ICD and ICF
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The document provides an overview of the International Classification of Diseases (ICD-10) and the International Classification of Functioning, Disability, and Health (ICF), including their definitions, types, and purposes. It discusses the evolution of ICD and details its structure, coding guidelines, and chapters along with the challenges faced in its application. Additionally, it introduces ICD-11, emphasizing its development and the advantages of digital collaboration in updating health classifications.
ICD and ICF
- 1. International Classification of Diseases -10 AND An Introduction to ICF Dr Lipilekha Patnaik Professor, Community Medicine Institute of Medical Sciences & SUM Hospital Siksha ‘O’Anusandhan deemed to be University Bhubaneswar, Odisha, India Email: drlipilekha@yahoo.co.in
- 2. Contents v Definition of Classification v Types of classification v ICD-10 vDefinition vPurpose and uses vEvolution vStructure vBasic coding Guidelines v ICD 11 at doorstep
- 3. Statistical Classification of Diseases • A classification of disease is a system of categories or groupings to which diseases, injuries, conditions and procedures assigned according to established criteria. • ICD-10 is a statistical classification, which means that it contains a limited number of mutually exclusive code categories, which describe all disease concepts.
- 4. WHO Family of International Classifications • ‘Family’ designates a suite of integrated classification productsthat share similar features and can be used singularly or jointly to provide information on different aspects of health and the health-care system. • The WHO Family of International Classifications (WHO-FIC) attempts to serve as the framework of international standards to provide the building blocks of health information systems.
- 5. Types of classifications in WHO-FIC • Reference classifications • Derived classifications • Related classifications
- 6. Reference classifications • Cover the main parameters of the health system, such as death, disease, functioning, disability, health and health interventions. • Approved and recommended as guidelines for international reporting on health. • International Classification of Diseases (ICD) • International Classification of Functioning, Disability and Health (ICF) • International Classification of Health Interventions (ICHI)
- 7. Derived classifications • It include specialty-based adaptations of ICF and ICD, such as • the International Classification of Diseasesfor Oncology • the ICD-10 for Mental and Behavioural Disorders and • the Application of the International Classification of Diseases to Neurology (ICD-10-NA) • Provide additional detail beyond that provided by the reference classification
- 8. Related classifications • Related classifications are those that § partially refer to reference classifications, or §that are associated with the reference classification at specific levels of the structure only. • International Classification of Primary Care (ICPC-2), • International Classification of External Causes of Injury (ICECI), • Technical aids for persons with disabilities: Classification and terminology
- 9. International classification of diseases • Represents International Statistical Classification of Diseases and Related Health Problems. • Can be defined as a system of categories to which morbid entities are assigned according to established criteria. • Used to translate diagnoses of diseases and other health problems from words into an alphanumeric code.
- 10. Why to use classification ? • To allow easy storage, retrieval and analysis of data • To allow systematic recording, analysis, interpretation and comparison of mortality and morbidity data between hospitals, provinces and countries • To allow comparisons in the same location across differenttime periods
- 11. Evolution of ICD • During 17th century, John Graunt recognised the need to organise mortality data into some logical form and therefore developed the first statistical study of disease, called the London Bills of Mortality. • In this work, Graunt classified the deaths of all children who were born alive but who died before they reached the age of six.
- 12. EVOLUTION Sauvages first attempted to systematically classify all diseases & published under the title Nosologia methodica OF ICD Francois Bossier de Lacroix (1706-1777)
- 13. Linnaeus (1707-1778 Linnaeus (1707-1778) EVOLUTION a great methodologist and contemporary of Lacroix published his work under the title Genera morborum OF ICD
- 14. EVOLUTION OF ICD simplified the system for general use & published it under the title Synopsis nosologiae methodicae William Cullen (1710-1790)
- 15. EVOLUTION OF ICD first medical statistician of the General Register Office of England and Wales submitted his Report in 1855 on nomenclature and statistical classification of diseases, in which he included most of those diseases that affect health and that are fatal. William Farr (1807-1883)
- 16. A Beginning of Modern Classification Chief of Statistical Services of Paris, prepared classification based on the principle of distinguishing between general diseases and those localized to a particular organ or anatomical site. This was adopted in 1893. Jacques Bertillon(1851-1922)
- 17. A Beginning of Modern Classification • The French Government, called the first International Conference for the Revision of the Bertillon, in Paris in 1900, thus beginning a series of revision conferences approximately 10 years apart • The Sixth Decennial Revision Conference in 1948 was a significant event in international vital and health statistics. • It recommended the adoption of a comprehensive programme of international cooperation in the field of vital and health statistics.
