International Classification of Diseases & Coding Unit 3

Unit 3 Description of the International

Statistical Classification of Diseases (ICD)
and Related Health Problems
Structure
3.1 Introduction
Objectives
3.2 The Concept of a "Family" of Disease and Health-Related Classifications
Diagnosis-related classifications
Non-diagnostic classifications
lnformation support to primary health care
International Nomenclature of Diseases
The role of WHO
3.3 General Principles of Disease Classification
3.4 The Basic Structure and Principles of Classification of the ICD
Volumes
Chapters
Blocks of categories
Three-character categories
Four-character subcategories
Supplementary subdivisions for use at the fifth or subsequent
character level
The unused "U" codes
3.5 ICD-10 Updates
3.6 Summary
3.7 Terminal Questions
3.8 Answers

3.1 Introduction
A classification of diseases can be defined as a system of categories to
which morbid entities are assigned according to established criteria. The
purpose of the ICD is to permit the systematic recording, analysis,
interpretation and comparison of mortality and morbidity data collected in
different countries or areas and at different times. The ICD is used to
translate diagnoses of diseases and other health problems from words into
an alphanumeric code that permits easy storage, retrieval and analysis of
the data.
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In practice, the ICD has become the international standard diagnostic

classification for all general epidemiological and many health management
purposes. These include the analysis of the general health situation of
population groups and the monitoring of the incidence and prevalence of
diseases and other health problems in relation to other variables, such as
the characteristics and circumstances of the individuals affected. The ICD is
neither intended nor suitable for indexing of distinct clinical entities. There
are also some constraints on the use of the ICD for studies of financial
aspects, such as billing or resource allocation.
Objectives
After studying this unit, you should be able to:
 explain the concept of “family” of disease and health-related
classifications
 explain the two types of classification of disease and related health
problems
 explain the general principles of disease classifications
 discuss the basic structure and principles of classification of diseases
 discuss contents of ICD-10
 describe the structure of codes of ICD-10 and basic coding guidelines
 discuss the updates of ICD-10

3.2 The Concept of a "Family" of Disease and Health-Related

Classifications
Although the ICD is suitable for many different applications, it does not
always allow the inclusion of sufficient detail for some specialities and
sometimes information on different attributes of the classified conditions
may be needed. It has also been suggested that the lCD should include
classifications of additional information related to health status or health
care.
It was felt that the main ICD (the three and four-character classification),
covered by the three volumes of ICD-10, could not incorporate all this
additional information and remain accessible and relevant to its traditional
users, So the idea arose of a "family" of disease and health-related
classifications, including volumes published separately from the main lCD,
to be used as required.

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The "core" classification of ICD-10 is the three-character code, which is the

mandatory level of coding for international reporting to the WHO mortality
database and for general international comparisons. The four-character
subcategories, while not mandatory for reporting at the international level
are recommended for many purposes and form an integral part of the lCD,
as do the special tabulation lists.
There are two main types of classification. Those in the first group cover
data related to diagnoses and health status, and are derived directly from
the ICD by either condensation or expansion of the tabular list, The
condensed lists can he used for many kinds of data presentation, for
summary statistical tables, and potentially for information support in the
development of primary health care, while the expanded lists are used to
obtain increased clinical detail as in the specialty-based adaptations. This
group also includes classifications complementary to the tabular list, that
allow the allocation of diagnoses using a different axis of classification, such
as the morphology of tumours.
The second group of classifications covers aspects related to health
problems generally outside the formal diagnoses of current conditions, as
well as other classifications related to health care. This group includes
classifications of disablement, of medical and surgical procedures and of
reasons for contact with health care providers.
The ICD family also covers a conceptual framework of definitions,
standards, and methods that, although they are not classifications in
themselves, have been closely linked to the ICD for a long time. One of
these concepts is the development of methods to support the local collection
and use of information for primary health care.
Another publication related to, but not derived from, the ICD is the
International Nomenclature of Diseases (IND). The difference between a
classification and a nomenclature is discussed.
The figure below shows the content and inter-relationship of the various
members of the family of classifications.

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INTERNATIONAL STATISTICAL
CLASSIFICATION OF
DISEASES AND RELATED
HEALTH PROBLEMS

ICD 3-CHARACTER CORE SPECIFICATION-

CLASSIFICATION BASED
 Diagnoses ADAPTATIONS
INFORMATION
 Symptoms  Oncology
SUPPORT
 Abnormal laboratory findings  Dentistry and
TO PRIMARY stomatology
HEALTH CARE  Injuries and poisonings
 Dermatology
 Lay reporting  External causes of morbidity
 Other community- and mortality  Psychiatry
based information  Neurology
 Factors influencing health
schemes in health
status  Obsterics and
gynaecology
 Rheumatology and
orthopaedics
 Paediatrics etc.

 General medical
practice
Short ICD
tabulation 4 -Character
lists classification

INTERNATIONAL
OTHER HEALTH
NOMENCLATURE
RELATED
OF DISEASES
CLASSIFICATIONS
 Impairments,
(IND)
Disabilities and
Handicaps
 Procedures
 Reason for encounter
(complaints)

3.2.1 Diagnosis-related classifications Special tabulation lists

The special tabulation lists are derived directly from the core classification,
for use in data presentation and to facilitate analysis of health status and
trends at the international, national and subnational levels. The special
tabulation lists recommended for international comparisons and publications

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are included in Volume 1. There are five such lists, four for mortality and one
for morbidity.
Specialty-based adaptations
Specialty-based adaptations usually bring together in a single, compact
volume the sections or categories of the ICD that are relevant to a particular
specialty. The four-character subcategories of the ICD are retained, but
more detail is often given by means of fifth-character or sometimes sixth
character subdivisions, and there is an alphabetical index of relevant terms.
Other adaptations may give glossary definitions of categories and
subcategories within the speciality.
The adaptations have often been developed by international groups of
specialists, but national groups have sometimes published adaptations that
have later been used in other countries. The following list includes some of
the major speciality adaptations to date.
Oncology
The second edition of the International Classification of Diseases for
Oncology (ICD-O), published by WHO in 1990, is intended for use in cancer
registries, and in pathology and other departments specializing in cancer (I).
ICD-O is a dual-axis classification with coding systems for both topography
and morphology. The topography code uses, for most neoplasms, the same
three- character and four-character categories used in ICD-10 for malignant
neoplasms (categories COO-C80). ICD-O thus allows greater specificity of
site for non-malignant neoplasms than is possible in ICD-10.
The morphology code for neoplasms is identical to that in the Systematized
nomenclature of medicine (SNOMED) (2), which was derived from the 1968
edition of the Manual of tumor nomenclature and coding (MOTNAC) (3) and
the systemized nomenclature of pathology (SNOP) (4). The morphology
code has five digits; the first four digits identify the histological type and the
fifth the behaviour of the neoplasm (malignant, in situ, benign, etc.). The
ICD-O morphology codes also appear in Volume 1 of ICD-10 and are added
to the relevant entries in Volume 3, the Alphabetical Index.
Dermatology
In 1978, the British Association of Dermatologists published the International
Coding Index for Dermatology compatible with the Ninth Revision of the

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ICD. As the present volume went to press, the Association was working on
an adaptation of ICD-IO to dermatology, under the auspices of the
International League of Dermatological Societies.
Dentistry and Stomatology
The third edition of the Application of the International Classification
Diseases to Dentistry and Stomatology (ICD-DA), based on ICD-IO, is in
preparation for publication by WHO. It is designed to bring together ICD
categories for diseases or conditions that occur in, have manifestations in,
or have associations with the oral cavity and adjacent structures. It provides
greater detail than ICD-10 by means of a fifth digit, but the numbering
system is organized so that the relationship between an lCD-DA code and
the ICD code from which it is derived is immediately obvious, and so that
data from ICD-DA categories can be readily incorporated into ICDI
categories.
Neurology
WHO intends to publish a neurological adaptation of ICD-10, which retains
the classification and coding systems of ICD-l0 but is further subdivide at the
fifth-character level and beyond to allow neurological diseases to be
classified with greater precision.
Rheumatology and orthopaedics
The International League against Rheumatism is working on a revision of
the Application of the International Classification of Diseases to
Rheumatology and Orthopaedics (ICD-R&O), including the International
Classification of Musculoskeletal Disorders (ICMSD), to be compatible with
ICD-10. The ICD-R&O provides detailed specification of conditions through
the use of additional digits, which allow for extra detail while retaining
compatibility with ICD-10. The ICMSD is designed to clarify and standardize
the use of terms and is supported by a glossary of generic descriptors for
groups or conditions, such as the inflammatory polyarthropathies.
Paediatrics
Under the auspices of the International Paediatric Association, the British
Paediatric Association (BPA) is working on an application of ICD-10 to
paediatrics, which will use a fifth digit to provide greater specificity. This
follows similar applications prepared by BPA for ICD-8 and ICD-9.

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Mental disorders
The ICD-10 classification of Mental and Behavioural Disorders: clinical
descrition and diagnostic guidelines. This volume, published in 1992,
provides for each category in Chapter V of ICD-10 (Mental and behavioural
disorders) a general description and guidelines concerning the diagnosis, as
well comments about differential diagnosis and a listing of synonyms and
exclusion terms. Where more detail is required, the guidelines give further
subdivisions at the fifth and sixth digit levels- A second publication relating
ICD-10 Chapter V, Diagnostic criteria for research, is in press.
It is also planned to test a version of the classification for use in primary
health care, and another version that will use a rearrangement of categories
of childhood mental disorders in a multiaxial system, to allow simultaneous
assessment of the clinical state, relevant environmental factors, and the
degree of disability linked to the disease.
3.2.2 Non-diagnostic classifications
Procedures in medicine
The International Classification of Procedure in Medicine (ICPM) was
published in two volumes by WHO in 1978 (6). It includes procedures for
medical diagnosis, prevention, therapy, radiology, drugs, and surgical and
laboratory procedures. Some countries have adopted the classification,
while others have used it as a basis for developing their own national
classification of surgical operation.
The Heads of WHO Collaborating Centres for Classification of Diseases
recognized that the process of consultation that had to be followed before
finalization and publication was inappropriate in such a wide and rapidly
advancing field. They therefore recommended that there should be no
revision of the ICPM in conjunction with the Tenth Revision of the ICD.
In 1987, the expert committee on the International Classification of disease
asked WHO to consider updating at least the outline for surgical of the
International Classification of Diseases noted in its report:
Procedures of the ICPM for the 10th Revision. In response to this request
and the needs expressed by a number of countries, the Secretariat
prepared a tabulation list for procedures.

