Classification of tuberculosis

In most countries of the world, the international statistical system for the registration of diseases and health-related problems is applied, the international classification of diseases of the tenth revision (ICD-10). Application of ICD-10 ensures the unity of information collection and comparability of materials on public health, the prevalence of diseases and their epidemiology both within the same country and in different countries of the world. ICD-10 makes it possible to translate verbal formulations of diagnoses into alphanumeric codes that provide computer storage of information and its accumulation. Application of ICD-10 creates conditions for the automation of information about human health. This allows for a comprehensive in-depth comparative analysis of data, including assessing the quality of health care in various 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 denoted by a letter, the next three are indicated by numbers. This system allows you to increase the encoding structure more than twice. The letter indicates classes (in ICD-10 there are 21 of them), the first two digits are a block. For greater detail, the fourth character is entered - the digit after the point.

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 is quite complete, at least for the time being, satisfying the requirements of phthisiatricians in Russia. In this regard, it is very important to adapt the domestic classification of tuberculosis to ICD-10 and develop an adapted version of the coding that satisfies both the requirements of the international classification and domestic phthisiology.

The need to introduce additional coding of tuberculosis and the problems associated with it. Is caused by that. 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 made during the treatment. In addition, the registration of diseases accompanied by the release of mycobacterium tuberculosis, is provided only for the diagnosis of tuberculosis of the respiratory system.

Information on the incidence of tuberculosis of respiratory organs and extrapulmonary localization in the world is incomplete. This is due to the fact. That in accordance with the current clinical classification of tuberculosis in combination with the combined lesions of organs in the account-reporting forms, one localization is shown with the most pronounced changes. WHO recommends that when combined with tuberculosis localization, the patient should be taken into account for the disease of pulmonary tuberculosis or respiratory organs, regardless of the degree of tuberculosis damage of other organs.

In this regard, for the registration of the form and localization of tuberculosis, the presence of destruction in tissues, combined organ damage, surgical operations, complications of the tuberculosis process, and detection of mycobacteria of tuberculosis in extrapulmonary tuberculosis localization and disseminated (miliary) processes, it is recommended to use additional coding and administration for these goals of 5-10 characters.

To facilitate the coding of tuberculosis of various localizations and reading of ciphers, it is suggested to make them the same length, while keeping the same semantic load for certain digits of digits. The exception is the 10th character, which is used only when coding information about the presence or absence of mycobacterium tuberculosis in the headings A17-A19.

The change in the code of the disease is made after the diagnosis or condition has been changed or the condition is clarified.

[1], [2], [3], [4], [5], [6], [7], [8], [9],

International Classification of Diseases

Currently, the International Statistical Classification of Diseases and Related Health Problems is being applied to the tenth revision (WHO, 1995).

Block "tuberculosis" (A15-A19) is included in the class "Some infectious and parasitic diseases" (A00-B99).

A15-A16 Tuberculosis of the respiratory system.

А15 Tuberculosis of respiratory organs, confirmed bacteriologically and histologically.

A16 Tuberculosis of respiratory organs, not confirmed bacteriologically or histologically.

A17 Tuberculosis of the nervous system.

А18 Tuberculosis of other organs and systems (extrapulmonary localization of tuberculosis).

А19 Miliary tuberculosis.

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

Additional coding for tuberculosis

Coding for active tuberculosis

ICD-10 does not provide for the coding of a number of significant signs that are used by phthisiatricians in Russia when diagnosing tuberculosis and determining the tactics of patient management.

In connection with this, it is proposed to use additional signs to encode some of the most important features. To denote the relevant signs in the domestic clinical classification of tuberculosis in accordance with the cipher ICD-10 code dictionaries are developed.

