Indian Journal of Public Health

: 2015  |  Volume : 59  |  Issue : 1  |  Page : 68--69

Implementation of ICD 10: A study on the doctors' knowledge and coding practices in Delhi

Kayia Priscilla Kayina1, Arun K Sharma2, Kamal Agrawal2,  
1 Assistant Professor, Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
2 Professor, Department of Community Medicine, University College of Medical Sciences, Dilshad Garden, Delhi, India

Correspondence Address:
Kayia Priscilla Kayina
Assistant Professor, Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Porompat, Imphal - 795 005, Manipur

How to cite this article:
Kayina KP, Sharma AK, Agrawal K. Implementation of ICD 10: A study on the doctors' knowledge and coding practices in Delhi.Indian J Public Health 2015;59:68-69

How to cite this URL:
Kayina KP, Sharma AK, Agrawal K. Implementation of ICD 10: A study on the doctors' knowledge and coding practices in Delhi. Indian J Public Health [serial online] 2015 [cited 2023 Mar 23 ];59:68-69
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An efficient Health Information System forms the basis for good health policies in any country and is one of the main building blocks for the strengthening of the health system according to the World Health Organization (WHO). [1 ] International Classification of Disease (ICD) is the international standard diagnostic classification given by the WHO for standardizing mortality and morbidity data reporting. India adopted the ICD 10 in 2000, the latest version of the ICD, [2 ] and the Central Bureau of Health Intelligence took up the initiative of directing all states for implementing ICD10. A study was conducted in the National Capital Territory (NCT) of Delhi to examine the status of implementation of ICD10 in the government health facilities, to assess the knowledge of ICD10 among the doctors, and to observe the ICD10 coding practices followed in the facilities using ICD10. A total of 126 doctors from 12 hospitals and 11 dispensaries using ICD10 were interviewed with a pre-tested, semi-open-ended, interviewer-administered questionnaire, which included demographic and ICD10 knowledge questions. A separate checklist was administered to the 12 persons-in-charge of the Medical Records Departments for information on the coding practices in the hospitals.

Knowledge about ICD 10 among doctors is evident in [Table 1] and [Table 2] and reflects the knowledge about its utility.{Table 1}{Table 2}

The use of ICD10 in the hospitals has been recent and 11 of the 12 hospitals that were studied started using it only in the last five years. Morbidity and mortality coding with ICD10 was done manually in all the hospitals for Inpatients (IPD), however, for Outpatients (OPD), computerized coding with software was done in two hospitals. In seven hospitals, the doctors alone were the coders, in two hospitals the Medical Record staff was in charge of the coding, and in three hospitals, the OPD sheet coding was conducted by the doctors, while the IPD record was prepared by the Medical record staff. The multiple condition coding method, where all the diagnoses of a patient were given codes was used in nine hospitals and the rest of them used the single coding system, where only the main condition was given a code.

Doctors who felt ICD10 served its purpose and were in favor of using it formed 76.2 and 74.6%, respectively, but almost two-thirds of them (60%) felt that it was not their responsibility to do the coding.

The development of ICD10 is a big boon to the Health Management Information System (HMIS), but its full potential can only be realized upon fully understanding and knowing the system. An extensive literature search was executed in both electronic databases and libraries, but no studies could be found addressing the knowledge and coding practices of ICD10 both in India and elsewhere.

Knowledge about the different aspects of ICD, such as, conventions used, lead terms, and the like, will help in making full and proper use of the books, thereby, producing quality data for a good HMIS. In the study it was found that the overall knowledge of ICD10 was poor [Table 1]. This could be because of a lack of training in record keeping and ICD in Undergraduate and Postgraduate programs and after job induction, as seen in the study. [3] The knowledge regarding the utilities of ICD 10 was found to be good.

A positive attitude toward the use was observed among the respondents, as 74.6% answered that they favored ICD10. The favorable response could be owing to a high awareness of the important purposes ICD10 served, but a high patient load and inadequate time for coding probably pushed the majority (60%) toward considering coding as someone else's responsibility. [3]

Coding was done mostly by doctors. In the absence of trained professional coders, the onus of coding almost always fell on the doctors and Medical Records staff. Nine of the hospitals in the study used multiple coding. This system allowed full capture of the conditions of the patient, which provided a richer data. Evidently we see the use of it in most of the hospitals. Manual coding was seen in all the hospitals. In the absence of training and logistics in terms of computers and theICD10 software, there was no other choice, but to do manual coding, which became a cumbersome job when coupled with high patient load. [3]

Employing an in-depth interview and interviewing about the attitude toward ICD10, in detail, could have improved the content of the study. Only few hospitals used ICD10, but fewer still were those who had a proper knowledge of ICD10. [3 ] Intensive hands-on training to undergraduate and postgraduate students along with the appropriate standard study program on ICD10, emphasizing its importance in the healthcare setting, pre-induction, and regular in-service trainings and seminars on ICD10, would help in producing uniformly good quality data. Development of professional coders could bring about a massive change in the HMIS, where at present it is practically nonexistent.


1World Health Organization. Utilization of health information for decision making [online]. Available from: http:. [Last accessed on 2010 Nov 10].
2Central Bureau of Health Intelligence. Module and workbook: Orientation training on ICD-10. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare, Nirman Bhavan. Available from: http:. [Last accessed on 2013 Oct 11].
3Kayina KP, Agrawal K, Sharma AK. Implementation of ICD-10: Constraints and difficulties of healthcare providers. Natl Med J India 2013;26:115-6.