Dr.
Asrade Abate
National Classification of Diseases
(NCoD)
Instructions Manual
July 2017
9
Contents
Acronyms................................................................................................................................... 2
I. Introduction....................................................................................................................... 3
II. Background........................................................................................................................ 3
III. The National Classification of Diseases (NCoD).............................................3
IV. Features........................................................................................................................... 4
V. Organisation...................................................................................................................... 4
VI. Instructions for use..................................................................................................... 6
A. Conventions Used........................................................................................................ 6
B. Basic Coding Guidelines............................................................................................ 8
References.................................................................................................................................. 8
NCoD Instruction Manual | Dr. Asrade Abate
Acronyms 9
HMIS Health Management Information System
ICD International Classification of Diseases
IPD In-Patient Department
MoH Ministry of Health
NCoD National Classification of Diseases
OPD Out Patient Department
WHO World Health Organization
NCoD Instruction Manual | Dr. Asrade Abate
9
I. Introduction
This Instruction Manual is prepared
for health care providers as a guide to the
National Classification of Disease (NCoD).
It provides a basic description of the NCoD
with practical instructions on how to use it for
recording, coding and reporting.
Health care providers will be able to:-
Understand the NCoD;
Write the appropriate code for a diagnosis
according to NCoD;
Use NCoD in morbidity and mortality
recoding and reporting.
II. Background
- Health system depends on a constant flow of information to make decisions.
- At the global level the WHO developed the International Classification of Diseases
(ICD) which has achieved broad acceptance across the globe, and is approved and
recommended as a guideline for reporting on health.
The WHO revises the ICD periodically and publishes it in a series of editions
reflecting advances in health and medical science over time. The latest version, the
tenth version of ICD, was endorsed in 1990 by the forty-third World Health
Assembly as a standard classification of diseases. Currently, a revision process is
underway and the release of ICD-11 is expected by 2017.
In our country, prior to 2005, the Ministry of Health (MoH) used the sixth edition of
ICD which was released in 1948, as the national disease reporting system. However,
the ICD-6 had two major problems – first it uses disease codes rather than disease
names, which was very difficult for health professionals and administratorsto
NCoD Instruction Manual | Dr. Asrade Abate
understand. Second - significant diseases
9 such as HIV were not included. These
made the reporting system to be error prone ,unreliable, inconsistent, cumbersome,
and unable to support decision making.
Therefore, the MoH launched the Health Management Information System (HMIS)
reform. The ICD-6 based national reporting system was revised according to the
principles of “standardization”, “integration” and “simplification”. The reform shifts
the focus from reporting data to the national level to information use for decision
making at all levels.
III. The National Classification of Diseases (NCoD)
The NCoD was developed as part of the HMIS reform to organize health information.
It isthe national standard system of defining, monitoring and reporting health
conditions and their outcomes.
The preparation of the NCoD started with a countrywide study of samples from
service points & administrative units. It also includes the relationship of
geographical setup in respect to a disease. This study produced a list of diseases,
from which a selection of priority diseases was made. The disease list was then,
harmonised with different international standards: Integrated Disease Surveillance
and Response (IDSR) protocols (using disease names in IDSR list), ICD-10 codes and
Global Burden of Disease (GBD) classification. The NCoD was finalised after the
recommendations of healthcare providers and specialists in each discipline were
incorporated.
The main target of the revised disease classification is morbidity and mortality
reporting with focus on priority diseases. The national level report is limited only to
diseases that are relevant for epidemiological surveillance, planning and
management purposes.
IV. Features
The NCoD comprises of three documents that incorporate essential list of diseases
corresponding to the diagnostic capacity of the respective level of the health care
system.
The Health Post edition of the NCoD comprises of 45 diseases. The Mini Edition
modified for the primary level health care contains a selection 617 diseases. The
Compact Edition for use by secondary level facilities has 1,849 diseases. The
NCoD Instruction Manual | Dr. Asrade Abate
Extended Edition with 2,055 diseases
9 is developed as a reference and for tertiary
level health care providers.
V. Organisation
The NCoD is a simplified disease classification system; it is organized according to
the ICD-10 framework with specification of ICD-codes corresponding to each
diagnosis or disease categories. It is also fully mapped to the ICD-10.
ICD-10 is a system of categorising diseases and health problems. It translates their
lengthy descriptions into unique codes, which are easier to store, retrieve and
analyse. It is used to systematically record, analyse, interpret and compare mortality
and morbidity data collected at different times, at any level of the health system.
It constitutes about 12,000 diseases and conditions distributed in 21 chapters:
broken down into 261 groups containing a total of about 2,036 categories. Chapters
I–XVII relate to diseases and other morbid conditions, and Chapter XIX relates to
Injury, poisoning and certain other consequences of external causes. Chapter XVIII
covers Symptoms, signs and abnormal clinical and laboratory findings, not
elsewhere classified. Chapter XX, External causes of morbidity and mortality. Finally,
Chapter XXI, Factors influencing health status and contact with health services, for
the classification of data explaining the reason for contact with health-care
services .The chapters are subdivided into homogeneous blocks of three-character
categories.
