Instructions for the Automated Classification of the Initiating and Multiple Causes of Fetal Deaths – Section II – 2020

SECTION II: General Instructions

A. INTRODUCTION

EXCERPT FROM U.S. STANDARD REPORT OF FETAL DEATH (Rev. 11/2003)

CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

18a. INITIATING CAUSE/CONDITION 18b. OTHER SIGNIFICANT CAUSES OR

CONDITIONS

(AMONG THE CHOICES BELOW, PLEASE

SELECT THE ONE WHICH MOST LIKELY (SELECT OR SPECIFY ALL OTHER

BEGAN THE SEQUENCE OF EVENTS CONDITIONS CONTRIBUTING TO DEATH

RESULTING IN THE DEATH OF THE FETUS) IN ITEM 18b)

Maternal Conditions/Diseases Maternal Conditions/Diseases

(Specify)_____________________________ (Specify)_____________________________

Complications of Placenta, Cord, or Complications of Placenta, Cord, or

Membranes Membranes

☐ Rupture of membranes prior to ☐ Rupture of membranes prior to

onset of labor onset of labor

☐ Abruptio placenta ☐ Abruptio placenta

☐ Placental insufficiency ☐ Placental insufficiency

☐ Prolapsed cord ☐ Prolapsed cord

☐ Chorioamnionitis ☐ Chorioamnionitis

☐ Other ☐ Other

(Specify)_____________________________ (Specify)_____________________________

Other Obstetrical or Pregnancy Other Obstetrical or Pregnancy

Complications Complications

(Specify)_____________________________ (Specify)_____________________________

Fetal Anomaly Fetal Anomaly

(Specify)_____________________________ (Specify)_____________________________

Fetal Injury Fetal Injury

(Specify)_____________________________ (Specify)_____________________________

Fetal Infection Fetal Infection

(Specify)_____________________________ (Specify)_____________________________

Other Fetal Conditions/Disorders Other Fetal Conditions/Disorders

(Specify)_____________________________ (Specify)_____________________________

☐ Unknown ☐ Unknown

Code all information reported in Item 18 of the Fetal Death Report, “CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH”

Refer to the sex of the fetus to assign the most appropriate cause of fetal death code.

In Volumes 1 and 3 of ICD-10 and the Perinatal Subset, the fourth-character subcategories of three-character categories are preceded by a decimal point. For coding purposes, omit the decimal point.

The data will be entered in the same format for coding and entering multiple causes of fetal deaths as used for coding multiple causes of death for regular mortality data and will be processed through Underlying cause selection Rule 3 and the Modification Tables of the ACME System Decision Tables. A screen will be generated in the same format used for entering regular mortality multiple cause data. The State File Number will also be generated.

Enter codes in 18a as if reported on the uppermost line of Part I of the regular death certificate in the same order as the entries they represent, proceeding from the entry reported uppermost, downward and from the left to right. Terms requiring special formatting may affect the placement of codes. If the lower line is an obvious continuation of a line above, enter the codes accordingly. When an identical code applies to more than one condition reported, enter the code for the first-mentioned of these conditions only. If the entries are numbered, code in numeric order.

Enter codes in 18b as if reported in Part II of the regular death certificate in the same order as the entries they represent, proceeding from the entry reported uppermost, downward and from the left to right. If the lower line is an obvious continuation of a line above, enter the codes accordingly. When an identical code applies to more than one condition reported, enter the code for the first-mentioned of these conditions only.

NOTE: Repetitive (identical) codes are acceptable, if reported once in 18a (Part 1) and once in 18b (Part II). They are not acceptable if reported together in 18a (Part 1) or together in 18b (Part II).

