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Government of India

Module and Work Book

Orientation Training On ICD 10

Government of India
Central Bureau of Health Intelligence (CBHI)
Directorate General of Health Services
Ministry of Health & Family Welfare,
Nirman Bhawan, New Delhi 110 011
CBHI Website : www.cbhidghs.nic.in

CBHI email : dircbhi@nb.nic.in

GOVERNMENT OF INDIA

MODULE AND WORK BOOK


ORIENTATION TRAINING ON ICD 10

Compiled and Edited by :


Dr. Ashok Kumar, M.D., Director
Smt. S Jeyalakshmi, Joint Director ( NFSG)
Sh. P K Mukhopadhyay, Joint Director
Ms. Pratima Gupta, Assistant Director

Central Bureau of Health Intelligence


Directorate General of Health Services
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi - 110011
Website - www.cbhidghs.nic.in
Email : dircbhi@nb.nic.in

In Collaboration with
National Centre for Classification in Health (Brisbane), Australia
And
World Health Organisation, New Delhi

1st Edition
2nd Edition

: December 2004
: January 2008

Also available on CBHI Website


www.cbhidghs.nic.in

PREFACE
The 10th version of International Classification of Diseases (ICD-10) was introduced by WHO in
1993 and India adopted the same for implementation in the year 2000. Accordingly, the Directors of
Health Services of all States/Union Territories were advised to adopt the ICD-10 classification
system for coding morbidity and mortality records. As is well known, the hospital morbidity and
mortality data are an important component of health information system and their coding ensures a
uniform data analysis as well as comparison throughout the country and globally.
Central Bureau of Health Intelligence (CBHI) being the national nodal institution for health statistics in the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; has introduced a well designed inservice Orientation Training Course on ICD-10
of one week duration, in order to appropriately build the capacity amongst the officials engaged in
preparation, handling and maintenance of medical and health data.
This Module and Work Book (M&WB) is compiled and designed to facilitate the requisite orientation and self-learning on efficient use of ICD-10. Besides containing modules and related practical learning exercises covering all the chapters as contained in WHO's publication on ICD-10 (3
volumes); this Module and Work Book also contains the ready materials on (i) Body parts and their
key functions, (ii) Medical Terminologies, (iii) ICD-10 code list of three digit categories, and (iv)
special tabulation code lists for mortality and morbidity .
Based upon updation of ICD-10 by WHO Family of International classification Network, the 2nd
edition of M&WB is published during January 2008
We hope that this Module and Work Book will prove to be very handy for all those medical,
nursing, paramedical and concerned officials who are involved and keen to develop their skills in
efficient use of ICD-10. For further indepth details on ICD-10, kindly refer to the WHO's original
publication (three volumes) on ICD-10, namely, International Statistical Classification of Diseases
and Related Health Problems (Volume I), International Classification of Diseases (Volume II) and
International Statistical Classification of Diseases and Related Health Problems (Volume III); which
may be available as reference publication in libraries of medical, nursing and paramedical teaching
institutions, inservice health and family welfare training centres, institutions and hospitals, etc.
This WHO publication on ICD 10 (3 volumes) is also available on www.who.int/classifications/en.

ACKNOWLEDGMENT
This Module & Work Book has been prepared using the material developed (and concurred during October/November 2004) by Ms. Sue Waker & Maryann Wood, National
Centre for Classification in Health (Brisbane), School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove Q 4059 Australia, which was based
on the original work by Luminaire Training Enterprises.
The suggestions are also appreciated from Dr. Megha Chander Singh (MAMC), Mr. Shiv
Kumar (Dy RGI) and the representatives of twenty study hospitals from Delhi and Rohtak,
who participated in case study to improve and strengthen the use of ICD 10 in India, for
compilation of this ICD 10 Module & Work Book.
The concern and guidance of Dr. S.P. Agarwal, the then Director General of Health
Service and Dr. R. K. Srivastava, Addl. D.G .H.S. now Director General of Health Service,
Government of India, have been very valuable
Based on updation of ICD-10 by WHO-FIC Network the support of Mr. Umed Singh, Asstt.
Director CBHI and Mr. K. S. S. Nair, Statical Investigatior, CBHI is acknowledged for
updating this publication during the year 2008.

Please send your comments and suggestions to :


The Director,
Central Bureau of Health Intelligence (CBHI)
Directorate General of Health Services
Ministry of Health & Family Welfare
Room No. 401, A Wing, Nirman Bhavan, New Delhi - 110011
Email : dircbhi@nb.nic.in
TeleFax : 91-011-23061529
91-011-23063175

CONTENTS
ICD 10
Chapter
No.
-

Module
No.

Introduction To ICD-10 Structure and Principles of


Classification
What is clinical coding?
What is a statistical classification?
Why use a classification?
History of the International Classification of Diseases
Overview of the ICD-10 classification
Volumes of the ICD-10
Chapters of the ICD-10
Structure of the ICD-10 code

Volume 1 - Tabular List


Important points regarding the Tabular List
Chapters using more than one letter:
Blocks
Three character categories or rubrics
Four character categories or rubrics
Conventions
Inclusion Terms
Exclusion Terms
Glossary descriptions
Dagger and Asterisk convention
Parentheses ( )
Square brackets [ ]
Co1lon :
Brace }
Not Otherwise Specified (NOS)
N1ot elsewhere classified (NEC)
"A1nd" in code titles
Point dash
Volume 3 - Alphabetic Index
Important points regarding the Alphabetic Index
Structure of Index entries
Conventions
Parentheses ( )
Not Elsewhere Classified (NEC)
Cross-references
Procedure Coding Using ICHI
Important points for Coding with the ICHI
Conventions used in the Tabular List of Procedures
1st level - anatomical site axis
2nd level - procedural type axis
Block number
Abbreviations
Punctuation
Instructional terms
Conventions used in the Alphabetic List of Procedures
Blocks

Subject

Page
No.

13

18

5
6

II

III

10

Sequence
Modifiers
Not Elsewhere Classified (NEC)
Omit Block
Cross References
Eponyms
BASIC CODING GUIDELINES
Overview of Morbidity Coding
Sources of morbidity data
Uses of morbidity data
Central concepts for morbidity coding
Why single-condition coding?
Rules for reselection of main condition
Guidelines for coding of the main condition and other
Optional additional codes
Overview of Mortality Coding
Important points for mortality coding chapter
International Form of Medical Certificate of
Concept of underlying cause of death:
Selecting the underlying cause of death
General Principle:
Rule 1
Rule 2
Rule 3
Rules for modification:
Rule A. Senility and other ill-defined conditions
Rule B. Trivial conditions
Rule C. Linkage
Rule D. Specificity
Rule E. Early and late stages of disease
Rule F. Sequelae
Using the Medical Mortality Data System (MMDS)
Assumption of intervening cause
Highly improbable
Duration
Sequelae
Rheumatic fever with heart involvement
Nature of injury
Malignancy:
Certain Infectious and Parasitic Diseases
Important points for Chapter I
Coding exercises for Chapter I
Sample Hospital Discharge Summaries for Chapter I
Mortality Coding Exercises for Chapter I
Neoplasms
Important points for Chapter II
Coding exercises for Chapter II
Sample Hospital Discharge Summaries for Chapter II
Mortality Coding Exercises for Chapter II
Diseases of the Blood and Blood-Forming Organs and
Certain Disorders Involving The Immune Mechanism
Important points for Chapter III

23
25

36

55

63

72

ii

IV

11

12

VI

13

VII

14

VIII

15

IX

16

17

XI

18

XII

19

XIII

20

Coding exercises for Chapter III


Sample Hospital Discharge Summaries for Chapter III
Mortality Coding Exercise for Chapter III
Endocrine, Nutritional and Metabolic Disorders
Important points for Chapter IV
Coding exercises for Chapter IV
Sample Hospital Discharge Summaries for Chapter IV
Mortality Coding Exercises for Chapter IV
Mental and Behavioural Disorders
Important points for Chapter V
Coding exercises for Chapter V
Sample Hospital Discharge Summaries for Chapter V
Mortality Coding Exercises for Chapter V
Diseases of the Nervous System
Important points for Chapter VI
Coding exercises for Chapter VI
Sample Hospital Discharge Summaries for Chapter VI
Mortality Coding Exercises for Chapter V
Diseases of the Eye and Adnexa
Important points for Chapter VII
Coding exercises for Chapter VII
Sample Hospital Discharge Summary for Chapter VII
Diseases of the Ear and Mastoid Process
Important points for Chapter VIII
Coding exercises for Chapter VIII
Sample Hospital Discharge Summary for Chapter VIII
Diseases of the Circulatory System
Important points for Chapter IX
Coding exercises for Chapter IX
Sample Hospital Discharge Summaries for Chapter IX
Mortality Coding Exercises for Chapter IX
Diseases of the Respiratory System
Important points for Chapter X
Coding exercises for Chapter X
Sample Hospital Discharge Summaries for Chapter X
Mortality Coding Exercises for Chapter X
Diseases of Digestive System
Important points for Chapter XI
Coding exercises for Chapter XI
Sample Hospital Discharge Summaries for Chapter XI
Mortality Coding Exercises for Chapter XI
Diseases of the Skin and Subcutaneous Tissue
Important points for Chapter XII
Coding exercises for Chapter XII
Sample Hospital Discharge Summaries for Chapter XII
Mortality Coding Exercises for Chapter XII
Diseases of the Musculoskeletal System & Connective Tissue
Important points for Chapter XIII
Coding exercises for Chapter XIII
Sample Hospital Discharge Summaries for Chapter XIII
Mortality Coding Exercises for Chapter XIII

80

88

96

104

108

113

121

129

137

145

iii

XIV

21

XV

22

XVI

23

XVII

24

XVIII

25

XX

26

XXI

27

28

Diseases of the Genitourinary System


Important points for Chapter XIV
Coding exercises for Chapter XIV
Sample Hospital Discharge Summaries for Chapter XIV
Pregnancy, Childbirth and the Puerperium
Important points for Chapter XV
Coding exercises for Chapter XV
Sample Hospital Discharge Summaries for Chapter XV
Mortality Coding Exercises for Chapter XV
Certain Conditions Originating in the Perinatal Period
Important points for Chapter XVI
Coding exercises for Chapter XV
Sample Hospital Discharge Summaries for Chapter XVI
Mortality Coding Exercises for Chapter XVI
Congenital Malformations, Deformations and Chromosomal
Abnormalities
Important points for Chapter XVII
Coding exercises for Chapter XVII
Sample Hospital Discharge Summaries for Chapter XVII
Mortality Coding Exercises for Chapter XVII
Symptoms, Signs and Abnormal Clinical & Laboratory
Findings, Not Elsewhere Classified
Important points for Chapter XVIII
Coding exercises for Chapter XVIII
Sample Hospital Discharge Summaries for Chapter XVIII
Mortality Coding Exercises for Chapter XVIII
Injury, Poisoning and Certain Other Consequences of
External Causes (Chapter Xix) & External Causes of
Morbidity and Mortality
The external cause concept
Important points for Chapter XIX
Important points for Chapter XX
Coding exercises for Chapters XIX and XX
Sample Hospital Discharge Summaries for Chapter XIX &
XX
Mortality Coding Exercises for Chapter XIX &
Chapter XX
Factors Influencing Health Status and Contact With Health
Services
Important points for Chapter XXI
Coding exercises for Chapter XXI
Procedure Coding Exercises

153

161

169

177

184

193

207

211

APPENDIX 1

Human Body Structure and Their Key Functions. 216

APPENDIX 2

Medical Terminologies..239

APPENDIX 3

ICD 10 List of Three Digit Categories.. 244

APPENDIX 4

Special Tabulation Lists for Mortality & Morbidity (ICD-10) 297

iv

MODULE 1
Introduction to ICD-10 Structure
and
Principles of Classification

CBHI ICD 10 Student Workbook January 2008 Page 1

Module 1: Introduction to ICD-10 Structure And Principles of Classification


What Is Clinical Coding?
Clinical coding is the translation of diagnoses of diseases, health related problems and procedural
concepts from text to alphabetic/numeric codes for easy storage, retrieval and analysis.
What is a statistical classification of diseases?
A classification of diseases is a system of categories or groupings to which diseases, injuries,
conditions and procedures are assigned according to established criteria. It is the element of
grouping similar terms, which distinguishes a statistical classification from a nomenclature. A
nomenclature requires a separate name or title for each disease or procedure concept.
ICD-10 is a statistical classification, which means that it contains a limited number of mutually
exclusive code categories, which describe all disease concepts. The classification is hierarchical in
structure with subdivisions to identify broad groups and specific entities. The classification
includes specific rules to guide its use.
Why use a classification?
To allow easy storage, retrieval and analysis of data.
To allow systematic recording, analysis, interpretation and comparisons of mortality and
morbidity data between hospitals, provinces or countries.
To allow comparisons in the same location across different time periods.

History of the International Classification of Diseases


The theory of disease classification began in the 17th Century when 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. Death were classified as due to
thrush, convulsions, rickets, teeth and worms, chrysomes, livergrown, smallpox, swine pox, measles
and worms without convulsions. It was hoped that clues regarding the nature and aetiology of these
diseases would be brought to light and that this understanding would ultimately lead to better
treatments.
During the 18th Century, Sauvages first attempted to systematically classify all diseases in a work
called "Nosologia Methodica".
William Farr, the first medical statistician, who worked in the newly formed General Register Office
of England and Wales in the mid-1800s, further developed the work of both of these men. Farr's work
formed the basis of a recommendation to create the International List of Causes of Death, which was
presented to the first International Statistical Congress, held in Brussels in 1853. Although modified
in 1874, 1880 and 1886 to suit the needs of the time, Farr's classification did not receive universal
acceptance, despite his best efforts to promote it. The general arrangement of the classification
which included the principle of classifying diseases according to body site - became the basis for
work carried out by Dr Jacques Bertillon from Paris. Bertillon developed a classification that
distinguished between diseases that affected the body as a whole (systemic diseases) and those that
were localised to a particular body site. The Bertillon Classification of Causes of Death received
general approval and was adopted for use by several countries. When the American Public Health
Association recommended its use for Canada, Mexico and the USA, it also developed plans for the
updating of the classification every ten years. At this time, in the very early 1900s, there were only
179 groups of causes of death!
In 1920, the Health Organization of the League of Nations, which had taken an active role in the
collection and classification of death statistics, determined that it would take over the management of
CBHI ICD 10 Student Workbook January 2008 Page 2

the Causes of Death classification. When revising the classification for the fourth and fifth times, in
1929 and 1938, this organisation included classifications for non-fatal conditions for the first time.
In 1946, the Interim Commission of the World Health Organization was charged with the
responsibility for the continued revision of the classification. The sixth revision conference marked a
milestone in the collection of health and vital statistics. A new publication entitled "International
Classification of Diseases, Injuries and Causes of Death" was issued in 1948, based on the previous
work but including recommendations for the collection of morbidity data, as well as mortality
statistics. This classification underwent minor amendment in 1955 and 1965 but mainly to correct
errors of fact and inconsistencies. The 1965 revision included, for the first time, two volumes - a
tabular list and an alphabetical index.
In 1975, the 46 member states of the WHO convened in Geneva to begin development of the ninth
revision of the ICD, as it came to be known. In addition to the member states, a number of medical
specialty groups sent representatives, due to the now almost universal interest in using the
classification for medical record coding and indexing, monitoring and evaluation of health services
and epidemiological research. The next year, the World Health Assembly agreed to the revision of the
classification and to the development, on a trial basis, of a procedure classification as an
accompaniment to the disease classification. Thus the ICD-9 and ICPM (International Classification
of Procedures in Medicine) were introduced.
Work on the tenth revision of the International Classification of Diseases began in September 1983
when a preparatory meeting on ICD-10 was convened by the World Health Organisation in Geneva.
This was followed by several meetings of an expert committee in 1984 and 1987 to make decisions
on the direction the work should take and the form of the final proposal. In addition to the technical
contribution provided by the expert committees, a large number of comments and suggestions were
received from WHO member states and regional offices as a result of the worldwide circulation of the
draft proposals for revision and review.
It became clear that many users wished the ICD to encompass types of data other than simply
diagnostic information. Even if it was restructured, the ICD could not cope with the extremes of the
requirements. The concept was therefore developed of a "family" of classifications, with the main
ICD as the core, covering the traditional mortality and morbidity statistics, while the needs for more
detailed or different classifications would be dealt with by other members of the family such as the
International Classification of Functioning (ICF) and the Diagnostic and Statistical Manual of Mental
Disorders (DSM).
Several alternative models for the restructure of the main ICD were investigated, and the final
decision was to use an alphanumeric system, which would give a better balance to the chapters and
allow sufficient space for future additions and changes without disrupting the codes.
The alphanumeric coding scheme uses one letter followed by three numbers, at the fourth character
level. This has more than doubled the size of the coding frame in comparison with the ninth revision
and has enabled the vast majority of chapters to be assigned a unique letter or group of letters, each
capable of providing 100 three character categories. Of the 26 available letters, 25 have been used
the letter U having been left vacant for future additions and changes and for possible interim
classifications to solve difficulties arising between revisions.
ICD-10 is part of the ICD family of classification systems, which also includes:
International Classification of Functioning, Disability and Health (ICF)
International Classification of Diseases for Oncology (ICD-O)
Application of the International Classification of Diseases to Dentistry and Stomatology
(ICD-DA)
CBHI ICD 10 Student Workbook January 2008 Page 3

Application of the International Classification of Diseases to Rheumatology and


Orthopaedics (ICD-R&O), including the International Classification of Musculoskeletal
Disorders (ICMSD).

Overview of the ICD-10 classification


ICD-10 is a variable-axis classification - meaning the epidemiological data and statistical data
coded to it may be grouped as follows:
epidemic diseases
constitutional or general diseases
local diseases arranged by site
developmental diseases
injuries
There are three (3) main elements to the structure of the ICD-10. They are:
1. there are 3 volumes
2. there are 21 chapters
3. the structure of the code is alphanumeric.
Volumes of the ICD-10
Volume 1 is the Tabular list, which is an alphanumeric listing of diseases and disease groups,
along with inclusion and exclusion notes, some coding rules,special tabulation lists for
mortality and morbidity, definitions and regulation.
Volume 2 is Instruction Manual.It provides :
an introduction to, and instructions on how to use volumes 1 and 3
guidelines for certification and rules for mortality coding
guidelines for recording and coding for morbidity coding
Statistical presentation
Volume 3 is the comprehensive Alphabetical index of the diseases and conditions found in
the Tabular list.
Chapters of the ICD-10
The ICD-10 contains 21 chapters, each of which is identified by a Roman Numeral i.e. I, II,
III, IV, V etc. When referring to a chapter, you should call it by its chapter number and not by
the letters of the codes associated with it. i.e. refer to Diseases of the Digestive System as
Chapter XI and not as the K chapter. This is because some chapters contain more than one
letter and some letters are used in more than one chapter.
Structure of the ICD-10 code
The first character of the code is an alpha character, followed by two, three or four numeric
characters.

CBHI ICD 10 Student Workbook January 2008 Page 4

The structure of the three-character category is:

A37
first character
A to Z

followed by
2 digits

Most three-character categories are further subdivided into sub-categories to enable coding
of a disease or condition more specifically.

A37.1

first character
A-Z

followed by
2 digits

then a
point

lastly
another
digit

NOTE: In some countries and data collection systems, the decimal point may not be used, but for
the purposes of this course the decimal point should be included in all exercises.

CBHI ICD 10 Student Workbook January 2008 Page 5

MODULE 2
Volume 1 Tabular List

CBHI ICD 10 Student Workbook January 2008 Page 6

Module 2: Volume 1 - Tabular List


Important points regarding the Tabular List

Most chapters are associated with particular body systems, special diseases or external factors.
There is, however, one exception which is Chapter XVIII Symptoms, signs and abnormal
clinical and laboratory findings, not elsewhere classified.

The number of categories assigned to a chapter is influenced by the number of diseases and
conditions that fall within the scope of the chapter.

Fourteen of the chapters have a single letter assigned to them and use most of the 100
categories available. For example, Chapter XI contains codes ranging from K00 to K93. The
codes K94 to K99 have not been used at this stage and have been left vacant for future
additions to the classification.

Three chapters have a smaller range of categories assigned to them and share letters.

Four chapters use more than one letter in defining categories. e.g. Chapter II contains codes
beginning with C and D.

Exercise 1:
1. What is the range of 3-character categories used in Chapter III?
2. Two letters are split between a multiple chapters. Which are they?
3. How many letters does Chapter XX use?
Chapters using more than one letter:
Chapter I
Certain infectious and parasitic diseases
Chapter II
Neoplasms
Chapter XIX
Injury, poisoning and certain other
consequences of external causes
Chapter XX
External causes of morbidity and mortality
Chapters using same letter
Chapters II & III D ; Chapters VII & VIII H

A,B
C,D
S,T
V,W,X,Y

Look at titles of the chapters of the ICD-10. The chapter titles indicate that the conditions included
are wide ranging, therefore a large number of codes are required to cover all the conditions. Using
an alpha character at the beginning of the code has allowed for 2,600 available 3-character codes.
This in turn allows for a large number of 4 character subcategories. Each 3-character code can
have up to 10 subcategories.
Blocks
Each chapter has been divided into blocks of related conditions. The blocks are then divided into
three, four and five digit categories.
Three character categories or rubrics
Some blocks have three character categories for single conditions. Other blocks contain groups of
diseases.
Four character categories or rubrics
These are not mandatory for reporting at international level but the use of fourth characters adds
detail and specificity to the coded data. The use of fourth characters allows up to ten subcategories.
The fourth character 8 is generally used for other conditions belonging to the three character
CBHI ICD 10 Student Workbook January 2008 Page 7

category, and 9 conveys similar meaning as the three character category title, without adding any
additional information.
Conventions
The ICD-10 Tabular List (Volume I) makes use of certain abbreviations, punctuations, symbols
and instructional terms which must be clearly understood. These are referred to as the coding
conventions.
Inclusion Terms
Within the three and four character rubrics there are usually listed a number of other diagnostic
terms in addition to the code title. These are known as "inclusion terms" and are given as examples
of diagnostic statements to be classified to that rubric. They may refer to different conditions or be
synonyms. They are not a subclassification of the rubric. They are to be used as a guide to the
content of the rubric, keeping in mind that the list is not exhaustive.
e.g. G91 Hydrocephalus includes acquired hydrocephalus
Exercise 2:
1. Does the code L03.0 Cellulitis of finger and toe include paronychia?
Exclusion Terms
Certain rubrics contain lists of conditions preceded by the word "Excludes". These terms are to be
coded elsewhere, not within this category as the code may suggest. The correct code that should
be assigned is in parentheses following the term.
e.g. Q74 Other congenital malformations of limb(s) excludes polydactyly (Q69.-),
reduction defect of limb (Q71-Q73), syndactyly (Q70.-)
Exercise 3:
1. Should reduction defects of the feet be coded within the 3-character category Q66?
If not, where should they be coded?
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,
particularly between different countries and the same name may be used to describe quite different
conditions. The glossary is not intended for use by coding staff to make a diagnosis but is
intended as a guide for clinicians to indicate the content of the rubric.
Dagger and Asterisk convention
The dual coding system of creating combinations of codes through attachment of daggers () and
asterisks (*) has been used in ICD-10, thus allowing the description of a condition in terms of its
underlying cause or aetiology () and current manifestation (*). This enables a better
description of the medical care provided and resources used in its treatment to be given.
Using this convention, two codes are assigned for diagnostic statements that contain information
about both an underlying generalised disease and a manifestation in a particular organ or site,
which is a clinical problem in its own right.
The primary code is for the underlying disease and is marked with a dagger (). An optional code
for the manifestation is marked with an asterisk (*).
CBHI ICD 10 Student Workbook January 2008 Page 8

It is a basic principle of the ICD that the dagger code is the primary code and must always be used
for single condition coding. An asterisk code should never be used alone. When coding underlying
cause of death for mortality purposes, the dagger code should be used, never an asterisk code.
Dagger and asterisk codes convey different meanings in combinations depending upon the
circumstances of placing the signs.
+ with * mark in headin gdenotes same code used for the conditions listed below it.
e.g. A 170+ Tuberclulosis memingeo (areoral) (spinal)
tuberenlons upto memingitis
+ without * in the heading but mentioned in codes in parespests below it denotes that
different codes are available for the conditions following the dianosis in the heading
e.g A 18.1 + Tuberonlosis of genitourinary system
Tuberculosis of:
Bladder (N 33.0*)
Cervix (or 74.0*)
None of the symbols + & * present in title/heading indicates that there are individual
terms with alternative codes.
e.g. A 54.8 other gonococcnl infections
Gonococcal:
Peritonitis + (K 67.1*)
Pneumonia + (J17.0*)
Septicasmia
There are 83 asterisk categories in ICD-10 (listed at the start of relevant chapters) which may be
used in conjunction with a dagger code, but must not be used alone. Asterisk categories are listed
at the beginning of each chapter, block and rubric where appropriate.
Exercise 4:
1. How many asterisk categories are there in Chapter IX, Diseases of the Circulatory System?
Parentheses ( )
Parentheses are used in four ways in Volume 1:
1. To enclose supplementary words, which may follow a diagnostic term without affecting
the code number to which the words outside the parentheses would be assigned.
e.g. G11.1 Early-onset cerebellar ataxia
Friedrichs ataxia (autosomal recessive)
2. To enclose the code to which an exclusion term refers.
e.g. B25 Cytomegaloviral disease excludes congenital cytomegalovirus infection
(P35.1)
3. To enclose the three-character codes of categories in a particular block.
e.g. Diseases of peritoneum (K65-K67)
4. To enclose the dagger code in an asterisk category or the asterisk code in a dagger term.
e.g. K77.0* Liver disorders in infectious and parasitic diseases classified elsewhere
Hepatitis
- cytomegaloviral (B25.1)
CBHI ICD 10 Student Workbook January 2008 Page 9

Exercise 5:
1. Is N13.0 the correct code for Hydronephrosis with ureteropelvic junction obstruction and
infection? If not, what is the correct code?
Square brackets [ ]
Square brackets are used:
For enclosing synonyms, alternative words or explanatory phrases.
e.g. A84.0 Far Eastern tick-borne encephalitis [Russian spring-summer encephalitis]
2. For referring to notes.
e.g. C21.8 Overlapping lesion of rectum, anus and anal canal
[see note 5 on page 182]
3. For referring to a previously stated set of fourth character subdivisions common to a
number of categories.
e.g. F10.- Mental and behavioural disorders due to use of alcohol [see pages 321
323 for subdivisions]
Exercise 6:
1. What does the note in [ ] tell us for codes in the M79 rubric?
Colon :
The colon [:] is used in listings of inclusion and exclusion terms when the words that
precede it are not complete terms for assignment of the diagnosis to that rubric.
In other words, the words require one or more of the modifying or qualifying words
indented under the lead term before the diagnosis can be assigned to the rubric.
e.g. G71.0 Muscular dystrophy:
autosomal recessive
benign
distal

Brace }
A brace is used in listings of inclusion and exclusion terms to indicate that neither the
words that precede it nor the words after it are complete terms. In other words, one or more
of the terms that follow the brace should be part of the diagnosis, to qualify any of the
terms before the brace.
e.g. E10.1 Insulin dependent diabetes mellitus with ketoacidosis
See the brace under the entry for the relevant fourth character
1.

With ketoacidosis
Diabetic:
Acidosis
Ketoacidosis

} without mention of coma


}

CBHI ICD 10 Student Workbook January 2008 Page 10

Not Otherwise Specified (NOS)


NOS is an abbreviation for 'not otherwise specified', implying 'unspecified' or 'unqualified'.
Coders should be careful not to code a term as unqualified unless it is quite clear that no
other information is available that would permit a more specific code assignment from
elsewhere in the classification.
e.g. K14.9 Disease of tongue, unspecified
Glossopathy NOS
Not elsewhere classified (NEC)
NEC stands for not elsewhere classified. When used in a three-character category title,
NEC serves as a warning that certain specified types of the listed conditions may appear in
other parts of the classification.
e.g. K73 Chronic hepatitis, not elsewhere classified
"And" in code titles
In Volume 1 of ICD-10, "and" stands for "and/or".
e.g. S49.9 Unspecified injury of shoulder and upper arm means Unspecified injury
of shoulder or unspecified injury of upper arm or unspecified injury of shoulder and
upper arm.
Point dash .
When used as a replacement for the fourth character of a subcategory, a point dash [.-]
indicates to the coder that a fourth character exists and should be sought in the appropriate
category in the Tabular list.
e.g. D59.1 Other autoimmune haemolytic anaemias
Excludes haemolytic disease of fetus and newborn (P55.-)
Corrections:
There have been some corrections to the Tabular list which have been included in a corrigendum
at the back of volume 3..
As noted earlier, as part of the updating process for ICD-10, addenda of changes and updates to
the classification are also released. A copy of the updates made to the classification since 1996 are
included as an appendix to this manual or is available at
http://www3.fhs.usyd.edu.au/ncchwww/site/3.2.htm#10
Coders should ensure that the changes outlined in the corrigenda and the addenda are made before
commencing coding. This will assist in maintaining comparability with statistical reporting in
other countries, and will ensure that the classification reflects current clinical practice.

CBHI ICD 10 Student Workbook January 2008 Page 11

MODULE 2 - ANSWERS

Volume 1 Tabular List


Exercise 1
1. What is the range of 3-character categories used in Chapter III?
D50 to D89. Only some of the codes are used however - have a look through the chapter. Now
look at other chapters and compare them.
2. Two letters are split between multiple chapters - which are they?
D is used in chapters 2 and 3; H is used in chapters 7 and 8.
3. How many letters does Chapter XX use?
4 letters - V, W, X, Y
Exercise 2
1. Does the code L03.0, Cellulitis of finger and toe include paronychia?
Yes - it is listed as an inclusion term.
Exercise 3
1. Should reduction defects of the feet be coded within the three-character category Q66?
No - the exclusion note directs the coder to Q72.Exercise 4
1. How many asterisk categories are there in Chapter IX?
8 - they are listed at the beginning of the chapter.
Exercise 5
1. Is N13.0 the correct code for Hydronephrosis with ureteropelvic junction obstruction and
infection? If not, what is the correct code?
No - the exclusion note under N13.0 excludes hydronephrosis that occurs with infection. The
correct code is N13.6.
Exercise 6
1. What does the note in [ ] tell us for codes in the M79 category?
The coder should refer to pages 628 - 629 for site codes for this category.

CBHI ICD 10 Student Workbook January 2008 Page 12

MODULE 3
Volume 3 Alphabetical Index

CBHI ICD 10 Student Workbook January 2008 Page 13

Module 3: Volume 3 - Alphabetic Index


Important points regarding the Alphabetic Index
Volume 3 is an alphabetic index to the Tabular Listing of Volume 1. As such, it contains far
more diagnostic terms than the tabular list, reflecting the many and varied ways that doctors
and other clinical staff describe diseases.
Volume 3 consists of:
an Introduction, explaining the purpose of the index, its general arrangement and
conventions used in the index
Section I which is an alphabetic listing of terms relating to diseases, nature of injury,
reasons for contact with health services and factors influencing a persons health
Section II which is an alphabetic listing of external causes of injury, morbidity and
mortality
Section III, which is an alphabetically arranged table of drugs and chemicals.
Structure of Index entries
Index entries contain:
Lead terms (usually nouns, sometimes adjectives e.g. carious, tuberculous etc) to the far
left of each column, in bold. They refer mainly to the names of diseases or conditions.
Modifiers at different levels of indentation to the right. They usually refer to varieties of
sites or circumstances that affect coding. Modifiers which do not affect code assignment
appear in parentheses ( ) after the condition. All modifiers appear in alphabetical order
except with which always appears first.
e.g. to code a bilateral inguinal hernia with gangrene and obstruction, firstly identify the
lead term (hernia), then follow the series of indentations in the Index until all of the
diagnosis description has been covered.
Hernia
- inguinal
- - bilateral
- - - with
- - - - gangrene (and obstruction) K40.1
Note that there are often many entries at each level of indentation and
it is necessary to be careful in following the trail of relevant entries
for your diagnosis under each lead term.
Code numbers follow the terms in the index and may appear as a 3-character category or
be subdivided with either the appropriate 4th digit or a dash (.-). Where the dual system
of coding ( and *) applies, both codes are given in the index. The dagger is always
mentioned first, followed by the asterisk code.
If you cannot identify the lead term in the Index, there are a number of standard ways
that codes can be found. Try using one of the following generic lead terms:
disease
complication
syndrome
pregnancy
labour
delivery
CBHI ICD 10 Student Workbook January 2008 Page 14

puerperal
maternal condition affecting fetus or newborn
injury
sequelae
suicide
assault
legal intervention
war operations
counselling
observation
examination
history
problem
screening
status
vaccination
Exercise 1:
Identify the lead term and the modifier in the diagnosis Chronic Bronchitis.
Exercise 2:
Look up the following conditions in Volume 3 (Alphabetical Index):
Laryngotracheobronchitis
Hippels Disease
Anesthesia overdose
Mumps with orchitis
NOTE: American spelling is used throughout Volume 3, with cross-references
diphthongs appear at the beginning of a term

wherever

eg. Oesophag(o) ... - see Esophag(o) ...


However, in Volume 1 so-called English spelling is used. For example: look up
Haemochromatosis with refractory anaemia
Conventions
Parentheses ( )
Parentheses are used in the same way as in Volume 1, to enclose non-essential modifiers
which do not affect code assignment.
e.g. Deafness (acquired)(complete)(hereditary)(partial) H91.9
Not Elsewhere Classified (NEC)
"Not elsewhere classified" indicates that specified variants or types of the disease are
classified elsewhere, and that where appropriate, a more precise term should be looked for
in the Index. If the specific diagnostic term cannot be found in the Index, then the NEC
code can be used indicating that the condition does not have a unique code elsewhere in the
classification.
CBHI ICD 10 Student Workbook January 2008 Page 15

e.g. Mastoiditis (coalescent)(haemorrhagic)(suppurative) H70.9


- acute, subacute H70.0
- chronic (necrotic)(recurrent) H70.1
- specified NEC H70.8
Cross-references
Cross references are used to avoid unnecessary duplication of terms in the Index.
"See" requires the coder to refer to the other term. This is a mandatory instruction.
e.g. Ingestion
- chemical - see Table of Drugs and Chemicals
"See also" directs the coder to refer elsewhere in the Index if the statement being coded
contains other information that is not found indented under the term to which "see
also" is attached. This helps the coders to find the most specific code possible for
the diagnosis being coded.
e.g. Injury (see also specified injury type)
It is imperative that Volumes 1 and 3 be used together in locating codes to accurately
describe each clinical case - coders should not fall into the trap of coding straight
from the Alphabetical Index or browsing around the Tabular List looking for a code
that seems to fit the case being coded.
Exercise 3:
Assign codes for the following conditions firstly just from Volume 3 (column 1) and then again
after completing the coding process through Volume 1 (column 2):
ICD-10 Codes
Index
Tabular
Patient diagnosed with:
Aortic stenosis
_______
_______
and
Mitral Insufficiency
_______
_______

CBHI ICD 10 Student Workbook January 2008 Page 16

MODULE 3 - ANSWERS
Volume 3 Alphabetical Index
Exercise 1
1. Identify the lead term and the modifier in the diagnosis Chronic Bronchitis.
Lead term -

Bronchitis

Modifier -

Chronic - this is an essential modifier

Exercise 2
1. Look up the following conditions in Volume 3, Alphabetical Index:
Laryngotracheobronchitis

J40

Hippel's Disease

Q85.8

Anesthesia overdose

T41.-

Mumps with orchitis

B26.0 N51.1*

Exercise 3
1. Assign codes for the following conditions firstly just from Volume 3 (see column 1) and then
again after completing the coding process also using Volume 1 (see column 2):
Col 1

Col 2

Aortic stenosis

I35.0

I08.0

Mitral insufficiency

I34.0

I08.0

CBHI ICD 10 Student Workbook January 2008 Page 17

MODULE 4
Procedure Coding Using the ICHI

CBHI ICD 10 Student Workbook January 2008 Page 18

Module 4 : Procedure Coding Using ICHI


Important points for Coding with the ICHI
ICHI stands for the International Classification of Health Interventions. It was developed by the
NCCH in 2002 and is a subset of the Australian procedure classification, the Australian
Classification of Health Interventions (ACHI). The ACHI is based on an Australian fee schedule
known as the Medicare Benefits Schedule, or MBS. ICHI includes codes for surgical and medical
procedures, allied health interventions and dental procedures.
The ICHI was created to provide a short and simple classification of procedures and interventions,
specifically for countries which have previously used the International Classification of
Procedures in Medicine (WHO:1978) and which wish to migrate to a more current classification.
It is also for those countries that have not used a procedure classification in the past.
The Australian Classification of Health Interventions (ACHI), which is the source of the ICHI, is
updated biennially by the National Centre for Classification in Health. The classification has been
accepted as a member of the Family of International Health Classifications and consideration is
being given to having it published by WHO.
ICHI includes an extensive Index and a Tabular list, both published within the one volume. Code
numbers are between 1-4 characters in length and are in sequential numerical order in the tabular
list.
More information about ICHI is available at http://www3.fhs.usyd.edu.au/ncchwww/site/4.1.4.htm
Conventions used in the Tabular List of Procedures
1st level - anatomical site axis
The principal axis of classification in the ICHI is anatomical site. Within each chapter, the
anatomical site has been structured using a superior to inferior, or head to toe, approach.
2nd level - procedural type axis
The secondary axis, within the site chapters, relates to procedure type, beginning with the least
invasive procedure through to the most invasive procedure. The standard procedural axes are:
Examination
Application, insertion or removal
Incision
Destruction
Excision
Reduction (only applicable to the musculoskeletal chapter)
Repair
Reconstruction
Revision
Re-operation
Other procedures
Block number
The block numbers represent the codes in the ICHI and are numbered sequentially to assist coders
to locate specific codes.

CBHI ICD 10 Student Workbook January 2008 Page 19

There are certain chapters which contains exceptions to the general format of the ICHI. These are:
Dental Services
This chapter is based on 'An Australian Schedule of Dental Services and Glossary, Sixth
Edition, 2000' which is published by the Australian Dental Association Incorporated. In line
with its parent schedule, the Dental Services chapter is structured on a service basis e.g.
diagnostic services, preventive services, periodontics, oral surgery, etc. Secondary axes
generally relate to procedure types.
Obstetric Procedures
The principal axis of classification in this chapter relates to the pregnancy cycle e.g.
antepartum procedures, procedures associated with labour and delivery, postnatal procedures,
etc. Secondary axes relate to the type of procedure.
Chemotherapeutic and radiation oncology procedures
This chapter has, as its principal axis, procedures relating to chemotherapeutic treatment and
radiation oncology. Secondary axes within the radiation oncology axis relate to the type of
radiation e.g. external beam therapy, brachytherapy, etc.
Non-invasive, cognitive and interventions NEC
The principal axis of classification in this chapter refers to the purpose of the intervention
(diagnostic, therapeutic or administrative/clinical/client support). The secondary axis relates to
the type of procedure or the body system. For example, within the primary axis of Diagnostic
Interventions, the secondary axes are Assessment, Consultation, Interview, Examination,
Evaluation or Diagnostic tests/measures/investigations. In the axis of Therapeutic
Interventions, the secondary axes are Counselling, Education, Nutritional Support,
Interventions, Immunisation, Injections, Perfusions or Therapeutic interventions.
Imaging Services
The type of imaging service performed forms the primary (and only) axis of this chapter - e.g.
ultrasound, tomography, radiotherapy, etc.
Abbreviations
NEC is used in the same way as in the ICD-10 to indicate that other specified variants or types
of the condition being coded appear in other parts of the classification and should be used if
the coder has sufficient information to assign one of the more specific codes.
Punctuation
Colon :
Colons are also used in the same way as the ICD-10 to indicate to the coder that the terms to
the left of the colon are incomplete and require a modifier from the terms to the right of the
colon for assignment of the code.
Instructional terms
There are two instructions that are used in the ICHI. These are Code also and Code also when
performed. These may be found at the chapter level or at the level of the first or second axis or
at the block level. The two instructions indicate to the coder that an additional block code is to
be used when certain associated procedures are also performed or where a certain type of
equipment is employed.

CBHI ICD 10 Student Workbook January 2008 Page 20

Conventions used in the Alphabetic List of Procedures


Blocks
Block numbers appear in the Index in bold and are located to the right of the text.
Sequence
Main terms are sequenced alphabetically with hyphens, spaces and symbols preceding numbers
and letters of the alphabet.
For example:
Amnio-infusion 1330
Amniocentesis
- diagnostic 1330
- therapeutic 1330
Diathermy
- bladder (endoscopic) 1097
- - tumour (single)(solitary)(with resection) 1097
- - - >2cm dia. 1097
- - - - multiple 1097
Numbers, whether Arabic or Roman, are sequenced numerically before alphabetic characters.
For example:
Suture
- obstetric laceration, current (tear) 1344
- - 1st degree 1344
- - 2nd degree 1344
- - - 3rd degree 1344
- - - - 4th degree 1344
- - bladder (and urethra) 1344
- - cervix 1344
The prepositions 'as', 'by', 'for', 'with' and 'without' immediately follow the main term or subterm to
which they relate. When the description of a procedure includes both a description beginning with
a preposition, and also an alphabetic subterm, the prepositional term takes precedence.
For example:
Arthoplasty (see also Repair, joint) 1571
- by osseointegration (implantation of titanium fixture)
- - digit (finger)(toe) 1698
- for hallux valgus (hallux rigidus)(unilateral) 1547
- - with prosthesis 1547
- - bilateral 1547
- - - with prosthesis 1547
- ankle
- - for joint replacement (total) 1544
- Austin Moore, hip 1489

CBHI ICD 10 Student Workbook January 2008 Page 21

Modifiers
A main term or a subterm may be followed by a series of terms in parentheses. The presence or
absence of these terms makes no difference to the selection of the block code. These terms are
called non-essential modifiers.
A term may also be followed by subterms, which do have an effect on selection of the appropriate
block code. These are called essential modifiers and are found on individual lines at different
levels of indentation following the lead term and are preceded by hyphens. Each line represents an
essential difference in site or surgical technique.
Not Elsewhere Classified (NEC)
In the ICHI the NEC convention is used in two ways:
With ill-defined terms, to serve as a warning that specific forms of the procedure being coded
are classified differently. The only time such codes should be used in where more specific
information is unavailable.

Terms for which a more specific category is not provided by the classification and no amount
of additional information will alter the selection of the block code.

Omit Block
This convention may refer to terms that identify incisions that are listed as main terms in the
alphabetic list of procedures. If the incision is made only for the purposes of performing further
surgery, the instruction 'omit block' is given.
For example:
Arthrotomy 1555
- as operative approach - omit block
- ankle 1529
- elbow 1410
- hip 1481
Omit block may also be used to apply to certain procedures which, when performed with other
procedures, should not be coded.
For example:
Cardioversion 1890
- in conjunction with cardiac surgery - omit block
Cross References
Cross references point the coder to possible synonyms or modifiers for a term. There are three
types of cross references in ICHI.
See is an explicit direction to look elsewhere in the classification.
See also directs the coder to another lead term for use where the entries under the first term do not
provide an appropriate block.
See block xxxx indicates that the tabular list should be consulted for further information or specific
site references.
Eponyms
Procedures named after persons are called eponyms. These are listed both as main terms in the
appropriate alphabetical sequence and also under the main term 'procedure'. A description of the
procedure or the anatomical site usually follows the eponym.
CBHI ICD 10 Student Workbook January 2008 Page 22

MODULE 5
Basic Coding Guidelines

CBHI ICD 10 Student Workbook January 2008 Page 23

Module 5: Basic Coding Guidelines


When coding you must use the Alphabetical Index as well as the Tabular List. These guidelines
should be followed when coding using ICD-10 and the ICHI.
1. Identify the type of statement to be coded and refer to the appropriate section of the
Alphabetical Index. (If the Statement is a disease or injury or other condition classifiable to
Chapters I-XIX or XXI, consult Section I of the Index. If the statement is the external cause of
an injury or other event classifiable to Chapter XX, consult Section II. If the statement is a
procedure, surgery or other intervention, refer to ICHI)
2. Locate the lead term. For diseases and injuries this is usually a noun for the pathological
condition. However, some conditions expressed as adjectives or eponyms are included in the
Index as lead terms.
3. Read and be guided by any note that appears under the lead term.
4. Read any terms enclosed in parentheses after the lead term, as well as any terms indented under
the lead term, until all the words in the diagnostic term have been accounted for.
5. Follow carefully any cross-references ("see" and "see also") found in the Index.
6. Refer to the Tabular List to verify the suitability of the code number selected.
7. Be guided by any inclusion or exclusion terms under the selected code or under the chapter,
block or category heading.
8. Assign the code.

CBHI ICD 10 Student Workbook January 2008 Page 24

MODULE 6
Overview of Morbidity Coding

CBHI ICD 10 Student Workbook January 2008 Page 25

Module 6: Overview of Morbidity Coding


This section covers the coding of diagnoses and other reasons for contact with health services.
Prior to 1948, the International Classification of Diseases was used only for mortality coding. With
the 6th revision of ICD in 1948 came the recognition of its potential for morbidity coding. The 6th
revision then became an expanded version that included codes for non-fatal conditions. This
expansion has continued ever since - there has been a steady increase in the number of categories
for coding non-fatal conditions and other health-related circumstances.
For the purposes of ICD, the term morbidity covers illness, injuries and reasons for contact with
health services including screening and preventive care. Coding usually relates to an episode of
health care in a health institution but may also apply to surveys or other diagnostic data.
Morbidity usually relates to a single episode of health care. An episode of health care may be
defined as:
A period of inpatient care;
or
a contact (or series of contacts in a specific time period) with a health care
practitioner in relation to the same condition or its immediate consequences.

Sources of morbidity data


Sources of data for morbidity coding include:

Hospital records
School medical records
Death certificates
Armed services records
Occupational medical records
Health surveys
Outpatient records (ambulatory care)
Maternal and child health services records
Disease surveillance records e.g. vaccine preventable diseases, HIV etc.
Cancer and chronic disease registry records
Other

Uses of morbidity data


Morbidity data may be used, among other things, to provide clues to causes of disease, and it may
form the basis on which decisions are made about previous measures or the allocation of resources
or priorities for disease prevention programs.

Central concepts for morbidity coding


At the end of an episode of care, the clinician should record all conditions which affected the
patient in that period.

CBHI ICD 10 Student Workbook January 2008 Page 26

Practice may vary from establishment to establishment or health authority to health authority
in some places, one diagnosis will be singled out for coding (single-condition coding) while in
other places, all diagnoses will be coded for each episode of care (multi-condition coding).
Coders need to be aware of the policy of their establishments in this regard.
Why single-condition coding?
Some establishments may implement this policy because of lack of resources (e.g. coding,
administrative) or because the resultant simpler data may be more appropriate for its needs.
With single-condition coding, there is the need to choose the main condition from the set of
diagnoses so that it can then be coded.
Section 4.4 of Volume 2 (page 96) concerns the rules and guidelines adopted by the World Health
Assembly regarding the selection of a single cause or condition for routine tabulation from
morbidity records, and also guidelines for the application of the rules and for coding of the
condition selected for tabulation. The following is an excerpt from this section - you should read
the entire section to ensure you understand the WHO requirements for morbidity coding.
The condition to be used for single-condition morbidity analysis is the main condition treated
or investigated during the relevant episode of health care. The main condition is defined as
the condition, diagnosed at the end of the episode of health care, primarily responsible for the
patients need for treatment or investigation. If there is more than one such condition, the one
held most responsible for the greatest use of resources should be selected. If no diagnosis was
made, the main symptom, abnormal finding or problem should be selected as the main
conditionBy limiting the analysis to a single condition for each episode, some available
information may be lost. It is therefore recommended, where practicable, to carry out
multiple condition coding and analysis to supplement the routine data.
Clinicians and coders will have no trouble in choosing a main condition if the patient is treated for
only one condition during an episode of care but many cases are not that simple.
What distinguishes the main condition (MC) from the rest of the recorded conditions?
The main condition is the diagnosis established at the end of the episode
of health care to be the condition primarily responsible for the patient
receiving treatment or being investigated i.e. that condition which is
determined as being mainly responsible for the episode of health care.
What then are other conditions (OC) which might be coded?
Other conditions are defined as those that coexist or develop during the
episode of health care and affect the management of the patient.
For coding purposes, other conditions (also known as additional diagnoses) should be
interpreted as conditions that affect patient management in terms of requiring any of the
following:

therapeutic treatment
diagnostic procedures
increased nursing care and/or monitoring

One or more of the above factors will generally result in an extended length of hospital
stay.

CBHI ICD 10 Student Workbook January 2008 Page 27

Rules for reselection of main condition


In some instances, the Main Condition recorded by the clinician may not be consistent with the
WHO definition. Alternatively, no Main Condition may have been specified. WHO has
developed a set of rules that can be used to ensure that the Main Condition selected and coded
reflects the condition mainly responsible for the episode of care. Coders need to be familiar with
these rules and be able to apply them. More information and examples of the rules is available in
volume 2 of ICD-10.
MB1. Minor condition recorded as main condition, more significant condition recorded as
other condition.
Where a minor or longstanding condition, or an incidental problem, is recorded as the
main condition, and a more significant condition, relevant to the treatment given and/or
the specialty that cares for the patient, is recorded as an other condition, reselect the
latter as the main condition.
Exercise 1:
MC Gastritis
OC
Carcinoma of the intestine
Proc Colectomy
LOS 5 weeks
MC =

ICD-10 code =

Exercise 2:
MC Impacted wisdom tooth
OC
Hypertensive heart disease
Neuralgia
Halitosis
Proc Dental extraction
Spec Dentistry
LOS 2 days
MC =

ICD-10 code =

Review the examples for applying MB1 on page 107-108 of Volume 2.


MB2. Several conditions recorded as main condition.
If several conditions that cannot be coded together are recorded as the main condition,
and other details on the record point to one of them as the main condition for which the
patient received care, select that condition. Otherwise select the condition first
mentioned.
Exercise 3:
MC Bilateral bunions
Secondary lesion, lymph node
Cancer of breast
Proc Mastectomy
MC =

ICD-10 code =

CBHI ICD 10 Student Workbook January 2008 Page 28

Exercise 4:
MC
Premature rupture of membranes
Breech presentation
Anaemia of pregnancy
Proc Spontaneous Vaginal Delivery
MC =

ICD-10 code =

Review the examples for MB2 on pages 108-110 of Volume 2.


MB3. Condition recorded as main condition is presenting symptom of diagnosed, treated
condition
If a symptom or sign (usually classifiable to Chapter XVIII), or a problem classifiable
to Chapter XXI, is recorded as the main condition and this is obviously the presenting
sign, symptom or problem of a diagnosed condition recorded elsewhere and care was
given for the latter, reselect the diagnosed condition as the main condition.
Exercise 5:
MC Abdominal pain
OC
Acute appendicitis
Proc Appendicectomy
MC =

ICD-10 code =

Exercise 6:
MC
Faecal incontinence
OC
Angina
Crohns Disease, large intestine
Proc Partial excision, colon
MC =

ICD-10 code =

Review the examples of MB3 on pages 110-111 of Volume 2.


MB4. Specificity
Where the diagnosis recorded as the main condition describes a condition in general
terms, and a term that provides more precise information about the site or nature of the
condition is recorded elsewhere, reselect the latter as the main condition.
Exercise 7:
MC Congenital heart disease
OC
Ventricular septal defect
MC =

ICD-10 code =

Review the examples of MB4 on page 111 of Volume 2.

CBHI ICD 10 Student Workbook January 2008 Page 29

MB5. Alternative main diagnoses


Where a symptom or sign is recorded as the main condition with an indication that it
may be due to either one condition or another, select the symptom as the main
condition. Where two or more conditions are recorded as diagnostic options for the
main condition, select the first condition recorded.
Exercise 8:
MC Nausea and vomiting due to food poisoning or appendicitis
OC
MC =

ICD-10 code =

Exercise 9:
MC Abdominal pain due to acute cholecystitis or acute pancreatitis
OC
MC =

ICD-10 code =

Exercise 10:
MC Gastroenteritis due to Salmonella or gastroenteritis due to Yersinia
OC
MC =

ICD-10 code =

Guidelines for coding of the main condition and other conditions


Selection of the main condition should be done by the clinician caring for the patient or may, if
necessary, be identified at the time of coding, by application of the rules for reselection.
Once the main condition has been selected correctly, you may then code the case, following
normal procedures.
For guidelines to selection of the correct code for MC, see Volume 2, section 4.4.
The sequence to follow for morbidity coding is as follows:

All cases

Single-condition coding
Multi-condition coding

Multi-condition coding

Selection of MC

Code MC

Code other conditions

Where practicable, other conditions should be recorded, even when single-cause coding is to
be performed. This provides the coder with a fuller picture of the case, thus making it easier to
assign a more specific ICD code for the main condition or to verify the main diagnosis using
the rules.
Optional additional codes
Before continuing further, you should read Section 4.4.2 of Volume 2. The ICD-10 classification
itself sometimes indicates when a "main condition" can be made more specific by the addition of
another code.