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At their meeting in 1989, the Heads of the Collaborating Centres agreed that
the list could serve as a guide for the national publication of statistics on
surgical procedures and could also facilitate intercountry comparisons. The
list could also be used as a basis for the development of comparable
national classification of surgical procedures.
Work on the list will continue, but any publication will follow the issue of
ICD-10. In the meantime, other approaches to this subject are being
explored. Some of these have common characteristics, such as a fixed field
for specific items, the possibility of being automatically updated, and the
flexibility of being used for more than one purpose.
International Classification of Impairments, Disabilities, and Handicaps
(ICIDH)
This manual of classification relating to the consequences of disease was
published in English by WHO in 1980. It was subsequently been translated
into over a dozen languages.
ICIDH contains three distinct classifications, each relating to a different
consequence of disease.
Impairments (I code) are concerned with loss or abnormality of
psychological, physiological, or anatomical structure or function. In principle,
impairments represent disturbances at the level of the organ.
The basic structure of the I code consists of two digits before and one digit
after a decimal point. In some parts, a fourth digit has been used. There is
an alphabetical index to this classification.
Disabilities (D code) reflect the consequences of impairment in terms of any
restriction or lack of ability to perform an activity in the manner or within the
range considered normal for a human being; disabilities thus reflect
disturbances at the level of the person.
The basic structure of the disability code consists of two digits, with the
option of a supplementary digit after a decimal point. There is no
alphabetical index to this classification.
Handicaps (H codes) are disadvantages for a given individual, resulting from
an impairment or a disability, that limit or prevent the fulfilment of a role that
is normal (depending on age, sex, and social and cultural factors) for that

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individual; handicaps thus reflect discordance between the individual’s

performance and the expectations of the individual or of the group of which
he or she is member.
The handicap classification has seven dimensions: six key dimensions
which have been designated as “survival roles” and one “other handicaps”
dimension to accommodate the problems not included in the survival roles.
A one-digit scale is applied to each dimension. This classification is not
classification of individuals. It is a classification of circumstances that place
people with disabilities at a disadvantage relative to their peers when viewed
from the norms of society. There is no alphabetical index to this
classification.
Work is in progress on the use of the ICIDH various countries, and has been
reviewed at several international meetings in recent years. WHO
Collaborating Centres for the development and use of the ICIDH have been
established and will participate in work on the revision of the ICIDH.
3.2.3 Information support to primary health care
One of the challenges of the Global Strategy for Health for all by the year
2000 was to provide information support to primary health care (PHC). In
countries without complete information or with only poor-quality data, a
variety of approaches need to be adopted to supplement or replace the
conventional use of the ICD.
Since the late 1970s, various countries have experimented with the
collection of information by lay personnel. Lay reporting has subsequently
been extended to a broader concept called “non-conventional methods”.
These methods, covering a variety of approaches, have evolved in different
countries as a means of obtaining information on health status where
conventional methods (censuses, surveys, vital or institutional morbidity and
mortality statistics) have been found to be inadequate.
One of these approaches, “community-based information”, involves
community participation in the definition, collection and use of health-related
data. The degree of community participation ranges from involvement only
in data collection to the design, analysis and utilization of information.
Experience in several countries has shown that this approach is more than a
theoretical framework. The International Conference for the 10th Revision.

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The Conference was informed about the experience of countries in

developing and applying community-based health information that covered
health problems; and needs, related risk factors and resources. It supported
the concept of developing non-conventional methods at the community level
as a method of filling information gaps in individual countries and
strengthening their information systems. It was stressed that, for both
developed and developing countries, such methods or systems should be
developed locally and that because of factors such as morbidity patterns as
well as language and cultural variations, transfer to other areas or countries
should not be attempted.
Given the encouraging results of this approach in many countries, the
Conference agreed that WHO should continue to give guidance on the
development of local schemes and to support the progress of the
methodology.
3.2.4 International Nomenclature of Diseases
In 1970, the Council for International Organizations of Medical Sciences
(CIOMS) began the preparation of an International Nomenclature of
Diseases (IND), with the assistance of its member organizations and five
volumes of provisional nomenclature were issued during 1972-1974. It was
soon realized, however, that the compilation of such a nomenclature were it
to be truly international, would need much wider consultation than was
possible through the members of CIOMS alone. In 1975, the IND became a
joint project of CIOMS and WHO, guided by a Technical Steering
Committee of representatives from both organizations.
The principal objective of the IND is to provide, for each morbid entity, a
single recommended name. The main criteria for selection of this name are,
that it should be specific (applicable to one and only one disease),
unambiguous, as self-descriptive as possible, as simple as possible, and
(whenever feasible) based on cause. However, many widely used names
that do not fully meet the above criteria are being retained as synonyms,
provided they are not inappropriate, misleading, or contrary to the
recommendations of international specialist organizations. Eponymous
terms are avoided since they are not self-descriptive; however, many of
these names are in such widespread use (e.g. Hodgkin disease, Parkinson
disease and Addison disease) that they must be retained.

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Each disease or syndrome for which a name is recommended is defined as

unambiguously and as briefly as possible. A list of synonyms appears after
each definition. These comprehensive lists are supplemented, if necessary,
by explanations about why certain synonyms have been rejected or why an
alleged synonym is not a true synonym.
The IND is intended to be complementary to the ICD. The differences
between a nomenclature and a classification are discussed. As far as
possible, IND terminology has been given preference in the ICD.
The volumes of the IND published up to 1992 (8) are: Infectious diseases
bacterial diseases.
(1985), mycoses (1982), viral diseases (1983), parasitic diseases (1987);
Diseases of the lower respiratory tract ( 1979); Diseases of the digestive
system (1990); Cardiac and vascular diseases (1989); Metabolic, nutritional
and endocrine disorders (1991); Diseases of the kidney, the lower urinary
tract, and the male genital system (1992); and Diseases of the female
genetile system (J992).
3.2.5 The role of WHO
Most of the classifications described above are the product of very close
collaboration between nongovernmental organizations, other agencies, and
divisions and units of WHO, with the unit responsible for the ICD assuming a
coordinating roal and providing guidance and advice.
WHO promotes the development of adaptations that extend both the
usefulness of the ICD and the comparability of health statistics. The role of
WHO in the development of new classifications, adaptations, and glossaries
is to provide cooperative leadership and to act as a clearing-house, giving
technical advice, guidance and support when needed. Anyone interested in
preparing an adaptation of ICD-1.0 should consult with WHO as soon as a
clear statement of the objectives of the adaptation has been developed.
Unnecessary duplication will thus be avoided by a coordinated approach to
the development of the various components of the family.
Self Assessment Questions
1. ICD-O is a _____________ classification with coding systems for both
topography and morphology.
2. The special tabulation lists recommended for international comparisons
and publications are included in ______________ .
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3. _____________ are concerned with loss or abnormally of psychological,

physiological, or anatomical structure or function.

3.3 General Principles of Disease Classification

William Farr’s classification
Classification is a method of generalization. Several classifications may,
therefore, be used with advantage; and the physician, the pathologist, or the
jurist, each from his own point of view, may legitimately classify the diseases
and the causes of death in the way that he thinks best adapted to facilitate
his inquiries, and to yield general results.
A statistical classification of diseases must be confined to a limited number
of mutually exclusive categories able to encompass the whole range of
morbid conditions. The categories have to be chosen to facilitate the
statistical study of disease phenomena. A specific disease entity that is of
particular public health importance or that occurs frequently should have its
own category. Otherwise, categories will be- assigned to groups of separate
but related conditions. Every disease or morbid condition must have a well
defined place in the list of categories. Consequently, throughout the
classification, there will be residual categories for other and miscellaneous
conditions that cannot be allocated to the more specific categories. As few
conditions as possible should be classified to residual categories.
It is the element of grouping that distinguishes a statistical classification from
a nomenclature, which must have a separate title for each known morbid
condition. The concepts of classification and nomenclature are nevertheless
closely related because a nomenclature is often arranged systematically.
A statistical classification can allow for different levels of detail if it has a
hierarchical structure with subdivisions. A statistical classification of
diseases should retain the ability both to identify specific disease entities
and to allow statistical presentation of data for broader groups, to enable
useful and understandable information to be obtained.
The same general principles can be applied to the classification of other
health problems and reasons for contact with health care services, which
are also incorporated in the lCD.
The lCD has developed as a practical, rather than a purely theoretical
classification, in which there are a number of compromises between

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classification based on etiology, anatomical site, circumstances of onset,

etc. There have also been adjustments to meet the variety of statistical
applications for which the lCD is designed, such as mortality, morbidity,
social security and other types of health statistics and surveys.
Self Assessment Questions
4. It is the element of ________________ that distinguishes a statistical
classification from a nomenclature.
5. A statistical classification can allow for different levels of detail if it has a
_______________ structure with subdivisions.

3.4 The Basic Structure and Principles of Classification of the

ICD
The ICD is a variable-axis classification. The structure has developed out of
that proposed by William Farr in the early days of international discussions
on classification structure. His scheme was that, for all practical,
epidemiological purposes, statistical data on diseases should be grouped in
the following way :
 epidemic diseases
 constitutional or general diseases
 local diseases arranged by site
 developmental diseases
 injuries.
This pattern can be identified in the chapters of ICD-I0. It has stood the test
of time and, though in some ways arbitrary, is still regarded as a more useful
structure for general epidemiological purposes than any of the alternatives
tested.
The first two, and the last two, of the groups listed above comprise “special
groups", which bring together conditions that would be inconveniently
arranged for epidemiological study were they to be scattered, for instance in
a classification arranged primarily by anatomical site. The remaining group,
"local diseases arranged by site", includes the ICD chapters for each of the
main body systems.
The distinction between the "special groups" chapters and the "body
systems" chapters has practical implications for understanding the structure

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of the classification, for coding to it, and for interpreting statistics based on it.
It has to be remembered that, in general, conditions are primarily classified
to one of the "special groups" chapters. Where there is any doubt as to
where a condition should be positioned, the "special groups" chapters
should take priority.
The basic ICD is a single coded list of three-character categories, each of
which can be further divide into up to ten four character subcategories. In
place of the purely numeric coding system of previous revisions, the Tenth
Revision uses an alphanumeric code with a letter in the first position and a
number in the second, third and fourth positions. The fourth character
follows a decimal point. Possible code numbers therefore range from A00.0
to Z99.9. The letter U is not used.
3.4.1 Volumes
lCD-10 comprises three volumes: Volume 1 contains the main
classifications; Volume 2 provides guidance to users of the ICD; and
Volume 3 is the Alphabetical Index to the classification.
Most of Volume 1 is taken up with the main classification, composed of the
list of three-character categories and the tabular list of inclusions and four-
character subcategories. The "core" classification-the list of three-character
categories (Volume 1) is the mandatory level for reporting to the WHO
mortality database and for general international comparisons. This core
classification also lists chapter and block titles. The tabular list, giving the full
detail of the four-character level, is divided into 21 chapters.
Volume 1 also contains the following:
Morphology of neoplasms: The classification of morphology of neoplasms
may be used, if desired, as an additional code to classify the morphological
type for neoplasms which, with a few exceptions, are classified in Chapter II
only according to behaviour and site (topography). The morphology codes
are the same as those used in the special adaptation of the ICD for
oncology (ICD-O).
Special tabulation lists:-. Because the full four-character list of the ICD, and
even the three-character list, are too long to be presented in every statistical
table, most routine statistics use a tabulation list that emphasizes certain
single conditions and groups others. The four special lists for the tabulation

