Assigning a code for a particular disease or diagnosis is done in 3 steps:
Step 1 - Identify the chapter in which the disease will fall under
Step 2 – Within the identified chapter, recognizing the block under which the disease will appear
Step 3 – Once the block is identified, noting down the exact code of the given disease
Steps in assigning an ICD code to diseases
Example 1 - What is the code for Migraine?
These 3 steps are explained in the following examples. Please refer to the ICD-10 Booklet and follow the below steps.
Step 1 - Migraine comes under Chapter VI: Diseases of nervous system
Step 2 - In this chapter, look at the block,"Episodic and paroxysmal disorders"
Step 3 - Under this block, you will find Migraine with the code G43
The code for Migraine is G43.
Example 2 - What is the code for Acute Pericarditis?
Step 1 - Acute Pericarditis comes under Chapter IX: Diseases of cardiovascular system
Step 2 - In this chapter, look at the block,"Other forms of heart disease"
Step 3 - Under this block, you will find Acute Pericarditis with the code I30
The code for Acute Pericarditis is I30.
The next set of slides will provide examples from each chapter of ICD-10. These examples are explained in a tabular format in the slides.
| Item | Example # |
|---|---|
| Case | This a case scenario |
| Disease | This represents the name of the disease or diagnosis in the case scenario |
| Chapter | This represents the name of the chapter under which the disease falls into |
| Block | This represents the name of the block within the particular chapter under which the disease falls into |
| Code | This represents the code for the particular disease |
| Item | Example 1 |
|---|---|
| Case | A 11-yr old boy drowned in a swimming-pool |
| Disease | Drowning and submersion while in swimming-pool |
| Chapter | Chapter XX: External causes of morbidity and mortality |
| Block | Accidental drowning and submersion |
| Code | Drowning and submersion while in swimming pool - W67 |
| Item | Example 2 |
|---|---|
| Case | About 100 people died due to Cholera outbreak in a village in North Karnataka |
| Disease | Cholera |
| Chapter | Chapter I: Certain infectious and parasitic diseases |
| Block | Intestinal infectious diseases |
| Code | Cholera - A00 |
| Example 3 |
|---|
| A tourist back from Africa who lived on street food has jaundice and elevated serum bilirubin levels |
| Acute hepatitis A |
| Chapter I: Certain infectious and parasitic diseases |
| Viral hepatitis |
| Acute hepatitis A - B15 |
| Example 4 |
|---|
| Patient diagnosed with HIV dies due to secondaries in lung |
| HIV with malignancy |
| Chapter I: Certain infectious and parasitic diseases |
| Human immunodeficiency virus disease |
| Human immunodeficiency virus [HIV] disease with malignant neoplasms - B21 |
| Item | Example 5 |
|---|---|
| Case | A 50-yr old man complaining of indigestion and severe weight loss died due a mass in the left upper quadrant |
| Disease | Malignancy of Stomach |
| Chapter | Chapter II: Neoplasms |
| Block | Malignant Neoplasms of digestive organs |
| Code | Malignancy of Stomach - C16 |
| Example 6 |
|---|
| Patient on treatment for Hodgkin’s lymphoma died |
| Hodgkin Lymphoma |
| Chapter II: Neoplasms |
| Malignant neoplasms of lymphoid, haematopoietic and related tissue |
| Hodgkin’s disease - C81 |
| Item | Example 7 |
|---|---|
| Case | Haemoglobin level of a pregnant lady is extremely low |
| Disease | Iron deficiency anaemia |
| Chapter | Chapter III: Diseases of blood and blood-forming organs and certain disorders involving the immune mechanisms |
| Block | Nutritional anaemias |
| Code | Iron deficiency anaemia -D50 |
| Example 8 |
|---|
| A 35-yr old women is diagnosed with Cushing’s syndrome |
| Cushing's syndrome |
| Chapter IV: Endocrine, nutritional and metabolic diseases |
| Disorders of other endocrine glands |
| Cushing's syndrome - E24 |
| Example 9 |
|---|
| A man died due to respiratory failure caused by cystic fibrosis |
| Cystic fibrosis |
| Chapter IV: Endocrine, nutritional and metabolic diseases |
| Disorders of other endocrine glands |
| Cystic fibrosis - E84 |
| Item | Example 10 |
|---|---|
| Case | A woman was diagnosed with Myasthenia gravis |
| Disease | Myasthenia gravis |
| Chapter | Chapter VI: Diseases of nervous system |
| Block | Diseases of myoneural junction and muscle |
| Code | Myasthenia gravis - G70 |
| Example 11 |
|---|
| A 14 week old infant was diagnosed with hydrocephalus |
| Hydrocephalus |
| Chapter VI: Diseases of nervous system |
| Other disorders of the nervous system |
| Hydrocephalus - G91 |
| Item | Example 12 |
|---|---|
