National Vital Statistics System

Instructions for Classifying Multiple Causes of Death, 2018 – Section II

SECTION II – GENERAL INSTRUCTIONS

A. Introduction

Code all information reported in the medical certification section of the death certificate and any other information pertaining to the medical certification, when reported elsewhere on the certificate. In Volumes 1 and 3 of ICD-10, the fourth-character subcategories of three-character categories are preceded by a decimal point. For coding purposes, omit the decimal point.

Enter codes in the same order and location as the entries they represent appear on the death certificate, proceeding from the entry reported uppermost in Part II downward and from the left to right. If the uppermost line in Part II is an obvious continuation of a line below, enter the codes accordingly.

For instructions on placement of codes when the certifier states or implies a “due to” relationship between conditions not reported in sequential order, refer to Section II, Part C, Format. For instructions on placement of nature of injury (N-code) and external cause codes (E-codes), refer to Section V, Part B, Placement of Nature of Injury and External Cause Codes.

When an identical code applies to more than one condition reported on the same line, enter the code for the first-mentioned of these conditions only. When conditions classifiable to the same code are reported on different lines of the certificate, enter the code for each of the reported conditions. (This does not apply to external cause of morbidity and mortality (E-codes)).

1. Excessive Codes

  1. When a single line in Part I or Part II requires more than eight codes, delete the excessive codes (any over eight) for the line using the following criteria in the order listed:

(1) Delete ill-defined conditions (I461, I469, I959, I99, J960, J969, P285, R00-R94, R96, R98) except when this code is the first code on a line, proceeding right to left.

(2) Delete nature of injury codes (S000-T983) except for the first one entered on a line, proceeding right to left.

(3) If, after applying the preceding criteria, any single line still has more than eight codes, delete beginning with the last code on the line until only 8 remain.

            I    (a) I460

                 (b) I219 I739

                 (c)

                 (d)

            II  &E109 I739 T811 &Y835 R18 R33 N19 C475 N359 I490 I493 J181

After deleting excessive codes:

            I    (a) I460

                 (b) I219 I739

                 (c)

                 (d)

            II  &E109 I739 T811 &Y835 N19 C475 N359 I490

                   Delete (1) R33, (2) R18, (3) J181 and (4) I493

  1. When a single record requires more than 14 codes, delete the excessive codes using the following criteria in the order listed:

(1) Delete ill-defined conditions (I461, I469, I959, I99, J960, J969, P285, R00 – R94, R96, R98) except when this code is the first code on a line, beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d, line c, line b, line a).

(2) Delete nature of injury codes (S000-T983) except for the first one entered on a line beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d, line c, line b, line a).

(3) Delete repetitive codes except when it is the first code on a line beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d, line c, line b, line a).

(4) If after applying the preceding criteria, any record still has more than 14 codes, delete beginning with the last code in Part II, proceeding upward right to left on each line (Part II, line e, line d, line c, line b, line a).

            I    (a) C80    I460  R570

                 (b) R098  R53

                 (c) R54    F09   F03

                 (d) I709   I635

            II  I119 C473 R200 I258 I251 D539 R798 I635

            After deleting excessive codes:

            I    (a) C80    I460

                 (b) R098

                 (c) R54    F09    F03

                 (d) I709   I635

            II  I119 C473 I258 I251 D539 I635

            Delete (1) R798, (2) R200, (3) R53 and (4) R570

2. Created Codes

To facilitate automated data processing, the following ICD-10 codes have been amended for use in coding and processing the multiple cause data. Special five character subcategories are for use in coding and processing the multiple cause data; however, they will not appear in official tabulations.

A169     Respiratory tuberculosis, unspecified

Excludes: Any term indexed to A169 not qualified as respiratory or pulmonary (A1690)

*A1690      Tuberculosis NOS

Includes:  Any term indexed to A169 not qualified as respiratory or pulmonary

E039       Hypothyroidism, unspecified

Excludes: Any term indexed to E039 qualified as advanced, grave, severe, or with a similar qualifier (E0390)

*E0390      Advanced hypothyroidism

                 Grave hypothyroidism

                 Severe hypothyroidism

Includes:  Any term indexed to E039 qualified as advanced, grave, severe, or with a similar qualifier

G122       Motor neuron disease

Excludes: Any term indexed to G122 qualified as advanced, grave, severe, or with a similar qualifier (G1220)

*G1220      Advanced motor neuron disease

                 Grave motor neuron disease

                 Severe motor neuron disease

Includes:  Any term indexed to G122 qualified as advanced, grave, severe, or with a similar qualifier

G20         Parkinson disease

Excludes: Any term indexed to G20 qualified as advanced, grave, severe, or with a similar qualifier (G2000)

*G2000      Advanced Parkinson disease

                 Grave Parkinson disease

                 Severe Parkinson disease

Includes:  Any term indexed to G20 qualified as advanced, grave, severe, or with a similar qualifier

I219        Acute myocardial infarction, unspecified

Excludes: Embolism of any site classified to I219

*I2190       Embolism cardiac, heart, myocardium or a synonymous site

Includes:  Embolism of any site classified to I219

I420        Dilated cardiomyopathy

Excludes:  Any term indexed to I420 qualified as familial, idiopathic, or primary (I4200)

*I4200       Familial dilated cardiomyopathy

                 Idiopathic dilated cardiomyopathy

                 Primary dilated cardiomyopathy

Includes:  Any term indexed to I420 qualified as familial, idiopathic, or primary

I421        Obstructive hypertrophic cardiomyopathy

Excludes:  Any term indexed to I421 qualified as familial, idiopathic, or primary (I4210)

*I4210       Familial obstructive hypertrophic cardiomyopathy

                 Idiopathic obstructive hypertrophic cardiomyopathy

                 Primary obstructive hypertrophic cardiomyopathy

Includes:  Any term indexed to I421 qualified as familial, idiopathic, or primary

I422        Other hypertrophic cardiomyopathy

Excludes:        Any term indexed to I422 qualified as familial, idiopathic, or primary (I4220)

*I4220       Familial other hypertrophic cardiomyopathy

                 Idiopathic other hypertrophic cardiomyopathy

                 Primary other hypertrophic cardiomyopathy

Includes:  Any term indexed to I422 qualified as familial, idiopathic, or primary

I425        Other restrictive cardiomyopathy

Excludes:        Any term indexed to I425 qualified as familial, idiopathic, or primary (I4250)

*I4250       Familial other restrictive cardiomyopathy

                 Idiopathic other restrictive cardiomyopathy

                 Primary other restrictive cardiomyopathy

Includes:  Any term indexed to I425 qualified as familial, idiopathic, or primary

I428        Other cardiomyopathies

Excludes:  Any term indexed to I428 qualified as familial, idiopathic, or primary (I4280)

*I4280 Familial other cardiomyopathies

                 Idiopathic other cardiomyopathies

                 Primary other cardiomyopathies

Includes:  Any term indexed to I428 qualified as familial, idiopathic, or primary

I429        Cardiomyopathy, unspecified

Excludes:  Any term indexed to I429 qualified as familial, idiopathic, or primary (I4290)

*I4290       Familial cardiomyopathy

                 Idiopathic cardiomyopathy

                 Primary cardiomyopathy

Includes:  Any term indexed to I429 qualified as familial, idiopathic, or primary

I500        Congestive heart failure

Excludes: Any term indexed to I500 qualified as advanced, grave, severe, or with a similar qualifier (I5000)

*I5000       Advanced congestive heart failure

                 Grave congestive heart failure

                 Severe congestive heart failure

Includes:  Any term indexed to I500 qualified as advanced, grave, severe, or with a similar qualifier

I514        Myocarditis, unspecified

Excludes: Any term indexed to I514

                 qualified as arteriosclerotic (I5140)

*I5140       Arteriosclerotic myocarditis

Includes:  Any term indexed to I514 qualified as arteriosclerotic

I515        Myocardial degeneration

Excludes: Any term indexed to I515

                 qualified as arteriosclerotic (I5150)

*I5150       Arteriosclerotic myocardial degeneration

Includes: Any term indexed to I515 qualified as arteriosclerotic

I600        Subarachnoid hemorrhage from carotid siphon and bifurcation

Excludes: Ruptured carotid aneurysm (into brain) (I6000)

*I6000       Ruptured carotid aneurysm (into brain)

I606        Subarachnoid hemorrhage from other intracranial arteries

Excludes: Ruptured aneurysm (congenital) circle of Willis (I6060)

*I6060       Ruptured aneurysm (congenital) circle of Willis

I607        Subarachnoid hemorrhage from intracranial artery, unspecified

Excludes: Ruptured berry aneurysm (congenital) brain (I6070)

                 Ruptured miliary aneurysm (I6070)

*I6070       Ruptured berry aneurysm (congenital) brain

                 Ruptured miliary aneurysm

I608        Other subarachnoid hemorrhage

Excludes: Ruptured aneurysm brain meninges (I6080)

                 Ruptured arteriovenous aneurysm (congenital) brain (I6080)

                 Ruptured (congenital) arteriovenous aneurysm cavernous sinus (I6080)

*I6080       Ruptured aneurysm brain meninges

                 Ruptured arteriovenous aneurysm (congenital) brain

                 Ruptured (congenital) arteriovenous aneurysm cavernous sinus

I609        Subarachnoid hemorrhage, unspecified

Excludes: Ruptured arteriosclerotic cerebral aneurysm (I6090)

                 Ruptured (congenital) cerebral aneurysm NOS (I6090)

                 Ruptured mycotic aneurysm brain (I6090)

*I6090       Ruptured arteriosclerotic cerebral aneurysm

                 Ruptured (congenital) cerebral aneurysm NOS

                 Ruptured mycotic aneurysm brain

I610        Intracerebral hemorrhage in hemisphere, subcortical

Excludes: Any term indexed to I610 qualified as bilateral, multiple, or [i]similar term (I6100)

*I6100       Bilateral, multiple [or [i]similar term] intracerebral hemorrhages in hemisphere, subcortical

Includes: Any term indexed to I610 qualified as bilateral, multiple, or [i]similar term

I611        Intracerebral hemorrhage in hemisphere, cortical

Excludes: Any term indexed to I611 qualified as bilateral, multiple, or [i]similar term (I6110)

*I6110       Bilateral, multiple [or [i]similar term] intracerebral hemorrhages in hemisphere, cortical

Includes: Any term indexed to I611 qualified as bilateral, multiple, or [i]similar term

I612        Intracerebral hemorrhage in hemisphere, unspecified

Excludes: Any term indexed to I612 qualified as bilateral, multiple, or [i]similar term (I6120)

*I6120       Bilateral, multiple [or [i]similar term] intracerebral hemorrhages, unspecified

Includes: Any term indexed to I612 qualified as bilateral, multiple, or [i]similar term

