INTERNATIONAL CLASSIFICATION OF DISEASES MANUAL OF THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES, INJURIES, AND CAUSES OF DEATH Based on the Recommendations of the Eighth Revision Conference, 1965, and Adopted by the Nineteenth World Health Assembly Volume 2 ALPHABETICAL INDEX WORLD HEALTH ORGANIZATION GENEVA 1969 Volume 1 Introduction List of Three-digit Categories Tabular List of Inclusions and Four-digit Sub- categories Medical Certification and Rules for Classification Special Lists for Tabulation Definitions and Recommendations Regulations Volume 2 Alphabetical Index PRINTED IN ENGLAND CONTENTS Introduction Page General arrangement of the Index ....................................... VIII Main sections ............................................................... VIII Structure ..................................................................... IX Code numbzrs .............................................................. x Primary and secondary conditions. ................................... x Multiple diagnoses. ........................................................ XI Spelling....................................................................... XI Order of listing ............................................................. Conventions used in the Index ........................................... XII Parentheses. ................................................................. XII Cross-referexes ........................................................... XI1 Abbreviation NEC. ....................................................... XIII Alphabetical Index Section I: Alphabetical Index to Diseases and Nature of Injury. ....................................................... 1 Section 11: Alphabetical Index to External Causes of Injury ... 499 Section 111: Alphabetical Index to Adverse Effects of Drugs and Other Chemical Substances (Table of Ad- verse Effects) .............................................. 541 INTRODUCTION INTRODUCTION Volume 2 of the International Classification of Diseases is an alpha- betical index to the Tabular List of Volume 1. Although the Index re- flects the provisions of the Tabular List in regard to the notes varying the assignment of a diagnostic term when it is reported with other conditions, or under particular circumstances (e.g. certain conditions arising during pregnancy), it is not possible to express all such varia- tions in the index terms and Volume 1 should be regarded as the primary coding tool. Reference should always be made back to the Tabular List and its notes to ensure that the code given by the Index fits the circum- stances of a particular case. The Index is, however, an essential adjunct to the Tabular List, since it contains a great number of diagnostic terms which do not appear in Volume 1. The terms included in a category of the Tabular List are not exhaustive; they serve as examples of the content of the category. The Index, on the other hand, is intended to include all diagnostic terms cur- rently in use. Because of its exhaustive nature, the Index inevitably includes many imprecise and undesirable terms. Since these terms are still occasionally encountered on medical records, coders need an indication of their as- signment in the Classification, even if this is to a rubric for residual or ill-defined conditions. The presence of a term in this volume, therefore, should not be taken as sanction for its usage in good medical terminology; the International Classification of Diseases is in no sense a medical nomenclature. VIII INTRODUCTION General Arrangement of the Index Main Sections The Alphabetical lndex consists of three sections, as follows: Section /.-Index to the disease section of the Classification, in- cluding causes of foetal death (categories 000-796) and to the section on the nature and anatomical site of injury (fracture, dislocation, open wound, burn, etc.; categories N800-N999) except for adverse effects of chemical substances (see Section 111). These types of terms are included in Section I because they are similar, constituting the diagnosis of the case as it would be given by an attending physician, a clinic, or a hospital. Section 11. - lndex to the external cause of injury (categories E800- E999) except for poisoning (see Section 111). These items are in no sense medical diagnoses, but are descriptions of the circumstances under which the accident or violence occurred, and of the means of injury. This sec- tion includes such terms as fire, explosion, fall, assault, collision, and submersion. Section /I/.- lndex to adverse effects of drugs and other chemical substances (referred to in Sections 1 and 11 as Table of Adverse Effects). It includes the N codes for adverse effects (categories N960-N989) and the E codes for accidental poisoning (E850-E877), suicide and self- inflicted injury by poisoning (E950-E952), and poisoning undetermined whether accidentally or purposely inflicted (E980-E982). The purpose of this separate section for poisoning agents is to provide the coder with both the relevant codes, N and E, from a single reference to the Index. Some effects of external agents (e.g. contact dermatitis) are not classi- fied to N and E codes, but to disease codes. If there is any doubt whether the effect in a particular case is one of these, the term should be looked up in Section 1. One section of the Tabular List (Volume 1) has not been indexed: the Supplementary Classifications. These categories are intended for the coding of, for example, hospital admissions which cannot be assigned to the main Classification either because the person admitted was not sick or because no classifiable diagnosis was reported. The categories (Y00-Y89) occupy only six pages of Volume 1 and their content is largely self-explanatory. In categories Y00-YO9 (Examination and investigation of specific systems without reported diagnosis), the general intention is to classify cases according to the system which is the subject of the investigation rather than the suspected condition, since if the latter were reported the case would be coded to the main Classification and not to Y00-Y09. INTRODUCTION IX Structure To avoid repetition, the Index is organized in the form of lead terms, which $start at the extreme left of a column, and various levels of in- dentation, which start progr&ssivelyfurther and further to the right. A complete index term, therefore, may be composed of several lines, some- times quite widely separated. For example, in the entry Atrophy, atrophic muscle, muscular 733.1 progressive 348.2 spinal 348.2 specified as hereditary or familial 330.1 pseudohypertrophic 330.3 spinal 348.2 Aran-Duchenne 348.2 familial 330.1 the last line stands for "Atrophy muscular spinal familial." Usually, the lead term is the name of a disease or pathological condi- tion, while the terms indented beneath it refer either to varieties of this condition or to the anatomical sites affected by it. The coder should therefore first look up the disease condition as a lead term and then find the anatomical site in alphabetical order below it. Thus, he will find "tu- berculosis of hip" under T, not under H, and "stomach ulcer" under U, not under S. Some important terms indicating varieties do, however, appear also as lead terms. Thus "typhoid fever" will be found under T as well as under F. Under the terms "Delivery," "Pregnancy," "Puer- peral," and "Birth" appear fairly complete listings of conditions frequently qualified by these terms, in addition to the alphabetical listings of the conditions themselves with the qualifying terms as indents. It is not always feasible, however, to include a complete listing of the various combinations of modifiers which could apply to a given term. In such instances there are some types of modifiers which tend to have priority over others. For example, under the lead term "Abscess" are indented a large number of anatomical sites with their appropriate codes. However, tuberculous abscesses are not classified to these codes but to the codes for tuberculosis of these sites. Instead of inserting an indent "tubercu- lous" under each anatomical site, the lndex uses one single indent "tuberculous - see Tuberculosis, abscess" under the lead term "Ab- scess." In general, the types of modifiers which tend to have priority over others are: in Section 1, those indicating that a disease or condition was infectious or parasitic, malignant, neoplastic, psychogenic, hyster- ical, congenital, traumatic, or arose during pregnancy, childbirth, or the X INTRODUCTION puerperium; in Section 11, those indicating transport accidents, compli- cations of medical or surgical procedures, late effects, suicide and self- inflicted injury, homicide and assault, legal intervention, or war ope?ations. The terms "Complication" (for medical and surgical pro- cedures), "Late effect," "Suicide," "Assault," "Legal intervention," and "War operations" also appear as lead terms with complete lists of the appropriate categories indented under them. In Section I1 (External Cause of Injury), the lead term is usually the description of the type of accident or violence, with the agency in the subordinate position. Thus all collisions are indexed under C, with the types of vehicles involved indented below, and not under motor vehicle, railway train, etc. Code nunzbers The code number's which follow the terms in the Index are those of the three-digit categories to which the terms are classified. In general, if the three-digit category is subdivided into four-digit subcategories,