verbal autopsy standards - WHO | World Health …. APPLYING ICD-10 TO VERBAL AUTOPSY 3.1 Objectives This verbal autopsy guide aims to assist staff who conduct verbal autopsies in applying

3. APPLYING ICD-10 TO VERBAL AUTOPSY

3.1 Objectives

This verbal autopsy guide aims to assist staff who conduct verbal autopsies in applying the

International statistical classification of diseases and related health problems, 10th revision (ICD-10)

rules to the diagnoses resulting from such an autopsy. The aim is to assist staff who: record

diagnoses on the standard certificate of death (certifiers), code the diagnoses (coders) and select

the cause of death (coders). This guide provides an overview of certification, coding and cause-

of-death assignment so that people working on only one aspect of the verbal autopsy procedure

will be able to understand all the steps involved. The use of this guide will ensure consistency in

verbal autopsy-based mortality statistics, and their comparability with other sources of cause-of-

death data that are coded to ICD-10. It incorporates questions and exercises aimed at acquainting

users with ICD-10 in order to help them avoid frequent pitfalls. The verbal autopsy guide,

contained in sections 3.2–3.8, should be used in conjunction with the three volumes of ICD-10.

The cause-of-death list for verbal autopsy with corresponding ICD-10 codes (the correspondence

table), in section 3.9 provides a list of verbal autopsy cause-of-death categories that are mapped

to broad three- and four-character ICD-10 categories; the correspondence table simplifies the

process of using ICD-10 for coding. It contains codes, some criteria that ensure categories are used

correctly and hints to help users avoid common mistakes. When sufficient information is

available to describe the cause of death in more detail than provided for by this table, the coder

should refer to the full ICD-10.

A separate field instruction manual must be individually compiled by those who plan to set

up a verbal autopsy project. Its content will depend largely on the local setting, and for any

particular project should describe:

• the process of verbal autopsy;

• the organization and workflow of the project;

• the collection of data;

• the use of separate interview questionnaires;

• instructions on interpreting data obtained from verbal autopsy interviews;

• the responsibilities and roles of all staff involved;

• quality assurance procedures; and

• local circumstances, such as who the contact people are, relevant telephone numbers, and

whether computers are available.

3.2 Overview

This section provides an overview on the use of mortality information, explains how such

information is usually collected by physicians and how this process differs in places where verbal

autopsy is used. It also discusses how standardization of classifications is relevant to allowing

comparability of data across peoples and over time. The instructions in this section show how to

apply these steps to the results of verbal autopsy.

3.2.1 Introduction to mortality information

In many areas of the world, a large proportion of the population has no access to health care

provided by medically qualified personnel. In these areas, health care is often provided by lay or

3. Applying ICD-10 to verbal autopsy

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paramedical personnel and is based on traditional methods or elementary medical training. In

these situations, the information on mortality that is needed to indicate the existence of a health

problem or to facilitate the management of health systems is provided by the same personnel.

Mortality information may be used to:

• develop information about epidemiology and prevention;

• manage health care;

• spend public money in the most useful way;

• compare health across different regions.

3.2.2 Sources of mortality information

Mortality information is collected using a process called “vital registration”. This describes how

a country collects information on the births and deaths of its people. This information is usually

gathered at a national centre that keeps a written record of all vital events (births and deaths) on

standardized forms.

Countries around the world have vital registration systems at different stages of development.

The proportion of vital events registered (coverage) and the detail and quality of the information

recorded vary between countries. In the development from having no system of registration to

one of full registration, a stepwise approach has proven useful.

• Sentinel registration is a system in which single diseases or groups of diseases are monitored

in samples of a population – for example, maternal mortality is measured in population

samples in urban and rural areas.

• Demographic surveillance systems are registration areas where registration practices for

births and deaths are developed, tested and validated.

• Sample registration systems register a nationally representative sample of the population

using established protocols for vital registration.

• Partial vital registration means that registration is expanded to full registration where the

necessary infrastructure exists – for example, in urban areas – and that sample registration is

maintained in other, mainly rural, sites.

• Full vital registration refers to a system in which at least 90% of a country’s deaths and

births are registered. Information collected during the registration of death includes age and

sex, the cause of death, the place of residence and the place of death.

3.2.3 Verbal autopsy

Verbal autopsy is a technique used to determine the cause of death by asking caregivers, friends

or family members about signs and symptoms exhibited by the deceased in the period before

death. This is usually done using a standardized questionnaire that collects details on signs,

symptoms, complaints and any medical history or events.

The cause of death, or the sequence of causes that led to death, are assigned based on the data

collected by this questionnaire and on any other available information. Rules and guidelines,

algorithms or computer programmes, may assist in evaluating the information.

The purpose of verbal autopsy is to describe the causes of death at the community level or

population level where no, or only limited, vital registration is completed with medical

certificates.


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3.2.4 The cause of death

Cause-of-death registration in the context of verbal autopsy aims to assign a single underlying

cause of death. It is essential to undertake four standard steps to identify the underlying cause of

death. In order to collect reliable and useful statistical information, each step must be performed

in a standard fashion.

The following sections provide the necessary detail on each of the four steps.

3.2.4.1 Step 1: Identify the cause of death

In places where doctors certify the cause of death directly, they do so by examining the body of

the deceased, interpreting medical records and other information, and/or performing an autopsy.

In situations where people die without seeing a doctor, and doctors do not have access to the

body, a verbal autopsy may be used to gather the information necessary to assign a cause of death.

3.2.4.2 Step 2: Certify the death

The conditions that led to death – the causes of death – are reported on the “international form

of the medical certificate for cause of death”.

