spontaneous abortion O04 Medical abortion O05 Other abortion O06 Unspecified abortion O07 Failed attempted abortion O08 Complications following abortion and ectopic and molar pregnancy Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium (O10?O16) O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium O11 Pre-existing hypertensive disorder with superimposed proteinuria O12 Gestational [pregnancy-induced] oedema and proteinuria without hypertension O13 Gestational [pregnancy-induced] hypertension without significant proteinuria O14 Gestational [pregnancy-induced] hypertension with significant proteinuria O15 Eclampsia O16 Unspecified maternal hypertension Other maternal disorders predominantly related to pregnancy (O20?O29) O20 Haemorrhage in early pregnancy O21 Excessive vomiting in pregnancy O22 Venous complications in pregnancy CBHI ICD 10 Student Workbook December 2004 Page 272 O23 O24 O25 O26 O28 O29 Infections of genitourinary tract in pregnancy Diabetes mellitus in pregnancy Malnutrition in pregnancy Maternal care for other conditions predominantly related to pregnancy Abnormal findings on antenatal screening of mother Complications of anaesthesia during pregnancy Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30?O48) O30 Multiple gestation O31 Complications specific to multiple gestation O32 Maternal care for known or suspected malpresentation of fetus O33 Maternal care for known or suspected disproportion O34 Maternal care for known or suspected abnormality of pelvic organs O35 Maternal care for known or suspected fetal abnormality and damage O36 Maternal care for other known or suspected fetal problems O40 Polyhydramnios O41 Other disorders of amniotic fluid and membranes O42 Premature rupture of membranes O43 Placental disorders O44 Placenta praevia O45 Premature separation of placenta [abruptio placentae] O46 Antepartum haemorrhage, not elsewhere classified O47 False labour O48 Prolonged pregnancy Complications of labour and delivery (O60?O75) O60 Preterm delivery O61 Failed induction of labour O62 Abnormalities of forces of labour O63 Long labour O64 Obstructed labour due to malposition and malpresentation of fetus O65 Obstructed labour due to maternal pelvic abnormality O66 Other obstructed labour O67 Labour and delivery complicated by intrapartum haemorrhage, not elsewhere classified O68 Labour and delivery complicated by fetal stress [distress] O69 Labour and delivery complicated by umbilical cord complications O70 Perineal laceration during delivery O71 Other obstetric trauma O72 Postpartum haemorrhage O73 Retained placenta and membranes, without haemorrhage O74 Complications of anaesthesia during labour and delivery O75 Other complications of labour and delivery, not elsewhere classified Delivery (O80?O84) O80 Single spontaneous delivery O81 Single delivery by forceps and vacuum extractor O82 Single delivery by caesarean section O83 Other assisted single delivery O84 Multiple delivery CBHI ICD 10 Student Workbook December 2004 Page 273 Complications predominantly related to the puerperium (O85?O92) O85 Puerperal sepsis O86 Other puerperal infections O87 Venous complications in the puerperium O88 Obstetric embolism O89 Complications of anaesthesia during the puerperium O90 Complications of the puerperium, not elsewhere classified O91 Infections of breast associated with childbirth O92 Other disorders of breast and lactation associated with childbirth Other obstetric conditions, not elsewhere classified (O95?O99) O95 Obstetric death of unspecified cause O96 Death from any obstetric cause occurring more than 42 days but less than one year after delivery O97 Death from sequelae of direct obstetric causes O98 Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium Chapter XVI Certain conditions originating in the perinatal period (P00?P96) Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery (P00?P04) P00 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy P01 Fetus and newborn affected by maternal complications of pregnancy P02 Fetus and newborn affected by complications of placenta, cord and membranes P03 Fetus and newborn affected by other complications of labour and delivery P04 Fetus and newborn affected by noxious influences transmitted via placenta or breast milk Disorders related to length of gestation and fetal growth (P05?P08) P05 Slow fetal growth and fetal malnutrition P07 Disorders related to short gestation and low birth weight, not elsewhere classified P08 Disorders related to long gestation and high birth weight Birth trauma (P10?P15) P10 Intracranial laceration and haemorrhage due to birth injury P11 Other birth injuries to central nervous system P12 Birth injury to scalp P13 Birth injury to skeleton P14 Birth injury to peripheral nervous system P15 Other birth injuries Respiratory and cardiovascular disorders specific to the perinatal period (P20?P29) P20 Intrauterine hypoxia P21 Birth asphyxia P22 Respiratory distress of newborn P23 Congenital pneumonia P24 Neonatal aspiration syndromes P25 Interstitial emphysema and related conditions originating in the perinatal period P26 Pulmonary haemorrhage originating in the perinatal period CBHI ICD 10 Student Workbook December 2004 Page 274 P27 P28 P29 Chronic respiratory disease originating in the perinatal period Other respiratory conditions originating in the perinatal period Cardiovascular disorders originating in the perinatal period Infections specific to the perinatal period (P35?P39) P35 Congenital viral diseases P36 Bacterial sepsis of newborn P37 Other congenital infectious and parasitic diseases P38 Omphalitis of newborn with or without mild haemorrhage P39 Other infections specific to the perinatal period Haemorrhagic and haematological disorders of fetus and newborn (P50?P61) P50 Fetal blood loss P51 Umbilical haemorrhage of newborn P52 Intracranial nontraumatic haemorrhage of fetus and newborn P53 Haemorrhagic disease of fetus and newborn P54 Other neonatal haemorrhages P55 Haemolytic disease of fetus and newborn P56 Hydrops fetalis due to haemolytic disease P57 Kernicterus P58 Neonatal jaundice due to other excessive haemolysis P59 Neonatal jaundice from other and unspecified causes P60 Disseminated intravascular coagulation of fetus and newborn P61 Other perinatal haematological disorders Transitory endocrine and metabolic disorders specific to fetus and newborn (P70?P74) P70 Transitory disorders of carbohydrate metabolism specific to fetus and newborn P71 Transitory neonatal disorders of calcium and magnesium metabolism P72 Other transitory neonatal endocrine disorders P74 Other transitory neonatal electrolyte and metabolic disturbances Digestive system disorders of fetus and newborn (P75?P78) P75? Meconium ileus P76 Other intestinal obstruction of newborn P77 Necrotizing enterocolitis of fetus and newborn P78 Other perinatal digestive system disorders Conditions involving the integument and temperature regulation of fetus and newborn (P80?P83) P80 Hypothermia of newborn P81 Other disturbances of temperature regulation of newborn P83 Other conditions of integument specific to fetus and newborn Other disorders originating in the perinatal period (P90?P96) P90 Convulsions of newborn P91 Other disturbances of cerebral status of newborn P92 Feeding problems of newborn P93 Reactions and intoxications due to drugs administered to fetus and newborn P94 Disorders of muscle tone of newborn P95 Fetal death of unspecified cause P96 Other conditions originating in the perinatal period CBHI ICD 10 Student Workbook December 2004 Page 275 Chapter XVII Congenital malformations, deformations and chromosomal abnormalities (Q00?Q99) Congenital malformations of the nervous system (Q00?Q07) Q00 Anencephaly and similar malformations Q01 Encephalocele Q02 Microcephaly Q03 Congenital hydrocephalus Q04 Other congenital malformations of brain Q05 Spina bifida Q06 Other congenital malformations of spinal cord Q07 Other congenital malformations of nervous system Congenital malformations of eye, ear, face and neck (Q10?Q18) Q10 Congenital malformations of eyelid, lacrimal apparatus and orbit Q11 Anophthalmos, microphthalmos and macrophthalmos Q12 Congenital lens malformations Q13 Congenital malformations of anterior segment of eye Q14 Congenital malformations of posterior segment of eye Q15 Other congenital malformations of eye Q16 Congenital malformations of ear causing impairment of hearing Q17 Other congenital malformations of ear Q18 Other congenital malformations of face and neck Congenital malformations of the circulatory system (Q20?Q28) Q20 Congenital malformations of cardiac chambers and connections Q21 Congenital malformations of cardiac septa Q22 Congenital malformations of pulmonary and tricuspid valves Q23 Congenital malformations of aortic and mitral valves Q24 Other congenital malformations of heart Q25 Congenital malformations of great arteries Q26 Congenital malformations of great veins Q27 Other congenital malformations of peripheral vascular system Q28 Other congenital malformations of circulatory system Congenital malformations of the respiratory system (Q30?Q34) Q30 Congenital malformations of nose Q31 Congenital malformations of larynx Q32 Congenital malformations of trachea and bronchus Q33 Congenital malformations of lung Q34 Other congenital malformations of respiratory system Cleft lip and cleft palate (Q35?Q37) Q35 Cleft palate Q36 Cleft lip Q37 Cleft palate with cleft lip Other congenital malformations of the digestive system (Q38?Q45) Q38 Other congenital malformations of tongue, mouth and pharynx Q39 Congenital malformations of oesophagus Q40 Other congenital malformations of upper alimentary tract Q41 Congenital absence, atresia and stenosis of small intestine Q42 Congenital absence, atresia and stenosis of large intestine CBHI ICD 10 Student Workbook December 2004 Page 276 Q43 Q44 Q45 Other congenital malformations of intestine Congenital malformations of gallbladder, bile ducts and liver Other congenital malformations of digestive system Congenital malformations of genital organs (Q50?Q56) Q50 Congenital malformations of ovaries, fallopian tubes and broad ligaments Q51 Congenital malformations of uterus and cervix Q52 Other congenital malformations of female genitalia Q53 Undescended testicle Q54 Hypospadias Q55 Other congenital malformations of male genital organs Q56 Indeterminate sex and pseudohermaphroditism Congenital malformations of the urinary system (Q60?Q64) Q60 Renal agenesis and other reduction defects of kidney Q61 Cystic kidney disease Q62 Congenital obstructive defects of renal pelvis and congenital malformations of ureter Q63 Other congenital malformations of kidney Q64 Other congenital malformations of urinary system Congenital malformations and deformations of the musculoskeletal system (Q65?Q79) Q65 Congenital deformities of hip Q66 Congenital deformities of feet Q67 Congenital musculoskeletal deformities of head, face, spine and chest Q68 Other congenital musculoskeletal deformities Q69 Polydactyly Q70 Syndactyly Q71 Reduction defects of upper limb Q72 Reduction defects of lower limb Q73 Reduction defects of unspecified limb Q74 Other