Instructions for Classifying Multiple Causes of Death, 2024 – Section V
SECTION V – EFFECTS OF EXTERNAL CAUSE OF INJURY AND EXTERNAL CAUSES OF INJURY AND POISONING
In ICD-10, the Nature of Injury Chapter (XIX) is part of the main Classification but certain effects of external causes are classified in Chapters I-XVIII. The external cause codes (Chapter XX) are intended for use, where relevant, to identify the external cause of conditions classifiable to Chapters I-XVIII, as well as to Chapter XIX. While not all external causes will have a corresponding code in Chapter XIX, an external cause code is required when a code from Chapter XIX is applicable.
A. External cause code (E-Code) concept
An external cause of injury may be classified to Accidents (V01-X59), Intentional self harm (X60-X84), Assault (X85-Y09), Event of undetermined intent (Y10-Y34), Legal intervention and operations of war (Y35-Y36), Complications of medical and surgical care (Y40-Y84), and Sequela of external causes (Y85-Y89). When unspecified, assume all external cause one-term entities to be accidental unless the External Causes of Injury Index provides otherwise.
The objective in assigning the external cause codes is to combine into the entity being coded any related entries on the record that will permit the assignment of the most specific external cause codes in accordance with the intent of the certifier. After the determination of the most specific external cause code is made, enter this code where it is first encountered on the record. Do not repeat the same external cause code when it is reported on other lines. When more than one external cause is reported, code each external cause code where it is first encountered on the certificate.
The death certificate provides a specific place for information concerning the external cause of injury that is usually entered on the lines below the line labeled “Part II.” However, a description of the external cause is reported frequently in Part I and may be repeated in the space provided for this information.
When the manner of death block is marked as Homicide but the certifier specifies Accident elsewhere on the certificate, code as Accident. The definition of homicide as “death at the hands of another” may lead certifiers to mark Homicide in the checkbox when really the death itself was unintentional. For all other manners of death, if there is more than one reported, code as could not be determined.
When such statements as: “jumped or fell,” “don’t know,” “accident or suicide,” “accident or homicide,” “undetermined,” or “open verdict” are reported, code the external cause as “undetermined.” The “undetermined” categories include self-inflicted injuries, except poisoning, when not specified whether accidental or with intent to harm.
1. Use of Index
ICD-10 provides separate indexing in Volume 3, Section II for the external causes of injury, with frequent references to Volume 1. The External Causes of Injury Index provides a double axis of indexing — descriptions of the circumstances under which the accident or violence occurred and the agent involved in the occurrence. Usually, the “lead terms” in the External Causes of Injury Index describe the circumstances of the injury with a secondary (indented) entry naming the agent involved.
Fall from building W13
Locate the E-code for “fall”:
Fall, falling
– from, off
– – building W13.-
2. Use of Tabular List
After locating the external cause code in the Index, always refer to Volume 1 since certain external cause codes for transport accidents require a fourth character not provided for in the Index. When ICD-10 provides a fourth character subcategory for an external cause code, always code the fourth character.
Fell from boat V929
Locate the E-code for “fall”:
Fall
– from
– – boat, ship, watercraft NEC (with drowning or submersion) V92.-
In Volume 1, the fourth character describes the type of boat. Code the fourth character “9,” unspecified watercraft.
The Classification provides a fourth character for use with categories W00-Y34, except Y06.- and Y07.-, to identify the place of occurrence of the external cause. NCHS uses a separate field for this purpose. Only the three-character category codes are assigned in multiple cause coding.
House fire X00
Locate the E-code for “House fire”:
House Fire (uncontrolled) X00.-
In Volume 1, a fourth character identifying the place of occurrence is required. Assign code 0 (home) to the place of occurrence variable in the field provided for this variable.
3. Place of occurrence of external cause
Enter a one-character place of occurrence code (0-9), for external causes of injury classifiable to W00-Y34, except Y06.- and Y07.-, if the effects of the external cause are classifiable to Chapter XIX. Do not enter a place code for external causes classifiable to any other external cause code. Use only the information reported in the medical certification section of the death certificate or additional information (AI) to determine the place code. Refer to Appendix D for the list of place of occurrence codes.
4. Manner of death (Item 37) on death certificate
- Affecting multiple cause codes
(1) When separate check boxes for indicating whether an external cause was accidental, suicidal, homicidal, undetermined, or pending investigation appear on the medical certification form, treat the check box entry as a one-term entity.
(2) When “accident,” “pending,” “unknown,” or “undetermined” is written in the “check box” or is one of the items checked and no condition is coded to Chapter XIX, disregard the check box entry for assignment of codes.
(3) When “suicide” or “homicide” is written in the “check box”, or is one of the items checked and no condition is coded to Chapter XIX, assign the appropriate external cause code preceded by Injury NOS, T149.
(4) When “unknown” or “open verdict” is written in the check box and there is a condition(s) coded to Chapter XIX, code the external cause to the appropriate “event of undetermined intent” category.
(5) When “pending,” “pending investigation,” “deferred,” or “unclassified” is reported in the check box and there is a condition(s) coded to Chapter XIX, code the external cause as indexed.
(6) Enter a code for an entry in a check box for “natural cause” only if this is the only codable entry on the certificate or the only other codable entry is “unknown cause” (R97).
- As a separate variable
Enter an alpha character manner of death code (N, A, S, H, P, or C) in the appropriate data position for any entry in the manner of death check box. Use only the information reported in the manner of death box to assign the code.
Code the manner of death as:
Natural………………………………… N
Accident………………………………. A
Suicide…………………………………. S
Homicide……………………………… H
Pending Investigation……………… P
Could not be determined………….. C
Blank…………………………………… Blank
5. Nature of injury and external cause code lists
Since certain entities state or imply cause (E-code) and effect (N-code), ICD-10 provides both N-codes and E-codes for many terms. Determination must be made whether to code nature of injury code only, external cause code only, or both nature of injury and external cause codes for such terms. Use the following lists as guides in classifying these terms. When ICD-10 provides a nature of injury code for an entity that does not appear on either list, use the nature of injury code only.
The E-code is only coded the first time external information is mentioned. A term requiring a N-code is coded each time it is reported.
Nature of injury code only (N-Code)
Allergy Intoxication when due to a
Anaphylactic reaction drug
Anaphylactic shock Lacerations
Anaphylaxic, anaphylaxis Lack of care
Anoxia Mucus plug
Bezoar Multiple injuries
Burns Polypharmacy (when it means
Cremation drug poisoning)
Crushed Scald
Decapitation Severed
Deceleration injury Sharp force injury
Drug NOS or named drug Smoke
(when it means drug poisoning) Starvation
Drug synergism Trauma NOS (any site)
Exhaustion Traumatic
Fracture Traumatic death
Inattention at birth Traumatic injury (any site)
Incineration Traumatism
Injury NOS (any site) Wound (penetrating)
External cause code only (E-code)
Abandonment Explosive blasts to site(s) Inhalation
Accident, accidental Fall Physical violence
Arson Fight Projectile
Assault Fire Reaction of drug with a
Beaten Flood reported complication
Blow to any site Foreign body Striking any site
Blunt force NOS Heat Suicide, suicidal
Blunt impact NOS Hitting any site
Conflagration Homicide, homicidal
Desertion Hot environment
Excessive heat Hot weather
Explosion Impact
Entities Requiring nature of injury and external cause codes on the same line (N\E Codes)
Abuse (child) (elder) (spousal) Hypothermia
Airway obstruction by foreign Immersion
body Impact injury (any site)
Alcohol intoxication (any term Impact to a site (any)
meaning intoxication) Incised (wound)
Anastomotic leak Ingestion of foreign body
*Asphyxia Inhalation injury (any)
*Aspiration *Inhalation of foreign body
Battered child (syndrome) Lightning (struck by)
Bite Mangled
Blunt blow to a site Mechanical trauma
Blunt force injury (any site) Overdose (of drug or alcohol)
Blunt force to a site (any) Overheated
Blunt impact to a site (any) Overexertion
Blunt injury (any site) Poisoning (by substance)
Blunt trauma (any site) Pulled trigger
Bullet (to site) Puncture, punctured (any site)
Bullet wound Puncture wound
Child neglect Radiation burns
Choking on foreign body Rape
Crushed by specified object Razor cut
Cut Shoot, shooting, shot (to site)
Drowning Shotgun blast (to site)
Electrocution Slash, slashed (any site)
Electrical burns Smothered
Electrical shock Snake bite
Exposure (to element) (cold, heat) Stab
Firearm (any type) (discharge) Sting
Flame burn Strangulation
Foreign body in any site Submersion
Freezing, froze, frostbite Suffocation
Got too hot Sunstroke
Gun went off Suspension, suspended
Gunshot (to site) Swallowed object
Gunshot wound Toxicity (of substance)
Hanging (by neck) Vehicular trauma
Heat exhaustion Weapon wound
Heat stress .22, .32 or any caliber
Heat stroke
(* This does not apply when certain localized effects result from asphyxia, aspiration, or inhalation. Refer to Section V, Part O.)
B. Placement of nature of injury and external cause codes
When a nature of injury code and an external cause code are required for an entity, enter the nature of injury code followed by the external cause code on the same line.
Place I (a) Gunshot wound of chest S219 &W34
9 (b)
(c)
MOD II
A
Accident |
Since “gunshot wound” requires a nature of injury and an E-code, enter on I(a) the nature of injury code for wound of chest followed by the most specific E-code for gunshot, accidental. Code place of occurrence as 9 (unspecified). Code manner of death as A (accident).
When entries requiring nature of injury codes and external cause codes are reported on the same line in Part I, code the first nature of injury code followed by the most specific external cause code; then code any remaining conditions for the line in the order indicated by the certifier.
Place I (a) Laceration of throat S118
9 (b) Dog bite of shoulder, S410 &W54 T111 S119
(c) arm and neck
Code the nature of injury code only for I(a). On I(b), code the nature of injury code for “bite of shoulder” followed by the E-code for dog bite followed by the remaining nature of injury codes for “bite arm and neck.” Code place of occurrence as 9 (unspecified).
Place I (a) Fracture skull S029
9 (b) Fell from window, crushed S280 &W13 S381
(c) chest and abdomen
I(a) requires a nature of injury code only. I(b) requires both nature of injury and E-code since the external cause and injuries are reported on this line. Code first nature of injury code followed by the external cause code, followed by the remaining nature of injury codes. Code place of occurrence as 9 (unspecified).
Place I (a) Renal failure N19
0 (b) Injury kidney, liver and S370 &W11 S361 S360
(c) spleen. Fell from ladder at home
Code I(b) injury kidney followed by external cause code for the fall, followed by the remaining injuries. Code place of occurrence as 0 (home).
Place I (a) Cerebral laceration & contusion S062
9 (b) Blow to right temporal area &X599
Code I(a) to the nature of injury code only, and I(b) to the external cause code only. Code place of occurrence as 9 (unspecified).
In Part II, code each entry in the same order as entered on the certificate. For entities requiring both nature of injury and external cause codes, enter the nature of injury code followed by the external cause code. Enter the information recorded in the special spaces that have been provided on the medical certification form for recording information about external causes of injury following any codes that are applicable to Part II.
Place I (a) Crushed chest S280
9 (b) Broken rib S223
(c)
II Fracture hip and arm S720 T10 &W24
43 |
Run over by a forklift |
In Part II, code each entry in the order entered on the certificate. Code place of occurrence as 9 (unspecified).
Place I (a) Subdural hematoma S065
9 II Blunt impact injury to head S099 &Y00
MOD
H
Homicide |
43 |
Struck on head with a blunt object by another person |
Since the entry in Part II requires both nature of injury and external cause codes, enter the nature of injury code followed by the most specific external cause code. Code place of occurrence as 9 (unspecified).
Place I (a) Head wound S019
9 II &W34 S062 S019
MOD
A
Accident |
43 |
Cerebral laceration, GSW of head |
Code external cause code first in Part II since manner of death box requires an external cause code. Code place of occurrence as 9 (unspecified).
C. Use of ampersand
- Use an ampersand to identify the following
- The most specific external cause code causing injuries or poisoning.
- Certain localized effects of poisonous substances (X45-X49) or aspiration (W78,W79, W80) when classifiable to Chapters I-XVIII.
- Ampersand the E-code for aspiration (W78-W80) anytime it is reported.
Place I (a) Aspiration T179 &W78
0 (b) Vomitus
II Fx Hip Fall at home S720 &W19
Ampersand both the E-code for aspiration and the E-code for fall at home.
Exceptions to c:
- When reporteddue to:
- nature of injury codes
- medical and surgical care
- other external causes
- When a nature of injury code other than T179 is reported as thefirst condition on the lowest used line in Part I.
Place I (a) Aspiration of vomitus T179 W78
0 (b) Fx hip S720
II Fall at home &W19
Do not ampersand the E-code for aspiration since both Exception 1 and 2 apply.
- More than one external cause reported
- In determining the most specific external cause code, consider all of the information reported on the record.If two or more external causes are reported and the nature of injuries and/or the order in which the conditions are reported indicates that one of the external causes led to the condition that terminated in death, precede the code for this external cause by an ampersand. If no determination can be made, precede the code for the first mentioned external cause with an ampersand.
Place I (a) Aspiration of vomitus T179 W78
9 (b) Internal chest injury S279
(c) Fall down stairs &W10
The order in which the conditions are reported indicates that the fall down stairs led to aspiration; therefore, the ampersand precedes the code for this external cause.
Place I (a) Gunshot wound of head S019 &X95
9 (b) Stab wound of chest S219 X99
MOD II
H
Homicide |
The order in which the external causes are reported does not indicate which event occurred first; therefore, precede the code for the gunshot wound with an ampersand since it is the first external cause reported.
Place I (a) Head trauma S099
9 II Alcohol intoxication, auto accident T519 X45 &V499
Precede the code for the auto accident with an ampersand. Alcohol intoxication did not cause the head trauma.
Place I (a) Positional asphyxia complicating mixed drug (morphine T71 &W84 T402 X44 T424
9 (b) and temazepam) intoxication
MOD II Obesity and obstructive sleep apnea E669 G473 J969 T402 T424
A
|
Accident |
|
Positional respiratory compromise after self-administering morphine and temazepam |
Code I(a) as indexed, preceding the W84 with an ampersand since it is the first mentioned e-code. Assign the N and E-codes for the named drug poisoning on line I(a). In Part II, code the diseases as indexed and assign the nature of injury codes for the drugs repeated in the How Injury Occurred block.
- When alcohol intoxication (or any term meaning intoxication) is reported with another external cause other than aspiration, precede the code for the first mentioned external cause with an ampersand.
When alcohol intoxication is reported with drugs, refer to Section V, Part Q, 4, Poisoning by alcohol and drugs.
When alcohol intoxication is reported with exposure or hypothermia, refer to Section V, Part L, 2, Exposure, cold exposure and hypothermia.
Place I (a) Head trauma S099
9 (b) Auto Accident &V499
(c) Alcohol intoxication T519 X45
Precede the code for the auto accident with an ampersand since it is the first external cause reported.
Place I (a) Drowning T751 &W74
9 (b) Alcohol intoxication T519 X45
II Drinking heavily F101
Precede the code for the drowning with an ampersand since it is the first external cause reported. Code Part II as indexed.
Place I (a) Alcohol intoxication and hip fx T519 &X45 S720
9 II Fall while intoxicated W19 T519
Precede the code for the alcohol intoxication with an ampersand since it is the first external cause reported.
Place I (a) Positional asphyxia in the setting of acute ethanol T71 &W84
9 (b)intoxication T510 X45
Precede the code for the positional asphyxia with an ampersand since it is the first external cause reported.
D. Certifications with mention of nature of injury and without mention of external cause
All certifications that have an entry classifiable to Chapter XIX must have an external cause code. When only one type of injury is reported without indication of the external cause and the External Cause Index provides a code for this type of injury, code accordingly. If the External Cause Index does not provide a code for the type of injury, code to Accident, unspecified (X599). When no external cause is reported and the external cause code must be assumed, code the external cause code as the last entry in Part II.
Place I (a) Crushed chest S280
9 II &X599
Code Crushed (accidentally), X599 as indexed.
Place I (a) Fracture of hip and arm S720 T10
9 II &X590
Code Fracture (circumstances unknown or unspecified), X590 as indexed.
Place I (a) Penetrating wound of abdomen S318 S219
9 (b) and chest
II &X599
Code Wound (accidental) NEC, X599 as indexed.
If different types of injuries are reported without indication of the external cause, use the injury reported in the lowest due to position to assign the appropriate external cause code for this injury. If more than one injury is reported on the lowest line, assign the appropriate external cause code for the first mentioned injury.
Place I (a) Brain injury S069
9 (b) Fracture of skull S029
II &X590
Code Fracture (circumstances unknown or unspecified), X590.
Place I (a) Fracture of hip S720
9 (b) Crushing hip injury S770
II &X599
Code Crushed (accidentally), X599.
Place I (a) Cerebral concussion and S060 S062
9 (b) laceration of brain
II &X599
Concussion is not indexed in External Cause Index. Code to Accident, unspecified, X599.
These generalizations do not apply if the place of occurrence of the injury was highway, street, road, or alley. Refer to instructions for transport accidents in Section V, Part J.
Implied site of injury
Relate most injuries of an unspecified site to a condition of a specified site, whether or not qualified as generalized, multiple, or stated plural, following general instructions for relating disease conditions.
Exceptions:
Do not relate
Injury(ies) (generalized) (internal) (multiple)
Trauma(s) (generalized) (internal) (multiple)
Wound(s) (generalized) (internal) (multiple)
Place I (a) Crushed skull with multiple fractures S071 S029
9 II &X599
Code crushed skull followed by multiple skull fractures relating the injury of unspecified site to the site of the injury that is reported on the same line. Since there is no external cause reported, code Crushed (accidentally) as indexed in Part II.
Place I (a) Fractured neck and contusions S129 S109
9 II &X590
Code fractured neck followed by neck contusion relating the injury of unspecified site to the site of the injury that is reported on the same line. Since there is no external cause reported, code Fracture (circumstances unknown or unspecified) as indexed in Part II.
Place I (a) Fracture of hip S720
9 (b) Crushing injury S770
II &X599
Code crushing injury hip since there is only one site reported either on the line above or below the fracture. Since there is no external cause reported, code Crushed (accidentally) as indexed in Part II.
Place I (a) Fracture of skull with generalized trauma S029 T07
9 II &X590
Code the generalized trauma as indexed. Do not relate to the site of the injury reported on the same line with it. Since there is no external cause reported, code Fracture (circumstances unknown or unspecified) as indexed in Part II.
Place I (a) Skull fracture S029
9 (b) Wound T141
II &X599
Code I(b) to Wound as indexed. Do not relate to the site of the fracture reported on the upper line. Since there is no external cause reported, code Wound (accidental) NEC, X599 as indexed in Part II.
E. Conditions qualified as traumatic
- Some conditions are indexed directly to a nontraumatic category but the Classification also provides a traumatic code. Consider these conditions to be traumatic and code as traumatic:
- When they are qualified as “traumatic”
- Or they are reported on the certificate with:
- Injury or trauma (any specified type or site)
- An external cause
- TheManner of Death is Accident, Homicide, Suicide, Pending Investigation or Undetermined
Exception:
Do not apply this instruction if:
- the condition is reported due to a nontraumatic condition
- W78-W80 is the only external cause reported
- poisoning is reported
Place I (a) Pneumothorax S270
6 (b) Fracture rib S223
II &X590
Place of injury- Factory |
Since pneumothorax is reported on the certificate with an injury, code pneumothorax as traumatic.
Place I (a) Cerebral hemorrhage S062
9 (b)
(c)
MOD II &X599
A
Accident |
Consider cerebral hemorrhage to be traumatic since Accident is reported in the Manner of Death box.
I (a) Cardiorespiratory failure R092
(b) Intracerebral hemorrhage I619
(c) Meningioma D329
MOD II
A
Accident |
Since intracerebral hemorrhage is reported due to a disease condition, code as nontraumatic. Do not enter an E-code for Accident reported in the check box since no condition is coded to Chapter XIX.
Place I (a) Subarachnoid hemorrhage S066
9 (b) Fall &W19
MOD II
N
Natural |
Code subarachnoid hemorrhage as traumatic since it is reported on the certificate with an external cause, disregarding Natural in the Manner of Death box.
Exceptions:
- Code emphysema, encephalitis, and meningitis to the nature of injury code only when they are stated to be “traumatic” or are reporteddue to or on the same line with an injury or external cause.
Place I (a) Emphysema T797
9 (b) Injury chest S299
(c) Fall &W19
Code I(a) emphysema, traumatic since the condition is reported due to an injury.
Place I (a) Internal injury T148
9 (b) Fall from ladder &W11
II Meningitis G039
Do not code the meningitis as traumatic since it is not reported due to or on the same line with an injury or external cause. Code place of occurrence as 9 (unspecified).
- Code the following terms to the traumatic categoryonly when stated “traumatic:”
blindness (H540-H549)
epilepsy (G400-G409)
gastrointestinal hemorrhage (any K922)
pneumonia (classifiable to J120-J168, J180-J189, J690, J698)
Place I (a) Pneumonia J189
9 (b) Fracture hip S720
II Fall &W19
Code I(a) pneumonia as indexed since it is not reported as traumatic.
I (a) Traumatic epilepsy T905
(b) Head injury T909
(c) Fall from ladder &Y86
Code epilepsy to the nature of injury code since it is stated traumatic.
- When the traumatic form of a condition is classified to Chapters I-XVIII, code as traumaticonly when stated to be “traumatic”
Place I (a) Cardiac arrest I469
9 (b) Organic brain syndrome F069
(c) Brain injury S069
(d) Fall &W19
Code organic brain syndrome as indexed since it is not stated “traumatic.”
- When a condition of a specified site is stated to be traumatic but there is no provision in the Classification for coding the condition as traumatic, code to injury unqualified of the site.
Place I (a) Traumatic cerebral thrombosis S069
9 (b) Fall &W19
Code Injury, cerebral.
- When a condition that does not indicate a specified site is stated to be traumatic, but there is no provision in the Classification for coding the condition as traumatic code trauma unspecified and the condition separately.
Place I (a) Traumatic coma T149 R402
9 (b) Fall &W19
Code trauma unspecified and coma separately.
