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ICD-11Education ToolUnit 4Chapter 01 Certain infectious or parasitic diseases

Chapter 02 Neoplasms

Chapter 03 Diseases of the blood or blood-forming organs

Chapter 04 Diseases of the immune system

Unit 4 – Chapters 01, 02, 03 and 04 Learning Outcomes 1. Understand the structure, conventions and content of Chapters 01, 02, 03 and 04.

2. Understand the chapter-specific notes for Chapters 01, 02, 03 and 04, if applicable.

3. Apply the structure, conventions, content and chapter-specific notes to classify common clinical concepts from Chapters 01, 02, 03 and 04.

Chapter 01 Certain infectious or parasitic diseasesChapter 01 StructureChapter 01 Certain infectious or parasitic diseases lists the infectious diseases in structures grouped by:

clinical syndromes, mode of transmission, and groupings by infectious agents

conditions of major public health concern

The use of the term ‘certain’ in the title of the Chapter indicates that there are some infectious and parasitic diseases which are found in other chapters of the ICD-11. Infections that are localised, and where the agent is usually unknown, not relevant, or there is a mixed aetiology reside in the organ chapters.

A tabulation list groups the infections by agents and is intended for special tabulation only.

Chapter 01 StructureThe purpose of the structure of Chapter 01 is to minimise the impact on longitudinal statistics of major infections, to allow reporting of main infection syndromes without mention of a specific agent, while allowing for special tabulation by infectious agent using the information in segment 2.

The chapter includes more infectious diseases than in previous versions of the ICD.

Influenza, though visibly affecting the respiratory tract, affects multiple parts of the body and is also of important public health concern. For that reason, it has been moved into the infectious chapter.

Chapter 01 StructureAcute rheumatic fever has also moved to Chapter 01.

Tuberculosis and Leprosy have been grouped under ‘mycoplasms’, because identification, course, and treatment of these conditions are similar.

Chapter 01 StructureThis chapter contains the following top level blocks:

Gastroenteritis or colitis of infectious origin

Predominantly sexually transmitted infections

Mycobacterial diseases

Certain staphylococcal or streptococcal diseases

Pyogenic bacterial infections of the skin or subcutaneous tissues

Certain zoonotic bacterial diseases

Other bacterial diseases

Human immunodeficiency virus disease

Viral infections of the central nervous system

Chapter 01 StructureTop level blocks

Non-viral and unspecified infections of the central nervous system

Dengue

Certain arthropod-borne viral fevers

Certain zoonotic viral diseases

Certain other viral diseases

Influenza

Viral hepatitis

Viral infections characterised by skin or mucous membrane lesions

Chapter 01 StructureTop level blocks

Mycoses

Parasitic diseases

Sepsis

Sequelae of infectious diseases

Structure DemonstrationInteractive Activity:

Open the ICD-11 Browser. A link to the ICD-11 Coding Tool and Browser (blue) can be found on the EIC Education Tool platform.

Select Chapter 01 Certain infectious or parasitic diseases on the hierarchy tree of ICD-11.

Expand Chapter 01 Certain infectious or parasitic diseases by using the grey arrow to view the list of top-level blocks. Information about the block will be displayed on the right side panel.

Chapter 01 Medical InformationSome useful information with regard to Chapter 01 includes:

Certain staphylococcal or streptococcal diseasesincludes diseases such as acute rheumatic fever, scarlet fever and toxic shock syndrome.

Pyogenic bacterial infections of the skin or subcutaneous tissuesincludes diseases such as necrotising fasciitis and impetigo.

Certain zoonotic bacterial diseases and Certain zoonotic viral diseasesincludes diseases that are transmitted by infected vertebrate animals such as cows, sheep and rats.

Chapter 01 Medical Information Human immunodeficiency virus disease

classifies HIV infection by clinical stage, with the clinical stage being indicated by the manifestations of the infection.

For example:HIV with acute HIV infection syndrome is a clinical stage 1HIV with a herpes or mycosis infection is a clinical stage 2HIV with haematological abnormalities is a clinical stage 3HIV with a neoplasm (e.g. Kaposi’s sarcoma) is a clinical stage 4

Chapter 01 Medical Information Human immunodeficiency virus disease

Note: Some manifestations of HIV are classified elsewhere, for example Dementia due to human immunodeficiency virus is classified to Chapter 06 Mental, behavioural or neurodevelopmental disorders (6D85.3).

There is a chapter-specific note for HIV (discussed later in this unit).

Chapter 01 Medical Information Other bacterial diseases

includes diseases such as whooping cough, tetanus and meningococcal disease.

Certain arthropod-borne viral feversincludes diseases such as Zika virus disease and Ross River disease.

Certain other viral diseasesincludes diseases such as mumps, infectious mononucleosis and cytomegaloviral disease.

Mycosesincludes a range of fungal infectious diseases such as aspergillosis, cryptococcosis, tinea and ringworm.

Chapter 01 Medical Information Infectious or communicable diseases are those caused by biological agents such as

viruses, bacteria or parasites.

The biological agents or organisms that cause illness are known as pathogens. When a pathogen invades and replicates, the body is known as the host. Diseases are caused in the host when the organism disrupts a vital body process, or stimulates the body’s immune system to defend itself against an attack by the infectious agent.

An infectious disease may or may not be contagious. It will be considered contagious if it is capable of being transmitted from one host to another.

Chapter 01 Medical Information Infectious diseases require an agent and a vector. A vector is the mode of

transmission of the infection. For example, the disease Malaria does not affect humans unless the Anopheles mosquito (the vector) introduces one of the Plasmodial parasites (the agent) into the human bloodstream.