CBHI ICD 10 Student Workbook January 2008 Page 30

Example:
Acute pulmonary oedema due to exposure to sulphur dioxide fumes
MC = Acute pulmonary oedema
OC = Accidental poisoning by and exposure to
other gases and vapours

ICD-10 code = J68.1


ICD-10 code = X47.9

Instruction under J68 states use additional external cause code (Chapter XX), if desired, to
identify cause.
Coding of conditions to which the dagger and asterisk system applies (dual system)
Example:
MC = Post chickenpox encephalitis

ICD-10 code = B01.1


G05.1*

The dagger and asterisk codes should be used together, wherever possible, because they describe
different aspects of the condition. The dagger code is the preferred main condition.
See page 100 of Volume 2 for further details.
External causes of morbidity and injuries
Injuries may be classified by their nature (Chapter XIX) and by the external cause that led to the
injury (Chapter XX). Both codes should be used but the nature of the injury code is the preferred
main condition for morbidity coding.
Example:
Fracture of skull - motorcycle passenger in head-on collision with pick-up truck.
MC = Fractured skull
ICD-10 code = S02.9
OC = Circumstances of accident
ICD-10 code = V23.5
See page 103 of Volume 2 for further details.
Sequelae (late effects) of certain conditions
A number of categories entitled sequelae of ..( B90-B94, E64.-,G09, I69.-, 097, T90-T98,
Y85=Y89) are available which enable the coding of a past condition which is itself no longer
present, but which is the cause of a present problem. In such a case, the current condition is the
preferred main condition.
However, where a past condition is responsible for the presence of multiple current conditions
and not one of the current conditions can be identified as predominant, then the sequela code (for
past condition) may be used as the preferred main condition and followed by codes for each of the
current conditions.

CBHI ICD 10 Student Workbook January 2008 Page 31

Example:
Entropion due to old inactive trachoma
MC = Entropion
OC = Sequela of trachoma

ICD-10 code = H02.0


ICD-10 code = B94.0

See page 104 of Volume 2 for further details.


Coding of suspected conditions, unexplained symptoms and abnormal findings and nonillness situations
Codes from Chapters XVIII and XXI should only be used if the clinician is unable to describe the
case more specifically. If the final diagnosis is suspected or questionable or if it is
documented with a question mark (?), it should be coded as if it is a certain diagnosis.
Example:
Suspected intracranial space-occupying lesion (abnormal Skull X-Ray) - not yet diagnosed
MC = Abnormal findings on diagnostic imaging
of central nervous system - intracranial
space-occupying lesion

ICD-10 code = R90.0

See page 100 of volume 2 for further details.


Multiple conditions
Categories exist which allow indication of multiple conditions within one code (this mainly
applies mainly to conditions associated with HIV). Where appropriate, a multiple code can be
used as main condition, and additional codes may appear to describe each of the conditions
specifically. This is only an issue if no one single condition is indicated by the clinician as the
MC or if none can be stated as the predominant focus of treatment.
Example:
Pneumocystis carinii pneumonia,
Tuberculosis,
Dementia

due to HIV

Single condition coding


MC= HIV resulting in multiple disease classified
elsewhere
ICD-10 code = B22.7
Multiple condition coding
MC = HIV resulting in multiple disease classified
elsewhere
OC = Pneumocystis carinii pneumonia due to HIV
Tuberculosis resulting from HIV
Dementia (non-organic) resulting from HIV

ICD-10 code = B22.7


ICD-10 code = B20.6
ICD-10 code = B20.0
ICD-10 code = B22.0

CBHI ICD 10 Student Workbook January 2008 Page 32

Example:
Fractures of multiple bones in right lower leg and forearm
Single condition coding
MC = Fractures involving multiple regions of upper
limbs with lower limbs

ICD-10 code = T02.6

Multiple condition coding


MC = Fractures involving multiple regions of upper
limbs with lower limbs
OC = Multiple fractures of lower leg
OC = Multiple fractures of forearm

ICD-10 code = T02.6


ICD-10 code = S82.7(0)
ICD-10 code = S52.7(0)

See page 101 of Volume 2 for further details.


Combination categories
This is where the presence of two or more conditions (or a condition plus associated conditions)
can be represented by one code.
Example:
Viral hepatitis B with hepatic coma
MC = Acute hepatitis B without delta-agent
with hepatic coma

ICD-10 code = B16.2

Kyphoscoliosis with related heart disease


MC = Kyphoscoliotic heart disease

ICD-10 code = I27.1

See page 101 of Volume 2 for further details.


Acute (or subacute) on chronic conditions
Where the patient is suffering an acute exacerbation of a chronic illness and there is no
combination category available, the acute aspect of the condition should be assigned as the
preferred main condition, with the chronic aspect as an optional additional code.
Example:
Acute on chronic appendicitis
MC = acute appendicitis
OC = chronic appendicitis

ICD-code = K35.9
ICD-code = K36

See page 104 of volume 2 for further details.


Postprocedural conditions and complications
The code range T80-T88 (Chapter XIX) is available to classify certain complications relating to
surgical and other procedures. Complications coded here generally affect the whole body. Other
categories are also provided near the end of most body system chapters for conditions which
occur either as a consequence of specific procedures and techniques or as a result of the absence
of an organ or postprocedural conditions which affect a specific body system.
CBHI ICD 10 Student Workbook January 2008 Page 33

Postprocedural conditions or complications are defined as:


conditions caused by acquired absence of an organ;
any conditions resulting from surgical procedures;
the after-effect of radiotherapy or similar treatment.
Some conditions are common post procedurally. They are coded in the normal way but an
additional code may be used to identify the relationship of the condition to a previous procedure.
The additional code would be assigned from Chapter XX, External causes of morbidity and
mortality (Y83 and Y84).
When a postprocedural condition or complication is recorded as the main condition, it is essential
that the coder refers to modifiers in the Index to ensure arrival at the correct code.
Example:
Postgastrectomy dumping syndrome
MC = Postgastric surgery syndromes

ICD-code = K91.1

SPECIFIC NOTES
Section 4.4.4 on p.112 of Volume 2, contains specific guidance notes to each chapter of ICD-10.
The Tabular List and the Index refer the coder to these notes where they apply to a code. When
the coder comes across such a reference, he/she should read the relevant note in 4.4.4 before
assigning the code.
The general guidelines and rules as discussed previously apply to all chapters unless a specific
chapter note states otherwise.

CBHI ICD 10 Student Workbook January 2008 Page 34

MODULE 6 - ANSWERS
Overview of morbidity coding
Exercise 1
MC Carcinoma of Intestine

ICD-10 code

C26.0

Exercise 2
MC Impacted Wisdom tooth

ICD-10 code

K01.1

Exercise 3
MC Cancer of Breast

ICD-10 code

C50.9

Exercise 4
MC Premature Rupture of Membranes

ICD-10 code

O42.9

Exercise 5
MC Acute Appendicitis

ICD-10 code

K35.9

Exercise 6
MC Crohn's disease, large intestine

ICD-10 code

K50.1

Exercise 7
MC Ventricular Septal Defect

ICD-10 code

Q21.0

Exercise 8
MC Nausea and Vomiting

ICD-10 code

R11

Exercise 9
MC Acute cholecystitis

ICD-10 code

K81.0

Exercise 10
MC Gastroenteritis due to Salmonella

ICD-10 code

A02.0

CBHI ICD 10 Student Workbook January 2008 Page 35

MODULE 7
Overview of Mortality Coding

CBHI ICD 10 Student Workbook January 2008 Page 36

Module 7: Overview Of Mortality Coding


Important points for mortality coding chapter

The International Classification of Diseases has its origins in the preparation of mortality
statistics.

Death certificates are the main source of mortality data. Information on death certificates may
be provided by either a health practitioner or in the case of accidents or violent deaths, a
coroner. In some jurisdictions, another official (who may not be medically trained) is
responsible for the completion of the medical certificate of cause of death.

The person certifying the cause of death will enter the sequence of events leading to the death
on the death certificate in the international format specified by WHO.
See page 31 of Volume 2 for further information.
International Form of Medical Certificate of Cause of Death
Cause of Death
I
Disease or condition
directly leading to death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)..
due to or as a consequence of

Approximate
interval between
onset and death

(b)
due to or as a consequence of

...

(c)
due to or as a consequence of

...

(d).
...
II
Other significant conditions contributing to the death, but not related to the
disease or condition causing it

........................
*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

WHO recommends that, where practicable, a separate certificate should be used to record
perinatal death. An international format is also recommended for this certificate.

See page 90 of volume 2 for a sample of the Certificate of Cause of Perinatal Death and further
information about coding perinatal deaths.

CBHI ICD 10 Student Workbook January 2008 Page 37

Exercise 1:
Mortality data, in the form of ICD codes, is mainly used for a particular purpose. Is it:
1. Analysis of current causes of death ?
2. Management of public health ?
3. Prevention of major causes of death ?
Concept of underlying cause of death:
Many Death Certificates give only a single cause of death. These are relatively simple to deal with
and all you have to do is code the single cause.
However, in many other cases, two or more morbid conditions contribute to death. These must all
be recorded on the certificate. In such cases it has been the practice in vital statistics to select one
of the causes of death for coding and reporting purposes. This single cause is called the
Underlying Cause of Death.
The concept of the underlying cause of death is central to mortality coding.
WHO has defined the underlying cause of death as:
the disease or injury which initiated the train of morbid events leading directly to
death; or
the circumstances of the accident or violence which produced the fatal injury.
Therefore, the underlying cause of death is the condition, event or circumstances without which
the patient would not have died. For example, a cancer patient dies and the immediate cause of
death was heart failure resulting from carcinomatosis. However, the original neoplasm site was
colon. The sequence would be malignant neoplasm resulting in carcinomatosis resulting in heart
failure. In this example, the heart failure was the final morbid event in the sequence, starting with
cancer of the colon. The malignant neoplasm of the colon is the condition to be coded as the
underlying cause of death.
Exercise 2:
What would be the underlying cause of death in this case?
Coma resulting from subdural haematoma after a fall from a ladder at work.
By the time the death certificate reaches you for coding, the health care practitioner or certifier
should have recorded:

the sequence of morbid events leading to death


the original cause of the sequence

Preferably the death certificate used should be the international form recommended by the WHO.
This has 2 parts.
Part I - is used for diseases related to the sequence of events leading directly to the death.
Part II - is used for unrelated conditions which have no direct connection with the events
leading to death but which, by their nature, contributed to death.
Part I of the form has 3 - 4 lines, depending on the local practice, to record the sequence of events
leading to death.

CBHI ICD 10 Student Workbook January 2008 Page 38

Exercise 3:
Where do you think the underlying cause of death should be entered on the death certificate shown
on the first page of this module?
Where two or more conditions must be recorded, the certifying practitioner should record the
sequence of events leading to death. Each event in the sequence should be recorded on a separate
line, in reverse order.

The direct cause of death is entered on the first line


The underlying cause of death is entered on the lowest used line
Any intervening causes are entered on the lines between the first
line and the lowest used line.

The completed certificate therefore contains the following information:


I(a) Direct cause
(b) Intervening Cause of (a)
(c) Intervening cause of (b)
(d) Originating cause of (c)
In terms of the previous example of heart failure, carcinomatosis and cancer of the colon, the
completed certificate would look like this:
I(a) Heart failure
(b) Carcinomatosis
(c) Cancer of the colon
II
There are two ways of classifying injuries:
By their nature (chapter XIX)
By the external cause resulting in the injury (chapter XX)
For mortality purposes it is the external cause that should be used for single cause coding and
tabulating underlying cause.
You should note that whilst most of the ICD is used for coding underlying cause of death, there
are particular sections and codes that should NOT be used for this purpose. For example asterisk
codes should not be used to classify underlying cause of death.
Exercise 4:
Find the following examples of codes that are not used to code underlying cause of death. Why do
you think that they are not used?
B95-B97

Bacterial, viral and other infectious agents

G97,H95, N99

Post procedural disorders (Note the cross reference to Section 4.2.6


Operations on page 71)

O80 -O84

Method of delivery

S00 - T98

Injury, poisoning and certain other consequences of external causes.

CBHI ICD 10 Student Workbook January 2008 Page 39

Selecting the underlying cause of death


The World Health Organisation has defined a set of procedures or coding rules to be followed for
coding the underlying cause of death. This series of steps will be outlined in the following pages.
When coding, for each case the rules should be applied in a logical sequence beginning with the
General Principle.
General Principle:
When more than one condition is entered on the certificate, the condition entered alone on
the lowest used line of part I should be selected only if it could have given rise to all the
conditions entered above it.
Example:
I(a) Abscess of lung
(b) Lobar pneumonia
Select lobar pneumonia (J18.1) as the underlying cause as the lung abscess could
have been the result of the lobar pneumonia .
Exercise 5:
Select the underlying cause, applying the general principle:
I (a) Hepatic failure
(b) Bile duct obstruction
(c) Carcinoma of head of pancreas
In about 25% of cases the General Principle cannot be applied for some reason. Rules 1, 2 and 3
then need to be applied.
Rule 1
If the General Principle does not apply and there is a reported sequence terminating in the
condition first entered on the certificate, select the originating cause of this sequence. If
there is more than one sequence terminating in the condition mentioned first, select the
originating cause of the first-mentioned sequence.
In other words, Rule 1 applies when there is a reported sequence but the General Principle cannot
be applied. For example, rule 1 may be applied when there is more than one condition entered on
the lowest used line
Example:
I(a) Bronchopneumonia
(b) Cerebral infarction and hypertensive heart disease
Select cerebral infarction. There are two reported sequences terminating in the condition
first entered on the certificate; bronchopneumonia due to cerebral infarction, and
bronchopneumonia due to hypertensive heart disease. The originating cause of the first-mentioned
sequence is selected.
Rule 1 is also invoked if the single condition entered on the lowest used line on the certificate
could not have resulted in all of the conditions listed above.

CBHI ICD 10 Student Workbook January 2008 Page 40

Example:
I(a) Acute myocardial infarction
(b) Atherosclerotic heart disease
(c) Influenza
Select atherosclerotic heart disease. The reported sequence terminating in the
condition first mentioned on the certificate is acute myocardial infarction due to
atherosclerotic heart disease. Influenza could not have caused the atherosclerotic
heart disease or the myocardial infarction.
Exercise 6:
Select the underlying cause:
I(a) Pericarditis
(b) Uraemia and pneumonia
If there is no logical sequence, Rule 2 should be applied.
Rule 2
If there is no reported sequence terminating in the condition first entered on the certificate,
select this first-mentioned condition.
Example:
I(a) Pernicious anaemia and gangrene of foot
(b) Atherosclerosis
Select pernicious anaemia (D51.0). There is no reported sequence terminating in the
pernicious anaemia, which is the first mentioned condition.
Exercise 7:
Select the underlying cause of death:
I(a) Fibrocystic disease of the pancreas
(b) Bronchitis and bronchiectasis
In some cases there is a condition reported in Part I or II that has not been selected using the
General rule or Rule 1 or 2, but which could have obviously caused the other conditions on the
certificate. In these cases rule 3 is applied.
Rule 3
If the condition selected by the General Principle or by Rule 1 or Rule 2 is obviously a direct
consequence of another reported condition, whether in Part I or Part II, select this primary
condition.
Note that there is a lot of information about assumed consequences of other reported conditions in
Volume 2. This information should be read carefully.
Example:
I(a) Bronchopneumonia
II
Secondary anaemia and chronic lymphatic leukaemia

CBHI ICD 10 Student Workbook January 2008 Page 41

Select chronic lymphatic leukaemia (C91.1). Bronchopneumonia, selected by the General


Principle, and secondary anaemia can both be considered direct sequels of chronic
lymphatic leukaemia.
Exercise 8:
Select the underlying cause of death.
I(a) Nephrectomy
II Clear Cell carcinoma of kidney
Some conditions are assumed to be direct consequences of another condition such as:
Burkitts tumour, Kaposis sarcoma, malignant neoplasms of lymphoid, Aaematopoietic and
related tissue considered to be a direct consequence of HIV disease.
Any infection classifiable to Aoo-B19, B25-B49, B58-B64, B-99 or J12-J18 considered as
direct consequence of HIV disease.
Pnenmonia, from chopnenmomia acceptable as complication of any disease such as
malnutrition, matignant neoplasm, paralysis, injuries etc.
Rules for modification:
In some cases the underlying cause that has been selected using the above rules is not the most
useful or informative for public health or prevention purposes, e.g. senility or a general disease
process such as atherosclerosis. In such cases modification rules may need to be applied after the
General Principle, Rule 1, Rule 2 and Rule 3 have been applied.
There are 6 modification rules (A-F).
Rule A. Senility and other ill-defined conditions
Where the selected cause is ill-defined and a condition classified elsewhere is reported on the
certificate, reselect the cause of death as if the ill-defined condition had not been reported,
except to take account of that condition if it modifies the coding. The following conditions are
considered ill-defined: I46.9 (Cardiac arrest, unspecified), I95.9 (Hypotension unspecified),
I99 (Other and unspecified disorders of circulatory system), J96.0 (Acute respiratory
failure), J96.9 (Respiratory failure unspecified), P28.5 (Respiratory failure of newborn),
R00-R94 or R96-R99 (Symptoms, sings and laboratory findings, not elsewhere classified).
Note that R95 (Sudden Infant Death Syndrome) is not regarded as ill-defined.
Example:
I(a) Senility and hypostatic pneumonia
(b) Rheumatoid arthritis
Code to rheumatoid arthritis(M06.9). Senility, selected by Rule 2, is ignored and the
General Principle applied.
Exercise 9:
Select the underlying cause of death.
I(a) Myocardial degeneration and emphysema
(b) Senility

CBHI ICD 10 Student Workbook January 2008 Page 42

Rule B. Trivial conditions


Where the selected cause is a trivial condition unlikely to cause death, and a more serious
condition (any condition except an ill-defined or another trivial condition) is reported,
reselect the underlying cause as if the trivial condition had not been reported. If the death
was the result of an adverse reaction to treatment of the trivial condition, select the adverse
reaction.
When a trivial condition is reported as causing any other condition, the trivial condition is
not discarded, i.e. Rule B is not applicable.
Example:
I(a) Dental caries
II Diabetes
Code to diabetes (E14.9). Dental caries, selected by the General Principle is ignored, as it
may be considered a trivial condition.
Example:
I(a) Septicaemia
(b) Impetigo
Code to impetigo (L01.0). The trivial condition selected by the General Principle is not
discarded since it is reported as the cause of another condition, in this case the cause of the
septicaemia.
Exercise 10:
Select the underlying cause of death.
I(a) Ingrowing toenail and acute renal failure
Rule C. Linkage
Where the selected cause is linked by a provision in the classification or in the notes for use
in underlying cause mortality coding with one or more of the other conditions on the
certificate, code the combination.
Where the linkage provision is only for the combination of one condition specified as due to
another, code the combination only when the correct causal relationship is stated or can be
inferred from application of the selection rules.
Where a conflict in linkage occurs, link with the condition that would have been selected if
the cause initially selected had not been reported. Make any further linkage that is
applicable.
See Section 4.1.11 and 4.1.12 of Volume 2 for Notes for use in underlying cause mortality coding
for detailed instruction on linkages to be applied by the classification. These linkages are given in
description and code tables, and indicate how to code cases where one condition is reported as the
originating antecedent cause of another condition, or if a condition is reported with mention of
another condition elsewhere on the death certificate.
Example:
I(a) Intestinal obstruction
(b) Femoral hernia
Code to femoral hernia with obstruction (K41.3).
CBHI ICD 10 Student Workbook December 2004 Page 43

Example:
I(a) Acute myocardial infarction
(b) Atherosclerotic heart disease
(c) Influenza
Code to acute myocardial infarction (I21.9). Atherosclerotic heart disease, selected by
Rule 1, links with acute myocardial infarction (see Section 4.1.11, Volume 2).
Exercise 11:
Select the underlying cause of death.
I(a) Cerebral infarction
(b) Hypertension
(c) Atherosclerosis
Rule D. Specificity
Where the selected cause describes a condition in general terms and a term that provides
more precise information about the site or nature of this condition is reported on the
certificate, prefer the more informative term. This rule will often apply when the general
term becomes an adjective qualifying the more precise term.
Example:
I(a) Meningitis
(b) Tuberculosis
Code to tuberculous meningitis (A17.0). The conditions are stated in the correct causal
relationship.
Exercise 12:
Select the underlying cause of death.
I(a) Rheumatic heart disease, mitral stenosis
Rule E. Early and late stages of disease
Where the selected cause is an early stage of a disease and a more advanced stage of the same
disease is reported on the certificate, code to the more advanced stage. This rule does not
apply to a "chronic" form reported as due to an "acute" form unless the classification gives
special instructions to that effect.
Example:
I(a) Tertiary syphilis
(b) Primary syphilis
Code to tertiary syphilis (A52.9).
Example 13:
Select the underlying cause of death.
I(a) Chronic myocarditis
(b) Acute myocarditis

CBHI ICD 10 Student Workbook January 2008 Page 44

Rule F. Sequelae
Where the selected cause is an early form of a condition for which the classification provides
a separate "Sequelae of " category, and there is evidence that death occurred from
residual effects of this condition rather than from those of its active phase, code to the
appropriate "Sequelae of " category.
Example:
I(a) Pulmonary fibrosis
(b) Old pulmonary tuberculosis
Code to sequelae of respiratory tuberculosis (B90.9).
Exercise 14:
Select the underlying cause of death.
I(a) Hydrocephalus
(b) Tuberculosis meningitis
Using the Medical Mortality Data System (MMDS) Decision Tables to select the Underlying
Cause of Death (UCOD) 1
The MMDS Decision Tables are used to assist with the allocation of the correct UCOD and
assignment of valid multiple cause codes. The Decision Tables are a collection of lists which
provide guidance and direction in the application of the selection and modification rules published
in Volume 2 of ICD-10. Although originally designed for use with the automated coding software
available from the National Center for Health Statistics in the USA, they are also useful for
assisting coders with decisions about acceptable and non-acceptable sequences.
Details regarding the use of each of the tables are outlined below.
Table A lists each ICD-10 code that is valid for use in both multiple and underlying cause coding
Table B lists those codes valid for use in multiple cause coding but NOT underlying cause coding
Table C lists all ICD-10 codes that are invalid for BOTH multiple and underlying cause coding.
Table D is used to determine the causal relationships of conditions listed on the medical certificate
of cause of death. The address code is displayed at the top of lists of codes and code ranges (sub
addresses) that have a valid causal relationship appear below the address code. The address code
is the code listed on the UPPER line of Part I. The sub address codes identify conditions which can
give rise to, or cause, that condition. Conditions for which codes are not listed cannot cause the
condition specified by the address code in other words, they are non-acceptable sequences. This
table is used to determine the causal relationships when applying the General Principle and
Selection Rules 1 and 2.
Table D ambivalent causal relationships
There are some ICD-10 code sub addresses that have an ambivalent causal relationship to the
condition listed in the address code. That is, they may or they may not have an acceptable causal
relationship. This applies to all sub addresses marked with the letter M. When the MMDS
encounters such a code, the system assumes the relationship to be acceptable but the record is
listed for nosological review in case the relationship is, in fact, unacceptable. A coder is required
to make the final decision about the use of the code.

CBHI ICD 10 Student Workbook January 2008 Page 45

In order to minimise the size of Table D those codes which are infrequently used in mortality
coding have not been included as addresses. Therefore certain codes listed in Table A are not
found as address codes in Table D and the use of these codes will require further review by the
coder to confirm the diagnosis.
Table E is the Modification Table and is used for application of Selection Rule 3, Modification
Rule A Senility and ill-defined conditions, Modification Rule C Linkage and Modification Rule D
Specificity. Modification Rules E Early and late stages of disease and F Sequelae are also
integrated into Table E.
The address code in Table E is the tentative underlying cause code. That is, the code selected after
the application of the General Principle and Selection Rules 1 and 2. This code may be modified a
number of times before determination of the final underlying cause. The ICD-10 sub address codes
identify conditions which will either combine with the tentative UCOD code or direct the coder to
use a preferred code. In either case, the new code becomes the address code. This process may be
repeated several times before assignment of the final UCOD code.
The use of Table E requires the understanding of a number of symbols and acronyms that alert
coders to special conditions and circumstances that must be met before assigning individual sub
address codes as the underlying cause.
Table E Symbols
The symbol M, as for Table D, denotes an ambivalent relationship and should be processed in
the same way as for Table D.
The symbol # denotes special considerations in the application of Modification Rule C Linkage.
Where a condition listed in ICD-10 categories C000 to D489 Neoplasms, is marked with the #
symbol, the address may be reported in Part I and the sub address may be reported in Part II or
vice versa. Normally, to apply Rule C to neoplasm codes both conditions must be reported
TOGETHER in Part I, or TOGETHER in Part II.
To apply Rule C to categories F03, F09 and F29, certain sub addresses must be reported on the
same line as the address code in order to be selected by Rule C. These subaddresses are flagged
with the # in Table E.
Table E Acronyms
DS: (Selection Rule 3)
When the tentative underlying cause is considered a direct sequel (DS) of another condition on the
certificate in Part I because it is reported on the same or a lower line as the tentative underlying
cause, or if is reported in Part II, the code for that other condition is preferred over the code for the
tentative underlying cause.
DSC: (Selection Rule 3)
When the tentative underlying cause is considered a direct sequel of another condition on the
certificate in Part I (must be on the same or lower line as tentative underlying cause) or in Part II,
and the codes for the tentative underlying cause and the other condition combine into a third code.
IDDC: (Modification Rule A)
When the tentative underlying cause is an ill-defined condition in the due to position to another
condition, and the codes for the tentative underlying cause and the other condition combine into a
third code.

CBHI ICD 10 Student Workbook January 2008 Page 46

SENMC: (Modification Rule A)


When the tentative underlying cause is senility (R54), and this condition is reported with mention
of another condition on the certificate, and the codes for the tentative underlying cause and the
other condition combine into a third code.
SENDC: (Modification Rule A)
When the tentative underlying cause is senility (R54), and is reported in a due to position to
another condition, and the codes for the tentative underlying cause and the other condition
combine into a third code.
LMP: (Modification Rule C)
When the tentative underlying cause is reported with mention of another condition in Part I or Part
II of the certificate, and the code for the other condition is preferred over the code for the tentative
underlying cause.
LMC: (Modification Rule C)
When the tentative underlying cause is reported with mention of another condition, in Part I or Part
II of the certificate, and the codes for the tentative underlying cause and the other condition
combine into a third code.
LDP: (Modification Rule C)
When the tentative underlying cause is reported in the due to position to another condition, and the
code for the other condition is preferred over the code for the tentative underlying cause.
LDC: (Modification Rule C)
When the tentative underlying cause is reported in the due to position to another condition, and the
codes for the tentative underlying cause and the other condition combine into a third code.
SMP: (Modification Rule D)
When the tentative underlying cause describes a condition in general terms, and a condition which
provides more precise information about the site or nature of this condition is reported anywhere
on the certificate, the code for the more precise condition is preferred over the code for the
tentative underlying cause.
SMC: (Modification Rule D)
When the tentative underlying cause describes a condition in general terms, and a condition which
provides more precise information about the site or nature of this condition is reported anywhere
on the certificate, and the codes for the tentative underlying cause and the other condition combine
into a third code.
SDC: (Modification Rule D)
When the tentative underlying cause is reported in the due to position to another condition, and
can be regarded as an adjective modifying this condition, and the codes for the tentative
underlying cause and the other condition combine into a third code.
Table F explains most ambivalent (M) entries found in Tables D and E. Table F provides further
guidance in selection of the most appropriate underlying cause of death. If the conditions laid out
in Table F can be met, the code or combination code is selected as the underlying cause of death.
This code may be further modified by further application of rules.
Table G is the list of codes created to assist the MMDS software to distinguish between certain
conditions which are coded to the same category. The table contains conversions to change the
created ICD-10 categories back to the original ICD-10 codes.

CBHI ICD 10 Student Workbook January 2008 Page 47

Table H contains the list of codes considered to be trivial when assigning the underlying cause of
death. If a selected underlying cause is on the list, Modification Rule B is applied to establish the
appropriate course of action. This may involve selecting a non-trivial condition as the underlying
cause of death.
The process of using the Decision Tables goes hand in hand with application of the selection and
modification rules. Remember that the process of selection of tentative underlying cause may need
to be repeated a number of times before a final underlying cause can be determined.
Copies of the Decision Tables, and regular updates, can be obtained from the National Center for
Health Statistics. The tables can be downloaded from
http://www.cdc.gov/nchs/about/major/dvs/im.htm
or can be requested by contacting Dawn King on DOK1@cdc.gov .
(1 Reference: National Center for Health Statistics. Instruction Manual Part 2C: ICD-10 ACME
Decision Tables for Classifying Underlying Causes of Death. NCHS: Hyattsville, Maryland; 2004)
Assumption of intervening cause
On some medical certificates, one condition may be indicated as due to another, but the first one is
not a direct sequel of the other. In such cases it may be possible to assume that there are
intervening causes that have not been reported but which, if understood by the coder, will enable
the 'construction' of a correct sequence of events.
When making an assumption about intervening causes, you should only assume an intervening
cause for the purpose of interpreting the sequence not for modifying the coding of the death.
Example:
I(a) Cerebral haemorrhage
(b) Chronic nephritis
Code to chronic nephritis (N03.9). It is necessary to assume hypertension as a condition
intervening between cerebral haemorrhage as a condition and the underlying cause, chronic
nephritis.
Exercise 15:
Select the underlying cause of death.
I(a) Mental retardation
(b) Premature separation of placenta
Highly improbable
Sometimes the recorded sequence is highly improbable. The words highly improbable are used
to describe a non-acceptable sequence.
See page 67 of Volume 2, for examples of several situations considered highly improbable and
how the certificates should be interpreted.
Exercise 16:
Using the list, decide whether each of the following sequences is acceptable or not:
Tetanus due to malignant neoplasm of the lung
Diabetes due to malignant neoplasm of the pancreas
Intracranial haemorrhage due to endocarditis
CBHI ICD 10 Student Workbook January 2008 Page 48

NOTE: acute or terminal circulatory disease which are reported as being due to:
malignant neoplasm
asthma
or diabetes
are acceptable as possible sequences when they occur in PART I of the certificate.
Duration
The stated time factor (or duration) in a sequence should be considered. This is important when
you are considering whether one condition was caused by another. However, this is often a poorly
completed item on a death certificate and this should be taken into account when interpreting
entries.
Exercise 17:
When can malformation, deformation or chromosomal abnormality be considered to be
congenital?
(a) only when it is stated to be congenital by the certifier
(b) when it is clear that the condition existed from birth
Sequelae
The terms sequelae or late effects are used to describe a certain group of conditions where a
considerable amount of time might elapse between cause and effect. The aetiology or originating
condition is often no longer present when the late effect occurs. Certain categories in ICD-10 have
been designated for use in coding sequelae as the underlying cause of death. They are:
B90-B94; E64.-; E68; G09; I69.-; O97;

Y85-89

Exercise 18:
Which modification rule applies to sequelae?
Does the interval between the original disease and its sequelae matter, for the purposes of
underlying cause coding?
Rheumatic fever with heart involvement
If there is no statement that the rheumatic process was active at the time of death, assume activity
if the heart condition (other than terminal conditions and bacterial endocarditis) that is specified as
rheumatic, or stated to be due to rheumatic fever, is described as acute or subacute. In the absence
of such description, the terms carditis, endocarditis, heart disease, myocarditis and pancarditis can
be regarded as acute if either the interval between onset and death is less than one year or, if no
interval is stated, the age at death is under 15 years. Pericarditis can be regarded as acute at any
age.
Exercise 19:
Terms such as carditis, endocarditis, heart disease, myocarditis and pancarditis can be regarded as
acute if :
(a) at least one of the factors listed below applies
(b) both factors listed below apply
(c) neither factors listed below apply
1. The interval between onset and death is less than one year
2. No interval is stated and the age at death is under 15 years
CBHI ICD 10 Student Workbook January 2008 Page 49

Nature of injury
Although the external cause of an injury or injuries should be coded as the underlying cause of
death, WHO also recommends that the nature of injury is also classified. When more than one kind
of injury to a single body region is recorded, and there is no clear indication as to which caused
death, you must apply the General Principle and selection rules in the usual way. This relates to
categories:
S00-S99
T08-T35
T66-T79
Malignancy:
When malignancy is given as the underlying cause of death three factors must be taken into
consideration when assigning a code. These are the:
Site
Morphology
Behaviour
of the neoplasm. If there are 3 factors associated with recording malignant neoplasms as a cause of
death then it is not surprising that problems can arise with the way the certificate has been
completed.
You may be coding a certificate where malignancy is implied but not explicitly stated. Metastases
or secondaries are recorded but malignancy itself is not mentioned.
Example:
I(a) Metastatic involvement of lymph node
(b) Carcinoma-in-situ of breast
Code to malignant neoplasm of breast (C50.9).
If a neoplasm has given rise to metastases or secondaries it means that the neoplasm is malignant.
Sometimes the site of a neoplasm may be stated imprecisely. You may find sites prefixed with
words like: peri-, para-, pre-, supra-, or infra-.
Example:
I(a) Fibrosarcoma in the region of the leg
Code to malignant neoplasm of connective and soft tissue of lower limb (C49.2).
You may find a site stated to be in the region of. If such a description is indexed in the
classification then you will be able to code it by looking for the site documented.
You will find guidance on this sort of problem in paragraph B, page 72, Volume 2.
You should not assume the site of a malignancy from other conditions reported on the certificate if
the site of the primary neoplasm is not mentioned.
Example:
I(a) Obstruction of intestine
(b) Carcinoma
Code to malignant neoplasm without specification of site (C80).
CBHI ICD 10 Student Workbook January 2008 Page 50

When a malignancy is entered on the certificate and the primary site is indicated, you should
always select the primary site as the underlying cause of death and not any recorded metastatic
sites. Do this regardless of the position of the primary site on the certificate.
There are 3 ways the site may be indicated:

when one site is specified as primary in either part I or part II


when other sites may be described as secondary or metastatic
when the morphology itself may indicate a primary malignancy.

You may encounter cases where the primary site is stated to be unknown. In such cases, do not
make any assumptions about the primary site from any other conditions, which are specified.
Instead, you should look at the morphology of the neoplasm or code to C80 Malignant neoplasm
without specification of site.
Refer to volume 2 section 4.2.7 paragraph E for further details.
In some cases of malignancy there may be more than one primary site. [ If the sites are not in the
same organ system and there is no indication that any is primary or secondary, code to malignant
neoplasms of independent (primary) multiple sites (C97)]. A special category has been created for
these cases at C97 Malignant neoplasms of independent (primary) multiple sites.
A malignancy may spread to another site. This is called metastasis. The adjective metastatic is
frequently used ambiguously - sometimes meaning a secondary FROM a primary elsewhere and
sometimes meaning a primary which has given rise TO metastases. It is very difficult to resolve
this situation as there are no specific rules and usage varies between countries and language.
However, there are some guidelines set out in section G of 4.2.7 (Volume 2, page 75) that can be
followed.
In some cases multiple sites may be recorded with no indication as to which is the primary site.
Guidance on selection of the underlying cause is given in paragraph H(Volume 2, page 81).
You may find that an infectious disease has been given as a consequence of a malignancy. This is
an acceptable sequence. Malignant neoplasms can also cause certain types of circulatory diseases.
The underlying cause of death will be malignancy.

CBHI ICD 10 Student Workbook January 2008 Page 51

MODULE 7 - ANSWERS
OVERVIEW OF MORTALITY CODING
Exercise 1
Mortality data, in the form of ICD codes, is mainly used for a particular purpose. What is it?
1. It is part of the overall process that leads to 3. In fact, once the data has been collected it is used
like this:
data analysis resource management prevention
Exercise 2
What would be the underlying cause of death (UCOD) in this case?
Coma resulting from subdural hematoma after a fall at work.
Since the rest of the sequence started due to the fall at work, that is the UCOD.
Exercise 3
Where do you think underlying cause of death should be entered on the death certificate shown
on page 52?
On the lowest used line in Part 1. (This answer covers cases where there are not 4 recorded
conditions. Where there is a single cause of death this is recorded on the first line, if two
conditions are reported the UCOD is on the second line, etc.)
Exercise 5
Select the underlying cause of death, applying the general principle.
I(a) Hepatic failure
(b) Bile duct obstruction
(c) Carcinoma of head of pancreas
Carcinoma of head of pancreas would be the underlying cause of death. It is the condition entered on
the lowest used line in part I and could have given rise to the conditions entered above it.
Exercise 6
Select the underlying cause of death.
I(a) Pericarditis
(b) Uraemia and pneumonia
Select uraemia. There are two reported sequences terminating in the condition first entered on the
certificate. The underlying cause of the first mentioned sequence is selected.

Exercise 7
Select the underlying cause of death.
I(a) Fibrocystic disease of the pancreas
(b) Bronchitis and bronchiectasis
Select fibrocystic disease of the pancreas. There is no reported sequence of events leading to
fibrocystic disease of the pancreas, so the first mentioned condition is selected.
CBHI ICD 10 Student Workbook January 2008 Page 52

Exercise 8
Select the underlying cause of death.
I(a) Nephrectomy
II Clear Cell carcinoma of the kidney
Select Clear Cell Carcinoma of the kidney. There is no doubt that the nephrectomy was performed
for the carcinoma.
Exercise 9
Select the underlying cause of death
I(a) Myocardial degeneration and emphysema
(b) Senility
Code the myocardial degeneration. The senility is ignored and rule 2 applied to select the first
mentioned condition.
Exercise 10
Select the underlying cause of death.
I(a) Ingrowing toenail and acute renal failure
Code to acute renal failure. Ingrowing toenail as selected by rule 2, is ignored because it is a trivial
condition.
Exercise 11
Select the underlying cause of death
I(a) Cerebral infarction
(b) Hypertension
(c) Atherosclerosis
Code to cerebral infarction. Atherosclerosis, selected by Rule 1, links with hypertension, which itself
links with cerebral infarction. See the linkage table on pages 62-65 of volume 2.
Exercise 12
Select the underlying cause of death.
I(a) Rheumatic heart disease, mitral stenosis
Code to rheumatic mitral stenosis. This is known as a combination code.
Exercise 13
Select the underlying cause of death
I(a) Chronic myocarditis
(b) Acute myocarditis
Code to acute myocarditis. There is no code for acute on chronic myocarditis and the classification
does not indicate that chronic myocarditis should be preferred over the code for the acute form of the
disease.
Exercise 14
Select the underlying cause of death
I(a) Hydrocephalus
(b) Tuberculosis meningitis
Code to sequelae of tuberculous meningitis.
CBHI ICD 10 Student Workbook January 2008 Page 53

Exercise 15
Select the underlying cause of death.
I(a) Mental retardation
(b) Premature rupture of placenta
Code to premature separation of placenta affecting fetus or newborn. It is necessary to assume birth
trauma, anoxia or hypoxia as a condition intervening between mental retardation and the underlying
cause, premature separation of placenta.
Exercise 16
Using the list, decide whether each of the following sequences is acceptable or not:
Tetanus due to malignant neoplasm of the lung. Highly improbable (a)
Diabetes due to malignant neoplasm of the pancreas. Acceptable sequence (d)
Intracranial hemorrhage due to endocarditis. Acceptable sequence (h)
Exercise 17
When can malformation, deformation or chromosomal abnormality be considered to be
congenital?
(a) Only when it is stated to be congenital by the certifier.
(b) When it is clear the condition existed from birth.
(b) provided there is no indication that the condition was acquired after birth. The duration field may
assist with determining this.
Exercise 18
Which modification rule applies to sequelae?
Modification rule F
Does the interval between the original disease and its sequelae matter, for the underlying cause
coding?
No. Guidance about coding of sequelae for mortality purposes is given in most of the appropriate
categories in the tabular listing.
Exercise 19
Terms such as carditis, endocarditis, heart disease, myocarditis and pancarditis can be
regarded as acute if:
(a) at least one of the factors listed below applies.
(b) both factors listed below apply.
(c) Neither factor listed below applies.
1. The interval between onset and death is less than one year.
2. No interval is stated and the age at death is under 15 years.
(a) - at least one of the factors applies to the case being coded.

CBHI ICD 10 Student Workbook January 2008 Page 54

MODULE 8
Infectious And Parasitic Diseases

CBHI ICD 10 Student Workbook January 2008 Page 55

Module 8: Certain Infectious and Parasitic Diseases (Chapter I)


This chapter includes diseases generally recognised as communicable or transmissible.
Important points for Chapter I
Categories range from A00 to B99. In fact, this is one of the largest chapters in ICD-10.
171 of the 200 available categories have been allocated.
The chapter is divided into 21 blocks.
The use of the modifier Certain in the title indicates that some infectious and parasitic
diseases are classified elsewhere it is necessary to carefully read inclusion and exclusion
notes.
Chapter I has five exclusions listed at chapter level.
It should also be noted that there are some exceptions to the exclusions - they are related to
obstetrical and neonatal tetanus, congenital syphilis, perinatal gonococcal information and
obstetric and perinatal HIV disease -which are included in Chapter I.
A rule exists in relation to the presumption of infectious or noninfectious origin of
gastroenteritis or diarrhoea dependent on the country in which the patient contracted the
condition. This rule only applies where there is no specification as to whether the diarrhoea is
infectious or non-infectious. If the diarrhoea is presumed to be non-infectious, it should be
coded to K52.9 (in the Diseases of Digestive System chapter). If the diarrhoea is presumed
infectious, it is coded to Chapter I. The decision about which code to use should be made by
each individual country but be aware that this rule only applies to cases which are not
specified as infectious or non-infectious.
When coding tuberculosis, categories A15-A16 identify whether the tuberculosis was
confirmed and what method was used for the confirmation e.g. sputum microscopy, chest x-ray.
Block B20-B23 has a note at the beginning concerning the use of the fourth character
subcategory. The categories have been provided for optional use when it is not possible to
multiple code.
Block B50- B64 provides guidance by the use of exclusion and inclusion notes on how mixed
plasmodium infections are to be coded.
B90-B94 codes are to be used when the condition being treated is a sequelae of an infectious
disease.
B95-B97 is a block of additional codes that enables infectious organisms to be recorded as the
cause of conditions primarily classified to other chapters. These codes should never be used for
primary/main condition coding; they are additional or supplementary codes.

CBHI ICD 10 Student Workbook January 2008 Page 56

Coding exercises for Chapter I

1. Chronic viral hepatitis C

2. Congenital syphilis in an 18-month old child

3. Non-infective diarrhoea in a 3-week old infant

4. Tuberculosis of lung, confirmed

5. Axillary cutaneous abscess

CBHI ICD 10 Student Workbook January 2008 Page 57

Sample Hospital Discharge Summaries for Chapter I


Summary 1
ADMISSION DATE : 19-2-2004

DISCHARGE DATE : 28-2-2004

AGE : 40 years

SEX

male

A 40-year-old male who is HIV positive, was admitted with a history of shortness of breath,
profuse sweating and elevated temperatures. A bronchoscopy with biopsy was performed and
diagnosis on discharge was tuberculosis, which was associated with his HIV. The patient is also
being currently treated for Cytomegaloviral (CMV) retinitis.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

Summary 2
ADMISSION DATE : 14-9-2003

DISCHARGE DATE : 16-9-2003

AGE : 68 years

SEX : male

A 68-year-old male was admitted with retrosternal dysphagia. A gastroscopy with biopsy was
performed, which indicated that he was suffering from Candida oesophagitis as well as gastric
erosions.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 58

Mortality Coding Exercises for Chapter I


Exercise 1
I
Disease or condition
directly leading to death*

(a)Septic shock.
due to or as a consequence of

Duration between
onset and death
days

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b)Staphylococcus aureus
sepsis..
due to or as a consequence of
days
(c) Staphylococcus aureus
meningitis.
due to or as a consequence of

days

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

renal transplant, NIDDM


.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 59

Exercise 2

I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Duration between
onset and death
(a)SARS .
due to or as a consequence of

days

(b).
due to or as a consequence of

..

(c)..
..
due to or as a consequence of
(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

..
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 60

MODULE 8 - ANSWERS
Chapter I Certain infectious and parasitic diseases
1. Chronic viral hepatitis C
Look up hepatitis in the Index (Volume 3, page 263).
Hepatitis
- viral
- - chronic
- - - type
- - - - C -> B18.2
Note that WHO has introduced a new entry in the Index, effective from January 2005, to clarify
the duration of a disease before it is considered chronic. The new index entry is:
Hepatitis
- viral
- - type
- - -C
- - - - chronic (duration six months or longer) -> B18.2
2. Congenital syphilis in an 18-month old child
Look up syphilis in the Index (Volume 3, page 524).
Syphilis
- congenital
- - early or less than two years after birth -> A50.2
Note that no symptoms are specified and the syphilis is not specified as being latent. A50.2 is
described in volume 1 as Early congenital syphilis, unspecified.
3. Non-infective diarrhoea in a 3-week old infant
Look up diarrhoea in the Index (see Volume 3, page 158) - note that the terms in parentheses
indicate that diarrhoea not otherwise specified is presumed infectious and coded to Chapter 1.
Because this case is specified as non-infectious, look up
Diarrhoea
- neonatal (non infective) -> P78.3.
Note that the age of the patient modifies the selection of the code. If the patient was not a
neonate, the code would be K52.9 - diarrhoea, non-infective.
4. Tuberculosis of lung, confirmed
Look up tuberculosis in the Index (Volume 3, page 545).
Tuberculosis
- lung - see Tuberculosis, pulmonary.
- pulmonary
- - confirmed (by)
- - - unspecified means -> A15.3.

CBHI ICD 10 Student Workbook January 2008 Page 61

5. Axillary cutaneous abscess


Look up Abscess in the Index (Volume 3, page 17)
Abscess
- axilla (region) -> L02.4.
Note that if you look up Abscess, cutaneous the Index suggests to see also Abscess, by site. This
indicates that there are other, more specific, codes available for body sites. There is also a code
for the axillary lymph node under Abscess, axilla but the diagnosis here is for a cutaneous
abscess. The exclusion notes on page 107 of volume 3 indicate that certain localised infections,
such as this one, are coded to the relevant body system chapter and not to chapter 1.
Hospital Discharge Summaries
Summary 1:
Main Condition:
Other conditions:

B20.0 HIV disease resulting in mycobacterial infection


B20.2 HIV disease resulting in cytomegaloviral disease
H32.0 Chorioretinal inflammation in infectious & parasitic diseases
classified elsewhere

Note that if you are only coding single conditions, you might choose to select B20.7 HIV disease
resulting in multiple infections as your main condition.
Summary 2:
Main Condition:
Other Conditions:

K20

Oesophagitis

B37.8 Candidiasis of other sites


K25.9 Gastric ulcer (includes erosions)

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: G00.3 Staphylococcal meningitis
Which rule applied:

General principle

Exercise 2:
Underlying cause of death: U04.9
Which rule applied:

General principle

CBHI ICD 10 Student Workbook January 2008 Page 62

MODULE 9
Neoplasms

CBHI ICD 10 Student Workbook January 2008 Page 63

Module 9: Neoplasms (Chapter II)


This chapter covers the coding of all neoplastic tumours, both malignant and benign and also cases
where there is some uncertainty about the behaviour of a tumour.
Important points for Chapter II
Categories range from C00 to D48.
136 of the 149 available categories have been allocated.
The chapter is divided into 7 blocks, with the block of primary malignancy codes subdivided
into 12 further sub-blocks.
It is especially important when coding neoplasms to use both Volume 1 and Volume 3 in
identifying the correct set of codes
The three specific aspects to take into account when coding neoplasms are
the site of the tumour
the nature of the tumour (also known as the morphology or histological type),
and the behaviour of the tumour.
Chapter II is organised by tumour site and grouped in terms of the behaviour of neoplasms.
The behaviour may be coded using the morphology codes further information is provided
below.
D10-D36
D37-D48
D00-D07
C00-C75 &
C81-C97
C76-C80

/0 benign neoplasms
/1 neoplasms of uncertain and unknown behaviour
/2 in situ neoplasms
/3 malignant neoplasms, stated or
presumed to be primary lesions
/6 malignant neoplasms, stated or presumed to be secondary lesions.

Morphology describes the structure and type of cells or tissues as seen under the microscope.
The tissue of origin and the type of cells that make up a malignant neoplasm often determine
the expected rate of growth, the severity and the type of treatment given. Morphology is
described by an additional coding system found in the ICD-10. The morphology code numbers
are 6 digits long, including the prefix M.
Behaviour indicates how the tumour will behave ie. malignant (primary or secondary), in situ,
of uncertain or unknown behaviour or benign. The behaviour is the final digit of the
morphology code. Sometimes the ICD-10 Index indicates the behaviour of a neoplasm (because
the histological type always acts in a certain pattern) but, when coding, if the clinician overrides
the expected behaviour then accept the override in that particular case e.g. adenoma is usually
benign, but if clinician documents a case as malignant adenoma, code the case as such. The
behaviour code is changed from the expected /0 to /3 to indicate malignant primary.
The Table of Neoplasms is included in Volume 3 and includes the Chapter II codes for each
anatomical site of tumour. For each site, there are five possible code numbers according to the
behaviour of the tumour. If the diagnosis you are coding does not describe the behaviour of the
tumour, you should look up the morphology description in the rest of the Index for guidance as
to how the tumour should be coded. E.g. Mesonephroma - see Neoplasm, malignant. You
would therefore use the code for malignant primary tumour or malignant secondary tumour,
depending on the diagnosis.
CBHI ICD 10 Student Workbook January 2008 Page 64

Check the Table of Neoplasms on pages 370-401 of the Alphabetical Index and look at how it is
structured. Read also the notes on page 369.
In Chapter II, the 4th digit .9 is for unspecified site and .8 is for overlapping lesions of
contiguous sites.
At the back of the Tabular List, is a Table of Morphology of Neoplasms. This table consists of
a comprehensive but not exhaustive list of morphological types of neoplasms; the coder should
be aware that if the behaviour type being sought is not listed with the histological type then the
final digit can be changed (if this is clinically correct). For example, many malignant neoplasms
are listed only with the morphology code for the primary lesion; if a secondary lesion needs to
be coded, change the final 3 to 6 and the code is correct.
Example:
To find the correct site and morphology codes for a female patient suffering from lobular
carcinoma arising in the lower outer quadrant of the left breast.
Step 1:
Look up the lead term, carcinoma, in the Alphabetical Index.
Carcinoma
- lobular (infiltrating) (M8520/3)
- - specified site - see Neoplasm, malignant
Step 2:
The morphology you are given is M8520/3. Confirm that the behaviour (/3) is appropriate for the
tumour being described. /3 indicates a primary malignancy and is therefore appropriate for this
case because our diagnosis specifies that the tumour arose from the breast.
Step 3:
Check the morphology (M8520) in the Table of Morphology of Neoplasms in Volume 1. The
morphology is correct for this case.
Step 4:
Look up the Table of Neoplasms in volume 3. Use the alphabetic listing of anatomical sites to find
the entry for breast. Note the subdivisions under the lead term for different parts of the breast.
Find the section for the lower outer quadrant.
Step 5:
Find the code in the column Malignant primary tumour by looking across the row for lower outer
quadrant of the breast. We are told that the tumour arose in the patients breast; it is therefore a
primary tumour and not a metastasis. The correct site or Chapter II code is therefore C50.5.
Step 6:
Confirm your code selection in Volume 1 of the ICD-10. Check whether there are any relevant
exclusion notes.
Step 7:
The codes for this case are C50.5, M8520/3
Pages 71-85 of Volume 2 provide a large amount of information and direction for the coder in
dealing with neoplasms. Read these notes now.

