User Guide - Web demo - The University of Sydney

User Guide - Web demo - The University of Sydney
USERS GUIDE
ICPC-2 PLUS
INSTRUCTIONS
This guide consists of six Sections outlining the advantages of coding and
classifying your data, giving guidelines to the use of ICPC-2 PLUS and a
number of Appendices which are updated with each release.
You may print parts of the guide, the whole document (≈ 77 pages) or use it
as an “on line” version on your computer screen. This is a demonstration
document that has sections removed that are updated and sent to users.
To navigate through the guide click the blue underlined text to jump to that
Section or Appendix.
The beginning and bottom of most pages has a link to bring you back here.
Table of Contents
Copyright and Licensing Information
Section 1
Why code? Why classify?
Which code? Which classification?
Section 2
International Classification for Primary Care
Section 3
ICPC — Structure and Derivatives
Section 4
About ICPC-2 Plus
Section 5
Hints for using ICPC-2 Plus
Getting Started
“Terming” With ICPC-2 Plus
Analysing Information Stored with ICPC-2 Plus
GP’s Questions Answered
Section 6
ICPC–2 Tabular List
Appendix A
ICPC-2 Plus Keyword List for speedy term access
Appendix B
ICPC-2 Plus Standardised Keyword Abbreviations for
speedy term access
Appendix C
ICPC-2 Plus New Terms added in this release
Appendix D
FMRC Code Groups — by ICPC-2 chapter and components
Appendix E
FMRC Code Groups — by diagnosis/ problem/ concept
Family Medicine Research Centre
University of Sydney
in co-operation with
World Organisation of Family Doctors
(WONCA)
ICPC – 2 PLUS Users’ Guide
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ICPC-2 PLUS
Family Medicine
Research Centre
ICPC-2
 World Organisation of National Colleges, Academics and Academic Associations of General Practitioners/Family
Physicians, 1998
ICPC-2 PLUS and ICPC-2 PLUS User’s Guide
 University of Sydney, 1998
(Family Medicine Research Centre)
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the Family Medicine Research Centre, University of
Sydney.
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The International Classification of Primary Care (ICPC-2)
Copyright © 1987 WONCA
ICPC-2 PLUS
Copyright © 1994 by the Family Medicine Research Centre, University of Sydney
All rights reserved. No part of this publication may be reproduced, stored on a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise
without prior written permission from the Family Medicine Research Centre, University of Sydney. For
information, address the Family Medicine Research Centre, Department of General Practice, University
of Sydney; Acacia House, Westmead Hospital; WESTMEAD NSW AUSTRALIA 2145
Telephone: (02) 9845 8151 Facsimile: (02) 9845 8155 E-mail: [email protected]
LICENSING FEES FOR GENERAL PRACTICE (AUSTRALIA AND NEW ZEALAND):
WONCA SITE LICENSE COSTS (once only payment):
A single licence fee for the lifelong use of ICPC-2 has been set by WONCA at the
following rates:Single user
$100
2 - 4 user site
5+ user site
$150
$200
The licence fee is payable to the FMRC, who pass payment on to WONCA at regular
intervals. The monies received by WONCA will assist the Classification Committee in
continuing its work in further developing classification systems (including ICPC-2) for
general practice.
ANNUAL SITE LICENCE FEE FOR ICPC-2 PLUS FOR GENERAL
PRACTICE (AUSTRALIA AND NEW ZEALAND):
The annual fees for ICPC-2 PLUS have been set by the FMRC at the same rate:Single user
2 - 4 user
5 - 10 user
11 – 15 user
16 – 20 user
21+ user
$120
$180
$250
$310
$370
$420
This fee will cover the provision of regular database updates. If you feed back terms you
find difficult or impossible to find we will add them in time for the next upgrade.
The University of Sydney is a non-profit organisation and any surplus will be utilised for
research and development of classification systems for general practice.
OUTSIDE AUSTRALIA AND NEW ZEALAND:
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TABLE OF CONTENTS
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BY QUOTATION
TABLE OF CONTENTS
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SECTION 1: ............................................................................................................... 5
Why code? Why classify? .................................................................................................................................. 5
Which code? Which classification?................................................................................................................... 13
SECTION 2: ............................................................................................................. 25
INTERNATIONAL CLASSIFICATION FOR PRIMARY CARE............................................................... 25
SECTION 3: ............................................................................................................. 34
THE INTERNATIONAL CLASSIFICATION OF PRIMARY CARE –STRUCTURE AND
DERIVATIVES .................................................................................................................................................. 34
SECTION 4: ............................................................................................................. 38
ABOUT ICPC-2 PLUS....................................................................................................................................... 38
SECTION 5: ............................................................................................................. 46
HINTS FOR USING ICPC-2 PLUS ................................................................................................................. 46
Getting Started ................................................................................................................................................. 46
“Terming’ with ICPC-2 Plus ........................................................................................................................... 46
Analysing Information Stored With Icpc Plus................................................................................................. 49
GPs’ Questions Answered ............................................................................................................................... 49
SECTION 6: ............................................................................................................. 55
THE INTERNATIONAL CLASSIFICATION OF PRIMARY CARE - 2................................................... 55
APPENDIX A ........................................................................................................... 73
Keyword List....................................................................................................................................................... 73
APPENDIX B ........................................................................................................... 90
Keyword Abbreviations ..................................................................................................................................... 90
APPENDIX C ........................................................................................................... 99
New Terms .......................................................................................................................................................... 99
APPENDIX D ......................................................................................................... 104
FMRC Code Groupers by ICPC-2 chapter and component ........................................................................ 104
APPENDIX E ......................................................................................................... 105
FMRC Code Groupers by ICPC-2 Diagnosis ................................................................................................ 105
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SECTION 1:
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WORKSHOP REPORT
As published in Australian Family Physician Vol 24. No 4. April 1995. pages 612-615
General Practice Medical Records:
Why code? Why classify?
Helena Britt
BA, PhD, Director, Family Medicine Research Unit, Department of General
Practice, University of Sydney
Neil Beaton
MBBS, MRCGP, DA. Medical Advisor, The Aboriginal Primary Health Care
Project, Far North Queensland Division of General Practice.
Graeme Miller
MBBS, FRACGP. Clinical Senior Lecturer, Department of General Practice,
University of Sydney.
Recently the Information Management Steering Group (IMSG), [a
RACGP-AMA-Commonwealth Government committee responsible
for the planning of information management in general practice],
held a Coding Workshop at which available coding systems and
their application in general practice computerised medical records
were reviewed. As there has been in the past some discussion as
to the value of coding, the workshop participants agreed that a
paper outlining the reasons for coding and classifying clinical data
should be prepared and disseminated to all general practitioners.
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Over 95 million general practice service rebates are claimed through Medicare every
year. These services are provided by over 20,000 medical practitioners including
16,000 recognised general practitioners. Eighty two percent of the population visit a
general practitioner at least once a year and each patient visits a GP an average five
times per year (data obtained for the General Practice Branch, Department of Human
Services and Health). However the management of the information recorded in the
course of these services is generally poor. As a result very little of this large data
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source provides information which is useful to general practitioners for comprehensive
and continuing patient and community care.
Clinicians need reliable clinical data: to provide quality patient management; for patient
audit; for quality assurance and for practice management. Group information for the
practice or the community also aids the management of specific groups of patients.
Further, data collected for the primary purpose of patient care have secondary benefits.
When collected and aggregated it can be used for clinical, health services and health
economics research.
The use of a computer system will improve the quality of patient medical records2 as
they will be always be legible and will usually have greater structure than paper based
systems. However the collection of information alone is not sufficient to provide
meaningful data. In order to make information useful to individual practitioners, the
practice or to epidemiologists, it must be easily accessed.
Why code the data?
Having decided to introduce computerised medical records into your practice you will be
faced with the question of whether or not to code the data. Without codes computers
will allow you to access information stored in free text by use of word search
mechanisms. These allow you to sort your patients into groups, such as "all patients
who have the word hypertension in their record". However the margin for error is great
for you must ask the computer to search for every term you may have used to describe
this diagnosis. The search will miss words which you have misspelt; and you will miss
abbreviations (now forgotten) which you entered in a hurry during a rushed surgery.
For analysis across the practice you must also be aware of all terms which may have
been used by your partner or locum.
A code is a shorthand for a concept. It accurately compresses the data for storage. In
the computer records environment most agree that it is unsatisfactory to store
information only in free text, if you wish to retrieve the data and collate it at a later date.
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At a workshop held by the RACGP during 1993 specific reasons for coding data in
medical records were identified. They include: to provide an audit trail; practice audit;
memory prompts; continuity of care; assisting other carers in the practice (eg: partners
and locums); quality assurance; better record keeping; decision support and protocols;
periodic and incidental health checks; checking for disease-medication interactions;
dynamic structured patient records; cost savings.
The use of codes does not preclude the use of synonyms, acronyms and key words to
describe a concept in a medical record but ensures that the concept represented by the
code is uniform for all practitioners. This results in greater consistency of
data input and reliability of reporting. Clarity of communication in a common language,
whether between partners or between primary and secondary care providers will
increase quality of care. Just as importantly it facilitates accurate and speedy data
retrieval. If a code has been attached to the label at the time of the encounter, a single
search for one code will provide a list of all patients with the disease of interest, no
matter how you described it in the medical record.
In addition to aiding in the selection of records for groups of patients, coding aids the
linkage of events over time within a patient record. Using a single code to represent the
disease or problem, during a consultation you can ask the computer to show you all
encounters for this patient at which code X was managed, and view them consecutively
on the screen. This is far easier than searching through pages and pages of records,
(whether on paper or computer) when trying to build a historical view of the progress of
a disease or of its management.
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Coding may also have some disadvantages which include the impact it has on the style
of practice of the doctor. It requires the practitioner to think more specifically about the
term selected to describe a problem. Coding systems must therefore be sufficiently
flexible to allow individual preferences in terminology whilst maintaining accurate
interpretation by others. Like computerised records, the introduction of coding systems
requires a new form of discipline and a new way of thinking about records by
professionals.
Some people suggest that coding the problems and their management is an extra job
for the clinician.2 They inevitably describe the time consuming task of looking up a list,
selecting the code and then entering it on the record manually. Think again. Things are
fast changing. In most software systems available overseas, and in an increasing
number in Australia the concept of "terming" has been introduced. Terming refers to
the entry of a few key letters (eg: osteo), an acronym (OA) or a brief key term to access
a list of terms which should include the one you are looking for. You select the term
from the pick list by a single key stroke (ie terming). The selected label and its code are
automatically entered and stored by the computer.
In the future, as hand written
recognition systems are refined and become less expensive, you will be able to use the
same process with the tip of your pen.
Coding is regarded by some as only useful in the diagnostic area.
However,
increasingly coding systems will include codes for all sorts of information in your
medical records including the details of the drugs you prescribe, therapeutic
procedures, pathology results, family history, risk factors etc. This will allow you to
undertake more complex record reviews. eg: to investigate the number of patients who
are on risk levels of a selected medication for a selected disease; develop reliable recall
systems for preventive or follow-up care; check that none of your patients on NSAIDs
also suffer from asthma.
It is hoped that codes which facilitate the use of warning
systems for allergies, adverse effects, possible contraindications and drug interactions,
will also soon be available. This cannot help but assist general practitioners in the
provision of quality care.
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Classification
The next question is "why classify?"
A classification is merely a method of placing the codes in a sorted and meaningful
manner. A good structure allows you to manage the data within the practice in terms of
groups of codes rather than just a specific individual code.
We use structured coding systems in many areas of our lives. Using an example within
a student registration system, a typical hierarchical system may be:
Student ID number is 9435267:
94. . . . . = year of entry;
3. . . . = faculty of science;
5. . . = school of physics;
267 = student number.
With this structured coding system you can easily identify:
.
the number of students who first enrolled in 1994 at the university;
(sort on 94 only)
.
the number who first enrolled in the faculty of science in 1994; (943)
.
the number specifically studying physics in the faculty in 1994.(9435)
.
the individual student
Applying the same thinking to general practice where D = digestive disease; D1 =
digestive infection; D116 = specifically gastroenteritis, you can select records at all
levels: all patients who have at least one digestive disease; all who have had a digestive
infection; and all who have suffered specifically from gastroenteritis. If the codes are not
structured in a hierarchical manner the search at the gastroenteritis level is easy but
those above become increasingly difficult. Without a hierarchy a search for digestive
problems would require you to list all the codes which you feel fall into that group.
Without a code you would have to list and search for all the possible terms you may
have used to describe a digestive problem of any type. Codes which are classified
make any data retrieval easier.
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One classification system or many?
There are many levels at which data retrieved from medical records are useful:
•
individual patient information in general practice
•
.
information about groups and families in a general practice
•
.
community or practice population information
•
.
regional health information (eg: Divisions)
•
.
state and national information
•
.
international comparisons
The level of specificity required by each of these participants in the health care system
varies considerably. Ideally one universal coding system would meet the needs of all
these competing interests, but this is not usually the case. For example a coding
system which classifies diseases in terms of broad group headings only (eg: digestive;
cardiovascular etc.), is of little use in the GP surgery when you wish to record, code and
store minute details about the health event which has occurred to your patient. On the
other hand, the fine detail of a patient record is of little use to a regional health planner
who may wish to allocate resources on the basis of broad parameters such as a body
system heading. The decision of which coding system must be determined by the
level of detail required at the first entry point, in this case the patient medical record.
Where the chosen classification does not suit all needs, multiple systems can be utilised
through a process of "mapping". This is the process of working out the relationship
between individual codes in each of the systems. Usually the more detailed system is
"mapped" to the less detailed. Thus a group of codes, or multiple individual codes from
a variety of sections in one system may be placed together under one code in another.
The majority of internationally recognised classifications are mapped to multiple other
classifications. For example, the International Classification of Primary care (ICPC)3 has
a body system based structure and is ideal for population based general practice data
analysis. The International Classification of Diseases4 has a disease based structure,
far more specific codes and is designed for hospital data systems. The latter is mapped
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to the former so that data collected in terms of ICD can be analysed in terms of ICPC.
Another example is the Read Clinical codes which are mapped to both ICD-9 and to
ICPC.
The mapping process is the responsibility of the classification designer and allows
people using different classification systems, possibly at different levels of care, to
transfer information in a common language. It is therefore to your advantage to select a
coding system which is internationally recognised, mapped to other systems, and
designed for use in general practice.
For meaningful data retrieval there is one more facet of computerised medical records
which needs to be considered in parallel to the selection of a coding system or systems.
The medical record must be structured in a manner which allows the computer to
recognise the true meaning of the code or term. For example, the code for "Ca-breast"
has a very different meaning in the family history section of the record to its meaning in
the patient problem list. Any data retrieval requires consideration of the sector of the
record in which the term or code is noted. The RACGP manual record system has
three structural elements based on the work of Lawrence Weed5 and both can be
effectively applied to computerised systems.
Firstly the problem orientation allows
linkage of a problem over time and tracks changing problem definition. Secondly the
SOAP structure of the data within the encounter - subjective data, objective data,
assessment and plan- which assures differentiation between lable meanings. Thirdly,
the patient summary which includes an up-to-date list of all important morbidity and its
management.
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Summary
Classification systems are being increasingly adopted by general practitioners
throughout the world, particularly in the fast growing number of practices utilising
computerised medical records. The advantages of coding data at the point of entry
have been outlined in this paper and general practitioners in Australia should consider
these points when thinking of using computers, whether for full medical records, recall
systems, direct printing of prescriptions or age-sex disease registers.
The implications for later meaningful data retrieval to assist practitioners in the provision
of quality care for their patients are enormous.
References
1.
Dick SR, Steen EB. (ed). The computer-based patient record, an essential
technology for health care. Institute of Medicine.
National Academy Press.
Washingtom DC 1991.
2.
Regan B, Ireland M. Inappropriateness of coding systems for recording clinical
data. Informatics in Healthcare Australia July 1994;3(2):101-014.
3.
Wood M, Lamberts H, Meijer JS, Hofmans-Okkes IM. The conversion between
ICPC and ICD-10. Requirements for a family of classification systems in the next
decade. Fam Pract 1992; 9: 340-348.
4.
WHO.(ed)
International classification of diseases (9th revision). Geneva: World
Health Organisation, 1977.
5.
Weed LL, Hertzberg R. Clinical application of medical software for problem solving
in ambulatory care J Ambulatory Care Manage 1985; 8: 66-83.
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AS PUBLISHED IN INFORMATICS IN HEALTH CARE AUSTRALIA.
September/October 1996 Vol 5, No 4.
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Which code? Which classification?
Helena Britt
In the past few years, there has been considerable discussion about whether or not
coding data in computerised clinical systems is necessary or even desirable1,2,3.
More recently, in parallel with wider adoption of computerised clinical systems in
primary care such discussion has subsided, suggesting a broader acceptance of the
need to code and classify. However, as it appears that the Commonwealth
Government is unlikely to make a directive decision about a set of “preferred
classifications” for primary care in the foreseeable future, it is probably time to review
the advantages and disadvantages of those that are available. While this paper
concentrates on morbidity classifications we should not lose sight of the need to
code other fields in the patient’s record.
In the recently completed NSW data modeling exercise for Community Health, over
400 data items which could be classified were identified. These included some fields
that clinicians automatically “classify”. For example:
•
the type of consultation - in general practice this is classified with the
Commonwealth Medical Benefits Schedule (CMBS);
•
patient characteristics such as age and sex are automatically classified (through
habit)
Many other patient characteristics such as country of birth, language spoken at
home etc. can be classified according to standardised systems provided by the
Australian Bureau of Statistics (ABS ).