I613        Intracerebral hemorrhage in brain stem

Excludes: Any term indexed to I613 qualified as bilateral, multiple, or [i]similar term (I6130)

*I6130       Bilateral, multiple [or [i]similar term] intracerebral hemorrhages in brain stem

Includes: Any term indexed to I613 qualified as bilateral, multiple, or [i]similar term

I614        Intracerebral hemorrhage in cerebellum

Excludes: Any term indexed to I614 qualified as bilateral, multiple, or [i]similar term (I6140)

*I6140       Bilateral, multiple [or [i]similar term] intracerebral hemorrhages in cerebellum

Includes: Any term indexed to I614 qualified as bilateral, multiple, or [i]similar term

I615        Intracerebral hemorrhage, intraventricular

Excludes: Any term indexed to I615 qualified as bilateral, multiple, or [i]similar term (I6150)

*I6150       Bilateral, multiple [or [i]similar term] intracerebral hemorrhages, intraventricular

Includes: Any term indexed to I615 qualified as bilateral, multiple, or [i]similar term

I618        Other intracerebral hemorrhage

Excludes: Any term indexed to I618 qualified as bilateral, multiple, or [i]similar term (I6180)

*I6180       Bilateral, multiple [or [i]similar term] other intracerebral hemorrhages

Includes: Any term indexed to I618 qualified as bilateral, multiple, or [i]similar term

I619        Intracerebral hemorrhage, unspecified

Excludes: Any term indexed to I619 qualified as bilateral, multiple, or [i]similar term (I6190)

*I6190       Bilateral, multiple [or [i]similar term] intracerebral hemorrhages, unspecified

Includes: Any term indexed to I619 qualified bilateral, multiple, or [i]similar term

I630        Cerebral infarction due to thrombosis of precerebral arteries

Excludes: Any term indexed to I630 qualified as bilateral, multiple, or [i]similar term (I6300)

*I6300       Cerebral infarction due to bilateral, multiple [or [i]similar term] thrombi of precerebral arteries

Includes: Any term indexed to I630 qualified as bilateral, multiple, or [i]similar term

I631        Cerebral infarction due to embolism of precerebral arteries

Excludes: Any term indexed to I631 qualified as bilateral, multiple, or [i]similar term (I6310)

*I6310       Cerebral infarction due to bilateral, multiple [or [i]similar term] emboli of precerebral arteries

Includes: Any term indexed to I631 qualified as bilateral, multiple, or [i]similar term

I632        Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries

Excludes: Any term indexed to I632 qualified as bilateral, multiple, or [i]similar term (I6320)

*I6320       Cerebral infarction due to bilateral, multiple [or [i]similar term]unspecified occlusions or stenosis of precerebral arteries

Includes: Any term indexed to I632 qualified as bilateral, multiple, or [i]similar term

I633        Cerebral infarction due to thrombosis of cerebral arteries

Excludes: Any term indexed to I633 qualified as bilateral, multiple, or [i]similar term (I6330)

*I6330       Cerebral infarction due to bilateral, multiple [or [i]similar term] thrombi of cerebral arteries

Includes: Any term indexed to I633 qualified as bilateral, multiple, or [i]similar term

I634        Cerebral infarction due to embolism of cerebral arteries

Excludes: Any term indexed to I634 qualified as bilateral, multiple, or [i]similar term (I6340)

*I6340       Cerebral infarction due to bilateral, multiple [or [i]similar term] emboli of cerebral arteries

Includes: Any term indexed to I634 qualified as bilateral, multiple, or [i]similar term

I635        Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries

Excludes: Any term indexed to I635 qualified as bilateral, multiple, or [i]similar term(I6350)

*I6350       Cerebral infarction due to bilateral, multiple [or [i]similar term]unspecified occlusions or stenosis of cerebral arteries

Includes: Any term indexed to I635 qualified as bilateral, multiple, or [i]similar term

I636        Cerebral infarction due to cerebral venous thrombosis, nonpyogenic

Excludes: Any term indexed to I636 qualified as bilateral, multiple, or [i]similar term (I6360)

*I6360       Cerebral infarction due to bilateral, multiple [or [i]similar term]

                 cerebral venous thrombi, nonpyogenic

Includes: Any term indexed to I636 qualified as bilateral, multiple, or [i]similar term

I638        Other cerebral infarction

Excludes: Any term indexed to I638 qualified as bilateral, multiple, or [i]similar term (I6380)

*I6380       Bilateral, multiple [or [i]similar term] other cerebral infarctions

Includes: Any term indexed to I638 qualified bilateral, multiple, or [i]similar term

I639        Cerebral infarction, unspecified

Excludes: Any term indexed to I639 qualified as bilateral, multiple, or [i]similar term (I6390)

*I6390       Bilateral, multiple [or [i]similar term] cerebral infarctions, unspecified

Includes: Any term indexed to I639 qualified as bilateral, multiple, or [i]similar term

I64          Stroke, not specified as hemorrhage or infarction

Excludes: Any term indexed to I64 qualified as bilateral, multiple, or [i]similar term(I6400)

*I6400       Bilateral, multiple [or [i]similar term] strokes, not specified as hemorrhage or infarction

Includes: Any term indexed to I64 qualified as bilateral, multiple, or [i]similar term

I691        Sequelae of intracerebral hemorrhage

                 Excludes: Any term indexed to I691 qualified as bilateral, multiple, or [i]similar term (I6910)

*I6910       Sequela of bilateral, multiple [or [i]similar term] intracerebral hemorrhages

Includes: Any term indexed to I691 qualified as bilateral, multiple, or [i]similar term

I693        Sequelae of cerebral infarction

Excludes: Any term indexed to I693 qualified as bilateral, multiple, or [i]similar term (I6930)

*I6930       Sequela of bilateral, multiple [or [i]similar term] cerebral infarctions

Includes: Any term indexed to I693 qualified as bilateral, multiple, or [i]similar term

I694        Sequelae of stroke, not specified as hemorrhage or infarction

Excludes: Any term indexed to I694 qualified as bilateral, multiple, or [i]similar term (I6940)

*I6940       Sequela of bilateral, multiple [or [i]similar term] strokes, not specified as hemorrhage or infarction

Includes: Any term indexed to I694 qualified as bilateral, multiple, or [i]similar term

J101        Influenza with other respiratory manifestations, influenza virus identified

Excludes: Influenza, flu, grippe (viral), influenza virus identified (without specified manifestations) (J1010)

*J1010      Influenza, flu, grippe (viral), influenza virus identified (without specified manifestations)

J111        Influenza with other respiratory manifestations, virus not identified

Excludes: Influenza, flu, grippe (viral), influenza virus not identified (without specified manifestations) (J1110)

*J1110      Influenza, flu, grippe (viral), influenza virus not identified (without specified manifestations)

J849        Interstitial pulmonary disease, unspecified

Excludes: Interstitial pneumonia, not elsewhere classified (J8490)

*J8490      Interstitial pneumonia, not elsewhere classified

J984        Other disorders of lung

Excludes: Lung disease (acute) (chronic) NOS (J9840)

*J9840      Lung disease (acute) (chronic) NOS

K319       Disease of stomach and duodenum, unspecified

Excludes: Disease, stomach NOS (K3190)

                 Lesion, stomach NOS (K3190)

*K3190      Disease, stomach NOS

                 Lesion, stomach NOS

K550       Acute vascular disorders of intestine

Excludes: Any term indexed to K550 qualified as embolic (K5500)

*K5500      Acute embolic vascular disorders of intestine

Includes: Any term indexed to K550 qualified as embolic

K631       Perforation of intestine (nontraumatic)

Excludes: Intestinal penetration, unspecified part (K6310)

                 Intestinal perforation, unspecified part (K6310)

                 Intestinal rupture, unspecified part (K6310)

*K6310      Intestinal penetration, unspecified part

                 Intestinal perforation, unspecified part

                 Intestinal rupture, unspecified part

K720       Acute and subacute hepatic failure

Excludes: Acute hepatic failure (K7200)

*K7200      Acute hepatic failure

K721       Chronic hepatic failure

Excludes: Chronic hepatic failure (K7210)

*K7210      Chronic hepatic failure

K729       Hepatic failure, unspecified

Excludes: Hepatic failure (K7290)

*K7290      Hepatic failure

M199       Arthrosis, unspecified

Excludes: Any term indexed to M199 qualified as advanced, grave, severe, or with a similar qualifier (M1990)

*M1990     Advanced arthrosis

                 Grave arthrosis

                 Severe arthrosis

Includes:  Any term indexed to M199 qualified as advanced, grave, severe, or with a similar qualifier

Q278       Other specified congenital malformations of peripheral vascular system

Excludes: Congenital aneurysm (peripheral) (Q2780)

*Q2780      Congenital aneurysm (peripheral)

Q282       Arteriovenous malformation of cerebral vessels

Excludes: Congenital arteriovenous cerebral aneurysm (nonruptured) (Q2820)

*Q2820      Congenital arteriovenous cerebral aneurysm (nonruptured)

Q283       Other malformations of cerebral vessels

Excludes: Congenital cerebral aneurysm (nonruptured) (Q2830)

*Q2830      Congenital cerebral aneurysm (nonruptured)

R58         Hemorrhage, not elsewhere classified

Excludes: Hemorrhage of unspecified site (R5800)

*R5800      Hemorrhage of unspecified site

R99         Other ill-defined and unspecified causes of mortality

Excludes: Cause unknown (R97)

*R97         Cause unknown

3.“Dagger and asterisk” codes

ICD-10 provides for the classification of certain diagnostic statements according to two different axes-etiology or underlying disease process and manifestation or complication. Thus, there are two codes for diagnostic statements subject to dual classification. The etiology or underlying disease codes are marked with a dagger () and the manifestations or complication codes are marked with an asterisk (*) following the code. The terms classified to codes with an asterisk are to be coded to the dagger code for the term only. These codes will not appear in official tabulations on multiple cause data.

I (a)      Salmonella meningitis                                                               A022

Use only the dagger code for multiple cause-of-death coding.

Do not use the following ICD-10 codes for multiple cause coding:

D63*           H03*     I68*     M36*

D77*           H06*     I79*     M49*

E35*           H13*     I98*     M63*

E90*           H19*     J17*     M68*

F00*           H22*     J91*     M73*

F02*           H28*     J99*     M82*

G01*           H32*     K23*     M90*

G02*           H36*     K67*     N08*

G05*           H42*     K77*     N16*

G07*           H45*     K87*     N22*

G13*           H48*     K93*     N29*

G22*           H58*     L14*     N33*

G26*           H62*     L45*     N37*

G32*           H67*     L54*     N51*

G46*           H75*     L62*     N74*

G53*           H82*     L86*     P75*

G55*           H94*     L99*

G59*           I32*     M01*

G63*           I39*     M03*

G73*           I41*     M07*

G94*           I43*     M09*

G99*           I52*     M14*

B. General coding concept

The coding of cause-of-death information for the ACME system consists of the assignment of the most appropriate ICD-10 code(s) for each diagnostic entity that is reported on the death certificate. In order to arrive at the appropriate code for a diagnostic entity, code each entity separately. Do not apply provisions in ICD-10 for linking two or more diagnostic terms to form a composite diagnosis classifiable to a single ICD-10 code.

