International Statistical Classification Of Diseases And Related Health Problems ( Icd )

The International Statistical Classification of Diseases and Related Health Problems (ICD, English International Statistical Classification of Diseases and Related Health problem) is the most important, internationally recognized diagnostic classification system of medicine. It is published by the World Health Organization (WHO). The current, internationally valid output (engl. Revision) is ICD-10, version 2012.

In Germany participating in the contract primary care physicians and medical institutions (medical billing services) are, according to § 295 paragraph 1 sentence 2 of the Fifth Book of the Social Code obliged diagnoses according to ICD-10 German Modification (GM) to encrypt. Binding for encryption in Germany is the German Institute for Medical Documentation and Information (DIMDI) published ICD-10-GM version 2014.

History of ICD

The origins of the ICD system date back to the 1850s. 1893, compiled by Jacques Bertillon Bertillon Classification or International directory of death was introduced. Gradually emerged from earlier international classifications that were used exclusively for recording causes of death, the ICD system that already existed in the 5th edition in 1938. Since the founding of the World Health Organization 1948 classification system of the WHO will be further developed. She put 1948 before the 6th edition. Until the ICD-9 (1976) carried out every ten years or more revised editions, as a result of advances in medicine changes and additions were required. Work on the last, the tenth edition began in 1983 and was completed in 1992. The currently valid edition of the ICD-10 in the version of 2013. In the spring of 2007 began the initial work on ICD-11.


ICD-10 is a single axis, and mono-hierarchical classification system. It is divided into:

-A three-digit general scheme (for example A95: yellow fever)
-A detailed four-digit classification (eg A95.0: Bush yellow fever)
-Occasionally five digit refinements (eg M23.31: Other meniscus injury, anterior cruciate ligament or anterior horn of the medial meniscus)
The notation is alphanumeric. The first digit is a letter, the bodies contain two to five digits, the fourth digit is separated by a dot. The U00-U49 and U50 areas-U99 are reserved for extensions or research purposes. ICD-10 includes:

-Chapter 22 disease
-261 groups of diseases (E10-E14 for example: diabetes)
-2,037 three-digit disease classes (categories) (for example E10.-: primary insulin-dependent diabetes mellitus [type I diabetes])
-12,161 four-digit disease categories (subcategories) (for example: E10.1: primary insulin-dependent diabetes mellitus [type I diabetes] with ketoacidosis)
Change the Disposition criteria between topography, etiology and pathology.

The systematic directory contains an additional classification (M-axis), can be classified histologically with neoplasms. This is a six digit code that begins with the letter "M". This is followed by four digits for coding the formation, followed by a slash (/) and a digit for coding the pathological behavior (for example: M8051 / 3: verrucous carcinoma on A.). The structure of the M-axis corresponds largely with classification according to ICD-O and SNOMED after.

Double classification of diseases

Some diseases are mapped into ICD-10 with a double classification. The primary classification is according to the etiology, the secondary after organ manifestation. In the scheme of the primary key is mapped with a cross sign (+), the secondary key with an asterisk (*). This notation is referred to as cross-rating system.

Example: The ICD-10 code A17.0 + (tuberculous meningitis) with respect to the etiology of an infectious disease, and in respect of organ manifestation of a disease of the nervous system (G01 *).

Example: An eye doctor who treats diabetic retinopathy and not the underlying disease (diabetes mellitus) is primarily interested in clinical secondary key:

-Etiology: + E10.30 Diabetes mellitus type I with eye complication, not called derailed.
-Organ manifestation: H36.0 * diabetic retinopathy.
The cross-notation is used for statistical purposes. The asterisk notation has one major clinical reference and is used among others for activity allocation.

Criticism of the ICD

In Germany the statutory medical billing already had 1996 should only be carried out on the basis of encryption according to ICD-10. After massive resistance from the medical profession, the ICD-10 was first introduced as a voluntary option, the use of a revised version is mandatory since 2000.

Main criticisms of the ICD are:

-It was feared that by data-technical evaluation process medical confidentiality could be undermined ("transparent patient").
-Due to the possibility of a mechanical evaluation of the accounting data, the medical profession should be made transparent and controllable to an inadmissible degree ("naked doctor").
-The structure corresponds to non-medical or practical considerations, but merely follows the statistical requirements. So be about K under all diseases of the digestive system combined (from the teeth to the anus), relating in medical practice entirely different subject groups. On the other hand there are missing important diseases such as gastrointestinal cancers which are generally classified under C.
-The national applications of the ICD are incomplete. So were temporarily excluded in the Federal Republic of Germany codes. The international comparability of causes of disease is thus limited.
-The use of some diagnoses, especially among Z, could be an illegal disclosure of the personal situation and environment of the patient, z. B. Information about impact on family or professional environment.
-Not all symptoms corresponds to a disease according to ICD; the more difficult for the doctor a clear indication, if not a disease initially fits one hundred percent.
-Also, from a statistical point the ICD is questionable because it does not differentiate clearly between diagnoses and symptoms. (Hematuria [ICD-10: D68.3]. Is a symptom that can have various causes resulting in inaccuracy, because formally always the symptom and the cause should be coded, but in practice rarely both is coded.)

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