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International Classification of Diseases, 10th Edition (ICD-10)

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FINAL VERSION (1977 words)

Marc J. Tassé & Kelsey Bush

Nisonger Center
The Ohio State University

December 18, 2015

PRE-PRINT VERSION

To Appear in: Braaten, E., (Editor). The SAGE Encyclopedia of Intellectual and Developmental Disorders.
Sage Publications.
ICD-10 2

International Classification of Diseases, 10th Edition (ICD-10)

The World Health Organization (WHO) was created by the United Nations on April 7, 1948

as the directing and coordinating authority on global health within the United Nations’ System. The

headquarters of the WHO are in Geneva, Switzerland, and there are currently 194 member countries

of the WHO. The WHO’s constitution views health broadly as being a state of complete physical,

mental, and social well-being and not merely the absence of diseases or infirmity (World Health

Organization, 2005). WHO is a global entity that coordinates the eradication of diseases, leads the

effort to improve global nutrition, housing, sanitation and even working conditions and

environmental matters, especially in low income countries.

A 1978 WHO Assembly resolution established that the WHO, as a global organization,

would provide all its materials and information in six official languages: Arabic, Chinese, English,

French, Russian and Spanish. When the WHO releases an official document, such as the

International Classification of Diseases (ICD), it is released in all six languages simultaneously.

Often, many of the WHO documents are eventually translated into many more languages.

Although updates of the ICD are now released by the WHO, the first publication of this

system can be traced back to 1900. The French government convened 26 countries to an

international meeting in Paris to revise French statistician Jacques Bertillon’s “Classification of Causes of

Death” (Siener, 1982). When the WHO was created in 1948, it tasked its Expert Committee on

Health Statistics to assume the oversight and publication of the International Classification of

Diseases, then in its 6th edition (Siener, 1982; Tassé, Luckasson, & Nygren, 2013).

The ICD, currently in its 10th edition, is now published by the WHO as a comprehensive

system of identification and classification of all known diseases and disorders (WHO, 1992). The

ICD-10, available in more than 43 languages, is used around the world to identify and diagnose

diseases, as an aid to health management. It facilitates the reporting and recording of diseases for
ICD-10 3

epidemiological and public health purposes, and the tracking of morbidity and mortality. Although

the ICD 10 was first published by the WHO in 1992, the United States only started using the ICD-

10 on October 1, 2015. The WHO permitted the US Department of Health and Human Services to

adapt the ICD-10 for use in the United States into two distinctive classification systems: ICD-10

Clinical Modifications (CM) and ICD-10 Procedure Coding System (PCS). These replaced the use of

the ICD-9 CM (Volumes I & II) and the ICD-9 PCS (Volume III). The ICD-10 CM is used

specifically for the identification, diagnosis, and coding of all diseases. In the US, the ICD also plays

an important role in the reimbursement of costs associated with medical care. The ICD-10 CM

contains approximately 68,000 codes compared to its predecessor, the ICD-9 CM which contained

13,600 codes (DiSantostefano, 2010). The ICD-10 PCS, developed by the US Centers for Medicare

and Medicaid Services, is used to record and track inpatient medical procedure codes (Mullin, 1999).

The Health Insurance Portability and Accountability Act (HIPAA) requires that all health plan

systems and health care providers use the ICD-10 CM as the standard code set to establish

diagnoses and the ICD-10 PCS code set for all hospital inpatient procedures.

ICD-10 CM and Intellectual and Developmental Disabilities

The ICD-10 CM is used in the United States to assign a diagnostic code or codes and

explain a healthcare encounter. The ICD-10 CM is also used for reporting purposes to a state or

federal state healthcare agency for statistical or public health tracking. The ICD-10 CM has almost

four times the number of codes than its predecessor, the ICD-9 CM. The greater number of codes

in the ICD10 CM is explained in large part by increased specificity of codes, in an effort to better

define conditions and allow a more meaningful use of the healthcare data. For example, greater

specificity may lead to better design of clinically robust algorithms and better tracking of healthcare

outcomes.
ICD-10 4

Coding can be extremely complex especially in large hospital settings where an individual

patient may present with multiple health diagnoses that necessitate a complex array of healthcare

procedures. This complexity has led to the development of a new career path for specialists trained

in determining the correct coding of diagnoses and medical procedures. These certified medical

coders assist in translating medical records into proper codes that are submitted for use by insurance

companies, government healthcare programs, and state and federal health entities that aggregate

health statistics. These coders strive to provide an optimal management of the available health

information to describe health conditions and associated medical procedures. This process facilitates

correct coding and reporting, and ensures a more accurate and timely submission of claims and

reimbursement.

The ICD-10 CM codes consist of three to seven alpha and numeric digits and full code titles.

The first digit is alpha, the second digit is numeric, and digits three to seven can be alpha or numeric.

Digit 1 Digit 2 Digit 3 Digit 4 Digit 5 Digit 6 Digit 7

Alpha digit digit ● alpha or alpha or alpha or alpha or

digit digit digit digit

category etiology, anatomical site, severity extension

(if needed)

A diagnostic code must minimally have the first 3 digits to categorize the condition. Digits 4, 5, and

6 provide clinical information regarding the cause, anatomical site, and level of severity and the

seventh digit is available for expanded information about the encounter. An example of the use of

just the first 3 digits might be: F70 for mild intellectual disabilities.
ICD-10 5

The definitions and codes for intellectual disability and autism spectrum disorder in the

ICD-10 and ICD-10 CM are identical and can be found in chapter 5 “Mental, Behavioral and

Neurodevelopmental Disorders”.