| Case | Patient in the emergency had a sudden death due to pulmonary embolism |
| Disease | Pulmonary embolism |
| Chapter | Chapter IX: Diseases of cardiovascular system |
| Block | Pulmonary heart disease and diseases of pulmonary circulation |
| Code | Pulmonary embolism - I26 |
| Example 13 |
|---|
| Echocardiogram of a recent death showed left ventricular systolic dysfunction and the physician diagnosed it as systolic heart failure |
| Heart failure |
| Chapter IX: Diseases of cardiovascular system |
| Other forms of heart disease |
| Heart failure - I50 |
| Item | Example 14 |
|---|---|
| Case | A child with history of Asthma dies due to severe dyspnoea |
| Disease | Status Asthmaticus |
| Chapter | Chapter X: Diseases of respiratory system |
| Block | Chronic lower respiratory diseases |
| Code | Status Asthmaticus - J46 |
| Example 15 |
|---|
| A heavy smoker in emergency complains of sudden stabbing pain in his right hemi thorax |
| Pneumothorax |
| Chapter X: Diseases of respiratory system |
| Other diseases of pleura |
| Pneumothorax - J93 |
| Example 16 |
|---|
| A female with severe dyspnoea on exertion, progressive edema in lower extremities was diagnosed with emphysema |
| Emphysema |
| Chapter X: Diseases of respiratory system |
| Chronic lower respiratory diseases |
| Emphysema - J43 |
| Item | Example 17 |
|---|---|
| Case | A patient with severe abdominal pain is diagnosed with H.pylori infection |
| Disease | Gastric ulcer |
| Chapter | Chapter XI: Diseases of the digestive system |
| Block | Diseases of oesophagus, stomach and duodenum |
| Code | Gastric ulcer - K25 |
| Example 18 |
|---|
| A patient hospitalised for acute pancreatitis dies in emergency |
| Acute pancreatitis |
| Chapter XI: Diseases of the digestive system |
| Disorders of gallbladder, biliary tract and pancreas |
| Acute pancreatitis - K85 |
| Example 19 |
|---|
| A patient has discomfort and a lump in the right groin. The lump disappears when supine |
| Inguinal hernia |
| Chapter XI: Diseases of the digestive system |
| Hernia |
| Inguinal hernia - K40 |
| Item | Example 20 |
|---|---|
| Case | A 40-yr old woman died due to Systemic lupus erythematosus |
| Disease | SLE |
| Chapter | Chapter XIII: Diseases of the musculoskeletal system and connective tissue |
| Block | Systemic connective tissue disorders |
| Code | Systemic lupus erythematosus - M32 |
| Item | Example 21 |
|---|---|
| Case | A patient with facial puffiness and proteinuria was diagnosed with nephrotic syndrome |
| Disease | Nephrotic syndrome |
| Chapter | Chapter XIV: Diseases of the genitourinary system |
| Block | Glomerular diseases |
| Code | Nephrotic syndrome - N04 |
| Example 22 |
|---|
| A patient has crush-injury to the kidneys with extremely low urine output |
| Acute Renal failure |
| Chapter XIV: Diseases of the genitourinary system |
| Renal failure |
| Acute Renal failure - N17 |
| Example 23 |
|---|
| A 14-yr old football player presents with diffused testicular pain and swelling |
| Torsion of testis |
| Chapter XIV: Diseases of the genitourinary system |
| Diseases of male genital organs |
| Torsion of testis - N44 |
| Item | Example 24 |
|---|---|
| Case | A 22 week pregnant woman with high blood pressure, proteinuria and convulsions is brought to emergency |
| Disease | Eclampsia |
| Chapter | Chapter XV: Pregnancy, childbirth and the puerperium |
| Block | Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium |
| Code | Eclampsia - O15 |
| Example 25 |
|---|
| A pregnant woman develops regular contractions at 32 weeks of pregnancy |
| Preterm labour |
| Chapter XV: Pregnancy, childbirth and the puerperium |
| Complications of labour and delivery |
| Preterm labour -O60 |
| Example 26 |
|---|
| Post-delivery, a woman develops high fever, chills and stomach ache |
| Puerperal sepsis |
| Chapter XV: Pregnancy, childbirth and the puerperium |
| Complications predominantly related to the puerperium |
| Puerperal sepsis - O85 |
| Item | Example 27 |
|---|---|
| Case | A Neonate with G6PD deficiency died due to Kernicterus |
| Disease | Kernicterus |
| Chapter | Chapter XVI: Certain conditions originating in the perinatal period |
| Block | Haemorrhagic and haematological disorders of fetus and newborn |
| Code | Kernicterus - P57 |
| Example 28 |
|---|
| A low-birth-weight newborn died due to hypothermia |
| Hypothermia of newborn |
| Chapter XVI: Certain conditions originating in the perinatal period |
| Conditions involving the integument and temperature regulation of fetus and newborn |
| Hypothermia of newborn - P80 |
| Item | Example 29 |
|---|---|