EXAMPLE:

18a. INITIATING CAUSE/CONDITION 18b. OTHER SIGNIFICANT CAUSES OR

CONDITIONS

(AMONG THE CHOICES BELOW, PLEASE

SELECT THE ONE WHICH MOST LIKELY (SELECT OR SPECIFY ALL OTHER

BEGAN THE SEQUENCE OF EVENTS CONDITIONS CONTRIBUTING TO DEATH

RESULTING IN THE DEATH OF THE FETUS) IN ITEM 18b)

Maternal Conditions/Diseases Maternal Conditions/Diseases

(Specify)_____________________________ (Specify)_____________________________

Complications of Placenta, Cord, or Complications of Placenta, Cord, or

Membranes Membranes

☐ Rupture of membranes prior to ☐ Rupture of membranes prior to

onset of labor onset of labor

☐ Abruptio placenta ☐ Abruptio placenta

☐ Placental insufficiency ☐ Placental insufficiency

X Prolapsed cord ☐ Prolapsed cord

☐ Chorioamnionitis ☐ Chorioamnionitis

☐ Other ☐ Other

(Specify)_____________________________ (Specify)_____________________________

Other Obstetrical or Pregnancy Other Obstetrical or Pregnancy

Complications Complications

(Specify)_____________________________ (Specify) Breech delivery

Fetal Anomaly Fetal Anomaly

(Specify)_____________________________ (Specify)_____________________________

Fetal Injury Fetal Injury

(Specify)_____________________________ (Specify)_____________________________

Fetal Infection Fetal Infection

(Specify)_____________________________ (Specify)_____________________________

Other Fetal Conditions/Disorders Other Fetal Conditions/Disorders

(Specify) fetal distress (Specify) fetal heart failure during

delivery

☐ Unknown ☐ Unknown

Code in this order, Part 1 (18a) prolapsed cord, fetal distress, Part II (18b) breech delivery affecting fetus and fetal heart failure.

B. EXCESSIVE CODES

When a line in 18a (Part I) or 18b (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:

NOTE: During the deletion process, when the numbers of existing codes become eight, discontinue the deletion process. The ACME System can tolerate a record with eight codes per line.

Delete ill-defined conditions, P042, P070, P071, P072, P073, P201, P209, P219, P95, and R000-R99 (except when one of these codes is the first code on the line), proceeding right to left.
Delete any nature of injury codes classified to S000-T983 (except when one of these codes is the first code on the line), proceeding right to left.
Delete any repetitive codes (except the first one on a line) proceeding right to left.
If, after applying the preceding criteria, 18a or 18b still has more than eight codes, delete beginning with the last code on the line until only eight remain.

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

NOTE: During the deletion process, when the number of existing codes become fourteen, discontinue the deletion process. The ACME System can tolerate a record with fourteen codes.

Begin deleting in 18b (Part II).

Delete all ill-defined conditions classified to P042, P070, P071, P072, P073, P201, P209, P219, P95 and R000-R99 in 18b (Part II).Do not delete an ill-defined condition when it is the first code in 18b (Part II). Proceed deleting right to left in 18b (Part II). If there are more than fourteen codes remaining after deleting the ill-defined codes in 18b (Part II), delete any of the above ill-defined codes in 18a (Part I) applying the same criteria and order of deletion.
Delete any nature of injury codes classified to S000-T983. Do not delete a nature of injury code when it is the first code in 18b (Part II). Proceed deleting right to left in 18b (Part II). If there are more than fourteen codes remaining after deleting the nature of injury codes in 18b (Part II), delete any of the above nature of injury codes in 18a (Part I) applying the same criteria and order of deletion.
Delete any repetitive codes. Do not delete a repetitive code when it is the first code in 18b (Part II). If there are more than fourteen codes remaining after deleting the repetitive codes in 18b (Part II), delete repetitive codes in 18a (Part I), applying the same criteria and order of deletion. Proceed right to left until there are only fourteen codes remaining on the record.

C. GENERAL CODING CONCEPT

The coding of cause of fetal death information consists of the assignment of the most appropriate ICD-10 code(s) for each diagnostic entity reported on the Fetal Death Report. 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.

Plural form of disease

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

EXAMPLE: Congenital defects Q899

Code Q899, Defect, congenital. Do not code Q897, multiple congenital defects.

Implied “disease”

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

Drug dependent, drug dependency

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

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

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

Non-indexed and illegible entries

Terms not indexed

When a term is reported that is not in the index, enter “P95” on the record where a code for the non-indexed term would go. If there are other classifiable entries reported, disregard the non-indexed term and code the remaining entries as indexed.