However, the area presenting the greatest classification problems to primary care
providers is clinical information. Thinking in terms of the SOAP structure
recommended by the RACGP, we have a wide range of information which ideally
would be classified according to accepted national and international standards:
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S = Subjective
•
Patient reasons for encounter (the patient expressed reasons for attending
on that occasion). These may be in terms of the need for a service (check
up, referral, etc.), symptoms (headache), or a diagnostic label (about my
diabetes).
•
presenting symptoms (information collected by the GP in the diagnostic
process)
O = Objective findings
A = Assessment (problem label or diagnosis)
P = Plan (including prescribing, therapies and other treatments).
While all of these fields should be able to be coded and classified, the majority of
recent interest has centred on the classification of the patient reasons for encounter,
the presenting systems, and the problem labels or diagnoses.
When coding, one should always keep in mind the purpose. Coding should be used
to facilitate logical and meaningful data retrieval, to find groups of patients for
practice audit, follow up and recall systems, or to gain a view of your practice
population and its morbidity. The classification you choose should therefore have
sufficient specificity to allow you to select and save the term you want but not be so
specific that it cannot be used with consistency and reliability.
THE INTERNATIONAL CLASSIFICATION OF DISEASES is the oldest and most
widely recognised diagnostic classification available4. The 9th edition is used widely
in the Australian hospital system (ICD 9 CM(A)), where trained coders receive paper
records from clinicians and secondarily classify the diagnostic data. Another revision
(ICD-10)5 is to be released in early 1998 after adaptation for Australia.
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ICD began its development in the late 19th century as an international list of causes
of death. It therefore has an emphasis on disease in terms of its aetiology, pathology
and morphology. In primary care many of the problems presented and managed
remain ill-defined at the end of the consultation and it is difficult to classify them in
such a disease oriented system. In a comparative study of classification systems it
was estimated that almost half the problems dealt with in primary care could be not
classified with ICD6. In the late 1980’s when New Zealand family practitioners were
told to code using ICD 9, they simply stopped coding because it was far too difficult.
All looked forward to the new version (ICD 10) which was said to overcome this
problem. Alas, the experts agree it fails to do so.
Advantages:
ICD is an international classification widely used in tertiary institutions in Australia
and elsewhere.
Disadvantages:
•
The rubric (i.e. the ICD description of the medical concept) is often a false
terminology with little relationship to the natural language of clinicians, having
been designed for secondary, rather than clinician coding.
•
ICD is a static classification. It is only revised every 10-15 years so it does not
keep up to date with changing medical terminology and the discovery of new
diseases.
•
It lacks sufficient rubrics for the many ill-defined conditions managed in primary
care
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THE READ CLINICAL CODES:
The Read codes have been described in more detail elsewhere7 but in summary:
they are a comprehensive nomenclature of medical terms derived from international
classifications such as ICD 94 and OPCS 4 (a classification of surgical operations
and procedures, similar to our CMBS).8 The version presently used in the UK (READ
5 byte set) includes over 100,000 preferred terms and 150,000 synonyms. The
original developer, a GP named James Read, started with a list of terms he used in
his practice and asked GPs to try and use it. As they requested the addition of other
specific terms they were added to RCC. It is regularly updated each three months in
response to GP needs.
Read codes suffer from confusing version terminology. A brief history is tabulated
below.
Year
Name
No of Codes
1982
25
Description
brief problem list
1985
4 byte
40,000
GP record summary
1988
5 byte
90,000
Hospital record summary
1994
Version 3
110,000
Full medical record
1995
Version 3
150,000
Full health record
The 5 byte set had two versions of data file structure, version 1 and 2. Read Version
3 represents a term set, code set and file structure. Future versions will be labelled
by date.)
Advantages: (Read 5 byte set)
•
It was designed in general practice, and therefore includes terms used by GPs.
•
It was the first system designed for computers rather than for paper based
secondary coding;
•
It is a hierarchical system with five levels, each level being more specific.
•
Its quarterly updates make it dynamic rather than static
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Disadvantages:
•
The five level structure means you can go down one path looking for the term you
want and not realise there is a more appropriate term somewhere else in the
hierarchy. This can lead to poor inter-practitioner reliability in the coding of the
same medical concept.
•
It is sometimes far too specific: For example:- you can code “hit simultaneously
by two trains moving in opposite directions”.
•
There is therefore a high signal to noise ratio which often makes it difficult to
locate the term you want.
•
In other areas it lacks sufficient specificity for clinical purposes (particularly in the
psychological and social areas).
•
Analysing data using Read can also be difficult because of its size and its ICD
structure.
From a practical viewpoint there are other things about Read that Australian primary
care providers should consider. The Aus Read Trial9 demonstrated that:•
many of the Read “preferred terms” are not suitable in the Australian environment
— the synonymous terms are more appropriate
•
the hierarchy is not always suitable (e.g.: asthma is classified as a specific type of
COAD).
•
many of the key words, (i.e. words that the GP enters in order to find the term
they want), need to be Australianised
Since the trial the Australian Government has not bought a National license for the
codes so they will remain fully controlled from the UK. Individuals who wish to buy a
license for Read Clinical Codes can do so by contacting the distributors direct. There
will be no Australian back-up nor production of an Australian version unless Australia
negotiates a licence.. Those considering buying New Zealand medical record
software which uses Read should be aware of this.
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Read Version 3 is even larger than its predecessor. It has been broadened to cover
terms used in the entire health record. It includes many specialty codes which have
been added after a $40 million project in which 40 professional colleges designed a
term set for its specialty. It has 250,000 terms organised in a hierarchical structure
one could describe as a "tree". Classifications can be “laid over” the top of the terms,
so you can analyse data almost any way you wish. However it is not yet in
widespread practical use. Software systems using Read 3 are still under
development. Some feel that general practice terms have been somewhat lost in the
mire.
THE INTERNATIONAL CLASSIFICATION OF PRIMARY CARE (ICPC)
In the 50’s and 60’s a number of countries (including Canada and the UK) attempted
to develop new classifications specifically for primary care. In the early seventies, the
newly formed Classification Committee of the World Organisation of Family Doctors
(WONCA) decided it was time to develop a new international classification for
primary care. This resulted in the International Classification of Health Problems in
Primary Care (ICHPPC), the second version having the added advantage of
inclusion and exclusion criteria10. However, it still lacked sufficient codes for illdefined conditions and patient expressed reasons for encounter largely because it
retained the ICD structure which confined its flexibility.
In 1978 WHO set up a working party to develop a classification system for patient
reasons for encounter. Most of its members were also members of WONCA. This
work resulted in the International Classification of Primary Care (ICPC)11 which
incorporated codes for patient reasons for encounter, symptoms and ill-defined
conditions, with the addition of the morbidity codes from ICHPPC2 (Defined).10
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The structure of ICPC differs from that of ICD and Read. It has a biaxial structure
with 17 chapters on one axis , mainly based on body systems with an additional
chapter for broad, ill defined conditions (e.g.: feeling tired; general ill feeling etc.),
another for psychological problems and one for social problems. On the other axis
are 7 components. Component 1 covers symptoms and complaints. Component 7
covers diagnosis/disease and components 2-6 are process codes (e.g. check,
immunisation, test results) which apply equally in all chapters. It was designed for
paper based data collection with the primary care provider selecting the code at the
time of the encounter.
Advantages:
•
Its structure follows the natural process of primary care and facilitates access to
meaningful morbidity groups (e.g.: all cardiovascular disease, all respiratory
symptoms; all skin infections; all injuries; all preventive care; all immunisations).
•
It is small enough to handle, having only 1300 rubrics
Disadvantages
•
Because it was designed as an epidemiological tool, it only includes a specific
rubric for the most common problems managed in general practice. The less
common problems are placed into “rag-bag” codes such as ‘other diseases of the
respiratory system’ or “other digestive symptom”.
•
The published version of ICPC (now out of print) has a poor index. Therefore,
when a practitioner cannot find the term in the index s/he has to make a decision
about where it should best be classified. This leads to a lack of coding reliability
which has repercussions when you later wish to later compare data from multiple
sources.
•
For computerised clinical systems the disk copy of the book lacks sufficient
specificity for medical records or even for disease registers and recall systems. A
prime example is: all types of diabetes are grouped in one rubric (diabetes) - yet
for quality care, for legal reasons and for sheer convenience you need to have
recorded IDDM or NIDDM in the patient’s record, not just diabetes. Another
example is the combination of HIV+ and AIDS together in one code.
•
Like ICD, it is a static system which is only reviewed each decade.
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ICPC PLUS:
Recognising the advantages of ICPC as an analytical tool and its disadvantages in
terms of its lack of specificity for clinical systems the Family Medicine Research Unit,
University of Sydney developed an extended version of the ICPC. The extension was
based on data recorded by GPs about more than 800,000 GP-patient encounters,
collected during the Australian Morbidity and Treatment Survey (AMTS)12, the
Country-Metropolitan Comparison Study13 and a popular quality assurance option the
Morbidity and Therapeutic index. All the terms recorded by GPs to describe patient
reasons for encounter and the problems managed were classified according to the
ICPC. However, each term was given its own extension code. As with Read Clinical
Codes, multiple key words were attached to each term to facilitate easy access to
terms. On entry of a key word (e.g. OA) a pick list is offered to the user who
highlights the term required and “clicks” or hits “return” to select it. This is called
“terming” rather than “coding”. The clinician should hardly be aware that a “code” is
attached - that is the computer’s job. Used in suitable computerised clinical system
ICPC PLUS allows the clinician to save the term as selected - it does not replace
that term with a “higher” description of the concept. Like Read, ICPC PLUS is
updated quarterly with additions made in response to users’ requests.
USAGE OF THESE CLASSIFICATIONS:
ICD9 CM (A) is being used throughout the hospital system in Australia and many
other countries. Some primary care software relies on selected sub-groups of its
available codes. It is available through the National Coding Centre.
Read Clinical Codes are being used throughout general practice in the UK and are
being trialed in New Zealand in both primary and secondary care. About 15 practices
in Australia use them, most having adopted them as part of the Demonstration
Practice Trials, funded by the Commonwealth Department of Human Services and
Health. However, since the trials are finished these practices will now require a
license for Read which can be obtained from their UK distributor, Computer Aided
Medical Services.
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ICPC: is being used by between 20 and 40 practices in Australia, usually having
been provided with a disk copy of the codes only . Without the book which described
the philosophy of ICPC the users may have difficulties when needing to choose a
code for an unlisted concept. Throughout Scandinavia and in parts of North America
ICPC is being used in combination with ICD 10. While ICPC is not available in book
form at present , a disk copy of the book can be obtained from the Family Medicine
Research Unit, University of Sydney. The revised version, ICPC 2, will be published
in 1997 through Oxford University Press.
ICPC PLUS: is being used by 45 general practices in Australia and one in Fiji; the
Department of Veterans’ Affairs for the Health Care Plans; and the national
hypertension study (ANBP2). A feasibility study of its application in Community
Health Centres is under way, funded by a consortium of NSW, SA, ACT and QLD
State Health Departments. It is being considered by the RFDS, Aboriginal Health,
Northern Territory and Victorian Community Health. Under Federal Government
funding it is presently being mapped to ICD 9 CM(A), so that data from different
sources can be compared. ICPC PLUS is distributed by the Family Medicine
Research Unit.
OTHER SYSTEMS
There are some other coding systems which should be mentioned for completeness:
SNOMED is an internationally designed classification with its origins in pathology. It
works on a combination of pathophysiology, histopathology and anatomical site. It is
a constructionist model which allows the development of highly specific codes which
may be extremely useful in pathology. The level of specificity it allows goes far
beyond the interests of primary care. Further, the system allows you to “build”
nonsensical constructs such as “broken heart”, “fractured eye”. Its structure may be
suitable to the reductionist theory of specialist practice but is the very antithesis of
holistic care. Further, while SNOMED has enthusiastic supporters throughout the
world, it is not widely used in general practice .
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UMLS (Universal Medical Language System) is strictly speaking a database
access system, not a classification. The database includes both medical and
scientific terms. It originated with the keywords from Medline and recently the terms
used in many classification systems have been added. It is a search engine which
was designed to contain sufficient terms (including words such as “aluminium”) to
allow access to information from multiple sources using different medical
terminology. It is, however, being used experimentally in several hospitals in the
United States for the coding of medical problems.
In addition to these international systems, there are a multitude of Australian homegrown coding systems which do not have an international basis. The most well
known of these is Docle which is based on the Linnean model, invented some 200
years ago for the classification of species. Unlike other systems it does not utilise
numeric codes. It was described at a recent conference14 as made up of two core
concepts: " The first core concept of Docle is an algorithm that converts a piece of
real world medical vernacular into a standard abbreviation. For example 'diabetes
mellitus' is repackaged by the Docle algorithm as 'diabetesMellitus' before it maps to
the Docle word 'diabm'. The second core concept is that of operators. Docle words
can be combined together to form any number of complicated expressions by
combining Docle terms with operators. For example a fracture of the radius can be
expressed as 'frac.radi' - the dot operator translates to 'located at'." Docle is being
used by one Australian GP software vendor.
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CONCLUSION
When selecting a coding system you need to consider the issues raised above. All
classifications have some disadvantages but the most important issues are:
•
breadth of coverage of primary care
•
ease of access to the required term
•
national and international acceptance and comparability
•
ease of “sorting” the information for analysis and identification of patient groups.
Note that the classification you choose should be “mapped” (with authorisation) to
ICD-9 CM(A) and later to ICD 10 if transfer of information across the health care
system is ever to come to pass.
The computerisation of primary care is at the beginning of an exponential curve. Any
acceptable classification system will cost you money. Think before you buy.
About the Author
Helena Britt is a Senior Research Fellow and the Director of the Family Medicine
Research Unit, Department of General Practice University of Sydney. She is a
clinical psychologist with over twenty years research experience, the majority in
health services research in general practice. Her interests centre in improved
information management and analytical techniques in primary care and the
classification of clinical data.
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References:
1. Regan B, Ireland M. Inappropriateness of coding systems for recording clinical
data. Informaitcs in Healthcare - Australia. 1994; 3(3):101-4.
2. Britt H. Recording clinical data - the advantages of coding - a response.
Informatics in Healthcare - Australia 1994; 3(4): 149-152.
3. Britt H, Beaton N, Miller G. Coding and classification in computerised general
practice medical records: Why code? Why classify? Aust Fam Physician 1995;
24: 612-615.
4. World Health Organisation. International classification of diseases (9th revision)
Geneva: World Health Organisation, 1978.
5. World Health Organisation: International classification of diseases and related
health problems, 10th revision. Geneva, World Health Organisation 1992.
6. Westbury RC, Tarrant M. Classification of disease in general practice: A
comparative study. Can Med Assoc J 1969; 101:82.
7. Miller G, Britt H. Data collection and changing health care systems. 1. United
Kingdom. Med J Aust 1993; 159; 471-475.
8. Classification of Surgical Operations and Procedures, Version 4. 9. London:
Office of Population Census and Survey; Operations, 1987.
9. Family Medicine Research Unit, University of Sydney. The Aus-Read Trial.
Report to the Evaluation Steering Group, General Practice Branch, , Canberra:
Department of Human Services and Health. August 1994.
10. Classification Committee of WONCA. ICHPPC-2 defined. (International
classification of health problems in primary care). Oxford: Oxford University
Press, 1983.
11. Lamberts H and Woods M (eds). ICPC - the International classification of
primary care. Oxford: Oxford University Press, 1987.
12. Bridges-Webb C, Britt H, Miles DA, Neary S, Charles J, Traynor V. Morbidity and
treatment in general practice in Australia 1990-1991. Med J Aust 1992; 157
Suppl: S1-S56
13. Britt H, Miles DA, Bridges-Webb C, Neary S, Charles J, Traynor V. A comparison
of country and metropolitan general practice. Med J Aust 1993, 159 Suppl: S9S64.
14. Oon YK. The Linnean Model of Medical Classification. In the Proceeedings of the
Fourth National Health Informatics Conference, pp153-9. Melbourne: Health
Informatics Society of Australia, August 1996.
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SECTION 2:
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INTERNATIONAL CLASSIFICATION
FOR PRIMARY CARE
Charles Bridges-Webb,
Emeritus Professor of General Practice,
University of Sydney and
Chairman, WONCA Classification Committee
Introduction
The International Classication of Disease (ICD) is the most widely recognised
classification of diseases. The advent of yet another revision, the tenth (ICD-10)1 in
1992 can cause confusion for those familiar with the currently used ICD-92. This may
be even worse for primary health care physicians who may also need to use other
classifications such as the International Classification of Health Problems in Primary
Care (ICHPPC)3 or the International Classification of Primary Care (ICPC)4/(ICPC2)5. The difficulties might be lessened by an account of their historical development,
role, relationships, and relative merits.
Classification, nomenclature and thesaurus
Firstly however, it is important to appreciate what a classification is, and how it differs
from a nomenclature or coding system. A medical nomenclature is a list or
catalogue of approved terms for describing and recording clinical and pathological
observations. It should be extensive so that any morbid condition that can be
separately described has a specific designation. Classification is a method of
generalisation to obtain data about groups of cases rather than individual
occurrences. The categories should be chosen so that they will facilitate the
statistical study of disease phenomena, grouping like with like. A specific disease
entity should have a separate title in the classification only when its separation is
warranted because of the frequency of its occurrence, or its importance as a morbid
condition. Many titles in the classification will refer to groups of separate but related
morbid conditions.
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It is the grouping of like with like which is the essential feature of a classification. If
this is done in a hierarchical way, with varying levels of specificity (eg. diseases of
the respiratory tract, diseases of the lung, pneumonia, lobar pneumonia) continuing
into great detail, then a comprehensive classification such as ICD can be used in its
most detailed form as a nomenclature. However an alphabetical list of conditions in a
nomenclature cannot act as a classification.
