Classification of tuberculosis

Most countries in the world use the international statistical system for recording diseases and health problems - the International Classification of Diseases, Tenth Revision (ICD-10). The use of ICD-10 ensures the uniformity of information collection and comparability of materials on the health of the population, the prevalence of diseases and their epidemiology both within one country and in different countries of the world. ICD-10 makes it possible to transform verbal formulations of diagnoses into alphanumeric codes that provide computer storage of information and its accumulation. The use of ICD-10 creates conditions for the automation of information on human health. This allows for a comprehensive in-depth comparative analysis of data, including assessing the quality of medical care in different regions of the country and the completeness of information collection.

The basis of ICD-10 is an alphanumeric code, mandatory for coding diseases, in which the first character is designated by a letter, the three following ones by numbers. Such a system allows to increase more than twice the size of the coding structure. The letter designates classes (there are 21 of them in ICD-10), the first two numbers - a block. For greater detail, a fourth character is introduced - a number after the period.

The classification of tuberculosis in Russia largely does not correspond to ICD-10. At the same time, the classification of tuberculosis used in our country quite fully, at least at present, satisfies the requirements of Russian phthisiologists. In this regard, it is very important to adapt the domestic classification of tuberculosis to ICD-10 and develop an adapted version of coding that satisfies both the requirements of the international classification and domestic phthisiology.

The need to introduce additional coding of tuberculosis diseases and problems associated with it is due to the fact that ICD-10 does not provide for the registration of forms of tuberculosis adopted in our country. ICD-10 does not take into account destructive changes, combined organ damage, complications of the disease, as well as surgical interventions performed during treatment. In addition, the registration of diseases accompanied by the release of Mycobacterium tuberculosis is provided only when diagnosing tuberculosis of the respiratory organs.

Information on the incidence of tuberculosis of the respiratory organs and extrapulmonary localizations in the world is incomplete. This is due to the fact that in accordance with the clinical classification of tuberculosis in force in our country, with combined lesions of organs, one localization is shown in the accounting and reporting forms - with the most pronounced changes. WHO recommends that with combined localizations of tuberculosis, a patient be considered as having tuberculosis of the lungs or respiratory organs, regardless of the degree of tuberculosis damage to other organs.

In this regard, to register the form and localization of tuberculosis, the presence of destruction in tissues, combined organ damage, surgical operations, complications of the tuberculosis process, as well as the detection of Mycobacterium tuberculosis in extrapulmonary localizations of tuberculosis and disseminated (miliary) processes, it is recommended to use additional coding and introduce 5-10 characters for these purposes.

To facilitate coding of tuberculosis of different localizations and reading of codes, it is proposed to make them of the same length, while maintaining the same semantic load for certain digits. The exception is the 10th character, which is used only when coding information on the presence or absence of tuberculosis mycobacteria in the headings A17-A19.

The disease code is changed after the diagnosis or condition has changed or has been clarified.

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International Classification of Diseases

Currently, the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (WHO, 1995) is used.

The block "tuberculosis" (A15-A19) is included in the class "Certain infectious and parasitic diseases" (A00-B99).

A15-A16 Tuberculosis of the respiratory system.

A15 Tuberculosis of the respiratory organs, confirmed bacteriologically and histologically.

A16 Tuberculosis of the respiratory system, not confirmed bacteriologically or histologically.

A17 Tuberculosis of the nervous system.

A18 Tuberculosis of other organs and systems (extrapulmonary localizations of tuberculosis).

A19 Miliary tuberculosis.

The Tuberculosis block includes infections caused by M. tuberculosis and M. bovis. The Tuberculosis block excludes congenital tuberculosis (P37.0), pneumoconiosis associated with tuberculosis (065), and consequences of tuberculosis (B90).

Additional coding for tuberculosis

Coding for active tuberculosis

ICD-10 does not provide for coding of a number of essential features that Russian phthisiatricians use when diagnosing tuberculosis and determining patient management tactics.

In this regard, it is proposed to use additional signs to code some of the most important features. Code dictionaries have been developed to designate the corresponding features in the domestic clinical classification of tuberculosis in accordance with the ICD-10 code.