Illegible entries

When an illegible entry is the only entry on the report, code P95. When an illegible entry is reported with other classifiable entries, disregard the illegible entry and code the remaining entries as indexed.

Qualifying Conditions as Acute or Chronic

Acute and chronic

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

Punctuation Marks

Disregard punctuation marks such as a period, comma, semicolon, colon, dash, slash, question mark or exclamation mark when placed at the end of a line in 18a. Do not apply this instruction to a hyphen (-) which indicates a word is incomplete.
When conditions are separated by a slash (/), code each condition as indexed.
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.
When conditions are indexed together, yet separated by a comma, code the conditions separately. If the term following the comma is an adjective, refer to instructions on coding adjectival modifiers.

D. 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.”

One-term entity

A one-term entity is a diagnostic entity classifiable to a single ICD-10 code.
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 the above adjectival modifiers only.)

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

If the modifier and lead term are indexed together, code as indexed.
If the modifier is not indexed under the lead term, but “specified” is, use the code for specified (usually .8).
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 an applicable specified 4th character subcategory.
If neither a, b, or c apply, code the lead term without the modifier.

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.

Adjectival modifiers

NOTE: Code an adjective reported at the end of a diagnostic entity as if it preceded the entity. If indexed to a single code, use that code. If not indexed together, follow the instructions for coding multiple one-term entities.

If an adjectival modifier is reported with more than one condition, modify only the first condition.
If an adjectival modifier is reported with one condition and more than one site is reported, modify all sites.
If an adjectival modifier precedes two different diseases that are reported with a connecting term, modify only the first disease.
If the adjectival form of a word(s) or a qualifier(s) is reported in parenthesis, use the adjective to modify the term preceding it.

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases

(Specify) Diabetic nephrosis and vascular disease

Code 18a (Part 1) to P701 P003.

Code 18a (Part I) P701, Maternal condition, affecting fetus or newborn, diabetes mellitus (conditions in E10-E14) and P003, Maternal condition, affecting fetus or newborn, circulatory disease, (conditions in I00-I99, Q20-Q28). Do not modify the vascular disease as diabetic since there are two separate diseases reported with a connecting term.

Parenthetical Entries

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

a) When the adjective form of words or qualifiers are reported in parenthesis, use the adjectives to modify the entity preceding it.
b) If the term in parenthesis is not a complete term and is not a modifier, consider as part of the preceding term.

EXAMPLES:

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases

(Specify) Diabetic renal disease (Nephrosis)

Code 18a (Part 1) P701 P001.

Code 18a (Part I) P701, Maternal condition, affecting fetus or newborn, diabetes mellitus (conditions in E10-E14) and P001, Maternal condition, affecting fetus or newborn, nephritis, nephrotic syndrome and nephrosis (conditions in N00-N08). Nephrosis enclosed in parenthesis is a complete medical entity that can stand alone; therefore, code as a separate entity.

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases

(Specify) Renal disease (Diabetic)

Code 18a (Part 1) P701.

Code 18a (Part I) P701, Maternal condition, affecting fetus or newborn, diabetes mellitus (conditions in E10-E14). Code as Diabetic renal disease. Consider “Diabetic” as an adjective modifying renal disease.

E. CODING FETAL CONDITIONS

Conditions of the fetus can be coded to almost any category in the list of valid codes (Appendix D) other than P000-P049 but will most often be coded to categories P050-P95, Perinatal conditions and Q000-Q999, Congenital anomalies.

In assigning codes for conditions of the fetus, code as indexed in this priority order:

fetus

fetal

affecting fetus or newborn

fetus or newborn

congenital

However, pay special attention to the availability of a relevant code in the Perinatal Subset. There is a subset of Volume 3, the alphabetical index, dedicated to perinatal conditions and referred to as the Perinatal Subset. NCHS provides this as a separate document to assist coders in identifying conditions indexed as “fetus and newborn” or classified to Chapter XVI. It is updated annually.