- Traumatic hemorrhage (T148, T149)
Internal 1 Due to or on same line Code the hemorrhage to T148,
hemorrhage with injury (any site) internal injury NOS
NOS
Hemorrhage 2 Due to injury of a Relate the hemorrhage to the
NOS specified site site of the specified injury
3 Due to injury NOS or Code the hemorrhage to T149,
multiple injuries NOS injury NOS
4 Due to injury of multiple Relate the hemorrhage to site
specified sites of the first mentioned specified
injury
5 Due to internal injury Code the hemorrhage to T148,
NOS or internal injuries internal injury NOS
NOS
6 On same line with Relate the hemorrhage to the
injury of site site of the specified injury
7 On same line with Code the hemorrhage to T149,
injury of multiple injury NOS
specified sites
8 On same line with Code the hemorrhage to T148,
internal injury NOS or internal injury NOS
internal injuries NOS
9 Due to and on same Relate the hemorrhage to the
line with injuries of site of the injury that is entered
different specified sites on the same line with
hemorrhage
Instruction
Number
Place I (a) Internal hemorrhage T148 1
9 (b) Crushed thorax S280
(c)
II &X599
Place I (a) Hemorrhage S799 2
9 (b) Fracture of femur S729
(c)
II &X590
Place I (a) Hemorrhage S299 2
9 (b) Laceration of chest S219
(c)
II &X599
Place I (a) Hemorrhage T149
9 (b) Multiple injuries T07 3
(c)
II &X599
Place I (a) Hemorrhage S299
9 (b) Injury of chest, lung and S299 S273 S223 4
(c) fractured rib
II &X599
Place I (a) Contusion chest with S202 S299
9 (b) hemorrhage 6
(c)
II &X599
Place I (a) Laceration of liver, lung, S361 S273 S360 T149
9 (b) & spleen with hemorrhage 7
(c)
II Fracture rt. femur S729 &X599
Place I (a) Cerebral contusion S062
9 (b) with hemorrhage 9
(c) Injury of chest, lung, back S299 S273 S399
II &X599
F. Assumption of nature of injury code
When an external cause is reported on a certificate without a nature of injury code, assign both a nature of injury and an external cause code. Assume the nature of injury to be Injury NOS, T149 and place it preceding the external cause code.
Place I (a) Respiratory failure J969
9 (b) Fire T149 &X09
I(b) is an external cause code only. Since there is not a nature of injury reported on the certificate, code nature of injury T149 preceding the external code for fire.
Place I (a) Subarachnoid hemorrhage I609
9 (b) Stroke I64
(c) Fall T149 &W19
Do not code the hemorrhage on I(a) as traumatic since it is reported due to a nontraumatic condition. I(c) is an external cause code only and there is not a nature of injury reported on the certificate. Code nature of injury T149 preceding the external code for fall.
Place I (a) Struck by falling tree &W20
9 II Head wound S019
I(a) is an external cause code only. Since there is a nature of injury on the certificate, do not code T149 preceding the external code.
Place I (a) Struck by falling tree T149 &W20
9 II Respiratory failure J969
I(a) is an external cause code only. Since there is not a nature of injury on the certificate, code T149 preceding the external code.
Exceptions:
- When conditions classified to categories A000-R99 are reported due to “second hand smoke”, code the “second hand smoke” to X49.
I (a) Pulmonary emphysema J439
(b) Second hand smoke X49
I (a) Lung cancer C349
(b) Second hand smoke X49
I (a) Cardiac arrest I469
(b) Second hand smoke X49
- Anthrax is reported with accident, suicide, homicide or undetermined
When anthrax (A220-A229) is reported with accident, suicide or homicide anywhere on the record (including in the check box) or undetermined in the check box only, code the anthrax as indexed and code the external cause code as:
- Accident specified (X58)
- Suicide specified (X83)
- Homicide specified (Y08)
- Undetermined specified (Y33)
Anthrax designated as an act of terrorism is classified to U016.
MOD I (a) Inhalation anthrax A221
H II Y08
Homicide |
Code I(a) as indexed under Anthrax, inhalation. Code an E-code only in Part II for homicide based upon the check box entry. Also enter a H for Homicide in the Manner of Death item.
I (a) Anthrax A229
(b) Homicide Y08
Code I(a) as indexed. Code an E-code only on I(b); do not assume an injury code.
- When conditions in J680-J709 are reported due to an external cause not considered to be medical or surgical care, refer to Section V, Part O,Guides for differentiating between effects of external causes classifiable to Chapters I-XVIII and Chapter XIX.
- If a pathological fracture and an external event are reported, no assumption of a nature of injury code is required.
G. Multiple injuries (T00-T07 )
When injury (of a site) or specified type of injury (of a site) is:
Stated as Code as indexed under
Bilateral Injury (or specified type of injury), site,
bilateral
Both Injury (or specified type of injury), site,
both
Multiple Injury (or specified type of injury), site,
multiple
Do not consider the plural form of injury or the plural form of a site to indicate multiple. Do not consider “right and left” as bilateral or both.
Examples of injuries:
- Fracture of both hips T025
Fracture
– hip
– – both T025
- Fracture of hips S720
Fracture
– hip S720
- Multiple fractures of ribs S224
Fracture
– rib
– – multiple S224
- Fractures of ribs S223
Fracture
– rib S223
- Multiple wounds of lower limb T013
Wound
– limb
– – lower NEC
– – – multiple sites T013
- Multiple injuries Followed by specified Code T07 and the specified
type(s) of injuries injuries
- Multiple injuries Followed byspecified Code multiple injuries by
site(s) site(s) only
- Single site Reported on same lineCode the specified types of
with multiple types of injuries of the reported site
injuries
- More than one site Reported on same line Code the specified type of
with multiple types of injury immediately
injuries preceding the reported sites
to the sites code all other
injuries to the NOS code
- Place I (a) Multiple injuries with T07 S029 S062
9 (b) fracture skull and
(c) laceration brain
II &X599
- Place I (a) Multiple injuries – head, neck, chest S097 S197 S297
9
II &X599
- Place I (a) Fracture, laceration and contusion T12 T131 T130
9 (b) of leg
(c) Fall from roof &W13
- Place I (a) Contusions, lacerations, fracture of trunk T140 T141 T021 T142
9 (b) and extremities
II &X599
H. Burns: multiple degrees of burns/percentage of body surface burned
- When multiple degrees of burns are reported, with or without mention of sites, code the most severe degree only.
Place I (a) 2nd and 3rd degree burns T203 T213
0 (b) of face, chest wall and abdomen
(c)
MOD II &X00
A
Accident |
|
home |
|
house fire |
Code 3rd degree burns of each site reported.
Place I (a) 2nd and 3rd degree burns T303
9 (b)
(c)
II &X09
Code 3rd degree burns of unspecified body region.
- When a percentage of burns or a percentage of body (entire, total) burns is reported, code to the percentage.
Place I (a) Burns of 50% of T315
9 (b) body surface
(c)
MOD II &X06
A
Accident |
|
clothing caught on fire |
Code burns involving 50-59% of body surface.
- When specified degrees of burns are reported with the percentage of body surface involved, code only the percentage of body surface involved.
Place I (a) 30-40%, 2nd and 3rd degree burns of body T314
0 (b)
(c)
II House fire &X00
Code burns involving 40-49% of body surface.
When a percentage of burns of specified sites is reported, code to burn of site(s) involved.
Place I (a) Burns, 76% of face, anterior trunk, and T200 T210 T300
8 (b) extremities
(c)
MOD II &X00 T300
A
Accident |
|
burned in fire in abandoned shack |
Code unspecified degree burns of each site reported. In Part II, code burned as burn of unspecified body region, unspecified degree.
I. Specified types and sites of injuries
- When specifiedtypes of injuries of sites are reported, code to site only. Do not use Index entries of “specified type NEC” or “specified NEC” (usually .8) .
Place I (a) Impact injury, upper arm S499 &X599
9
Indexed as:
Injury
– arm NEC T119
– – upper S499
– – – specified NEC S498
Place I (a) Blunt injury, trunk T099 &X599
9
Indexed as:
Injury
– trunk T099
– – specified type NEC T098
- When specifiedsites of injuries are reported, do not use Index entries of “specified type NEC” or “specified NEC”. Use only if indexed as “specified site NEC” or “specified part NEC.”
Place I (a) Fracture third cervical vertebra S129
9 (b) Fall &W19
Indexed as:
Fracture
– vertebra T08
– – cervical (teardrop) S129
– – – specified NEC S122
Place I (a) GSW right side of neck S118 &W34
9
Indexed as:
Wound
– neck S119
– – specified part NEC S118
J. Transportation accidents (V01-V99)
The main axis of classification for land transports (V01-V89) is the victim’s mode of transportation. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important for prevention purposes.
Definitions and examples relating to transport accidents are in Volume 1, Chapter XX. Refer to these definitions when any means of transportation (aircraft and spacecraft, watercraft, motor vehicle, railway, other road vehicle) is involved in causing death.
For classification purposes, a motor vehicle not otherwise specified is NOT equivalent to a car. Motor vehicle accidents where the type of vehicle is unspecified are classified to V87-V89.
A vehicle not otherwise specified is NOT equivalent to a motor vehicle unless the accident occurred on the street, highway, road(way), etc. Vehicle accidents where the type of vehicle is unspecified are classified to V87-V89.
Additional information about type of transports are given below
(1) Car (automobile) includes blazer, jeep, minivan, sport utility vehicle
(2) Pick-up truck or van includes ambulance, motor home, or truck (farm) (utility)
(3) Heavy transport vehicle includes armored car, dump truck, fire truck, panel truck, semi, tow truck, tractor trailer, 18-wheeler
(4) A special all-terrain vehicle (ATV) or motor vehicle designed primarily for off-road use includes dirt bike, dune buggy, four-wheeler, go cart, golf cart, race car, snowmobile, three-wheeler
(5) Motor vehicle includes passenger vehicle (private), street sweeper
1. Use of the Index and Tabular List
The Classification provides a Table of land transport accidents in Volume 3,
Section II. This table is referenced with any land transport accident if the mode of transport is known. Since the Index does not always provide a complete code, reference to Volume 1, Chapter XX is required.
For V01-V09, the fourth character indicates whether a pedestrian was injured in a nontraffic accident, traffic accident, or unspecified whether traffic or nontraffic accident.
For V10-V79, the fourth character represents the status of the victim, i.e., whether the decedent was driver, passenger, etc. For each means of transportation, there is a different set of fourth characters. Each means of transportation is preceded by its set of fourth characters in Volume 1.
- Car overturned, killing driver V485
In the Index refer to:
Overturning
– transport vehicle NEC (see also Accident, transport) V89.9
Accident
– transport (involving injury to) (see also Table of land transport accidents) V99
In the Table of land transport accidents, select the intersection of:
Under Victim and mode of transport, select
Occupant of:
– car (automobile)
Under In collision with or involved in: select
Noncollision transport accident
The code is V48.-. From Volume 1 the fourth character is 5, driver injured in traffic accident.
- Auto collision with animal V409
In the Index refer to:
Collision (accidental) NEC (see also Accident, transport) V89.9
Accident
– transport (involving injury to) (see also Table of land transport accidents) V99
In the Table of land transport accidents, select the intersection of:
Under Victim and mode of transport, select
Occupant of:
– car (automobile)
Under In collision with or involved in: select
Pedestrian or animal
The code is V40.-. From Volume 1, determine the fourth character is 9, unspecified car occupant injured in traffic accident.
2. Classifying accidents as traffic or nontraffic.
If an event is unspecified as to whether it is a traffic or nontraffic accident, it is assumed to be:
- A traffic accident when the event is classifiable to categories V02-V04, V10-V82 and V87.
- A nontraffic accident when the event is classifiable to categories V83-V86. These vehicles are designed primarily for off-road use.
- Consider category V05 to be unspecified whether traffic or nontraffic if no place is indicated or if the place is railroad (tracks).
- Consider category V05 to be traffic if place is railway crossing.
- Consider accidents involving occupants of motor vehicles as traffic when the place is indicated or if the place is railroad (tracks).
I (a) Laceration lung S273
(b)
(c) Accident &V575
MOD II
A
Accident |
|
Truck struck bridge |
|
Driver |
Code to occupant of pick-up truck or van injured in collision with fixed or stationary object, driver. When a motor vehicle strikes another vehicle or object, assume the collision occurred on the highway unless otherwise indicated.
I (a) Fractured skull S029
(b)
MOD II &V866
A
Accident |
|
Farm |
|
Dune buggy overturned-passenger |
Code to passenger of all-terrain or other off-road motor vehicle injured in nontraffic accident.
I (a) Drowning T751 &V863
MOD II
A
Accident |
|
Snowmobile ran off road and went into pond |
Code to unspecified occupant of all-terrain or other off road motor vehicle injured in traffic accident. Code as traffic accident since the accident originated on the road.
3. Status of victim
- General coding instructions relating to transport accidents are in Volume 1, Chapter XX. Refer to these instructions for clarification of the status of the victim when not clearly stated.
I (a) Multiple internal injuries T065
(b) Crushed by car T147 &V031
Code to pedestrian injured in collision with car, pick-up truck or van, traffic. Refer to Volume 1, Chapter XX, instruction 3, Crushed by car. The victim is classified as a pedestrian. Refer to Table of land transport accidents. Victim and mode of transport, pedestrian, in collision (with) car. Refer to Volume 1 for fourth character.
- In classifying motor vehicle traffic accidents, a victim of less than 14 years of age is assumed to be a passenger provided there is evidence the decedent was an occupant of the motor vehicle. A statement such as “thrown from car,” “fall from,” “struck head on dashboard,” “drowning,” or “carbon monoxide poisoning” is sufficient.
Female, 4 years old
I (a) Fractured skull S029
(b) Struck head on windshield when car &V476
(c) struck tree that had fallen across road
Code to car occupant injured in collision with fixed or stationary object, passenger (V476).
- When transport accident descriptions do not specify the victim as being a vehicle occupant and the victim is described as:
pedestrian versus (vs) any vehicle (car, truck,
versus (vs) etc.)
any vehicle (car, truck, versus (vs) pedestrian
etc.) versus (vs)
classify the victim as a pedestrian (V0l-V09).
4. Coding categories V01-V89
- When drowning occurs as a result of a motor vehicle accident NOS, code as noncollision transport accident. The assumption is the motor vehicle ran off the highway into a body of water. If drowning results from a specified type of motor vehicle accident, code the appropriate E-code for the specified type of motor vehicle accident.
I (a) Drowning T751 &V589
MOD II
A
Accident |
|
Street |
|
Truck accident |
Refer to Table of land transport accidents. Code to occupant of truck injured in noncollision transport accident, unspecified.
I (a) Drowning T751 &V435
MOD II
A
Accident |
|
Street |
|
Driver-2 car collision |
Refer to Table of land transport accidents. Code to occupant of car injured in collision with car, driver.
- When falls from transport vehicles occur, apply the following instructions:
(1) Consider a transport vehicle to be in motion unless there is clear indication the vehicle was not in transit. Refer to Table of land transport accidents, specified type of vehicle reported, noncollision. Refer to Volume 1 for appropriate fourth character.
I (a) Multiple injuries T07
MOD II &V583
A
Accident |
|
Home |
|
Fell from truck in driveway |
Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of pick-up truck, noncollision transport accident, (V58.-). Refer to Volume 1 for fourth character and select 3, unspecified occupant of pick-up truck, nontraffic accident.
(2) Consider statements like these as stationary:
(a) Coded as transports (most often with 4th character .4)
alighting leaving
boarding exiting
entering getting in or out of vehicle
(b) Coded as fall
stationary
parked
not in transit
not in motion
I (a) Head injury S099
MOD II &V784
A
Accident |
|
Street |
|
Fell alighting from bus |
Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of bus, noncollision transport accident, (V78.-). Refer to Volume 1 for fourth character and select 4, person injured while boarding or alighting.
I (a) Head injury S099
MOD II &V892
A
Accident |
|
Street |
|
Fell on curb as he was exiting his daughter’s vehicle |
Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of motor vehicle (traffic), noncollision transport accident (V892).
Place I (a) Head injury S099
4
MOD II &W17
A
Accident |
|
Street |
|
Fell from parked car |
Code as indexed under Fall, from, vehicle, stationary (W17).
5. Additional examples
I (a) Fractures of ribs S223
(b)
(c)
MOD II &V234
A
Accident |
|
Driver of motorcycle that collided with parked taxicab |
Code to motorcycle rider injured in collision with car, pick-up truck or van, driver (V234).
I (a) Third degree burns T303
(b) Auto accident – car overturned &V489
(c)
Code to car occupant injured in noncollision transport accident, unspecified (V489).
I (a) Fracture of ribs S223
(b)
(c)
MOD II &V892
A
Accident |
|
Street |
|
Vehicle Accident |
Code to person injured in unspecified motor vehicle accident, traffic (V892). Code as motor vehicle accident since the accident occurred on the street.
I (a) Blunt force trauma T149 &V230
(b) Motorcycle accident in a field
(c)
MOD II
A
Accident |
|
Driver of motorcycle vs parked cars |
Code to motorcycle rider injured in collision with car, pick-up truck or van, driver, nontraffic (V230).
6. Occupant of special all-terrain or other motor vehicle designed primarily for off-road use, injured in transport accident (V86)
This category includes accidents involving an occupant of any off-road vehicle. The fourth character indicates whether the decedent was injured in a nontraffic or traffic accident. Unless stated to the contrary, these accidents are assumed to be nontraffic.
I (a) Multiple injuries T07
(b) Driver of snowmobile that collided with auto &V860
Code to driver of all-terrain or other off-road motor vehicle injured in traffic accident since the collision occurred with an automobile.
I (a) Injuries of head S099
(b) Fracture both legs T025
(c) Driver of ATV &V865
Code to driver of all-terrain or other off-road motor vehicle injured in nontraffic accident.
I (a) Head injuries S099
(b) Overturning snowmobile &V869
Code to unspecified occupant of all-terrain or other off-road motor vehicle injured in nontraffic accident.
I (a) Fracture skull S029
(b) ATV accident &V869
Code to unspecified occupant of all-terrain or other off-road motor vehicle injured in nontraffic accident (V869)
7. Scooter (motorized) vs Motor scooter
It is often hard to distinguish between when a scooter should be considered a pedestrian conveyance or a motorcycle.
In most cases, a scooter or motorized scooter refers to a motorized chair for people with immobility issues, code as a pedestrian conveyance. In instances where there is a scooter accident and POI is Home (with no other details provided) code to X599. However, if POI is street (with no other details provided) code to V099.
A motor scooter is a small motorcycle type vehicle, code to motorcycle.
I (a) Cardiopulmonary arrest I469
(b) Severe head injury S099
(c)
MOD II &W18
A
Accident |
|
Home |
|
Victim fell off of scooter |
Code to fall, from, sitting height or position (W18). Code as pedestrian conveyance since scooter (motorized) is listed in Volume 1 under the definition (e) for pedestrian.
I (a) Multiple blunt force injuries T07 &V299
(b) Motor scooter incident
(c)
MOD II
A
Accident |
|
Highway |
|
Scooter incident |
Code to motorcycle rider (any) injured in unspecified traffic accident (V299). Code as a motorcycle since motor scooter is listed in Volume 1 under definition (k) for motorcycle.
I (a) Injuries sustained in auto – motorized scooter collision T149 &V031
(b)
(c)
MOD II Chronic obstructive lung disease and generalized arteriosclerosis J449 I709
A
Accident |
|
Street |
|
Collision between automobile and motorized scooter, driver |
Code to pedestrian injured in collision with car, pick-up truck or van (V031). Code as pedestrian conveyance since scooter (motorized) is listed in Volume 1 under the definition (e) for pedestrian.
I (a) Respiratory failure J969
(b) Pneumonia J189
(c) Brain injury S069
MOD II Scooter accident &V299
A
Accident |
|
Street |
|
Moped crash |
Code to motorcycle rider (any) injured in unspecified traffic accident (V299). Code as a motorcycle since moped is listed in Volume 1 under definition (k) for motorcycle.
PLACE I (a) Scooter accident T149 &X599
0 (b)
(c)
MOD II
A
|
Accident |
|
home |
Code to exposure to unspecified factor causing other and unspecified injury(X599). Code as pedestrian conveyance since scooter is listed in Volume 1 under definition (e) for pedestrian.
I (a) Scooter accident T149 &V099
(b)
(c)
MOD II
A
|
Accident |
|
street |
Code to pedestrian injured in unspecified transport accident(V099). Code as pedestrian conveyance since scooter(motorized) is listed in Volume 1 under the definition (e) for pedestrian.Scooter accidents occurring on the street are assigned to a transport category.
8. Traffic accident of specified type but victim’s mode of transport unknown (V87)
Nontraffic accident of specified type but victim’s mode of transport unknown (V88)
- If more than one type of vehicle is mentioned, do not make any assumptions as to which vehicle was occupied by the victim unless the vehicles are the same. Instead, code to the appropriate categories V87-V88. Statements such as these do not indicate status of victim:
- Auto (passenger) vs. truck • Passenger car vs. truck
- Car vs. truck, driver • Car vs. truck, driver
- Driver, car vs. truck • Driver-car vs. truck
I (a) Intrathoracic injury S279
(b)
(c) Auto vs. motor bike accident &V870
Do not make any assumption as to which vehicle the victim was occupying. Using the Index, code:
Accident
– transport (involving injury to) (see also Table of land transport accidents) V99
– – person NEC (unknown means of transportation) (in) V99
– – – collision (between)
– – – – car (with)
– – – – – two- or three-wheeled motor vehicle (traffic) V87.0
I (a) Multiple injuries T07
(b) Driver – collision of car and bus &V873
(c)
Do not make any assumption as to which vehicle the victim was driving. Using the Index, code:
Accident
– transport (involving injury to) (see also Table of land transport accidents) V99
– – person NEC (unknown means of transportation) (in) V99
– – – collision (between)
– – – – car (with)
– – – – – bus (traffic) V87.3
- If reported types of vehicles are not indexed under Accident, transport, person, collision, code V877 for traffic and V887 for nontraffic.
I (a) Multiple injuries T07
(b) Bus and pick-up truck collision, driver &V877
(c)
Do not make any assumption as to which vehicle the victim was driving. Collision between bus and pick-up is not indexed under Accident, transport, person, collision. Code V877.