Labelling aspects of general/family practice, such as reasons for encounter and
health problems, requires that the available labels reflect the characteristics of the
domain: general practice/family medicine. Labels should be derived from a
nomenclature or thesaurus. A nomenclature contains all the terms and professional
jargon of medicine, and a thesaurus is a storehouse of terms like an encyclopedia
or computer tape with a large index and synonyms6.
Classification systems provide a structure to order named objects in classes
according to established criteria. They do not necessarily contain all terms, and
difficulties arise when they are used as a nomenclature and terms are not found
within them. Often many terms are included within one rubric, so that the use of
coding based on a classification does not provide adequate specificity6.
ICPC is a classification which reflects the characteristic distribution and content of
aspects of primary care. It is not a nomenclature. The richness of medicine at the
level of the individual patient needs a nomenclature and thesaurus much more
extensive than ICPC, particularly for recording the specific detail required in an
individual patient record. The use of ICPC together with ICD-10 and other
classification systems, such as the Anatomical-Therapeutic-Chemical classification
of medications (ATC), can provide the basis of an adequate nomenclature and
thesaurus, but if full coding is required these must be supplemented by even more
specific coding systems. However unless such coding systems are based upon a
suitable classification, such as ICPC is for general/family practice, it is not possible to
extract coherent data about populations rather than just individuals6.
For clinical and medical record purposes a comprehensive nomenclature is needed,
since the greatest possible level of specificity is required (eg. lobar pneumonia not
just pneumonia or lung disease) without grouping even rare conditions together.
However for statistical purposes this leads to so many categories that the data are
unmanageable. Grouping of similar rare or less important conditions is essential.
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Historical background of Classification
The statistical study of disease began with work on the London Bills of Mortality in
the seventeenth century2. In the eighteenth and the early nineteenth century there
was much interest in the relative incidence of diseases and especially in the change
in incidence caused by the disappearance of plague and the control of smallpox.
Information, however, was based for the most part on mortality. Scanty references to
morbidity were derived from general impressions only.
In the early part of the twentieth century James McKenzie appreciated the
importance of morbidity data in his work at St Andrews and in the 1930's William
Pickles reported important epidemiological investigations in country practice with
information based on recording of morbidity. Since then there has been increasing
recognition of the importance of morbidity studies, particularly from general practice,
to describe and detect changes in the community's health status, and to predict
health trends that may affect the need for medical services. Morbidity data are
necessary for the study of causation of disease and factors influencing the incidence
and natural history of disease, and in the evaluation of the effect of preventive
procedures and medical care on the prevalence and severity of disease and the
disability resulting from disease.
The International Classification of Diseases began its career in 1893 as an
international list of causes of death. Listing for both mortality and morbidity purposes,
and change of name, did not occur until the sixth revision in 1948. The emphasis has
therefore been on diseases in terms of their aetiology, pathology and morphology.
Historical Background of ICPC
In primary care many of the conditions treated are vague and ill-defined and they can
be classed only under broad general headings. In 1963 the Royal College of General
Practitioners estimated that only fifty-five per cent of diseases in general practice
could be diagnosed accurately in terms of aetiology, pathology and morphology.
Others can only be diagnosed in terms of symptoms or complaints, and some
consultations such as those for immunisation or medical examination do not relate to
an underlying condition.
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Until the mid 1970's most morbidity data collected in primary care research was
classified using the International Classification of Diseases (ICD)7,8.This had the
important advantage of international recognition, aiding comparability of data from
different countries. However there was the disadvantage that the many symptoms
and non-disease conditions that present in primary care were difficult to code with
this classification, originally designed for application to mortality statistics and with a
disease-based structure.
The Classification Committee of the World Organisation of National Colleges,
Academies and Academic Associations of General Practitioners/Family Doctors
(WONCA) first met in 1972 in Melbourne at the time of the inauguration of WONCA.
Many of its members had already been corresponding for some years about
morbidity classifications for general practice. The Committee agreed that it was
time to design a classification specifically for primary care.
Recognising the problems of the ICD, and the need for an internationally recognised
classification for general practice, the WONCA Classification Committee designed
the International Classification of Health Problems in Primary Care (ICHPPC), first
published in 19759 , with a second edition in 197910 related to the 9th revision of ICD.
Although this provided a section for the classification of some undiagnosed
symptoms, it was still based on the ICD structure and was still inadequate. A third
edition (ICHPPC-2-Defined) in 1983 had added to it criteria for the use of most of the
rubrics11 greatly adding to the reliability with which it could be used, but not
overcoming its deficiencies for primary care. A new classification was needed for
both the patient's reason for encounter and the provider's record of the patients
problems.
At the 1978 World Health Organisation (WHO) Conference on Primary Health Care
in Alma Ata12, adequate primary health care was recognised as the key to the goal of
"health for all by the year 2000". Subsequently both WHO and WONCA recognised
that the building of appropriate primary care systems to allow the assessment and
implementation of health care priorities was only possible if the right information was
available to health care planners. This led to the development of new classification
systems.
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Later in 1978 WHO appointed what became the WHO Working Party for
Development of an International Classification of Reasons for Encounter in Primary
Care13. This group, a majority of whose members were also members of the
WONCA Classification Committee, developed a Reason for Encounter Classification
(RFEC) 13,14,15 which later became ICPC.
Reasons for Encounter
Reasons for encounter (RFEs) are the agreed statement of the reason(s) why a
patient enters the health care system, representing the demand for care by that
person. They may be symptoms or complaints (headache or fear of cancer), known
diseases (flu or diabetes), requests for preventive or diagnostic services (a blood
pressure check or an ECG), a request for treatment (repeat prescription), to get test
results, or administrative (a medical certificate). These reasons are usually related to
one or more underlying problems which the doctor formulates at the end of the
encounter as the conditions that have been treated, which may or may not be the
same as the reason for the encounter.
Disease classifications are designed to allow the health care providers' interpretation
of a patient's health care problem to be coded in the form of an illness, disease, or
injury. In contrast, a Reason for Encounter classification focuses on data elements
from the patient's perspective13,16,17. In this respect, it is patient-oriented rather than
disease- or provider -oriented. The reason for encounter, or demand for care, given
by the patient has to be clarified by the physician or other health worker before there
is an attempt to interpret and assess the patient's health problem in terms of a
diagnosis, or to make any decision about the process of management and care.
The working group developing the RFE classification tested its several versions in
field trials. The first field trial to test the completeness and reliability of the RFEC was
a pilot study carried out in the Netherlands in 198014. The results obtained from this
pilot study prompted further feasibility testing in 1983. This was carried out in nine
countries, namely, Australia, Brazil, Barbados, Hungary, Malaysia, The Netherlands,
Norway, the Phillipines and the United States15,18,19. The entire classification was
translated from English into several languages, including French, Hungarian,
Norwegian, Portuguese and Russian. The analysis of more than 90,000 reasons for
encounter recorded during over 75,000 individual encounters and the collective
experience of the participants resulted in the development of a more comprehensive
classification 15,18,19.
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In the course of this feasibility testing it was noted that the RFEC could easily be
used to classify simultaneously the reasons for encounter and two other elements of
problem-oriented care, namely the process of care and the health problems
diagnosed. Thus this conceptual framework allowed the evolution of the Reason for
Encounter Classification into the International Classification of Primary Care (ICPC).
Problems in relation to the concurrent development of ICD-10 prevented WHO from
publishing the RFEC. However WONCA was able to develop ICPC from it and
publish the first edition in 1987. While ICPC-1 was much more appropriate for
primary care than previous classifications based on the ICD framework, it did not
include inclusion criteria for the rubrics, or any cross referencing. It was thus in this
respect less useful than the previous publication, ICHPPC-2-defined, though it
referred to it as a source of inclusion criteria which could e used.
In 1985 a project began in a number of European countries to use the new
classification system to produce morbidity data from general practice for national
health information systems. This involved translations of the classification and
comparative studies across countries. The results were published in 1993 in a book
including an update of ICPC20.
In 1980 WONCA became a Non-Government Organisation (NGO) in official relations
with WHO, and joint work together since has led to a better understanding of the
requirements of primary care for its own information systems and classifications
within an overall framework encompassing all health services.
The International Classification of Primary Care (ICPC)
The International Classification of Primary Care (ICPC*)21 broke new ground in the
world of classification when it was published in 1987 by WONCA, the World
Organisation of National Colleges, Academies, and Academic Associations of
General Practitioners/Family Physicians, now known more briefly as the World
Organisation of Family Doctors. For the first time health care providers could
classify, using a single classification, three important elements of the health care
encounter; reasons for encounter (RFE), diagnoses or problems, and process of
care. Linkage of elements permits categorisation from the beginning of the encounter
with RFE to its conclusion.
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The new classification departed from the traditional International Classification of
Disease (ICD) chapter format where the axes of its several chapters vary, from body
systems *(Chapters III, IV, V, VI, VII, VIII, IX, X, XI, XIII and XIV) to *aetiology
(Chapters I,II,XVII,XIX,XX) and to others (Chapters *XV,XVI,XVIII,XXI). This mixture
of axes creates confusion, since diagnostic entities can with equal logic be classified
in more than one chapter, for example influenza in either the infections chapter or
the respiratory chapter, or both. Instead of conforming to this format, the ICPC
chapters are all based on body systems, following the principle that localization
has precedence over aetiology . The components that are part of each chapter
permit considerable specificity for all three elements of the encounter, yet their
symmetrical structure and frequently uniform numbering across all chapters facilitate
usage even in manual recording systems. The rational and comprehensive structure
of ICPC is a compelling reason to consider the classification a model for future
international classifications.
Since publication ICPC has gradually received increasing world recognition as an
appropriate classification for general/family practice and primary care, and has been
used extensively in some parts of the world, notably in Europe 20 and Australia 22.
* ICPC was first published in 198720. This is now referred to as ICPC-1. In 1993 it
was included in a publication about its use in Europe19. This is referred to as ICPCE. This 1998 publication is referred to as ICPC-2. ICPC is used when referring to
the generic classification.
Classifications for primary care
Classifications for primary care have a number of requirements which differ from
those of other branches of medicine because of the different spectrum of conditions
seen and the different diagnostic and management processes involved.
The classification must cover the full spectrum of conditions treated, including
undifferentiated complaints and symptoms, health promotion and prevention, as well
as a full range of specified diseases. Abdominal pain should be reportable as
"abdominal pain" and not, for example, as "?appendicitis" simply because there is
nowhere else to include it.
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Conditions must be able to be determined on clinical grounds, without requiring
distinctions to be made by inappropriate sophisticated investigations, or, even worse,
by requiring knowledge of the underlying pathogy.
The classification should be logical and based on recognised criteria such as body
systems, so that every condition has only one logical place. This is not the case with
ICD, where the main groupings (chapters) include body systems, aetiology and
patient age, with the result that influenza could as logically be in the infection chapter
as in the respiratory chapter, and all perinatal conditions in any body system are
grouped in one chapter.
The classification should be hierarchical, allowing entry of data at a specific level
when indicated (eg. adeno-carcinoma of the colon) or at a much less specific level
(bowel cancer) when either the clinical condition is not yet clear or the purpose of the
data recording does not require detail. The more specificity required, the less reliable
is the data.
Finally the classification should have clear outlines and rules, so that users
appreciate how conditions are related within it. This means that the basic structure
should not be too extensive, and the classification not too large.
No one classification meets all these requirements. Even if one did, it would not
necessarily be ideal for all purposes. It is however important in the interests of
comparability of data, particularly but not only on an international basis, to use
classifications which have a defined relationship to others, especially to the most
used, ICD. The narrow pathological basis of ICD has been considerably widened in
the 9th and 10th revisions, the latter now including in its title "diseases and related
health problems". However it is far from easy to use for primary care purposes, and
the classifications specially developed for that purpose are to be preferred.
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References
1.
World Health Organisation, International Statistical Classification of Diseases and Related Health Problems, 10th Revision,
ICD-10, Geneva, WHO, 1992
2.
World Health Organisation, International Classification of Diseases, 9th Revision. Geneva, WHO 1977
3.
Classification Committee of WONCA, ICHPPC-2-Defined; International Classification of Health Problems in Primary Care,
Oxford, Oxford University Press, 1983
4.
5
Lamberts H and Wood M (eds) ICPC: International Classification of Primary Care, Oxford, Oxford University Press, 1987
World Organisation of National Colleges, Academic & Academic Associations of General Practitioners/Family Physicians.
The International Classification of Primary Care, Oxford University Press. 1998 (ISBN 0-10-262802-X)
6
Hofmans-Okkes IM, Lamberts H. The International Classification of Primary Care (ICPC): new applications in research and
computer based patient records in family practice.Family Practice 1996; 13: 294-302
7
*International classification of diseases (9th revision). *Geneva, World Health Organization, 1977.
8
*International Statistical Classification of Diseases and Related Health Problems (10th revision).Geneva,World Health
Organisation,1992.
9
International Classification of Health Problems in Primary Care (ICHPPC). Chicago, World Organization National Colleges,
Academies and Academic Associations of General Practitioners/Family Physicians (WONCA)/American Hospital
Association (AHA), 1975.
10
ICHPPC-2 (International Classification of Health Problems in Primary Care). Oxford, Oxford University Press, 1979.
11
ICHPPC-2-Defined: International Classification of Health Problems in Primary Care, 3rd edition. Oxford, Oxford University
Press, 1983.
12
Report of the International Conference on Primary Care, Alma Ata, USSR, 6-12, September 1978; WHO/Alma Ata/78.10.
13
Meads, S. The WHO Reason for Encounter classification. WHO Chronicle, 1983; 37 (5): 159-162.
14
*.Lamberts H, Meads S, and Wood M. Classification of reasons why persons seek primary care: pilot study of a new
system. Public Health Reports, 1984; 99: 597-605.
15
*Lamberts H, Meads S, and Wood M. Results of the international field trial with the Reason for Encounter Classification
(RFEC). Med Sociale Preventive,1985; 30: 80-87.
16
Working Party to develop a classification of the 'Reasons for Contact with Primary Health Care Services'. Report to the
World Health Organization, Geneva, Switzerland, 1981.
17
*Wood M. Family medicine classification systems in evolution. J Fam Pract, 1981; 12: 199-200.
18
*Lamberts H, Meads S, and Wood M. Results of the field trial with the Reason for Encounter Classification (RFEC). In:
Cote RA, Protti AJ, and Scherner JR eds. Role of Informatics in Health Data Coding and Classification Systems.
Amsterdam, Elsevier Sci Publ/JFIP-JMIA, 1985.
19
Bentsen BG. International Classification of Primary Care. Scandinavian J Primary Hlth Care 1986;4:43-56
20
*Lamberts H, Wood M, Hofmans-Okkes I, eds. The International Classification of Primary Care in the European
Community: with Multi-Language Layer. Oxford, Oxford University Press, 1993.
21
Lamberts H, Wood M eds. ICPC: International Classification of Primary Care. Oxford, Oxford University Press, 1987
22
Bridges-Webb C, Britt H, Miles DA, Neary S, Charles J, Traynor V. Morbidity and treatment in general practice in Australia
1990-1991. Med J Aust 1992; 157, Supp.19 Oct :S1-S56.
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SECTION 3:
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THE INTERNATIONAL
CLASSIFICATION OF PRIMARY CARE
–STRUCTURE AND DERIVATIVES
This section has largely been drawn from:
Lamberts H, Wood M. (eds). ICPC International Classification of Primary Care.
Oxford. Oxford University Press 1987.1
Though ICPC was primarily designed for the classification of patient reasons for
encounter (RFEs)* by the primary care provider at the time of the consultation, it can
also be applied to the provider's assessment of the problem (diagnoses) and to the
diagnostic and therapeutic interventions utilised at the encounter.
*
Patient reasons for encounter (RFEs) are very different from the diagnoses or
problems managed. For an adequate description of the content of general
practice, the whole process of care needs to be considered, including the
reasons patients seek care. While the concept of recording patients' reasons
for attendance is relatively new in Australia, in many countries increased
interest in the patient-centred approach to medical care has led GPs to record
the patients RFE in their medical records as a matter of course. In Australian
general practice it is more likely that the GP will record presenting symptoms,
which may represent only part of the patient's RFE. ICPC is ideal for recording
both RFEs and presenting symptoms, and it is up to the individual general
practitioner to decide whether either or both of these elements are to be coded.
SOAP
Therefore three of the four parts of a patient's problem-oriented clinical record, which
reflect the essential elements of each patient/provider encounter, can be coded using
the ICPC.
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S=
Subjective:the patient's reason for encounter (or presenting symptoms)
O = Objective:this element cannot be classified using ICPC
A = Assessment:the provider's interpretation of the problem in the form of a diagnosis
or problem label
P = Plan:the process of care intervention undertaken by the provider
ICPC STRUCTURE
It has a biaxial structure with 17 chapters on one axis and seven components on the
other.
Chapters are based on body systems with an additional chapter for psychological
problems and one for social problems. Each chapter is identified by a single alpha
code which is the first character of all rubrics belonging in the chapter (Figure 3.1)
Each chapter is divided into seven components, identified by a range of two digit
numeric codes which are not always uniform across chapters.
Figure 3.1: Structure of ICPC
Chapters
A
Components
B
D
F
H
K
L
N
P
R
S
T
U
W X
U
W
X
Y
Z
Urinary
Pregnancy, family planning
Female genital
Male genital
Social
1. Symptoms, complaints
2. Diagnostic,screening
prevention
3. Treatment, procedures
medication
4. Test results
5. Administrative
6. Other
7. Diagnoses,disease
A
B
D
F
H
K
General
Blood, blood forming
Digestive
Eye
Ear
Circulatory
L
N
P
R
S
T
Musculoskeletal
Neurological
Psychological
Respiratory
Skin
Metabolic, endocrine,
nutrition
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Y
Z
Return to Instructions
Component 1 provides rubrics for symptoms and complaints. It drew on the National
Ambulatory Medical Care Survey/Reason for Visit Classification (NAMCS/RFV) 2,3 and
on the RFE-C developed by the WHO working party.2,4,5. Rubrics in this component
can be used to describe presenting symptoms, and are valuable for describing the
problem under management (in a problem list in the medical record) when the condition
is as yet ill-defined (eg: general ill-feeling; feeling tired).
