Scientific Data DocumentationInternational Classification Of Diseases - 9 - CM, (1979)*SEE ICD-9-CM DATASET NAMES ABSTRACTPurpose of The ICD-9-CM FileThe International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is based on the official version of the World Health Organization's 9th Revision, International Classification of Diseases (ICD-9). ICD-9 is designed for the classification of morbidity and mortality information for statistical purposes, and for the indexing of hospital records by disease and operations, for data storage and retrieval. This modification of ICD-9 supplants the Eighth Revision International Classification of Diseases, Adapted for Use in the United States (ICDA-8) and the Hospital Adaptation of ICDA (H-ICDA). Description of The ICD-9-CM FileThis third edition of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is being published by the United States Government in recognition of its responsibility to promulgate this classification throughout the United States for mobidity coding. The International Classification of Diseases, 9th Revision, PUBLISHED BY THE World Health Organization (WHO) is the foundation of the ICD-9-CM and continues to be the classification employed in cause-of-death coding in the United States. The ICD-9-CM is completely comparable with the ICD-9. The WHO Collaborating Center for Classification of Diseases in North America serves as liaison between the international obligations for comparable classifications and the national health data needs of the United States. The ICD-9-CM is recommended for use in all clinical settings but is required for reporting diagnoses and diseases to all U.S. Public Health Service and Health Care Financing Administration programs. ICD-9-CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the Federal Government. However, because the ICD-9-CM represents the best in contemporary thinking of clinicians, nosologists, epidemiologists, and statisticians from both public and private sectors, no future modifications will be considered without extensive advice from the appropriate representatives of all major users. All official authorized addenda through October 1, 1988, have been included in this third edition.BACKGROUNDIntroductionIn February 1977, a Steering Committee was convened by the National Center for Health Statistics to provide advice and counsel to the development of a clinical modification of the ICD-9. The organizations represented on the Steering Committee included: American Association of Health Data Systems American Hospital Association American Medical Record Association Association for Health Records Council on Clinical Classifications Health Care Financing Administration, Department of Health and Human Services WHO Center for Classification of Diseases for North America, sponsored by the National Center for Health Statistics, Department of Health and Human Services The Council on Clinical Classifications is sponsored by: American Academy of Pediatrics American College of Obstetricians and Gynecologists American College of Physicians American College of Surgeons American Psychiatric Association Commission on Professional and Hospital Activities The Steering Committee met periodically in 1977. Clinical guidance and technical input were provided by Task Forces on Classification from the Council on Clinical Classification's sponsoring organizations. ICD-9-CM is a clinical modification of the World Health Organization's International Classification of Diseases, 9th Revision (ICD-9). The term "clinical" is used to emphasize the modification's intent: to serve as a useful tool in the area of classification of morbidity data for indexing of medical records, medical care review, and ambulatory and other medical care programs, as well as for basic health statistics. To describe the clinical picture of the patient, the codes must be more precise than those needed only for statistical groupings and trend analysis. DevelopmentThe concept of extending the International Classification of Diseases for use in hospital indexing was originally developed in response to a need for a more efficient basis for storage and retrieval of diagnostic data. In 1950, the U.S. Public Health Service and the Veterans Administration began independent tests of the International Classification of Diseases for hospital indexing purposes. In the following year, the Columbia Presbyterian Medical Center in New York City adopted the International Classification of Diseases, 6th Revision, with some modifications for use in its medical record department. A few years later, the Commission on Professional and Hospital Activities adopted the International Classification of Diseases with similar modifications for use in hospitals participating in the Professional Activity Study. The problem of adapting ICD for indexing hospital records was taken up by the U.S. National Committee on Vital and