International Classification of Diseases, 10th Revision: it's coming, ready or not

The current diagnostic and inpatient procedure coding system, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), has been used in the United States since 1979. The coding system has become insufficient because of many medical and technological improvements that have occurred since then. On September 20, 2013, the US health care system will assign the final ICD-9-CM code. The new system, International Classification of Diseases, 10th Revision, Clinical Modification, Procedure Classification System, will become effective on October 1, 2013, including more codes and other differences. Although October 2013 is the implementation deadline, facilities should start preparing for the change at this time. A thorough understanding of the new official guidelines is key to a successful transition from ICD-9-CM to International Classification of Diseases, 10th Revision, Clinical Modification, Procedure Classification System. As we are embracing 1 of the greatest health care changes in 30 years, specific considerations are offered for initiating implementation and ensuring a smooth transition.     

Comparability between ICD-9 and ICD-10 for the leading causes of death in Spain

BACKGROUND: Implementation of a new Revision of the International Classification of Diseases can create discontinuity in mortality statistics. Revisions are nevertheless essential to ensure international comparability of health statistics. The purpose of this work was to describe the effects of the 10th Revision on mortality statistics by sex and age for leading causes of death in Spain. METHODS: A cross-sectional study of leading causes of death was carried out when the underlying cause of death was coded using both the 9th and 10th Revisions of the International Classification of Diseases in 88,044 death certificates completed in five Autonomous Communities of Spain (Andalusia, Cantabria, Murcia, Navarra, the Basque Country), and the city of Barcelona during the year 1999. Changes introduced by the 10th Revision were described by simple correspondence, percentage of change, Kappa index and comparability ratios between the 10th and the 9th Revision along with their 95% confidence intervals by sex and five-year age group, for the leading causes of death. RESULTS: Under the 10th Revision, AIDS deaths rose by 3.6% (comparability ratio (CR): 1.036; 95% confidence interval (CI):1.015-1.058), arteriosclerosis by 7.1% (CR: 1.071; 95% CI: 1.052-1.090), and drug overdose by 5.2% (CR: 1.052; 95% CI: 0.964-1.140). Mortality due to vascular and senile dementia and non specific dementia declined by 3.2% under the 10th (CR: 0.969; 95% CI: 0.950-0.988). In all the other causes of death the percentage of change regardless of direction was less than 2%. CONCLUSION: The present study found good agreement between ICD-9 and ICD-10 on the leading causes of death and premature mortality in Spain. Causes of death which present differences between Revisions were AIDS, arteriosclerosis, drug overdose and senile dementia. For these causes, the comparability ratios must be taken into account when interpreting mortality statistics.     

中国澳门居民1997-2006年死亡现况及趋势分析

目的 了解中国澳门特别行政区居民死亡情况,为卫生保健需求和规划提供科学依据.方法 按国际疾病分类第9次修订文本( ICD-9)对澳门统计暨普查局1997-2006年的人口统计、统计年鉴等死亡资料进行分类;采用Excel 2003对分类资料进行描述性分析.结果 澳门居民1997-2006年均粗死亡率为316.37/10万;年均增长速度为0.02%;循环系统疾病、肿瘤和呼吸系统疾病是澳门居民的前3位死因,肿瘤死亡率呈增长趋势,年均增长速度为3.20%,逐渐成为首位死因,呼吸系统疾病死亡率呈增长趋势,年均增长速度为1.65%;1997-2006年澳门居民循环系统疾病死亡率年均下降4.39%.结论 澳门居民1997-2006年粗死亡率较低,循环系统疾病死亡率呈下降趋势,肿瘤和呼吸系统死亡率呈增高趋势.     

Government statistics of certified causes of perinatal mortality in Moscow and certain problems with its improvement

While preparing the Ninth Revision of the International Classification of Diseases, Injuries and Causes of Death (1970-1975), the World Health Organisation sought ways of improving the accuracy of statistics of perinatal mortality. A new Certificate of Cause of Perinatal Death, developed for use in all regions of the USSR and introduced there in 1974, was recommended for introduction in other countries. This was based on the reorganised and more clear-cut coding outlined in Chapter XV of ICD-9. Comparison of the perinatal death rates in 1975 with those in 1986 showed a fall from 25 to 20 per 1000 births, with changes in causes related to changes on classification. Cross-tabulation of multiple-cause perinatal death was made possible by coding maternal conditions affecting the fetus or newborn separately from fetal conditions originating in the perinatal period. Analysis of the results of tabulation of multiple-cause perinatal death in Moscow in 1986 proceeded to a proposed structure for a Basic Tabulation List allowing comparisons of the statistics of perinatal mortality.     