congenital malformations of limb(s) Q75 Other congenital malformations of skull and face bones Q76 Congenital malformations of spine and bony thorax Q77 Osteochondrodysplasia with defects of growth of tubular bones and spine Q78 Other osteochondrodysplasias Q79 Congenital malformations of the musculoskeletal system, not elsewhere classified Other congenital malformations (Q80?Q89) Q80 Congenital ichthyosis Q81 Epidermolysis bullosa Q82 Other congenital malformations of skin Q83 Congenital malformations of breast Q84 Other congenital malformations of integument Q85 Phakomatoses, not elsewhere classified Q86 Congenital malformation syndromes due to known exogenous causes, not elsewhere classified Q87 Other specified congenital malformation syndromes affecting multiple systems Q89 Other congenital malformations, not elsewhere classified Chromosomal abnormalities, not elsewhere classified (Q90?Q99) Q90 Down's syndrome Q91 Edwards' syndrome and Patau's syndrome Q92 Other trisomies and partial trisomies of the autosomes, not elsewhere classified Q93 Monosomies and deletions from the autosomes, not elsewhere classified CBHI ICD 10 Student Workbook December 2004 Page 277 Q95 Q96 Q97 Q98 Q99 Balanced rearrangements and structural markers, not elsewhere classified Turner's syndrome Other sex chromosome abnormalities, female phenotype, not elsewhere classified Other sex chromosome abnormalities, male phenotype, not elsewhere classified Other chromosome abnormalities, not elsewhere classified Chapter XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00?R99) Symptoms and signs involving the circulatory and respiratory systems (R00?R09) R00 Abnormalities of heart beat R01 Cardiac murmurs and other cardiac sounds R02 Gangrene, not elsewhere classified R03 Abnormal blood-pressure reading, without diagnosis R04 Haemorrhage from respiratory passages R05 Cough R06 Abnormalities of breathing R07 Pain in throat and chest R09 Other symptoms and signs involving the circulatory and respiratory systems Symptoms and signs involving the digestive system and abdomen (R10?R19) R10 Abdominal and pelvic pain R11 Nausea and vomiting R12 Heartburn R13 Dysphagia R14 Flatulence and related conditions R15 Faecal incontinence R16 Hepatomegaly and splenomegaly, not elsewhere classified R17 Unspecified jaundice R18 Ascites R19 Other symptoms and signs involving the digestive system and abdomen Symptoms and signs involving the skin and subcutaneous tissue (R20?R23) R20 Disturbances of skin sensation R21 Rash and other nonspecific skin eruption R22 Localized swelling, mass and lump of skin and subcutaneous tissue R23 Other skin changes Symptoms and signs involving the nervous and musculoskeletal systems (R25?R29) R25 Abnormal involuntary movements R26 Abnormalities of gait and mobility R27 Other lack of coordination R29 Other symptoms and signs involving the nervous and musculoskeletal systems Symptoms and signs involving the urinary system (R30?R39) R30 Pain associated with micturition R31 Unspecified haematuria R32 Unspecified urinary incontinence R33 Retention of urine R34 Anuria and oliguria R35 Polyuria R36 Urethral discharge R39 Other symptoms and signs involving the urinary system CBHI ICD 10 Student Workbook December 2004 Page 278 Symptoms and signs involving cognition, perception, emotional state and behaviour (R40?R46) R40 Somnolence, stupor and coma R41 Other symptoms and signs involving cognitive functions and awareness R42 Dizziness and giddiness R43 Disturbances of smell and taste R44 Other symptoms and signs involving general sensations and perceptions R45 Symptoms and signs involving emotional state R46 Symptoms and signs involving appearance and behaviour Symptoms and signs involving speech and voice (R47?R49) R47 Speech disturbances, not elsewhere classified R48 Dyslexia and other symbolic dysfunctions, not elsewhere classified R49 Voice disturbances General symptoms and signs (R50?R69) R50 Fever of unknown origin R51 Headache R52 Pain, not elsewhere classified R53 Malaise and fatigue R54 Senility R55 Syncope and collapse R56 Convulsions, not elsewhere classified R57 Shock, not elsewhere classified R58 Haemorrhage, not elsewhere classified R59 Enlarged lymph nodes R60 Oedema, not elsewhere classified R61 Hyperhidrosis R62 Lack of expected normal physiological development R63 Symptoms and signs concerning food and fluid intake R64 Cachexia R68 Other general symptoms and signs R69 Unknown and unspecified causes of morbidity Abnormal findings on examination of blood, without diagnosis (R70?R79) R70 Elevated erythrocyte sedimentation rate and abnormality of plasma viscosity R71 Abnormality of red blood cells R72 Abnormality of white blood cells, not elsewhere classified R73 Elevated blood glucose level R74 Abnormal serum enzyme levels R75 Laboratory evidence of human immunodeficiency virus [HIV] R76 Other abnormal immunological findings in serum R77 Other abnormalities of plasma proteins R78 Findings of drugs and other substances, not normally found in blood R79 Other abnormal findings of blood chemistry Abnormal findings on examination of urine, without diagnosis (R80?R82) R80 Isolated proteinuria R81 Glycosuria R82 Other abnormal findings in urine CBHI ICD 10 Student Workbook December 2004 Page 279 Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83?R89) R83 Abnormal findings in cerebrospinal fluid R84 Abnormal findings in specimens from respiratory organs and thorax R85 Abnormal findings in specimens from digestive organs and abdominal cavity R86 Abnormal findings in specimens from male genital organs R87 Abnormal findings in specimens from female genital organs R89 Abnormal findings in specimens from other organs, systems and tissues Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90?R94) R90 Abnormal findings on diagnostic imaging of central nervous system R91 Abnormal findings on diagnostic imaging of lung R92 Abnormal findings on diagnostic imaging of breast R93 Abnormal findings on diagnostic imaging of other body structures R94 Abnormal results of function studies Ill-defined and unknown causes of mortality (R95?R99) R95 Sudden infant death syndrome R96 Other sudden death, cause unknown R98 Unattended death R99 Other ill-defined and unspecified causes of mortality Chapter XIX Injury, poisoning and certain other consequences of external causes (S00?T98) Injuries to the head (S00?S09) S00 Superficial injury of head S01 Open wound of head S02 Fracture of skull and facial bones S03 Dislocation, sprain and strain of joints and ligaments of head S04 Injury of cranial nerves S05 Injury of eye and orbit S06 Intracranial injury S07 Crushing injury of head S08 Traumatic amputation of part of head S09 Other and unspecified injuries of head Injuries to the neck (S10?S19) S10 Superficial injury of neck S11 Open wound of neck S12 Fracture of neck S13 Dislocation, sprain and strain of joints and ligaments at neck level S14 Injury of nerves and spinal cord at neck level S15 Injury of blood vessels at neck level S16 Injury of muscle and tendon at neck level S17 Crushing injury of neck S18 Traumatic amputation at neck level S19 Other and unspecified injuries of neck Injuries to the thorax (S20?S29) S20 Superficial injury of thorax S21 Open wound of thorax CBHI ICD 10 Student Workbook December 2004 Page 280 S22 S23 S24 S25 S26 S27 S28 S29 Fracture of rib(s), sternum and thoracic spine Dislocation, sprain and strain of joints and ligaments of thorax Injury of nerves and spinal cord at thorax level Injury of blood vessels of thorax Injury of heart Injury of other and unspecified intrathoracic organs Crushing injury of thorax and traumatic amputation of part of thorax Other and unspecified injuries of thorax Injuries to the abdomen, lower back, lumbar spine and pelvis (S30?S39) S30 Superficial injury of abdomen, lower back and pelvis S31 Open wound of abdomen, lower back and pelvis S32 Fracture of lumbar spine and pelvis S33 Dislocation, sprain and strain of joints and ligaments of lumbar spine and pelvis S34 Injury of nerves and lumbar spinal cord at abdomen, lower back and pelvis level S35 Injury of blood vessels at abdomen, lower back and pelvis level S36 Injury of intra-abdominal organs S37 Injury of urinary and pelvic organs S38 Crushing injury and traumatic amputation of part of abdomen, lower back and pelvis S39 Other and unspecified injuries of abdomen, lower back and pelvis Injuries to the shoulder and upper arm (S40?S49) S40 Superficial injury of shoulder and upper arm S41 Open wound of shoulder and upper arm S42 Fracture of shoulder and upper arm S43 Dislocation, sprain and strain of joints and ligaments of shoulder girdle S44 Injury of nerves at shoulder and upper arm level S45 Injury of blood vessels at shoulder and upper arm level S46 Injury of muscle and tendon at shoulder and upper arm level S47 Crushing injury of shoulder and upper arm S48 Traumatic amputation of shoulder and upper arm S49 Other and unspecified injuries of shoulder and upper arm Injuries to the elbow and forearm (S50?S59) S50 Superficial injury of forearm S51 Open wound of forearm S52 Fracture of forearm S53 Dislocation, sprain and strain of joints and ligaments of elbow S54 Injury of nerves at forearm level S55 Injury of blood vessels at forearm level S56 Injury of muscle and tendon at forearm level S57 Crushing injury of forearm S58 Traumatic amputation of forearm S59 Other and unspecified injuries of forearm Injuries to the wrist and hand (S60?S69) S60 Superficial injury of wrist and hand S61 Open wound of wrist and hand S62 Fracture at wrist and hand level S63 Dislocation, sprain and strain of joints and ligaments at wrist and hand level S64 Injury of nerves at wrist and hand level S65 Injury of blood vessels at wrist and hand level S66 Injury of muscle and tendon at wrist and hand level CBHI ICD 10 Student Workbook December 2004 Page 281 S67 S68 S69 Crushing injury of wrist and hand Traumatic amputation of wrist and hand Other and unspecified injuries of wrist and hand Injuries to the hip and thigh (S70?S79) S70 Superficial injury of hip and thigh S71 Open wound of hip and thigh S72 Fracture of femur S73 Dislocation, sprain and strain of joint and ligaments of hip S74 Injury of nerves at hip and thigh level S75 Injury of blood vessels at hip and thigh level S76 Injury of muscle and tendon at hip and thigh level S77 Crushing injury of hip and thigh S78 Traumatic amputation of hip and thigh S79 Other and specified injuries of hip and thigh Injuries to the knee and lower leg (S80?S89) S80 Superficial injury of lower leg S81 Open wound of lower leg S82 Fracture of lower leg, including ankle S83 Dislocation, sprain and strain of joints and ligaments of knee S84 Injury of nerves at lower leg level S85 Injury of blood vessels at lower leg level S86 Injury of muscle and tendon at lower leg level S87 Crushing injury of lower leg S88 Traumatic amputation of lower leg S89 Other and unspecified injuries of lower leg Injuries to the ankle and foot (S90?S99) S90 Superficial injury of ankle and foot S91 Open wound of ankle and foot S92 Fracture of foot, except ankle S93 Dislocation, sprain and strain of joints and ligaments at