National Vital Statistics System

Instructions for Classifying Multiple Causes of Death, 2019 – 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

  1. 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).

  1. 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

  1. Use an ampersand to identify the following
  2. The most specific external cause code causing injuries or poisoning.
  3. Certain localized effects of poisonous substances (X45-X49) or aspiration (W78,W79, W80) when classifiable to Chapters I-XVIII.
  4. 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:

  1. When reporteddue to:
  • nature of injury codes
  • medical and surgical care
  • other external causes
  1. 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.

  1. More than one external cause reported
  2. 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.

  1. 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.

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.

Place     I    (a) AKI                                                                              S370

  9        II                                                                                           &X599

Code Injury, injured (accidental(ly)) 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

  1. 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:
  2. When they are qualified as “traumatic”
  3. 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:

  1. 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).

  1. 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.

  1. 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.”

  1. 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.

  1. 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.

  1. 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 inuries 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:

  1. 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

  1. 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.

  1. 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.
  2. 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:

  1. Fracture of both hips                                      T025

Fracture

– hip

– – both T025

  1. Fracture of hips                                             S720

Fracture

– hip S720

  1. Multiple fractures of ribs                                 S224

Fracture

– rib

– – multiple S224

  1. Fractures of ribs                                            S223

Fracture

– rib S223

  1. Multiple wounds of lower limb                         T013

Wound

– limb

– – lower NEC

– – – multiple sites                                         T013

                                                                                 

  1. Multiple injuries    Followed byspecified    Code T07 and the specified

                         type(s) of injuries      injuries

                                                                                 

  1. Multiple injuries    Followed byspecified    Code multiple injuries by

                         site(s)                  site(s) only

                                                                                 

  1. Single site          Reported on same lineCode the specified types of

                         with multiple types of   injuries of the reported site

                         injuries

                                                                                 

  1. 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

                                                                                 

  1. Place     I     (a) Multiple injuries with                                                           T07 S029 S062

     9               (b) fracture skull and

                      (c) laceration brain

                II                                                                                                 &X599

  1. Place     I     (a) Multiple injuries – head, neck, chest                                       S097 S197 S297

     9

                II                                                                                                 &X599

  1. Place     I     (a) Fracture, laceration and contusion                                         T12 T131 T130

     9               (b) of leg

                      (c) Fall from roof                                                                     &W13

  1. 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

  1. 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.

  1. 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.

  1. 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

  1. 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

  1. 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:

  1. A traffic accident when the event is classifiable to categories V02-V04, V10-V82 and V87.
  2. A nontraffic accident when the event is classifiable to categories V83-V86. These vehicles are designed primarily for off-road use.
  3. Consider category V05 to be unspecified whether traffic or nontraffic if no place is indicated or if the place is railroad (tracks).
  4. Consider category V05 to be traffic if place is railway crossing.
  5. 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

  1. 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.

  1. 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).

  1. 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

  1. 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.

  1. 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 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.

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)

  1. 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

  1. 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)

  1. 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.
  2. 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.

  1. 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.

  1. 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.

  1. 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.

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.

  1. 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-

  1. Is a fire involved?

YES:   Refer to coding instructions for categories X00 – X09. Review Threats to Breathing, Table 3, Fire.

  1. Is machinery in operation involved?

YES:   See code categories W28 – W31.

  1. 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.

  1. Is struck by a falling object involved?

YES:   See code categories W20 – W49

  1. 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         W33         X73          X94      Y23

 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:

  1. 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

  1. 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

  1. 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.

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            drowning               upper line T751 and the

                    asphyxia          submersion            appropriate external cause

                    strangulation                                code.

                    suffocation

                                                                       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  Code

                                         line with                                                          

 2                  anoxia            drowning                      T751 and the appropriate

                    asphyxia          submersion                   external cause code.

                    strangulation

                    suffocation                                                                            

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        hanging                   upper line T71 and the appropriate

                    strangulation  mechanical               external cause code.

                    suffocation     strangulation

                                        (by external means)    lower line T71 only.

                                        compression of neck                                                     

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     Code

                                         record with                                                                        

 2                  asphyxia        hanging                   the asphyxia, strangulation, suffocation,

                    strangulation  mechanical               T71 followed by the appropriate

                    suffocation     strangulation             external cause code.

                                        (by external means)

                                        compression of neck   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

                                                                                                                  

 Instruction  When            Is reported    Which is         Code

                                         due to           reported due

                                                             to                                                  

 3                  asphyxia        asphyxia        the external   uppermost line to T71

                    strangulation  strangulation  means of the  and the appropriate

                    suffocation     suffocation     mechanical     external cause code.

                                                             strangulation

                                                             (such as:        the next lower line to

                                                             ligature, rope  T71.

                                                             around neck,

                                                             sheet)

                                                                                  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   hanging                           upper line T71 only.

                     of neck          mechanical

                     stricture of     strangulation          lower line T71 and the

                     neck              (by external means)          appropriate external

                                         suffocation                        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             Code

                                         record with                                                                              

 5                  compression   hanging                           compression of neck, stricture of neck

                     of neck          mechanical                       to T71 only.

                     stricture of     strangulation

                     neck              (by external means)          T71 followed by the appropriate

                                          suffocation                       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

                     suffocation  inhalation | (carbon monoxide, products   the nature of injury code for

                                                     | of combustion, smoke)           the gas, fumes, vapor and the

                                                                                                   appropriate external cause

                                                                                                   code for the fire where

                                                       with                                      required.

