EN ISO 13120:2013

SLOVENSKI STANDARD
01-junij-2013
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SIST EN 14463:2008
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Health informatics - Syntax to represent the content of healthcare classification systems -
Classification Markup Language (ClaML) (ISO 13120:2013)
Medizinische Informatik - Syntax zur Darstellung des Inhalts medizinischer
Klassifikationssysteme - Klassifikations-Auszeichnungssprache ClaML (ISO 13120:2013)
Informatique de santé - Syntaxe de représentation du contenu des systèmes de
classification des soins de santé - Langage de marquage de la classification (ClaML)
(ISO 13120:2013)
Ta slovenski standard je istoveten z: EN ISO 13120:2013
ICS:
35.060 Jeziki, ki se uporabljajo v Languages used in
informacijski tehniki in information technology
tehnologiji
35.240.80 Uporabniške rešitve IT v IT applications in health care
zdravstveni tehniki technology
2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

EUROPEAN STANDARD
EN ISO 13120
NORME EUROPÉENNE
EUROPÄISCHE NORM
April 2013
ICS 35.240.80 Supersedes EN 14463:2007
English Version
Health informatics - Syntax to represent the content of
healthcare classification systems - Classification Markup
Language (ClaML) (ISO 13120:2013)
Informatique de santé - Syntaxe de représentation du Medizinische Informatik - Syntax zur Darstellung des
contenu des systèmes de classification des soins de santé Inhalts medizinischer Klassifikationssysteme -
- Langage de marquage de la classification (ClaML) (ISO Klassifikations-Auszeichnungssprache ClaML (ISO
13120:2013) 13120:2013)
This European Standard was approved by CEN on 14 March 2013.

CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this European
Standard the status of a national standard without any alteration. Up-to-date lists and bibliographical references concerning such national
standards may be obtained on application to the CEN-CENELEC Management Centre or to any CEN member.

This European Standard exists in three official versions (English, French, German). A version in any other language made by translation
under the responsibility of a CEN member into its own language and notified to the CEN-CENELEC Management Centre has the same
status as the official versions.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania,
Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and United
Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION

EUROPÄISCHES KOMITEE FÜR NORMUNG

Management Centre: Avenue Marnix 17, B-1000 Brussels
© 2013 CEN All rights of exploitation in any form and by any means reserved Ref. No. EN ISO 13120:2013: E
worldwide for CEN national Members.

Contents Page
Foreword .3
Foreword
This document (EN ISO 13120:2013) has been prepared by Technical Committee ISO/TC 215 "Health
informatics" in collaboration with Technical Committee CEN/TC 251 “Health informatics” the secretariat of
which is held by NEN.
This European Standard shall be given the status of a national standard, either by publication of an identical
text or by endorsement, at the latest by October 2013, and conflicting national standards shall be withdrawn at
the latest by October 2013.
Attention is drawn to the possibility that some of the elements of this document may be the subject of patent
rights. CEN [and/or CENELEC] shall not be held responsible for identifying any or all such patent rights.
This document supersedes EN 14463:2007.
According to the CEN-CENELEC Internal Regulations, the national standards organizations of the following
countries are bound to implement this European Standard: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech
Republic, Denmark, Estonia, Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece,
Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal,
Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and the United Kingdom.
Endorsement notice
The text of ISO 13120:2013 has been approved by CEN as EN ISO 13120:2013 without any modification.

INTERNATIONAL ISO
STANDARD 13120
First edition
2013-04-01
Health informatics — Syntax to
represent the content of healthcare
classification systems — Classification
Markup Language (ClaML)
Informatique de santé — Syntaxe de représentation du contenu des
systèmes de classification des soins de santé — Langage de marquage
de la classification (ClaML)
Reference number
ISO 13120:2013(E)
©
ISO 2013
ISO 13120:2013(E)
© ISO 2013
All rights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized otherwise in any form
or by any means, electronic or mechanical, including photocopying, or posting on the internet or an intranet, without prior
written permission. Permission can be requested from either ISO at the address below or ISO’s member body in the country of
the requester.
ISO copyright office
Case postale 56 • CH-1211 Geneva 20
Tel. + 41 22 749 01 11
Fax + 41 22 749 09 47
E-mail copyright@iso.org
Web www.iso.org
Published in Switzerland
ii © ISO 2013 – All rights reserved