If a verbal autopsy has been performed, the international form of the medical certificate for cause

of death is used. This allows standard ICD procedures to be used as early as possible in the process

of information collection. The person who identifies the diagnoses from the verbal autopsy is

personally responsible for recording the causes of death on a death certificate.

3.2.4.3 Step 3: Code the causes of death

The diagnoses reported on the certificate are coded. Coding means that a standard number is

assigned to represent a disease or cause of death. The code identifies the correct category in

ICD-10. ICD-10 provides rules and guidelines for assigning codes.

Assigning a code to a disease makes it possible to group similar causes of death. The coded data

can then be analysed regardless of the wording or language originally used for the certification

itself.

This coding may be done by a physician or a lay person who has received special training. In

either case good knowledge of ICD-10 codes is important. All coders should understand medical

terms and have some knowledge of how the human body works.

3.2.4.4 Step 4: Select the underlying cause of death

The rules for selecting the underlying cause of death have been defined by WHO in ICD-10. These

rules are used to identify the single underlying cause of death if there is more than one cause

reported on the death certificate.

These rules ensure that the selection process used is the same everywhere. When these rules are

followed, selection does not depend on an individual’s opinion, and the results (underlying cause

Continual training and considerable experience are essential to ensure that selection rules are

followed correctly.

In some deaths only a single cause of death is identified and reported on the death certificate. In

these cases, all that has to be done is to code this single cause.


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of death) can be compared at local, national or international levels.

In other cases, two or more causes of death may be identified and recorded on the certificate.

Where two or more causes are listed, the most relevant cause of death for coding and reporting

purposes is selected. This selected single cause is called the “underlying cause of death”.

Therefore, the underlying cause of death is the condition, event or circumstance without which

the patient would not have died.

WHO defines the underlying cause of death as: the disease or injury that initiated

the train of morbid events leading directly to death, or the circumstances of the

accident or violence that produced the fatal injury.

Example:

A cancer patient dies. The immediate cause of death was heart failure resulting from the

spread of the cancer. However, the original cancer site was in the breast. Thus, the

sequence would be: cancer (malignant neoplasm) that had spread, resulting in heart

failure.

In this example, heart failure was the final cause of death in the sequence that started with breast

cancer.

The breast cancer (malignant neoplasm) is the condition that should be coded as the underlying

cause of death.

3.3 Instructions

This section provides instructions for completing the four steps explained in section 3.2. In verbal

autopsy, the standard death certificate (Fig. 1) is often not filled in completely. However, this

standard certificate should always be used for verbal autopsy, so that the same rules as for medical

This section also provides a simplified description of ICD-10 coding guidelines and rules for

selecting the underlying cause of death. Coders will need specific training to correctly apply the

rules.

3.3.1 Assigning cause of death in verbal autopsy

The completed verbal autopsy questionnaire will contain information on diseases, signs and

symptoms, the age and sex of the deceased as well as his or her history and medical reports (if

available). This information is used to assign the causes that led to death.

3.3.1.1 Assigning diseases from signs and symptoms

The use of a standard set of diagnostic criteria ensures that the results of evaluation and selection

are determined in a standard fashion by staff involved in this step. This could be a physician or

a lay person who has been medically trained.

3.3.1.2 Diagnostic criteria (algorithms)

Diagnostic criteria may also be called algorithms. They describe which combination of symptoms,

duration and severity may lead to a specific diagnosis.

These diagnostic criteria are used to:

• provide guidance. Algorithms may be used to guide and support a physician’s decision-making

so that all of the relevant factors are taken into account when a diagnosis is made;


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certification can be followed in assigning the underlying cause of death.

• ensure stability of outcome. Algorithms help focus diagnostic possibilities on one or more

probable conditions and reduce the number of highly improbably ones.

Example:

From interview to diagnosis

The wife of a man who died 2 months ago is interviewed. She reports that he had

complained for some days of headache. He then had problems turning his head and

complained of neck pain.

She noticed that he felt increasingly hot to the touch, had chills and sweated heavily.

During his last days he was vomiting and was confused. He was tired and slept most of

the time.

The interviewer asked if the dead man had had an accident and whether he had hurt his

head during the weeks before he died. His wife reported that he had not fallen or had an

injury to his head.

The responses to the questionnaire would be evaluated using a set of criteria. After this,

one verbal autopsy category and one ICD-10 code would be assigned to the case. The

process for the example above is shown in Fig. 1.

FIG. 1. SAMPLE OF A DIAGNOSTIC ALGORITHM FOR IDENTIFYING THE DIAGNOSIS

“MENINGITIS”

Fever

Headache

Stiff neck

Neck pain

Vomiting

Confusion

DrowsinessNo fall or

injury to the

head

Some irritation of

meninges of brain

and spinal chordMost

probably

infectious

With

impairment of

brain function

Meningitis infectious serious VA-1.11; ICD G03

Nothing else

causing brain

impairment

No other frequent

similar cause

Diagnosis

Algorithms used to select one specific diagnosis during verbal autopsy may take into

account, for example, how frequently a disease occurs in a specific region. ICD-10 gives

one such example (see the note under code A09, chapter 1, volume 1).

Different sets of algorithms are in use. You need to identify which ones should be used in

your verbal autopsy project. Common agreement exists on some sets of criteria. These

criteria are included in the list at the end of Part 3.

3.3.1.3 Computers

Computers may be useful during the different steps of determining the cause of death. They may

make it easier to assign a diagnosis using information gathered during verbal autopsy; they may

assist in coding; and they may also be helpful in selecting the underlying cause of death if there

is more than one condition mentioned on the certificate.