ankle and foot level S94 Injury of nerves at ankle and foot level S95 Injury of blood vessels at ankle and foot level S96 Injury of muscle and tendon at ankle and foot level S97 Crushing injury of ankle and foot S98 Traumatic amputation of ankle and foot S99 Other and unspecified injuries of ankle and foot Injuries involving multiple body regions (T00?T07) T00 Superficial injuries involving multiple body regions T01 Open wounds involving multiple body regions T02 Fractures involving multiple body regions T03 Dislocations, sprains and strains involving multiple body regions T04 Crushing injuries involving multiple body regions T05 Traumatic amputations involving multiple body regions T06 Other injuries involving multiple body regions, not elsewhere classified T07 Unspecified multiple injuries Injuries to unspecified part of trunk, limb or body region (T08?T14) T08 Fracture of spine, level unspecified T09 Other injuries of spine and trunk, level unspecified T10 Fracture of upper limb, level unspecified CBHI ICD 10 Student Workbook December 2004 Page 282 T11 T12 T13 T14 Other injuries of upper limb, level unspecified Fracture of lower limb, level unspecified Other injuries of lower limb, level unspecified Injury of unspecified body region Effects of foreign body entering through natural orifice (T15?T19) T15 Foreign body on external eye T16 Foreign body in ear T17 Foreign body in respiratory tract T18 Foreign body in alimentary tract T19 Foreign body in genitourinary tract Burns and corrosions (T20?T32) Burns and corrosions of external body surface, specified by site (T20?T25) T20 Burn and corrosion of head and neck T21 Burn and corrosion of trunk T22 Burn and corrosion of shoulder and upper limb, except wrist and hand T23 Burn and corrosion of wrist and hand T24 Burn and corrosion of hip and lower limb, except ankle and foot T25 Burn and corrosion of ankle and foot Burns and corrosions confined to eye and internal organs (T26?T28) T26 Burn and corrosion confined to eye and adnexa T27 Burn and corrosion of respiratory tract T28 Burn and corrosion of other internal organs Burns and corrosions of multiple and unspecified body regions (T29?T32) T29 Burns and corrosions of multiple body regions T30 Burn and corrosion, body region unspecified T31 Burns classified according to extent of body surface involved T32 Corrosions classified according to extent of body surface involved Frostbite (T33?T35) T33 Superficial frostbite T34 Frostbite with tissue necrosis T35 Frostbite involving multiple body regions and unspecified frostbite Poisoning by drugs, medicaments and biological substances (T36?T50) T36 Poisoning by systemic antibiotics T37 Poisoning by other systemic anti-infectives and antiparasitics T38 Poisoning by hormones and their synthetic substitutes and antagonists, not elsewhere classified T39 Poisoning by nonopioid analgesics, antipyretics and antirheumatics T40 Poisoning by narcotics and psychodysleptics [hallucinogens] T41 Poisoning by anaesthetics and therapeutic gases T42 Poisoning by antiepileptic, sedative-hypnotic and antiparkinsonism drugs T43 Poisoning by psychotropic drugs, not elsewhere classified T44 Poisoning by drugs primarily affecting the autonomic nervous system T45 Poisoning by primarily systemic and haematological agents, not elsewhere classified T46 Poisoning by agents primarily affecting the cardiovascular system T47 Poisoning by agents primarily affecting the gastrointestinal system T48 Poisoning by agents primarily acting on smooth and skeletal muscles and the respiratory system CBHI ICD 10 Student Workbook December 2004 Page 283 T49 T50 Poisoning by topical agents primarily affecting skin and mucous membrane and by ophthalmological, otorhinolaryngological and dental drugs Poisoning by diuretics and other and unspecified drugs, medicaments and biological substances Toxic effects of substances chiefly nonmedicinal as to source (T51?T65) T51 Toxic effect of alcohol T52 Toxic effect of organic solvents T53 Toxic effect of halogen derivatives of aliphatic and aromatic hydrocarbons T54 Toxic effect of corrosive substances T55 Toxic effect of soaps and detergents T56 Toxic effect of metals T57 Toxic effect of other inorganic substances T58 Toxic effect of carbon monoxide T59 Toxic effect of other gases, fumes and vapours T60 Toxic effect of pesticides T61 Toxic effect of noxious substances eaten as seafood T62 Toxic effect of other noxious substances eaten as food T63 Toxic effect of contact with venomous animals T64 Toxic effect of aflatoxin and other mycotoxin food contaminants T65 Toxic effect of other and unspecified substances Other and unspecified effects of external causes (T66?T78) T66 Unspecified effects of radiation T67 Effects of heat and light T68 Hypothermia T69 Other effects of reduced temperature T70 Effects of air pressure and water pressure T71 Asphyxiation T73 Effects of other deprivation T74 Maltreatment syndromes T75 Effects of other external causes T78 Adverse effects, not elsewhere classified Certain early complications of trauma (T79) T79 Certain early complications of trauma, not elsewhere classified Complications of surgical and medical care, not elsewhere classified (T80?T88) T80 Complications following infusion, transfusion and therapeutic injection T81 Complications of procedures, not elsewhere classified T82 Complications of cardiac and vascular prosthetic devices, implants and grafts T83 Complications of genitourinary prosthetic devices, implants and grafts T84 Complications of internal orthopaedic prosthetic devices, implants and grafts T85 Complications of other internal prosthetic devices, implants and grafts T86 Failure and rejection of transplanted organs and tissues T87 Complications peculiar to reattachment and amputation T88 Other complications of surgical and medical care, not elsewhere classified Sequelae of injuries, of poisoning and of other consequences of external causes (T90?T98) T90 Sequelae of injuries of head T91 Sequelae of injuries of neck and trunk T92 Sequelae of injuries of upper limb T93 Sequelae of injuries of lower limb T94 Sequelae of injuries involving multiple and unspecified body regions CBHI ICD 10 Student Workbook December 2004 Page 284 T95 T96 T97 T98 Sequelae of burns, corrosions and frostbite Sequelae of poisoning by drugs, medicaments and biological substances Sequelae of toxic effects of substances chiefly nonmedicinal as to source Sequelae of other and unspecified effects of external causes Chapter XX External causes of morbidity and mortality (V01?Y98) Transport accidents (V01?V99) Pedestrian injured in transport accident (V01?V09) V01 Pedestrian injured in collision with pedal cycle V02 Pedestrian injured in collision with two- or three-wheeled motor vehicle V03 Pedestrian injured in collision with car, pick-up truck or van V04 Pedestrian injured in collision with heavy transport vehicle or bus V05 Pedestrian injured in collision with railway train or railway vehicle V06 Pedestrian injured in collision with other nonmotor vehicle V09 Pedestrian injured in other and unspecified transport accidents Pedal cyclist injured in transport accident (V10?V19) V10 Pedal cyclist injured in collision with pedestrian or animal V11 Pedal cyclist injured in collision with other pedal cycle V12 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle V13 Pedal cyclist injured in collision with car, pick-up truck or van V14 Pedal cyclist injured in collision with heavy transport vehicle or bus V15 Pedal cyclist injured in collision with railway train or railway vehicle V16 Pedal cyclist injured in collision with other nonmotor vehicle V17 Pedal cyclist injured in collision with fixed or stationary object V18 Pedal cyclist injured in noncollision transport accident V19 Pedal cyclist injured in other and unspecified transport accidents Motorcycle rider injured in transport accident (V20?V29) V20 Motorcycle rider injured in collision with pedestrian or animal V21 Motorcycle rider injured in collision with pedal cycle V22 Motorcycle rider injured in collision with two- or three-wheeled motor vehicle V23 Motorcycle rider injured in collision with car, pick-up truck or van V24 Motorcycle rider injured in collision with heavy transport vehicle or bus V25 Motorcycle rider injured in collision with railway train or railway vehicle V26 Motorcycle rider injured in collision with other nonmotor vehicle V27 Motorcycle rider injured in collision with fixed or stationary object V28 Motorcycle rider injured in noncollision transport accident V29 Motorcycle rider injured in other and unspecified transport accidents Occupant of three-wheeled motor vehicle injured in transport accident (V30?V39) V30 Occupant of three-wheeled motor vehicle injured in collision with pedestrian or animal V31 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle V32 Occupant of three-wheeled motor vehicle injured in collision with two- or three-wheeled motor vehicle V33 Occupant of three-wheeled motor vehicle injured in collision with car, pick-up truck or van V34 Occupant of three-wheeled motor vehicle injured in collision with heavy transport vehicle or bus CBHI ICD 10 Student Workbook December 2004 Page 285 V35 V36 V37 V38 V39 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle Occupant of three-wheeled motor vehicle injured in collision with other nonmotor vehicle Occupant of three-wheeled motor vehicle injured in collision with fixed or stationary object Occupant of three-wheeled motor vehicle injured in noncollision transport accident Occupant of three-wheeled motor vehicle injured in other and unspecified transport accidents Car occupant injured in transport accident (V40?V49) V40 Car occupant injured in collision with pedestrian or animal V41 Car occupant injured in collision with pedal cycle V42 Car occupant injured in collision with two- or three-wheeled motor vehicle V43 Car occupant injured in collision with car, pick-up truck or van V44 Car occupant injured in collision with heavy transport vehicle or bus V45 Car occupant injured in collision with railway train or railway vehicle V46 Car occupant injured in collision with other nonmotor vehicle V47 Car occupant injured in collision with fixed or stationary object V48 Car occupant injured in noncollision transport accident V49 Car occupant injured in other and unspecified transport accidents Occupant of pick-up truck or van injured in transport accident (V50?V59) V50 Occupant of pick-up truck or van injured in collision with pedestrian or animal V51 Occupant of pick-up truck or van injured in collision with pedal cycle V52 Occupant of pick-up truck or van injured in collision with two- or three-wheeled motor vehicle V53 Occupant of pick-up truck or van injured in collision with car, pick-up truck or van V54 Occupant of pick-up truck or van injured in collision with heavy transport vehicle or bus V55 Occupant of pick-up truck or van injured in collision with railway train or railway vehicle V56 Occupant of pick-up truck or van injured in collision with other nonmotor vehicle V57 Occupant of pick-up truck or van injured in collision with fixed or stationary object V58 Occupant of