ISO 13120:2013(E)
Contents Page
Foreword .iv
Introduction .v
1 Scope . 1
1.1 Main purposes . 1
1.2 Topics considered outside the scope of this International standard . 1
2 Normative references . 1
3 Abbreviated terms . 2
4 Conformance . 2
5 Conventions . 2
6 Classification markup language . 2
6.1 Basis of the syntax . 2
6.2 Document Type Definition . 2
6.3 Semantic description of the Classification Markup Language . 6
Annex A (informative) Examples of usage of this International Standard .31
Annex B (informative) Suggested usage of ClaML attributes .35
Bibliography .37
ISO 13120:2013(E)
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out
through ISO technical committees. Each member body interested in a subject for which a technical
committee has been established has the right to be represented on that committee. International
organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.
ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of
electrotechnical standardization.
International Standards are drafted in accordance with the rules given in the ISO/IEC Directives, Part 2.
The main task of technical committees is to prepare International Standards. Draft International
Standards adopted by the technical committees are circulated to the member bodies for voting.
Publication as an International Standard requires approval by at least 75 % of the member bodies
casting a vote.
Attention is drawn to the possibility that some of the elements of this document may be the subject of
patent rights. ISO shall not be held responsible for identifying any or all such patent rights.
ISO 13120 was prepared by Technical Committee ISO/TC 215, Health informatics.
iv © ISO 2013 – All rights reserved

ISO 13120:2013(E)
Introduction
Healthcare classifications are developed and distributed in a variety of informal formats, such as MS
Word, with little consistency in approach between developers. Exchanging data from these systems
or attempting to parse the informal text into a more formal structure, say for publishing purposes,
presents many challenges because unwanted mistakes are easily made, and difficult to detect. For
example, the accidental deletion of a tab can transform a sibling rubric into a parent. ASCII files with
comma separated value fields is another mechanism widely used for storing and transferring data, but
as a solution here is limited by insufficient formal structuring capabilities.
In the interests of safely exchanging and distributing the content and hierarchical structure of
healthcare classification systems, this International Standard presents a simple XML specification,
ClaML, for exchange and distribution of healthcare classifications systems. XML is the chosen format
for this International Standard as: a) XML provides the necessary structuring elements, and b) there are
many readily available XML parsers in existence.
This International Standard builds on CEN/TS 14463:2002 in that the primary focus of CEN/TS 14463:2002
was to support electronic data processing. Assessment of CEN/TS 14463:2002 revealed the need to
extend the areas for version control and maintenance within the Standard and this was supported by
insight from the health informatics community who have been active in the implementation of this
International Standard.
This International Standard is intended to serve as the core representation from which all publication
forms can be derived. It contains information of a depth sufficient to uniquely identify and describe the
structure and relevant element of healthcare classification systems. This International Standard does
not intend to prescribe to developers how healthcare classification systems should be structured, nor
does it define or explain the meaning of the structuring elements. This International Standard is not
meant to be a direct format for printing or viewing the content of a healthcare classification system.
Views and prints are to be derived from this representation by post processing.
This International Standard is targeted at:
[2]
a) developers of first generation healthcare classification systems, to assist in the construction,
maintenance and publication (both in paper and electronic formats) of a particular system;
b) developers of information systems to assist in the inclusion of mechanisms for unambiguous loading
of healthcare classification systems in their applications;
c) organizations responsible for updating healthcare classification systems;
d) institutions receiving updated healthcare classification systems.
INTERNATIONAL STANDARD ISO 13120:2013(E)
Health informatics — Syntax to represent the content of
healthcare classification systems — Classification Markup
Language (ClaML)
1 Scope
1.1 Main purposes
The main purpose of this International Standard is to formally represent the content and hierarchical
structure of healthcare classification systems in a markup language for the safe exchange and distribution
of data and structure between organizations and dissimilar software products.
The scope of healthcare classifications systems covered in this International Standard encompasses
terminologies, and is constrained to traditional paper-based systems (like ICD-10) and systems built
[3]
according to categorial structures and a cross thesaurus (like ICNP). This International Standard
is intended for representation of healthcare classification systems in which classes have textual
definitions, hierarchical ordering, named hierarchical levels (such as “chapter”, “section”), inclusion-
and exclusion criteria, and codes. It is not intended to cover any formal representation, either for
definition or composition, of concepts, or for specification of classification rules. Systems with such
formal specifications can at best be partially represented using this International Standard, and are
hence out of scope.
1.2 Topics considered outside the scope of this International standard
This International Standard is not intended to:
a) provide a normative syntax on how a healthcare classification system is to be constructed;
b) define link types between elements in a healthcare classification system; this is left to the developers
of healthcare classification systems;
c) provide a representation for direct viewing or printing.
2 Normative references
The following referenced documents are indispensable for the application of this document. For dated
references, only the edition cited applies. For undated references, the latest edition of the referenced
document (including any amendments) applies.
ISO 3166-1, Codes for the representation of names of countries and their subdivisions — Part 1: Country codes
ISO 639-1, Codes for the representation of names of languages — Part 1: Alpha-2 code
ISO 13120:2013(E)
3 Abbreviated terms
ClaML Classification Markup Language
XML eXtensible Markup Language 1.0
DRG Diagnosis-Related Group
DTD Document Type Definition
IANA Internet Assigned Numbers Authority
ICD International Classification of Diseases
ICF International Classification of Functioning, disability and health
ICNP International Classification for Nursing Practice
OPS “Operationen und Prozedurenschlüssel”, the German procedure classification
WHO World Health Organization
4 Conformance
The normative part of this International Standard is written in the form of a document type definition
(DTD). Many commercially available XML tools provide facilities to test the conformance of an XML
document with a DTD. Users of this International Standard are encouraged to perform such a test before
distributing their healthcare classifications in the format of this International Standard. Alternatively, a
conformance test using an XML Schema Definition (XSD) can be performed, but an XSD is not part of the
current revision of this International Standard.
5 Conventions
The font Courier New is used to denote the DTD of ClaML.
Bold text is used to denote elements and attributes defined in the DTD. For names of elements CamelCase
is used (i.e. a single string, without spaces, consisting of multiple words, each starting with a capital); for
names of attributes lowercase is used.
6 Classification markup language
6.1 Basis of the syntax
The basis of the syntax is to represent the content of healthcare classification systems. The syntax
defined in this International Standard is called Classification Markup Language. It is defined here in the
form of a DTD. The reference to this syntax will be headed to ClaML in the remainder of this document.
The Version of ClaML described in this document is Version 2.0.0.
6.2 Document Type Definition

