Instructions for Classification of Underlying and Multiple Causes of Death – Section I – 2023

This manual provides instructions to mortality medical coders and nosologists for coding the underlying cause of death from death certificates filed in the states. These mortality coding instructions are used by both the State vital statistics programs and the National Center for Health Statistics (NCHS), which is the Federal agency responsible for the compilation of U.S. statistics on causes of death. NCHS is part of the Centers for Disease Control and Prevention.

In coding causes of death, NCHS adheres to the World Health Organization Nomenclature Regulations specified in the most recent revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). NCHS also uses the ICD international rules for selecting the underlying cause of death for primary mortality tabulation in accordance with the international rules.

Beginning with deaths occurring in 1999, the Tenth Revision of the ICD (ICD-10) is being used for coding and classifying causes of death. This revision of the Classification is published by the World Health Organization (WHO) and consists of three volumes. Volume 1 contains a list of three-character categories, the tabular list of inclusions and the four-character subcategories. The supplementary Z code appears in Volume 1 but is not used for classifying mortality data. Optional fifth characters are provided for certain categories and an optional independent four-character coding system is provided to classify histological varieties of neoplasms, prefixed by the letter M (for morphology) and followed by a fifth character indicating behavior. These optional codes are not used in NCHS. Volume 2 includes the international rules and notes for use in classifying and tabulating underlying cause-of-death data. Volume 3 is an alphabetical index containing a comprehensive list of terms for use in coding. Copies of these volumes may be purchased in hardcopy or on diskettes from the following address:

WHO Publications Center
49 Sheridan Avenue
Albany, New York 12210
Tel. 518-436-9686

NCHS has prepared an updated version of Volume 1 and Volume 3 to be used for both underlying and multiple cause-of-death coding. The major purpose of the updated version is to provide a single published source of code assignments including terms not indexed in Volume 3 of ICD-10. NCHS has included all non-indexed terms encountered in the coding of deaths during 1979-1994, under the Ninth Revision of the International Classification of Diseases (ICD-9). Due to copyright considerations, the updated Volumes 1 and 3 may not be reproduced for distribution outside of NCHS and State vital statistics agencies. With the availability of the updated Volumes 1 and 3, NCHS will discontinue publishing the Part 2e manual, Non-indexed Terms, Standard Abbreviations, and State Geographic Codes as Used in Mortality Data Classification that was first published in 1983. The list of geographic codes (Appendix C), the list of abbreviations used in medical terminology (Appendix D), and the synonymous sites list (Appendix E) are included in this publication.

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 those diagnostic statements subject to dual classification. The etiology or underlying disease process codes are marked with a dagger (†), and the manifestation or complication codes are marked with an asterisk (*) following the codes in ICD-10. NCHS does not use the asterisk codes in mortality coding. For example, cytomegaloviral pneumonia has a code marked with a dagger (B25.0†) and a different code, marked with an asterisk (J17.1*). In this example, only the dagger code (B25.0) would be used.

Major Revisions from Previous Manuals

1. Corrections have been made to clarify instructions, spelling and format throughout the manual. These changes are not specifically noted.

2. Section IV, Part B, F17.-, updated NOTE and added a 3rd example.

3. Section IV, Part B, X49.-, added info about second hand smoke.

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Other manuals available from NCHS which contain information related to coding causes of death are:

Part 2b, NCHS Instructions for Classifying Multiple Causes of Death, 2023

Part 2c, ICD-10 ACME Decision Tables for Classifying Underlying Causes of Death, 2023

Part 2k, Instructions for the Automated Classification of the Initiating and Multiple Causes of Fetal Death, 2023

Part 2s, SuperMICAR Data Entry Instruction, 2011

B. MEDICAL CERTIFICATION

The U. S. Standard Certificate of Death provides spaces for the certifying physician, coroner, or medical examiner to record pertinent information concerning the diseases, morbid conditions, and injuries which either resulted in or contributed to death as well as the circumstances of the accident or violence which produced any such injuries. The medical certification portion of the death certificate is designed to obtain the opinion of the certifier as to the relationship and relative significance of the causes which he reports.