Note that the vector (the mode of transmission) need not be biological. Many infectious diseases are transmitted by droplets which enter the airway. Tuberculosis is an example of an infection transmitted in this way.

Chapter 01 Medical Information The word virus is derived from a Latin word which means ‘poison’ or ‘venom’.

Because viruses use a host cell to reproduce and also to live in, they are difficult to kill without also affecting the host cell. The most effective medical approaches to viral diseases are vaccinations which provide resistance to infection, and drugs which treat the symptoms of viral infections.

Chapter 01 Medical Information Bacteria are living organisms. They are the most abundant of all living organisms

and are found in soil, air and in various host organisms. Bacteria can be divided into two groups (Gram positive and Gram negative) based on differences in cell wall structure tested through staining seen under a microscope. Bacteria reproduce through a process of cell division. Antibiotics are used to attack bacteria. There are many different bacteria and many different antibiotics. Each antibiotic has action against a particular type or types of bacteria and is therefore useful for treating specific infections.

Chapter 01 Medical Information Parasites are organisms that obtain food and shelter by living on or within another

organism. The parasite derives all the benefits from the association and the host may either not be harmed or may suffer the consequences of this association, a parasite disease. Such parasites range in size from tiny protozoans such as the amoebae and trypanosomes to multicellular worms and flukes and arthropod parasites such as fleas and lice. Diseases caused by parasites include amoebic dysentery, sleeping sickness, malaria, river-blindness and elephantiasis. Antibiotics and various other chemical treatments are used to eradicate parasitic diseases.

Chapter 01 Medical Information Fungi, known as mycoses, cause a wide variety of diseases in humans. Some of the

more common internal and external mycoses include: aspergillosis, blastomycosis, candidiasis, coccidiodomycosis, cryptococcosis, histoplasmosis, sporotrichosis and tinea. Topical medications and drug treatments are the most widespread forms of therapy.

Chapter 01 Medical Information Diagnosis of an infection is made initially by medical history, physical examination

and imaging (such as X-rays). However, the most common tool for the diagnosis of infectious disease is the microbiological culture.

In a culture, a growth medium is provided which is sensitive to a particular organism. After a sample of the fluid or tissue from the patient is introduced onto the medium, it is examined to determine if bacterial growth occurs. This diagnostic method is suitable for bacteria such as Staphylococcus or Streptococcus.

When growth of a specific organism occurs in a culture medium, the culture is described as a 'positive culture'. If no growth occurs, the culture is known as 'negative'.

Chapter 01 Medical Information Certain agents are difficult to culture – for example, most viruses cannot be

diagnosed this way.

For this reason, serological markers were developed. Serology involves detecting the antibodies produced against an infectious agent in the patient’s blood. The first serology test to be developed was for syphilis (known as the Wasserman test).

A more recent development in diagnosis is direct detection of viral proteins or deoxyribonucleic acid (more commonly known as DNA) in blood or secretions. This can be done by polymerase chain reaction, or PCR, which utilises anti-DNA probes to detect viruses.

Chapter 01 Medical InformationTreatment for infectious diseases When a culture has proven to be positive, the sensitivity of an infectious organism to

an antibiotic can be demonstrated by exposing it to test doses of specific medications. This testing can also demonstrate the organism’s resistance to particular antibiotics.

This type of testing is used to demonstrate the sensitivity and resistance of the organism to different drugs, enabling the doctor to choose the most adequate antibiotic or drug for the type of infection.

Chapter 01 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there are two chapter-specific notes

Human immunodeficiency virus [HIV] disease

Sepsis with or without septic shock

Chapter 01 Chapter-specific notesHuman immunodeficiency virus [HIV] diseaseA patient with a compromised immune system due to HIV disease may sometimes require treatment during the same episode of care for more than one disease, for example mycobacterial and cytomegalovirus infections. Only subcategories for HIV disease associated with, tuberculosis, and malaria are precoordinated in this block for HIV disease.

When another specified HIV-caused disease is documented by the health care practitioner, postcoordinate the HIV-caused disease with the appropriate subcategory for HIV disease as recorded by the health care practitioner.

Chapter 01 Chapter-specific notesSepsis with or without septic shockThe concept of sepsis has undergone major changes during the last decades and the current description established and widely accepted internationally in 2016 is that sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.

Sepsis is not considered to be a disease in itself, but a reaction to an infectious disease which may be of bacterial, viral, fungal or protozoal aetiology. Septic shock is defined as a subset of sepsis in which circulatory, cellular and metabolic abnormalities are profound enough to substantially increase mortality.

Chapter 01 Chapter-specific notesA cluster involving a case of documented sepsis should include:

First, a stem code representing the causing infection (specified or unspecified) and as applicable, an optional extension code for the infectious agent if it is known.

Second, a stem code for sepsis with or without septic shock depending on the documentation

Note: If the causing infection is documented as generalised or a specific infection is not documented, assign a stem code for the greatest level of specificity documented in relationship to the infection.

Chapter 01 Coding examples Example 1A patient presented with symptoms of fever, otalgia, cough and a blotchy rash and was found to be positive for Morbillivirus. A diagnosis of measles with otitis media was made and treatment commenced.

1F03.Y Measles with other complications

AB0Y Other specified otitis media

Cluster: 1F03.Y/AB0Y

Chapter 01 Coding examples Example 1Interactive Activity: Open the ICD-11 Coding Tool. A link to the ICD-11 Coding Tool and Browser (blue)

can be found on the EIC Education Tool platform

Enter the diagnostic statement – measles with otitis media

Note that the diagnostic term is listed as an entity under 1F03.Y

Open the code 1F03.Y Measles with other complications in the browser window using the icon in the coding tool display

Note the postcoordination option for has manifestation

Using the postcoordination function assign AB0Y Other specified otitis media.