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of mortality are an integral part of the ICD. Lists 1 and 2 are for general
mortality and lists 3 and 4 are for infant and child mortality (ages 0-4 years).
There is also a special tabulation list for morbidity. These are set out on
Volume 1. Guidance on the appropriate use of the various levels of the
classification and the tabulation lists is given in section 5 of this volume.
Definitions: The definitions on of Volume 1 have been adopted by the World
Health Assembly and are included to facilitate the international comparability
of data.
Nomenclature regulations: The regulations adopted by the World Health
Assembly set out the formal responsibilities of WHO Member States
regarding the classification of diseases and causes of death, and the
compilation and publication of statistics. They are found in Volume 1.
3.4.2 Chapters
The classification is divided into 21 chapters. The first character of the ICD
code is a letter, and each letter is associated with a particular chapter,
except for the letter D, which is used in both Chapter II, Neoplasms, and
Chapter III, Diseases of the blood and blood-forming organs and certain
disorders involving the immune mechanism, and the letter H, which is used
in both Chapter VII, Diseases of the eye and adnexa and Chapter VIII,
Diseases of the year and mastoid process. Four chapters (Chapters I, II,
XI-X, and XX) use more than one letter in the first position of their codes.
Each chapter contains sufficient three-character categories to cover its
content; not all available codes are used, allowing space for future revision
and expansion.
Chapters I to XVII relate to diseases and other morbid conditions, and
Chapter XIX to injuries, poisoning and certain other consequences of
external causes. The remaining chapters complete the range of subject
matter now a days included in diagnostic data. Chapter XVIII covers
Symptoms, signs and abnormal clinical and laboratory findings, not
elsewhere classified. Chapter XX, External causes of morbidity and
mortality, was traditionally used to classify causes of injury and poisoning,
but, since the Ninth Revision, has also provided for any recorded external
cause of diseases and other morbid conditions. Finally, Chapter XXI, factors
influencing health status and contact with health services, is intended for the

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classification of data explaining the reason for contact with health care
services of a person not currently sick, or the circumstances in which the
patient is receiving care at that particular time or otherwise having some
bearing on that person's care.
3.4.3 Blocks of categories
The chapters are subdivided into homogeneous "blocks" of three-character
categories. In Chapter I, the block titles reflect two axes of classification-
mode of transmission and broad group of infecting organisms. In, Chapter II,
the first axis is the behaviour of the neoplasm; within behaviour, the axis is
mainly by site, although a few three-character categories are provided for
important morphological types (e.g. leukaemias, lymphomas, melanomas,
mesotheliomas, Kaposi's sarcoma). The range of categories is given in
parentheses after each block title.
3.4.4 Three-character categories
Within each block, some of the three-character categories are for single
conditions, selected because of their frequency, severity or susceptibility to
public health intervention, while others are for groups of diseases with some
common characteristic. There is usually provision for "other" conditions to
be classified allowing many different but rarer conditions, as well as
"unspecified" conditions, to be included.
List of 3 – Character categories
Chapter I: Certain infectious and parasitic diseases (A00-B99)
Intestinal infectious diseases (A00-A09)
Tuberculosis (A15-A19)
Certain zoonotic bacterial diseases (A20-A28)
Other bacterial diseases (A30-A49)
Infections with a predominantly sexual mode of transmission (A50-A64)
Other spirochaetal diseases (A65-A69)
Other diseases caused by chamydiae (A70-A74)
Rickettsioses (A75-A79)
Viral infections of the central nervous system (A80-A89)
Arthropod-borne viral fevers and viral haemorrhagic fevers (A90-A99)
Viral infections characterized by skin and mucous membrane lesions
(B00-B09)
Viral hepatitis (B15-B19)
Human Immunodeficiency Virus (HIV) Disease (B20-B24)
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Other Viral diseases (B25-B34)

Mycoses (B35-B49)
Protozoal diseases (B50-B64)
Helminthiases (B65-B83)
Pediculosis, acariasis and other infestations (B85-B89)
Sequelae of infectious and parasitic diseases (B90-B94)
Bacterial, viral and other infectious agents (B95-B97)
Other infectious diseases (B99)
Chapter II Neoplasms (C00-D48)
Malignant neoplasms (C00-C97)
Malignant neoplasm of lip, oral cavity and pharynx (C00-C14)
Malignant neoplasm of digestive organs(C15-C26)
Malignant neoplasms of respiratory and intrathoracic organs (C30-C39)
Malignant neoplasms of bone and articular cartilage (C40-C41)
Melanoma and other malignant neoplasms of skin (C43-C44)
Malignant neoplasms of mesothelial and soft tissue (C45-C49)
Malignant neoplasm of breast (C50)
Malignant neoplasm of female genital organs (C51-C58)
Malignant neoplasm of male genital organs (C60-C63)
Malignant neoplasm of urinary tract (C64-C68)
Malignant neoplasm of eye, brain and other parts of central nervous system
(C69-C72)
Malignant neoplasm of thyroid and other endocrine glands (C73-C75)
Malignant neoplasm of ill-defined, secondary and unspecified sites
(C76-C80)
Malignant neoplasms of lymphoid, haematopoietic and related tissue
(C81-C96)
Malignant neoplasms of independent (primary) multiple sites (C97)
In situ neoplasms (D00-D09)
Benign neoplasms (D10-D36)
Neoplasms of uncertain or unknown behavior (D37-D48)
Chapter III Diseases of blood and blood-forming organs and certain
disorders involving the immune mechanism (D50-D89)
Nutritional anaemias (D 50-D53)
Haemolytic anaemias (D55-D59)
Aplastic and other anaemias (D60-D64)
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Coagulation defects, purpura and other haemorrhagic conditions (D65-D69)

Other diseases of blood and blood-forming organs (D70-D77)
Certain disorders involving the immune mechanism (D80-D89)
Chapter IV Endocrine, nutritional and metabolic diseases (E00-E90)
Disorders of thyroid gland (E00-E07)
Diabetes mellitus (E10-E14)
Other disorders of glucose regulation and pancreatic internal secretion
(E20-E35)
Malnutrition (E40-E46)
Other nutritional deficiencies (E50-E64)
Obesity and other hyper alimentation (E65-E68)
Metabolic disorders (E70-E90)
Chapter V Mental and behavioural disorders (F00-F00)
Organic, including symptomatic, mental disorders (F00-F09)
Mental and behavioural disorders due to psychoactive substance use
(F10-F19)
Schizophrenia, schizotypal and delusional disorders (F20-F29)
Mood [affective] disorders (F30-F39)
Neurotic, stress-related and somatoform disorders (F40-F48)
Behavioural syndromes associated with physiological disturbances and
physical factors (F50-F59)
Disorders of adult personality and behaviour (F60-F69)
Mental retardation (F70-F79)
Disorders of psychological development (F80-F89)
Behavioural and emotional disorders with onset usually occurring in
childhood and adolescence (F90-F98)
Unspecified mental disorder (F99)
Chapter VI Diseases of nervous system (G00-G99)
Inflammatory diseases of central nervous system (G00-G09)
Systemic atrophies primarily affecting the central nervous system
(G10-G13)
Extra pyramidal and movement disorders (G20-G26)
Other degenerative diseases of the nervous system (G30-G32)
Demyelinating diseases of the central nervous system (G35-G37)
Episodic and paroxysmal disorders (G40-G47)

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Nerve, nerve root and plexus disorders (G50-G59)

Polyneuropathies and other disorders of the peripheral nervous system
(G60-G64)
Diseases of myoneural junction and muscle (G70-G73)
Cerebral palsy and other paralytic syndromes (G80-G83)
Other disorders of the nervous system (G90-G99)
Chapter VII Diseases of the eye and adnexa (H00-H59)
Disorders of eyelid, lacrimal and orbit (H00-H06)
Disorders of conjunctiva (H10-H13)
Disorders of sclera, cornea, iris and ciliary body (H15-H22)
Disorders of lens (H25-H28)
Disorders of choroid and retina (H30-H36)
Glaucoma (H40-H42)
Disorders of vitreous body and globe (H43-H45)
Disorders of optic nerve and visual pathways (H46-H48)
Disorders of ocular muscles, binocular movement, accommodation and
refraction (H49-H52)
Visual disturbances and blindness (H53-H54)
Other disorders of eye and adnexa (H55-H59)
Chapter VIII Diseases of the ear and mastoid process (H60-H95)
Diseases of external ear (H60-H62)
Diseases of middle ear and mastoid (H65-H75)
Diseases of inner ear (H80-H83)
Other disorders of ear (H90-H95)
Chapter IX Diseases of the circulatory system (I00-I99)
Acute rheumatic fever (I00-I02)
Chronic rheumatic heart diseases (I05-I09)
Hypertensive diseases (I10-I15)
Ischaemic heart diseases (I20-I25)
Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)
Other forms of heart disease (I30-I52)
Cerebrovascular diseases (I60-I69)
Diseases of arteries, arterioles and capillaries (I70-I79)
Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere
classified (I80-I89)
Other and unspecified disorders of the circulatory system (I95-I99)

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Chapter X Diseases of the respiratory system (J00-J99)

Acute upper respiratory infections (J00-J06)
Influenza and pneumonia (J10-J18)
Other acute lower respiratory infection (J20-J22)
Other diseases of upper respiratory tract (J30-J39)
Chronic lower respiratory diseases (J40-J47)
Lung diseases due to external agents (J60-J70)
Other respiratory diseases principally affecting the interstitium (J80-J84)
Suppurative and necrotic conditions of lower respiratory tract (J85-J86)
Other diseases of pleura (J90-J94)
Other diseases of the respiratory system (J95-J99)
Chapter XI Diseases of the digestive system (K00-K93)
Diseases of oral cavity, salivary glands and jaws (K00-K14)
Disease of oesophagus, stomach and duodenum (K20-K31)
Diseases of appendix (K35-K38)
Hernia (K40-K46)
Noninfective enteritis and colitis (K50-K52)
Other diseases of intestines (K55-K63)
Diseases of peritoneum (K65-K67)
Disease of liver (K70-K77)
Disorders of gallbladder, biliary tract and pancreas (K80-K87)
Other diseases of the digestive system (K90-K93)
Chapter XII Diseases of the skin and subcutaneous tissue (L00-L99)
Infections of the skin and subcutaneous tissue (L00-L08)
Bullous disorders (L10-L14)
Dermatitis and eczema (L20-L30)
Papulosquamous disorders (L40-L45)
Urticaria and erythema (L50-L54)
Radiation related disorders of the skin and subcutaneous tissue (L55-L59)
Disorders of skin appendages (L60-L75)
Other disorders of the skin and subcutaneous tissue (L80-L99)
Chapter XIII Diseases of the musculoskeletal system and connective
tissue (M00-M99)
Arthropathies (M00-M25)
Infectious arthropathies (M00-M03)