| Case | A neonate is diagnosed with microcephaly |
| Disease | Microcephaly |
| Chapter | Chapter XVII: Congenital malformations, deformations and chromosomal abnormalities |
| Block | Congenital malformations of the nervous system |
| Code | Microcephaly - Q02 |
| Example 30 |
|---|
| A child is diagnosed with the genetic disorder Trisomy 21 |
| Down syndrome |
| Chapter XVII: Congenital malformations, deformations and chromosomal abnormalities |
| Chromosomal abnormalities, not elsewhere classified |
| Down syndrome - Q90 |
| Item | Example 31 |
|---|---|
| Case | A patient who was well the previous night, was found dead the next morning with cause not known |
| Disease | Unattended death |
| Chapter | Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified |
| Block | Ill-defined and unknown causes of mortality |
| Code | R98 -Unattended death |
| Example 32 |
|---|
| A patient has fever lasting more than 3 weeks and the physician could not determine the cause of fever |
| Fever of unknown origin |
| Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified |
| General symptoms and signs |
| Fever of unknown origin - R50 |
| Item | Example 33 |
|---|---|
| Case | A bus passenger died after bus accident |
| Disease | Bus occupant injured in collision with heavy transport vehicle or bus |
| Chapter | Chapter XX: External causes of morbidity and mortality |
| Block | Bus occupant injured in transport accident |
| Code | Bus occupant injured in collision with heavy transport vehicle or bus - V74 |
Sometimes assigning an ICD code to a disease can be confusing or complicated.
In certain situations, it is important to have complete details on manner of death. In order to identify if it was an accident/suicide/intentional injury/unknown intent/iatrogenic injury and assign an ICD code accordingly (as in scenarios 1 to 3 in next set of slides) ;in other situations, it is important to know the timing of the disease diagnosis, so as to be aware of the definition of the disease condition (scenario 4).
These concepts are explained through a set of examples.
| Case | Case 1 | Case 2 |
|---|---|---|
| Question | A man dies after accidental exposure to pesticides. What is the code? | A man dies after intentional ingestion of chlorine containing pesticide. What is the code? |
Scenario 1
| Disease | Accidental poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours |
Intentional self-poisoning by and exposure to pesticides |
|---|---|---|
| Chapter | Chapter XX: External causes of morbidity and mortality | Chapter XX: External causes of morbidity and mortality |
| Block | Accidental poisoning by and exposure to noxious substances | Intentional self-harm |
| Code | X46 | X68 |
| Case | Case 1 | Case 2 |
|---|---|---|
| Question | A man died in the temple firework disaster in Kollam, Kerala. What is the code? | A man died in the same disaster but due to crush injury because of the building collapse. What is the code? |
Scenario 2
| Disease | Discharge of firework | Struck by thrown, projected or falling object |
|---|---|---|
| Chapter | Chapter XX: External causes of morbidity and mortality | Chapter XX: External causes of morbidity and mortality |
| Block | Exposure to inanimate mechanical forces | Exposure to inanimate mechanical forces |
| Code | W39 | W20 |
| Case | Case 1 | Case 2 |
|---|---|---|
| Question | A 1-yr old boy is bitten and mauled to death by a dog. What is the code? | A physician diagnoses a child to have died due to rabies. What is the code? |
Scenario 3
| Disease | Bitten or struck by dog | Rabies |
|---|---|---|
| Chapter | Chapter XX: External causes of morbidity and mortality | Chapter I: Certain infectious and parasitic diseases |
| Block | Exposure to animate mechanical forces | Viral infections of the central nervous system |
| Code | W54 | A82 |
| Case | Case 1 | Case 2 |
|---|---|---|
| Question | A pregnant woman is diagnosed with diabetes at 12 weeks. What is the code? | A pregnant woman is diagnosed with diabetes at 26 weeks. What is the code? |
Scenario 4
| Disease | Insulin-dependent diabetes mellitus | Diabetes mellitus in pregnancy |
|---|---|---|
| Chapter | Chapter IV: Endocrine, nutritional and metabolic diseases | Chapter XV: Pregnancy, childbirth and puerperium |
| Block | Diabetes mellitus | Other maternal disorders predominantly related to pregnancy |
| Code | E10 | O24 |
** If in a pregnant woman, diabetes is detected before 20 weeks it will be coded as E10. If the onset of diabetes is after 20 weeks and it is confirmed as gestational diabetes then it will be coded as O24, since diseases arising due to pregnancy are listed under Chapter XV.
