National Vital Statistics System

Instructions for Classifying Multiple Causes of Death, 2022 – 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

a.  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).

b.  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

a.  The most specific external cause code causing injuries or poisoning.

b.  Certain localized effects of poisonous substances (X45-X49) or aspiration (W78,W79, W80) when classifiable to Chapters I-XVIII.

c.  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 reported due to:

•  nature of injury codes

•  medical and surgical care

•  other external causes

2.  When a nature of injury code other than T179 is reported as the first 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.

2.  More than one external cause reported

a.  In determining the most specific external cause code, consider all of the information reported on the record. If two or more external causes are reported and the nature of injuries and/or the order in which the conditions are reported indicates that one of the external causes led to the condition that terminated in death, precede the code for this external cause by an ampersand. If no determination can be made, precede the code for the first mentioned external cause with an ampersand.

Place     I    (a) Aspiration of vomitus                                                      T179    W78

  9             (b) Internal chest injury                                                       S279

                 (c) Fall down stairs                                                              &W10

The order in which the conditions are reported indicates that the fall down stairs led to aspiration; therefore, the ampersand precedes the code for this external cause.

Place     I    (a) Gunshot wound of head                                                  S019    &X95

  9             (b) Stab wound of chest                                                       S219    X99

MOD     II

  H

Homicide

The order in which the external causes are reported does not indicate which event occurred first; therefore, precede the code for the gunshot wound with an ampersand since it is the first external cause reported.

Place     I    (a) Head trauma                                                                  S099

9          II  Alcohol intoxication, auto accident                                        T519  X45 &V499

Precede the code for the auto accident with an ampersand. Alcohol intoxication did not cause the head trauma.

Place     I (a) Positional asphyxia complicating mixed drug (morphine      T71  &W84  T402  X44  T424

  9           (b) and temazepam) intoxication

MOD     II Obesity and obstructive sleep apnea                                     E669 G473 J969 T402 T424

  A

 

Accident

 

Positional respiratory compromise after self-administering morphine and temazepam

Code I(a) as indexed, preceding the W84 with an ampersand since it is the first mentioned e-code. Assign the N and E-codes for the named drug poisoning on line I(a). In Part II, code the diseases as indexed and assign the nature of injury codes for the drugs repeated in the How Injury Occurred block.

b.  When alcohol intoxication (or any term meaning intoxication) is reported with another external cause other than aspiration, precede the code for the first mentioned external cause with an ampersand.

When alcohol intoxication is reported with drugs, refer to Section V, Part Q, 4, Poisoning by alcohol and drugs.

When alcohol intoxication is reported with exposure or hypothermia, refer to Section V, Part L, 2, Exposure, cold exposure and hypothermia.

Place     I    (a) Head trauma                                                                  S099

  9             (b) Auto Accident                                                                &V499

                 (c) Alcohol intoxication                                                        T519 X45

Precede the code for the auto accident with an ampersand since it is the first external cause reported.

Place     I    (a) Drowning                                                                      T751  &W74

  9             (b) Alcohol intoxication                                                        T519  X45

            II  Drinking heavily                                                                  F101

Precede the code for the drowning with an ampersand since it is the first external cause reported. Code Part II as indexed.

Place     I    (a) Alcohol intoxication and hip fx                                         T519  &X45  S720

9          II  Fall while intoxicated                                                           W19   T519

Precede the code for the alcohol intoxication with an ampersand since it is the first external cause reported.

Place     I (a) Positional asphyxia in the setting of acute ethanol              T71  &W84

  9             (b)intoxication                                                                   T510  X45

Precede the code for the positional asphyxia with an ampersand since it is the first external cause reported.

D. Certifications with mention of nature of injury and without mention of external cause

All certifications that have an entry classifiable to Chapter XIX must have an external cause code. When only one type of injury is reported without indication of the external cause and the External Cause Index provides a code for this type of injury, code accordingly. If the External Cause Index does not provide a code for the type of injury, code to Accident, unspecified (X599). When no external cause is reported and the external cause code must be assumed, code the external cause code as the last entry in Part II.

Place     I    (a) Crushed chest                                                                S280

  9        II                                                                                           &X599

Code  Crushed (accidentally), X599 as indexed.

Place     I    (a) Fracture of hip and arm                                                   S720    T10

  9        II                                                                                           &X590

Code Fracture (circumstances unknown or unspecified), X590 as indexed.

Place     I    (a) Penetrating wound of abdomen                                       S318    S219

  9             (b) and chest

            II                                                                                           &X599

Code Wound (accidental) NEC, X599 as indexed.

If different types of injuries are reported without indication of the external cause, use the injury reported in the lowest due to position to assign the appropriate external cause code for this injury. If more than one injury is reported on the lowest line, assign the appropriate external cause code for the first mentioned injury.

Place     I    (a) Brain injury                                                                    S069

  9             (b) Fracture of skull                                                              S029

            II                                                                                           &X590

Code Fracture (circumstances unknown or unspecified), X590.

Place     I    (a) Fracture of hip                                                               S720

  9             (b) Crushing hip injury                                                         S770

            II                                                                                           &X599

Code Crushed (accidentally), X599.