CBHI ICD 10 Student Workbook January 2008 Page 65

Coding exercises for Chapter II


1. Malignant bronchial adenoma

2. Cholangiocarcinoma

3. Acute myelomonocytic leukaemia

4. Squamous cell carcinoma of cervix uteri

5. Bilateral synchronous Wilm's tumour (in a patient who is four years old)

Sample Hospital Discharge Summaries for Chapter II


Summary 1
ADMISSION DATE : 26-8-2003

DISCHARGE DATE : 4-9-2003

AGE : 15 years

SEX : female

This young girl was admitted for investigation of lethargy. She had complained of increasing
tiredness over the past six months, accompanied by dyspnoea and frequent headaches. She had
also noticed a lot of spontaneous bruising. On examination, she appeared pale with dark circles
under her eyes, her spleen was palpable and hepatomegaly was present. Haematological
investigations showed a decreased platelet count, very low haemoglobin (Hb) and an abnormal
white cell count (WCC). A bone marrow biopsy was performed under local anaesthetic. This
confirmed a diagnosis of acute lymphoblastic leukaemia. Chemotherapy was started immediately.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 66

Summary 2
ADMISSION DATE : 9-10-2003

DISCHARGE DATE : 1-11-2003

AGE : 76 years

SEX : female

FINAL DIAGNOSIS: Superficial spreading melanoma


HISTORY
This is a 76 year old lady who was admitted from Gynaecology OPD for radical vulvectomy and
bilateral groin dissections for a melanoma of the vulva. She gave a two month history of a
pigmented lesion on the right side of the vulva which had been getting larger and became itchy.
She reported a 4kg weight loss over the last two months but was otherwise in good health.
EXAMINATION
She was a very spritely 76 year old lady who had a 2 cm lesion on the lower posterior aspect of the
right labia. There was superficial thickening of the lesion, otherwise atrophy only of the vulva and
vagina. There were no palpable nodes.
MANAGEMENT
A radical vulvectomy and bilateral groin dissection were performed on 12-10-2003. Post
operatively she had significant bruising over the mons and around the buttocks and vulva but
otherwise had an essentially uncomplicated course. Redivac drains were removed on 19-10-2003
from the bilateral groin incisions. The vulval wound was a little moist but settled with salt baths
and she was discharged home on 1-11-2003 to be seen at the Radiotherapy Clinic in four weeks
time.
HISTOLOGY
Histology showed a superficial spreading melanoma as reported on the frozen section at the time
of the operation. There was involvement of two inguinal nodes. All excision margins were clear.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 67

Mortality Coding Exercises for Chapter II


Exercise 1

I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Metastatic abdominal carcinoma,


primary of pancreas.
due to or as a consequence of

Duration between
onset and death
4 months

(b)
due to or as a consequence of

(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.
Selected Underlying Cause of Death:
ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 68

Exercise 2
I
Disease or condition
directly leading to
death*

(a)Small cell
carcinoma, unknown primary.
due to or as a consequence of

Duration
between onset
and death
13 Months

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b).

due to or as a consequence of
...
(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 69

MODULE 9 - ANSWERS
Chapter II Neoplasms
1. Malignant bronchial adenoma
Look up adenoma in the Index (see Volume 3, page 31)
Adenoma
- bronchial (M8140/1) D38.1
In this case, the behaviour code (/1) indicates that an adenoma is generally a tumour of uncertain
or unspecified nature. Remember that it is possible to change the behaviour (that is the fifth digit
of the morphology code) to suit the diagnosis you have been given. Our diagnosis states that, in
this case, the tumour is malignant and we can assume it is a primary cancer. Therefore we can
change the morphology code to M8140/3. The /3 behaviour code indicates a malignant primary
tumour.
To find the Chapter 2 code for a primary cancer of the bronchus, we need to look up the
Neoplasms table (Volume 3, page 374). Look up
Neoplasm
- bronchus - see under Malignant primary -> C34.9.
2. Cholangiocarcinoma
Look up cholangiocarcinoma in the Index (see Volume 3, page 96)
Cholangiocarcinoma -> (M8160/3)
- unspecified site -> C22.1
Note that even though a site for the cancer is not specified, the morphological description
indicates that the tumour is in the intrahepatic bile ducts - check the code description in Volume
1, page 193.
3. Acute myelomonocytic leukaemia
Look up leukemia in the Index (Volume 3, page 334)
Leukemia
- myelomonocytic
- - acute (M9867/3) -> C92.5.
Note that it is important to look up the complete morphological description first - in this case,
myelomonocytic leukemia - before looking up the modifiers "acute" or "chronic".
4. Squamous cell carcinoma cervix uteri
Look up carcinoma in the Index (Volume 3, page 89)
Carcinoma
- squamous cell -> (M8070/3).
Read the note under "Carcinoma" in the Index on page 85, which states that, except where
otherwise indicated, carcinomas of any site should be coded to a malignant neoplasm of that site.
If you are coding multiple diagnoses, to find the sites you should look up the Neoplasms table.
Neoplasm
- cervix (uteri) -> C53.9

CBHI ICD 10 Student Workbook January 2008 Page 70

5. Bilateral synchronous Wilm's tumour (patient is four years old)


Look up either tumor or Wilm's in the Index (Volume 3, page 552 or 566)
Tumor
- Wilm's (M8960/3) -> C64.
You will note that the code description in the Tabular list is "Malignant neoplasm of kidney,
except renal pelvis". A Wilm's tumor is a cancer of the kidney, mainly occurring in children.
Remember that the spelling used in the Index is usually American whilst in the Tabular list, it is
English.
Hospital Discharge Summaries
Summary 1:
Main Condition:

C91.0 Acute lymphoblastic leukaemia

Other conditions:

M9821/3 Acute lymphoblastic leukaemia NOS

Summary 2:
Main Condition:

C51.9 Malignant neoplasm of vulva, unspecified

Other Conditions:

M8743/3 Superficial spreading melanoma, primary site


C77.4 Secondary & unspecified neoplasm of inguinal & lower
limb lymph nodes
M8743/6 Superficial spreading melanoma, secondary site
T81.0 Haemorrhage & haematoma complicating a procedure, NEC
Y83.6 Surgical operation as cause of abnormal reaction of patient or of
later complication, without mention of misadventure at time of procedure;
removal of other organ

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: C25.9 Malignant neoplasm of pancreas, unspecified
Which rule applied:

Rule 1, sequence terminating in the condition first


entered on death certificate (primary carcinoma
causing metastases)

Exercise 2:
Underlying cause of death: C80
Which rule applied:

Malignant neoplasm without specification of site

General principle

CBHI ICD 10 Student Workbook January 2008 Page 71

MODULE 10
Diseases of the Blood and Blood-forming Organs and
Certain Disorders involving the Immune Mechanism

CBHI ICD 10 Student Workbook January 2008 Page 72

MODULE 10: Diseases of The Blood And Blood


Forming Organs And Certain Disorders Involving
The Immune Mechanism (CHAPTER III)

Important points for Chapter III


Categories range from D50 to D89.
34 of the available 40 categories have been used.
The chapter is divided into 6 blocks, 3 of which relate to anaemia.
There are 2 asterisk categories in this chapter.
Note that the exclusions remind the coder that HIV disease is coded to Chapter I (see Chapter I
- B20-B24).

CBHI ICD 10 Student Workbook January 2008 Page 73

Coding exercises for Chapter III


1. Hypogammaglobulinaemia

2. Thalassaemia major

3. Hypochromic-microcytic anaemia

4. Hyperimmunoglobulin E(Hyper-IgE) syndrome

5. Thrombotic thrombocytopenic purpura

CBHI ICD 10 Student Workbook January 2008 Page 74

Sample Hospital Discharge Summaries for Chapter III


Summary 1
ADMISSION DATE : 15-4-2004

DISCHARGE DATE: 19-4-2004

AGE: 44 years

SEX: male

This patient was admitted with post-haemorrhagic anaemia due to acute blood loss following
perforation of a chronic duodenal ulcer. The ulcer was oversewn and the patient was given a blood
transfusion.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

Summary 2
ADMISSION DATE : 15-4-2004

DISCHARGE DATE : 18-4-2004

AGE : 2 years

SEX: female

This 2-year-old child was admitted with microangiopathic haemolytic anaemia and an E Coli
urinary tract infection. An intravenous pyelogram (IVP) suggested a duplex left ureter. She was
started on antibiotics and responded well, but her haemolytic anaemia persists.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 75

Mortality Coding Exercise for Chapter III


Exercise 1
I
Disease or condition
directly leading to
death*

(a)Anaemia.
due to or as a consequence of

Duration
between onset
and death
2 years

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b)Splenomegaly ..
due to or as a consequence of
(c) .
due to or as a consequence of

1 year

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 76

Exercise 2
Age 34

I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex M

(a) HIV disease with


Kaposis sarcoma
due to or as a consequence of

Duration
between onset
and death
18 months

(b)Iron deficiency anaemia ..


due to or as a consequence of
(c). .
due to or as a consequence of

Years

(d).

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

..
..

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 77

MODULE 10 - ANSWERS
Chapter III Blood and blood-forming organs and immune mechanism

1. Hypogammaglobulinemia
Look up hypogammaglobulinemia in the Index (Volume 3, page 280).
Hypogammaglobulinemia -> D80.1
2. Thalassemia major
Look up Thalassemia in the Index (Volume 3, page 532).
Thalassemia -major ->D56.1
3. Hypochromic-microcytic anemia
Look up anemia in the Index (Volume 3, page 44).
Anemia
-hypochromic
- - microcytic ->D50.8
4. Hyperimmunoglobulin E (Hyper-IgE) syndrome
Look up Syndrome in the Index (Volume 3, page 520).
Syndrome
-hyperimmunoglobulin E (IgE) ->D82.4
5. Thrombotic thrombocytopenic purpura
Look up Purpura in the Index (Volume 3, page 467).
Purpura
-thrombocytopenic
- - thrombotic -> M31.1
Hospital Discharge Summaries
Summary 1:
Main Condition:

K26.6 Duodenal ulcer, chronic or unspecified with both


haemorrhage and perforation

Other conditions:

D62

Summary 2:
Main Condition:

D59.4 Other nonautoimmune haemolytic anaemia

Other Conditions:

Acute posthaemorrhagic anaemia

N39.0 Urinary tract infection, site not specified


B96.2 E coli as cause of diseases classified to other chapters
Q62.5 Duplication of ureter

Mortality Coding Exercises


Exercise 1:
CBHI ICD 10 Student Workbook January 2008 Page 78

Underlying cause of death: D64.9 Anaemia, unspecified


Which rule applied:

Entries rearranged according to Durations, then


General Principle

Exercise 2:
Underlying cause of death: B21.0 HIV disease resulting in Kaposis sarcoma
Which rule applied:

Rule 2 no sequence is recorded, so first


mentioned condition is selected

CBHI ICD 10 Student Workbook January 2008 Page 79

MODULE 11
Endocrine, Nutritional and Metabolic Diseases

CBHI ICD 10 Student Workbook January 2008 Page 80

MODULE 11: Endocrine, Nutritional and Metabolic Disorders (Chapter IV)


This chapter includes disorders of the endocrine glands, nutritional disorders and metabolic
disorders.
Important points for Chapter IV
Categories in this chapter range from E00 to E90.
73 of the available 91 categories have been allocated.
The chapter is divided into 8 blocks.
There are 2 asterisk categories.
Included are disorders of the endocrine glands (E00-E35), nutritional disorders (E40-E64) and
metabolic disorders (E65-E90).
The disorders of endocrine glands are grouped anatomically.
Some of the codes in this chapter can be used as additional codes to indicate the functional
activity of neoplasms.
An additional code can be assigned to indicate presence of mental retardation associated with
iodine deficiency. The Use additional code instruction is utilised.
E10-E14, the block on diabetes mellitus, uses insulin-dependent diabetes mellitus (IDDM) and
non-insulin-dependent diabetes mellitus (NIDDM) as preferred terminology, although it does
include reference to Types I and II diabetes mellitus (among others) within the categories. Type
I diabetes is equivalent to IDDM, Type II is equivalent to NIDDM.
Insulin dependent diabetes mellitus, non-insulin dependent diabetes mellitus and malnutritionrelated varieties of diabetes are identified at the 3 character level and complications of the
diabetes are identified at the fourth character level.
Example:
Non-insulin dependent diabetes mellitus (NIDDM) with diabetic nephropathy. The correct
code would be:

E11.2
Indicates the
type of diabetes
(NIDDM) at the 3rd
character level.

Indicates the complication


(nephropathy) at the
4th character level.

Block E40-E46 (Malnutrition) is principally associated with chronic insufficiency/


inappropriateness of diet and is usually measured in terms of variation in weight from a
reference standard that is specific to each country. ICD-10 provides explanatory notes at the
beginning of the block to assist in the correct classification of malnutrition.

CBHI ICD 10 Student Workbook January 2008 Page 81

Coding exercises for Chapter IV


1. Type II diabetes mellitus with (related) peripheral angiopathy, left foot

2. Cystic fibrosis, admitted because of chronic pseudomonas bronchitis

3. Obesity associated with Prader-Willi Syndrome

4. Medullary carcinoma of the thyroid with hyperparathyroidism

5. Gouty arthropathy, left ankle and knee

Sample Hospital Discharge Summaries for Chapter IV


Summary 1
ADMISSION DATE : 20-11-2003

DISCHARGE DATE : 8-12-2003

AGE : 50 years

SEX : female

DISCHARGE DIAGNOSIS: Insulin dependent diabetes


PRESENTATION:
Mrs X. presented with an episode of uncontrolled diabetes with hypoglycaemia. Once again she
had presented in unusual circumstances having had quite some warning of the episode and having
called a taxi from her home address. The patient then arrived at the hospital for her second
episode of severe hypoglycaemia within a 3 week period.
Management on this occasion consisted of supplementation of the patients low sugar level by
both oral and intravenous supplements. Examination demonstrated signs of severe diabetic
retinopathy.
The patient has been referred to the Diabetes clinic.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 82

Summary 2
ADMISSION DATE : 8-7-04

DISCHARGE DATE : 12-7-04

AGE : 38 years

SEX : female

DISCHARGE DIAGNOSIS: Papillary carcinoma thyroid gland


PRESENTATION:
This 38 year old woman was admitted for a total thyroidectomy for a multi-nodular goitre. She
also has hypertension.
The procedure was performed uneventfully, but unfortunately the histology showed a poorly
differentiated papillary carcinoma of the thyroid gland with invasion and spread into the
parathyroid gland.
She will be readmitted in 4 weeks for radioactive iodine treatment
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 83

Mortality Coding Exercises for Chapter IV


Exercise 1
Age: 69
I
Disease or condition
directly leading to
death*

Sex: Female

(a)Acute on chronic renal failure


due to or as a consequence of

Duration
between onset
and death
12 days

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b)Glomerulonephritis..
due to or as a consequence of
(c).Diabetic nephropathy
due to or as a consequence of

1 year

(d)Diabetes Type II
5 years

10 years
II
Other significant conditions
fracture
contributing to the death,
but not related to the disease
or condition causing it

Femoral neck fracture, femoral


repair, Post operative; haematoma

1 month

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 84

Exercise 2
Age: 92

Sex: Female

I
Disease or condition
directly leading to
death*

(a)Dental caries
due to or as a consequence of

Duration
between onset
and death
months

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b) ..
due to or as a consequence of
(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Diabetes 30 years
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.
Selected Underlying Cause of Death:
ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 85

MODULE 11 - ANSWERS
Chapter IV Endocrine, nutritional and metabolic diseases
1. Type II diabetes mellitus with (related) peripheral angiopathy, left foot
Look up diabetes in the Index (Volume 3, page 158).
Diabetes
- type II (nonobese)(obese) E11.Refer to page 278 in the Tabular list for E11. You will find a note referring you to page 277 for
a fourth character subdivision. The patient has peripheral angiopathy, a peripheral circulatory
complication. Therefore .5 is the appropriate fourth character to use. Note also that peripheral
angiopathy is listed as an inclusion term beneath .5 and that an asterisk code is listed with it.
Therefore the codes to use would be E11.5 and I79.2*
2. Cystic fibrosis, admitted because of chronic pseudomonas bronchitis
Look up bronchitis in the Index (Volume 3, page 77).
Bronchitis
-chronic ->J42
As the type of organism is given but not listed under bronchitis we have to code the organism as
well. Look up infection in the Index (Volume 3, page 296).
Infection
-pseudomonas
- - as cause of diseases classified elsewhere ->B96.5
When multiple coding, the Cystic Fibrosis should be coded as well. Look up fibrosis in the Index
(Volume 3, page 226).
Fibrosis
-cystic
- - with
- - - pulmonary manifestations -> E84.0
3. Obesity associated with Prader-Willi Syndrome
Look up obesity in the Index (Volume 3, page 411).
Obesity
- specified E66.8
Refer to the exclusion note for E66 in the Tabular list, which states that if the obesity occurs with
Prader-Willi Syndrome the code Q87.1 should be used instead.
4. Medullary carcinoma of the thyroid with hyperparathyroidism
Look up carcinoma in the Index (Volume 3, page 87).
Carcinoma
-medullary ->(M8510/3)

CBHI ICD 10 Student Workbook January 2008 Page 86

A site code needs to be obtained from the neoplasms section of the Index (Volume 3, page 399).
Neoplasm
-thyroid -> C73
When multiple coding, the hyperparathyroidism should be coded as well.
Look up hyperparathyroidism in the Index (Volume 3, page 275).
Hyperparathyroidism
-secondary ->E21.1
5. Gouty arthropathy, left ankle and knee
Look up arthropathy in the Index (Volume 3, page 60).
Arthropathy
-gouty M10.0
Refer to page 634 of Volume 1 for the M10 category. You will see a note referring you to pages
628-629 for site codes. These codes are to be added as a fifth character for the M10.0 category
to indicate the site of the gouty arthropathy. The appropriate fifth characters to be used would be
.6 for the knee and .7 for the ankle. Therefore the codes to be used would be M10.06 and
M10.07.
Hospital Discharge Summaries
Summary 1:
Main Condition:

E10.3 Insulin dependent diabetes mellitus with ophthalmic


complications

Other conditions:

H36.0* Diabetic retinopathy

Summary 2:
Main Condition:

C73 Malignant neoplasm of thyroid gland

Other Conditions:

M8050/3 Papillary carcinoma NOS, primary site


C79.8 Malignant neoplasm of other secondary sites
M8050/6 Papillary carcinoma NOS, secondary site

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: E11.2 Non insulin dependent diabetes mellitus with
Renal complications
Which rule applied:

General Principle, then Rule D Specificity

Exercise 2:
Underlying cause of death: E14.9 Unspecified diabetes mellitus, without complications
Which rule applied:

General principle, then rule B Trivial conditions

CBHI ICD 10 Student Workbook January 2008 Page 87

MODULE 12
Mental and Behavioural Disorders

CBHI ICD 10 Student Workbook January 2008 Page 88

MODULE 12: Mental and Behavioural Disorders (Chapter V)


This chapter deals with mental and behavioural disorders of all origins.
Important points for Chapter V
Categories range from F00 to F99.
Of the 100 available categories, 78 have been allocated.
The chapter is divided into 11 blocks.
There are 2 asterisk categories, relating to dementia in Alzheimers disease and in other
diseases classified elsewhere.
Each category is prefaced by a comprehensive description of the disorders it contains.
There is emphasis on behavioural disorders as well as mental disorders.
Block F00-F09 covers organic mental disorder. That is, those disorders resulting from a
physical cause e.g. dementia in Alzheimers disease.
Block F10-F19 covers disorders due to the use of psychoactive or other substances. The third
character indicates the substance involved and the fourth character indicates the clinical state of
the patient.
Example:
F12.2

Indicates that
the substance
involved is
a cannabinoid

Indicates that the patient is


clinically dependent on
the drug

CBHI ICD 10 Student Workbook January 2008 Page 89

Coding exercises for Chapter V


1. Trichotillomania
2. Psychogenic impotence
3. Korsakov's psychosis
4. Huntington's disease with dementia
5. Bipolar disorder, currently severely depressed but not psychotic

Sample Hospital Discharge Summaries for Chapter V


Summary 1
ADMISSION DATE : 3-4-2004

DISCHARGE DATE: 5-4-2004

AGE : 34 years

SEX : female

DIAGNOSIS: Chronic schizophrenia


SUMMARY OF ADMISSION: This thirty-four year old lady was brought in by police following
verbal abuse and physical threats against customers and staff at the local shopping mall.
Aggressive and violent towards police, punching cell walls at police station. Known to police and
admitted to this unit on 2 previous occasions.
First diagnosed with schizophrenia 5 years ago and has had multiple admissions to this and other
mental health units. Non-compliant with medications. Moved to this area 2 years ago.
Unemployed with a 9 year old daughter being cared for by patients sister.
Difficult two hour evaluation. Patient abusive and threatening to staff. Complained of auditory and
visual hallucinations. Paranoid delusions regarding staff intentions to harm her. When questioned
about behaviour at shopping mall stated that she "yelled at them because staff were selling the
things I wanted to buy to other customers". Stated she hadn't been taking her medications because
"they" were trying to poison her. Agreed to voluntary admission for assessment.
10mg haloperidol given orally with good effect. Maintain on 5mg haloperidol nocte. Abrasions
and swelling to the back of both hands from punching cell wall at police station were cleaned and
dressed.
Patient discharged into care of her sister.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 90

Summary 2
ADMISSION DATE : 10-01-04

DISCHARGE DATE : 14-02-04

AGE : 43 years

SEX : female

DIAGNOSIS: Overdose of Diazepam, chronic depression


SUMMARY OF ADMISSION:
This 43 year old woman was admitted to this unit via
Accident & Emergency department following a deliberate overdose of Diazepam. She claimed she
felt depressed and wanted to stay in hospital for a while. She stated that she had felt depressed
some months prior to admission, but felt worse in past month.
Mental state examination revealed an overweight lady who was pleasant and co-operative. She
appeared depressed at interview and felt somewhat helpless in her situation. There was no formal
thought disorder or psychotic features. Cognitive testing was intact.
The patient was discharged and seemed reasonably well. She is to visit the outpatient department
in two weeks.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 91

Mortality Coding Exercises for Chapter V


Exercise 1
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Alcoholic amnesic syndrome


due to or as a consequence of

Duration between
onset and death
hours

(b) Alcoholic liver cirrhosis


due to or as a consequence of
(c)Chronic alcoholism
due to or as a consequence of

years

(d)

years..

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 92

Exercise 2
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Suicide by gunshot wound to head


due to or as a consequence of

Duration between
onset and death
instant

(b)Severe depression
due to or as a consequence of
Years
(c) .
due to or as a consequence of
.........
(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 93

MODULE 12 - ANSWERS
Chapter V Mental and behavioural disorders
1. Trichotillomania
Look up trichotillomania in the Index (Volume 3, page 541).
Trichotillomania ->F63.3
2. Psychogenic impotence
Look up impotence in the Index (Volume 3, page 287).
Impotence(sexual)(psychogenic) -> F52.2
3. Korsakov's psychosis
Look up psychosis in the Index (Volume 3, page 464).
Psychosis
-Korsakov's(alcoholic) F10.6
If you refer to page 323 of the Tabular List for F10, you will see a note telling you to look at
pages 321-323 for a fourth character subdivision. However when we have already been given a
fourth character by the Index. We should still confirm that the .6 is the correct code to use. By
reading the notes under .6 (Volume 1, page 322) we can see Korsakov's psychosis listed there.
Therefore the correct code is F10.6.
4. Huntington's disease with dementia
Look up Huntington's disease or chorea in the Index (Volume 3, page 270).
Huntington's disease or chorea
- with dementia -> G10 F02.2*
5. Bipolar disorder, currently severely depressed but not psychotic
Look up disorder in the Index (Volume 3, page 174).
Disorder
-bipolar F31.9
Refer to page 335 of the Tabular List (Volume 1) for F31.9. F31.9 is unspecified bipolar affective
disorder. We now know that bipolar disorder and bipolar affective disorder are the same.
Therefore we can look in the F31 category to see if we can find a more specific code as we has
been told that this person is severely depressed but not psychotic. The correct code is F31.4.
Hospital Discharge Summaries
Summary 1:
Main Condition:
Other conditions:

F25.9 Schizoaffective disorder, unspecified


Z91.1 Personal history of non compliance with medical treatment and
regimen
S60.7 Multiple superficial injuries of wrist and hand
W22.29 Striking against or struck by other objects, police cell, unspecified
activity
X83.29 Intentional self-harm by other specified means, police cell, unspecified
activity
CBHI ICD 10 Student Workbook January 2008 Page 94

Summary 2:
Main Condition:

T42.4 Poisoning by benzodiazepines

Other Conditions:

X61.99 Intentional self-poisoning by antiepileptic, sedative- hypnotic,


antiparkinsonism and psychotropic drugs NEC, unspecified site, unspecified
activity
F32.9 Depressive episode, unspecified

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: X73.98 Intentional self-harm by rifle, shotgun and
larger firearm discharge, unspecified site, other
specified activity
Which rule applied:

General Principle, then 4.2.2 in Volume 2


Highly Improbable

Exercise 2:
Underlying cause of death: F10.6 Mental and behavioural disorders due to use
of alcohol, amnesic syndrome
Which rule applied:

General principle, with rule C Linkage (alcoholism


(F10,2) links with alcoholic amnesic syndrome
(F10.6), code to amnesic syndrome)

CBHI ICD 10 Student Workbook January 2008 Page 95

MODULE 13
Diseases of the Nervous System

CBHI ICD 10 Student Workbook January 2008 Page 96

Module 13: Diseases of The Nervous System (Chapter VI)


This chapter provides codes for diseases and disorders of the nervous system.
Important points for Chapter VI
The categories in this chapter range from G00 to G99.
67 of the 100 available categories have been used.
There are 16 asterisk categories.
The chapter relates to both the central and peripheral nervous systems.
G00-G09 classifies disease where the nerve tissue is attacked by different organisms. All
meningoencephalitis and meningomyelitis are included here, as are encephalitis, myelitis and
encephalomyelitis.
G40-G47 is for the coding of disorders that occur episodically, e.g. epilepsy, migraines and
sleep disorders.
The exclusion note at the beginning of block G50-G59 should be clearly understood. Current
injuries to nerves should be classified under injury of the particular body region. There are a
number of exclusions within this block which direct the coder to Chapter XIII, Diseases of the
Musculoskeletal System and Connective Tissue.

CBHI ICD 10 Student Workbook January 2008 Page 97

Coding exercises for Chapter VI


1. Diabetic polyneuropathy

2. Herpesviral encephalitis

3. Congenital muscular dystrophy

4. Carpal tunnel syndrome

5. Chronic fatigue syndrome

Sample Hospital Discharge Summaries for Chapter VI


Summary 1
ADMISSION DATE : 30-11-03

DISCHARGE DATE : 8-12-03

AGE :75 years

SEX: female

This elderly lady has a history of bouts of severe facial pain. The pain is often set off when she is
eating or brushing her teeth. She was diagnosed as having trigeminal neuralgia and a surgical
division of the fifth cranial nerve was carried out.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 98

Summary 2
ADMISSION DATE : 3-4-04

DISCHARGE DATE : 7-4-04

AGE : 39 years

SEX : female

FINAL DIAGNOSIS: Migraine, hypertension


HISTORY: This thirty-nine year old lady was admitted for investigation of headache. She had a
sudden onset of bifrontal headache followed by collapse, possible right focal fitting. She was noted
to be confused afterwards. At the local doctor's surgery she was noted to be hypertensive with a
BP of 180/120. There was no associated fever, cough, nausea, vomiting, diplopia or focal
weakness. There is no past history of migraine or other headache. She had a head injury at the age
of eighteen but there had been no problems since then.
EXAMINATION: On examination she was noted to be obese. She had a blood pressure of 140/90
in both arms, pulse of 90/min and regular. She was afebrile. Auscultation of her heart sounds was
normal and chest was clear. Abdominal examination was unremarkable. Cranial nerves were
normal. Power and tone in upper and lower limbs were normal. There were no cerebellar signs.
Sensation was normal.
INVESTIGATIONS: Due to the suspicion of a subarachnoid haemorrhage, contrast CT head scan
was performed. This was normal. She then proceeded to a lumbar puncture which was normal and
showed normal biochemistry. Full blood count did show some neutrophilia, normal coagulation
profile. ECG was normal.
MANAGEMENT: Admitted to ward where she was observed. Headache resolved and there was
no further evidence of fitting. Neurological signs returned to normal. Blood pressure continued to
be erratic, ranging from 140/100 to 170/110. It was elected to commence antihypertensive drug
treatment. Further investigations for an underlying cause for her hypertension were undertaken.
Microurine was negative.
Was very keen to return home. Outstanding investigations include - renal ultrasound and EEG.
She has also been referred to the dietician for weight loss.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 99

Mortality Coding Exercises for Chapter VI


Exercise 1
I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Occipital fracture.
due to or as a consequence of

Duration between
onset and death
1 week

(b)Fall following epileptic fit


due to or as a consequence of
1 week
(c)Hypertension
due to or as a consequence of
10 years
(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Asthma
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 100

Exercise 2
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Chronic renal failure


due to or as a consequence of

Duration between
onset and death
2 years

(b)Quadriplegia
due to or as a consequence of
(c)MVA.
due to or as a consequence of

10 years

(d)

10 years

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Smoking
.Heroin addiction

20 years
10 years

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.
Selected Underlying Cause of Death:
ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 101

MODULE 13 - ANSWERS
Chapter VI Diseases of the nervous system
1. Diabetic polyneuropathy
Look up polyneuropathy in the Index (Volume 3, page 448).
Polyneuropathy
-diabetic (see also E10-E14 with fourth character .4) -> E14.4 G63.2*
You should always refer to the E10-E14 categories to determine that you have the correct code
for the type of diabetes. In this case the diabetes is unspecified, therefore the E14 is the code to
use.
2. Herpesviral encephalitis
Look up encephalitis in the Index (Volume 3, page 204).
Encephalitis
-herpesviral -> B00.4 G05.1*
3. Congenital muscular dystrophy
Look up dystrophy in the Index (Volume 3, page 194).
Dystrophy
-muscular
- - congenital -> G71.2
4. Carpal tunnel syndrome
Look up syndrome in the Index (Volume 3, page 519).
Syndrome
-carpal tunnel -> G56.
5. Chronic fatigue syndrome
Look up syndrome in the Index (Volume 3, page 520).
Syndrome
-fatigue
- - chronic -> G93.3
Hospital Discharge Summaries
Summary 1:
Main Condition:

G50.0 Trigeminal neuralgia

Other conditions:
Summary 2:
Main Condition:
Other Conditions:

G43.9 Migraine, unspecified


I10
Essential Hypertension
E66.9 Obesity, unspecified

CBHI ICD 10 Student Workbook January 2008 Page 102

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: G40.9 Epilepsy, unspecified
Which rule applied:

Rule 1, Sequence terminating in condition first


mentioned on certificate (epileptic fit causing fall,
causing fracture)

Exercise 2:
Underlying cause of death: Y85.0 Sequelae of motor vehicle accident
Which rule applied:

General principle, then rule F Sequelae

CBHI ICD 10 Student Workbook January 2008 Page 103

MODULE 14
Diseases of the Eye and Adnexa

CBHI ICD 10 Student Workbook January 2008 Page 104

Module 14: Diseases of The Eye and Adnexa (Chapter VII)


This is chapter deals exclusively with diseases of the eye and its adnexa.
Important points for Chapter VII
The categories in this chapter range from H00 to H59.
47 of the available 60 categories have been used.
The chapter is divided into 11 blocks.
There are 12 asterisk categories.
Note the use of additional/optional codes for H40.3, H40.4, H40.5 and H40.6 to identify the
cause of glaucoma.
H54 blindness and low vision is an important category, which has a table detailing impairment
categories. Check page 457 of the Tabular List for this table.

CBHI ICD 10 Student Workbook January 2008 Page 105

Coding exercises for Chapter VII


1. Juvenile cataract
2. Tuberculous chorioretinitis
3. Progressive external ophthalmoplegia
4. Blindness right eye, with concurrent low vision left eye
5. Chronic simple glaucoma, both eyes

Sample Hospital Discharge Summary for Chapter VII


Summary 1
ADMISSION DATE : 28-4-04

DISCHARGE DATE : 29-4-04

AGE : 83 years

SEX : female

FINAL DIAGNOSIS: Conjunctivitis due to Chlamydia trachomatis


This elderly woman was admitted for investigation of acute pain, burning and purulent discharge
from her left eye and redness and lacrimation of the right eye. She stated that the left eye had been
sore and itchy for the last two days. On awakening this morning, the pain had intensified in the
left eye and had spread to the right eye.
EXAMINATION: This thin elderly lady presented with suppurative discharge from left eye,
redness in right eye. Examination of the left eye showed superficial hyperaemia of the eyelids and
globe, vision slightly impaired, intraocular pressure normal, cornea clear and light reactions
normal. Right eye showed slight reddening of the eyelids. Vision, intraocular pressure and the
cornea were all normal.
INVESTIGATIONS: Swabs from both eyes showed Chlamydia trachomatis infection
MANAGEMENT: Patient was admitted to ward and started on Sulfacetamide eye drops and
Achromycin, to which she responded well.
She was keen to return home and was discharged the following day for follow-up by her local GP.
Dx

ICD-10 Code

Main Condition:
Other Conditions:
CBHI ICD 10 Student Workbook January 2008 Page 106

MODULE 14 - ANSWERS
Chapter VII Diseases of the eye and adnexa
1. Juvenile cataract
Look up cataract in the Index (Volume 3, page 91).
Cataract
- juvenile -> H26.0
Note that the Tabular list indicates that juvenile = infantile = presenile.
2. Tuberculous chorioretinitis
Look up chorioretinitis in the Index (Volume 3, page 98)
Chorioretinitis
- tuberculous -> A18.5 H32.0 *
If you are only coding single conditions, use the A18.5 to indicate the underlying cause. Also note
in the Tabular list on page 117, that there are bullet points to indicate the various manifestations
of the tuberculosis of the eye.
3. Progressive external ophthalmoplegia
Look up ophthalmoplegia in the Index (Volume 3, page 417)
Ophthalmoplegia
- progressive external -> H49.4
The Tabular list indicates that this is a form of paralytic strabismus.
4. Blindness right eye, with concurrent low vision left eye
Look up blindness (Volume 3, page 74) OR vision (Volume 3, page 563)
Blindness
- one eye (other eye normal)
- - low vision, other eye -> H54.1
Note the Table on page 457, which indicates the levels of visual impairment which are used to
determine the appropriate H54.- code.
5. Chronic simple glaucoma, both eyes
Look up glaucoma (Volume 3, page 245)
Glaucoma
- chronic
- - simple -> H40.1
OR
Glaucoma
- simple (chronic) -> H40.1
Hospital Discharge Summary
Summary 1:
Main Condition:

A74.0 Chlamydial conjunctivitis

Other conditions:

H13.1*Conjunctivitis in infectious and parasitic diseases classified elsewhere


CBHI ICD 10 Student Workbook January 2008 Page 107

MODULE 15
Diseases of the Ear and Mastoid Process

CBHI ICD 10 Student Workbook January 2008 Page 108

Module 15: Diseases of The Ear and Mastoid Process (Chapter VIII)
This chapter deals exclusively with diseases of the ear and mastoid process.
Important points for Chapter VIII
The categories in this chapter range from H60 to H95.
24 of the available 36 categories have been used.
The chapter is divided into 4 blocks.
There are 5 asterisk categories.
The blocks are divided anatomically: external ear, middle ear and mastoid, and inner ear. The
final block (H90-H95) contains codes relating to hearing loss, symptom-type conditions,
disorders of the acoustic nerve and postprocedural problems.
H90 classifies conductive and sensorineural hearing loss by unilateral and bilateral impairment.

CBHI ICD 10 Student Workbook January 2008 Page 109

Coding exercises for Chapter VIII


1. Acute purulent otitis media
2. Mixed conductive and sensorineural hearing loss, bilateral
3. Glue ear
4. Aspergillosis in otitis externa
5. Malignant chemodectoma, right middle ear

Sample Hospital Discharge Summary for Chapter VIII


Summary 1
ADMISSION DATE : 22-4-04

DISCHARGE DATE : 23-4-04

AGE : 23 years

SEX : male

FINAL DIAGNOSIS: Acute myringitis due to Streptococcal pneumoniae


HISTORY: This 23 year old fit male presented complaining of acute pain in the left ear. Patient
has had the pain for the last 24 hours and had taken aspirin with minimal relief. Patient stated he
had recently recovered from a chest infection.
EXAMINATION: Aural examination revealed inflammation of the tympanic membrane of the
left ear with multiple small vesicles.
MANAGEMENT: Myringotomy with aspiration of vesicle fluid for pathology showed
streptococcal pneumoniae bacteria. Patient commenced on erythromycin 250mg qid.

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 110

MODULE 15 - ANSWERS
Chapter VIII Diseases of the ear and mastoid process
1. Acute purulent otitis media
Look up otitis (Volume 3, page 421)
Otitis
- media
- - acute or subacute
- - - purulent -> H66.0
Note that you need to go to three levels of indentation to find the correct code in the Index.
2. Mixed conductive and sensorineural hearing loss, bilateral
Look up Loss in the Index (Volume 3, page 337)
Loss
- hearing - see also Deafness.
Deafness
- mixed conductive and sensorineural
- - bilateral -> H90.6
3. Glue ear
Look up glue in the Index (Volume 3, page 247)
Glue
- ear -> H65.3.
4. Aspergillosis in otitis externa
Look up otitis in the Index (Volume 3, page 421)
Otitis
- externa
- - in (due to)
- - - aspergillosis -> B44.8 H62.2 *
Remember, for single condition coding, use the underlying cause only (B44.8, Other forms of
aspergillosis).
5. Malignant chemodectoma, right middle ear
Look up chemodectoma (Volume 3, page 95)
Chemodectoma (M8693/1) see Paraganglioma, nonchromaffin
Paraganglioma
- nonchromaffin
- - malignant -> (M8693/3)
- - - specified site - see Neoplasm, malignant.
Look up the Neoplasm Table in the Index (Volume 3, page 379).

CBHI ICD 10 Student Workbook January 2008 Page 111

Neoplasm
- ear
- - middle - see under Malignant, primary -> C30.1
This is the code to use for single condition coding - add the morphology code if you are coding
multiple conditions.
Hospital Discharge Summary
Summary 1:
Main Condition:
Other conditions:

H73.0 Acute myringitis


B95.3 Streptococcus pneumoniae as cause of diseases
classified to other chapters

CBHI ICD 10 Student Workbook January 2008 Page 112

MODULE 16
Diseases of the Circulatory System

CBHI ICD 10 Student Workbook January 2008 Page 113

Module 16: Diseases of the Circulatory System (Chapter IX)


Chapter IX covers the organs and systems involved in the circulation of blood and lymph, but not
the blood itself. Blood is covered in Chapter III.
Important points for Chapter IX
Categories I00 to I99 make up this chapter.
Of the 100 categories available, 77 have been allocated.
The chapter is divided into 10 blocks.
There are 8 asterisk categories.
Care should be taken with this chapter because the prefix "I" looks like a "1", when written or
typed, and this can be confusing.
I05-I09 includes most valvular disease whether they are specified as rheumatic or not. Be
aware of the exceptions though: valvular diseases of the aortic valve are classified to this block
only if they are specified as rheumatic.
I10-I15 Hypertensive disorders have no distinction between malignant and benign types as was
the case in ICD-9.
I20-I25 has a note which provides guidance for coders in establishing duration of ischaemic
heart diseases. This makes a distinction between morbidity and mortality coding in the
application of the codes.
Read the note on page 477 of the Tabular List and ensure you understand the distinction.

CBHI ICD 10 Student Workbook January 2008 Page 114

Coding exercises for Chapter IX

1. Syphilitic aneurysm of aorta

2. Acute cor pulmonale

3. Biventricular failure

4. Dissection of abdominal aorta

5. Strangulated internal haemorrhoids

CBHI ICD 10 Student Workbook January 2008 Page 115

Sample Hospital Discharge Summaries for Chapter IX


Summary 1

ADMISSION DATE : 10-11-03

DISCHARGE DATE : 18-11-03

AGE : 75 years

SEX : female

This 75-year-old female was admitted with incapacitating angina on exertion. An


electrocardiogram (ECG) showed cardiac changes consistent with subendocardial acute
myocardial infarction. He was treated with medication for his unstable angina and rapidly
improved over the next few days. He will be followed up by his cardiac surgeon.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

Summary 2
ADMISSION DATE : 2-10-03

DISCHARGE DATE : 12-10-03

AGE : 58 years

SEX : male

This patient presented to hospital with severe congestive cardiac failure. During his stay in
hospital, he developed sweats and leukocytosis. This was determined to be due to bacterial
endocarditis. Treatment with antibiotics was provided and the patient responded well.

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 116

Mortality Coding Exercises for Chapter IX


Exercise 1
I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Acute myocardial infarction


due to or as a consequence of

Duration between
onset and death
Minutes

(b)Ischaemic heart disease


due to or as a consequence of

Years

(c)..
due to or as a consequence of

(d)..

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Alcoholism
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 117

Exercise 2
I
Disease or condition
directly leading to
death*

(a)Hypertensive heart disease


due to or as a consequence of

Duration
between onset
and death
years

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b)Ischaemic heart disease..


due to or as a consequence of
(c).
due to or as a consequence of

years

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 118

MODULE 16 - ANSWERS
Chapter IX Diseases of the circulatory system
1. Syphilitic aneurysm of aorta
Look up aneurysm in the Index (Volume 3, page 45)
Aneurysm
-aorta
- - syphilitic -> A52.0 I79.0*
If you only code one condition then only the A52.0 will be recorded. The asterisk code should
never be your main condition.
2. Acute cor pulmonale
Look up Cor in the Index (Volume 3, page 118)
Cor
-pulmonale
- - acute -> I26.0
3. Biventricular failure
Look up Failure in the Index (Volume 3, page 219).
Failure
- biventricular -> I50.9
4. Dissection of abdominal aorta
Look up Dissection in the Index (Volume 3, page 185).
Dissection
-aorta (any part)(ruptured) -> I71.0
5. Strangulated internal haemorrhoids
Look up Hemorrhoids in the Index (Volume 3, page 262).
Hemorrhoids
-internal
- - bleeding, prolapsed, strangulated or ulcerated -> I84.1
Hospital Discharge Summaries
Summary 1:
Main Condition:

I21.4 Acute subendocardial myocardial infarction

Other conditions:
Summary 2:
Main Condition:

I50.0 Congestive heart failure

Other Conditions:

I33.0 Acute and subacute infective endocarditis

CBHI ICD 10 Student Workbook January 2008 Page 119

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: I21.9 Acute myocardial infarction, unspecified
Which rule applied:

General principle, then rule C linkage (ischaemic


heart disease NOS (I25.9) with mention of acute
myocardial infarction (I21.9), code to AMI)

Exercise 2:
Underlying cause of death: I25.9 Chronic ischaemic heart disease, unspecified
Which rule applied:

General principle

CBHI ICD 10 Student Workbook January 2008 Page 120

MODULE 17
Diseases of the Respiratory System

CBHI ICD 10 Student Workbook January 2008 Page 121

Module 17: Diseases of the Respiratory System (Chapter X)


Chapter X is concerned with diseases and disorders of the respiratory organs including those
caused by infection and some external agents, such as in occupational exposure.
Important points for Chapter X
This chapter includes categories J00 to J99.
63 of the available 100 categories have been allocated.
The chapter is divided into 10 blocks.
There are 3 asterisk categories in the chapter.
When a respiratory condition is described as occurring in more than one site and the condition
is not specified in the Index, it should be classified to the lower anatomical site eg.
tracheobronchitis is coded to bronchitis (J40), not tracheitis plus bronchitis (J04.1 + J40). This
coding rule is to be found at the beginning of the chapter. In practice, however, the Index
includes many of the possible combinations (eg. pharyngotracheitis (J06.8),
laryngotracheobronchitis (J40), tracheobronchopneumonitis (J12-J18)) and directs the coder to
the appropriate code.
The section concerning acute upper respiratory infections (J00-J06) is arranged anatomically,
from nose down to larynx.
Bronchitis not specified as acute or chronic is assumed to be acute if the person is under 15
years and is coded as J20.9.
Abscess of lung with pneumonia where the causative organism is not specified, is coded to
J85.1. If the causative organism is specified, the condition is classified to block J10-J16.
Pleurisy without mention of effusion or current tuberculosis is classified to the symptoms
chapter (R09.1). Pleurisy with pleural effusion is classified to J90 Pleural effusion, not
elsewhere classified.

CBHI ICD 10 Student Workbook January 2008 Page 122

Coding exercises for Chapter X


1. Subglottic edema
2. Bronchitis (in a 10 year old female)
3. Aspiration pneumonitis after inhaling food whilst eating in restaurant
4. Anthracosis and Tuberculosis of lung (confirmed by x-ray and sputum microscopy)
5. Nasopharyngeal polyp

Sample Hospital Discharge Summaries for Chapter X


Summary 1
ADMISSION DATE : 18-3-04

DISCHARGE DATE : 20-3-04

AGE : 22 months

SEX : male

FINAL DIAGNOSIS:

Croup and chronic asthma

HISTORY: This patient is a 22 month old boy with a background of chronic persistent asthma,
who was admitted with acute croup and an acute exacerbation of asthma. He has had a history of
wheezing and coughing, occurring with exercise and also nocturnally. He has needed his Ventolin
every one to two days. This episode of asthma was precipitated by upper respiratory tract infection
which is still evident. Nil allergies, normal development and vaccinations are up to date.
PAST MEDICAL HISTORY: Chronic persistent asthma.
EXAMINATION: He was alert and his respiratory rate was 40/min. His heart rate was 150/min.
He had moderate intercostal recession and audible inspiratory stridor and expiratory wheeze. On
chest examination he had good air entry. ENT examination revealed tonsillitis and pharyngitis.
The ear examination was normal. Dual heart sounds were heard, no murmurs. Abdominal
examination was normal. The impression was acute croup and an acute exacerbation of chronic
asthma precipitated by URTI.
MANAGEMENT: He was admitted for observation and overnight monitoring and started on
regular nebulised Ventolin and Pulmicort; and given oral Prednisone. His inspiratory stridor
resolved overnight. He is for follow up at OPD in four weeks time.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 123

Summary 2

ADMISSION DATE : 10-11-03

DISCHARGE DATE : 13-11-03

AGE : 64 years

SEX : female

On admission, this patients chest examination revealed signs consistent with bilateral
bronchopneumonia and a left pleural effusion. There was marked respiratory failure. She
continued to deteriorate and died three days after admission.

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 124

Mortality Coding Exercises for Chapter X


Exercise 1
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Bronchitis.
due to or as a consequence of

Duration between
onset and death
Hours

(b)Emphysema ..
due to or as a consequence of
(c) Chronic obstructive pulmonary
disease
due to or as a consequence of

Years

10 years
(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Peripheral vascular disease


.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 125

Exercise 2
I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Terminal hypostatic pneumonia


due to or as a consequence of

Duration between
onset and death
2 days

(b) Right hemiplegia


due to or as a consequence of
Years..
(c). .
due to or as a consequence of

(d)..
.

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

CVA
.

1992

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 126

MODULE 17 - ANSWERS
Chapter X Diseases of the respiratory system
1. Subglottic edema
Look up Edema in the Index (Volume 3, page 198)
Edema
-subglottic (see also Edema, glottis) -> J38.4
2. Bronchitis (in a 10 year old female)
Look up Bronchitis in the Index (Volume 3, pages 77 & 78)
As we know this patient is a child we need to look for a modifier that refers to children or ages.
Bronchitis
-under 15 years of age - see also Bronchitis, acute or subacute
Bronchitis
-acute or subacute (with bronchospasm or obstruction) -> J20.9
3. Aspiration pneumonitis after inhaling food whilst eating in a restaurant
Look up Pneumonitis in the Index (Volume 3, page 445)
Pneumonitis
-aspiration -> J69.0
When we refer to J69.0 in the Tabular List, Volume 1 page 540 there is a note at the beginning of
the J69 category advising coders to use an additional external cause code from Chapter XX if
desired. We would use this code when multiple coding.
We know that the patients pneumonitis has been caused by the aspiration of food, therefore we
need to look for aspiration in the external causes of injury section of the Index (Volume 3, page
581).
Aspiration
-food W79.Remember that the .- means that there is a fourth digit required to complete the code.
When we look up W79 in Volume 1 (page 1071) we note that at the beginning of the section on
page 1070 there is a note directing the coder to pages 1013-1017 for the fourth character
subdivisions for place of occurrence. As this incident occurred in a restaurant (a trade and
service area), the fourth character subdivision will be 5. The activity is eating, thus an Activity
code of .4 is appropriate. Therefore our complete code is W79.54.
4. Anthracosis and Tuberculosis of lung (confirmed by chest x-ray and sputum microscopy)
Look up Anthracosis in the Index (Volume 3, page 54).
Anthracosis -> J60
If we look up J60 there is an exclusion note excluding anthracosis with tuberculosis. (J65).
Therefore the code J65 should be used for this condition. We then need to find a code for the
tuberculosis as well.
CBHI ICD 10 Student Workbook January 2008 Page 127

Look up Tuberculosis in the Index (Volume 3, page 547).


Tuberculosis
-pulmonary
- - confirmed(by)
- - - sputum microscopy with or without culture -> A15.0
5. Nasopharyngeal polyp
Look up polyp in the Index (Volume 3, page 449).
Polyp
-nasopharyngeal -> J33.0
Hospital Discharge Summaries
Summary 1:
Main Condition:
Other conditions:

J05.0 Acute obstructive laryngitis [Croup]


J45.9 Asthma, unspecified
J06.8 Other acute upper respiratory infections of multiple sites

Summary 2:
Main Condition:

J18.0 Bronchopneumonia, unspecified

Other Conditions:

J90

Pleural effusion, NEC

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: J44.8 Other specified chronic obstructive pulmonary disease
Which rule applied:

General principle with rule D Specificity

Exercise 2:
Underlying cause of death: I64
Which rule applied:

Stroke, not specified as haemorrhage or infarction

General principle, then rule 3 other condition


(CVA) obvious cause of condition selected by
general principle (right hemiplegia)

CBHI ICD 10 Student Workbook January 2008 Page 128

MODULE 18
Diseases of the Digestive System

CBHI ICD 10 Student Workbook January 2008 Page 129

Module 18: Diseases of Digestive System (Chapter XI)


Chapter XI involves diseases and disorders of the alimentary tract or digestive system.
Important points for Chapter XI
Categories K00 to K93 comprise this chapter.
71 of the available 94 categories have been used.
The chapter is divided into 10 blocks.
Except for block K40-K46 (Hernias), the codes in the range K00-K63 are arranged
anatomically from mouth to anus. These are then followed by blocks concerning disorders of
the other main organs associated with digestion.
There are 5 asterisk categories.
Block K25-K29 has a fourth character subdivision to identify if haemorrhage or perforation
occurred.
For block K40-K46 there is a note which states that if a hernia is described as both gangrenous
and obstructed, only the gangrene need be coded (specified at 4th digit level). This is because
the gangrene is the result of the obstruction.
Block K57 Diverticular disease of the intestine includes diverticulosis, diverticulum and
diverticulitis. The fourth character level is used to specify if there is perforation or an abscess
present.

