1. INTRODUCTION TO CODING MORBIDITY AND MORTALITY BY USING I. C
INTRODUCTION TO CODING MORBIDITY AND MORTALITY BY USING I.C.D VERSION 10

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Presentation outline
Introduction to ICD 10
Evolution of ICD
Mobile Apps
ICD 10 code structure and format
Benefits of transition to ICD 10
Compare and contrast ICD 9&10
Rules, guidelines and standards for coding
New concepts in ICD10
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Acknowledgements
NHIF Tanzania
Bugando Medical Centre
NHIF Facilitator
Dr. Gwamaka Edward - NHIF
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INTRODUCTION TO ICD
ICD = International Statistical Classification of Diseases
ICD 10 = 10th review
Is a system of coding of diseases, symptoms, signs, laboratory findings, complaints, social circumstances & external causes of injuries or illness
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ICD EVOLUTION
Versions of ICD as endorsed by W.H.O
 ICD-6 – 1949
 ICD-7 – 1955
 ICD-8 – 1965
 ICD-9 – 1975
ICD-10 – 1990 ratified by W.H.O
 ICD-11 – Not yet released.
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MOBILE APP
FOR ANDROID & APPLE USERS
FOR APPLE USERS
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WHY ICD?
Disease classification according to set criteria
Enables data storage and information retrieval
Enables compilation of National and International mortality and morbidity statistics
Used in reimbursement systems
When Fund started its operations in 2001, it adopted the three digits ICD 9 codes for claims reimbursement system.
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8. TRANSITION FROM ICD9 TO ICD10
NHIF is migrating in order to keep up with the changes occurring worldwide and so is BMC.
Benefits of using ICD10:
Measures quality, efficacy & safety of care
Conducting research, trials and studies
Maintaining uniformity in disease coding
Preventing and detecting healthcare frauds
Designing payments system and processing claims for reimbursement.
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9. FORMAT & STRUCTURE - ICD
Chapters
Three character blocks
Fourth character further define Site, Etiology, Manifestation and State of the disease or condition
ICD-10-Tz has 3 to 4 Characters – alphanumeric
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11. ICD-9-NHIF Comparison to ICD-10-NHIF
Now for a quick look at the layout changes in the coding set.
Chapters 3 and 4 flip flop – endocrine and blood – puts the blood dyscrasias next to the neoplasms
In 10, we pick up VII – eye and adnexa and VIII ear and mastoid process
Then X and XI (Genitourinary and pregnancy) move to after muscular skeletal (next page)
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ICD 10 CODING SYSTEM
CHAPTER
TITLE
CODING RANGE I
CERTAIN INFECTIOUS DISEASES AND PARASITIC DISEASES
A00 - B99 II
NEOPLASMS
C00 - D48
III
DISEASES OF BLOOD AND IMMUNE MECHANISMS
D50 - D89 IV
ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES
E00 - E90 V
MENTAL AND BEHAVIOURAL DISORDERS
F00 - F99 VI
DISEASES OF THE NERVOUS SYSTEM
G00 – G99
VII
DISEASES OF THE EYE AND ADNEXA
H00 – H59
VIII
DISEASES OF THE EAR AND MASTOID PROCESS
H60 – H95 IX
DISEASES OF THE CIRCULATORY SYSTEM
I00 – I99 X
DISEASES OF THE RESPIRATORY SYSTEM
J00 – J99 XI
DISEASES OF THE DIGESTIVE SYSTEM
K00 – K93
XII
DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE
L00 – L99
XIII
DISEASES OF THE MUSCULOSKELETAL AND CONNECTIVE TISSUE
M00 – M99
XIV
DISEASES OF GENITOURINARY SYSTEM
N00 – N99 XV
PREGNANCY AND CHILDBIRTH PUERPERIUM
O00 – O99
XVI
CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD
P00 – P96
XVII
CONGENITAL DEFORMATIONS AND MALFORMATION
Q00 – Q99
XVIII
SYMPTOMS, SIGNS AND ABNORMAL FINDINGS NEC
R00 – R99
XIX
INJURY, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES
S00 – T98 XX
EXTERNAL CAUSES OF MORBIDITY AND MORTALITY
V01 – Y98
XXI
FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICE
Z00 – Z99
XXII
CODES FOR SPECIAL PURPOSES (DRUGS RESISTANCE)
U82-85
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13. IN COMPARISON ICD 9 AND 10 CODE STRUCTURE
Diagnosis structure 3 characters only taken in Tz (but full codes up to 5th)
Diagnosis structure 4 characters adopted in Tz (but full codes up to 7th character)
All codes are numeric e.g 084 / 250 / 999
All codes have both alphabetical and numeric characters e.g B50.8 digit 1 is alpha, 2-4 are numeric
Number of codes 999-for Tanzania (Approximately 12,000 for full codes book)
Number 14,400 for Tanzania ( About 71,000 codes book)
No location specificity can be provided
Allows for higher specificity such as location e.g disease of ovary R/L or unspecified
First character is numeric
1stcharacter is alpha, 2nd one is numeric then 3rd to 7thcharacter can be alpha numeric
Printed in two volumes
Printed in three volumes
Does not allow laterality
Allows laterality
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14. EXAMPLE – 4 character definitions
C15 Malignant neoplasm of the esophagus
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
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1. LOCATING A CODE IN ICD-10
Look for diagnosis (Lead term/key words) in the record e.g. Asthma, uremia (noun for diseases, injuries) and Cancerous, bilious, carious tooth (adj.)