Place     I    (a) Cerebral concussion and                                                  S060    S062

  9             (b) laceration of brain

            II                                                                                           &X599

Concussion is not indexed in External Cause Index. Code to Accident, unspecified, X599.

These generalizations do not apply if the place of occurrence of the injury was highway, street, road, or alley. Refer to instructions for transport accidents in Section V, Part J.

Implied site of injury

Relate most injuries of an unspecified site to a condition of a specified site, whether or not qualified as generalized, multiple, or stated plural, following general instructions for relating disease conditions.

Exceptions:

Do not relate

Injury(ies) (generalized) (internal) (multiple)

Trauma(s) (generalized) (internal) (multiple)

Wound(s) (generalized) (internal) (multiple)

Place     I    (a) Crushed skull with multiple fractures                                 S071    S029

9          II                                                                                           &X599

Code crushed skull followed by multiple skull fractures relating the injury of unspecified site to the site of the injury that is reported on the same line. Since there is no external cause reported, code Crushed (accidentally) as indexed in Part II.

Place     I    (a) Fractured neck and contusions                                         S129    S109

9          II                                                                                           &X590

Code fractured neck followed by neck contusion relating the injury of unspecified site to the site of the injury that is reported on the same line. Since there is no external cause reported, code Fracture (circumstances unknown or unspecified) as indexed in Part II.

Place     I    (a) Fracture of hip                                                               S720

  9             (b) Crushing injury                                                               S770

            II                                                                                           &X599

Code crushing injury hip since there is only one site reported either on the line above or below the fracture. Since there is no external cause reported, code Crushed (accidentally) as indexed in Part II.

Place     I    (a) Fracture of skull with generalized trauma                           S029    T07

9          II                                                                                           &X590

Code the generalized trauma as indexed. Do not relate to the site of the injury reported on the same line with it. Since there is no external cause reported, code Fracture (circumstances unknown or unspecified) as indexed in Part II.

Place     I    (a) Skull fracture                                                                  S029

  9             (b) Wound                                                                          T141

            II                                                                                           &X599

Code I(b) to Wound as indexed. Do not relate to the site of the fracture reported on the upper line. Since there is no external cause reported, code Wound (accidental) NEC, X599 as indexed in Part II.

E. Conditions qualified as traumatic

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:

a.  When they are qualified as “traumatic”

b.  Or they are reported on the certificate with:

•  Injury or trauma (any specified type or site)

•  An external cause

•  The Manner 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  &nnbsp;  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:

a.  Code emphysema, encephalitis, and meningitis to the nature of injury code only when they are stated to be "traumatic" or are reported due 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).

b.  Code the following terms to the traumatic category only 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.

c.  When the traumatic form of a condition is classified to Chapters I-XVIII, code as traumatic only 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.”

2.  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.

3.  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.

4. Traumatic hemorrhage (T148, T149)

                                                                                  

 Internal    1     Due to or on same line      Code the hemorrhage to T148,       

 hemorrhage        with injury (any site)      internal injury NOS                

 NOS                                                                              

                                                                                  

 Hemorrhage  2     Due to injury of a          Relate the hemorrhage to the       

 NOS               specified site              site of the specified injury       

                                                                                  

             3     Due to injury NOS or        Code the hemorrhage to T149,       

                   multiple injuries NOS       injury NOS                         

                                                                                  

             4     Due to injury of multiple   Relate the hemorrhage to site      

                   specified sites             of the first mentioned specified   

                                               injury                             

                                                                                  

             5     Due to internal injury      Code the hemorrhage to T148,       

                   NOS or internal injuries    internal injury NOS                

                   NOS                                                            

                                                                                  

             6     On same line with           Relate the hemorrhage to the       

                   injury of site              site of the specified injury       

                                                                                  

             7     On same line with           Code the hemorrhage to T149,       

                   injury of multiple          injury NOS                         

                   specified sites                                                

                                                                                  

             8     On same line with           Code the hemorrhage to T148,       

                   internal injury NOS or      internal injury NOS                

                   internal injuries NOS                                          

                                                                                  

             9     Due to and on same          Relate the hemorrhage to the       

                   line with injuries of        site of the injury that is entered 

                   different specified sites   on the same line with              

                                               hemorrhage                         

                                                                                  

 

                                                                                                                               Instruction

                                                                                                                               Number

 

Place     I   (a)     Internal hemorrhage                                    T148                                     1

   9            (b)     Crushed thorax                                            S280        

                 (c)    

            II                                                                             &X599

  

Place     I   (a)     Hemorrhage                                                S799                                     2

   9            (b)     Fracture of femur                                         S729        

                 (c)

            II                                                                             &X590     

 

Place     I   (a)     Hemorrhage                                                S299                                     2

   9            (b)     Laceration of chest                                       S219

                 (c)    

            II                                                                             &X599     

 

Place     I   (a)     Hemorrhage                                                T149

   9            (b)     Multiple injuries                                            T07                                     3

                 (c)

            II                                                                             &X599

 