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3.3.2 The international form of the medical certificate for cause of death

Death certificates are the main source of mortality data. A properly completed death certificate

shows clearly why and how the death occurred. The information gathered during verbal autopsy

may be used to assign one or more diagnoses to complete cause-of-death information and to fill

in the medical certificate of death.

In completing the certificate, the certifier should report any disease, abnormality, injury or

external cause that is believed to have contributed to the death. It is essential to note that modes

of death – such as respiratory failure, heart failure or brain death – should not be considered

causes of death.

The certificate has two parts (part I and part II) and a section to record the time interval between

the onset of each condition and the date of death.

FIG. 2. INTERNATIONAL FORM OF THE MEDICAL CERTIFICATE FOR CAUSE OF DEATH

INTERNATIONAL FORM OF MEDICAL CERTIFICATE OF DEATH

Cause of death

I

II

Disease or condition directly

leading to death *

Other significant conditions

contributing to the death, but

not related to the disease or

conditions causing it

Morbid conditions, if any,

giving rise to the above cause,

stating the underlying

condition last.

Antecedent causes

a)due to (or as a consequence of)

b)due to (or as a consequence of)

c)due to (or as a consequence of)

d)

Approximate

Interval between

onset and death

*This does not mean the mode of dying, e.g. heart failure, respiratory failure,

it means the disease, injury, or complication that caused death.

Part I is used to record diseases or conditions related to the sequence of events leading

directly to the death.

Part II is used to record conditions that have no direct connection with the events leading to

death but which, by their nature, contributed to the death.

3.3.2.1 Part I of the certificate

Part I of the certificate provides four lines on which the sequence of events leading to death are

recorded. This space is used for diseases that are related to the sequence of events leading directly

to death. The condition thought to be the underlying cause of death should appear on the

last completed line of part I.

The direct cause of death is entered on the first line, i.e. I(a). There must always be an entry on

line I(a). The entry on line I(a) may be the only condition reported in part I.

Where two or more conditions must be recorded, the sequence of events leading to death should

be entered. Each event in the sequence should be recorded on a separate line.


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There is an exception: two independent diseases may be occasionally thought to have contributed

equally to the sequence at a particular point. In such unusual circumstances they may be entered

on the same line.

The sequence of entries in part I is as follows:

• line (a) records the disease or condition directly leading to death;

• line (b) records other disease or condition, if any, leading to (a);

• line (c) records other disease or condition, if any, leading to (b); and

• line (d) records other disease or condition, if any, leading to (c).

The underlying cause of death is entered on the last line used.

The certifier should make every attempt to provide a clear sequence of events in part I.

If the cause of death is unknown even after investigation, it is acceptable to record “unknown”.

This is preferable to speculating about a cause of death.

3.3.2.2 Part II of the certificate

Part II is used to record conditions that have had no direct connection with the events leading

to death but which, by their nature, contributed to the death.

3.3.2.3 Reporting the duration of conditions

The duration of the disease or condition is the interval between the onset of each condition

entered on the certificate (not the time of the diagnosis of the condition) and the date of death;

the interval is recorded in the column to the right of the disease or condition.

The best estimate of the interval should be recorded when the time or date of onset is not known.

The unit of time should be entered for each diagnosis whether it is:

• years

• months

• days

• hours

• minutes or

• unknown.

In a correctly completed certificate, the duration entered on each line will not exceed the duration

entered for the condition on the line underneath (the condition that preceded it) since the causal

sequence requires that antecedent conditions are reported in reverse order of their occurrence.

On the form, this means conditions are reported in an ascending sequence (Fig. 3).

The information on duration is useful in coding certain diseases and also provides a check on the

accuracy of the reported sequence of conditions.


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FIG. 3. SAMPLE OF CERTIFICATE

INTERNATIONAL FORM OF MEDICAL CERTIFICATE OF DEATH

Cause of death

I

II

Disease or condition directly

leading to death *

Other significant conditions

contributing to the death, but

not related to the disease or

conditions causing it

Morbid conditions, if any,

giving rise to the above cause,

stating the underlying

condition last.

Antecedent causes

a)due to (or as a consequence of)

b)due to (or as a consequence of)

c)due to (or as a consequence of)

d)

Approximate

Interval between

onset and death

*This does not mean the mode of dying, e.g. heart failure, respiratory failure,

it means the disease, injury, or complication that caused death.

Pneumonia 2 weeks

Malnutrition

Diabetes

months

In this case malnutrition caused pneumonia. The pneumonia killed the person. The person also

had diabetes mellitus. Diabetes may have contributed to the death. It was not part of the sequence

of events that caused the deadly pneumonia.

3.3.2.4 The three “golden rules” of completing a certificate

The causes of death reported on a certificate provide the basis for coding and selecting the

underlying cause of death. Some well-known behaviours hamper the evaluation of certificates.

The “golden rules” address them all.

1. Write clearly and do not use abbreviations.

2. Always have an entry on line (a) of part I.

3. List all conditions in a causal sequence. The most recent condition – the

direct cause of death – should appear on the top line and the least recent

condition should appear on the bottom line.

3.4 Structure and principles of ICD-10

The ICD is an internationally agreed scheme used to code diseases in a standardized fashion. It

has been revised 10 times since its origins more than 100 years ago, so the current version is called

ICD-10.

This section is intended to be an introduction to the classification scheme. You are not expected

to become an ICD expert after reading it. You will learn how ICD is organized and how it works.

