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:

  1. Case 1- skull fracture

  2. 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.

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