Place     I   (a)     Hemorrhage                                                S299

   9            (b)     Injury of chest, lung and                              S299   S273   S223                4   

                 (c)     fractured rib                                               

            II                                                                             &X599

 

Place     I   (a)     Contusion chest with                                     S202   S299

   9            (b)     hemorrhage                                                                                            6

                 (c)

            II                                                                             &X599

 

Place     I   (a)     Laceration of liver, lung,                               S361   S273   S360   T149 

   9            (b)     & spleen with hemorrhage                                                                        7

                 (c)    

            II  Fracture rt. femur                                                 S729   &X599

 

Place     I   (a)     Cerebral contusion                                       S062

   9            (b)     with hemorrhage                                                                                     9

                 (c)     Injury of chest, lung, back                            S299   S273   S399  

            II                                                                             &X599     

 

F. Assumption of nature of injury code

When an external cause is reported on a certificate without a nature of injury code, assign both a nature of injury and an external cause code. Assume the nature of injury to be Injury NOS, T149 and place it preceding the external cause code.

Place     I    (a) Respiratory failure                                                          J969

  9             (b) Fire                                                                               T149    &X09

I(b) is an external cause code only. Since there is not a nature of injury reported on the certificate, code nature of injury T149 preceding the external code for fire.

Place     I    (a) Subarachnoid hemorrhage                                               I609

  9             (b) Stroke                                                                           I64

                 (c) Fall                                                                               T149    &W19

Do not code the hemorrhage on I(a) as traumatic since it is reported due to a nontraumatic condition. I(c) is an external cause code only and there is not a nature of injury reported on the certificate. Code nature of injury T149 preceding the external code for fall.

Place     I    (a) Struck by falling tree                                                       &W20

9          II  Head wound                                                                       S019

I(a) is an external cause code only. Since there is a nature of injury on the certificate, do not code T149 preceding the external code.

Place     I    (a) Struck by falling tree                                                       T149    &W20

9          II  Respiratory failure                                                               J969

I(a) is an external cause code only. Since there is not a nature of injury on the certificate, code T149 preceding the external code.

Exceptions:

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

2.  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.

3.  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.

4.  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

2.  Fracture of hips                                             S720

Fracture

- hip S720

3.  Multiple fractures of ribs                                 S224

Fracture

- rib

- - multiple S224

4.  Fractures of ribs                                            S223

Fracture

- rib S223

5.  Multiple wounds of lower limb                         T013

Wound

- limb

- - lower NEC

- - - multiple sites                                         T013

                                                                                 

 1. Multiple injuries    Followed by specified    Code T07 and the specified     

                         type(s) of injuries      injuries                       

                                                                                 

 2. Multiple injuries    Followed by specified    Code multiple injuries by      

                         site(s)                  site(s) only                   

                                                                                 

 3. Single site          Reported on same line    Code the specified types of    

                         with multiple types of   injuries of the reported site  

                         injuries                                                

                                                                                 

 4. 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

2. Place     I     (a) Multiple injuries - head, neck, chest                                       S097 S197 S297

     9

                II                                                                                                 &X599

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

     9               (b) of leg

                      (c) Fall from roof                                                                     &W13

4. 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.

2.  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.

3.  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 specified types 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

2.  When specified sites of injuries are reported, do not use Index entries of “specified type NEC” or “specified NEC”. Use only if indexed as “specified site NEC” or “specified part NEC.”

Place     I    (a) Fracture third cervical vertebra                                        S129

  9            (b) Fall                                                                               &W19

Indexed as:

Fracture

- vertebra T08

- - cervical (teardrop) S129

- - - specified NEC S122

 

Place     I    (a) GSW right side of neck                                                   S118    &W34

  9

Indexed as:

Wound

- neck S119

- - specified part NEC S118

J. Transportation accidents (V01-V99)

The main axis of classification for land transports (V01-V89) is the victim’s mode of transportation. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important for prevention purposes.

Definitions and examples relating to transport accidents are in Volume 1, Chapter XX. Refer to these definitions when any means of transportation (aircraft and spacecraft, watercraft, motor vehicle, railway, other road vehicle) is involved in causing death.

For classification purposes, a motor vehicle not otherwise specified is NOT equivalent to a car. Motor vehicle accidents where the type of vehicle is unspecified are classified to V87-V89.

A vehicle not otherwise specified is NOT equivalent to a motor vehicle unless the accident occurred on the street, highway, road(way), etc. Vehicle accidents where the type of vehicle is unspecified are classified to V87-V89.

Additional information about type of transports are given below

(1) Car (automobile) includes blazer, jeep, minivan, sport utility vehicle

(2) Pick-up truck or van includes ambulance, motor home, or truck (farm) (utility)

(3) Heavy transport vehicle includes armored car, dump truck, fire truck, panel truck, semi, tow truck, tractor trailer, 18-wheeler

(4) A special all-terrain vehicle (ATV) or motor vehicle designed primarily for off-road use includes dirt bike, dune buggy, four-wheeler, go cart, golf cart, race car, snowmobile, three-wheeler

(5) Motor vehicle includes passenger vehicle (private), street sweeper

1. Use of the Index and Tabular List

The Classification provides a Table of land transport accidents in Volume 3,

Section II. This table is referenced with any land transport accident if the mode of transport is known. Since the Index does not always provide a complete code, reference to Volume 1, Chapter XX is required.