Additional 5th character

Pulmonary tuberculosis

A15.0-A15.3; A16.0-A16.2 Tuberculosis of the lungs

• 1 - focal tuberculosis
• 2 - Infiltrative tuberculosis
• 3 - caseous pneumonia
• 4 - Tuberculosis 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 VGLU tuberculosis (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 ductus arteriosus (ducts)
• 6 - mediastinal lymph nodes
• 7 - other
• 8 - multiple localizations
• 9 - without further clarification

A15.5; А16.4 tuberculosis of larynx, trachea and bronchi

• 1 - bronchial tuberculosis
• 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 - tuberculosis empyema
• 3 - inter-partic pleurisy
• 4 - other localizations
• 5 - combined defeat

A15-7; A16.7 Primary pulmonary tuberculosis

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

А15.8: А16.8 Tuberculosis of other respiratory organs

• 1 - tuberculosis of the nose
• 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 meninges
• 2 - tubercular leptomeningitis

A17.1 Meningitis tuberculoma

• 1 - meningic tuberculoma

A17.8 Tuberculosis of the nervous system of other localizations

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

A17.9 Tuberculosis of the nervous system of unspecified site

• 1 - tuberculosis of the nervous system of the unspecified site

А18 Tuberculosis of other organs

A18.0 Tuberculosis of bones and joints

• 1 - tuberculosis of the hip joints
• 2 - tuberculosis of 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 urino-genital organs

• 1 - kidney tuberculosis
• 2 - tuberculosis of the ureter
• 3 - tuberculosis of the bladder
• 4 - tuberculosis of the urethra
• 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 peritoneum
• 3 - Tuberculosis of mesenteric lymph nodes
• 4 - other localizations
• 5 - combined lesions

А18.4 tuberculosis of skin and subcutaneous tissue

• 1 - lupus erythematosus
• 2 - common lupus
• 3 - Lupus Erythematosus
• 4 - scrofuloderma
• 5 - papulo-necrotic 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-keratoconjunctivitis phlyctenular
• 7 - other localizations
• 8 - combined lesions

A18.6 Ear tuberculosis

• 1 - tuberculosis of the ear

A18.7 Adrenal Tuberculosis

• 1 - tuberculosis of the adrenal gland

A18.8 Tuberculosis of other specified organs

• 1 - endocardial tuberculosis
• 2 - myocardial tuberculosis
• 3 - tuberculosis of the pericardium
• 4 - esophagus tuberculosis
• 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 localization

• 1 - generalized
• 2 - polyserosite

A19.2 Acute miliary tuberculosis of unspecified site

• 1 - acute miliary tuberculosis of unspecified site

А19.8 Other forms of miliary tuberculosis

• 1 - other forms of miliary tuberculosis

A19.9 Miliary tuberculosis of unspecified location

• 1 - miliary tuberculosis of unspecified site

Additional 6th character

• 1 - without decay
• 2- with disintegration (fistulas, ulcerous changes, other destruction)
• 3 - without mention of decay

Additional 7th character

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

Additional 8th character

• 1 - no operation was performed
• 2 - the operation was carried out

Additional 9th character

• 1 - uncomplicated course
• 2 - complicated course

Additional 10th character

• 1 - mycobacterium tuberculosis detected: confirmed by microscopy, with or without growth of culture
• 2 - Mycobacterium tuberculosis detected: confirmed only by culture growth
• 3 - mycobacterium tuberculosis detected: histologically confirmed
• 4 - Mycobacterium tuberculosis not found: with negative bacteriological or histological studies
• 5 - mycobacterium tuberculosis not detected: without bacteriological and histological studies
• 6 - Mycobacterium tuberculosis not found: without mention of a bacteriological or histological study, or without indicating the method

Sequence of diagnosis formulation

For the convenience of coding the diagnosis of the disease, it is advisable to follow a certain sequence in its formulation, beginning with the disease designation - "tuberculosis":

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

Examples of coding of active tuberculosis of various localizations

The first 4 digits mean the main coding, the 5th-9th characters mean additional coding.

