24112015 icd10 tb_rr
TRANSCRIPT
ICD-10 & TB
Rehab Rayan
HIFB, PharmD
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Agenda
ICD10 & TB
Session-1 (Theoretical)
1. Overview
2. Introduction to ICD-10
3. Structure of the Classification and How to Code
4. Morbidity Coding
5. Certification
6. Statistical Presentation
Session-2 (Practice)
1. Brief Coding Rules
2. Coding
3. Morbidity Practice
4. Certification Practice
5. Statistical Presentation Practice
6. Summary & Conclusion
Overview
Session-1_1
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Overview
• Methods to assess TB mortality1
– Direct measurement: Vital Registration (VR)
– Direct measurement: Verbal Autopsy (VA)– Demographic Surveillance Sites (DSS)
– Sample Vital Registration
– Indirect estimation: = (estimated) disease
incidence * case fatality
1: State of the art review. IJTLD 2009;13:283-303
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Overview
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• Vital Registration
–Direct, continuous measurement – in broader
context of national public health monitoring
–Quality / Completeness
• Diagnosis of cause-of-death on death certificates
• Adequate coding ? ICD-10
Ana Bierrenbach
WHO /STB / TME
Introduction to ICD-10
Session-1_2
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Introduction to ICD-10
• To make people count,
• we first need to count people!
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Introduction to ICD-10
• ICD is an internationally endorsed classifications facilitate
the:– storage,
– retrieval,
– analysis, and
– interpretation
• of data and their comparison– within populations over time and
– between populations at the same point in time as well as the
– compilation of internationally consistent data.
• Populations may be nations, states and territories, regions,
minority groups or other specified groups.
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Introduction to ICD-10
• For comparison and communication– The ICD is designed to capture mortality and morbidity data for
reporting for public health, epidemiology and treatment, and
allows comparison of frequencies of e.g. causes of death from
community level up to the whole world
– ICD is the international standard for this purpose, with all WHO
members states having committed to report causes of death and
illness to WHO since 1967 (Nomenclature regulations). The ICD is
a classification that is used in 194 countries. It has been developed
internationally since 1893. There have been ten major revisions with
the most recent being ICD-10.
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Introduction to ICD-10
• The WHO Family of International Classifications in health consists
of :
– Reference classifications cover the diseases and related health
problems (ICD), disability (ICF) and health interventions (ICHI, under
development).
– Other members of the Family cover drugs, causes of injury and
reasons for encounter, or provide more detail, for use in oncology.
• These classifications are the building blocks of health
information used for measures to help provide the best
possible health to all people.
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Introduction to ICD-10
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Structure of the Classification and How to Code
Session-1_3
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Structure of the Classification and How to Code
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Structure of the Classification and How to Code
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• To code correctly, there are various rules and coding
conventions that must be followed, spread across all three
volumes. Coding consists of the following steps:
– Determining from the medical documentation, the conditions that
need to be coded, following the ICD rules.
– Using the Alphabetical Index (Vol 3) to locate the condition and
allocate the code.
– Using the Tabular List (Vol 1) to ascertain that the code found in the
Index is correct by reviewing all coding instructions related to that
code (e.g. inclusion note, exclusion note).
– Using the Instruction Manual (Vol 2) for any rules regarding the
selection of a particular code for reporting mortality or morbidity
data.
Morbidity Coding
Session-1_4
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Rules and guidelines for morbidity coding
• ICD was first used as a classification system of
causes of death, and is since 1948 used for both
mortality coding (causes of death) and morbidity
coding (illness, injuries and reasons for contact with
health services).
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Rules and guidelines for morbidity coding
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• Sources and uses of morbidity data• Hospital medical records
• Outpatient records (ambulatory care)
• School medical records
• Maternal and child health services records
• Occupational medical records
• Armed services records
• Death certificates – providing information also about certain diseases which, by
themselves, have not caused death but which have contributed to the
decedent’s overall morbidity and contributed to the death
• Health surveys
• Cancer and chronic disease registry records
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Rules and guidelines for morbidity coding
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• Once the morbidity data has been collected from these
various sources it may be used for a variety of purposes.