            I    (a) Cholecystitis with cholelithiasis                                         K819    K802

Code each entity separately even though the Index has provided for a combination code for cholecystitis with cholelithiasis.

            I    (a) Malignant neoplasm of colon with rectum                          C189    C20

Code malignant neoplasm of colon and malignant neoplasm of rectum separately even though the Index has provided for a combination code for malignant neoplasm of colon with rectum.

Place     I    (a) Injury of intra-abdominal and intrathoracic organs             S369    S279

  9        II  &X599

Code injury of each site separately even though the Index has provided for a combination code for intra-abdominal and intrathoracic injury.

1. Definitions and types of diagnostic entities

A diagnostic entity is a single term or a composite term, comprised of one word or of two or more adjoining words, that is used to describe a disease, nature of injury, or other morbid condition. In this manual diagnostic entity and diagnostic term are used interchangeably.           A diagnostic entity may indicate the existence of a condition classifiable to a single ICD-10 category or it may contain elements of information that are classifiable to different ICD-10 categories. For coding purposes, it is necessary to distinguish between two different kinds of diagnostic entities – a “one-term entity,” and a “multiple one-term entity.”

a. One-term entity

(1) A one-term entity is a diagnostic entity that is classifiable to a single ICD-10.

            I    (a) Pneumonia                                                                    J189

                 (b) Arteriosclerosis                                                              I709

                 (c) Emphysema                                                                   J439

                   These terms are codable one-term entities.

            I    (a) Allergic vasculitis                                                           D690

                   This condition is indexed as one-term entity under “vasculitis.”

            I    (a) Cerebral arteriosclerosis                                                  I672

                   This condition is indexed as one-term entity.

(2) A diagnostic term that contains one of the following adjectival modifiers indicates the condition modified has undergone certain changes and is considered to be a one-term entity.

adenomatous   hypoxemic

anoxic        hypoxic

congestive    inflammatory

cystic        ischemic

embolic       necrotic

erosive       obstructed, obstructive

gangrenous    ruptured

hemorrhagic

                             (These instructions apply to these adjectival modifiers only).

                   For code assignment, apply the following criteria in the order stated.

(a) If the modifier and lead term are indexed together, code as indexed.

            I    (a) Embolic nephritis                                                            N058

Code Nephritis, embolic. The adjectival modifier “embolic” is indexed under nephritis.

(b) If the modifier is not indexed under the lead term, but “specified” is, use the code for specified (usually .8).

            I    (a) Obstructive cystitis                                                         N308

Code Cystitis, specified NEC. The adjectival modifier “obstructive” is not indexed under cystitis.

(c) If neither the modifier nor “specified” is indexed under the lead term, refer to Volume 1 under the NOS code for the lead term and look for a specified 4th character subcategory.

            I    (a) Hemorrhagic cardiomyopathy                                          I428

Code hemorrhagic cardiomyopathy to I428, Other cardiomyopathies. “Hemorrhagic” is not indexed under cardiomyopathy, neither is Cardiomyopathy, specified NEC indexed. The Classification does provide a code, I428, for “Other cardiomyopathies” in Volume 1.

(d) If neither (a), (b), or (c) apply, code the lead term without the modifier.

            I    (a) Adenomatous bronchiectasis                                            J47

“Adenomatous” is not an index term qualifying bronchiectasis. Code bronchiectasis only, since there is no provision in the Classification for coding “other bronchiectasis.”

b. Multiple one-term entity

A multiple one-term entity is a diagnostic entity consisting of two or more contiguous words on a line for which the Classification does not provide a single code for the entire entity but does provide a single code for each of the components of the diagnostic entity. Consider as a multiple one-term entity if each of the components can be considered as separate one-term entities, i.e., they can stand alone as separate diagnosis. Code each component of the multiple one-term entity as indexed and on the same line where reported.

I (a)      Myocardial infarction                                                                I219

  (b)     Uremic acidosis                                                                        N19 E872

  (c)      Chronic nephritis                                                                     N039

“Uremic acidosis” is not indexed as a one-term entity. Code “uremia” and “acidosis” as separate one-term entities, each of which can stand alone as a diagnosis.

I (a)      Uremia                                                                                    N19

  (b)     Diabetic heart disease                                                                E149 I519

  (c)

“Diabetic heart disease” is not indexed as a one-term entity. Code “diabetic” and “heart disease” as separate one-term entities, each of which can stand alone as a diagnosis.

I (a)      Senile cardiovascular disease, MI                                                R54 I516 I219

  (b)

  (c)

“Senile cardiovascular disease.” is not indexed as a one-term entity. Code “senile” and “cardiovascular disease” as separate one-term entities each of which can stand alone as a diagnosis.

Exception:

When any condition classifiable to I20-I25, except I250, or I60-I69 is qualified as “hypertensive,” code to I20-I25 or I60-I69 only.

            I    (a) Hypertensive arteriosclerotic

                      cerebrovascular disease                                                   I672

            I    (a) Hypertensive myocardial ischemia                                    I259

(1) Code an adjective reported at the end of a diagnostic entity as if it preceded the entity. This applies whether reported in Part I or II.

            I    (a) Arteriosclerosis, hypertensive                                          I10 I709

                 (b)

                 (c)

The complete term is not indexed as a one-term entity. “Hypertensive” is an adjectival modifier; code as if it preceded the arteriosclerosis.

            I    (a) MI                                                                                I219

                 (b)

                 (c)

            II  Coronary occlusion, arteriosclerotic                                        I709 I219

“Coronary occlusion, arteriosclerotic” is not indexed as a one-term entity. Arteriosclerotic is an adjectival modifier; code as if it preceded the coronary occlusion.

(2) (a) When a multiple one-term entity indicates a condition involving different sites or systems for which the Classification provides different codes, code the condition of each site or system separately.

            I    (a) Cardiac, respiratory, hepatic, renal failure                         I509     J969  K7290 N19

Code each site separately since the Classification provides a different code for each site.

(b) Where there is provision for coding the condition of one or more but not all of the sites or systems, code the conditions of the site(s) or system(s) that are indexed. Disregard the site(s) or system(s) for which the Classification does not provide a code.

            I    (a) Cerebro-hepatic failure                                                    K7290

“Hepatic failure” is the only term indexed. Do not enter a code for “cerebral failure.”

(c) When a site is not indexed and the Classification provides an NOS code for the condition, assign this code.

            I    (a) Ischemia colon, liver and spleen                                       K559 I99

                 (b)

“Ischemia colon” is the only term indexed. Since liver and spleen are not indexed and the condition has an NOS code, assign the NOS code for these terms.

c. Adjectival modifier reported with multiple conditions

(1) If an adjectival modifier is reported with more than one condition, modify only the first condition.

            I    (a) Arteriosclerotic cardiomyopathy

                      and nephritis                                                                  I251    N059

            I    (a) Diabetic coma and gangrene                                            E140    R02

(2) If an adjectival modifier is reported with one condition and more than one site is reported, modify all sites.

            I    (a) Diabetic gangrene of hands and feet                                 E145

            I    (a) Arteriosclerotic cardiovascular and                                    I250     I672

                      cerebrovascular disease

(3) When an adjectival modifier precedes two different diseases that are reported with a connecting term, modify only the first disease.

            I    (a) Arteriosclerotic cardiovascular disease                               I250     I679

                      and cerebrovascular disease

2. Parenthetical entries

  1. When one medical entity is reported, followed by another complete medical entity enclosed in parenthesis, disregard the parenthesis and enter as separate terms.

            I    (a) Heart dropsy                                                                  I500

                 (b) Renal failure (CVRD)                                                       N19      I139

Code each medical entity as indexed.

Place     I    (a) Pneumonia (aspiration)                                                   J189     T179  &W80

  9

Code each medical entity as indexed.

  1. When the adjectival form of words or qualifiers are reported in parenthesis, use these adjectives to modify the term preceding it.

            I    (a) Collapse of heart                                                            I509

                 (b) Heart disease (rheumatic)                                                I099

                 (c)

Use the adjective to modify the term and code rheumatic heart disease.

  1. If the term in parenthesis is not a complete term and is not a modifier, consider as part of the preceding term.

            I    (a) Metastatic carcinoma (ovarian)                                         C56

Consider the site as part of the preceding term and code metastatic ovarian carcinoma.

            I    (a) Drug dependence (heroin) (cocaine)                                 F112     F142

Consider the specified drugs as part of the preceding term and code heroin and cocaine dependence.

3. Special diagnostic entities

  1. When a condition is qualified as “HIV-related,” “HIV,” disregard the indexing of these conditions and code as separate one-term entities.

            I    (a) HIV-related encephalopathy                                            B24      G934

            I    (a) AIDS-related tuberculosis                                               B24      A1690

            I    (a) AIDS encephalopathy                                                     B24      G934

            I    (a) HIV encephalopathy                                                       B24      G934

  1. Alzheimer dementia: Consider the following terms as one term entities and code as indicated:

When reported as:                             Code

Endstage Alzheimer, senile dementia

Senile dementia, Alzheimer                    G301

Senile dementia, Alzheimer type

Senile dementia of the Alzheimer

When reported as:

Alzheimer, dementia

Alzheimer; dementia

Alzheimer disease (dementia)

Dementia Alzheimer

Dementia, Alzheimer

Dementia-Alzheimer

Dementia, Alzheimer type                      G309

Dementia of Alzheimer

Dementia-Alzheimer type

Dementia; Alzheimer type

Dementia, probable Alzheimer (disease)

Dementia syndrome, Alzheimer type

Endstage dementia (Alzheimer)

4. Plural form of disease

Do not use the plural form of a disease or the plural form of a site to indicate multiple.

            I    (a) Cardiac arrest                                                                I469

                 (b) Congenital defects                                                          Q899

Code I(b) Q899 (congenital defect); do not code as multiple (Q897).

5. Implied “disease”

When an adjective or noun form of a site is entered as a separate diagnosis, i.e., it is not part of an entry immediately preceding or following it, assume the word “disease” after the site and code accordingly.

            I    (a) Congestive heart failure                                                  I500

                 (b) Myocardial                                                                     I515

Code I(b) to I515, myocardial disease. The site “myocardial” is not indexed with congestive heart failure.

