A Comprehensive Report on the Historical Narrative of ICD Codes

This report provides a comprehensive historical narrative of the International Classification of Diseases (ICD) codes, tracing their origins from Florence Nightingale's initial proposal for hospital data collection in 1860 through the current ICD-11. It details the evolution of the coding system, starting with Jacques Bertillon's work in 1893 and the subsequent revisions and adaptations by various countries. The report highlights the legislative track of ICD, including the roles of international health organizations like WHO, and the implementation of ICD codes in the United States and other countries. It also discusses the changes made by committees over the years, the identified stakeholders (doctors, nurses, researchers, etc.), the beneficiaries, and potential adversaries of the ICD codes. The report concludes with change recommendations and a personal reflection on the usefulness of ICD codes in healthcare.

Running head: HEALTHCARE POLICY AND POLITICS
Historical Narrative of ICD Codes
Name of Student
Name of University
Author Note

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Historical Development
Florence Nightingale was the first person to make a proposal to develop a model for collection of
hospital data the International Statistical Congress held in London in 1860 (1). Jacques Bertillon,
a French physician first simulated a paper classifying the causes of death among the population
in the International Statistical Institute in 1893, Chicago. Several countries popularized the
Bertillon system where the diseases were segregated into general and localized forms to classify
the deaths in Paris (2). This lead to revision of this technique by many countries like UK,
Germany and Switzerland and each country implemented and modified according to their own
needs. The classification grew from 44 categories to a whopping 161 categories. It was proposed
by the American Public Health Association in 1898 to adopt similar techniques in Canada,
Mexico as well as United States. Revision of the policy was also recommended by the APHA
every ten years to keep the policy updated according to the current medical practices. This lead
to the inauguration of the first International Classification Causes of Death conglomerate in the
1900. The revisions and updates occurring consequently after 10 years (3). The initial
classification system consisted of a tabular list with alphabetical arrangement to help identify the
diseases. Many revisions changed the setting of policy codes until only after revision of the sixth
update the policy was segregated into two categories, the Statistical Classification of Diseases
and Injuries and Causes of Death or ICD. Before the segregation the ICD acts was under the
governance of a union of ISI and Health Organization of the League of Nations called Mixed
Commission. It was in 1948 that the World Health Organization undertook the responsibility to
handle the ICD matters of governance and revision every ten years (4). The subsequent revisions
were conducted by WHO after every ten years but it was later decided that the time span was too
short for updates. Currently ICD is the most widespread statistical classification many major

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countries like Australia, Canada as well as United states and implemented their own adaptations
according to the country’s diseases prevalence. The codes now classify for diagnostic and
operative techniques.
Legislative track of ICD
The joint efforts of the international health organizations lead the development of the ICD
governing body since the beginning of sixth century. The accumulated efforts formed a
constructive governing body to track disease epidemics across the globe. The Registration Act
was passed in 1837 in England to study the causation of mortality rates in the country as a
population study (5). 1909 was the beginning from where the use of ICD-1 was being
implemented as a part of The United Nations. The responsibility of the governance of ICD was
passed to WHO in 1946. The central office of the American Hospital association (AHA)
published the Memorandum of Understanding twenty years later for the ICD-9 based issues. The
beginning of late 1960s leads the development of ICD-8 codes. After which in 1975 the WHO
published the specific changes in the policy of the ICD codes and became ICD-9. It was this time
the segregation of the codes was done to include the diagnostic procedural in the coding system.
The ICD-10 code set included 155,000 codes from the ICD-9 version, which were 17,000 codes
(6). The draft for this development was implemented in the United States only five years later in
1995. Thereafter, UK legislations started implementing the codes for the purpose of
reimbursements in that year. A year later after the publication of the new codes, thirteen new
countries adopted the ICD0-10 for assessment of morbid statistic purposes. The evaluation of
ICD-10 codes was conducted by the national Centre for Health Statistics in 1997, which included
updated revision of terminologies, classification of diseases and updated medical advancements.