Component 7 is the diagnoses/disease component in each chapter. This component
will be the one most often used when you have sufficient information to arrive at a
diagnosis in the medical record or problem list. It is based on the ICHPPC-2 and most
rubrics are directly comparable. However the psychological and social chapters of ICPC
are drawn from problem lists developed by the WHO sponsored Triaxial Classification
Group 6,7.
Within this diagnostic component are five sub groups which are not numerically uniform
across chapters:
. infectious diseases;
. neoplasms;
. injuries;
. congenital anomalies;
. other diseases.
Components 1 and 7 in ICPC function independently in each chapter and either can
be used to code patient RFEs, presenting symptoms, or problems managed.
Components 2-6 are common throughout all chapters, each rubric being equally
applied to any body system.
Component 2 covers diagnostic screening, prevention. It is useful when there is no
underlying pathology for the problem under management eg: immunisation, check up
(partial or full); advice and health instruction.
Component 3, treatment, procedures and medication. This component should rarely if
ever be used to describe a problem under management as it covers the processes
involved in patient care. However for those who wish to code procedures as well as
problems, these codes will prove very useful.
Components 2 and 3 are based broadly on the ICD-9 Procedures in Medicine 8 and
are heavily influenced by the International Classification of Process in Primary Care (ICProcess-PC).9
Component 4, Test results and Component 5, Administrative, provide somewhere to
put those difficult problem labels which frequently have no pathology (eg: completing a
patient's application for a passport would fall into Component 5).
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The structure of ICPC represents a move away from the combined anatomical and
aetiology based structure of ICD. For example, where ICD includes a separate chapter
for neoplasms, one for infections and infestations, and another for injuries, such
problems are distributed among chapters in ICPC, depending on the body system to
which they belong. Regrouping of the rubrics (eg for all neoplasms in all body systems)
can still be undertaken across chapters if analysis of totals is required. Grouping is
further discussed in Section 5.
REFERENCES
1. Lamberts H, Woods M (eds). ICPC. The international classification of primary care. Oxford: Oxford
University Press, 1987.
2. A reason for visit classification for ambulatory care. Hyattsville,MD: U.S. Public Health Service,
National Centre for Health Statistics (DHEW Pub. 79-1352), 1979.
3. Patients' reasons for visiting physicians: National Ambulatory Medical Care Survey, United States,
1977-1978. Hyattsville,MD: Series 13,56 (DHS Publications 82-1717), 1981.
4. Lamberts H, Meads S, Wood M. Results of the international field trial with the reason for encounter
classification (RFEC). Role of informatics in health data coding and classification systems.
Amsterdam Elsevier Sci. Publications, 1985.
5. Meads S. The WHO reason-for-encounter classification. WHO Chronicle 1983; 37: 159-162.
6. Lipkin M and Kupka K.(eds) Psycho-social factors affecting health. New York: Praeger, 1982.
7. WHO. Psychological factors affecting health assessment, classification and utilisation. Report of the
World Health Organisation on the Bellagio Conference. Geneva: WHO, 1980.
8. WHO. International classification of diseases (9th revision). Geneva: World Health Organisation,
1977. 9. WONCA Classification Committee. IC-Process-PC (International classification of process
in primary care ) Oxford: Oxford University Press, 1986
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SECTION 4:
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ABOUT ICPC-2 PLUS
This section has been based on the following paper:
Development of a database for the International Classification of Primary Care, for direct
entry. H Britt.
Presented to the 14th WONCA WORLD CONFERENCE, Hong Kong. June 1995.
Background to ICPC PLUS
The International Classification of Primary Care, or ICPC, was designed by the WONCA
Classification Committee, primarily for use by the health care provider at the time of the
consultation on paper based records.
The Family Medicine Research Unit (FMRU), University of Sydney has however used it in
the centralised coding of patient reasons for encounter (RFEs) and problems managed in
the Australian Morbidity and Treatment Survey (AMTS)1 and in a popular Quality Assurance
option, the Morbidity and Therapeutic Index (MTI). The FMRU have secondarily coded over
3/4 of a million patient RFEs and equivalent numbers of problems managed from paper
based encounter records completed by general practitioners throughout Australia.
In the early stages of this paper based coding, it was evident that high inter and intra coder
reliability was difficult to attain with ICPC. Errors in the index were noted and the
classification’s layout was sometimes confusing. But more importantly the ICPC’s
alphabetical index was found to be inadequate for reliable coding of many terms commonly
recorded by GPs.
From 1991-97 thousands of terms were added by the FMRU to the ICPC index to facilitate
access to the correct code. When unsure of where to place a term in ICPC, the Chairman of
the WONCA Classification Committee was referred to, who by reference to ICD-9/10,
selected the correct code. Utilising this mechanism the index continued its expansion on the
basis of terminology used by Australian GPs, to describe patient RFEs and diagnoses.
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Development of the computerised database
The FMRU found that using ICPC with a widely expanded index worked well in a centralised
paper based coding system and provided sufficient specificity for epidemiological data
analysis. However, in the absence of any other acceptable classification system, the unit
came under increasing pressure from GPs to adapt ICPC for computer usage in the clinical
primary care setting.
One of the major problems with using ICPC for computerised medical systems, was its lack
of specificity in some areas.
For epidemiologists it may be adequate to count the number of patients or encounters
with an “other viral illness” (i.e. the number of A77’s that arise). However, in a clinical
setting the practitioner must be able to differentiate between the 33 viral illnesses
which fall into this rubric:
A77 - Other viral illness
For Example, if you practice in one of our sub-tropical areas, it may be very important to be
able to identify the patients who are suffering specifically from Ross River Fever, not just
"other viral illness".
There are two ways around the problem, neither ideal:
1.
2.
Select all records including A77 then use a word search engine to find all records
involving Ross River Fever... and hope you have never mis-spelt it.
Create another level in the hierarchy.
When developing ICPC PLUS (a computerised classification system derived from ICPC)
some users of ICPC suggested that further hierarchical layers should be added for
increased specificity. However ICPC was not designed for such extension.
Using hypertension as an example, a possible hierarchy may have one code at the upper
level for hypertension (not otherwise stated). The next level may be defined as "primary" or
"secondary". At the third level it may be "benign" or "malignant" and at the fourth level
"with/without target organ involvement" (see Figure 4.1). Specific target organ involvement
could be differentiated at the next level.
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In ICPC there are already two codes for hypertension, one without complications and
one with involvement of target organs. Both of these rubrics cross multiple levels of
the hierarchy.
FIGURE 4.1: A possible hierarchy for the diagnosis of hypertension.
HYPERTENSION
(not otherwise stated)
PRIMARY
Benign
SECONDARY
Malignant
Malignant
No
+
involved target involved target
organs
organs
+
involved target
organs
Non-malignant
No
involved target
organs
Extension of the hierarchy is further complicated by lack of agreement about definitions and
synonymous terms, even within one country. Using Diabetes as an example (see Figure
4.2) we could probably gain clinician consensus that: Type I diabetes is synonymous with
insulin dependent diabetes, and that IDDM is an acceptable acronym; that Type II diabetes
is synonymous with non-insulin dependent diabetes and NIDDM is an acceptable acronym.
However, the extent to which the remaining terms listed in Figure 4.2 are synonymous with
either of these labels is questionable. Some people would state that "juvenile onset diabetes"
equates with Type I. Others would disagree, stating that Type I diabetes can also be adult
onset. In the long term, agreement between practitioners, (both nationally and
internationally), regarding definitions and synonyms may be reached. Until such time,
creating a hierarchical structure under the upper level of (e.g.) "diabetes" is not possible.
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Figure 4.2
Possible terms in the Diabetes Mellitus group
Diabetic coma
Diabetes Mellitus (NOS)
Diabetes; complicated
Non Insulin dependent diabetes
Insulin dependent diabetes
Juvenile onset diabetes
Adult onset diabetes
Diabetes:Type I
Diabetes:Type II
Figure 4.3 - ICPC CODE A77 - Other viral illness
Keyword
Term Description
ICPC Code
Term Code
VIRAL
ADENOVIRUS
VIRUS
COWPOX
DISEASE
COXSACKIE
VIRAL
VIRUS
HERPANGINA
DENGUE
VIRUS
VIRAL
DISEASE
HANDFOOT
COXSACKIE
VIRAL
VIRUS
HERPANGINA
VIRUS
VIRAL
HERPES
VIRAL
INFECTIONS
PSITTACOSI
ORNITHOSIS
ORNITHOSIS
PSITTACOSI
VIRUS
RABIES
VIRAL
FEVER
ROSSRIVER
VIRAEMIA
VIRUS
BLOOD
VIRAL
VIREMIA
ILLNESS
DISEASE
VIRAL
VIRUS
FEVER
VIRAL
VIRUS
YELLOW
Adenovirus
Adenovirus
Adenovirus
Cowpox
Coxsackie virus
Coxsackie virus
Coxsackie virus
Coxsackie virus
Coxsackie virus
Dengue
Dengue
Dengue
Disease;hand foot & mouth
Disease;hand foot & mouth
Herpangina
Herpangina
Herpangina
Herpangina
Herpes
Herpes
Herpes
Infection;viral
Infection;viral
Ornithosis
Ornithosis
Psittacosis
Psittacosis
Rabies
Rabies
Rabies
Ross River fever
Ross River fever
Viraemia
Viraemia
Viraemia
Viraemia
Viraemia
Viral illness
Viral illness
Viral illness
Virus
Yellow fever
Yellow fever
Yellow fever
Yellow fever
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
A77
001
001
001
024
003
003
003
003
003
002
002
002
004
004
008
008
008
008
023
023
023
010
010
011
011
016
016
012
012
012
013
013
017
017
017
017
017
005
005
005
020
007
007
007
007
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ICPC PLUS
The extended medical term index developed from the GP encounter forms was entered in a
SQL relational database.
ICPC PLUS term and code creation
Terms codes: As each term was entered into the database, the computer automatically
allocated a term code. (eg: in Fig. 4.3: Viral illness = term code 005 within ICPC code A77).
Thus each term has a unique identifier (A77023) which allows storage of the more specific
term in the medical record.
Keywords: For each term, one or more keywords were allocated.
eg: in Fig 4.3: Term code 005 has three keywords by which access can be gained to that
term: vira, illness and disease. Therefore, while each term within any one ICPC rubric has a
unique code, a GP may, on different occasions, use different keys to access that term.
The GP may choose to describe a single medical concept in different terms on specific
occasions. (e.g. "Diabetes Type I" and "Insulin dependent diabetes"), and his/her term
selection should be saved in the medical record - not changed to the description of the ICPC
rubric.
Note that the terms are listed in term code order which is derived purely from the order of
entry. There is only one term code per term, irrespective of the number of keywords. New
keywords and additional codes are being added and will continue to be added on request.
In ICPC PLUS, as in any other indexed system, a single keyword can lead to multiple
concepts and at times, to multiple ICPC rubrics, and these should be offered as a pick list.
For example, if you enter the term diab or diabetes, the picklist (all the terms attached to
diabetes - in the second column in Figure 4.2) should appear together with others (such as
diabetes in pregnancy) which do not belong with code T90.
The concept follows that used in the Read Clinical Codes. For the clinician, the exercise is
one of terming, rather than coding. What secondary coders do (i.e. medical records coding
clerks in hospitals) is find the recorded medical term and allocate the correct code to the
term. In contrast, this system allows the practitioner to select the TERM most suitable to
his/her needs, from the pick list. The computer transparently attaches the correct ICPC
code for the concept and the code number of the selected term, i.e. "terming" rather than
"coding". To all intents and purposes, you should be relatively unaware of the coding
process.
Distribution of ICPC/ICPC-2
Permission was sought from WONCA to offer the database to software houses for wider
application in general practice. While some GPs were already using ICPC in noncommercial GP data systems, in the main they were using unlicensed copies of ICPC.
Further, in many cases, they used idiosyncratic adaptations which resulted in noncomparable data.
In an effort to improve the standardised use of the classification, and to ensure copyright of
the ICPC/ICPC-2 was upheld, WONCA provided the FMRU with the exclusive license for the
distribution of ICPC/ICPC-2 in electronic form in Australia and the Pacific Basin.
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ICPC-2 PLUS
ICPC PLUS broke new ground when it was first released in 1991. It was the first
computerised classification system that had been specifically designed for Australian
general practice and primary care. It has been implemented by a number of software
suppliers in clinical systems across the nation and has an End User base that is rapidly
growing and diversifying.
With the advent of the World Organisation of Family Doctors release of a revised edition of
ICPC the Family Medicine Research Unit has created a second version of ICPC PLUS,
namely ICPC-2 PLUS.
This new revised version was developed with continued consultation with the Chairman of
the WONCA classification committee. It maintains its predecessors structure of terms and
process of keyword allocation approach to classification as a terming rather than coding
process
Development of ICPC-2 PLUS
The conversion process from ICPC PLUS to ICPC-2 PLUS was a 3 stage process due to the
significant changes in the structure of ICPC-2. A number of ICPC rubrics were deleted in
ICPC-2 and a number of new rubrics were added to the classification.
Firstly the final version of ICPC PLUS was copied into a new database that contained ICPC2’s structure and revised rubrics. ICPC PLUS terms located in rubrics that had been deleted
in ICPC-2 were then moved to applicable ICPC-2 rubrics and their path mapped. Finally all
new ICPC-2 rubrics were identified and terms added to them.
In particular, there were significant additions made in the areas of therapeutic and diagnostic
procedures, psychological counseling and referrals to specialists and allied health
professionals.
Map creation
Through this entire process of term movement a map was developed to convert
retrospective data collected by End Users of ICPC PLUS into ICPC-2 PLUS. Such a map
allows users to access all information previously collected in ICPC PLUS in a valid ICPC-2
PLUS term.
Once the conversion from ICPC PLUS to ICPC-2 PLUS was complete the following steps
were undertaken as part of the ongoing development of the extended vocabulary:
A number of new terms were added in response to user requests and the Units own review
process:• Significant revision of keywords and term access pathways was undertaken
• Picklist structure and presentation was targeted for refinement
• Tests ordered (particularly pathology and imaging) were expanded
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Analysing stored information with ICPC PLUS
Getting the data in to a medical record system in a classified form is of course only the first
part of the process. There is no point in entering the information if you are unable to draw it
out in a useful manner. It is important that you utilise the conversion map provided to your
software developer to transfer any data collected in ICPC PLUS into ICPC-2 PLUS terms
before you begin any data analysis.
Sorting at ICPC-2 rubric level
This is the easiest method of identifying a specific group of patients in your practice.
You want a list of all your patients who have attended your practice for uncomplicated
hypertension:
Enter hypertensi and you will find the normal picklist associated with that keyword; highlight
the one you want ("hypertension uncomplicated") and ask the computer to provide the list
of patients having that entry.
Alternatively you may wish to identify the ICPC-2 code for uncomplicated hypertension (K86)
and then ask for the list of all records having that code attached.
Sorting at multiple rubric level
While it is useful to be able to sort your stored data at individual rubric level (as above),
sometimes you may want to identify a group of patients who have any one of multiple
diagnoses or symptoms.
Example 1
You want to identify all patients in the practice who have attended for uncomplicated
hypertension (K86); hypertension with complications (K87); and elevated blood pressure
without diagnosis of hypertension (K85). You would search for all records which include any
one of these three codes.
Example 2
When viewing the relative frequency of presentations of rash, there are two symptom codes
available to represent this concept: localised skin rash, coded as S06 and generalised skin
rash, coded as S07. If you wanted to identify all the patients who had presented with skin
rash (generalised or localised) both codes would need to be searched.
For these more general concepts which involve multiple ICPC-2 rubrics, you can also utilise
the list of Code Groupers provided in Section 5 to ensure all cases will be selected. These
code groupers have been provided to software developers so you should be able to view the
grouper list on your computer or select them automatically if your software allows.
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Revised components
Analysing your records by CHAPTER-COMPONENT Groupers you can identify the codes
to be included when analysing on the basis of broader medical constructs.
As described in Section 3, the ICPC-2 is divided into seven components which are common
to all chapters, only components 2-6 being made up of rubrics which can be applied equally
in all chapters. Components 1 (symptoms) and 7 (diagnoses) differ in each chapter
according to the most frequent symptoms and diagnoses which occur in each body system
or psychosocial area.
While working with ICPC-2 it became clear to the Family Medicine Research Unit that the
division between the two components was not always correct. Some diagnostic labels (e.g.
paronychia; warts) had been included in the symptom section. This was particularly so in the
skin chapter where there were insufficient codes available in the diagnostic section. In other
cases symptoms were included in the diagnostic component (eg: K85; high blood pressure
without a diagnosis of hypertension).
Further, attempts had clearly been made by the Classification Committee to subdivide the
diagnostic component in a uniform manner across chapters, into infections, neoplasms,
injuries, congenital anomalies, and other diagnoses. However, due to the variable extent to
which each of these types of problems applied in each body system, the range of numerical
codes falling into each sub-group varied between chapters. This meant that analysis of a
sub-group across chapters (eg: all injuries; all neoplasms) could not be undertaken by a
simple selection of common numerals across all chapters.
A detailed review of the component breakdown was undertaken and under the guidance of
the Chairman of the WONCA Classification Committee rubrics were re-allocated to their
correct component and a more detailed component breakdown created.
The new categorisation includes eleven components, the original diagnostic component
(component 7) having been further broken down into the sub-groups mentioned above. A
chart of the new components by chapter, including lists of all codes which should be
included in each cell is shown in your User Guide. This chart has been supplied to all
software developers utilising ICPC-2 and should therefore be included in your program in
some form.