Mental Retardation/Intellectual Disabilities (F70 – F79)

The ICD-10 (WHO, 1992) defined mental retardation/intellectual disabilities (F70 – F79) as

characterized by significant impairments in intellectual functioning resulting in deficits in adaptive

functioning manifested during the developmental period.

Although the ICD-10 published by the WHO (1992) continues to use the older outdated

terminology “mental retardation,” the ICD-10 CM replaced “mental retardation” with “intellectual

disabilities.” The codes used to indicate the severity of the intellectual disabilities are as follows:

- F70: mild intellectual disabilities (IQ ranges between 50-69)

- F71: moderate intellectual disabilities (IQ ranges between 35-49)

- F72: severe intellectual disabilities (IQ ranges between 20-34)

- F73: profound intellectual disabilities (IQ < 20)

- F78: other intellectual disabilities

- F79: unspecified intellectual disabilities

The following fourth digits can be used with codes F70 to F79 to identify the extent of co-

occurring behavioral impairment:

.0 With the statement of no, or minimal, impairment of behavior

.1 Significant impairment of behavior requiring attention or treatment

.8 Other impairments of behavior

.9 Without mention of impairment of behavior

Pervasive Developmental Disorders (F84)

The ICD-10 (WHO, 1992) terminology for autism is quite different than what is currently in

use in the United States (i.e., autism spectrum disorder). The ICD-10 defined autism under the

broader category of pervasive developmental disorders (PDD) and are defined as a group of

neurodevelopmental disorders characterized by qualitative deficits in reciprocal social interactions,

qualitative deficits in communication, and presence of restricted, stereotypic, and repetitive

behavioral interests and activities.

F84.0: Childhood Autism

Presence of significant impairments in all three domains: reciprocal social interactions,

communication, and restricted and repetitive behaviors and interests. Onset is generally before the

age of three years.

F84.1: Atypical Autism

Similar in characteristics to childhood autism but does not manifest before the age of three

years or significant deficits are not present in all three aforementioned areas: social interaction,

communication, behavioral interests and activities.

F84.2: Rett Syndrome

Disorder present only in girls and characterized by sudden loss of previously acquired

developmental skills, including social and communication skills and onset of repetitive and

stereotypic motor movements.

F84.3: Other Childhood Disintegrative Disorder

Characterized by a period of normal development with an abrupt behavioral deterioration

and loss of previous acquired developmental skills over a course of a few months. Deterioration

results in significant impairments in social interactions, loss of interest in one’s surroundings, loss of

communication skills, onset of repetitive motor movements and stereotypic behavior.

F84.4: Overactive Disorder Associated with Mental Disorder and Stereotyped

Movements

This category of PDD includes individuals with more severe intellectual disability (IQ < 35)

and co-occurring challenging behavior, including hyperactivity, inattention, and stereotypic

behaviors.

F84.5: Asperger Syndrome

Characterized by qualitative impairments in social reciprocal interactions and the presence of

restricted and repetitive behaviors, interests and activities. Asperger syndrome differs from

childhood autism by the lack of cognitive or communication delay.

F84.6: Other Pervasive Developmental Disorders

F84.7: Pervasive Developmental Disorders, Unspecified

ICD-10 PCS

The ICD-10 PCS is used in hospital settings to record and report medical procedures.

ICD-11

As noted, the ICD-10 was originally published by the WHO in 1992, more than 2 decades

ago. Although the WHO has periodically revised and updated the ICD-10 over the past 20 years, it

has not updated or modified its definition or codes for intellectual disability or autism spectrum

disorder. The 11th edition of the ICD (i.e., ICD-11) should provide an update of its terminology and

diagnostic criteria which are expected to be in alignment with current diagnostic systems such as the

American Association on Intellectual and Developmental Disabilities (Schalock et al., 2010) and the

Diagnostic and Statistical Manual, 5th edition (American Psychiatric Association, 2013). Work on the

11th edition of the ICD has been underway for more than a decade. The anticipated release data for

the ICD-11 is currently May 2018 (WHO, 2015).

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

Arlington, VA: American Psychiatric Publishing.

DiSantostefano, J. (2010). Getting to know the ICD-10-CM. The Journal for Nurse Practitioners, 6(2),

149-150.

Mullin, R. (1999). A Brief History of ICD-10-PCS. Journal of AHIMA, 70(9), 97-98.

Schalock, R. L., Borthwick-Duffy, S. A., Bradley, V. J. Buntinx, W. H. E., Coulter, D. L., Craig, E.

M., … & Yeager, M. H. (2010). Intellectual disability: Diagnosis, classification, and systems of supports

(11th ed.). Washington, DC: American Association on Intellectual and Developmental

Disabilities.

Siener, C. H. (1982). International Classification of Diseases (p. 365) in J. A. (Ed), International

encyclopedia of population. New York: Free Press.

Tassé, M. J., Luckasson, R. A., & Nygren, M. A. (2013). AAIDD Proposed Recommendations for

ICD-11 and the Condition Previously Known as Mental Retardation. Intellectual and

Developmental Disabilities, 51, 127-131.

World Health Organization (2015). ICD Revision Timeline. Retrieved 12-11-2015 from:

http://www.who.int/classifications/icd/revision/timeline/en/

World Health Organization (2005). Constitution of the World Health Organization. Geneva: Author.

Downloaded from the WHO website on 12-11-2015:

http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1

World Health Organization (1992). International Statistical Classification of Diseases and Related

Health Problems (10th Revision). Geneva: Author.

World Health Organization (2001). International Classification of Diseases (10th edition). Geneva:

Author.
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World Health Organization (1980). International Classification of Diseases (9th edition). Geneva:

Author.

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