technological developments and the introduction of hospital information systems have greatly promoted interest in the use of computer systems for recording findings and images at endoscopy . several database systems have been developed for this purpose , most working only as a report generator . these systems are , however , hampered by the lack of a specific code system for endoscopic diagnoses and terminology . as a result of this shortcoming , systems use different database structures and variable terminology and are thus not compatible or comparable . the international classification of diseases ( icd ) is designed to promote international comparability in the collection , processing , classification , and presentation of mortality statistics . this icd is developed , published , and maintained by the world health organization ( who ) . the system is , in its current setting , not applicable for endoscopy , as it does not include descriptive terminology . adequate description of this appearance in uniform terminology is essential for the interpretation of endoscopy reports and allows important conclusions to be made with respect to therapy and prognosis . this is , however , hampered by the lack of a specific , uniformly applicable code system for endoscopic terminology and findings . in addition , only about 80% of report systems are able to use a code in their database . the icd , 9th edition ( icd-9 ) , and the clinical modification of the icd-9 ( icd-9-cm ) have already been used and proven to be of value in a specific and defined gastrointestinal endoscopic setting . the tenth edition ( icd-10 ) differs from the ninth edition in several ways , although the overall content is similar . second , some chapters have been rearranged , some titles changed , and conditions have been regrouped . other medical specialities , such as oncology and dentistry , have produced an extended code system for their field of interest based on the icd-10 . the aim of this project is to develop a comprehensive code system for gastrointestinal endoscopic terminology , based on the widely accepted icd-10 code system , that can be used in any gastrointestinal endoscopic information system . as a basis for the new coding system the latest edition of the icd , the icd-10 , was chosen . the reason for choosing this code system was that a predecessor has already been in use for some gastrointestinal endoscopic databases . in addition , the current version of the icd is now accepted in a majority of countries throughout the world . extensions of the icd-10 are made according to the recommendations of the who , without changing the structure of the icd-10 . the first four characters are never changed , but one or more characters are added behind these first four descriptors . in this way it is always possible to delete the extension to come back to the original icd-10 . also , the draft version of the icd-10-cm of the national center for health statistics ( nchs ) was studied , which is available on the internet . a working group , the trans.it working group , was founded , comprised of representatives from two academic hospitals ( utrecht , amsterdam ) and four general hospitals . besides the minimal standard terminology ( mst ) , text - blocks and standard reports are also available . a standard report is a complete report based on a diagnosis or a combination of diagnoses . with text - blocks , these two variants enable more rapid generation of reports and are well accepted and widely used in the netherlands . in the trans.it project group , which was founded as a peer reference group , standard reports , text - blocks , and linkage to the new code system were discussed . a list of every endoscopic finding , intervention , or complication described using one of the three methods of report writing available for trans.it users was generated . we first generated a list of the different fields necessary for evaluation of endoscopic data ( table  1 ) . all these fields are necessary to generate a comprehensive anonymous database with endoscopic information for extensive research . in addition , demographic data such as gender and age of patients and specialty of referring doctor are recorded.table 1different fields that need a specific code in endoscopic information systemsreason for endoscopymedication usesedation and medication during endoscopypreparationprocedure for investigationendoscopic diagnosis / findingstherapeutic and diagnostic interventionshistology resultstherapy startedadvice to referring doctorcomplications different fields that need a specific code in endoscopic information systems we included all available standard reports , text - blocks , and diagnoses of minimal standard terminology ( mst ) accepted by the trans.it group . the endoscopic findings , interventions , and complications were extracted and linked to a specific code . in this way , a total of 316 standard reports and 1571 text - blocks were coded , to assure coding of every item within this project . in total , 2593 different items were extracted and received a specific code . of these items , 630 ( 24% ) could be coded with the existing icd-10 . thus , 1963 