Additional 5th character

Pulmonary tuberculosis

A15.0-A15.3; A16.0-A16.2 Pulmonary tuberculosis

• 1 - focal tuberculosis
• 2 - Infiltrative tuberculosis
• 3 - caseous pneumonia
• 4 - Tuberculoma of the lungs
• 5 - cavernous tuberculosis
• 6 - fibrous-cavernous tuberculosis of the lungs
• 7 - Cirrhotic tuberculosis of the lungs
• 8 - disseminated tuberculosis

Tuberculosis of the respiratory system

A15.4; A16.3 Tuberculosis of the intrathoracic lymph nodes (secondary)

• 1 - bronchopulmonary lymph nodes
• 2 - paratracheal lymph nodes
• 3 - trachebronchial lymph nodes
• 4 - bifurcation lymph nodes
• 5 - lymph nodes of the window of the arterial duct (Botallo's duct)
• 6 - mediastinal lymph nodes
• 7 - others
• 8 - multiple localizations
• 9 - without further clarification

A15.5; A16.4 tuberculosis of the larynx, trachea and bronchi

• 1 - tuberculosis of the bronchi
• 2 - tuberculosis of the larynx
• 3 - tuberculosis of the trachea
• 4 - other localizations
• 5 - combined defeat

A15.6; A16.5 Tuberculous pleurisy (secondary)

• 1 - pleural tuberculosis
• 2 - tuberculous empyema
• 3 - interlobar pleurisy
• 4 - other localizations
• 5 - combined defeat

A15-7; A16.7 Primary tuberculosis of the respiratory system

• 1 - primary tuberculosis intoxication in children and adolescents
• 2 - primary tuberculosis complex
• 3 - VGLU tuberculosis
• 4 - pleural tuberculosis
• 5 - other localizations
• 6 - combined defeat

A15.8: A16.8 Tuberculosis of other respiratory organs

• 1 - nasal tuberculosis
• 2 - tuberculosis of the oral cavity
• 3 - tuberculosis of the paranasal sinuses
• 4 - other localization
• 5 - combined defeat

Tuberculosis of other organs

A17 Tuberculosis of the nervous system

A17.0 Tuberculous meningitis

• 1 - tuberculosis of the meninges
• 2 - tuberculous leptomeningitis

A17.1 Meningeal tuberculoma

• 1 - meningeal tuberculoma

A17.8 Tuberculosis of the nervous system of other localizations

• 1 - tuberculoma of the brain
• 2 - tuberculosis of the spinal cord
• 3 - brain abscess
• 4 - meningoencephalitis
• 5 - myelitis

A17.9 Tuberculosis of nervous system, unspecified site

• 1 - tuberculosis of the nervous system of unspecified localization

A18 Tuberculosis of other organs

A18.0 Tuberculosis of bones and joints

• 1 - tuberculosis of the hip joints
• 2 - tuberculosis of the knee joints
• 3 - tuberculosis of the spine
• 4 - tuberculosis of small joints
• 5 - tuberculosis of flat bones
• 6 - other localizations
• 7 - combined defeat

A18.1 tuberculosis of the genitourinary organs

• 1 - tuberculosis of the kidneys
• 2 - tuberculosis of the ureter
• 3 - tuberculosis of the bladder
• 4 - urethral tuberculosis
• 5 - tuberculosis of male genital organs
• 6 - tuberculosis of female genital organs
• 7 - other localizations
• 8 - combined lesions

A18.2 Tuberculosis of peripheral lymph nodes

• 1 - submandibular lymph nodes
• 2 - cervical lymph nodes
• 3 - axillary lymph nodes
• 4 - inguinal lymph nodes
• 5 - other localizations
• 6 - combined lesions
• 7 - without further clarification

A18.3 Tuberculosis of the intestine, peritoneum and mesenteric lymph nodes

• 1 - intestinal tuberculosis
• 2 - tuberculosis of the peritoneum
• 3 - tuberculosis of the mesenteric lymph nodes
• 4 - other localizations
• 5 - combined lesions

A18.4 Tuberculosis of the skin and subcutaneous tissue

• 1 - lupus ulcerosa
• 2 - lupus vulgaris
• 3 - lupus of the eyelid
• 4 - scrofuloderma
• 5 - papulonecrotic tuberculosis
• 6 - other forms
• 7- without further clarification