Refer tabular list (chapters / alphabetical index).
Read and be guided by blocks or categories or subcategories.
Verify the suitability of the code selected
Assign the code. For example B54 is code for unspecified Malaria.
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16. 2. LEVEL OF DETAIL IN CODING
Diagnosis codes are to be used and reported at their higher number of characters available.
ICD-10 diagnosis codes are composed of codes with 3 or 4 characters as per ICD 10 codes used in Tanzania.
Codes with three characters are included in ICD-10 as the heading of a category of codes that may be further subdivided by the use of fourth character which provide greater detail
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17. 3. CODE OR CODES FROM A00.0 THROUGH T88.9, Z00-Z99.8
The appropriate code or codes from A00.0 through T88.9, Z00-Z99.8 must be used to identify diagnoses, symptoms, conditions, problems, complaints or other reason(s) for the encounter/visit.
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4. SIGNS AND SYMPTOMS
In cases where a particular diagnosis is not established, it is ok to use signs and symptoms (Chapter XVIII, R00-R99)
Each healthcare encounter should be coded to the level of certainty known for that encounter.
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19. 5. Encounters for circumstances other than a disease or injury
ICD-10 provides codes to deal with encounters for circumstances other than a disease or injury.
The Factors Influencing Health Status and Contact with Health Services codes (Z00-Z99) are provided to deal with occasions when circumstances other than a disease or injury are recorded as diagnosis or problems.
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Coding Rules
Most rules are the same in ICD 9 as well as in ICD 10:
Same – Abbreviations NOS eg J22
Same acronym- NEC eg J16
Same – other and unspecified codes & disease classified elsewhere
Same – most of coding principles & rules
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MULTIPLE CODING
Code all documented conditions that coexist: at the time of the encounter/visit, and require or affect patient care treatment or management or work up.
Do not code conditions that were previously treated and no longer exist. However, history codes (categories Z80-Z87) may be coded.
When coding from chapter XIX, use an external cause code (chapter XX) in addition to codes from chapter XIX (pdx:T01 sdx:V01)
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SECONDARY DIAGNOSIS IN ICD 10
Secondary codes never exist alone, as they are preceded by primary codes:
Chapter XX (V01-Y98) external causes of morbidity, they are all secondary codes.
The ‘U’ codes (chapter XXII) the selected codes for drug resistance 2° codes (U82-85)
Causative organism can never be primary (B95)
Dialysis session , chemotherapy session
Sequelae codes can never be primary diagnoses
The current condition or reason for admission is coded as the primary code. The sequelae code is coded as the secondary code
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23. Sequelae (Late Effects) codes:
Sequelae codes are used to indicate conditions that are no longer present but are the cause of a current problem now under treatment. Terms such as “old”, “no longer present”, “late effect”, or those present 1 year or more after onset of the causal condition may be used to indicate a sequelae condition.
Sequelae of external causes of morbidity and mortality (Y85 – Y89) must be coded in addition to any codes for Sequelae of injuries, of poisoning and of other consequences of external causes (T90 – T98). E.g pdx:R13 & sdx: I69.4
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24. Complications of medical & surgical care (Y40-Y84)
A complication usually arises subsequent to: an existing condition, disease, pregnancy, injury, etc.; treatments and procedures; adverse reactions to drugs and / or chemicals.