EXAMPLES:

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Fetal anomaly

(Specify) Congenital diaphragmatic hernia

Code 18a (Part 1) Q790.

Code 18a (Part I) Q790, Hernia, diaphragm, diaphragmatic, congenital since not indexed as fetus, fetal, affecting fetus or newborn, fetus or newborn or newborn. or less than 28 days.

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Other Fetal Conditions/Disorders

(Specify) Central respiratory failure

Code 18a (Part 1) G938

Code 18a (Part 1) G938, Failure, respiratory, central since central respiratory failure is not indexed as fetus, fetal, fetus or newborn or congenital. G938 is a valid fetal death code. Refer to Appendix D for a list of Valid Fetal Death Codes.

F. CODING MATERNAL CONDITIONS

Maternal conditions affecting the fetus should be coded to categories P000-P049. When conditions of the mother directly impact the fetus and are reported on the Fetal Death Report and the condition is not indexed, refer to Volume I, Chapter XVI to categories P000-P049, Fetus and newborn affected by maternal factors and by complications of pregnancy, labor and delivery. Also, refer to the Index under:

Maternal condition, affecting fetus or newborn

Pregnancy, complicated by

Delivery, complicated by

Labor

The complication itself, such as Placenta, abnormality, affecting fetus or newborn.

EXAMPLES:

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases

(Specify) Maternal malnutrition

Code 18a (Part I) P004

Code 18a (Part I) P004, Maternal malnutrition affecting fetus or newborn as indexed.

Assign category P008 to maternal conditions not indexed or classifiable to any other specified category. A list of all conditions not indexed and assigned code P008 will be maintained and will be added to the annual update of Volume 3 and also included in the Perinatal Subset. Please refer all conditions assigned to code P008 to Supervisor and/or a designated contact to ensure they will be incorporated into the next annual edition of Volume 3 and the Perinatal Subset.

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases

(Specify) Crohn disease

Code 18a (Part 1) P008

Code 18a (Part 1) P008, Maternal condition, affecting fetus or newborn, specified condition NEC.

Complications of Placenta, Cord, or Membranes

When the checkbox items in 18a and 18b are marked, each should be assigned codes as follows:

Rupture of membranes prior to onset of labor

Abruptio placenta

Placental insufficiency

Prolapsed cord

Chorioamnionitis

Other (specify)

If the checkbox for rupture of membranes prior to onset of labor is marked, assign code P011.

If the checkbox for abruptio placenta is marked, assign code P021.

If the checkbox for placental insufficiency is marked, assign code P022.

If the checkbox for prolapsed cord is marked, assign code P024.

If the checkbox for chorioamnionitis is marked, assign code P027.

If the checkbox for Other is marked ‘Y’ and no codeable condition or a condition classified to P95 is reported in the ‘Other (specify)’, assign codes P022, P026, and P029; regardless of whether any of the previous boxes have been checked.

If specified conditions are written in the ‘Other (specify)’, code the condition to the mother unless obviously of the fetus. (example, anencephaly – the absence of a large part of the brain and the skull; this is clearly a condition of the fetus.)

☐ Fetal injury If reported as a result of an external cause, the instructions for coding external causes on regular mortality data will apply.

☐ Unknown code P95 (only if no other information is on record)

EXAMPLES:

18a. INITIATING CAUSE/CONDITION

Complications of Placenta, Cord, or Membranes

Other: Y Other: Y

Other (specify) Unknown OR Other (specify): NONE

Code 18a (Part I) P022 P026 P029

Code 18a (Part I) P022 P026 P029, complication of placenta, cord, or membranes. It seems that the certifier is saying yes, there is a complication of the placenta, cord, or membranes: they’re just not sure what the specific complication is.

18a. INITIATING CAUSE/CONDITION

Complications of Placenta, Cord, or Membranes

Rupture of membranes: Y

Other: Y

Other (specify): Previous Birth

Code 18a (Part I) P011 P022 P026 P029

Code 18a (Part I) P011, Rupture of membranes and P022, P026, P029 complication of placenta, cord, or membranes since the checkbox is marked ‘Y’ and previous birth is not a codeable condition.