CBHI ICD 10 Student Workbook January 2008 Page 130

Coding exercises for Chapter XI


1. Adenomatous rectal polyp
2. Chronic gastrojejunal ulcer
3. Obstructed left inguinal hernia
4. Diverticulitis of jejunum and ileum with perforation
5. Postgastrectomy dumping syndrome

Sample Hospital Discharge Summaries for Chapter XI


Summary 1
ADMISSION DATE : 20-1-04

DISCHARGE DATE : 8-2-04

AGE : 49 years

SEX : female

FINAL DIAGNOSIS: Multiple stones in Common Bile Duct


HISTORY: This was a routine admission of a 49-year-old woman for open cholecystectomy. She
had a twelve-month history of epigastric pains associated with nausea and sweating. She was
admitted in December 2003 with probable gallstone pancreatitis. An ultrasound scan at this time
revealed gallstones. The common bile duct was not dilated.
EXAMINATION: Examination on admission was unremarkable and the patient was not
jaundiced at this stage.
OPERATION: Open cholecystectomy was performed on 21.1.04 via a Kocher's incision. An
operative cholangiogram at this time revealed filling defects with no flow into the duodenum.
Subsequently the common bile duct was explored and multiple stones were removed from the
common bile duct.
Post-operatively Mrs. X suffered some pain at the site of her operative wound. She also had some
transient fevers. This was not thought to be a cholangitis or wound infection.
The patient was discharged home with review in Surgical Outpatients planned.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 131

Summary 2
ADMISSION DATE : 8-4-04

DISCHARGE DATE : 17-4-04

AGE : 27 years

SEX : female

This patient is a 27-year-old hospital worker with recently diagnosed Crohns disease of the ileum.
During this admission, a segmental resection of her terminal ileum was performed, following
colonoscopy. She was also found to have a perianal abscess which was drained. The patient was
discharged eight days post-operatively having suffered no significant complications.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 132

Mortality Coding Exercises for Chapter XI


Exercise 1
Age: 29
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex: Male

(a)Gastrointestinal haemorrhage
due to or as a consequence of

Duration between
onset and death

(b)Cirrhosis of liver..
due to or as a consequence of
(c) Alcoholism ...
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 133

Exercise 2
Age: 49
I
Disease or condition
haemorrhage
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex: Male

(a)Gastrointestinal

Duration between
onset and death

due to or as a consequence of

day

(b).Perforated duodenal ulcer


due to or as a consequence of

years

(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 134

MODULE 18 - ANSWERS
Chapter XI Diseases of the digestive system
1. Adenomatous rectal polyp
Look up polyp in the Index (Volume 3, page 448).
Polyp
-adenomatous (M8210/0) see also Neoplasm benign
Look up Neoplasm in the Index (Volume 3, page 394)
Neoplasm
-rectum -> D12.8
Therefore the correct codes will be D12.8, M8210/0
2. Chronic gastrojejunal ulcer
Look up ulcer in the Index (Volume 3, page 554).
Ulcer
-gastrojejunal
- - chronic -> K28.7
3. Obstructed left inguinal hernia
Look up hernia in the Index (Volume 3page 264).
Hernia
-inguinal
- - unilateral
- - - with
- - - - obstruction-> K40.3
Note that as the hernia is specified as on the left side only, the unilateral code is the appropriate
one.
4. Diverticulitis of jejunum and ileum with perforation
Look up Diverticulitis in the Index (Volume 3, page 188).
Diverticula, diverticulitis
-jejunum (see also Diverticula, small intestine)
Diverticula, diverticulitis
-ileum (see also Diverticula, small intestine)
As both of these modifiers have no mention of perforation we need to look under Diverticula,
small intestine for the modifier for perforation.
Diverticula
-intestine
- - small
- - - with abscess, perforation or peritonitis -> K57.0
5. Postgastrectomy dumping syndrome
Look under Postgastrectomy dumping syndrome in the Index (Volume 3, page 450).
Post gastrectomy dumping syndrome -> K91.1
CBHI ICD 10 Student Workbook January 2008 Page 135

Hospital Discharge Summaries


Summary 1:
Main Condition:

K80.5 Calculus of bile duct without cholangitis or cholecystitis

Other conditions:
Summary 2:
Main Condition:

K50.0 Crohns disease of small intestine

Other Conditions:

K61.0 Anal abscess

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: K70.3 Alcoholic cirrhosis of liver
Which rule applied:

General principle, then rule C linkage (alcoholism links with cirrhosis


of liver, code to alcoholic liver cirrhosis)

Exercise 2:
Underlying cause of death: K26.6 Duodenal ulcer, chronic or unspecified with
Haemorrhage and perforation
Which rule applied:

General principle, then rule D Specificity

CBHI ICD 10 Student Workbook January 2008 Page 136

MODULE 19
Diseases of the Skin and Subcutaneous Tissue

CBHI ICD 10 Student Workbook January 2008 Page 137

Module 19: Diseases of the Skin And Subcutaneous Tissue (Chapter XII)
This chapter covers diseases of the skin and subcutaneous tissue.
Important points for Chapter XII

Categories range from L00 to L99.

72 of the 100 available categories have been allocated.

There are 10 exclusions listed at the start of the chapter.

8 of the exclusions listed are at chapter level, one at block level and at one at code level.

There are 8 blocks.

There are 6 asterisk categories.

This chapter has many exclusions and inclusions, listed at the beginning of many of the blocks
and categories, in addition to those at the start of the chapter. The exclusion notes identify
elements of codes that are classified elsewhere.

The terms dermatitis and eczema are used synonymously and interchangeably.
Contact dermatitis is classified according to whether it is allergic, irritant or unspecified. The
three categories do not have the same fourth character subdivisions, so care must be taken when
assigning codes. Take special note of the exclusions and cross references within these codes.
L55 sunburn is classified according to the depth of skin which is affected:
First degree/erythema - affecting epidermis only
Second degree/partial thickness - affecting both epidermis and dermis causing possible
blistering
Third degree/ full thickness - affecting epidermis, dermis and subcutaneous layers,
usually causing extensive damage.

CBHI ICD 10 Student Workbook January 2008 Page 138

Coding exercises for Chapter XII


1. Trichorrhexis invaginata
2. Drug induced androgenic alopecia
3. Contact dermatitis due to cosmetics
4. Arthropathic psoriasis
5. Perforating granuloma annulare

Sample Hospital Discharge Summaries for Chapter XII


Summary 1
ADMISSION DATE :30-4-04

DISCHARGE DATE : 2-5-04

AGE : 63 years

SEX : female

FINAL DIAGNOSIS:

Basal Cell Carcinoma (BCC) of nose and forehead


Squamous Cell Carcinoma (SCC) lip and forearm
Non Insulin Dependent Diabetes Mellitus (NIDDM)

PROCEDURE:

Excision and biopsy of multiple skin lesions.


Flap graft to nose.

SUMMARY OF ADMISSION: This 63 year old female was admitted after being referred by her
local doctor for removal of skin lesions from her left forearm, nose, forehead and upper lip. She
went to surgery on 1/5/04, following stabilisation of her diabetes. The surgery was unremarkable
with the excision of 3 skin lesions and wide excision of 1 skin lesion from her nose with flap graft.
Biopsies showed SCC of the left forearm and upper lip and BCC from her nose and forehead. The
graft to her nose appeared to have taken well and she was discharged the following day. She will
be followed up in outpatients. Previously diet controlled NIDDM was unstable on admission, and
she was prescribed Diabex 500mg bd. While in hospital she was seen by the diabetic educator on
three occasions for nutritional education and self-monitoring techniques. Booked to attend diabetic
clinic and will continue review of her diabetes with her local doctor.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 139

Summary 2

ADMISSION DATE : 10-01-03

DISCHARGE DATE : 25-02-03

AGE : 34 years

SEX :male

FINAL DIAGNOSIS: Infected foreign body left calf.


PROCEDURE: Incision and drainage of staphylococcal abscess left calf.
Removal of foreign body and excisional debridement of wound 11/01/03
SUMMARY OF ADMISSION: Patient presented to Accident & Emergency department
complaining of pain and swelling in left calf. Patient reported having multiple scratches, splinters
and abrasions of left calf 2 weeks ago following a motor cycle accident while competing in motorcross competition. At the time the patients protective clothing had been torn by a broken branch
after collision with a tree. Multiple splinters were removed at the time and the wound was cleaned
and dressed by the First Aid Officer. The patient now has a large abscess, 4cm x 6cm inflamed
area, to left calf. Patient was admitted for incision and drainage of abscess of calf.
Incision and drainage with removal of 2cm sliver of wood was conducted. Pus++ drained from
wound. Necrosis of surrounding muscle tissue debrided. The wound was left open to heal. A Split
skin graft was subsequently applied from donor site of left hip with good result. Patient discharged
25/02/03 and will be followed up in outpatients department.
EXAMINATION FINDINGS: Histology wound swab left calf showed staphylococcus aureus
infection

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 140

Mortality Coding Exercises for Chapter XII


Exercise 1
Age: 68

Sex: Male

I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Pneumonia.
due to or as a consequence of

Duration between
onset and death

(b)
due to or as a consequence of

(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Cutaneous T-Cell lymphoma


.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.
Selected Underlying Cause of Death:
ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 141

Exercise 2
Age: 56

Sex: Female

I
Disease or condition
directly leading to
death*

(a)Systemic lupus erythematosus


due to or as a consequence of

Duration
between onset
and death

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b)
due to or as a consequence of
(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Alcoholic
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 142

MODULE 19 - ANSWERS
Chapter XII Diseases of the skin and subcutaneous tissue
1. Trichorrhexis invaginata
Look up trichorrhexis in the Index (Volume 3, page 541).
Trichorrhexis (nodosa)(invaginata) ->L67.0
2. Drug induced androgenic alopecia
Look up Alopecia in the Index (Volume 3, page 38).
Alopecia
-androgenic
- - drug induced -> L64.0
A note under L64.0 states to use an external cause code to identify the drug if known. If you know
what drug is causing the alopecia, then you would identify it by using the table of drugs and
chemicals in the Index.
3. Contact dermatitis due to cosmetics
Look up dermatitis in the Index (Volume 3, page 153).
Dermatitis
-contact (see also Dermatitis, due to)
As we know the dermatitis is due to cosmetics, we should follow the instruction and look under
Dermatitis, due to.
Dermatitis
-due to
- - cosmetics (contact) -> L25.0
4. Arthropathic psoriasis
Look up psoriasis in the Index (Volume 3, page 463).
Psoriasis
-arthropathic ->L40.5 M07.3*
5. Perforating granuloma annulare
Look up granuloma in the Index (Volume 3, page 249).
Granuloma
-annulare (perforating) ->L92.0

CBHI ICD 10 Student Workbook January 2008 Page 143

Hospital Discharge Summaries


Summary 1:
Main Condition:

C44.0

Other malignant neoplasm of skin of lip

Other conditions: M8070/3


C44.6
M8070/3
C44.3
M8090/3
E11.9

Squamous cell carcinoma


Other malignant neoplasm of upper limb
Squamous cell carcinoma
Other malignant neoplasm of other and unspecified parts of face
Basal cell carcinoma
Non insulin dependent diabetes mellitus

Summary 2:
Main Condition:

Open wound of other parts of lower leg

S81.8

Other Conditions: T79.3


B95.6
R02
V27.00

Post-traumatic wound infection NEC


Staphylococcus aureus as cause of diseases classified to other
chapters
Gangrene, NEC
Motorcycle rider injured in collision with fixed or stationary
object, driver injured in non traffic accident while engaged in
sports activity

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: C84.5 Other and unspecified T cell lymphoma
Which rule applied:

General principle, then rule 3 selected condition an obvious


consequence of another condition reported elsewhere

Exercise 2:
Underlying cause of death: M32.9 Systemic lupus erythematosus, unspecified
Which rule applied:

General principle

CBHI ICD 10 Student Workbook January 2008 Page 144

MODULE 20
Diseases of the Musculoskeletal System
and Connective Tissue

CBHI ICD 10 Student Workbook January 2008 Page 145

Module 20: Diseases of the Musculoskeletal System & Connective Tissue


(Chapter XIII)
This chapter covers diseases and conditions relating to the spine, joint, muscles and connective
tissue of the body. It also covers deformities acquired after birth.
Important points for Chapter XIII
Categories range from M00 to M99.
79 of the 100 available categories have been allocated.
12 of the categories have asterisk codes.
The Site of Musculoskeletal Involvement is an additional optional subclassification (located at
the beginning of the chapter) provided to indicate the site of involvement of a condition where
this is appropriate. Valid fifth digits are indicated in square brackets [ ] after each code to which
they apply. The use of these optional codes is a matter for decision by each country as they are
not a mandatory part of the codes.
Supplementary classifications for optional use are also given for the following conditions:
M23
Internal derangement of knee
M40-M54
Dorsopathies (except M50 & M51)
M99
Biomechanical lesions NEC.
There are 6 major blocks in this chapter, 4 of which are broken down into smaller blocks
making 15 blocks in total.
M00-M03 begins with a note explaining an important distinction that is made between the
causes (direct or indirect aetiological relationship) of the various disorders. This is the basis of
the classification used for this block.
Read the Note on page 629 of the Tabular list now.
M15-M19 Arthrosis. The term arthrosis is synonymous with osteoarthritis and osteoarthrosis.
M40-M54 Dorsopathies, has a second supplementary subclassification to indicate the site of
involvement. This is set for optional use for all categories in this block, except M50 and M51.

CBHI ICD 10 Student Workbook January 2008 Page 146

Coding exercises for Chapter XIII


1. Rubella arthritis
2. Gout of the big toe
3. Bilateral post-traumatic coxarthrosis
4. Osteolysis
5. Tuberculous arthritis

Sample Hospital Discharge Summaries for Chapter XIII


Summary 1
ADMISSION DATE : 20-3-04

DISCHARGE DATE :21-3-04

AGE : 32 years

SEX : male

This male patient was admitted for investigation of pain in his left knee. He stated the pain had
begun during a soccer game yesterday. He was taken to theatre for an arthroscopy which showed a
bucket handle tear of his left medial meniscus. A meniscectomy was performed without
complication and he was discharged the following day.

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 147

Summary 2
ADMISSION DATE : 28-4-04

DISCHARGE DATE :5-6-04

AGE : 83 years

SEX : female

FINAL DIAGNOSIS:

Osteoarthritis L) knee
Total knee replacement

This elderly woman was admitted for a left total knee replacement. She had severe osteoarthritis
of this joint.
The procedure went well but the post-operative period was problematic. On 14.5.04,
approximately two weeks post procedure, she collapsed. The cause of collapse was uncertain but
thought to be due to orthostatic hypotension. No cause could be identified. She required an ICU
admission for several days. Her recovery from this event was slow but on 5.6.04 she was
discharged to Mount Hospital for rehabilitation.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 148

Mortality Coding Exercises for Chapter XIII


Exercise 1
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Pathological osteoporotic femoral


fracture.
due to or as a consequence of

Duration between
onset and death

1 week
(b)Vision impairment
due to or as a consequence of
(c)General debility; dementia;
Osteoporosis.
due to or as a consequence of

10 years

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Postural hypotension
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 149

Exercise 2
I
Disease or condition
directly leading to
death*

(a)Gangrene left foot due to


peripheral vascular disease (PVD)

Duration between
onset and death
2 weeks

due to or as a consequence of
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(b)
due to or as a consequence of

(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 150

MODULE 20 - ANSWERS
Chapter XIII Diseases of the musculoskeletal system & connective tissue
1. Rubella arthritis
Look up arthritis in the Index (Volume 3, page 59).
Arthritis
-rubella -> B06.8 M01.4*
Refer to M01.4 in the Tabular List (Volume 1, page 630). The note at the beginning of the M01
block directs the coder to pages 628-629 for a site code.
On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision.
The appropriate code would be .9 as no site has been specified. The correct codes for rubella
arthritis site unspecified are B06.8 and M01.49*.
2. Gout of the big toe
Look up gout in the Index (Volume 3, page 249).
Gout, gouty -> M10.9
Refer to M10.9 in the Tabular List (Volume 1 page 634). The note at the beginning of M10
directs the coder to pages 628-629 for a site code.
On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision.
The appropriate code for the big toe would be 7. The correct code for gout of the big toe is
M10.97.
3. Bilateral post-traumatic coxarthrosis
Look up coxarthrosis in the Index (Volume 3, page 120).
Coxarthrosis
-post-traumatic(unilateral)
- - bilateral -> M16.4
4. Osteolysis
Look up osteolysis in the Index (Volume 3, page 419)
Osteolysis -> M89.5
Refer to M89.5 in the Tabular List (Volume 1 page 671) a note at the beginning of M89 directs
the coder to pages 628-629 for a site code.
On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision.
The appropriate code for this condition would be unspecified as no site has been given in our
diagnosis. Therefore the code for osteolysis, unspecified is M89.59.
5. Tuberculous arthritis
Look up arthritis in the Index (Volume 3, page 59).
Arthritis
-tuberculous -> A18.0 M01.1*

CBHI ICD 10 Student Workbook January 2008 Page 151

Refer to M01.1 in the Tabular List (Volume 1 page 630) a note at the beginning of M01 directs
the coder to pages 628-629 for a site code.
On pages 628-629 is a list of body sites that you can use to choose a fifth character subdivision.
The appropriate code would be .9 as no site has been specified. The correct codes for
tuberculous arthritis site unspecified are A18.0 and M01.19*.
Hospital Discharge Summaries
Summary 1:
Main Condition:

S83.2

Tear of meniscus, current

Other conditions:

X59.90

Exposure to unspecified factor, unspecified place of


occurrence, while engaged in sports activity

Summary 2:
Main Condition:

M17.9

Gonarthosis, unspecified

Other Conditions:

I95.1

Orthostatic hypotension

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: M80.95 Unspecified osteoporosis with pathological fracture
Which rule applied:

Rule 1, sequence terminating in first mentioned Condition, then rule D


specificity

Exercise 2:
Underlying cause of death: I73.9 Peripheral vascular disease, unspecified
Which rule applied:

Rule 1, sequence terminating in condition first mentioned

CBHI ICD 10 Student Workbook January 2008 Page 152

MODULE 21
Diseases of the Genitourinary System

CBHI ICD 10 Student Workbook January 2008 Page 153

Module 21: Diseases of the Genitourinary System (Chapter XIV)


This chapter comprises the urinary system and the male and female reproductive systems.
Important points for Chapter XIV
Categories range from N00 to N99.
82 of the 100 available categories have been allocated.
9 of the categories have asterisk codes.
Chapter XVI has 8 exclusions listed at chapter level.
There are 11 blocks.
N00-N08 Glomerular disease The three character categories relate to clinical syndromes (e.g.
chronic nephrotic syndrome) and the fourth characters allow the coding of morphological
changes (e.g. focal and segmental glomerular lesions).
An additional code from N17-N19 Renal Failure may be used with a code from another
chapter, if desired, to identify the presence of renal failure.
N70-N77 Inflammatory disease of female pelvic organs consists of eight categories organised
to follow the structure of the female reproductive system, starting with the ovary and fallopian
tube.
Dysplasia of the cervix, vagina and vulva are classified by severity in categories N87, N89 and
N90
Note that CINI, VINI and VAINI are equivalent to mild dysplasia
CINII, VINII and VAINII are the same as moderate dysplasia
CINIII, VINIII, VAINIII are equivalent to severe dysplasia or carcinoma in situ

CBHI ICD 10 Student Workbook January 2008 Page 154

Coding exercises for Chapter XIV


1. Renal tubulo-interstitial disorder due to brucellosis
2. Acute diffuse membranous glomerulonephritis
3. Acute cystitis with urolithiasis
4. Incomplete uterovaginal prolapse
5. Glomerulitis in diabetes mellitus

Sample Hospital Discharge Summaries for Chapter XIV


Summary 1
ADMISSION DATE : 15-9-03

DISCHARGE DATE : 22-9-03

AGE : 62 years

SEX : female

FINAL DIAGNOSIS: Chronic cystitis


PRESENTATION:
This 62 year old lady, who is an insulin dependent diabetic, has a history of on-going cystitis.
This manifests itself mainly with frequency and discomfort in the retropubic region. On several
occasions in the past, gram negative organisms have been cultured from her urine.
Despite treatment with sensitive oral antibiotics, she has had no reduction in symptoms. A
previous seven day course of intravenous Gentamyacin was successful in clearing her of her
problem for a lengthy period.
MANAGEMENT:
It was therefore elected to admit her for seven days for intravenous antibiotic treatment. This was
carried out between 15.9.03 - 22.9.03 with intravenous Gentamyacin at a dose of 120 mgs each 24
hours.
At discharge the patient felt that there may have been some improvement of her bladder symptoms
although this was slight. She was discharged on antibiotics twice a day for seven days until review
by her urologist.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 155

Summary 2
ADMISSION DATE : 11-9-03

DISCHARGE DATE : 16-9-03

AGE : 89 years

SEX : male

FINAL DIAGNOSIS: Proteus UTI


PRESENTATION:
This patient was admitted via Urology Outpatients Clinic for investigation of a recent onset of
urinary incontinence and haematuria.
EXAMINATION:
This 89-year-old man had a six-month history of a poor stream with dribbling ++. He had night
time and day time incontinence. He had one episode of frank haematuria three months prior and a
further episode just prior to his admission.
MANAGEMENT:
On admission a urine specimen was collected which showed a heavy growth of Proteus mirabilis.
He was treated with intravenous Gentamicin in hospital and discharged on Augmentin.

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 156

Mortality Coding Exercises for Chapter XIV


Exercise 1
Age: 62

Sex: Female

I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Uraemia.
due to or as a consequence of

Duration between
onset and death
2 days

(b)Acute on chronic renal failure..


due to or as a consequence of
1 week
(c)Klebsiella UTI/anaemia.
due to or as a consequence of
1 week
(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory failure.
It means the disease, injury or complication that caused death.
Selected Underlying Cause of Death:
ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 157

Exercise 2
Age: 59

Sex: Female

I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Acute renal failure, Chronic renal..


failure
due to or as a consequence of

Duration between
onset and death
Month

(b)cardiogenic shock..
due to or as a consequence of

Week

(c)sepsis..
due to or as a consequence of

3 Weeks

(d)UTI.

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory failure.
It means the disease, injury or complication that caused death.
Selected Underlying Cause of Death:
ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 158

MODULE 21 - ANSWERS
Chapter XIV Diseases of the genitourinary system
1. Renal tubulo-interstitial disorder due to brucellosis
Look up disorder in the Index (Volume 3, page 183).
Disorder
-tubulo-interstitial(in)
- - brucellosis -> A23._ N16.0*
Refer to pages 119 and 120 of Volume 1 to find the correct code in the A23 category for
brucellosis. The .- means a further digit is required to complete the code. As the brucellosis is
unspecified then the correct should be A23.9.
2. Acute diffuse membranous glomerulonephritis
Look up glomerulonephritis in the Index (Volume 3, page 247).
Glomerulonephritis
-membranous(diffuse)NEC code to N00-N07 with a fourth character of .2
Refer to pages 681-682 to determine which is the correct code to use from the range N00-N07.
We are looking for a code that includes acute glomerulonephritis. The code we are looking for is
N00 Acute nephrotic syndrome - which includes acute glomerulonephritis. The Index has already
indicated that the fourth character should be a .2. Therefore our code is N00.2.
3. Acute cystitis with urolithiasis
Look up cystitis in the Index (Volume 3, page 129).
Cystitis
-acute -> N30.0
If we refer to page 693, at the beginning of the block there is an exclusion note stating if the
conditions in this block occur with urolithiasis then the coder should refer to the block N20-N23.
If we check this section we note that the correct code is N20.9 as no site of calculus is given.
4. Incomplete uterovaginal prolapse
Look up prolapse in the Index (Volume 3, page 460).
Prolapse
-uterovaginal
- - incomplete -> N81.2
5. Glomerulitis in diabetes mellitus
Look up glomerulitis in the Index (Volume 3, page 246).
Glomerulitis (see also Glomerulonephritis) N05._
As there is no modifier for "in diabetes mellitus" we should look up glomerulonephritis in the
Index (Volume 3, page 246).
Glomerulonephritis
-in(due to)
- - diabetes mellitus (see also E10-E14 with fourth character of .2) -> E14.2 N08.3*
CBHI ICD 10 Student Workbook January 2008 Page 159

As the diabetes is unspecified we can use the codes that the Index has indicated are appropriate
for this condition.

Hospital Discharge Summaries


Summary 1:
Main Condition:

N30.2 Other chronic cystitis

Other conditions:

E10.9 Insulin dependent diabetes mellitus

Summary 2:
Main Condition:

N39.0 Urinary tract infection, site not specified

Other Conditions:

B96.4 Proteus mirabilis as cause of disease classified to other Chapters

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: N39.0 Urinary tract infection, site not specified
Which rule applied:

Rule 1, more than one sequence terminating in first


reported condition first sequence used to select
underlying cause

Exercise 2:
Underlying cause of death: N39.0 Urinary tract infection, site not specified
Which rule applied:

General principle

CBHI ICD 10 Student Workbook January 2008 Page 160

MODULE 22
Pregnancy, Childbirth and the Puerperium

CBHI ICD 10 Student Workbook January 2008 Page 161

MODULE 22: Pregnancy, Childbirth and the Puerperium (Chapter XV)


This chapter covers disorders and complications that arise during pregnancy, childbirth and the
puerperium.
Important points for Chapter XV

Coders should be very careful in distinguishing the letter O from the number 0 in this
chapter.

Categories range from O00 to O99.


75 of the 100 available categories have been allocated.
The chapter starts with a list of 8 exclusions.
There are 8 blocks.
The first 3 blocks are mostly concerned with pregnancy.
Inclusion and exclusions are found at the beginning of each block or category.
Throughout this chapter there are quite a few notes, some of which refer you to either morbidity
or mortality guidelines in Volume 2. Make sure you read these before you assign a code from
this chapter.
O00-O08 Pregnancy with abortive outcome, covers all abortions, but excludes continuing
pregnancy in multiple gestation after abortion of one fetus or more. Complications related to
abortions are specified by fourth character subdivisions. Category O08 also has a note to
indicate that this category is primarily for morbidity coding.
O20-O29 Other maternal disorders predominantly related to pregnancy, contains many varied
conditions associated with pregnancy, e.g.:
O20 Haemorrhage in early pregnancy
O21 Excessive vomiting in pregnancy
O22 Venous complication in pregnancy
O60-O75 Complications of Labour and delivery is structured to follow the progress of labour.
O80-O84 Delivery, is a block which allows for single deliveries to be classified at the three
character level. The codes are primarily for morbidity purposes. Guidelines are provided in
Volume 2 and should be referred to before assigning codes from this block.
Read the notes on page 121 of Volume 2 which indicate how to select Main Condition for
obstetric cases.
O85-O92 covers the puerperium and includes problems with lactation.
O95-O99 includes maternal health.
There are time limits associated with O96 Death from any obstetric cause occurring more than
42 days but less than 1 year after delivery, and O97 Death from sequelae of direct obstetric
cause (one year or more).

Coders should refer to pages 1235-1238 of Volume 1 for definitions related to obstetric deaths
prior to beginning coding.

CBHI ICD 10 Student Workbook January 2008 Page 162

Coding exercises for Chapter XV


1. Spontaneous abortion

2. Live twin delivery

3. Cardiomyopathy in the puerperium

4. Fetal distress affecting labour and delivery

5. Premature separation of the placenta

CBHI ICD 10 Student Workbook January 2008 Page 163

Sample Hospital Discharge Summaries for Chapter XV


Summary 1
ADMISSION DATE : 13-11-03

DISCHARGE DATE : 19-11-03

AGE : 27 years

SEX : female

This 27-year-old primigravida was admitted at full term. Her delivery was complicated by placenta
praevia which, fortunately, had not caused a haemorrhage. Because of this, an emergency classical
caesarean section was performed. A single healthy female infant weighing 3980 grams was
delivered.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

Summary 2
ADMISSION DATE : 16-11-03

DISCHARGE DATE : 20-11-03

AGE : 31 years

SEX : female

An artificial rupture of membranes was performed on this lady at 39 weeks gestation, because of
pregnancy-induced hypertension. Labour was obstructed due to shoulder presentation of the fetus.
Neville Barnes forceps with episiotomy were used to help delivery of a live male infant. Manual
removal of a retained placenta was performed. Mother and baby were discharged well.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 164

Mortality Coding Exercises for Chapter XV


Exercise 1
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Massive Haemorrhage
due to or as a consequence of

Duration between
onset and death
3 hours

(b)Placenta praevia
due to or as a consequence of
(c)
due to or as a consequence of

3 hours

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Gestational Diabetes
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 165

Exercise 2
I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

(a)Pelvic trauma..
due to or as a consequence of

Duration between
onset and death
2 hours

(b)Obstructed delivery
due to or as a consequence of

(c)Breech presentation.
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Home birth
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 166

MODULE 22 - ANSWERS
Chapter XV Pregnancy, childbirth and the puerperium
1. Spontaneous abortion
Look up abortion in the Index, (Volume 3, page 16).
Abortion
-spontaneous -> O03._
Refer to page 724 of volume 1 for the fourth character subdivision. The list of fourth character
subdivisions is listed above the O03 category as indicated in the note for O03. As the abortion is
unspecified with no mention of complications, the fourth character code will be .9. Therefore the
correct code will be O03.9.
2. Live twin delivery
Don't forget that you are coding the mother's record here. Look up delivery in the Index (Volume
3, page 148).
Delivery
-multiple -> O84.9
As there is no index entry to indicate twins, we have to think of another word to describe twins.
Therefore we look for multiple delivery.
3. Cardiomyopathy in the puerperium
The puerperium is also known as the postpartum period.
Look up cardiomyopathy in the Index (Volume 3, page 90).
Cardiomyopathy
-postpartum -> O90.3
4. Fetal distress affecting labour and delivery
Look up distress in the Index (Volume 3, page 186).
Distress
-fetal(syndrome)
- - affecting
- - - labour and delivery -> O68._
Refer to page 748 of Volume 1 to determine which code from the O68 category is appropriate
for this patient. As the type of fetal distress is not specified, the code O68.9 should be used.
5. Premature separation of the placenta
Look up separation in the Index (Volume 3, page 492).
Separation
-placenta(normally implanted)(premature)(see also Abruptio placentae) --> O45.9
As we do not have further details to code, we can accept this code and do not have to refer to
Abruptio placentae as the Index suggests.

CBHI ICD 10 Student Workbook January 2008 Page 167

Hospital Discharge Summaries


Summary 1:
Main Condition:

O82.1

Delivery by emergency caesarean section

Other conditions:

O44.0

Placenta praevia specified as without haemorrhage


Z37.0 Single live birth

Summary 2:
Main Condition:

O13

Other Conditions:

O64.4
O81.0
O73.0
Z37.0

Gestational (Pregnancy induced) hypertension without significant


proteinuria
Obstructed labour due to shoulder presentation
Low forceps delivery
Retained placenta without haemorrhage
Single live birth

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: O44.1 Placenta praevia with haemorrhage
Which rule applied:

General principle, then rule C Linkage

Exercise 2:
Underlying cause of death: O64.1 Obstructed labour due to breech presentation
Which rule applied:

General principle and table on page 66 of volume 2

CBHI ICD 10 Student Workbook January 2008 Page 168

MODULE 23
Certain Conditions Originating in the Perinatal Period

CBHI ICD 10 Student Workbook January 2008 Page 169

Module 23: Certain Conditions Originating in the Perinatal Period (Chapter


XVI)
This chapter is concerned with conditions affecting the fetus and the newborn baby, originating in
the perinatal period.
Important points for Chapter XVI
Categories range from P00 to P96.
Of the 100 available categories 59 have been allocated.
There is one inclusion at the beginning of this chapter, and 5 exclusions.
For disorders related to length of gestation and foetal growth, birth weight takes priority over
gestational age as evidence of maturity of the baby. This is because birth weight is a more
objective measure than gestational age, which might be miscalculated. For example, P07
Disorders related to short gestation and low birth weight, not elsewhere classified, has a note at
the beginning of the category to give guidance on the assignment of this code if both birth
weight and gestational age are specified.
P10-P15 birth trauma is classified to six categories which are arranged according to the
physical effect of the injury, e.g. P10.2 Intraventricular haemorrhage due to birth injury.
P35-P39 Infections specific to the perinatal period, includes only congenital infections and
parasitic disease and those infections acquired in utero or which are present at birth. There are
some exceptions to this and these are clearly noted in the appropriate category.
Coders should refer to pages 1235-1238 of Volume 1 for definitions related to perinatal deaths
prior to beginning coding.

CBHI ICD 10 Student Workbook January 2008 Page 170

Coding exercises for Chapter XVI


(Remember it is the baby's record you are coding in these exercises)
1. Low birth weight - baby weighed 900g

2. Fetal death

3. Congenital hydrocele

4. Feeding problems of newborn

5. Birth injury to spine

CBHI ICD 10 Student Workbook January 2008 Page 171

Sample Hospital Discharge Summaries for Chapter XVI


Summary 1
ADMISSION DATE : 15-8-03

DISCHARGE DATE : 28-8-03

AGE at discharge : 18 days

SEX : male

This baby was born on 28-7-03 at 34 weeks gestation. His birthweight was 2150 grams and birth
head circumference was 31cm. His weight had dropped to 1990g in the week following delivery.
His blood group was A positive. He had been a cephalic occipito-anterior (OA) presentation
delivered by urgent caesarean section because of fetal distress.
DIAGNOSES:
prematurity
jaundice non-haemolytic requiring phototherapy for 72 hours
Dx

ICD-10 Code

Main Condition:
Other Conditions:

Summary 2
ADMISSION DATE : 8-4-04

DISCHARGE DATE : 3-7-04

AGE at discharge : 86 days

SEX : female

This 3400 gram female infant was admitted to Special Care Nursery after being delivered at term
by forceps delivery. The baby had suffered meconium aspiration during stage 1 of labour. The
cord was prolapsed. The baby also had atelectasis of the left lung and was mildly distressed on
admission.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 172

Mortality Coding Exercises for Chapter XVI


Exercise 1
Age: 30 mins
I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex: Male

(a)Asphyxia
due to or as a consequence of

Duration between
onset and death

(b)Umbilical cord around neck


due to or as a consequence of

(c) Birth
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Chorioamnionitis
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 173

Exercise 2
Age : 3 hours
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex : Female

(a)Pulmonary haemorrhage
due to or as a consequence of

Duration between
onset and death
1 hour

(b).
due to or as a consequence of
(c) .
due to or as a consequence of
(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Meconium aspiration
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 174

Chapter XVI Certain conditions originating in the perinatal period


1. Low birth weight - baby weighed 900 grams
Look up low in the Index (Volume 3, page 338).
Low
-birthweight
- - extreme (999 grams or less) -> P07.0
2. Fetal death
Look up death in the Index (Volume 3, page 132).
Death
-fetus, fetal(cause not stated)(intrauterine) -> P95
This is a really poor diagnosis - you should try to get more information about why the baby died.
3. Congenital hydrocele
Look up hydrocele in the Index (Volume 3, page 271).
Hydrocele
-congenital -> P83.5
4. Feeding problems of newborn
Look up feeding in the Index (Volume 3, page 222).
Feeding
-problem
- - newborn -> P92.9
5. Birth injury to spine
Look up injury in the Index (Volume 3, page 304).
Injury
-birth(see also Birth injury) P15.9
As we have an injury of the spine specified we should look for a more specific code. Therefore we
can look up Birth injury in the Index, page 72.
Birth
-injury
- - spine -> P11.5

CBHI ICD 10 Student Workbook January 2008 Page 175

Hospital Discharge Summaries


Summary 1:
Main Condition:

P07.1 Other low birth weight

Other conditions:

P59.0 Neonatal jaundice associated with preterm delivery

Summary 2:
Main Condition:

P24.0 Neonatal aspiration of meconium

Other Conditions:

P02.4 Fetus and newborn affected by prolapsed cord


P28.1 Other and unspecified atelectasis of newborn

Mortality Coding Exercises


Exercise 1:
Underlying cause of death: P02.5 Fetus and newborn affected by other
compression of umbilical cord
Which rule applied:

Rule 1 - sequence terminating in the condition first


entered on death certificate (cord around neck
causing asphyxia)

Exercise 2:
Underlying cause of death: P26.9 Unspecified pulmonary haemorrhage
originating in perinatal period
Which rule applied:

General principle

CBHI ICD 10 Student Workbook January 2008 Page 176

MODULE 24
Congenital Malformations, Deformations and Chromosomal Abnormalities

CBHI ICD 10 Student Workbook January 2008 Page 177

MODULE 24: Congenital Malformations, Deformations and Chromosomal


Abnormalities (Chapter XVII)
This chapter covers congenital malformations, deformations and chromosomal anomalies.
Important points for Chapter XVII
Categories range from Q00 to Q99.
87 of the available 100 categories have been allocated.
No asterisk categories are found in this chapter.

CBHI ICD 10 Student Workbook January 2008 Page 178

Coding exercises for Chapter XVII


1. Patent ductus arteriosus

2. Cervical spina bifida with hydrocephalus

3. Von Recklinghausen's disease

4. Pentalogy of Fallot

5. Laryngocele

Sample Hospital Discharge Summaries for Chapter XVII


Summary 1
ADMISSION DATE : 18-8-03

DISCHARGE DATE : 18-8-03

AGE : 3 years

SEX: male

This 3-year-old boy was admitted with pain in the left upper arm. He had been diagnosed with
osteogenesis imperfecta at birth. He had suffered multiple fractures since. An X-ray of his upper
arm revealed a pathological fracture of the shaft of his left humerus. An open reduction with
internal fixation was performed in theatre.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 179

Summary 2

ADMISSION DATE : 4-7-04

DISCHARGE DATE : 16-7-04

AGE : 3 months

SEX : male

DIAGNOSIS: Ventricular Septal Defect


Relevant History: Breathless at times, especially during feeding, failure to thrive, and a heart
murmur.
Relevant Clinical Evidence:
hepatomegaly.

Alert child. Pansystolic murmur at left sternal edge.

No

Relevant Investigations And Results:


Cardiac catheter/coronary angiogram revealed a large perimembranous ventricular septal defect.
Chest x-ray showed cardiomegaly.
Treatment In Hospital: A tissue patch closure of ventricular septal defect was performed under
GA with cardiopulmonary bypass.
The post-operative period was uncomplicated and the patient was discharged home to his parents.

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 180

Mortality Coding Exercises for Chapter XVII


Exercise 1
Age: 1 day
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex : M

(a) Aortic and mitral valve atresia


due to or as a consequence of

Duration between
onset and death
1 day

(b)Congenital malformation..
due to or as a consequence of
(c)..
due to or as a consequence of

1 day..

(d).
II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

. Prematurity (32/40)
.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.
Selected Underlying Cause of Death:
ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 181

Exercise 2
Age: 5 minutes
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex : M

(a) Anencephaly
due to or as a consequence of

Duration between
onset and death
1 day

(b)Birth defect..
due to or as a consequence of
(c)..
due to or as a consequence of
(d)..

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

..
...

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 182

MODULE 24 - ANSWERS
Chapter XVII Congenital malformations, deformations and chromosomal abnormalities
1. Patent ductus arteriosus
Look up patent in the Index (Volume 3, page 431).
Patent
- ductus arteriosus or botalli -> Q25.0
2. Cervical spina bifida with hydrocephalus
Look up spina bifida in the Index (Volume 3, page 503).
Spina bifida
- cervical
- - with hydrocephalus -> Q05.0
3. Von Recklinghausen's disease
Look up Von Recklinghausen's in the Index (Volume 3, page 563).
Von Recklinghausen's
- disease (neurofibromatosis) -> Q85.0
4. Pentalogy of Fallot
Look up Pentalogy of Fallot in the Index (Volume 3, page 432).
Pentalogy of Fallot -> Q21.8
5. Laryngocele
Look up laryngocele in the Index (Volume 3, page 330).
Laryngocele (congenital)(ventricular) -> Q31.3
Hospital Discharge Summaries
Summary 1:
Main Condition:

Q78.0

Osteogenesis imperfecta

Other conditions:

M84.42

Pathological fracture NEC, upper arm

Summary 2:
Main Condition:

Q21.0

Ventricular septal defect

Other Conditions:
Mortality Coding Exercises
Exercise 1:
Underlying cause of death: Q23.0 Congenital stenosis of aortic valve
Which rule applied:

General principle, then rule 3 (selected condition an obvious


consequence of another reported condition), then rule 2 (first
mentioned condition)

Exercise 2:
Underlying cause of death: Q00.0 Anencephaly
Which rule applied:

General principle, then rule D Specificity


CBHI ICD 10 Student Workbook January 2008 Page 183

MODULE 25
Symptoms, Signs and Abnormal Clinical and Laboratory Findings,
Not Elsewhere Classified

CBHI ICD 10 Student Workbook January 2008 Page 184

Module 25: Symptoms, Signs And Abnormal Clinical & Laboratory Findings,
Not Elsewhere Classified (Chapter XVIII)
This chapter covers:

symptoms

signs

abnormal results of clinical or other investigative procedures


and

ill defined conditions regarding which no diagnosis classifiable elsewhere is recorded

Important points for Chapter XVIII


Categories range from R00 to R99
90 of the available 100 categories have been allocated
A group has been created for symptoms involving cognition perception, emotional state and
behaviour at R40 -R46 and speech and voice at R47-R49
Blocks are listed after 2 exclusions for the chapter
Any exclusions from a block or category are given and the category or subcategory to which the
exclusion belongs is always specified.
There are no asterisk categories in this chapter
The Alphabetical Index (Volume 2) should always be used to clarify which signs and
symptoms are to be assigned to chapter XVIII and which to other chapters.
R10 Abdominal and pelvic pain is subdivided according to the site of the pain, e.g. Pain
localised to the upper abdomen.
R47-R49 classifies symptoms and signs involving speech and voice, and conditions such as
speech disturbance not elsewhere classified, and voice disturbance.
R70-R94 deals with abnormal findings. These codes are to be used when no clear diagnosis has
been given and a person is having follow-up of an examination indicating abnormal findings.
R95-R99 Ill-defined and unknown causes of mortality, as the titles suggest, are to be used for
mortality coding. They are only to be used if no other specific code can be assigned.

CBHI ICD 10 Student Workbook January 2008 Page 185

Coding exercises for Chapter XVIII


1. Pyrexia of unknown origin

2. False-positive Wassermann reaction for syphilis

3. Hyperglycaemia

4. Petechiae

5. Hallucinations (visual)

CBHI ICD 10 Student Workbook January 2008 Page 186

Sample Hospital Discharge Summaries for Chapter XVIII


Summary 1
ADMISSION DATE : 26-12-03

DISCHARGE DATE : 28-12-03

AGE : 65 years

SEX : male

FINAL DIAGNOSIS:

Chest pain

SUMMARY OF ADMISSION:
This 65 year old aged pensioner was admitted to hospital with a prolonged episode of central chest
pain. At the time of admission this had been present for eleven hours without any significant
electrocardiographic change or cardiac enzyme rise. The pain had begun whilst he was having a
glass of beer in the afternoon, although there were no gastrointestinal features. The pain was
described as a central heaviness which radiated to the right hand. It was atypical in nature with
pleuritic and positional elements and also exacerbation with posture and use of the arms. There
was no associated sweating, nausea or presyncope. There had been one episode of similar chest
pain six years previously. There was no ongoing exertional chest pain or dyspnoea however.
EXAMINATION FINDINGS:
There was a sinus tachycardia of 110/min and blood pressure of 150/100. Pulses were symmetric
and blood pressure equal in both upper arms. Heart sounds were dual, chest was clear, carotids
were decreased in volume, but there were no associated bruits. Femoral pulses were also
decreased in volume. There were well maintained peripheral pulses. Abdomen was soft to
examine. There was marked chest wall tenderness which reproduced some of the pain.
INVESTIGATIONS:
ECG and chest x-ray were normal. Full Blood Count and Cardiac enzymes were normal. BSL
was normal.
ASSESSMENT & MANAGEMENT:
The impression of the pain was that it was atypical in nature and related to the chest wall. There
were no obvious rib fractures on x-ray. Thyroid function was also checked and found to be normal.
Serial ECGs and cardiac enzymes failed to demonstrate evidence of myocardial infarction.
The patient is to attend follow up with his local medical officer

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 187

Summary 2
ADMISSION DATE : 20-1-04

DISCHARGE DATE : 21-1-04

AGE : 49 years

SEX

female

FINAL DIAGNOSIS: Epigastric pain


HISTORY: This 49-year-old woman admitted for investigation. She had a two-day history of
epigastric pains associated with nausea and sweating.
EXAMINATION: Examination on admission was unremarkable and the patient was not
jaundiced at this stage.
OPERATION: Ultrasound revealed no abnormality and the pain eased
The patient was discharged home with review in Surgical Outpatients planned.

Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 188

Mortality Coding Exercises for Chapter XVIII


Exercise 1
Age: 91

I
Disease or condition
directly leading to
death*

Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex: F

(a)Natural causes
due to or as a consequence of

Approximate
Duration between
onset and death

(b)
due to or as a consequence of

(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 189

Exercise 2
Age: 77
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex: Male

(a) Old age


due to or as a consequence of

Duration
between onset
and death

(b)Frailty
due to or as a consequence of
(c) Debility
due to or as a consequence of

(d)..

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 190

MODULE 25 - ANSWERS
Chapter XVIII Symptoms, signs and abnormal clinical & laboratory findings, not elsewhere
classified
1. Pyrexia of unknown origin
Look up pyrexia in the Index (Volume 3, page 469).
Pyrexia (of unknown origin) -> R50.9
Note that there are more specific codes shown in the Index and as Exclusion notes in the Tabular
list for pyrexia occurring in conjunction with different conditions, but our diagnosis is pyrexia of
unknown origin.
2. False-positive Wassermann reaction for syphilis
Look up false in the Index (Volume 3, page 221).
False
- positive serological test for syphilis (Wassermann reaction) -> R76.2
3. Hyperglycaemia
Look up hyperglycemia in the Index (Volume 3, page 274).
Hyperglycemia, hyperglycemic -> R73.9
Again, note that there are more specific codes to use if you know the cause of the hyperglycemia.
4. Petechiae
Look up Petechiae in the Index (Volume 3, page 437).
Petechia, petechiae -> R23.3
If the petechiae had been occurring in a newborn baby, we would use code P54.5 from the
Perinatal Conditions chapter.
5. Hallucinations (visual)
Look up hallucinations in the Index (Volume 3, page 252).
Hallucinations
- visual -> R44.1
There are individual codes for the differing types of hallucinations - visual, auditory and other
hallucinations.

CBHI ICD 10 Student Workbook January 2008 Page 191

Hospital Discharge Summaries


Summary 1:
Main Condition:

R07.4

Chest pain unspecified

R10.1

Pain localised to upper abdomen

R99

Other ill-defined and unspecified causes of mortality

Other conditions:
Summary 2:
Main Condition:
Other Conditions:

Mortality Coding Exercises


Exercise 1:
Underlying cause of death:
Which rule applied:
Exercise 2:
Underlying cause of death:
Which rule applied:

General principle

R54

Senility

Rule 2 no reported sequence, so select first mentioned condition.


Note Rule A Senility does not apply because all reported conditions
are coded to chapter XVIII.

CBHI ICD 10 Student Workbook January 2008 Page 192

MODULE 26
Injury, Poisoning and Certain Other Consequences of External Causes
&
External Causes of Morbidity and Mortality

CBHI ICD 10 Student Workbook January 2008 Page 193

Module 26: Injury, Poisoning And Certain Other Consequences Of External


Causes (Chapter Xix) & External Causes Of Morbidity And
Mortality (Chapter XX)
These two chapters cover injury, poisoning and certain other consequences of external causes and
the classification of environmental events and circumstances as the cause of injury, poisoning and
other adverse effects.
The external cause concept
The use of Chapter XX codes permits the classification of environmental events, circumstances
and conditions as the cause of injury, poisoning and other adverse effects. The use of Chapter
XX codes along with Chapter XIX codes provides additional information of particular concern
to industrial medicine, national safety programs and national health agencies. Injury prevention
programs are often based on the information coded to this Chapter.
When multiple coding, a Chapter XX code should always be assigned with a Chapter XIX
code. That is, a code describing how the injury(s) occurred as well as the injury code(s) will be
assigned.
When coding underlying cause of death, the code for the external cause takes priority. Conversely,
when coding morbidity records, the main condition will be the nature of the most severe injury.
Important points for Chapter XIX
Categories range from S00 to T98.
Of the 199 available categories 195 have been allocated.
There are 21 blocks.
Blocks S00-S99, at the three-character level are classified by site of injury, e.g. head, arms.
The fourth character level indicates the type of injury that occurred, e.g. fracture, open wound.
Codes in the range T00-T98 are used to code all other trauma, e.g. burns, complications of
surgery, poisonings.
When multiple coding, all injuries should be coded, avoid the use of 'multiple' type codes.
Multiple codes are useful for single condition coding. eg T06.- can be used to code fractures of
multiple regions of upper limb(s) in association with lower limb(s).
Important points for Chapter XX
Four letters of the alphabet - V,W,X.and Y - have been assigned to this chapter, making it the
largest in ICD-10.
Categories range from V01 to Y98.
Of the 400 available categories 372 have been used.
8 major blocks

CBHI ICD 10 Student Workbook January 2008 Page 194

The Chapter includes Place of occurrence codes, which are fourth character subdivisions used
to identify the place where an injury occurred. They are to be used with categories W00 - Y34
(except Y06 and Y07).
.0
.1
.2
.3
.4
.5
.6
.7
.8
.9

Home
Residential institution
School, other institution, public administrative area
Sports and athletics area
Street and highway
Trade and Service area
Industrial and construction area
Farm
Other specified places
Unspecified place
See pages 1013 - 1017 of Volume 1 for the detailed breakdown of Place of Occurrence
codes.

An Activity code is also provided for optional use in a supplementary character position with
categories V01-Y34 to indicate the activity the injured person was involved in at the time of the
injury. This code should not be confused with, or be used instead of, the place of occurrence
code.
0
1
2
3
4
8
9

while engaged in sports activity


while engaged in leisure activity
while working for income
while engaged in other types of work
while resting, sleeping, eating or engaging in other vital activities
while engaged in other specified activities
while engaged in unspecified activities
The codes can be found on pages 1018-1019 of Volume 1. Note that if an activity falls into
more than one of the categories, select the code that is higher on the list (i.e. the lower
number).

Chapter XX codes can also be assigned with codes from Chapter I-XVII to identify the external
cause of a condition, e.g. dermatitis due to solvents.
Chapter XX codes are never assigned as the main condition code for morbidity coding. For
mortality coding the Chapter XX code is the code assigned for the underlying cause of death.
V01-V79 Motor vehicle transport accidents, are classified at the three character level by the
mode of transport of the injured person and at the fourth character level according to the
position of the person in the motor vehicle.
Read the notes and definitions on pages 1018-1025 of the Tabular List. These notes refer to
the classification of transport accidents and need to be understood before assigning codes
from Chapter XX. The table on page 576 of Volume 3 is useful as a guide to finding the
correct code for transport accidents.
X60-X80 Intentional self harm, are incidents determined as being suicide or self-inflicted
injuries.
CBHI ICD 10 Student Workbook January 2008 Page 195

The Table of Drugs and Chemicals, found at the back of the Alphabetical Index, guides the
coder to the correct codes to describe poisonings by drugs and chemicals. To use the Table, first
of all look up the name of the drug in the alphabetical list. The first column indicates the nature
of injury code from Chapter XIX that is appropriate for the specific drug. Check the Tabular list
to confirm this code selection. The other four columns in the Table give the External Cause
codes to describe the circumstances of the poisoning e.g. accidental, intentional self-harm,
undetermined intent and adverse effect in therapeutic use. Select the appropriate code and
confirm it in the Tabular list. Add the Place of Occurrence and/or Activity codes as required.
Y10-Y34 Event of undetermined intent, includes occurrences where it is not clear whether the
person was accidentally injured or the injury was purposely inflicted.
Terms to be aware of when searching the index for the external cause are exposure and
contact if the person comes in contact with an object or instrument; or is exposed to an
element.

CBHI ICD 10 Student Workbook January 2008 Page 196

Coding exercises for Chapters XIX and XX


1. Multiple lacerations to abdomen, inflicted by a knife during a fight in a bar. The victim was
a bar attendant working in the bar at the time.
2. Cerebral contusion due to fall from bed onto floor, whilst sleeping, at home.
3. Adverse reaction to anaesthetic given prior to surgical operation
4. The final diagnosis for this 24-year motor cycle rider who was involved in a collision with a
car was a closed fracture mid shaft right femur, compound fracture mid shaft right tibia.
5. Second degree burn to leg sustained from uncontrolled house fire.

Sample Hospital Discharge Summaries for Chapter XIX and XX


Summary 1
ADMISSION DATE : 24-4-03

DISCHARGE DATE : 23-5-03

AGE : 24 years

SEX : male

FINAL DIAGNOSIS: trail bike accident


Mr X. had been riding his trail bike on a country track when he lost control and the bike went
down a 10 metre embankment. Mr X. sustained an open fracture of the left tibia and fibula and a
dislocation of the right ankle.
On admission the patient was taken to theatre where the ankle dislocation was reduced and the
fracture site underwent debridement and lavage. A fracture reduction was performed on day five
with fixation using two nails. Unfortunately the wound became infected and grew pseudomonas.
He was managed on oral antibiotic treatment.
At discharge he was placed in a short leg plaster of Paris. He is for continuing follow up in
outpatients.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 197

Summary 2
ADMISSION DATE : 10-11-02

DISCHARGE DATE : 16-11-02

AGE : 47 years

SEX : male

FINAL DIAGNOSIS:
Mr X. is a sailor who suffered a fractured zygoma and mandible after falling down stairs at work.
He was mildly concussed on arrival at hospital. X-rays showed that the fracture to the zygoma was
not displaced but the mandibular fracture would require wiring. CT scan of the brain was clear. He
was taken to theatre on the day of admission where the mandible was wired.
Three days after surgery Mr X. became drowsy then unresponsive. A second CT scan of the brain
identified a subdural haematoma. He was taken back to theatre where a craniotomy was performed
to evacuate the haematoma.
He has recovered quite well from his accident. He remains on a liquid diet until the wires are
removed from his mandible, which will be in another three weeks. He seems to have had no
residual effects from the subdural haematoma.
He is presently continuing management in outpatients and we expect him to make a complete
recovery.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 198

Summary 3
ADMISSION DATE : 10-1-04

DISCHARGE DATE: 22-1-04

AGE : 91 years

SEX : female

FINAL DIAGNOSIS: fractured neck of femur, requiring open reduction of fracture

Mrs X. is a charming elderly lady who was admitted with an intertrochanteric fracture of her left
neck of femur. She sustained this when she slipped on a wet path in the garden at her home.
The fracture was reduced and internally fixed with a pin and plate.
Post-operatively she progressed slowly but on day 3 she fell out of bed and dislocated her right
shoulder and sustained a laceration to her right forearm. She was taken back to theatre where the
shoulder dislocation was reduced and her forearm sutured under a light GA. There were no further
complications but re-mobilisation was slow.
At discharge she was mobile with the assistance of a walking frame and was discharged home into
the care of her daughter.
Dx

ICD-10 Code

Main Condition:
Other Conditions:

CBHI ICD 10 Student Workbook January 2008 Page 199

Mortality Coding Exercises for Chapter XIX and Chapter XX


Exercise 1
Age
I
Disease or condition
directly leading to
death*

Sex

(a)Shock; haemorrhage.
due to or as a consequence of

Antecedent causes
(b)Multiple rib fractures, lacerated
Morbid conditions
lungs and spleen . . . . . . .
giving rise to the above
due to or as a consequence of
cause, stating the underlying
condition last
(c)MVA
due to or as a consequence of
(d)
II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Driver, of car Vs semi trailer


.