            I    (a) Coronary                                                                       I251

                 (b) Hypertension                                                                 I10

Code I(a) to I251, coronary disease. Coronary hypertension is not indexed.

            I    (a) Renal                                                                            I129

                 (b) Hypertension

Code I(a) to I129, renal hypertension. Consider the site, renal, to be a part of the condition that immediately follows it on line b, since Hypertension, renal is indexed.

6. Non-traumatic conditions

Consider conditions that are usually but not always traumatic in origin to be qualified as non-traumatic when reported due to or on the same line with disease.

            I    (a) Fat embolism                                                                 I749

                 (b) Pathological fracture                                                       M844

Code line (a) as non-traumatic since reported due to disease.

7. Drug dependent, drug dependency

When drug dependent or drug dependency modifies a condition, consider as a non-codable modifier unless indexed.

            I    (a) Perforated gastric ulcer                                                   K255

                 (b) Steroid-dependent COPD                                                J449

Code I(a) as indexed. Code I(b) to J449, chronic obstructive pulmonary disease NOS. Consider the “steroid dependent” to be a non-codable modifier.

C. Format

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

Four lines, (a), (b), (c), and (d) have been provided in Part I of the death certificate for reporting conditions involved in the sequence of events leading directly to death and for indicating the causal relationship of the reported conditions. In cases where the decedent had more than four causally related conditions leading to death, certifiers have been instructed to report all of these conditions and to add line, (e), to indicate the relationship of the conditions. In the ACME system, provision has been made for identifying conditions reported on the additional “due to” line in Part I. Code conditions reported on line (e) or in equivalent “due to” positions as having been reported on separate lines. (Refer to Section II, Part I, 2, Reject code 9 – More than four “due to” statements, for instructions for coding certificates with conditions reported on more than five “due to” lines.)

            I    (a) Shock due to pneumonia                                                 R579

                 (b) Rupture of esophageal varices                                          J189

                 (c) Cirrhosis of liver due to alcoholism                                   I859

                 (d)                                                                                     K746

                 (e)                                                                                     F102

2. Connecting terms

a. “Due to” written in or implied

When the certifier has stated that one condition was due to another or has between conditions in Part I, enter the codes as though the conditions had been reported, one due to the other, on separate lines. Code the conditions on each of the remaining lines in Part I, if there are any, as though they had been reported on the succeeding line. (Refer to Section II, Part I, 2, Reject code 9 – More than four “due to” statements, for instructions for coding certificates with more than four “due to” statements).

            I    (a) Myocardial infarction as a result of                                   I219

                 (b) ASHD                                                                            I251

Interpret “as a result of” as “due to” and code the ASHD on I(b).

            I    (a) Stomach hemorrhage from gastric ulcer                            K922

                 (b) Cholecystitis                                                                  K259

                 (c)                                                                                     K819

Because of the implied “due to,” code the gastric ulcer on I(b) and the cholecystitis on I(c).

(1) The following connecting terms should be interpreted as meaning “due to” or “as a consequence of” when the entity immediately preceding and following these terms is a disease condition, nature of injury, or an external cause.

after                    incident to       received in

arising in or during     incurred after    resulting from

as (a) complication of   incurred during   resulting when

as a result of           incurred in       secondary to (2°)

because of               incurred when     subsequent to

caused by                induced by        sustained as

complication(s) of       occurred after    sustained by

during                   occurred during   sustained during

etiology                 occurred in       sustained in

following                occurred when     sustained when

for                      occurred while    sustained while

from                     origin

in                       received from

            I    (a) Myocardial infarction                                                       I219

                 (b) Nephritis due to arteriosclerosis                                       N059

                 (c) Hypertension from toxic goiter                                         I709

                 (d)                                                                                     I10

                 (e)                                                                                     E050

Both “due to” and “from” indicate the conditions following these terms are moved to the next due to position.

            I    (a) Neurological devastation due to stroke

                 (b)                                                                                     I64

Neurological devastation is a disease condition. Move stroke down to the next due to position.

            I    (a) Death from heart attack                                                  I219

                 (b)

Death is not a disease condition, nature of injury, or external cause. Do not reformat heart attack.

            I    (a) Complication from diabetes                                             E149

Complication is not a disease condition, nature of injury, or external cause. Do not reformat diabetes.

(2) When one of the previous terms is the first entry in Part II, indicating that the following entry is a continuation of Part I, code in Part I in next due to position.

            I    (a) Respiratory failure                                                          J969

                 (b) Cardiac arrest                                                                I469

                 (c) Coronary occlusion                                                         I219

                 (d)                                                                                     I251

            II  due to ASHD

Since Part II is indicated to be a continuation of Part I, code the ASHD on I(d).

(3) Certain connecting terms imply that the condition following the connecting term was “due to” the condition preceding it. In such cases, enter the code for the condition following the connecting term on the line above that for the condition that preceded it.

Interpret the following connecting terms as meaning that the condition following the term was due to the condition that preceded it:

as a cause of        manifested by

cause of             producing

caused               resulted in

causing              resulting in

followed by          underlying

induced              with resultant

leading to           with resulting

led to

            I    (a) Myocardial infarction followed by                                     I469

                 (b) Cardiac arrest                                                                I219

                 (c)

Code the cardiac arrest on I(a) since “followed by” indicates it was due to the myocardial infarction.

            I    (a) Respiratory arrest                                                           R092

                 (b) Pulmonary edema                                                           J81

                 (c) Bronchitis with resulting pneumonia                                  J189     I469

                 (d) and cardiac arrest                                                           J40

Code the pneumonia and cardiac arrest on I(c) since “with resulting” indicates they were due to the bronchitis.

b. Not indicating a “due to” relationship

When conditions are separated by “and” or by another connecting term that does not imply a “due to” relationship, enter the codes for these conditions on the same line in the order that the conditions are reported on the certificate.

The following terms imply that conditions are meant to remain on the same line

and (&)                   consistent with

accompanied by            with ( c )

also                      precipitated by

associated with           predisposing (to)

complicated by            superimposed on

complicating

            I    (a) Acute bronchitis superimposed on                                    J209     J439

                 (b) Emphysema

                 (c) Tobacco abuse (smokes 3 packs a day)                             F171     F179

Interpret “superimposed on” as “and.” Enter the code for the condition on I(b) as the second code on I(a). Do not enter a code on I(b).

            I    (a) MI                                                                                I219

                 (b) ASHD                                                                            I251

                 (c) Hypertension                                                                  I10

                 (d) Diabetes                                                                        E149    E142

            II  also diabetic nephropathy

Consider “also” as a connecting word that does not imply “due to” and code Part II as a continuation of I(d).

3. Condition reported as due to I(a), I(b), or I(c)

When a condition(s) in Part I is reported with a specific statement interpreted or stated as “due to” another on lines I(a), I(b), I(c), or I(d), rearrange the codes according to the certifier’s statement. Do not apply this instruction to such statements reported in Part II.

            I    (a) Myocardial failure                                                           I249

                 (b) Pneumonia                                                                    I509

                 (c) Myocardial ischemia                                                        J189

                      due to (a)                                              3wks

Accept the certifier’s statement that the condition reported on I(c) is “due to” the condition on I(a). Move the codes for conditions reported on I(a) and I(b) downward. (Apply the duration on I(c) to the myocardial ischemia).

            I    (a) Heart failure                                                                   I509     N19

                 (b) Pneumonia                                                                     J189

                 (c) Uremia due to (b)

Take into account the certifier’s statement on I(c) and code the condition reported on I(c) as the second entry on I(a).

            I    (a) Carcinomatosis                                                               I469

                 (b) Cancer of lung                                                                C80

                 (c) Cardiorespiratory arrest due                                             C349

                      to above

Take into account the certifier’s statement and code the cardiorespiratory arrest on I(a), then move the codes for the remaining conditions downward.

            I    (a) Coronary thrombosis                                                      I219

                 (b) Chronic nephritis                                                            N039

                 (c) Arteriosclerosis                                                               I709

            II  Uremia caused by above                                                       N19

Disregard the certifier’s statement, “caused by above,” reported in Part II.

4. Numbering of causes reported in Part I

  1. When the certifier has numbered all causes or lines in Part I, that is 1, 2, 3, etc., code these entries as if reported on the same line. This instruction applies whether or not the numbering extends into Part II, and it also applies whether or not the “due to” below lines I(a) and/or I(b) and/or I(c) are marked through.

            I    (a) 1. Coronary thrombosis                                                  I219 I250 I10 I709 N289 J1110

                 (b) 2. ASCVD

                 (c) 3. Hypertension and arteriosclerosis

                 (d) 4. Renal disease

            II  5. Influenza

Code all the entries on I(a).

  1. When part of the causes in Part I are numbered, make the interpretation for coding such entries on an individual basis.

            I    (a) 1. Bronchopneumonia                                                     J180     C169

                 (b) 2. Cancer of stomach

                 (c) Chronic nephritis                                                            N039

Enter the codes for the conditions numbered “1” and “2” on I(a) in the order indicated by the certifier. Do not enter a code on I(b); however, enter the code for the condition on I(c) on that line.

            I    (a) Bronchopneumonia                                                         J180

                 (b) 1. Cancer of stomach                                                      C169    N039

                 (c) 2. Chronic nephritis

Enter the codes for conditions numbered “1” and “2” on I(b) in the order indicated by the certifier. Do not enter a code on I(c).

            I    (a) Congestive heart failure                                                  I500

                 (b) Influenza                                                                       J1110

                 (c) 1. Pulmonary emphysema                                               J439     J449  C349

                 (d) 2. COPD

            II  3. Cancer of lung

Enter the codes for the conditions numbered 1, 2, and 3 on I(c) in the order indicated by the certifier. Do not enter a code on I(d) or in Part II.

  1. When the causes in Part I are numbered, and an entry is stated or implied as “due to” another, enter the code(s) connected by the stated or implied “due to” in the next “due to” position, followed by the codes for theremaining numbered causes.

            I    (a) 1. Bronchopneumonia due to                                           J180

                 (b) influenza                                                                       J1110   J841 J40

                 (c) 2. Pulmonary fibrosis 3. Bronchitis

Enter the code for the condition followed by the stated “due to” on I(b), followed by codes for the conditions numbered “2” and “3.” Do not enter a code on I(c).

            I    (a) 1. Pneumonia                                                                 J189

                 (b) MI                                                                                 I219     I251

                 (c) 2. ASHD

Code the condition numbered “2” as a continuation of I(b). Leave I(c) blank.

5. Punctuation marks

  1. Disregard punctuation marks such as a period, comma, question mark, or exclamation mark when placed at the end of a line in Part I. Do not apply this instruction to a hyphen (-), which indicates a word is incomplete.