9. Water transport accidents (V90-V94)
The fourth character subdivision indicates the type of watercraft. Refer to Volume 1, Chapter XX, Water transport accidents for a list of the fourth character subdivisions.
I (a) Drowning T751 &V929
(b) Fell over-board
MOD II
A
Accident |
Code drowning, due to fall overboard. Use fourth character “9,” unspecified watercraft.
10. Air and space transport accidents (V95-V97)
For air and space transport accidents, the victim is only classified as an occupant.
Military aircraft is coded to V958, Other aircraft accidents injuring occupant, since a military aircraft is not considered to be either a private aircraft or a commercial aircraft. Where death of military personnel is reported with no specification as to whether the airplane was a commercial or private craft, code V958.
11. Miscellaneous coding instructions (V01-V99)
- When multiple deaths occur from the same transportation accident, all the certifications should be examined, and when appropriate, the information obtained from one may be applied to all. There may be other information available such as newspaper articles. A query should be sent to the certifier if necessary to obtain the information.
- When classifying accidents which involve more than one kind of transport, use the following order of precedence:
aircraft and spacecraft (V95-V97)
watercraft (V90-V94)
other modes of transport (V01-V89, V98-V99)
I (a) Multiple fractures and internal injuries T029 T148
(b) Driver of car killed when a private plane &V973
(c) collided with car on highway after forced landing.
Code to person on ground injured in air transport accident following above order of precedence. Refer to Index under Accident, transport, aircraft, person, on ground.
- When no external cause information is reported and the place of occurrence of the injury was highway, street, road(way), or alley, assign the external cause code to person injured in unspecified motor vehicle accident occurring on the highway.
I (a) Head injuries and fracture S099 S029
MOD II &V892
A
Accident |
|
Highway |
Code to person injured in unspecified motor vehicle accident, traffic since the accident occurred on the highway.
- Homicide, suicide or undetermined in manner of death
(1) When “undetermined” is reported in the manner of death box with transport accidents, code the external cause as accidental unless a statement on the certificate clearly establishes an investigation has not determined whether accidental, homicidal, or suicidal.
I (a) Multiple head injuries S097
(b) Car ran off cliff &V489
MOD II
C
Undetermined |
Code I(a) as indexed. Code I(b) as unspecified car occupant injured in noncollision transport accident. Do not code to undetermined since there is no statement that clearly establishes an investigation resulted in an undetermined verdict.
Place I (a) Multiple head injuries S097
8 (b)Car ran off cliff &Y32
MOD II Police report indicates possible suicide or accident. Verdict
C pending.
Undetermined |
Code I(a) as indexed. Code I(b) as indexed under Crash, transport vehicle, motor NEC, undetermined since there is a statement, which clearly establishes an investigation of “undetermined intent,” is pending.
(2) When “homicide” is reported in the manner of death box with transport accidents, code the external cause as accidental unless a statement on the certificate clearly establishes an intentional act of homicide occurred. Words like deliberately, intentionally, purposefully or assault can be interpreted as intentional and coded as homicide.
Place I (a) Multiple traumatic injuries T07
8 (b) Decedent run over by vehicle &Y03
several times in parking lot
MOD II
H
Homicide |
Code I(a) as indexed. Code I(b) as indexed under Assault, crashing of motor vehicle. Homicide is coded since there was evidence the victim was repeatedly run over.
I (a) Multiple traumatic injuries T07
(b) Struck by car while walking on side of road &V031
MOD II
H
Homicide |
|
Hit and run – driver left scene of accident |
Code I(a) as indexed. Code pedestrian struck by car on I(b). Do not code as homicide since there is no statement of intentional homicide.
(3) When “suicide” is reported in the manner of death box with transport accidents, code the external cause qualified as suicide.
- Garbage /dump truck accidents
When accidents involving garbage/dump trucks are reported and information indicates the mechanism of the body or truck bed caused the injuries, assign the E-code based on reported information. Usually, the statement of events will be falling on, struck by, or caught in and external codes W20, W22, or W23 will be used.
Place I (a) Crushed chest S280
4 (b) Dump truck body fell on chest &W20
MOD II
A
Accident |
|
Street |
Code external cause to Struck (by), object, falling, W20.
Place I (a) Fracture skull S029
4 (b) Struck by dump truck body &W22
MOD II
A
Accident |
|
Street |
Code external cause to Struck (by), object, W22.
Place I (a) Crushed chest S280
4 (b) Caught in compactor of garbage &W23
truck
MOD II
A
Accident |
|
Street |
Code external cause to Caught, between, objects, W23.
- Use of asterisks to identify decedent’s vehicle
When certifiers report a named vehicle preceded by a string of asterisks, interpret as the decedent’s mode of transport.
I (a) Blunt force injuries T149 &V594
(b) Motor vehicle collision
MOD II
A
Accident |
|
Driver of vehicle involved in two-vehicle collision ***vehicle = pickup truck/cargo van |
Code I(a) as indexed. Code to occupant of pickup truck or van in collision with motor vehicle, driver.
K. Falls
1. Other fall on same level (W18)
Code W18 if other or additional information is reported about the fall such as:
Fell from standing height
Fell moving from wheelchair to bed
Fell striking head
Fell striking object
Fell to floor
Fell while transferring from chair to bed
Fell while walking
Lost balance and fell
Place I (a) Fracture right hip S720
0 II Lost balance and fell to floor &W18
MOD
A
Accident |
|
Home |
Code external cause to other fall on same level.
2. Unspecified fall (W19)
Code W19, unspecified fall, for terms such as:
Fall
Fell
Fell at a place
Place I (a) Fracture right hip S720
1 II Fell at nursing home &W19
MOD
A
Accident |
|
Nursing Home |
Code external cause to fall, unspecified.
3. Falls with other external events
When fall is reported more information must be obtained in order to assign the most appropriate code. This information will be reported in Part I and Part II of the medical certification, also the place of injury and the description of how injury occurred.
- Is a vehicle or transport involved?
YES: Refer to coding instructions for categories V01 – V89. This includes reference to table of land transport accidents. This section also includes specific instructions for fall from transport vehicle.
NOTE: fall from animal: see V80-
- Is a fire involved?
YES: Refer to coding instructions for categories X00 – X09. Review Threats to Breathing, Table 3, Fire.
- Is machinery in operation involved?
YES: See code categories W28 – W31.
- Is drowning or submersion in water involved?
YES: Refer to coding instructions for categories W65 – W74. Review Threats to Breathing, Table 1, Drowning and submersion, if applicable.
- Is struck by a falling object involved?
YES: See code categories W20 – W49
- Is a human stampede or pushed by a crowd involved?
YES: Code W52
If none of the above, see code categories W00 – W19 for specific codes.
L. Natural and environmental factors
1. Lightning
Code X33 only when the decedent is injured from direct contact with lightning.
Code injuries, such as stroke or shock, due to direct contact with lightning to T750.
Code burn(s) due to lightning to burn(s) (T200-T289, T300-T319).
Place I (a) Shock T750
9 (b) Struck by lightning T750 &X33
Place I (a) Burns T300
0 (b) House fire &X00
(c) House struck by lightning
When a secondary fire results from lightning, code to the fire. Do not enter a code for lightning.
2. Exposure, cold exposure and hypothermia
When exposure, cold exposure or hypothermia is reported anywhere on the record with another stated or implied external cause, code the nature of injury code (T68-T699, T758) and the E-code for the exposure, cold exposure or hypothermia (X599, X31). Do not modify the nature of injury code for exposure NOS. Ampersand the external cause code for the other event.
Place I (a) Exposure T758 X599
9 (b) Intoxication with hip fx T519 &X45 S720
II X590
Place I (a) Hypothermia with drowning T68 X31 T751 &W74
9 (b)
(c)
Place I (a) Exposure T758 X83
4 (b)
(c)
MOD II Multiple fractures T029 &X80
S
Suicide |
|
Jumped from bridge |
Place I (a) Exposure to cold T699 X31
9 (b)
(c)
II MVA &V892
Place I (a) Exposure and hypothermia T758 X31 T68
9 (b) Unconsciousness R402
(c)
MOD II Blunt trauma to head S099 &W18 T758
A
Accident |
|
Exposed to elements after falling and striking head |
Place I (a) Hypothermia T68 X31
9 (b)
(c)
II Alcohol intoxication T519 &X45
3. Storms and Wildfires
Categories X30-X39 include deaths from direct effects of forces of nature.
General Guidelines
– Use these categories for deaths resulting from direct effects of the storm.
– Do not use these categories for deaths resulting from a second event, such as clean-up after a cataclysmic event.
– When hurricane, storm, etc is reported, consider references to power failure, loss of power, lack of air conditioning, etc as part of the storm and not a subsequent accident.
– Code wildfire as X01, Exposure to uncontrolled fire, not in building or structure
Place I (a) Drowned T751 &X37
9 (b) Car which decedent was driving was washed
(c) away with bridge during hurricane
II
Code as victim of cataclysmic storm (X37). The drowning was a direct result of the hurricane.
Place I (a) Suffocation T71 &X36
9 (b) Covered by landslide
(c)
Code as victim of avalanche, landslide and other earth movements (X36).
I (a) Ruptured diaphragm S278
(b) Driver of auto which struck &V475
(c) landslide covering road
II
Code as car occupant injured in collision with fixed or stationary object, driver (V475).
Place I (a) Acute respiratory failure J960
9 (b) Severe emphysema T797
(c) Heat and loss of air conditioner power from hurricane &X37
Code as death from hurricane (X37). Consider statement of loss of air conditioner power as part of the storm. The external cause code for storm is assigned where first reported on the record.
I (a) Fracture vertebra T08
(b) Contusion spinal cord T093
(c) Light pole accident &W20
II Working to restore power from hurricane
|
Accident |
|
Light pole fell on him |
Code as struck by falling object (W20). This is clearly a subsequent accident and not a direct impact of the storm.
Place I (a) Smoke inhalation T598 &X01
9 (b)
MOD (c)
A II Wildfire
|
Accident |
|
Wildfire |
Code as wildfire (X01). Follow the Index as Exposure, fire, uncontrolled, not in building or structure.
Place I (a) Thermal injuries and smoke inhalation T300 &X01 T598
0 (b)
MOD (c)
A II Multiple sclerosis G35
|
Accident |
|
Home |
|
Unable to leave home – overcome by wildfire |
Code as wildfire (X01) since this house fire resulted from the wildfire. Follow the Index as Exposure, fire, uncontrolled, not in building or structure.
M. Firearms and firearm injuries
1. Coding specific types of firearms
The type of firearm involved in a death is identified at the three character level. Use the following guide to identify the type of firearm:
Intentional Undetermined
Type Firearm Accidental Self-harm Assault Intent
Handgun W32 X72 X93 Y22
25 Caliber
32 Caliber
38 Caliber
45 Caliber
357 Magnum
380 Caliber
Pistol
Revolver Saturday night
special
Rifle, shotgun, larger W33 X73 X94 Y23
firearm
25.06 (25 ought 6)
30.6 (30 ought 6)
30/30
308
AK47
M1 (carbine)
M14
M16
Machine gun
Rifle (army) (hunting)
(military)
Shotgun (8, 10, 12, 16, 20,
410 gauge,
buckshot)
Other and unspecified W34 X74 X95 Y24
firearms
9 mm
22 Caliber gun
30 Caliber gun
Airgun
BB gun
Pellet gun
Pellet pistol
Pellet rifle
Very pistol (Flare)
2. External cause code
a.
When reported as Code
“playing with gun” NOS or external cause as accidental (W32-
“cleaning gun” NOS W34)
“playing Russian external cause as handgun accident
roulette” (whether or not stated (W32)
suicide)
Place I (a) Gunshot wound of femur S711 &W34
9 (b) Cleaning gun T141
Code as accidental since reported due to cleaning gun.
Place I (a) Gunshot wound chest S219 &W32
9 (b)Self-inflicted while playing Russian roulette
MOD II
S
Suicide |
Code as handgun accident since Russian roulette is reported.
3. Nature of injury code
a.
When Is reported due to Code
Injury NOS any caliber the nature of injury to wound
bullet
gun went off
pulled trigger
specified firearm
Place I (a) Injury T141
9 (b) Rifle T141 &W33
b.
When reported as Code
Gunshot or bullet entering and/or exiting a site the nature of injury to wound of site(s)
Place I (a) Bullet entering chest & S219 &W34 S212
9 (b) exiting back
c.
When reported as Code
Bullet (to site) the nature of injury to wound (of site(s))
Gunshot (to site)
Shoot, shooting, shot (to site)
Shotgun blast (to site)
Place I (a) Shot in head S019 &W34
9
4. Other firearm examples
Place I (a) Gunshot wound chest S219 &Y24
9 (b) Self-inflicted
Code as undetermined gunshot since self-inflicted is reported and is unspecified as accidental or intentional.
Place I (a) Gunshot injury chest S219 &W34 S273
9 (b) and lung
Code the nature of injury to wound of sites and external code to accidental gunshot wound
N. Child abuse, battering and other maltreatment (Y070-Y079)
Code to Child battering and other maltreatment (Y070-Y079) if the age of the decedent is under 18 years and the cause of death meets one of the following criteria:
- The certifier specifies abuse, battering, beating, or other maltreatment, even if homicide is not specified.
Male, 3 years
I (a) Traumatic head injuries S099
(b)
(c)
MOD II &Y079
H
Homicide |
|
Home |
|
Deceased had been beaten |
- The certifier specifies homicide and injury or injuries with indication of more than one episode of injury, i.e., current injury coupled with old or healed injury consistent with a history of child abuse.
Male, 1-1/2 years
I (a) Anoxic encephalopathy G931
(b) Subdural hematoma S065
(c) Old and recent contusions of body T910 T090
MOD II &Y079
H
Homicide |
- The certifier specifies homicide and multiple injuries consistent with an assumption of battering or beating, if assault by a peer, intruder, or by someone unknown to the child cannot be reasonably inferred from the reported information.
Female, 1 year
I (a) Massive internal bleeding T148
(b) Multiple internal injuries T065
(c)
MOD II Injury occurred by child being struck T149 &Y079
H
Homicide |
Exception:
Deaths at ages under 18 years for which the cause of death certification specifies homicide and an injury occurring as an isolated episode, with no indication of previous mistreatment, should not be classified to Y070-Y079. This excludes from Y070-Y079 deaths due to injuries specified to be the result of events such as shooting, stabbing, hanging, fighting, or involvement in robbery or other crime, because it cannot be assumed such injuries were inflicted simply in the course of punishment or cruel treatment.
Female, 1 year
Place I (a) Hypovolemic shock T794
0 (b) Laceration of heart S268
(c) Multiple stab wounds thorax S217 &X99
MOD II Stabbed with kitchen knife by mother T141
H
Homicide |
|
Home |
O. Guides for differentiating between effects of external causes classifiable to Chapters I – XVIII and Chapter XIX
Categories in Chapters I-XVIII and XIX are mutually exclusive. Where provision has been made for coding effects of an external cause to Chapters I-XVIII, do not use a nature of injury code.
The effects of external causes classifiable to Chapters I-XVIII are primarily those associated with drugs, medicaments and biological substances, surgical procedures, and other medical procedures. Refer to Section V, Part R, Complications of medical and surgical care (Y40-Y84).
A limited number of conditions that can result from other external causes, e.g., certain localized effects of fumes, vapors and nonmedicinal chemical substances and respiratory conditions from aspiration of foreign substances are also classified to Chapters I-XVIII. It is intended that Chapters I-XVIII be used to identify the localized effects and the substance be identified by the external cause code in Chapter XX.
To determine if the conditions reported due to external causes, other than drugs, medicaments, and biological substances, surgical procedures, and other medical procedures, are classified to localized effects in Chapters I-XVIII or to the nature of injury in Chapter XIX – look up the stated condition in the Index and scan the listing under this condition for qualifying terms that relate to the reported external cause. For example, to determine whether pneumonia due to aspiration of vomitus should be coded to Chapter X or to Chapter XIX, look up “Pneumonia, aspiration, due to, food (regurgitated), milk, vomit.” This determination cannot be made by looking up “Aspiration.” Where there is provision in the Index for coding a condition due to an external cause to Chapter I-XVIII, take the external cause into account if it modifies the coding.
I (a) Pneumonia &J690
(b) Aspiration of vomitus W78
Code Pneumonia, aspiration, due to vomit. Code “aspiration of vomitus” as an external cause code only.
I (a) Pneumonia &J690
(b) Aspiration W80
(c) Cancer of lung C349
Code Pneumonia, aspiration. Code I(b) “aspiration” as an external cause code only.
I (a) Pneumonia &J690
(b) Asphyxia W80
(c) Aspiration
Code Pneumonia, aspiration. Code I(b) external cause code only.
I (a) Pneumonia &J680
(b) Smoke inhalation X00
II House fire
Code Pneumonia, in (due to), fumes and vapors (J680). Code I(b) external cause code only.
I (a) Acute pulmonary edema &J681
(b) Inhaled gasoline fumes X46
Code Edema, pulmonary, acute, due to, chemicals fumes or vapors (J681). Code I(b) external cause code only.
Place I (a) Pneumonia J189
9 (b) Cardiac arrest I469
(c) Aspiration of vomitus T179 &W78
Code each entity as indexed. Do not code the pneumonia on I(a) due to aspiration of vomitus since it is reported due to another condition.
Place I (a) MRSA Pneumonia J152
9 (b) Aspiration T179 &W80
Code each entity as indexed. Do not code the pneumonia on I(a) as due to aspiration since it is not together in the Index.
Place I (a) Viral Pneumonia J129
9 (b) Aspiration T179 &W80
Code each entity as indexed. Do not code the pneumonia on I(a) as due to aspiration since it is not together in the Index.
P. Threats to breathing
Certain effects of external causes can be classified to more than one nature of injury code depending on the type of external cause. Some of these effects are “anoxia,” “asphyxia,” “aspiration,” “choking,” “compression of neck,” “obstruction of a site,” “strangulation,” “stricture of neck,” and “suffocation.”
The most frequently reported external causes which result in these effects are “aspiration, ingestion, and inhalation of objects and substances,” “drowning,” “fires,” “fumes, gases and vapors,” “hanging,” “mechanical strangulation and suffocation,” and “submersion.”
The following pages contain tables that are used as guides in coding these types of external causes and effects.
In general, if the specific external cause is not in Tables 1-5, it will most likely be in Table 6, which contains the most frequently reported external causes which result in asphyxia, suffocation, etc. If not in any of the tables, code the effect as indexed.
Table Title
Table 1 Drowning and submersion
Table 2 *Hanging and mechanical
strangulation (by external means)
Table 3 Fires (includes burns, gases, fumes in
association with burns and fires)
Table 4 Ingestion, inhalation of gases, fumes,
vapors (without fires, burns)
Table 5 Compression chest, crushed chest by
external means
Table 6 Aspiration NOS, ingestion NOS,
inhalation NOS or aspiration, ingestion,
inhalation of substances or objects
(W78, W79, W80)
*NOTE: Interpret mechanical strangulation as strangulation caused by external means to the exterior of the body.
Table 1. Drowning and submersion
Instruction |
When |
Is reported due to
|
Code |
1
|
anoxia asphyxia strangulation suffocation |
drowning submersion |
upper line T751 and the appropriate external cause code. lower line T751 only. |
Examples – Corresponding Table and Instruction 1.1
Place I (a) Asphyxia T751 &W69
8 (b) Drowning T751
MOD (c)
A II T751
Accident |
|
Drowned while swimming in river |
I (a) Asphyxia T751 &V909
(b) Strangulation T751
MOD (c) Drowning T751
A II
Accident |
|
Lake |
|
Boat Overturned |
Place I (a) Anoxia T751 &W70
8 (b) Drowning T751
MOD (c)
A II
Accident |
|
Fell into Lake |
Instruction |
When |
Is reported on the same line with |
Code |
2 |
anoxia asphyxia strangulation suffocation |
drowning submersion |
T751 and the appropriate external cause code. |
Example – Corresponding Table and Instruction 1.2
Place I (a) Drowning – asphyxia T751 &W69
8 (b)
MOD (c)
A II
Accident |
|
Pond |
Table 2. Hanging and mechanical strangulation (by external means)
Instruction |
When |
Is reported due to |
Code |
1
|
asphyxia strangulation suffocation |
hanging mechanical strangulation (by external means) compression of neck |
upper line T71 and the appropriate external cause code. lower line T71 only. |
Examples – Corresponding Table and Instruction 2.1
Place I (a) Asphyxia T71 &X70
0 (b) Hanging T71
MOD (c)
S II
Suicide |
|
Home |
Place I (a) Aspiration of vomitus T179 W78
0 (b) Strangulation T71 &X70
MOD (c) Hanging T71
S II T71
Suicide |
|
Home |
|
Hanged Self |
I (a) Asphyxia T71 &V499
(b) Compression of neck T71
(c) Auto accident
II
Instruction |
When |
Is reported on the record with |
Code |
2
|
asphyxia strangulation suffocation |
hanging mechanical strangulation (by external means) compression of neck |
the asphyxia, strangulation, suffocation, T71 followed by the appropriate external cause code. T71 only where the hanging, mechanical strangulation, compression of neck is reported. |
Example – Corresponding Table and Instruction 2.2
Place I (a) Suffocation by hanging T71 &X70
9 (b)
MOD (c)
S II T71
Suicide |
|
Hanging by neck |
Male 1 month old
Place I (a) Suffocation T71 &W75
9 (b)
MOD (c)
A II
Accident |
|
Co-sleeping with adults |
Place I (a) Asphyxia T71 &W84
7 (b) Entrapment in grain bin
MOD (c)
A II
Accident |
|
Farm |
|
Fell into grain bin and became trapped under corn |
Instruction |
When |
Is reported due to |
Which is reported due to |
Code |
3
|
asphyxia strangulation suffocation |
asphyxia strangulation suffocation |
the external means of the mechanical strangulation (such as: ligature, rope around neck, sheet ) |
uppermost line to T71 and the appropriate external cause code. the next lower line to T71. lower line blank. |
Example – Corresponding Table and Instruction 2.3
Place I (a) Asphyxia T71 &W75
9 (b) Suffocation T71
(c) Crib sheet
II
Instruction |
When |
Is reported due to |
Code |
4
|
compression of neck stricture of neck |
hanging mechanical strangulation (by external means) suffocation |
upper line T71 only. lower line T71 and the appropriate external cause code. |
Example – Corresponding Table and Instruction 2.4
Place I (a) Compression of neck T71
9 (b) Hanging T71 &X91
MOD (c)
H II T71
Homicide |
|
Hanging |
Instruction |
When |
Is reported on the record with |
Code |
5
|
compression |
hanging |
compression of neck, stricture of neck to T71 only. T71 followed by the appropriate external cause code for the hanging, mechanical strangulation, suffocation. |
Example – Corresponding Table and Instruction 2.5
Place I (a) Compression of neck T71
9 (b)
MOD (c)
H II Strangulation by cord around neck T71 &X91
Homicide |
Table 3. Fires (includes burns, gases, fumes in association with burns and fires)
Instruction |
When |
Is reported due to |
Code |
|
1 |
asphyxia |
ingestion, |
of gas, fumes, or vapors |
the asphyxia, suffocation to the nature of injury code for the gas, fumes, vapor and the appropriate external cause code for the fire where required. lower line to the appropriate nature of injury code for the gas, fumes, vapor. |
with mention of a fire (specified) |
||||
Examples – Corresponding Table and Instruction 3.1
Place I (a) Suffocation T599 &X00
0 (b) Inhalation of products of combustion T599
MOD (c)
A II T599
Accident |
|
Inhaled fumes in house fire |
Place I (a) Suffocation T598 &X09
9 (b) Smoke inhalation T598
MOD (c) Fire
A II
Accident |
Instruction |
When |
Is reported on the record with |
Code |
|
2 |
asphyxia |
ingestion, |
of gas, fumes, or vapors |
the asphyxia, suffocation to the nature of injury code for the gas, fumes, vapor and the appropriate external cause code for the fire where required. the appropriate nature of injury code for the gas, fumes, vapor where reported. |
with mention of a fire (specified) |
||||
Example – Corresponding Table and Instruction 3.2
Place I (a) Asphyxia – carbon monoxide T58 &X00
0 (b)
MOD (c)
A II
Accident |
|
Home |
|
House Fire |
Instruction When Is reported due to Code
3 asphyxia burns NOS upper line T300 and the
suffocation (any degree) appropriate external cause code
(any percentage)
(any site) lower line as indexed.