pick-up truck or van injured in noncollision transport accident V59 Occupant of pick-up truck or van injured in other and unspecified transport accidents Occupant of heavy transport vehicle injured in transport accident (V60?V69) V60 Occupant of heavy transport vehicle injured in collision with pedestrian or animal V61 Occupant of heavy transport vehicle injured in collision with pedal cycle V62 Occupant of heavy transport vehicle injured in collision with two- or three-wheeled motor vehicle V63 Occupant of heavy transport vehicle injured in collision with car, pick-up truck or van V64 Occupant of heavy transport vehicle injured in collision with heavy transport vehicle or bus V65 Occupant of heavy transport vehicle injured in collision with railway train or railway vehicle V66 Occupant of heavy transport vehicle injured in collision with other nonmotor vehicle V67 Occupant of heavy transport vehicle injured in collision with fixed or stationary object V68 Occupant of heavy transport vehicle injured in noncollision transport accident V69 Occupant of heavy transport vehicle injured in other and unspecified transport accidents Bus occupant injured in transport accident (V70?V79) V70 Bus occupant injured in collision with pedestrian or animal V71 Bus occupant injured in collision with pedal cycle V72 Bus occupant injured in collision with two- or three-wheeled motor vehicle CBHI ICD 10 Student Workbook December 2004 Page 286 V73 V74 V75 V76 V77 V78 V79 Bus occupant injured in collision with car, pick-up truck or van Bus occupant injured in collision with heavy transport vehicle or bus Bus occupant injured in collision with railway train or railway vehicle Bus occupant injured in collision with other nonmotor vehicle Bus occupant injured in collision with fixed or stationary object Bus occupant injured in noncollision transport accident Bus occupant injured in other and unspecified transport accidents Other land transport accidents (V80?V89) V80 V81 V82 V83 V84 V85 V86 V87 V88 V89 Animal-rider or occupant of animal-drawn vehicle injured in transport accident Occupant of railway train or railway vehicle injured in transport accident Occupant of streetcar injured in transport accident Occupant of special vehicle mainly used on industrial premises injured in transport accident Occupant of special vehicle mainly used in agriculture injured in transport accident Occupant of special construction vehicle injured in transport accident Occupant of special all-terrain or other motor vehicle designed primarily for off-road use, injured in transport accident Traffic accident of specified type but victim's mode of transport unknown Nontraffic accident of specified type but victim's mode of transport unknown Motor- or nonmotor-vehicle accident, type of vehicle unspecified Water transport accidents (V90?V94) V90 Accident to watercraft causing drowning and submersion V91 Accident to watercraft causing other injury V92 Water-transport-related drowning and submersion without accident to watercraft V93 Accident on board watercraft without accident to watercraft, not causing drowning and submersion V94 Other and unspecified water transport accidents Air and space transport accidents (V95?V97) V95 Accident to powered aircraft causing injury to occupant V96 Accident to nonpowered aircraft causing injury to occupant V97 Other specified air transport accidents Other and unspecified transport accidents (V98?V99) V98 Other specified transport accidents V99 Unspecified transport accident Other external causes of accidental injury (W00?X59) Falls (W00?W19) W00 Fall on same level involving ice and snow W01 Fall on same level from slipping, tripping and stumbling W02 Fall involving ice-skates, skis, roller-skates or skateboards W03 Other fall on same level due to collision with, or pushing by, another person W04 Fall while being carried or supported by other persons W05 Fall involving wheelchair W06 Fall involving bed W07 Fall involving chair W08 Fall involving other furniture W09 Fall involving playground equipment W10 Fall on and from stairs and steps W11 Fall on and from ladder CBHI ICD 10 Student Workbook December 2004 Page 287 W12 W13 W14 W15 W16 W17 W18 W19 Fall on and from scaffolding Fall from, out of or through building or structure Fall from tree Fall from cliff Diving or jumping into water causing injury other than drowning or submersion Other fall from one level to another Other fall on same level Unspecified fall Exposure to inanimate mechanical forces (W20?W49) W20 Struck by thrown, projected or falling object W21 Striking against or struck by sports equipment W22 Striking against or struck by other objects W23 Caught, crushed, jammed or pinched in or between objects W24 Contact with lifting and transmission devices, not elsewhere classified W25 Contact with sharp glass W26 Contact with knife, sword or dagger W27 Contact with nonpowered hand tool W28 Contact with powered lawnmower W29 Contact with other powered hand tools and household machinery W30 Contact with agricultural machinery W31 Contact with other and unspecified machinery W32 Handgun discharge W33 Rifle, shotgun and larger firearm discharge W34 Discharge from other and unspecified firearms W35 Explosion and rupture of boiler W36 Explosion and rupture of gas cylinder W37 Explosion and rupture of pressurized tyre, pipe or hose W38 Explosion and rupture of other specified pressurized devices W39 Discharge of firework W40 Explosion of other materials W41 Exposure to high-pressure jet W42 Exposure to noise W43 Exposure to vibration W44 Foreign body entering into or through eye or natural orifice W45 Foreign body or object entering through skin W49 Exposure to other and unspecified inanimate mechanical forces Exposure to animate mechanical forces (W50?W64) W50 Hit, struck, kicked, twisted, bitten or scratched by another person W51 Striking against or bumped into by another person W52 Crushed, pushed or stepped on by crowd or human stampede W53 Bitten by rat W54 Bitten or struck by dog W55 Bitten or struck by other mammals W56 Contact with marine animal W57 Bitten or stung by nonvenomous insect and other nonvenomous arthropods W58 Bitten or struck by crocodile or alligator W59 Bitten or crushed by other reptiles W60 Contact with plant thorns and spines and sharp leaves W64 Exposure to other and unspecified animate mechanical forces CBHI ICD 10 Student Workbook December 2004 Page 288 Accidental drowning and submersion (W65?W74) W65 Drowning and submersion while in bath-tub W66 Drowning and submersion following fall into bath-tub W67 Drowning and submersion while in swimming-pool W68 Drowning and submersion following fall into swimming-pool W69 Drowning and submersion while in natural water W70 Drowning and submersion following fall into natural water W73 Other specified drowning and submersion W74 Unspecified drowning and submersion Other accidental threats to breathing (W75?W84) W75 Accidental suffocation and strangulation in bed W76 Other accidental hanging and strangulation W77 Threat to breathing due to cave-in, falling earth and other substances W78 Inhalation of gastric contents W79 Inhalation and ingestion of food causing obstruction of respiratory tract W80 Inhalation and ingestion of other objects causing obstruction of respiratory tract W81 Confined to or trapped in a low-oxygen environment W83 Other specified threats to breathing W84 Unspecified threat to breathing Exposure to electric current, radiation and extreme ambient air temperature and pressure (W85?W99) W85 Exposure to electric transmission lines W86 Exposure to other specified electric current W87 Exposure to unspecified electric current W88 Exposure to ionizing radiation W89 Exposure to man-made visible and ultraviolet light W90 Exposure to other nonionizing radiation W91 Exposure to unspecified type of radiation W92 Exposure to excessive heat of man-made origin W93 Exposure to excessive cold of man-made origin W94 Exposure to high and low air pressure and changes in air pressure W99 Exposure to other and unspecified man-made environmental factors Exposure to smoke, fire and flames (X00?X09) X00 Exposure to uncontrolled fire in building or structure X01 Exposure to uncontrolled fire, not in building or structure X02 Exposure to controlled fire in building or structure X03 Exposure to controlled fire, not in building or structure X04 Exposure to ignition of highly flammable material X05 Exposure to ignition or melting of nightwear X06 Exposure to ignition or melting of other clothing and apparel X08 Exposure to other specified smoke, fire and flames X09 Exposure to unspecified smoke, fire and flames Contact with heat and hot substances (X10?X19) X10 Contact with hot drinks, food, fats and cooking oils X11 Contact with hot tap-water X12 Contact with other hot fluids X13 Contact with steam and hot vapours X14 Contact with hot air and gases X15 Contact with hot household appliances CBHI ICD 10 Student Workbook December 2004 Page 289 X16 X17 X18 X19 Contact with hot heating appliances, radiators and pipes Contact with hot engines, machinery and tools Contact with other hot metals Contact with other and unspecified heat and hot substances Contact with venomous animals and plants (X20?X29) X20 Contact with venomous snakes and lizards X21 Contact with venomous spiders X22 Contact with scorpions X23 Contact with hornets, wasps and bees X24 Contact with centipedes and venomous millipedes (tropical) X25 Contact with other specified venomous arthropods X26 Contact with venomous marine animals and plants X27 Contact with other specified venomous animals X28 Contact with other specified venomous plants X29 Contact with unspecified venomous animal or plant Exposure to forces of nature (X30?X39) X30 Exposure to excessive natural heat X31 Exposure to excessive natural cold X32 Exposure to sunlight X33 Victim of lightning X34 Victim of earthquake X35 Victim of volcanic eruption X36 Victim of avalanche, landslide and other earth movements X37 Victim of cataclysmic storm X38 Victim of flood X39 Exposure to other and unspecified forces of nature Accidental poisoning by and exposure to noxious substances (X40?X49) X40 Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics X41 Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified X42 Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified X43 Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system X44 Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances X45 Accidental poisoning by and exposure to alcohol X46 Accidental poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours X47 Accidental poisoning by and exposure to other gases and vapours X48 Accidental poisoning by and exposure to pesticides X49 Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances Overexertion, travel and privation (X50?X57) X50 Overexertion and strenuous or repetitive movements X51 Travel and motion X52 Prolonged stay in weightless environment X53 Lack of food CBHI ICD 10 Student Workbook December 2004 Page 290 X54 X57 Lack of water Unspecified privation Accidental exposure to other and unspecified factors (X58?X59) X58 Exposure to other