- 18. ICD Revisions • The Seventh Revision Conference was held in Paris in 1955 and, the revision was limited to essential changes. • The Eighth Revision Conference was convened by WHO in Geneva in 1965. The Eighth Revision was much more extensive. • The International Conference for the Ninth Revision was convened by WHO in Geneva in 1975 and it came into effect from 1979. • ICD-10 was endorsed by the Forty-third World HealthAssembly in May 1990 and came into use in WHO Member States as from 1994. • India adopted this classification in the year 2000.
- 19. ICD-9 & ICD-10 • Much larger than ICD-9 • ICD-10 has 21 chapters against 17 Chapters in ICD-9 • Numeric codes ( 001-999 ) were used in ICD-9 where as an alphanumeric coding, (A00-Z99) has been adopted in ICD-10. • It enlarged the number of categories available for the classification. • Further detail by means of decimal numeric subdivisions at the four character level.
- 20. Primary users Users include • Physicians, • Nurses, • Health workers, • Researchers, • Health information managers, • Policy-makers, • Insurers and • National health programme managers
- 21. Structure and Principles of ICD • Originally conceived by William Farr • The Classification is grouped as below: • Epidemic diseases • Constitutional or general diseases • Local diseases arranged by site • Developmental diseases • Injuries.
- 22. Volumes of ICD-10 v Volume 1: Tabular list v Volume 2: Instruction manual v Volume 3: Alphabetical Index The image part with relationship ID rId2 was not found in the file.
- 23. Volume 1: Tabular list An alphanumeric listing of diseases and disease groups, along with inclusion and exclusion notes, some coding rules, special tabulation lists for mortality and morbidity, definition and regulation. The image part with relationship ID rId2 was not found in the file.
- 24. Volume 2: Instruction manual It provides • An introduction to and instructions on how to use volume 1 and 3. • Guidelines for certification and rules for mortality coding • Guidelines for recording and coding for morbidity coding • Statistical presentation The image part with relationship ID rId2 was not found in the file.
- 25. Volume 3: Alphabetical index • Is the comprehensive Alphabetical index of the diseases and conditions found in the tabular list The image part with relationship ID rId2 was not found in the file.
- 26. Chapters of ICD-10 • The ICD-10 contains 21 chapters, each of which identified by a Roman numeral. • Chapters I to XVII: Diseases and other morbid conditions • Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified. • Chapter XIX: Injuries, poisoning and certain other consequences of external causes. • Chapter XX: External causes of morbidity andmortality, • Chapter XXI: Factors influencing health status and contact with health services
- 27. Chapters of ICD-10 • The chapters are subdivided into homogeneous "blocks" of three-alphanumeric character categories. E.g., • Chapter I: (A00-B99): Certain infectious and parasitic disease • A00-A09 Intestinal infectious diseases • A15-A19 Tuberculosis • A20-A28 Certain zoonotic bacterial diseases • A30-A49 Other bacterial diseases
- 28. The image part with relationship ID rId2 was not found in the file. International Statistical Classification of Diseases and Related Health Problems 10th Revision Chapter Blocks Title I A00–B99 Certain infectious and parasitic diseases II C00–D48 Neoplasms III D50–D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism IV E00–E90 Endocrine, nutritional and metabolic diseases V F00–F99 Mental and behavioural disorders VI G00–G99 Diseases of the nervous system VII H00–H59 Diseases of the eye and adnexa
- 29. The image part with relationship ID rId2 was not found in the file. International Statistical Classification of Diseases and Related Health Problems 10thRevision tissue and connective tissue Chapter Blocks Title VIII H60–H95 Diseases of the ear and mastoid process IX I00–I99 Diseases of the circulatory system X J00–J99 Diseases of the respiratory system XI K00–K93 Diseases of the digestive system XII L00–L99 Diseases of the skin and subcutaneous XIII M00–M99 Diseases of the musculoskeletal system XIV N00–N99 Diseases of the genitourinary system
- 30. The image part with relationship ID rId2 was not found in the file. International Statistical Classification of Diseases and Related Health Problems 10th Revision period chromosomal abnormalities laboratory findings, not elsewhere classified consequences of external causes with health services Chapter Blocks Title XV O00–O99 Pregnancy, childbirth and the puerperium XVI P00–P96 Certain conditions originating in the perinatal XVII Q00–Q99 Congenital malformations, deformations and XVIII R00–R99 Symptoms, signs and abnormal clinical and XIX S00–T98 Injury, poisoning and certain other XX V01–Y98 External causes of morbidity and mortality XXI Z00–Z99 Factors influencing health status and contact XXII U00–U99 Codes for special purposes
- 31. Basic coding guidelines • The basic ICD is a single coded list of three- character categories, each of which can be further divided into up to 10 four- character subcategories. • Three-character categories is mandatory level of coding for international reporting to the WHO mortality database and for general international comparisons. • Tenth Revision uses an alphanumeric code with a letter in the first position and a number in the second, third and fourth positions.