3.4.1 Overview of ICD-10 classification

In ICD-10 diseases and their causes are grouped for practical, epidemiological reasons as follows:

• communicable diseases

• general diseases that may affect the whole body

• localized diseases arranged by site


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• developmental diseases

• injuries

• external causes.

The ICD-10 has three volumes.

Volume 1: the list

• Volume 1 is the tabular list. It is an alphanumeric listing of diseases and disease groups. It

contains notes on inclusion and exclusion and some coding rules.

• It has 22 chapters and 11 400 categories enumerated to 4 characters. However, only the

1655, 3-character categories are relevant to coding a single underlying cause of mortality.

At the end of volume 1 there are five special tabulation lists. These are not designed

for coding; they are for tabulation only. They must not be used for coding or

reporting. The lists mentioned here should not be confused with the

correspondence table at the end of Part 3 of this manual, which shows the

correspondence between ICD-10 codes and those used in verbal autopsy.

Exercise:

Look up list number 1 in ICD-10 and identify differences between it and the correspondence table

at the end of this guide.

Volume 2: the manual

This provides an introduction to, and instructions on how to use, ICD-10.

• It also contains guidelines for certification and rules for mortality coding (that is, coding

causes of death).

• It contains guidelines for recording and coding morbidity (for example, for hospital

statistics).

• It also contains guidelines for tabulating statistical data and definitions (for example, for

“perinatal”).

Volume 3: index and guide

• This is an alphabetical index of the diseases and conditions found in the tabular list.

• It has a table of neoplasms.

• There is also a table of chemicals and drugs.

• There is a table of external causes.

• There is guidance on selecting appropriate codes for many conditions not displayed in the

tabular list.

Volume 1 and volume 3 are inseparable. Volumes 1 and 3 must be used together to find

codes to describe each case correctly (for example, the cause of death).


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3.4.2 The tabular list

ICD-10 has 22 chapters, each of which is identified by a Roman numeral. Chapters XIX (Injury,

poisoning and certain other consequences of external causes) and XXI (Factors influencing health

status and contact with health services) are not used for coding the underlying cause of death.

The full list of chapters is as follows.

Chapter Title Range of codes in

whole chapters

I Certain infectious and parasitic diseases A00–B99

II Neoplasms C00–D48

III Diseases of the blood and blood-forming organs and

certain disorders involving the immune mechanism

D50–D89

IV Endocrine, nutritional and metabolic diseases E00–E90

V Mental and behavioural disorders F00–F99

VI Diseases of the nervous system G00–G99

VII Diseases of the eye and adnexa H00–H59

VIII Diseases of the ear and mastoid process H60–H95

IX Diseases of the circulatory system I00–I99

X Diseases of the respiratory system J00–J99

XI Diseases of the digestive system K00–K93

XII Diseases of the skin and subcutaneous tissue L00–L99

XIII Diseases of the musculoskeletal system and connective

tissue

M00–M99

XIV Diseases of the genitourinary system N00–N99

XV Pregnancy, childbirth and the puerperium O00–O99

XVI Certain conditions originating in the perinatal period P00–P96

XVII Congenital malformations, deformations and

chromosomal abnormalities

Q00–Q99

XVIII Symptoms, signs and abnormal clinical and laboratory

findings, not elsewhere classified

R00–R99

XIX Injury, poisoning and certain other consequences of

external causes

S00–T99

XX External causes of morbidity and mortality V01–Y98

XXI Factors influencing health status and contact with health

services

Z00–Z99

XXII Codes for special purposes U00–U99a

a Only some categories in this chapter are used in mortality coding.

3.4.2.1 Blocks of related conditions in ICD-10

Each chapter is divided into blocks of related conditions. The blocks are further divided into

3-character and 4-character categories.


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Example:

Example of a block in chapter I

Viral hepatitis (B15–B19)

B15 Acute hepatitis A

B16 Acute hepatitis B

B17 Other acute viral hepatitis

B18 Chronic viral hepatitis

B19 Unspecified viral hepatitis

3.4.2.2 3-character categories or rubrics

Some 3-character categories are used only for single conditions. Others contain groups of diseases.

Example:

3-character category with a single disease

A71 Trachoma

Excludes: sequelae of trachoma (B94.0)

3-character category with a group of diseases

A75 Typhus fever

Excludes: rickettsiosis due to Ehrlichia sennetsu (A79.8)

A75.0 Epidemic louse-borne typhus fever due to Rickettsia prowazekii

Classical typhus (fever)

Epidemic (louse-borne) typhus

A75.1 Recrudescent typhus [Brill’s disease]

Brill-Zinsser disease

A75.2 Typhus fever due to Rickettsia typhi

Murine (flea-borne) typhus

A75.3 Typhus fever due to Rickettsia tsutsugamushi

Scrub (mite-borne) typhus

Tsutsugamushi fever

A75.9 Typhus fever, unspecified

Typhus (fever) NOS

3.4.2.3 4-character categories or rubrics

These 4-character categories are not mandatory for reporting at the international level but the

use of a fourth character adds detail and specificity to the coded data. The use of a fourth character

allows for as many as 10 subcategories.


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Example:

A01 Typhoid and paratyphoid fevers

A01.0 Typhoid fever

Infection due to Salmonella typhi

4-character categories

A01.1 Paratyphoid fever A

A01.2 Paratyphoid fever B

A01.3 Paratyphoid fever C

A01.4 Paratyphoid fever, unspecified

Infection due to Salmonella paratyphi NOS

3.4.2.4 Content structure

Most chapters are associated with particular body systems, special diseases or external factors.