For V01-V09, the fourth character indicates whether a pedestrian was injured in a nontraffic accident, traffic accident, or unspecified whether traffic or nontraffic accident.

For V10-V79, the fourth character represents the status of the victim, i.e., whether the decedent was driver, passenger, etc. For each means of transportation, there is a different set of fourth characters. Each means of transportation is preceded by its set of fourth characters in Volume 1.

•  Car overturned, killing driver V485

In the Index refer to:

Overturning

- transport vehicle NEC (see also Accident, transport) V89.9

Accident

- transport (involving injury to) (see also Table of land transport accidents) V99

In the Table of land transport accidents, select the intersection of:

Under Victim and mode of transport, select
Occupant of:

- car (automobile)

Under In collision with or involved in: select
Noncollision transport accident

The code is V48.-. From Volume 1 the fourth character is 5, driver injured in traffic accident.

•  Auto collision with animal V409

In the Index refer to:

Collision (accidental) NEC (see also Accident, transport) V89.9

Accident

- transport (involving injury to) (see also Table of land transport accidents) V99

In the Table of land transport accidents, select the intersection of:

Under Victim and mode of transport, select
Occupant of:

- car (automobile)

Under In collision with or involved in: select
Pedestrian or animal

The code is V40.-. From Volume 1, determine the fourth character is 9, unspecified car occupant injured in traffic accident.

2. Classifying accidents as traffic or nontraffic.

If an event is unspecified as to whether it is a traffic or nontraffic accident, it is assumed to be:

a.  A traffic accident when the event is classifiable to categories V02-V04, V10-V82 and V87.

b.  A nontraffic accident when the event is classifiable to categories V83-V86. These vehicles are designed primarily for off-road use.

c.  Consider category V05 to be unspecified whether traffic or nontraffic if no place is indicated or if the place is railroad (tracks).

d.  Consider category V05 to be traffic if place is railway crossing.

e.  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

a.  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.

b.  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).

c.  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

a.  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.

b.  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                                                               nbsp;                            &V892

  A

Accident

 

Street

 

Fell on curb as he was exiting his daughter’s vehicle

Refer to Table of land transport accidents under Victim and mode of transport. Select occupant of motor vehicle (traffic), noncollision transport accident (V892).

Place     I    (a) Head injury                                                                    S099

4

MOD     II                                                                                           &W17

  A

Accident

 

Street

 

Fell from parked car

Code as indexed under Fall, from, vehicle, stationary (W17).

5. Additional examples

            I    (a) Fractures of ribs                                                             S223

                 (b)

                 (c)

MOD     II                                                                                           &V234

  A

Accident

 

Driver of motorcycle that collided with parked taxicab

Code to motorcycle rider injured in collision with car, pick-up truck or van, driver (V234).

            I    (a) Third degree burns                                                         T303

                 (b) Auto accident - car overturned                                         &V489

                 (c)

Code to car occupant injured in noncollision transport accident, unspecified (V489).

            I    (a) Fracture of ribs                                                               S223

                 (b)

                 (c)

MOD     II                                                                                           &V892

  A

Accident

 

Street

 

Vehicle Accident

Code to person injured in unspecified motor vehicle accident, traffic (V892).   Code as motor vehicle accident since the accident occurred on the street.

            I    (a) Blunt force trauma                                                      T149 &V230

                 (b) Motorcycle accident in a field                                        

                 (c)

MOD     II                                                                                          

  A

Accident

 

Driver of motorcycle vs parked cars

Code to motorcycle rider injured in collision with car, pick-up truck or van, driver, nontraffic (V230).

6. Occupant of special all-terrain or other motor vehicle designed primarily for off-road use, injured in transport accident (V86)

This category includes accidents involving an occupant of any off-road vehicle. The fourth character indicates whether the decedent was injured in a nontraffic or traffic accident. Unless stated to the contrary, these accidents are assumed to be nontraffic.

            I    (a) Multiple injuries                                                              T07

                 (b) Driver of snowmobile that collided with auto                     &V860

Code to driver of all-terrain or other off-road motor vehicle injured in traffic accident since the collision occurred with an automobile.

            I    (a) Injuries of head                                                              S099

                 (b) Fracture both legs                                                          T025

                 (c) Driver of ATV                                                                 &V865

Code to driver of all-terrain or other off-road motor vehicle injured in nontraffic accident.

            I    (a) Head injuries                                                                  S099

                 (b) Overturning snowmobile                                                  &V869

Code to unspecified occupant of all-terrain or other off-road motor vehicle injured in nontraffic accident.

            I    (a) Fracture skull                                                                 S029

                 (b) ATV accident                                                                &V869

Code to unspecified occupant of all-terrain or other off-road motor vehicle injured in nontraffic accident (V869)

7. Scooter (motorized) vs Motor scooter

It is often hard to distinguish between when a scooter should be considered a pedestrian conveyance or a motorcycle.