            I    (a) Myocardial infarct,                                                         I219

                 (b) Meningitis, mastoiditis                                                    G039    H709

                 (c) Otitis media                                                                   H669

Disregard the punctuation marks and code the conditions reported on I(a), I(b), and I(c) as indicated by the certifier.

            I    (a) Chronic rheu-                                                                I099     I958

                 (b)   matic heart disease, chronic hypotension

                 (c) Cancer                                                                          C80

Regard the conditions reported on I(b) as a continuation of I(a). Do not enter a code on I(b).

  1. When conditions are separated by a slash (/), code each condition as indexed.

                 I    (a) Cardiac arrest/respiratory                                           I469     R092  J189

                       arrest/pneumonia

                      (b) ASHD                                                                       I251

Disregard the slash and code conditions as indexed.

  1. When a dash (-) or slash (/) is used to separate sites reported with one condition and the combination of the sites is indexed to a single ICD-10 code, disregard the punctuation and code as indexed. This does not apply to commas.

            I    (a) Cardiac-respiratory arrest                                                I469

Code as one code assignment since the 2 sites are indexed as Arrest, cardiorespiratory.

            I    (a) Cardiac, respiratory arrest                                               I469     R092

Code each site separately since this instruction does not apply to commas.

            I    (a) Cardiac respiratory arrest                                                I469

Code as one code assignment since the 2 sites are indexed as Arrest, cardiorespiratory.

  1. When conditions are indexed together yet separated by a comma, code conditions separately. If the term following the comma is an adjective, refer to Section II, Part B, 1, b (1).

            I    (a) Cancer, cachexia                                                             C80      R64

                 (b) Anxiety, depression                                                        F419     F329

Code each term separately even though indexed together.

6. Conditions in the duration box

When a condition is entered in the duration block, code the condition on the same line where it is reported.

                                                                                      Duration

            I    (a) Arteriosclerotic heart disease              CVA                       I251   I64

                 (b)

                 (c)

            II  Arteriosclerosis                                                                   I709

Code the condition reported in the duration block as the last entry on I(a).

D. Doubtful diagnosis

1. Doubtful qualifying expression

  1. When expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly,” qualify any condition, disregard these expressions and code condition as indexed.

            I    (a) ? hemorrhage of stomach                                                K922

                 (b) Possible ulcer of stomach                                                K259

Disregard “?” and code hemorrhage of stomach on I(a) as reported.
Disregard “possible” and code ulcer of stomach on I(b) as reported.

            I    (a) Heart disease, probable ASHD                                         I519     I251

Disregard “probable” and code heart disease and ASHD on I(a).

Place     I    (a) Pneumonia, probably aspiration                                       J189     T179  &W80

  9

Disregard the “probably” and code both pneumonia and aspiration as indexed.

  1. When these expressions are reported at the end of a line in Part I,do not consider to be a continuation of the next lower line.

            I    (a) Heart disease probably                                                    I519

                 (b) Acute myocardial infarction                                              I219

Disregard “probably” and code heart disease on I(a) and acute myocardial infarction on I(b).

            I    (a) Cardiovascular disease presumably                                   I516

                 (b) Cerebral thrombosis                                                       I633

Disregard “presumably” and code each condition on the line where it is reported.

  1. When these expressions are reported at the beginning of a line in Part I,do not consider to be a continuation of the line above it.

            I    (a) Heart disease                                                                 I519

                 (b) Possibly acute myocardial infarction                                  I219

Disregard “possibly” and code each condition on the line where it is reported.

  1. When these expressions are reported at the beginning of Part II,do not consider to be a continuation of Part I.

            I    (a) Heart disease probably                                                    I519

                 (b)

                 (c)

            II  Probably MI                                                                        I219

Disregard “probably” and code heart disease on I(a) and MI in Part II.

2. Interpretation of “either…or…”

Consider the following as a statement of “either or:”

  • Two conditions reported on one line and both conditions qualified by expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly”
  • Two or more conditions connected by “or” or “versus”

Code using the following instructions:

  1. When a condition of more than one site is qualified by a statement of “either…or…” and both sites are classified to thesame system, code the condition to the residual category for the system.

            I    (a) Pneumonia                                                                     J189

                 (b) Cancer of kidney or bladder                                             C689

Code I(b) C689, malignant neoplasm of other and unspecified urinary organs.

            I    (a) Heart failure                                                                   I509

                 (b) Coronary or pulmonary blood clot                                    I749

Code I(b) I749, blood clot.

  1. When a condition of more than one site is qualified by a statement of “either…or…” and these sites are in different systems, code to the residual category for the disease or condition specified.

            I    (a) Cardiac arrest                                                                I469

                 (b) Carcinoma of gallbladder                                                 C80

                      or kidney

Code I(b) C80, malignant neoplasm without specification of site.

            I    (a) Respiratory failure                                                          J969

                 (b) Congenital anomaly of heart                                            Q899

                      or lungs

Code I(b) Q899, anomaly, congenital, unspecified.

  1. When conditions are qualified by a statement of “either…or…” andonly one site/system is involved, code to the residual category for the site/system.

            I    (a) Apparently stroke, perhaps heart attack                            I99

Since both conditions are preceded by a doubtful qualifying expression, consider as a statement of “either…or….” Stroke and heart attack are classified to the circulatory system. Code to Disease, circulatory system, NEC.

            I    (a) Pulmonary edema                                                           J81

                 (b) Tuberculosis or cancer of lung                                          J9840

Code I(b) J9840, lung disease NOS.

Note: When embolism and thrombosis are qualified by a statement of “either…or…,” code to Clot (I749)

            I    (a) Cardiac thrombosis vs pulmonary embolism                       I749

Code I(a) I749, Clot (blood). Embolism and thrombosis are both blood clots, and Clot NOS is a more specific category than Disease, circulartory system.

  1. When conditions are classified to the same three character category with different fourth characters, code to the three character category with fourth character “9.”

            I    (a) ASCVD vs ASHD                                                             I259

Code to I259 the residual category. ASCVD and ASHD are both classified to 125.-, chronic ischemic heart disease.

  1. When conditions are classified to different three character categories and Volume 1 provides a residual category for the diseases in general, code to that residual category.

            I    (a) MI vs coronary aneurysm                                                 I259

Code to I259 the residual category for ischemic heart disease. MI and coronary aneurysm are both classified as “ischemic heart diseases.”

  1. When conditions involving different systems are qualified by “either… or…,” and cannot be classified to the residual category for the disease, code R688, other specified general symptoms and signs.

            I    (a) Coma                                                                            R402

                 (b) ? gallbladder colic ? coronary                                           R688

                      thrombosis

Code I(b) R688, other ill-defined conditions. (Consider the two question marks on a single line as “either…or…”).

  1. When diseases and injuries are qualified by “either… or…,” code R99, other unknown and unspecified cause, provided this is the only entry on the certificate. When other classifiable entries are reported, omit R99.

            I    (a) Head injury or CVA                                                         R99

Code I(a) R99, other unknown and unspecified cause.

  1. For doubtful diagnosis in reference to “either… or…”accidentssuicides, and homicides, refer to Section V, Part A, External Cause Code Concept.

E.       Conditions specified as “healed” or “history of”

The Classification provides sequela categories for certain conditions qualified as “healed” or “history of.” Refer to Section IV, Part F, Sequela. When the Classification does not provide a code or a sequela category for a condition qualified as “healed” or “history of,” code the condition as though not qualified by this term.

            I    (a) Myocardial infarction                                                       I219

                 (b)

                 (c)

            II  Gastritis, healed                                                                  K297

Code K297, gastritis NOS in Part II.

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

When the certifier enters “same,” “ditto mark (“),” “as above,” etc., in a “due to” position to a specified condition, do not enter a code for that line.

            I    (a) Coronary occlusion                                                         I219

                 (b) Same

                 (c) Hypertension                                                                 I10

Do not enter a code on I(b) for the entry “same.”

            I    (a) Pneumonia                                                                     J189

                 (b) “

                 (c) Emphysema                                                                   J439

Do not enter a code on I(b) for the “ ditto mark (“).”

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

When a condition is qualified by “postmortem,”, “rule out,” “ruled out”, or “r/o,” etc., do not enter a code for the condition.

H.      Nonindexed and illegible entries

1. Terms that are not indexed

When a term is reported that does not appear in the ICD-10 Index, refer the term to the supervisor.

2. Illegible entries

When an illegible entry is the only entry on the certificate, code R99. When an illegible entry is reported with other classifiable entries, disregard the illegible entry and code the remaining entries as indexed.

I.       Coding one-character reject codes

When a death record qualifies for more than one reject code, code only one in this order: 1, 2, 3, 4, 5, 9.

1. Reject code 1-5–Inconsistent duration

When a duration of an entity in a “due to” position is shorter than that of an entity reported on a line above it and only one codable entity is reported on each of these lines, enter a reject code (1-5) in the appropriate data position. When more than one codable entity is reported on the same line, disregard the duration entered on that line. Use the appropriate reject code even though there are lines without a duration or with more than one codable entity between the entities with the inconsistent duration; in such cases, consider the inconsistency to be between the line immediately above and the line with the shorter duration.

If the inconsistent duration is between:

Lines     ………………………………………………………………………………… Enter Reject Code

I   (a)   and I (b)…………………………………………………………………………………………… 1

I   (b)   and I (c)…………………………………………………………………………………………… 2

I   (c)    and I (d)…………………………………………………………………………………………… 3

I   (d)   and I (e)…………………………………………………………………………………………… 4

Inconsistent durations between more than two lines in Part I,
or any situation where reject codes 1-4 would not be applicable……………………………….. 5

Do not enter a reject code if the only inconsistency is between the durations of malignant neoplasms classifiable to C00-C96.

            I    (a) ASHD                                               10 yrs.         I251

                 (b) Chronic nephritis and hypertension     5 yrs.           N039  I10

                 (c) Diabetes                                           5 yrs.           E149

                                                                                                Reject 2

Disregard the duration on I(b), since more than one codable entity is reported on this line. Only one codable entity is reported on lines I(a) and I(c) and the duration of the diabetes was shorter than that of ASHD. For the purposes of assigning the reject code, consider the duration on I(b) to be at least as long as the duration on I(a). Therefore, enter reject code 2 denoting an inconsistency between I(b) and I(c).

            I    (a) ASHD                                                5 yrs           I251

                 (b) Chronic nephritis and hypertension       10 yrs         N039  I10

                 (c) Diabetes                                            5 yrs           E149

Do not enter reject code 2. The duration on I(b) is disregarded. The duration of diabetes on I(c) was not shorter than that of ASHD on I(a).

            I    (a) Cardiac arrest                                                       I469

                 (b) Congestive heart failure                      1 week         I500

                 (c) Cancer of stomach                             1 year          C169

                 (d) Metastatic cancer of lung                    6 months      C780

Do not use reject code 3 since the inconsistent duration is between malignant neoplasms.