Cluster: 1F03.Y/AB0Y

Chapter 01 Coding examples Example 2A patient presented with symptoms of high fever and headache, with nausea and vomiting. A lumbar puncture identified adenovirus. A diagnosis of meningitis due to adenovirus was made, and treatment was commenced.

1C8E.2 Meningitis due to adenovirus



Enter the diagnostic statement – meningitis due to adenovirus

Open the code 1C8E.2 Meningitis due to adenovirus in the browser window using the icon in the coding tool display

Note the postcoordination options for specific anatomy and infectious agent. Where the infectious agent is precoordinated in the code title, it is not necessary to postcoordinate the agent from Chapter X Extension codes.

Chapter 01 Coding examples Example 3A patient in respiratory distress was admitted to ICU. He reported a persistent cough and dyspnoea at rest, together with intermittent chills, drenching sweats, and fever. Upon arrival at the ICU, he was profoundly hypoxic, hypotensive and required immediate intubation, ventilation and vasopressor support.

Blood and sputum cultures were positive for Streptococcus pneumoniae. Chest X-ray and ABG (arterial blood gas) confirmed the diagnosis of bronchopneumonia and acute type 1 (hypoxic) respiratory failure.

He was diagnosed with sepsis and acute respiratory failure secondary to bronchopneumonia.

Chapter 01 Coding examples Example 3 Diagnostic statement: Bronchopneumonia with sepsis and acute type 1 (hypoxic) respiratory failure

CA40.07 Pneumonia due to Streptococcus pneumoniae

1G40 Sepsis without septic shock

CB41.00 Acute respiratory failure, Type I

Cluster: CA40.07/1G40/CB41.00****manual postcoordination

Note: sequencing determined by chapter-specific note



Enter the diagnostic statement – Bronchopneumonia

Note the multiple results found for the term bronchopneumonia

Open the code CA40.07 Pneumonia due to Streptococcus pneumoniae in the browser window using the icon in the coding tool display

Note the postcoordination options for laterality and associated with. Using the associated with postcoordination option assign 1G40 Sepsis without septic shock.

Chapter 01 Coding examples Example 3 Interactive Activity To add the specificity of the other associated condition, return to the Coding Tool

and enter the condition acute respiratory failure to assign CB41.00 Acute respiratory failure, Type I

Cluster: CA40.07/1G40/CB41.00

Chapter 01 Coding exercises Using the ICD-11 Coding Tool and Browser code the exercises to demonstrate chapter content and code structure. Exercises range from easy to more complex.

A link to the ICD-11 Coding Tool and Browser (blue) can be found on the EIC Education Tool platform.

Ensure that the ‘Extension Codes’ box is ticked in the Chapter distribution/filter in the Coding Tool.

Leave Coding Tool Tab open until all exercises for this unit are completed.

To ‘paste’ an answer into the exercise, you will need to use ctrl+v (or the equivalent in your system).

Chapter 01 Coding exercises

Assign codes for the following diseases:

1. Acute bronchiolitis due to respiratory syncytial virus

_____________________________________________________________

2. Gastroenteritis due to Campylobacter

_____________________________________________________________

3. HIV resulting in candidal stomatitis.

______________________________________________________________

4. A patient presented to the emergency department with several day history of fever, chills and small-volume haemoptysis. A bronchoalveolar lavage (BAL) sample was positive for H1N1 influenza. She received a course of Tamiflu.

____________________________________________________________

5. A patient was admitted with a urinary tract infection. A urinalysis confirmed that the UTI was caused by Escherichia coli (E. coli). On day 2, the patient deteriorated, and blood cultures were taken. The physician documented on day 3 that the patient had generalised sepsis due to E.coli, as confirmed by the blood culture.

Disease: UTI caused by Escherichia coli with generalised sepsis

__________________________________________________________

You have completed Coding exercises for Chapter 01.

Please go to the next section in this unit.


Chapter 02 Neoplasms Chapter 02 StructureThe broad structure of Chapter 02 Neoplasms is as follows:

Neoplasms of brain or central nervous system (2A00-2A0Z)

Neoplasms of haematopoietic or lymphoid tissues (2A20-2B3Z)

Neoplasms, except of lymphoid, haematopoietic, central nervous system or related tissues (2B50-2F9Z)

Chapter 02 Structure This chapter contains the following top level blocks:

Neoplasms of brain or central nervous system

Neoplasms of haematopoietic or lymphoid tissues

Malignant neoplasms, except of lymphoid, haematopoietic, central nervous system or related tissues

In situ neoplasms, except of lymphoid, haematopoietic, central nervous system or related tissues

Benign neoplasms, except of lymphoid, haematopoietic, central nervous system or related tissues

Chapter 02 StructureTop level blocks:

Neoplasms of uncertain behaviour, except of lymphoid, haematopoietic, central nervous system or related tissues

Neoplasms of unknown behaviour, except of lymphoid, haematopoietic, central nervous system or related tissues

Inherited cancer-predisposing syndromes

Note: all neoplasms are primary parented to Chapter 02, with a multiple parent in the organ/system chapter as appropriate. For example, neoplasms of the respiratory system are primary parented in Chapter 02 Neoplasms and multiple parented in Chapter 12 Diseases of the respiratory system.

Structure DemonstrationInteractive Activity: Open the ICD-11 Browser. A link to the ICD-11 Coding Tool and Browser (blue) can

be found on the EIC Education Tool platform. Select Chapter 02 Neoplasms on the hierarchy tree of ICD-11 Expand Chapter 02 Neoplasms by using the grey arrow to view the list of top-level

blocks Information about the block will be displayed on the right side panel.

Chapter 02 Medical Information A neoplasm occurs when there is an abnormal proliferation of new cells in the body.