1. Tuberculosis of the lungs, focal, mycobacterium tuberculosis were detected (seeding method), with disintegration: A15.1.1.2.1.1.1.
2. Tuberculosis of the lungs, Infiltrative, mycobacterium tuberculosis were detected (seeding method), with disintegration. Skin tuberculosis: A15.1.2.2.2.1.1.
3. Tuberculosis of the lungs, focal, mycobacterium tuberculosis not found (without mentioning the study), without disintegration: A16.2.1.1.1.1.1.
4. Tuberculosis of the lungs, caseous pneumonia, mycobacterium tuberculosis were detected (microscopy method), with disintegration. Tuberculosis of the kidneys. Pulmonary heart failure: A15.0.3.2.2.1.2.
5. Tuberculosis of the lungs is fibrous-cavernous, mycobacterium tuberculosis is detected (microscopy method). Hemoplegia. Tuberculosis of the eye: A15.0.6.2.2.1.2.
6. Tuberculosis of the lungs fibrous-cavernous, mycobacterium tuberculosis detected (histologically confirmed). Surgery: A15.2.6.2.1.2.1.
7. Tuberculosis of the lungs, Cirrhotic, amyloidosis: A16.2.7.2.1.1.2.
8. Tuberculosis of the lungs, disseminated, with disintegration (chronic), tuberculosis of male genital organs: A16.2.8.2.2.1.1.6.
9. Tuberculosis miliary, generalized, mycobacterium tuberculosis not found: A19.1.1.1.2.1.1.6.
10. Tuberculoma of the brain, mycobacterium tuberculosis not found (method of inoculation). Paresis of the lower extremities. Focal pulmonary tuberculosis: A17.8.1.1.2.1.6.4.
11. Tuberculosis of the spine (with a filament), mycobacterium tuberculosis detected (histological method), surgical operation. Tuberculosis of the pleura: A18.0.3.2.2.2.2.3.
12. Tuberculosis of the kidneys (with a cavern), mycobacterium tuberculosis was found (seeding method): A18.1.1.2.1.1.1.2.
13. Tuberculous iridocyclitis. Tuberculosis of peripheral lymph nodes: A18.5.4.1.2.1.1.6.

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

The long-term consequences of extrapulmonary tuberculosis (B90.0-B90 2, B90.8)

The long-term consequences of tuberculosis according to ICD-10 are to be coded with four signs taking into account the localization of tuberculosis lesions:

B90.0 Long-term consequences of tuberculosis of the central nervous system.

B90.1 Long-term consequences of tuberculosis of the genito-urinary organs.

B90.2 Long-term consequences of tuberculosis of bones and joints.

B90.8 Long-term consequences of tuberculosis of other specified organs. The existing system of dispensary observation of tuberculosis patients provides for the registration of patients cured of extrapulmonary tuberculosis localization, according to IIIDU, depending on the timing of recovery from tuberculosis.

Coding of the group of persons registered with tuberculosis with extrapulmonary localization:

B90.0 Long-term consequences of tuberculosis of the central nervous system.

B90.0.1 - III.

B90.0.2 - can not be accounted for.

B90.1 Long-term consequences of tuberculosis of the genito-urinary organs.

B90.1.1 - III of the State Duma.

B90.1.2 - can not be accounted for.

B90.2 Long-term consequences of tuberculosis of bones and joints.

890.2.1 - III of the State Duma.

890.2.2 - can not be accounted for.

B90.8 Long-term consequences of tuberculosis of other specified organs.

890.8.1 - III of the State Duma.

890.8.2 - can not be accounted for.

Long-term consequences of tuberculosis of the respiratory system (B90.9)

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

Encoding a group of persons. Cured of tuberculosis of the respiratory system:

B90.9 Long-term consequences of tuberculosis.

В90.9Л - III of the State Duma for Adults.

B90.9.2 - IIIA,

V90.9.3 - IIIB GDU for children and adolescents.

В90.9.4 - can not be accounted for.

Coding of some conditions associated with tuberculosis

Results of tuberculosis diagnosis of tuberculosis

The class R00-R99 includes symptoms, signs and abnormalities found in clinical or other studies, as well as inaccurately indicated conditions for which no diagnosis has been identified, classified elsewhere. This class includes, among other things, cases in which a more accurate diagnosis is impossible, even after studying all available evidence.

