23. Icd, Certification of Causes of Death (Mhs)

8/9/2019 23. Icd, Certification of Causes of Death (Mhs)

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30/04/10

ICD, CERTIFICATION OFCAUSES OF DEATH, AND

MEDICAL RECORD

LECTURE 23

H. Moch. Harris Suhamihardja, dr., MPH.



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Introduction

The development of public health, especially in the eld ofhealth management, health care, and research, broughtabout the need and opportunity to collect and compare largeamounts of data of high quality.

The use of ICD as the basic format has contributed to thecomparability between data collection systems.

Determination of disease-speci c death rates depends onaccurate completion of death certi cates. It is, therefore,essential that doctors completion the certi cation of deathcorrectly



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For individual doctors to be able to monitor the progress oftheir patients and to decide on the best treatment forparticular diseases, they need information (recordedexperiences) on ho the symptoms of former and present

patients have responded to the treatments given!"atients# medical records should provide information forboth purposes$ as communication vehicle for the healthpersonnel involved in the care of patients and as a source

of administrative data!%herefore, each hospital, clinic, outpatient department,and other health institution, needs to &eep ade'uatemedical records for all inpatients and outpatients



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eneral !earning "b#ective

To introduce to the students, $. the principles of the International

Classi cation of Diseases %ICD&, itsapplication, and the completion of

data.

'. the medical record as an essentialsource of data



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(peci c learning ob#ective )t the end of the lesson the student should be able to*

$. + plain the purpose of classifying diseases andcauses of death and discuss the problems encountered indoing so.

'. + plain the structure of ICD and its uses.. Discuss the problem in de ning cause of death, give the

de nition underlying cause of death/, and e plain its useand applications.

0. Complete correctly a certi cation of cause of death on aprescribed form, on the basis of a patient1s medical le.



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eneral principles of ICD ) classi cation of diseases may be de ned as a system of categories to

which morbid entities are assigned according to some establishedcriteria.

The anatomist, for e ample, may desire a classi cation based on the

part of the body a2ected, whereas the pathologist is primarily interestedin the nature of the disease process.

The public health practitioner would be more interested in the diseaseetiology, and the clinician in the particular manifestations requiring hiscare.

There are therefore many a es of classi cation, and the particular a isselected will depend on the interest of the investigator.


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statistical classification of disease and in ury ill depend,therefore, on the use to be made of the statistics to becompiled! d ustments must be made to meet the variedre'uirements of vital statistics offices, hospitals of differenttypes, medical services of the armed forces, socialinsurance organi*ations, sic&ness surveys, and numerousother agencies! +hile no single classification ill fit all the

speciali*ed needs, it should provide a common basis ofclassification for general statistical use$ that is storage ,retrieval , and tabulation of data!

statistical classification of disease must be confined to a

limited number of categories that encompass the entirerange of morbid conditions! %he categories should bechosen so that they ill facilitate the statistical study ofdisease phenomena!





The International Classi cation ofDisease

n order to ma&e accurate comparisons of morbidity/mortalitydata, specified for various diseases/causes of death, it isessential that a uniform classification is used throught the

orld! -uch a classification as introduced many years ago,and is &no n as the nternational .lassification of iseases( . )!

-ince its inception, it has been revised about once every 10years the latest revision as adopted by ! +orld2ealth ssembly in



- in previous revisions, the . is arranged in 1 mainchapters$

! nfectious and parasitic diseases ! eoplasms ! 5ndocrine, nutritional and metabolic diseases and

immunity disorders!6! iseases of the blood and blood forming organs

6! 7ental disorders 6 ! iseases of the nervous system and sense organs

6 ! iseases of the circulatory system 6 ! iseases of the respiratory system 8! iseases of the digestive system 8! iseases of the genitourinary system



8 ! .omplications of pregnancy, childbirth, and thepuerperium!

8 ! iseases of the s&in and subcutaneous tissue

8 ! iseases of the musculos&eletal system and connectivetissue!

8 6! .ongenital anomalies86! .ertain conditions originating in the perinatal period!

86 ! -ymptoms, signs, and ill9defined conditions86 ! n ury and poisoning



%here are t o supplementary classification $%he 5 code for classifying external causes of in uryand poisoning (for example, motor vehicle,accident, fall, fire)

%he 6 code for classifying reasons for contact ithmedical care and other factors influencing healthstatus, other than current diseases or in uries!

For single cause tabulation of the underlying causeof death, ho ever, the 5 code ould be used as theprimary code if, and only if, the morbid condition isclassifiable to .hapter 86 !





The coding system

%hree digits codes ranging from 001 to 00; are given to thedisease categories!