Often these cells form masses or tumours which grow as the number of cells in them increases. The change from a normal cell to a cancerous one is not very well understood but it is believed to relate to changes in the genetic materials carried in each cell.

Many factors contribute to the origin of most neoplasms and there is usually no single cause for the transformation from a normal cell to a neoplastic one.

Chapter 02 Medical InformationFactors include:

Carcinogens such as tobacco smoke.

Medication – certain drugs and hormone treatments can lead to neoplastic changes.

Age – the older we live the more likely it is that something will go wrong with our genes, causing abnormal cells to develop.

Viruses – it is believed that certain infections can damage cells and make them more susceptible to the development of neoplastic changes.

Diet – too much animal fat and not enough fruit and vegetables.

Problems with the immune system.

Genetic mutations.

Chapter 02 Medical Information There are several hundred types of neoplasms which arise in different body tissues

and most are specific to one particular type of cell. So, the type of neoplasm that affects one type of cell may not necessarily affect another.

The differences in neoplasm behaviour are:

they grow at different rates

they affect the body differently by releasing different hormones and chemicals

they are more or less likely to spread

they react differently to treatments with drugs and radiation.

Chapter 02 Medical InformationNeoplasms, (except of 2B50–2F9Z Neoplasms of unknown behaviour of unspecified site) are classified by the following types of behaviour:

Malignant – the neoplasm invades surrounding tissue or disseminates from its point of origin and begins to grow at another site;

In situ – the neoplasm is malignant but still fully confined to the tissue in which it originated;

Benign – the neoplasm grows in the place of origin without the potential for spread;

Chapter 02 Medical InformationNeoplasms, (except of 2B50–2F9Z Neoplasms of unknown behaviour of unspecified site) are classified by the following types of behaviour – continued

Uncertain behaviour – A neoplasm displaying morphologic, phenotypic, or genotypic characteristics that are clearly not benign but do not permit the establishment of a definitive diagnosis of malignancy

Unknown behaviour – it is unknown whether the neoplasm is benign or malignant.

Chapter 02 Medical InformationTo assign the correct multiple cause code for a neoplasm, you must first determine behaviour (malignant, in situ, benign, uncertain or unknown) for each of the neoplasms reported. For malignant neoplasms, you must also determine whether to code them as primary or secondary.

The primary site is the anatomical location where the malignant neoplasm originated. A malignant neoplasm may spread to other parts of the body, and these sites are referred to as secondary or metastases.

If a malignant neoplasm is described as ‘metastatic from’ a specified site, code to a primary neoplasm of this site.

If a malignant neoplasm is described as ‘metastatic to’ a specified site, code to a secondary neoplasm of this site.

Chapter 02 Medical InformationIn this example, the malignant neoplasm arose in the pancreas and has spread (metastasised) to the lungs and liver.

Chapter 02 Medical InformationThe type (as opposed to behaviour) of a neoplasm depends on the type of cell in which it arises. The cell type of a neoplasm is called its morphology. Another term you may see is histopathological type.

Chapter 02 Medical InformationEpithelial cells are the skin cells and tissues that cover the body and also internal body organs in the thoracic and abdominal cavities. Most malignant neoplasms begin in the epithelial cells and are called carcinomas.

There are different types of epithelial cells in the body, giving rise to different carcinomas. For example, the epithelial cells that cover the surface of the body and internal organs are called squamous cells and give rise to squamous cell carcinomas. Stretchy cells that layer various organs are called transitional cells and give rise to transitional cell carcinomas.

Chapter 02 Medical InformationGlandular cells are called adenomatous.

Adenomas, adenocarcinomas or adenomatous cell carcinomas arise here.

Other types of neoplasm arise in bone and connective tissue and are called sarcomas.

These include:

neoplasms that arise in the osteocytes in the bone

chondroblastic neoplasms that arise in connective tissue

and neoplasms that begin in the muscle cells.

Chapter 02 Medical Information

Lymphoid and haematopoietic tissueNeoplasms of the blood and lymphatic tissue are different to the so-called solid tumours that arise in body organs.

Blood cells are made in the bone marrow in tissue known as haematopoietic tissue (from the Greek, meaning ‘blood making’). This tissue is where lymphomas and leukaemias arise.

Chapter 02 Medical InformationOther cellsThere are other neoplasms arising in other body organs or in a mixture of different types of cells.

Astrocytomas are tumours which arise in the glial cells in the brain. Glial cells are the non-neuron cells which form the bulk of the brain tissue.

Chapter 02 Medical InformationOther cells – continuedMixed cell tumours are called teratomas (from the Greek, meaning ‘terrible tumour’). They can contain a mixture of body cell types.

Those arising in the male testes or female ovaries are called germ cell teratomas.

Other teratomas can arise from embryonal cells, usually on the body midline areas.

Chapter 02 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there are several chapter-specific notes:

General notes regarding neoplasm classification

Malignant neoplasms of independent, primary multiple sites

Unspecified malignant neoplasms of ill-defined or unspecified sites

Malignant neoplasm metastases, unspecified

Chapter 02 Chapter-specific notesGeneral notesWhen coding neoplasms, refer to the instructions at the level of the individual categories regarding code assignment, and the use of additional morphological or site descriptions from the extension codes. A neoplasm, whether primary or metastatic, that is the focus of care during a relevant episode of health care, should be recorded.

When the ‘main condition’ recorded by the health care practitioner is a primary neoplasm and the ‘other condition’ is a secondary neoplasm (metastasis), code each neoplasm separately. Do not postcoordinate the stem code for primary neoplasm with the stem code for secondary neoplasm.