Some examples of analyses using chapter-component combinations are:
• All patients treated for any injury over the past year (All chapters- Component 10);
• All patients managed for an infection of the skin (Chapter S - Comp 8) in the last month;
• All male patients managed for a male genital disease (Chapter Y - component 7 [made up
of components 8-12]).
Analysis using part of an ICPC rubric
When you are only interested in one part of an ICPC rubric: first view the list of terms
available with their varied term keys, select all those which you feel should be included and
select these term codes for inclusion in the analysis.
For example:
You wish to send a recall letter to all patients who require DPT immunisations:- review the list of all
terms for *44 and select those which you feel should be included in this sub-group. If the software
allows, you could select on a variety of other fields as well, e.g. all female patients, aged 0-6 years.
REFERENCES
1.
Bridges-Webb C, Britt H, Miles DA, Neary S, Charles J, Traynor V. Morbidity and treatment in general practice. Med J
Aust 1992; 157 (19 Oct Spec Supl): S1-S56
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SECTION 5:
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HINTS FOR USING ICPC-2 PLUS
Getting Started
Firstly, to get a "feeling" for the classification you are about to use, read the background
(particularly the structure of the coding frame, Sections 3 & 4).
“Terming’ with ICPC-2 Plus
ICPC-2 PLUS utilises a technique of ‘terming’ rather than ‘coding‘ to summarise data.
‘Terming’ refers to the entry of a few key letters or a brief keyword to access a picklist of
possible terms which may be used to describe a particular medical concept (see over).
When a term is selected the computer transparently attaches the correct ICPC-2 PLUS code
number. In contrast ‘coding’ is a much more laborious task which involves interpretation of
the medical record, looking up, selecting and applying the most appropriate code.
Keywords
Term ICPC
Code No.
Speaking
Unable (to); speak
N19 002
Medical concept you wish to
describe
Automatically allocated when
you select a term
Speech
Unable
Inability
Talk
Keywords that can be used to
access a picklist of related
terms
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Term organisation
To facilitate the reading of ‘picklists’ the terms in ICPC-2 PLUS are generally organised
using two basic structures:
1. ‘Common usage’ expression eg. Irritable bowel syndrome or
2. ‘Problem or Procedure; type; site’ organisation. eg. Pain;cardiovascular; chest.
The Problem or Procedure is usually the first word to appear in the term which provides a
‘generic’ description of the issue to be coded eg. pain. These ‘first words’ may be used as
keywords when a comprehensive list of all the terms under that generic description is
required.
Problems include words such as lesion, inability, infection, anaemia, fracture etc.
Procedures include words such as excision, destruction, test , admin etc. (see Section 6 for
a list of the standard process components of ICPC - components 2 to 6).
Type usually includes words such as acute, chronic, benign, malignant etc. These are often
not designated keywords unless they are particularly relevant to a term. The problem or
procedure ‘type’ facilitates terming because it provides a secondary level of organisation of
terms on a picklist.
Site identifies the location of the problem or procedure eg. chest, arm, leg, heart etc.
Selecting a ‘site’ as a keyword will often produce a long ‘picklist’ of terms. This is useful
when identifying terms related to a specific site.
Acronyms you see in ICPC-2
The following acronyms are generally not used in ICPC-2 terms:
NOS: Not otherwise specified (or in clinical terms - not yet able to be more specific),
NEC: Not elsewhere classified (or in clinical terms - not able to be classified more precisely
within the options
Levels of specificity are usually indicated by the type or site part of the term. If this level of
specificity is not included then the term is assumed to include the ‘not otherwise specified’.
eg. the term ‘hypertension’ is equivalent to the previously used ‘hypertension;NOS’.
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Keywords in ICPC-2 PLUS
In addition to the development of a more comprehensive list of Keywords, a number of
changes have been implemented regarding keywords to provide easier access to terms.
Following are some hints specifically related to keyword usage:
Avoid spaces, dashes or slashes within Keywords: To provide greater uniformity of keyword
syntax all spaces, dashes and slashes have been deleted.
No slash
S/E replaced with SE
No dash
POST-OP replaced with POSTOP
CHECK-UP replaced with CHECKUP
SIDE-EFFECT replaced with SIDEEFFECT
X-RAY replaced with XRAY
No space
HIGH BLOOD replaced with HIGHBLOOD
POST TERM replaced with POSTTERM
CIN 1replaced with CIN1
PORT WINE replaced with PORTWINE
Use singular keywords instead of plural
Eg.
TOE instead of TOES
INJURY instead of INJURIES
TEST instead of TESTS
NB. You will see that the keyword listing provided in ‘Appendix A’ uses pleural rather than
singular syntax. In general, the keywords on the list are the longest version of the most
suitable keyword. The list has been created this way as a precaution for users who might
forget to use singular keywords. It is advised, however, that users adopt generally, a practice
of entering keywords in their singular form.
Keyword selection. If you cannot find the term you require consider:
spelling....
(ICPC-2 PLUS generally uses Australian English rather than American eg. Oesophagus
NOT esophagus, immunisation NOT immunization)
entering a shorter version of the keyword.... eg. Arteri instead of arteriosus, thrombo
instead of thrombocytic. The shorter the keyword the wider the picklist.
a different form of the word .... e.g. aged or aging, allergic or allergy, absent or absence,
depression or depressive or depressed
the term organisation....
ie. ‘Common usage’ or ‘problem;type;site’ structure.
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Analysing Information Stored With ICPC-2 PLUS
Code groupers
When trying to analyse the data you have recorded, the medical concept of interest may not
always be contained within a single term. The example of hypertension was described
earlier. Another example is the concept of depression: there are two codes available, one for
the diagnosis of depression and one for the symptom of "feeling depressed". If searching for
all patients with any form of depression you may wish to search the database for the
occurrence of BOTH codes (P03 and P76). A list of code groupers is provided below in
Figure 5.1 and should be available in your software.
Major chapter-component groups
These have been discussed earlier. The corrected chapter component groups are presented
below (Figure 5.2) and have been provided to your software supplier for incorporation into
your software.
GPs’ Questions Answered
The FMRC has received several inquiries from users of ICPC-2 PLUS, which suggest that
some hints about its application in a clinical setting may be helpful.
Question:
Can appendicectomy, mastectomy and hysterectomy be coded?
Answer: YES
These are all terms which refer to a process rather than to a diagnosis or problem under
management. ICPC-2 PLUS now covers these procedural terms, if, you wish to record
problems in this form in the History section of a record.
This brings up the issue of how the meaning of a medical term may change according to
where it is in the medical record. If you record appendicectomy in the History section it
clearly indicates it has been done in the past. If you record it in the Problem list it suggests
you personally undertook an appendicectomy as part of the management of a problem (i.e.
appendicitis).
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Question:
"How do I find a code for "pregnancy results" in my problem list?”
Answer:
Enter "pregnancy", “results”, or “test” . Your picklist will offer a choice one of which is "W60" Test;results;pregnancy, together with others specifically attached to a body system
However, in a problem based medical record, there should never be a diagnosis/ problem
labelled in this manner. If a patient rings and asks for repeat scripts for multiple problems,
each repeat should be recorded within the problem to which it is linked. e.g. Patient requests
repeat scripts for hypertension and "the pill". You saw the patient recently and you do not
need to see her again at this time. Within the patient's record, the problem list should already
include problems called oral contraception and hypertension. You need to enter the "Pill"
linked to the oral contraception and enter the anti-hypertensive against the hypertension.
The “pregnancy test” should be recorded as part of the process of care.
Using the same argument, if a patient returns for test results, the problem you are managing
is still the one for which you requested the tests (eg. diabetes; hypertension; amenorrhoea;
general check up). The problem title should not be recorded as "test results". In the above
example the problem label may be “question of pregnancy” or “late menses” or
amenorrhoea”.
Note: ICPC -2 is not designed to code the drug prescribed. However, we are developing a
drug classification which will be offered to GPs when available.
Question:
Could you please include severity levels for some diseases (e.g. COAD)
and more detail about site (location) for others?
Answer;
While it is possible to add this more specific information and provide a specific code for
different severity levels or for site, this would enlarge ICPC-2 PLUS by about three or four
fold. One of the advantages of ICPC-2 PLUS over systems such as Read Clinical Codes or
ICD9-CM, is its size. The more codes we introduce the more difficult it becomes to find the
term required as the pick list become longer.
In deciding on the level of detail to be included in ICPC-2 PLUS we have constantly kept in
mind that the main use of a hierarchical coding system is for getting the data out in a
meaningful manner.
E.g.: you may wish to identify all your patients who have presented with an injury. You may
wish to further group these patients into sub-groups such as fractures, and still further into
fractures of the ulna. Ideally, you may like to differentiate between fractured mid-shaft ulna
versus those with a fractured proximal ulna.
However, incorporating this level of detail about site or severity throughout ICPC-2 PLUS
would result in a large database that no longer has its ‘economies of scale’. If you want more
detail about your diagnosis than is provided by ICPC-2 PLUS your software should allow you
to add free text to further describe problems. For severity levels we suggest that you speak
to your software developer and request the introduction of an additional field for severity
which you can use when you wish.
ICPC – 2 PLUS Users’ Guide
Page 50
In summary: ICPC-2 PLUS will not be expanded to include severity and codes which specify
site will remain at the upper level (i.e. ulna) rather than be expanded (i.e. to mid-shaft versus
proximal).
Question:
How do I know which keyword is best?
Answer;
Some keywords such as check, disease, pain, cyst, injury, are associated with many terms.
As you get used to the lists provided with these terms, you can experiment with other key
words which may provide a shorter pick list and so lead you to the desired term with less
effort.
For example, for a diagnosis of "whiplash":- if you enter "injury" as your keyword you will be
presented with a long picklist (about 81 options). A shorter list will present if you enter "neck"
(13 options) or "whip" (2 options).
If you think that the key word you have entered is appropriate but the "pick list" is too narrow,
then consider whether your key word could be made more "generic".
For example:
“Allerg” will pick up lists for both "allergic" and "allergy"
“Hypertensi” will pick up a list which includes "hypertension" and "hypertensive"
"Infecti" will pick up a list which includes "infections" infective" "infectious" etc.
"Degenerat" will pick up "degeneration and "degenerative"
"Diabet" will pick up "diabetes" and "diabetic"
Of course, as you get to know the range of terms in the database, you will learn to enter
"infection" in full when you specifically do not want the choice of "infective” options on your
pick list.
Allergies and sensitivities:
If you are using ICPC-2 PLUS to record allergies and sensitivities in a patient medical record
or summary sheet, a variety of key words may be used such as: allerg, allergic; reaction;
adverse; effect; sideeffect; SE.
Furthermore, if the allergy/sensitivity is related to antibiotics the generic drug name may be
used as a key word:
eg:
"Penicillin" for Amoxycillin, Abbocillin etc;
"Cephalosporin" for Keflex, Ceclor etc
"Macrolide" for Erythromycin, Rulide etc.
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ICPC – 2 PLUS Users’ Guide
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Question:
“How do I find an ICPC-2 PLUS code for repeat scripts as a problem? “
Answer:
Code -50 (replace the dash with the associated ICPC-2 chapter) does allow the coding of
"repeat script(s)" as a diagnosis. So if you enter "script" as the keyword, you will be offered
a picklist of body systems to which the drug prescribed relates. (e.g. prescription:
respiratory).
Question:
"What do I do when I can't find the term I want?"
Answer:
After considering spelling, keyword length and term organisation if you
still can't find the term you want:In each software product, there should be a facility to enter the term in free text and apply a
temporary code - J99. The term you record should be retained in the database and
allocated a term code (so that the first time you use J99, the term you record will be saved
as term number J99-001 and so on.) Your software should allow you to view your list of
temporary terms. You could print out the list and post or fax it to the Family Medicine
Research Centre so that the terms can be allocated to the correct ICPC-2 code and added
to ICPC-2 PLUS with their term keys. The next upgrade you receive will therefore include the
term, the correct code and term code. Your software should allow you to alter your original
record to the correct code (of course always retaining the hidden audit trail of the change for
medico-legal purposes).
Question:
“What do I do when I change a diagnosis?”
Answer:
This question brings up the concept of problem linkage over time
through changes in diagnosis.
For example:
A patient presents with a headache, the problem is entered as "headache". At a later date,
you decide that these headaches could more specifically be described as Migraine
headaches (which has a different code in ICPC-2). This should not be entered as a new
problem in your problem list. Rather your software should allow a change of label for the old
problem of headache. Your software will include an audit trail (for legal purposes) which
should include the old diagnosis and the date of change to the new.
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ICPC – 2 PLUS Users’ Guide
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Return to Instructions
The aim of a problem list in a medical record or summary is to ensure that each problem is
only recorded once. This means that each time you go to enter any information, you should
view your problem list to check whether the problem is already on the list. Otherwise, double
recording of the same problem with different labels can occur.
For example:
A patient arrives for Pap smear. You do a breast check as well and select "check
up;partial;genital;F" (X31 003) from your pick-list. The patient's Pap smear was insufficient
and re-test is required. You request the patient's re-attendance, and on this occasion only do
the Pap smear. You may be tempted to enter this problem as “Pap smear” which will be
allocated ICPC-2 PLUS code X37 001. If you look at your problem list, you now have two
problems, both of which cover the same medical concept, one just being slightly more
specific than the other. In fact, the follow-up visit for the Pap smear should have been
entered under the old problem of "female genital check". When the results return they show
an abnormality. You could then feel free to record an additional problem called “abnormal
Pap smear” (X86 001), or if the Pap smear results were more specific:- CIN I (X86 005); CIN
II (X86 006); CIN III (X86 032)
There are a few good examples in ICPC-2 which lend themselves to multiple recording of
the same problem in different terms. These are usually cases where you have the choice of
being more general or more specific. An example is where the patient presents after an
accident, questioning whether his leg is fractured. You suspect it is and you send the patient
for x-ray.
The problem at this point should be recorded as injury - leg (L81). As yet, you haven't
sufficient information to label it as a fracture. When the patient returns, x-rays show a
fracture. It is the same problem to the patient and therefore should not now be recorded as a
new problem of "fractured femur" (L75). It should result in a change of diagnosis from injury
(L81), to fracture (L75).
The Code Groupers listed later in this section will give you some idea of the more subtle
choices which may present to you in selecting a medical term. E.g. osteoarthritis: there is
one general OA code but others are more specifically identified by body part.
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ICPC – 2 PLUS Users’ Guide
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Question:
What do I do when I want to write a diagnosis with a question mark (e.g.
? anaemia)
Answer;
This form of provisional diagnosis is often useful in your medical notes, as it reminds you of
your thoughts about the symptoms at the previous consultation. However, a problem list
should only contain the diagnosis or problem managed, described at the highest level of
specificity allowed by the information available.
For Example:
The patient presents with symptoms of pallor and shortness of breath. After history and
examination , you feel it is likely to be anaemia and send the patient off for blood tests. The
recording of the problem should, at this stage be both pallor and shortness of breath - these
are the problems you are investigating. Only when the results are returned and your
diagnosis of anaemia is confirmed should the problem be recorded in such specific
diagnostic terminology (linked as earlier suggested). If your software allows, this does not
preclude the additional entry of ? Anaemia in free text in your notes, after that first
consultation (i.e. not coded).
FUTURE PLANS FOR ICPC -2PLUS
Continued improvement of keywords and terms to facilitate easy access.
Extension of the agreement with WONCA, to allow the provision of other classifications
as they become available. Possible additions include:- Functional Status Charts and
the Duke University Severity Index. The aim will be to include new tools at no
additional costs or at an "upgrade cost".
ICPC-2 has inclusion and exclusion criteria for the majority of problems. The possibility of
applying these criteria in computer systems in the future is being considered by the FMRC.
Your input is extremely useful in the maintenance and ongoing development of ICPC -2 PLUS.
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ICPC – 2 PLUS Users’ Guide
Page 54
SECTION 6:
Return to Instructions
THE INTERNATIONAL CLASSIFICATION
OF PRIMARY CARE - 2
SUMMARY OF MAIN CHANGES TO COMPONENTS 1 AND 7
FROM ICPC-1 TO ICPC-2
Only major changes are listed here; additions, change in meaning of the rubric, or
transfer or deletion of a rubric. There are many other changes of detail to the titles of
the rubrics which do not change the meaning, and are not listed here.