specified factors X59 Exposure to unspecified factor Intentional self-harm (X60?X84) X60 Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics X61 Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified X62 Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified X63 Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system X64 Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances X65 Intentional self-poisoning by and exposure to alcohol X66 Intentional self-poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours X67 Intentional self-poisoning by and exposure to other gases and vapours X68 Intentional self-poisoning by and exposure to pesticides X69 Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances X70 Intentional self-harm by hanging, strangulation and suffocation X71 Intentional self-harm by drowning and submersion X72 Intentional self-harm by handgun discharge X73 Intentional self-harm by rifle, shotgun and larger firearm discharge X74 Intentional self-harm by other and unspecified firearm discharge X75 Intentional self-harm by explosive material X76 Intentional self-harm by smoke, fire and flames X77 Intentional self-harm by steam, hot vapours and hot objects X78 Intentional self-harm by sharp object X79 Intentional self-harm by blunt object X80 Intentional self-harm by jumping from a high place X81 Intentional self-harm by jumping or lying before moving object X82 Intentional self-harm by crashing of motor vehicle X83 Intentional self-harm by other specified means X84 Intentional self-harm by unspecified means Assault (X85?Y09) X85 Assault by drugs, medicaments and biological substances X86 Assault by corrosive substance X87 Assault by pesticides X88 Assault by gases and vapours X89 Assault by other specified chemicals and noxious substances X90 Assault by unspecified chemical or noxious substance X91 Assault by hanging, strangulation and suffocation X92 Assault by drowning and submersion X93 Assault by handgun discharge X94 Assault by rifle, shotgun and larger firearm discharge X95 Assault by other and unspecified firearm discharge CBHI ICD 10 Student Workbook December 2004 Page 291 X96 X97 X98 X99 Y00 Y01 Y02 Y03 Y04 Y05 Y06 Y07 Y08 Y09 Assault by explosive material Assault by smoke, fire and flames Assault by steam, hot vapours and hot objects Assault by sharp object Assault by blunt object Assault by pushing from high place Assault by pushing or placing victim before moving object Assault by crashing of motor vehicle Assault by bodily force Sexual assault by bodily force Neglect and abandonment Other maltreatment syndromes Assault by other specified means Assault by unspecified means Event of undetermined intent (Y10?Y34) Y10 Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined intent Y11 Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent Y12 Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent Y13 Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent Y14 Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent Y15 Poisoning by and exposure to alcohol, undetermined intent Y16 Poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours, undetermined intent Y17 Poisoning by and exposure to other gases and vapours, undetermined intent Y18 Poisoning by and exposure to pesticides, undetermined intent Y19 Poisoning by and exposure to other and unspecified chemicals and noxious substances, undetermined intent Y20 Hanging, strangulation and suffocation, undetermined intent Y21 Drowning and submersion, undetermined intent Y22 Handgun discharge, undetermined intent Y23 Rifle, shotgun and larger firearm discharge, undetermined intent Y24 Other and unspecified firearm discharge, undetermined intent Y25 Contact with explosive material, undetermined intent Y26 Exposure to smoke, fire and flames, undetermined intent Y27 Contact with steam, hot vapours and hot objects, undetermined intent Y28 Contact with sharp object, undetermined intent Y29 Contact with blunt object, undetermined intent Y30 Falling, jumping or pushed from a high place, undetermined intent Y31 Falling, lying or running before or into moving object, undetermined intent Y32 Crashing of motor vehicle, undetermined intent Y33 Other specified events, undetermined intent Y34 Unspecified event, undetermined intent Legal intervention and operations of war (Y35?Y36) Y35 Legal intervention Y36 Operations of war CBHI ICD 10 Student Workbook December 2004 Page 292 Complications of medical and surgical care (Y40?Y84) Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40?Y59) Y40 Systemic antibiotics Y41 Other systemic anti-infectives and antiparasitics Y42 Hormones and their synthetic substitutes and antagonists, not elsewhere classified Y43 Primarily systemic agents Y44 Agents primarily affecting blood constituents Y45 Analgesics, antipyretics and anti-inflammatory drugs Y46 Antiepileptics and antiparkinsonism drugs Y47 Sedatives, hypnotics and antianxiety drugs Y48 Anaesthetics and therapeutic gases Y49 Psychotropic drugs, not elsewhere classified Y50 Central nervous system stimulants, not elsewhere classified Y51 Drugs primarily affecting the autonomic nervous system Y52 Agents primarily affecting the cardiovascular system Y53 Agents primarily affecting the gastrointestinal system Y54 Agents primarily affecting water-balance and mineral and uric acid metabolism Y55 Agents primarily acting on smooth and skeletal muscles and the respiratory system Y56 Topical agents primarily affecting skin and mucous membrane and ophthalmological, otorhinolaryngological and dental drugs Y57 Other and unspecified drugs and medicaments Y58 Bacterial vaccines Y59 Other and unspecified vaccines and biological substances Misadventures to patients during surgical and medical care (Y60?Y69) Y60 Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care Y61 Foreign object accidentally left in body during surgical and medical care Y62 Failure of sterile precautions during surgical and medical care Y63 Failure in dosage during surgical and medical care Y64 Contaminated medical or biological substances Y65 Other misadventures during surgical and medical care Y66 Nonadministration of surgical and medical care Y69 Unspecified misadventure during surgical and medical care Medical devices associated with adverse incidents in diagnostic and therapeutic use (Y70?Y82) Y70 Anaesthesiology devices associated with adverse incidents Y71 Cardiovascular devices associated with adverse incidents Y72 Otorhinolaryngological devices associated with adverse incidents Y73 Gastroenterology and urology devices associated with adverse incidents Y74 General hospital and personal-use devices associated with adverse incidents Y75 Neurological devices associated with adverse incidents Y76 Obstetric and gynaecological devices associated with adverse incidents Y77 Ophthalmic devices associated with adverse incidents Y78 Radiological devices associated with adverse incidents Y79 Orthopaedic devices associated with adverse incidents Y80 Physical medicine devices associated with adverse incidents Y81 General- and plastic-surgery devices associated with adverse incidents Y82 Other and unspecified medical devices associated with adverse incidents CBHI ICD 10 Student Workbook December 2004 Page 293 Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure (Y83?Y84) Y83 Surgical operation and other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure Y84 Other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure Sequelae of external causes of morbidity and mortality (Y85?Y89) Y85 Sequelae of transport accidents Y86 Sequelae of other accidents Y87 Sequelae of intentional self-harm, assault and events of undetermined intent Y88 Sequelae with surgical and medical care as external cause Y89 Sequelae of other external causes Supplementary factors related to causes of morbidity and mortality classified elsewhere (Y90?Y98) Y90 Evidence of alcohol involvement determined by blood alcohol level Y91 Evidence of alcohol involvement determined by level of intoxication Y95 Nosocomial condition Y96 Work-related condition Y97 Environmental-pollution-related condition Y98 Lifestyle-related condition Chapter XXI Factors influencing health status and contact with health services (Z00?Z99) Persons encountering health services for examination and investigation (Z00?Z13) Z00 General examination and investigation of persons without complaint and reported diagnosis Z01 Other special examinations and investigations of persons without complaint or reported diagnosis Z02 Examination and encounter for administrative purposes Z03 Medical observation and evaluation for suspected diseases and conditions Z04 Examination and observation for other reasons Z08 Follow-up examination after treatment for malignant neoplasms Z09 Follow-up examination after treatment for conditions other than malignant neoplasms Z10 Routine general health check-up of defined subpopulation Z11 Special screening examination for infectious and parasitic diseases Z12 Special screening examination for neoplasms Z13 Special screening examination for other diseases and disorders Persons with potential health hazards related to communicable diseases (Z20?Z29) Z20 Z21 Z22 Z23 Z24 Z25 Z26 Z27 Contact with and exposure to communicable diseases Asymptomatic human immunodeficiency virus [HIV] infection status Carrier of infectious disease Need for immunization against single bacterial diseases Need for immunization against certain single viral diseases Need for immunization against other single viral diseases Need for immunization against other single infectious diseases Need for immunization against combinations of infectious diseases CBHI ICD 10 Student Workbook December 2004 Page 294 Z28 Z29 Immunization not carried out Need for other prophylactic measures Persons encountering health services in circumstances related to reproduction (Z30?Z39) Z30 Contraceptive management Z31 Procreative management Z32 Pregnancy examination and test Z33 Pregnant state, incidental Z34 Supervision of normal pregnancy Z35 Supervision of high-risk pregnancy Z36 Antenatal screening Z37 Outcome of delivery Z38 Liveborn infants according to place of birth Z39 Postpartum care and examination Persons encountering health services for specific procedures and health care (Z40?Z54) Z40 Prophylactic surgery Z41 Procedures for purposes other than remedying health state Z42 Follow-up care involving plastic surgery Z43 Attention to artificial openings Z44 Fitting and adjustment of external prosthetic device Z45 Adjustment and management of implanted device Z46 Fitting and adjustment of other devices Z47 Other orthopaedic follow-up care Z48 Other surgical follow-up care Z49 Care involving dialysis Z50 Care involving use of rehabilitation procedures Z51 Other medical care Z52 Donors of organs and tissues Z53 Persons encountering health services for specific procedures, not carried out Z54 Convalescence Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55?Z65) Z55 Problems related to education and literacy Z56 Problems related to employment and unemployment Z57 Occupational exposure to risk-factors Z58 Problems related to physical