Chapter 02 Chapter-specific notesGeneral notesWhen the main condition recorded by the health care practitioner is a secondary neoplasm (metastasis) and the primary neoplasm is no longer present (having been removed during a previous episode of care/personal history of), code the secondary neoplasm (metastasis) as the main condition and separately code as an other condition the stem code for ‘personal history of’. Do not postcoordinate the stem code for secondary neoplasm with the stem code for ‘personal history of’. Also, refer to Section Coding ’History of’ and ‘Family history of’ in the ICD-11 Reference Guide for further coding direction.

Chapter 02 Chapter-specific notesGeneral notesWhen the main condition recorded by the health care practitioner is ‘Follow-up examination’ (a circumstance classified to Chapter 24 Factors influencing health status or contact with health services) and the ‘other condition’ recorded is a ‘personal history of’, code the applicable ‘follow-up examination’ code as the main condition and separately code the stem code for ‘personal history of’ as the other condition. Do not postcoordinate the ‘follow-up examination’ stem code with the stem code for ‘personal history of’. Refer to Section Coding ’History of’ and ‘Family history of’ in the ICD-11 Reference Guide for coding direction.

Chapter 02 Chapter-specific notesMalignant neoplasms of independent, primary multiple sitesThe stem code for malignant neoplasms of independent (primary) multiple sites should be coded as the main condition when the health care practitioner records as the main condition two or more independent primary malignant neoplasms, none of which predominates. Then, optionally, additional codes to identify the individual neoplasms may be coded as other conditions to identify the individual primary malignant neoplasms recorded by the health care practitioner. Extension codes may be added to each primary malignant neoplasm stem code to identify additional detail of the histopathology and the site.

Chapter 02 Chapter-specific notesUnspecified malignant neoplasms of ill-defined or unspecified sitesThis code should be used only when the health care practitioner has clearly recorded the neoplasm as an unknown primary site or as an unspecified malignancy, assumed primary.

Chapter 02 Chapter-specific notesMalignant neoplasm metastases, unspecifiedThis code should be used as the main condition only when the malignancy is described as ‘disseminated metastases’ or ‘metastatic carcinoma’ (or other similar terms as described in the inclusion list of the code) and the specific sites are not documented.

Chapter 02 Coding examplesExample 1A patient was admitted with a tumour of the temporal lobe, histopathology showed the tumour was an anaplastic astrocytoma.

2A00.0Y Other specified gliomas of brain

XA97T4 Temporal lobe

XH96C7 Astrocytoma, anaplastic

Cluster: 2A00.0Y&XA97T4&XH96C7

Underlined text indicates optional extension code



Enter the diagnostic statement – anaplastic astrocytoma

Open the code 2A00.0Y Other specified gliomas of brain in the browser window using the icon in the coding tool display

Note the postcoordination options for laterality, specific anatomy, histopathology and has manifestation.

Using the specific anatomy and histopathology postcoordination options assign XA97T4 Temporal lobe and XH96C7 Astrocytoma, anaplastic.

Cluster: 2A00.0Y&XA97T4&XH96C7

Chapter 02 Coding examplesExample 2A patient was admitted with an adenocarcinoma of the rectum for Hartmann’s resection.

2B92.0 Adenocarcinomas of rectum



Enter the diagnostic statement – adenocarcinoma rectum

Open the code 2B92.0 Adenocarcinomas of rectum in the browser window using the icon in the coding tool display

Note the postcoordination options for specific anatomy and histopathology. Where the specific anatomy and/or histopathology is precoordinated in the code title, it is not necessary to postcoordinate them from Chapter X Extension codes.

Chapter 02 Coding examplesExample 3 A patient was admitted with an Ewing sarcoma of the right tibial shaft, for resection.

Ewing sarcoma of the right tibial shaft

2B52.0 Ewing sarcoma of bone or articular cartilage of limbs

XK9K Right

XA66B3 Tibial shaft

Cluster: 2B52.0&XK9K&XA66B3**


**manual postcoordination



Enter the diagnostic statement – ewing sarcoma

Open the code 2B52.0 Ewing sarcoma of bone or articular cartilage of limbs in the browser window using the icon in the coding tool display

Note the postcoordination options for laterality. Using the laterality postcoordination option assign XK9K Right.

To add the specificity of the specific anatomy, return to the Coding Tool (ensuring the extensions code chapter is ticked on) and enter the specific anatomy tibia shaft to assign XA66B3 Tibial shaft.

Cluster: 2B52.0&XK9K&XA66B3





Chapter 02 Coding exercises Assign codes for the following diseases:

1. Myelodysplastic syndrome

____________________________________________________________

2. Diffuse large B-cell lymphoma

____________________________________________________________

3. Squamous cell carcinoma, of middle third of oesophagus.

____________________________________________________________

4. A patient presented to hospital for a colonoscopy which demonstrated hyperplastic polyps in the sigmoid colon. The polyps were removed for pathology. Pathology report revealed tubular adenoma with low grade dysplasia.

Benign neoplasm of the large intestine _________________________

Sigmoid colon _________________________

Tubular adenoma, NOS __________________________

5. Patient presented to hospital with increasing haematuria due to pre-existing bladder transitional cell carcinoma (TCC). They were discharged for follow up with community nursing.

Bladder TCC _________________________

Transitional cell carcinoma _________________________




Chapter 03 Diseases of the blood or blood-forming organsChapter 03 StructureChapter 03 Diseases of the blood or blood-forming organs is organised into three major sections:

Anaemias and other erythrocyte disorders

Coagulation defects, purpura or other haemorrhagic or related conditions

Diseases of spleen

Structure DemonstrationInteractive Activity: Open the ICD-11 Browser. A link to the ICD-11 Browser (blue) can be found on the

EIC Education Tool platform. Select Chapter 03 Diseases of the blood or blood-forming organs on the hierarchy

tree of ICD-11 Expand Chapter 03 Diseases of the blood or blood-forming organs by using the grey

arrow to view the list of top-level blocks. Information about the block will be displayed on the right.

