INSTRUCTIONS FOR CLASSIFYING MULTIPLE CAUSES OF DEATH,

7,04

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2005

442

stron

3525

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World Health Organization

2004

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TABLE OF CONTENTS

SECTION I –

INTRODUCTION

A. Introduction .

B. Medical Certification ..

8Excerpt of U.S. Certificate of Death 9

U.S. Standard Certificate of Death . 10

SECTION II – GENERAL INSTRUCTIONS A. Introduction.. 13

1. Excessive Codes 13

2. Created Codes 15

3. “Dagger and asterisk” codes .. 21

B. General coding concept 22

1. Definitions and types of diagnostic entities . 22 a. One-term entity 22 b. Multiple one-term entity

. 24 c. Adjectival modifier reported with multiple conditions .. 26 2. Parenthetical entries . 27 3.

Special diagnostic entities . 28 4. Plural form of disease.. 29 5. Implied “disease . 29

C. Format.. 30 1. “Due to” relationships involving more than four causally related conditions 30

2. Connecting terms .. 30 a. “Due to” written in or implied . 30 b. Not indicating a “due to”

relationship . 33 3. Condition entered above line I(a) . 33 4. Condition reported between lines in Part

I .. 34 5. Condition reported as due to I(a), I(b), or I(c) 35 6. Conditions reported in Part II.. 36 7.

Deletion of “due to” on the death certificate .. 36 8. Deletion of “Part II” on death certificate .. 37 9.

Numbering of causes reported in Part I . 38 10. Punctuation marks . 39 11. Conditions in the

duration box

D. Doubtful diagnosis 41

1. Doubtful qualifying expression.. 41 2. Interpretation of “either…or…”. 42 E. Conditions specified

as “healed” or “history of” .. 45

F. Coding entries such as “same,” “ditto ("),” “as above” 46

G. Conditions qualified by “postmortem, ” “rule out,” “ruled out,” “r/o” .. 47

H. Non-indexed and illegible entries 48 1. Terms that are not indexed 48 2. Illegible entries 48

I. Coding one-character reject codes . 49 1. Reject code 1-5 – Inconsistent duration. 49 2. Reject

code 9 – More than four “due to” statements .. 51

J. Inclusion of additional information (AI) to mortality

source documents 52

K. Amended certificates . 55

L. Effect of age of decedent on classification . 56 1. NEWBORN OR NEONATAL means less than

28 days of age at the time of death .. 56 2. INFANT OR INFANTILE means less than 1 year of

age at the time of death .. 56 3. CHILD, CHILDHOOD means less than 18 years of age at the time

of death .. 57 4. Congenital anomalies (Q00-Q99) . 57 5. Congenital syphilis 58 6. Age limitation..

59

M. Sex limitations . 61

N. Effect of duration on assignment of codes . 62 1. Qualifying conditions as acute or chronic 62

2. Subacute . 63 3. Acute exacerbation 64 4. Acute and chronic . 64 5. Qualifying conditions as

congenital or acquired .. 65 6. Two conditions with one duration 65 7. Conflict in durations. 66 8.

Span of dates 66

O. Relating and modifying conditions. 67 1. Implied site of disease . 67 a. General instructions for

implied site of a disease. . 67 b. Relating specific categories . 70 c. Exceptions to relating and

modifying instructions 72 2. Coding conditions classified to injuries as disease conditions .. 74

SECTION III – INTENT OF CERTIFIER.. 78 1. Charcot’s Arthropathy (A521).. 79 2. General

Paresis (A521) . 80 3. Organisms and Infection NOS (B99) 82 4. Erythremia (C940) .. 88 5.

Polycythemia (D45) 89 6. Hemolytic Anemia (D589) . 90 7. Sideroblastic Anemia (D643) 91 8.