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Inflammatory polyarthropathies (M05-M14)

Arthrosis (M15-M19)
Other joint disorders (M20-M25)
Systemic connective tissue disorders (M30-M36)
Dorsopathies (M40-M54)
Deforming dorsopathies (M40-M43)
Spondylopathies (M45-M49)
Other dorsopathies (M50-M54)
Soft tissue disorders (M60-M79)
Disorders of synovium and tendon (M65-M68)
Other soft tissue disorders (M70-M79)
Osteopathies and chondropathies (M80-M94)
Disorders of bone and density and structure (M80-M85)
Other osteopathies (M86-M90)
Chondropathies (M91-M94)
Other disorders of the musculoskeletal system and connective tissue (M95-
M99)
Chapter XIV Disease of the genitourinary system (N00-N99)
Glomerular diseases (N00-N08)
Renal tubulo-interstitial diseases (N10-N16)
Renal failure (N17-N19)
Urolithiasis (N20-N23)
Other disorders of kidney and ureter (N25-N29)
Other diseases of the urinary system (N30-N39)
Diseases of male genital organs (N40-N51)
Disorders of breast (N60-N64)
Inflammatory diseases of female pelvic organs (N70-N77)
Noninflammatory disorders of female genital tract (N80-N98)
Other disorders of the genitourinary system (N99)
Chapter XV Pregnancy, childbirth and the puerperium (O00-O99)
Pregnancy with abortive outcome (O00-008)
Odema, proteinuria and hypertensive disorders in pregnancy, childbirth and
the puerperium (O10-O16)
Other maternal disorders predominantly related to pregnancy (O20-O29)
Maternal care related to the fetus and amniotic cavity and possible delivery
problems (O30-O48)
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Complications of labour and delivery (O60-O75)

Delivery (O80-O84)
Complications predominantly related to the puerperium (O85-O92)
Other obstetric conditions, not elsewhere classified (O95-O99)
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)
Disorders related to length of gestation and fetal growth (P05-P08)
Birth trauma (P10-P15)
Respiratory and cardiovascular disorders specific to the perinatal period
(P20-P29)
Infections specific to the perinatal period (P35-P39)
Haemorrhagic and haematological disorders of fetus and newborn
(P50-P61)
Transitory endocrine and metabolic disorders specific to fetus and newborn
(P70-P74)
Digestive system disorders of fetus and newborn (P75-P78)
Conditions involving the integument and temperature regulation of fetus and
newborn (P80-P83)
Other disorders originating in the perinatal period (P90-P96)
Chapter XVII Congenital malformations, deformations and chromo-
somal abnormalities (Q00-Q99)
Congenital malformations of nervous system (Q00-Q07)
Congenital malformations of eye, ear, face and neck (Q10-Q18)
Congenital malformations of circulatory system (Q20-Q28)
Congenital malformations of the respiratory system (Q30-Q34)
Cleft lip and cleft palate (Q35-Q37)
Other congenital malformations of the digestive system (Q38-Q45)
Congenital malformations of genital organs (Q50-Q56)
Congenital malformation of the urinary system (Q60-Q64)
Congenital malformations and deformations of the musculoskeletal system
(Q65-Q79)
Other congenital malformations (Q80-Q89)
Chromosomal abnormalities, not elsewhere classified (Q90-Q99)

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Chapter XVIII Symptoms and signs and abnormal clinical and

laboratory findings, not elsewhere classified (R00-R99)
Symptoms and signs involving the circulatory and respiratory systems
(R00-R09)
Symptoms and signs involving the digestive system and abdomen
(R10-R19)
Symptoms and signs involving the skin and subcutaneous tissue (R20-R23)
Symptoms and signs involving the nervous and musculoskeletal systems
(R25-R29)
Symptoms and signs involving the urinary system (R30-R39)
Symptoms and signs involving cognition, perception, emotional state and
behaviour (R40-R46)
Symptoms and signs involving speech and voice (R47-R49)
General symptoms and signs (R50-R69)
Abnormal findings on examination of blood, without diagnosis (R70-R79)
Abnormal findings on examination of urine, without diagnosis (R80-R82)
Abnormal findings on examination of other body fluids, substances and
tissues, without diagnosis (R83-R89)
Abnormal findings on diagnostic imaging and in function studies, without
diagnosis (R90-R94)
Ill defined and unknown causes of mortality (R95-R99)
Chapter XIX Injury, poisoning and certain other consequences of
external causes (S00-T98)
Injuries to the head (S00-S09)
Injuries to the neck (S10-S19)
Injuries to the thorax (S20-S29)
Injuries to the abdomen, lower back, lumbar spine and pelvis (S30-S39)
Injuries to the shoulder and upper arm (S40-S49)
Injuries to the elbow and forearm (S50-S59)
Injuries to the wrist and hand (S60-S69)
Injuries to the hip and thigh (S70-S79)
Injuries to the knee and lower leg (S80-S89)
Injuries to the ankle and foot (S90-S99)
Injuries involving multiple body regions (T00-T07)
Injuries to unspecified part of trunk, limb or body region (T08-T14)
Effects of foreign body entering through natural orifice (T15-T19)

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Burns and corrosions (T20-T32)

Burns and corrosions of external body surface, specifies by site (T20-T25)
Burns and corrosions confined to eye and internal organs (T26-T28)
Burns and corrosions of multiple and unspecified body regions (T29-T32)
Frostbite (T33-T35)
Poisoning by drugs, medicaments and biological substances (T36-T50)
Toxic effect of substances chiefly nonmedicinal as to source (T51-T65)
Other and unspecified effects of external causes (T66-T78)
Certain early complications of trauma (T79)
Complications of surgical and medical care, not elsewhere classified
(T80-T88)
Sequelae of injuries, of poisoning and of other consequences of external
causes (T90-T98)
Chapter XX External causes of morbidity and mortality (V01-Y98)
Transport accidents (V01-V99)
Pedestrian injured in transport accident (V01-V09)
Pedal cyclist injured in transport accident (V10-V19)
Motorcycle rider injured in transport accident (V20-V29)
Occupant of three-wheeled motor vehicle injured in transport accident
(V30-V39)
Car occupant injured in transport accident (V40-V49)
Occupant of pick-up truck or van injured in transport accident (V50-V59)
Occupant of heavy transport vehicle injured in transport accident (V60-V69)
Bus occupant injured in transport accident (V70-V79)
Other land transport accidents (V80-V89)
Water transport accidents (V90-V94)
Air and space transport accidents (V95-V97)
Other and unspecified transport accidents (V98-V99)
Other external causes of accidental injury (W00-X59)
Falls (W00-W19)
Exposure to inanimate mechanical forces (W20-W49)
Exposure to animate mechanical forces (W50-W64)
Accidental drowning and submersion (W65-W74)
Other accidental threats to breathing (W75-W84)
Exposure to electric current, radiation and extreme ambient air temperature
and pressure (W85-W99)

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Exposure to smoke, fire and flames (X00-X09)

Contact with heat and hot substances (X10-X19)
Contact with venomous animals and plants (X20-X29)
Exposure to forces of nature (X30-X39)
Accidental poisoning by and exposure to noxious substances (X40-X49)
Overexertion, travel and privation (X50-X57)
Accidental exposure to other and unspecified factors (X58-X59)
Intentional self-harm (X60-X84)
Assault (X85-Y09)
Event of undermined intent (Y10-Y34)
Legal intervention and operations of war (Y35-Y36)
Complications of medical care and surgical care (Y40-Y84)
Drugs, medicaments and biological substances causing adverse effects in
therapeutic use (Y40-Y59)
Misadventures to patients during surgical and medical care (Y60-Y69)
Medical devices associated with adverse incidents in diagnostic and
therapeutic use (Y70-Y82)
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)
Sequelae of external causes of morbidity and mortality (Y85-Y89)
Supplementary factors related to causes of morbidity and mortality classified
elsewhere (Y90-Y98)
Chapter XXI Factors influencing health status and contact with health
services (Z00-Z99)
Persons encountering health services for examination and investigation
(Z00-Z13)
Persons with potential health hazards related to communicable diseases
(Z20-Z29)
Persons encountering health services in circumstances related to
reproduction (Z30-Z39)
Persons encountering health services for specific procedures and health
care (Z40-Z54)
Persons with potential health hazards related to socioeconomic and
psychosocial circumstances (Z55-Z65)
Persons encountering health services in other circumstances (Z70-Z76)

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Persons with potential health hazards related to family and personal history
and certain conditions influencing health status (Z80-Z89)
International Classification of Diseases
3.4.5 Four-character subcategories
Structure of Codes
 Major change is the move to alphanumeric codes
 In ICD-10, the category code is made up on one alphabetic character
followed by two numeric digits.
Example
Acute appendicitis – K37

First character A-Z followed by two digits

Most of the three character categories are further subdivided into

subcategories to specify a diseases or condition as specifically as possible.
Adding a fourth digit identifies these subcategories.
Example:
Acute appendicitis with peritoneal abscess – K 35. 1

First character two digits decimal point another digit

Volume of codes
By the use of alphabetical character in ICD-10, it has provision to use 2600
categories. However, presently just over 2000 categories are used.
Increase in codes is not uniform but rather concentrated in chapters relating
to signs and symptoms, congenital abnormalities and perinatal conditions.
Majority of codes in ICD-10 are four character codes.
Converting ICD-9 to ICD-10.

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Major changes:
Structure – there are now three volumes of ICD-10
Chapters – there are now 21 chapters
Codes – the structure of code has changed from numeric to alphanumeric.
Although not mandatory for reporting at the international level, most of the
three-character categories are subdivided by means of a fourth numeric
character after a decimal point, allowing up to ten subcategories. Where a
three-character category is not subdivided, it is recommended that the letter
"X" be used to fill the fourth position so that the codes are of a standard
length for data-processing.
The four-character subcategories are used in whatever way is most
appropriate, identifying, for example, different sites or varieties if the three
character category is for a single disease, or individual diseases if the three
character category is for a group of conditions.
The fourth character .8 is generally used for "other" conditions belonging to
the three-character category, and .9 is mostly used to convey the same
meaning as the three-character category title, without adding any additional
information.
When the same fourth-character subdivisions apply to a range of three-
character categories, they are listed once only, at the start of the range. A
note at each of the relevant categories indicates where the details are to be
found. For example, categories O03 - O06, for different types of abortion,
have common fourth characters relating to associated complications.
3.4.6 Supplementary subdivisions for use at the fifth or subsequent
character level
The fifth and subsequent character levels are usually subclassifications
along a different axis from the fourth character. They are found in:
Chapter XIII – subdivisions by anatomical site
Chapter XIX – subdivisions to indicate open and closed fractures as well as
intracranial, intrathoracic and intra abdominal injuries with and without open
wound
Chapter XX – subdivisions to indicate the type of activity being undertaken
at the time of the event.