Chapter 03 Medical InformationBlood cells and their functionsBlood is a fluid used by the body as a transportation system. It circulates oxygen, carries nutrients, hormones and other gases to body cells and removes waste products from the cells.

The blood and immune systems also function together to help protect the body from disease and infection.

Blood is pumped around the body by the heart and it flows through every organ and tissue in the body.

Chapter 03 Medical InformationBlood consists of cells which are suspended in plasma, a clear liquid. Plasma is a solution made up of nutrients and various proteins, mainly albumin and various globulins, including the immunoglobulins which are responsible for the body's ability to defend itself against infection.

The cells which are suspended in the plasma include erythrocytes (red blood cells), leukocytes (white blood cells), and the cells that aid in the clotting of the blood, known as platelets or thrombocytes.

Chapter 03 Medical InformationErythrocytes, or red blood cells, develop in the bone marrow. They carry iron and haemoglobin to the rest of the body. Haemoglobin is vital because it acts as the transportation system for oxygen from the lungs to the body cells.

Leukocytes, or white blood cells, help fight off foreign substances such as bacteria, viruses and abnormal cells, to help the body to avoid disease. Types of leukocytes include granulocytes, neutrophils, lymphocytes and monocytes.

Platelets or thrombocytes are the smallest cells in the blood. They regulate the clotting of the blood following an injury, in a process known as coagulation. Platelets are created in the bone marrow from megakaryocytes.

Chapter 03 Medical InformationDiseases of the bloodAnaemia is the term given to a group of blood disorders characterised by a lack of erythrocytes or of circulating haemoglobin.

There are many types of anaemia as you will see when you look at the blocks in the chapter.

The main types are:

nutritional anaemia

haemolytic anaemia

aplastic and other anaemias.

Chapter 03 Medical InformationAnaemiaThere are two types of nutritional anaemia:

iron deficiency anaemia – this is the most common type of anaemia and is caused by a lack of iron in the blood. Iron is necessary for the production of haemoglobin. This type of anaemia is most commonly associated with chronic blood loss, but may be due to other factors.

pernicious anaemia – occurs when the body’s inability to absorb vitamin B12 via an intrinsic factor in the gastrointestinal tract is impaired. The lack of vitamin B12 causes large erythrocytes as they do not divide normally. The large size impairs the ability of the erythrocyte to leave the bone marrow and function properly.

Chapter 03 Medical InformationAnaemiaHaemolysis is the premature destruction of erythrocytes, and it leads to haemolytic anaemia when bone marrow activity cannot compensate for the erythrocyte loss. Examples are:

sickle cell anaemia – a hereditary condition in which erythrocytes have an unusual crescent shape causing oxygen deprivation, cell clumping and infarction (tissue death caused by lack of local oxygen supply).

thalassaemia – is an inherited disorder in which a haemoglobin protein (alpha or beta) is produced in an abnormal form. The abnormal protein results in excessive destruction of the red blood cell while the body cannot produce enough healthy red blood cells to compensate for the destruction.

Chapter 03 Medical InformationOther diseases of the red blood cellsHaemochromatosis is a condition occurring when large amounts of iron are deposited throughout the body. This can lead to liver failure.

In polycythaemia (rubra) vera, the blood is thick and sticky because of an excessive number of erythrocytes formed in the bone marrow.

Chapter 03 Medical InformationDiseases of the white blood cellsGranulocytosis is a disease of the white blood cells characterised by an abnormal number of granulocytes in the blood as a result of infection or inflammation.

Granulocytes include cell forms eosinophils, neutrophils and basophils.

Chapter 03 Medical InformationDiseases of blood clotting and coagulationHaemophilia is caused by a congenital lack of a protein in the blood needed for clotting. The disease leads to excessive bleeding, easy bruising and slow clotting time.

Purpura is a disorder resulting in leakage of small blood vessels under the skin. The condition may also affect the mucus membranes and other organs. A person with purpura may have normal or decreased platelet levels.

Chapter 03 Medical InformationDiseases of blood clotting and coagulationThrombocytopaenia occurs when a low amount of platelets are present either due to low production or too many are destroyed.

Disseminated intravascular coagulation (also known as defibrination syndrome) is a condition in which small clots form throughout the blood stream. This reduces the number of platelets available for clotting and control of bleeding and, in turn, leads to haemorrhage. The formation of blood clots may be due to a variety of disorders including sepsis, endothelial cell damage, obstetric complications such as abruptio placenta and amniotic fluid embolism and certain neoplasms.

Chapter 03 Chapter-specific notes Chapter-specific notes for Chapter 03As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there is one chapter-specific note.

General notesCertain conditions classifiable to this chapter may result from drugs or other external causes. Codes from Chapter 23 External causes of morbidity and mortality may be used as optional additional codes.

Chapter 03 Coding examplesExample 1A patient presented to hospital with pallor, jaundice, iron overload, fatigue, and shortness of breath. Blood and genetic testing were undertaken, confirming a diagnosis of thalassaemia.

The patient was discharged with a referral to a haematologist.

3A50.Z Thalassaemias, unspecified



Enter the diagnostic statement – thalassaemia

Open the code 3A50.Z Thalassaemias, unspecified in the browser window using the icon in the coding tool display

Note there are no postcoordination options for this code.

Chapter 03 Coding examplesExample 2 A patient was admitted due to an abnormal blood profile. After further tests a diagnosis of congenital Heinz body anaemia was made.