In most cases, a scooter or motorized scooter refers to a motorized chair for people with immobility issues, code as a pedestrian conveyance. In instances where there is a scooter accident and POI is Home (with no other details provided) code to X599. However, if POI is street (with no other details provided) code to V099.

A motor scooter is a small motorcycle type vehicle, code to motorcycle.

            I    (a) Cardiopulmonary arrest                                                 I469

                 (b) Severe head injury                                                        S099

                 (c)

 

MOD     II                                                                                          &W18

  A

Accident

 

Home

 

Victim fell off of scooter

Code to fall, from, sitting height or position (W18). Code as pedestrian conveyance since scooter (motorized) is listed in Volume 1 under the definition (e) for pedestrian.

 

            I    (a) Multiple blunt force injuries                                           T07 &V299

                 (b) Motor scooter incident

                 (c)

 

MOD     II          

  A

Accident

 

Highway

 

Scooter incident

Code to motorcycle rider (any) injured in unspecified traffic accident (V299). Code as a motorcycle since motor scooter is listed in Volume 1 under definition (k) for motorcycle.

 

            I    (a) Injuries sustained in auto – motorized scooter collision                 T149 &V031

                 (b)

                 (c)

 

MOD     II    Chronic obstructive lung disease and generalized arteriosclerosis        J449 I709

  A

Accident

 

Street

 

Collision between automobile and motorized scooter, driver

Code to pedestrian injured in collision with car, pick-up truck or van (V031). Code as pedestrian conveyance since scooter (motorized) is listed in Volume 1 under the definition (e) for pedestrian.

 

            I    (a) Respiratory failure                                                        J969

                 (b) Pneumonia                                                                  J189

                 (c) Brain injury                                                                  S069

 

MOD     II     Scooter accident                                                              &V299

  A

Accident

 

Street

 

Moped crash

Code to motorcycle rider (any) injured in unspecified traffic accident (V299). Code as a motorcycle since moped is listed in Volume 1 under definition (k) for motorcycle.

 

 

PLACE I    (a) Scooter accident                                                          T149   &X599

  0            (b)

                (c)

MOD II

  A

 

Accident

 

home

Code to exposure to unspecified factor causing other and unspecified injury(X599). Code as pedestrian conveyance since scooter is listed in Volume 1 under definition(e) for pedestrian.

 

            I   (a) Scooter accident                                                         T149   &V099

                (b)

                (c)

MOD II

  A

 

Accident

 

street

Code to pedestrian injured in unspecified transport accident(V099). Code as pedestrian conveyance since scooter(motorized) is listed in Volume 1 under the definition(e) for pedestrian.Scooter accidents occurring on the street are assigned to a transport category.

8. Traffic accident of specified type but victim’s mode of transport unknown (V87)
Nontraffic accident of specified type but victim’s mode of transport unknown (V88)

a.  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

b.  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)

a.  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.

b.  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.

c.  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.

d.  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.

e.  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-

2.  Is a fire involved?

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

3.  Is machinery in operation involved?

YES:   See code categories W28 - W31.

4.  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.

5.  Is struck by a falling object involved?

YES:   See code categories W20 - W49

6.  Is a human stampede or pushed by a crowd involved?

YES:   Code W52

If none of the above, see code categories W00 - W19 for specific codes.

L. Natural and environmental factors

1. Lightning

Code X33 only when the decedent is injured from direct contact with lightning.

Code injuries, such as stroke or shock, due to direct contact with lightning to T750.

Code burn(s) due to lightning to burn(s) (T200-T289, T300-T319).

Place     I    (a) Shock                                                                            T750

  9             (b) Struck by lightning                                                         T750    &X33

Place     I    (a) Burns                                                                            T300

  0             (b) House fire                                                                      &X00

                 (c) House struck by lightning

When a secondary fire results from lightning, code to the fire. Do not enter a code for lightning.

2. Exposure, cold exposure and hypothermia

When exposure, cold exposure or hypothermia is reported anywhere on the record with another stated or implied external cause, code the nature of injury code (T68-T699, T758) and the E-code for the exposure, cold exposure or hypothermia (X599, X31). Do not modify the nature of injury code for exposure NOS. Ampersand the external cause code for the other event.

Place     I    (a) Exposure                                                                       T758    X599

  9             (b) Intoxication with hip fx                                                   T519    &X45  S720

            II                                                                                           X590

Place     I    (a) Hypothermia with drowning                                            T68      X31  T751  &W74

  9             (b)

                 (c)

Place     I    (a) Exposure                                                                       T758 X83

  4             (b)

                 (c)
MOD     II  Multiple fractures                                                                 T029 &X80

  S

Suicide

 

Jumped from bridge

 

 

Place     I    (a) Exposure to cold                                                            T699    X31

  9             (b)

                 (c)

            II  MVA                                                                                  &V892

Place     I    (a) Exposure and hypothermia                                              T758    X31  T68

  9             (b) Unconsciousness                                                            R402

                 (c)

MOD     II  Blunt trauma to head                                                           S099    &W18  T758

  A

Accident

 

Exposed to elements after falling and striking head


Place     I    (a) Hypothermia                                                                  T68      X31

  9             (b)

                 (c)

            II  Alcohol intoxication                                                             T519    &X45

3. Storms and Wildfires

Categories X30-X39 include deaths from direct effects of forces of nature.