18a. INITIATING CAUSE/CONDITION

Complications of Placenta, Cord, or Membranes

Other: Y

Other (specify): Twin-Twin Transfusion Syndrome

Code 18a (Part I) P023

Code 18a (Part I) P023, Twin-Twin Transfusion Syndrome. Since a codeable condition is reported in the ‘Other (specify)’, do not assign the 3 codes for complication of placenta, cord, or membranes.

18a. INITIATING CAUSE/CONDITION

Complications of Placenta, Cord, or Membranes

Other: Y

Other (specify):

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS

Other Fetal Conditions/Disorders: Fetal Demise

Code 18a (Part I) P022 P026 P029

Code 18a (Part I) P022 P026 P029, complication of placenta, cord, or membranes and leave 18b (Part II) blank since P95 is not assigned when other information is on the record.

18a. INITIATING CAUSE/CONDITION

Complications of Placenta, Cord, or Membranes

Other: Y

Other (specify):

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS

Complications of Placenta, Cord, or Membranes

Other: Y

Other (specify):

Code 18a (Part I) P022 P026 P029/Code 18b (Part II) P022 P026 P029

Code 18a (Part I) P022 P026 P029, complication of placenta, cord, or membranes and code 18b (Part II) P022 P026 P029, complication of placenta, cord, or membranes since the checkbox is marked ‘Y’ in both places.

G. Format

Conditions reported in 18a

Enter the codes for entries in 18a in the order the entries are reported, proceeding from the entry reported uppermost in 18a from left to right, if there is more than one entry on the same line. If the entries are numbered, code in numeric order.

Connecting Terms

“Due to” written in or implied in Items 18a and 18b

When the certifier has stated that one condition was due to another or has used another connecting term that implies a due to relationship between conditions in items18 and 18b, take into consideration the position of the term in 18a/18b and code the entry following the “written-in due to” directly preceding the term.

a) The following connecting terms must be “written in” and are interpreted as meaning “due to” 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

EXAMPLES:

18a. INITIATING CAUSE/CONDITION

(AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY

BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)

Other Fetal Conditions/Disorders

(Specify) Anoxia and hemorrhage caused by hemolytic disease of fetus

Code 18a (Part 1) to P209 P559 P509

Code 18a (Part 1) P209, Anoxia, fetal, fetus, P559, Disease, hemolytic (fetus) (newborn) and P509, Hemorrhage, fetal, fetus. Code the Hemolytic disease of fetus immediately preceding the hemorrhage.

18a. INITIATING CAUSE/CONDITION

Maternal Conditions/Diseases

(Specify) Fetal cardiac failure due to maternal polyhydramnios

Code 18a (Part 1) P013 P298

Code 18a (Part 1) P013, Polyhydramnios, affecting fetus or newborn and P298, Failure, cardiac, fetal. Code maternal polyhydramnios as the first entry in 18a (Part I), directly preceding the fetal cardiac failure.

When one of the above terms is the first entry in 18b, indicating the entry following the term on the above list is a continuation of 18a, code in 18a. Take into consideration the position of the term in 18a and code the entry following the “written-in due to” in 18b directly preceding the term in 18a.

EXAMPLES:

18a. INITIATING CAUSE/CONDITION 18b. OTHER SIGNIFICANT CAUSES OR

CONDITIONS

(AMONG THE CHOICES BELOW,

PLEASE SELECT THE ONE WHICH (SELECT OR SPECIFY ALL OTHER

MOST LIKELY BEGAN THE SEQUENCE CONDITIONS CONTRIBUTING TO

OF EVENTS RESULTING IN THE DEATH IN ITEM 18b)

DEATH OF THE FETUS)

Fetal Injury Maternal Conditions/Diseases

(Specify)Fetal anoxia (Specify)resulting from maternal

hypertension

Code 18a (Part 1) P000 P209

Code 18a (Part 1) P000, Maternal condition, affecting fetus or newborn, hypertension (conditions in 010-011, 013-016) and P209, Anoxia, fetal, fetus. Code maternal hypertension in 18b directly preceding fetal anoxia in 18a.