- 32. • Some three-character categorieshave been left vacant for future expansion / Revision • Codes U00–U49 are to be used by WHO for the provisional assignment of new diseases of uncertain etiology. • Codes U50–U99 may be used in research, e.g. when testing an alternative sub-classification for a special project.
- 33. • The fourth character follows a decimal point. • Possible code numbers therefore range fromA00.0 to Z99.9. • Fill fourth position with X , when sub-division is not there, so that the codes are of a standard length for data-processing. A N N . N
- 34. • A00 Cholera • A01 Typhoid and paratyphoid fevers • A02 Other salmonella infections • A03 Shigellosis • A04 Other bacterial intestinal infections Excl.: Foodborne intoxications elsewhere classified Tuberculous enteritis (A18.3)
- 35. • A01 Typhoid and paratyphoid fevers • A01.0 Typhoid fever Infection due to Salmonella typhi • A01.1 Paratyphoid fever A • A01.2 Paratyphoid fever B • A01.3 Paratyphoid fever C • A01.4 Paratyphoid fever, unspecified Infection due to Salmonella paratyphi NOS
- 36. • Inclusion terms- Within the three- and four-character rubrics, there are usually listed a number of other diagnostic terms. • These are known as ‘inclusion terms’ and are given, in addition to the title. • Rubric - In the context of the ICD, rubric denotes either a three-character category or a four-character subcategory.
- 37. • Exclusion terms- Certain rubrics contain lists of conditions preceded by the word “Excludes”. These are terms which are classified elsewhere. • A06 Amoebiasis Incl.: infection due to Entamoeba histolytica Excl.: other protozoal intestinal diseases (A07.-)
- 38. • Glossary descriptions- Chapter V, Mental and behavioural disorders, uses glossary descriptions to indicate the content of rubrics. • This device is used because the terminology of mental disorders varies greatly
- 39. 2 codes for certain conditions • The “dagger and asterisk” system • There are two codes for diagnostic statements containing information about both • an underlying generalized disease and • a manifestation in a particular organ or site which is a clinical problem in its own right. • This convention was provided because coding to underlying disease alone was often unsatisfactory for compiling statistics relating to particular specialties.
- 40. • The primary code is for the underlying disease and is marked with a dagger (†); • an optional additional code for the manifestation is marked with an asterisk (*). • E.g., • A17 † Tuberculosis of nervous system • A17.0 † Tuberculous meningitis (G01*) • A17.1 † Meningeal tuberculoma (G07*)
- 41. • It is a principle of the ICD that the dagger code is the primary code and must always be used. • For coding, the asterisk code must never be used alone. • There are 83 asterisk categories in ICD-10 which may be used in conjunction with a dagger code.
- 42. Volume 3 Volume 3 is divided into three sections as follows: • Section-I lists all the terms classifiable to Chapters I-XIX and Chapter XXI, except drugs and other chemicals. • Section II is the index of external causes of morbidity and mortality and contains all the terms classifiable to Chapter XX, except drugs and other chemicals.
- 43. Volume 3 • Section III gives Table of Drugs and Chemicals lists for substance the codes for poisonings & adverse effectsof drugs (under Chapter XIX ) • This volume also includes the Chapter XX codes that indicate whether the poisoning was accidental, deliberate (self-harm), undetermined, or an adverse effectof a correct substance properly administered.
- 44. Problem encountered • Size of the Classification • No formal training • No user-friendly software to guide • Inadequate staff in MRD • Use of nonstandard abbreviations • Delay/ incomplete case sheets • Procedure (instead of diagnosis) are written • Manually done – very slow and difficult
- 45. ICD 11 at Door step • The 11th version, ICD-11, is now being prepared. • Nearly 20 years have passed since the tenth revision was published. Much has changed: • Subject matter:e.g. due to better understanding of the genetic basis of some diseases • Context: e.g. the rise of electronic health records& terminologies
- 46. Construction of ICD-11 • Internet-based permanent platform • All year round • Open to all people in a structured way • Content experts focus • Digital curation • Wiki enabled collaboration • Ontology based • Enhanced discussion & peer review • TAGs serve as the editorial group • Electronic copy print version (multiple languages)
- 47. ICD 11 • For the first time, through advances in information technology, public health users, stakeholders and others interested can provide input to the beta version of ICD-11 using an online revision process. • Peer-reviewed comments and input will be added through the revision period. • When finalized, ICD-11 will be ready to use with electronic health recordsand information systems.