ment | List | Table”>
Meta*,
Identifier*,
Title,
Authors?,
2 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
Variants?,
ClassKinds,
UsageKinds?,
RubricKinds,
Modifier*,
ModifierClass*,
Class*)
>
version CDATA #REQUIRED
>

name CDATA #REQUIRED
value CDATA #REQUIRED
variants IDREFS #IMPLIED
>

authority NMTOKEN #IMPLIED
uid CDATA #REQUIRED
>

name NMTOKEN #REQUIRED
version CDATA #IMPLIED
date CDATA #IMPLIED
>


name ID #REQUIRED
>


name ID #REQUIRED
>




name ID #REQUIRED
>

name ID #REQUIRED
mark CDATA #REQUIRED
>

name ID #REQUIRED
inherited (true|false) “false”
>

xml:lang NMTOKEN #REQUIRED
variants IDREF #IMPLIED
>
Meta*,
SubClass*,
Rubric*,
History*)
>
code NMTOKEN #REQUIRED
variants IDREFS #IMPLIED
>
ISO 13120:2013(E)
Meta*,
SuperClass,
SubClass*,
Rubric*,
History*)
>
modifier NMTOKEN #REQUIRED
code NMTOKEN #REQUIRED
usage IDREF #IMPLIED
variants IDREFS #IMPLIED
>
Meta*,
SuperClass*,
SubClass*,
ModifiedBy*,
ExcludeModifier*,
Rubric*,
History*)
>
code NMTOKEN #REQUIRED
kind IDREF #REQUIRED
usage IDREF #IMPLIED
variants IDREFS #IMPLIED
>
Meta*,
ValidModifierClass*)
>
code NMTOKEN #REQUIRED
all (true|false) “true”
position CDATA #IMPLIED
variants IDREFS #IMPLIED
>