Some examples of what morbidity data is used for include:
– Providing information about a particular disease – causes, frequency
etc.
– Forming the basis on which decisions are made about health care
management and the allocation of resources
– Providing information to help with the prioritisation of disease
prevention programs
– Clinical research
– Education
– Epidemiology
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Rules and guidelines for morbidity coding
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• Section 4.4 Morbidity in Volume 2 of ICD (the instruction
manual) contains the rules and guidelines adopted by the
World Health Assembly regarding the selection of the
appropriate conditions from morbidity records, as well as
guidelines for the application of the rules for coding of the
conditions selected.
• National health systems have differing definitions of
treatment episodes, and nationally different rules. Thus
comparability of morbidity data is subject to limitations.
Certification
Session-1_5
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Certification
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• Goal:
– To correctly report and interpret the events and
conditions leading to death using the ICD as
recommended by the WHO, including:
• the immediate cause of death
• the sequence from the underlying cause to the
immediate cause
• any conditions not directly leading to death but
contributing to it
• the duration of the reported conditions.
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Certification
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• The death certificate is the main source of
mortality data.
• The death certificate recommended by the WHO,
which you will find in Volume 2 of ICD-10 in section
4.1.3.
• The information on a death certificate may be
provided ideally by:
– an experienced medical practitioner that is well informed
about the medical history of the dead person, and has
carefully carried out a post mortem examination.
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Certification
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• The death certificate has two parts:
– Part I: It has four lines to record the sequence of events leading to
death.
– The disease or condition directly leading to death (the immediate
cause) is always recorded at line I(a). This may be the only
condition recorded if there are no other conditions in the sequence.
– Other conditions leading to I(a) are entered in sequence on lines (b),
(c) and (d) with the underlying cause on the lowest line used.
– The underlying cause of death is defined by the WHO as (a) the
disease or injury which initiated the train of morbid events leading
directly to death.
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Certification
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• Part II is used to record other significant conditions
contributing to the death but not relating to the disease or
condition causing it.
• The right hand column is used to report the duration of the
conditions recorded in Parts I and II. Conditions should be
listed with the oldest conditions lowest, so that the timing of
the sequence confirms the cause-based sequence.
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Certification
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• Durations– On the right hand side of the certificate is a column headed
Approximate interval between onset and death. This is for
reporting the duration or the time interval between:
• the onset of each condition entered on the certificate and
the date of death.
– Where the time or date of onset is not known, a
best estimate should be recorded. It is also
acceptable to put ‘unknown’ if it is not possible to
establish or estimate the duration.
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Certification Rules
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• All entries should be typed or written legibly in black ink,
without the use of abbreviations, alterations or erasures.
• As much detail as possible should be recorded so that it can
be used to assign complete and specific codes from the ICD.
• The mode of dying, such as cardiac arrest or respiratory
failure, should not be reported as the immediate cause of
death.
• If the cause of death is unknown, even after investigation, it
is correct to record it as ‘unknown’.
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Certification Rules
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• The starting point of the sequence should never be
entered in Part II because of lack of space in Part I. Instead,
extra lines can be added to Part I if needed to report a long
or complicated sequence.
• Only one condition should be entered on each line, with the
following exception. In the unusual situation where two
independent diseases are thought to have contributed
equally to the sequence at a particular point, they may be
entered on the same line.
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Certification
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Dr. Ali Sadek
Direct
Intervening
Intervening
Underlying
Contributing
D
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Certification
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• A separate certificate is available to record perinatal
death. An international format is also recommended
for this certificate.
Statistical Presentation
Session-1_6
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Rules and guidelines for statistical presentation
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• Regulations and guidelines for presentation of coded statistical data
facilitate international comparisons.