The chapters on special diseases include conditions that are not found in the body-system

chapters even though they may be present in that body system. Conditions that are coded to a

special disease chapter take precedence over those that are coded to the body-system chapter.

Exercise:

Look at the titles of the chapters in ICD-10. The chapter titles indicate that the conditions included

are wide-ranging; therefore a large number of codes are required to cover all of the conditions.

Inclusion terms

Within the 3-character and 4-character rubrics, a number of other diagnostic terms, in addition

to the code title, are usually listed. These are known as “inclusion terms” and are given as examples

of diagnostic statements to be classified to that rubric. In essence, they reflect similar diseases that

may be coded to the same category or different words and terms used to describe the same disease.

Example:

A06 Amoebiasis

includes infection due to Entamoeba histolytica

The A06 category is further subdivided, and all conditions and inclusions in these subdivisions

may be coded with A06 too. This is the reason why you will always need ICD-10 and all its

subdivisions (blocks, categories) in order to code thoroughly: the fourth characters provide

additional useful specificity.

Exercise:

Look up the subdivisions of A06 in ICD-10 and see what else is included under that category.

Exclusion terms

Certain rubrics contain lists of conditions preceded by the word “excludes”. This means that the

excluded terms are to be coded elsewhere. The correct code that should be assigned is given in

parentheses following the term.

Example:

Category A06 Amoebiasis excludes other protozoal intestinal diseases mentioned under

A07.-, such as giardiasis and ascariasis (roundworm disease).


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If there is an exclusion term in a subdivision of A06, this exclusion would also be valid for A06.

Please note that exclusions also appear at the chapter level and block level, and these exclusions

are relevant to codes at the 3-character and 4-character levels.

Exercise:

Look up A06 and A04. Identify the exclusion terms.

3.4.2.5 Conventions of ICD-10

The ICD-10 tabular list (volume 1) and the alphabetical index (volume 3) make use of

abbreviations, punctuation marks, symbols and instructional terms that must be clearly

understood. These are referred to as “coding conventions”.

Dagger (†) and asterisk (*) codes

The dagger and asterisk conventions are not used when coding a single underlying cause of

mortality. A dagger code represents the etiology of the disease and must be used, where applicable.

The asterisk code is used to describe the manifestation of a disease, if desired. Asterisk codes must

not be used for coding the underlying cause of death in verbal autopsy.

Example:

B57.0† Acute Chagas’ disease with heart involvement (I41.2*, I98.1*)

Acute Chagas’ disease with:

• cardiovascular involvement NEC (I98.1*)

• myocarditis (I41.2*)

In this example there is a dagger next to B57.0. Codes with an asterisk are given in parentheses.

In verbal autopsy you would code B57.0 and ignore the codes with asterisks.

Not otherwise specified

NOS is an abbreviation for “not otherwise specified”; it implies that a cause is “unspecified” or

“unqualified”. Coders should be careful not to code a term as unqualified unless it is quite clear

that no other information is available that would permit a more specific code to be assigned from

elsewhere in the classification.

Example:

B50.0 Plasmodium falciparum malaria with cerebral complications

Cerebral malaria NOS

Not elsewhere classified

NEC stands for “not elsewhere classified”. This abbreviation serves as a warning that certain

specified types of the listed conditions may appear in other parts of the classification.

Example:

K73 Chronic hepatitis, not elsewhere classified

“Not elsewhere classified” is mentioned here because there are other categories in ICD-10

for specified chronic hepatitis, for example in chapter I:

B18 Chronic viral hepatitis


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Other conventions

There is a difference between parentheses “( )”and square brackets “[ ]”.

Parentheses enclose supplementary words that may follow a diagnostic term without changing

the code number to which the words outside the parentheses would be assigned.

Examples:

G11.1 Early-onset cerebellar ataxia

Friedrich’s ataxia (autosomal recessive)

Gonorrhoea (acute)(chronic) A54.9

Square brackets enclose synonyms, alternative words or explanatory phrases.

Examples:

A77 Spotted Fever [tick-borne rickettsioses]

B02 Zoster [herpes zoster]

When “and” is used in code titles in volume 1 it means “and/or”.

Example:

A18.4 Tuberculosis of skin and subcutaneous tissue

In this case, “tuberculosis of skin” and “tuberculosis of subcutaneous tissue” and

“tuberculosis of skin and subcutaneous tissue” can be coded to A18.4.

Certain postprocedural disorders should not be used to code the underlying cause

of mortality. They are E89.-, G97.-, H59.-, H95.-, I97.-, J95.-, K91.-, M96.-, N99.-.

Exercise:

Look up the postprocedural disorders listed above and see what the codes cover.

3.4.3 The alphabetical index

The alphabetical index contains more diagnostic terms than the tabular list.

Volume 3 is an alphabetical index of the tabular listing found in volume 1. It contains far more

diagnostic terms than the tabular list, reflecting the many and varied ways that doctors and other

clinical staff describe diseases.

By using the index, the coder can find a suggested code from a range of substitute terms. The

coder should then check the code against the tabular list to ensure there are no relevant notes or

conventions that might change the coding decision.

Volumes 1 and 3 must be used together to locate codes to describe accurately each clinical

case.

Coders should not fall into the trap of coding directly from the alphabetical index

or browsing the tabular list looking for a code that seems to fit the case being

assessed.

• Section I is an alphabetical listing of terms relating to diseases. It also incorporates a table of

neoplasms.

• Section II is an alphabetical listing of external causes of injury and poisoning.

• Section III is an alphabetically arranged table of drugs and chemicals.