code NMTOKEN #REQUIRED
variants IDREFS #IMPLIED
>

code NMTOKEN #REQUIRED
variants IDREFS #IMPLIED
>
Label+,
History*)
>
id ID #IMPLIED
kind IDREF #REQUIRED
usage IDREF #IMPLIED
>

xml:lang NMTOKEN #REQUIRED
xml:space (default|preserve) “default”
variants IDREFS #IMPLIED
>

author IDREF #REQUIRED
date NMTOKEN #REQUIRED
>

code NMTOKEN #REQUIRED
variants IDREFS #IMPLIED
4 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
>

code NMTOKEN #REQUIRED
variants IDREFS #IMPLIED
>

class CDATA #IMPLIED
authority NMTOKEN #IMPLIED
uid NMTOKEN #IMPLIED
code NMTOKEN #IMPLIED
usage IDREF #IMPLIED
variants IDREFS #IMPLIED
>

class CDATA #IMPLIED
>

class CDATA #IMPLIED
usage IDREF #IMPLIED
type (item | list) “item”
>

class CDATA #IMPLIED
rubric IDREF #REQUIRED
>

code NMTOKEN #REQUIRED
kind IDREF #REQUIRED
>

class CDATA #IMPLIED
>
%rubric.simple;
| Para
| Include
| List
| Table)*
>
class CDATA #IMPLIED
>
Caption?,
THead?,
TBody?,
TFoot?)
>
class CDATA #IMPLIED
>

class CDATA #IMPLIED
>

class CDATA #IMPLIED
>

class CDATA #IMPLIED
>

ISO 13120:2013(E)
class CDATA #IMPLIED
>

class CDATA #IMPLIED
>
%rubric.simple;
| Para
| Include
| List
| Table)*
>
class CDATA #IMPLIED
rowspan CDATA #IMPLIED
colspan CDATA #IMPLIED
>

class CDATA #IMPLIED
>
6.3 Semantic description of the Classification Markup Language
6.3.1 ClaML
6.3.1.1 General
The element ClaML identifies a Classification Markup Language file.
6.3.1.2 Contents
The element ClaML shall contain:
— an optional number of Meta elements;
— an optional number of Identifier elements;
— one Title element;
— one optional Authors element;
— one optional Variants element;
— one ClassKinds element;
— one optional UsageKinds element;
— one RubricKinds element;
— an optional number of Modifier elements;
— an optional number of ModifierClass elements;
— an optional number of Class elements.
6.3.1.3 Required attribute
The attribute version shall specify the version of ClaML used in the remaining document. The value to
indicate the current version shall be “2.0.0”.
6 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
6.3.1.4 Optional attribute
The element ClaML has no optional attributes.
6.3.2 Meta
6.3.2.1 General
The element Meta shall be used to define meta information about a class or the classification.
6.3.2.2 Contents
The element Meta has no content.
6.3.2.3 Required attributes
The attribute name defines the name for the meta information.
The attribute value defines the content of the meta information.
The attribute variants defines the variants in which this Meta element is valid. When the attribute is
absent the Meta element is valid in all variants. The variants are defined in the element Variants (6.3.7).
EXAMPLE

NOTE The example is taken from the OPS . It indicates that the class is used for coding in a DRG-System.
6.3.2.4 Optional attribute
The element Meta has no optional attributes.
6.3.3 Identifier
6.3.3.1 General
The optional element Identifier may occur multiple times. It defines an issuing authority and the unique
identifier for the classification defined by that authority.
6.3.3.2 Contents
The element Identifier has no content.
6.3.3.3 Required attribute
The attribute uid is required and defines the unique identifier for the classification.
6.3.3.4 Optional attribute
The optional attribute authority identifies the authority that issued the uid.
EXAMPLE