CODE
TITLE ICPC-1
CODE TITLE ICPC-2 (some abbreviated)
A
A05 GENERAL DETERIORATION
FEELING ILL
A11 (omitted by mistake from ICPC)
CHEST PAIN NOS
A12 ALLERGY/ALLERGIC REACTION
(transferred to A92)
A13 CONCERN ABOUT DRUG REACTION
CONCERN/FEARABOUT TREATMENT
A14 INFANTILE COLIC
(deleted, included in D01)
A15 EXCESSIVE CRYING INFANT
(deleted, included in A16)
A17 OTHER GEN SYMPT INFANT
A18 (new rubric in ICPC-2)
A21 (new rubric in ICPC-2)
A23 (new rubric in ICPC-2)
(deleted, included in A16)
CONCERN ABOUT APPEARANCE
RISK FACTOR FOR MALIGNANCY
RISK FACTOR NOS
A92 TOXOPLASMOSIS (deleted, included with A78)
A98 (new rubric in ICPC-2)
ALLERGY/ALLERGIC REACT (transfer from A12)
HEALTH MAINTENANCE/PREVENT MED
B
B03 OTHER SYMPT LYMPH GLANDS
B85 UNEXPLAINED ABNORMAL BLOOD TEST
B86 OTHER HAEMATOLOGICAL ABNORMALITY
(deleted,included in B02)
(deleted,included in A91)
(deleted,included in B99)
D
D07 (new rubric in ICPC-2)
D22 WORMS/PINWORMS/OTHER PARASITES
D23 (transferred from D96)
D96 HEPATOMEGALY
D96 (changed rubric in ICPC-2)
DYSPEPSIA/INDIGESTION
(transferred to D96)
HEPATOMEGALY
(transferred to D23)
WORMS/OTHER PARASITES
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ICPC – 2 PLUS Users’ Guide
Page 55
K
K22 (new rubric in ICPC-2)
K74 ANGINA PECTORIS
K76 OTHER AND CHRONIC ISCHAEMIC
HEART DISEASE
K80 ECTOPIC BEATS, ALL TYPES
K81 HEART MURMER, NOS
K91 ATHEROSCLEROSIS
K91 (altered rubric in ICPC-2)
K92 OTHER ARTERIAL OBSTRUCTION
RISK FACTOR FOR CARDIOVASC DISEASE
ISCHAEMIC HEART DISEASE WITH ANGINA
ISCHAEMIC HEART DISEASE,HEART DISEASE W\O ANGINA
CARDIAC ARRYTHMIA NOS
HEART/ARTERIAL MURMER, NOS
(included with K92 in ICPC-2) (Excl.Heart/Brain)
CEREBROVASCULAR DISEASE
ATHEROSCLEROSIS/PERIPH VASC DIS
L
L05 FLANK SYMPTOMS/COMPLAINTS
L06 AXILLA SYMPTOMS/COMPLAINTS
L71 NEOPLASMS
L83 SYNDROMES RELATED TO CERVICAL SPINE
L84 OSTEOARTHRITIS OF SPINE
L86 LUMBAR DISC LESION, BACK PAIN
L87 GANGLION JOINT/TENDON
L97 CHRONIC INTERNAL KNEE DERANGEMENT
(included with L99 in ICPC-2)
FLANK/AXILLA SYMPTOMS/COMPLAINTS
(deleted,included in L05)
MALIGNANT NEOPLASM
NECK SYNDROME
BACK SYNDROME WITHOUT RADIATION
DISC LESION/BACK PAIN WITH RADIATION
BURSITIS/TENDONITIS/SYNOVITIS NOS
NEOPLASM,BENIGN/UNCERTAIN
(split from L71 in ICPC-2)
N
N02 TENSION HEADACHE
N08 (new rubric in ICPC-2)
N80 OTHER HEAD INJURY W\O SKULL FRACTURE
N95 (new rubric in ICPC-2)
(transferred to N95)
ABNORM INVOLUNTARY MOVEMENT (split from N06)
HEAD INJURY,OTHER
TENSION HEADACHE (transferred from N02)
P
P21 OVERACTIVE CHILD, HYPERKINETIC
P75 HYSTERICAL/HYPOCHONDRIACAL DISEASE
P77 SUICIDE ATTEMPT
P81 (new rubric in ICPC-2)
P82 (new rubric in ICPC-2)
P86 (new rubric in ICPC-2)
(transferred to P81)
SOMATIZATION DISORDER
SUICIDE/SUICIDE ATTEMPT
HYPERKINETIC DISORD (transfer from P21)
POSTTRAUMATICSTRESS DISORD (split from P02)
ANOREXIA NERVOSA,BULIMIA (transferred from T06)
R
R22 SYMPTOM/COMPLAINT TONSILS
R70 TUBERCULOSIS
R72 STREP-THROAT/SCARLET FEVER
R79 (new rubric in ICPC-2)
R80 INFLUENZA WITHOUT PNEUMONIA
R82 PLEURISY
R93)
R91 CHRONIC BRONCHITIS
R92 (new rubric in ICPC-2)
R93 PLEURAL EFFUSION
(deleted,included in R21)
(deleted,included in A70)
STREP THROAT (scarlet fever include A78)
CHRONIC BRONCHITIS (transfer from R91)
INFLUENZA
PLEURISY/PLEURAL EFFUSION (include pleural effusion from
(transferred to R79)
NEOPLASM RESPIRAT, UNCERT NATURE
(deleted,included in R82)
S
S11 OTHER LOCALIZED SKIN INFECTION
S79 OTHER BENIGN NEOPLASMS OF SKIN
S80 OTHER UNSPECIFIED NEOPLASM SKIN
S94 INGROWING NAIL/OTHER DISEASE OF NAIL
WOUND INFECTION,POST-TRAUMATIC
NEOPLASM SKIN,BENIGN/UNCERTAIN
SOLAR KERATOSIS/SUNBURN
INGROWING NAIL (oth disease of nail S99)
T
T06 ANOREXIA NERVOSA W/WO BULEMIA
T15 THYROID LUMP/MASS
T88 RENAL GLYCOSURIA
T89 (new rubric in ICPC-2)
T90 DIABETES MELLITUS
transferred to P86)
(deleted,included in T81)
(deleted,included in T99)
DIABETES,INSULIN DEPENDENT
DIABETES,NON-INSULIN DEPENDENT
U
U08 (new rubric in ICPC-2)
URINARY RETENTION
ICPC – 2 PLUS Users’ Guide
Page 56
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W
W20 OTHER SYMPT/COMPLAINTS OF BREAST
W21 (new rubric in ICPC-2)
W77 OTHER NON-OBSTETRICAL CONDITION
W85 (new rubric in ICPC-2)
(deleted,included in W19)
CONCERN BODY IMAGE IN PREGNANCY
(deleted)
GESTATIONAL DIABETES
X
X22 (new rubric in ICPC-2)
X92 (new rubric in ICPC-2)
CONCERN ABOUT BREAST APPEARANCE
CHLAMYDIA INFECTION,GENITAL
STANDARD PROCESS COMPONENTS OF ICPC-2
Applicable in every chapter Replace dash (-) with Chapter Alpha code.
The dash (-) shown in first position must be replaced with the appropriate alpha code for each
chapter.
Component 2 -DIAGNOSTIC AND PREVENTIVE PROCEDURES
-30
-31
-32
-33
-34
-35
-36
-37
-38
-39
-40
-41
-42
-43
-44
-45
-46
-47
-48
-49
Medical Examination/Health Evaluation -Complete
Medical Examination/Health Evaluation -Partial/Pre-op check
Sensitivity Test
Microbiological/Immunological Test
Blood Test
Urine Test
Faeces Test
Histological/Exfoliative Cytology
Other Laboratory Test NEC
Physical Function Test
Diagnostic Endoscopy
Diagnostic Radiology/Imaging
Electrical Tracings
Other Diagnostic Procedures
Preventive Immunisations/Medications
Observation/Health Education/Advice/Diet
Consultation with Primary Care Provider
Consultation with Specialist
Clarification/Discussion of Patient's RFE/Demand
Other Preventive Procedures/High Risk Medication, Condition
Component 3 -MEDICATION, TREATMENT, THERAPEUTIC PROCEDURES
-50
-51
-52
-53
-54
-55
-56
-57
-58
-59
Medication-Prescription/Request/Renewal/Injection
Incision/Drainage/Flushing/Aspiration/Removal Body Fluid (EXCL. Catheterisation -53)
Excision/Removal Tissue/Biopsy/Destruction/Debridement/Cauterisation
Instrumentation/Catheterisation/Intubation/Dilation
Repair/Fixation-Suture/Cast/Prosthetic device (Apply/Remove)
Local Injection/Infiltration
Dressing/Pressure/Compression/Tamponade
Physical Medicine/Rehabilitation
Therapeutic Counselling/Listening
Other Therapeutic Procedures/Surgery NEC
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ICPC – 2 PLUS Users’ Guide
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Component 4 -RESULTS
-60 Results Tests/Procedures
-61 Results Examination/Test/Record/Letter from Other Provider
Component 5 -ADMINISTRATIVE
-62 Administrative Procedure
Component 6 -REFERRALS AND OTHER REASONS FOR ENCOUNTER
-63 Follow-up Encounter Unspecified
-64 Encounter/Problem Initiated by Provider/Post-op check
-65 Encounter/Problem Initiated by Other than Patient/Provider/Anxiety by third person not at
encounter
-66 Referral to Other Provider/Nurse/Therapist/Social Worker (EXCL. M.D.)
-67 Referral to Physician/Specialist/Clinic/Hospital
-68 Other Referrals NEC/Assist at operation
-69 Other Reason for Encounter NEC
A
GENERAL & UNSPECIFIED
Component 1
A01
A02
A03
A04
A05
A06
A07
A08
A09
A10
A11
A13
A16
A18
A20
A21
A23
A25
A26
A27
A28
A29
PAIN, GENERAL/MULTIPLE SITES
CHILLS
FEVER
WEAKNESS/TIREDNESS GENERAL
FEELING ILL
FAINTING/SYNCOPE
COMA
SWELLING
SWEATING PROBLEMS
BLEEDING, HAEMORRHAGE NOS
PAIN, CHEST NOS
CONCERN/FEAR ABOUT TREATMENT
IRRITABLE INFANT
CONCERN ABOUT APPEARANCE
EUTHANASIA REQUEST/DISCUSSION
RISK FACTOR FOR MALIGNANCY
RISK FACTOR NOS
FEAR OF DEATH, DYING
FEAR OF CANCER, NOS
FEAR OF OTHER DISEASE, NOS
LIMITED FUNCTION/DISABILITY NOS
GENERAL SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
A70
A71
A72
A73
A74
A75
A76
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
TUBERCULOSIS
MEASLES
CHICKENPOX
MALARIA
RUBELLA
INFECTIOUS MONONUCLEOSIS
VIRAL EXANTHEM, OTHER
Return to Instructions
A77
VIRAL DISEASE, OTHER/NOS
ICPC – 2 PLUS Users’ Guide
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A78
A79
A80
A81
A82
A84
A85
A86
A87
A88
A89
A90
A91
A92
A93
A94
A95
A96
A97
A98
A99
INFECTIOUS DISEASE, OTHER/NOS
MALIGNANCY NOS
TRAUMA/INJURY, NOS
MULTIPLE TRAUMA/INJURIES
SECONDARY EFFECT OF TRAUMA
POISONING BY MEDICAL AGENT
ADVERSE EFFECT MEDICAL AGENT
TOXIC EFFECT NON MEDICAL SUBSTANCE
COMPLICATION OF TREATMENT
ADVERSE EFFECTS PHYSICAL FACTORS
EFFECTS PROSTHETIC DEVICE
CONGENITAL ANOMALY NOS/MULTIPLE
ABNORMAL RESULTS INVESTIGATION NOS
ALLERGY/ALLERGIC REACTION NOS
PREMATURE NEWBORN*
PERINATAL MORBIDITY, OTHER
#
PERINATAL MORTALITY
DEATH
NO DISEASE
HEALTH MAINTENANCE/PREVENTIVE MEDICINE
GENERAL DISEASE NOS
*NOTE: Livebirth Infant under 37 weeks
#
NOTE: Death originating in utero or within 7 days of birth
B
BLOOD, BLOOD FORMING ORGANS AND IMMUNE MECHANISM
Component 1
B02
B04
B25
B26
B27
B28
B29
PAINFUL/ENLARGED LYMPH GLAND(S)
BLOOD SYMPTOM/COMPLAINT
FEAR OF AIDS
FEAR OF CANCER BLOOD/LYMPH
FEAR OF BLOOD/LYMPH DISEASE, OTHER
LIMITED FUNCTION/DISABILITY BLOOD/LYMPH
BLOOD AND IMMUNE MECHANISM SYMPTOM/COMPLAINT
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
B70
B71
B72
B73
B74
B75
B76
B77
B78
B79
B80
B81
B82
B83
B84
B87
B90
B99
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
LYMPHADENITIS, ACUTE
LYMPHADENITIS, NON-SPECIFIC
HODGKIN'S DISEASE/LYMPHOMAS
LEUKAEMIA
MALIGNANT NEOPLASM BLOOD, OTHER
BENIGN/UNCERTAIN NEOPLASM BLOOD/LYMPH
RUPTURED SPLEEN, TRAUMATC
INJURY BLOOD/LYMPH/SPLEEN, OTHER
HEREDITARY HAEMOLYTIC ANAEMIAS
CONGENITAL ANOMALY BLOOD/LYMPH, OTHER
IRON DEFICIENCY ANAEMIA
ANAEMIA, VITAMIN B12/FOLATE DEFICIENCY
ANAEMIA OTHER/UNSPECIFIED
PURPURA/COAGULATION DEFECTS
ABNORMAL WHITE CELLS
SPLENOMEGALY
HIV-INFECTION, AIDS
BLOOD/LYMPH/SPLEEN DISEASE, OTHER
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ICPC – 2 PLUS Users’ Guide
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D
DIGESTIVE
Component 1
D01
D02
D03
D04
D05
D06
D07
D08
D09
D10
D11
D12
D13
D14
D15
D16
D17
D18
D19
D20
D21
D23
D24
D25
D26
D27
D28
D29
PAIN/CRAMPS, ABDOMINAL GENERAL
PAIN, ABDOMINAL EPIGASTRIC
HEARTBURN
PAIN, RECTAL/ANAL
PERIANAL ITCHING
PAIN, ABDOMINAL LOCALIZED, OTHER
DYSPEPSIA/INDIGESTION
FLATULENCE/GAS/BELCHING
NAUSEA
VOMITING
DIARRHOEA
CONSTIPATION
JAUNDICE
HAEMATEMESIS/VOMITING BLOOD
MELAENA
RECTAL BLEEDING
INCONTINENCE OF BOWEL
CHANGE IN FAECES/BOWEL MOVEMENTS
TEETH/GUM SYMPTOM/COMPLAINT
MOUTH/TONGUE/LIP SYMPTOM/COMPLAINT
SWALLOWING PROBLEMS
HEPATOMEGALY
ABDOMINAL MASS NOS
ABDOMINAL DISTENSION
FEAR OF CANCER OF DIGESTIVE SYSTEM
FEAR OF DIGESTIVE DISEASE, OTHER
LIMITED FUNCTION/DISABILITY DIGESTIVE
DIGESTIVE SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
D70
D71
D72
D73
D74
D75
D76
D77
D78
D79
D80
D81
D82
D83
D84
D85
D86
D87
D88
D89
D90
D91
D92
D93
D94
D95
D96
D97
D98
D99
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
GASTROINTESTINAL INFECTION
MUMPS
VIRAL HEPATITIS
GASTROENTERITIS, PRESUMED INFECTION
MALIGNANT NEOPLASM STOMACH
MALIGNANT NEOPLASM COLON/RECTUM
MALIGNANT NEOPLASM PANCREAS
MALIGNANT NEOPLASM DIGESTIVE, OTHER/NOS
BENIGN/UNCERTAIN NEOPLASM DIGESTIVE
FOREIGN BODY IN DIGESTIVE SYSTEM
INJURY DIGESTIVE SYSTEM, OTHER
CONGENITAL ANOMALY DIGESTIVE
TEETH/GUM DISEASE
MOUTH/TONGUE/LIP DISEASE
OESOPHAGUS DISEASE
DUODENAL ULCER
PEPTIC ULCERS, OTHER
STOMACH FUNCTION DISORDER
APPENDICITIS
INGUINAL HERNIA
HIATUS HERNIA
ABDOMINAL HERNIA, OTHER
DIVERTICULAR DISEASE
IRRITABLE BOWEL SYNDROME
CHRONIC ENTERITIS/ULCERATIVE COLITIS
ANAL FISSURE/PERIANAL ABSCESS
WORMS/OTHER PARASITES
LIVER DISEASE NOS
CHOLECYSTITIS, CHOLELITHIASIS
DISEASE DIGESTIVE SYSTEM, OTHER
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ICPC – 2 PLUS Users’ Guide
Page 60
F
EYE
Component 1
F01
F02
F03
F04
F05
F13
F14
F15
F16
F17
F18
F27
F28
F29
Complaints & Symptoms
PAIN, EYE
RED EYE
EYE DISCHARGE
VISUAL FLOATERS/SPOTS
VISUAL DISTURBANCE, OTHER
EYE SENSATIONS ABNORMAL
EYE MOVEMENTS ABNORMAL
EYE APPEARANCE ABNORMAL
EYELID SYMPTOM/COMPLAINT
GLASSES SYMPTOM/COMPLAINT
CONTACT LENS SYMPTOM/COMPLAINT
FEAR OF EYE DISEASE
LIMITED FUNCTION/DISABILITY EYE
EYE SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
F70
F71
F72
F73
F74
F75
F76
F79
F80
F81
F82
F83
F84
F85
F86
F91
F92
F93
F94
F95
F99
CONJUNCTIVITIS, INFECTIOUS
CONJUNCTIVITIS, ALLERGIC
BLEPHARITIS/STYE/CHALAZION
EYE INFECTIONS/INFLAMMATION, OTHER
NEOPLASM EYE/ADNEXA
CONTUSION/ABRASIONS EYE
FOREIGN BODY IN EYE
INJURY EYE, OTHER
BLOCKED LACRIMAL DUCT OF INFANT
CONGENITAL ANOMALY EYE, OTHER
DETACHED RETINA
RETINOPATHY
MACULAR DEGENERATION
CORNEAL ULCER (INCL HERPETIC)
TRACHOMA
REFRACTIVE ERROR
CATARACT
GLAUCOMA
BLINDNESS
STRABISMUS
EYE/ADNEXA DISEASE, OTHER
H
EAR
Component 1
H01
H02
H03