new codes were required and added to the icd-10 system , in order to be able to specifically code every endoscopic term . the problem with that design is that the structure used in the icd-10 is not very detailed . this is true especially for gastrointestinal endoscopic terms , which do not always include a mortality risk but , most of the time , descriptive items essential for prognosis and therapy . for example , specific descriptions of peptic ulcers are relevant for determination of outcome risks , therapy , and prognosis . we thus , for instance , changed the diagnosis k25.2 ( acute gastric ulcer with both hemorrhage and perforation ) to k25.21 ( acute gastric ulcer with spurting bleeding and perforation ; forrest ia ) in the gastrointestinal endoscopic terminology coding ( get - c ; table  2).table 2comparison of icd-10 and get - c codes for gastric ulcericd-10descriptionget - cdescriptionk25.0gastric ulcer , acute with hemorrhagek25.0gastric ulcer , acute with hemorrhagek25.01gastric ulcer , acute with spurting bleeding ( forrest ia)k25.02gastric ulcer , acute with nonspurting active bleeding ( forrest ib)k25.1gastric ulcer , acute with perforationk25.1gastric ulcer , acute with perforationk25.2gastric ulcer , acute with both hemorrhage and perforationk25.2gastric ulcer , acute with both hemorrhage and perforationk25.21gastric ulcer , acute with spurting bleeding and perforation ( forrest ia)k25.22gastric ulcer , acute with nonspurting active bleeding and perforation ( forrest ib)k25.3gastric ulcer , acute without hemorrhage or perforationk25.3gastric ulcer , acute without hemorrhage or perforationk25.31gastric ulcer , acute with visible vessel ( forrest iia)k25.32gastric ulcer , acute nonbleeding with overlying clot ( forrest iib)k25.33gastric ulcer , acute with hematin - covered basis ( forrest iic)k25.34gastric ulcer , acute with clean ulcer ground ( forrest iii)k25.5gastric ulcer , chronic or unspecified with perforationk25.5gastric ulcer , chronic or unspecified with perforationk25.6gastric ulcer , chronic or unspecified with both hemorrhage and perforationk25.6gastric ulcer , chronic or unspecified with both hemorrhage and perforationk25.61gastric ulcer , chronic or unspecified with spurting bleeding and perforation ( forrest ia)k25.62gastric ulcer , chronic or unspecified with non- spurting active bleeding and perforation ( forrest ib)k25.7gastric ulcer , chronic without hemorrhage or perforationk25.7gastric ulcer , chronic without hemorrhage or perforationk25.71gastric ulcer , chronic with visible vessel ( forrest iia)k25.72gastric ulcer , chronic non - bleeding with overlying clot ( forrest iib)k25.73gastric ulcer , chronic with hematin - covered basis ( forrest iic)k25.74gastric ulcer , chronic with clean ulcer ground ( forrest iii)k25.9gastric ulcer , unspecified , without hemorrhage or perforationk25.9gastric ulcer , unspecified , without hemorrhage or perforationk25.91gastric ulcer , unspecified , with visible vessel ( forrest iia)k25.92gastric ulcer , unspecified , nonbleeding with overlying clot ( forrest iib)k25.93gastric ulcer , unspecified , with hematin - covered basis ( forrest iic)k25.94gastric ulcer , unspecified , with clean ulcer ground ( forrest iii ) comparison of icd-10 and get - c codes for gastric ulcer besides such an adaptation of the icd-10 system , endoscopy is still developing and new terms and endoscopic techniques are continuously being created . for example , new disease classifications are being introduced from time to time , such as the semirecent los angeles classification for reflux esophagitis [ 9 , 10 ] . for several fields , there was no icd-10 code available , and the item thus could not be categorized under an existing icd-10 code . for example , the procedure for investigation and interventions could not be covered within the icd-10 or even the icd-10-cm system . because these items are essential for good analysis of endoscopic data , a new chapter with the same structure as the icd-10 was developed . we chose to categorize therapeutic interventions in this new chapter also because new therapies are developed frequently and can now be adapted . adaptations were made in different chapters of the icd-10 . in chapter 1 , certain infectious and parasitic diseases ( a00b99 ) , the exact locations in the gastrointestinal tract of some specific infections were added . in chapter 2 , neoplasms ( c00d48 ) , besides the exact locations in the gastrointestinal tract , the endoscopic characteristics of polyps were described and coded in more detail . it is important to register whether a polyp is pedunculated , sessile , or flat or has a villous endoscopic aspect . also , the number of polyps found in a specific part of the intestine must be coded , because of important diagnostic and therapeutic options for patients and the follow - up of these patients . in chapter 9 , diseases of the circulatory system ( i00i99 ) , hemorrhoids and varices were described according to a classification . most changes were , however , made in chapter 11 , diseases of the digestive system ( k00k93 ) . gastric and duodenal ulcers were coded according to the forrest classification and their