            I    (a) Basilar artery thrombosis                    7 weeks        I630

                 (b) Renal failure                                      4 weeks        N19

                 (c) Pneumonia                                        1 week         J189

                                                                                                Reject 5

Enter reject code 5 since the inconsistent durations are between more than 2 lines.

            Age 1 yr.

            I    (a) Congenital nephrosis life                                       N049

                 (b)

                 (c) Intestinal hemorrhage                        1 day           K922

                                                                                                Reject 5

Enter reject code 5 since reject codes 1-4 are not applicable.

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

When certifier’s entries or reformatting result in more than four statements of “due to,” continue the remaining codes horizontally on the fifth line and enter reject code 9 in the appropriate position.

            I    (a) Terminal pneumonia                                                       J189

                 (b) Congestive heart failure                                                  I500

                 (c) Myocardial infarction                                                       I219

                 (d) ASHD                                                                            I251

                 (e) Generalized arteriosclerosis                                             I709     E039

                 (f) Myxedema

                                                                                                          Reject 9

Enter the code for the myxedema reported on the fifth “due to” line, I(f), following the code for the condition reported on this line (generalized arteriosclerosis). Enter reject code 9 in the appropriate data position.

If there are more than four “due to” statements in Part I and there is no codable condition reported on one or more lines, consider the condition(s) on each subsequent “due to” line as though reported on the preceding line. Enter reject code 9 only if, after reformatting, there are codable conditions on more than five lines.

            I    (a) Pneumonia                                                                     J189

                 (b) Extended illness                                                             G839

                 (c) Paralysis following CVA                                                   I64

                 (d) Hypertension due to                                                       I10

                 (e) adrenal adenoma                                                          D350

Do not enter reject code 9. Since extended illness is not a codable condition, enter the code for paralysis on I(b), the code for CVA on I(c), etc. As a result of the rearrangement of the conditions, there are codable conditions on only five lines.

When a death record qualifies for more than one reject, prefer a reject code for inconsistent durations over reject code 9.

J. Inclusion of additional information \(AI\) to mortality source documents

Code supplemental information when it modifies or supplements data on the original mortality source document.

  1. When additional information (AI)states the underlying cause of a specified disease in Part I, code the additional information (AI) in a “due to” position to the specified disease.

            I    (a) Pulmonary edema                                                           J81

                 (b) Congestive heart failure                                                  I500

                 (c) Arteriosclerosis                                                              I251

                 (d) I709

            II

       AI      The underlying cause of the congestive heart failure was ASHD.

Since the certifier states the underlying cause of the congestive heart failure is ASHD, code I251 on I(c) and move the condition on I(c) to the next “due to” position.

  1. When additional information (AI)modifies a disease condition, use the AI and code the disease modified by the AI in the position first indicated by the certifier.

            I    (a) Pneumonia                                                                     J181

                 (b)

                 (c)

                 AI  Lobar pneumonia

Code lobar pneumonia as the specified type of pneumonia on I(a) only.

  1. When there is a stated or implied complication of surgery and the additional information indicates the condition for which surgery was performed, code this condition in a “due to” position to the surgery when reported in Part I and following the surgery when reported in Part II. Precede this code with an ampersand (&).

            I    (a) Coronary occlusion                                                         T818

                 (b) Gastrectomy                                                                  &Y836

                 (c)                                                                                     &K259

                 AI  Gastrectomy done for gastric ulcer.

Code the condition necessitating the surgery on I(c) and precede this code with an ampersand.

            I    (a) Respiratory arrest                                                           R092

                 (b) Septicemia                                                                     T814

                 (c)

            II  Uremia, cholecystectomy                                                      N19 &Y836 &K802

            AI  Surgery for gallstones

Code the condition necessitating the surgery following the E-code for surgery in Part II.

  1. When additional information (AI)states a certain condition is the underlying cause of death, code this condition in Part I in a “due to” position (on a separate line) to the conditions reported on the original death record.

            I    (a) Cardiac arrest                                                                I469

                 (b) MI                                                                                I219

                 (c) ASHD                                                                            I251

                 (d) E149

            II

            AI  U.C. was diabetes

Accept the certifier’s statement that the underlying cause of death was “diabetes,” and code this condition on I(d) in a “due to” position to the conditions originally reported in Part I.

  1. When any morphological type of neoplasm is reported in Part I with no mention of a “site” and additional information specifies a site,code the specified site only on the line where the morphological type is reported.

            I    (a) Cancer                                                                          C349

                 (b)

                 (c)

            II

            AI  Cancer of lung

Code only the specified cancer (lung) on I(a).

  1. When additional information states the primary site of a malignant neoplasm, code this condition in a “due to” position to the other malignant neoplasms reported in Part I.

            I    (a) Metastatic neoplasm                                                       C80

                 (b) Metastasis to liver                                                          C787

                 (c) C189

            II

                 AI  Colon was primary site.

Code the stated primary site on I(c) in a “due to” position to the other neoplasms reported in Part I.

            I    (a) Carcinomatosis                                                               C80

                 (b)                                                                                     C61

                 (c)

            II

                 AI  Prostate was probably the primary site.

Code the presumptive primary site (prostate) on I(b) in a “due to” position to the stated neoplasm reported on the original death certificate.

  1. When the additional informationdoes not modify a condition on the certificate, or does not state that this condition is the underlying cause, code the AI as the last condition(s) in Part II. Code AI reported on the certificate beginning with the uppermost downward and from left to right.

            I    (a) Coronary thrombosis                                                      I219

                 (b) HASCVD                                                                        I119

                 (c)

            II Hypertension                                                                       I10       I709  I64     I258

                 AI Arteriosclerosis, CVA, old MI

The additional information does not modify conditions on the certificate. Code as the last entries in Part II.

Male, 30 minutes-Twin B

            I    (a) Immature                                                                      P073

  600 gm    (b)

                 (c)

            II  Atelectasis                                                                          P281    P015  P070

Code the additional information in the order reported, uppermost downward and from left to right.

K.      Amended certificates

When an “amended certificate” is submitted, code the conditions reported on the amended certificate only.

L.       Effect of age of decedent on classification

Always note the age of the decedent at the time the causes of death are being coded. Certain groups of categories are provided for certain age groups. There are several conditions within certain categories which cannot be properly classified unless the age is taken into consideration. Use the following terms to identify certain age groups:

1. NEWBORN OR NEONATAL means less than 28 days of age at the time of death.

Code any index term with the indention of “newborn,” “neonatal,” “neonatorum,” “perinatal,” “perinatal period,” “fetus or newborn,” or “fetal” (in this priority order) to the newborn category if the decedent is less than 28 days of age or there is evidence the condition originated in the first 27 days of life, even though death may have occurred later.

            Female, 4 hours

            I    (a) Anoxia                                                                          P219

                 (b) Cerebral hemorrhage                                                      P524

Since the age of decedent is less than 28 days, code anoxia of newborn, and cerebral hemorrhage of newborn.

            Male, 31 days                                                                          Duration

            I    (a) Pulmonary hemorrhage                                                   26 days P269

                 (b)

Since the condition originated in the first 27 days of life, code as a newborn.

2. INFANT or INFANTILE means less than 1 year of age at the time of death

            Male, 9 months

            I    (a) Pneumonia                                                                     J189

                 (b) Osteomalacia                                                                 E550

Since the decedent is less than 1 year of age at the time of death, code Osteomalacia, infantile.

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

            Male, 11 years

            I    (a) Asthma                                                                         J450

Code as Asthma, childhood.

4.Congenital anomalies (Q00-Q99)

Regard the conditions listed below as congenital and code to the appropriate congenital category if death occurred within the age limitations stated, provided there is no indication that they were acquired after birth.

a. Less than 28 days:

heart disease NOS

hydrocephalus NOS

            Male, 27 days

            I    (a) Renal failure                                                                   N19

                 (b) Hydrocephalus                                                               Q039

Code the hydrocephalus as congenital since the decedent was less than 28 days of age at the time of death.

b. Less than 1 year:

aneurysm (aorta) (aortic)                 cyst of brain

     (brain) (cerebral) (circle of        deformity

     Willis) (coronary)                   displacement of organ

     (peripheral) (racemose)              ectopia of organ

     (retina) (venous)                    hypoplasia of organ

aortic stenosis                           pulmonary stenosis

atresia                                   valvular heart disease (any valve)

atrophy of brain

            Female, 3 months

            I    (a) Pneumonia                                                                     J189

                 (b) Cyst of brain                                                                  Q046

Code cyst of brain as congenital since the age of the decedent is less than 1 year.

5. Congenital syphilis

Regard syphilis and conditions that are qualified as syphilitic as congenital and code to the appropriate congenital syphilis category if the decedent was less than two years of age.

            Male, 16 mos

            I    (a) Syphilitic pneumonia                                                       A500

                 (b)

                 (c)

Code congenital syphilitic pneumonia since age is less than 2 years.

6. Age limitation

Some categories in ICD-10 are limited by provisions of the Classification to certain ages. Code the categories listed below only if the age at the time of death was as follows:

  1. Age 28 days or over

A32    E14    J13       R00

A35    E162   J14       R01

A40    E561   J15       R048

A41    E63    J16       R090

A56    E834   J18       R092

A74    E835   J43       R11

B30    F10    J80       R17

B370   F11    J849      R230

B371   F12    J96       R233

B372   F13    J981      R290

B373   F14    J982      R40

B374   F15    J984      R50

B375   F16    J988      R53

B376   F17    K27       R56

B377   F18    K631      R58

B378   F19    K65       R60

B379   G473   K92       R633

D65    G700   L01       R680

D751   I48    L10       R681

E05    I49    L50

E10    I50    L530

E11    I61    M34

E12    I62    N390

E13    J12    N61

            Male, age 25 days

            I    (a) Urinary tract infection                                                     P393

                (b)

Code urinary tract infection, newborn since age is less than 28 days.

            Female, age 27 days

            I    (a) Respiratory failure                                                          P285

                 (b)

                 (c)

Code respiratory failure, newborn since age is less than 28 days.

            Female, age 28 days

            I    (a) Atelectasis                                                                     J981

                 (b)

                 (c)

Code atelectasis, J981 since age is reported as 28 days.