A complication may become a primary diagnosis despite it not being the initial reason for seeking medical treatment
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COMBINATION CODE
Represents a single code used to classify two diagnoses
A diagnosis with an associated sign or symptom
Diagnosis with an associated complication
Simplifies the number of codes needed to clinically spell out a condition
Documentation will need to house all elements
Combination codes are created to have the manifestations included in codes, this will actually allow us to report fewer codes in ICD-10
E11.2 Type 2 diabetes mellitus with diabetic renal complications
K71.5 Toxic liver disease with chronic active hepatitis
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26. CONVENTIONS USED IN ICD 10
NOS- Not Otherwise Specified – J22
‘’Unspecified ‘’ codes
NEC – Not Elsewhere Classified - J16
‘’Other ‘’ codes
Clinicians may be ICD-10 compliant, but if they abuse the “other” or “unspecified” codes, payment will not occur if a more specific alternative exists.”
It is felt that “bad coding habits” should not be encouraged and that correct, appropriate coding should be stressed upfront.
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Special ‘’U’’ Codes
There are codes from (U80 – U89) indicate resistance to antimicrobial, antiviral, antifungal and antineoplastic drugs.
These codes (categories) should never be used in primary coding as they are secondary
The codes are provided for use as supplementary or additional codes when it is desired to identify the resistance, non-responsiveness and refractive properties of a condition to antimicrobials and antineoplastic drugs.
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ROUTINE ANC
Routine outpatient prenatal visits:
Routine outpatient prenatal visit see codes Z34, 35, Z36
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EXAMPLES
Case1: A patient is found to have two distinct malignant tumors in his right lung– one in his right lower lobe and one in his right upper lobe.
ICD-10 codes:
C34.3 Malignant neoplasm of lower lobe, bronchus or lung
C34.1 Malignant neoplasm of upper lobe, bronchus or lung
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30. CHAPTER XV - OBSTETRICS
Case 2: A pregnant patient presents to the office for a visit. She is 19 weeks, 3 days, and is diagnosed with a bladder infection caused by E. coli. The doctor told the patient to drink more water and prescribes cephalexin. She is to return in 10 days for a recheck.
ICD-10 codes:
O Infections of bladder in pregnancy
B Escherichia coli (E. coli) as the cause of diseases classified elsewhere
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31. FRACTURES – chapter XIX
CASE 3: A 14 year-old boy is at a movie theater and running in a parking lot when he was hit by a car. He was diagnosed with a non-displaced fracture of the medial condyle of the lower end of the left femur. The leg was placed in a long leg splint and no further intervention was required
ICD-10 code:
S fracture of lower end of femur
Note: Additional V, W, X, Y codes are reported to indicate the circumstances surrounding the injury. There would be external cause codes to complete the coding scenarios
(NB: CHAPTER XX, COMPOSE 34-36% OF ALL ICD10 CODES)
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Factors influencing health status and contact with health services (Z00 - Z99).
This chapter Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00 - Y89 are recorded as "diagnoses" or "problems".
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33. special purposes codes - XXII
Codes for special purpose: they are for WHO use (U00-U85)
This chapter contains the following blocks:
U00-U49 are to be used by WHO for the provisional assignment of new diseases of uncertain etiology e.g xeno strains EBOLA
U82-U85 Resistance to antimicrobial and antineoplastic drugs
“ U” codes are unused with exception of U82 – U85 as per Tanzania ICD 10 Codes.
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34. ICD10-IMPLEMENTATION & REVIEW
Fund decided to implement by three phases whereby in phase 1&2 some facilities in some regions started implementing on 1st March and 1st April 2018.
On 1st JULY 2018 all accredited Fund facilities in Tanzania will start coding morbidity in claim forms by ICD10.
ICD-9- claims for services won’t be accepted for services provided on / after July 1st , 2018 (definitive opinion).
Periodically, the Fund will assess, monitor and evaluate implementation of the ICD 10 in a bid to review (ICD 10 codes updates and subsequent ICD revisions like the upcoming edition ie ICD11) the same from time to time as per W.H.O and MoHCDGEC guide.
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