environment Z59 Problems related to housing and economic circumstances Z60 Problems related to social environment Z61 Problems related to negative life events in childhood Z62 Other problems related to upbringing Z63 Other problems related to primary support group, including family circumstances Z64 Problems related to certain psychosocial circumstances Z65 Problems related to other psychosocial circumstances Persons encountering health services in other circumstances (Z70?Z76) Z70 Counselling related to sexual attitude, behaviour and orientation Z71 Persons encountering health services for other counselling and medical advice, not elsewhere classified Z72 Problems related to lifestyle Z73 Problems related to life-management difficulty Z74 Problems related to care-provider dependency CBHI ICD 10 Student Workbook December 2004 Page 295 Z75 Z76 Problems related to medical facilities and other health care Persons encountering health services in other circumstances Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z80?Z99) Z80 Family history of malignant neoplasm Z81 Family history of mental and behavioural disorders Z82 Family history of certain disabilities and chronic diseases leading to disablement Z83 Family history of other specific disorders Z84 Family history of other conditions Z85 Personal history of malignant neoplasm Z86 Personal history of certain other diseases Z87 Personal history of other diseases and conditions Z88 Personal history of allergy to drugs, medicaments and biological substances Z89 Acquired absence of limb Z90 Acquired absence of organs, not elsewhere classified Z91 Personal history of risk-factors, not elsewhere classified Z92 Personal history of medical treatment Z93 Artificial opening status Z94 Transplanted organ and tissue status Z95 Presence of cardiac and vascular implants and grafts Z96 Presence of other functional implants Z97 Presence of other devices Z98 Other postsurgical states Z99 Dependence on enabling machines and devices, not elsewhere classified Chapter XXII Codes for special purposes (U00?U99) Provisional assignment of new diseases of uncertain etiology (U00?U49) U04 Severe acute respiratory syndrome [SARS] CBHI ICD 10 Student Workbook December 2004 Page 296 APPENDIX 4 TABULATION LISTS FOR MORTALITY AND MORBIDITY Mortality tabulation lists List 1 - General mortality - condensed list (103 causes) List 2 - General mortality - selected list (80 causes) List 3 - Infant and child mortality - condensed list (67 causes) List 4 - Infant and child mortality - selected list (51 causes) Tabulation list for morbidity (298 causes) CBHI ICD 10 Student Workbook December 2004 Page 297 Special tabulation lists for mortality and morbidity Note: These lists were adopted by the World Health Assembly in 1990 for the tabulation of data. They are described, and their use is explained, in Volume 2, the Instruction Manual. Mortality tabulation list 1 General mortality Condensed list 1-001 Certain infectious and parasitic diseases 1-002 1-003 1-004 1-005 1-006 1-007 1-008 1-009 1-010 1-011 1-012 1-013 1-018 1-019 1-020 1-021 1-022 1-023 1-024 1-025 Cholera Diarrhoea and gastroenteritis of presumed infectious origin Other intestinal infectious diseases Respiratory tuberculosis Other tuberculosis Plague Tetanus Diphtheria Whooping cough Meningococcal infection Septicaemia Infections with a predominantly sexual mode of transmission Acute poliomyelitis Rabies Yellow fever Other arthropod-borne viral fevers and viral haemorrhagic fevers Measles Viral hepatitis Human immunodeficiency virus [HIV] disease Malaria Leishmaniasis Trypanosomiasis Schistosomiasis Remainder of certain infectious and parasitic diseases 1-026 1-027 1-028 1-029 1-030 1-031 1-032 1-033 1-034 1-035 Neoplasms Malignant neoplasm of lip, oral cavity and pharynx Malignant neoplasm of oesophagus Malignant neoplasm of stomach Malignant neoplasm of colon, rectum and anus Malignant neoplasm of liver and intrahepatic bile ducts Malignant neoplasm of pancreas Malignant neoplasm of larynx Malignant neoplasm of trachea, bronchus and lung Malignant melanoma of skin 1-014 1-015 1-016 1-017 A00-B99 A00 A09 A01-A08 A15-A16 A17-A19 A20 A33-A35 A36 A37 A39 A40-A41 A50-A64 A80 A82 A95 A90-A94, A96-A99 B05 B15-B19 B20-B24 B50-B54 B55 B56-B57 B65 A21-A32, A38, A42-A49, A65-A79, A81, A83-A89, B00-B04, B06-B09, B25B49, B58-B64, B66-B94, B99 C00-D48 C00-C14 C15 C16 C18-C21 C22 C25 C32 C33-C34 C43 CBHI ICD 10 Student Workbook December 2004 Page 298 1-036 1-037 1-038 1-039 1-040 1-041 1-042 1-043 1-044 1-045 1-046 1-047 1-048 1-049 1-050 1-051 1-052 1-053 1-054 1-055 1-056 1-057 1-058 1-059 1-060 1-061 1-062 1-063 1-064 1-065 1-066 1-067 1-068 1-069 1-070 1-071 1-072 1-073 1-074 1-075 Malignant neoplasm of breast Malignant neoplasm of cervix uteri Malignant neoplasm of other and unspecified parts of uterus Malignant neoplasm of ovary Malignant neoplasm of prostate Malignant neoplasm of bladder Malignant neoplasm of meninges, brain and other parts of central nervous system Non-Hodgkin's lymphoma Multiple myeloma and malignant plasma cell neoplasms Leukaemias Remainder of malignant neoplasms Remainder of neoplasms Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Anaemias Remainder of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Endocrine, nutritional and metabolic diseases Diabetes mellitus Malnutrition Remainder of endocrine, nutritional and metabolic diseases Mental and behavioural disorders Mental and behavioural disorders due to psychoactive substance use Remainder of mental and behavioural disorders Diseases of the nervous sytem Meningitis Alzheimer's disease Remainder of diseases of the nervous system Diseases of the eye and adnexa Diseases of the ear and mastoid process Diseases of the circulatory system Acute rheumatic fever and chronic rheumatic heart diseases Hypertensive diseases Ischaemic heart diseases Other heart diseases Cerebrovascular diseases Atherosclerosis Remainder of diseases of the circulatory system Diseases of the respiratory system Influenza Pneumonia Other acute lower respiratory infections C50 C53 C54-C55 C56 C61 C67 C70-C72 C82-C85 C90 C91-C95 C17, C23-C24, C26-C31, C37-C41, C44-C49, C51C52, C57-C60, C62-C66, C68-C69, C73-C81, C88, C96-C97 D00-D48 D50-D89 D50-D64 D65-D89 E00-E88 E10-E14 E40-E46 E00-E07, E15-E34, E50E88 F01-F99 F10-F19 F01-F09, F20-F99 G00-G98 G00, G03 G30 G04-G25, G31-G98 H00-H59 H60-H93 I00-I99 I00-I09 I10-I13 I20-I25 I26-I51 I60-I69 I70 I71-I99 J00-J98 J10-J11 J12-J18 J20-J22 CBHI ICD 10 Student Workbook December 2004 Page 299 1-076 1-077 1-078 1-079 1-080 1-081 Chronic lower respiratory diseases Remainder of diseases of the respiratory system Diseases of the digestive system Gastric and duodenal ulcer Diseases of the liver Remainder of diseases of the digestive system 1-082 1-083 Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connective tissue Diseases of the genitourinary system Glomerular and renal tubulointerstitial diseases Remainder of diseases of the genitourinary system Pregnancy, childbirth and the puerperium Pregnancy with abortive outcome Other direct obstetric deaths Indirect obstetric deaths Remainder of pregnancy, childbirth and the puerperium Certain conditions originating in the perinatal period Congenital malformations, deformations and chromosomal abnormalities Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified External causes of morbidity and mortality Transport accidents Falls Accidental drowning and submersion Exposure to smoke, fire and flames Accidental poisoning by and exposure to noxious substances Intentional self-harm Assault All other external causes 1-084 1-085 1-086 1-087 1-088 1-089 1-090 1-091 1-092 1-093 1-094 1-095 1-096 1-097 1-098 1-099 1-100 1-101 1-102 1-103 J40-J47 J00-J06, J30-J39, J60-J98 K00-K92 K25-K27 K70-K76 K00-K22, K28-K66, K80-K92 L00-L98 M00-M99 N00-N99 N00-N15 N17-N98 O00-O99 O00-O07 O10-O92 O98-O99 O95-O97 P00-P96 Q00-Q99 R00-R99 V01-Y89 V01-V99 W00-W19 W65-W74 X00-X09 X40-X49 X60-X84 X85-Y09 W20-W64, W75-W99, X10-X39, X50-X59, Y10-Y89 Mortality tabulation list 2 General Mortality Selected list 2-001 Cholera 2-002 Diarrhoea and gastroenteritis of presumed infectious origin 2-003 Other intestinal infectious diseases 2-004 Respiratory tuberculosis 2-005 Other tuberculosis 2-006 Plague 2-007 Tetanus 2-008 Diphtheria 2-009 Whooping cough 2-010 Meningococcal infection A00 A09 A01-A08 A15-A16 A17-A19 A20 A33-A35 A36 A37 A39 CBHI ICD 10 Student Workbook December 2004 Page 300 2-011 2-012 2-013 2-014 2-015 2-016 2-017 2-018 2-019 2-020 2-021 2-022 2-023 2-024 2-025 2-026 2-027 2-028 2-029 2-030 2-031 2-032 2-033 2-034 2-035 2-036 2-037 2-038 2-039 2-040 2-041 2-042 2-043 2-044 2-045 2-046 2-047 2-048 2-049 Septicaemia Infections with a predominantly sexual mode of transmission Acute poliomyelitis Rabies Yellow fever Other arthropod-borne viral fevers and viral haemorrhagic fevers Measles Viral hepatitis Human immunodeficiency virus [HIV] disease Malaria Leishmaniasis Trypanosomiasis Schistosomiasis Remainder of certain infectious and parasitic diseases A40-A41 A50-A64 A80 A82 A95 A90-A94, A96-A99 B05 B15-B19 B20-B24 B50-B54 B55 B56-B57 B65 A21-A32, A38, A42-A49, A65-A79, A81, A83-A89, B00-B04, B06-B09, B25B49, B58-B64, B66-B94, B99 Malignant neoplasm of lip, oral cavity and pharynx C00-C14 Malignant neoplasm of oesophagus C15 Malignant neoplasm of stomach C16 Malignant neoplasm of colon, rectum and anus C18-C21 Malignant neoplasm of liver and intrahepatic bile ducts C22 Malignant neoplasm of pancreas C25 Malignant neoplasm of larynx C32 Malignant neoplasm of trachea, bronchus and lung C33-C34 Malignant melanoma of skin C43 Malignant neoplasm of breast C50 Malignant neoplasm of cervix uteri C53 Malignant neoplasm of other and unspecified parts of uterus C54-C55 Malignant neoplasm of ovary C56 Malignant neoplasm of prostate C61 Malignant neoplasm of bladder C67 Malignant neoplasm of meninges, brain and other parts of C70-C72 central nervous system Non-Hodgkin's lymphoma C82-C85 Multiple myeloma and malignant plasma cell neoplasms C90 Leukaemias C91-C95 Remainder of malignant neoplasms C17, C23-C24, C26-C31, C37-C41, C44-C49, C51C52, C57-C60, C62-C66, C68-C69, C73-C81, C88, C96-C97 Anaemias D50-D64 Diabetes mellitus E10-E14 Malnutrition E40-E46 Mental and behavioural disorders due to pyschoactive F10-F19 substance use Meningitis G00, G03 CBHI ICD 10 Student Workbook December 2004 Page 301 2-050 2-051 2-052 2-053 2-054 2-055 2-056 2-057 2-058 2-059 2-060 2-061 2-062 2-063 2-064 2-065 2-066 2-067 2-068 2-069 2-070 2-071 2-072 2-073 2-074 2-075 2-076 2-077 2-078 2-079 2-080 Alzheimer's disease Acute rheumatic fever and chronic rheumatic heart diseases Hypertensive diseases Ischaemic heart diseases Other heart diseases Cerebrovascular diseases Atherosclerosis Remainder of diseases of the circulatory system Influenza Pneumonia Other acute lower respiratory infections Chronic lower respiratory diseases Remainder of diseases of the respiratory system Gastric and duodenal ulcer Diseases of the liver Glomerular and renal tubulo-interstitial diseases Pregnancy with abortive outcome Other direct obstetric deaths Indirect