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3.4.3.1 Index entries

Index entries consist of lead terms and of modifiers.

Lead terms (usually nouns) appear on the far left of each column in bold. They refer mainly to

the names of diseases or conditions. They describe either the patient’s actual pathological

condition or the reason for seeking medical attention.

Modifiers are found at different levels of indentation to the right. They usually refer to varieties

of diseases or external causes of death that affect coding. Modifiers might identify the site of the

condition (for example, leg), the stage of the condition (for example, acute or chronic) or the type

of consultation, problem or encounter. Modifiers need not be used for every statement. Modifiers

that do not affect code assignment appear in parentheses ( ) after the condition.

Examples:

Index term Lead term Modifier

Fracture of the spine fracture fracture spine (site of the condition)

Acute otitis media otitis otitis acute (stage of disease), media (site of

the condition)

Upper respiratory

infection

infection infection upper (site), respiratory (system

involved)

Blackwater fever

malaria

malaria blackwater fever (type of condition)

Congenital malaria malaria congenital (type of condition)

Acute gonorrhoea of

the cervix

gonorrhoea gonorrhoea acute (stage of disease), cervix

(site of the condition)

Septic embolism embolism embolism septic (nature of condition)

Note: In the index there are often many entries at each level of indentation. It is necessary to be careful

while following the trail of relevant entries for the diagnosis under each lead term.

Example:

Sample index

Malaise R53

Malakoplakia – see Malacoplakia

Malaria, malarial (fever) B54

– with

– – blackwater fever B50.8

– – – hemoglobinuric (bilious) B50.8

– – hemoglobinuria B50.8

– accidentally induced (therapeutically) –

see Malaria, by type

– algid B50.9

– cerebral B50.0† G94.8*

– clinically diagnosed (without

parasitological confirmation) B54

– complicating pregnancy, childbirth or

puerperium O98.6

– congenital NEC P37.4


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– – falciparum P37.3

– continued (fever) B50.9

– estivo-autumnal B50.9

– falciparum B50.9

– – with complications NEC B50.8

– – – cerebral B50.0† G94.8*

– – severe B50.8

– malariae (with) B52.9

Exercises:

Look up “haemochromatosis with refractory anaemia”.

Look up “breast cancer”.

Look up “car accident”.

Do you remember what square brackets mean?

What do you do with a † or an * in mortality coding?

3.4.4 Selecting the underlying cause of death

Once the causes of death have been assigned and reported on the international form of the

medical certificate for cause of death by clinicians, the certificate needs to be validated. First, the

sequence of events that led to death must be correct. “Sequence” refers to two or more conditions

entered on successive lines, each condition being an acceptable cause of the one entered on the

line above it.

• When only one cause of death is recorded, this cause is the underlying cause of death and is

used for tabulation.

• When more than one cause of death is recorded, the selection of the underlying cause should

be made in accordance with the rules outlined in this chapter.

Set of procedures – Selection starts with the “general principle” and a first set of rules. The

cause of death thus selected may then be modified by a second set of rules.

This manual provides a brief overview of these rules. In the rare cases when you may need to refer

to the rules during verbal autopsy, you may look up section 4.1 and 4.2 of volume 2. These

sections contain detailed explanation and examples.

Comparability – The rules ensure that the selection process is carried out the same way

everywhere and does not depend on an individual’s opinion. This makes the results comparable.

Several selection rules are meant to correct mistakes that certifiers may make while filling in the

death certificate.

3.4.4.1 The general principle

When more than one condition is entered on the certificate, the condition entered alone on the

last line used in part I should be selected but only if it could have given rise to all the conditions

entered above it.

Example:

I(a) Abscess of lung

I(b) Lobar pneumonia


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Select lobar pneumonia (J18.1) as the underlying cause since the lung abscess could have resulted

from lobar pneumonia.

3.4.4.2 Rule 1

If the general principle does not apply and there is a reported sequence terminating in the

condition first entered on the certificate – leftmost on line I(a) – select the cause of this

sequence on the last possible line. If there is more than one sequence, select the one that ends

with the first term on line I(a).

In other words, rule 1 applies when there is a reported sequence but the cause on the last line in

part I of the certificate does not explain all the diseases mentioned above it.

Example: I (a) Bronchopneumonia

(b) Cerebral infarction and hypertensive heart disease

Select cerebral infarction (I63.9). There are two reported sequences terminating in the

condition first entered on the certificate: bronchopneumonia due to cerebral

infarction and bronchopneumonia due to hypertensive heart disease. The originating

cause of the first-mentioned sequence is selected.

Example: I (a) Oesophageal varices and congestive heart failure

(b) Chronic rheumatic heart disease and cirrhosis of liver

Select cirrhosis of liver (K74.6). The sequence terminating in the condition first

entered on the certificate is oesophageal varices due to cirrhosis of liver.

Example: I (a) Acute myocardial infarction

(b) Atherosclerotic heart disease

(c) Influenza

Select atherosclerotic heart disease. The reported sequence terminating in the

condition first entered on the certificate is acute myocardial infarction due to

atherosclerotic heart disease. But modification rule C also applies.

Example: I (a) Pericarditis

(b) Uraemia and pneumonia

Select uraemia. There are two reported sequences terminating in the condition first

entered on the certificate: pericarditis due to uraemia and pericarditis due to

pneumonia. The originating cause of the first-mentioned sequence is selected. But

modification rule D also applies.