NOTE The example shows a HL7 registered identifier specifying that the ClaML-file is containing ICD-10 data.
ISO 13120:2013(E)
6.3.4 Title
6.3.4.1 General
The element Title defines the title for the classification.
6.3.4.2 Contents
The content of the element Title is limited to plain text.
6.3.4.3 Required attribute
The attribute name defines a short name for the classification.
6.3.4.4 Optional attributes
The attribute version defines the version of the classification. It is recommended to use the well-known
major.minor.patch version numbering scheme.
The attribute date defines the date of publication. It is recommended to use a string with the format
“YYYYMMDDHHMMSS.UUUU[+|-ZZzz]” that conforms to the constrained ISO 8601 that is defined
in ISO 8824:1990, (ASN.1), Clause 32 (generalized time). Digits can be omitted from the right side to
express less precision.
EXAMPLE
International Classification of
th
Diseases, 10 revision


NOTE The first example shows a title element for the ICD-10. In the second example a title element is given for
the OPS just holding the short name.
6.3.5 Authors
6.3.5.1 General
The element Authors defines the authors of the ClaML file. This can, for example, be an organization
issuing the file or a person creating a healthcare classification. In case multiple organizations work on a
healthcare classification they can all be named as authors (see example below).
6.3.5.2 Contents
The element Authors contains an optional number of Author elements.
6.3.5.3 Required attribute
The element Authors has no required attributes
6.3.5.4 Optional attribute
The element Authors has no optional attributes
6.3.6 Author
6.3.6.1 General
The element Author represents the name of an author of the classification.
8 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
6.3.6.2 Contents
The content of the element Author is limited to plain text.
6.3.6.3 Required attribute
The attribute name uniquely identifies the author. The first character of the attribute name shall be a
letter, underscore or colon. This attribute is referenced in the element History.
EXAMPLE

World Health Organization
Dutch WHO-FIC

6.3.6.4 Optional attribute
The element Author has no optional attributes
6.3.7 Variants
6.3.7.1 General
Optionally, this International Standard supports multiple variants of a classification in the same ClaML
file. The element Variants defines the variants (if any) that are contained within the ClaML file.
6.3.7.2 Contents
The element Variants contains one or more Variant elements.
6.3.7.3 Required attribute
The element Variants has no required attributes.
6.3.7.4 Optional attribute
The element Variants has no optional attributes.
6.3.8 Variant
6.3.8.1 General
The element Variant uniquely identifies a variant within the ClaML file.
6.3.8.2 Contents
The content of the element Variant is limited to plain text.
6.3.8.3 Required attribute
The attribute name uniquely identifies the variant in the remainder of the ClaML file.
EXAMPLE

Clinical Modification
Australian Modification

ISO 13120:2013(E)
6.3.8.4 Optional attribute
The element Variant has no optional attributes.
6.3.9 ClassKinds
6.3.9.1 General
The element ClassKinds lists the kinds of classes, which are present in the classification.
6.3.9.2 Contents
The element ClassKinds contains one or more ClassKind elements.
EXAMPLE





NOTE In the example, the three common kinds of Classes are listed. This example ClaML section applies to
ICD-10, ICF and OPS.
6.3.9.3 Required attribute
The element ClassKinds has no required attributes.
6.3.9.4 Optional attribute
The element ClassKinds has no optional attributes.
6.3.10 ClassKind
6.3.10.1 General
The element ClassKind defines the name of a Class.
6.3.10.2 Contents
The element ClassKind contains an optional number of the Display elements.
6.3.10.3 Required attribute
The attribute name defines the name for the ClassKind and uniquely identifies the ClassKind. The first
character of the attribute name shall be a letter, underscore or colon.
6.3.10.4 Optional attribute
The element ClassKind has no optional attributes
6.3.11 UsageKinds
6.3.11.1 General
The optional element UsageKinds lists the kinds of usage of classes, which are present in the classification.
10 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
6.3.11.2 Contents
The element UsageKinds contains one or more UsageKind elements.
EXAMPLE



NOTE The example shows the usage kind that is used in the OPS. It specifies if a code can be used according
to the laterality of the procedure, e.g. at the left or right arm.
6.3.11.3 Required attribute
The element UsageKinds has no required attributes
6.3.11.4 Optional attribute
The element UsageKinds has no optional attributes
6.3.12 UsageKind
6.3.12.1 General
The element UsageKind defines the name of a UsageKind.
6.3.12.2 Contents
The element UsageKind has no content.
6.3.12.3 Required attributes
The attribute name defines the name for a UsageKind and uniquely identifies the UsageKind. The first
character of the attribute name shall be a letter, underscore or colon.
The attribute mark specifies how the code of a Class with a specific UsageKind shall be marked.
EXAMPLE