General Guidelines

-  Use these categories for deaths resulting from direct effects of the storm.

-  Do not use these categories for deaths resulting from a second event, such as clean-up after a cataclysmic event.

-  When hurricane, storm, etc is reported, consider references to power failure, loss of power, lack of air conditioning, etc as part of the storm and not a subsequent accident.

-  Code wildfire as X01, Exposure to uncontrolled fire, not in building or structure

 

 Place    I    (a) Drowned                                                                        T751   &X37

   9            (b) Car which decedent was driving was washed

                 (c) away with bridge during hurricane

            II 

Code as victim of cataclysmic storm (X37). The drowning was a direct result of the hurricane.

 

 Place    I    (a) Suffocation                                                                     T71    &X36

   9            (b) Covered by landslide

                 (c)

Code as victim of avalanche, landslide and other earth movements (X36).

 

            I    (a) Ruptured diaphragm                                                        S278

                 (b) Driver of auto which struck                                               &V475

                 (c) landslide covering road

            II 

Code as car occupant injured in collision with fixed or stationary object, driver (V475).

 

 Place    I    (a) Acute respiratory failure                                                   J960

   9            (b) Severe emphysema                                                         T797

                 (c) Heat and loss of air conditioner power from hurricane         &X37

Code as death from hurricane (X37). Consider statement of loss of air conditioner power as part of the storm. The external cause code for storm is assigned where first reported on the record.

 

            I    (a) Fracture vertebra                                                            T08

                 (b) Contusion spinal cord                                                      T093

                 (c) Light pole accident                                                           &W20

            II   Working to restore power from hurricane

 

 

Accident

 

Light pole fell on him

Code as struck by falling object (W20). This is clearly a subsequent accident and not a direct impact of the storm.

 

 Place     I    (a) Smoke inhalation                                                           T598   &X01

   9             (b)

 MOD          (c)

   A        II   Wildfire

 

 

Accident

 

Wildfire

Code as wildfire (X01). Follow the Index as Exposure, fire, uncontrolled, not in building or structure.

 

 Place     I    (a) Thermal injuries and smoke inhalation                             T300   &X01   T598

   0             (b)

 MOD          (c)

   A        II   Multiple sclerosis                                                                G35

 

 

Accident

 

Home

 

Unable to leave home – overcome by wildfire

Code as wildfire (X01) since this house fire resulted from the wildfire. Follow the Index as Exposure, fire, uncontrolled, not in building or structure.

 

M. Firearms and firearm injuries

1. Coding specific types of firearms

The type of firearm involved in a death is identified at the three character level. Use the following guide to identify the type of firearm:

                                                                              

                                           Intentional           Undetermined 

 Type Firearm                  Accidental  Self-harm    Assault  Intent       

                                                                              

 Handgun                       W32         X72          X93      Y22          

 25 Caliber                                                                   

 32 Caliber                                                                   

 38 Caliber                                                                   

 45 Caliber                                                                   

 357 Magnum                                                                   

 380 Caliber                                                                  

 Pistol                                                                       

 Revolver Saturday night                                                      

   special                                                                    

                                                                              

 Rifle, shotgun, larger        W33         X73          X94      Y23          

 firearm                                                                      

 25.06 (25 ought 6)                                                           

 30.6 (30 ought 6)                                                            

 30/30                                                                        

 308                                                                          

 AK47                                                                         

 M1 (carbine)                                                                 

 M14                                                                          

 M16                                                                          

 Machine gun                                                                  

 Rifle (army) (hunting)                                                       

   (military)                                                                 

 Shotgun (8, 10, 12, 16, 20,                                                  

   410 gauge,                                                                 

   buckshot)                                                                  

                                                                              

 Other and unspecified         W34         X74          X95      Y24          

 firearms                                                                     

 9 mm                                                                         

 22 Caliber gun                                                               

 30 Caliber gun                                                               

 Airgun                                                                       

 BB gun                                                                       

 Pellet gun                                                                   

 Pellet pistol                                                                

 Pellet rifle                                                                 

 Very pistol (Flare)                                                          

                                                                              

 

2. External cause code

a.

                                                                        

 When reported as                   Code                                

                                                                        

 “playing with gun” NOS or          external cause as accidental (W32-  

 “cleaning gun” NOS                 W34)                                

                                                                        

 “playing Russian                   external cause as handgun accident  

 roulette” (whether or not stated   (W32)                               

 suicide)                                                               

                                                                        

 

Place     I    (a) Gunshot wound of femur                                                 S711    &W34

  9             (b) Cleaning gun                                                                  T141

Code as accidental since reported due to cleaning gun.

Place     I    (a) Gunshot wound chest                                                     S219    &W32

  9             (b)Self-inflicted while playing Russian roulette

MOD     II

  S

Suicide

Code as handgun accident since Russian roulette is reported.