Chapte Block Title
r
I A00-B99 Certain infectious and parasitic diseases
II C00-D48 Neoplasms
III D50-D89 Diseases of the blood and blood-forming organs and certain disorders
involving the immune mechanism
IV E00-E90 Endocrine, nutritional and metabolic diseases
V F00-F99 Mental and behavioural disorders
VI G00-G99 Diseases of the nervous system
VII H00-H59 Diseases of the eye and adnexa
VIII H60-H95 Diseases of the ear and mastoid process
IX I00-I99 Diseases of the circulatory system
X J00-J99 Diseases of the respiratory system
XI K00-K93 Diseases of the digestive system
XII L00-L99 Diseases of the skin and subcutaneous tissue
XIII M00-M99 Diseases of the musculoskeletal system and connective tissue
XIV N00-N99 Diseases of the genitourinary system
XV O00-O99 Pregnancy, childbirth and the puerperium
XVI P00-P96 Certain conditions originating in the perinatal period
XVII Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities
XVIII R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not
NCoD Instruction Manual | Dr. Asrade Abate
elsewhere classified9
XIX S00-T98 Injury, poisoning and certain other consequences of external causes
XX V01-Y98 External causes of morbidity and mortality
XXI Z00-Z99 Factors influencing health status and contact with health services
XXII U00-U99 Codes for special purposes
Table 1: ICD-10 List of Chapters, Block groups and Chapter titles.
NCOD
HEADING ICD-10 CODES
CODE
0100 Certain infectious and parasitic diseases A00-B99
Epidemic prone diseases
0101 Malaria (clinical without laboratory confirmation) B54
0102 Malaria (confirmed with P. falciparum) B50
0103 Malaria (confirmed with species other than P. falciparum) B51-B53
0104 Diarrhoea (non-bloody) A09
0105 Diarrhea with dehydration A09
A02.0, A03.0-A03.9,
0106 Diarrhea with blood (dysentery) A04.0-A04.9, A06.0-A06.1,
A07.0-A07.9
0107 Meningitis A39.0, G00-G03
0108 Typhoid fever A01.0
0109 Relapsing fever A68.0-A68.9
0100 Certain infectious and parasitic diseases A00-B99
Table 2:NCoD Mapping to ICD-10
VI. Instructions for use
A. Conventions Used
1. Parentheses ()
Used to enclose supplementary words, which may follow a diagnostic term without
affecting the code number to which the words outside the parentheses would be
assigned. For example,
Compac Extende Disease Name
Mini t d Chapter
171 569 619 Circulatory System Hypertension (Essential
NCoD Instruction Manual
(primary) | Dr. Asrade Abate
hypertension)
9
‘Hypertension (Essential (primary) hypertension)’, implies that the code number for
the word ‘Hypertension’ alone or when qualified by any, or any combination, of the
words in parentheses is one and the same.
2. Square brackets [ ]
Used for enclosing synonyms, alternative words or explanatory phrases; for
example:
Extende Disease Name
Mini Compact d Chapter
Schistosomiasis
(Schistosomiasis due to
Schistosoma haematobium
85 197 213 Infectious & Parasitic [urinary schistosomiasis])
3. Colon :
Colon is used in terms when the words that precede it are not complete terms for
assignment to that code. They require one or more of the modifying or qualifying
words indented under them before they can be assigned to the code. For
example,the diagnosis ‘Malignant neoplasm’ is to be classified there only if qualified
by the word ‘Stomach, unspecified’.
Compac Extende Disease Name
Mini t d Chapter
Malignant (Malignant neoplasm:
103 244 261 Neoplasms Stomach, unspecified)
NCoD Instruction Manual | Dr. Asrade Abate
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4. Semicolon ;
Semicolon is used to provide description of a term.
Compac Disease Name
Mini t Extended Chapter
Dental Disorder (Fluorosis;
204 661 744 Digestive System Abnormalities of size and form of teeth)
5. ‘NOS’
The letter ‘NOS’ is an abbreviation for ‘not otherwise specified’, implying
‘unspecified’ or ‘unqualified’.
Extende Disease Name
Mini Compact d Chapter
103 244 976 Skin & Subcutaneous Alopecia (NOS)
6. Not elsewhere classified
Not elsewhere classified serves as a warning that certain specified variants of the
listed conditions may appear in other parts of the classification. For example:
Extende Disease Name
d Chapter
Bacterial Diseases (Other bacterial diseases, not
79 Infectious & Parasitic elsewhere classified)
7. ‘And’
‘And’ stands for ‘and/or’. For example, cases of ‘tuberculosis of bones’, ‘tuberculosis
of joints’ and ‘tuberculosis of bones and joints’ are to be classified in the code
Tuberculosis of bones and joints.
NCoD Instruction Manual | Dr. Asrade Abate
9
Compac Disease Name
t Extended Chapter
46 49 Infectious &Parasitic Tuberculosis of bones and joints
B. Basic Coding Guidelines
To find a code from NCoD editions;
1. Identify the statement to be coded
2. Find the chapter to which the condition belongs to
3. Locate the lead term for the condition from the list in the chapter.
4. Read any terms enclosed in parentheses after the lead term as well as any terms
under the lead term until all the words in the diagnostic expression have been
accounted for.
5. The corresponding code in digits will be adjacent to the disease name in the tabular
list.
6. Verify the suitability of the code number selected.
7. Assign the code.
References
1. The International Statistical Classification of Diseases and Related Health Problems
(ICD-10), Tenth Revision, Volume 2 Instruction Manual. Fifth Edition, 2016 World
Health Organization.
2. The National Classification of Diseases. Mini Edition: Ministry of Health; May 2015.
3. The National Classification of Diseases. Compact Edition.
4. The National Classification of Diseases. Extended Edition.
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NCoD Instruction Manual | Dr. Asrade Abate