In ICD-10, the term "abnormal reactions to a tuberculin test" is used. This term should be understood as a positive tuberculin response to the introduction of tuberculin as a result of infection with tuberculosis. To denote abnormal reactions to the introduction of tuberculin, the code R76.1 is used. This code should be used to encode the state of infection with tuberculosis in children and adolescents, which in accordance with the "dispensary grouping" should be observed in anti-tuberculosis institutions according to the VI GDU.

Coding of subgroups of 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 administration of BCG vaccine

In section Y40-Y84 ICD-10 noted complications of therapeutic and surgical interventions.

The categories Y40-Y59 indicate the complications caused by drugs. Medicines and biological substances that cause adverse reactions during their therapeutic use.

Complications of BCG vaccine introduction. Those. Complications caused by bacterial vaccines, in ICD-10 are included in the rubric Y58.0. The code is used to encode complications for the introduction of BCG vaccine. Due to which children and adolescents should be observed according to V GDU.

To clarify the nature of complications after the introduction of anti-tuberculosis vaccine, it is proposed to use the 5th sign. Coding complications for the introduction of BCG vaccine (V GDU): Y58.0 Complications of BCG vaccine administration. Y58.0.1 - subcutaneous cold abscess. Y58.0.2 - superficial ulcer. Y58.0.3 - postvaccinal 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 on contact with a patient with tuberculosis is under heading Z. To code contact with a patient with tuberculosis and the possibility of associating tuberculosis with others in connection with this, one should use the code Z20.1. In order to register the character of the contact, it is proposed to enter the 5th character.

Encoding the character of the contact (IV GDU):

• Z20.1.1 - family contact, with bacteriovirus.
• Z20.1.2 - family contact, with a sick tuberculosis that does not secrete mycobacteria.
• Z20.1.3 - professional contact.
• Z20.1.4 - contact production with bacteriovirus.
• Z20.1.5 - Other contact.

Tuberculosis of doubtful activity and differential-diagnostic cases

Conditions suspicious of tuberculosis are indicated in Z. To code for tuberculosis of unclear activity and differential-diagnostic cases, code Z03.0 should be used. Currently, patients whose TB activity is in doubt and who carry out differential diagnosis of tuberculosis and non-tuberculosis disease should be under the dispensary supervision of a phthisiatrician at the OGDU.

For the purpose of recording the nature of diagnostic measures, the introduction of the 5th sign is proposed.

Coding the nature of diagnostic activities:

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

Condition of recovery after surgical treatment

To encode the state of recovery after the application of surgical methods of treatment, i.e. After removal of the diagnosis of active tuberculosis, it is recommended to use the code Z54.0.

Screening for tuberculosis of respiratory system

To encode a screening test to identify patients with respiratory tuberculosis, it is recommended that the Z11.1 code be used.

Vaccination and revaccination against tuberculosis (BCG)

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

To encode the execution of this measure, it is recommended to use the Z23.2 code.

Unexplained BCG vaccination

Code Z28 is used to encode unplanned immunization. To encode an unplanned immunization against tuberculosis, the 5th digit is introduced. Z28, Unprotected immunization. Z28.0.1 - immunization is not performed due to medical contraindications. Z28.1.1 - Immunization is not carried out because of a patient's refusal due to his beliefs or group pressure. Z28.2.1 - Immunization is not performed due to a patient's refusal by another or

Unspecified reason. Z28.8.1 - immunization is not carried out for another reason. Z28.9.1 - Immunization not carried out for the unspecified reason. Additional coding of tuberculosis and related problems in accordance with ICD-10 allows:

• unify approaches to the collection of information and its registration;
• to receive more extensive and versatile data than before;
• conduct a more in-depth analysis of the epidemic situation of tuberculosis and tuberculosis care for the population;
• to obtain comparable data with WHO and different countries of the world;
• To retain the advantages of the Russian clinical classification of tuberculosis;
• to take into account the peculiarities of dispensary observation of contingents of anti-tuberculosis institutions in the Russian Federation.