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 200

Exercise 2
Age : 45
I
Disease or condition
directly leading to
death*
Antecedent causes
Morbid conditions
giving rise to the above
cause, stating the underlying
condition last

Sex : Male

(a)Hanging.
due to or as a consequence of

(b)..Successful suicide
due to or as a consequence of

(c)
due to or as a consequence of

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

*This does not mean the mode of dying e.g. heart failure, respiratory
failure. It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 201

Exercise 3
Age : 34
I
Disease or condition
directly leading to
death*
Antecedent causes
conditions
giving rise to the above
cause, stating the underlying
condition last

Sex : Female

(a)Subdural haemorrhage
due to or as a consequence of

1 hour

(b)..Fracture of base of skull and Morbid


orbital floor
due to or as a consequence of

1 hour

(c)Fall from gangplank of cruise ship


onto wharf
due to or as a consequence of

1 hour

(d)

II
Other significant conditions
contributing to the death,
but not related to the disease
or condition causing it

Acute alcohol intoxication


.

*This does not mean the mode of dying e.g. heart failure, respiratory failure.
It means the disease, injury or complication that caused death.

Selected Underlying Cause of Death:


ICD-10 Code:
Which rule applied:
Explanation:

CBHI ICD 10 Student Workbook January 2008 Page 202

MODULE 26 - ANSWERS
Chapter XIX Injury, poisoning and certain other consequences of external causes & Chapter
XX External causes of morbidity and mortality

1. Multiple lacerations to abdomen, inflicted by a knife during a fight in a bar. The victim was
a bar attendant working in the bar at the time.
Look up laceration in the Index (Volume 3, page 328).
Laceration (see also Wound, open)
As there is no listing under Laceration for abdomen, we need to refer to Wound, open in the
Index (Volume 3, page 567).
Wound, open
- multiple
- - abdomen, lower back and pelvis -> S31.7
We can now code the external cause of the injury (that is, how the injury occurred). In this case
the wounds were 'inflicted by a knife in a fight in a bar'. Look up fight in the Index under
External Causes of Injury section (Volume 3, page 599).
Fight (hand)(fists)(foot) (see also Assault, fight) Y04.Y04 does not cover fight with a knife, therefore we need to refer to Assault, fight in the External
Causes of injury section,(Volume 3, page 582), to find fight with a knife.
Assault
- fight
- - with weapon
- - - cutting or piercing -> X99.The .- at the end of the code indicates that the coder must assign a fourth digit. At the beginning
of the X85-Y09 section there is a note referring the coder to pages 1013-1017 for the fourth
character subdivision. These pages list the places of occurrence for injuries - in other words,
where they happened. We need to select from this section an appropriate code for bar. We will
select .5 Trade and service area.
As well, X99.- is in the range of codes that require an activity code to be selected. Turn to page
1017-1018 of Volume when and determine the correct activity code. We know the victim was a
bar attendant at the time of the incident, and we assume he was working at the time of the injury,
so the correct activity code is .2. The complete external cause code for this case is X99.52.
2. Cerebral contusion due to fall from bed onto floor, whilst sleeping, at home.
Look up contusion in the Index (Volume 3, page 116).
Contusion
- cerebral -> S06.2

CBHI ICD 10 Student Workbook January 2008 Page 203

Refer to page 900 of the Tabular List (Volume 1). At the beginning of the S06 rubric is a list of
optional fifth character subdivisions to indicate if the contusion occurred with or without open
intracranial wound. As there is no mention of open intracranial wound in our diagnosis, we
would use 0 in the fifth character position. Our code for cerebral contusion would be S06.20.
For the external cause of the injury, we look up fall in the Index (Volume 3, page 597).
Fall
- bed -> W06.The .- indicates that more digits are required to complete this code. The additional codes are the
activity code and the place of occurrence code. Refer to page 1013-1017 for the place of
occurrence code first. The correct code would be .0 for home. Refer to page 1017-1018 for the
activity code. The person was sleeping at the time of the accident, so the code to use would be a
4. Therefore the complete external cause code for this case would be W06.04.
3. Adverse reaction to anaesthetic
Look up Reaction in the Index (Volume 3, page 472)
Reaction
- anesthesia - see Anesthesia, complication
Anesthesia
- complication or reaction NEC (see also Complications, anesthesia) -> T88.5
Complications
- anesthesia NEC -> T88.5
Because we do not know any more information about the nature of the adverse reaction or the
type of operation being performed we cannot use a more specific injury code. It is possible to add
an external cause code to specify that the patient had an abnormal reaction to an anesthetic
agent. Look up the Table of Drugs and Chemicals (volume 3, page 633).
Anesthetic NEC - see under adverse effect in therapeutic use -> Y48.4.
If you refer to page 1013 for Place of occurrence you will note that a place of occurrence code is
not required for this code.

4. The final diagnosis for this 24-year-old motor cycle rider, who was involved in a collision
with a car, was a closed fracture mid shaft right femur, compound fracture mid shaft right
tibia.
Look up fracture in the Index (Volume 3, page 235).
Fracture
-femur
- - shaft(lower third)(middle third)(upper third) -> S72.3
Refer to page 932 Tabular List for S72.3. At the beginning of the S72 category is a note
providing fifth character subdivisions for use with this category. They are used to indicate
whether a fracture is open or closed. We have been told that the fracture is closed, there we
would use the 0. The full code for the fractured femur is S72.30.
CBHI ICD 10 Student Workbook January 2008 Page 204

As the patient has two fractures, we need to code the other fracture as well. Look up fracture in
the Index (Volume 3, page 238).
Fracture
-tibia(shaft)(with fibula) -> S82.2
Refer to page 936 of the Tabular List. At the beginning of the S82 section on page 935 is a note
providing a fifth character subdivision for use with this section to indicate whether the fracture is
open or closed. The fractured tibia is described as a compound fracture, which is an open
fracture, therefore we would use a 1. The complete code for the fractured tibia is S82.21.
To find the correct external cause code refer to the transport accident table in Volume 3, page
576. The first column indicates the type of transport the person who was injured was using and
the list across the top indicates what they collided with, or how the accident happened. We need
to match up the motor cycle rider with the collision with a car. This will give us code V23.-. If
we refer to Volume we note that a fourth digit is required to indicate the person's status in the
vehicle and whether it was a traffic accident or not. The correct digit to assign is a 4. You will
note that no place of occurrence code is required for this code, but an activity code needs to be
assigned. Although we can refer to page 1017-1018, we do not know what activity the patient was
involved in at the time. Assign 9 for the activity code to complete external cause code, V23.49.
5. Second degree burns to leg from an uncontrolled house fire.
Look up burn in the Index (Volume 3, page 80).
Burn
- legs - see limb, lower
Burn
- limb
- - lower -> T24.Refer to Volume 1 page 962 for the fourth character, which will be .2 for our case. The correct
code for the leg burns is therefore T24.2.
To code the external cause, look up Fire in the Index (Volume 3, page 599).
Fire (see also Exposure fire)
Exposure
- fire
- - uncontrolled
- - - in building or structure -> X00.Refer to page 1075 of the Tabular list for X00.- which refers the coder to pages 1013-1017 for
the appropriate fourth digit to indicate the place of occurrence. We will use .0 to indicate home.
Then refer to pages 1017-1018 for the correct activity code. As no indication is given as to the
activity the person was involved in at the time of the house fire, the correct fifth digit would be 9.
The final correct code is X00.09.

CBHI ICD 10 Student Workbook January 2008 Page 205

Hospital Discharge Summaries


Summary 1:
Main Condition:
Other conditions:

S82.21

Fracture of shaft of tibia, open fracture

S93.0
V28.09

Dislocation of ankle joint


Motorcycle rider in non collision transport accident,
driver injured in non traffic accident, activity not specified
Infection following a procedure, NEC
Pseudomonas as cause of disease classified to other chapters
Surgical operation with implant of artificial internal device

T81.4
B96.5
Y83.1
Summary 2:
Main Condition:
Other Conditions:

Summary 3:
Main condition:
Other conditions:

S06.50

Traumatic subdural haematoma, without open intracranial


wound

S02.60
S02.40
W10.92

Fracture of mandible, closed


Fracture of malar and maxillary bones, closed
Fall on and from stairs and steps, place of occurrence
unspecified, activity whilst working for income

S72.10

Pertrochanteric fracture

W01.09
S43.0
S51.9
W06.24

Fall on same level from slipping, tripping and stumbling


Dislocation of shoulder joint
Open wound of forearm, part unspecified
Fall involving bed, in hospital, while resting or sleeping

Mortality Coding Exercises


Exercise 1:
Underlying cause of death:

V44.59

General principle, then rule D Specificity

Which rule applied:


Exercise 2:
Underlying cause of death:

X70.98

Which rule applied:

Intentional self-harm by hanging, strangulation and


suffocation, place of occurrence unspecified, other
specified activity
General principle

Which rule applied:


Exercise 3:
Underlying cause of death:

Car occupant involved in collision with heavy transport


vehicle, driver involved in traffic accident, activity
unspecified

V93.19

Accident on board watercraft without accident to


watercraft, not causing drowning and submersion, place
of occurrence residential institution, activity not specified
General principle

CBHI ICD 10 Student Workbook January 2008 Page 206

MODULE 27
Factors Influencing Health Status and Contact with Health Services

CBHI ICD 10 Student Workbook January 2008 Page 207

Module 27: Factors Influencing Health Status and Contact with Health
Services
(CHAPTER XXI)
This chapter is for use for occasions when circumstances other than a disease, injury or external
cause classifiable to categories A00-Y89 are recorded as diagnoses or problems.
Important points for Chapter XXI
Categories range from Z00 to Z99
84 of the available 100 categories have been used.
There are 7 blocks.
A code for asymptomatic HIV is provided in this chapter.
Codes for contact with or exposure to HIV infection are also part of Chapter XXI.
Z00-Z13 Persons encountering health services for examination and investigation, has many
exclusions throughout the block, both to other categories within the block and other categories
outside of the block. For example Z02 and Z09 have exclusions to categories within this block
as well as exclusions to other categories within this chapter.
Z30-Z39 Person encountering health services in circumstances related to, covers all aspects of
reproduction, including contraceptive management, procreative management and pregnancy
and antenatal care. Of particular note is the use of Z37 Outcome of delivery, which can be used
as an additional code to identify the outcome of delivery on the mother's record. Z38 Liveborn
infants, according to place of birth is used to code health infants who are occupying a cot, but
are not sick.

CBHI ICD 10 Student Workbook January 2008 Page 208

Coding exercises for Chapter XXI


1. Incidental pregnancy

2. Convalescence following surgery

3. Reversal of vasectomy (also known as vasoplasty)

4. Patient "has been in contact with cholera"

5. Outcome of delivery: single live birth (coding mothers record)

6. Routine follow-up after surgery for malignant bladder papilloma

7. Chemotherapy session

8. Fitting and adjustment of external breast prosthesis

CBHI ICD 10 Student Workbook January 2008 Page 209

MODULE 27 - Answers
Chapter XXI Factors influencing health status and contact with health services
1. Incidental pregnancy
Look up pregnancy in the Index (Volume 3, page 454).
Pregnancy
-incidental finding -> Z33
2. Convalescence following surgery
Look up convalescence in the Index (Volume 3, page 117).
Convalescence(following)
-surgery NEC -> Z54.0
3. Reversal of vasectomy (also known as vasoplasty).
Look up vasoplasty in the Index (Volume 3, page 561).
Vasoplasty, after previous sterilisation -> Z31.0
4. Patient "has been in contact with cholera"
Look up contact in the Index (Volume 3, page 114).
Contact(with)
- cholera -> Z20.0
5. Outcome of delivery: single live birth (code the mother's record)
Look up outcome in the Index (Volume 3, page 421).
Outcome of delivery
-single
- - liveborn -> Z37.0
6. Routine follow-up after surgery for malignant bladder papilloma
Look up examination in the Index (Volume 3, page 215).
Examination
-follow-up(routine)(following)
- - malignant neoplasm
- - -surgery -> Z08.0
7. Chemotherapy session
Look up chemotherapy in the Index (Volume 3, page 95).
Chemotherapy (session)(for) -> Z51.2
8. Fitting and adjustment of external breast prosthesis
Look up fitting(of) in the Index (Volume 3, page 232).
Fitting (of)
-prosthesis(external)
- - breast -> Z44.3
CBHI ICD 10 Student Workbook January 2008 Page 210

MODULE 28
Procedure Coding Exercises

CBHI ICD 10 Student Workbook January 2008 Page 211

Module 28: Procedure Coding Exercises


1. Appendicectomy

2. Assisted breech delivery with forceps to aftercoming head

3. Control of arterial haemorrhage by ligation

4. Repair of broncho-oesophageal fistula with oesophageal atresia

5. Closed biopsy of stomach with endoscopic brushings

6. Lobectomy of lung

7. Excision of squamous cell carcinoma from eyelid

8. Substernal bilateral thyroidectomy, complete

9. Repair of myelomeningocoele

10. Total abdominal hysterectomy with unilateral salpingo-oophorectomy

CBHI ICD 10 Student Workbook January 2008 Page 212

MODULE 28 - ANSWERS
Procedure coding with ICHI
Appendicectomy
Look up appendicectomy in the Procedures Index.
Appendicectomy (incidental)(open) -> 926
If the appendicectomy was performed laparoscopically, note the block code is the same. The
laparoscopy could also be coded to indicate the approach.
Assisted breech delivery with forceps to aftercoming head
Look up delivery in the Procedures Index.
Delivery
- breech
- - assisted
- - - with forceps to aftercoming head (FACH) -> 1339
Control of haemorrhage by ligation
Note that it is difficult to code this procedure without knowing the site of, or reason for, the
haemorrhage - this information should always be provided.
Control
- haemorrhage
- - artery NEC -> 767
Repair of broncho-oesophageal fistula
Look up Repair in the Procedures Index.
Repair
- fistula - see also Closure, fistula
Closure
- fistula
- - broncho-oesophageal
- - -with repair of oesophageal atresia -> 866
Closed biopsy of stomach with endoscopic brushings
Look up Biopsy in the Procedures Index.
Biopsy
- stomach
- - closed -> 1008
It is not necessary to separately code the brushings.
Lobectomy of lung
Look up Lobectomy in the Procedures Index.
Lobectomy
- lung (complete) -> 552
CBHI ICD 10 Student Workbook January 2008 Page 213

Excision of squamous cell carcinoma from eyelid


Look up Excision, tumour
Excision
- tumour
- - skin - see excision, lesion, skin
Excision
- lesion
- - skin
- - - specified site
- - - - eyelid -> 1620
Substernal bilateral thyroidectomy, complete
Look up thyroidectomy in the Procedures Index.
Thyroidectomy
- complete
- - bilateral - see Thyroidectomy, bilateral
Thyroidectomy
- bilateral
- - substernal -> 115
Repair of myelomeningocoele
Look up Repair in the Procedures Index.
Repair
- myelomeningocoele (with excision) -> 55
10. Total abdominal hysterectomy with unilateral salpingo-oophorectomy
Look up hysterectomy in the Procedures Index.
Hysterectomy
- abdominal
- - with
- - - salpingo-oophorectomy
- - - - unilateral -> 1268

CBHI ICD 10 Student Workbook January 2008 Page 214

References

1. World Health Organization. International Statistical Classification of Diseases and Related


Health Problems, 10th Revision (ICD-10). WHO: Geneva; 1992
2. Meads, M. Sue & Brown, Faye. ICD-10 Coding Fundamentals: A comprehensive coding
guide for healthcare professionals. PMIC: Los Angeles; 1997
3. National Centre for Classification in Health. International Statistical Classification of
Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10AM) 3rd Ed. NCCH: Sydney; 2002
4. World Health Organization Collaborating Centre for the Classification of Diseases,
London. TENDON: ICD-10 computer based training. OPCS: London; 1996
5. National Centre for Classification in Health. International Classification of Health
Interventions, 2nd edition. NCCH : Sydney; 2004
6. Berkhow, Robert & Fletcher, J. Andrew (Eds). The Merck Manual of Diagnosis and
Therapy 16th Ed. Merck Research Laboratories: New Jersey; 1992
7. Pan American Health Organization. Intercod ICD-10 computer based interactive training.
PAHO: Washington; 2002
8. National Center for Health Statistics. Instruction Manual Part 2C: ICD-10 ACME Decision
Tables for Classifying Underlying Causes of Death. NCHS: Hyattsville, Maryland; 2004

CBHI ICD 10 Student Workbook January 2008 Page 215

APPENDIX 1
Human Body Structure and Functions

CBHI ICD 10 Student Workbook January 2008 Page 216

Human Body Structure and Functions


CELL
DEFINITION
The cell is the smallest structure unit of our body. The cell is capable of independent
functioning. A cell membrane surrounds each cell and allows material to leave and enter the cell.
The nucleous contains chromosomes which carrier characteristic of the parents to the next
generation. Each normal body, normal cells contains 23 pairs of chromosomes which carries
characteristic of the parents to the next generation. Each normal body, normal cells contains 23
pair of chromosomes in a cell. Genes in the chromosomes are hereditary units of the body. DNA
(Deoxyribonucleic acid) in the genes in the transmeter of hereditary characteristics. The nuclei in
the nucleous contain ribonucleic acid or RNA which controls the manufacturer of protein.
Cytoplasm :- It carries out the functions of the cell e.g. It maintains the structure of the cells. It
removes the waste product from the cell and maintains nutrition of the cell.
FUNCTIONS OF THE CELL
Digestion :- Proper digestion and absorption of nutrients.
Excretion :- Elimination of the waste of the body.
Respiration :- Inhaling oxygen and using it and giving out CO2 (carbondioxide)
Growth & Repair :
Reproduction :- Each cell simply divided into tissues.
TISSUES
Tissues are materials composed of cells and intercellular or interstitial fluid. Many tissues
unite together forms organs.
Types of Tissues

I. Epithelial tissue
II. Connective tissue
III. Muscle tissue
IV. Nervous tissue
I.

Epithelial tissue
Epithelial tissues form covering like skin or epidermis, glands, inner living of blood vessels
and lines of digestive, respiratory and genitourinary tracts.
Functions epithelial tissues :
1. This group of tissues is found in covering of the body and living cavities and tubes and
also found in glands. They epithelial tissues protects the underlying organs.
2. Secretion and absorption.

CBHI ICD 10 Student Workbook January 2008 Page 217

Types of epithelial tissues :


1. Simple epithelium
2. Cuboidal epithelium
3. Ciliated epithelium
4. Transitional epithelium
II. Connective tissue
It helps in connection, protection and supporting the different parts together and helping and
holding them in place. The cells forming the connective tissues are more widely separated
from each other than those forming the epithelium e.g. bone, cartilage, ligaments, blood and
lymph etc.
Functions of connective tissues:
1. Binding and support
2. Protection
3. Transport
Insulation (maintains body temperature)
Types of connective tissues
1. Fibroblast
2. Macrophages
3. Plasma cells
4. Mast cells
5. Fat cells
III. Muscle tissue
It has power of contraction movement. There are three types of muscle tissues.
1. Skeletal muscle tissue
2. Cardiac muscle tissue*
3. Smooth muscle tissue
*Voluntary muscles or involuntary muscles or cardiac muscles.
Functions of muscle tissue : Contraction and relaxation.
IV. Nervous tissue
Nervous tissue conduct nerve impulses between body structure and controls body function. It
consists of two kinds of cells. Nerve cell or neurons and supporting cells called neurolgia.
Functions of nervous tissues :
Excitable cells - They initiate, receive, conduct and transmit information.
Non-excitable cells - They support the neurons.
MEMBRANES
Membranes are sheets of epithelial tissues and their basement membranes that cover or line
internal structures of cavities. The main membranes are mucous membranes, serous membranes
and synovial membranes.
Mucous membranes disease the moist living of the elementary tract, respiratory tract and genito
urinary tracts and sometimes it is also called mucosa.
Serous membranes or srosa secreta serous watery fluid, they are found in the thoracic cavity, the
pleura surround the lungs and the pericardium surrounds the heart. Peritonium surrounds the
abdominal organs.
CBHI ICD 10 Student Workbook January 2008 Page 218

Functions of serous membranes :- There are two living end two layers in the serous membranes
visceral and parietal layer filled with serous fluid which protects the organs from friction rub or
jerky movements.
Synovial membranes : This membrane is found lining the joint cavities and surrounding the
tendous which could be injured by rubbing against bones. This membrane is found over wrist joint
and knee joints. Synovial membranes secretes clear sticky oily synovial fluid which helps the
joints from any injury.
ANATOMICAL TERMS
1. Anatomical position :- Anatomical position is the body in the upright position with the head
facing forward, the arms at the sites with the palms of the hands facing forward and the feet
together.
2. Median plane :- When the body in the anatomical position is divided longitudinally into right
and left halves. It has been divided in the median plane.
3. Medial and lateral :- Any structure which is median to another is nearer to the midline and
any structure lateral to another is farther from the midline or at the side of the body.
4. Proximal and distal :- These terms are used when describing the bones of the limbs, the
proximal end of a bone is the one nearest to the point of attachment of the limb and the distal
end is farthest away.
5. Anterior or ventral :- This indicates that the part being described is nearer the front of the
body.
6. Posterior or dorsal :- This means that part being described is nearer to the back of the body.
7. Superior :- This indicates our structure nearer the head.
8. Inferior :- This indicate our structure farther away from the head.
9. Border :- This is a ridge of bone which separates two surfaces.
10. Spine, spinous process or crest :- This is a sharp ride of a bone.
11. Trochanter, tuberosity and tubercle :- These are rough ended bony projections usually for
the attachment of muscles or ligaments. The different names are used according to the size of
the projection. Trochanters are the largest and tubercles are the smallest.
12. Styloid process :- This is a sharp downward projection of bone which gives attachment to
muscles and ligaments.
13. Fossa (Pleural Fossae) :- This is a hollow or depression.
14. Foramen (Foramana Pleural) :- This is a whole in a structure.
15. Bony sinus :- This is a hollow cavity within a bone.
16. Meatus :- This indicates a tube shaped cavity within a bone.
17. Articulation :- This is a joint between two or more bones.
18. Suture :- This is the name given to an immovable joint e.g. between the bones of skull.
19. Articulating surface :- This is the part of the bones which enters into the formation of a joint.
20. Facet :- This is a small generally rather flat, articulating surface.
21. Condyle :- This is a smooth rounded projection of the bone which takes part in a joint.
22. Septum :- This is a partition separating two cavities.
23. Fissure or cleft :- This indicates a narrow slit.
24. Supination :- It means superior or above.
25. Pronation :- It means downward.
26. Flexion :- Bending
27. Abduction :- Away from the midline.
28. Adduction :- Nearer to the midline
29. Circumduction :- Moving the limb in a circular way.

CBHI ICD 10 Student Workbook January 2008 Page 219

DIGESTIVE SYSTEM
Definition:
It prepares food for consumption by the cells through 5 basic activities.
i) Ingestion
=
taking food into the body.
ii) Peristalsis
=
the movement of food along the digestive tract.
iii) Digestion
=
break-down of food by both chemical & mechanical processes.
iv) Absorption =
the passage of digested food from the digestive tract into the cardio
vascular & lymphatic systems for distribution to cells.
v) Defaecation =
the elimination of indigestible substances from the body.
I. ORGANS /PARTS:
i) Mouth
Tongue
Teeth
Salivary Glands (3 pairs)
Palate cheeks
Pharynx
Oesophagus
Stomach
Small Intestine
Deudenum
Jejunum
Ileum
Large Intestine (colon)
Ascending Colon
Transverse Colon
Descending Colon
Rectum & Anus
Mouth / Oral Cavity:
The mouth is formed by cheeks, palates, lips, tongue, parotid glands, salivary glands,
submandibular glands and sublingual glands.
Pharynx : - It helps in swallowing the food.
Oesophagus : - It is a hollow tube extends from pharynx to stomach. It is about 10 inches long. It
helps in passage of food & liquids.
Stomach: - It lies in epigastric region and left hypochondriac region of the abdomen cavity. It
digests food and secretes gastric juices like Hydrochloric Acid, intrinsic factor and
stomach gastrin. It serve food reservoir. It secrete antianaemic factor. It helps in
absorption of food, water, alcohol and drugs (in limited amount). Stomach secretes
hormone, gastrin.
Small Intestine :- It is about 6 mt. long and its diameter is about 2.5 cms. Parts are (i) duodenum,
(ii) jejunum & (iii) ileum.
Functions :- Complete digestion of food, absorption of food and water. It It secretes
hormone.
Large Intestine : - It is 1.8 meters long and 6 cm in diameter. Parts of large intestine are cecum,
rectum, colon & anal canal.
Functions
1.
Absorption of water
2.
Elimination of food product.
CBHI ICD 10 Student Workbook January 2008 Page 220

vii) Rectum and anus :- Elimination of food products.


ACCESSORY ORGANS:
Salivary Glands (3 pairs)
Pancreas
Liver
Gall Bladder
i)

Salivary Glands (3 pairs) :


There are 3 pairs of salivary glands. The parotid, mandibular gland & two sublingual glands.
It secretes ptylin (saliva).

ii) Pancreas :
a) Pancreas is a pale grey gland weighing about 60 gms.
b) It is about 12-15 cms long and is situated in the epigastric and left hypochondriac region
of the abdominal cavity.
c) It consists of a broad head, a body and a narrow tail.
d) The head lies in the curve of the body of duodenum, the body behind the stomach and the
tail lies in front of the left kidney.
Functions :
a) It secrete pancreatic juices by acinar cells
b) It secretes insulin by b cells (Islets of langerhans)
c) It secretes glucagon by a cells.
iii) Liver :
It is situated in right hypo-chondrium. It is the largest gland in our body. Its approximate
weight is about 1.5 kg. It is divided in three lobes (right-lobe, left lobe and posterior caudate
lobe). It consist of hepatic duct, cystic duct and common bile duct.
Functions:a) It secrete bile juices.
b) It plays essential role in metabolism of carbohydrates, proteins and fats.
c) It also metabolises drugs and alcohol.
iv) Gall Bladder :
The size and shape of gallbladders is like a pear. It lies under surface of liver.
Functions :
a.
Concentration and storage of bile during digestion.
b.
It ejects bile into ampulla / duodenum.

CBHI ICD 10 Student Workbook January 2008 Page 221

URINARY / EXCRETORY SYSTEM


Organs of urinary system :
Right and left Kidneys Glands (supra renal glands)
Right and left Ureters The ducts of kidney
The Urinary Bladder The reservoir of urine
The Urethra The passage from bladder to the outside
FUNCTIONS OF URINARY SYSTEM
1. Primary function of urinary system is to regulate the concentration and volume of blood by
removing and restoring selected amount of water and solutes.
2. Excretion of waste products from the body.
i)

Kidneys:
There are two kidneys (left and right) situated in posterior abdominal wall. They are bean
shaped. Each kidney consists of thousands of nephrons. [Basic unit of the kidney is nephron
which does filteration]. They are about 11.25 cms. long and 5 to 7.5 cms. wide and 2.5 cms.
thick. Right kidney is slightly lower then the left kidney due to liver.
Functions :
a) To drain urine and waste product from the body.
b) Nephron is the functioning unit of the kidney.

ii) Ureters :
There are 2 ureters in human body.
Functions:
a) To drain urine from kidney to the urinary bladder.
b) Ureters are situated posterior to the peritonium.
iii) Urinary Bladder:
It is situated behind posterior to the symphysis to the pubis.
Functions:
It stores urine prior to micturation (passing of urine).
Urethra :
Urethra is the tube extended from the urinary bladder to the exterior.
Functions : - To discharge urine from the body.
The normal quantity of urine in a normal adult person in 24 hrs. is 1500 ml. Blood supply of
adrenal vein is controlled by the autonomic nerves system.

CBHI ICD 10 Student Workbook January 2008 Page 222

THE LYMPHATIC SYSTEM


Lymph is a fluid like plasma and the tissue fluid, but in cases of infection it may contain
bacteria.
Lymphatic system composed of
The Lymph
The Lymphatic Vessels
The Lymph glands or nodes
Lymphathic organs are:Tonsils, Thumus and Spleen
LYMPHATIC VESSELS ARE :
The Thoracic Duct :
It collects lymph from legs, trunk, left arms, left side of chest and left side of head.
Right Lymphatic Duct :
It collects lymph from right arm, right side of chest and right side of head.
Functions of Lymph:Lymph glands help to protect the body from infection.
Producing new lymphocytes for the blood.
Spleen is a largest lymphatic gland
It is 12 cm long and 8cm broad and it is protected by lower ribs.
Functions of Spleen
It produces new lymphocytes for the blood.
It helps to fight the infection.
It acts as a reservoir of RBC.
Lymph nodes
e.g.
Cervical Lymph Nodes
Axillary Lymph Nodes
Submaxillary Nodes
Intestinal Nodes
Iliac Nodes

CBHI ICD 10 Student Workbook January 2008 Page 223

CIRCULATORY SYSTEM / CARDIOVASCULAR SYSTEM


Organs:
Heart
Arteries
Veins
Lungs
Heart:
The heart is roughly cone-shaped hollow muscular organ. It is approximately10 cm long and
weight is about 225 gms in females and 310 gms in male. The size of the heart is equal to the
owners fist. The heart is situated in thoracic cavity in the medium stinum between the 2 lungs. It
lies obliquely little more to the left then the right.
Structure of the Heart:
Heart is composed of 3 layers of tissues:
i) Pericardium
- Outermost layer 2 Pericardial fluid.
ii) Myocardium
- Muscular layer Middle.
iii) Endocardium - Innermost layer of the heart
Internal Organs of the Heart:
The heart is divided into right and left side by the septum. Each side upper and lower
chambers are divided by an artio-ventricular valve. Upper chamber are called Atrium and Lower
chamber are ventricles. The right artio-ventricular is called Tricuspid Valve. The left artio
ventricular is called Bicuspid Mitral.
The largest veins of the body is superior and inferior vena cava. These veins empty their
blood into right atrium then blood is pushed into right ventricle by the right atrioventricular valve
and from their it is pumped into the pulmonary arteries(Pulmonary arteries are the only arteries
which carries de-oxygenated (impure) blood. Pulmonary arteries carries impure blood to the lungs
for purification or exchange of gases. After purification of blood pulmonary veins carries
oxygenated (pure) blood to the left side of the heart in the left atrium then it is pushed to the left
ventricle. From left ventricle it is pushed into the aorta then it is passed on to various parts of the
body.
Blood supply to the heart :
The heart is supplied by coronary arteries.
Sinoatrial Node (Pace maker)
It initiate impulse of the heart.
Nerve supply to the heart
Sympathetic fibers-Cardiac nerve
Parasympathetic fibers-Vagus nerve
Cardiac cycle:
Each cardiac cycle consists of systole, diastole, pause. One cardiac cycle completes in 0.8
seconds.
Arteries
It breakdown in arterioles and these becomes capillaries.
Veins
It breakdown in veinioles and these becomes capillaries.
CBHI ICD 10 Student Workbook January 2008 Page 224

RESPIRATORY SYSTEM
Respiratory centre is situated in the brain. Following are the organs of the respiratory system :
Nose
Pharynx
Larynx
Trachia
Bronchia
Lungs
i)

Nose :
1. Contains two nostrils
2. These nostrils are covered with ciliated nucous membrane
3. Nose serves as passage way for the air
4. Filtering, moistering and worming of the air occurs in the nose.
5. Nose helps in smelling good and bad odour.

ii) Pharynx :
1. It is located behind the nose.
2. It serves passage way for air, food and liquids.
iii) Larynx:
1. It is located between pharynx and trachea.
2. It helps in producing voice.
Trachea :
1. It is situated in the chest cavity.
2. Walls of trachea is made-up of smooth muscles and C-shaped rings of cartilage at
intervals which keeps the tube opened all the time.
3. Trachea is also covered with ciliated mucous membrane
4. Trachea is about 4 long
5. It helps in passage of air.
Bronchi :
1. There are two bronchus (right and left).
2. Right bronchus is slightly larger than left bronchus.
3. Bronchus have same structure like trachea.
4. These also help in passage way of air.
vi) Lungs:
Right lung :- It contains 3 lobes Upper, middle and lower lobe.
Left lung :- It contains 2 lobes Upper and lower lobe.
1. Lungs are two in number (right and left).
2. There are three lobes in right lung.
3. There are two lobes in left lung.
4. Each lung consist of air sacs (alveoli).
In these air sacs exchange of gases takes place CO2 is taken in and CO2 is expelled
out).
Cycle of respiration
Inspiration, expiration and pause. Normal respiration in an adult person is 12-16 times/minute.

CBHI ICD 10 Student Workbook January 2008 Page 225

BLOOD CELL
Definition:
The blood is composed of a strew-coloured transparent fluid in which different types of cells
are suspended. Blood contains 55% plasma, and 45% blood cells.
Types of blood cells
There are 3 types of cells present in blood :
i. Erythrocytes (R.B.C.)
[ 4.5 to 5.5 per mm3 ]
ii. Leucocytes (W.B.C.)
[ 5,000 to 11,000 per mm3 ]
a. Granular Leucocytes
1. Neutrophils (40 to 75%)
2. Eosinophils ( 1 to 6% )
3. Basophils (<1%)
b. Agranulocytes
1. Monocytes (2-10%)
2. Lymphocytes (20-50%)
iii. Platelets or Thrombocytes [ 150,000 to 350,000 per mm3 ]
Functions of blood :
Blood is a complex liquid. Its functions are as under:
i.
It transports oxygen from the lungs to all cells (parts) of the body.
ii.
It transports carbondioxide from cells to the lungs.
iii. It transports nutrients from the digestive organs to the cell.
iv. It transports waste products from cell to kidneys, lungs and sweat glands.
v.
It transports hormones from endocrine glands to the cell.
vi. It transports enzymes to various cells.
vii. It regulates body pH (Hydrogen Ion Concentration) through buffers and amino acids.
viii. It maintains the normal body temperature i.e. 37C.
ix. It maintains fluid and water balance.
x.
It protects our body from toxins, foreign microbes and destroying and engulfing them.
xi. It protects our body from fluid and blood loss by clotting mechanisms.
Rh Factor
When Rh antigen is present in the RBCs, it is Rh+ve blood.
When Rh antigen is not present in the RBCs, it is Rh-ve blood.
Blood forming Organs: - Red Bone Marrow & Liver.
Life Span
R.B.C.
W.B.C. Platelets Function
R.B.C.
W.B.C.

120 days.
Few hours to few days.
5 to 9 days.

To transport Oxygen & Carbon Dioxide


1. They are Soldiers of the body (phagocytocis)
2. Prevention of allergies.
Platelets - Helps blood clotting.
(Thrombocytes)

CBHI ICD 10 Student Workbook January 2008 Page 226

Branches of Blood Vessels


Artery
- Arteioles
Vein
- Veinuoles

Capillary
Capillary

Types of Blood Group


Blood
Group

Can Receive Blood

A, O

B
AB

B, O
A, B, AB, O
(Universal recipient)
O
(Self recipient)

Can Donate Blood


A, AB
B, AB
AB
A, B, AB, O
(Universal donor)

Plasma
Plasma is the liquid portion of blood. It consists of 91.5% water and 8.5% solutes. These
solutes are proteins (albumins, globulins, fibrinogen substances, foods, enzymes, hormones,
respiratory gases and electrolytes).

CBHI ICD 10 Student Workbook January 2008 Page 227

ENDOCRINE SYSTEM
Endocrine system consist of glands. These glands are ductless glands. They pour their
hormones directly into the blood stream.
DEFINITION OF HORMONE
It is a chemical messenger which is secreted by endocrine glands.
TYPES OF ENDOCRINE GLANDS
1. Pituitary gland (master gland of our body)
2. Thyroid gland
3. Parathyroid glands
4. Adrenal or supra renal glands
5. Pancreas
6. Pineal gland
7. Thymus gland
8. Ovaries (female gonad)
9. Testis (male gonad)
10. Placenta (temporary endocrine gland) in females only

-1
-1
-4
-2
-1
-1
-1
-1
-2
- As per number of babies

1. Pituitary gland (master gland of our body)


Situated in skull cavity.
Location :
a) In sella Turcica of sphenoid bone
b) It consist of two endocrine glands Anterior lobe and posterior lobe
Anterior lobe : Secrete growth hormone (STH). Follicle stimulating hormone (FSH), prolactin
hormone, lactogenic hormone, leucotropic hormones (LTH).
Posterior lobe : Secrete anti-diuretic hormone and oxytocin hormone (ADH).
2. Thyroid gland
It is located in neck just below larynx. It secretes thyroid hormones i.e. T3, T4, TSH, calcitonin.
3. Parathyroid glands
These are situated in the posterior surface of thyroid gland. These are small in size like peas. They
are 4-5 in number. They secrete parathormone (parathyroid hormone).
4. Adrenal or supra renal glands
Located at the top of kidneys. They secrete epinephrin, nor-epinephrin, mineralo corticoids,
glucocorticoid hormones.
5. Pancreas
Located in abdomen cavity. It secretes insulin and glucagon hormone.
6. Pineal gland
It is situated in the skull cavity. It secretes Milatorun adrenoglomerulotropin hormone.
7. Thymus gland
It is situated in chest. It secrete thymosin.
8. Ovaries (female gonad)
It is situated in lower abdomen in females. They secrete progestrone and estrogen hormones.
9. Testis (male gonad)
They secrete testosteron.
10. Placenta (temporary endocrine gland) in females only
It is temporary endocrine gland. It secrete estrogen, progesteron chorionic gonadotropin hormone.

CBHI ICD 10 Student Workbook January 2008 Page 228

REPRODUCTIVE SYSTEM
FEMALE REPRODUCTIVE ORGANS
1.
Ovaries
-2
2.
Uterus
-1
3.
Breast
-2
4.
Vagina
-1
STRUCTURE OF UTERUS
Uterus is a pear shaped organ situated in the lower abdomen.
Size :- Size of uterus is 3x2x1 inch. It consists of body, cervix and fallopian tubes.
Walls of the uterus :- There are three layers in uterus Outermost layer is perimetrium, middle
layer is myometrium, inner layer is endometrium.
FUNCTIONS OF UTERUS
1. Menstruation
2. Pregnancy
3. Labour and expulsion of fetus
Blood supply
Blood supply is done by ovarian arteries.
Venous drainage
Venous drainage into internal iliac veins.
Fallopian tubes (uterus tubes)
They are 10 cms long and attached to uterus at upper, out angles. Fallopian tubes have
same three layers like uterus.
Parts of fallopian tubes
1. Isthmus Attached to the uterus
2. Ampulla Intermediate dilated portion
3. Infuindibulum Funnel shaped terminal component.
Functions of fallopian tube
1. Serve as ducts for ovaries
2. Gives passage way by which ova can reach uterus
3. Fertilization occurs in the fallopian tubes
Ovaries (Female Gonads)
Size
1. Size and shape of large donads.
2. Lie behind and below uterine tube (i.e. fallopian tube).
3. Attached to uterus and broad ligaments.
Functions of ovaries
1. Oogenesis formation of mature female gametes (Ova)
2. Secretion of hormones Estrogens and progesterone
Vagina
Location
It is located between rectum and urethra.

CBHI ICD 10 Student Workbook January 2008 Page 229

Functions of Vagina
1. Receive seminal fluid
2. It is excretory duct for uterine secretion and menstrual flow.
3. It is the lower part of the birth canal
Internal Organs
Uterus, fallopian tubes, ovaries, cervix, vagina
External organs
Vulva and perineum
THE BREAST
They are two in numbers. It is located under skin over peritoneal muscles.
Structure : Niples, areola, lactiferus
Functions : It secrete milk for infant
MALE REPRODUCTIVE ORGANS
1. A pair of testes Function To produce sperms
2. Epididymis They store sperms
3. Vas diferens They carry sperms from the testes to the penis
4. Penis Used for injecting sperms into females.

CBHI ICD 10 Student Workbook January 2008 Page 230

SPECIAL SENSES
i)
ii)
iii)
iv)
v)

Eyes
Ear
Nose
Tongue
Skin

Sight
Hearing
Smell
Taste
Touch

There are 5 special senses in our body, which gives us awareness of surroundings through the
senses.
I.

EYES
Eyes are the sense organs of sight. They give us visual sensation. The structures of the eyes
are eyebrows, eyelids, eyelashes and the lachrimal apparatus. Eyes are situated in the orbital
cavity on both sides of the nose. There are 3 layers of tissues in the eyes, first / outermost layer is
sclera made up of fibrous tissues; second layer is choroid made up of vascular tissue and the third
is retina (inner most layer) made up of nervous tissue.
The anterior cavity contains aqueous humor and the posterior cavity contains viterous humor.
Optic nerve supplies sensation to the eyes.
II. EAR
Ears are the sense organs of hearing. They give us auditory sensation. The structures of the
ears are:
a) External Ear (Outer Ear) : It consists of pinna auricles.
b) Auditory Canal (Meatus) : It consists of 3 bones called Ossicles (MIS Malleus, Incus &
Stapes), Eustacian Tube & Ear Drum (tympunum).
c) Internal Ear : It consists of Vestibule, Chochlea, Bony Labyrinth & Semi-circular Canals.
III. NOSE
It is the sensitive organ of smell. Olfactory nerve endings are found in the nose. There are 2
naries, which is divided by a septum. Olfactory cells convey impulses to olfactory nerves for the
sensation, for example, sweet, good, bad
There are small hairs found in the nose and the nose is covered by celliated mucus membrane.
These prevents entrance of foreign body into the nose.
IV. TONGUE
Tongue is a voluntary muscular structure, which occupies the floor of the mouth. It consists of
little projections called papilae and these papilae containing nerve endings of the sense of taste
called taste-buds.
Blood supply to the tongue is by the lingual branch of external carotid artery. And the venous
drainage is by the lingual vein. Nerves supply by 12 cranial nerve called hypoglossal nerve.
Functions of the Tongue
Mastication
Swallowing
Speech
Taste

Chewing
Deglutition

CBHI ICD 10 Student Workbook January 2008 Page 231

V. SKIN
It is one of the largest organs of the body. It contains glands, hair & nails. The principal parts
of the skin are,
1. Epidermis (outer portion), &
2. Dermis (inner portion).
Dermis contains blood vessels, nerves, hair follicles, oil glands and ducts of sweat glands.
The colour of the skin is due to melanin, carotine & blood-in-capillaries in the dermis.
FUNCTIONS OF EPIDERMIS
1. Skin protects us against various factors like micro-organisms, sun-light and chemicals.
2. Epidermis is the covering of our body, which protects us from all the above things.
3. Skin maintains the normal temperature of the body.
4. It protects our body from heat loss.
5. It helps in formation of Vit. D with the sun-light.
6. It also absorbs some drugs, which are applied on the skin.
7. It is made from stratific squamous epithelial tissues.
FUNCTIONS OF DERMIS
1. It maintains body temperature
2. It protects from bacterial invasion
3. It gives beauty / structure to the skin
4. It maintains fluid & electrolytic balance
Dermis is made of fibrous connective tissues. It has blood vessels, which gives nourishment
to the skin; sweat glands excretes waste product from the body; oil glands excretes oil, which
gives moisturisation to the skin.

CBHI ICD 10 Student Workbook January 2008 Page 232

SKELETON SYSTEM
BONE
Bone is a hardest tissue in the body when fully developed. It is composed of water, organic
materials and inorganic materials.
TYPES OF BONES (as per formation)
1. Compact bone :- It appears to be solid. Microscopic structure shows large numbers of
haversian system.
2. Calcillous bone :- It looks spongy. Microscopically the haversian canals are much larger than
in compact bone.
TYPES OF BONES (as per structure)
1. Long bones e.g. femur, radius, ulna, humerus, tibia, fibula.
2. Short bones e.g. Corpals (wrist bones), tarsals (ankle bones), phalangese.
3. Flat bones e.g. skull bones, rib bones, shoulder and hip bones.
4. Irregular bones e.g. Vertebrae, some skull bones, sphenoid, ethmoid bones and mandible
bones.
FUNCTIONS OF BONES
1. Bones provide framework (shape) to the body.
2. Bones gives attachment to muscles and ligaments
3. Bones helps in movement of the body.
4. Bones protect delicate (vital) organs of our body e.g. brain, heart, lungs and female
reproductive organs.
5. Blood cells are formed in the bone marrow (hemopoiesis)
6. Bones serve as a major reservoir for calcium (deposit and withdrawal).
7. Bones help in locomotion (movement).
DIVISION OF SKELETAL SYSTEM
Total bones in our body are 206.
Skeleton system is divided into two parts :
1. Axial skeleton (80 bones)
2. Appendicular skeleton (126 bones)
1. Axial skeleton :- Bones that form upright axis of the body and ear bones (6 bones) are
included in the axial skeleton system. There are 80 bones (including 6 ear bones) in axial
skeleton system.
Breakup of bones
I.
Axial Skeleton = 80 bones
1. Cranium bones
=8
Frontal bones
Parietal bone
Temporal bone
Occipital bone
Sphenoid bone
Ethmoid bone

-1
-2
-2
-1
-1
-1

CBHI ICD 10 Student Workbook January 2008 Page 233

2. Face bones

= 14

3. Ear bones

=6
Malleus
(3x3) Incus
Stapes

4. Hyoid bone

(neck) = 1

5. Vertebral column = 26

6. Chest sternum

=1

7. Ribs

= 24

II.

Nasal bones
Maxillary bones
Zygomatic (molar) bones
Mandible
Lacrimal bones
Palat (soft and hard)
Vomer bone
Inferior chonche
or forbinates

-2
-2
-2
-1
-2
-2
-1
-2

-2
-2
-2

Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacrum vertebrae
Coccyx vertebrae

-7
- 12
-5
-1
-1

True ribs
False fibs

- 7 pairs
- 5 pairs

Appendicular skeleton = 126 bones

It consists of upper and lower extremities.


1. Upper extremities = 64

Clavicle bones
Scapula bones
Humerus bones
Radium bones
Ulna bones
Carpals bones
Metacarpals bones
Phalanges bones

-2
-2
-2
-2
-2
- 16
- 10
- 28

2. Lower extremities = 62

Hip or innominate bones


Femur bones
Patella (knee bones)
Tibia bones
Fibula bones
Tarsals
Metatarsals
Phalanges

-2
-2
-2
-2
-2
- 14
- 10
- 28

CBHI ICD 10 Student Workbook January 2008 Page 234

JOINTS
Joint is the site at which any two or more bones comes together.
TYPES OF JOINTS
1. Fibrous of joints :- They have no movement e.g. skull between teeth maxilla and mandible.
2. Cartilaginous joints They have slight movements e.g. between body of vertibrae and
symphysis pubis.
3. Synovial joints They are freely movable joints. They are classified according to there range
of movements. Types of synovial joints are as under :
a) Ball and Socket joints e.g. Shoulder and hip joints.
b) Hinge joints e.g. elbow joint, knee joints, ankle joints, interphalangeal joints between atlas
and axis.
c) Gliding joints e.g. sternoclavicular joint, acramioclavicular joint, joint between capal and
tarsal bones.
d) Pivot joint e.g. radio-ulner joint between atlas and axis.
e) Condyloid and saddle joint e.g. wrist tempremandibular, metacarpo-phalangeal joints,
metalarso-phalangeal joints.

NERVOUS SYSTEM
Basic unit of nervous system is nerve cells or neuron
PARTS OF NEURON
a) The cell body or cyton
b) The dendrites
c) The tail of axon which is long tube like part
Nerve cells are found in the brain and spinal cord. Nerve cells are joined end to end forming long
nerve fibres. These nerve fibres forming a nerve.
TYPES OF NEURONS
1. Sensory neuron :- It carry impulses from the sense organs to the spinal cord and brain e.g.
optic nerve of the eyes.
2. Motor neuron : It carry impulses from the brain to spinal cord and then to the muscles or
glands.
FUNCTIONS OF NEURON
To conduct messages from one part of the body to the other. The message that travels along a
neuron is called an impulse.
TYPES OF NERVOUS SYSTEM
Nervous system has two parts :
1. Central Nervous System Consisting brain and spinal cord.
2. Peripheral Nervous System Consisting nerves (spinal cord) and brain (cranial nerves).
There are 31 pairs of spinal nerves and 12 pairs of cranial nerves.
Autonomic Nervous System It consists of nerve cells called ganglia. It contgrols the involuntary
muscles (which are not under control of our will) and vital functions of the heart, lungs and makes
them work harmoniously. This system always functions whether we sleep or awake.
CBHI ICD 10 Student Workbook January 2008 Page 235

MUSCLES
TYPES OF MUSCLES :
1. Voluntary muscles or skeletal muscles
2. Involuntary muscles or smooth or visceral muscles.
3. Cardiac muscles (found in heart only)
FUNCTIONS OF MUSCLES
1. Muscles give shape to our body.
2. By contraction and retraction they help in locomotion.
3. They help in storage of calcium, glucose and nutritional materials.
4. They help in lifting of weight (by stored energy in the muscles).

BRAIN
The brain is the main central centre of nervous system. It consists of 3 main centres cerebrum,
cerebellum and brain stem.
I. CEREBRUM
a) It is uppermost and largest part of the brain.
b) Its surface is thrown into grooves and ridges.
c) It is divided into right and left halves called right and left cerebral hemiphereses.
Functions of cerebrum
a) Controls mental activities like thinking and reasoning.
b) Centre for intelligence and memory.
c) Centre for perceiving pain, sound, touch, taste, smell etc.
II. CEREBELLUM
It is a small area located just under the cerebrum at the back of the head.
Functions :
a) Maintains balance of the body.
b) Coordinates musclar activity.
III. BRAIN STEM
It is the lowest part of the brain and joins the brain to the spinal cord. It has three parts i.e.
Medulla, Pons and Mid brain.
Functions
Controls the activity of internal organs like heartbeat, breathing etc.
VERTICLES OF BRAIN (Total = 14)
1. Two lateral verticles
2. Third lateral verticles
3. Fourth lateral verticles
Cerebrospinal fluid (CSF) is formed in ventricles.
SPINAL CORD
Spinal cord extends from the medulla of the brain and runs down through the whole length of
the vertebral column. A section through the spinal cord shows the following structure.

CBHI ICD 10 Student Workbook January 2008 Page 236

Functions
a) To conduct messages from the skin and muscles to the brain.
b) To conduct messages or commands from the brain to the muscles of the body trunk and
limbs.
Covering of the brain and spinal cord - Meningese
Meningese
1. Dura Mater Outer layer
2. Arachnoid Mater Middle layer
5. Pia Mater Inner layer

BURSAE
Bursae are small connective tissue sacs lined with synovial membrane and containing synovial
fluid e.g. between skin and bone
-

between tendon and bone


head of the humerous and acromion process and deltoid muscles
between patella and skin

Functions of the Bursae


1. They act as cushion
2. They relieve pressure between moving parts

LIGAMENTS
Ligaments are strong band of fibrous tissue. They give additional stability to the joints.
Ligaments of vertebrae
1. Anterior longitudinal ligament
2. Posterior longitudinal ligament
3. The ligamenta flova
4. Inter spinous ligaments
5. Supra spinous ligaments
6. Ligamentum Nuchae
7. Transverse ligaments
Ligaments of knee
1. Anterior cruciate ligament
2. Posterior cruciate ligament
3. Tibial collateral ligament
4. Fibular collateral ligament

CBHI ICD 10 Student Workbook January 2008 Page 237

MAMMARY GLANDS
Breasts:
Breasts are accessory glands of female reproductive system. There are 2 breasts situated on
chest cavity. Each breast consists of about 20 lobes and these lobes being made up of lobules,
consisting of cluster of Alveoli. These alveoli open into lactiferous duct, which opens into the
nipple.
This nipple is the projected part of the breast and is surrounded by pigmented area, which is
called areola and areola has sebaceous glands, which lubricate the nipple during lactation.
[ 20 lobes = lobules = alveoli = open into lactiferous duct
= open into nipple = projected part ]
Blood supplies by the branches of axillary arteries to the nipple, venous drainage by axillary &
mammary veins. Nerve supply by 4th, 5th & 6th Thoracic Nerves.
Function
After birth of baby, breast produce milk.