A cause of death is the morbid condition or disease process, abnormality, injury, or poisoning leading directly or indirectly to death. The underlying cause of death is the disease or injury which initiated the train of morbid events leading directly or indirectly to death or the circumstances of the accident or violence which produced the fatal injury. A death often results from the combined effect of two or more conditions. These conditions may be completely unrelated, arising independently of each other or they may be causally related to each other, that is, one cause may lead to another which in turn leads to a third cause, etc.

The order in which the certifier is requested to arrange the causes of death upon the certification form facilitates the selection of the underlying cause when two or more causes are reported. He is requested to report in Part I on line (a) the immediate cause of death and the antecedent conditions on lines (b), (c) and (d) which gave rise to the cause reported on line (a), the underlying cause being stated lowest in the sequence of events. However, no entry is necessary on I(b), I(c) or I(d) if the immediate cause of death stated on I(a) describes completely the sequence of events.

Any other significant condition which unfavorably influenced the course of the morbid process and thus contributed to the fatal outcome but was not related to the immediate cause of death is entered in Part II.

Excerpt from U.S. STANDARD CERTIFICATE OF DEATH (REV 11/2003)

U.S. Standard Certificate of Death

U.S. STANDARD CERTIFICATE OF DEATH (REV 11/2003)

U.S. Standard Certificate of Death

C. DEFINITIONS

The terms defined in this section are used throughout the manual.

A reported sequence two or more conditions on successive lines in Part I, each condition being an acceptable cause of the one on the line immediately above it.

Accident in medical care a misadventure or poisoning occurring during surgery or other medical care.

Causation table (Table D) contains address codes and subaddress codes that indicate an acceptable causal relationship (reported sequence). Table D is in Part 2c Instruction Manual.

Combination code a third code which is the result of the merging of two or more codes.

Conflict in linkage when the selected underlying cause links con-currently “with” or in “due to” position with two or more conditions.

Contributory cause any cause of death that is neither the direct, intervening, originating antecedent nor underlying is a contributory cause of death.

Direct cause of death also known as terminal cause of death, is the condition entered on line I(a) in Part I. If the certifier has entered more than one condition on line I(a), these terms apply to the first one. In the selection rules themselves, the direct cause is often referred to as the condition first entered on the certificate.

Direct sequel a condition which is documented as one of the most frequent manifestations, consequences, or complications of another condition.

“Due to” position when there are entries on more than one line in Part I with only one entity on the lowest used line in Part I, the single entity on the lowest used line is considered to be in a “due to” position of all entries entered above it. When there are entries on more than one line in Part I, each entity on the lower of two lines is considered to be in a “due to” position of each entity on the next higher line.

Entity a diagnostic term or condition entered on the certificate of death that constitutes a codable entry.

Error in medical care a misadventure or poisoning occurring during surgery or other medical care.

Further linkage another step in the linkage process which must be made to conform with the Classification after one or more linkages have been made.

Intervening cause any causes between the originating antecedent cause and the direct cause of death are called intervening causes.

Late maternal death the death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy.

Maternal death the death of any woman while pregnant or within 42 days (less than 43 days) of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Modification table (Table E) contains address codes and subaddress codes that are used with Selection Rule 3 and Modification Rules A, C, and D. Table E is in Part 2c Instruction Manual.

Multiple one-term entity a diagnostic entity consisting of two or more words together 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.

One-term entity a diagnostic entity that is classifiable to a single ICD-10 code. It can be one word or more than one word.

Originating antecedent cause this term designates the condition entered on the lowest used line in Part I, or, if the certificate has not been filled out correctly, the condition that the certifier should have reported there. The originating antecedent cause is, from a medical point of view, the starting point of the train of events that eventually caused the death.

Preference code a code which has priority over other code(s) which may also qualify as a combination code.

Perinatal period the period which commences at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g), and ends seven (7) completed days after birth.

Properly positioned condition(s) placed in an appropriate order to form a sequence of events.

Selected underlying cause of death a condition which is chosen either temporarily or finally by the application of an international selection rule.

Sequence two or more conditions entered on successive lines of Part I, each condition being an acceptable cause of the one entered on the line above it.