3. Nature of injury code

a.

When           Is reported due to      Code

Injury NOS      any caliber            the nature of injury to wound

                bullet

                gun went off

                pulled trigger

                specified firearm

 

Place     I    (a) Injury                                                                            T141

  9             (b) Rifle                                                                              T141    &W33

b.

When reported as                                     Code

Gunshot or bullet entering and/or exiting a site     the nature of injury to wound of site(s)

 

Place     I    (a) Bullet entering chest &                                                    S219    &W34  S212

  9             (b) exiting back

c.

When reported as             Code

Bullet (to site)             the nature of injury to wound (of site(s))

Gunshot (to site)

Shoot, shooting, shot (to site)

Shotgun blast (to site)

 

Place     I    (a) Shot in head                                                                  S019    &W34

9

4. Other firearm examples

Place     I    (a) Gunshot wound chest                                                     S219    &Y24

  9             (b) Self-inflicted

Code as undetermined gunshot since self-inflicted is reported and is unspecified as accidental or intentional.

Place     I    (a) Gunshot injury chest                                                       S219    &W34  S273

  9             (b) and lung

Code the nature of injury to wound of sites and external code to accidental gunshot wound

N. Child abuse, battering and other maltreatment (Y070-Y079)

Code to Child battering and other maltreatment (Y070-Y079) if the age of the decedent is under 18 years and the cause of death meets one of the following criteria:

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

 

2.  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


3.  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

asphyxia

strangulation

suffocation

drowning

submersion

upper line T751 and the appropriate external cause code.

 

lower line T751

only.

 

Examples - Corresponding Table and Instruction 1.1

Place     I    (a) Asphyxia                                                                       T751    &W69

  8             (b) Drowning                                                                      T751

MOD          (c)

  A        II                                                                                           T751

 

Accident

 

Drowned while swimming in river

 

 

            I    (a) Asphyxia                                                                       T751    &V909

                 (b) Strangulation                                                                 T751

MOD          (c) Drowning                                                                      T751

  A        II                                                                                          

 

Accident

 

Lake

 

Boat Overturned

 

 

Place     I    (a) Anoxia                                                                          T751    &W70

  8             (b) Drowning                                                                      T751

MOD          (c)

  A        II

 

Accident

 

Fell into Lake

 

 

 

 

Instruction

When

Is reported on the same line with

Code

 2

anoxia

asphyxia

strangulation

suffocation

drowning

submersion

T751 and the appropriate external cause code.

 

Example - Corresponding Table and Instruction 1.2

 

Place     I    (a) Drowning - asphyxia                                                       T751    &W69

  8             (b)

MOD          (c)

  A        II

 

Accident

 

Pond

 

Table 2.      Hanging and mechanical strangulation (by external means)

 

Instruction

When

Is reported due to

Code

 1

 

 

 

asphyxia

strangulation

suffocation

hanging

mechanical strangulation

 (by external means)

compression of neck

upper line T71 and the appropriate external cause code.

 

lower line T71 only.

 

Examples - Corresponding Table and Instruction 2.1

Place     I    (a) Asphyxia                                                                       T71      &X70

  0             (b) Hanging                                                                        T71

MOD          (c)

  S        II

 

Suicide

 

Home

 

 

Place     I    (a) Aspiration of vomitus                                                      T179    W78

  0             (b) Strangulation                                                                 T71      &X70

MOD          (c) Hanging                                                                        T71

  S        II                                                                                           T71

 

Suicide

 

Home

 

Hanged Self

 

           

            I    (a) Asphyxia                                                                       T71      &V499

                 (b) Compression of neck                                                       T71

                 (c) Auto accident                                                                

            II

 

 

 

Instruction

When

Is reported on the record with

Code

 2

 

asphyxia

strangulation

suffocation

hanging

mechanical strangulation

 (by external means)

compression of neck

the asphyxia, strangulation, suffocation, T71 followed by the appropriate external cause code.

 

T71 only where the hanging, mechanical strangulation, compression of neck is reported.

 

Example - Corresponding Table and Instruction 2.2

Place     I    (a) Suffocation by hanging                                                   T71      &X70

  9             (b)

MOD          (c)

  S        II                                                                                           T71

 

Suicide

 

Hanging by neck

 

                   Male  1 month old

Place     I    (a) Suffocation                                                                    T71      &W75

  9             (b)

MOD          (c)

  A        II      

 

Accident

 

Co-sleeping with adults

 

 

 

Instruction

When

Is reported due to

Which is reported due to

Code

 3

 

asphyxia

strangulation

suffocation

asphyxia

strangulation

suffocation

the external means of the mechanical

strangulation

(such as: ligature, rope around neck, sheet )

uppermost line to T71 and the appropriate external cause code.

 

the next lower line to T71.

 

lower line blank.

 

Example - Corresponding Table and Instruction 2.3

Place     I    (a) Asphyxia                                                                       T71      &W75

  9             (b) Suffocation                                                                    T71

                 (c) Crib sheet                                                                     

            II

 

 

 

Instruction

When

Is reported due to

Code

 4

 

compression

 of neck

stricture of

 neck

hanging

mechanical strangulation

 (by external means)

suffocation

upper line T71 only.