CBHI ICD 10 Student Workbook January 2008 Page 238

APPENDIX 2
Medical Terminology

CBHI ICD 10 Student Workbook January 2008 Page 239

MEDICAL TERMINOLOGY
1. DEFINITION, OBJECTIVES & VALUES
The Principle or fundamental method of building medical vocabulary consists breaking down
a word into three parts i.e. prefix, root and suffix. Each component has a distinct meaning.
a) Prefix:- In a word Intercostal, Inter Means between and Costa means ribs. Inter is the
prefix and costa is the root.
b) Suffix:- In the word Rhinitis, Rhin means nose, is the root and it is means inflammation
is the suffix.
c) Root:- There may be one unit in a word. If its meaning is complete without the addition of
prefix or suffix, it is a root word.
Medical Terminology may be defined as study of Medical Terms.
2. SCIENCE DEVOTED TO THE STUDY OF THE BODY
a) Anatomy: It is the study of structure of body and relationship of its parts.
b) Physiology: It is the study of normal functions and activities of the body.
c) Pathology: It is the study of the changes caused by disease in the structure or functions of the
body.
d) Embryology: It is the study of the development of the body from the ovum (female
reproductive cell) after union with the sperm (male reproductive cell)
e) Histology: It is the microscopic study of the minute structure, composition and function of
the normal cells and tissues.
f) Biology: It is the study of all forms of life.
3. MEDICAL SPECIALTIES
a) Pediatrics
b) Gynecology
c) Obstetrics .
d) Surgery
e) Otology
f) Laryngology
4. COLOURS & NUMBERS
S.No.

Term
ALBUS, LEUCO, LEUKO
CHLOROS
CIRRHOS
CYANO
ERYTHRO, RHODO,
RUBER
MELANO
POLIO
PORPHYRO
XANTHO

Meaning
White
Green
Orange - yellow
Blue
Red
Black
Gray particularly relating to the gray matter of the
nervous system
Purple
Yellow

CBHI ICD 10 Student Workbook January 2008 Page 240

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.

UNI, MONO
PRIMUS, PROTO, PROCT
SESQUI
SEMI, HEMI
DEUTERO, DEUTO,
SECUNDUS
DUO
DIS, DI
TRI
TERTIUS, TRITOS
TETRA, QUADRI
PENT, PENTA, QUINQUE,
QUINTUS
HEX, HEXA, SEX
HEPT, HEPTA, SEPTEM
OCTO
NONUS
CENTI
HEC, HECTO
MILLI
KILO

One, Single
First
One and a half
One half
Second
Two
Twice or duplicate
Three or thrice
Third
Four or four folds
Five, Fifth
Six
Seven
Eight
Nine or Ninth
Hundred or Hundredth part
One Hundred
One Thousand part
One Thousand

5. PREFIXES
(Few examples)
S.No. Prefix

Meaning

Medical Term

A (AN
BEFORE
VOWEL

Without, lack of

Anemia
Apnea

Meaning of Medical
Term
Lack of blood
Without breath

AB, APO

Away from

ANTE

Before, forward

ANTI
CONTRA

against
Opposite
Against
Across,
Through, beyond
Beyond,
In excess

Aboral
Aponeurosis
Antecubital
Ante flexion
Anti sepsis
Contraception

Away from mouth


Away from tendon
Before elbow
Forward bending
Against infection
Prevention of conception

Transectin

Cut across

Ultraviolet

Beyond violet
End of spectrum

TRANS
ULTRA

CBHI ICD 10 Student Workbook January 2008 Page 241

6. PREFIXES
(Few examples)
S. No.
1.

Prefix
AGO, IGO

Meaning
Disease

Medical Term
Lumbago
Impetigo

Hematuria
Osteonecrosis
Osteosclerosis

Meaning of Medical Term


Lumber disease
Acute inflammatory
Skin disease
Inflammation of the appendix
Pathological Drinking of
alcohol
Presence of blood in the urine
Death of a bone
Hardening of bone

2.
3.

IT IS
MANIA

Inflammation
Madness

Appendicitis
Dipsomania

4.
5.
6.

URIA
In the urine
NECROSIS Death
SCLEROSIS Hardening

Medical Term
Hymenotomy

Meaning of Medical Term


Incision of Hymen

Rhinoplasty

Plastic repair of nose

Myostasis

Stretching of muscles

7. OPERATIVE SUFFIXES
(Few examples)
S.No.
1.

Prefix
OTOMY

2.

PLASTY

3.

TASIS

Meaning
Incision
Cutting up
Repair
Plastic repair
stretching

8. ROOTS
a) SKELETAL SYSTEM:
(Few examples)
S.No.
1.
2.
3.
4.
5.

Root
ARTHRON
CARPUS
MYO
MYELOS
SPONDYLOS, RACHI

Meaning
Joints
Wrist
Muscles
Marrow of spine
Vertebra (Spinal bone)

Integumentary System
(skin, breast, sweat gland, mammary gland, hair and nail)
(Few examples)
S.No.
1.
DERMA (IN GREEK)
CUTIS (IN LATIN)
2.
MAMMA, MAST

Skin
Nipple

Respiratory System
S.No.
1.
PNEUMON
2.
RHIN

Lungs
Nose

CBHI ICD 10 Student Workbook January 2008 Page 242

Gastro Intestinal System


S.No.
1.
STOMA
2.
HEPAT
3.
GINGIVA

Mouth
Liver
Gum

Endocrine System
S.No.
1.
GOITER

Thyroid

Genito Urinary System


S.No.
1.
RENAL, NEPHR

Kidney

Nervous System
S.No.
1.
Neuron

nerve

Special senses System


S.No.
1.
OPSIS
2.
OTO

Vision
Ear

Circulatory & Lymphatic System


S.No.
1.
ANGION
2.
HEM

Vessal
Blood

CBHI ICD 10 Student Workbook January 2008 Page 243

APPENDIX 3
List of Three character categories have been updated as per WHO
FLE Network updates 2007
For codes upto 5 Character categories as well as their updates revision (year 2007).
Please refer website www.who.int /classification/en

CBHI ICD 10 Student Workbook January 2008 Page 244

Chapter I
Certain infectious and parasitic diseases
~
(0099)
~
Intestinal infectious diseases (A00A09)
A00
Cholera
A01
Typhoid and paratyphoid fevers
A02
Other salmonella infections
A03
Shigellosis
A04
Other bacterial intestinal infections
A05
Other bacterial foodborne intoxications
A06
Amoebiasis
A07
Other protozoal intestinal diseases
A08
Viral and other specified intestinal infections
A09
Diarrhoea and gastroenteritis of presumed infectious origin
~
Tuberculosis (A15A19)
A15
Respiratory tuberculosis, bacteriologically and histologically confirmed
A16
Respiratory tuberculosis, not confirmed bacteriologically or histologically
A17 Tuberculosis of nervous system
A18
Tuberculosis of other organs
A19
Miliary tuberculosis
~
Certain zoonotic bacterial diseases (A20A28)
A20
Plague
A21
Tularaemia
A22
Anthrax
A23
Brucellosis
A24
Glanders and melioidosis
A25
Rat-bite fevers
A26
Erysipeloid
A27
Leptospirosis
A28
Other zoonotic bacterial diseases, not elsewhere classified
~
Other bacterial diseases (A30 A49)
A30
Leprosy [Hansen's disease]
A31
Infection due to other mycobacteria
A32
Listeriosis
A33
Tetanus neonatorum
A34
Obstetrical tetanus
A35
Other tetanus
A36
Diphtheria
A37
Whooping cough
A38
Scarlet fever
A39
Meningococcal infection
A40
Streptococcal septicaemia
A41
Other septicaemia
A42
Actinomycosis
A43
Nocardiosis
A44
Bartonellosis
A46
Erysipelas
A48
Other bacterial diseases, not elsewhere classified
A49
Bacterial infection of unspecified site
CBHI ICD 10 Student Workbook January 2008 Page 245

~
Infections with a predominantly sexual mode of transmission (A50A64)
A50
Congenital syphilis
A51
Early syphilis
A52
Late syphilis
A53
Other and unspecified syphilis
A54
Gonococcal infection
A55
Chlamydial lymphogranuloma (venereum)
A56
Other sexually transmitted chlamydial diseases
A57
Chancroid
A58
Granuloma inguinale
A59
Trichomoniasis
A60
Anogenital herpesviral [herpes simplex] infection
A63
Other predominantly sexually transmitted diseases, not elsewhere classified
A64
Unspecified sexually transmitted disease
~
Other spirochaetal diseases (A65A69)
A65
Nonvenereal syphilis
A66
Yaws
A67
Pinta [carate]
A68
Relapsing fevers
A69
Other spirochaetal infections
~
Other diseases caused by chlamydiae (A70A64)
70
Chlamydia psittaci infection
A71
Trachoma
A74
Other diseases caused by chlamydiae
~
Rickettsioses (A75A79)
A75
Typhus fever
A77
Spotted fever [tick-borne rickettsioses]
A78
Q fever
A79
Other rickettsioses
~
Viral infections of the central nervous system (A80A89)
A80
Acute poliomyelitis
A81
Atypical virus infections of central nervous system
A82
Rabies
A83
Mosquito-borne viral encephalitis
A84
Tick-borne viral encephalitis
A85
Other viral encephalitis, not elsewhere classified
A86
Unspecified viral encephalitis
A87
Viral meningitis
A88
Other viral infections of central nervous system, not elsewhere classified
A89
Unspecified viral infection of central nervous system
~
Arthropod-borne viral fevers and viral haemorrhagic fevers (A90A99)
A90
Dengue fever [classical dengue]
A91
Dengue haemorrhagic fever
A92
Other mosquito-borne viral fevers
A93
Other arthropod-borne viral fevers, not elsewhere classified
A94
Unspecified arthropod-borne viral fever
A95
Yellow fever
A96
Arenaviral haemorrhagic fever
CBHI ICD 10 Student Workbook January 2008 Page 246

~
~

A98
A99

Other viral haemorrhagic fevers, not elsewhere classified


Unspecified viral haemorrhagic fever

~
Viral infections characterized by skin and mucous membrane lesions (B00B09)
B00
Herpesviral [herpes simplex] infections
B01
Varicella [chickenpox]
B02
Zoster [herpes zoster]
B03
Smallpox
B04
Monkeypox
B05
Measles
B06
Rubella [German measles]
B07
Viral warts
B08
Other viral infections characterized by skin and mucous membrane lesions, not elsewhere
classified
B09
Unspecified viral infection characterized by skin and mucous membrane lesions
~
Viral hepatitis (B15B19)
B15
Acute hepatitis A
B16
Acute hepatitis B
B17
Other acute viral hepatitis
B18
Chronic viral hepatitis
B19
Unspecified viral hepatitis
~
Human immunodeficiency virus [HIV] disease (B20B24)
B20
Human immunodeficiency virus [HIV] disease resulting in infectious and parasitic
diseases
B21
Human immunodeficiency virus [HIV] disease resulting in malignant neoplasms
B22
Human immunodeficiency virus [HIV] disease resulting in other specified diseases
B23
Human immunodeficiency virus [HIV] disease resulting in other conditions
B24
Unspecified human immunodeficiency virus [HIV] disease
~
Other viral diseases (B25B34)
B25
Cytomegaloviral disease
B26
Mumps
B27
Infectious mononucleosis
B30
Viral conjunctivitis
B33
Other viral diseases, not elsewhere classified
B34
Viral infection of unspecified site
~
Mycoses (B35B49)
B35
Dermatophytosis
B36
Other superficial mycoses
B37
Candidiasis
B38
Coccidioidomycosis
B39
Histoplasmosis
B40
Blastomycosis
B41
Paracoccidioidomycosis
B42
Sporotrichosis
B43
Chromomycosis and phaeomycotic abscess
B44
Aspergillosis
B45
Cryptococcosis
B46
Zygomycosis
B47
Mycetoma

CBHI ICD 10 Student Workbook January 2008 Page 247

B48
B49

Other mycoses, not elsewhere classified


Unspecified mycosis
~
Protozoal diseases (B50B64)
B50
Plasmodium falciparum malaria
B51
Plasmodium vivax malaria
B52
Plasmodium malariae malaria
B53
Other parasitologically confirmed malaria
B54
Unspecified malaria
B55
Leishmaniasis
B56
African trypanosomiasis
B57
Chagas' disease
B58
Toxoplasmosis
B59 Pneumocystosis
B60
Other protozoal diseases, not elsewhere classified
B64
Unspecified protozoal disease
~
Helminthiases (B65B83)
Schistosomiasis [bilharziasis]
B65
Other fluke infections
B66
Echinococcosis
B67
Taeniasis
B68
Cysticercosis
B69
Diphyllobothriasis and sparganosis
B70
Other cestode infections
B71
Dracunculiasis
B72
Onchocerciasis
B73
Filariasis
B74
Trichinellosis
B75
Hookworm diseases
B76
Ascariasis
B77
Strongyloidiasis
B78
Trichuriasis
B79
Enterobiasis
B80
Other intestinal helminthiases, not elsewhere classified
B81
Unspecified intestinal parasitism
B82
Other helminthiases
B83
~
Pediculosis, acariasis and other infestations (B85B89)
B85
Pediculosis and phthiriasis
B86
Scabies
B87
Myiasis
B88
Other infestations
B89
Unspecified parasitic disease
~
Sequelae of infectious and parasitic diseases (B90B94)
B90
Sequelae of tuberculosis
B91
Sequelae of poliomyelitis
B92
Sequelae of leprosy
B94
Sequelae of other and unspecified infectious and parasitic diseases

CBHI ICD 10 Student Workbook January 2008 Page 248

~
Bacterial, viral and other infectious agents (B95B97)
B95
Streptococcus and staphylococcus as the cause of diseases classified to other chapters
B96
Other bacterial agents as the cause of diseases classified to other chapters
B97
Viral agents as the cause of diseases classified to other chapters
Other infectious diseases (B99)
B99

Other and unspecified infectious diseases

Chapter II
Neoplasms
~
(C00D48)
~
Malignant neoplasms (C00C97)
~
Malignant neoplasms of lip, oral cavity and pharynx (C00C14)
C00
Malignant neoplasm of lip
C01
Malignant neoplasm of base of tongue
C02
Malignant neoplasm of other and unspecified parts of tongue
C03
Malignant neoplasm of gum
C04
Malignant neoplasm of floor of mouth
C05
Malignant neoplasm of palate
C06
Malignant neoplasm of other and unspecified parts of mouth
C07
Malignant neoplasm of parotid gland
C08
Malignant neoplasm of other and unspecified major salivary glands
C09
Malignant neoplasm of tonsil
C10
Malignant neoplasm of oropharynx
C11
Malignant neoplasm of nasopharynx
C12
Malignant neoplasm of piriform sinus
C13
Malignant neoplasm of hypopharynx
C14
Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx
~
Malignant neoplasms of digestive organs (C15C26)
C15
Malignant neoplasm of oesophagus
C16
Malignant neoplasm of stomach
C17
Malignant neoplasm of small intestine
C18
Malignant neoplasm of colon
C19
Malignant neoplasm of rectosigmoid junction
C20
Malignant neoplasm of rectum
C21
Malignant neoplasm of anus and anal canal
C22
Malignant neoplasm of liver and intrahepatic bile ducts
C23
Malignant neoplasm of gallbladder
C24
Malignant neoplasm of other and unspecified parts of biliary tract
C25
Malignant neoplasm of pancreas
C26
Malignant neoplasm of other and ill-defined digestive organs
~
Malignant neoplasms of respiratory and intrathoracic organs (C30C39)
C30
Malignant neoplasm of nasal cavity and middle ear
C31
Malignant neoplasm of accessory sinuses
C32
Malignant neoplasm of larynx
C33
Malignant neoplasm of trachea
C34
Malignant neoplasm of bronchus and lung
C37
Malignant neoplasm of thymus
CBHI ICD 10 Student Workbook January 2008 Page 249

C38
C39

Malignant neoplasm of heart, mediastinum and pleura


Malignant neoplasm of other and ill-defined sites in the respiratory system and
intrathoracic organs
~
Malignant neoplasms of bone and articular cartilage (C40C41)
C40
Malignant neoplasm of bone and articular cartilage of limbs
C41
Malignant neoplasm of bone and articular cartilage of other and unspecified sites
~
Melanoma and other malignant neoplasms of skin (C43C44)
C43
Malignant melanoma of skin
C44
Other malignant neoplasms of skin
~
Malignant neoplasms of mesothelial and soft tissue (C45C49)
C45
Mesothelioma
C46
Kaposi's sarcoma
C47
Malignant neoplasm of peripheral nerves and autonomic nervous system
C48
Malignant neoplasm of retroperitoneum and peritoneum
C49
Malignant neoplasm of other connective and soft tissue
Malignant neoplasm of breast (C50)
C50
Malignant neoplasm of breast

~
Malignant neoplasms of female genital organs (C51C58)
C51
Malignant neoplasm of vulva
C52
Malignant neoplasm of vagina
C53
Malignant neoplasm of cervix uteri
C54
Malignant neoplasm of corpus uteri
C55
Malignant neoplasm of uterus, part unspecified
C56
Malignant neoplasm of ovary
C57
Malignant neoplasm of other and unspecified female genital organs
C58
Malignant neoplasm of placenta
~
Malignant neoplasms of male genital organs (C60C63)
C60
Malignant neoplasm of penis
C61
Malignant neoplasm of prostate
C62
Malignant neoplasm of testis
C63
Malignant neoplasm of other and unspecified male genital organs
~
Malignant neoplasms of urinary tract (C64C68)
C64
Malignant neoplasm of kidney, except renal pelvis
C65
Malignant neoplasm of renal pelvis
C66
Malignant neoplasm of ureter
C67
Malignant neoplasm of bladder
C68
Malignant neoplasm of other and unspecified urinary organs
~
Malignant neoplasms of eye, brain and other parts of central nervous system (C69C72)
C69
Malignant neoplasm of eye and adnexa
C70
Malignant neoplasm of meninges
C71
Malignant neoplasm of brain
C72
Malignant neoplasm of spinal cord, cranial nerves and other parts of central nervous
system

CBHI ICD 10 Student Workbook January 2008 Page 250

Malignant neoplasms of thyroid and other endocrine glands (C73C75)


C73
Malignant neoplasm of thyroid gland
C74
Malignant neoplasm of adrenal gland
C75
Malignant neoplasm of other endocrine glands and related structures
~
Malignant neoplasms of ill-defined, secondary and unspecified sites (C76C80)
C76
Malignant neoplasm of other and ill-defined sites
C77
Secondary and unspecified malignant neoplasm of lymph nodes
C78
Secondary malignant neoplasm of respiratory and digestive organs
C79
Secondary malignant neoplasm of other sites
C80
Malignant neoplasm without specification of site
~
Malignant neoplasms of lymphoid, haematopoietic and related tissue (C81C96)
C81
Hodgkin's disease
C82
Follicular [nodular] non-Hodgkin's lymphoma
C83
Diffuse non-Hodgkin's lymphoma
C84
Peripheral and cutaneous T-cell lymphomas
C85
Other and unspecified types of non-Hodgkin's lymphoma
C88
Malignant immunoproliferative diseases
C90
Multiple myeloma and malignant plasma cell neoplasms
C91
Lymphoid leukaemia
C92
Myeloid leukaemia
C93
Monocytic leukaemia
C94
Other leukaemias of specified cell type
C95
Leukaemia of unspecified cell type
C96
Other and unspecified malignant neoplasms of lymphoid, haematopoietic and related
tissue
Malignant neoplasms of independent (primary) multiple sites (C97)
C97
Malignant neoplasms of independent (primary) multiple sites
~
In situ neoplasms (D00D09)
D00
Carcinoma in situ of oral cavity, oesophagus and stomach
D01
Carcinoma in situ of other and unspecified digestive organs
D02
Carcinoma in situ of middle ear and respiratory system
D03
Melanoma in situ
D04
Carcinoma in situ of skin
D05
Carcinoma in situ of breast
D06
Carcinoma in situ of cervix uteri
D07
Carcinoma in situ of other and unspecified genital organs
D09
Carcinoma in situ of other and unspecified sites
~
Benign neoplasms (D10D36)
D10
Benign neoplasm of mouth and pharynx
D11
Benign neoplasm of major salivary glands
D12
Benign neoplasm of colon, rectum, anus and anal canal
D13
Benign neoplasm of other and ill-defined parts of digestive system
D14
Benign neoplasm of middle ear and respiratory system
D15
Benign neoplasm of other and unspecified intrathoracic organs
D16
Benign neoplasm of bone and articular cartilage
D17
Benign lipomatous neoplasm
D18
Haemangioma and lymphangioma, any site
D19
Benign neoplasm of mesothelial tissue
D20
Benign neoplasm of soft tissue of retroperitoneum and peritoneum
CBHI ICD 10 Student Workbook January 2008 Page 251

D21
D22
D23
D24
D25
D26
D27
D28
D29
D30
D31
D32
D33
D34
D35
D36

Other benign neoplasms of connective and other soft tissue


Melanocytic naevi
Other benign neoplasms of skin
Benign neoplasm of breast
Leiomyoma of uterus
Other benign neoplasms of uterus
Benign neoplasm of ovary
Benign neoplasm of other and unspecified female genital organs
Benign neoplasm of male genital organs
Benign neoplasm of urinary organs
Benign neoplasm of eye and adnexa
Benign neoplasm of meninges
Benign neoplasm of brain and other parts of central nervous system
Benign neoplasm of thyroid gland
Benign neoplasm of other and unspecified endocrine glands
Benign neoplasm of other and unspecified sites
~
Neoplasms of uncertain or unknown behaviour (D37D48)
D37
Neoplasm of uncertain or unknown behaviour of oral cavity and digestive organs
D38
Neoplasm of uncertain or unknown behaviour of middle ear and respiratory and
intrathoracic organs
D39
Neoplasm of uncertain or unknown behaviour of female genital organs
D40
Neoplasm of uncertain or unknown behaviour of male genital organs
D41
Neoplasm of uncertain or unknown behaviour of urinary organs
D42
Neoplasm of uncertain or unknown behaviour of meninges
D43
Neoplasm of uncertain or unknown behaviour of brain and central nervous system
D44
Neoplasm of uncertain or unknown behaviour of endocrine glands
D45
Polycythaemia vera
D46
Myelodysplastic syndromes
D47
Other neoplasms of uncertain or unknown behaviour of lymphoid, haematopoietic and
related tissue
D48
Neoplasm of uncertain or unknown behaviour of other and unspecified sites
Chapter III
Diseases of the blood and blood-forming organs and certain disorders involving the immune
mechanism
~
(D50D89)
~
Nutritional anaemias (D50D53)
D50
Iron deficiency anaemia
D51
Vitamin B12 deficiency anaemia
D52
Folate deficiency anaemia
D53
Other nutritional anaemias
~
Haemolytic anaemias (D55D59)
D55
Anaemia due to enzyme disorders
D56
Thalassaemia
D57
Sickle-cell disorders
D58
Other hereditary haemolytic anaemias
D59
Acquired haemolytic anaemia

CBHI ICD 10 Student Workbook January 2008 Page 252

~
Aplastic and other anaemias (D60?
D64)
D60
Acquired pure red cell aplasia [erythroblastopenia]
D61
Other aplastic anaemias
D62
Acute posthaemorrhagic anaemia
D63? Anaemia in chronic diseases classified elsewhere
D64
Other anaemias

~
Coagulation defects, purpura and other haemorrhagic conditions (D65?D69)
D65
Disseminated intravascular coagulation [defibrination syndrome]
D66
Hereditary factor VIII deficiency
D67
Hereditary factor IX deficiency
D68
Other coagulation defects
D69
Purpura and other haemorrhagic conditions
~
Other diseases of blood and blood-forming organs (D70?D77)
D70
Agranulocytosis
D71
Functional disorders of polymorphonuclear neutrophils
D72
Other disorders of white blood cells
D73
Diseases of spleen
D74
Methaemoglobinaemia
D75
Other diseases of blood and blood-forming organs
D76
Certain diseases involving lymphoreticular tissue and reticulohistiocytic system
D77? Other disorders of blood and blood-forming organs in diseases classified elsewhere
~
Certain disorders involving the immune mechanism (D80?
D89)
D80
Immunodeficiency with predominantly antibody defects
D81
Combined immunodeficiencies
D82
Immunodeficiency associated with other major defects
D83
Common variable immunodeficiency
D84
Other immunodeficiencies
D86
Sarcoidosis
D89
Other disorders involving the immune mechanism, not elsewhere classified
Chapter IV
Endocrine,
nutritional and metabolic diseases
~
(E00?E90)
~
Disorders of thyroid gland (E00?E07)
E00
Congenital iodine-deficiency syndrome
E01
Iodine-deficiency-related thyroid disorders and allied conditions
E02
Subclinical iodine-deficiency hypothyroidism
E03
Other hypothyroidism
E04
Other nontoxic goitre
E05
Thyrotoxicosis [hyperthyroidism]
E06
Thyroiditis
E07
Other disorders of thyroid
~
Diabetes mellitus (E10?
E14)
E10
Insulin-dependent diabetes mellitus
E11
Non-insulin-dependent diabetes mellitus
E12
Malnutrition-related diabetes mellitus
E13
Other specified diabetes mellitus
E14
Unspecified diabetes mellitus
CBHI ICD 10 Student Workbook January 2008 Page 253

~
Other disorders of glucose regulation and pancreatic internal secretion (E15?E16)
E15
Nondiabetic hypoglycaemic coma
E16
Other disorders of pancreatic internal secretion
~
Disorders of other endocrine glands (E20?
E35)
E20
Hypoparathyroidism
E21
Hyperparathyroidism and other disorders of parathyroid gland
E22
Hyperfunction of pituitary gland
E23
Hypofunction and other disorders of pituitary gland
E24
Cushing's syndrome
E25
Adrenogenital disorders
E26
Hyperaldosteronism
E27
Other disorders of adrenal gland
E28
Ovarian dysfunction
E29
Testicular dysfunction
E30
Disorders of puberty, not elsewhere classified
E31
Polyglandular dysfunction
E32
Diseases of thymus
E34
Other endocrine disorders
E35? Disorders of endocrine glands in diseases classified elsewhere
~
Malnutrition (E40?E46)
E40
Kwashiorkor
E41
Nutritional marasmus
E42
Marasmic kwashiorkor
E43
Unspecified severe protein-energy malnutrition
E44
Protein-energy malnutrition of moderate and mild degree
E45
Retarded development following protein-energy malnutrition
E46
Unspecified protein-energy malnutrition
~
Other nutritional deficiencies (E50?E64)
E50
Vitamin A deficiency
E51
Thiamine deficiency
E52
Niacin deficiency [pellagra]
E53
Deficiency of other B group vitamins
E54
Ascorbic acid deficiency
E55
Vitamin D deficiency
E56
Other vitamin deficiencies
E58
Dietary calcium deficiency
E59
Dietary selenium deficiency
E60
Dietary zinc deficiency
E61
Deficiency of other nutrient elements
E63
Other nutritional deficiencies
E64
Sequelae of malnutrition and other nutritional deficiencies
~
Obesity and other hyperalimentation (E65?E68)
E65
Localized adiposity
E66
Obesity
E67
Other hyperalimentation
E68
Sequelae of hyperalimentation
~
Metabolic disorders (E70?E90)
E70
Disorders of aromatic amino-acid metabolism
E71
Disorders of branched-chain amino-acid metabolism and fatty-acid metabolism
CBHI ICD 10 Student Workbook January 2008 Page 254

E72
E73
E74
E75
E76
E77
E78
E79
E80
E83
E84
E85
E86
E87
E88
E89
E90?

Other disorders of amino-acid metabolism


Lactose intolerance
Other disorders of carbohydrate metabolism
Disorders of sphingolipid metabolism and other lipid storage disorders
Disorders of glycosaminoglycan metabolism
Disorders of glycoprotein metabolism
Disorders of lipoprotein metabolism and other lipidaemias
Disorders of purine and pyrimidine metabolism
Disorders of porphyrin and bilirubin metabolism
Disorders of mineral metabolism
Cystic fibrosis
Amyloidosis
Volume depletion
Other disorders of fluid, electrolyte and acid-base balance
Other metabolic disorders
Postprocedural endocrine and metabolic disorders, not elsewhere classified
Nutritional and metabolic disorders in diseases classified elsewhere

Chapter V
Mental and behavioural disorders
~
(F00?F99)
~
Organic, including symptomatic, mental disorders (F00?F09)
F00? Dementia in Alzheimer's disease
F01
Vascular dementia
F02? Dementia in other diseases classified elsewhere
F03
Unspecified dementia
F04
Organic amnesic syndrome, not induced by alcohol and other psychoactive substances
F05
Delirium, not induced by alcohol and other psychoactive substances
F06
Other mental disorders due to brain damage and dysfunction and to physical disease
F07
Personality and behavioural disorders due to brain disease, damage and dysfunction
F09
Unspecified organic or symptomatic mental disorder
~
Mental and behavioural disorders due to psychoactive substance use (F10?F19)
F10
Mental and behavioural disorders due to use of alcohol
F11
Mental and behavioural disorders due to use of opioids
F12
Mental and behavioural disorders due to use of cannabinoids
F13
Mental and behavioural disorders due to use of sedatives or hypnotics
F14
Mental and behavioural disorders due to use of cocaine
F15
Mental and behavioural disorders due to use of other stimulants, including caffeine
F16
Mental and behavioural disorders due to use of hallucinogens
F17
Mental and behavioural disorders due to use of tobacco
F18
Mental and behavioural disorders due to use of volatile solvents
F19
Mental and behavioural disorders due to multiple drug use and use of other psychoactive
substances
~
Schizophrenia, schizotypal and delusional disorders (F20?F29)
F20
Schizophrenia
F21
Schizotypal disorder
F22
Persistent delusional disorders
F23
Acute and transient psychotic disorders
F24
Induced delusional disorder
CBHI ICD 10 Student Workbook January 2008 Page 255

F25
F28
F29

Schizoaffective disorders
Other nonorganic psychotic disorders
Unspecified nonorganic psychosis
~
Mood [affective] disorders (F30?F39)
F30
Manic episode
F31
Bipolar affective disorder
F32
Depressive episode
F33
Recurrent depressive disorder
F34
Persistent mood [affective] disorders
F38
Other mood [affective] disorders
F39
Unspecified mood [affective] disorder

~
Neurotic, stress-related and somatoform disorders (F40?F48)
F40
Phobic anxiety disorders
F41
Other anxiety disorders
F42
Obsessive-compulsive disorder
F43
Reaction to severe stress, and adjustment disorders
F44
Dissociative [conversion] disorders
F45
Somatoform disorders
F48
Other neurotic disorders
Behavioural syndromes associated with physiological disturbances and physical factors
~
(F50?F59)
F50
Eating disorders
F51
Nonorganic sleep disorders
F52
Sexual dysfunction, not caused by organic disorder or disease
F53
Mental and behavioural disorders associated with the puerperium, not elsewhere classified
F54
Psychological and behavioural factors associated with disorders or diseases classified
elsewhere
F55
Abuse of non-dependence-producing substances
F59
Unspecified behavioural syndromes associated with physiological disturbances and
physical factors
~
Disorders of adult personality and behaviour (F60?F69)
F60
Specific personality disorders
F61
Mixed and other personality disorders
F62
Enduring personality changes, not attributable to brain damage and disease
F63
Habit and impulse disorders
F64
Gender identity disorders
F65
Disorders of sexual preference
F66
Psychological and behavioural disorders associated with sexual development and
orientation
F68
Other disorders of adult personality and behaviour
F69
Unspecified disorder of adult personality and behaviour
~
Mental retardation (F70?F79)
F70
Mild mental retardation
F71
Moderate mental retardation
F72
Severe mental retardation
F73
Profound mental retardation
F78
Other mental retardation
F79
Unspecified mental retardation

CBHI ICD 10 Student Workbook January 2008 Page 256

~
Disorders of psychological development (F80?F89)
F80
Specific developmental disorders of speech and language
F81
Specific developmental disorders of scholastic skills
F82
Specific developmental disorder of motor function
F83
Mixed specific developmental disorders
F84
Pervasive developmental disorders
F88
Other disorders of psychological development
F89
Unspecified disorder of psychological development
Behavioural and emotional disorders with onset usually occurring in childhood and
~
adolescence (F90?F98)
F90
Hyperkinetic disorders
F91
Conduct disorders
F92
Mixed disorders of conduct and emotions
F93
Emotional disorders with onset specific to childhood
F94
Disorders of social functioning with onset specific to childhood and adolescence
F95
Tic disorders
F98
Other behavioural and emotional disorders with onset usually occurring in childhood and
adolescence
Unspecified mental disorder (F99)
F99
Mental disorder, not otherwise specified
Chapter VI
Diseases of the nervous system
~
(G00?G99)
~
Inflammatory diseases of the central nervous system (G00?G09)
G00
Bacterial meningitis, not elsewhere classified
G01? Meningitis in bacterial diseases classified elsewhere
G02? Meningitis in other infectious and parasitic diseases classified elsewhere
G03
Meningitis due to other and unspecified causes
G04
Encephalitis, myelitis and encephalomyelitis
G05? Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere
G06
Intracranial and intraspinal abscess and granuloma
G07? Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere
G08
Intracranial and intraspinal phlebitis and~thrombophlebitis
G09
Sequelae of inflammatory diseases of central nervous system
~
Systemic atrophies primarily affecting the central nervous system (G10?G13)
G10
Huntington's disease
G11
Hereditary ataxia
G12
Spinal muscular atrophy and related syndromes
G13? Systemic atrophies primarily affecting central nervous system in diseases classified
elsewhere
~
Extrapyramidal and movement disorders (G20?G26)
G20
Parkinson's disease
G21
Secondary parkinsonism
G22? Parkinsonism in diseases classified elsewhere
G23
Other degenerative diseases of basal ganglia
G24
Dystonia
G25
Other extrapyramidal and movement disorders
G26? Extrapyramidal and movement disorders in diseases classified elsewhere
CBHI ICD 10 Student Workbook January 2008 Page 257

~
Other degenerative diseases of the nervous system (G30?G32)
G30
Alzheimer's disease
G31
Other degenerative diseases of nervous system, not elsewhere classified
G32? Other degenerative disorders of nervous system in diseases classified elsewhere
~
Demyelinating diseases of the central nervous system (G35?G37)
G35
Multiple sclerosis
G36
Other acute disseminated demyelination
G37
Other demyelinating diseases of central nervous system
~
Episodic and paroxysmal disorders (G40?G47)
G40
Epilepsy
G41
Status epilepticus
G43
Migraine
G44
Other headache syndromes
G45
Transient cerebral ischaemic attacks and related syndromes
G46? Vascular syndromes of brain in cerebrovascular diseases
G47
Sleep disorders
~
Nerve, nerve root and plexus disorders (G50?G59)
G50
Disorders of trigeminal nerve
G51
Facial nerve disorders
G52
Disorders of other cranial nerves
G53? Cranial nerve disorders in diseases classified elsewhere
G54
Nerve root and plexus disorders
G55? Nerve root and plexus compressions in diseases classified elsewhere
G56
Mononeuropathies of upper limb
G57
Mononeuropathies of lower limb
G58
Other mononeuropathies
G59? Mononeuropathy in diseases classified elsewhere
~
Polyneuropathies and other disorders of the peripheral nervous system (G60?G64)
G60
Hereditary and idiopathic neuropathy
G61
Inflammatory polyneuropathy
G62
Other polyneuropathies
G63? Polyneuropathy in diseases classified elsewhere
G64
Other disorders of peripheral nervous system
~
Diseases of myoneural junction and muscle (G70?G73)
G70
Myasthenia gravis and other myoneural disorders
G71
Primary disorders of muscles
G72
Other myopathies
G73? Disorders of myoneural junction and muscle in diseases classified elsewhere
~
Cerebral palsy and other paralytic syndromes (G80?G83)
G80
Infantile cerebral palsy
G81
Hemiplegia
G82
Paraplegia and tetraplegia
G83
Other paralytic syndromes
~
Other disorders of the nervous system (G90?G99)
G90
Disorders of autonomic nervous system
G91
Hydrocephalus
G92
Toxic encephalopathy
CBHI ICD 10 Student Workbook January 2008 Page 258

G93
G94?
G95
G96
G97
G98
G99?

Other disorders of brain


Other disorders of brain in diseases classified elsewhere
Other diseases of spinal cord
Other disorders of central nervous system
Postprocedural disorders of nervous system, not elsewhere classified
Other disorders of nervous system, not elsewhere classified
Other disorders of nervous system in diseases classified elsewhere

Chapter VII
Diseases
of the eye and adnexa
~
(H00?
H59)
~
Disorders of eyelid, lacrimal system and orbit (H00?
H06)
H00
Hordeolum and chalazion
H01
Other inflammation of eyelid
H02
Other disorders of eyelid
H03? Disorders of eyelid in diseases classified elsewhere
H04
Disorders of lacrimal system
H05
Disorders of orbit
H06? Disorders of lacrimal system and orbit in diseases classified elsewhere
~
Disorders of conjunctiva (H10?
H13)
H10
Conjunctivitis
H11
Other disorders of conjunctiva
H13? Disorders of conjunctiva in diseases classified elsewhere
~
Disorders of sclera, cornea, iris and ciliary body (H15?
H22)
H15
Disorders of sclera
H16
Keratitis
H17
Corneal scars and opacities
H18
Other disorders of cornea
H19? Disorders of sclera and cornea in diseases classified elsewhere
H20
Iridocyclitis
H21
Other disorders of iris and ciliary body
H22? Disorders of iris and ciliary body in diseases classified elsewhere
~
Disorders of lens (H25?
H28)
H25
Senile cataract
H26
Other cataract
H27
Other disorders of lens
H28? Cataract and other disorders of lens in diseases classified elsewhere
~
Disorders of choroid and retina (H30?H36)
H30
Chorioretinal inflammation
H31
Other disorders of choroid
H32? Chorioretinal disorders in diseases classified elsewhere
H33
Retinal detachments and breaks
H34
Retinal vascular occlusions
H35
Other retinal disorders
H36? Retinal disorders in diseases classified elsewhere
~
Glaucoma (H40?
H42)
H40
Glaucoma
H42? Glaucoma in diseases classified elsewhere
CBHI ICD 10 Student Workbook January 2008 Page 259

~
Disorders of vitreous body and globe (H43?H45)
H43
Disorders of vitreous body
H44
Disorders of globe
H45? Disorders of vitreous body and globe in diseases classified elsewhere
~
Disorders of optic nerve and visual pathways (H46?
H48)
H46
Optic neuritis
H47
Other disorders of optic [2nd] nerve and visual pathways
H48? Disorders of optic [2nd] nerve and visual~ pathways in diseases classified elsewhere
~
Disorders of ocular muscles, binocular movement, accommodation and refraction (H49?
H52)
H49
Paralytic strabismus
H50
Other strabismus
H51
Other disorders of binocular movement
H52
Disorders of refraction and accommodation
~
Visual disturbances and blindness (H53?H54)
H53
Visual disturbances
H54 Visual impairment including blindness (binocular or nonocular)
~
Other disorders of eye and adnexa (H55?H59)
H55
Nystagmus and other irregular eye movements
H57
Other disorders of eye and adnexa
H58? Other disorders of eye and adnexa in diseases classified elsewhere
H59
Postprocedural disorders of eye and adnexa, not elsewhere classified
Chapter VIII
Diseases
of the ear and mastoid process
~
(H60?
H95)
~
Diseases of external ear (H60?
H62)
H60
Otitis externa
H61
Other disorders of external ear
H62? Disorders of external ear in diseases classified elsewhere
~
Diseases of middle ear and mastoid (H65?H75)
H65
Nonsuppurative otitis media
H66
Suppurative and unspecified otitis media
H67? Otitis media in diseases classified elsewhere
H68
Eustachian salpingitis and obstruction
H69
Other disorders of Eustachian tube
H70
Mastoiditis and related conditions
H71
Cholesteatoma of middle ear
H72
Perforation of tympanic membrane
H73
Other disorders of tympanic membrane
H74
Other disorders of middle ear and mastoid
H75? Other disorders of middle ear and mastoid in diseases classified elsewhere
~
Diseases of inner ear (H80?H83)
H80
Otosclerosis
H81
Disorders of vestibular function
H82? Vertiginous syndromes in diseases classified elsewhere
H83
Other diseases of inner ear

CBHI ICD 10 Student Workbook January 2008 Page 260

~
Other disorders of ear (H90?H95)
H90
Conductive and sensorineural hearing loss
H91
Other hearing loss
H92
Otalgia and effusion of ear
H93
Other disorders of ear, not elsewhere classified
H94? Other disorders of ear in diseases classified elsewhere
H95
Postprocedural disorders of ear and mastoid process, not elsewhere classified
Chapter IX
Diseases of the circulatory system
~ I99)
(I00?
~
Acute rheumatic fever (I00?I02)
I00
Rheumatic fever without mention of heart involvement
I01
Rheumatic fever with heart involvement
I02
Rheumatic chorea
~
Chronic rheumatic heart diseases (I05?I09)
I05
Rheumatic mitral valve diseases
I06
Rheumatic aortic valve diseases
I07
Rheumatic tricuspid valve diseases
I08
Multiple valve diseases
I09
Other rheumatic heart diseases
~
Hypertensive diseases (I10?I15)
I10
Essential (primary) hypertension
I11
Hypertensive heart disease
I12
Hypertensive renal disease
I13
Hypertensive heart and renal disease
I15
Secondary hypertension
~
Ischaemic heart diseases (I20?I25)
I20
Angina pectoris
I21
Acute myocardial infarction
I22
Subsequent myocardial infarction
I23
Certain current complications following acute myocardial infarction
I24
Other acute ischaemic heart diseases
I25
Chronic ischaemic heart disease
~
Pulmonary heart disease and diseases of pulmonary circulation (I26?I28)
I26
Pulmonary embolism
I27
Other pulmonary heart diseases
I28
Other diseases of pulmonary vessels
~
Other forms of heart disease (I30?I52)
I30
Acute pericarditis
I31
Other diseases of pericardium
I32?
Pericarditis in diseases classified elsewhere
I33
Acute and subacute endocarditis
I34
Nonrheumatic mitral valve disorders
I35
Nonrheumatic aortic valve disorders
I36
Nonrheumatic tricuspid valve disorders
I37
Pulmonary valve disorders
I38
Endocarditis, valve unspecified
CBHI ICD 10 Student Workbook January 2008 Page 261

I39?
I40
I41?
I42
I43?
I44
I45
I46
I47
I48
I49
I50
I51
I52?

Endocarditis and heart valve disorders in diseases classified elsewhere


Acute myocarditis
Myocarditis in diseases classified elsewhere
Cardiomyopathy
Cardiomyopathy in diseases classified elsewhere
Atrioventricular and left bundle-branch block
Other conduction disorders
Cardiac arrest
Paroxysmal tachycardia
Atrial fibrillation and flutter
Other cardiac arrhythmias
Heart failure
Complications and ill-defined descriptions of heart disease
Other heart disorders in diseases classified elsewhere
~
Cerebrovascular diseases (I60?
I69)
I60
Subarachnoid haemorrhage
I61
Intracerebral haemorrhage
I62
Other nontraumatic intracranial haemorrhage
I63
Cerebral infarction
I64
Stroke, not specified as haemorrhage or infarction
I65
Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction
I66
Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction
I67
Other cerebrovascular diseases
I68?
Cerebrovascular disorders in diseases classified elsewhere
I69
Sequelae of cerebrovascular disease
~
Diseases of arteries, arterioles and capillaries (I70?
I79)
I70
Atherosclerosis
I71
Aortic aneurysm and dissection
I72
Other aneurysm
I73
Other peripheral vascular diseases
I74
Arterial embolism and thrombosis
I77
Other disorders of arteries and arterioles
I78
Diseases of capillaries
I79?
Disorders of arteries, arterioles and capillaries in diseases classified elsewhere
~
Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80?I89)
I80
Phlebitis and thrombophlebitis
I81
Portal vein thrombosis
I82
Other venous embolism and thrombosis
I83
Varicose veins of lower extremities
I84
Haemorrhoids
I85
Oesophageal varices
I86
Varicose veins of other sites
I87
Other disorders of veins
I88
Nonspecific lymphadenitis
I89
Other noninfective disorders of lymphatic vessels and lymph nodes
~
Other and unspecified disorders of the circulatory system (I95?I99)
I95
Hypotension
I97
Postprocedural disorders of circulatory system, not elsewhere classified

CBHI ICD 10 Student Workbook January 2008 Page 262

I98
I99

Other disorders of circulatory system in diseases classified elsewhere


Other and unspecified disorders of circulatory system

Chapter X
Diseases of the respiratory system
~
(J00?
J99)
~
Acute upper respiratory infections (J00?J06)
J00
Acute nasopharyngitis [common cold]
J01
Acute sinusitis
J02
Acute pharyngitis
J03
Acute tonsillitis
J04
Acute laryngitis and tracheitis
J05
Acute obstructive laryngitis [croup] and epiglottitis
J06
Acute upper respiratory infections of multiple and unspecified sites
~
Influenza and pneumonia (J10?
J18)
J10
Influenza due to identified influenza virus
J11
Influenza, virus not identified
J12
Viral pneumonia, not elsewhere classified
J13
Pneumonia due to Streptococcus pneumoniae
J14
Pneumonia due to Haemophilus influenzae
J15
Bacterial pneumonia, not elsewhere classified
J16
Pneumonia due to other infectious organisms, not elsewhere classified
J17? Pneumonia in diseases classified elsewhere
J18
Pneumonia, organism unspecified
~
Other acute lower respiratory infections (J20?J22)
J20
Acute bronchitis
J21
Acute bronchiolitis
J22
Unspecified acute lower respiratory infection
~
Other diseases of upper respiratory tract (J30?J39)
J30
Vasomotor and allergic rhinitis
J31
Chronic rhinitis, nasopharyngitis and pharyngitis
J32
Chronic sinusitis
J33
Nasal polyp
J34
Other disorders of nose and nasal sinuses
J35
Chronic diseases of tonsils and adenoids
J36
Peritonsillar abscess
J37
Chronic laryngitis and laryngotracheitis
J38
Diseases of vocal cords and larynx, not elsewhere classified
J39
Other diseases of upper respiratory tract
~
Chronic lower respiratory diseases (J40?
J47)
J40
Bronchitis, not specified as acute or chronic
J41
Simple and mucopurulent chronic bronchitis
J42
Unspecified chronic bronchitis
J43
Emphysema
J44
Other chronic obstructive pulmonary disease
J45
Asthma
J46
Status asthmaticus
J47
Bronchiectasis
CBHI ICD 10 Student Workbook January 2008 Page 263

~
Lung diseases due to external agents (J60?J70)
J60
Coalworker's pneumoconiosis
J61
Pneumoconiosis due to asbestos and other mineral fibres
J62
Pneumoconiosis due to dust containing silica
J63
Pneumoconiosis due to other inorganic dusts
J64
Unspecified pneumoconiosis
J65
Pneumoconiosis associated with tuberculosis
J66
Airway disease due to specific organic dust
J67
Hypersensitivity pneumonitis due to organic dust
J68
Respiratory conditions due to inhalation of chemicals, gases, fumes and vapours
J69
Pneumonitis due to solids and liquids
J70
Respiratory conditions due to other external agents
~
Other respiratory diseases principally affecting the interstitium (J80?J84)
J80
Adult respiratory distress syndrome
J81
Pulmonary oedema
J82
Pulmonary eosinophilia, not elsewhere classified
J84
Other interstitial pulmonary diseases
~
Suppurative and necrotic conditions of lower respiratory tract (J85?J86)
J85
Abscess of lung and mediastinum
J86
Pyothorax
~
Other diseases of pleura (J90?
J94)
J90
Pleural effusion, not elsewhere classified
J91? Pleural effusion in conditions classified elsewhere
J92
Pleural plaque
J93
Pneumothorax
J94
Other pleural conditions
~
Other diseases of the respiratory system (J95?J99)
J95
Postprocedural respiratory disorders, not elsewhere classified
J96
Respiratory failure, not elsewhere classified
J98
Other respiratory disorders
J99?Respiratory disorders in diseases classified elsewhere
Chapter XI
Diseases of the digestive system
~
(K00?K93)
~
Diseases of oral cavity, salivary glands and jaws (K00?K14)
K00
Disorders of tooth development and eruption
K01
Embedded and impacted teeth
K02
Dental caries
K03
Other diseases of hard tissues of teeth
K04
Diseases of pulp and periapical tissues
K05
Gingivitis and periodontal diseases
K06
Other disorders of gingiva and edentulous alveolar ridge
K07
Dentofacial anomalies [including malocclusion]
K08
Other disorders of teeth and supporting structures
K09
Cysts of oral region, not elsewhere classified
K10
Other diseases of jaws
K11
Diseases of salivary glands
K12
Stomatitis and related lesions
CBHI ICD 10 Student Workbook January 2008 Page 264

K13
K14

Other diseases of lip and oral mucosa


Diseases of tongue

~
Diseases of oesophagus, stomach and duodenum (K20?K31)
K20
Oesophagitis
K21
Gastro-oesophageal reflux disease
K22
Other diseases of oesophagus
K23? Disorders of oesophagus in diseases classified elsewhere
K25
Gastric ulcer
K26
Duodenal ulcer
K27
Peptic ulcer, site unspecified
K28
Gastrojejunal ulcer
K29
Gastritis and duodenitis
K30
Dyspepsia
K31
Other diseases of stomach and duodenum
~
Diseases of appendix (K35?K38)
K35
Acute appendicitis
K36
Other appendicitis
K37
Unspecified appendicitis
K38
Other diseases of appendix
~
Hernia (K40?K46)
K40
Inguinal hernia
K41
Femoral hernia
K42
Umbilical hernia
K43
Ventral hernia
K44
Diaphragmatic hernia
K45
Other abdominal hernia
K46
Unspecified abdominal hernia
~
Noninfective enteritis and colitis (K50?
K52)
K50
Crohn's disease [regional enteritis]
K51
Ulcerative colitis
K52
Other noninfective gastroenteritis and colitis
~
Other diseases of intestines (K55?K63)
K55
Vascular disorders of intestine
K56
Paralytic ileus and intestinal obstruction without hernia
K57
Diverticular disease of intestine
K58
Irritable bowel syndrome
K59
Other functional intestinal disorders
K60
Fissure and fistula of anal and rectal regions
K61
Abscess of anal and rectal regions
K62
Other diseases of anus and rectum
K63
Other diseases of intestine
~
Diseases of peritoneum (K65?K67)
K65
Peritonitis
K66
Other disorders of peritoneum
K67? Disorders of peritoneum in infectious diseases classified elsewhere

CBHI ICD 10 Student Workbook January 2008 Page 265

~
Diseases of liver (K70?K77)
K70
Alcoholic liver disease
K71
Toxic liver disease
K72
Hepatic failure, not elsewhere classified
K73
Chronic hepatitis, not elsewhere classified
K74
Fibrosis and cirrhosis of liver
K75
Other inflammatory liver diseases
K76
Other diseases of liver
K77? Liver disorders in diseases classified elsewhere
~
Disorders of gallbladder, biliary tract and pancreas (K80?K87)
K80
Cholelithiasis
K81
Cholecystitis
K82
Other diseases of gallbladder
K83
Other diseases of biliary tract
K85
Acute pancreatitis
K86
Other diseases of pancreas
K87? Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere
~
Other diseases of the digestive system (K90?K93)
K90
Intestinal malabsorption
K91
Postprocedural disorders of digestive system, not elsewhere classified
K92
Other diseases of digestive system
K93? Disorders of other digestive organs in diseases classified elsewhere
Chapter XII
Diseases of the skin and subcutaneous tissue
~
(L00?L99)
~
Infections of the skin and subcutaneous tissue (L00?
L08)
L00
L01
L02
L03
L04
L05
L08

Staphylococcal scalded skin syndrome


Impetigo
Cutaneous abscess, furuncle and carbuncle
Cellulitis
Acute lymphadenitis
Pilonidal cyst
Other local infections of skin and subcutaneous tissue
~
Bullous disorders (L10?L14)
L10
Pemphigus
L11
Other acantholytic disorders
L12
Pemphigoid
L13
Other bullous disorders
L14? Bullous disorders in diseases classified elsewhere
~
Dermatitis and eczema (L20?L30)
L20
Atopic dermatitis
L21
Seborrhoeic dermatitis
L22
Diaper [napkin] dermatitis
L23
Allergic contact dermatitis
L24
Irritant contact dermatitis
L25
Unspecified contact dermatitis
L26
Exfoliative dermatitis
CBHI ICD 10 Student Workbook January 2008 Page 266

L27
L28
L29
L30

Dermatitis due to substances taken internally


Lichen simplex chronicus and prurigo
Pruritus
Other dermatitis
~
Papulosquamous disorders (L40?
L45)
L40
Psoriasis
L41
Parapsoriasis
L42
Pityriasis rosea
L43
Lichen planus
L44
Other papulosquamous disorders
L45? Papulosquamous disorders in diseases classified elsewhere
~
Urticaria and erythema (L50?
L54)
L50
Urticaria
L51
Erythema multiforme
L52
Erythema nodosum
L53
Other erythematous conditions
L54? Erythema in diseases classified elsewhere
~
Radiation-related disorders of the skin and subcutaneous tissue (L55?L59)
L55
Sunburn
L56
Other acute skin changes due to ultraviolet radiation
L57
Skin changes due to chronic exposure to nonionizing radiation
L58
Radiodermatitis
L59
Other disorders of skin and subcutaneous tissue related to radiation
~
Disorders of skin appendages (L60?L75)
L60
Nail disorders
L62? Nail disorders in diseases classified elsewhere
L63
Alopecia areata
L64
Androgenic alopecia
L65
Other nonscarring hair loss
L66
Cicatricial alopecia [scarring hair loss]
L67
Hair colour and hair shaft abnormalities
L68
Hypertrichosis
L70
Acne
L71
Rosacea
L72
Follicular cysts of skin and subcutaneous tissue
L73
Other follicular disorders
L74
Eccrine sweat disorders
L75
Apocrine sweat disorders
~
Other disorders of the skin and subcutaneous tissue (L80?
L99)
L80
Vitiligo
L81
Other disorders of pigmentation
L82
Seborrhoeic keratosis
L83
Acanthosis nigricans
L84
Corns and callosities
L85
Other epidermal thickening
L86? Keratoderma in diseases classified elsewhere
L87
Transepidermal elimination disorders
L88
Pyoderma gangrenosum
L89
Decubitus ulcer
CBHI ICD 10 Student Workbook January 2008 Page 267

L90
L91
L92
L93
L94
L95
L97
L98
L99?