Examples – Corresponding Table and Instruction 3.3
Place I (a) Asphyxia T300 &X04
0 (b) Burns of chest and face T210 T200
MOD (c)
A II
Accident |
|
Home |
|
Ignition of kerosene |
Place I (a) Suffocation T300 &X00
9 (b) 3° burns T303
MOD (c)
A II
Accident |
|
Burning Bldg. |
Instruction |
When
|
Is reported due to
|
Code |
4
|
asphyxia suffocation |
fire NOS specified fire |
upper line T300 and the appropriate external cause code. lower line blank. |
Instruction |
When |
Is reported on the record with |
Code
|
5 |
asphyxia suffocation |
fire NOS specified fire |
the asphyxia, suffocation T300, followed by the appropriate external cause code for the fire. |
Example – Corresponding Table and Instruction 3.5
Place I (a) Asphyxia, fire in house T300 &X00
0 (b)
(c)
II
Table 4. Ingestion, inhalation of gases, fumes, vapors (without fires, burns)
Instruction |
When |
Is reported due to |
Code |
|
1 |
asphyxia |
ingestion, |
of gas, |
upper line to the appropriate nature of injury code for the gas, fumes, or vapor and the appropriate external cause code. lower line to the appropriate nature of injury code for the gas, fumes, or vapor. |
|
||||
Example – Corresponding Table and Instruction 4.1
Place I (a) Asphyxia T58 &X67
0 (b) Inhalation of carbon monoxide T58
MOD (c)
S II T58
Suicide |
|
Home |
|
Inhaled car exhaust fumes in garage |
Place I (a) Asphyxiation T598 &X67
8 (b) Plastic bag over head with helium infusion T598
MOD (c)
S II T598
Suicide |
|
Lot |
|
Placed plastic bag over head. Tube from helium tank inserted under bag. |
Instruction |
When |
Is reported on the same line with |
Code |
|
2 |
asphyxia |
ingestion, |
of gas, |
the appropriate nature of injury code for the gas, fumes, or vapor and the appropriate external cause code. |
|
||||
Example – Corresponding Table and Instruction 4.2
Place I (a) Suffocation by inhalation of propane gas T598 &X47
0 (b)
MOD (c)
A II T598
Accident |
|
Home |
|
Inhaled propane gas |
Table 5. Compression chest, crushed chest by external means
Instruction |
When |
Is reported due to |
Code
|
1 |
asphyxia suffocation |
crushed chest |
upper line S280 plus the appropriate external cause code. lower line S280. |
Example – Corresponding Table and Instruction 5.1
I (a) Asphyxia S280 &V892
(b) Crushed chest S280
MOD (c) MVA
A II
Accident |
|
Street |
|
MVA |
Instruction |
When |
Is reported due to |
Code
|
2 |
asphyxia suffocation |
compression chest |
upper line S299 plus the appropriate external cause code. lower line S299. |
Example – Corresponding Table and Instruction 5.2
Place I (a) Suffocation S299 &W30
7 (b) Compression chest S299
MOD (c) Tractor accident
A II
Accident |
|
Farm |
|
Tractor overturned on victim |
Table 6. Aspiration NOS, ingestion NOS, inhalation NOS, or aspiration, ingestion, inhalation of substances or objects (W78, W79, W80)
EXCLUDES: Ingestion, inhalation of drugs and poisonous substances
Instruction |
When |
Is reported due to |
Code |
|
1 |
asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation |
aspiration NOS ingestion NOS inhalation NOS
or
|
upper line to T17 plus appropriate fourth character and the appropriate external cause code (W78, W79, W80). lower line to T17 with appropriate fourth character. |
|
aspiration ingestion inhalation |
of substances or objects |
|||
Examples – Corresponding Table and Instruction 6.1
Place I (a) Strangulation T179 &W79
9 (b) Aspiration of food T179
(c)
II
Place I (a) Asphyxia T179 &W78
9 (b) Aspiration T179
(c) Vomitus
II
Place I (a) Choked T179 W80
9 (b) Aspiration of blood T179
(c) Crushed chest S280
II Car vs. Pedestrian &V031
Instruction |
When |
Is reported due to |
Code |
2
|
asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation |
foreign body in a site (such as: blood, food, gum, medicine, mucus, vomitus) |
upper line to T17 plus appropriate fourth character and the appropriate external cause code (W78, W79, W80). lower line to T17 with appropriate fourth character. |
Example – Corresponding Table and Instruction 6.2
Place I (a) Obstruction of pharynx T172 &W79
9 (b) Bolus of meat in throat T172
(c)
II
Instruction |
When |
Is reported due to |
Code |
3 |
asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation |
foreign body NOS (such as: blood, food, gum, medicine, mucus, vomitus) |
upper line to T17 plus appropriate fourth character and the appropriate external cause code (W78, W79, W80). lower line blank. |
Examples – Corresponding Table and Instruction 6.3
Place I (a) Obstruction of trachea T174 &W79
9 (b) Bolus of meat
(c)
II
Place I (a) Asphyxia T179 &W78
9 (b) Aspiration T179
(c) Vomitus
II
Instruction |
When |
Is reported on the same line with |
Code |
|
4 |
asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation |
aspiration NOS ingestion NOS inhalation NOS or
|
on the same line, T17 with appropriate fourth character and the appropriate external cause code (W78, W79, W80). |
|
|
|
aspiration ingestion inhalation |
of substances or objects |
|
Example – Corresponding Table and Instruction 6.4
Place I (a) Asphyxia by aspiration of vomitus T179 &W78
9 (b)
(c)
II
Instruction |
When |
Is reported on the same line with |
Code |
5 |
asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation |
foreign body in a site (such as: blood, food, gum, medicine, mucus, vomitus)
|
on the same line, T17 with appropriate fourth character and the appropriate external cause code (W78, W79, W80). |
Example – Corresponding Table and Instruction 6.5
Place I (a) Choked by peanut obstructing trachea T174 &W79
9 (b)
(c)
II
Instruction |
When |
Is reported on the same line with |
Code |
6 |
asphyxia aspiration choking obstruction of a site occlusion of a site strangulation suffocation |
foreign body NOS (such as: blood, food, gum, medicine, mucus, vomitus)
|
on the same line, T17 with appropriate fourth character and the appropriate external cause code (W78, W79, W80). |
Examples – Corresponding Table and Instruction 6.6
Place I (a) Choked on chicken bone T179 &W79
9 (b)
(c)
II
Place I (a) Obstruction airway by bolus of food T179 &W79
9 (b)
(c)
II
Instruction |
When |
Is reported due to |
Code
|
7 |
aspiration NOS aspiration of substances strangulation NOS strangulation by substances |
a disease |
upper line T17 plus appropriate fourth character and the appropriate W78, W79, W80 if not previously coded. lower line as indexed. |
Example – Corresponding Table and Instruction 6.7
Place I (a) Aspiration T179 &W80
9 (b) C.V.A I64
(c)
II
Place I (a) Cerebro vascular accident I64
9 (b) Aspiration T179 &W80
MOD (c) Acute respiratory failure with hypoxemia J960 R090
C II
Could not be determined |
Instruction When Is reported due to Code
8 aspiration NOS vomiting upper line T179, W78.
lower line R11.
Example – Corresponding Table and Instruction 6.8
Place I (a) Aspiration T179 &W78
9 (b) Vomiting R11
(c)
II
Instruction |
When |
Is reported due to |
Code |
|
9 |
aspiration NOS or |
injuries (other than those classified to T17-) and/or an external cause (other than W78, W79, W80) |
upper line T17 plus appropriate fourth lower line as indexed. |
|
aspiration |
of substances or objects |
|||
Examples – Corresponding Table and Instruction 6.9
Place I (a) Aspiration of vomitus T179 W78
0 (b) Strangulation T71 &X70
MOD (c) Hanging T71
S II T71
Suicide |
|
Home |
|
Hanged Self |
Place I (a) Choked T179 W80
9 (b) Aspiration of blood T179
(c) Crushed chest S280
II Car vs. Pedestrian &V031
Place I (a) Aspiration T179 W80
9 (b) Drowning T751 &W74
MOD (c)
A II
Accident |
Place I (a) Pneumonia J189
9 (b) Cardiorespiratory arrest I469
MOD (c) Aspiration T179 &Y33
C II
Could not be determined |
Since none of the previous instructions apply, assign the e-code for aspiration to the undetermined category.
Q. Poisoning
When poisoning (any) is reported, code nature of injury code and external cause code for the substance.
When poisoning by fumes, gas, liquids, or solids is reported, refer to Index under “Poisoning (acute)” to determine the nature of injury code for the substance.
To determine the external cause code when a poisonous substance is ingested, inhaled, injected, or taken, refer to the description of such circumstances (acts) for example, Ingestion, Inhalation, or Took.
When a condition is reported due to poisoning and the Index provides a code for the condition qualified as “toxic,” use this code. If the Index does not provide a code for the condition qualified as “toxic,” code the condition as indexed.
1. Poisoning by substances other than drugs
Assume poisoning (self- inflicted) by a substance to be accidental unless otherwise indicated.
Place I (a) Aplastic anemia D612
9 (b) Benzene poisoning T521 &X46
Code I(a) Anemia, aplastic, toxic. Code I(b) to nature of injury and external cause code for benzene poisoning from Table of Drugs and Chemicals.
Place I (a) Toxic poisoning T659 &X46
9 (b) Drank turpentine T528
Code I(a), nature of injury code for poison NOS and the most specific external cause code (turpentine) taking into account the entire certificate. Code nature of injury for turpentine on I(b).
a. Carbon monoxide poisoning
Code carbon monoxide poisoning from motor vehicle exhaust gas to noncollision motor vehicle accident (traffic) according to type of motor vehicle involved unless there is indication the motor vehicle was not in transit. Consider statements of “sleeping in car,” “sitting in parked car,” “in parked car” or place stated as “garage” to indicate the motor vehicle was “not in transit.” Assume “not in transit” in self-harm (intentional) and self-inflicted cases.
I (a) Carbon monoxide poisoning T58 &V892
(b)
(c)
II Motor vehicle exhaust gas T58
Code I(a) nature of injury for carbon monoxide and most specific external cause. Code external cause to person injured in unspecified motor vehicle accident, traffic. Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of motor vehicle (traffic), noncollision transport accident. Code nature of injury for exhaust gas in Part II.
Place I (a) Poisoned by carbon monoxide T58 &X47
9 II Sitting in parked car
Code I(a) nature of injury and external cause for carbon monoxide from Table of drugs and chemicals. The external cause includes poisoning by gas, motor exhaust, not in transit.
Place I (a) Carbon monoxide inhalation T58 &X67
5 II Found in garage. Suicide.
Code I(a) nature of injury and external cause for carbon monoxide from Table of drugs and chemicals. The external cause includes intentional self-harm poisoning by gas, motor exhaust, not in transit.
b. Inhalation and sniffing sprays and aerosol substances
When inhalation of sprays, aerosol substances, etc. is reported, code to the appropriate accidental poisoning category for the external cause.
Exceptions:
“Glue sniffing” and “cocaine sniffing” and “huffing” are indexed to mental and behavioral disorders due to psychoactive substance use (F181, F142, F181).
Place I (a) Toxicity T659 &X46
0 (b) Inhalation of aerosol substance T659
(c)
MOD II Breathed “PAM” (freon) in plastic bag T535
A
Accident |
|
Home |
Code I(a) nature of injury code for toxicity as indexed. Code external cause to accidental inhalation of freon gas or spray (X46), the specific substance indicated by the certifier. Code nature of injury for aerosol on I(b) and freon in Part II.
c. Intoxication by certain substances or toxic poisoning due to disease
When ammonia intoxication (NH), carbon dioxide intoxication (C0), or toxic poisoning is reported due to a disease, do not code to poisoning. When due to a disease, code ammonia intoxication to R798, carbon dioxide intoxication to R068, and toxic poisoning to R688.
I (a) Ammonia intoxication R798
(b) Cirrhosis of liver K746
Code I(a) as indexed, Intoxication, ammonia, due to disease (R798).
I (a) Carbon dioxide intoxication R068
(b) Chronic pulmonary emphysema J439
Code I(a) as indexed, Intoxication, carbon dioxide, due to disease (R068).
I (a) Toxic poisoning R688
(b) Gastroenteritis A099
Code I(a) as indexed, Poisoning, toxic, from a disease (R688).
d. Condition qualified as “toxic” with poisoning reported
(1) When a condition is qualified as “toxic” and there is indication of poisoning on the certificate, code the external cause code for the poisoning where the “toxic” is reported, followed by the condition code. If the Classification provides a code for the condition qualified as “toxic,” use this code. If no provision is made for qualifying the condition as toxic, code to the unspecified code for the condition.
Place I (a) Toxic nephritis &X48 N144
9 II Organophosphate poisoning, T600
accidental
Code most specific external cause code on I(a) where toxic is reported followed by condition code for toxic nephritis as indexed. Code nature of injury for organophosphate in Part II.
Place I (a) Toxic GI hemorrhage &X49 K922
9 (b) Carbolic acid T540
Code most specific external cause code on I(a) where toxic is reported followed by condition code for GI hemorrhage as indexed. The Classification does not provide a code for GI hemorrhage qualified as toxic. Code nature of injury for carbolic acid on I(b).
Place I (a) Toxic diarrhea &X48 K521
9 II Rat poison T604
Code most specific external cause code on I(a) where toxic is reported followed by condition code for toxic diarrhea as indexed. Code nature of injury for rat poison in Part II.
(2) When a condition is qualified as “toxic” and there is no indication of poisoning on the certificate, code the condition as indexed to the unspecified code.
I (a) Toxic anemia D612
Code toxic anemia as indexed since there is no indication of poisoning on the certificate.
2. Poisoning by drugs
- When the following statements are reported, see Table of Drugs and Chemicals and code as accidental poisoning unless otherwise indicated.
Interpret all these statements to mean poisoning by drug and code as poisoning whether or not the drug was given in treatment:
Drug taken inadvertently
Lethal (amount) (dose) (quantity) of a drug
Overdose of drug
Poisoning by a drug
Toxic effects of a drug
Toxic reaction to a drug
Toxicity (of a site) by a drug
Wrong dose taken accidentally
Wrong drug given in error
Place I (a) Cardiac arrest I469
9 (b) Digitalis toxicity T460 &X44
(c) Congestive heart failure I500
Code digitalis toxicity to digitalis poisoning. Code nature of injury and external cause code for digitalis poisoning on I(b). Do not ampersand a disease condition when poisoning from a drug occurs while the drug is being administered for medical reasons.
Place I (a) Shock R578
9 (b) Insulin overdose T383 &X44
(c) Diabetes E149
Code I(a) shock, toxic since reported due to poisoning. Code insulin overdose to insulin poisoning. Code nature of injury and external cause code for insulin poisoning on I(b). Do not ampersand a disease condition when poisoning from a drug occurs while the drug is being administered for medical reasons.
- Interpret the terms
(1) “intoxication by drug” to mean poisoning by drug unless indicated or stated to be due to drug therapy or as a result of treatment for a condition (refer to Section V, Part R, 1, (6), “Intoxication by drug” due to drug therapy).
Place I (a) Respiratory failure J969
9 (b)Drug intoxication T509 &X44
II Ingested undetermined T509
amount of drugs
Code “drug intoxication” to poisoning when there is no indication the drug was given for therapy. Code I(b) nature of injury and external cause code for drug poisoning. Code nature of injury code for drug NOS in Part II.
(2) intentional with drug poisoning as Suicide. If the manner of death is reported as something other than Suicide, code as undetermined. If, however, the manner of death is marked Natural, Blank, or Pending Investigation code as Suicide.
Place I (a) Sudden cardiac arrest I469
9 (b) Intentional drug overdose T509 &X64
II Morbid obesity, obstructive sleep apnea, hypertension E668 G473 I10
Natural |
Code I(a) as indexed. Code the nature of injury and external cause code for drug nos as suicide on line I(b) since intentional is reported with drug poisoning and the manner of death box is marked Natural. Code Part II conditions as indexed.
- When poisoning by drug NOS is reported in Part I and a specified drug is reported in Part II, code the external cause code to the specified drug.
Place I (a) Took overdose of drug T509 &X41
9 II Overdose of barbiturates T423
Code “took overdose of drug” as accidental unless otherwise specified. Code I(a) nature of injury for drug NOS and external cause code to the specified drug reported in Part II. Code nature of injury for barbiturates in Part II.
- When a condition is qualified as “toxic” or “drug induced”and there is indication of drug poisoning on the certificate, code the external cause code for the drug poisoning where the “toxic” or “drug induced” is reported, followed by the condition code. If the Classification provides a code for the condition qualified as “toxic”, “due to drug” or “drug induced,” use this code. If no provision is made for qualifying the condition as “toxic”, “due to drug” or “drug induced,” whichever applies, code to the unspecified code for the condition. Code the nature of injury code for poisoning by the specified drug. NOTE: Depending on how the record is reported, the placement of the N & E may vary. See examples below.
Place I (a) Toxic hemolytic anemia &X41 D594
9 (b) Levodopa toxicity T428
Code most specific external cause on I(a) where toxic is reported followed by condition code for toxic hemolytic anemia as indexed. Code nature of injury for levodopa on I(b).
Place I (a) Drug induced hemolytic anemia &X41 D592
9 (b) Levodopa toxicity T428
Code most specific external cause on I(a) where drug induced is reported followed by condition code for Anemia, hemolytic due to, drugs as indexed. Code nature of injury for levodopa on I(b).
Place I (a) Drug induced hypotension &X44 I952
9 II Drug induced hypotension T509 I952
MOD
A
Accident |
|
Code external cause on I(a) where drug induced is reported followed by condition code for drug induced hypotension as indexed. Code nature of injury for drug NOS in Part II.
Place I (a) Drug induced hypotension T509 &X44 I952
9 II
MOD
A
Accident |
|
Code nature of injury and external cause on I(a) where drug induced is reported followed by condition code for drug induced hypotension as indexed. Since there are no other drugs reported, the nature of injury code is placed on line (a).
When a condition is qualified as “toxic” and there is no indication of drug poisoning on the certificate, code the condition as indexed.
When a condition is qualified as “drug induced” and there is no mention of drug poisoning on the certificate, code as a complication of drug therapy.
- Poisoning by combination of drugs (X40-X44)
(1) When poisoning by a combination of drugs is stated or indicated to be accidental, intentional self-harm (suicide), or undetermined code as follows:
(a) When poisoning by a combination of drugs classified to the same external cause code is reported, use that external cause code.
Place I (a) Doxepin and barbiturate overdose T430 &X41 T423
9
Code external cause code to X41 since both doxepin and barbiturates are indexed to this code. Code nature of injury for each drug reported.
Place I (a) Doxepin and prozac overdose T430 &X61 T432
9
MOD
S
Suicide |
Code external cause code to X61 since both doxepin and prozac are indexed to this code. Code nature of injury for each drug reported.
(b) When poisoning from a single drug is reported in Part I with a combination of drugs in Part II, code the external cause code for the drug reported in Part I. Code the nature of injury for each drug reported.
Place I (a) Acute barbiturate intoxication T423 &X41
9 II Took unknown amount of T423 T390
MOD barbiturates and aspirin
A
Accident |
Code external cause code to X41, accidental poisoning by barbiturates, the single drug reported in Part I. Code nature of injury for barbiturates on I(a) and for barbiturates and aspirin in Part II.
(c) When poisoning by a combination of drugs classified to different external cause codes is reported and (b) does not apply, use the following external cause codes when the manner of death is reported as:
Accident |
Code X44, Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. |
Intentional self-harm |
Code X64, Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. |
Undetermined |
Code Y14, Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent. |
NOTE: This does not apply to chemicals such as carbon monoxide and acetone.
Place I (a) Drug intoxication T509 &X44
9 (b) Digitalis, cocaine T460 T405
The external cause code for accidental poisoning by digitalis is X44 and for cocaine is X42. Since the drugs are assigned to different external cause codes, code X44, Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. Code nature of injury for each drug reported.
