1. CLASSIFICATION & CODING OF MORTALITY & MORBIDITY - AN OVERVIEW Dr.Sidhartha Satpathy Assoc Prof, Hosp Admn AIIMS, New-Delhi.

2. Conduct Protocol Introduction Historical Backdrop ICD-10:salient features Mortality classification-an overview Morbidity classification-an overview Some illustrative cases Conclusion

3. Introduction Principle: “People forget, but records remember” Importance of MR is undisputed esp in light of CPA Newer legislation- Right to info Act, MOCRA

4. Historical Backdrop 18 th century- stats classification of COD 1948-(6R)-non fatal morbidity added 1975-(9R)- suppl classifications added 1984-87-(10R)-to develop a family with main ICD as core; alpha-numeric code accepted(1L3N)

5. ICD-10; Salient Features Alphanumeric coding- doubled size Unique letter for majority of chapters Each of these capable of 100 3ch categories Letter U kept aside for additions/changes Chapter titles changed as per contents New chapters added at appropriate place Exclusion notes, overviews more lucid Creation of post procedural condn in some

6. Mortality classificn: overview L1-Gen mort (103) L2-Gen mort (80) L3-Infant & child mortality (67) L4-Infant & child mortality (51) TOTAL= 301 causes

7. Morbidity classificn overview Arranged in 21 major chapters Letter D is associated with Chapter 2&3 Letter H is associated with Chapter 6&7 Chapters 1,2,19 & 20 have 2 letters Each chapter has enough 3 character categories, not all are numbered. Most 3 ch categories are subdivided by a 4rth numeric ch after decimal point.

8. Morbidity classfn overview… Ch I=Infectious & parasitic ds(A00-B99) Ch II= Neoplasms (C00-D48) Ch III= Ds in blood & blood forming organs & immune status(D50-89) Ch IV=Endo, metab & nutrn ds(E00-90) Ch V=Mental & Behav disorder(F00-99) Ch VI= Ds of nervous system(G00-99) Ch VII=Ds of eye & adnexa(H00-59)

9. Morbidity classfn overview… Ch VIII=Ds of ear & mastoid(H60-95) Ch IX=Ds of circulatory system(I00-99) Ch X=Ds of respiratory system(J00-99) Ch XI=Ds of digestive system(K00-93) Ch XII=Ds of skin & subcutaneous (L00-99) Ch XIII=Ds of musculoskeletal system & connective tissue(M00-99) Ch XIV= Ds of Genitourinary system(N00-99)

10. Morbidity classfn overview… Ch XV=Preg, delivery & puerperium (O00-99) Ch XVI= Condns in perinatal period(P00-96) Ch XVII=congenital diseases(Q00-99) Ch XVIII=S/s & abn clin/lab findings(R00-99) Ch XIX= Injury, poisoning & consequences of external causes(S00-T98) Ch XX=External causes of morbidity & mortality (V01-Y98) Ch XXI= Factors influencing health status & contact with health services(Z00-99)

11. ICD 10- illustrative cases Aplastic anemia with mucosal bleed: D64.9-anemia, NOS D61.9-AplasticA NOS Fibroid uterus(intra mural fibroid) D25.9- leiomyoma of uterus unspecified D25.2- intramural L

12. ICD 10- illustrative cases… Infertility with tubal block N97.9- female infertility unspecified N97.1- female infertility- tubal origin PG at 35 wks with Gestational DM O00.0- abd pregnancy O24.4-DM in pregnancy

13. ICD 10- illustrative cases… Partial sensory simple seizure (left) R56.8-Convulsions NOS G40.1-focal/partial symptomatic epilepsy with simple partial seizure Gross hydronephrosis with NFK with UPJO N13.8-other obstructive & reflux uropathy N13.2- hydronephrosis with ureteropelvic junction obstruction

14. ICD 10- Problems faced Incomplete/prov diagnosis by doctors Use of unfamiliar terminology/ abbrev Temptation to use NOS category Lack of exposure to basic tenets

15. Conclusion Sensitization to key staff about ICD10 Training of trainers- cascading effect Start phased implementation Regular monitoring & evaluation “A journey of thousand miles starts with a single step.”