obstetric deaths Certain conditions originating in the perinatal period Congenital malformations, deformations and chromosomal abnormalities Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified All other diseases Transport accidents Falls Accidental drowning and submersion Exposure to smoke, fire and flames Accidental poisoning by and exposure to noxious substances Intentional self-harm Assault All other external causes G30 I00-I09 I10-I13 I20-I25 I26-I51 I60-I69 I70 I71-I99 J10-J11 J12-J18 J20-J22 J40-J47 J00-J06, J30-J39, J60-J98 K25-K27 K70-K76 N00-N15 O00-O07 O10-O92 O98-O99 P00-P96 Q00-Q99 R00-R99 D00-D48, D65-D89, E00E07, E15-E34, E50-E88, F01-F09, F20-F99, G04G25, G31-G98, H00-H93, K00-K22, K28-K66, K80-K92, L00-L98, M00M99, N17-N98, O95-O97 V01-V99 W00-W19 W65-W74 X00-X09 X40-X49 X60-X84 X85-Y09 W20-W64, W75-W99, X10-X39, X50-X59 Mortality tabulation list 3 Infant and child mortality Condensed list 3-001 Certain infectious and parasitic diseases 3-002 Diarrhoea and gastroenteritis of presumed infectious origin 3-003 Other intestinal infectious diseases 3-004 Tuberculosis A00-B99 A09 A00-A08 A15-A19 CBHI ICD 10 Student Workbook December 2004 Page 302 3-005 3-006 3-007 3-008 3-009 3-010 3-011 3-012 3-013 Tetanus Diphtheria Whooping cough Meningococcal infection Septicaemia Acute poliomyelitis Measles Human immunodeficiency virus [HIV] disease Other viral diseases 3-014 3-015 Malaria Remainder of certain infectious and parasitic diseases 3-016 3-017 3-018 3-019 3-020 Neoplasms Leukaemia Remainder of malignant neoplasms Remainder of neoplasms Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Anaemias Remainder of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Endocrine, nutritional and metabolic diseases Malnutrition and other nutritional deficiencies Remainder of endocrine, nutritional and metabolic diseases Diseases of the nervous system Meningitis Remainder of diseases of the nervous system Diseases of the ear and mastoid process Diseases of the circulatory system Diseases of the respiratory system Pneumonia Other acute respiratory infections Remainder of diseases of the respiratory system Diseases of the digestive system Diseases of the genitourinary system Certain conditions originating in the perinatal period Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery Disorders relating to length of gestation and fetal growth Birth trauma Intrauterine hypoxia and birth asphyxia Respiratory distress of newborn Congenital pneumonia Other respiratory conditions of newborn Bacterial sepsis of newborn Omphalitis of newborn with or without mild haemorrhage Haemorrhagic and haematological disorders of fetus and newborn 3-021 3-022 3-023 3-024 3-025 3-026 3-027 3-028 3-029 3-030 3-031 3-032 3-033 3-034 3-035 3-036 3-037 3-038 3-039 3-040 3-041 3-042 3-043 3-044 3-045 3-046 3-047 A33, A35 A36 A37 A39 A40-A41 A80 B05 B20-B24 A81-B04, B06-B19, B25B34 B50-B54 A20-A32, A38, A42-A79, B35-B49, B55-B94, B99 C00-D48 C91-C95 C00-C90, C96-C97 D00-D48 D50-D89 D50-D64 D65-D89 E00-E88 E40-E64 E00-E34, E65-E88 G00-G98 G00, G03 G04-G98 H60-H93 I00-I99 J00-J98 J12-J18 J00-J11, J20-J22 J30-J98 K00-K92 N00-N98 P00-P96 P00-P04 P05-P08 P10-P15 P20-P21 P22 P23 P24-P28 P36 P38 P50-P61 CBHI ICD 10 Student Workbook December 2004 Page 303 3-048 Remainder of perinatal conditions 3-049 3-059 Congenital malformations, deformations, and chromosomal abnormalities Congenital hydrocephalus and spina bifida Other congenital malformations of the nervous system Congenital malformations of the heart Other congenital malformations of the circulatory system Down's syndrome and other chromosomal abnormalities Other congenital malformations Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Sudden infant death syndrome Other symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified All other diseases 3-060 3-061 3-062 3-063 3-064 3-065 3-066 3-067 External causes of morbidity and mortality Transport accidents Accidental drowning and submersion Other accidental threats to breathing Exposure to smoke, fire and flames Accidental poisoning by and exposure to noxious substances Assault All other external causes 3-050 3-051 3-052 3-053 3-054 3-055 3-056 3-057 3-058 P29, P35, P37, P39, P70P96 Q00-Q99 Q03, Q05 Q00-Q02, Q04, Q06-Q07 Q20-Q24 Q25-Q28 Q90-Q99 Q10-Q18, Q30-Q89 R00-R99 R95 R00-R94, R96-R99 F01-F99, H00-H59, L00L98, M00-M99 V01-Y89 V01-V99 W65-W74 W75-W84 X00-X09 X40-X49 X85-Y09 W00-W64, W85-W99, X10-X39, X50-X84, Y10-Y89 Mortality tabulation list 4 Infant and child mortality Selected list 4-001 4-002 4-003 4-004 4-005 4-006 4-007 4-008 4-009 4-010 4-011 4-012 Diarrhoea and gastroenteritis of presumed infectious origin Other intestinal infectious diseases Tuberculosis Tetanus Diphtheria Whooping cough Meningococcal infection Septicaemia Acute poliomyelitis Measles Human immunodeficiency virus [HIV] disease Other viral diseases 4-013 4-014 Malaria Remainder of certain infectious and parasitic diseases 4-015 Leukaemia A09 A00-A08 A15-A19 A33, A35 A36 A37 A39 A40-A41 A80 B05 B20-B24 A81-B04, B06-B19, B25B34 B50-B54 A20-A32, A38, A42-A79, B35-B49, B55-B94, B99 C91-C95 CBHI ICD 10 Student Workbook December 2004 Page 304 4-016 4-017 4-018 4-019 4-020 4-021 4-022 4-023 4-024 4-025 4-026 4-027 4-028 4-029 4-030 4-031 4-032 4-033 4-034 4-035 4-036 4-037 4-038 4-039 4-040 4-041 4-042 4-043 Remainder of malignant neoplasms Anaemias Remainder of diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Malnutrition and other nutritional deficiencies Meningitis Remainder of diseases of the nervous system Pneumonia Other acute respiratory infections Diseases of the digestive system Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery Disorders relating to length of gestation and fetal growth Birth trauma Intrauterine hypoxia and birth asphyxia Respiratory distress of newborn Congenital pneumonia Other respiratory conditions of newborn Bacterial sepsis of newborn Omphalitis of newborn with or without mild haemorrhage Haemorrhagic and haematological disorders of fetus and newborn Remainder of perinatal conditions 4-044 Congenital hydrocephalus and spina bifida Other congenital malformations of the nervous system Congenital malformations of the heart Other congenital malformations of the circulatory system Down's syndrome and other chromosomal abnormalities Other congenital malformations Sudden infant death syndrome Other symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified All other diseases 4-045 4-046 4-047 4-048 4-049 4-050 4-051 Transport accidents Accidental drowning and submersion Other accidental threats to breathing Exposure to smoke, fire and flames Accidental poisoning by and exposure to noxious substances Assault All other external causes C00-C90, C96-C97 D50-D64 D65-D89 E40-E64 G00, G03 G04-G98 J12-J18 J00-J11, J20-J22 K00-K92 P00-P04 P05-P08 P10-P15 P20-P21 P22 P23 P24-P28 P36 P38 P50-P61 P29, P35, P37, P39, P70P96 Q03, Q05 Q00-Q02, Q04, Q06-Q07 Q20-Q24 Q25-Q28 Q90-Q99 Q10-Q18, Q30-Q89 R95 R00-R94, R96-R99 D00-D48, E00-E34, E65E88, F01-F99, H00-H95, I00-I99, J30-J98, L00L98, M00-M99, N00-N98 V01-V99 W65-W74 W75-W84 X00-X09 X40-X49 X85-Y09 W00-W64, W85-W99, X10-X39, X50-X84, Y10-Y89 CBHI ICD 10 Student Workbook December 2004 Page 305 Tabulation list for morbidity 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 Cholera Typhoid and paratyphoid fevers Shigellosis Amoebiasis Diarrhoea and gastroenteritis of presumed infectious origin Other intestinal infectious diseases Respiratory tuberculosis Other tuberculosis Plague Brucellosis Leprosy Tetanus neonatorum Other tetanus Diphtheria Whooping cough Meningococcal infection Septicaemia Other bacterial diseases 019 020 021 022 023 024 033 034 035 036 037 038 039 040 041 Congenital syphilis Early syphilis Other syphilis Gonococcal infection Sexually transmitted chlamydial diseases Other infections with a predominantly sexual mode of transmission Relapsing fevers Trachoma Typhus fever Acute poliomyelitis Rabies Viral encephalitis Yellow fever Other arthropod-borne viral fevers and viral haemorrhagic fevers Herpesviral infections Varicella and zoster Measles Rubella Acute hepatitis B Other viral hepatitis Human immunodeficiency virus [HIV] disease Mumps Other viral diseases 042 Mycoses 025 026 027 028 029 030 031 032 A00 A01 A03 A06 A09 A02, A04-A05, A07-A08 A15-A16 A17-A19 A20 A23 A30 A33 A34-A35 A36 A37 A39 A40-A41 A21-A22, A24-A28, A31-A32, A38, A42-A49 A50 A51 A52-A53 A54 A55-A56 A57-A64 A68 A71 A75 A80 A82 A83-A86 A95 A90-A94, A96-A99 B00 B01-B02 B05 B06 B16 B15, B17-B19 B20-B24 B26 A81, A87-A89, B03-B04, B07-B09, B25, B27-B34 B35-B49 CBHI ICD 10 Student Workbook December 2004 Page 306 043 044 045 046 047 048 049 050 051 052 053 054 055 056 057 Malaria Leishmaniasis Trypanosomiasis Schistosomiasis Other fluke infections Echinococcosis Dracunculiasis Onchocerciasis Filariasis Hookworm diseases Other helminthiases Sequelae of tuberculosis Sequelae of poliomyelitis Sequelae of leprosy Other infectious and parasitic diseases 058 059 060 061 062 Malignant neoplasm of lip, oral cavity and pharynx Malignant neoplasm of oesophagus Malignant neoplasm of stomach Malignant neoplasm of colon Malignant neoplasm of rectosigmoid junction, rectum, anus and anal canal Malignant neoplasm of liver and intrahepatic bile ducts Malignant neoplasm of pancreas Other malignant neoplasms of digestive organs Malignant neoplasms of larynx Malignant neoplasm of trachea, bronchus and lung Other malignant neoplasms of respiratory and intrathoracic organs Malignant neoplasm of bone and articular cartilage Malignant melanoma of skin Other malignant neoplasms of skin Malignant neoplasms of mesothelial and soft tissue Malignant neoplasm of breast Malignant neoplasm of cervix uteri Malignant neoplasm of other and unspecified parts of uterus Other malignant neoplasms of female genital organs Malignant neoplasm of prostate Other malignant neoplasms of male genital organs Malignant neoplasm of bladder Other malignant neoplasms of urinary tract Malignant neoplasm of eye and adnexa Malignant neoplasm of brain Malignant neoplasm of other parts of central nervous system Malignant neoplasm of other, ill-defined, secondary, unspecified and multiple sites Hodgkin's disease Non-Hodgkin's lymphoma Leukaemia 063 064 065 066 067 068 069 070 071 072 073 074 075 076 077 078 079 080 081 082 083 084 085 086 087 B50-B54 B55 B56-B57 B65 B66 B67 B72 B73 B74 B76 B68-B71, B75, B77-B83 B90 B91 B92 A65-A67, A69-A70, A74, A77-A79, B58-B64, B85B89, B94, B99 C00-C14 C15 C16 C18 C19-C21 C22 C25 C17, C23-C24, C26 C32 C33-C34 C30-C31, C37-C39 C40-C41 C43 C44 C45-C49 C50 C53 C54-C55 C51-C52, C56-C58 C61 C60, C62-C63 C67 C64-C66, C68 C69 C71 C70, C72 C73-C80, C97 C81 C82-C85 C91-C95 CBHI ICD 10 Student Workbook December 2004 Page 307 088 089 090 091 092 093 094 095 096 097 098 099 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 Other malignant neoplasms of lymphoid, haematopoietic and related tissue Carcinoma in situ of cervix uteri Benign neoplasm of skin Benign neoplasm of breast Leiomyoma of uterus Benign neoplasm of ovary Benign neoplasm of urinary organs Benign neoplasm of brain and other parts