18a. INITIATING CAUSE/CONDITION 18b. OTHER SIGNIFICANT CAUSES OR

CONDITIONS

(AMONG THE CHOICES BELOW,

PLEASE SELECT THE ONE WHICH (SELECT OR SPECIFY ALL OTHER

MOST LIKELY BEGAN THE SEQUENCE CONDITIONS CONTRIBUTING TO

OF EVENTS RESULTING IN THE DEATH IN ITEM 18b)

DEATH OF THE FETUS)

Maternal Conditions/Diseases

(Specify)Fetopelvic disproportion

Other Fetal Conditions/Disorders

Other Fetal Conditions/Disorders (Specify)Breech deliver

(Specify) Anoxia due to 18b

Code 18a (Part 1) P031 P030 P209

Code 18a (Part 1) P031, Disproportion (fetopelvic), affecting fetus or newborn, P030, Delivery, breech, affecting fetus or newborn, and P209, Anoxia, fetal, fetus. Code Breech delivery, affecting fetus or newborn in18b, directly preceding the anoxia in 18a.

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 the conditions are reported.

The following terms imply that conditions are meant to remain on the same line. They are separated by “and” or by another connecting term that does not imply a “due to” relationship”:

and consistent with

accompanied by with (c )

also precipitated by

associated with predisposing (to)

complicated by superimposed on

complicating

EXAMPLE:

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS

(SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN

ITEM 18b)

Fetal Anomaly

(Specify) Cleft palate with cleft lip

Code 18b (Part II) Q359 Q369

Code 18b (Part II) Q359, Cleft, palate and Q369, Cleft lip. Code each entity separately even though ICD-10 provides a combination code for cleft palate and cleft lip.

c) Conditions reported in 18b

NOTE: Enter the codes for entries in 18b in the order the entries are reported, proceeding from the entry reported uppermost in 18b from left to right, if there is more than one entry on the same line. If entries are numbered, code in numeric order.

d) Deletion of “18b” on Fetal Death Report

When the certifier has marked through the printed 18b, disregard the marking and code the entities as reported in 18b (Part II).

e) Doubtful Diagnosis
Doubtful qualifying expression: When expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly,” qualify any condition, disregard these expressions and code the condition as indexed.
a) 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 as follows:

When more than one condition of the placenta classifiable to P020, P021,P022 is qualified by one of the expressions interpreted as “either/or,” code P022, “Unspecified morphological and functional abnormalities of the placenta”.

EXAMPLE:

Placenta previa versus abruption placenta

Code P022, Placenta, abnormal, affecting fetus or newborn.

When more than one condition of the umbilical cord classifiable to P024, P025, P026 is qualified by one of the expressions interpreted as “either/or,” code P026, Unspecified condition of the umbilical cord.”

EXAMPLE:

Knot in umbilical cord or short cord

Code P026, Abnormal, abnormality, umbilical cord, affecting fetus or newborn.

When more than one condition of the maternal membranes (P027, P028) is qualified by one of the expressions interpreted as “either/or,” code P029, “Unspecified abnormality of membranes”.
When more than one fetal anomaly is reported and qualified by one of the terms interpreted as “either/or,” code as follows:
a) If an anomaly is reported of different parts of the same site, code Anomaly of the specified site only.

EXAMPLE:

Congenital anomaly of the tricuspid or aortic valve

Code Q248, Anomaly of heart valve NEC.

b) When conditions are qualified by a statement of “either or” and only one site/system is involved, code to the residual category for the site/system.

EXAMPLES:

Encephalocele or hypoplasia of brain
Code Q049, Anomaly, of brain.

Anomaly of the bladder or kidney
Code Q649, Anomaly, unspecified of the urinary system.

c) If different specified anomalies of the same system, code anomaly of the specified system only.

EXAMPLE:
Congenital stenosis of pylorus or atresia of duodenum.
Code Q459, Anomaly, gastrointestinal tract NEC.