6.3.12.4 Optional attribute
The element UsageKind has no optional attributes
6.3.13 RubricKinds
6.3.13.1 General
The element RubricKinds lists the kinds of rubrics, which are present in the classification.
6.3.13.2 Contents
The element RubricKinds contains one or more RubricKind elements.
EXAMPLE
ISO 13120:2013(E)







NOTE Again this section of ClaML applies to ICD-10, ICF and OPS in the same way. An explanation of the
recommended kinds of rubrics is given in Table B.3.
6.3.13.3 Required attribute
The element RubricKinds has no required attributes.
6.3.13.4 Optional attribute
The element Rubrickinds has no optional attributes.
6.3.14 RubricKind
6.3.14.1 General
The element RubricKind defines the name of a RubricKind.
6.3.14.2 Contents
The element RubricKind contains an optional number of Display elements.
6.3.14.3 Required attributes
The attribute name defines the name for the RubricKind and uniquely identifies the RubricKind. The
first character of the attribute name shall be a letter, underscore or colon.
The attribute inherited specifies if rubrics with this RubricKind are inherited by subclasses. The
default value for this attribute is false.
6.3.14.4 Optional attribute
The element RubricKind has no optional attributes.
6.3.15 Display
6.3.15.1 General
The element Display defines how a ClassKind or RubricKind is to be displayed in a specific language.
6.3.15.2 Contents
The content of the element Display is limited to plain text.
6.3.15.3 Required attribute
The attribute xml:lang defines the language of the content of the element. The attribute values of
xml:lang shall follow ISO 639-1 if they are two-letter codes, and ISO 3166-1 if they contain two-letter
subcodes. Language identifiers registered with the IANA shall contain the prefix “I-” or “i-”. Any privately
used codes shall contain the prefix “X-” or “x-”.
12 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
6.3.15.4 Optional attribute
The attribute variants define the variants in which this Display element is used. When the attribute is
absent the Display element is used in all variants.
EXAMPLE


Chapter


Section







Inklusiva


6.3.16 Modifier
6.3.16.1 General
The element Modifier defines a modifier within the classification.
6.3.16.2 Contents
The element Modifier contains:
— an optional number of Meta elements;
— an optional number of SubClass elements;
— an optional number of Rubric elements;
— an optional number of History elements.
6.3.16.3 Required attribute
The attribute code defines the code for the Modifier.
6.3.16.4 Optional attribute
The attribute variants defines the list of variants in which this Modifier is valid. When the attribute is
absent the Modifier is valid in all variants.
EXAMPLE





NOTE In this Modifier the SubClass with the code 2 is valid for the ICD-10-CM only whereas the other
SubClasses are valid for all Modifications contained in one file.
ISO 13120:2013(E)
6.3.17 ModifierClass
6.3.17.1 General
The element ModifierClass defines a modifier class in the classification.
6.3.17.2 Contents
The element ModifierClass contains:
— an optional number of the Meta elements;
— exactly one SuperClass element;
— an optional number of the SubClass elements;
— an optional number of the Rubric elements;
— an optional number of the History elements.
6.3.17.3 Required attributes
The attribute modifier references the code of the modifier the ModifierClass belongs to.
The attribute code defines the code for the ModifierClass.
6.3.17.4 Optional attributes
The attribute usage refers to a UsageKind and specifies the usage of the ModifierClass.
The attribute variants defines the list of variants in which this ModifierClass is valid. When the
attribute is absent the ModifierClass is valid in all variants.
EXAMPLE






6.3.18 Class
6.3.18.1 General
The element Class defines a class in the classification.
6.3.18.2 Contents
The element Class contains:
— an optional number of Meta elements;
— an optional number of SuperClass elements;
— an optional number of SubClass elements;
— an optional number of ModifiedBy elements;
— an optional number of ExcludeModifier elements;
14 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
— an optional number of Rubric elements;
— an optional number of History elements.
6.3.18.3 Required elements
The attribute code defines the code for the class.
The attribute kind references the ClassKind of the class, e.g. chapter, block, category, etc. A list is
provided in Table B.1.
6.3.18.4 Optional attributes
The attribute usage refers to a UsageKind and specifies the usage of the class.
The attribute variants defines the list of variants in which this Class is valid. When the attribute is
absent the Class is valid in all variants. A list is provided in Table B.2.
EXAMPLE