                                                       mention of a fire (specified)

                                                                                                   lower line to the appropriate

                                                                                                   nature of injury code for the

                                                                                                   gas, fumes, vapor.                 

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

                     suffocation  inhalation | (carbon monoxide,             the nature of injury code for

                                                     | products of combustion,      the gas, fumes, vapor and the

                                                     | smoke)                               appropriate external cause

                                                                                                code for the fire where

                                                       with                                   required.

                                                       mention of a fire (specified)

                                                                                                the appropriate nature of

                                                                                                injury code for the gas,

                                                                                                fumes, vapor where reported. 

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      fire NOS                       upper line T300 and the

                     suffocation  specified fire                 appropriate

                                                                         external cause code.

                                                                         lower line blank.            

                                                                                                                            

 Instruction  When          Is reported on the record with   Code

                                                                                                                            

 5                  asphyxia      fire NOS                                  the asphyxia, suffocation

                     suffocation  specified fire                            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

                     suffocation  inhalation | fumes,       injury code for the gas, fumes, or

                                                     | or vapors    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   Code

                                       line with                                                                           

 2                  asphyxia      ingestion | of gas,            the appropriate nature of injury

                     suffocation  inhalation | fumes,            code for the gas, fumes, or vapor

                                                     | or vapors         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      crushed chest         upper line S280 plus the

                     suffocation                               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      compression chest   upper line S299 plus the

                     suffocation                                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 NOS                    upper line to T17 plus

                     aspiration                ingestion NOS                     appropriate fourth

                     choking                   inhalation NOS                    character and the

                     obstruction of a site                                           appropriate external cause

                     occlusion of a site                                              code (W78, W79, W80).

                     strangulation

                     suffocation               or                                      lower line to T17 with

                                                                                             appropriate fourth

                                                   aspiration | of substances or  character.

                                                   ingestion  | objects

                                                   inhalation |                                                               

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                  foreign body in a site (such as:  upper line to T17 plus

                     aspiration                blood, food, gum, medicine,      appropriate fourth

                     choking                   mucus, vomitus)                      character and the

                     obstruction of a site                                               appropriate external cause

                     occlusion of a site                                                  code (W78, W79, W80).

                     strangulation

                     suffocation                                                            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                  foreign body NOS                  upper line to T17 plus

                     aspiration                (such as: blood, food, gum,    appropriate fourth

                     choking                   medicine, mucus, vomitus)     character and the

                     obstruction of a site                                             appropriate external cause

                     occlusion of a site                                                code (W78, W79, W80).

                     strangulation

                     suffocation                                                          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   Code   

                                                   with                                                                           

 4                  asphyxia                  aspiration NOS                      on the same line, T17 with

                     aspiration                ingestion NOS                       appropriate fourth

                     choking                   inhalation NOS                      character and the

                     obstruction of a site                                             appropriate external cause

                     occlusion of a site                                                code (W78, W79, W80).

                     strangulation

                     suffocation              or

                                                   aspiration | of substances or

                                                   ingestion  | objects

                                                   inhalation |                                                                  

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   Code   

                                                   with                                                                                    

 5                  asphyxia                  foreign body in a site (such as:    on the same line, T17 with

                     aspiration                blood, food, gum, medicine,        appropriate fourth

                     choking                   mucus, vomitus)                        character and the

                     obstruction of a site                                                 appropriate external cause

                     occlusion of a site                                                    code (W78, W79, W80).

                     strangulation

                     suffocation                                                                                                    

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   Code   

                                                   with                                                                                    

 6                  asphyxia                  foreign body NOS (such as:     on the same line, T17 with

                     aspiration                blood, food, gum, medicine,        appropriate fourth

                     choking                   mucus, vomitus)                        character and the

                     obstruction of a site                                                 appropriate external cause

                     occlusion of a site                                                    code (W78, W79, W80).

                     strangulation

                     suffocation                                                                                                    

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               a disease                upper line T17 plus

                     aspiration of substances                               appropriate fourth

                     strangulation NOS                                       character and the

                     strangulation by                                          appropriate W78, W79,

                     substances                                                 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

                                                                                     

 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                    injuries (other than those  upper line T17 plus

                     ingestion NOS                    classified to T17-) and/or   appropriate fourth

                     inhalation NOS                   an external cause (other    character. Also, code the

                                                             than W78, W79, W80)       appropriate W78, W79,

                     or                                                                            W80 if not previously

                                                                                                    coded.

                     aspiration | of substances or

                     ingestion  | objects

                     inhalation |                                                               lower line as indexed.      

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

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

  1. 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.

  1. Interpret the term “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.

  1. 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.

  1. 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).

  1. Poisoning by combination of drugs (X40-X44)

(1) When poisoning by a combination of drugs is stated or indicated to be accidentalintentional 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 X6l 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-          | Code X64, Intentional self-poisoning by and exposure

    harm                         | to other and unspecified drugs, medicaments and

    (Suicide)                    | 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:

  1. Drugs, medicaments and biological substances causing adverse effects in therapeutic.
  2. Misadventures to patients during surgical and medical care (Y60-Y69).
  3. 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)

  1. 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

  1. 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

  1. 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

  1. 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

  1. 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

  1. 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)

  1. 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 toY590, 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               I00-I099

 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.

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 aneurysmectomycholelithotomy, 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 “staus 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 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) 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.

(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.

  1. 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.

  1. 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

  1. 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.

  1. 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:

  1. 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.

  1. Code the external cause code to Y842, (Radiological procedure and radiotherapy).
  2. 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                                      &nb