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3.4.7 The unused "U" codes

Codes U00-U49 are to be used for the provisional assignment of new
diseases of uncertain etiology. Codes U50-U99 may be used in research
e.g. which testing an alternative subclassification for a special project.
Examples of Diseases and ICD-9 and ICD-10 codes
Diseases ICD-9 ICD-10
Enteropathogenic Escherichia coli infection 008.0 A04.0
† †
Tuberculosis of adrenal glands 017.6 A18.7
255.4* E35.1*
Typhus fever Rickettsia typhi 081.9 A75.2
†
Acute hepatitis A with hepatic coma 070.0 B15.0
573.1*
Candidal septicaemia ____ B37.7
Cutaneous chromomycosis 111.9 B43.0
† †
Chagas disease (chronic) with heart involvement 086.0 B57.2
425.6* I42.2*
Idiopathic thrombocytopenic purpura 287.3 D69.3
Chronic congestive splenomegaly 289.5 D73.2
Adrenosine deaninase deficiency ____ D81.3
Acute thyroiditis 245.0 E06.0
† †
Insulin Dependent Diabetes Mellitus with nephropathy 250.0 E10.2
251.8* N08.3*
Drug introduced Cushing's Syndrome 255.0 E42.2
Beriberi 265.0 E51.1
Dementia in Alzheimer's disease 290.1 F01.9
†
Dementia in HIV disease _____ B22.0
F02.4*
Catatonic schizophrenia 295.2 F20.2
Agoraphobia 300.2 F40.0
Schizoid personality disorder 301.2 F60.1
Streptococcal meningitis 320.2 G00.1
Idiopathic nonfamilial dystonia _____ G24.2
Alzheimer's disease with late onset _____ G30.1
Gullian-Barre Syndrome 357.0 G61.0

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Myasthenia Gravis 358.0 G70.0

Blepharoconjunctivitis 372.2 H10.5
Senile cataract (unspecified) 366.1 H25.9
Degenerative myopia _____ H44.2
Ocular pain _____ H57.1
Otorrhoea 388.6 H92.1
Rheumatic aortic stenosis 395.0 I06.6
Mitral valve prolapse 394.9 I34.1
Hypertensive encephalopathy 437.2 I67.4
Pyothorax with fistula 510.0 J86.0
Chronic respiratory failure ____ J96.1
Ankylosis of teeth 521.6 K03.5
Fistula of appendix 543 K38.3
Hepatic sclerosis 571.9 K74.1
Alopecia totalis 704.0 L63.0
†
Psoriatic spondylitis _____ L50.5
_____ M07.3*
† †
Tuberculosis of spine 015.0 A18.0
730.4* M49.0*
Pain in limb 729.5 M79.6
Leucoplakia of cervix uteri 622.2 N88.0
Secondary dysmenorrhoea _____ N94.5
Ovarian pregnancy 633.2 O00.2
Severe pre-eclampsia _____ O14.1
Low weight gain in pregnancy _____ O26.1
Spontaneous Vertex Delivery 650.0 O80.0
Congenital pneumonia due to staphylococcus _____ P23.2
Umbilical polyp of new born _____ P83.6
Occipital encephalocele _____ Q01.2
Stenosis of aorta (congenital) 746.3 Q25.3
Pes Cavus (congenital) 754.7 Q66.7
Triploidy & Polyploidy _____ Q92.7
Sneezing 786.9 R06.7
Aphonia 784.4 R49.1

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Biliuria 791.4 R82.2

Traumatic amputation of ear 872.8 S08.1
Fracture of pubis 808.2 S32.5
Multiple open wounds of wrist & hand _____ S61.7
Contusion of thigh 924.0 S70.1
Foreign body in cornea 930.0 T15.0
Burns involving 50 – 59% of body surface 948.5 T31.5
Poisoning by Cocaine 968.5 J40.5
Traumatic ischaemia of muscle _____ T79.6
Occupant of 3-wheeled motor vehicle injured in collision with E813 V33
car
Helicopter accident injuring occupant E841 V95.0
Person on ground injured in air transport accident E821 V97.3
Bitten by dog E906.0 W54
Drowning & Submersion following fall into swimming pool E910.8 W68
Victim of earth quake E909 X34
Victim of flood E908 X38
Sexual assault by bodily force E960.1 Y05
Legal execution E978 Y35.5
Sterilization V25.2 Z30.2

Self Assessment Questions

6. The chapters are subdivided into homogenous –––––––––––– of three-
character categories.
7. The definitions on of volume 1 are included to facilitate the ––––––––.

3.5 ICD-10 UPDATES – 1999

The following pages include changes to the tabular list and to all three parts
of the alphabetical index for ICD-10.
Changes which were approved at the 1996 meeting of the Heads of WHO
Collaborating Centers for the Classification of Diseases but which have not
yet been officially released are annotated with the year 1996.
The remainder of the changes was approved at the 1997 meeting of Heads
of WHO Collaborating Centres and has been annotated with the year 1997.

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Changes, which apply to corrections, only (particularly for Volumes 2 and 3)

may be taken into effect immediately. The tabular list (Volume 1) changes
and their associated index entries should not come into effect until the
beginning of 1999 (i.e. for 1999 data).
Relevant changes in other language versions of ICD-10 and in related tools
will also have to be made and disseminated by the appropriate authority.
Volume 1: Tabular List
YEAR
TABULAR LIST ENTRIES COMMENT
APPROVED
A81 Atypical virus infections of central Modify title 1997
nervous system
Includes: prion diseases of the Add inclusion note 1997
central nervous system
A81.8 Other atypical virus infections of
central nervous system Modify title 1997
Kuru
A81.9 Atypical virus infection of central Modify title 1997
nervous system, unspecified Prion
disease of central nervous system
NOS Add inclusion term 1997
Slow virus infection NOS Delete inclusion term 1997

B60 Other protozoal diseases, not Add exclusion term 1997

elsewhere classified
Excludes: cryptosporidiosis (A07.2)
intestinal micro-sporidiosis (A07.8)
isosporiasis (A07.3)
E16.4 Abnormal secretion of gastrin Add sub-category 1997
Hypergastrinaemia Add inclusion terms 1997
Zollinger-Ellison syndrome
E16.8 Other specified disorders of
pancreatic internal secretion
Hypergastrinaemia Delete subterm 1997
… Delete subterm 1997
Zollinger-Ellison syndrome

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YEAR
TABULAR LIST ENTRIES COMMENT
APPROVED
F06.3 Organic mood [affective] disorders
Disorders characterized by a change
in mood or affect, usually
accompanied by a change in the
overall level of activity, depressive, Modify code range 1997
hypomanic, manic or bipolar (see
F30-F38), but arising as a
consequence of an organic disorder.
F31 Bipolar affective disorder
A disorder characterized by two or
more episodes in which the

are significantly disturbed, this

disturbance consisting on some
occasions of an elevation of mood Delete code 1997
and increased energy and activity reference
(hypomania or mania) and on others
of a lowering of mood and decreased
energy and activity (depression).
Repeated episodes of hypomania or
mania only are classified as bipolar
(F31.8)
F31.8 Other bipolar affective disorders
Bipolar II disorder Modify inclusion term 1997
Recurrent manic episodes NOS
F45.0 Somatization disorder
... Add inclusion term 1997

Multiple psychosomatic disorder

F48.8 Other specified neurotic disorders
Delete inclusion term 1997
Dhat syndrome

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YEAR
TABULAR LIST ENTRIES COMMENT
APPROVED
H50.2 Vertical strabismus
Hypertropia Add inclusion terms 1997
Hypotropia
H50.4 Other and unspecified heterotropia
Concomitant strabismus NOS
Cyclotropia
Hypertropia Delete inclusion 1997
Hypotropia terms
Microtropia
Monofixation syndrome
J34.1 Cyst and mucocele of nose and
nasal sinus Modify title 1997
K31.7 Polyp of stomach and duodenum Add subcategory 1997
Excludes: adenomatous polyp of Add exclusion note 1997
stomach (D13.1)
K63.5 Polyp of colon
Excludes: adenomatous polyp of Add subcategory 1997
colon (D12.6) Add exclusion notes 1997
polyposis of colon (D12.6)
K75.4 Autoimmune hepatitis Add subcategory 1997
Q15.0 Congenital glaucoma
Buphthalmos
Glaucoma of newborn
Hydrophthalmos
Keratoglobus, congenital, with
glaucoma Modify inclusion term 1997
Macrocornea with glaucoma Add inclusion term 1997
Macrophthalmos in congenital
glaucoma Modify inclusion term 1997
Megalocornea with glaucoma
Q35.0 Cleft hard palate, bilateral Delete code & title 1997
Q35.1 Cleft hard palate, unilateral Modify title 1997
Cleft hard palate NOS Delete inclusion term 1997
Q35.2 Cleft soft palate, bilateral Delete code & title 1997

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International Classification of Diseases & Coding Unit 3

YEAR
TABULAR LIST ENTRIES COMMENT
APPROVED
Q35.3 Cleft soft palate, unilateral Modify title 1997
Cleft soft palate NOS Delete inclusion term 1997
Q35.4 Cleft hard palate with cleft soft Delete code & title 1997
palate, bilateral
Q35.5 Cleft hard palate with cleft soft Modify title 1997
palate, unilateral
Cleft hard palate with cleft soft Delete inclusion term 1997
palate NOS
Q35.8 Cleft palate, unspecified, bilateral Delete code & title 1997
Q35.9 Cleft palate, unspecified, Modify title 1997
unilateral
Q37.0 Cleft hard palate with bilateral Modify title 1997
cleft lip
Q37.1 Cleft hard palate with unilateral Modify title 1997
cleft lip
Cleft hard palate with cleft lip NOS
Q37.2 Cleft soft palate with bilateral Modify title 1997
cleft lip
Q37.3 Cleft soft palate with unilateral Modify title 1997
cleft lip
Cleft soft palate with cleft lip NOS
Q37.4 Cleft hard and soft palate with Modify title 1997
bilateral cleft lip
Q37.5 Cleft hard and soft palate with Modify title 1997
unilateral cleft lip
Cleft hard and soft palate with cleft
lip NOS
Q37.8 Unspecified cleft palate with Modify title 1997
bilateral cleft lip
Q37.9 Unspecified cleft palate with Modify title 1997
unilateral cleft lip
Cleft palate with cleft lip NOS
Q75.4 Mandibulofacial dysostosis Add inclusion terms 1997
Syndrome:
Franceschetti
Treacher Collins

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International Classification of Diseases & Coding Unit 3

YEAR
TABULAR LIST ENTRIES COMMENT
APPROVED
Q87.0 Congenital malformation
syndromes predominantly
affecting facial appearance
...
Syndrome:
...