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The French, Norway and other countries also implemented the codes for reimbursement
purposes. The US government started utilizing the code to evaluate mortality rates in the year
1999 and it became a part of the healthcare service during that time. During the same time the
Health endurance Portability and Accountability (HIPPA) the Health and Human Services
(HHS) which utilized the data from ICD-10 passed act. The International Classification of
Functioning, Disability and Health (ICF) was approved by World Health assembly along with
the publication of ICD-10 in 42 foreign languages along with 6 official WHO languages. ICD-9
was identified by the HIPPA as a medium for presenting diagnostic procedures associated with
electronic administrative transaction in the year 2003. In 2008, HHS gave a legislative proposal
to update the new codes for ICD-10 on 2011 (7). In the 2013, the HHS finalized the publication
date to change the rule, which provided the legislative bodies and stakeholder additional couple
of years to inaugurate the preparation for the transition. An estimation was published by the
Centres for Medicare and Medicaid services (CMS), which showed that the increases of 0.03 %
revenue would result for the implementation of ICD-10. The US Secretary was banned from
adopting the ICD-10 by the Protecting Access to Medicare Act in 2014, that resulted in the delay
of the compliance. During this time the WHO announced were appropriately reported. Their
updated version of ICD-11 on 2017. The White House proceeded with the freeze of ICD-10 with
support from the AMA to avoid the financial disaster along with CMS collaboration.
Changes made by the Committees
Over the years the ICD have been updated and revised to include the current medical trends with
the change in the world. The ICD-6 published in 1949 was the first updated version of the
modern coding system, which included the morbidities. The code included the combination for
the injuries and recorded the external factors. The need for inclusion of mental health was for the

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first time considered that were added in the next update (8). The ICD-7 included the mentioned
inclusion of mental health records and was published in 1955. The eighth revision of ICD codes
ICD-8a was published in Geneva, 1965 where the updated revision was done in a more thorough
approach. The initial structures of the Codes were not changed but the indexing of hospital
records was included in the new revised version. The independent group in USA devised an
analytical evaluation of the codes, which included the hospital morbidity data. The American
Hospital Association’s “Advisory Committee to the Central Office on ICDA” introduced the
adaptation procedures (9). Finally, in 1968 the ICDA released the updated data of codes, which
included the diagnostic data along with both morbidity and mortality statistics of the hospitals. In
1975 the WHO published the ninth revision of the codes of ICD contained the codes which were
about 3-4 digits long with approximately 3000 codes. The technology described the ninth codes
were not updated to the current times. The laterality of the codes was outdated. The
terminologies used were general instead of clinical. The methodology and technology did not
describe the details. The data was insufficient. The updated version of the tenth version ICD
code was published in 1999 (10). The code set included seven digit long letter and numbers for
inclusion of more data, which contributed to make 87.000 codes. The new code set included
newer and updated terminology where the terms, body parts and techniques were described
properly as per clinical standards. The segregation of the body parts were according to the
diseases morbidities. The newest version of the ICD code was published as a draft in 2015. The
new draft is supposedly inclusive of the diseases with important definitions in normal readable
format. The newer version contains a “content model” describes the coded definition of key
terms (11). The version includes a title of identity with the classification properties as well as
textual; definitions, terms, description of structure, temporal properties, description of severity of

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the diseases, manifestation of diseases, casual properties, functional properties, specific
conditions, treatment as well as diagnostic criteria. These will be separate chapter of the codes
published version. The newer version includes the historical information along with current
information. Additionally the digitization of the ICD codes is being developed. According to the
WHO website the new updated version will include online editing, granted access to users.
Quality will be assured by peer reviewed journal and article citations. Multiple languages will be
incorporated (12). The ICD-11 will include electronic health application additions and will be
freely downloadable for personal use.
Identification of Stakeholders
The identified stakeholders of the ICD are doctors, nurses, researchers, healthcare providers,
coders, Information technology workers, policy makers and healthcare organizations that utilize
the codes for their benefit. The importance of the support of the stakeholders is implementation
of changes, which benefit the system. The CMS allows the stakeholders to identify the problems
with the codes and make respective changes by accessing the technical supportive system (13).
Various government organizations that utilize the codes for maintain the surveillance of health
risks respective of every country is also part of the stakeholders of the ICD.
Beneficiaries of the ICD codes
The purpose the ICD codes is to help readers, government health officials, policy makers,
practitioners, nurses and other medical professionals stay updated on the current medical trends
and develop better clinical practice initiates and identify the risks for providing better care to the
general public (13). The public is the main benefactor of the codes as the health outcomes
derived from the codes are dependent on the development of newer improved health policies.

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Adversaries of the ICD codes
The misguidance from the ICD will have direct effect on the healthcare professionals and
researchers. The development of improved medicines is depending on the accuracy of the
information provided by the ICD (14). The ultimate effect will be focused on the public who will
be deprived form the advancements if the policies are not up to date.
Cost of the ICD program
The WHO does not disclose the cost of production for the ICD codes along with the necessary
updates, but considering the large impact and effectiveness of the codes, it can be contemplated
that the cost of making is in millions.
Personal benefit
Personally, I will be using the codes to keep myself updated about the current medical affairs and
diseases, since my duty, as a nursing student is to keep myself updated about the current clinical
practices.
Change recommendations
Currently the changes that need to be incorporated in the ICD, is the inclusion of social
determinants of health that affect the minority community for the identification of the health gaps
and developments of separate criteria.

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