A18.5 tuberculosis of the eye

• 1 - Chorioretinitis
• 2 - episcleritis
• 3 - interstitial keratitis
• 4 - iridocyclitis
• 5 - interstitial keratoconjunctivitis
• 6 - phlyctenular keratoconjunctivitis
• 7 - other localizations
• 8 - combined lesions

A18.6 tuberculosis of the ear

• 1 - ear tuberculosis

A18.7 Adrenal tuberculosis

• 1 - tuberculosis of the adrenal gland

A18.8 Tuberculosis of other specified organs

• 1 - endocardial tuberculosis
• 2 - myocardial tuberculosis
• 3 - pericardial tuberculosis
• 4 - tuberculosis of the esophagus
• 5 - thyroid tuberculosis
• 6 - other localizations
• 7 - combined lesions

A19. Miliary tuberculosis

A19.0 Acute miliary tuberculosis

• 1 - miliary tuberculosis of the lungs
• 2 - miliary tuberculosis of other localizations

A19.1 Acute miliary tuberculosis of multiple localizations

• 1 - generalized
• 2 - polyserositis

A19.2 Acute miliary tuberculosis of unspecified site

• 1 - acute miliary tuberculosis of unspecified localization

A19.8 Other forms of miliary tuberculosis

• 1 - other forms of miliary tuberculosis

A19.9 Miliary tuberculosis of unspecified localization

• 1 - miliary tuberculosis of unspecified localization

Additional 6th character

• 1 - no decay
• 2- with decay (fistulas, ulcerative changes, other destructions)
• 3 - no mention of breakup

Additional 7th sign

• 1 - one organ is affected
• 2 - tuberculosis of the respiratory organs + tuberculosis of extrapulmonary localizations
• 3 - tuberculosis of extrapulmonary localizations + tuberculosis of the respiratory organs

Additional 8th character

• 1 - the operation was not performed
• 2 - the operation is completed

Additional 9th character

• 1 - uncomplicated course
• 2 - complicated course

Additional 10th digit

• 1 - Mycobacterium tuberculosis detected: confirmed by microscopy, with or without culture growth
• 2 - Mycobacterium tuberculosis detected: confirmed only by culture growth
• 3 - Mycobacterium tuberculosis detected: confirmed histologically
• 4 - Mycobacterium tuberculosis is not detected: with negative bacteriological or histological studies
• 5 - Mycobacterium tuberculosis not detected: without bacteriological and histological studies
• 6 - Mycobacterium tuberculosis not detected: no mention of bacteriological or histological examination, or no indication of the method

Sequence of diagnosis formulation

For the purpose of convenience of coding the diagnosis of the disease, it is advisable to follow a certain sequence when formulating it, starting with the designation of the disease - "tuberculosis":

• tuberculosis (1st-3rd signs);
• localization (4th character);
• form of tuberculosis or specified localization (5th character);
• the presence or absence of mycobacteria tuberculosis and the method of examination - for tuberculosis of the respiratory organs (3rd sign), for extrapulmonary localizations (10th sign);
• presence or absence of destructive changes (6th sign);
• second localization of tuberculosis (7th sign);
• application of surgical operation (8th sign);
• presence or absence of complications (9th sign).

Examples of coding of active tuberculosis of various localizations

The first 4 characters represent the basic coding, the 5th-9th characters represent additional coding.