Government statistics of certified causes of perinatal mortality in Moscow and certain problems with its improvement

Summary. While preparing the Ninth Revision of the International Classification of Diseases, Injuries and Causes of Death (1970–1975), the World Health Organisation sought ways of improving the accuracy of statistics of perinatal mortality. A new Certificate of Cause of Perinatal Death, developed for use in all regions of the USSR and introduced there in 1974, was recommended for introduction in other countries. This was based on the reorganised and more clear-cut coding outlined in Chapter XV of ICD-9. Comparison of the perinatal death rates in 1975 with those in 1986 showed a fall from 25 to 20 per 1000 births, with changes in causes related to changes on classification. Cross-tabulation of multiple-cause perinatal death was made possible by coding maternal conditions affecting the fetus or newborn separately from fetal conditions originating in the perinatal period. Analysis of the results of tabulation of multiple-cause perinatal death in Moscow in 1986 proceeded to a proposed structure for a Basic Tabulation List allowing comparisons of the statistics of perinatal mortality.     

Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates.

OBJECTIVES: This report presents preliminary results describing the effects of implementing the Tenth Revision of the International Classification of Diseases (ICD-10) on mortality statistics for selected causes of death effective with deaths occurring in the United States in 1999. The report also describes major features of the Tenth Revision (ICD-10), including changes from the Ninth Revision (ICD-9) in classification and rules for selecting underlying causes of death. Application of comparability ratios is also discussed. METHODS: The report is based on cause-of-death information from a large sample of 1996 death certificates filed in the 50 States and the District of Columbia. Cause-of-death information in the sample includes underlying cause of death classified by both ICD-9 and ICD-10. Because the data file on which comparability information is derived is incomplete, results are preliminary. RESULTS: Preliminary comparability ratios by cause of death presented in this report indicate the extent of discontinuities in cause-of-death trends from 1998 through 1999 resulting from implementing ICD-10. For some leading causes (e.g., Septicemia, Influenza and pneumonia, Alzheimer's disease, and Nephritis, nephrotic syndrome and nephrosis), the discontinuity in trend is substantial. The ranking of leading causes of death is also substantially affected for some causes of death. CONCLUSIONS: Results of this study, although preliminary, are essential to analyzing trends in mortality between ICD-9 and ICD-10. In particular, the results provide a means for interpreting changes between 1998, which is the last year in which ICD-9 was used, and 1999, the year in which ICD-10 was implemented for mortality in the United States.     

Disease classification: measuring the effect of the Tenth Revision of the International Classification of Diseases on cause-of-death data in the United States

The purpose of this paper is to describe the statistical impact of the Tenth Revision of the International Classification of Diseases (ICD-10) on cause-of-death data for the United States. ICD-10 was implemented in the U.S. effective with deaths occurring in 1999. The paper is based on cause-of-death information from a large sample of 1996 death certificates filed in the 50 States and the District of Columbia. Cause-of-death information in the sample includes underlying cause of death classified by both ICD-9 and ICD-10. Preliminary comparability ratios by cause of death presented in this paper indicate the extent of discontinuities in cause-of-death trends from 1998 to 1999 resulting from implementing ICD-10. For some leading causes (for example, septicaemia, influenza and pneumonia, Alzheimer's disease, and nephritis, nephrotic syndrome and nephrosis) the discontinuity in trend is substantial. Results of this study, although preliminary, are essential to analysing trends in mortality statistics between ICD-9 and ICD-10. In particular, the results provide a means for interpreting changes between 1998, which is the last year in which ICD-9 was used, and 1999, the year in which ICD-10 was implemented for mortality in the United States. Published in 2003 by John Wiley & Sons, Ltd.     

Trends in mortality caused by respiratory distress syndrome in the United States, 1969-83.