Trivial condition a condition which will not of itself cause death. The trivial conditions are listed in Part 2c Instruction Manual in Table H.

TUC NCHS abbreviation for tentative underlying cause. This is the same as the originating antecedent cause.

Underlying cause of death the disease or injury which initiated the train of morbid events leading directly to death or the circumstances of the accident or violence which produced the fatal injury.

D. 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. When a created code is selected as the underlying cause it must be converted to its official ICD-10 code using Appendix B.

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 item 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 brain aneurysm (I6090)

*I6090 Ruptured arteriosclerotic cerebral aneurysm

Ruptured (congenital) cerebral aneurysm NOS

Ruptured mycotic brain aneurysm

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

Excerpt from U.S. STANDARD CERTIFICATE OF DEATH (REV 11/2003)

U.S. STANDARD CERTIFICATE OF DEATH (REV 11/2003)

DEFINITIONS

The terms defined in this section are used throughout the manual.

A reported sequence
Two or more conditions on successive lines in Part I, each condition being an acceptable cause of the one on the line immediately above it.

Accident in medical care
A misadventure or poisoning occurring during surgery or other medical care.

Causation table (Table D)
Contains address codes and subaddress codes that indicate an acceptable causal relationship (reported sequence). Table D is in Part 2c Instruction Manual.

Combination code
A third code which is the result of the merging of two or more codes.

Conflict in linkage
When the selected underlying cause links con-currently “with” or in “due to” position with two or more conditions.

Contributory cause
Any cause of death that is neither the direct, intervening, originating antecedent nor underlying is a contributory cause of death.

Direct cause of death
Also known as terminal cause of death, is the condition entered on line I(a) in Part I. If the certifier has entered more than one condition on line I(a), these terms apply to the first one. In the selection rules themselves, the direct cause is often referred to as the condition first entered on the certificate.

Direct sequel
A condition which is documented as one of the most frequent manifestations, consequences, or complications of another condition.

“Due to” position
When there are entries on more than one line in Part I with only one entity on the lowest used line in Part I, the single entity on the lowest used line is considered to be in a “due to” position of all entries entered above it. When there are entries on more than one line in Part I, each entity on the lower of two lines is considered to be in a “due to” position of each entity on the next higher line.

Entity
A diagnostic term or condition entered on the certificate of death that constitutes a codable entry.

Error in medical care
A misadventure or poisoning occurring during surgery or other medical care.

Further linkage
Another step in the linkage process which must be made to conform with the Classification after one or more linkages have been made.

Intervening cause
Any causes between the originating antecedent cause and the direct cause of death are called intervening causes.

Late maternal death
The death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy.

Maternal death
The death of any woman while pregnant or within 42 days (less than 43 days) of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Modification table (Table E)
Contains address codes and subaddress codes that are used with Selection Rule 3 and Modification Rules A, C, and D. Table E is in Part 2c Instruction Manual.

Multiple one-term entity
A diagnostic entity consisting of two or more words together 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.

One-term entity
A diagnostic entity that is classifiable to a single ICD-10 code. It can be one word or more than one word.

Originating antecedent cause
This term designates the condition entered on the lowest used line in Part I, or, if the certificate has not been filled out correctly, the condition that the certifier should have reported there. The originating antecedent cause is, from a medical point of view, the starting point of the train of events that eventually caused the death.

Preference code
A code which has priority over other code(s) which may also qualify as a combination code.

Perinatal period
The period which commences at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g), and ends seven (7) completed days after birth.

Properly positioned
Condition(s) placed in an appropriate order to form a sequence of events.

Selected underlying cause of death
Acondition which is chosen either temporarily or finally by the application of an international selection rule.

Sequence
Two or more conditions entered on successive lines of Part I, each condition being an acceptable cause of the one entered on the line above it.

Trivial condition
Acondition which will not of itself cause death. The trivial conditions are listed in Part 2c Instruction Manual in Table H.

TUC
NCHS abbreviation for tentative underlying cause. This is the same as the originating antecedent cause.

Underlying cause of death
The disease or injury which initiated the train of morbid events leading directly to death or the circumstances of the accident or violence which produced the fatal injury.