Place I (a) Drug toxicity T509 &X64
9 (b) Overdose of salicylates T390 T423
(c) and seconal
MOD II Overdose of drugs T509
S
Suicide |
The external cause code for intentional self-harm (suicide) by salicylates is X60 and for seconal, X61. Since the drugs are assigned to different external cause codes, code X64, Intentional self poisoning by and exposure to other and unspecified drugs, medicaments and biological substances. Code nature of injury for each drug reported.
Place I (a) Darvon and promazine T404 &Y14 T433
9 (b) intoxication
MOD II Drug intoxication T509
C
Undetermined |
The external cause code for poisoning of undetermined intent by darvon is Y12 and for promazine, Y11. Since the drugs are assigned to different external cause codes, code Y14, Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent. Code nature of injury for each drug reported.
3. Percentage of drug(s) in blood
When a percentage (%) of any drug(s) in the blood, code the nature of injury code for the drug if there is mention of drug poisoning elsewhere on the record.
When a complication is reported due to a percentage (%) of any drug(s), code as a complication of drug therapy unless otherwise indicated.
When a percentage (%) of any drug(s) in the blood without mention of drug poisoning or a complication, do not enter a code for the drug.
Place I (a) Gunshot wound brain S069 &X74
9 II .05 mg. barbiturates in blood
MOD
S
Suicide |
Since there is no mention of poisoning or a complication of the barbiturates, do not enter a code for the percentage of drug in the blood.
4. Poisoning by alcohol and drugs
When alcoholism or alcohol poisoning (any F10-, R780, R826, R893, T510-T519) is reported in Part I with drug poisoning in Part I, code the alcohol to the appropriate code (F10-, R780, R826, R893, T510-T519), the nature of injury code for the drug and code the appropriate external cause code for the drug preceded by an ampersand. If alcohol poisoning is reported, code the external cause code for alcohol also, but do not precede this code with an ampersand. Interpret the following statements to mean poisoning by alcohol and drugs and code the appropriate E-code for alcohol poisoning:
Alcohol and drug interaction
Alcohol and drug synergism
Combination of alcohol and drugs
Combined action alcohol and drugs
Combined effects of alcohol and drugs
Mixed effects of alcohol and drugs
Synergistic effects of alcohol and drugs
Place I (a) Combined effects of alcohol T519 X45 T509 &X44
9 (b) and drugs
MOD II Ingested alcohol and drugs F109 T509
A
Accident |
Interpret I(a) as alcohol poisoning and drug poisoning. Code the nature of injury and external cause for the alcohol and drugs. Precede the E-code for the drugs with an ampersand. In Part II, code the ingested alcohol as indexed. Code nature of injury for drugs as last entry.
Place I (a) Alcohol ingestion F109
9 (b) Barbiturate intoxication T423 &X41
Code I(a) alcohol ingestion as indexed and code the nature of injury and external cause for barbiturate intoxication on I(b).
Place I (a) Alcoholism F102
9 II Alcohol and barbiturate T519 X45 T423 &X41
MOD intoxication
A
Accident |
Code alcoholism as indexed in Part I. Code the nature of injury and external cause for the alcohol and barbiturate intoxication in Part II. Precede the E-code for the drug with an ampersand.
Place I (a) Barbiturate toxicity T423 &X61
9 II Barbiturate and T423 T519 X65
MOD alcohol intoxication
S
Suicide |
Code I(a) nature of injury for barbiturate T423 and external cause code X61 for suicidal barbiturate toxicity. Precede the E-code for barbiturate with an ampersand. Code the nature of injury and external cause for barbiturate and alcohol intoxication as indexed Part II.
Place I (a) Poisoning by alcohol T519 &X45
9 II Toxic levels of heroin and T401 X44 T424
flunitrazepam
Code I (a) nature of injury for alcohol, T519 and external cause X45. Precede the E-code for alcohol with an ampersand. Code the nature of injury and external cause for the heroin and flunitrazepam in Part II.
5. Intoxication (acute) NOS
When intoxication (acute) NOS is reported, code the nature of injury code for alcohol as indexed and the appropriate external cause for alcohol poisoning.
When intoxication (acute) NOS is reported “due to” drugs or poisonous substances, code the intoxication to the nature of injury code for the first substance reported in the “due to” position.
Exception:
Intoxication (acute) NOS “due to” drug(s) with indication the drug was being given for therapy.
Place I (a) Intoxication T519 &X45
9
Code intoxication as indexed to T519 and code the external cause code for alcohol poisoning X45. Precede the external cause code with an ampersand.
Place I (a) Acute intoxication T404
9 (b) Darvon & alcohol poisoning T404 &X62 T519 X65
MOD II
S
Suicide |
Code I(a) T404, the nature of injury code for darvon since this is the first substance reported in the “due to” position. Code I(b) to the nature of injury and external cause code for darvon poisoning and alcohol poisoning. Precede the external cause code for darvon poisoning with an ampersand. Do not ampersand external cause code for alcohol poisoning.
Place I (a) Intoxication T58
9 (b) Carbon monoxide inhalation T58 &X47
MOD II
A
Accident |
Code I(a) T58, the nature of injury for the substance (carbon monoxide) reported in “due to” position. Code I(b) to the nature of injury and external cause code for carbon monoxide inhalation. Precede the external cause code with an ampersand.
NOTE: See Appendix H for additional drug examples.
R. Complications of medical and surgical care (Y40-Y84)
Code any complication, abnormal reaction, misadventure to patient, or other adverse effect that occurred as a result of or during medical care except obstetrical procedures to the appropriate category in Chapters I-XIX, but take into account the medical care if it modifies the code assignment. Assign the appropriate external cause (E-code) pertaining to the medical care regardless of whether the complication is classified to Chapters I-XVIII or to Chapter XIX.
The E-code distinguishes between:
- Drugs, medicaments and biological substances causing adverse effects in therapeutic.
- Misadventures to patients during surgical and medical care (Y60-Y69).
- Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure (Y83-Y84).
Use of ampersand (More than one instruction may apply)
- Always precede the condition that necessitated the medical or surgical care with an ampersand the first time it is reported. Generally, the first condition on the lowest used line will be the reason for medical care.
I (a) Pneumonia J958
(b) Surgery Y839
(c) Pulmonary hemorrhage R048
(d) Lung cancer &C349
- Precede the external cause (Y40-Y84) with an ampersandif the complication is classified to Chapter XIX (T80-T88).
I (a) Pulmonary embolism T817
(b) Surgery &Y839
- Precede the first complication with an ampersandif the complication is classified to Chapter I-XVIII and the condition requiring medical or surgical care is NOT reported.
I (a) Renal failure &N19
(b) Drug therapy Y579
- If the medical or surgical care was administered for an injury, precede the code for the external cause of the injury with an ampersand.
I (a) Pneumonia J958
Place (b) Surgery Y839
9 (c) Fracture of hip S720
(d) Fall &W19
- If two or more conditions for which the medical or surgical care could be administered are reported and the reason for treatment cannot be determined, precede the first condition with an ampersand.
I (a) Pneumonia J958
(b) Surgery Y839
II Lung cancer, gastric ulcer &C349 K259
- If the medical care was administered for diagnostic purposes, precede the code for the condition that was found or confirmed by the diagnostic finding with an ampersand the first time it is reported.
I (a) Cerebral edema G978
(b) Cerebral arteriogram Y848
(c) Brain tumor &D432
1. Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59)
- Complications of drugs
Although almost any condition reported due to drug therapy is regarded as a complication, there are a few diseases that are not considered complications.
The drug therapy (Y40-Y59) is not coded when there is no evidence of a complication.
Interpret “due to drug therapy” as a condition(s) on an upper line with drug therapy as the first condition on the next lower line.
(1) The following are not regarded as complications of drug therapy.
(a) These conditions due to drug therapy:
Infectious and parasitic diseases A000-A309, A320-A329, A360-A399, A420-
A449, A481-A488, A500-A690, A692-B199,
B250-B349, B500-B942, B949
(EXCEPT: Antineoplastic drugs Y431-Y433;
Immunosuppressive agents Y434)
B200-B24
Neoplasms C000-D45, D47-D489
Diabetes E10-E14 (EXCEPT: Steroids Y425, Y427)
Hemophilia D66-D682
Alcoholic disorders E244, E52, F101-F109, G312, G405, G621,
G721, I426, K292, K700-K709, K852,
K860, L278, R780, R826, R893
Rheumatic fever or rheumatic heart I00-I099
disease
Arteriosclerosis and arteriosclerotic
conditions
Influenza J09-J118
Hernia K400-K469
Congenital malformations Q000-Q999
This is not an all inclusive list.
I (a) Lung cancer C349
(b) Drug therapy
Since lung cancer is not considered a complication of drug therapy, no code is assigned for I(b).
I (a) Pancytopenia D619
(b) Lung cancer chemotherapy C349
Do not code the chemotherapy since there is no reported complication. Lung cancer is the first condition on the next lower line.
(b) Any condition stated as congenital, familial, hereditary, idiopathic or conditions with a duration that predates the drug therapy.
I (a) Congenital cardiomyopathy I424
(b) Drug therapy
Do not code the drug therapy since conditions stated as congenital cannot be considered as complications.
I (a) Nephritis 6 months N059
(b) Drug therapy 2 months
Reject 1
Do not code the drug therapy on I(b). The nephritis cannot be considered as a complication since it occurred prior to the drug therapy.
(2) Code any condition classifiable to Chapters I-XVIII that could result from a drug, medicament, or biological substance (including anesthesia) known or presumed to have been properly administered to the appropriate category in these chapters.
If the Classification provides a code for the condition reported as “due to drug” or “drug induced,” use this code. If no provision is made for the condition reported as “due to drug” or “drug induced,” code to the unspecified code for the condition.
When a condition classifiable to Chapters I-XVIII is reported due to a drug reaction (named drug) NOS, e.g., insulin reaction, code the condition as indexed and code the drug reaction to the external cause code.
Classify only those complications that cannot be assigned to Chapters I-XVIII to Chapter XIX (T80.-, T88.-).
I (a) Respiratory and cardiac arrest &R092 I469
(b) Local anesthesia reaction Y483
Code the conditions reported on I(a) as complications of local anesthesia since the local anesthesia is presumed to have been properly administered. Precede the first complication with an ampersand. Since a complication is reported, assign only an external cause on I(b) indicating Adverse effect in therapeutic use.
I (a) Drug reaction T887 &Y400
(b) Penicillin
Code the drug reaction on I(a) to nature of injury and external cause since no specified complication is reported. Precede the E-code with an ampersand. Do not enter a code for penicillin on I(b) since it was coded on I(a).
I (a) Encephalitis &G040
(b) Measles vaccination Y590
Code the encephalitis as a complication of the measles vaccine since the measles vaccine is presumed to have been properly administered. Encephalitis is indexed following vaccination or other immunization procedure. Precede the complication (G040) with an ampersand. Code the measles vaccination to Y590, Adverse effect in therapeutic use.
I (a) Pulmonary embolism I269
(b) Estrogen to control excessive Y425 &N920
(c) menses
Code the pulmonary embolism as a complication of the estrogen since the estrogen is presumed to have been properly administered. Code the estrogen as Adverse effect in therapeutic use and excessive menses as indexed. Precede the code for excessive menses with an ampersand to indicate the condition requiring treatment.
(3) Unless there are indications to the contrary, assume the drug, medicament, or biological substance was used for medical care purposes and was properly administered in correct dosage. Do not make this assumption if:
- The drug was one which is not used for medical care purposes, e.g., LSD or heroin,
or
- It was an analgesic, sedative, narcotic or psychotropic drug (or combination thereof) or drug NOSAND the certifier indicated the death was due to an “accident” “suicide” or it occurred under “undetermined circumstances ,”
or
- One or more of these drugs was taken in conjunction with alcohol
Code to poisoning (refer to Section V, Part Q, 2, Poisoning by drugs).
Place I (a) Respiratory failure J969
9 (b) Ingestion of mixed sedatives T426 &X41
MOD
A
Accident |
Code I(a) as indexed. Code I(b) nature of injury and external cause code for accidental poisoning by mixed sedatives. Code as poisoning since the drug is a sedative and the certifier indicated the death was due to an accident. Precede the E-code with an ampersand.
Place I (a) Cerebral anoxia G931
9 (b) Ingestion of barbiturates T423 &X41
II Had been drinking F109
Code I(a) as indexed. Code I(b), accidental ingestion of barbiturates since the drug is a sedative and it was taken in conjunction with alcohol. Precede the E-code with an ampersand. Code Part II as indexed.
(4) When the condition for which the drug is usually administered is reported elsewhere on the certificate, code this condition as indexed, preceded by an ampersand to identify the condition requiring treatment.
I (a) Hemorrhage K922
(b) Ulcer of stomach K259
(c) Cortisone therapy Y420
II Scleroderma &M349
The ulcer of the stomach is the complication of the cortisone therapy. Code the E-code for cortisone on I(c). Since cortisone is used in treatment of scleroderma, precede this condition with an ampersand.
When a complication occurs as the result of a drug being given in treatment and the condition requiring the drug is not reported elsewhere on the certificate, do not assume a disease condition.
When a complication classifiable to Chapters I-XVIII occurs as the result of a drug being administered in therapeutic use and the condition requiring the treatment is not reported, place an ampersand preceding the code for the complication.
I (a) Renal failure &N19
(b) Ingested antidiabetic drug Y423
The renal failure on I(a) is the complication of the antidiabetic drug. Code the E-code for antidiabetic drug on I(b). Do not assume a disease condition requiring therapy even though antidiabetic drug is one used in the treatment of diabetes. Precede the complication with an ampersand.
(5) “Drug induced” complications
When a condition is stated to be “drug induced,” consider the condition to be a complication of drug therapy, unless otherwise indicated. Code as follows:
(a) If the complication is classified to Chapter I-XVIII, code the E-code for the drug, followed by the code for the complication.
I (a) Drug induced aplastic anemia Y579 D611
II Carcinoma of lung &C349
Code I(a) Y579, complication of an unspecified drug, and the “drug induced aplastic anemia” as indexed. Ampersand the carcinoma of lung as the condition requiring treatment.
I (a) Drug induced polyneuropathy Y579 &G620
Code I(a) Y579, complication of an unspecified drug, and the “drug induced polyneuropathy” as indexed. Place an ampersand preceding the code for the complication.
(b) If the complication is classified to Chapter XIX, code the nature of injury code for the complication followed by the E-code for the drug. Place an ampersand preceding the E-code.
I (a) Chloramphenicol induced reaction T887 &Y402
(b) Septicemia A419
Code I(a) as a complication of the drug (named). Code the nature of injury for the complication followed by the E-code for the named drug. Place an ampersand preceding the E-code and the septicemia to indicate the condition requiring treatment.
(6) “Intoxication by drug” due to drug therapy
When “intoxication by drug” is reported or indicated to be treatment for a condition or due to drug therapy, consider these to be complications of drug therapy, not poisoning.
I (a) Cardiac arrest I469
(b) Digitalis intoxication T887 &Y520
(c) ASHD &I251
Code the digitalis intoxication as drug therapy since it is indicated as treatment for a condition by its position on the record. Code the intoxication as indexed under Intoxication, drug, correct substance properly administered and the E-code for digitalis.
(7) Gastric Hemorrhage as a Complication of Steroids, NSAIDS, Aspirin
When gastric hemorrhage is reported as the first condition on the lowest used line in Part I, and aspirin, steroids or NSAIDS are reported elsewhere on the certificate, consider the gastric hemorrhage as a complication of drug therapy and code as indexed. Code the appropriate e-code for the drug to the adverse effect in therapeutic use (Y40-Y59). If reported, ampersand the condition for which the drug was administered.
(8) Combined effects of two or more drugs
When a complication is reported due to the combined effects of two or more drugs, code the complication as indexed. On the next lower line, code the appropriate E-code (Y400-Y599). To determine the appropriate E-code, refer to the column for “Adverse effect in therapeutic use” in the Table of drugs and chemicals. (refer to Section V, Part R, 1 (3) when coded as poisoning)
(a) When the drugs are classified to different fourth characters of the same three-character category, code the appropriate E-code with the fourth character for “other.”
I (a) Cardiac arrest I469
(b) Valium and sleeping pills Y478
(c) Anxiety &F419
Code I(b) to the appropriate E-code for the combined effects of two drugs in therapeutic use classified to the same three-character category.
(b) When the drugs are classified to different three-character categories, code the E-code to Y578, “Other drugs and medicaments.”
I (a) Congestive heart failure I500
(b) Cor pulmonale &I279
II Hemorrhage from anticoagulant R5800 Y578
and aspirin
Code Y578, the appropriate E-code for combined effect of two drugs in therapeutic use classified to different three-character categories.
(9) Complications of chemotherapy
(a) When a complication of chemotherapy is reported, code the complication as indexed and Y579 unless a malignancy is reported on the certificate. When the complication is classified to Chapters I-XVIII and the reason for the chemotherapy is not reported, precede the complication with an ampersand.
I (a) Aplastic anemia &D611
(b) Chemotherapy Y579
Code I(a), aplastic anemia due to drugs (D611) and code I(b) Y579, adverse effect of unspecified drug in correct usage. Precede the complication with an ampersand.
(b) When a complication of chemotherapy is reported with mention of a malignancy on the certificate, consider the chemotherapy to be antineoplastic drugs and code E-code Y433.
I (a) Purpura D692
(b) Chemotherapy Y433
(c) Leukemia &C959
Code I(a) as indexed. Consider the chemotherapy on I(b) as antineoplastic drugs and code Y433. Ampersand the leukemia as the condition requiring treatment.
(10) Complications of immunosuppression
Immunosuppression can be drug therapy or a complication of drug therapy. Code immunosuppression as drug therapy unless reported due to a drug, then code as a complication of the drug (D849). If the drug is not reported elsewhere on the certificate, code Y434 for the immunosuppressive drug.
I (a) Pneumonia and sepsis J189 A419
(b) Immunosuppression D849
(c) Chemotherapy for carcinoma of brain Y433
(d) &C719
Since the immunosuppression is due to chemotherapy, consider as a complication. Ampersand the carcinoma of brain as the condition requiring treatment.
I (a) Immunosuppression D849
(b) Vancomycin Y408
(c) Acute bacterial endocarditis &I330
Since the immunosuppression is due to a drug, consider as a complication. Ampersand the acute bacterial endocarditis as the condition requiring treatment.
I (a) Infection B99
(b) Immunosuppression for Y434
(c) Carcinoma of prostate &C61
Consider the infection as a complication of drug therapy (immunosuppression) on I(b). Ampersand the carcinoma of prostate as the condition requiring treatment.
I (a) Cardiorespiratory arrest I469
(b) Sepsis A419
(c) Immunosuppression for Y434
(d) Rheumatoid vasculitis &M052
Consider the sepsis as a complication of drug therapy (immunosuppression) on I(c). Ampersand the rheumatoid vasculitis as the condition requiring treatment.
I (a) Sepsis A419
(b) Immunosuppression Y427
(c) Renal transplant &N289
II Steroid therapy
Consider the sepsis as a complication of drug therapy (immunosuppression) on I(b). Code external cause code to steroids, the immunosuppressive drug reported elsewhere on the certificate. Code and ampersand Disease, kidney, as the condition for which the renal transplant was performed and the condition requiring the immunosuppressive drug.
I (a) Respiratory arrest R092
(b) Septicemia A419
(c) Immunosuppression Y434
II Renal transplant &N289
Consider the septicemia as a complication of drug therapy (immunosuppression) on I(c). In Part II, code and ampersand Disease, kidney, as the condition for which the renal transplant was performed and the condition requiring the immunosuppressive drug.
I (a) Bacteremia A499
(b) Immunosuppression Y434
(c)
II Idiopathic thrombocytopenia purpura &D693
Consider the bacteremia as a complication of drug therapy (immunosuppression) on I(b). Ampersand the idiopathic thrombocytopenia purpura as the condition requiring treatment.
I (a) Cardiac arrest I469
(b) ASHD I251
(c)
II DM, AS, immunosuppression E149 I709
Do not enter a code for the immunosuppression since there is not a reported complication.
(11) Drugs administered for one year or more
When a complication is reported due to a drug being administered for one year or more, consider the drug was given on a continuing basis. Code as a current complication; do not code as sequela.
I (a) Hypercorticosteronism E242
(b) Steroids – 6 years Y427
(c) Arthritis &M139
Consider the steroids as being administered on a continuing basis for six years. Code as a current complication of the drug. Code I(a) Hypercorticosteronism, correct substance properly administered (E242).
2. Surgical procedures as the cause of abnormal reaction of the patient or later complication (Y83)
a. Complications of surgical procedures
Although almost any condition reported due to surgery is regarded as a complication of surgery, there are a few diseases that are not considered complications. The surgical procedure (Y83) is not coded when there is no evidence of a surgical complication.
Interpret “due to surgery” as a condition(s) on an upper line with a surgical procedure as the first condition on the next lower line.
(1) The following are not regarded as complications of surgical procedures:
(a) These conditions reported due to surgery:
Infectious and parasitic diseases A000-A309, A320-A329, A360-A399,
A420-A449, A481-A488, A500-A690,
A692-B349, B500-B978
Neoplasms C000-D489
Hemophilia D66, D67, D680, D681, D682
Diabetes E10-E14
Alcoholic disorders E52, E244, F101-F109, G312, G405,
G621, G721, K860, I426, K292, K700-
K709, K852,L278, R780, R826, R893
Rheumatic fever or I00-I099
rheumatic heart disease
Hypertensive diseases I11-I139, I150, I159
Coronary artery disease
Coronary disease I251
Ischemic cardiomyopathy I255
Chronic or degenerative I514
myocarditis
Arteriosclerosis and
arteriosclerotic conditions except
those classified
to I219
Calculus or stones of any
type or site
Influenza J09-J118
Hernia except ventral K400-K429
(incisional) K440-K469
Diverticulitis K570-K579
Rheumatoid arthritis M050-M089
Collagen diseases M300-M359
Congenital malformations Q000-Q999
This is not an all inclusive list.
I (a) Myocardial infarction I219
(b) Arteriosclerosis I709
(c) Surgery
Since arteriosclerosis is not accepted as a complication of surgery, do not code the surgery.
I (a) Diabetic gangrene E145
(b) Leg amputation
Do not code the leg amputation (surgery) since there is no indication of a surgical complication.
I (a) Pneumonia J189
(b) Brain tumor removal D432
Do not code the removal since there is no complication. Brain tumor is the first condition on the next lower line.