Example: I (a) Cerebral infarction and hypostatic pneumonia

(b) Hypertension and diabetes

(c) Atherosclerosis

Select atherosclerosis. There are two reported sequences terminating in the condition

first entered on the certificate: cerebral infarction due to hypertension due to

atherosclerosis, and cerebral infarction due to diabetes. The originating cause of the

first-mentioned sequence is selected. But modification rule C also applies.

If there is no logical sequence, rule 2 should be applied (see below).

3.4.4.3 Rule 2

If nothing is reported on the lower lines of the certificate that could explain the first-mentioned

condition – line I(a) – then select the condition on line I(a).

Example: I (a) Pernicious anaemia and gangrene of foot

(b) Atherosclerosis


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Select pernicious anaemia (D51.0). There is no reported sequence terminating in the

condition entered first.

Example: I (a) Rheumatic and atherosclerotic heart disease

Select rheumatic heart disease (I09.9). There is no reported sequence; both conditions

are on the same line.

Example: I (a) Fibrocystic disease of the pancreas

(b) Bronchitis and bronchiectasis

Select fibrocystic disease of the pancreas (E84.9). There is no reported sequence.

Example: I (a) Senility and hypostatic pneumonia

(b) Rheumatoid arthritis

Select senility. There is a reported sequence – hypostatic pneumonia due to

rheumatoid arthritis – but it does not terminate in the condition entered first on the

certificate. But modification rule A also applies.

Example: I (a) Bursitis and ulcerative colitis

Select bursitis. There is no reported sequence. But modification rule B also applies.

Example: I (a) Acute nephritis, scarlet fever

Select acute nephritis. There is no reported sequence. But rule 3 (see below) also

applies.

Some of the examples above contain a reference to an additional rule that also has to be applied.

Look up those rules and consider how they would modify the outcome of the selection.

3.4.4.4 Rule 3

If the condition selected by the general principle or by rule 1 or rule 2 is obviously a direct

consequence of another reported condition, whether in part I or part II, select the primary

condition. This means that in some cases there is a condition reported in part I or II of the form

that has not been selected using the general principle, rule 1 or rule 2 but which could have caused

the other conditions on the certificate. In these cases rule 3 is applied.

This rule is particularly tricky. The examples below are meant to provide guidance. The

information in volume 2, section 4.1.7 should be read carefully, and considerable experience is

needed to understand the rule. In verbal autopsy if a certificate has been completed properly you

will rarely need to apply rule 3.

Example: I (a) Kaposi’s sarcoma

II AIDS

Select HIV disease resulting in Kaposi’s sarcoma (B21.0).

Example: I (a) Cancer of ovary

II HIV disease

Select malignant neoplasm of ovary (C56).

Example: I (a) Tuberculosis

II HIV disease

Select HIV disease resulting in mycobacterial infection (B20.0).

Example: I (a) Cerebral toxoplasmosis and herpes zoster

(b) Burkitt’s lymphoma, HIV disease

Select HIV disease resulting in multiple diseases classified elsewhere (B22.7). Cerebral

toxoplasmosis, selected according to rule 2, could be considered a direct consequence

of HIV disease.


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Example: I (a) Bronchopneumonia

II Secondary anaemia and chronic lymphatic leukaemia

Select chronic lymphatic leukaemia (C91.1). Bronchopneumonia, selected by the

general principle (see rule 2, example of bursitis and ulcerative colitis), and secondary

anaemia can both be considered direct sequelae of chronic lymphatic leukaemia.

Example: I (a) Cerebral haemorrhage

(b) Hypertension

(c) Chronic pyelonephritis and prostatic obstruction

Select prostatic obstruction (N40). Chronic pyelonephritis, selected according to

rule l, can be considered a direct sequela of prostatic obstruction.

Example: I (a) Acute nephritis, scarlet fever

Select scarlet fever (A38). Acute nephritis, selected according to rule 2 (see example

below referring to hypostatic pneumonia and cerebral haemorrhage), can be

considered a direct sequela of scarlet fever.

Example: I (a) Nephrectomy

II Clear cell carcinoma of kidney

Select clear cell carcinoma of kidney (C64). There is no doubt that the nephrectomy

was performed for the malignant neoplasm of kidney.

Example: I (a) Acute anaemia

(b) Haematemesis

(c) Bleeding of oesophageal varices

(d) Portal hypertension

II Cirrhosis of liver

Select cirrhosis of liver (K74.6). Portal hypertension, selected according to the general

principle, can be considered a direct consequence of cirrhosis of liver.

Example: I (a) Hypostatic pneumonia

(b) Cerebral haemorrhage and cancer of breast

Select cerebral haemorrhage (I61.9). Hypostatic pneumonia, selected according

to rule 2, can be considered a direct sequela of either of the other conditions

reported; select the one mentioned first.

Example: I (a) Pulmonary infarction

II Left pneumonectomy for carcinoma of lung 3 weeks ago

Select carcinoma of lung (C34.9).

3.4.4.5 Rules for modification

In some cases the underlying cause that has been selected using the above rules is not the cause

that is the most useful or informative for public health or prevention purposes – for example,

senility, or a general disease process such as atherosclerosis.

In such cases modification rules may need to be applied after the general principle, rule 1, rule 2

and rule 3 have been applied.

There are six modification rules (A–F). Please note that this set of rules is particularly tricky. The

paragraphs below are meant to provide an idea of what the rules cover. The information in

volume 2, section 4.1.8 must be read carefully, and considerable experience is needed to

understand and apply the rules.


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Rule A: Senility and other “ill-defined” conditions

Where the selected cause of death is “ill defined” and another condition is reported on the

certificate, select the cause of death as if the ill-defined condition had not been reported.