NOTE: IF MORE THAN ONE CONDITION OF THE FETUS (INCLUDING MATERNAL CONDITIONS) IS REPORTED WITH A TERM INTERPRETED AS “EITHER/OR,” AND THE ABOVE INSTRUCTIONS DO NOT APPLY, REFER TO IMMEDIATE SUPERVISOR FOR A CODE ASSIGNMENT.

H. Screening/Tests Results

When a statement is reported on the Fetal Death Report indicating a screening or diagnostic test was performed and the results of the test are not reported, do not enter a code for the screening/test. Tests are used for diagnostic purposes and not considered a diagnosis unless the results are reported. If results are reported, code as indexed.

EXAMPLES

Diagnostic imaging of the kidney performed
Liver function studies
Screened for tuberculosis

Do not enter a code for a condition when the results are reported as “negative”.

EXAMPLES:

Negative for tuberculosis
Tested negative for HIV
Tested positive for tuberculosis P370. Indexed under Tuberculosis, congenital

I. Inclusion of additional information (AI) to Fetal Death Reports

Code supplemental information when it modifies or supplements data on the original Fetal Death Report as follows:

When additional information (AI)states the initiating cause of a specified disease or condition in 18a (Part 1), code the additional information (AI) preceding the specified disease.
When additional information (AI)modifies a specified disease or condition, use the AI and code the specified disease where reported.
When there is a stated or implied complication of surgery and the additional information indicates the condition for which the surgery was performed, code this condition as follows:
a) If the surgical procedure was performed on the mother, code the condition for which the surgical procedure was performed following the P006 (the code used for the fetus and newborn affected by a surgical procedure on the mother).
b) If the surgical procedure was performed on the fetus, refer to your immediate supervisor for a code assignment.
When the additional information (AI)states a certain condition is the initiating cause of death, code this as the first condition in 18a (Part 1).
When any morphological type of neoplasm is reported in 18a (Part 1) with no mention of the “site” and additional information specifies a site, code the specified site only on the line where the morphological type is reported.
When additional information states the primary site of a malignant neoplasm of the fetus, enter the code preceding where information concerning the neoplasm is reported.
When the additional information does not modify a condition on the report, or does not state that this condition is the initiating cause, code the AI as the last condition(s) in 18b (Part II).

J. Amended Reports

When an “Amended Fetal Death Report” is submitted, code the conditions reported on the amended report only.

K. Sex Limitations

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

For Males Only For Females Only

B260 C51-C579

C60-C63 D06

D074-D076 D070-D073

D176 D25-D28

D29 D390-D391

D40 D397-D399

Q53-Q55 P546

Q98 Q500-Q529

Q960-Q962

Q964-Q979

L. Plurality Limitations

Certain categories in ICD-10 are limited to one plurality. If the number in the Plurality box on the Fetal Death Record is greater than “1”, code P015 as the last entry in 18b (Part II).

For Multiples Only

P01.5

Q89.4

NOTE: Do not add/code P01.5 for “twin to twin transfusion”. Code to P02.3 as indexed.

M. 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. Apply the following instructions when relating a condition of unspecified site to the site of the specified condition:

a. General instructions for implied site of a disease

When applying the instructions for Implied site of a Disease and Relating and Modifying, consider all specified conditions for the following choices to be on the same line and apply applicable instructions for relating and modifying:

Maternal Conditions/Diseases

(Specify)_____________________________

Complications of Placenta, Cord, or Membranes

Rupture of membranes prior to onset of labor

Abruptio placenta

Placental insufficiency

Prolapsed cord

Chorioamnionitis

Other (Specify) _____________________________

Other Obstetrical or Pregnancy Complications

(Specify)_______________________________________

Fetal Anomaly (Specify)___________________________
Fetal Injury (Specify) _____________________________
Fetal Infection (Specify) ___________________________
Other Fetal Conditions/Disorders

(Specify) _______________________________________

Unknown

(1) When conditions are reported on the same line, assume the condition of unspecified site was of the same site as the condition of specified site.

(2) 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.

b. Relating specific categories

(1) 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.

(2) 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.

Non-traumatic conditions

Consider conditions that are usually but not always traumatic in origin to be qualified as non-traumatic when