  1. Age under 1 year:

R95

  1. Age 1 year or over:

R960

            Age 1 year

            I    (a) Sudden infant death syndrome                                         R960

  1. Age 5 years or over:

X60-X84

            Age 4 years

Place     I    (a) GSW to head Suicide                                                       S019    &W34

  9

M. Sex limitations

Certain categories in ICD-10 are limited to one sex:

For Males Only      For Females Only

B260                A34           M830

C60-C63             B373          N70-N98

D074-D076           C51-C58       N992-N993

D176                C796          O00-O99

D29.-               D06.-         P546

D40.-               D070-D073     Q50-Q52

E29.-               D25-D28       Q96

E895                D39.-         Q97

F524                E28.-         R87

I861                E894          S314

L291                F525          S374-S376

N40-N50             F53.-         T192-T193

Q53-Q55             I863          T833

Q98                 L292          Y424

R86                 L705          Y425

S312-S313           M800-M801     Y76.-

                    M810-M811

__________________________________________________________________________

If the cause of death is inconsistent with the sex, code the cause of death to the minimum necessary to be acceptable for either gender.

            Female, age 32

            I    (a) Cancer of prostate                                                          C80

                 (b)

                 (c)

Code to cancer NOS C80, which is acceptable for both male and female.

N. Effect of duration on assignment of codes

Before assigning codes, take into account any statements entered on the certificate in the spaces for duration since these statements may affect the code assignments for certain conditions.

1. Qualifying conditions as acute or chronic

  1. Usually the duration shouldnot be used to qualify the condition as “acute” or “chronic.”

                                                                                                          Duration

            I    (a) Nephritis                                                                       2 years             N059

Code nephritis as indexed. Do not use the duration to qualify the nephritis as chronic.

  1. However, when assigning codes to certain conditions classified as “ischemic heart diseases” the Classification provides the following specific guidelines for classifying a condition with astated duration as acute or chronic:

–    acute or with a stated duration of 4 weeks or less

–    chronic or with a stated duration of over 4 weeks

                                                                                                          Duration

            I    (a) Acute myocardial infarction                                             3 mos.             I258

                 (b)

                 (c)

Code Infarction, myocardium, chronic or with a stated duration of over 4 weeks, I258.

(1) For the purpose of interpreting these instructions:

                                                

    Consider these terms:     To mean:

                                                

    brief

    days

    hours

    immediate

    instant                   4 weeks or less

    minutes                   or acute

    recent

    short

    sudden

    weeks (few) (several)

                                                

    longstanding              over 4 weeks

    1 month                   or chronic

                                                

                                                                                                          Duration

            I    (a) Aneurysm heart  weeks                                                  I219

                 (b)

                 (c)

Code Aneurysm, heart, acute or with a stated duration of 4 weeks or less, I219. “Weeks” is interpreted to mean 4 weeks or less.

  1. When the duration is stated to be “acute” or “chronic,” consider the condition to be specified as acute or chronic.

                                                                                                          Duration

            I    (a) Heart failure 1 hour                                                        I509

                 (b) Bronchitis  acute                                                           J209

Code “acute” bronchitis on I(b).

2. Subacute

In general, code a disease that is specified as subacute as though qualified as acute if there is provision in the Classification for coding the acute form of the disease but not for the subacute form.

            I    (a) Subacute pyelonephritis                                                  N10

Code subacute pyelonephritis to N10, acute pyelonephritis since there is no code for subacute pyelonephritis.

3. Exacerbation

Interpret “exacerbation” as an acute phase of a disease. Code “exacerbation” of a chronic specified disease to the acute and chronic stage of the disease if the Classification provides separate codes for “acute” and “chronic.”

            I    (a) Exacerbation of leukemia                                                 C950

                 (b) Chronic lymphocytic leukemia                                          C911

            I    (a) Exacerbation of chronic                                                   C910    C911

                 (b) lymphocytic leukemia

            I    (a) Chronic leukemia with conversion to                                 C951    C950

                 (b) acute phase

            I    (a) Exacerbation of chronic                                                   N10      N119

                 (b) pyelonephritis

            I    (a) Exacerbation of bronchitis                                               J209

                 (b)

            I    (a) Acute exacerbation of chronic                                          J209     J42

                 (b) bronchitis

            I    (a) Chronic obstructive lung disease exacerbation                   J449 J441

                 (b)

Code the preceding examples to the acute and chronic stages of each specified disease since the Classification provides separate codes for the “acute” and “chronic.”

4. Acute and chronic

Sometimes the terms acute and chronic are reported preceding two or more diseases. In these cases, use the term (“acute” or “chronic”) with the condition it immediately precedes.

            I    (a) Chronic renal and liver failure                                          N189    K7290

Code renal failure, chronic and liver failure NOS.

5. Qualifying conditions as congenital or acquired

Code conditions classified as congenital in the Classification as congenital, even when not specified as congenital if the interval between onset and death and the age of the decedent indicate that the condition existed from birth.

            Female, age 2 years                                                                  Duration

            I    (a) Pneumonia                                                                     1 week  J189

                 (b) Heart disease                                                                 2 years Q249

Code the condition on I(b) as congenital since the age of the decedent and the duration of the condition indicate that the heart disease existed at birth.

Do not use the interval between onset and death to qualify conditions that are classified to categories Q00-Q99, congenital anomalies, as acquired.

            Male, 62 years                                                                         Duration

            I    (a) Renal failure                                                                   3 months  N19

                 (b) Pulmonary stenosis                                                         5 years Q256

Do not use the duration to qualify the pulmonary stenosis as acquired.

6. Two conditions with one duration

When two or more conditions are entered on the same line with one duration, disregard the duration and code the conditions as indexed.

                                                                                                         Duration

            I    (a) Myocardial ischemia and                                                  3 weeks I259  I500

                      congestive heart failure

                             (b)        Hypertension                             5 years                         I10

Disregard the duration on I(a) and code the myocardial ischemia as indexed.

                                                                                                         Duration

            I    (a) MI due to nephritis 3 months                                           I219

                 (b) Arteriosclerosis                                                              N059

                 (c)                                                                                     I709

Disregard the duration on I(a) and code myocardial infarction as indexed.

7. Conflict in durations

When conflicting durations are entered for a condition, give preference to the duration entered in the space for interval between onset and death.

                                                                                    Duration

            I    (a) Ischemic heart disease              2 weeks       years            I259

Use the duration in the block to qualify the ischemic heart disease.

8. Span of dates

Interpret dates that are entered in the spaces for interval between onset and death separated by a slash (/), dash (-), etc., as meaning from the first date to the second date. Disregard such dates if they extend from one line to another and there is a condition reported on both of these lines since the span of dates could apply to either condition.

Date of death 10-6-98                                         Duration

            I    (a) MI                                                10/1/98 –                   I219

                 (b) Ischemic heart disease                    10/6/98                     I259

Disregard duration and code each condition as indexed since the dates extend from I(a) to I(b).

Date of death 10-6-98                                         Duration

            I    (a) Aneurysm of heart                          10/1/98 – 10/6/98      I219

                 (b)

Since there is only one condition reported, apply the duration to this condition.

Date of death 10-6-98                                         Duration

            I    (a) Ischemic heart disease                    10/1/98 – 10/6/98      I249

                 (b) Arteriosclerosis                                                              I709

Apply the duration to I(a).

O. Relating and modifying conditions

1. Implied site of disease

Certain conditions are classified in the ICD-10 according to the site affected, e.g.:

atrophy         enlargement     obstruction

calcification   failure         perforation

calculus        fibrosis        rupture

congestion      gangrene        stenosis

degeneration    hypertrophy     stones

dilatation      insufficiency   stricture

embolism        necrosis

(This list is not all inclusive)

Occasionally, these conditions are reported without specification of site. Relate conditions such as these for which the Classification does not provide a NOS code. Also relate conditions which are usually reported of a site. Generally, it may be assumed that such a condition was of the same site as another condition if the Classification provides for coding the condition of unspecified site to the site of the other condition. These coding principles apply whether or not there are other conditions reported on other lines in Part I. Apply the following instructions when relating a condition of unspecified site to the site of a specified condition:

a. General instructions for implied site of a disease

(1) Conditions of unspecified site reported on the same line:

(a) When conditions are reported on the same line, with or without a connecting term that implies a due to relationship, assume the condition of unspecified site was of the same site as the condition of specified site.

            I    (a) Congestive heart failure                                                  I500

                 (b) Infarction with myocardial                                               I219     I515

                 (c) degeneration

                 (d) Coronary sclerosis                                                          I251

Code the infarction as myocardial, the site of the condition reported on the same line.

            I    (a) Aspiration pneumonia                                                     J690

                 (b) Cerebrovascular accident due to                                       I64

                 (c) thrombosis                                                                    I633

Code the thrombosis as cerebral, the site of the condition reported on the same line.

            I    (a) Duodenal ulcer with internal hemorrhage                          K269    K922

Code Hemorrhage, duodenal (K922). Relate the internal hemorrhage to the site of the condition reported on the same line.

            I    (a) CVA with hemorrhage                                                     I64       I619

                 (b) MI                                                                                I219

Code Hemorrhage, cerebral (I619). Relate the hemorrhage to the site of the condition reported on the same line.

(b) When conditions of different sites are reported on the same line, assume the condition of unspecified site was of the same site as the condition immediately preceding it.

            I    (a) ASHD, infarction, CVA                                                    I251     I219  I64

                 (b)

                 (c)

Code Infarction, heart (I219). Relate the infarction to the site of the condition immediately preceding it.

(2) Conditions of unspecified site reported on a separate line:

(a) If there is only one condition of a specified site reported either on the line above or below it, code to this site.

            I    (a) Massive hemorrhage                                                       K922

                 (b) Gastric ulceration                                                           K259

Code the hemorrhage as gastric. Relate hemorrhage to the site of the condition reported on I(b).

            I    (a) Uremia                                                                          N19

                 (b) Chronic prostatitis                                                          N411

                 (c) Benign hypertrophy                                                        N40

Code the hypertrophy as prostatic. Relate hypertrophy to prostate, the site of the condition reported on I (b).

            I    (a) Internal hemorrhage                                                       K868

                 (b) Pancreatitis                                                                    K859

Code Hemorrhage, pancreas (K868). Relate the internal hemorrhage to the site of the condition reported on I(b).

     (b)     If there are conditions of different specified sites on the lines above and below it and the Classification provides for coding the condition of unspecified site to only one of these sites, code to that site.

            I    (a) Intestinal fistula                                                             K632

                 (b) Obstruction                                                                    K566

                 (c) Carcinoma of peritoneum                                                C482

Code the obstruction as intestinal since the Classification does not provide for coding obstruction of the peritoneum.

(c) If there are conditions of different specified sites on the lines above and below it and the Classification provides for coding the condition of unspecified site to both of these sites, code the condition unspecified as to site.

            I    (a) CVA                                                                              I64

                 (b) Thrombosis                                                                    I829

                 (c) ASHD                                                                            I251

Code Thrombosis NOS on I(b). Do not relate the thrombosis since the Classification provides codes for both sites reported.