H04
H05
H13
H15
H27
H28
H29
Complaints & Symptoms
PAIN, EAR/EARACHE
HEARING COMPLAINT
TINNITUS, RINGING/BUZZING EAR
EAR DISCHARGE
BLEEDING EAR
PLUGGED FEELING EAR
CONCERN ABOUT APPEARANCE OF EARS
FEAR OF EAR DISEASE
LIMITED FUNCTION/DISABILITY EAR
EAR SYMPTOM/COMPLAINT, OTHER
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Component 2
Diagnostic Screening & Preventive Procedures
ICPC – 2 PLUS Users’ Guide
Page 61
Component 3
Component 4
Component 5
Component 6
Component 7
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
H70
H71
H72
H73
H74
H75
H76
H77
H78
H79
H80
H81
H82
H83
H84
H85
H86
H99
OTITIS EXTERNA
ACUTE OTITIS MEDIA/MYRINGITIS
SEROUS OTITIS MEDIA
EUSTACHIAN SALPINGITIS
CHRONIC OTITIS MEDIA
NEOPLASM EAR
FOREIGN BODY IN EAR
PERFORATION EAR DRUM
INJURY EAR, SUPERFICIAL
INJURY EAR, OTHER
CONGENITAL ANOMALY EAR
EXCESSIVE EAR WAX
VERTIGINOUS SYNDROMES
OTOSCLEROSIS
PRESBYACUSIS
ACOUSTIC TRAUMA
DEAFNESS
EAR/MASTOID DISEASE, OTHER
K
CARDIOVASCULAR
Component 1
K01
K02
K03
K04
K05
K06
K07
K22
K24
K25
K27
K28
K29
PAIN, HEART
PRESSURE/TIGHTNESS OF HEART
PAIN, CARDIOVASCULAR NOS
PALPITATIONS/AWARENESS OF HEART
IRREGULAR HEARTBEAT, OTHER
PROMINENT VEINS
SWOLLEN ANKLES/OEDEMA
RISK FACTOR FOR CARDIOVASCULAR DISEASE
FEAR OF HEART DISEASE
FEAR OF HYPERTENSION
FEAR OF CARDIOVASCULAR DISEASE, OTHER
LIMITED FUNCTION/DISABILITY CARDIOVASCULAR
CARDIOVASCULAR SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
K70
K71
K72
K73
K74
K75
K76
K77
K78
K79
K80
K81
K82
K83
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
CARDIOVASCULAR SYSTEM INFECTION
RHEUMATIC FEVER/HEART DISEASE
NEOPLASM CARDIOVASCULAR
CONGENITAL ANOMALY CARDIOVASCULAR
ISCHAEMIC HEART DISEASE WITH ANGINA
ACUTE MYOCARDIAL INFARCTION
ISCHAEMIC HEART DISEASE WITHOUT ANGINA
HEART FAILURE
ATRIAL FIBRILLATION/FLUTTER
PAROXYSMAL TACHYCARDIA
CARDIAC ARRHYTHMIA NOS
HEART/ARTERIAL MURMER NOS
PULMONARY HEART DISEASE
HEART VALVE DISEASE NOS
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K84
K85
K86
K87
HEART DISEASE, OTHER
ELEVATED BLOOD PRESSURE
HYPERTENSION, UNCOMPLICATED
HYPERTENSION, COMPLICATED
ICPC – 2 PLUS Users’ Guide
Page 62
K88
K89
K90
K91
K92
K93
K94
K95
K96
K99
POSTURAL HYPOTENSION (LOW BLOOD PRESSURE)
TRANSIENT CEREBRAL ISCHAEMIA
STROKE/CEREBROVASCULAR ACCIDENT
CEREBROVASCULAR DISEASE (EXCL HEART/BRAIN)
ATHEROSCLEROSIS/PERIPHERAL VASCULAR DISEASE
PULMONARY EMBOLISM
PHLEBITIS AND THROMBOPHLEBITIS
VARICOSE VEINS OF LEG
HAEMORRHOIDS
CARDIOVASCULAR DISEASE, OTHER
L
MUSCULOSKELETAL
Component 1
L01
L02
L03
L04
L05
L07
L08
L09
L10
L11
L12
L13
L14
L15
L16
L17
L18
L19
L20
L26
L27
L28
L29
NECK SYMPTOM/COMPLAINT
BACK SYMPTOM/COMPLAINT
LOW BACK SYMPTOM/COMPLAINT
CHEST SYMPTOM/COMPLAINT
FLANK/AXILLA SYMPTOM/COMPLAINT
JAW SYMPTOM/COMPLAINT
SHOULDER SYMPTOM/COMPLAINT
ARM SYMPTOM/COMPLAINT
ELBOW SYMPTOM/COMPLAINT
WRIST SYMPTOM/COMPLAINT
HAND & FINGER SYMPTOM/COMPLAINT
HIP SYMPTOM/COMPLAINT
LEG/THIGH SYMPTOM/COMPLAINT
KNEE SYMPTOM/COMPLAINT
ANKLE SYMPTOM/COMPLAINT
FOOT & TOE SYMPTOM/COMPLAINT
PAIN, MUSCLE
MUSCLE SYMPTOM/COMPLAINT NOS
JOINT SYMPTOM/COMPLAINT NOS
FEAR OF CANCER, MUSCULOSKELETAL
FEAR OF MUSCULOSKELETAL DISEASE, OTHER
LIMITED FUNCTION/DISABILITY MUSCULOSKELETAL
MUSCULOSKELETAL SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
L70
L71
L72
L73
L74
L75
L76
L77
L78
L79
L80
L81
L82
L83
L84
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
MUSCULOSKELETAL INFECTION
MALIGNANT NEOPLASM MUSCULOSKELETAL
FRACTURE: RADIUS/ULNA
FRACTURE: TIBIA/FIBULA
FRACTURE: HAND/FOOT BONE
FRACTURE: FEMUR
FRACTURE: OTHER
SPRAINS & STRAINS OF ANKLE
SPRAINS & STRAINS OF KNEE
SPRAINS & STRAINS OF JOINTS NOS
DISLOCATION & SUBLUXATION
INJURY MUSCULOSKELETAL NOS
CONGENITAL ANOMALY MUSCULOSKELETAL
NECK SYNDROME (INCL OSTEOARTHRITIS)
BACK SYNDROME WITHOUT RADIATING PAIN
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ICPC – 2 PLUS Users’ Guide
Page 63
Return to Instructions
L85
L86
L87
L88
L89
L90
L91
L92
L93
L94
L95
L96
L97
L98
L99
ACQUIRED DEFORMITY OF SPINE
BACK SYNDROME WITH RADIATING PAIN
BURSITIS/TENDONITIS/SYNOVITIS NOS
RHEUMATOID ARTHRITIS
OSTEOARTHROSIS OF HIP
OSTEOARTHROSIS OF KNEE
OSTEOARTHROSIS, OTHER
SHOULDER SYNDROME (INCL ARTHRITIS, OSTEOARTHRITIS)
TENNIS ELBOW
OSTEOCHONDROSIS
OSTEOPOROSIS
ACUTE INTERNAL DAMAGE KNEE
BENIGN/UNCERTAIN NEOPLASM MUSCULOSKELETAL
ACQUIRED DEFORMITY OF LIMB
MUSCULOSKELETAL DISEASE, OTHER
N
NEUROLOGICAL
Component 1
N01
N03
N04
N05
N06
N07
N08
N16
N17
N18
N19
N26
N27
N28
N29
HEADACHE
PAIN, FACE
RESTLESS LEGS
TINGLING FINGERS/FEET/TOES
SENSATION DISTURBANCES, OTHER
CONVULSIONS/SEIZURES
ABNORMAL INVOLUNTARY MOVEMENTS
DISTURBANCE SMELL/TASTE
VERTIGO/DIZZINESS
PARALYSIS/WEAKNESS
SPEECH DISORDER
FEAR OF CANCER OF NEUROLOGICAL SYSTEM
FEAR OF NEUROLOGICAL DISEASE, OTHER
LIMITED FUNCTION/DISABILITY NEUROLOGICAL
NEUROLOGICAL SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
N70
N71
N72
N73
N74
N75
N76
N79
N80
N81
N85
N86
N87
N88
N89
N90
N91
N92
N93
N94
N95
N99
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
POLIOMYELITIS
MENINGITIS/ENCEPHALITIS
TETANUS
NEUROLOGICAL INFECTION, OTHER
MALIGNANT NEOPLASM NERVOUS SYSTEM
BENIGN NEOPLASM NERVOUS SYSTEM
UNCERTAIN NATURE NEOPLASM NERVOUS SYSTEM
CONCUSSION
INJURY HEAD, OTHER
INJURY NERVOUS SYSTEM, OTHER
CONGENITAL ANOMALY NEUROLOGICAL
MULTIPLE SCLEROSIS
PARKINSONISM
EPILEPSY
MIGRAINE
CLUSTER HEADACHE
FACIAL PARALYSIS/BELL'S PALSY
TRIGEMINAL NEURALGIA
CARPAL TUNNEL SYNDROME
PERIPHERAL NEURITIS/NEUROPATHY
TENSION HEADACHE
NEUROLOGICAL DISEASE, OTHER
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Page 64
P
PSYCHOLOGICAL
Component 1
P01
P02
P03
P04
P05
P06
P07
P08
P09
P10
P11
P12
P13
P15
P16
P17
P18
P19
P20
P22
P23
P24
P25
P27
P28
P29
FEELING ANXIOUS/NERVOUS/TENSE
ACUTE STRESS REACTION
FEELING DEPRESSED
FEELING/BEHAVING IRRITABLE/ANGRY
SENILITY, FEELING/BEHAVING OLD
SLEEP DISTURBANCE
SEXUAL DESIRE REDUCED
SEXUAL FULFILMENT REDUCED
CONCERN ABOUT SEXUAL PREFERENCE
STAMMERING, STUTTERING, TICS
EATING PROBLEMS IN CHILDREN
BEDWETTING, ENURESIS
ENCOPRESIS/BOWEL TRAINING PROBLEM
CHRONIC ALCOHOL ABUSE
ACUTE ALCOHOL ABUSE
TOBACCO ABUSE
MEDICATION ABUSE
DRUG ABUSE
MEMORY DISTURBANCE
CHILD BEHAVIOR SYMPTOM/COMPLAINT
ADOLESCENT BEHAVIOUR SYMPTOM/COMPLAINT
SPECIFIC LEARNING PROBLEM
PHASE OF LIFE PROBLEM IN ADULT
FEAR OF MENTAL DISORDER
LIMITED FUNCTION/DISABILITY PSYCHOLOGICAL
PSYCHOLOGICAL SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
P70
P71
P72
P73
P74
P75
P76
P77
P78
P79
P80
P81
P82
P85
P86
P98
P99
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
DEMENTIA (INCL SENILE, ALZHEIMER)
ORGANIC PSYCHOSIS, OTHER
SCHIZOPHRENIA
AFFECTIVE PSYCHOSIS
ANXIETY DISORDER/ANXIETY STATE
SOMATISATION DISORDER
DEPRESSIVE DISORDER
SUICIDE/SUICIDE ATTEMPT
NEURASTHENIA, SURMENAGE
PHOBIA, COMPULSIVE DISORDER
PERSONALITY DISORDER
HYPERKINETIC DISORDER
POST TRAUMATIC STRESS DISORDER
MENTAL RETARDATION
ANOREXIA NERVOSA, BULIMIA
PSYCHOSES NOS, OTHER
PSYCHOLOGICAL DISORDERS, OTHER
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ICPC – 2 PLUS Users’ Guide
Page 65
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R
RESPIRATORY
Component 1
R01
R02
R03
R04
R05
R06
R07
R08
R09
R21
R23
R24
R25
R26
R27
R28
R29
PAIN, RESPIRATORY SYSTEM
SHORTNESS OF BREATH, DYSPNOEA
WHEEZING
BREATHING PROBLEMS, OTHER
COUGH
NOSE BLEED/EPISTAXIS
SNEEZING/NASAL CONGESTION
NOSE SYMPTOM/COMPLAINT, OTHER
SINUS SYMPTOM/COMPLAINT (INCL PAIN)
THROAT SYMPTOM/COMPLAINT
VOICE SYMPTOM/COMPLAINT
HAEMOPTYSIS
SPUTUM/PHLEGM ABNORMAL
FEAR OF CANCER OF RESPIRATORY SYSTEM
FEAR OF RESPIRATORY DISEASE, OTHER
LIMITED FUNCTION/DISABILITY RESPIRATORY
RESPIRATORY SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
R71
R72
R73
R74
R75
R76
R77
R78
R79
R80
R81
R82
R83
R84
R85
R86
R87
R88
R89
R90
R92
R95
R96
R97
R98
R99
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
WHOOPING COUGH
STREP THROAT
BOIL, ABSCESS NOSE
UPPER RESPRATORY INFECTION, ACUTE
SINUSITIS ACUTE/CHRONIC
TONSILLITIS ACUTE
LARYNGITIS/TRACHEITIS, ACUTE
ACUTE BRONCHITIS/BRONCHIOLITIS
CHRONIC BRONCHITIS
INFLUENZA
PNEUMONIA
PLEURISY/PLEURAL EFFUSION
RESPIRATORY INFECTION, OTHER
MALIGNANT NEOPLASM BRONCHUS, LUNG
MALIGNANT NEOPLASM RESPIRATORY, OTHER
BENIGN NEOPLASM RESPIRATORY
FOREIGN BODY IN NOSE/LARYNX/BRONCHUS
INJURY RESPIRATORY, OTHER
CONGENITAL ANOMALY RESPIRATORY
HYPERTROPHY TONSILS/ADENOIDS
UNCERTAIN NATURE NEOPLASM RESPIRATORY
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
ASTHMA
ALLERGIC RHINITIS
HYPERVENTILATION SYNDROME
RESPIRATORY DISEASE, OTHER
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ICPC – 2 PLUS Users’ Guide
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Return to Instructions
S
SKIN
Component 1
S01
S02
S03
S04
S05
S06
S07
S08
S09
S10
S11
S12
S13
S14
S15
S16
S17
S18
S19
S20
S21
S22
S23
S24
S26
S27
S28
S29
PAIN, TENDERNESS OF SKIN
PRURITUS
WARTS
LUMP/SWELLING, LOCALISED
LUMP/SWELLING, MULTIPLE
RASH LOCALIZED
RASH GENERALIZED
SKIN COLOR CHANGE
INFECTED FINGER/TOE
BOIL/CARBUNCLE
SKIN INFECTION, POST TRAUMATIC
INSECT BITE/STING
ANIMAL/HUMAN BITE
BURNS/SCALDS
FOREIGN BODY IN SKIN
BRUISE/CONTUSION
ABRASION/SCRATCH/BLISTER
LACERATION/CUT
INJURY SKIN, OTHER
CORNS/CALOSITIES
SKIN TEXTURE SYMPTOM/COMPLAINT
NAIL SYMPTOM/COMPLAINT
HAIR LOSS/BALDNESS (INCL ALOPECIA)
HAIR/SCALP SYMPTOM/COMPLAINT
FEAR OF CANCER OF SKIN
FEAR OF SKIN DISEASE, OTHER
LIMITED FUNCTION/DISABILITY SKIN
SKIN SYMPTOM/COMPLAINT
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
S70
S71
S72
S73
S74
S75
S76
S77
S78
S79
S80
S81
S82
S83
S84
S85
S86
S87
S88
S89
S90
S91
S92
S93
S94
S95
S96
S97
S98
S99
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
HERPES ZOSTER
HERPES SIMPLEX
SCABIES AND OTHER ACARIASES
PEDICULOSIS/SKIN INFESTATIONS, OTHER
DERMATOPHYTOSIS
MONILIASIS/CANDIDIASIS SKIN
SKIN INFECTION, OTHER
MALIGNANT NEOPLASM SKIN
LIPOMA
BENIGN/UNCERTAIN NEOPLASM SKIN
SOLAR KERATOSIS/SUNBURN
HAEMANGIOMA/LYMPHANGIOMA
NAEVUS/MOLE
CONGENITAL ANOMALY SKIN, OTHER
IMPETIGO
PILONIDAL CYST/FISTULA
DERMATITIS, SEBORRHOEIC
DERMATITIS, ATOPIC ECZEMA
DERMATITIS, CONTACT/ALLERGIC
DIAPER RASH
PITYRIASIS ROSEA
PSORIASIS
SWEAT GLAND DISEASE
SEBACEOUS CYST
INGROWNING NAIL
MOLLUSCA CONTAGIOSUM
ACNE
CHRONIC ULCER SKIN (INCL VARICOSE ULCER)
URTICARIA
SKIN DISEASE, OTHER
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T
ENDOCRINE, METABOLIC AND NUTRITIONAL
ICPC – 2 PLUS Users’ Guide
Page 67
Component 1
T01
T02
T03
T04
T05
T07
T08
T10
T11
T26
T27
T28
T29
Complaints & Symptoms
EXCESSIVE THIRST
EXCESSIVE APPETITE
LOSS OF APPETITE
FEEDING PROBLEM OF INFANT/CHILD
FEEDING PROBLEM OF ADULT
WEIGHT GAIN
WEIGHT LOSS
GROWTH DELAY
DEHYDRATION
FEAR OF CANCER OF ENDOCRINE SYSTEM
FEAR OF ENDOCRINE/METABOLIC DISEASE, OTHER
LIMITED FUNCTION/DISABILITY ENDOCRINE/METABOLIC
ENDOCRINE/METAB/NUTRITION SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
T70
ENDOCRINE INFECTION
T71
T72
T73
T78
T80
T81
T82
T83
T85
T86
T87
T88
T89
T90
T91
T92
T93
T99
MALIGNANT NEOPLASM THYROID
BENIGN NEOPLASM THYROID
NEOPLASM ENDOCRINE, OTHER/UNSPECIFIED
THYROGLOSSAL DUCT/CYST
CONGENITAL ANOMALY ENDOCRINE/METABOLIC
GOITRE
OBESITY (BMI > 30)
OVERWEIGHT (BMI < 30)
HYPERTHYROIDISM/THYROTOXICOSIS
HYPOTHYROIDISM/MYXOEDEMA
HYPOGLYCEMIA
deleted transferred to t99
DIABETES, INSULIN DEPENDENT
DIABETES, NON-INSULIN DEPENDENT
VITAMIN/NUTRITIONAL DEFICIENCY
GOUT
LIPID DISORDER
ENDOCRINE/METABOLIC/NUTRITIONAL DISEASE, OTHER
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ICPC – 2 PLUS Users’ Guide
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Return to Instructions
U
UROLOGICAL
Component 1
U01
U02
U04
U05
U06
U07
U08
U13
U14
U26
U27
U28
U29
Complaints & Symptoms
DYSURIA/PAINFUL URINATION
URINARY FREQUENCY/URGENCY
INCONTINENCE, URINE
URINATION PROBLEMS, OTHER
HAEMATURIA
URINE COMPLAINTS, OTHER
URINARY RETENTION
BLADDER SYMPTOM/COMPLAINT, OTHER
KIDNEY SYMPTOM/COMPLAINT
FEAR OF CANCER OF URINARY SYSTEM
FEAR OF URINARY DISEASE, OTHER
LIMITED FUNCTION/DISABILITY URINARY
URINARY SYMPTOM/COMPLAINT, OTHER
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
U70
U71
U72
U75
U76
U77
U78
U79
U80
U85
U88
U90
U95
U98
U99
PYELONEPHRITIS/PYELITIS
CYSTITIS/URINARY INFECTION, OTHER
URETHRITIS
MALIGNANT NEOPLASM KIDNEY
MALIGNANT NEOPLASM BLADDER
MALIGNANT NEOPLASM URINARY, OTHER
BENIGN NEOPLASM URINARY TRACT