Cholera


NOTE This Class with the Code A00 is a category. Its SuperClass is the block A00-A09, its SubClasses are
A00.0, A00.1 and A00.9. The preferred term is Cholera. The example shows a simple Class which would look much
the same as well in ICF or OPS.
6.3.19 ModifiedBy
6.3.19.1 General
The element ModifiedBy refers to the code of a Modifier, which modifies the class and its descendants.
In case the Modifier shall not modify a descendant of the Class the element ExcludeModifier shall be
defined at that specific descendant (see 6.3.20).
6.3.19.2 Contents
The element ModifiedBy contains:
— an optional number of Meta elements;
— an optional number of ValidModifierClass elements.
6.3.19.3 Required attribute
The attribute code references the code of the Modifier.
6.3.19.4 Optional attributes
The attribute all is used to indicate that all ModifierClasses are valid. In such a case, the element
ModifiedBy does not contain an element ValidModifierClass. The default value of the attribute all is true.
The attribute position specifies the position for the code of the ModifierClass when the Modifier is used
to generate the subclasses of the modified Class. The first position shall be specified by the number ‘1’.
ISO 13120:2013(E)
The attribute variants defines the list of variants in which this ModifiedBy element is valid. When the
attribute is absent this ModifiedBy element is valid in all variants.
EXAMPLE
If a clinical modification of the classification is created which allows limited addition of a fifth digit, the modification
is specified as follows:

...











In the example, both Class C88 and its descendant C88.0 are modified by Modifier Md1. At the descendant
Class C88.1 the modifier is excluded, i.e. Class C88.1 is not modified by Modifier Md1.
6.3.20 ExcludeModifier
6.3.20.1 General
The element ExcludeModifier refers to the code of a Modifier, which is not to be used for this class and
its descendants.
6.3.20.2 Contents
The element ExcludeModifier has no content.
6.3.20.3 Required attribute
The attribute code references the code of the excluded Modifier.
6.3.20.4 Optional attribute
The attribute variants defines the list of variants in which this ExcludeModifier element is valid. When
the attribute is absent this ExcludeModifier element is valid in all variants.
6.3.21 ValidModifierClass
6.3.21.1 General
The element ValidModifierClass refers to the code of a ModifierClass that is valid for this class. Only
valid modifier classes may be used to modify the Class. When the element ModifiedBy contains one or
more ValidModifierClass elements the attribute all at ModifiedBy shall be set to false.
6.3.21.2 Contents
The element ValidModifierClass has no content.
6.3.21.3 Required attribute
The attribute code defines the code of the ModifierClass.
16 © ISO 2013 – All rights reserved

ISO 13120:2013(E)
6.3.21.4 Optional attribute
The attribute variants defines the list of variants in which this ValidModifierClass element is valid.
When the attribute is absent this ValidModifierClass element is valid in all variants.
EXAMPLE





6.3.22 Rubric
6.3.22.1 General
The element Rubric defines the labels that belong to a Class, Modifier, or ModifierClass.
6.3.22.2 Contents
The element Rubric contains:
— one or more Label elements;
— an optional number of History elements.
6.3.22.3 Required attribute
The attribute kind refers to the RubricKind of rubric: preferred, inclusion, exclusion, etc. A list is provided
in Table B.3.
6.3.22.4 Optional attributes
The attribute id uniquely identifies the rubric. The first character of the attribute id shall be a letter,
underscore or colon.
The attribute usage refers to a UsageKind and specifies the usage of the Rubric.
6.3.23 Label
6.3.23.1 General
The element Label defines a piece of text.
6.3.23.2 Contents
The element Label contains plain text and:
— an optional number of Reference elements;
— an optional number of Term elements;
— an optional number of Para elements;
— an optional number of Include elements;
— an optional number of IncludeDescendants elements;
— an optional number of Fragment elements;
ISO 13120:2013(E)
— an optional number of List elements;
— an optional number of Table elements.
6.
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