Delete inclusion term 1997

Whistling face
S37 Injury of urinary and pelvic Modify title 1997
organs
Z52.6 Liver donor Add subcategory 1997
Z52.7 Heart donor Add subcategory 1997

Volume 2
Additions are necessary in two sections. These are indicated in bold and
underlined below.
Categories with common characteristics
Categories limited to one sex
The following categories apply only to females:
A34, B37.3, C51-C58, C79.6, D06.-, D07.0-D07.3, D25-D28, D39.-, E28.-,
E89.4, F52.5, F53.-, I86.3, L29.2, L70.5, M80.0-M80.1, M81.0-M81.1,
M83.0, N70-N98, N99.2-N99.3, O00-O99, P54.6, Q50-Q52, R87, S31.4,
S37.4-S37.6, T19.2-T19.3, T83.3, Y76.-, Z01.4, Z12.4, Z30.1, Z30.3, Z30.5,
Z31.1, Z31.2, Z32-Z36, Z39.-, Z43.7, Z87.5, Z97.5.
Chapter-specific notes
Chapter VIII: Diseases of the ear and mastoid process
H90-H91 Hearing loss

condition@ if the cause is recorded, unless the episode of care was mainly
for the hearing loss itself. When coding to the cause, H90.- or H91.- may be
used as an optional additional code.

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Volume 3
Alphabetical Index to Diseases and Nature of Injury
YEAR
INDEX ENTRIES COMMENTS
APPROVED
Abnormal, abnormality,
abnormalities - see also Anomaly
- apertures, congenital, diaphragm Q79.1
- heart
- - rate NEC R00.8 Modify code 1997
- secretion
- - gastrin E16.4 Modify subterm & 1997
code
Modify code 1997
Absence (organ or part) (complete
or partial)
- artery (congenital) (peripheral) Q27.8 Modify code 1997
- vein (peripheral), congenital Q27.8 Modify code 1997
Abuse Modify subterm & 1996
- child NEC T74.9 code 1966
- - specified NEC T74.8 Add subterm &
code
Acanthosis (acquired) (nigricans)
L83 Modify code 1996
- tongue K14.3
Accessory (congenital) Modify code 1997
- bone NEC Q79.8 Modify code 1997
- vagina Q52.1
Agenesis Modify subterm 1996
- artery (peripheral) NEC Q27.9 Add subterm & 1996
- - specified NEC Q27.8 code

Angina (attack) (cardiac) (chest) Modify code 1997

(heart) (pectoris) (syndrome)
(vasomotor)
- decubitus I20.0

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Ankylosis (fibrous) (osseous) (joint) Delete modifier & 1997
M24.6 modify code
- spine (spondylitic) M43.2 Delete subterm & 1997
- - rheumatoid M45 code 1997
- - specified NEC M43.2 Delete subterm &
code
Anomaly, anomalous (congenital)
(unspecified type) Q89.9
- nasal sinus (wall) Q30.9 Modify code 1997
- reduction (extremity) (limb)
- - upper limb Q71.9 Modify code 1997
Appendage
- testicular (organ of Morgagni) Q55.4 Modify code 1997
Appendix, appendicular - see also condition
- Morgagni
- - male Q55.4
- testis Q55.4 Modify code 1997
Modify code 1997
Arthropathy (see also Arthritis)
M13.9
- in (due to)
- - neoplastic disease NEC (M8000/1) Modify morphology 1997
(see also code
Ascites (abdominal) (malignant) Delete modifier 1996
R18
- malignant C78.6 Add subterm & 1996
code
Aspergillosis, aspergilloma B44.9
- with pneumonia B44.- Indent subterm 1997
Asphyxia, asphyxiation R09.0
- mucus (in) T17.9 Delete code 1997
- newborn P21.9 P24.1
Bacteremia A49.9 Modify code 1996

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Modify code 1997
F45.0
Burn (electricity) (flame) (hot gas,
liquid or object) (radiation) Delete instruction & 1997
(steam) (thermal) T30.0 insert code
- scrotum - code as Burn, by site, with
fourth character .2 T21.-
Bursitis M71.9
- 0 Modify code 1997
Calculus, calculi, calculous Add subterm & 1997
- xanthine E79.8 N22.8* code

Change(s) (of) - see also Removal

- hypertrophic
- - nasal sinus (see also Sinusitis)
J34.8 Delete cross- 1997
- inflammatory - see also reference
Inflammation & modify code
- - sacroiliac M46.1 1997
- personality (enduring) (see also Modify code
Personality, change) F62.9 Modify code 1997
Chorea (gravis) (minor) (spasmodic) Delete modifier 1997
G25.5
- minor I02.9 Add subterm & 1997
- - with heart involvement I02.0 code 1997
Add subterm &
code
Cirrhosis, cirrhotic (hepatic) K74.6 Delete modifier & 1997
- obstructive (biliary) K74.4 - see code, add cross-
reference
Cirrhosis, biliary

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Cleft (congenital) - see also Delete modifier 1997
Imperfect, closure Add modifier 1997
- palate (unilateral) Q35.9 Add subterm & 1997
- - with cleft lip (unilateral) Q37.9 code 1997
- - - bilateral Q37.8 Delete subterm & 1997
code
- - bilateral Q35.8 1997
Delete subterm &
- - - with cleft lip Q37.8
code
- - hard (unilateral) Q35.1 1997
Delete modifier
- - - with cleft 1997
- - - - lip (unilateral) Q37.1
Add modifier
- - - - - bilateral Q37.0 1997
Add subterm &
- - - - soft palate Q35.5 code
- - - - - with cleft lip (unilateral) 1997
Q37.5 Add modifier 1997
- - - - - - bilateral Q37.4 Add subterm & 1997
- - - bilateral Q35.0 code 1997
- - - - with cleft Delete subterm & 1997
- - - - - lip Q37.0 code 1997
- - - - - soft palate Q35.4 Delete subterm 1997
- - - - - - with cleft lip Q37.4 Delete subterm &
code
- - - - - - bilateral Q35.4 1997
Delete subterm &
- - medial Q35.6
code
- - soft (unilateral) Q35.3
Delete subterm &
- - - with cleft code 1997
- - - - hard palate Q35.5 Delete subterm &
- - - - - with cleft lip (unilateral) code
Q37.5 Delete modifier 1997
- - - - - - bilateral Q37.4 Add modifier 1997
- - - - lip (unilateral) Q37.3 Add modifer 1997
- - - - - bilateral Q37.2 Add subterm & 1997
- - - bilateral Q35.2 code 1997
- - - - with cleft Delete subterm & 1997
code
- - - - - hard palate Q35.4 1997
Delete subterm &
- - - - - - with cleft lip Q37.4 code
Delete subterm &
code
Delete subterm &
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code
International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Clot (blood) - see also Embolism Add cross- 1997
reference
Complications (from) (of)
- pancreas transplant, failure or
rejection (immune or nonimmune Modify code 1997
cause) T86.8
Compression
- umbilical cord Modify code 1996
- - complicating delivery O69.2
Constriction - see also Stricture Add cross- 1997
reference
Convulsions (idiopathic) (see also Add cross- 1997
Seizure(s)) R56.8 reference

Crush, crushed, crushing T14.7

- hip S77.0
- - with thigh S77.2 Modify code 1996
- thigh S77.1
- - with hip S77.2 Modify code 1996
Cyst (colloid) (mucous) (retention)
(simple)
- implantation (dermoid)
- - vulva N90.7 Modify code 1997
- paramesonephric duct Q50.4 Modify code 1997
- skin (epidermal) (epidermoid) Delete modifiers 1996
(epithelial) (inclusion) L72.9 Delete modifiers 1996
- - epidermal, epidermoid L72.0 Add subterm & 1996
- - epithelial L72.0 code 1996
- - inclusion L72.0 Add subterm & 1996
code
- - scrotum L72.9 1996
Add subterm &
- turbinate (nose) J34.1 code
Modify code
Modify code

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Deafness (acquired) (complete) Modify code 1997
(hereditary) (partial) H91.9 Modify code 1997
- high frequency H91.9
- low frequency H91.9
Delivery (single) O80.9 Modify code 1997
- cesarean (for) O82.9
- - distress Modify code 1997
- - - fetal O36.3 Modify code 1997
- - fetus, fetal
- - - distress O36.3
- - meconium in liquor O36.3 Modify code 1996
- complicated (by)
- - compression of cord (umbilical)
NEC O69.2
Dermatomegaly NEC Q82.8 Modify code 1997
Destruction, destructive - see also Add cross- 1997
Damage reference

Detachment
- meniscus (knee) (due to) M23.3 Modify subterm 1997
- - old tear or injury M23.2
Deuteranomaly (anomalous Add modifier 1997
trichromat) H53.5
Deuteranopia (anomalous trichromat) Delete modifier 1997
(complete) (incomplete)
H53.5

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Disease, diseased - see also
Syndrome
- artery I77.9 Add subterm & 1997
- - coronary I25.1 code 1997
- prion, central nervous system Add subterm &
code
A81.9 1997
- - specified NEC A81.8 1997
Add subterm &
- trophoblastic (M9100/0) (see also code
Mole, hydatidiform) O01.9 Add morphology
code
Disorder (of) - see also Disease
- ear, postprocedural H95.9
- - specified NEC H95.8 Modify code 1996
- female
- - hypoactive sexual desire F52.0 Modify code 1997
- - orgasmic F52.3 Modify code 1997
- - sexual arousal F52.2 Modify code 1997
- male
- - hypoactive sexual desire F52.0 Modify code 1997
- - orgasmic F52.3 Modify code 1997
Distress
- fetal (syndrome) P20.-
- - affecting
- - - management of pregnancy
(unrelated to labor or delivery)
O36.3 Modify code 1996
Disturbance - see also Disease Modify code 1997
- stomach (functional) K31.9
Diverticula, diverticulitis,
diverticulosis, diverticulum
(acute) (multiple) K57.9
- ileum (see also Diverticula, intestine,
small) K57.1 Add code 1997

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Donor (organ or tissue) Z52.9
- heart Z52.7 Add subterm & 1997
- liver Z52.6 code 1997
Add subterm &
code
Ectromelia Q73.8 Modify code 1997
- upper limb Q71.9
Eczema (acute) (chronic)
(erythematous) (fissum) (rubrum)
(squamous) (see also Dermatitis)
L30.9
- infantile (due to any substance)
(intertriginous) (seborrheic) L20.8 Delete modifiers 1997
- - intertriginous L21.1 Add subterm & 1997
- - seborrheic L21.1 code 1997
Add subterm &
code
Effusion
- pleura, pleurisy, pleuritic,
pleuropericardial J90
- - malignant C78.2 Add subterm & 1996
code
Embolism (septic) I74.9
- cerebral (see also Occlusion, artery Modify cross- 1997
cerebral) I66.9 reference
- intracranial (see also Occlusion, 1997
artery cerebral) I66.9 Modify cross-
reference
- vessels of brain (see also Occlusion, 1997
artery cerebral) I66.9
Modify cross-
reference