NEOPLASM URINARY TRACT NOS
INJURY URINARY TRACT
CONGENITAL ANOMALY URINARY TRACT
GLOMERULONEPHRITIS/NEPHROSIS
ORTHOSTATIC ALBUMINURIA/PROTEINURIA
URINARY CALCULUS
ABNORMAL URINE TEST NOS
URINARY DISEASE, OTHER
W
PREGNANCY, CHILDBEARING, FAMILY PLANNING
Component 1
W01
W02
W03
W05
W10
W11
W12
W13
W14
W15
W17
W18
W19
W21
W27
W28
W29
Complaints & Symptoms
QUESTION OF PREGNANCY
FEAR OF PREGNANCY
ANTEPARTUM BLEEDING
PREGNANCY NAUSEA/VOMITING
CONTRACEPTION, POSTCOITAL
CONTRACEPTION, ORAL
CONTRACEPTION, INTRAUTERINE
STERILIZATION (FEMALE)
CONTRACEPTION, OTHER
INFERTILITY/SUBFERTILITY
POST PARTUM BLEEDING
POST PARTUM SYMPTOM/COMPLAINT
BREAST/ LACTATION SYMPTOM/COMPLAINT
CONCERN ABOUT BODY IMAGE RELATED TO PREGNANCY
FEAR OF COMPLICATIONS OF PREGNANCY
LIMITED FUNCTION/DISABILITY PREGNANCY
PREGNANCY SYMPTOM/COMPLAINT, OTHER
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ICPC – 2 PLUS Users’ Guide
Page 69
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
W70
W71
W72
W73
W75
W76
W78
W79
W80
W81
W82
W83
W84
W85
W90
W91
W92
W93
W94
W95
W96
W99
PUERPERAL INFECTION/SEPSIS
INFECTIONS COMPLICATING PREGNANCY
MALIGNANT NEOPLASM RELATED TO PREGNANCY
BENIGN/UNCERTAIN NEOPLASM RELATED TO PREGNANCY
INJURY COMPLICATING PREGNANCY
CONGENITAL ANOMALY COMPLICATING PREGNANCY
PREGNANCY
UNWANTED PREGNANCY
ECTOPIC PREGNANCY
TOXAEMIA OF PREGNANCY
ABORTION, SPONTANEOUS
ABORTION, INDUCED
PREGNANCY HIGH RISK
GESTATIONAL DIABETES
UNCOMPLICATED DELIVERY, LIVEBIRTH
UNCOMPLICATED DELIVERY, STILLBIRTH
COMPLICATED DELIVERY, LIVEBIRTH
COMPLICATED DELIVERY, STILLBIRTH
PUERPERAL MASTITIS
BREAST DISORDER IN PREGNANCY/PUERPERIUM, OTHER
COMPLICATIONS OF PUERPERIUM, OTHER
DISORDERS OF PREGNANCY/DELIVERY, OTHER
X
FEMALE GENITAL
Component 1
X01
X02
X03
X04
X05
X06
X07
X08
X09
X10
X11
X12
X13
X14
X15
X16
X17
X18
X19
X20
X21
X22
X23
X24
X25
X26
X27
X28
X29
Complaints & Symptoms
PAIN, GENITAL (FEMALE)
PAIN, MENSTRUAL
PAIN, INTERMENSTRUAL
PAINFUL INTERCOURSE (FEMALE)
MENSTRUATION ABSENT/SCANTY
MENSTRUATION EXCESSIVE
MENSTRUATION IRREGULAR/FREQUENT
INTERMENSTRUAL BLEEDING
PREMENSTRUAL SYMPTOM/COMPLAINT
POSTPONEMENT OF MENSTRUATION
MENOPAUSAL SYMPTOM/COMPLAINT
POSTMENOPAUSAL BLEEDING
POSTCOITAL BLEEDING
VAGINAL DISCHARGE
VAGINAL SYMPTOM/COMPLAINT, OTHER
VULVAL SYMPTOM/COMPLAINT
PELVIS SYMPTOM/COMPLAINT (FEMALE)
PAIN, BREAST (FEMALE)
BREAST LUMP/MASS (FEMALE)
NIPPLE SYMPTOM/COMPLAINT(FEMALE)
BREAST SYMPTOM/COMPLAINT, OTHER (FEMALE)
CONCERN ABOUT BREAST APPEARANCE (FEMALE)
FEAR OF SEXUALLY TRANSMITTED DISEASE (FEMALE)
FEAR OF SEXUAL DYSFUNCTION (FEMALE)
FEAR OF CANCER GENITAL (FEMALE)
FEAR OF CANCER OF BREAST(FEMALE)
FEAR OF GENITAL/BREAST DISEASE, OTHER (FEMALE)
LIMITED FUNCTION/DISABILITY GENITAL (FEMALE)
GENITAL SYMPTOM/COMPLAINT, OTHER (FEMALE)
Return to Instructions
ICPC – 2 PLUS Users’ Guide
Page 70
Return to Instructions
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
X70
X71
X72
X73
X74
X75
X76
X77
X78
X79
X80
X81
X82
X83
X84
X85
X86
X87
X88
X89
X90
X91
X92
X99
SYPHILIS (FEMALE)
GONORRHOEA (FEMALE)
GENITAL CANDIDIASIS (FEMALE)
GENITAL TRICHOMONIASIS (FEMALE)
PELVIC INFLAMMATORY DISEASE
MALIGNANT NEOPLASM CERVIX
MALIGNANT NEOPLASM BREAST (FEMALE)
MALIGNANT NEOPLASM GENITAL, OTHER (FEMALE)
FIBROMYOMA UTERUS
BENIGN NEOPLASM BREAST (FEMALE)
BENIGN NEOPLASM GENITAL (FEMALE)
UNCERTAIN NATURE NEOPLASM GENITAL (FEMALE)
INJURY GENITAL (FEMALE)
CONGENITAL ANOMALY GENITAL (FEMALE)
VAGINITIS/VULVITIS NOS
CERVICAL DISEASE NOS
ABNORMAL PAP SMEAR
UTEROVAGINAL PROLAPSE
FIBROCYSTIC DISEASE BREAST
PREMENSTRUAL TENSION SYNDROME
GENITAL HERPES (FEMALE)
CONDYLOMATA ACUMINATA (FEMALE)
CHLAMYDIA INFECTION, GENITAL (FEMALE)
GENITAL DISEASE, OTHER (FEMALE)
Y
MALE GENITAL
Component 1
Y01
Y02
Y03
Y04
Y05
Y06
Y07
Y08
Y10
Y13
Y14
Y16
Y24
Y25
Y26
Y27
Y28
Y29
PAIN, PENIS
PAIN, TESTIS/SCROTUM
URETHRAL DISCHARGE (MALE)
PENIS SYMPTOM/COMPLAINT
SCROTUM/TESTIS SYMPTOM/COMPLAINT
PROSTATE SYMPTOM/COMPLAINT
IMPOTENCE NOS
SEXUAL FUNCTION SYMPTOM/COMPLAINT (MALE)
INFERTILITY/SUBFERTILITY (MALE)
STERILISATION (MALE)
FAMILY PLANNING, OTHER (MALE)
BREAST SYMPTOM/COMPLAINT (MALE)
FEAR OF SEXUAL DYSFUNCTION
FEAR OF SEXUALLY TRANSMITTED DISEASE (MALE)
FEAR OF CANCER GENITAL (MALE)
FEAR OF GENITAL DISEASE, OTHER (MALE)
LIMITED FUNCTION/DISABILITY GENITAL (MALE)
GENITAL SYMPTOM/COMPLAINT, OTHER (MALE)
Component 2
Component 3
Component 4
Component 5
Component 6
Component 7
Y70
Y71
Y72
Y73
Y74
Complaints & Symptoms
Diagnostic Screening & Preventive Procedures
Medication, Treatment Procedures
Test Results
Administrative
Referrals & Other Reason for Encounter
Diagnosis/diseases
SYPHILIS (MALE)
GONORRHOEA (MALE)
GENITAL HERPES (MALE)
PROSTATITIS/SEMINAL VESICULITIS
ORCHITIS/EPIDIDYMITIS
Return to Instructions
Y75
Y76
Y77
BALANITIS
CONDYLOMATA ACUMINATA (MALE)
MALIGNANT NEOPLASM PROSTATE
ICPC – 2 PLUS Users’ Guide
Page 71
Y78
Y79
Y80
Y81
Y82
Y83
Y84
Y85
Y86
Y99
MALIGNANT NEOPLASM GENITAL, OTHER (MALE)
BENIGN/UNCERTAIN NEOPLASM GENITAL (MALE)
INJURY GENITAL (MALE)
PHIMOSIS/REDUNDANT PREPUCE
HYPOSPADIA
UNDESCENDED TESTICLE
CONGENITAL ANOMALY GENITAL (MALE)
BENIGN PROSTATIC HYPERTROPHY
HYDROCOELE
GENITAL DISEASE, OTHER (MALE) (INCL BREAST)
Z
SOCIAL PROBLEMS
Component 1
Z01
Z02
Z03
Z04
Z05
Z06
Z07
Z08
Z09
Z10
Z11
Z12
Z13
Z14
Z15
Z16
Z18
Z19
Z20
Z21
Z22
Z23
Z24
Z25
Z27
Z28
Z29
Complaints & Symptoms
POVERTY/FINANCIAL PROBLEM
FOOD AND WATER PROBLEM
HOUSING/NEIGHBORHOOD PROBLEM
SOCIAL CULTURAL PROBLEM
WORK PROBLEM
UNEMPLOYMENT PROBLEM
EDUCATION PROBLEM
SOCIAL WELFARE PROBLEM
LEGAL PROBLEM
HEALTH CARE SYSTEM PROBLEM
COMPLIANCE/BEING ILL PROBLEM
RELATIONSHIP PROBLEM, PARTNERS
PARTNER BEHAVIOUR PROBLEM
PARTNER ILLNESS PROBLEM
LOSS OR DEATH OF PARTNER (INCL MARITAL BREAKDOWN)*
RELATIONSHIP PROBLEM, CHILD
ILLNESS PROBLEM WITH CHILD
LOSS OR DEATH OF CHILD
RELATIONSHIP PROBLEM, PARENT/FAMILY
BEHAVIOR PROBLEM, PARENT/FAMILY
ILLNESS PROBLEM, PARENT/FAMILY
LOSS/DEATH OF PARENT/FAMILY MEMBER
RELATIONSHIP PROBLEM, FRIENDS
ASSAULT/HARMFUL EVENT
FEAR OF SOCIAL PROBLEM
SOCIAL HANDICAP
SOCIAL PROBLEM NOS
Return to Instructions
ICPC – 2 PLUS Users’ Guide
Page 72
Appendix A
Return to Instructions
Keyword List
APPENDIX A
Version 4/01
ICPC-2 PLUS - KEYWORDS
A comprehensive list of ICPC-2 PLUS keywords has been provided to enable users
to acquire a firm understanding of keywords available and to assist in the selection of
the most appropriate access route to a term.
1. You will note that in order to minimise space and reduce the total number of
keywords created, shorter keywords are in some instances incorporated into a
longer version of the word. For example:
♦Prostatectomy also incorporates the keyword prostate
♦Rheumatica also incorporates the keyword rheumatic
♦Toxicity also incorporates the keyword toxic
♦Accessory also incorporates the keyword access
♦Sores also incorporates the keyword sore
2. The structure of the ICPC-2 PLUS ‘keyword search’ allows users to enter as much
or little of a keyword as they require when creating a picklist. Thus the keyword list
that follows is a guide to the longest version of a word that can be entered as a
keyword. Shorter versions or the first few letters of the keyword may be entered if
required. For example:
Keyword listed
prostatectomy
nerveroot
ulnar
swallowing
glandular
earache
Shorter keywords you can enter
prostat
nerv
ulna
swallo
glan
ear
Remember - entering a shorter keyword will make your picklist of terms longer.
If you are unable to find the term you require, refer to Section 5, (Terming’ with
ICPC-2 PLUS) for hints on keyword selection, or contact the FMRC.
The "Keyword List" has been removed from THIS electronic version.
The Full "APPENDIX A" is included in the hardcopy version sent to licensed users.
Return to Instructions
ICPC – 2 PLUS Users’ Guide
Page 73
Appendix B
Return to Instructions
Keyword Abbreviations
APPENDIX B
Version 04/01
KEYWORD ABBREVIATIONS
To facilitate fast and easy access to terms, the latest version of ICPC-2 PLUS includes many
new abbreviations as keywords. The list of abbreviations available in ICPC-2 PLUS is attached.
Where an acronym is not a recognisable part of a word (eg. CCF, COPD) you will find you gain
speedy access to a very short picklist. However where the acronym can form part of a word it
will not provide a mutually exclusive picklist of terms attached to that acronym. It will give you a
picklist of terms attached to the acronym and those linked to keywords beginning with the same
letters.
For example if you enter “CAL” (chronic airways limitation) as a keyword your picklist will consist of terms associated with
keywords beginning with CAL (i.e. keywords such as calculus, callosite, callus and calf). In most cases however, the picklist
provided will be significantly shorter than previous access routes.
Please continue to notify us of other commonly used abbreviations to be considered for
inclusion. Your suggestions are extremely valuable.
The Keyword Abbreviations List has been removed from THIS electronic version.
The Full "APPENDIX B" is included in the hardcopy version sent to licensed users.
Return to Instructions
ICPC – 2 PLUS Users’ Guide
Page 90
Appendix C
Return to Instructions
New Terms
APPENDIX C
Version 07/2003
NEW TERMS
Since the last release a number of new terms have been added to ICPC-2 PLUS.
The objective of ICPC-2 PLUS is to provide a database of medical concepts (terms) that
adequately cover the type and process of care GP’s and community health provide, in a
language that is readily utilised by them. ICPC-2 PLUS does not aim to provide a code for every
condition identifiable, but provides a meaningful structural hierarchy to allow classification,
grouping and analysis for common similar conditions.
If you are unable to find a term that adequately defines the medical concept you wish to
describe, you can record it as a J99 code (see Section 7 - J codes and requested additional
term keys).
Please fax or send copies of your J99 codes, other queries and requested codes to the FMRC for
consideration by the ICPC-2 PLUS team. We look forward to hearing from you!
The New Terms list has been removed from THIS electronic version.
The Full "APPENDIX C" is included in the hardcopy version sent to licensed users.
ICPC – 2 PLUS Users’ Guide
Page 99
Appendix D
Return to Instructions
FMRC Code Groupers
by ICPC-2 chapter and component
APPENDIX D: FMRC CODE GROUPERS FOR ANALYSIS OF MORBIDITY DATA - by ICPC-2 chapters
and components
The Grouper table has been removed from THIS electronic version.
The Full "APPENDIX E" is included in the hardcopy version sent to licensed users.
ICPC – 2 PLUS Users’ Guide
Page 104
Appendix E
Return to Instructions
FMRC Code Groupers by ICPC-2 Diagnosis
APPENDIX E
Version 04/01
FMRC REPORT CODE GROUPERS USING ICPC-2 - by diagnosis
When searching for patients who have a particular condition, either for self audit or for patient
recall, the problem/diagnosis for which you are searching may not always be contained within a
single ICPC-2 PLUS term or even an ICPC-2 rubric.
To assist in these reports/searches of your records the Family Medicine Research Centre has
undertaken significant work to improve the quality of “groupers” available in ICPC-2 PLUS. This
work has resulted in a more comprehensive list of concept types both within and across rubrics
and chapters.
HINTS when utilising ICPC-2 PLUS’s inbuilt groupers:If you are searching for a set of patients who may fulfill multiple criteria of a grouper (e.g. your
search = all patients with “High BP” OR “Simple Hypertension” OR “Hypertension with
complications”. If your patient was originally labeled “high BP” and later diagnosed as
“hypertension” your software could identify this patient more than once.
What is the solution?
You need to ensure that your search can run a count of patients who fulfill ‘at least one’
of the criteria codes listed for your grouper.
Check with your software supplier to ensure this is feasible
If this sounds confusing check the “hypertension” grouper criteria listed on page E-8
The Grouper list has been removed from THIS electronic version.
The Full "APPENDIX E" IS included in the hardcopy version sent to licensed users.
ICPC – 2 PLUS Users’ Guide
Page 105
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