Atrophic disorders of skin


Hypertrophic disorders of skin
Granulomatous disorders of skin and subcutaneous tissue
Lupus erythematosus
Other localized connective tissue disorders
Vasculitis limited to skin, not elsewhere classified
Ulcer of lower limb, not elsewhere classified
Other disorders of skin and subcutaneous tissue, not elsewhere classified
Other disorders of skin and subcutaneous tissue in diseases classified elsewhere

Chapter XIII
Diseases of the musculoskeletal system and connective tissue
~
(M00?M99)
~
Arthropathies (M00?M25)
~
Infectious arthropathies (M00?M03)
M00 Pyogenic arthritis
M01? Direct infections of joint in infectious and parasitic diseases classified elsewhere
M02 Reactive arthropathies
M03? Postinfective and reactive arthropathies in diseases classified elsewhere
~
Inflammatory polyarthropathies (M05?
M14)
M05 Seropositive rheumatoid arthritis
M06 Other rheumatoid arthritis
M07? Psoriatic and enteropathic arthropathies
M08 Juvenile arthritis
M09? Juvenile arthritis in diseases classified elsewhere
M10 Gout
M11 Other crystal arthropathies
M12 Other specific arthropathies
M13 Other arthritis
M14? Arthropathies in other diseases classified elsewhere
~
Arthrosis (M15?M19)
M15 Polyarthrosis
M16 Coxarthrosis [arthrosis of hip]
M17 Gonarthrosis [arthrosis of knee]
M18 Arthrosis of first carpometacarpal joint
M19 Other arthrosis
~
Other joint disorders (M20?
M25)
M20 Acquired deformities of fingers and toes
M21 Other acquired deformities of limbs
M22 Disorders of patella
M23 Internal derangement of knee
M24 Other specific joint derangements
M25 Other joint disorders, not elsewhere classified
~
Systemic connective tissue disorders (M30?
M36)
M30 Polyarteritis nodosa and related conditions
M31 Other necrotizing vasculopathies
M32 Systemic lupus erythematosus
M33 Dermatopolymyositis
CBHI ICD 10 Student Workbook January 2008 Page 268

M34 Systemic sclerosis


M35 Other systemic involvement of connective tissue
M36? Systemic disorders of connective tissue in diseases classified elsewhere
~
Dorsopathies (M40?
M54)
~
Deforming dorsopathies (M40?
M43)
M40 Kyphosis and lordosis
M41 Scoliosis
M42 Spinal osteochondrosis
M43 Other deforming dorsopathies
~
Spondylopathies (M45?M49)
M45 Ankylosing spondylitis
M46 Other inflammatory spondylopathies
M47 Spondylosis
M48 Other spondylopathies
M49? Spondylopathies in diseases classified elsewhere
~
Other dorsopathies (M50?M54)
M50 Cervical disc disorders
M51 Other intervertebral disc disorders
M53 Other dorsopathies, not elsewhere classified
M54 Dorsalgia
~
Soft tissue disorders (M60?M79)
~
Disorders of muscles (M60?M63)
M60 Myositis
M61 Calcification and ossification of muscle
M62 Other disorders of muscle
M63? Disorders of muscle in diseases classified elsewhere
~
Disorders of synovium and tendon (M65?
M68)
M65 Synovitis and tenosynovitis
M66 Spontaneous rupture of synovium and tendon
M67 Other disorders of synovium and tendon
M68? Disorders of synovium and tendon in diseases classified elsewhere
~
Other soft tissue disorders (M70?
M79)
M70 Soft tissue disorders related to use, overuse and pressure
M71 Other bursopathies
M72 Fibroblastic disorders
M73? Soft tissue disorders in diseases classified elsewhere
M75 Shoulder lesions
M76 Enthesopathies of lower limb, excluding foot
M77 Other enthesopathies
M79 Other soft tissue disorders, not elsewhere classified
~
Osteopathies and chondropathies (M80?M94)
~
Disorders of bone density and structure (M80?M85)
M80 Osteoporosis with pathological fracture
M81 Osteoporosis without pathological fracture
M82? Osteoporosis in diseases classified elsewhere
M83 Adult osteomalacia
CBHI ICD 10 Student Workbook January 2008 Page 269

M84
M85

Disorders of continuity of bone


Other disorders of bone density and structure
~
Other osteopathies (M86?M90)
M86 Osteomyelitis
M87 Osteonecrosis
M88 Paget's disease of bone [osteitis deformans]
M89 Other disorders of bone
M90? Osteopathies in diseases classified elsewhere
~
Chondropathies (M91?
M94)
M91 Juvenile osteochondrosis of hip and pelvis
M92 Other juvenile osteochondrosis
M93 Other osteochondropathies
M94 Other disorders of cartilage
~
M99)
Other disorders of the musculoskeletal system and connective tissue (M95?
M95 Other acquired deformities of musculoskeletal system and connective tissue
M96 Postprocedural musculoskeletal disorders, not elsewhere classified
M99 Biomechanical lesions, not elsewhere classified
Chapter XIV
Diseases of the genitourinary system
~
(N00?N99)
~
Glomerular diseases (N00?N08)
N00
Acute nephritic syndrome
N01
Rapidly progressive nephritic syndrome
N02
Recurrent and persistent haematuria
N03
Chronic nephritic syndrome
N04
Nephrotic syndrome
N05
Unspecified nephritic syndrome
N06
Isolated proteinuria with specified morphological lesion
N07
Hereditary nephropathy, not elsewhere classified
N08? Glomerular disorders in diseases classified elsewhere
~
Renal tubulo-interstitial diseases (N10?
N16)
N10
Acute tubulo-interstitial nephritis
N11
Chronic tubulo-interstitial nephritis
N12
Tubulo-interstitial nephritis, not specified as acute or chronic
N13
Obstructive and reflux uropathy
N14
Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions
N15
Other renal tubulo-interstitial diseases
N16? Renal tubulo-interstitial disorders in diseases classified elsewhere
~
Renal failure (N17?N19)
N17
Acute renal failure
N18
Chronic renal failure
N19
Unspecified renal failure
~
Urolithiasis (N20?N23)
N20
Calculus of kidney and ureter
N21
Calculus of lower urinary tract

CBHI ICD 10 Student Workbook January 2008 Page 270

N22?
N23

Calculus of urinary tract in diseases classified elsewhere


Unspecified renal colic
~
Other disorders of kidney and ureter (N25?N29)
N25
Disorders resulting from impaired renal tubular function
N26
Unspecified contracted kidney
N27
Small kidney of unknown cause
N28
Other disorders of kidney and ureter, not elsewhere classified
N29? Other disorders of kidney and ureter in diseases classified elsewhere
~
Other diseases of urinary system (N30?N39)
N30
Cystitis
N31
Neuromuscular dysfunction of bladder, not elsewhere classified
N32
Other disorders of bladder
N33? Bladder disorders in diseases classified elsewhere
N34
Urethritis and urethral syndrome
N35
Urethral stricture
N36
Other disorders of urethra
N37? Urethral disorders in diseases classified elsewhere
N39
Other disorders of urinary system
~
Diseases of male genital organs (N40?N51)
N40
Hyperplasia of prostate
N41
Inflammatory diseases of prostate
N42
Other disorders of prostate
N43
Hydrocele and spermatocele
N44
Torsion of testis
N45
Orchitis and epididymitis
N46
Male infertility
N47
Redundant prepuce, phimosis and paraphimosis
N48
Other disorders of penis
N49
Inflammatory disorders of male genital organs, not elsewhere classified
N50
Other disorders of male genital organs
N51? Disorders of male genital organs in diseases classified elsewhere
~
Disorders of breast (N60?N64)
N60
Benign mammary dysplasia
N61
Inflammatory disorders of breast
N62
Hypertrophy of breast
N63
Unspecified lump in breast
N64
Other disorders of breast
~
Inflammatory diseases of female pelvic organs (N70?
N77)
N70
Salpingitis and oophoritis
N71
Inflammatory disease of uterus, except cervix
N72
Inflammatory disease of cervix uteri
N73
Other female pelvic inflammatory diseases
N74? Female pelvic inflammatory disorders in diseases classified elsewhere
N75
Diseases of Bartholin's gland
N76
Other inflammation of vagina and vulva
N77? Vulvovaginal ulceration and inflammation in diseases classified elsewhere

CBHI ICD 10 Student Workbook January 2008 Page 271

~
Noninflammatory disorders of female genital tract (N80?N98)
N80
Endometriosis
N81
Female genital prolapse
N82
Fistulae involving female genital tract
N83
Noninflammatory disorders of ovary, fallopian tube and broad ligament
N84
Polyp of female genital tract
N85
Other noninflammatory disorders of uterus, except cervix
N86
Erosion and ectropion of cervix uteri
N87
Dysplasia of cervix uteri
N88
Other noninflammatory disorders of cervix uteri
N89
Other noninflammatory disorders of vagina
N90
Other noninflammatory disorders of vulva and perineum
N91
Absent, scanty and rare menstruation
N92
Excessive, frequent and irregular menstruation
N93
Other abnormal uterine and vaginal bleeding
N94
Pain and other conditions associated with female genital organs and menstrual cycle
N95
Menopausal and other perimenopausal disorders
N96
Habitual aborter
N97
Female infertility
N98
Complications associated with artificial fertilization
Other disorders of the genitourinary system (N99)
N99
Postprocedural disorders of genitourinary system, not elsewhere classified
Chapter XV
Pregnancy, childbirth and the puerperium
(000-099)
~
Pregnancy with abortive outcome (O00?
O08)
O00
Ectopic pregnancy
O01
Hydatidiform mole
O02
Other abnormal products of conception
O03
Spontaneous abortion
O04
Medical abortion
O05
Other abortion
O06
Unspecified abortion
O07
Failed attempted abortion
O08
Complications following abortion and ectopic and molar pregnancy
Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the
~
puerperium (O10?O16)
O10
Pre-existing hypertension complicating pregnancy, childbirth and the puerperium
O11
Pre-existing hypertensive disorder with superimposed proteinuria
O12
Gestational [pregnancy-induced] oedema and proteinuria without hypertension
O13
Gestational [pregnancy-induced] hypertension without significant proteinuria
O14
Gestational [pregnancy-induced] hypertension with significant proteinuria
O15
Eclampsia
O16
Unspecified maternal hypertension
~
Other maternal disorders predominantly related to pregnancy (O20?O29)
O20
Haemorrhage in early pregnancy
O21
Excessive vomiting in pregnancy
O22
Venous complications in pregnancy
CBHI ICD 10 Student Workbook January 2008 Page 272

O23
O24
O25
O26
O28
O29

Infections of genitourinary tract in pregnancy


Diabetes mellitus in pregnancy
Malnutrition in pregnancy
Maternal care for other conditions predominantly related to pregnancy
Abnormal findings on antenatal screening of mother
Complications of anaesthesia during pregnancy

Maternal care related to the fetus and amniotic cavity and possible delivery problems
~
(O30?
O48)
O30
Multiple gestation
O31
Complications specific to multiple gestation
O32
Maternal care for known or suspected malpresentation of fetus
O33
Maternal care for known or suspected disproportion
O34
Maternal care for known or suspected abnormality of pelvic organs
O35
Maternal care for known or suspected fetal abnormality and damage
O36
Maternal care for other known or suspected fetal problems
O40
Polyhydramnios
O41
Other disorders of amniotic fluid and membranes
O42
Premature rupture of membranes
O43
Placental disorders
O44
Placenta praevia
O45
Premature separation of placenta [abruptio placentae]
O46
Antepartum haemorrhage, not elsewhere classified
O47
False labour
O48
Prolonged pregnancy
~
Complications of labour and delivery (O60?O75)
O60
Preterm labour and delivery
O61
Failed induction of labour
O62
Abnormalities of forces of labour
O63
Long labour
O64
Obstructed labour due to malposition and malpresentation of fetus
O65
Obstructed labour due to maternal pelvic abnormality
O66
Other obstructed labour
O67
Labour and delivery complicated by intrapartum haemorrhage, not elsewhere classified
O68
Labour and delivery complicated by fetal stress [distress]
O69
Labour and delivery complicated by umbilical cord complications
O70
Perineal laceration during delivery
O71
Other obstetric trauma
O72
Postpartum haemorrhage
O73
Retained placenta and membranes, without haemorrhage
O74
Complications of anaesthesia during labour and delivery
O75
Other complications of labour and delivery, not elsewhere classified
~
Delivery (O80?
O84)
O80
Single spontaneous delivery
O81
Single delivery by forceps and vacuum extractor
O82
Single delivery by caesarean section
O83
Other assisted single delivery
O84
Multiple delivery

CBHI ICD 10 Student Workbook January 2008 Page 273

~
Complications predominantly related to the puerperium (O85?O92)
O85
Puerperal sepsis
O86
Other puerperal infections
O87
Venous complications in the puerperium
O88
Obstetric embolism
O89
Complications of anaesthesia during the puerperium
O90
Complications of the puerperium, not elsewhere classified
O91
Infections of breast associated with childbirth
O92
Other disorders of breast and lactation associated with childbirth
~
Other obstetric conditions, not elsewhere classified (O95?O99)
O95
Obstetric death of unspecified cause
O96
Death from any obstetric cause occurring more than 42 days but less than one year after
delivery
O97
Death from sequelae of direct obstetric causes
O98
Maternal infectious and parasitic diseases classifiable elsewhere but complicating
pregnancy, childbirth and the puerperium
O99
Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and
the puerperium
Chapter XVI
Certain conditions originating in the perinatal period
~
(P00?P96)
Fetus and newborn affected by maternal factors and by complications of pregnancy, labour
~
and delivery (P00?P04)
P00
Fetus and newborn affected by maternal conditions that may be unrelated to present
pregnancy
P01
Fetus and newborn affected by maternal complications of pregnancy
P02
Fetus and newborn affected by complications of placenta, cord and membranes
P03
Fetus and newborn affected by other complications of labour and delivery
P04
Fetus and newborn affected by noxious influences transmitted via placenta or breast milk
~
Disorders related to length of gestation and fetal growth (P05?P08)
P05
Slow fetal growth and fetal malnutrition
P07
Disorders related to short gestation and low birth weight, not elsewhere classified
P08
Disorders related to long gestation and high birth weight
~
Birth trauma (P10?P15)
P10
Intracranial laceration and haemorrhage due to birth injury
P11
Other birth injuries to central nervous system
P12
Birth injury to scalp
P13
Birth injury to skeleton
P14
Birth injury to peripheral nervous system
P15
Other birth injuries
~
Respiratory and cardiovascular disorders specific to the perinatal period (P20?P29)
P20
Intrauterine hypoxia
P21
Birth asphyxia
P22
Respiratory distress of newborn
P23
Congenital pneumonia
P24
Neonatal aspiration syndromes
P25
Interstitial emphysema and related conditions originating in the perinatal period
P26
Pulmonary haemorrhage originating in the perinatal period
CBHI ICD 10 Student Workbook January 2008 Page 274

P27
P28
P29

Chronic respiratory disease originating in the perinatal period


Other respiratory conditions originating in the perinatal period
Cardiovascular disorders originating in the perinatal period
~
Infections specific to the perinatal period (P35?P39)
P35
Congenital viral diseases
P36
Bacterial sepsis of newborn
P37
Other congenital infectious and parasitic diseases
P38
Omphalitis of newborn with or without mild haemorrhage
P39
Other infections specific to the perinatal period
~
Haemorrhagic and haematological disorders of fetus and newborn (P50?P61)
P50
Fetal blood loss
P51
Umbilical haemorrhage of newborn
P52
Intracranial nontraumatic haemorrhage of fetus and newborn
P53
Haemorrhagic disease of fetus and newborn
P54
Other neonatal haemorrhages
P55
Haemolytic disease of fetus and newborn
P56
Hydrops fetalis due to haemolytic disease
P57
Kernicterus
P58
Neonatal jaundice due to other excessive haemolysis
P59
Neonatal jaundice from other and unspecified causes
P60
Disseminated intravascular coagulation of fetus and newborn
P61
Other perinatal haematological disorders
~
Transitory endocrine and metabolic disorders specific to fetus and newborn (P70?P74)
P70
Transitory disorders of carbohydrate metabolism specific to fetus and newborn
P71
Transitory neonatal disorders of calcium and magnesium metabolism
P72
Other transitory neonatal endocrine disorders
P74
Other transitory neonatal electrolyte and metabolic disturbances
~
Digestive system disorders of fetus and newborn (P75?P78)
P75? Meconium ileus
P76
Other intestinal obstruction of newborn
P77
Necrotizing enterocolitis of fetus and newborn
P78
Other perinatal digestive system disorders
Conditions involving the integument and temperature regulation of fetus and newborn
~
(P80?P83)
P80
Hypothermia of newborn
P81
Other disturbances of temperature regulation of newborn
P83
Other conditions of integument specific to fetus and newborn
~
Other disorders originating in the perinatal period (P90?P96)
P90
Convulsions of newborn
P91
Other disturbances of cerebral status of newborn
P92
Feeding problems of newborn
P93
Reactions and intoxications due to drugs administered to fetus and newborn
P94
Disorders of muscle tone of newborn
P95
Fetal death of unspecified cause
P96
Other conditions originating in the perinatal period

CBHI ICD 10 Student Workbook January 2008 Page 275

Chapter XVII
Congenital malformations, deformations and chromosomal abnormalities
~
(Q00?
Q99)
~
Congenital malformations of the nervous system (Q00?Q07)
Q00
Anencephaly and similar malformations
Q01
Encephalocele
Q02
Microcephaly
Q03
Congenital hydrocephalus
Q04
Other congenital malformations of brain
Q05
Spina bifida
Q06
Other congenital malformations of spinal cord
Q07
Other congenital malformations of nervous system
~
Congenital malformations of eye, ear, face and neck (Q10?Q18)
Q10
Congenital malformations of eyelid, lacrimal apparatus and orbit
Q11
Anophthalmos, microphthalmos and macrophthalmos
Q12
Congenital lens malformations
Q13
Congenital malformations of anterior segment of eye
Q14
Congenital malformations of posterior segment of eye
Q15
Other congenital malformations of eye
Q16
Congenital malformations of ear causing impairment of hearing
Q17
Other congenital malformations of ear
Q18
Other congenital malformations of face and neck
~
Congenital malformations of the circulatory system (Q20?Q28)
Q20
Congenital malformations of cardiac chambers and connections
Q21
Congenital malformations of cardiac septa
Q22
Congenital malformations of pulmonary and tricuspid valves
Q23
Congenital malformations of aortic and mitral valves
Q24
Other congenital malformations of heart
Q25
Congenital malformations of great arteries
Q26
Congenital malformations of great veins
Q27
Other congenital malformations of peripheral vascular system
Q28
Other congenital malformations of circulatory system
~
Congenital malformations of the respiratory system (Q30?Q34)
Q30
Congenital malformations of nose
Q31
Congenital malformations of larynx
Q32
Congenital malformations of trachea and bronchus
Q33
Congenital malformations of lung
Q34
Other congenital malformations of respiratory system
~
Cleft lip and cleft palate (Q35?
Q37)
Q35
Cleft palate
Q36
Cleft lip
Q37
Cleft palate with cleft lip
~
Other congenital malformations of the digestive system (Q38?Q45)
Q38
Other congenital malformations of tongue, mouth and pharynx
Q39
Congenital malformations of oesophagus
Q40
Other congenital malformations of upper alimentary tract
Q41
Congenital absence, atresia and stenosis of small intestine
Q42
Congenital absence, atresia and stenosis of large intestine
CBHI ICD 10 Student Workbook January 2008 Page 276

Q43
Q44
Q45

Other congenital malformations of intestine


Congenital malformations of gallbladder, bile ducts and liver
Other congenital malformations of digestive system
~
Congenital malformations of genital organs (Q50?
Q56)
Q50
Congenital malformations of ovaries, fallopian tubes and broad ligaments
Q51
Congenital malformations of uterus and cervix
Q52
Other congenital malformations of female genitalia
Q53
Undescended testicle
Q54
Hypospadias
Q55
Other congenital malformations of male genital organs
Q56
Indeterminate sex and pseudohermaphroditism
~
Congenital malformations of the urinary system (Q60?Q64)
Q60
Renal agenesis and other reduction defects of kidney
Q61
Cystic kidney disease
Q62
Congenital obstructive defects of renal pelvis and congenital malformations of ureter
Q63
Other congenital malformations of kidney
Q64
Other congenital malformations of urinary system
~
Congenital malformations and deformations of the musculoskeletal system (Q65?Q79)
Q65
Congenital deformities of hip
Q66
Congenital deformities of feet
Q67
Congenital musculoskeletal deformities of head, face, spine and chest
Q68
Other congenital musculoskeletal deformities
Q69
Polydactyly
Q70
Syndactyly
Q71
Reduction defects of upper limb
Q72
Reduction defects of lower limb
Q73
Reduction defects of unspecified limb
Q74
Other congenital malformations of limb(s)
Q75
Other congenital malformations of skull and face bones
Q76
Congenital malformations of spine and bony thorax
Q77
Osteochondrodysplasia with defects of growth of tubular bones and spine
Q78
Other osteochondrodysplasias
Q79
Congenital malformations of the musculoskeletal system, not elsewhere classified
~
Other congenital malformations (Q80?Q89)
Q80
Congenital ichthyosis
Q81
Epidermolysis bullosa
Q82
Other congenital malformations of skin
Q83
Congenital malformations of breast
Q84
Other congenital malformations of integument
Q85
Phakomatoses, not elsewhere classified
Q86
Congenital malformation syndromes due to known exogenous causes, not elsewhere
classified
Q87
Other specified congenital malformation syndromes affecting multiple systems
Q89
Other congenital malformations, not elsewhere classified
~
Chromosomal abnormalities, not elsewhere classified (Q90?Q99)
Q90
Down's syndrome
Q91
Edwards' syndrome and Patau's syndrome
Q92
Other trisomies and partial trisomies of the autosomes, not elsewhere classified
Q93
Monosomies and deletions from the autosomes, not elsewhere classified
CBHI ICD 10 Student Workbook January 2008 Page 277

Q95
Q96
Q97
Q98
Q99

Balanced rearrangements and structural markers, not elsewhere classified


Turner's syndrome
Other sex chromosome abnormalities, female phenotype, not elsewhere classified
Other sex chromosome abnormalities, male phenotype, not elsewhere classified
Other chromosome abnormalities, not elsewhere classified

Chapter XVIII
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
~
(R00?R99)
~
Symptoms and signs involving the circulatory and respiratory systems (R00?R09)
R00
Abnormalities of heart beat
R01
Cardiac murmurs and other cardiac sounds
R02
Gangrene, not elsewhere classified
R03
Abnormal blood-pressure reading, without diagnosis
R04
Haemorrhage from respiratory passages
R05
Cough
R06
Abnormalities of breathing
R07
Pain in throat and chest
R09
Other symptoms and signs involving the circulatory and respiratory systems
~
Symptoms and signs involving the digestive system and abdomen (R10?R19)
R10
Abdominal and pelvic pain
R11
Nausea and vomiting
R12
Heartburn
R13
Dysphagia
R14
Flatulence and related conditions
R15
Faecal incontinence
R16
Hepatomegaly and splenomegaly, not elsewhere classified
R17
Unspecified jaundice
R18
Ascites
R19
Other symptoms and signs involving the digestive system and abdomen
~
Symptoms and signs involving the skin and subcutaneous tissue (R20?R23)
R20
Disturbances of skin sensation
R21
Rash and other nonspecific skin eruption
R22
Localized swelling, mass and lump of skin and subcutaneous tissue
R23
Other skin changes
~
Symptoms and signs involving the nervous and musculoskeletal systems (R25?
R29)
R25
Abnormal involuntary movements
R26
Abnormalities of gait and mobility
R27
Other lack of coordination
R29
Other symptoms and signs involving the nervous and musculoskeletal systems
~
Symptoms and signs involving the urinary system (R30?R39)
R30
Pain associated with micturition
R31
Unspecified haematuria
R32
Unspecified urinary incontinence
R33
Retention of urine
R34
Anuria and oliguria
R35
Polyuria
R36
Urethral discharge
R39
Other symptoms and signs involving the urinary system
CBHI ICD 10 Student Workbook January 2008 Page 278

Symptoms and signs involving cognition, perception, emotional state and behaviour
~
(R40?R46)
R40
Somnolence, stupor and coma
R41
Other symptoms and signs involving cognitive functions and awareness
R42
Dizziness and giddiness
R43
Disturbances of smell and taste
R44
Other symptoms and signs involving general sensations and perceptions
R45
Symptoms and signs involving emotional state
R46
Symptoms and signs involving appearance and behaviour
~
Symptoms and signs involving speech and voice (R47?
R49)
R47
Speech disturbances, not elsewhere classified
R48
Dyslexia and other symbolic dysfunctions, not elsewhere classified
R49
Voice disturbances
~
General symptoms and signs (R50?
R69)
R50
Fever of unknown origin
R51
Headache
R52
Pain, not elsewhere classified
R53
Malaise and fatigue
R54
Senility
R55
Syncope and collapse
R56
Convulsions, not elsewhere classified
R57
Shock, not elsewhere classified
R58
Haemorrhage, not elsewhere classified
R59
Enlarged lymph nodes
R60
Oedema, not elsewhere classified
R61
Hyperhidrosis
R62
Lack of expected normal physiological development
R63
Symptoms and signs concerning food and fluid intake
R64
Cachexia
R68
Other general symptoms and signs
R69
Unknown and unspecified causes of morbidity
~
Abnormal findings on examination of blood, without diagnosis (R70?R79)
R70
Elevated erythrocyte sedimentation rate and abnormality of plasma viscosity
R71
Abnormality of red blood cells
R72
Abnormality of white blood cells, not elsewhere classified
R73
Elevated blood glucose level
R74
Abnormal serum enzyme levels
R75
Laboratory evidence of human immunodeficiency virus [HIV]
R76
Other abnormal immunological findings in serum
R77
Other abnormalities of plasma proteins
R78
Findings of drugs and other substances, not normally found in blood
R79
Other abnormal findings of blood chemistry
~
Abnormal findings on examination of urine, without diagnosis (R80?R82)
R80
Isolated proteinuria
R81
Glycosuria
R82
Other abnormal findings in urine

CBHI ICD 10 Student Workbook January 2008 Page 279

Abnormal findings
on examination of other body fluids, substances and tissues, without
~
diagnosis (R83?R89)
R83
Abnormal findings in cerebrospinal fluid
R84
Abnormal findings in specimens from respiratory organs and thorax
R85
Abnormal findings in specimens from digestive organs and abdominal cavity
R86
Abnormal findings in specimens from male genital organs
R87
Abnormal findings in specimens from female genital organs
R89
Abnormal findings in specimens from other organs, systems and tissues
Abnormal findings on diagnostic imaging and in function studies, without diagnosis
~
(R90?R94)
R90
Abnormal findings on diagnostic imaging of central nervous system
R91
Abnormal findings on diagnostic imaging of lung
R92
Abnormal findings on diagnostic imaging of breast
R93
Abnormal findings on diagnostic imaging of other body structures
R94
Abnormal results of function studies
~
Ill-defined and unknown causes of mortality (R95?
R99)
R95
Sudden infant death syndrome
R96
Other sudden death, cause unknown
R98
Unattended death
R99
Other ill-defined and unspecified causes of mortality
Chapter XIX
Injury, poisoning and certain other consequences of external causes
~
(S00?T98)
~
Injuries to the head (S00?S09)
S00
Superficial injury of head
S01
Open wound of head
S02
Fracture of skull and facial bones
S03
Dislocation, sprain and strain of joints and ligaments of head
S04
Injury of cranial nerves
S05
Injury of eye and orbit
S06
Intracranial injury
S07
Crushing injury of head
S08
Traumatic amputation of part of head
S09
Other and unspecified injuries of head
~
Injuries to the neck (S10?S19)
S10
Superficial injury of neck
S11
Open wound of neck
S12
Fracture of neck
S13
Dislocation, sprain and strain of joints and ligaments at neck level
S14
Injury of nerves and spinal cord at neck level
S15
Injury of blood vessels at neck level
S16
Injury of muscle and tendon at neck level
S17
Crushing injury of neck
S18
Traumatic amputation at neck level
S19
Other and unspecified injuries of neck
~
Injuries to the thorax (S20?S29)
S20
Superficial injury of thorax
S21
Open wound of thorax
CBHI ICD 10 Student Workbook January 2008 Page 280

S22
S23
S24
S25
S26
S27
S28
S29

Fracture of rib(s), sternum and thoracic spine


Dislocation, sprain and strain of joints and ligaments of thorax
Injury of nerves and spinal cord at thorax level
Injury of blood vessels of thorax
Injury of heart
Injury of other and unspecified intrathoracic organs
Crushing injury of thorax and traumatic amputation of part of thorax
Other and unspecified injuries of thorax
~
Injuries to the abdomen, lower back, lumbar spine and pelvis (S30?S39)
S30
Superficial injury of abdomen, lower back and pelvis
S31
Open wound of abdomen, lower back and pelvis
S32
Fracture of lumbar spine and pelvis
S33
Dislocation, sprain and strain of joints and ligaments of lumbar spine and pelvis
S34
Injury of nerves and lumbar spinal cord at abdomen, lower back and pelvis level
S35
Injury of blood vessels at abdomen, lower back and pelvis level
S36
Injury of intra-abdominal organs
S37
Injury of urinary and pelvic organs
S38
Crushing injury and traumatic amputation of part of abdomen, lower back and pelvis
S39
Other and unspecified injuries of abdomen, lower back and pelvis
~
Injuries to the shoulder and upper arm (S40?S49)
S40
Superficial injury of shoulder and upper arm
S41
Open wound of shoulder and upper arm
S42
Fracture of shoulder and upper arm
S43
Dislocation, sprain and strain of joints and ligaments of shoulder girdle
S44
Injury of nerves at shoulder and upper arm level
S45
Injury of blood vessels at shoulder and upper arm level
S46
Injury of muscle and tendon at shoulder and upper arm level
S47
Crushing injury of shoulder and upper arm
S48
Traumatic amputation of shoulder and upper arm
S49
Other and unspecified injuries of shoulder and upper arm
~
Injuries to the elbow and forearm (S50?
S59)
S50
Superficial injury of forearm
S51
Open wound of forearm
S52
Fracture of forearm
S53
Dislocation, sprain and strain of joints and ligaments of elbow
S54
Injury of nerves at forearm level
S55
Injury of blood vessels at forearm level
S56
Injury of muscle and tendon at forearm level
S57
Crushing injury of forearm
S58
Traumatic amputation of forearm
S59
Other and unspecified injuries of forearm
~
Injuries to the wrist and hand (S60?S69)
S60
Superficial injury of wrist and hand
S61
Open wound of wrist and hand
S62
Fracture at wrist and hand level
S63
Dislocation, sprain and strain of joints and ligaments at wrist and hand level
S64
Injury of nerves at wrist and hand level
S65
Injury of blood vessels at wrist and hand level
S66
Injury of muscle and tendon at wrist and hand level
CBHI ICD 10 Student Workbook January 2008 Page 281

S67
S68
S69

Crushing injury of wrist and hand


Traumatic amputation of wrist and hand
Other and unspecified injuries of wrist and hand
~
Injuries to the hip and thigh (S70?S79)
S70
Superficial injury of hip and thigh
S71
Open wound of hip and thigh
S72
Fracture of femur
S73
Dislocation, sprain and strain of joint and ligaments of hip
S74
Injury of nerves at hip and thigh level
S75
Injury of blood vessels at hip and thigh level
S76
Injury of muscle and tendon at hip and thigh level
S77
Crushing injury of hip and thigh
S78
Traumatic amputation of hip and thigh
S79
Other and specified injuries of hip and thigh
~
Injuries to the knee and lower leg (S80?S89)
S80
Superficial injury of lower leg
S81
Open wound of lower leg
S82
Fracture of lower leg, including ankle
S83
Dislocation, sprain and strain of joints and ligaments of knee
S84
Injury of nerves at lower leg level
S85
Injury of blood vessels at lower leg level
S86
Injury of muscle and tendon at lower leg level
S87
Crushing injury of lower leg
S88
Traumatic amputation of lower leg
S89
Other and unspecified injuries of lower leg
~
Injuries to the ankle and foot (S90?S99)
S90
Superficial injury of ankle and foot
S91
Open wound of ankle and foot
S92
Fracture of foot, except ankle
S93
Dislocation, sprain and strain of joints and ligaments at ankle and foot level
S94
Injury of nerves at ankle and foot level
S95
Injury of blood vessels at ankle and foot level
S96
Injury of muscle and tendon at ankle and foot level
S97
Crushing injury of ankle and foot
S98
Traumatic amputation of ankle and foot
S99
Other and unspecified injuries of ankle and foot
~
Injuries involving multiple body regions (T00?T07)
T00
Superficial injuries involving multiple body regions
T01
Open wounds involving multiple body regions
T02
Fractures involving multiple body regions
T03
Dislocations, sprains and strains involving multiple body regions
T04
Crushing injuries involving multiple body regions
T05
Traumatic amputations involving multiple body regions
T06
Other injuries involving multiple body regions, not elsewhere classified
T07
Unspecified multiple injuries
~
Injuries to unspecified part of trunk, limb or body region (T08?
T14)
T08
Fracture of spine, level unspecified
T09
Other injuries of spine and trunk, level unspecified
T10
Fracture of upper limb, level unspecified
CBHI ICD 10 Student Workbook January 2008 Page 282

T11
T12
T13
T14

Other injuries of upper limb, level unspecified


Fracture of lower limb, level unspecified
Other injuries of lower limb, level unspecified
Injury of unspecified body region

~
Effects of foreign body entering through natural orifice (T15?
T19)
T15
Foreign body on external eye
T16
Foreign body in ear
T17
Foreign body in respiratory tract
T18
Foreign body in alimentary tract
T19
Foreign body in genitourinary tract
~
Burns and corrosions (T20?T32)
~
Burns and corrosions of external body surface, specified by site (T20?T25)
T20
Burn and corrosion of head and neck
T21
Burn and corrosion of trunk
T22
Burn and corrosion of shoulder and upper limb, except wrist and hand
T23
Burn and corrosion of wrist and hand
T24
Burn and corrosion of hip and lower limb, except ankle and foot
T25
Burn and corrosion of ankle and foot
~
Burns and corrosions confined to eye and internal organs (T26?T28)
T26
Burn and corrosion confined to eye and adnexa
T27
Burn and corrosion of respiratory tract
T28
Burn and corrosion of other internal organs
~
Burns and corrosions of multiple and unspecified body regions (T29?T32)
T29
Burns and corrosions of multiple body regions
T30
Burn and corrosion, body region unspecified
T31
Burns classified according to extent of body surface involved
T32
Corrosions classified according to extent of body surface involved
~
Frostbite (T33?
T35)
T33
Superficial frostbite
T34
Frostbite with tissue necrosis
T35
Frostbite involving multiple body regions and unspecified frostbite
~
Poisoning by drugs, medicaments and biological substances (T36?T50)
T36
Poisoning by systemic antibiotics
T37
Poisoning by other systemic anti-infectives and antiparasitics
T38
Poisoning by hormones and their synthetic substitutes and antagonists, not elsewhere
classified
T39
Poisoning by nonopioid analgesics, antipyretics and antirheumatics
T40
Poisoning by narcotics and psychodysleptics [hallucinogens]
T41
Poisoning by anaesthetics and therapeutic gases
T42
Poisoning by antiepileptic, sedative-hypnotic and antiparkinsonism drugs
T43
Poisoning by psychotropic drugs, not elsewhere classified
T44
Poisoning by drugs primarily affecting the autonomic nervous system
T45
Poisoning by primarily systemic and haematological agents, not elsewhere classified
T46
Poisoning by agents primarily affecting the cardiovascular system
T47
Poisoning by agents primarily affecting the gastrointestinal system
T48
Poisoning by agents primarily acting on smooth and skeletal muscles and the respiratory
system

CBHI ICD 10 Student Workbook January 2008 Page 283

T49

Poisoning by topical agents primarily affecting skin and mucous membrane and by
ophthalmological, otorhinolaryngological and dental drugs
T50
Poisoning by diuretics and other and unspecified drugs, medicaments and biological
substances
~
Toxic effects of substances chiefly nonmedicinal as to source (T51?T65)
T51
Toxic effect of alcohol
T52
Toxic effect of organic solvents
T53
Toxic effect of halogen derivatives of aliphatic and aromatic hydrocarbons
T54
Toxic effect of corrosive substances
T55
Toxic effect of soaps and detergents
T56
Toxic effect of metals
T57
Toxic effect of other inorganic substances
T58
Toxic effect of carbon monoxide
T59
Toxic effect of other gases, fumes and vapours
T60
Toxic effect of pesticides
T61
Toxic effect of noxious substances eaten as seafood
T62
Toxic effect of other noxious substances eaten as food
T63
Toxic effect of contact with venomous animals
T64
Toxic effect of aflatoxin and other mycotoxin food contaminants
T65
Toxic effect of other and unspecified substances
~
Other and unspecified effects of external causes (T66?T78)
T66
Unspecified effects of radiation
T67
Effects of heat and light
T68
Hypothermia
T69
Other effects of reduced temperature
T70
Effects of air pressure and water pressure
T71
Asphyxiation
T73
Effects of other deprivation
T74
Maltreatment syndromes
T75
Effects of other external causes
T78
Adverse effects, not elsewhere classified
Certain early complications of trauma (T79)
T79
Certain early complications of trauma, not elsewhere classified
~
Complications of surgical and medical care, not elsewhere classified (T80?
T88)
T80
Complications following infusion, transfusion and therapeutic injection
T81
Complications of procedures, not elsewhere classified
T82
Complications of cardiac and vascular prosthetic devices, implants and grafts
T83
Complications of genitourinary prosthetic devices, implants and grafts
T84
Complications of internal orthopaedic prosthetic devices, implants and grafts
T85
Complications of other internal prosthetic devices, implants and grafts
T86
Failure and rejection of transplanted organs and tissues
T87
Complications peculiar to reattachment and amputation
T88
Other complications of surgical and medical care, not elsewhere classified
~
Sequelae of injuries, of poisoning and of other consequences of external causes (T90?T98)
T90
Sequelae of injuries of head
T91
Sequelae of injuries of neck and trunk
T92
Sequelae of injuries of upper limb
T93
Sequelae of injuries of lower limb
T94
Sequelae of injuries involving multiple and unspecified body regions
CBHI ICD 10 Student Workbook January 2008 Page 284

T95
T96
T97
T98

Sequelae of burns, corrosions and frostbite


Sequelae of poisoning by drugs, medicaments and biological substances
Sequelae of toxic effects of substances chiefly nonmedicinal as to source
Sequelae of other and unspecified effects of external causes

Chapter XX
External
causes of morbidity and mortality
~
(V01?Y98)
~
Transport accidents (V01?V99)
~
Pedestrian injured in transport accident (V01?V09)
V01
Pedestrian injured in collision with pedal cycle
V02
Pedestrian injured in collision with two- or three-wheeled motor vehicle
V03
Pedestrian injured in collision with car, pick-up truck or van
V04
Pedestrian injured in collision with heavy transport vehicle or bus
V05
Pedestrian injured in collision with railway train or railway vehicle
V06
Pedestrian injured in collision with other nonmotor vehicle
V09
Pedestrian injured in other and unspecified transport accidents
~
Pedal cyclist injured in transport accident (V10?V19)
V10
Pedal cyclist injured in collision with pedestrian or animal
V11
Pedal cyclist injured in collision with other pedal cycle
V12
Pedal cyclist injured in collision with two- or three-wheeled motor vehicle
V13
Pedal cyclist injured in collision with car, pick-up truck or van
V14
Pedal cyclist injured in collision with heavy transport vehicle or bus
V15
Pedal cyclist injured in collision with railway train or railway vehicle
V16
Pedal cyclist injured in collision with other nonmotor vehicle
V17
Pedal cyclist injured in collision with fixed or stationary object
V18
Pedal cyclist injured in noncollision transport accident
V19
Pedal cyclist injured in other and unspecified transport accidents
~
Motorcycle rider injured in transport accident (V20?V29)
V20
Motorcycle rider injured in collision with pedestrian or animal
V21
Motorcycle rider injured in collision with pedal cycle
V22
Motorcycle rider injured in collision with two- or three-wheeled motor vehicle
V23
Motorcycle rider injured in collision with car, pick-up truck or van
V24
Motorcycle rider injured in collision with heavy transport vehicle or bus
V25
Motorcycle rider injured in collision with railway train or railway vehicle
V26
Motorcycle rider injured in collision with other nonmotor vehicle
V27
Motorcycle rider injured in collision with fixed or stationary object
V28
Motorcycle rider injured in noncollision transport accident
V29
Motorcycle rider injured in other and unspecified transport accidents
~
Occupant of three-wheeled motor vehicle injured in transport accident (V30?V39)
V30
Occupant of three-wheeled motor vehicle injured in collision with pedestrian or animal
V31
Occupant of three-wheeled motor vehicle injured in collision with pedal cycle
V32
Occupant of three-wheeled motor vehicle injured in collision with two- or three-wheeled
motor vehicle
V33
Occupant of three-wheeled motor vehicle injured in collision with car, pick-up truck or
van
V34
Occupant of three-wheeled motor vehicle injured in collision with heavy transport vehicle
or bus
CBHI ICD 10 Student Workbook January 2008 Page 285

V35

Occupant of three-wheeled motor vehicle injured in collision with railway train or railway
vehicle
V36
Occupant of three-wheeled motor vehicle injured in collision with other nonmotor vehicle
V37
Occupant of three-wheeled motor vehicle injured in collision with fixed or stationary
object
V38
Occupant of three-wheeled motor vehicle injured in noncollision transport accident
V39
Occupant of three-wheeled motor vehicle injured in other and unspecified transport
accidents
~
Car occupant injured in transport accident (V40?V49)
V40
Car occupant injured in collision with pedestrian or animal
V41
Car occupant injured in collision with pedal cycle
V42
Car occupant injured in collision with two- or three-wheeled motor vehicle
V43
Car occupant injured in collision with car, pick-up truck or van
V44
Car occupant injured in collision with heavy transport vehicle or bus
V45
Car occupant injured in collision with railway train or railway vehicle
V46
Car occupant injured in collision with other nonmotor vehicle
V47
Car occupant injured in collision with fixed or stationary object
V48
Car occupant injured in noncollision transport accident
V49
Car occupant injured in other and unspecified transport accidents
~
Occupant of pick-up truck or van injured in transport accident (V50?V59)
V50
Occupant of pick-up truck or van injured in collision with pedestrian or animal
V51
Occupant of pick-up truck or van injured in collision with pedal cycle
V52
Occupant of pick-up truck or van injured in collision with two- or three-wheeled motor
vehicle
V53
Occupant of pick-up truck or van injured in collision with car, pick-up truck or van
V54
Occupant of pick-up truck or van injured in collision with heavy transport vehicle or bus
V55
Occupant of pick-up truck or van injured in collision with railway train or railway vehicle
V56
Occupant of pick-up truck or van injured in collision with other nonmotor vehicle
V57
Occupant of pick-up truck or van injured in collision with fixed or stationary object
V58
Occupant of pick-up truck or van injured in noncollision transport accident
V59
Occupant of pick-up truck or van injured in other and unspecified transport accidents
~
Occupant of heavy transport vehicle injured in transport accident (V60?
V69)
V60
Occupant of heavy transport vehicle injured in collision with pedestrian or animal
V61
Occupant of heavy transport vehicle injured in collision with pedal cycle
V62
Occupant of heavy transport vehicle injured in collision with two- or three-wheeled motor
vehicle
V63
Occupant of heavy transport vehicle injured in collision with car, pick-up truck or van
V64
Occupant of heavy transport vehicle injured in collision with heavy transport vehicle or
bus
V65
Occupant of heavy transport vehicle injured in collision with railway train or railway
vehicle
V66
Occupant of heavy transport vehicle injured in collision with other nonmotor vehicle
V67
Occupant of heavy transport vehicle injured in collision with fixed or stationary object
V68
Occupant of heavy transport vehicle injured in noncollision transport accident
V69
Occupant of heavy transport vehicle injured in other and unspecified transport accidents
~
Bus occupant injured in transport accident (V70?
V79)
V70
Bus occupant injured in collision with pedestrian or animal
V71
Bus occupant injured in collision with pedal cycle
V72
Bus occupant injured in collision with two- or three-wheeled motor vehicle
CBHI ICD 10 Student Workbook January 2008 Page 286

V73
V74
V75
V76
V77
V78
V79

Bus occupant injured in collision with car, pick-up truck or van


Bus occupant injured in collision with heavy transport vehicle or bus
Bus occupant injured in collision with railway train or railway vehicle
Bus occupant injured in collision with other nonmotor vehicle
Bus occupant injured in collision with fixed or stationary object
Bus occupant injured in noncollision transport accident
Bus occupant injured in other and unspecified transport accidents
~
Other land transport accidents (V80?V89)
V80
V81
V82
V83

Animal-rider or occupant of animal-drawn vehicle injured in transport accident


Occupant of railway train or railway vehicle injured in transport accident
Occupant of streetcar injured in transport accident
Occupant of special vehicle mainly used on industrial premises injured in transport
accident
V84
Occupant of special vehicle mainly used in agriculture injured in transport accident
V85
Occupant of special construction vehicle injured in transport accident
V86
Occupant of special all-terrain or other motor vehicle designed primarily for off-road use,
injured in transport accident
V87
Traffic accident of specified type but victim's mode of transport unknown
V88
Nontraffic accident of specified type but victim's mode of transport unknown
V89
Motor- or nonmotor-vehicle accident, type of vehicle unspecified
~
Water transport accidents (V90?V94)
V90
Accident to watercraft causing drowning and submersion
V91
Accident to watercraft causing other injury
V92
Water-transport-related drowning and submersion without accident to watercraft
V93
Accident on board watercraft without accident to watercraft, not causing drowning and
submersion
V94
Other and unspecified water transport accidents
~
Air and space transport accidents (V95?V97)
V95
Accident to powered aircraft causing injury to occupant
V96
Accident to nonpowered aircraft causing injury to occupant
V97
Other specified air transport accidents
~
Other and unspecified transport accidents (V98?
V99)
V98
Other specified transport accidents
V99
Unspecified transport accident
~
Other external causes of accidental injury (W00?X59)
~
Falls (W00?W19)
W00 Fall on same level involving ice and snow
W01 Fall on same level from slipping, tripping and stumbling
W02 Fall involving ice-skates, skis, roller-skates or skateboards
W03 Other fall on same level due to collision with, or pushing by, another person
W04 Fall while being carried or supported by other persons
W05 Fall involving wheelchair
W06 Fall involving bed
W07 Fall involving chair
W08 Fall involving other furniture
W09 Fall involving playground equipment
W10 Fall on and from stairs and steps
W11 Fall on and from ladder
CBHI ICD 10 Student Workbook January 2008 Page 287

W12
W13
W14
W15
W16
W17
W18
W19

Fall on and from scaffolding


Fall from, out of or through building or structure
Fall from tree
Fall from cliff
Diving or jumping into water causing injury other than drowning or submersion
Other fall from one level to another
Other fall on same level
Unspecified fall
~
Exposure to inanimate mechanical forces (W20?W49)
W20 Struck by thrown, projected or falling object
W21 Striking against or struck by sports equipment
W22 Striking against or struck by other objects
W23 Caught, crushed, jammed or pinched in or between objects
W24 Contact with lifting and transmission devices, not elsewhere classified
W25 Contact with sharp glass
W26 Contact with knife, sword or dagger
W27 Contact with nonpowered hand tool
W28 Contact with powered lawnmower
W29 Contact with other powered hand tools and household machinery
W30 Contact with agricultural machinery
W31 Contact with other and unspecified machinery
W32 Handgun discharge
W33 Rifle, shotgun and larger firearm discharge
W34 Discharge from other and unspecified firearms
W35 Explosion and rupture of boiler
W36 Explosion and rupture of gas cylinder
W37 Explosion and rupture of pressurized tyre, pipe or hose
W38 Explosion and rupture of other specified pressurized devices
W39 Discharge of firework
W40 Explosion of other materials
W41 Exposure to high-pressure jet
W42 Exposure to noise
W43 Exposure to vibration
W44 Foreign body entering into or through eye or natural orifice
W45 Foreign body or object entering through skin
W49 Exposure to other and unspecified inanimate mechanical forces
~
Exposure to animate mechanical forces (W50?W64)
W50 Hit, struck, kicked, twisted, bitten or scratched by another person
W51 Striking against or bumped into by another person
W52 Crushed, pushed or stepped on by crowd or human stampede
W53 Bitten by rat
W54 Bitten or struck by dog
W55 Bitten or struck by other mammals
W56 Contact with marine animal
W57 Bitten or stung by nonvenomous insect and other nonvenomous arthropods
W58 Bitten or struck by crocodile or alligator
W59 Bitten or crushed by other reptiles
W60 Contact with plant thorns and spines and sharp leaves
W64 Exposure to other and unspecified animate mechanical forces

CBHI ICD 10 Student Workbook January 2008 Page 288

~
Accidental drowning and submersion (W65?W74)
W65 Drowning and submersion while in bath-tub
W66 Drowning and submersion following fall into bath-tub
W67 Drowning and submersion while in swimming-pool
W68 Drowning and submersion following fall into swimming-pool
W69 Drowning and submersion while in natural water
W70 Drowning and submersion following fall into natural water
W73 Other specified drowning and submersion
W74 Unspecified drowning and submersion
~
Other accidental threats to breathing (W75?W84)
W75 Accidental suffocation and strangulation in bed
W76 Other accidental hanging and strangulation
W77 Threat to breathing due to cave-in, falling earth and other substances
W78 Inhalation of gastric contents
W79 Inhalation and ingestion of food causing obstruction of respiratory tract
W80 Inhalation and ingestion of other objects causing obstruction of respiratory tract
W81 Confined to or trapped in a low-oxygen environment
W83 Other specified threats to breathing
W84 Unspecified threat to breathing
Exposure to electric current, radiation and extreme ambient air temperature and pressure
~
(W85?W99)
W85 Exposure to electric transmission lines
W86 Exposure to other specified electric current
W87 Exposure to unspecified electric current
W88 Exposure to ionizing radiation
W89 Exposure to man-made visible and ultraviolet light
W90 Exposure to other nonionizing radiation
W91 Exposure to unspecified type of radiation
W92 Exposure to excessive heat of man-made origin
W93 Exposure to excessive cold of man-made origin
W94 Exposure to high and low air pressure and changes in air pressure
W99 Exposure to other and unspecified man-made environmental factors
~
Exposure to smoke, fire and flames (X00?
X09)
X00
Exposure to uncontrolled fire in building or structure
X01
Exposure to uncontrolled fire, not in building or structure
X02
Exposure to controlled fire in building or structure
X03
Exposure to controlled fire, not in building or structure
X04
Exposure to ignition of highly flammable material
X05
Exposure to ignition or melting of nightwear
X06
Exposure to ignition or melting of other clothing and apparel
X08
Exposure to other specified smoke, fire and flames
X09
Exposure to unspecified smoke, fire and flames
~
Contact with heat and hot substances (X10?
X19)
X10
Contact with hot drinks, food, fats and cooking oils
X11
Contact with hot tap-water
X12
Contact with other hot fluids
X13
Contact with steam and hot vapours
X14
Contact with hot air and gases
X15
Contact with hot household appliances
CBHI ICD 10 Student Workbook January 2008 Page 289