1. Pulmonary tuberculosis, focal, Mycobacterium tuberculosis detected (culture method), with breakdown: A15.1.1.2.1.1.1.
2. Tuberculosis of the lungs, infiltrative, mycobacteria tuberculosis detected (culture method), with decay. Tuberculosis of the skin: A15.1.2.2.2.1.1.
3. Pulmonary tuberculosis, focal, Mycobacterium tuberculosis not detected (no mention of study), no decay: A16.2.1.1.1.1.1.
4. Pulmonary tuberculosis, caseous pneumonia, Mycobacterium tuberculosis detected (microscopic method), with decay. Renal tuberculosis. Pulmonary heart failure: A15.0.3.2.2.1.2.
5. Tuberculosis of the lungs is fibrous-cavernous, mycobacteria of tuberculosis are detected (microscopic method). Hemoptysis. Tuberculosis of the eyes: A15.0.6.2.2.1.2.
6. Pulmonary tuberculosis is fibrous-cavernous, mycobacteria tuberculosis are detected (confirmed histologically). Surgery: A15.2.6.2.1.2.1.
7. Pulmonary tuberculosis, Cirrhotic, amyloidosis: A16.2.7.2.1.1.2.
8. Tuberculosis of the lungs, disseminated, with decay (chronic), tuberculosis of the male genital organs: A16.2.8.2.2.1.1.6.
9. Miliary tuberculosis, generalized, mycobacterium tuberculosis was not detected: A19.1.1.1.2.1.1.6.
10. Brain tuberculoma and Mycobacterium tuberculosis were not detected (culture method). Paresis of the lower extremities. Focal pulmonary tuberculosis: A17.8.1.1.2.1.6.4.
11. Tuberculosis of the spine (with abscess), Mycobacterium tuberculosis detected (histological method), surgical operation. Tuberculosis of the pleura: A18.0.3.2.2.2.2.3.
12. Kidney tuberculosis (with cavity), mycobacterium tuberculosis detected (culture method): A18.1.1.2.1.1.1.2.
13. Tuberculous iridocyclitis. Tuberculosis of the peripheral lymph nodes: A18.5.4.1.2.1.1.6.

Coding of consequences of tuberculosis and conditions of increased risk of tuberculosis

Remote consequences of extrapulmonary tuberculosis (B90.0-B90 2, B90.8)

According to ICD-10, remote consequences of tuberculosis are coded using four symbols, taking into account the localization of the tuberculous lesion:

B90.0 Remote consequences of CNS tuberculosis.

B90.1 Remote consequences of tuberculosis of the genitourinary organs.

B90.2 Remote consequences of tuberculosis of bones and joints.

B90.8 Remote consequences of tuberculosis of other specified organs. The current system of dispensary observation of patients with tuberculosis provides for the registration of patients cured of extrapulmonary localizations of tuberculosis, according to the IIIGDU depending on the time of recovery from tuberculosis.

Coding of the registration group of persons cured of tuberculosis with extrapulmonary localizations:

B90.0 Remote consequences of CNS tuberculosis.

B90.0.1 - III GDU.

B90.0.2 - not subject to accounting.

B90.1 Remote consequences of tuberculosis of the genitourinary organs.

B90.1.1 - III GDU.

B90.1.2 - not subject to accounting.

B90.2 Remote consequences of tuberculosis of bones and joints.

890.2.1 - III GDU.

890.2.2 - not subject to accounting.

B90.8 Remote sequelae of tuberculosis of other specified organs.

890.8.1 - III GDU.

890.8.2 - not subject to accounting.

Remote consequences of tuberculosis of the respiratory organs (B90.9)

Patients cured of tuberculosis of the respiratory organs, in accordance with current recommendations, were subject to observation under III GDU, spontaneously cured children and adolescents - under IIIA and IIIB GDU.

Coding of the registration group of persons cured of tuberculosis of the respiratory organs:

B90.9 Remote consequences of tuberculosis.

B90.9L - III GDU for adults.

B90.9.2 - IIIA,

B90.9.3 - IIIB GDU for children and adolescents.

B90.9.4 - not subject to accounting.

Coding of some conditions associated with tuberculosis

Results of tuberculin diagnostics of tuberculosis

Class R00-R99 includes symptoms, signs and abnormal findings in clinical or other investigations, as well as ill-defined conditions for which no diagnosis classified elsewhere is indicated. This class also includes cases in which a more precise diagnosis is not possible, even after examination of all available evidence.

ICD-10 uses the term "abnormal reactions to the tuberculin test". This term should be understood as a positive tuberculin reaction to the introduction of tuberculin as a result of infection with tuberculosis. The code R76.1 is used to designate abnormal reactions to the introduction of tuberculin. This code should be used to code the state of infection with tuberculosis in children and adolescents who, in accordance with the "dispensary grouping", must be observed in anti-tuberculosis institutions under the VI GDU.

Coding of subgroups of the VI GDU:

• R76.1.1 - subgroup A - turn (primary infection).
• R76.1.2 - subgroup B - hyperergic reaction.
• R76.1.3 - subgroup B - increase in the size of the tuberculin reaction.