5xample$ 0 1 <abies

0 : 7umps

0 3 =rnithosis

-ome changes in classification in successive revisions have

left gaps in the numbering system! %hese gaps have beenleft unfilled in order to avoid unnecessary changes in codenumbers familiar to coders ho have been using earlierrevisions!



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fourth digit (after a decimal point) provides a greaterdetail, here necessary, ithin a three9digit category! %hefourth digit ill not normally need to be used in statisticaltabulations or reporting, but some sub9groups may beparticularly relevant in a particular country or in aparticular context, e!g!, a hospital diagnostic index

5xample$ 0 :!0 7umps orchitis

0 :!1 7umps meningitis

0 :!: 7umps encephalitis

=ptional fifth digit are provided in certain places, toindicate for example



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=ptional fifth digit are provided in certain places,to indicate for example$

9 mode of diagnosis in tuberculosis9 method of delivery in .hapter 8 (> .omplication of

pregnancy, childbirth and puerperium)9 anatomical sites in musculos&eletal system9 place of accident in the 5 code



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Cause of death

%he causes of death to be entered on the medicalcertificate of cause of death are$

“all those diseases, morbid conditions or injurieswhich either resulted in or contributed to death andthe circumstances of the accident or violence which

produced any such injuries”

%his definition does not include symptoms andmodes of dying, such as heart failure, asthenia, etc!



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3nderlying cause of death

%his is defined as $

(i) the disease or in ury that initiated the train of morbidevents leading directly to death

(ii) the circumstances of the accident or violence thatproduced the fatal in ury



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Certi cate of cause of death

The medical certi cate of death is designed toelicit the information that will facilitate theselection of the underlying cause of deathwhen two or more causes are #ointly recorded



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. ?-5 =F 5 %2 pproximatenterval bet een

onset and death

Disease or condition directlyleading to death*

Antecedent causes7orbid conditions! f any,giving rise to the abovecause, stating underlyingcondition last!

Other significant conditions.ontributing to the death butnot related to the disease orcondition causing it

(a ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !!Due to ( or as aconse"uence of

(b ##########!! Due to (or as

conse"uences of(c ###########

##########

###########!

!

!!

!!

!!

!!

nternational form of medical certificate of causes of death



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4+DIC)! 5+C"5D

Identi cation data 6ealth care institutions are comple organi7ationswith medical, nursing, technical, clerical and othersta2 caring for the patients. It is essential that theright treatment be given to the right person by theappropriate member of the treatment team.



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%o help ensure this, identification data for eachpatient should include, as a minimum$

9 document reference number ( henappropriate)

9 name9 sex

9 date of birth (d9 m9 y)9 place of birth (if &no n)9 home address



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Data needed for healthmanagement

%he data elements from the medical record re'uired fornational, regional and local records, include$

9 sex9 age9 marital status9 separation (final or discharge) diagnosis ( . codes)9 accident cause ( . code)9 operations ( ."7 code)9 number of days of stay in hospital (for inpatients)



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8alidation of data

ncorrect information in medical records could lead to falseconclusions hen it is used! %he information may beincorrect, either because it as incorrectly recorded, or

because it as incorrectly coded, either by mista&e orthrough lac& of &no ledge! For example, a cler&responsible for coding may not properly understand thedifference bet een a malignant and benign tumor andmay use the rong code, thus giving a false pictureconcerning the tumor in 'uestion!



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iagnoses may be validated by other healthor&ers revie ing a random sample of medical

records ithout reference to the reported final

diagnoses, and ma&ing their o n diagnosesbased on data in the record!

-imilarly, a coding cler& from another institution

might code the diagnoses given ithout referringto the codes already allotted!



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Con dentiality of medicaldata

9atients should be assured that personal and privateinformation given to the health wor:er will remaincon dential. It is desirable, therefore, for each country tohave laws that enforce this rights of the patients.

Con dential information should be given only to those whoneed to :now. !aws, or local regulations, should ensurethat con dentiality is maintained by all such personnel andprovide for penalties for misuse of con dential information.If a patient1s personal data need to be published in areport, the identifying information should be given incoded format, unless permission is granted by the patientto publish detailed identi cation data.



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!imitations of medicalrecords

1! %he information does not cover all episodes of illnessthat occur in the community

:! s source of morbidity data, medical records

understate the level of morbidity due to conditions thatare difficult to diagnose and categori*e

3! %he patient9related data is sub ect to vagaries in recall!



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5eference

(; !wanga < Cho =oo: Tye. Teaching 6ealth(tatistics*Twenty lesson and seminar outlines.

eneva* >orld 6ealth "rgani7ation. $?@A.

pp $ ?-$0B and pp $B -$@

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23. Icd, Certification of Causes of Death (Mhs)