(b) Do not accept conditions with a duration which predates the surgery
I (a) MI 2 weeks I219
(b) Surgery 2 days
Reject 1
Do not code the surgery on I(b). Since the MI occurred before the surgery was performed it cannot be a complication.
(2) When a condition reported due to a named surgical (operative) procedure can be considered as a complication or abnormal reaction, code as follows:
STEP 1: Determine if the complication is in the Index qualified by the named surgery reported
I (a) Lymphedema I972
(b) Postmastectomy Y836
(c) Breast cancer &C509
Code I(a) using Step 1
Lymphedema
– postmastectomy I97.2
I (a) Hemorrhage T828
(b) Coronary artery bypass graft &Y832
(c) Coronary heart disease &I259
Code I(a) using Step 1
Hemorrhage
– due to or associated with
– – device, implant or graft
– – – heart NEC T82.8
“Coronary” is not indexed, but is located in the heart; therefore, heart can be used in place of coronary.
NOTE: Before continuing to STEP 2 (below), it is important to determine the nature of the named surgery.
I (a) Hemorrhage T828
(b) Cardiac revascularization &Y832
(c) Cardiovascular disease &I516
Revascularization is defined as the re-establishment of adequate blood supply to a part, by means of a vascular graft. Code I(a) as indexed:
Hemorrhage
– due to or associated with
– – device, implant or graft
– – – heart NEC T82.8
STEP 2: If the Index does not qualify the complication with the named surgery, determine if the complication is indexed under Complications (from) (of), surgical procedure.
I (a) Hemorrhage T810
(b) Postlaminectomy &Y836
(c) Intervertebral disc degeneration &M513
The Index does not qualify hemorrhage as postlaminectomy. Code I(a) as indexed:
Complications (from) (of)
– surgical procedure
– – hemorrhage or hematoma (any site) T81.0
Code I(b), as indexed under Complication, laminectomy.
I (a) Intestinal obstruction K913
(b) Colostomy Y833
(c) Ulcerative colitis &K519
Code I(a) as indexed
Complications (from) (of)
– surgical procedure
– – intestinal obstruction K91.3
Code I(b), surgery, as indexed under Complications, colostomy. Code I(c), ulcerative colitis, as indexed and precede with an ampersand indicating the reason for the surgery.
STEP 3: If the Index does not qualify the complication with the named surgery nor is the complication indexed under Complications (from) (of), surgical procedures, determine if the named surgery is indexed under Complications (from) (of).
I (a) Stroke T828
(b) Coronary artery bypass &Y832
(c) Arteriosclerotic heart disease &I251
The Index does not qualify stroke with coronary artery bypass nor is stroke indexed under Complications, surgical procedures; therefore, code I(a) using Step 3:
Complications (from) (of)
– coronary artery (bypass) graft
– – specified NEC T82.8
Stroke is neither an infection nor an inflammation nor mechanical; therefore, select “specified NEC.”
I (a) MI T828
(b) Postfemoral bypass graft &Y832
(c) Peripheral vascular disease &I739
Code I(a) as indexed
Complications (from) (of)
– graft
– – femoral artery (bypass) – See Complications, graft, arterial
Complications (from) (of)
– graft
– – arterial
– – – specified NEC T82.8
Code I(b), Y832, as indexed under Complication, graft. Precede the E-code (Y832) by an ampersand.
I (a) Cerebral embolism T858
(b) Bypass &Y832
Code I(a) as indexed
Complications (from) (of)
– bypass (see also Complications, graft)
Complications (from) (of)
– graft
– – specified NEC T85.8
Code I(b), Y832, as indexed under Complications, bypass. Precede the E-code (Y832) by an ampersand.
I (a) Anemia T858
(b) Gastrointestinal bypass &Y832
(c) Diverticulitis &K579
Code I(a) as indexed
Complications (from) (of)
– bypass (see also Complications, graft)
Complications (from) (of)
– graft
– – intestinal tract
– – – specified NEC T85.8
Code I(b), Y832, as indexed under Complications, bypass. Precede the E-code (Y832) by an ampersand. Code I(c), Diverticulitis, K579, as indexed. Precede the code (K579) by an ampersand to indicate the reason for surgery.
(3) When a condition that is
(a) reported due to a named surgery cannot be assigned a code using STEP 1- STEP 3 or
(b) reported due to a surgery (operation) (of a site) NOS, and can be considered as a complication or abnormal reaction, code as follows:
STEP 4: Determine if the complication is in the Index, qualified:
(a) as reported
(b) with any term meaning “due to” surgery (see Section II, Part C, 2, a, “Due to” written in or implied)
(c) as surgical or as complicating surgery
(d) as postoperative or postsurgical
(e) as postprocedural
(f) during or resulting from a procedure, so stated
(g) resulting from a procedure, so stated
I (a) Pulmonary insufficiency following &J952
(b) Surgery Y839
Code I(a) as reported using Step 4 (a)
Insufficiency
– pulmonary
– – following
– – – surgery J952
Precede the code J952 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.
I (a) Hypothyroidism E890
(b) Thyroid surgery Y839
(c) Thyroid cancer &C73
Code I(a) using Step 4 (b). Refer to “due to” list in Section II, Part C, 2, a, “Due to” written in or implied.
Hypothyroidism
– due to
– – surgery E890
Thyroid surgery is equivalent to surgery NOS.
I (a) Cardiac insufficiency T818
(b) Surgery &Y839
Code I(a) using Step 4 (c)
Insufficiency
– cardiac
– – complicating surgery T818
Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code (Y839) by an ampersand.
I (a) Pneumonia &J958
(b) Surgery Y839
Code I(a) using Step 4 (d). Indexed as Pneumonia (see also Pneumonitis).
Pneumonitis
– postoperative J958
Precede the code J958 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.
I (a) Renal failure &N990
(b) Surgery Y839
Code I(a) using Step 4 (e)
Failure
– renal
– – postprocedural N99.0
Precede the code N990 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.
I (a) Cerebral anoxia &G978
(b) Surgery Y839
Code I(a) using Step 4 (f)
Anoxia
– cerebral
– – during or resulting from a procedure G97.8
Precede the code G978 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.
I (a) Anoxic brain damage &G978
(b) Surgery Y839
Code I(a) using Step 4 (g)
Damage
– brain
– – anoxic
– – – resulting from a procedure G97.8
Precede the code G978 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical procedure NEC.
STEP 5: If the Index does not provide for the complication qualified with any of the terms defined in the previous steps, determine if the complication is indexed under Complications (from)(of), surgical procedure.
NOTE: If a “named” surgery is reported, this step has already been completed in Step 2.
I (a) Hyperglycemia &E891
(b) Surgery Y839
Code I(a) as indexed
Complications (from) (of)
– surgical procedure
– – hyperglycemia E89.1
Precede the code E891 by an ampersand. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC.
NOTE: Do not apply Step 6 when assigning a complication code for conditions classified to R00-R99.
STEP 6: If the Index does not provide for the complication as above, determine if:
(a) the site of the complication is in the Index under Complications (from) (of), surgical procedure
or
(b) the system in which the complication occurred (based upon the code assigned in the Index) is in the Index under Complications (from)(of), surgical procedure.
I (a) MI T818
(b) Surgery &Y839
Code I(a) using Step 6 (a)
Complications (from)(of)
– surgical procedure
– – cardiac T81.8
The site of a myocardial infarction is the muscle tissue of the heart which is synonymous with cardiac. Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code with an ampersand.
I (a) Uremia &N998
(b) Surgery Y839
Code I(a) using Step 6 (b)
Complications (from) (of)
– surgical procedure
– – genitourinary
– – – specified NEC N99.8
Uremia NOS is indexed to N19 which indicates this condition is a specified disease in the genitourinary system.
I (a) Mesenteric embolism K918
(b) Gallbladder surgery Y839
(c) Gallstones &K802
Code I(a) using Step 6 (b)
Complications (from)(of)
– surgical procedure
– – digestive system
– – – specified NEC K91.8
Mesenteric embolism is indexed to K550 which indicates that this condition is a specified disease in the digestive system.
STEP 7: When a reported complication cannot be classified to a system which is indexed, code to T818, other complications of procedures, not elsewhere classified.
I (a) Anemia T818
(b) Surgery &Y839
Anemia is not indexed as due to surgery or as postoperative. Anemia is a disease of the blood-forming organs and neither the term nor the body system is indexed under Complication (from) (of), surgical procedure.
Code I(a) as indexed
Complications (from)(of)
– surgical procedure
– – specified NEC T81.8
Code I(b), surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code with an ampersand.
I (a) Cardiac arrest I469
(b) Brain death T818
(c) Surgery &Y839
Code line I(b) using Step 7. Brain death is not a codable condition but can be a complication of surgery.
Complications (from) (of)
– surgical procedure
– – specified NEC T818
Code I(c) surgery, Y839, as indexed under Complication, surgical operation NEC. Precede the E-code with an ampersand.
b. Condition necessitating surgery
(1) When a complication of surgery is reported and the underlying condition which necessitated the surgery is stated or implied, place an ampersand (&) preceding this condition to indicate the reason for surgery.
I (a) Pulmonary embolism T817
(b) Surgery for &Y839
(c) Gangrene of foot &R02
Code the pulmonary embolism as the complication, Y839 for the surgery, and precede the code for gangrene with an ampersand to identify the reason for surgery. Precede the surgery code with an ampersand since the complication is coded to Chapter XIX.
(2) When the condition necessitating the surgery is not stated or implied and the complication is classifiable to Chapters I-XVIII, place an ampersand preceding the code for the complication.
I (a) Renal failure &N990
(b) Surgery Y839
Code I(a), renal failure, N990, as the complication of the surgery (Y839) on I(b). Precede the N990 with an ampersand since it is classified to Chapter I-XVIII and the reason for the surgery is not reported.
(3) Do not ampersand a condition necessitating surgery unless a complication of the surgical procedure is coded.
I (a) ASHD I251
II SP mastectomy, Cancer of breast C509
Do not precede the reason for surgery, C509 with an ampersand since no complication of the mastectomy is reported.
(4) When the condition that necessitated the surgery is not reported, but the organ or site is implied by the operative term, code disease of the organ or site.
I (a) Septic complications of open heart surgery I519
Even though no complication is reported, the reason for treatment can still be assigned. Code Disease, heart since the surgery was of the heart.
Exception:
Appendectomy
Code appendicitis (K37) when appendectomy is the only operative procedure reported. If appendectomy is reported with other abdominal or pelvic surgery, assume the appendectomy to be incidental to the other surgery and do not code K37.
Use the following codes when these surgical procedures are reported and the condition necessitating the surgery is not reported:
Aorta (with any other vessel NEC) bypass or graft…………………… I779
Aorta coronary bypass or graft……………………………………………. I251
Atrio-ventricular shunt……………………………………………………… G919
Bariatric surgery……………………………………………………………… E668
Billroth (I or II)…………………………………………………………….. K3190
Brock valvulotomy………………………………………………………….. Q223
Cardiac revascularization…………………………………………………… I251
Carotid endarterectomy…………………………………………………….. I679
Choledochoduodenostomy…………………………………………………. K839
Cholecystectomy…………………………………………………………….. K829
Cholelithotomy……………………………………………………………….. K802
Colostomy…………………………………………………………………….. K639
Coronary artery bypass graft (CABG)……………………………………. I251
Coronary endarterectomy………………………………………………….. I251
Coronary revascularization…………………………………………………. I251
Endarterectomy (artery) (aorta)………………………………………….. I779
Femoral bypass………………………………………………………………. I779
Femoral-popliteal bypass…………………………………………………… I779
Gastrectomy………………………………………………………………… K3190
Gastric stapling……………………………………………………………….. E668
Gastroenterostomy………………………………………………………….. K929
Gastro-intestinal surgery NOS…………………………………………….. K929
Gastrojejunostomy………………………………………………………….. K929
Gastrojejunectomy………………………………………………………….. K929
Herniorrhaphy……………………………………………………….. code hernia
Hip fixation…………………………………………………………………….. S720
Hip pinning…………………………………………………………………….. S720
Hip prosthesis………………………………………………………………… M259
Hip replacement…………………………………………………………….. M259
Hysterectomy………………………………………………………………… N859
Ileal conduit…………………………………………………………………… N399
Ileal loop………………………………………………………………………. N399
Iliofemoral bypass……………………………………………………………. I779
Lobectomy-when indicating lung………………………………………… J9840
Mammary artery(internal) implant……………………………………….. I251
Nephrectomy…………………………………………………………………. N289
Revascularization of heart………………………………………………….. I251
Revascularization, myocardial…………………………………………….. I251
T and A…………………………………………………………………………. J359
Thoracoplasty…………………………………………………………………. J989
Tonsillectomy…………………………………………………………………. J359
Ureterosigmoid bypass…………………………………………………….. N399
Ureterosigmoidostomy……………………………………………………… N399
Vein stripping………………………………………………………………….. I839
Ventricular peritoneal shunt……………………………………………….. G919
Vineberg operation…………………………………………………………… I251
When the condition that necessitated the surgery is not reported, do not assume a disease condition for surgical procedures such as:
amputation pelvic exenteration
arteriovenous shunt portocaval shunt
chordotomy radical neck dissection
craniotomy rhizotomy
cystostomy sympathectomy
D & C tracheotomy
gastrostomy tracheostomy
laminectomy tubal ligation
laparotomy vagotomy
lobectomy NOS vasectomy
lobotomy vas ligation
If one of these types of procedures is the only entry on the certificate, code R99.
When the following complications of surgery are reported and the reason for the surgery is not reported, use the following codes as the reason the surgery was performed:
Reason for Surgery
Code
Postsurgical hypothyroidism E079
Postsurgical hypoinsulinemia K869
Postsurgical blind loop syndrome K639
Other and unspecified
postsurgical malabsorption K639
I (a) Postsurgical blind loop syndrome Y839 K912 &K639
When a complication is reported due to:
“Surgery” with the underlying condition that necessitated the surgery stated, code:
the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required, and the underlying condition necessitating the surgery preceded by an ampersand.
I (a) Hemorrhage T810
(b) Surgery &Y839
(c) Ca. of lung &C349
Code I(a) as postoperative hemorrhage (T810). Code the external cause code for the surgical procedure and precede by an ampersand. Code C349, cancer of lung and precede by an ampersand to identify the stated underlying condition for which surgery was performed.
I (a) Pulmonary hemorrhage R048
(b) Lung cancer &C349
II Pneumonia due to surgery for J958 Y839 R048
pulmonary hemorrhage
Code line I(a) and (b) as indexed. Precede cancer of lung with an ampersand to indicate the underlying reason for which surgery was performed. Since the first entry in Part II, pneumonia, is reported due to surgery, code as a complication of surgery.
“Surgery” with the condition which necessitated the surgery not stated and only one condition for which surgery could have been performed is reported, code:
the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required. Since only one condition for which the surgery could have been performed is reported, code the condition and precede with an ampersand to identify the reason for the surgery.
I (a) Mesenteric thrombosis K918
(b) Surgery Y839
II ASHD &I251
Code mesenteric thrombosis as the complication of the surgery and code Y839 for the surgery. Since ASHD is the only condition on the certificate for which surgery could have been performed, precede the code for this condition by an ampersand.
“Surgery” with the condition which necessitated the surgery not stated and two or more conditions for which surgery could have been performed are reported, code:
the complication to Chapters I-XIX and the surgery to appropriate external cause code (Y83-) preceded by an ampersand, if required. Ampersand the first mentioned condition for which the surgery could have been performed.
I (a) Wound dehiscence T813
(b) Surgery &Y839
II Cancer of lung, gastric ulcer &C349 K259
Code I(a), wound dehiscence, T813, as the complication of the surgery and code I(b), surgery, Y839. Code Part II as indexed and precede the code for cancer of lung by an ampersand since it is the first mentioned condition for which the surgery could have been performed.
“Surgery” without indication of the condition which necessitated the surgery, code:
the complication to Chapters I-XIX, and the surgery to appropriate external cause code (Y83-) only. If the complication is classifiable to Chapters I-XVIII, precede the code for the complication with an ampersand.
I (a) Shock & hemorrhage T811 T810
(b) Surgery &Y839
Code I(a), shock and hemorrhage, T811 T810, both as complications of the surgery. Code I(b), surgery, Y839 and precede the code by an ampersand.
Surgical procedure such as aneurysmectomy, cholelithotomy, hemorrhoidectomy or herniorrhaphy which indicates the condition for which the surgery was performed, code:
the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required, and code the condition implied by the surgery following the external cause code for the surgery. Place an ampersand preceding the code for the condition.
I (a) CHF I978
(b) Cholelithotomy Y838 &K802
Code I(a), CHF (congestive heart failure), as the complication of surgery. Code I(b), cholelithotomy, Y838 K802. Cholelithotomy indicates cholelithiasis (K802) was the condition for which surgery was performed. Precede K802 by an ampersand.
Surgical procedure that indicates an organ or site with one related condition for which the surgery could have been performed, code:
the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required. Code the condition for which surgery could have been performed and precede with an ampersand.
I (a) MI T818
(b) Gastrectomy &Y836
II Bleeding gastric ulcer &K254
Code I(a), MI, as the complication of the surgery. Code I(b), gastrectomy, Y836, as indexed and precede with an ampersand. Code Part II, bleeding gastric ulcer, as indexed and precede with an ampersand to indicate it was the condition for which surgery was performed.
I (a) Cardiac arrest T828
(b) CABG &Y832
II Heart disease &I519
Code I(a), cardiac arrest, as the complication of the surgery. Code I(b), CABG, Y832 as indexed and precede with an ampersand. Code Part II, heart disease, as indexed and precede with an ampersand to indicate it was the condition for which surgery was performed.
Surgical procedure that indicates an organ or site without a related condition for which the surgery could have been performed, code:
the complication to Chapters I-XIX, the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required, and code disease of the organ or site following the external cause code for the surgery. Place an ampersand preceding the code for the condition.
I (a) Cardiac arrest I469
(b) Pneumonia J958
(c) Pancreatectomy Y836 &K869
Code I(a), cardiac arrest, as indexed. Code I(b), pneumonia, as the complication of the surgery. Code I(c), pancreatectomy, as indexed, and since the surgery indicates a disease of the pancreas, code this as the reason for surgery. Precede K869 by an ampersand.
Prophylactic or nontherapeutic surgery, code
the complication to Chapters I-XIX, and the surgery to the appropriate external cause code (Y83-) preceded by an ampersand, if required. Do not assume or ampersand a disease condition. When the complication is classifiable to Chapters I-XVIII, precede the code for the complication with an ampersand.
I (a) Sepsis A419
(b) Infection T814
(c) Liposuction &Y838
II
Code I(a), sepsis, as indexed. Code I(b), infection, as the complication of the nontherapeutic surgery. Code I(c) as a specified type of surgical operation.
c. Conditions qualified as postoperative
(1) When the following postoperative terms or a synonymous term qualifies a condition, determination must be made as to whether the condition is a surgical complication or the condition for which the surgery was performed.
p.o postoperative status postop
post-named surgery status p.o. status postoperative
(postgastrectomy) status post-named surgery status post surgery
postop (status post gastrectomy)
(2) The following conditions are common complications of surgery. Code these conditions as postoperative complications when preceded by or followed by one of the postoperative terms except when it is stated elsewhere on the certificate as the reason the surgery was performed.
abscess hemorrhage, hematoma sepsis
adhesions infarction septicemia
aspiration infection septic shock
atelectasis occlusion shock
bowel obstruction peritonitis thrombophlebitis
cardiac arrest phlebitis, phlebothrombosis thrombosis
embolism pneumonia wound infection
fistula pneumothorax
gas gangrene renal failure (acute)
hemolysis,
hemolytic
infection
This list is not all inclusive.
(3) When “postoperative,” “postop,” “status postoperative,” etc., qualifies (preceding or following) a complication:
(a) If the complication is classified to Chapters I-XVIII, code the external cause code followed by the code for the complication.
I (a) Pneumonia postgastrectomy Y836 J958 &K3190
Code pneumonia as the complication of surgery when reported as “postoperative” or a synonymous term. Since the reason for surgery is not stated, code disease stomach and precede by an ampersand to indicate the reason for surgery.
I (a) Postgastrectomy dumping syndrome Y836 K911
(b)
(c) Carcinoma of stomach &C169
Code I(a), Y836, as indexed under Complication, gastrectomy, and K911, as indexed under Syndrome, dumping. Code I(c) C169, as indexed under Neoplasm, stomach, malignant. Place an ampersand (&) preceding C169 to identify the underlying reason for surgery.
I (a) Pulmonary edema J958
(b) P.O. bowel obstruction Y839 K566
(c) Ca. of cecum &C180
II Surgery for bowel obstruction K566
Code I(a), pulmonary edema, as the complication of surgery. Code I(b) to surgery Y839 and code bowel obstruction as indexed K566 since it is stated as the reason for surgery. Code I(c), cancer of cecum, as indexed and precede the code by an ampersand to indicate the underlying reason for surgery. Part II, do not enter a code for surgery since P.O. was reported on line (b) and a surgery code was entered there. Code bowel obstruction as indexed.
(b) If the complication is classified to Chapter XIX, code the nature of injury code followed by the external cause code.
I (a) Sepsis and anuria A419 R34
(b) P.O. peritonitis T814 &Y839
(c) P.O. ca. of colon c obstruction &C189 K566
Code peritonitis as the complication as indexed under Peritonitis, postprocedural, T814. Code Y839 for the procedure. Peritonitis is considered to be a complication of surgery when reported as “postop” and not reported as the reason for surgery. Place an ampersand preceding the surgery code and the cancer of colon to identify the underlying reason for surgery.
I (a) Cardiac arrest I469
(b) Peritonitis, postop T814 &Y839
(c) Cholelithiasis &K802
Code I(a) as indexed. Code I(b), peritonitis, as the complication, T814 and Y839 for the procedure. Peritonitis is considered a complication of surgery when reported as “status postop” and not reported as the reason for surgery. Precede the E-code with an ampersand. Code I(c), cholelithiasis, as indexed and precede the code by an ampersand to indicate the condition necessitating surgery.
