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

SECTION III: INTENT OF CERTIFIER

A.      INTRODUCTION

In order to assign the most appropriate code for a given diagnostic entity, it may be necessary to take other recorded information into account. It is important to interpret this information properly so the meaning intended by the certifier is correctly conveyed. The objective is to code each diagnostic entity in accordance with the intent of the certifier without combining separate codable entities. The following instructions help to determine the intent of the certifier. Apply Intent of Certifier instructions to “See also” terms in the Index as well. These instructions are assumed to be for the fetus unless stated as a maternal condition or reported on the Maternal Condition line.

B.      Coding conditions classified to injuries as disease conditions

1. Some conditions (such as injury, hematoma or laceration) of a specified organ are indexed directly to a traumatic category but may not always be traumatic in origin. Consider these types of conditions to be qualified as non-traumatic when reported:

• with a written in due to, or on the same line with a disease or reported due to drug poisoning or drug therapy.
• When there is provision in the Classification for coding the condition considered to be qualified as non-traumatic as “non-traumatic,” code accordingly. Otherwise, code to the category that has been provided for “Other” diseases of the organ (usually .8).

1. Some conditions are indexed directly to a traumatic category, but the Classification also provides a non-traumatic code. When these conditions are reported of the fetus and due to or with a disease and an external cause is also reported on the record, the instructions for coding external causes on regular mortality data will apply.
2. Some conditions are indexed directly to a traumatic category, but the Classification also provides a non-traumatic code. When these conditions are reported, code the condition as non-traumatic unless the condition is reported due to or on the same line with an injury or external cause. This instruction applies only to conditions with the term “non-traumatic” in the Index.

C.      Organisms and Infections

          Organisms

 Escherichia coli     Cytomegalovirus     Candida

 Staphylococcal       Streptococcal       Fungus

          Infectious conditions

 Abscess        Infection     Sepsis, Septicemia

 Bacteremia     Pneumonia     Septic Shock

 Empyema        Pyemia        Words ending in “itis”

These lists are NOT all inclusive. Use them as a guide.

Infections and organisms are yet another situation in which care needs to be taken to determine if it is directly affecting the fetus or the fetus is merely impacted by a maternal condition before assigning a code. If the infection or organism is reported in the specified line for maternal conditions or if reported elsewhere but qualified as maternal, then code to a maternal code (e.g., P002 or P008). Otherwise, assume the fetus has the infection or organism and assign a fetal code. (e.g., P35-P39), if indexed.

Take into consideration that some infections and organisms of the fetus are classified to Chapter 1.

1. Do not use HIV or AIDS to modify an infectious or inflammatory condition. Code as two separate conditions.
2. When an infectious or inflammatory condition and a specified organism or specified non-systemic infection is reported, code the infectious or inflammatory condition and the organism or infection separately.
3. When any condition and infection NOS is reported, code both conditions where entered on the report.
4. When a non-infectious or non-inflammatory condition and infection NOS is reported as the initiating cause, code the non-infectious or non-inflammatory condition as indexed and code infection NOS where entered on the report.
5. When an organism is reported preceding two or more infectious conditions reported consecutively on the same line, code each of the infectious conditions modified by the organism.
6. When one infectious condition is modified by more than one organism, modify the condition by all organisms.
7. When any condition is reported and a generalized infection such as bacteremia, fungemia, sepsis, septicemia, systemic infection, or viremia is reported, code both the condition and the generalized infection where entered on the report. Do not modify the condition by the infection.

D.      Drug Use NOS and Noxious Substances

The code assignment depends upon whether the fetus is directly impacted or affected by maternal behavior or exposure. For instance, code maternal drug use P044, when reported in 18a or 18b. Refer to the indexing of maternal conditions in the Perinatal Subset and Volume 1, Category P04 to assign the appropriate code for a fetus affected by maternal behavior or exposure.