specific location in the stomach or duodenum . gastritis and duodenitis were coded according to their specific location and the endoscopically suspected cause . some complications related to gastrointestinal procedures were coded in more detail . in chapter 18 symptoms , signs , and abnormal clinical and laboratory findings that are an indication for endoscopic investigations were coded in more detail . in chapter 21 postoperative situations important for gastrointestinal endoscopic investigations such as gastric and colon operations were extensively coded . in the new , thirteenth chapter of the get - c the first part of this chapter includes coding of various indications for endoscopy that could not be categorized in the icd-10 . examples of therapeutic procedures are different kinds of polypectomies , endoscopic mucosal resections , placement of endoprotheses , and dilatation of stenoses . another aspect of these therapeutic interventions was used for the management of gastrointestinal bleeding such as injection therapy with or without coagulation , band ligations , and clipping . preparation and procedure for the endoscopic examination the extensions of the get - c were checked by the dutch translation board of the icd-10 to preclude any conflicts between the two code systems . the increased use of computer systems in health care and the need for communication between these systems necessitate the availability of generally accepted code systems . coding is of importance for hospitals and professionals because most of the financial systems used in health care are based on different codes . in addition , good coding makes statistical analysis of different diagnoses and collection of rare diagnoses easier . with an internationally accepted code , it is possible to compare and share information in one field of interest . only some coding systems , such as the icd-10 , are translated into different languages and used in different countries . for endoscopic report writing and endoscopic databases , we used the endobase iii system from olympus europe in our project to compose reports and record different codes . the system runs as a network version with different workstations as well as a stand - alone unit . the endobase iii system enables the generation of reports via three pathways ; in addition to standard reports and text - blocks , the latest translated version of the mst is also used to compose an endoscopic report . thus it is essential that all differently generated data are coded in the same way to enable analysis of the data anonymously . in this system , all standard reports and text - blocks are linked to one or more specific get - c codes . the choice of a standard report or text - block leads directly to the recording of the correct get - c code in the endobase iii database . due to the structure of the mst , we chose to link the diagnoses with the get - c code , which is separately selected within the mst by the endoscopist at the end of the report . automatic linking is essential to ensure correct and complete selection of codes and to make the system workable for endoscopists . in the trans.it project , after 3 years of use , a database of about 120,000 investigations using the same coding system has been built by this working group . the get - c system allows the encoding of any data collected during endoscopic investigations and recorded in any endoscopic database . by extending the icd-10 with respect to the structure developed by the who , it is always possible to extract the original icd-10 code from the get - c . thus , it is possible to link the endoscopic database with other health - care systems throughout the world . because endoscopy is an evolving medical specialty , new techniques are continuously becoming available . the get - c will be available for use in other systems and was discussed at the who family of international classifications network meeting in october 2004 . we hope that this coding system will help to make endoscopic databases and endoscopic report writing programs more meaningful .
technological developments have greatly promoted interest in the use of computer systems for recording findings and images at endoscopy and creating databases . the aim of this study was to develop a comprehensive who - approved code system for gastrointestinal endoscopic terminology . 
 the international classification of diseases , 10th edition ( icd-10 ) , and the icd-10 clinical modification ( icd-10-cm ) were expanded to allow description of every possible gastrointestinal endoscopic term under conditions defined by the who . 
 classifications of specific gastrointestinal disorders and endoscopic locations were added . 
 a new chapter was developed for frequently used terminology that could not be classified in the existing icd-10 , such as descriptions of therapeutic procedures . 
 the new extended code system was named gastrointestinal endoscopic terminology coding ( get - c ) . 
 the get - c is a complete icd-10-related code system that can be used within every endoscopic database program for all specific endoscopic terms . 
 the get - c is available for free at http://www.trans - it.org/.