I (a) MI postgastrectomy T818 &Y836
II Gastric ulcer surgery &K259
Code I(a), M.I. postgastrectomy, T818 Y836. M.I. is considered to be a complication of surgery when reported as “postoperative” and not reported as the reason for surgery. Precede the E-code with an ampersand. Code Part II, gastric ulcer, K259 as indexed and precede the code by an ampersand to indicate the condition necessitating surgery. Do not enter a code in Part II for surgery since gastrectomy was reported on I(a) and the code was entered there.
I (a) Postoperative embolism T817 &Y836
(b) Appendectomy
(c) Acute appendicitis &K358
Code I(a), postoperative embolism, as indexed to T817 and Y836 as indexed under Complication, appendectomy. Precede the E-code with an ampersand. Code I(c), acute appendicitis, as indexed and precede the code by an ampersand to identify the underlying condition that necessitated surgery.
I (a) Heart failure I509
(b) ASHD &I251
II Thrombophlebitis, postoperative T817 &Y839
Code I(a) and I(b) as indexed. Code Part II, thrombophlebitis, postoperative, T817 Y839. Precede the E-code (Y839) by an ampersand. Thrombophlebitis is considered to be a complication of surgery when reported as “postoperative” and not reported as the condition that necessitated surgery. Precede the code on I(b), I251 (ASHD), by an ampersand to indicate the underlying condition necessitating surgery.
I (a) Pneumonia J189
(b) P.O. infection (wound) T814 &Y839
(c) Intestinal obstruction &K566
Code I(a) as indexed. Code I(b), p.o. infection (wound), T814 Y839. Precede the E-code with an ampersand. Infection is considered to be a complication of surgery when reported as “postop” and not reported as the reason for surgery. Code I(c), intestinal obstruction, K566 and precede the code by an ampersand to indicate the condition necessitating surgery.
I (a) Postoperative complication T819 &Y839
(b) Open heart surgery
(c) Heart disease &I519
Code I(a) as indexed under Complications, postoperative. Code the external cause code where the surgery is first reported, in the second position on I(a). Precede the E-code with an ampersand. Code I(c), heart disease, as indexed and precede the code by an ampersand to indicate the condition necessitating surgery.
(c) When “postoperative intestinal obstruction” (any K560-K567) is reported and no condition which could have necessitated the procedure is reported:
(i) Code the postoperative intestinal obstruction as the condition which necessitated the surgical procedure if another condition is reported due to the postoperative obstruction.
I (a) Peritonitis T814
(b) Postoperative bowel &Y839 &K566
(c) obstruction
Code I(a), peritonitis, as the complication of surgery. Code I(b), postoperative bowel obstruction Y839 K566. Precede the E-code with an ampersand. Precede the K566 with an ampersand to indicate the condition necessitating surgery.
(ii) Code the postoperative intestinal obstruction to K913 as the complication if no other condition is reported due to postoperative obstruction.
I (a) Postoperative ileus Y839 &K913
Code I(a) Y839 K913. Precede K913 by an ampersand. Consider the postoperative ileus to be the complication since no other condition is reported due to this condition.
NOTE:
(4) Status post – When status post (s/p) qualifies a condition, disregard the statement of status post and code the condition as indexed. This applies whether or not surgery is mentioned elsewhere on the certificate.
I (a) Cardiogenic shock R570
(b) Myocardial infarction I219
(c) Ischemic heart disease; status post MI; CABG I259 I219
Code each condition as indexed. No code is entered for the surgery since no complication is reported. Assume the ischemic heart disease was the reason the CABG was performed.
I (a) S/P cardiac arrest I469
(b) Arteriosclerosis I709
II S/P gastrectomy, cancer stomach C169
Code each condition as indexed. No code is entered for the surgery since no complication is reported.
I (a) Status post MI I219
(b) ASHD I251
Code the MI as indexed.
d. Complication as first entry on lowest used line in Part I
(1) When one of the conditions listed below is reported as the first entry on the lowest used line in Part I with surgery (any) reported on same line or in Part II, code this condition as a complication of surgery.
Do not apply this instruction:
(a) When the surgery is stated to have been performed 28 days or more prior to death.
(b) When the condition on the lowest used line predates the surgery.
(c) When the surgery is stated to have been performed for the condition reported as the first entry on the lowest line.
Acute kidney injury
Acute renal failure
Aspiration
Atelectasis
Bacteremia
Cardiac arrest (any I469)
Disseminated intravascular coagulopathy (DIC)
Embolism (any site)
Gas gangrene
Hemolysis, hemolytic infection
Hemorrhage NOS
Infarction (any site)
Infection NOS
Occlusion (any site)
Phlebitis (any site)
Phlebothrombosis (any site)
Pneumonia (J120-J168, J180-J189, J690, J698)
Pneumothorax
Pulmonary insufficiency
Renal failure (acute) NOS
Septicemia (any A400-A419)
Shock (R570-R579)
Thrombophlebitis (any site)
Thrombosis (any site)
I (a) Pneumonia J958
(b)
(c)
II Diabetic gangrene, amputation &E145 Y835
Code pneumonia as a complication of the amputation since it is the first entry on the lowest used line in Part I and surgery, not indicated to have been performed 28 days or more prior to death, is reported in Part II.
I (a) Pneumonia J189
(b) Pulmonary embolism, gastrectomy T817 &Y836
(c)
II Cancer of stomach &C169
Code pulmonary embolism as a complication of gastrectomy since it is the first entry on the lowest used line in Part I and gastrectomy, not stated to have been performed 28 days or more prior to death, is reported on the same line as the embolism.
Date of death 09/17/96
I (a) Pleural effusion J90
(b) Pulmonary embolism & pneumonia T817 J189
(c)
II &Y839
Operation block
/ 9/15/96 /
NOTE: When a date is entered in the operation block, code as if surgery was performed on that date.
Code I(a) as indexed. Code pulmonary embolism as the complication of surgery since this condition is the first condition on the lowest used line in Part I and surgery was performed less than 28 days prior to death.
I (a) Cardiogenic shock R570
(b) Hypovolemic shock T828
II Dialysis shunt hemorrhage; renal failure T828 &Y832 &N19
Code line I(a) as indexed. Code Hypovolemic shock as a complication of the dialysis shunt since it is the first entry on the lowest used line in Part I and dialysis shunt, not stated to have been performed 28 days or more prior to death, is reported in Part II. Hemorrhage reported in Part II is also a complication.
I (a) Pulmonary infarction I269
(b)
(c)
II Cardiac catheterization
Cardiac catheterization is not classified as a surgical procedure; therefore, do not code the pulmonary infarction as a complication.
(2) When any of the conditions listed below are reported as the first entry on the lowest used line in Part I and abdominal or pelvic surgery is reported on the same line or in Part II, code complication as indexed and the surgery to appropriate external cause code (Y83-) where it is indicated on the record by the certifier.
Peritonitis
Intestinal obstruction (K560-K567)
I (a) Pneumonia J189
(b) Peritonitis K659
(c) Intestinal obstruction K913
II Colostomy – ulcerative colitis Y833 &K519
Code intestinal obstruction on I(c) as a complication of the surgery reported in Part II, since the surgery was abdominal and there is no indication that this procedure was performed 28 days or more prior to death.
(3) When any of the conditions listed below are reported as the first entry on the lowest used line in Part I and surgery of the same site or region is reported on the same line or in Part II, code complication as indexed and the surgery to appropriate external cause code (Y83-) where it is indicated on the record by the certifier.
Hemorrhage of a site
Fistula of site(s)
I (a) Pneumonia J189
(b) Gastrointestinal hemorrhage T810
II Gastrectomy for stomach cancer &Y836 &C169
Code gastrointestinal hemorrhage as a complication of the surgery reported in Part II since the surgery was of the same region and there is no indication that surgery was performed 28 days or more prior to death.
(4) When conditions listed in paragraph d(1), (2), and (3) are reported as the first entry on the lowest used line in Part I and surgery stated to have been performed 28 days or more prior to death is reported on the same line or in Part II, code condition as indexed. Do not code as a complication of the surgery.
I (a) Congestive heart failure I500
(b) Shock R579
(c) Acute renal failure N179
II Surgery performed 6 wks. ago for colon cancer C189
Code all conditions on this record as indexed. Do not code acute renal failure as a complication of surgery since the surgery was performed 28 days or more prior to death.
(5) When adhesions are reported as the first entry on the lowest used line in Part I and surgery stated to have been performed less than one year prior to death is reported on same line or in Part II, code adhesions to K918 and code the surgery to appropriate E-code (Y83-).
I (a) Septic shock A419
(b) Peritonitis K659
(c) Adhesions K918
II Surgery – 6 mos. ago for ca. of colon Y839 &C189
Code adhesions on I(c) as a complication of surgery and code the external cause code for the surgery as the first entry in Part II. Code the condition for which surgery was performed and precede by an ampersand.
(6) When adhesions are reported as the first entry on the lowest used line in Part I and surgery stated to have been performed one year or more prior to death is reported on same line or in Part II, code adhesions to K918, Other postprocedural disorders of the digestive system and code the surgery to Y883, sequela of surgery.
I (a) Renal failure N19
(b) Intestinal obstruction K566
(c) Adhesions K918
II Surgery – 16 months ago for diverticulitis Y883 &K579
Code adhesions on I(c) as a complication of the surgery reported in Part II. Since this surgery was performed more than 1 year ago, code Y883 for the sequela of surgery. Code diverticulitis as the condition for which surgery was performed.
e. Ill-defined condition as first entry on lowest used line in Part I
When an ill-defined condition classifiable to the following codes:
I461 (Sudden cardiac death, so described)
I959 (Hypotension, unspecified)
I99 Except occlusion and infarction (Other and unspecified disorders of circulatory system)
J960 (Acute respiratory failure)
J969 (Respiratory failure, unspecified)
P285 (Respiratory failure of newborn)
R000-R568, R590-R948, R960-R99 (Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified) is reported as the first entry on the lowest used line in Part I with surgery reported on the same line or in Part II, proceed:
(1) Code the ill-defined condition, then code the remaining conditions as if the ill-defined condition had not been reported.
I (a) Senility and MI R54 T818
II Gastrectomy &Y836 &K3190
Code senility on I(a) R54 as indexed. Then code MI as if senility had not been reported. MI is coded as the complication of the surgery reported in Part II. Gastrectomy indicates a disease of the stomach. Precede both the code for the surgery and the code for Disease, stomach, with an ampersand.
I (a) Renal failure N990
(b) Cause unknown R97
II Mastectomy Y836 &N649
Code cause unknown on I(b) as indexed, then code renal failure as the complication of the surgery reported in Part II as if cause unknown had not been reported. Code Part II, mastectomy, Y836 N649. Code Disease, breast as the condition necessitating the mastectomy and precede it by an ampersand.
Exceptions:
Code each entry as indexed when:
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
I461 A520 I260-I4290
B24 I510-I518
B332 M349
I010-I099 P293
I110-I119 Q200-Q269
I130-I139
J960 E841
E849
J969 E841
E849
R000 Tachycardia, unspecified I010-I099 I470-I519
I110-I119 J380-J399
I130-I461
R002 Palpitations I010-I099 I130-I461
I110-I119 I470-I519
R010 Benign and innocent I010-I099 I130-I461
cardiac murmurs
R011 Cardiac murmur, I110-I119 I470-I519
unspecified
R012 Other cardiac sounds
R02 Gangrene NEC A480 E135 K410
E100-E104 E136 K412
E105 E137 K413
E106 E139 K419
E107 E140-E144 K420
E109 E145 K429
E110-E114 E146 K430
E115 E147 K439
E116 E149 K440
E117 I702 K449
E119 I709 K450
E120-E124 I730-I739 K458
E125 K352-K389 K460
E126 K400 K469
E127 K402
E129 K403
E130-E134 K409
R030 Elevated blood pressure I10-I139
reading, without
diagnosis of hypertension
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R040 Epistaxis C300-C319C783 I10
C910-C959 J00-J019
D023 J068-J069
D140 J300-J311
D385 J320-J348
J393-J399
R041 Hemorrhage from throat C090-C148 D141
C320-C329 D370
C783 D380
C798 J00
C910-C959 J020-J040
D000 J042-J069
D020 J311-J312
D104-D109 J350-J399
R042 Hemoptysis A162-A1690 D141-D143
R048 Hemorrhage from other C320-C349 D380-D381
sites in respiratory C780 J040-J22
passages C783 J370-J387
C910-C959 J393-J989
D020-D022
R05 Cough F453 J111
J101 J1110
J1010 R042
R060 Dyspnea A162-A1690 D381-D383
B909 D385-D386
C33-C399 J40-J989
C780-C783 P221
D142-D159
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R061 Stridor J385
R062 Wheezing A162-A1690 D381-D383
B909 D385-D386
C33-C399 J40-J989
C780-C783 P221
D142-D159
R064 Hyperventilation F453
R066 Hiccough F453
R090 Asphyxia T360-T659
R104 Other and unspecified R100
abdominal pain R193
R11 Nausea and vomiting J1010 J118
J108 K250-K289
J1110 K800-K820
R17 Unspecified jaundice B150-B199 C787-C788
C220-C259 K700-K839
R18 Ascites C160-C269 C796
C56 C80-C969
C784 K740-K746
C787-C788
R233 Spontaneous ecchymoses D690-D699
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R250 Abnormal head movements G110-G119
R251 Tremor, unspecified G20-G259
R252 Cramp and spasm G400-G419
R253 Fasciculation G510
R258 Other and unspecified G800-G839
abnormal involuntary
movements
R260 Ataxic gait A521
R261 Paralytic gait
R262 Difficulty in walking,
not elsewhere classified
R268 Other and unspecified
abnormalities of gait
and mobility
R270 Ataxia, unspecified A521
A523
G110-G119
R278 Other and unspecified A521
lack of coordination G110-G119
R290 Tetany E200-E209
R291 Meningismus J1010 J1110
J108 J118
R298 Other and unspecified G800-G839
symptoms and signs
involving the nervous and
musculoskeletal systems
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R300 Dysuria C600-C689 D280-D309
R301 Vesical tenesmus C790-C791 D390-D419
R309 Painful micturition, C796 N000-N999
unspecified C798 Q600-Q649
D060-D061
R31 Unspecified hematuria B508 D060-D061
B54 D280-D309
C600-C689 D390-D419
C790-C791 N000-N999
C796 Q600-Q649
C798
R32 Unspecified urinary C600-C689 D280-D309
incontinence C790-C791 D390-D419
R33 Retention of urine C796 N000-N999
C798 Q600-Q649
D060-D061
R34 Anuria and oliguria C600-C689 D280-D309
C790-C791 D390-D419
C796 N000-N999
C798 Q600-Q649
D060-D061 T795
R35 Polyuria C600-C689 D280-D309
R36 Urethral discharge C790-C791 D390-D419
R390 Extravasation of urine C796 N000-N999
R391 Other difficulties with C798 Q600-Q649
micturition D060-D061
R392 Extrarenal uremia
R398 Other and unspecified
symptoms and signs
involving the urinary
system
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R400 Somnolence E100 E147
R401 Stupor E107 E15
E110 K729
E117 S020-S024
E120 S026-S029
E127 S060-S099
E130 T902
E137 T905-T909
E140
R402 Coma, unspecified E100 E132-E136
E101 E137
E102-E106 E139
E107 E140
E109 E141
E110 E142-E146
E111 E147
E112-E116 E149
E117 E15
E119 E160-E162
E120 K729
E121 S020-S024
E122-E126 S026-S029
E127 S060-S099
E129 T902
E130 T905-T909
E131
R529 Pain, unspecified G547
R568 Other and unspecified A35
convulsions G400-G419
O100-O11
O13-O16
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R590 Localized enlarged B270-B279
lymph nodes C810-C969
R591 Generalized enlarged B24 B589
lymph nodes B270-B279 C810-C969
B588
R599 Enlarged lymph nodes, B270-B279
unspecified C810-C969
R600 Localized edema E43 N000-N058
R601 Generalized edema E877 N059
R609 Edema, unspecified E43
E877
N000-N058
R628 Other lack of expected B24
normal physiological E45
development E46
R630 Anorexia F500
R631 Polydipsia E232
N251
R64 Cachexia B24
E41
E46
R730 Abnormal glucose E100-E162
tolerance test E891
R780 Finding of alcohol in F101-F109
blood
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R788 Finding of other A000-A079
specified substances, A090-A499
not normally found in J13-J159
blood J180-J189
R798 Other specified abnormal E100 E127
findings of blood E101 E129
chemistry E102-E106 E130
E107 E131
E109 E132-E136
E110 E137
E111 E139
E112-E116 E140
E117 E141
E119 E142-E146
E120 E147
E121 E149
E122-E126
R799 Abnormal finding of E101 E127
blood chemistry, E107 E131
unspecified E111 E137
E117 E141
E121 E147
R80 Isolated proteinuria C900 N000-N079
D511 N170-N19
D649 N250-N289
R81 Glycosuria E100-E149
E748
R823 Hemoglobinuria B508
B54
D595-D596
The first entry on the And a condition classifiable
lowest line in Part I is to one of the following
classifiable to codes is reported on the
same line or in Part II
R824 Acetonuria E101 E127
E107 E131
E111 E137
E117 E141
E121 E147
R826 Abnormal urine levels of F101-F109
substances chiefly
nonmedicinal as to source
R893 Abnormal findings in F101-F109
specimens from other
organs, systems and
tissues
I (a) Pneumonia J189
(b) Coma R402
II Surgery for diabetic gangrene E145
Code I(a) and I(b) as indexed. Coma is reported as the first condition on the lowest used line, but diabetic gangrene is reported in Part II. Therefore, pneumonia cannot be coded as a complication of surgery. Do not enter a code for surgery since no complication is reported.
I (a) Aspiration pneumonia J690
(b) Jaundice R17
II Cholecystectomy for gallstones K802
Code I(a) and I(b) as indexed. Jaundice is reported as the first condition on the lowest used line with gallstones reported in Part II. Therefore, aspiration pneumonia cannot be coded as a complication of surgery. Code Part II, K802 (gallstones). Do not enter a code for the cholecystectomy since no complication was reported.
I (a) Sepsis A419
(b) Gangrene, pneumonia, and R02 J189 I709
(c) arteriosclerosis
II Surgery
Code I(a) and I(b) as indexed. Gangrene is reported as the first condition on the lowest used line, but arteriosclerosis is reported on the same line; therefore, pneumonia cannot be a complication of surgery. Do not enter a code for surgery since no complication is reported.
f. Relating condition for which surgery was performed to the site of the surgery
(1) When a condition of unspecified site is reported with surgery of a defined site, code the condition of unspecified site to the defined site.
I (a) Aneurysm I719
II Operation for aortic aneurysm I719
Code I(a), aneurysm of unspecified site to aortic aneurysm, I719, since the surgery is of a defined site. Code aortic aneurysm in Part II. Do not enter a code for the surgery since there is no reported complication.
I (a) Pneumonia J958
(b) Esophagectomy due to cancer Y836
(c) &C159
Code I(c), cancer of unspecified site to esophageal cancer C159, since the surgery is of a defined site.
(2) When a condition of a site is reported with surgery of a more defined part of the site, code the condition to the more specified site.
I (a) Carcinoma colon C186
II Left colectomy
Code I(a), carcinoma colon to carcinoma left colon, C186, since the surgery is of a more specified part of the colon. Do not enter a code for the surgery since there is no reported complication.
I (a) Valvular heart disease I059 I069
II Status post mitral and aortic valve repair
Code I(a) valvular heart disease of unspecified valve to disease, mitral and aortic valves since the surgery is of specified valves. Do not enter a code for the surgery since there is no reported complication.
(3) When a condition of a site is reported with surgery for the same condition of unspecified or a less defined part of the site, code the condition to the most defined site.
I (a) Cancer of head of pancreas C250
II Pancreatectomy for cancer C250
Code I(a), cancer head of pancreas, C250. Code Part II as cancer of head of pancreas since elsewhere a more defined site was reported of the condition for which surgery was performed. Do not enter a code for the surgery since there is no reported complication.
(4) Do not apply these instructions when more than one condition or a condition of multiple specified sites which could have necessitated the surgery is reported.
I (a) Cardiac arrest I469
(b) Respiratory arrest R092
(c) Carcinoma of lung, liver, brain C349 C787 C793
II Findings of operation: Carcinoma C80
Code I(a), I(b) and I(c) as indexed and according to neoplasm instructions. Code Part II, carcinoma, C80. Do not code the carcinoma to a more defined site since multiple specified sites are reported for which the surgery could have been performed. Do not enter a code for the surgery since there is no reported complication.
g. Complications of amputation and amputation stump
When a complication (stated or implied) occurs as a result of an amputation, code the complication to Chapters I-XIX. When the complication is classifiable to Chapters I-XVIII and the condition that necessitated the amputation is not reported, precede the code for the complication with an ampersand.
I (a) Renal failure &N990
(b) Below knee amputation of leg Y835
Code I(a), renal failure, N990 as the complication of surgery. Code I(b), below knee amputation of leg, Y835. Precede the N990 with an ampersand since it is classified to Chapter XIV and the condition that necessitated the amputation is not reported.
When there is a complication of an amputation stump, code the complication to T873-T876 or to the appropriate code in Chapters I-XVIII. (Do not use T873-T876 for “stump” of internal organs).
I (a) Infected amputation stump T874 &Y835
(b) Osteosarcoma of leg &C402
Code I(a), infected amputation stump T874 Y835. Precede the E-code, Y835, by an ampersand. Code I(b), osteosarcoma of leg, C402. Precede C402 by an ampersand to indicate the condition that necessitated the amputation.
3. Complications of medical procedures other than surgical (Y84)
Medical procedures are any type of nonsurgical procedures used in the treatment of diseases or injuries. Although almost any condition reported due to medical procedures is regarded as a complication, there are a few diseases that are not considered complications. Do not code the conditions listed under 2. a. (1) (a) and (b) in Section V, Part R as complications of medical procedures. The medical procedure (Y84) is not coded when there is no evidence of a complication. If the reason for the medical procedure is not reported, do not assume a disease condition.
Interpret “due to medical procedures” as a condition(s) on an upper line with a medical procedure as the first condition on the next lower line.
- When a condition is reported due to a named medical procedure other than a surgical operation or is modified by a named procedure and can be considered as a complication(s) or adverse effect, code as follows:
STEP 1: Determine if the complication is in the Index qualified by the specific procedure reported.