Using United States vital statistical data we examined trends in infant deaths from Respiratory Distress Syndrome/Hyaline Membrane Disease (RDS/HMD) for 1969 to 1983, by race and age at death. In order to improve comparability of diagnosis across two revisions of the International Classification of Diseases, deaths from RDS/HMD were ascertained using both underlying and associated causes of death. These data document a 2 per cent per year increase in infant mortality attributed to RDS/HMD for all races during interval I (1969-73) followed by 9 per cent per year decreases during intervals II (1974-78) and III (1979-83). However, there was a marked difference between Whites and Blacks in these trends. In the White population, RDS/HMD infant mortality increased by 2.2 per cent per year in interval I but then decreased by 10.5 per cent per year in interval II and 8.9 per cent per year in interval III. Among Blacks, on the other hand, the initial increase in RDS/HMD mortality was steeper (5.2 per cent per year) and the subsequent decreases were less (6.3 per cent per year and 8.0 per cent per year). As a result, the Black-White ratio in infant mortality attributed to RDS/HMD increased from 1.32 in 1969-73, to 1.59 in 1974-78 and to 1.72 in 1979-83. The proportion of RDS/HMD deaths that occurred in the postneonatal period increased from 1.1 per cent in interval I to 3.6 per cent in interval II to 5.0 per cent in interval III.(ABSTRACT TRUNCATED AT 250 WORDS)     

Implications of the ICD-10 definitions related to death in pregnancy, childbirth or the puerperium

The Tenth Revision of the International Classification of Diseases (ICD-10) will include two new definitions concerning death related to pregnancy: --Late maternal death--the death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy. --Pregnancy-related death--the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. This article discusses the rationale underlying these definitions and their implications for public health statistics. The introduction of these definitions is a step, albeit a timid one, towards an increased acceptance of epidemiology in determining the relationships which affect death related to pregnancy. It is to be hoped that the trend thus initiated can be encouraged.     

Deaths: leading causes for 2004.

OBJECTIVES: This report presents final 2004 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2004. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. RESULTS: In 2004, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Alzheimer's disease; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 78 percent of all deaths occurring in the United States. Differences in the ranking are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2004 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Diseases of the circulatory system. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.     

Deaths: leading causes for 2003.

OBJECTIVES: This report presents final 2003 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2003. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. RESULTS: In 2003, the 10 leading causes of death were (in rank order): Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Influenza and pneumonia; Alzheimer's disease; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 78 percent of all deaths occurring in the United States. Differences in the ranking are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2003 were (in rank order): Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Accidents (unintentional injuries); Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Diseases of the circulatory system. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.     

Accuracy of cause-of-death coding in Taiwan: types of miscoding and effects on mortality statistics

BACKGROUND: The objectives of this study were to assess the accuracy of cause-of-death coding, determine the extent to which coders follow the selection rules of coding set out in the International Classification of Diseases, 9th Revision (ICD-9), and the effects of miscoding on mortality statistics in Taiwan. METHOD: A systematic sample of 5621 death certificates was reviewed. The underlying cause of death (UCD) selected by the reviewer for each death certificate was compared with that selected by the original coder. The UCD was selected according to ACME (Automated Classification of Medical Entities) Decision Tables. RESULTS: The overall agreement rates between the reviewer and coders according to the three-digit and two-digit categories of ICD-9 were 80.9% and 83.9%, respectively. Good agreement was found for malignant neoplasms (kappa = 0.94) and injuries and poisoning (kappa = 0.97), but there was poor agreement for nephrotic diseases (kappa = 0.74), hypertension-related diseases (kappa = 0.74), and cerebral infarction (kappa = 0.77). Reasons for disagreements included disagreement in nomenclature (42.8%), inappropriate judgement of causal relationships (41.5%), and incorrect interpretation of Selection Rule 3 and Modification Rules (15.7%). CONCLUSION: This study showed various levels of agreement for different diseases between the reviewer and the original coders in selection of the UCD. Owing to the 'compensatory effect of errors', the national mortality statistics were not affected significantly. The national administration should undertake routine internal studies to control the quality of UCD coding practices.     

Use of hospital discharge data to monitor uterine rupture--Massachusetts, 1990-1997

Uterine rupture (UR), a potentially life-threatening condition for both mother and infant, occurs in <0.1% of all pregnant women and <1% of women attempting vaginal birth after cesarean section (VBAC) (1-4). During 1990-1997, the proportion of vaginal deliveries among women who had previous cesarean sections (CS) in Massachusetts increased 50%, from 22.3% to 33.5% (5). Concern about a corresponding increase in UR prompted the Massachusetts Department of Public Health and CDC to initiate a state-wide investigation that included an assessment of the validity and reliability of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (6), codes in hospital discharge data to identify UR cases. This report summarizes the results of the investigation, which indicate that ICD-9-CM codes related to UR, designed before increased concern about UR, lack adequate specificity for UR surveillance and have not been applied consistently over time.     