Complications after BCG vaccine administration

Section Y40-Y84 of ICD-10 identifies complications of medical and surgical interventions.

Sections Y40-Y59 cover complications caused by drugs, medications and biological substances that cause adverse reactions during their therapeutic use.

Complications of the BCG vaccine administration, i.e. complications caused by bacterial vaccines, are included in the ICD-10 heading Y58.0. The code is used to encode complications of the BCG vaccine administration, as a result of which children and adolescents should be monitored according to the V GDU.

To clarify the nature of complications after the introduction of the anti-tuberculosis vaccine, it is proposed to use the 5th character. Coding of complications after the introduction of the BCG vaccine (V GDU): Y58.0 Complications from the introduction of the BCG vaccine. Y58.0.1 - subcutaneous cold abscess. Y58.0.2 - superficial ulcer. Y58.0.3 - post-vaccination lymphadenitis. Y58.0.4 - keloid scar. Y58.0.5 - disseminated BCG infection. Y58.0.6 - BCG ostitis. Y58.0.7 - post-BCG syndrome.

Contact with a patient with tuberculosis and the possibility of contracting tuberculosis

Information about contact with a tuberculosis patient is in the Z section. To code contact with a tuberculosis patient and the possibility of infecting others with tuberculosis in connection with this, code Z20.1 should be used. In order to register the nature of the contact, it is proposed to introduce a 5th character.

Coding of the nature of contact (IV GDU):

• Z20.1.1 - family contact with a bacteria carrier.
• Z20.1.2 - family contact with a patient with tuberculosis who does not excrete mycobacteria.
• Z20.1.3 - professional contact.
• Z20.1.4 - industrial contact with bacteria carrier.
• Z20.1.5 - other contact.

Tuberculosis of doubtful activity and differential diagnostic cases

Conditions suspicious for tuberculosis are designated in the Z section. Code Z03.0 should be used to code tuberculosis of unclear activity and differential diagnostic cases. Currently, patients whose tuberculosis activity is questionable and who are undergoing differential diagnostics of tuberculosis and non-tuberculous disease should be under the dispensary observation of a phthisiatrician at the regional state pulmonary hospital.

In order to register the nature of diagnostic measures, it is proposed to introduce a 5th sign.

Coding of the nature of diagnostic measures:

• Z03.0.1 - tuberculosis of doubtful activity.
• Z03.0.2 - differential diagnostics.

Recovery status after surgery

To code the state of recovery after the use of surgical treatment methods, i.e. after the diagnosis of active tuberculosis has been removed, it is recommended to use the code Z54.0.

Screening examination for the detection of tuberculosis of the respiratory organs

For coding screening examinations to identify patients with tuberculosis of the respiratory organs, it is recommended to use the Z11.1 code.

Vaccination and revaccination against tuberculosis (BCG)

ICD-10 uses the term "need for immunization against tuberculosis". This term should be understood as the introduction of the BCG vaccine, i.e. vaccination and revaccination against tuberculosis.

It is recommended to use the Z23.2 cipher to encode the execution of this event.

Undone BCG vaccination

To code for not performed immunization, code Z28 is used. To code for not performed immunization against tuberculosis, the 5th character is introduced. Z28, Not performed immunization. Z28.0.1 - immunization was not performed due to medical contraindications. Z28.1.1 - immunization was not performed due to the patient's refusal due to his/her beliefs or group pressure. Z28.2.1 - immunization was not performed due to the patient's refusal for another or

Unspecified reason. Z28.8.1 - immunization not performed for other reason. Z28.9.1 - immunization not performed for unspecified reason. Additional coding of tuberculosis diseases and related problems in accordance with ICD-10 allows:

• unify approaches to collecting information and recording it;
• obtain more extensive and diverse data than before;
• conduct a more in-depth analysis of the epidemiological situation regarding tuberculosis and anti-tuberculosis care for the population;
• obtain comparable data with WHO and different countries of the world;
• maintain the advantages of the Russian clinical classification of tuberculosis;
• take into account the specific features of dispensary observation of contingents of anti-tuberculosis institutions in the Russian Federation.