X16
X17
X18
X19

Contact with hot heating appliances, radiators and pipes


Contact with hot engines, machinery and tools
Contact with other hot metals
Contact with other and unspecified heat and hot substances
~
Contact with venomous animals and plants (X20?
X29)
X20
Contact with venomous snakes and lizards
X21
Contact with venomous spiders
X22
Contact with scorpions
X23
Contact with hornets, wasps and bees
X24
Contact with centipedes and venomous millipedes (tropical)
X25
Contact with other specified venomous arthropods
X26
Contact with venomous marine animals and plants
X27
Contact with other specified venomous animals
X28
Contact with other specified venomous plants
X29
Contact with unspecified venomous animal or plant
~
Exposure to forces of nature (X30?X39)
X30
Exposure to excessive natural heat
X31
Exposure to excessive natural cold
X32
Exposure to sunlight
X33
Victim of lightning
X34
Victim of earthquake
X35
Victim of volcanic eruption
X36
Victim of avalanche, landslide and other earth movements
X37
Victim of cataclysmic storm
X38
Victim of flood
X39
Exposure to other and unspecified forces of nature
~
Accidental poisoning by and exposure to noxious substances (X40?X49)
X40
Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and
antirheumatics
X41
Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic,
antiparkinsonism and psychotropic drugs, not elsewhere classified
X42
Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens],
not elsewhere classified
X43
Accidental poisoning by and exposure to other drugs acting on the autonomic nervous
system
X44
Accidental poisoning by and exposure to other and unspecified drugs, medicaments and
biological substances
X45
Accidental poisoning by and exposure to alcohol
X46
Accidental poisoning by and exposure to organic solvents and halogenated hydrocarbons
and their vapours
X47
Accidental poisoning by and exposure to other gases and vapours
X48
Accidental poisoning by and exposure to pesticides
X49
Accidental poisoning by and exposure to other and unspecified chemicals and noxious
substances
~
Overexertion, travel and privation (X50?X57)
X50
Overexertion and strenuous or repetitive movements
X51
Travel and motion
X52
Prolonged stay in weightless environment
X53
Lack of food
CBHI ICD 10 Student Workbook January 2008 Page 290

X54
X57

Lack of water
Unspecified privation

~
Accidental exposure to other and unspecified factors (X58?X59)
X58
Exposure to other specified factors
X59
Exposure to unspecified factor
~
Intentional self-harm (X60?
X84)
X60
Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and
antirheumatics
X61
Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic,
antiparkinsonism and psychotropic drugs, not elsewhere classified
X62
Intentional self-poisoning by and exposure to narcotics and psychodysleptics
[hallucinogens], not elsewhere classified
X63
Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous
system
X64
Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments
and biological substances
X65
Intentional self-poisoning by and exposure to alcohol
X66
Intentional self-poisoning by and exposure to organic solvents and halogenated
hydrocarbons and their vapours
X67
Intentional self-poisoning by and exposure to other gases and vapours
X68
Intentional self-poisoning by and exposure to pesticides
X69
Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious
substances
X70
Intentional self-harm by hanging, strangulation and suffocation
X71
Intentional self-harm by drowning and submersion
X72
Intentional self-harm by handgun discharge
X73
Intentional self-harm by rifle, shotgun and larger firearm discharge
X74
Intentional self-harm by other and unspecified firearm discharge
X75
Intentional self-harm by explosive material
X76
Intentional self-harm by smoke, fire and flames
X77
Intentional self-harm by steam, hot vapours and hot objects
X78
Intentional self-harm by sharp object
X79
Intentional self-harm by blunt object
X80
Intentional self-harm by jumping from a high place
X81
Intentional self-harm by jumping or lying before moving object
X82
Intentional self-harm by crashing of motor vehicle
X83
Intentional self-harm by other specified means
X84
Intentional self-harm by unspecified means
~
Assault (X85?Y09)
X85
Assault by drugs, medicaments and biological substances
X86
Assault by corrosive substance
X87
Assault by pesticides
X88
Assault by gases and vapours
X89
Assault by other specified chemicals and noxious substances
X90
Assault by unspecified chemical or noxious substance
X91
Assault by hanging, strangulation and suffocation
X92
Assault by drowning and submersion
X93
Assault by handgun discharge
X94
Assault by rifle, shotgun and larger firearm discharge
X95
Assault by other and unspecified firearm discharge
CBHI ICD 10 Student Workbook January 2008 Page 291

X96
X97
X98
X99
Y00
Y01
Y02
Y03
Y04
Y05
Y06
Y07
Y08
Y09

Assault by explosive material


Assault by smoke, fire and flames
Assault by steam, hot vapours and hot objects
Assault by sharp object
Assault by blunt object
Assault by pushing from high place
Assault by pushing or placing victim before moving object
Assault by crashing of motor vehicle
Assault by bodily force
Sexual assault by bodily force
Neglect and abandonment
Other maltreatment syndromes
Assault by other specified means
Assault by unspecified means
~
Event of undetermined intent (Y10?Y34)
Y10
Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics,
undetermined intent
Y11
Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and
psychotropic drugs, not elsewhere classified, undetermined intent
Y12
Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not
elsewhere classified, undetermined intent
Y13
Poisoning by and exposure to other drugs acting on the autonomic nervous system,
undetermined intent
Y14
Poisoning by and exposure to other and unspecified drugs, medicaments and biological
substances, undetermined intent
Y15
Poisoning by and exposure to alcohol, undetermined intent
Y16
Poisoning by and exposure to organic solvents and halogenated hydrocarbons and their
vapours, undetermined intent
Y17
Poisoning by and exposure to other gases and vapours, undetermined intent
Y18
Poisoning by and exposure to pesticides, undetermined intent
Y19
Poisoning by and exposure to other and unspecified chemicals and noxious substances,
undetermined intent
Y20
Hanging, strangulation and suffocation, undetermined intent
Y21
Drowning and submersion, undetermined intent
Y22
Handgun discharge, undetermined intent
Y23
Rifle, shotgun and larger firearm discharge, undetermined intent
Y24
Other and unspecified firearm discharge, undetermined intent
Y25
Contact with explosive material, undetermined intent
Y26
Exposure to smoke, fire and flames, undetermined intent
Y27
Contact with steam, hot vapours and hot objects, undetermined intent
Y28
Contact with sharp object, undetermined intent
Y29
Contact with blunt object, undetermined intent
Y30
Falling, jumping or pushed from a high place, undetermined intent
Y31
Falling, lying or running before or into moving object, undetermined intent
Y32
Crashing of motor vehicle, undetermined intent
Y33
Other specified events, undetermined intent
Y34
Unspecified event, undetermined intent
~
Legal intervention and operations of war (Y35?Y36)
Y35
Legal intervention
Y36
Operations of war
CBHI ICD 10 Student Workbook January 2008 Page 292

~
Complications of medical and surgical care (Y40?Y84)
Drugs, medicaments and biological substances causing adverse effects in therapeutic use
~
(Y40?Y59)
Y40
Systemic antibiotics
Y41
Other systemic anti-infectives and antiparasitics
Y42
Hormones and their synthetic substitutes and antagonists, not elsewhere classified
Y43
Primarily systemic agents
Y44
Agents primarily affecting blood constituents
Y45
Analgesics, antipyretics and anti-inflammatory drugs
Y46
Antiepileptics and antiparkinsonism drugs
Y47
Sedatives, hypnotics and antianxiety drugs
Y48
Anaesthetics and therapeutic gases
Y49
Psychotropic drugs, not elsewhere classified
Y50
Central nervous system stimulants, not elsewhere classified
Y51
Drugs primarily affecting the autonomic nervous system
Y52
Agents primarily affecting the cardiovascular system
Y53
Agents primarily affecting the gastrointestinal system
Y54
Agents primarily affecting water-balance and mineral and uric acid metabolism
Y55
Agents primarily acting on smooth and skeletal muscles and the respiratory system
Y56
Topical agents primarily affecting skin and mucous membrane and ophthalmological,
otorhinolaryngological and dental drugs
Y57
Other and unspecified drugs and medicaments
Y58
Bacterial vaccines
Y59
Other and unspecified vaccines and biological substances
~
Misadventures to patients during surgical and medical care (Y60?Y69)
Y60
Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care
Y61
Foreign object accidentally left in body during surgical and medical care
Y62
Failure of sterile precautions during surgical and medical care
Y63
Failure in dosage during surgical and medical care
Y64
Contaminated medical or biological substances
Y65
Other misadventures during surgical and medical care
Y66
Nonadministration of surgical and medical care
Y69
Unspecified misadventure during surgical and medical care
~
Medical devices associated with adverse incidents in diagnostic and therapeutic use (Y70?Y82)
Y70
Anaesthesiology devices associated with adverse incidents
Y71
Cardiovascular devices associated with adverse incidents
Y72
Otorhinolaryngological devices associated with adverse incidents
Y73
Gastroenterology and urology devices associated with adverse incidents
Y74
General hospital and personal-use devices associated with adverse incidents
Y75
Neurological devices associated with adverse incidents
Y76
Obstetric and gynaecological devices associated with adverse incidents
Y77
Ophthalmic devices associated with adverse incidents
Y78
Radiological devices associated with adverse incidents
Y79
Orthopaedic devices associated with adverse incidents
Y80
Physical medicine devices associated with adverse incidents
Y81
General- and plastic-surgery devices associated with adverse incidents
Y82
Other and unspecified medical devices associated with adverse incidents

CBHI ICD 10 Student Workbook January 2008 Page 293

Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later
~
complication, without mention of misadventure at the time of the procedure (Y83?
Y84)
Y83
Surgical operation and other surgical procedures as the cause of abnormal reaction of the
patient, or of later complication, without mention of misadventure at the time of the
procedure
Y84
Other medical procedures as the cause of abnormal reaction of the patient, or of later
complication, without mention of misadventure at the time of the procedure
~
Sequelae of external causes of morbidity and mortality (Y85?Y89)
Y85
Sequelae of transport accidents
Y86
Sequelae of other accidents
Y87
Sequelae of intentional self-harm, assault and events of undetermined intent
Y88
Sequelae with surgical and medical care as external cause
Y89
Sequelae of other external causes
Supplementary factors related to causes of morbidity and mortality classified elsewhere
~
(Y90?Y98)
Y90
Evidence of alcohol involvement determined by blood alcohol level
Y91
Evidence of alcohol involvement determined by level of intoxication
Y95
Nosocomial condition
Y96
Work-related condition
Y97
Environmental-pollution-related condition
Y98
Lifestyle-related condition
Chapter XXI
Factors influencing health status and contact with health services
~
(Z00?Z99)
~
Persons encountering health services for examination and investigation (Z00?Z13)
Z00
General examination and investigation of persons without complaint and reported
diagnosis
Z01
Other special examinations and investigations of persons without complaint or reported
diagnosis
Z02
Examination and encounter for administrative purposes
Z03
Medical observation and evaluation for suspected diseases and conditions
Z04
Examination and observation for other reasons
Z08
Follow-up examination after treatment for malignant neoplasms
Z09
Follow-up examination after treatment for conditions other than malignant neoplasms
Z10
Routine general health check-up of defined subpopulation
Z11
Special screening examination for infectious and parasitic diseases
Z12
Special screening examination for neoplasms
Z13
Special screening examination for other diseases and disorders
~
Persons with potential health hazards related to communicable diseases (Z20?Z29)
Z20
Z21
Z22
Z23
Z24
Z25
Z26
Z27

Contact with and exposure to communicable diseases


Asymptomatic human immunodeficiency virus [HIV] infection status
Carrier of infectious disease
Need for immunization against single bacterial diseases
Need for immunization against certain single viral diseases
Need for immunization against other single viral diseases
Need for immunization against other single infectious diseases
Need for immunization against combinations of infectious diseases

CBHI ICD 10 Student Workbook January 2008 Page 294

Z28
Z29

Immunization not carried out


Need for other prophylactic measures

~
Persons encountering health services in circumstances related to reproduction (Z30?Z39)
Z30
Contraceptive management
Z31
Procreative management
Z32
Pregnancy examination and test
Z33
Pregnant state, incidental
Z34
Supervision of normal pregnancy
Z35
Supervision of high-risk pregnancy
Z36
Antenatal screening
Z37
Outcome of delivery
Z38
Liveborn infants according to place of birth
Z39
Postpartum care and examination
~
Persons encountering health services for specific procedures and health care (Z40?Z54)
Z40
Prophylactic surgery
Z41
Procedures for purposes other than remedying health state
Z42
Follow-up care involving plastic surgery
Z43
Attention to artificial openings
Z44
Fitting and adjustment of external prosthetic device
Z45
Adjustment and management of implanted device
Z46
Fitting and adjustment of other devices
Z47
Other orthopaedic follow-up care
Z48
Other surgical follow-up care
Z49
Care involving dialysis
Z50
Care involving use of rehabilitation procedures
Z51
Other medical care
Z52
Donors of organs and tissues
Z53
Persons encountering health services for specific procedures, not carried out
Z54
Convalescence
Persons with potential health hazards related to socioeconomic and psychosocial
~
circumstances (Z55?Z65)
Z55
Problems related to education and literacy
Z56
Problems related to employment and unemployment
Z57
Occupational exposure to risk-factors
Z58
Problems related to physical environment
Z59
Problems related to housing and economic circumstances
Z60
Problems related to social environment
Z61
Problems related to negative life events in childhood
Z62
Other problems related to upbringing
Z63
Other problems related to primary support group, including family circumstances
Z64
Problems related to certain psychosocial circumstances
Z65
Problems related to other psychosocial circumstances
~
Persons encountering health services in other circumstances (Z70?Z76)
Z70
Counselling related to sexual attitude, behaviour and orientation
Z71
Persons encountering health services for other counselling and medical advice, not
elsewhere classified
Z72
Problems related to lifestyle
Z73
Problems related to life-management difficulty
Z74
Problems related to care-provider dependency
CBHI ICD 10 Student Workbook January 2008 Page 295

Z75
Z76

Problems related to medical facilities and other health care


Persons encountering health services in other circumstances

Persons with potential health hazards related to family and personal history and certain
~
conditions influencing health status (Z80?Z99)
Z80
Family history of malignant neoplasm
Z81
Family history of mental and behavioural disorders
Z82
Family history of certain disabilities and chronic diseases leading to disablement
Z83
Family history of other specific disorders
Z84
Family history of other conditions
Z85
Personal history of malignant neoplasm
Z86
Personal history of certain other diseases
Z87
Personal history of other diseases and conditions
Z88
Personal history of allergy to drugs, medicaments and biological substances
Z89
Acquired absence of limb
Z90
Acquired absence of organs, not elsewhere classified
Z91
Personal history of risk-factors, not elsewhere classified
Z92
Personal history of medical treatment
Z93
Artificial opening status
Z94
Transplanted organ and tissue status
Z95
Presence of cardiac and vascular implants and grafts
Z96
Presence of other functional implants
Z97
Presence of other devices
Z98
Other postsurgical states
Z99
Dependence on enabling machines and devices, not elsewhere classified
Chapter XXII
Codes for special purposes
~
(U00?U99)
~
Provisional assignment of new diseases of uncertain etiology (U00?U49)
U04
Severe acute respiratory syndrome [SARS]

CBHI ICD 10 Student Workbook January 2008 Page 296

APPENDIX 4
TABULATION LISTS FOR MORTALITY AND MORBIDITY
Mortality tabulation lists
List 1 - General mortality - condensed list (103 causes)
List 2 - General mortality - selected list (80 causes)
List 3 - Infant and child mortality - condensed list (67 causes)
List 4 - Infant and child mortality - selected list (51 causes)
Tabulation list for morbidity (298 causes)

CBHI ICD 10 Student Workbook January 2008 Page 297

Special tabulation lists for mortality and morbidity


Note:

These lists were adopted by the World Health Assembly in 1990 for the tabulation of data.
They are described, and their use is explained, in Volume 2, the Instruction Manual.

Mortality tabulation list 1


General mortality
Condensed list
1-001
Certain infectious and parasitic diseases
1-002
1-003
1-004
1-005
1-006
1-007
1-008
1-009
1-010
1-011
1-012
1-013

1-018
1-019
1-020
1-021
1-022
1-023
1-024
1-025

Cholera
Diarrhoea and gastroenteritis of presumed infectious origin
Other intestinal infectious diseases
Respiratory tuberculosis
Other tuberculosis
Plague
Tetanus
Diphtheria
Whooping cough
Meningococcal infection
Septicaemia
Infections with a predominantly sexual mode of
transmission
Acute poliomyelitis
Rabies
Yellow fever
Other arthropod-borne viral fevers and viral haemorrhagic
fevers
Measles
Viral hepatitis
Human immunodeficiency virus [HIV] disease
Malaria
Leishmaniasis
Trypanosomiasis
Schistosomiasis
Remainder of certain infectious and parasitic diseases

1-026
1-027
1-028
1-029
1-030
1-031
1-032
1-033
1-034
1-035

Neoplasms
Malignant neoplasm of lip, oral cavity and pharynx
Malignant neoplasm of oesophagus
Malignant neoplasm of stomach
Malignant neoplasm of colon, rectum and anus
Malignant neoplasm of liver and intrahepatic bile ducts
Malignant neoplasm of pancreas
Malignant neoplasm of larynx
Malignant neoplasm of trachea, bronchus and lung
Malignant melanoma of skin

1-014
1-015
1-016
1-017

A00-B99
A00
A09
A01-A08
A15-A16
A17-A19
A20
A33-A35
A36
A37
A39
A40-A41
A50-A64
A80
A82
A95
A90-A94, A96-A99
B05
B15-B19
B20-B24
B50-B54
B55
B56-B57
B65
A21-A32, A38, A42-A49,
A65-A79, A81, A83-A89,
B00-B04, B06-B09, B25
B49, B58-B64, B66-B94,
B99
C00-D48
C00-C14
C15
C16
C18-C21
C22
C25
C32
C33-C34
C43

CBHI ICD 10 Student Workbook January 2008 Page 298

1-036
1-037
1-038
1-039
1-040
1-041
1-042
1-043
1-044
1-045
1-046

1-047
1-048
1-049
1-050

1-051
1-052
1-053
1-054
1-055
1-056
1-057
1-058
1-059
1-060
1-061
1-062
1-063
1-064
1-065
1-066
1-067
1-068
1-069
1-070
1-071
1-072
1-073
1-074
1-075

Malignant neoplasm of breast


Malignant neoplasm of cervix uteri
Malignant neoplasm of other and unspecified parts of uterus
Malignant neoplasm of ovary
Malignant neoplasm of prostate
Malignant neoplasm of bladder
Malignant neoplasm of meninges, brain and other parts of
central nervous system
Non-Hodgkin's lymphoma
Multiple myeloma and malignant plasma cell neoplasms
Leukaemias
Remainder of malignant neoplasms

Remainder of neoplasms
Diseases of the blood and blood-forming organs and
certain disorders involving the immune mechanism
Anaemias
Remainder of diseases of the blood and blood-forming
organs and certain disorders involving the immune
mechanism
Endocrine, nutritional and metabolic diseases
Diabetes mellitus
Malnutrition
Remainder of endocrine, nutritional and metabolic diseases
Mental and behavioural disorders
Mental and behavioural disorders due to psychoactive
substance use
Remainder of mental and behavioural disorders
Diseases of the nervous sytem
Meningitis
Alzheimer's disease
Remainder of diseases of the nervous system
Diseases of the eye and adnexa
Diseases of the ear and mastoid process
Diseases of the circulatory system
Acute rheumatic fever and chronic rheumatic heart diseases
Hypertensive diseases
Ischaemic heart diseases
Other heart diseases
Cerebrovascular diseases
Atherosclerosis
Remainder of diseases of the circulatory system
Diseases of the respiratory system
Influenza
Pneumonia
Other acute lower respiratory infections

C50
C53
C54-C55
C56
C61
C67
C70-C72
C82-C85
C90
C91-C95
C17, C23-C24, C26-C31,
C37-C41, C44-C49, C51
C52, C57-C60, C62-C66,
C68-C69, C73-C81, C88,
C96-C97
D00-D48
D50-D89
D50-D64
D65-D89

E00-E88
E10-E14
E40-E46
E00-E07, E15-E34, E50
E88
F01-F99
F10-F19
F01-F09, F20-F99
G00-G98
G00, G03
G30
G04-G25, G31-G98
H00-H59
H60-H93
I00-I99
I00-I09
I10-I13
I20-I25
I26-I51
I60-I69
I70
I71-I99
J00-J98
J10-J11
J12-J18
J20-J22

CBHI ICD 10 Student Workbook January 2008 Page 299

1-076
1-077
1-078
1-079
1-080
1-081

Chronic lower respiratory diseases


Remainder of diseases of the respiratory system
Diseases of the digestive system
Gastric and duodenal ulcer
Diseases of the liver
Remainder of diseases of the digestive system

1-082
1-083

Diseases of the skin and subcutaneous tissue


Diseases of the musculoskeletal system and connective
tissue
Diseases of the genitourinary system
Glomerular and renal tubulointerstitial diseases
Remainder of diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
Pregnancy with abortive outcome
Other direct obstetric deaths
Indirect obstetric deaths
Remainder of pregnancy, childbirth and the puerperium
Certain conditions originating in the perinatal period
Congenital malformations, deformations and
chromosomal abnormalities
Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
External causes of morbidity and mortality
Transport accidents
Falls
Accidental drowning and submersion
Exposure to smoke, fire and flames
Accidental poisoning by and exposure to noxious
substances
Intentional self-harm
Assault
All other external causes

1-084
1-085
1-086
1-087
1-088
1-089
1-090
1-091
1-092
1-093
1-094
1-095
1-096
1-097
1-098
1-099
1-100
1-101
1-102
1-103

J40-J47
J00-J06, J30-J39, J60-J98
K00-K92
K25-K27
K70-K76
K00-K22, K28-K66,
K80-K92
L00-L98
M00-M99
N00-N99
N00-N15
N17-N98
O00-O99
O00-O07
O10-O92
O98-O99
O95-O97
P00-P96
Q00-Q99
R00-R99
V01-Y89
V01-V99
W00-W19
W65-W74
X00-X09
X40-X49
X60-X84
X85-Y09
W20-W64, W75-W99,
X10-X39, X50-X59,
Y10-Y89

Mortality tabulation list 2


General Mortality
Selected list
2001
Cholera
2002
Diarrhoea and gastroenteritis of presumed infectious origin
2003
Other intestinal infectious diseases
2004
Respiratory tuberculosis
2005
Other tuberculosis
2006
Plague
2007
Tetanus
2008
Diphtheria
2009
Whooping cough
2010
Meningococcal infection

A00
A09
A01-A08
A15-A16
A17-A19
A20
A33-A35
A36
A37
A39

CBHI ICD 10 Student Workbook January 2008 Page 300

2-011
2-012
2-013
2-014
2-015
2-016
2-017
2-018
2-019
2-020
2-021
2-022
2-023
2-024

2-025
2-026
2-027
2-028
2-029
2-030
2-031
2-032
2-033
2-034
2-035
2-036
2-037
2-038
2-039
2-040
2-041
2-042
2-043
2-044

2-045
2-046
2-047
2-048
2-049

Septicaemia
Infections with a predominantly sexual mode of
transmission
Acute poliomyelitis
Rabies
Yellow fever
Other arthropod-borne viral fevers and viral haemorrhagic
fevers
Measles
Viral hepatitis
Human immunodeficiency virus [HIV] disease
Malaria
Leishmaniasis
Trypanosomiasis
Schistosomiasis
Remainder of certain infectious and parasitic diseases

A40-A41
A50-A64
A80
A82
A95
A90-A94, A96-A99

B05
B15-B19
B20-B24
B50-B54
B55
B56-B57
B65
A21-A32, A38, A42-A49,
A65-A79, A81, A83-A89,
B00-B04, B06-B09, B25
B49, B58-B64, B66-B94,
B99
Malignant neoplasm of lip, oral cavity and pharynx
C00-C14
Malignant neoplasm of oesophagus
C15
Malignant neoplasm of stomach
C16
Malignant neoplasm of colon, rectum and anus
C18-C21
Malignant neoplasm of liver and intrahepatic bile ducts
C22
Malignant neoplasm of pancreas
C25
Malignant neoplasm of larynx
C32
Malignant neoplasm of trachea, bronchus and lung
C33-C34
Malignant melanoma of skin
C43
Malignant neoplasm of breast
C50
Malignant neoplasm of cervix uteri
C53
Malignant neoplasm of other and unspecified parts of uterus C54-C55
Malignant neoplasm of ovary
C56
Malignant neoplasm of prostate
C61
Malignant neoplasm of bladder
C67
Malignant neoplasm of meninges, brain and other parts of
C70-C72
central nervous system
Non-Hodgkin's lymphoma
C82-C85
Multiple myeloma and malignant plasma cell neoplasms
C90
Leukaemias
C91-C95
Remainder of malignant neoplasms
C17, C23-C24, C26-C31,
C37-C41, C44-C49, C51
C52, C57-C60, C62-C66,
C68-C69, C73-C81, C88,
C96-C97
Anaemias
D50-D64
Diabetes mellitus
E10-E14
Malnutrition
E40-E46
Mental and behavioural disorders due to pyschoactive
F10-F19
substance use
Meningitis
G00, G03
CBHI ICD 10 Student Workbook January 2008 Page 301

2-050
2-051
2-052
2-053
2-054
2-055
2-056
2-057
2-058
2-059
2-060
2-061
2-062
2-063
2-064
2-065
2-066
2-067
2-068
2-069
2-070
2-071
2-072

2-073
2-074
2-075
2-076
2-077
2-078
2-079
2-080

Alzheimer's disease
Acute rheumatic fever and chronic rheumatic heart diseases
Hypertensive diseases
Ischaemic heart diseases
Other heart diseases
Cerebrovascular diseases
Atherosclerosis
Remainder of diseases of the circulatory system
Influenza
Pneumonia
Other acute lower respiratory infections
Chronic lower respiratory diseases
Remainder of diseases of the respiratory system
Gastric and duodenal ulcer
Diseases of the liver
Glomerular and renal tubulo-interstitial diseases
Pregnancy with abortive outcome
Other direct obstetric deaths
Indirect obstetric deaths
Certain conditions originating in the perinatal period
Congenital malformations, deformations and chromosomal
abnormalities
Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
All other diseases

Transport accidents
Falls
Accidental drowning and submersion
Exposure to smoke, fire and flames
Accidental poisoning by and exposure to noxious
substances
Intentional self-harm
Assault
All other external causes

G30
I00-I09
I10-I13
I20-I25
I26-I51
I60-I69
I70
I71-I99
J10-J11
J12-J18
J20-J22
J40-J47
J00-J06, J30-J39, J60-J98
K25-K27
K70-K76
N00-N15
O00-O07
O10-O92
O98-O99
P00-P96
Q00-Q99
R00-R99
D00-D48, D65-D89, E00
E07, E15-E34, E50-E88,
F01-F09, F20-F99, G04
G25, G31-G98, H00-H93,
K00-K22, K28-K66,
K80-K92, L00-L98, M00
M99, N17-N98, O95-O97
V01-V99
W00-W19
W65-W74
X00-X09
X40-X49
X60-X84
X85-Y09
W20-W64, W75-W99,
X10-X39, X50-X59

Mortality tabulation list 3


Infant and child mortality
Condensed list
3-001 Certain infectious and parasitic diseases
3-002 Diarrhoea and gastroenteritis of presumed infectious origin
3-003 Other intestinal infectious diseases
3-004 Tuberculosis

A00-B99
A09
A00-A08
A15-A19

CBHI ICD 10 Student Workbook January 2008 Page 302

3005
3-006
3-007
3-008
3-009
3-010
3-011
3-012
3-013

Tetanus
Diphtheria
Whooping cough
Meningococcal infection
Septicaemia
Acute poliomyelitis
Measles
Human immunodeficiency virus [HIV] disease
Other viral diseases

3-014
3015

Malaria
Remainder of certain infectious and parasitic diseases

3-016
3-017
3-018
3-019
3020

Neoplasms
Leukaemia
Remainder of malignant neoplasms
Remainder of neoplasms
Diseases of the blood and blood-forming organs and
certain disorders involving the immune mechanism
Anaemias
Remainder of diseases of the blood and blood-forming
organs and certain disorders involving the immune
mechanism
Endocrine, nutritional and metabolic diseases
Malnutrition and other nutritional deficiencies
Remainder of endocrine, nutritional and metabolic diseases
Diseases of the nervous system
Meningitis
Remainder of diseases of the nervous system
Diseases of the ear and mastoid process
Diseases of the circulatory system
Diseases of the respiratory system
Pneumonia
Other acute respiratory infections
Remainder of diseases of the respiratory system
Diseases of the digestive system
Diseases of the genitourinary system
Certain conditions originating in the perinatal period
Fetus and newborn affected by maternal factors and by
complications of pregnancy, labour and delivery
Disorders relating to length of gestation and fetal growth
Birth trauma
Intrauterine hypoxia and birth asphyxia
Respiratory distress of newborn
Congenital pneumonia
Other respiratory conditions of newborn
Bacterial sepsis of newborn
Omphalitis of newborn with or without mild haemorrhage
Haemorrhagic and haematological disorders of fetus and
newborn

3-021
3-022

3-023
3-024
3025
3-026
3-027
3-028
3-029
3030
3-031
3-032
3-033
3-034
3035
3-036
3-037
3-038
3-039
3040
3-041
3-042
3-043
3-044
3045
3-046
3-047

A33, A35
A36
A37
A39
A40-A41
A80
B05
B20-B24
A81-B04, B06-B19, B25
B34
B50-B54
A20-A32, A38, A42-A79,
B35-B49, B55-B94, B99
C00-D48
C91-C95
C00-C90, C96-C97
D00-D48
D50-D89
D50-D64
D65-D89

E00-E88
E40-E64
E00-E34, E65-E88
G00-G98
G00, G03
G04-G98
H60-H93
I00-I99
J00-J98
J12-J18
J00-J11, J20-J22
J30-J98
K00-K92
N00-N98
P00-P96
P00-P04
P05-P08
P10-P15
P20-P21
P22
P23
P24-P28
P36
P38
P50-P61

CBHI ICD 10 Student Workbook January 2008 Page 303

3-048

Remainder of perinatal conditions

3-049

3-059

Congenital malformations, deformations, and


chromosomal abnormalities
Congenital hydrocephalus and spina bifida
Other congenital malformations of the nervous system
Congenital malformations of the heart
Other congenital malformations of the circulatory system
Down's syndrome and other chromosomal abnormalities
Other congenital malformations
Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
Sudden infant death syndrome
Other symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
All other diseases

3-060
3-061
3-062
3-063
3-064
3-065
3-066
3-067

External causes of morbidity and mortality


Transport accidents
Accidental drowning and submersion
Other accidental threats to breathing
Exposure to smoke, fire and flames
Accidental poisoning by and exposure to noxious substances
Assault
All other external causes

3-050
3-051
3-052
3-053
3-054
3-055
3-056
3-057
3-058

P29, P35, P37, P39, P70


P96
Q00-Q99
Q03, Q05
Q00-Q02, Q04, Q06-Q07
Q20-Q24
Q25-Q28
Q90-Q99
Q10-Q18, Q30-Q89
R00-R99
R95
R00-R94, R96-R99
F01-F99, H00-H59, L00
L98, M00-M99
V01-Y89
V01-V99
W65-W74
W75-W84
X00-X09
X40-X49
X85-Y09
W00-W64, W85-W99,
X10-X39, X50-X84,
Y10-Y89

Mortality tabulation list 4


Infant and child mortality
Selected list
4-001
4-002
4-003
4-004
4-005
4-006
4-007
4-008
4-009
4-010
4-011
4-012

Diarrhoea and gastroenteritis of presumed infectious origin


Other intestinal infectious diseases
Tuberculosis
Tetanus
Diphtheria
Whooping cough
Meningococcal infection
Septicaemia
Acute poliomyelitis
Measles
Human immunodeficiency virus [HIV] disease
Other viral diseases

4-013
4-014

Malaria
Remainder of certain infectious and parasitic diseases

4-015

Leukaemia

A09
A00-A08
A15-A19
A33, A35
A36
A37
A39
A40-A41
A80
B05
B20-B24
A81-B04, B06-B19, B25
B34
B50-B54
A20-A32, A38, A42-A79,
B35-B49, B55-B94, B99
C91-C95

CBHI ICD 10 Student Workbook January 2008 Page 304

4-016
4-017
4-018

4-019
4-020
4-021
4-022
4-023
4-024
4-025
4-026
4-027
4-028
4-029
4-030
4-031
4-032
4-033
4-034
4-035
4-036
4-037
4-038
4-039
4-040
4-041
4-042
4-043

Remainder of malignant neoplasms


Anaemias
Remainder of diseases of the blood and blood-forming
organs and certain disorders involving the immune
mechanism
Malnutrition and other nutritional deficiencies
Meningitis
Remainder of diseases of the nervous system
Pneumonia
Other acute respiratory infections
Diseases of the digestive system
Fetus and newborn affected by maternal factors and by
complications of pregnancy, labour and delivery
Disorders relating to length of gestation and fetal growth
Birth trauma
Intrauterine hypoxia and birth asphyxia
Respiratory distress of newborn
Congenital pneumonia
Other respiratory conditions of newborn
Bacterial sepsis of newborn
Omphalitis of newborn with or without mild haemorrhage
Haemorrhagic and haematological disorders of fetus and
newborn
Remainder of perinatal conditions

4-044

Congenital hydrocephalus and spina bifida


Other congenital malformations of the nervous system
Congenital malformations of the heart
Other congenital malformations of the circulatory system
Down's syndrome and other chromosomal abnormalities
Other congenital malformations
Sudden infant death syndrome
Other symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
All other diseases

4-045
4-046
4-047
4-048
4-049
4-050
4-051

Transport accidents
Accidental drowning and submersion
Other accidental threats to breathing
Exposure to smoke, fire and flames
Accidental poisoning by and exposure to noxious substances
Assault
All other external causes

C00-C90, C96-C97
D50-D64
D65-D89

E40-E64
G00, G03
G04-G98
J12-J18
J00-J11, J20-J22
K00-K92
P00-P04
P05-P08
P10-P15
P20-P21
P22
P23
P24-P28
P36
P38
P50-P61
P29, P35, P37, P39, P70
P96
Q03, Q05
Q00-Q02, Q04, Q06-Q07
Q20-Q24
Q25-Q28
Q90-Q99
Q10-Q18, Q30-Q89
R95
R00-R94, R96-R99
D00-D48, E00-E34, E65
E88, F01-F99, H00-H95,
I00-I99, J30-J98, L00
L98, M00-M99, N00-N98
V01-V99
W65-W74
W75-W84
X00-X09
X40-X49
X85-Y09
W00-W64, W85-W99,
X10-X39, X50-X84,
Y10-Y89

CBHI ICD 10 Student Workbook January 2008 Page 305

Tabulation list for morbidity


001
002
003
004
005
006
007
008
009
010
011
012
013
014
015
016
017
018

Cholera
Typhoid and paratyphoid fevers
Shigellosis
Amoebiasis
Diarrhoea and gastroenteritis of presumed infectious origin
Other intestinal infectious diseases
Respiratory tuberculosis
Other tuberculosis
Plague
Brucellosis
Leprosy
Tetanus neonatorum
Other tetanus
Diphtheria
Whooping cough
Meningococcal infection
Septicaemia
Other bacterial diseases

019
020
021
022
023
024

033
034
035
036
037
038
039
040
041

Congenital syphilis
Early syphilis
Other syphilis
Gonococcal infection
Sexually transmitted chlamydial diseases
Other infections with a predominantly sexual mode of
transmission
Relapsing fevers
Trachoma
Typhus fever
Acute poliomyelitis
Rabies
Viral encephalitis
Yellow fever
Other arthropod-borne viral fevers and viral haemorrhagic
fevers
Herpesviral infections
Varicella and zoster
Measles
Rubella
Acute hepatitis B
Other viral hepatitis
Human immunodeficiency virus [HIV] disease
Mumps
Other viral diseases

042

Mycoses

025
026
027
028
029
030
031
032

A00
A01
A03
A06
A09
A02, A04-A05, A07-A08
A15-A16
A17-A19
A20
A23
A30
A33
A34-A35
A36
A37
A39
A40-A41
A21-A22, A24-A28,
A31-A32, A38, A42-A49
A50
A51
A52-A53
A54
A55-A56
A57-A64
A68
A71
A75
A80
A82
A83-A86
A95
A90-A94, A96-A99
B00
B01-B02
B05
B06
B16
B15, B17-B19
B20-B24
B26
A81, A87-A89, B03-B04,
B07-B09, B25, B27-B34
B35-B49

CBHI ICD 10 Student Workbook January 2008 Page 306

043
044
045
046
047
048
049
050
051
052
053
054
055
056
057

Malaria
Leishmaniasis
Trypanosomiasis
Schistosomiasis
Other fluke infections
Echinococcosis
Dracunculiasis
Onchocerciasis
Filariasis
Hookworm diseases
Other helminthiases
Sequelae of tuberculosis
Sequelae of poliomyelitis
Sequelae of leprosy
Other infectious and parasitic diseases

058
059
060
061
062

Malignant neoplasm of lip, oral cavity and pharynx


Malignant neoplasm of oesophagus
Malignant neoplasm of stomach
Malignant neoplasm of colon
Malignant neoplasm of rectosigmoid junction, rectum, anus
and anal canal
Malignant neoplasm of liver and intrahepatic bile ducts
Malignant neoplasm of pancreas
Other malignant neoplasms of digestive organs
Malignant neoplasms of larynx
Malignant neoplasm of trachea, bronchus and lung
Other malignant neoplasms of respiratory and intrathoracic
organs
Malignant neoplasm of bone and articular cartilage
Malignant melanoma of skin
Other malignant neoplasms of skin
Malignant neoplasms of mesothelial and soft tissue
Malignant neoplasm of breast
Malignant neoplasm of cervix uteri
Malignant neoplasm of other and unspecified parts of uterus
Other malignant neoplasms of female genital organs
Malignant neoplasm of prostate
Other malignant neoplasms of male genital organs
Malignant neoplasm of bladder
Other malignant neoplasms of urinary tract
Malignant neoplasm of eye and adnexa
Malignant neoplasm of brain
Malignant neoplasm of other parts of central nervous system
Malignant neoplasm of other, ill-defined, secondary,
unspecified and multiple sites
Hodgkin's disease
Non-Hodgkin's lymphoma
Leukaemia

063
064
065
066
067
068
069
070
071
072
073
074
075
076
077
078
079
080
081
082
083
084
085
086
087

B50-B54
B55
B56-B57
B65
B66
B67
B72
B73
B74
B76
B68-B71, B75, B77-B83
B90
B91
B92
A65-A67, A69-A70, A74,
A77-A79, B58-B64, B85
B89, B94, B99
C00-C14
C15
C16
C18
C19-C21
C22
C25
C17, C23-C24, C26
C32
C33-C34
C30-C31, C37-C39
C40-C41
C43
C44
C45-C49
C50
C53
C54-C55
C51-C52, C56-C58
C61
C60, C62-C63
C67
C64-C66, C68
C69
C71
C70, C72
C73-C80, C97
C81
C82-C85
C91-C95

CBHI ICD 10 Student Workbook January 2008 Page 307

088
089
090
091
092
093
094
095
096

097
098
099
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114

Other malignant neoplasms of lymphoid, haematopoietic and


related tissue
Carcinoma in situ of cervix uteri
Benign neoplasm of skin
Benign neoplasm of breast
Leiomyoma of uterus
Benign neoplasm of ovary
Benign neoplasm of urinary organs
Benign neoplasm of brain and other parts of central nervous
system
Other in situ and benign neoplasms and neoplasms of
uncertain and unknown behaviour
Iron deficiency anaemia
Other anaemias
Haemorrhagic conditions and other diseases of blood and
blood-forming organs
Certain disorders involving the immune mechanism
Iodine-deficiency-related thyroid disorders
Thyrotoxicosis
Other disorders of thyroid
Diabetes mellitus
Malnutrition
Vitamin A deficiency
Other vitamin deficiencies
Sequelae of malnutrition and other nutritional deficiencies
Obesity
Volume depletion
Other endocrine, nutritional and metabolic disorders

115
116
117
118
119

Dementia
Mental and behavioural disorders due to use of alcohol
Mental and behavioural disorders due to other psychoactive
substance use
Schizophrenia, schizotypal, and delusional disorders
Mood [affective] disorders
Neurotic, stress-related, and somatoform disorders
Mental retardation
Other mental and behavioural disorders

120
121
122
123
124
125
126
127
128

Inflammatory diseases of the central nervous system


Parkinson's disease
Alzheimer's disease
Multiple sclerosis
Epilepsy
Migraine and other headache syndromes
Transient cerebral ischaemic attacks and related syndromes
Nerve, nerve root and plexus disorders
Cerebral palsy and other paralytic syndromes

C88-C90, C96
D06
D22-D23
D24
D25
D27
D30
D33
D00-D05, D07-D21, D26,
D28-D29, D31-D32,
D34-D48
D50
D51-D64
D65-D77
D80-D89
E00-E02
E05
E03-E04, E06-E07
E10-E14
E40-E46
E50
E51-E56
E64
E66
E86
E15-E35, E58-E63, E65,
E67-E85, E87-E90
F00-F03
F10
F11-F19
F20-F29
F30-F39
F40-F48
F70-F79
F04-F09, F50-F69, F80
F99
G00-G09
G20
G30
G35
G40-G41
G43-G44
G45
G50-G59
G80-G83

CBHI ICD 10 Student Workbook January 2008 Page 308

129

130
131
132
133
134
135
136
137
138
139

140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171

Other diseases of the nervous system

G10-G13, G21-G26,
G31-G32, G36-G37,
G46-G47, G60-G73,
G90-G99
Inflammation of eyelid
H00-H01
Conjunctivitis and other disorders of conjunctiva
H10-H13
Keratitis and other disorders of sclera and cornea
H15-H19
Cataract and other disorders of lens
H25-H28
Retinal detachments and breaks
H33
Glaucoma
H40-H42
Strabismus
H49-H50
Disorders of refraction and accommodation
H52
Blindness and low vision
H54
Other diseases of the eye and adnexa
H02-H06, H20-H22,
H30-H32, H34-H36,
H43-H48, H51, H53,
H55-H59
Otitis media and other disorders of middle ear and mastoid
H65-H75
Hearing loss
H90-H91
Other diseases of the ear and mastoid process
H60-H62, H80-H83,
H92-H95
Acute rheumatic fever
I00-I02
Chronic rheumatic heart disease
I05-I09
Essential (primary) hypertension
I10
Other hypertensive diseases
I11-I15
Acute myocardial infarction
I21-I22
Other ischaemic heart diseases
I20, I23-I25
Pulmonary embolism
I26
Conduction disorders and cardiac arrhythmias
I44-I49
Heart failure
I50
Other heart diseases
I27-I43, I51-I52
Intracranial haemorrhage
I60-I62
Cerebral infarction
I63
Stroke, not specified as haemorrhage or infarction
I64
Other cerebrovascular diseases
I65-I69
Atherosclerosis
I70
Other peripheral vascular diseases
I73
Arterial embolism and thrombosis
I74
Other diseases of arteries, arterioles and capillaries
I71-I72, I77-I79
Phlebitis, thrombophlebitis, venous embolism and thrombosis I80-I82
Varicose veins of lower extremities
I83
Haemorrhoids
I84
Other diseases of the circulatory system
I85-I99
Acute pharyngitis and acute tonsillitis
J02-J03
Acute laryngitis and tracheitis
J04
Other acute upper respiratory infections
J00-J01, J05-J06
Influenza
J10-J11
Pneumonia
J12-J18
Acute bronchitis and acute bronchiolitis
J20-J21
Chronic sinusitis
J32
CBHI ICD 10 Student Workbook January 2008 Page 309

172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218

Other diseases of nose and nasal sinuses


Chronic disease of tonsils and adenoids
Other diseases of upper respiratory tract
Bronchitis, emphysema and other chronic obstructive
pulmonary diseases
Asthma
Bronchiectasis
Pneumoconiosis
Other diseases of the respiratory system
Dental caries
Other disorders of teeth and supporting structures
Other diseases of the oral cavity, salivary glands and jaws
Gastric and duodenal ulcer
Gastritis and duodenitis
Other diseases of oesophagus, stomach and duodenum
Diseases of appendix
Inguinal hernia
Other hernia
Crohn's disease and ulcerative colitis
Paralytic ileus and intestinal obstruction without hernia
Diverticular disease of intestine
Other diseases of intestines and peritoneum
Alcoholic liver disease
Other diseases of liver
Cholelithiasis and cholecystitis
Acute pancreatitis and other diseases of the pancreas
Other diseases of the digestive system
Infections of the skin and subcutaneous tissue
Other diseases of the skin and subcutaneous
Rheumatoid arthritis and other inflammatory
polyarthropathies
Arthrosis
Acquired deformities of limbs
Other disorders of joints
Systemic connective tissue disorders
Cervical and other intervertebral disc disorders
Other dorsopathies
Soft tissue disorders
Disorders of bone density and structure
Osteomyelitis
Other diseases of the musculoskeletal system and connective
tissue
Acute and rapidly progressive nephritic syndromes
Other glomerular diseases
Renal tubulo-interstitial diseases
Renal failure
Urolithiasis
Cystitis
Other diseases of the urinary system
Hyperplasia of prostate

J30-J31, J33-J34
J35
J36-J39
J40-J44
J45-J46
J47
J60-J65
J22, J66-J99
K02
K00-K01, K03-K08
K09-K14
K25-K27
K29
K20-K23, K28, K30-K31
K35-K38
K40
K41-K46
K50-K51
K56
K57
K52-K55, K58-K67
K70
K71-K77
K80-K81
K85-K86
K82-K83, K87-K93
L00-L08
L10-L99
M05-M14
M15-M19
M20-M21
M00-M03, M22-M25
M30-M36
M50-M51
M40-M49, M53-M54
M60-M79
M80-M85
M86
M87-M99
N00-N01
N02-N08
N10-N16
N17-N19
N20-N23
N30
N25-N29, N31-N39
N40

CBHI ICD 10 Student Workbook January 2008 Page 310

219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242

243
244

Other disorders of prostate


Hydrocele and spermatocele
Redundant prepuce, phimosis and paraphimosis
Other diseases of male genital organs
Disorders of the breast
Salpingitis and oophoritis
Inflammatory disease of cervix uteri
Other inflammatory diseases of female pelvic organs
Endometriosis
Female genital prolapse
Noninflammatory disorders of ovary, fallopian tube and
broad ligament
Disorders of menstruation
Menopausal and other perimenopausal disorders
Female infertility
Other disorders of genitourinary tract
Spontaneous abortion
Medical abortion
Other pregnancies with abortive outcome
Oedema, proteinuria and hypertensive disorders in
pregnancy, childbirth and the puerperium
Placenta praevia, premature separation of placenta and
antepartum haemorrhage
Other maternal care related to fetus and amniotic cavity and
possible delivery problems
Obstructed labour
Postpartum haemorrhage
Other complications of pregnancy and delivery

247
248
249
250
251
252
253

Single spontaneous delivery


Complications predominantly related to the puerperium and
other obstetric conditions, not elsewhere classified
Fetus and newborn affected by maternal factors and by
complications of pregnancy, labour and delivery
Slow fetal growth, fetal malnutrition and disorders related to
short gestation and low birth weight
Birth trauma
Intrauterine hypoxia and birth asphyxia
Other respiratory disorders originating in the perinatal period
Congenital infectious and parasitic diseases
Other infections specific to the perinatal period
Haemolytic disease of fetus and newborn
Other conditions originating in the perinatal period

254
255
256
257
258

Spina bifida
Other congenital malformations of the nervous system
Congenital malformations of the circulatory system
Cleft lip and cleft palate
Absence, atresia and stenosis of small intestine

245
246

N41-N42
N43
N47
N44-N46, N48-N51
N60-N64
N70
N72
N71, N73-N77
N80
N81
N83
N91-N92
N95
N97
N82, N84-N90, N93-N94,
N96, N98-N99
O03
O04
O00-O02, O05-O08
O10-O16
O44-O46
O30-O43, O47-O48
O64-O66
O72
O20-O29, O60-O63,
O67-O71, O73-O75,
O81-O84
O80
O85-O99
P00-P04
P05-P07
P10-P15
P20-P21
P22-P28
P35-P37
P38-P39
P55
P08, P29, P50-P54, P56
P96
Q05
Q00-Q04, Q06-Q07
Q20-Q28
Q35-Q37
Q41

CBHI ICD 10 Student Workbook January 2008 Page 311

259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276

277
278
279
280

281

282
283
284
285
286
287
288

Other congenital malformations of the digestive system


Undescended testicle
Other malformations of the genitourinary system
Congenital deformities of hip
Congenital deformities of feet
Other congenital malformations and deformations of the
musculoskeletal system
Other congenital malformations

Q38-Q40, Q42-Q45
Q53
Q50-Q52, Q54-Q64
Q65
Q66
Q67-Q79

Q10-Q18, Q30-Q34,
Q80-Q89
Chromosomal abnormalities, not elsewhere classified
Q90-Q99
Abdominal and pelvic pain
R10
Fever of unknown origin
R50
Senility
R54
Other symptoms, signs and abnormal clinical and laboratory R00-R09, R11-R49, R51
findings, not elsewhere classified
R53, R55-R99
Fracture of skull and facial bones
S02
Fracture of neck, thorax or pelvis
S12, S22, S32, T08
Fracture of femur
S72
Fractures of other limb bones
S42, S52, S62, S82, S92,
T10, T12
Fractures involving multiple body regions
T02
Dislocations, sprains and strains of specified and multiple
S03, S13, S23, S33, S43,
body regions
S53, S63, S73, S83, S93,
T03
Injury of eye and orbit
S05
Intracranial injury
S06
Injury of other internal organs
S26-S27, S36-S37
Crushing injuries and traumatic amputations of specified and S07-S08, S17-S18, S28,
multiple body regions
S38, S47-S48, S57-S58,
S67-S68, S77-S78, S87
S88, S97-S98, T04-T05
Other injuries of specified, unspecified and multiple body
S00-S01, S04, S09-S11,
regions
S14-S16, S19-S21, S24
S25, S29-S31, S34-S35,
S39-S41, S44-S46, S49
S51, S54-S56, S59-S61,
S64-S66, S69-S71, S74
S76, S79-S81, S84-S86,
S89-S91, S94-S96, S99,
T00-T01, T06-T07, T09,
T11, T13-T14
Effects of foreign body entering through natural orifice
T15-T19
Burns and corrosions
T20-T32
Poisoning by drugs and biological substances
T36-T50
Toxic effects of substances chiefly nonmedicinal as to source T51-T65
Maltreatment syndromes
T74
Other and unspecified effects of external causes
T33-T35, T66-T73, T75
T78
Certain early complications of trauma and complications of
T79-T88
surgical and medical care, not elsewhere classified

CBHI ICD 10 Student Workbook January 2008 Page 312

289
290
291
292
293
294
295
296
297
298

Sequelae of injuries, poisoning and of other consequences of


external causes
Persons encountering health services for examination and
investigation
Asymptomatic human immunodeficiency virus [HIV]
infection status
Other persons with potential health hazards related to
communicable disease
Contraceptive management
Antenatal screening and other supervision of pregnancy
Liveborn infants according to place of birth
Postpartum care and examination
Persons encountering health services for specific procedures
and health care
Persons encountering health services for other reasons

T90-T98
Z00-Z13
Z21
Z20, Z22-Z29
Z30
Z34-Z36
Z38
Z39
Z40-Z54
Z31-Z33, Z37, Z55-Z99

CBHI ICD 10 Student Workbook January 2008 Page 313

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difficult
doesnt mean
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It means you
shold just try
harder

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