I (a) Kidney blockage &N990
(b) Postcystoscopic procedure Y848
Code I(a) as indexed using Step 1
Block
– kidney
– – postcystoscopic or postprocedural N99.0.
Code I(b) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede N990 with an ampersand.
STEP 2: If the Index does not qualify the complication with the specified procedure, determine if the procedure is indexed under Complications (from) (of).
I (a) Urinary tract infection T835
(b) Post-indwelling urinary catheter &Y846
Code I(a) using Step 2
Complications (from) (of)
– catheter (device)
– – urinary (indwelling)
– – – infection or inflammation T83.5
Select infection or inflammation since urinary tract infection is an infectious condition.
Code I(b) Y846 as indexed under Complication, catheter, catheterization (urinary). Precede the E-code with an ampersand.
I (a) Pulmonary embolism T838
(b) Catheter &Y846
Code I(a) using Step 2
Complications (from) (of)
– catheter (device)
– – specified NEC T83.8
Select specified since pulmonary embolism is a specified complication.
Code I(b) Y846 as indexed under Complication, catheter, catheterization (urinary). Precede the E-code with an ampersand.
When the Index does not provide for the term as specified in STEP 1 and STEP 2, code the complication as if procedure NOS was reported instead of the named medical procedure as defined in the following instructions:
NOTE: Before continuing to STEP 3, it is important to determine the nature of the named procedure.
- When a condition that is
(1) reported due to a named procedure cannot be assigned a code using STEP 1 or STEP 2 or
(2) reported due to a procedure other than surgical operation NOS or therapy NOS, and can be considered as a complication(s) or adverse effect, code as follows:
STEP 3: Determine if the complication is in the Index, qualified:
(a) as reported
(b) with any term meaning “due to” procedure or medical care (see Section II, Part C, 2, a, “Due to” written in or implied)
(c) as postprocedural
I (a) Renal failure &N990
(b) Paracentesis Y844
Code I(a) as indexed using Step 3 (c)
Failure
– renal
– – postprocedural N99.0
Code I(b) Y844 as indexed under Complication, paracentesis. Precede N990 with an ampersand.
STEP 4: If the Index does not provide a code for the complication in Steps 1-3, determine if:
(a) the site of the complication is in the Index under Complications (from) (of)
– medical procedure
or
(b) the system in which the complication occurred (based upon the code assigned in the Index) is in the Index under
Complications (from) (of)
– medical procedure
(c) the system in which the complication occurred (based upon the code assigned in the Index) is in the Index under
Complications (from) (of)
– postprocedural
I (a) Cardiac arrest T818
(b) Therapy &Y849
(c) Arteriosclerotic heart disease &I251
Code I(a) using Step 4 (a)
Complications (from) (of)
– medical procedure
– – cardiac T81.8
Select cardiac since this is the site of the complication.
Code I(b) Y849 as indexed under Complication, procedures other than surgical operation. Precede the E-code and the condition requiring treatment with an ampersand.
I (a) Pulmonary edema &J958
(b) Endotracheal tube Y848
Code I(a) using Step 4 (b)
Complications (from) (of)
– medical procedure
– – respiratory
– – – specified NEC J95.8
Select respiratory, specified since pulmonary edema is classified to J81, a specified disease in the respiratory system.
Code I(b) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede J958 with an ampersand.
I (a) Stroke I64
(b) Cerebral embolism T817
(c) Renal angiogram &Y848
Code I(b) using Step 4 (b)
Complications (from) (of)
– medical procedure
– – circulatory T81.7
Select circulatory since cerebral embolism is classified to I634, a specified disease in the circulatory system.
Code I(c) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede the E-code with an ampersand.
STEP 5: When a reported specified complication cannot be classified to a system that is indexed, code T818, Other complications of procedures, not elsewhere classified.
I (a) Shock R579
(b) Coagulation disorder T818
(c) Hyperthermia therapy &Y848
Coagulation disorder is not indexed as due to a procedure or as postprocedural. This condition is classified to D689, a disease of the blood-forming organs. Neither the term nor the body system is indexed under Complications (from) (of), medical procedure.
Code I(b) using Step 5
Complications (from) (of)
– procedure
– – specified T81.8
Select specified since coagulation disorder is a specified complication.
Code I(c) Y848 as indexed under Complication, procedures other than surgical operation, specified NEC. Precede the E-code with an ampersand.
4. Complications of procedures involving administration of drugs, radiation, and instruments
- Many procedures (e.g., angiogram, barium enema, pyelogram) involve the administration of drugs and the use of x-ray or radioactive substances and various instruments. When complications of these procedures are reported, determine, if possible, which specific part of the procedure caused the complication. Assign the appropriate codes for the complication and the procedure. When the complication is classified to Chapters I-XVIII and the reason for the procedure is not reported, precede the code for the complication with an ampersand. If the reason for the medical care is not reported, do not assume a disease condition.
I (a) Pulmonary embolism T828
(b) Cardiac catheterization &Y840
(c) Ventricular septal defect &Q210
Code I(a) as the complication of the catheterization. Code I(b) as indexed, Y840 and precede with an ampersand. Code I(c) as indexed and precede with an ampersand to indicate the reason for the procedure.
I (a) Barium impaction of intestine Y575 K564
(b) Barium enema
(c) Colon polyps &K635
Code the barium on I(a) to adverse effect in therapeutic use, Y575, since it was the drug that caused the impaction. Code the complication, impaction, as indexed, Impaction, intestine, K564. Do not enter a code on I(b) for barium since it was coded on I(a). Code I(c) as indexed and precede with an ampersand to indicate the reason for the procedure.
I (a) Anaphylactic shock T886
(b) Contrast medium (aortogram) &Y575
II Dissecting aortic arch aneurysm &I710
Code I(a) as the complication of the contrast medium. Indexed as Shock, anaphylactic, correct substance properly administered. Code I(b) contrast medium as adverse effect in therapeutic use, since the drug caused the anaphylactic shock. Code Part II as indexed and precede with an ampersand to indicate the reason for the procedure.
I (a) Peritonitis K659
(b) Hemorrhage of colon K918
(c) Barium enema Y848
(d) Diverticulitis &K579
Code I(a) as indexed. Code I(b) as the complication of the administration of the enema. Code I(c) barium enema, Y848, since the hemorrhage most likely resulted from the administration of the enema rather than the barium. Code I(d) as indexed and precede with an ampersand to indicate the reason for the procedure.
I (a) Cerebral hemorrhage T817
(b) Cerebral arteriogram &Y848
Code I(a) as the complication of the arteriogram. Code I(b) cerebral arteriogram, Y848, since the hemorrhage resulted from the procedure and precede with an ampersand. Do not assume a disease condition for the cerebral arteriogram.
- When a complication results from the administration of anesthesia, code the complication as indexed and code the appropriate external cause code (Y480-Y485) (refer to Section V, Part R, 1,Drugs, medicaments and biological substances causing adverse effects in therapeutic use).
I (a) Cardiac failure I509
(b) Anesthesia for prostate surgery Y484
(c) &N429
Code I(a) as indexed and as the complication of the anesthesia. Code I(b) anesthesia to adverse effect in therapeutic use, Y484, since it was the anesthesia that caused the heart failure. Code I(c) N429, disease prostate, as the reason for surgery and precede with an ampersand.
I (a) Cardiac failure T818
(b) Prostate surgery under anesthesia &Y839
(c) Benign prostatic hypertrophy &N40
Code I(a) as indexed under Failure, heart, complicating surgery. Code I(b) prostate surgery as indexed. Code I(c) as indexed and precede with an ampersand to indicate the reason for surgery.
5. Complications of radiation during medical care (Y842)
When a complication results from exposure to radiation, except radio-frequency radiation, infrared heaters or lamps and visible or ultraviolet light sources, consider as exposure of patient to radiation during medical care unless there is information on the certificate that indicates otherwise. Code complications of radiation during medical care as follows:
- Complications qualified as “radiation,” “radiation-induced,” “due to radiation,” or “following radiation”
(1) Coding the complication
(a) If the Index provides a code for the complication qualified by one of these terms, use that code.
(b) If the Index does not provide a code for the complication qualified by one of these terms, code the complication as indexed without the qualifier.
(2) Placement of codes
(a) If the complication is qualified as “radiation” or “radiation-induced” and classified to Chapters I-XVIII, code the external cause code followed by the code for the complication.
(b) If the complication is qualified as “radiation” or “radiation-induced” and classified to Chapter XIX, code the nature of injury code followed by the external cause code.
- Code the external cause code to Y842, (Radiological procedure and radiotherapy).
- Use of ampersand
(1) If the reason for the radiation therapy is reported, precede this condition with an ampersand.
(2) If the reason for the radiation therapy is not reported and a malignant neoplasm is reported, precede the neoplasm with an ampersand.
(3) If the reason for the radiation therapy is not reported and the complication is classified to Chapters I-XVIII, precede the complication with an ampersand.
I (a) Pulmonary edema J81
(b) Radiation pneumonitis Y842 J700
(c) Radiation therapy for cancer of breast
(d) &C509
Code I(b) to the external cause as indexed where the radiation is first reported followed by the code for the complication. Pneumonitis is the complication of the radiation and is indexed, Pneumonitis, radiation. Precede the code for cancer of breast with an ampersand to indicate the reason for the radiation.
I (a) Carcinomatosis C80
(b) Oat cell carcinoma &C349
(c)
II X-ray fibrosis – lung Y842 J701
Code Part II to the external cause as indexed followed by the code for the complication. Fibrosis of lung is the complication and is indexed, Fibrosis, lung, following radiation. Code I(b) as indexed and precede with an ampersand to indicate the reason for the radiation.
I (a) Pneumonia J700
(b) Radiation Y842
(c) Carcinoma of face &C760
Pneumonia is the complication of the radiation reported on I(b). Code I(a) as indexed, Pneumonia, radiation. Code the external cause as indexed on I(b). Code I(c) as indexed and precede with an ampersand to indicate the reason for the radiation.
I (a) Debility R53
(b) Radiation therapy Y842
(c) Hodgkin disease &C819
Debility is the complication of the radiation reported on I(b). Code I(a) as indexed since the Classification does not provide a code for radiation debility. Code the external cause as indexed on I(b). Code I(c) as indexed and precede with an ampersand to indicate the reason for the radiation.
I (a) Radiation-induced acute Y842 J700
(b) bronchitis
II Carcinoma of trachea &C33
Code I(a) to the external cause as indexed, followed by the code for the complication. Acute bronchitis is the complication and is indexed Bronchitis, acute, due to radiation. Code Part II as indexed and precede with an ampersand to indicate the reason for the radiation.
I (a) Alopecia L581
(b) Radiation Y842
II Hodgkin granuloma &C817
Alopecia is the complication of the radiation reported on I(b). Code I(a) as indexed under Alopecia, X-ray. Code the external cause as indexed on I(b). Code Part II as indexed and precede with an ampersand to indicate the reason for the radiation.
I (a) Peritonitis K659
(b) Intestinal fistula &K632
(c) Radiation therapy Y842
Intestinal fistula is the complication of the radiation reported on I(c). Code I(b) as indexed since the Classification does not provide a code for radiation intestinal fistula. Code the external cause as indexed on I(c). Precede the complication (intestinal fistula) with an ampersand since it is classified to Chapters I-XVIII and the reason for the radiation was not reported.
- When radiation fibrosis is reported without a site or of a site not indexed, code the fibrosis to T66, Complications, radiation.
I (a) Cerebral anoxia G931
(b) Carcinoma of tongue &C029
II Radiation fibrosis, upper airway obstruction T66 &Y842 J988
Code Part II Complications, radiation for the fibrosis and the external cause as indexed. Code the nature of injury followed by the external cause. Place an ampersand preceding the E-code and the condition on I(b) to indicate the reason for the radiation.
I (a) Radiation pelvic fibrosis T66 &Y842
(b) Carcinoma of uterus &C55
Code I(a) Complications, radiation for the pelvic fibrosis and the external cause as indexed. Code the nature of injury followed by the external cause. Place an ampersand preceding the E-code and the condition on I(b) to indicate the reason for the radiation.
6. Misadventures to patients during surgical and medical care (Y60-Y69)
Except for poisoning, overdose of drug and wrong drug given in error, code most misadventures (accidents or errors) to patients during surgical and medical care to Complications of surgical and medical care (T800-T889) in the nature of injury chapter and to Y600-Y69 in the external cause chapter. Code burns from local applications or irradiation to burns in the nature of injury chapter and to Y600-Y69 in the external cause chapter. Code trauma from instruments during delivery to Chapter XV and do not use an external cause. A limited number of conditions attributable to misadventure to patient (Y600-Y69) in the external cause code, e.g., serum hepatitis, are classified to Chapters I-XVIII.
Indications of Misadventures
Hemorrhage (of a site) Stated as intraoperative or
during medical and surgical
Rupture (of a site) care
Cut or cutting (of a site) Reported as postoperative,
Perforation (of a site) intraoperative, during or due
Puncture (of a site) to medical and surgical care
Laceration (of a site)
Burns (of a site) From local applications or
irradiation
Serum hepatitis From blood transfusions
Fracture (thoracic area) From cardiopulmonary resuscitation
From Heimlich maneuver
This list is not all inclusive.
When a misadventure to patient during surgical and medical care (classifiable to Y600-Y69) is reported and the condition which necessitated the surgical or medical care is stated or implied, precede the code for this condition with an ampersand. Apply the instructions for Condition necessitating Surgery in Section V, Part R, 2, b.
I (a) Hemorrhage during T810
(b) craniotomy &Y600
(c) Brain tumor &D432
Code I(a) Complication, surgical procedure, hemorrhage. Since “during” is stated, interpret I(b) as a misadventure and code Misadventure, hemorrhage, surgical operation. Code I(c) as indexed and precede with an ampersand to indicate the reason for surgery.
I (a) Perforation of colon T812
(b) Colostomy &Y600 &K639
Code I(a) Perforation, surgical. Interpret I(b) as a misadventure and code Misadventure, perforation, surgical operation. Since the surgery indicates a disease of the colon, code this as the reason for surgery. Precede K639 with an ampersand
I (a) Cardiac tamponade I319
(b) Perforation of auricle by cardiac catheter T812 &Y605
II Therapeutic misadventure T889
The perforation occurred during a cardiac catheterization. Code I(b) as accidental perforation of organ during a procedure, and accidental perforation during a heart catheterization. Code Part II as indexed, Misadventure (prophylactic) (therapeutic).
I (a) Peritonitis K659
(b) Accidental perforation of T812 &Y607
(c) colon
II Self-administered tap water enema
I(b) is a reported misadventure occurring during medical care. Code T812, accidental perforation during a procedure and Y607, accidental perforation during the administration of an enema.
I (a) Serum hepatitis B169
(b) Blood transfusion Y640
(c) Leukemia &C959
Serum hepatitis is a misadventure occurring during a blood transfusion. Code I(a) B169, serum hepatitis, and I(b) Y640, Contaminated medical or biological substance transfused or infused. Code I(c) as indexed and precede with an ampersand to indicate the reason for the transfusion.
I (a) Burns T300
(b) Radiation therapy &Y632
(c) Cancer of esophagus &C159
Code I(a) T300, radiation burns. Code I(b) Y632, Overdose of radiation given during therapy. Code I(c) as indexed and precede with an ampersand to indicate the reason for the radiation.
I (a) Rib fracture T818
(b) Cardiopulmonary resuscitation &Y658
(c) Pulmonary embolism &I269
Rib fracture due to cardiopulmonary resuscitation is considered a misadventure. Code I(a) Complications, medical procedure, specified NEC T818. Code I(b) Misadventure, specified type Y658. Code I(c) as indexed and precede with an ampersand to indicate the reason for cardiopulmonary resuscitation.
I (a) HIV B24
(b) Blood transfusion
(c) Hemophilia D66
Code I(a) and I(c) as indexed. No code for I(b) since there are no complications reported. Do not consider HIV (any B20-B24) as a misadventure occurring during a blood transfusion.
S. Sequela of injuries, poisonings, and other consequences of external causes
A sequela is a late effect, an after effect, or a residual of a nature of injury or external cause. The Classification provides categories T900-T983 for sequela of nature of injury codes and Y850-Y899 for sequela of external causes. There are separate instructions for determining if the nature of injury or the external cause should be coded as sequela. If either the nature of injury or the external cause requires a sequela code, both the nature of injury and the external cause must be coded to a sequela category.
1. Sequela of injuries, poisoning, and other consequences of external causes (T900-T983)
Use these categories for the classification of injuries and poisonings (conditions in S00-T88) if:
- A statement of sequela of the condition in S00-T88 is reported unless the interval between date of injury and date of death is less than 1 year.
I (a) Sequela of hip fracture T931
(b)
(c)
II &Y86
Code I(a) to T931 since it is stated as a sequela of hip fracture. Code Part II as sequela of accident NEC.
- The condition in S00-T88 is stated to be ancient, by history, healed, history, history of, late effect of, old, remote, regardless of reported duration, or the interval between onset of this condition and death is indicated to be 1 year or more, whether or not the residual (sequela) effect is specified.
Date of death 12/1/98
I (a) Old head injury T909
MOD II &Y86
A
Accident |
|
Farm |
|
Date of injury 9/3/98 |
|
Tractor overturned |
Code I(a) old head injury to Sequela, injury, head since it is stated as old. Interpret “tractor overturning on farm” as contact with agricultural machinery. Code Part II accident – tractor overturned to sequela of other accidents since it resulted in an injury stated as old.
- A condition with a duration of 1 year or more that was due to the condition in S00-T88 is reported.
I (a) Paralysis 16 mos. T941
(b) Spinal cord injury T913
(c) Auto accident &Y850
Code I(a) paralysis to sequela of traumatic paralysis since it is reported due to trauma and has a duration of 1 year or more. Code I(b) spinal cord injury to Sequela, injury, spinal, cord since it caused a condition of 1 year or more. Code I(c) auto accident, to Sequela, motor vehicle accident.
- More than one nature of injury or a nature of injury and an external cause are reported on the same line with a duration of 1 year or more, apply the duration to each condition.
I (a) Head injury and skull fracture Years T909 T902
(b)
II Fall &Y86
Code both conditions on I(a) as sequela. Do not disregard the duration since there is more than one injury on same line.
I (a) Gunshot wound head Years T901 &Y86
Code both head wound and gunshot as sequela. Apply duration to nature of injury and external cause.
2. Sequela of external causes (Y850-Y899)
Y850 Sequela of motor vehicle accident (includes V01-V89)
Y859 Sequela of other and unspecified transport accidents (includes V90-V99)
Y86 Sequela of other accidents (excludes W78-W80)
Y870 Sequela of intentional self-harm
Y871 Sequela of assault
Y872 Sequela of events of undetermined intent
Y880 Sequela of adverse effects caused by drugs, medicaments, and biological substances in therapeutic use
Y881 Sequela of misadventures to patients during surgical and medical procedures
Y882 Sequela of adverse incidents associated with medical devices in diagnostic and therapeutic use
Y883 Sequela of surgical and medical procedures as the cause of abnormal reaction of the patient, or of later complication, without
mention of misadventure at the time of the procedure
Y890 Sequela of legal intervention
Y891 Sequela of war operations
Y899 Sequela of unspecified external cause
Use the preceding categories with the appropriate fourth characters for the classification of external causes of injury (V010-Y849) if:
- A statement of sequela of the external cause is reported unless the interval between date of external cause and date of death is less than 1 year.
I (a) Paralysis, sequela of T941 &Y86
(b) fall down steps
Code I(a) to sequela of traumatic paralysis and sequela of fall down the steps.
- An injury that is stated to be ancient, by history, healed, history, history of, late effect of, old, remote, or a delayed union that was due to the external cause is reported.
I (a) Pneumonia J189
MOD (b) Debility R53
A (c) Nonunion of hip fracture M841
II Inanition R64 Y86
Accident |
|
Fell at home |
Code I(c) as indexed. Code sequela of fall last in Part II since the fall resulted in nonunion of the fracture.
I (a) ASHD I251
II Old fractured hip T931 &Y86
Code I(a) ASHD as indexed. Code Part II old fractured hip, T931 Y86, since the injury was specified as old.
- If the external cause is stated to be ancient, by history, history, history of, old, remote, regardless of reported duration, or the interval between onset of the external cause and death is indicated to be 1 year or more.
I (a) Old fall, fractured hip 6 months T931 &Y86
(b)
(c)
MOD II T931
A
Accident |
|
Fell and fractured hip 6 months ago |
Code as sequela since the external cause is stated as “old.”
- A condition with a duration of 1 year or more that was due to the external cause is reported.
I (a) Subdural hematoma 1 year T905
(b) Fall &Y86
Code I(a) subdural hematoma, T905, since it is reported to be of 1 year or more duration. Code I(b) fall, Y86, since it resulted in a condition of 1 year or more duration.
I (a) Esophageal stricture years K222
(b) Ingestion of lye T97 &Y870
II Suicide attempt
Code I(a) esophageal stricture as indexed. Code I(b) ingestion of lye, T97 Y870, since it resulted in a condition of 1 year or more duration.
- The interval between the time of occurrence of the external cause and death is indicated to be 1 year or more, whether or not the residual (sequela) effect is specified.
Date of death 11/1/96
I (a) Bronchopneumonia J180
MOD II Contusion brain T905 &Y850
A
Accident |
|
Street |
|
Date of injury 5/20/95 |
|
Bicycle (operator) vs. truck |
Code I(a) bronchopneumonia as indexed. Code sequela of nature of injury and external cause since the date of injury is 1 year or more prior to death.
I (a) Cardiac arrest I469
(b) Pacemaker failure weeks T983 &Y883 &I519
(c) Had pacemaker implanted 3 years ago
Code I(a) cardiac arrest as indexed. Code I(b) pacemaker failure to sequela T983 and Y883 since duration of implanted pacemaker is 3 years. Code I519, Disease, heart since pacemaker indicates a heart disease. Precede I519 with an ampersand as reason for the surgery. Do not enter a code on I(c).
- The complication of the external cause classified to Chapters I-XVIII and the external cause is reported on the same line and the duration is 1 year or more.
I (a) Radiation enteritis 3 years Y883 K520
(b) Lung cancer &C349
Code I(a) as a sequela of radiation therapy. Do not disregard the duration. Precede the code for the lung cancer with an ampersand to indicate the reason for medical care.