External Causes of death
While biomedical causes of death are considered ‘natural’ for the purpose of manner of death, other external causes such as accident, suicide, homicide or unknown intent are not natural (but they may be medico-legal). These have to be written in a precise and specific manner as explained in the following examples – let us consider 2 different cases of:
-
Case 1- skull fracture
-
Case 2- electrocution
Case 1: Skull Fracture
A skull fracture cannot be an underlying cause of death…the reason for the skull fracture must be identified as below by careful history-taking and written as the underlying cause…
It could be written in any one of the following ways.
| Scenario 1 | If the skull fracture was due to Slip & fall in bathroom then |
|---|---|
| Block | Other external causes of accidental injury (Falls) |
| Code | W01 (Fall on same level from slipping, tripping and stumbling) |
Case 1: Skull fracture
I (a) Hemorrhage S06
(b) Skull fracture S02
(c) Slip & fall in bathroom W01
Death Certificate will be as below
Case 1: Skull fracture
I (a) Hemorrhage S06
(b) Skull fracture S02
(c) Crush injury d/t falling stone W20
Death Certificate will be as below
| Scenario 2 | If the skull fracture was due to crush injury d/t falling stone then |
|---|---|
| Block | Other external causes of accidental injury (Exposure to inanimate mechanical forces) |
| Code | W20 (Struck by thrown, projected or falling object) |
Case 1: Skull fracture
I (a) Hemorrhage S06
(b) Skull fracture S02
(c) Pedestrian hit by moving truck V03
Death Certificate will be as below
| Scenario 3 | If the skull fracture was due to pedestrian hit by moving truck then |
|---|---|
| Block | Transport accidents (Pedestrian injured in transport accident) |
| Code | V03 (Pedestrian injured in collision with car, pick-up truck or van) |
Case 1: Skull fracture
| Scenario 4 | If the skull fracture was due to fall from tree then |
|---|---|
| Block | Other external causes of accidental injury (Falls) |
| Code | W14 (Fall from Tree) |
Death Certificate will be as below
I (a) Hemorrhage S06
(b) Skull fracture S02
(c) Fall from tree W14
Case 1: Skull fracture
I (a) Hemorrhage S06
(b) Skull fracture S02
(c) Assault by blunt object Y00
Death Certificate will be as below
| Scenario 5 | If the skull fracture was due to assault with blunt object then |
|---|---|
| Block | Assault |
| Code | Y00 (Assault by blunt object) |
Case 2
It could be written in any one of the following ways.
A case of electrocution, similarly, by itself cannot be an underlying cause of death…the way how the person got electrocuted must be identified as below by careful history-taking and written as the underlying cause…
Case 2
The block and the code for electrocution depends on the way the person was electrocuted.
| Scenario 1 | If the electrocution was suicidal then |
|---|---|
| Block | Intentional self-harm |
| Code | X83 (Intentional self-harm by other specified means) |
Death Certificate will be as below
I (a)
(b)
(c) Electrocution (Suicidal) X83
Case 2
| Scenario 2 | If the electrocution was accidental then |
|---|---|
| Block | Other external causes of accidental injury |
| Code | W87 (Other specified threats to breathing) |
Death Certificate will be as below
I (a)
(b)
(c) Electrocution (accidental) W87
Case 2
| Scenario 3 | If the electrocution was legal intervention then |
|---|---|
| Block | Legal intervention and operations of war |
| Code | Y35 (legal intervention) |
Death Certificate will be as below
I (a)
(b)
(c) Electrocution (legal intervention) Y35
Case 2
| Scenario 4 | If the electrocution was undetermined intent then |
|---|---|
| Block | Event of undetermined intent |
| Code | Y33 (Other specified events, undetermined intent) |
Death Certificate will be as below
I (a)
(b)
(c) Electrocution (undetermined intent) Y33
Remember:
Specific code over non-specific code:
When coding, always remember to select a more specific code over a non-specific code for a given disease if the details are available.
eg.
It is appropriate to code the underlying cause of death to a specific cause like a stroke (I64) or an infection (G00/G04) rather than to a manifestation or a non-specific cause like hemiplegia (G81), although hemiplegia can be used in clinical practice and in morbidity coding.
Version 3 e-MCCD M2U2S1 final
By drkavya1
Version 3 e-MCCD M2U2S1 final
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