(3) Do not relate conditions which are not reported in the first position on a line to the line above. It is acceptable to relate conditions not reported as the first condition on a line to the line below.

            I    (a) Kidney failure                                                                 N19

                 (b) Vascular insufficiency c thrombosis                                 I99       I219

                 (c) ASHD                                                                            I251

Code Thrombosis, cardiac (I219). Relate thrombosis to line below.

(4) When relating conditions to sites start at the top of the certificate and work down.

            I    (a) Hemorrhage                                                                   R5800

                 (b) Necrosis                                                                        K729

                 (c) Hepatoma                                                                      C220

The hemorrhage cannot be related. Relate necrosis to liver (K729), the site of the hepatoma.

b. Relating specific categories

(1) When ulcer, site unspecified or peptic ulcer NOS is reported causing, due to, or on the same line with gastrointestinal hemorrhage, code peptic ulcer NOS (K279).

            I    (a) Gastrointestinal hemorrhage                                            K922

                 (b) Peptic ulcer                                                                    K279

                 (c)

Code peptic ulcer (K279). Do not relate to gastrointestinal.

            I    (a) Ulcer causing gastrointestinal hemorrhage                        K922

                 (b)                                                                                     K279

Code ulcer to peptic ulcer (K279).

(2) When ulcer NOS (L984) is reported causing, due to, or on the same line with diseases classifiable to K20-K22, K30-K31, and K65, code peptic ulcer NOS (K279).

            I    (a) Peritonitis                                                                      K659

                 (b) Ulcer                                                                             K279

Code Ulcer, peptic (K279).

(3) When hernia (K40-K46) is reported with disease(s) of unspecified site(s), relate the disease of unspecified site to the intestine.

            I    (a) Hernia with hemorrhage                                                  K469    K922

Code Hemorrhage, intestine.

(4) When calculus NOS or stones NOS is reported with pyelonephritis, code to N209 (urinary calculus).

            I    (a) Pyelonephritis with calculus                                             N12      N209

Code calculus (N209) since it is reported with pyelonephritis.

(5) When arthritis (any type) is reported with

  • contracture  –        code contracture of the site
  • deformity    –        code deformity acquired of the site

If no site is reported or if site is not indexed, code contracture or deformity, joint.

            I    (a) Phlebitis                                                                        I809

                 (b) Contractures                                                                  M245

                 (c) Osteoarthritis lower limbs                                               M199

Code Contracture, joint (M245) since contracture lower limb is not indexed.

            I    (a) Pulmonary embolism                                                       I269

                 (b) Multiple deformities                                                        M219

                 (c) Arthritis in both hips                                                      M139

Code deformity (acquired) of hip.

(6) When embolism, infarction, occlusion, thrombosis NOS is reported

  • from a specified site – code the condition of the site reported
  • of a site, from a specified site  code the condition to both sites reported

            I    (a) Congestive heart failure                                                   I500

                 (b) Embolism from heart                                                      I2190

                 (c) Arteriosclerosis                                                               I709

Code I(b) embolism of heart (I2190).

            I    (a) Pulmonary embolism from leg veins                                  I269

                 (b)                                                                                     I803

                 (c)

Code I(a) pulmonary embolism (I269) and I(b) leg veins embolism (I803).

(7) Relate a condition of unspecified site to the complete term of a multiple site entity. If it is not indexed together, relate the condition to the site of the complete indexed term.

            I    (a) Cardiorespiratory arrest c failure                                      I469     R092

Code Failure, cardiorespiratory (R092). Relate failure to the complete term.

            I    (a) Cardiorespiratory arrest                                                  I469     I509

                 (b) c insufficiency

Code Insufficiency, heart (I509) since cardiorespiratory arrest is indexed to a heart condition. Relate insufficiency to the site of the complete term.

(8) When vasculitis NOS is reported, apply the general instructions for relating and modifying.

            I    (a) Renal failure                                                                  N19

                 (b) Vasculitis                                                                       I778

Code Vasculitis, kidney (I778). Relate vasculitis to the site reported on line I(a).

c. Exceptions to relating and modifying instructions

(1) Do not relate the following conditions:

Arteriosclerosis                             Neoplasms

Congenital anomaly NOS                       Paralysis

Hypertension                                 Vascular disease NOS

Infection NOS (refer to Section III, #6)

            I    (a) Arteriosclerosis with CVA                                                I709     I64

                 (b)

                 (c)

Code Arteriosclerosis NOS (I709).

            I    (a) Cardiac arrest                                                                I469

                 (b) Congenital anomaly                                                        Q899

                 (c)

Code congenital anomaly NOS (Q899).

            I    (a) Pneumonia                                                                    J189

                 (b) Infection

                 (c)

Code Pneumonia (J189) on I(a). Do not enter a code on I(b).

            I    (a) Perforation esophagus                                                    K223

                 (b) Cancer                                                                          C80

                 (c)

Code cancer NOS (C80).

(2) Do not relate hemorrhage when causing a condition of a specified site. Relate hemorrhage to site of disease reported on same line or on line below only.

            I    (a) Respiratory failure                                                          J969

                 (b) Hemorrhage                                                                  R5800

Code Hemorrhage NOS. Do not relate to respiratory.

            I    (a) Respiratory failure                                                          J969

                 (b) Hemorrhage                                                                  K922

                 (c) Gastric ulcer                                                                   K259

Relate hemorrhage on I(b) to gastric on I(c) and code gastric hemorrhage.

(3) Do not relate conditions classified to R00-R99 except:

Gangrene and necrosis                                                      R02

Hemorrhage                                                                     R5800

Regurgitation                                                                   R11

Stricture and stenosis                                                        R688

            I    (a) Myocardial infarction with anoxia                                     I219     R090

Code anoxia as indexed. Do not relate to heart since anoxia is classified to R090.

            I    (a) Pneumonia with gangrene                                               J189     J850

Code the gangrene as pulmonary, the site of the disease reported on the same line since gangrene is one of the exceptions.

(4) Do not relate a disease condition that, by the name of the disease, implies a disease of a specified site unless it is obviously an erroneous code. If not certain, refer to supervisor.

            I    (a) Cirrhosis, encephalopathy                                               K746    G934

Do not relate encephalopathy to liver since the name of the disease implies a disease of a specific site, brain.

            I    (a) Pulmonary embolism                                                       I269

                 (b) Thrombophlebitis                                                           I809

Code thrombophlebitis (I809) as indexed. Do not relate thrombophlebitis since it is not usually reported of any site other than extremities.

            I    (a) Cerebral hemorrhage with herniation                                I619     G935

Relate herniation to brain since hernia NOS is classified to a disease of the digestive system (K469) and it seems illogical to have a brain disease paired with a digestive system disease.

Refer to Section V, Part D, Implied site of injury for instructions on relating the site of injuries to another site.

2. Coding conditions classified to injuries as disease conditions

  1. Some conditions (such as injury, hematoma or laceration) of a specified organ are indexed directly to a traumatic category but may not always be traumatic in origin. Consider these types of conditions to be qualified as nontraumatic when reported:
  • due to or on the same line with a disease
  • due to:         drug poisoning

                          drug therapy

If there is provision in the Classification for coding the condition that is considered to be qualified as nontraumatic as such, code accordingly. Otherwise, code to the category that has been provided for “Other” diseases of the organ (usually .8).

            I    (a) Laceration heart                                                             I518

                 (b) Myocardial infarction                                                      I219

                 (c)

Code to myocardial infarction (I219) selected by General Principle. Since laceration heart is reported due to myocardial infarction, consider the laceration to be nontraumatic.

            I    (a) Subdural hematoma                                                       I620

                 (b) CVA                                                                              I64

                 (c)

Code Hematoma, subdural, nontraumatic (I620) as indexed.

            I    (a) Acute kidney injury                                                        N288

                 (b) Kidney disease                                                               N289

                 (c)

Code acute kidney injury as nontraumatic since reported due to a disease. Apply instruction to assign other diseases of kidney (N288), even though indexed as acute.

            I    (a) Cardiorespiratory failure                                                  R092

                 (b) Intracerebral hemorrhage                                                I619

                 (c) Meningioma, subdural hematoma                                     D329    I620

Code subdural hematoma as nontraumatic since it is reported on the same line with a disease.

            I    (a) Liver failure                                                                    K7290

                 (b) Cirrhosis with injury to liver                                            K746    K768

                 (c)

Code injury to liver as nontraumatic since it is reported on the same line with a disease.

            I    (a) Cerebral arteriosclerosis with                                           I672     I620

                 (b) subdural hematoma

Code subdural hematoma as nontraumatic since it is reported on the same line with a disease.

  1. Some conditions are indexed directly to a traumatic category but the Classification also provides a nontraumatic code. When these conditions are reported due to or with a diseaseand an external cause is reported on the record or the Manner of Death box is checked as Accident, Homicide, Suicide, Pending Investigation or could not be determined, code the condition as traumatic.

Place     I    (a) Subdural hematoma                                                        S065

  9             (b) CVA                                                                              I64

                 (c)

MOD     II                                                                                           &W18

  A

Accident       Fell while walking

Code the subdural hematoma as traumatic since the manner of death is accidental.

Place     I    (a) Cardiorespiratory arrest                                                  I469

  0             (b) Subdural hematoma                                                        S065

                 (c) Arteriosclerosis                                                              I709

MOD     II  Advanced age                                                                     R54      &W18

  A

Accident       Home          Fell in her room striking head

Code the subdural hematoma as traumatic since the manner of death is accidental.

Place     I    (a) Cerebral hematoma with                                                 S068    I672

  9             (b) cerebral arteriosclerosis

                 (c)

MOD     II                                                                                           &X599

  A

Accident

Code the cerebral hematoma as traumatic since the manner of death is accidental.

  1. Some conditions are indexed directly to a traumatic category, but the Classification also provides a nontraumatic code. When these conditions are reported and the Manner of Death is Natural, code condition as nontraumatic unless the condition is reported due to or on the same line with an injury or external cause. This instruction applies only to conditions with the term “nontraumatic” in the Index. It does not apply to conditions in Section III, Intent of Certifier.

            I    (a) Subdural hematoma                                                        I620

                 (b)

MOD     II

  N

Natural

Code I(a) as nontraumatic since Manner of Death box states “Natural.”

Place     I    (a) Subdural hematoma                                                        I620

  2             (b)

                 (c)

MOD     II  Hip fracture                                                                        S720    &W19

  N

Natural        Fell in hospital

Code I(a) as nontraumatic since Manner of Death box states “Natural.”

Place     I    (a) Subdural hematoma                                                        S065

  2             (b) Open wound of head                                                       S019

MOD     II  Fell in hospital                                                                    &W19

  N

Natural

Code subdural hematoma as traumatic since it is reported due to an injury, disregarding Natural in the Manner of Death box.