- 48. ICD Limitations • ICD does not provide sufficientdetail for some specialties and sometimes information on differentattributes of health conditions may be needed. • The ICD also is not useful to describe functioning and disability as aspects of health, anddoes not include a full array of health interventions or reasons for encounter.
- 49. An Introduction to the International Classification of Functioning, Disability, and Health (ICF)
- 50. What is the ICF? • Is a classification of health and health-related domains. • As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors. • ICF is the WHO framework for measuring health and disability at both individual and population levels. • ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001as the international standard to describe and measure health and disability.
- 51. • Functioning and disability are viewed as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors. The picture produced by this combination of factors and dimensions is of "the person in his or her world". • The classification treats these dimensions as interactive and dynamic. • It allows for an assessment of the degree of disability. • It is applicable to all people, whatever their health condition. • The language of the ICF is neutral as to etiology, placing the emphasis on function rather than condition or disease. • It also is carefully designed to be relevant across cultures as well as age groups and genders, making it highly appropriate for heterogeneous populations.
- 52. The Aims of the ICF • To provide a scientific basis for the consequences of health conditions • To establish a common languageto improve communications • To permit comparisons of data across: • Countries • Health care disciplines • Services • Time • To provide a systematic coding scheme for health information systems
- 53. ICF Domains • Body Function and Structures • Activities (related to tasks and actions by an individual) • Participation (involvement in a life situation) • Additional information on severity and environmental factors
- 54. Body Function and Structures • Physiological and psychological function of body systems • Very specific recording of detailed functional abilities and impairments • Not linked to cause. For example, fluency and rhythm of speech functions – could be from stuttering, stroke, or autism
- 55. Body Functions and Structures Broken into Eight Chapters Skin and related structuresFunctions of the skin and related structures Structures related to movementNeuromusculoskeletal and movement-related functions Structures related to the genitourinary and reproductive systems Genitourinary and reproductive functions Structures related to the digestive, metabolic and endocrine systems Functions of the digestive, metabolic and endocrine systems Structures of the cardiovascular, immunological and respiratory systems Functions of the cardiovascular, haematological, immunological and respiratory systems Structures involved in voice and speech Voice and speech functions The eye, ear and related structuresSensory functions and pain Structures of the nervous systemMental functions
- 56. Activities and Participation • Describes individual’s functioning as a whole person, as opposed to function and structure of his/her body parts • Range from Basic to Complex • basic would be, for example, dressing, eating, and bathing • complex include work, schooling, civic activities • WHO approach • Activities – what people can do inherently without assistance or barriers • Participation – functioning taking into account the impact of barriers and facilitators in the environment
- 57. Classification of Activities and Participation 1 Learning &Applying Knowledge 2 General Tasks and Demands 3 Communication 4 Movement 5 Self Care 6 Domestic Life Areas 7 Interpersonal Interactions 8 Major Life Areas 9 Community, Social & Civic Life
- 58. Health Condition (disorder/disease) Interaction of Concepts Environmental Factors Personal Factors Body function&structure (Impairment) Activities (Limitation) Participation (Restriction)
- 59. Example: Polio • May have caused paralysis of legs (Body Function) • Affects ability to walk or climb stairs (Activity) • Impedes ability to attend school or find employment within the current environment (Participation) BUT….
- 60. • Mobility related activities, such as getting around the house or community can be improved with accessible environment and assistive devices • Participation can be increased with reduced stigma, accessible environments and flexible job design • Disability is NOT independent of the environment, and therefore is not static
- 61. summary • ICD-10 is a statistical classification containing a limited numberof mutually exclusivecode categories, which describe all disease concepts. • The ICD-10 contains3 volumes,21 chapters, each of which identified by a Roman numeral. • Vol 1 – Tabularlist, Vol 2 –InstructionManual and Vol 3 – Alphabetical index • ICD-10 uses an alphanumericcodewith a letter in the first position and a numberin the second,third and fourth positions. • The fourth character followsa decimal point. • ICF is a classification of health and health-related domains. • The domainsare Body Functionand Structures, Activities, Participationand additional informationon severity and environmental factors