Health Statistics through its subcomittee on hospital statistics. The subcommittee reviewed the modifications made by the various users of ICD and proposed that uniform changes be made. This was done by a small working party. In view of the growing interest in the use of the International Classification of Diseases for hospital indexing, a study was undertaken in 1956 by the American Hospital Association and the American Medical Record Association (then the American Association of Medical Record Librarians) of the relative efficiencies of coding systems for diagnostic indexing. This study indicated that the International Classification of Diseases provided a suitable and efficient framework for indexing hospital records. The major users of the International Classification of Diseases for hospital indexing purposes then consolidated their experiences and an adaptation was first published in December 1959. A revision was issued in 1962 and the first "Classification of Operations and Treatments" was included. In 1966, the international conference for the revision of the International Classification of Diseases noted that the 8th revision of ICD has been constructed with hospital indexing in mind and considered that the revised classification would be suitable, in itself, for hospital use in some countries. However, it was recognized that the basic classification might provide inadequate detail for diagnostic indexing in other countries. A group of consultants was asked to study the 8th revision of ICD (ICD 8) for applicability to various users in the United States. This group recommended that further detail be provided for coding of hospital and morbidity data. The American hospital Association was requested to develop the needed adaptation proposals. This was done by an advisory committee (the Advisory Committee to the Central Office on ICDA). In 1968 the United States Public Health Service published the product, Eighth Revision International Classification of Diseases, Adapted for Use in the United States (PHS publication 1693). This became commonly known as ICDA-8, and beginning in 1968 it served as the basis for coding diagnostic data for both official morbidity statistics in the United States. In 1968, the Commission on Professional and Hospital Activities (CPHA) of Ann Arbor, Michigan, published the Hospital Adaptation of ICDA (H-ICDA) based on both the original ICD-8 and ICDA-8. In 1973, CPHA published a revision of H-ICDA, referred to as H-ICDA-2. Hospitals throughout the United States have been divided in their usage of these classifications. Effective January 1979, ICD-9-CM provides a single classification intended primarily for use in the United States replacing these earlier related but somewhat dissimilar classifications.CHARACTERISTICS OF ICD-9-CMGeneral InformationICD-9-CM is published as a three-volume set: Volume 1 Diseases: Tabular List Volume 2 Diseases: Alphabetic Index Volume 3 Procedures: Tabular List and Alphabetic Index ICD-9-CM far exceeds its predecessors in the number of codes provided. The disease classification has been expanded to include health-related conditions and to provide greater specificity at the fifth-digit level of detail. These fifth digits are not optional; they are intended for use in recording the information substantiated in the clinical record. Volume 1 of ICD-9-CM contains five appendices: Appendix A Morphology of Neoplasms Appendix B Glossary of Mental Disorders Appendix C Classification of Drugs by American Hospital Formulary Service List Number and Their ICD-9-CM Equivalents Appendix D Classification of Industrial Accidents According to Agency Appendix E List of Three-Digit Categories These appendices are included as a reference to the user in order to provide further information about the patient's clinical picture, to further define a diagnostic statement, to aid in classifying new drugs, or to reference three- digit categories. Volume 2 of the ICD-9-CM contains many diagnostic terms which do not appear in Volume 1 since the index includes most diagnostic terms currently in use. Volume 3 of ICD-9-CM also contains increased clinical detail over its predecessors, and this is accommodated by expansion of the rubrics from three to four digits.The Disease ClassificationGeneral InformationICD-9-CM is totally compatible with its parent system, ICD- 9, thus meeting the need for comparability of morbidity and mortality statistics at the international level. A few fourth-digit codes were created in existing three-digit rubrics only when the necessary detail could not be accommodated by the use of a fifth-digit sub- classification. In these few instances (28 three-digit categories) the special symbol > > to the left of the code indicates that the content of that category differs from its ICD-9 counterpart, but even in such cases it is possible to recreate the original ICD-9 rubrics through appropriate recombination of the ICD-9-CM categories. To ensure that each rubric of ICD-9-CM collapses back to its ICD-9 counterpart, several specifications governed the ICD- 9-CM disease classification. Specifications for The Tabular List1. Three-digit rubrics and their contents are unchanged from ICD-9. 