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Enteritis (acute) (diarrheal)
(epidemic) (hemorrhagic)
(presumed infectious) (septic) (see
also Note at category A09) A09
- microsporidial A07.8 Add subterm & 1997
code
Error, refractive H52.7 Modify lead term 1997
- metabolism, inborn - see Disorder, Add subterm & 1997
metabolism cross- reference
- refractive H52.7 Add subterm & 1997
code
Exsanguination, fetal P50.9 - see Delete modifier & 1997
Hemorrhage code, add cross-
reference
Failure, failed
- biventricular I50.0 Modify code 1997
Fever R50.9
- herpetic (see also Herpes) B00.1 Delete cross- 1997
reference & modify
code
- persistent (of unknown origin) R50.1 1996
Modify code
Fibrillation
- cardiac I49.8 Modify code 1997
- heart I49.8 Modify code 1997
Freiberg’s disease (infarction of Modify modifier 1997
metatarsal head or
osteochondrosis) M92.7
Gangrene, gangrenous (dry) (moist)
(skin) (ulcer) (see also Necrosis) Add cross- 1997
R02 reference
- 8 1996
Modify code
Glomerulonephritis (see also Add cross- 1997
Nephritis) N05.- reference

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Grand mal
- epilepsy (idiopathic) G40.6 Modify code 1996
- - on awakening G40.3 Add subterm & 1997
code
Gubler-Millard paralysis or
syndrome I67.9 Modify code 1997
Hellp syndrome O14.1 Modify code 1997
Hematobilia K83.8 Add lead term & 1997
code
Hemorrhage, hemorrhagic R58
- renal N28.8 Modify code 1997
Hepatitis K75.9
- autoimmune K75.4 Add subterm & 1997
code
Hepatomegaly (see also Hypertrophy,
liver) R16.0
- congenital Q44.7 Add subterm & 1997
code
Hernia, hernial (acquired)
(recurrent) K46.9
- obturator - see Hernia, abdomen,
specified site NEC
- - congenital Q40.1 Delete subterm & 1997
code
Hollow foot (congenital) Q66.7 Modify code 1997
Human
- immunodeficiency virus (HIV)
disease (infection) B24
-- Add subterm & 1997
code
Hydatid
-
- - male Q55.4 Modify code 1996

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Hydatidiform mole (benign)
(complicating pregnancy)
(delivered) (undelivered)
(M9100/0) (see also Mole, Add morphology 1997
hydatidiform) O01.9 code
- classical (M9100/0) O01.0 Add morphology 1997
code
- complete (M9100/0) O01.0 1997
Add morphology
- partial (M9103/0) O01.1 code 1997
Add morphology
code
Hydromphalos (since birth) Q45.8 Modify code 1997
Hypergastrinemia E16.4 Modify code 1997
Hyperglycemia, hyperglycemic
R73.9
- coma - code to E10-E14 with fourth Modify code
character .0 1996
Hypertension, hypertensive
(accelerated) (benign) (essential)
(idiopathic) (malignant) (primary)
(systemic) I10
- complicating pregnancy, childbirth
or puerperium O16
- - with
- - - edema (mild) (see also Pre- Delete modifier 1997
eclampsia) O14.9 Add code 1997
- kidney I12.9
- - with
- - - renal failure I12.0 Modify code 1996
Hypertropia H50.2 Modify code 1997
Hypotropia H50.2 Modify code 1997
Hypoxia - see also Anoxia Add cross- 1997
reference

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Infection, infected (opportunistic)
B99 Modify subterm
- Drechslera (hawaiiensis) B43.8 Add subterm & 1997
- prion - see Disease, prion, central cross- 1997
nervous system reference
- virus NEC B34.9
- - central nervous system A89
- - - atypical A81.9 Add subterm & 1997
code
- - - - specified NEC A81.8 1997
Add subterm &
- yeast (see also Candidiasis) B37.9 code 1997
Add subterm,
cross-reference &
code
Insanity, insane (see also condition) Modify cross- 1997
F99 reference
& add code
Insufficiency, insufficient Add modifier 1997
- lacrimal (secretion) H04.1 Add subterm & 1997
- - passages H04.5 code

Irideremia Q13.1 Modify code 1997

Ischemia, ischemic I99
- myocardium, myocardial (chronic or
with a stated duration of over 4
weeks) I25.9 Modify code 1997

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Jaundice (yellow) R17
- malignant (see also Failure, Add subterm & 1997
hepatic) K72.9 code
- nonhemolytic congenital familial 1997
(Gilbert) E80.4 Add subterm &
code
- nuclear, newborn (see also 1997
Kernicterus of newborn) P57.9
Add subterm,
- obstructive (see also Obstruction, cross- 1997
bile duct) K83.1 reference & code
- post-immunization - see Hepatitis, Add subterm, 1997
viral, type, B cross-
- post-transfusion - see Hepatitis, reference & code 1997
viral, type, B Add subterm &
- regurgitation (see also cross-reference 1997
Obstruction, bile duct) K83.1 Add subterm &
cross-reference
- serum (homologous) 1997
Add subterm &
(prophylactic) (therapeutic) - see cross-reference
Hepatitis, viral, type, B Add subterm &
- spirochetal (hemorrhagic) A27.0 cross-reference 1997

Add subterm &

code
Keratitis (nonulcerative) H16.9
- rosacea L71.8 Modify code 1997
Keratoglobus H18.7
- congenital Q15.8 Modify code 1997
- - with glaucoma Q15.0 Add subterm and 1997
code
Knock knee (acquired) M21.0
- congenital Q74.1 Modify code 1997

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Labor (see also Delivery)
- obstructed O66.9
- - by or due to
- - - abnormal
- - - - presentation or position O64.9 Modify subterm 1997
- - - contracted pelvis (general) O65.1
- - - - inlet O65.2
- - - - mid-cavity O65.3 Modify code 1997
- - - - outlet (mid-cavity) O65.3 Delete modifier 1997
Laceration (see also Wound, open)
T14.1
- chordae tendineae NEC I51.1 Modify subterm 1997
- - concurrent with acute Add subterm & 1997
myocardial infarction - see cross-
Infarct, myocardium reference
- - following acute myocardial 1997
infarction (current complication) Add subterm &
code
I23.4
Lithemia E79.0 Modify code 1997
Macrocornea Q15.8 Modify code 1997
- with glaucoma Q15.0 Add subterm & 1997
code

- disease L81.7 Modify code 1997

Megalocornea Q15.8 Modify code 1997
- with glaucoma Q15.0 Add subterm & 1997
code
Melanoma (malignant) (M8720/3)
C43.9
- site classification
- - elbow C43.6 Add subterm & 1997
code
Metastasis, metastatic
- calcification E83.5 Modify code 1997

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Microsporidiosis B60.8
- intestinal A07.8 Add subterm & 1997
code
Molar pregnancy NEC (M9100/0) Add morphology 1997
O01.9 code

Mole (pigmented) (M8720/0) – see

also Nevus
- hydatid, hydatidiform (benign)
(complicating pregnancy) (delivered)
(undelivered) (M9100/0) O01.9 Add morphology
- - classical (M9100/0) O01.0 code 1997
- - complete (M9100/0) O01.0 Add morphology 1997
code
- - incomplete (M9103/0) O01.1 1997
Add morphology
- - partial (M9103/0) O01.1 code 1997
- vesicular M9100/0) (see also Mole, Add morphology 1997
hydatidiform) O01.9 code 1997
Add morphology
code
Add morphology
code
Monochromat(ism),
monochromatopsia (acquired)
(congenital) H53.5 Modify code 1997
Mucocele
- lacrimal sac H04.4 Modify code 1996
Myelitis (acute) (ascending) (see also Add cross- 1997
Encephalitis) G04.9 reference

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Necrosis, necrotic (ischemic) (see
also Gangrene) R02 Add cross-
- bone (see also Osteonecrosis) reference 1997
M87.9
- - acute M87.8 Delete subterm 1997
and code
- hip, aseptic or avascular (see also 1997
Add cross-
Osteonecrosis) M87.9 reference & modify
- subendocardial (acute) I21.4 code
- - chronic I25.8 Modify code 1997
Neoplasm, neoplastic
- appendix C18.1 - C78.5 - D01.0
- D12.1 - D37.3 Modify code 1996
Neurofibromatosis (multiple)
(nonmalignant) (M9540/1) Q85.0 Add morphology 1997
code
Neuropathy, neuropathic (see also Delete cross- 1997
Disorder, nerve) G62.9 reference & modify
code
Nodule(s), nodular
- thyroid (gland) E04.1 Modify code 1996
Occlusion, occluded
- artery - see also Embolism, artery Modify code 1997
- - brain or cerebral I66.9 Add subterm & 1997
- - - with infarction (due to) I63.5 code 1997
- - - - embolism I63.4 Add subterm & 1997
code
- - - - thrombosis I63.3
Add subterm &
- - cerebral I66.9 code
- - - anterior I66.1
- - - - with infarction (due to) I63.5
- - - - - embolism I63.4 1997
- - - - - thrombosis I63.3 Modify code

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Ossification
- ligament M67.8 Add code 1997
- - posterior longitudinal M48.8 Add subterm & 1997
code
Osteoarthritis (see also Arthrosis)
M19.9
- interphalangeal (Bouchard, Delete modifiers & 1997
Heberden) M15.2 code
- - distal (Heberden) M15.1 Add subterm & 1997
- - proximal (Bouchard) M15.2 code 1997
Add subterm &
code
Osteopathia condensans
disseminata Q78.8 Modify code 1997
Panmyelosis (acute) (M9931/3) Modify morphology 1997
C94.4 code

Paralysis, paralytic (complete)

(incomplete) (see also Paresis) Add cross- 1997
G83.9 reference
- 9 1997
- Millard-Gubler-Foville I67.9 Modify code 1997
G46.3* Modify code
- nerve - see also Disorder, nerve
- - radial G56.3 1997
- radial nerve G56.3 Modify code 1997
- 9 Modify code 1997
Modify code
Parathyroid tetany E20.9 Modify code 1996
Perforation, perforated (non-
traumatic)
- palate (hard) (see also Cleft, palate) Delete modifier 1997
Q35.9
- palatine vault (see also Cleft, palate,
hard) Q35.1 Modify code 1997

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International Classification of Diseases & Coding Unit 3

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Periarthritis (joint) M77.9
- Duplay 0 Modify code 1997
Perlèche NEC (due to) K13.0
- candidiasis B37.8 Modify code 1996
- moniliasis B37.8 Modify code 1996
Placenta, placental (see also
condition)
- marginal sinus (hemorrhage)
(rupture) O44.1 Add code 1997
Pneumonia (acute) (double)
(migratory) (purulent) (septic)
(unresolved) J18.9
- lobe - see Pneumonia, lobar Delete subterm 1997
Polyp, polypus Delete morphology
- colon (M8210/0) (see also Polyp, code & cross- 1997
adenomatous) K63.5 reference &
modify code
- duodenum K31.7 Add subterm & 1997
- stomach (M8210/0) K31.7 code 1997
Delete morphology
code & modify
code
Positive
- serology for syphilis A53.0 Modify subterm & 1997
add code
- - false R76.2
- - syphilis A53.0 Delete subterm & 1997
code
- - with signs or symptoms - code as 1997
Modify indentation
Syphilis, by site and stage
level