3A1Y Other specified congenital haemolytic anaemia



Enter the diagnostic statement – heinz body

Open the code 3A1Y Other specified congenital haemolytic anaemia in the browser window using the icon in the coding tool display


Chapter 03 Coding examplesExample 3A patient presented with left upper quadrant abdominal pain, fever with chills, nausea and vomiting, and pleuritic chest pain. A chest and abdominal X-ray demonstrated splenic infarction.

3B81.6 Infarction of spleen



Enter the diagnostic statement – splenic infarction

Open the code 3B81.6 Infarction of spleen in the browser window using the icon in the coding tool display






Chapter 03 Coding exercises Assign codes for the following diseases:

1. Iron deficiency anaemia

_______________________________________________________________

2. Splenic cyst

________________________________________________________________

3. An elderly female presented to the emergency department complaining of several episodes of dizziness. Patient also complained of weakness and lethargy. Bloods were ordered, which revealed pancytopenia. Packed cell and platelet transfusions were administered.

_____________________________________________________________

4. A male patient was referred to the hospital by his general practitioner with onset of bruising, hypotension and confusion. He was diagnosed with disseminated intravascular coagulation disorder, treatment was commenced and the patient was discharged home.

_______________________________________________________________

5. A 60 year old male presents for transfusion of packed cells (4 units) with Hb 65. Patient has known refractory cytopenia with multilineage dysplasia.

_______________________________________________________________




Chapter 04 Diseases of the immune systemStructure of Chapter 04This new chapter was created to better capture the complexity of the disease processes of the immune system.

There are new sections for immune disorders that differ from the section located in Chapter III of previous ICDs.

For the immune system they are classified mainly by clinical syndrome, and in an alternate view the immune system conditions are shown by cell line.

A section for allergic or hypersensitivity conditions has been included in this chapter.

Structure of Chapter 04Chapter 04 Diseases of the immune system includes the following categories:

Immunodeficiencies

Nonorganic specific systemic autoimmune disorders

Autoinflammatory disorders

Allergic or hypersensitivity conditions

Immune system disorders involving white cell lineages

Certain disorders involving the immune system

Diseases of thymus

Structure DemonstrationInteractive Activity: Open the ICD-11 Browser. A link to the ICD-11 Browser (blue) can be found on the

EIC Education Tool platform. Select Chapter 04 Diseases of the immune system on the hierarchy tree of ICD-11 Expand Chapter 04 Diseases of the immune system by using the grey arrow to view

the list of top-level blocks. Information about the block will be displayed on the right.

Chapter 04 Medical InformationThe immune systemThe immune system is made up of all the mechanisms through which the body defends itself from infectious and parasitic diseases.

Defence mechanisms:

Physical barriers – the first line of defence

Inflammation

Immune system specific responses.

Chapter 04 Medical InformationPhysical barriers – the first line of defenceBarriers to the initial entry of infectious and parasitic diseases are:

the skin acts as a barrier to infectious agents such as bacteria and viruses. Tears and saliva secrete enzymes that break down the walls of bacteria cells. Glands in the skin secrete chemicals that slow down the growth of bacteria.

the mucous membranes in the respiratory, digestive, urinary and reproductive tracts secrete mucus that forms another barrier.

Chapter 04 Medical InformationInflammationWhen organisms manage to infiltrate the body, inflammation results.

The resulting heat created by the inflammation makes the environment unfavourable for microbes, promotes healing, motivates the creation of white blood cells and increases the metabolic rate of nearby cells which begin to swell.

Macrophages (a type of white blood cell) clean up dead microbes, cells and debris. Often, this response is strong enough to stop the spread of disease-causing agents such as viruses, bacteria and fungi. However, if it is not enough to stop the invaders, the immune response begins.

Chapter 04 Medical InformationImmune system specific responsesThe immune system generates specific responses to specific invaders.

The immune system is more effective than the method of defence described previously.

It also has the ability to improve response time when an invader of the same type is encountered again in the future by using a ‘memory’ of the infection.

Chapter 04 Medical InformationImmune system specific responses – continuedImmunity results from the production of antibodies specific to a given antigen. Antibodies attach themselves to the antigens on the invading infection and kill or deactivate it.

Chapter 04 Medical InformationImmune system specific responsesA vaccine given prior to infection stimulates the same antibody response and creation of a ‘memory’ without actually causing the disease. Vaccines are made from killed or weakened pathogens that are strong enough to cause antibody production but too weak to cause the disease itself.

Chapter 04 Medical InformationThe lymph systemThe lymph system is a separate organ system that is vital to the function of the immune system. It is made of three components: lymph; lymph vessels, called ducts; and lymph glands.

The lymph is a transparent, slightly yellow fluid that contains white blood cells, proteins and water. This fluid is collected from all tissues throughout the body. It is transported from the tissue and returned to the blood stream via the lymphatic vessels, known as lymph ducts.

Chapter 04 Medical Information

The lymph systemThere are several glands within the lymph system including the thymus, tonsils, spleen and lymph nodes. Lymph nodes are small nodules positioned along the ducts that help to filter the lymph and distribute immune-related cells and antibodies throughout the body. Lymph nodes tend to swell if there is a nearby infection because they are involved in the immune system's fight against the infection. Common sites of lymph nodes are the armpit, neck and groin

Chapter 04 Medical InformationThe spleenThe spleen is an organ located in the abdomen just beneath the diaphragm. It has a similar role to a lymph node, but involves filtering of the blood (rather than the lymph).

Chapter 04 Medical InformationThe tonsilsThe tonsils are areas of lymphoid tissue on either side of the throat. They contribute to the function of the immune system by helping to protect against infection. Specifically they are believed to be involved in helping fight off pharyngeal and upper respiratory tract infections.