of central nervous system Other in situ and benign neoplasms and neoplasms of uncertain and unknown behaviour Iron deficiency anaemia Other anaemias Haemorrhagic conditions and other diseases of blood and blood-forming organs Certain disorders involving the immune mechanism Iodine-deficiency-related thyroid disorders Thyrotoxicosis Other disorders of thyroid Diabetes mellitus Malnutrition Vitamin A deficiency Other vitamin deficiencies Sequelae of malnutrition and other nutritional deficiencies Obesity Volume depletion Other endocrine, nutritional and metabolic disorders 115 116 117 118 119 Dementia Mental and behavioural disorders due to use of alcohol Mental and behavioural disorders due to other psychoactive substance use Schizophrenia, schizotypal, and delusional disorders Mood [affective] disorders Neurotic, stress-related, and somatoform disorders Mental retardation Other mental and behavioural disorders 120 121 122 123 124 125 126 127 128 Inflammatory diseases of the central nervous system Parkinson's disease Alzheimer's disease Multiple sclerosis Epilepsy Migraine and other headache syndromes Transient cerebral ischaemic attacks and related syndromes Nerve, nerve root and plexus disorders Cerebral palsy and other paralytic syndromes C88-C90, C96 D06 D22-D23 D24 D25 D27 D30 D33 D00-D05, D07-D21, D26, D28-D29, D31-D32, D34-D48 D50 D51-D64 D65-D77 D80-D89 E00-E02 E05 E03-E04, E06-E07 E10-E14 E40-E46 E50 E51-E56 E64 E66 E86 E15-E35, E58-E63, E65, E67-E85, E87-E90 F00-F03 F10 F11-F19 F20-F29 F30-F39 F40-F48 F70-F79 F04-F09, F50-F69, F80F99 G00-G09 G20 G30 G35 G40-G41 G43-G44 G45 G50-G59 G80-G83 CBHI ICD 10 Student Workbook December 2004 Page 308 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 Other diseases of the nervous system G10-G13, G21-G26, G31-G32, G36-G37, G46-G47, G60-G73, G90-G99 Inflammation of eyelid H00-H01 Conjunctivitis and other disorders of conjunctiva H10-H13 Keratitis and other disorders of sclera and cornea H15-H19 Cataract and other disorders of lens H25-H28 Retinal detachments and breaks H33 Glaucoma H40-H42 Strabismus H49-H50 Disorders of refraction and accommodation H52 Blindness and low vision H54 Other diseases of the eye and adnexa H02-H06, H20-H22, H30-H32, H34-H36, H43-H48, H51, H53, H55-H59 Otitis media and other disorders of middle ear and mastoid H65-H75 Hearing loss H90-H91 Other diseases of the ear and mastoid process H60-H62, H80-H83, H92-H95 Acute rheumatic fever I00-I02 Chronic rheumatic heart disease I05-I09 Essential (primary) hypertension I10 Other hypertensive diseases I11-I15 Acute myocardial infarction I21-I22 Other ischaemic heart diseases I20, I23-I25 Pulmonary embolism I26 Conduction disorders and cardiac arrhythmias I44-I49 Heart failure I50 Other heart diseases I27-I43, I51-I52 Intracranial haemorrhage I60-I62 Cerebral infarction I63 Stroke, not specified as haemorrhage or infarction I64 Other cerebrovascular diseases I65-I69 Atherosclerosis I70 Other peripheral vascular diseases I73 Arterial embolism and thrombosis I74 Other diseases of arteries, arterioles and capillaries I71-I72, I77-I79 Phlebitis, thrombophlebitis, venous embolism and thrombosis I80-I82 Varicose veins of lower extremities I83 Haemorrhoids I84 Other diseases of the circulatory system I85-I99 Acute pharyngitis and acute tonsillitis J02-J03 Acute laryngitis and tracheitis J04 Other acute upper respiratory infections J00-J01, J05-J06 Influenza J10-J11 Pneumonia J12-J18 Acute bronchitis and acute bronchiolitis J20-J21 Chronic sinusitis J32 CBHI ICD 10 Student Workbook December 2004 Page 309 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 Other diseases of nose and nasal sinuses Chronic disease of tonsils and adenoids Other diseases of upper respiratory tract Bronchitis, emphysema and other chronic obstructive pulmonary diseases Asthma Bronchiectasis Pneumoconiosis Other diseases of the respiratory system Dental caries Other disorders of teeth and supporting structures Other diseases of the oral cavity, salivary glands and jaws Gastric and duodenal ulcer Gastritis and duodenitis Other diseases of oesophagus, stomach and duodenum Diseases of appendix Inguinal hernia Other hernia Crohn's disease and ulcerative colitis Paralytic ileus and intestinal obstruction without hernia Diverticular disease of intestine Other diseases of intestines and peritoneum Alcoholic liver disease Other diseases of liver Cholelithiasis and cholecystitis Acute pancreatitis and other diseases of the pancreas Other diseases of the digestive system Infections of the skin and subcutaneous tissue Other diseases of the skin and subcutaneous Rheumatoid arthritis and other inflammatory polyarthropathies Arthrosis Acquired deformities of limbs Other disorders of joints Systemic connective tissue disorders Cervical and other intervertebral disc disorders Other dorsopathies Soft tissue disorders Disorders of bone density and structure Osteomyelitis Other diseases of the musculoskeletal system and connective tissue Acute and rapidly progressive nephritic syndromes Other glomerular diseases Renal tubulo-interstitial diseases Renal failure Urolithiasis Cystitis Other diseases of the urinary system Hyperplasia of prostate J30-J31, J33-J34 J35 J36-J39 J40-J44 J45-J46 J47 J60-J65 J22, J66-J99 K02 K00-K01, K03-K08 K09-K14 K25-K27 K29 K20-K23, K28, K30-K31 K35-K38 K40 K41-K46 K50-K51 K56 K57 K52-K55, K58-K67 K70 K71-K77 K80-K81 K85-K86 K82-K83, K87-K93 L00-L08 L10-L99 M05-M14 M15-M19 M20-M21 M00-M03, M22-M25 M30-M36 M50-M51 M40-M49, M53-M54 M60-M79 M80-M85 M86 M87-M99 N00-N01 N02-N08 N10-N16 N17-N19 N20-N23 N30 N25-N29, N31-N39 N40 CBHI ICD 10 Student Workbook December 2004 Page 310 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 Other disorders of prostate Hydrocele and spermatocele Redundant prepuce, phimosis and paraphimosis Other diseases of male genital organs Disorders of the breast Salpingitis and oophoritis Inflammatory disease of cervix uteri Other inflammatory diseases of female pelvic organs Endometriosis Female genital prolapse Noninflammatory disorders of ovary, fallopian tube and broad ligament Disorders of menstruation Menopausal and other perimenopausal disorders Female infertility Other disorders of genitourinary tract Spontaneous abortion Medical abortion Other pregnancies with abortive outcome Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium Placenta praevia, premature separation of placenta and antepartum haemorrhage Other maternal care related to fetus and amniotic cavity and possible delivery problems Obstructed labour Postpartum haemorrhage Other complications of pregnancy and delivery 247 248 249 250 251 252 253 Single spontaneous delivery Complications predominantly related to the puerperium and other obstetric conditions, not elsewhere classified Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery Slow fetal growth, fetal malnutrition and disorders related to short gestation and low birth weight Birth trauma Intrauterine hypoxia and birth asphyxia Other respiratory disorders originating in the perinatal period Congenital infectious and parasitic diseases Other infections specific to the perinatal period Haemolytic disease of fetus and newborn Other conditions originating in the perinatal period 254 255 256 257 258 Spina bifida Other congenital malformations of the nervous system Congenital malformations of the circulatory system Cleft lip and cleft palate Absence, atresia and stenosis of small intestine 245 246 N41-N42 N43 N47 N44-N46, N48-N51 N60-N64 N70 N72 N71, N73-N77 N80 N81 N83 N91-N92 N95 N97 N82, N84-N90, N93-N94, N96, N98-N99 O03 O04 O00-O02, O05-O08 O10-O16 O44-O46 O30-O43, O47-O48 O64-O66 O72 O20-O29, O60-O63, O67-O71, O73-O75, O81-O84 O80 O85-O99 P00-P04 P05-P07 P10-P15 P20-P21 P22-P28 P35-P37 P38-P39 P55 P08, P29, P50-P54, P56P96 Q05 Q00-Q04, Q06-Q07 Q20-Q28 Q35-Q37 Q41 CBHI ICD 10 Student Workbook December 2004 Page 311 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 Other congenital malformations of the digestive system Undescended testicle Other malformations of the genitourinary system Congenital deformities of hip Congenital deformities of feet Other congenital malformations and deformations of the musculoskeletal system Other congenital malformations Q38-Q40, Q42-Q45 Q53 Q50-Q52, Q54-Q64 Q65 Q66 Q67-Q79 Q10-Q18, Q30-Q34, Q80-Q89 Chromosomal abnormalities, not elsewhere classified Q90-Q99 Abdominal and pelvic pain R10 Fever of unknown origin R50 Senility R54 Other symptoms, signs and abnormal clinical and laboratory R00-R09, R11-R49, R51findings, not elsewhere classified R53, R55-R99 Fracture of skull and facial bones S02 Fracture of neck, thorax or pelvis S12, S22, S32, T08 Fracture of femur S72 Fractures of other limb bones S42, S52, S62, S82, S92, T10, T12 Fractures involving multiple body regions T02 Dislocations, sprains and strains of specified and multiple S03, S13, S23, S33, S43, body regions S53, S63, S73, S83, S93, T03 Injury of eye and orbit S05 Intracranial injury S06 Injury of other internal organs S26-S27, S36-S37 Crushing injuries and traumatic amputations of specified and S07-S08, S17-S18, S28, multiple body regions S38, S47-S48, S57-S58, S67-S68, S77-S78, S87S88, S97-S98, T04-T05 Other injuries of specified, unspecified and multiple body S00-S01, S04, S09-S11, regions S14-S16, S19-S21, S24S25, S29-S31, S34-S35, S39-S41, S44-S46, S49S51, S54-S56, S59-S61, S64-S66, S69-S71, S74S76, S79-S81, S84-S86, S89-S91, S94-S96, S99, T00-T01, T06-T07, T09, T11, T13-T14 Effects of foreign body entering through natural orifice T15-T19 Burns and corrosions T20-T32 Poisoning by drugs and biological substances T36-T50 Toxic effects of substances chiefly nonmedicinal as to source T51-T65 Maltreatment syndromes T74 Other and unspecified effects of external causes T33-T35, T66-T73, T75T78 Certain early complications of trauma and complications of T79-T88 surgical and medical care, not elsewhere classified CBHI ICD 10 Student Workbook December 2004 Page 312 289 290 291 292 293 294 295 296 297 298 Sequelae of injuries, poisoning and of other consequences of external causes Persons encountering health services for examination and investigation Asymptomatic human immunodeficiency virus [HIV] infection status Other persons with potential health hazards related to communicable disease Contraceptive management Antenatal screening and other supervision of pregnancy Liveborn infants according to place of birth Postpartum care and examination Persons encountering health services for specific procedures and health care Persons encountering health services for other reasons T90-T98 Z00-Z13 Z21 Z20, Z22-Z29 Z30 Z34-Z36 Z38 Z39 Z40-Z54 Z31-Z33, Z37, Z55-Z99 CBHI ICD 10 Student Workbook December 2004 Page 313 CBHI - Module & Work Book - Orientation Training on ICD 10 Efficient Health Intelligence is the key to Healthy & Prosperous India Government of India Module and Work Book Orientation Training On ICD 10 Government of India Central Bureau of Health Intelligence (CBHI) Directorate General of Health Services Ministry of Health & Family Welfare Nirman Bhawan, New Delhi - 110 011 CBHI Website : www.cbhidghs.nic.in CBHI email : [email protected]