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Pregnancy (single) (uterine)
- complicated by
- - hemorrhage NEC
- - - antepartum (see also Hemorrhage,
antepartum) O46.9 Modify code 1996
- - onset of contractions before 37
weeks O60 Add code 1997
- - hydatidiform mole (M9100/0) (see Add morphology 1997
also Mole, hydatidiform) O01.9 code
- management affected by
- - fetal (suspected)
- - - abnormality or damage
- - - - acid-base balance O36.3 1997
- - - - heart rate or rhythm O36.3 Modify code 1997
- - - acidemia O36.3 Modify code 1997
- - - bradycardia O36.3 Modify code 1997
- - - distress O36.3 Modify code 1997
- - meconium in liquor O36.3 Modify code 1997
- molar NEC O02.0 Modify code
- - hydatidiform (M9100/0) (see also 1997
Mole, hydatidiform) O01.9 Add morphology
code
Premature - see also condition Add subterm &
- newborn - see Prematurity cross-reference 1997
Presentation, fetal
- transverse (mother) O32.2
- - causing obstructed labor O64.8 Modify code 1996
Protanomaly (anomalous Add modifier 1997
trichromat) H53.5
Protanopia (anomalous trichromat) Delete modifier 1997
(complete) (incomplete) H53.5
Pseudochromhidrosis L67.8 Modify lead term 1997

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Puberty (development state) Z00.3
- precocious (central) E30.1 Modify subterm 1996
- - central E22.8 Add subterm and 1996
code
Purpura D69.2
- annularis telangiectodes L81.7 Modify code 1997
Pyrexia (of unknown origin) R50.9
- persistent R50.1 Modify code 1996
Recklinghausen’s disease (M9540/1) Add morphology 1997
Q85.0 code

Retention, retained
- products of conception
- - following
- - - delivery (with hemorrhage) O72.2
- - - - without hemorrhage O73.1 Modify indentation 1997
level
Reticulosis (skin)
- polymorphic (M9713/3) C85.7 Modify morphology 1997
code
Rickets (active) (acute) (adolescent)
(adult) (chest wall) (congenital) Delete modifier 1997
(current) (infantile) (intestinal)
E55.0
Ring(s)
- 0 Modify code 1996
Rupture, ruptured
- myocardium, myocardial (see also
Infarct, myocardium) I21.9 Modify code 1997
- uterus (traumatic) S37.6
- - during or after labor O71.1
- - - affecting fetus or newborn
P03.8 Delete symbol & 1996
code

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Schwannoma (M9560/0) - see also
Neoplasm, nerve, benign
- melanocytic (M9560/0) – see Modify morphology 1996
Neoplasm, nerve, benign code
Seizure(s) (see also Convulsions) Add cross- 1997
R56.8 reference

Spina bifida (aperta) Q05.9

- with hydrocephalus NEC Q05.4 Modify subterm 1997
Spondylosis M47.9
- with
- - compression (of) Add subterm 1997
- - - nerve root or plexus M47.- Add subterm & 1997
G55.2* codes
- - myelopathy NEC M47.- 99.2* Modify code 1997
Spoon nail L60.3 Modify code 1996
Sprain, strain (joint) (ligament)
T14.3
- teres Delete subterm 1997
Stress
- reaction (acute) (see also Reaction, Delete modifier, 1997
stress) F43.9 add cross-
reference &
modify code
Stricture (see also Stenosis) R68.8 Add cross- 1997
reference
Strongyloidiasis, strongyloidosis
B78.9
- intestinal B78.0 Delete symbol & 1997
code
Supernumerary (congenital) Modify code 1997
- bone Q79.8
Syndactylism, syndactyly Q70.9
- fingers (without synostosis) Q70.1 Modify code 1996
- toes (without synostosis) Q70.3 Modify code 1996

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Syndrome - see also Disease
- anticardiolipin D68.8 Add subterm & 1997
- antiphospholipid (-antibody) code 1997
D68.8 Add subterm &
code
- hyponatremic E87.1 1997
- salt
Add subterm &
- - low E87.1 code 1997

Modify code
Syphilis, syphilitic (acquired) A53.9
- neuritis
- - acoustic A52.1 H94.0* Modify code 1996
- 2.0* Modify code 1997
Tear, torn (traumatic) - see also
Wound, open
- cartilage - see alsoSprain
- - articular, old M24.1
- cervix Add subterm 1996
- - obstetrical trauma (current) O71.3
- - old N88.1
- - traumatic S37.6
- pelvic
- - complicating delivery Delete subterm 1997
Thickening
- nail L60.2 Modify code 1996
Transection, trunk (abdomen)
(thorax) T05.8 Modify code 1996
Transverse - see also condition
- lie (mother) O32.2
- - causing obstructed labor O64.8 Modify code 1997
Treacher Collins syndrome Q75.4 Modify code 1997
Trophoblastic disease (M9100/0) Add morphology 1997
(see also Mole, hydatidiform) O01.9 code

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YEAR
INDEX ENTRIES COMMENTS
APPROVED
Ulcer, ulcerated, ulcerating,
ulceration, ulcerative L98.4
- stomach (eroded) (peptic) (round)
K25.9
- - chronic K25.7
- - - with
- - - - hemorrhage K25.4
- - - - - and perforation K25.6
- - - - and perforation K25.1 Modify subterm 1996
Ventriculitis (cerebral) (see also Add cross- 1997
Encephalitis) G04.9 reference

Von Recklinghausen’s
- disease (neurofibromatosis)
(M9540/1) Q85.0
- - bones E21.0 Add morphology 1997
code
Zollinger-Ellison syndrome E16.4 Modify code 1997

EXTERNAL CAUSES OF INJURY

YEAR
INDEX ENTRIES COMMENTS
APPROVED
Exposure (to)
- fire (accidental) (with exposure to smoke
or fumes or causing burns, or secondary
explosion) X09.-
- - in, of, on, starting in
- - - transport vehicle NEC (see also Modify cross-
Accident, transport, occupant, by reference & 1997
type of vehicle) V87.8 code

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TABLE OF DRUGS AND CHEMICALS

INDEX ENTRIES (modifications are indicated in bold or strikeout) YEAR
Substance
Benzhydramine T45.0 X44.- X64.- Y14.- Y43.0 1997
(chloride)
Benzphetamine T50.5 X44.- X64.- Y14.- Y57.0 1997
Binitrobenzol T65.3 X46.- X66.- Y16.- 1997
Calcium
- hypochlorite T37.8 X44.- X64.- Y14.0 Y41.8 1997
Carbaril T60.0 X48.- X68.- Y18.- Y56.0 1997
Chloramine (-T) T49.8 X44.- X64.- Y14.- Y56.8 1997
Chlorobutanol T42.6 X41.- X61.- Y11.- Y47.2 1997
Cleaner, cleansing agent T52.9 X49.- X69.- Y19.- 1997
NEC T52.9 X46.- X66.- Y16.-
- of paint or varnish
Ethyl
- carbamate T45.1 X44.- X64.- Y14.- Y43.3 1997
- carbinol T51.3 X45.- X65.- Y15.- Y43.3 1997
Fenylbutazone T39.2 X40.- X60.- Y10.- Y45.3 1997
Glutaraldehyde T65.8 X49.- X69.- Y19.-
(nonmedicinal) T49.0 X44.- X64.- Y14.- Y56.0 1997
- medicinal
Hydroxyamfetamine T49.5 X44.- X64.- Y14.- Y56.5 1997
Lead T56.0 X49.- X69.- Y19.-
(dust)(fumes)(vapour)
NEC T56.0 X46.- X66.- Y16.- 1997
- alkyl (fuel additive)
Levomepromazine T43.3 X41.- X61.- Y11.- Y49.3 1997
8-Methoxypsoralen T50.9 X44.- X64.- Y14.- Y57.8 1997
(8-MOP)
Parathion T60.0 X48.- X68.- Y18.- Y56.0 1997
Phenylbutazone T39.2 X40.- X60.- Y10.0 Y45.3 1997
Prussian blue
- therapeutic T50.6 X44.- X64.- Y14.- Y57.2 1997
Prussic acid T57.3 X48.- X68.- Y18.- 1997
Trichloroethylene T41.0 X44.- X64.- Y14.- Y48.0 1997

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3.6 Summary
 Although the ICD is suitable for many different applications, it does not
always allow the inclusion of sufficient detail for some specialties, and
sometimes information on different attributes of the classified conditions
may be needed. It has also been suggested that the lCD should include
classifications of additional information related to health status or health
care.
 The "core" classification of ICD-10 is the three-character code, which is
the mandatory level of coding for international reporting to the WHO
mortality database and for general international comparisons. The four-
character subcategories, while not mandatory for reporting at the
international level are recommended for many purposes and form an
integral part of the lCD,
 There are two main types of classification. Those in the first group cover
data related to diagnoses and health status, and are derived directly
from the ICD by either condensation or expansion of the tabular list. The
second group of classifications covers aspects related to health
problems generally outside the formal diagnoses of current conditions,
as well as other classifications related to health care.
 Specialty-based adaptations usually bring together in a single, compact
volume the sections or categories of the ICD that are relevant to a
particular specialty. The four-character subcategories of the ICD are
retained, but more detail is often given by means of fifth-character or
sometimes sixth character subdivisions, and there is an alphabetical
index of relevant terms.
 The principal objective of the IND is to provide, for each morbid entity, a
single recommended name. The main criteria for selection of this name
are, that it should be specific (applicable to one and only one disease),
unambiguous, as self-descriptive as possible, as simple as possible, and
(whenever feasible) based on cause.
 lCD-10 comprises three volumes: Volume 1 contains the main
classifications; Volume 2 provides guidance to users of the ICD; and
Volume 3 is the Alphabetical Index to the classification.
 Each chapter contains sufficient three-character categories to cover its
content; not all available codes are used, allowing space for future
revision and expansion.

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 Although not mandatory for reporting at the international level, most of

the three-character categories are subdivided by means of a fourth,
numeric character after a decimal point, allowing up to ten
subcategories. Where a three-character category is not subdivided, it is
recommended that the letter "X" be used to fill the fourth position so that
the codes are of a standard length for data-processing.

3.7 Terminal Questions

1. What was the reason for introducing the concept of “family” of disease
and health-related classifications?
2. Which are the two types of classifications? Explain.
3. What is IND? What is the objective of IND?
4. Write the role of WHO in Classification of Diseases.
5. Which are the basic groups of classification?
6. List the chapters of Volume 1 of ICD-10.
7. Write structure and steps in coding with example.

3.8 Answers
Self Assessment Questions
1. dual-axis
2. volume
3. impairments
4. grouping
5. hierarchical
6. blocks
7. International comparability of data

Terminal Questions
1. Refer 3.2
2. Refer 3.2
3. Refer 3.2
4. Refer 3.2
5. Refer 3.4
6. Refer 3.4
7. Refer 3.4

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