 

lower line T71 and the appropriate external cause code.

 

Example - Corresponding Table and Instruction 2.4

Place     I    (a) Compression of neck                                                       T71

  9             (b) Hanging                                                                        T71      &X91

MOD          (c)

  H       II                                                                                           T71

 

Homicide

 

Hanging

 

 

 

Instruction

When

Is reported on the record with

Code

 5

 

compression
 of neck
stricture of
 neck

hanging
mechanical strangulation
 (by external means)
suffocation

compression of neck, stricture of neck to T71 only.

 

T71 followed by the appropriate external cause code for the hanging, mechanical strangulation, suffocation.

 

Example - Corresponding Table and Instruction 2.5

Place     I    (a) Compression of neck                                                       T71

  9             (b)

MOD          (c)

  H       II  Strangulation by cord around neck                                        T71      &X91

 

Homicide

 

 

 

Table 3.      Fires (includes burns, gases, fumes in association with burns and fires)

Instruction

When

Is reported due to

Code

1

asphyxia
suffocation

ingestion,
inhalation

of gas, fumes, or vapors
(carbon monoxide, products of combustion, smoke)

the asphyxia, suffocation to the nature of injury code for the gas, fumes, vapor and the appropriate external cause code for the fire where required.

lower line to the appropriate nature of injury code for the gas, fumes, vapor.


 with

 mention of a fire (specified)

 

Examples - Corresponding Table and Instruction 3.1

Place     I    (a) Suffocation                                                                    T599    &X00

  0             (b) Inhalation of products of combustion                                T599

MOD          (c)

  A        II                                                                                           T599

 

Accident

 

Inhaled fumes in house fire

 

Place     I    (a) Suffocation                                                                    T598    &X09

  9             (b) Smoke inhalation                                                            T598

MOD          (c) Fire

  A        II

 

Accident

 

 

 

Instruction

When

Is reported on the record with

Code

2

asphyxia
suffocation

ingestion,
inhalation

of gas, fumes, or vapors
(carbon monoxide, products of combustion, smoke)

the asphyxia, suffocation to the nature of injury code for the gas, fumes, vapor and the appropriate external cause code for the fire where required.

the appropriate nature of injury code for the gas, fumes, vapor where reported.


 with

 mention of a fire (specified)

 

Example - Corresponding Table and Instruction 3.2

Place     I    (a) Asphyxia - carbon monoxide                                           T58      &X00

  0             (b)

MOD          (c)

  A        II 

 

Accident

 

Home

 

House Fire

 

 

 

                                                                                     

 Instruction  When          Is reported due to      Code                             

                                                                                     

  3           asphyxia      burns NOS               upper line T300 and the          

              suffocation        (any degree)       appropriate external cause code  

                                 (any percentage)                                    

                                 (any site)         lower line as indexed.           

                                                                                     

 

Examples - Corresponding Table and Instruction 3.3

Place     I    (a) Asphyxia                                                                       T300    &X04

  0             (b) Burns of chest and face                                                   T210    T200

MOD          (c)

  A        II

 

Accident

 

Home

 

Ignition of kerosene

 

Place     I    (a) Suffocation                                                                    T300    &X00

  9             (b) 3° burns                                                                        T303

MOD          (c)

  A        II

 

Accident

 

Burning Bldg.

 

 

 

 

Instruction

When

 

Is reported due to

 

Code

 4

 

asphyxia

suffocation

fire NOS

specified fire

upper line T300 and the appropriate

external cause code.

 

lower line blank.

 

Instruction

When

Is reported on the record with

Code

 

5

asphyxia suffocation

fire NOS

specified fire

the asphyxia, suffocation T300, followed by the appropriate external cause code for the fire.

 

Example - Corresponding Table and Instruction 3.5

Place     I    (a) Asphyxia, fire in house                                                   T300    &X00

  0             (b)

                 (c)

            II

 

 

Table 4.      Ingestion, inhalation of gases, fumes, vapors (without fires, burns)

Instruction

When

Is reported due to

Code

1

asphyxia
suffocation

ingestion,
inhalation

of gas,
fumes,
or vapors

upper line to the appropriate nature of injury code for the gas, fumes, or vapor and the appropriate external cause code.

lower line to the appropriate nature of injury code for the gas, fumes, or vapor.

 

 

Example - Corresponding Table and Instruction 4.1

Place     I    (a) Asphyxia                                                                       T58      &X67

  0             (b) Inhalation of carbon monoxide                                        T58

MOD          (c)

  S        II                                                                                           T58

 

Suicide

 

Home

 

Inhaled car exhaust fumes in garage

 

Place     I    (a) Asphyxiation                                                                 T598    &X67

  8             (b) Plastic bag over head with helium infusion                        T598

MOD          (c)

  S        II                                                                                           T598

 

Suicide

 

Lot

 

Placed plastic bag over head. Tube from helium tank inserted under bag.

 

 

Instruction

When