2. The sequence of three-digit rubrics is unchanged from ICD-9. 3. Three-digit rubrics are not added to the main body of the classification. 4. Unsubdivided three-digit rubrics are subdivided where necessary to: a) Add clinical detail b) Isolate terms for clinical accuracy 5. The modification in ICD-9-CM is accomplished by the addition of a fifth digit to existing ICD-9 rubrics, except as noted under #7 below. 6. Four-digit rubrics are added to subdivided three digit codes only when there is no other means of achieving desired detail. These codes, unique to ICD-9-CM (twenty- eight three-digit categories), are marked with the symbol > > in the Tabular List. 7. The optional dual classification in ICD-9 is modified. a) Duplicate rubrics are deleted: 1) Four-digit manifestation categories duplicating etiology entries. 2) Manifestation inclusion terms duplicating etiology entries. b) Manifestations of diseases are identified, to the extent possible, by creating five-digit codes in the etiology rubrics. c) When the manifestation of a disease cannot be included in the etiology rubrics, provision for its identification is made by retaining the ICD-9 rubrics used for classifying manifestations of disease. 8. The format of ICD-9-CM is revised from that used in ICD-9. a) American spelling of medical terms is used. b) Inclusion terms are indented beneath the titles of codes. c) Codes not to be used for primary tabulation of disease are printed in italics with the notation, "code also underlying disease." 1. Format of the Alphabetic Index follows the format of ICD-9. 2. Main terms in the Alphabetic Index are printed in bold type face. 3. When two codes are required to indicate etiology and manifestation, the optional manifestation code appears in brackets, e.g., diabetic cataract 250.5 +366.41+.The Procedure ClassificationGeneral InformationAn important new development occurred with the publication of ICD-9; a Classification of Procedures in Medicine. Heretofore, procedure classifications had not been a part of ICD, but were published with the adaptations to it produced in the United States. The ICD-9 Classification of Procedures in Medicine is published separately from the disease classification in a series of supplementary documents called fascicles. Each fascicle contains a classification of modes of therapy, surgery, radiology, laboratory, and other diagnostic procedures. The decision to publish each fascicle as a unique document was made in order to permit its revision on a separate schedule from the disease classification. Primary input to Fascicle V, "Surgical Procedures," came from the United States whose adaptations of ICD had contained a procedure classification since 1962. This experience was invaluable in constructing a classifica- tion to permit analysis of health care services in hospitals and primary care settings. The ICD-9-CM Procedure Classification is a modification of WHO's Fascicle V, "Surgical Procedures," and is published as Volume 3 of ICD-9-CM. It contains both a Tabular List and an Alphabetic Index. Greater detail has been added to the ICD-9-CM Procedure Classification necessitating expansion of the codes from three to four digits. Approximately 90% of the rubrics refer to surgical proce- dures with the remaining 10% accounting for other investigative and therapeutic procedures. Specifications for The Procedure Classification1. The ICD-9-CM Procedure Classification is published in its own volume containing both a Tabular List and an Alphabetic Index. 2. The classification is a modification of Fascicle V "Surgical Procedures" of the ICD-9 Classification of Procedures in Medicine, working from the draft dated Geneva, 30 September - 6 October 1975, and labeled WHO/ICD- 9/Rev. Conf. 75.4. 3. All three-digit rubrics in the range 01-86 are maintained as they appear in Fascicle V, whenever feasible. 4. Nonsurgical procedures are segregated from the surgical procedures and confined to the rubrics 87-99, whenever feasible. 5. Selected detail contained in the remaining fascicles of the ICD-9 Classification of Procedures in medicine is accommodated where possible. 6. The structure of the classification is based on anatomy rather than surgical specialty. 7. The ICD-9-CM Procedure Classification is numeric only, i.e., no alphabetic characters are used. 8. The classification is based on a two-digit structure with two decimal digits where necessary. 9. Compatibility with the ICD-9 Classification of Procedures in Medicine was not maintained when a different axis was deemed more clinically appropriate.
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