• The source used to obtain mortality data is the medical certificate of
the cause of death. The coding of the reported causes of death in
accordance with ICD provides us with a workable database of
information data with which to perform comparisons and statistical
analyses.
• Where no better system is in place, verbal autopsy may be an
alternative. However data from medical certification and those from
verbal autopsy differ in their level of detail, and in their reliability. They
can be compared, but they should not be merged.
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Rules and guidelines for statistical presentation
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• The regulations also apply to morbidity data. However, with morbidity
international comparability is limited by the differences in health
systems, and nationally modified rules.
• Section 5 Statistical Presentation in Volume 2 of ICD (the Instruction
Manual) provides the regulations and guidelines of the WHO for
statistical presentation. These include various tabulation lists,
definitions, standards and reporting requirements.
Questions?
Session-1_End
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Let’s Practice!
Session-2
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Brief Coding Rules
Session-2_1
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Chapters
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Dr. Ali Sadek
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Volume-1
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Dr. Ali Sadek
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Volume-1 Imp Conventions
Parentheses ( ) used in :
1. Enclose supplementary words, NOT affecting code
2. Enclose code referring exclusion
3. Block titles, to enclose three character codes of categories
4. To enclose the dagger code in an asterisk category or the asterisk code following a dagger term
Square brackets [ ] used to :
1. Enclose synonyms, alternative words
2. For referring to previous notes or stated sets [see…..]
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Dr. M.M. Singh
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Volume-1 Imp Conventions
Point dash .-
• Indicates existence of a fourth character
Colon :
• To list inclusion and exclusion terms
• When insertion of modifying words is required indiagnosise.g. K36 Other appendicitis
Appendicitis :
. Chronic
. recurrentICD10 & TB
Dr. M.M. Singh
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Dagger & Asterisk
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• Coding of conditions to which the dagger and
asterisk system applies
– The dagger and asterisk codes should be used together,
wherever possible, because they describe different
aspects of the condition. This dual coding system
provides information on the aetiology (cause) (dagger
code) and the manifestation (asterisk code) of the
condition.
– The dagger code (underlying cause) is the preferred and
reported main condition.
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Volume-1 Imp Conventions
NOS
• Not otherwise specified or unspecified/ unqualified
NEC
• Not elsewhere classified
• Serves a warning that certain variants are listedsomewhere
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Dr. M.M. Singh
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Volume 3 : Alphabetical index
Sections :
• I – list of all terms classifiable to Chapters I-XIX,and XXI, EXCEPT drugs and other chemicals
• II – index of external causes of morbidity and mortality, all terms classifiable to Chapter XX, EXCEPT drugs and other chemicals
• III – table of drugs & chemicals
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Dr. M.M. Singh
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Volume 3 : Alphabetical index
LEAD TERMS :
• key words (extreme left)/ Bold
• name of disease/pathological condition/ diagnosis
Indented :
• (in right after dash)
• the modifiers/ qualifier – variety, site, etc.
o -
o --
o ---
o ----ICD10 & TB
Dr. M.M. Singh
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Golden Rules
<
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Coding Rules Quiz
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• What are the names of the three
volumes of the ICD-10?
• Volume 1 is called the
• Volume 2 is called the
• Volume 3 is called the
Tabular List
Instruction Manual
Alphabetical Index
Coding
Session-2_2
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Chapter I – Certain infectious and parasitic diseases
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Chapter I – Certain infectious and parasitic diseases
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• Would you use Chapter I to code all of these
diseases?
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Chapter I – Certain infectious and parasitic diseases
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• Would you use Chapter I to code all of these
diseases?
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Chapter I – Certain infectious and parasitic diseases
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• The second block in Chapter I is A15-A19 which is for
coding Tuberculosis. The categories in this block identify the site of
the tuberculosis.
• For respiratory tuberculosis, the codes also specify whether the
diagnosis was confirmed and what method was used for the
confirmation e.g. sputum microscopy, chest x-ray.