Hemorrhagic Purpura NOS (D693) 92 9. Thrombocytopenia (D696) . 93 10. Hyperparathyroidism

(E213) . 95 11. Hyperaldosteronism (E269) 96 12. Lactase Deficiency (E730).. 97 13. Alcohol

(F100, F101, F109, R780, R826, R893) 98 14. Korsakov’s Disease, Psychosis, or Syndrome

(F106) .. 100 15. Drug Use NOS - Named Drug Use (F11-F16, F18-F19) 101 16. Tobacco Use

(F179) 104 17. Psychotic Episode NOS (F239) 105 18. Psychosis (any F29). 106 19. Dissociative

Disorder (F449). 107 20. Personality Disorder (F609), Personality Change (Enduring) (F629).. 108

21. Mental Disorder (any F99) . 109 22. Parkinson’s Disease (G20).. 110 23. Cerebral Sclerosis

(G379) 111 24. Myopathy (G729). 112 25. Brain Damage, child (G809).. 113 26. Paralysis (any

G81, G82, or G83 excluding senile paralysis) .. 114 27. Cataract (H269). 115 28. Varices NOS and

Bleeding Varices (I839). 116 29 Pneumonia in J188 or J189, Bronchopneumonia (J180), Lobar

pneumonia, organism unspecified only in J181. 117 30. Pneumoconiosis (J64) 118 31.

Diaphragmatic Hernia in K44.- 119 32. Laennec’s Cirrhosis (K703) 120 33. Biliary Cirrhosis NOS

(K745) .. 121 34. Lupus Erythematosus (L930), Lupus (L930) 122 35. Gout (M109) .. 123 36.

Polyarthrosis (M159) . 124 37. Coxarthrosis (M169) .. 125 38. Gonarthrosis (M179).. 126 39.

Arthrosis (M199) . 127 40. Kyphosis (M402) . 128 41. Scoliosis (M419) .. 129 42. Osteonecrosis

(M879) 130 43. Dysmenorrhea (N946) .. 131 44. Cesarean Delivery for Inertia Uterus (O622),

Cervical Dystocia (0622), Hypotonic Labor (0622), Hypotonic Uterus Dysfunction (O622),

Inadequate Uterus Contraction (O622), Uterine Inertia during Labor (O622), .. 132 45. Intracranial

Nontraumatic Hemorrhage of Fetus and Newborn (P52).. 133 46. Septal Defect (atrial), (auricular),

(heart), (ventricular) (Q210, Q211, Q212, Q219) . 134 47. Hypoplasia or Dysplasia of Lung NOS

(Q336) 135 48. Injury (S000-T149) . 136 49. Fracture (any site) (T142) 137 50. Starvation NOS

(T730) . 139

SECTION IV – CLASSIFICATION OF CERTAIN ICD CATEGORIES

A. Neoplasms (C00-D48) . 140 A. Malignant Neoplasms (C00-C96). 142 1. Neoplasms stated to be

secondary . 145 2. Malignant neoplasms with primary site indicated . 145 3. Site specific neoplasms

147 4. Other morphological types of neoplasms .. 148 5. Independent (primary) sites .. 149 6.

Metastases .. 152 7. Multiple sites. 154 8. Metastatic neoplasms 157 9. Primary site unknown ..

168 10 Implication of malignancy . 170 11. Sites with prefixes or imprecise definitions.. 171 12.

Malignant neoplasms described with “either/or” .. 171 13. Mass or lesion with malignant neoplasms .

172

B. Rheumatic Heart Diseases 173 1. Heart diseases considered to be described as rheumatic 173

2. Distinguishing between active and chronic rheumatic heart disease .. 174 3. Valvular diseases

jointly reported. 176 4. Valvular diseases not indicated to be rheumatic 177

C. Pregnancy, Childbirth and the Puerperium (O00-O99) .. 180 1. General Information . 180 2.

Pregnancy or childbirth without mention of complication .. 181 3. Pregnancy with abortive outcome

(O000-O089) .. 182 4. Other complications of pregnancy, childbirth and puerperium (O00-O99) 184

5. Delivery reported with anesthetic death or anesthesia 186 6. Operative delivery . 187

D. Congenital Conditions 189

E. Conditions of Early Infancy (P000-P969).. 191

F. Sequela . 193 1. B900-B909 Sequela of tuberculosis. 194 2. B91 Sequela of acute poliomyelitis .

195 3. B92 Sequela of leprosy .. 196 4. B940 Sequela of trachoma 196 5. B941 Sequela of viral

encephalitis 197 6. B942 Sequela of viral hepatitis .. 198 7. B948 Sequela of other specified

infectious and parasitic diseases,

B949 Sequela of unspecified infectious and parasitic diseases . 198 8. E640-E649 Sequela of

malnutrition and other nutritional deficiencies. 199 9. E68 Sequela of hyperalimentation 200 10. G09