Chapter 04 Medical InformationThe adenoidsThe adenoids, or pharyngeal tonsils, are folds of lymphatic tissue found in the roof and posterior wall of the throat behind the uvula. The adenoids trap inhaled viruses and produce antibodies, particularly in children. This function decreases with age as the adenoids shrink. Therefore the problems caused by enlarged adenoids seen in children rarely occur in adults.

Chapter 04 Medical InformationBone marrowBone marrow is the tissue found in the middle of large bones, and is the place where the majority of new blood cells are produced.

Bone marrow consists of stem cells which are responsible for the creation of white blood cells (leukocytes), red blood cells (erythrocytes), and platelets (thrombocytes). White blood cells help to defend the body against infectious disease and foreign materials as part of the immune system.

Chapter 04 Chapter-specific notes As per the ICD-11 Reference Guide, Section Main uses of the ICD: Morbidity/Chapter-specific notes there are no chapter-specific notes for Chapter 04 Diseases of the immune system.

Chapter 04 Coding examplesExample 1A patient was admitted with a persistent dry cough, fatigue, and shortness of breath. A chest CT identified an abnormality, so a bronchoscopy with biopsy was performed, confirming a diagnosis of sarcoidosis of the lung.

4B20.0 Sarcoidosis of lung



Enter the diagnostic statement – sarcoidosis lung

Open the code 4B20.0 Sarcoidosis of lung in the browser window using the icon in the coding tool display


Chapter 04 Coding examplesExample 2A patient was admitted with recurring purpura, an elevated erythrocyte sedimentation rate, and hypergammaglobulinaemia.

A diagnosis of Waldenström hypergammaglobulinaemia was made.

4B21 Polyclonal hypergammaglobulinaemia



Enter the diagnostic statement – Waldenström hypergammaglobulinaemia

Open the code 4B21 Polyclonal hypergammaglobulinaemia in the browser window using the icon in the coding tool display


Chapter 04 Coding examplesExample 3 A patient was admitted 62 days post kidney transplant with a maculopapular rash, fever and diarrhoea. The diagnosis of acute graft-versus-host disease was made, and treatment initiated.

4B24.0 Acute graft-versus-host disease

QB63.0 Presence of transplanted kidney

Cluster: 4B24.0/QB63.0**


Note: for the purposes of this example (i.e. to demonstrate content of Chapter 4) external cause codes have not been assigned.



Enter the diagnostic statement – acute graft versus host

Open the code 4B24.0 Acute graft-versus-host disease in the browser window using the icon in the coding tool display


To add the specificity of the transplanted organ, return to the Coding Tool and enter the specific transplanted organ i.e. transplanted kidney to assign QB63.0 Presence of transplanted kidney.

Cluster: 4B24.0/QB63.0





Chapter 04 Coding exercises Assign codes to the following diseases:

1. Cyclic neutropenia____________________________________________________________

2. Combined immunodeficiency due to CD3 gamma deficiency____________________________________________________________

3. Anaphylaxis due to allergic reaction to food

_____________________________________________________________

4. Good syndrome

_____________________________________________________________

5. Female patient aged 26 years presents to the emergency department with febrile neutropenia.

______________________________________________________________

You have now completed ICD-11 Education Tool Unit 4

Chapter 01 Certain infectious or parasitic diseases




Answers to Unit 4 Coding exercisesChapter 01 Coding exercises

1. CA41.0 Acute bronchiolitis due to respiratory syncytial virus.

2. 1A06 Gastroenteritis due to Campylobacter

3. 1F23.0 Candidosis of lips or oral mucous membranes

1C62.2 HIV disease clinical stage 3 without mention of tuberculosis or malaria

Note: In the Coding Tool 1C62.2 HIV disease clinical stage 3 has an inclusion term for HIV disease resulting in candidiasis.

4. Cluster: 1E31&XN297**



1E31 Influenza due to identified zoonotic or pandemic influenza virus

XN297 Influenza A/H1N1 virus

5. Cluster: GC08.0/1G40**


GC08.0 Urinary tract infection, site not specified, due to Escherichia coli

1G40 Sepsis without septic shock

(sequencing determined by chapter-specific note)

Chapter 02 Coding exercises 1. 2A3Z Myelodysplastic syndromes, unspecified

2. 2A81.Z Diffuse large B-cell lymphoma, not otherwise specified

3. Cluster: 2B70.1&XA2BY3


2B70.1 Squamous cell carcinoma of oesophagus

XA2BY3 Middle third of oesophagus

4. Cluster: 2E92.4Y&XA8YJ9&XH7SY6


2E92.4Y Other specified benign neoplasm of the large intestine

XA8YJ9 Sigmoid colon

XH7SY6 Tubular adenoma, NOS

5. Cluster: 2C94.2&XH8EH1


2C94.2 Urothelial carcinoma of bladder

XH8EH1 Transitional cell carcinoma, NOS

Chapter 03 Coding exercises 1. 3A00.Z Iron deficiency anaemia, unspecified

2. 3B81.5Z Splenic cyst, unspecified

3. 3A70.Z Aplastic anaemia, unspecified

4. 3B20 Disseminated intravascular coagulation

5. 2A34 Refractory cytopenia with multilineage dysplasia

Chapter 04 Coding exercises 1. 4B00.00 Constitutional neutropenia

2. 4A01.1Y Other specified combined immunodeficiencies

3. 4A84.0 Anaphylaxis due to allergic reaction to food

4. 4B40.2 Good syndrome

5. 4B00.0Z Neutropenia, unspecified

MG26 Fever of other or unknown origin

hscic.kahootz.com · web viewseptic shock is defined as a subset of sepsis in which circulatory,...

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