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Chapter I – Certain infectious and parasitic diseases
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• For mortality coding, section 4.2.4 of Volume 2 states that codes in this
block should be used for underlying cause coding to indicate that death
resulted from the late (or residual) effects of a given disease, rather than
during the active phase.
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Lead Term
• Modifiers
Vol-3
• Notes
• ( )
• -
• --
• ---
• ----
• †/* (dual)
-Ref
• See
• See also
Vol-1 (Confirm)
• Inclusion
• Exclusion
• •.- (4th )
Coding!
• Done!
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Coding!
Coding Practice
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Chapter I – Certain infectious and parasitic diseases
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• Now let’s find the code for Tuberculous meningoencephalitis.
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Chapter I – Certain infectious and parasitic diseases
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• Mr. Sami currently suffers from tuberculous bronchiectasis which was
confirmed by histological testing.
– How would this disease be coded?
Morbidity Practice
Session-2_3
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Morbidity Quiz
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• Match the following terms with their correction
definitions.
Episode of heath care
Morbidity coding
Mortality coding
1. The coding performed in hospitals.
2. The coding of causes of death.
3. A period of inpatient care or contact with a health care
practitioner for the same condition.
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Morbidity Quiz
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• Are these three statements true or
false?
–The asterisk code may be used to specify the
manifestation. Use of an asterisk code with
the dagger code is optional. The asterisk
code must never be used without an
appropriate dagger code.”
True
false
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Morbidity Quiz
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• A clinician records a patient’s conditions
as Tuberculous mastoiditis.
– What would be the correct code assignment for this
case in a multiple-condition coding episode?
A18.0† alone
H75.0* alone
A18.0† H75.0* together
H75.0* A18.0† together
Certification Practice
Session-2_4
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Certification Quiz
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• On which line do you think the condition thought to be the
immediate cause of death should appear?
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Certification Quiz
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• There must always be an entry on line I(a). Do you think this
can be the only condition reported in Part I?
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Certification Quiz
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• Is it correct?
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Certification Quiz
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• If four entries are required on Part I of the certificate,
where will you put each of the following?
– The condition that initiated the train of events
– The direct cause of death
– The intervening causes of the direct cause of death
Statistical Presentation Practice
Session-2_5
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Statistical presentation Quiz
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• Look at the following statement, and say
whether it is true or false.
– “If medical certification of the cause of death is
incomplete then the figures for deaths not
medically certified should be published separately.”
True
False
Summary & Conclusion
Session-2_6
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Summary for morbidity coding
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• Morbidity coding usually refers to the coding
performed using the medical records of inpatients or
outpatients.
• Coding is usually performed on each episode of
health care in a health institution, but it may also be
used in surveys or research programs or
registries.
• Due to the variable definitions of morbidity, the
comparability of morbidity data is limited
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Direct
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Intervening
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Contributing
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Summary of Certification
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• The format for completion of the standard international
death certificate recommended by the WHO is as follows:
– Part I
• (a): immediate cause of death due to
• (b): Intervening cause due to
• (c): Intervening cause due to
• (d): underlying cause of death
– Part II
• Any other significant disease or condition that contributed to
death.
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Summary of Certification
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• Entries in Part I should be in a sequence with
the underlying cause of death reported on the
lowest used line.
– All entries should be recorded legibly without the
use of abbreviations.
–As much detail as possible should be
recorded so that it can be used to assign
complete and specific codes from the ICD.
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Conclusion
• ICD derived Information is:
– reported, categorized, analysed, presented, and decisions
are made at any level of a health system.
• Such health information is used for:
– epidemiology, prevention, managing health care, allocation
of resources, outcomes monitoring, in research, and
primary care.
• ICD makes people count!
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Resources
• ICD 10 Interactive Self-learning Tool:
– http://apps.who.int/classifications/apps/icd/ICD10Tr
aining/
• ICD 10 Online Browser: Version 2016
– http://apps.who.int/classifications/icd10/browse/201
6/en#/
ICD10 & TB