Assessing Disparities in the Rates of HCV Diagnoses Within American Indian or Alaska Native Populations Served by the U.S. Indian Health Service, 2005–2015

Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The Indian Health Service (IHS), via federal and tribal health facilities provides medical services to an estimated 2.2 million AI/AN people in the United States. HCV diagnoses, defined by International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) codes, were analyzed from 2005 to 2015. Results showed 29,803 patients with an HCV diagnosis; 53.4% were among persons born 1945–1965 and overall HCV burden was higher among males than females. These data will help inform local, regional, and national efforts to address, plan for and carry out a national strategy to provide treatment for HCV infected patients and programs to prevent new HCV infections.     

Deaths: leading causes for 2002.

OBJECTIVES: This report presents final 2002 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2002. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. RESULTS: In 2002, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Influenza and pneumonia; Alzheimer's disease; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 79 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2002 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birthweight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Accidents (unintentional injuries); Respiratory distress of newborn; Bacterial sepsis of newborn; Diseases of the circulatory system; and Intrauterine hypoxia and birth asphyxia. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.     

2001-2010年上海市卢湾区居民心脑血管疾病死亡动态分析

目的 分析上海市卢湾区居民心脑血管疾病死亡变化及趋势,为进一步制定心脑血管疾病防治策略提供科学依据.方法 统计分析2001-2010年卢湾区户籍人口心脑血管疾病死亡及人口监测资料.2001年的死因分类按国际疾病分类法ICD-9,2002-2010年按国际疾病分类法ICD-10标准进行分类.用2000年全国人口构成进行标化率计算,进一步计算心脑血管疾病潜在减寿年数.结果 2001-2010年,上海市卢湾区户籍人口心脑血管疾病死亡率总体呈波动性下降趋势,其中脑血管疾病死亡率下降趋势较为明显,但随年龄增长呈几何级数增高.10年间,心脑血管疾病一直占据全人群死因顺位的第1位,死因减寿顺位的第2、3位.结论 心脑血管疾病已成为上海市卢湾区居民的主要死亡原因,全社会必须重视这类慢性病的预防.同时,应重点加强对60岁以上这部分年龄组人群心脑血管疾病的控制和预防.     

International statistical classification of diseases and related health problems. Tenth revision

The International Classification of Diseases has, under various names, been for many decades the essential tool for national and international comparability in public health. This statistical tool has been customarily revised every 10 years in order to keep up with the advances of medicine. At first intended primarily for the classification of causes of death, its scope has been progressively widening to include coding and tabulation of causes of morbidity as well as medical record indexing and retrieval. The ability to exchange comparable data from region to region and from country to country, to allow comparison from one population to another and to permit study of diseases over long periods, is one of the strengths of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD). WHO has been responsible for the organization, coordination and execution of activities related to ICD since 1948 (Sixth Revision of the ICD) and is now proceeding with the Tenth Revision. For the first time in its history the ICD will be based on an alphanumeric coding scheme and will have to function as a core classification from which a series of modules can be derived, each reaching a different degree of specificity and adapted to a particular specialty or type of user. It is proposed that the chapters on external causes of injury and poisoning, and factors influencing health status and contact with health services, which were supplementary classifications in ICD-9, should form an integral part of ICD-10. The title of ICD has been amended to "International Statistical Classification of Diseases and Related Health Problems"', but the abbreviation "ICD" will be retained.(ABSTRACT TRUNCATED AT 250 WORDS)     

2009年天津市汉沽区居民死亡原因分析

目的分析天津市汉沽区居民主要死亡原因,为政府制定卫生规划和疾病预防控制策略提供依据。方法对2009年汉沽区居民死亡资料进行分析,按国际疾病分类法ICD-10标准进行分类。用2000年全国人口构成进行标化率计算。结果 2009年报告死亡1 301人,死亡率为749.43/10万。居民死亡率,男性804.41/10万,女性693.53/10万。2009年汉沽区居民前5位死因为恶性肿瘤、心脏病、脑血管病、损伤和中毒、呼吸系统疾病,死亡率分别为214.86/10万、194.70/10万、193.55/10万、43.20/10万、40.32/10万。结论慢性非传染性疾病、损伤中毒已经成为严重影响汉沽区居民健康的主要疾病,应进一步加强预防控制工作。