Sequela of inflammatory diseases of central nervous system . 200 11. I690-I698 Sequela of

cerebrovascular disease .. 201 12. O97 Sequela of direct obstetric cause . 202

G. Ill-Defined and Unknown Causes 203 1. Sudden infant death syndrome (R95).. 203 2. Other

sudden death and other unspecified

cause (R960-R961, R98-R99).. 203 3. Unknown cause (R97). 206

SECTION V –EFFECTS OF EXTERNAL CAUSE OF INJURY AND EXTERNAL CAUSES OF

INJURY AND POISONING

A. External Cause Code (E-Code) Concept 208 1. Use of Index . 209 2. Use of Tabular List 209 3.

Place of occurrence of external cause . 210 4. Manner of death (Item 37) on death certificate . 210

5. Nature of injury and external cause code lists 212

B. Placement of nature of injury and external cause codes.. 216

C. Use of ampersand .. 218

D. Certifications with mention of nature of injury and without mention of external cause .. 220

E. Conditions qualified as traumatic .. 223

F. Assumption of nature of injury code 230

G. Multiple injuries (T00-T07) 232

H. Burns: Multiple degrees of burns/percentage of body surface burned 234

I. Specified types and sites of injuries 236

J. Transportation accidents (V01-V99). 2371. Use of Index and Tabular List. 238 2. Classifying

accidents as traffic or nontraffic .. 239 3. Status of victim .. 240 4. Coding categories V01-V89.

241 5. Additional examples. 243 6. Occupant of special all-terrain or other motor vehicle designed

primarily for off-road use, injured in transport accident (V86) . 244 7. Traffic accident of specified

type but victim’s mode of transport unknown (V87), Nontraffic accident of specified type but

victim’s mode of transport unknown (V88) 245 8. Water transport accidents (V90-V94) . 246 9. Air

and space transport accidents (V95-V97). 246 10. Miscellaneous coding instructions (V01-V99) ..

247

K. Falls . 250 1. Other fall on same level (W18).. 250 2. Unspecified fall (W19) 250

L. Natural and environmental factors 251 1. Lightning 251 2. Exposure (cold) and hypothermia .

251

M. Firearms and firearm injuries .. 253 1. Coding specific types of firearms . 253 2. External cause

code.. 254 3. Nature of injury code .. 255 4. Other firearm examples.. 256

N. Child abuse, battering and other maltreatment (Y070-Y079) . 257

O. Guides for differentiating between effects of external causes classifiable to Chapters I – XVIII

and Chapter XIX .. 259

P. Threats to breathing 261 1. Table 1. Drowning and submersion.262 2. Table 2. Hanging and

mechanical strangulation (by external means). 264 3. Table 3. Fires (includes burns, gases, fumes

in association with burns and fires) 268 4. Table 4. Ingestion, inhalation of gases, fumes, vapors

(without fires, burns) 272 5. Table 5. Compression chest, crushed chest by external means 274 6.

Table 6. Aspiration NOS, ingestion NOS, inhalation NOS, or aspiration, ingestion, inhalation of

substances or objects (W78, W79, W80) .. 276

Q. Poisoning 282

1. Poisoning by substances other than drugs 282 a. Carbon monoxide poisoning . 283 b. Inhalation

and “sniffing” sprays and aerosol substances 284 c. Intoxication by certain substances or toxic

poisoning due to disease . 284 d. Condition qualified as “toxic” with poisoning reported . 285 2.

Poisoning by drugs 286 3. Percentage of drug(s) in blood 290 4. Poisoning by alcohol and drugs .

291 5. Intoxication (acute) NOS due to specified substances 293

R. Complications of medical and surgical care (Y40-Y84) 294 1. Drugs, medicaments, and

biological substances causing adverse effects in therapeutic use (Y40-Y59).. 296 2. Surgical

procedures as the cause of abnormal reaction of the patient or later complication (Y83) . 306 a.

Complications of surgical procedures.. 306 b. Condition necessitating surgery .. 320 c. Conditions

qualified as postoperative.. 326 d. Complication as first entry on lowest used line in Part I.. 331 e.

Ill-defined condition as first entry on lowest used line in Part I.. 335 f. Relating surgical procedure to