Rule B: Trivial conditions

Where a serious condition is reported but the selected cause is a “trivial condition” (that is, a

condition unlikely to cause death), select the underlying cause as if the trivial condition had not

been reported.

Rule C: Linkage

ICD-10 provides a list of how to link some diseases in order to select the most relevant underlying

cause of death. You will find extensive explanation in sections 4.1.11 and 4.1.12 of volume 2.

Example:

I (a) Intestinal obstruction

(b) Femoral hernia

Code for femoral hernia with obstruction (K41.3).

Rule D: Specificity

Where the selected cause describes a disease in general terms, and a disease term that provides

more precise information about the site or nature of this condition is reported on the certificate,

prefer the more informative term. This rule often applies when the general term becomes an

adjective qualifying the more precise term.

Example:

I (a) Meningitis

(b) Tuberculosis

Code for tuberculous meningitis (A17.0). The certifier has stated that the meningitis was

due to tuberculosis.

Rule E: Early and late stages of disease

Where the selected cause is the early stage of a disease, and a more advanced stage of the same

disease is reported on the certificate, code for the more advanced stage.

This rule does not apply to a chronic form reported as being due to an acute form unless the

classification gives special instructions to that effect.

Example:

I (a) Tertiary syphilis

(b) Primary syphilis

Code for tertiary syphilis (A52.9).

Example:

I (a) Chronic nephritis

(b) Acute nephritis

Code for chronic nephritis, unspecified (N03.9), since special instruction is given to

this effect (see the following exercise).


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Exercise:

Look in volume 2 and try to find this instruction.

Rule F: Sequelae

This rule provides guidance on selection in cases where late damage from a disease (sequela) and

the causative disease (occurring a long time before death) are mentioned on the certificate.

Example:

I (a) Hydrocephalus

(b) Tuberculous meningitis

Code for sequelae of tuberculous meningitis (B90.0).

“Sequelae of” categories are as follows: B90, B94, E64, E68, G09, I69, O97, Y85 and Y89.

Exercise:

Look up these special categories in ICD-10 to become familiar with them.

3.5 Using the data

ICD-10 provides tabulation lists for mortality and morbidity in volume 1. Other professional

groups have made different lists for grouping diseases and presenting statistics. Regardless of the

list used, deaths should be classified by sex and into the following age groups: aged < 1 year, aged

1–4 years, and then in 5-year groups from age 5 years to 84 years, followed by a group for those

aged 85 years. Volume 2, section 5.6.1, contains a full set of instructions.

The purpose of verbal autopsy is to describe the causes of death at the community level or

population level in instances where no better alternative sources exist. Therefore, it is a limited

substitute for proper medical certification. The quality of information and of the diagnoses varies

depending on the skills of the interviewer and the memory of the respondents.

The “verbal autopsy causes of death list” is found in the two left-hand columns in the tabular list

at the end of this book. The verbal autopsy list is a core mortality classification system, specifying

some of the most important causes of death in low-income and middle-income countries. It may

be seen as the “lowest common denominator” that can be used to merge data from different verbal

autopsy projects. Coding diagnoses with ICD will facilitate the merging of data and the retention

of as much detail as needed in local settings.

Note: Never merge data collected from verbal autopsy with data from full vital

registration systems and medical certification (medical postmortem examination).

The way information is collected during verbal autopsy and the way in which a diagnosis is

assigned is different from the method used during medical certification. The certainty of the

diagnosis is much lower in verbal autopsy, and some diseases cannot be diagnosed. Merging data

from these two methods will hide differences that may result from these methods and lead to

misinterpretation of the results.

3.6 Confidentiality

The verbal autopsy procedure involves collecting and storing information that, if disclosed to

third parties, might cause harm or distress to the interviewee, friends or relatives of the deceased.

Investigators should arrange to protect the confidentiality of the people providing information


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by, for example, omitting information that might lead to the identification of individual

interviewees or by limiting access to the information or anonymizing data. During the process of

obtaining informed consent the investigator should let the prospective interviewee know about

the precautions that will be taken to protect confidentiality.

The investigator must establish robust safeguards to protect the confidentiality of

interviewees and the data provided by them. Interviewees should be informed of

the limits, legal or otherwise, to the investigator’s ability to safeguard

confidentiality and the possible consequences of breaches of confidentiality.

Prospective interviewees should be informed of the limits of the ability of investigators to ensure

strict confidentiality and of any foreseeable adverse social consequences of breaches of

confidentiality. Some jurisdictions require that deaths be reported to appropriate agencies.

Anything that limits the investigator’s ability to maintain confidentiality should be anticipated

and disclosed to prospective interviewees.

Ideally the interviewee should sign a locally relevant consent form based on these principles.

3.7 Additional sources of information

3.7.1 Changes and updates to ICD

As part of the updating process for ICD-10, addenda of changes and updates to the classification

are released annually. A copy of all of the updates made since 1996 is available at http://

www.who.int/classifications/en/.

3.7.2 Information on ICD

General information about the ICD can be found at http://www.who.int/classifications/icd/en/.

Volume 2 and a certification flyer are available on this page.

3.7.3 Decision tables

Decision tables to aid in selecting the underlying cause of death, and regular updates, can be

obtained from the United States Centers for Disease Control and Prevention’s National Center

for Health Statistics. The tables can be downloaded from http://www.cdc.gov/nchs/about/major/

dvs/im.htm.

3.7.4 An overview of training opportunities

The WHO Family of International Classifications (WHO–FIC) Education Committee has

compiled lists of experts and training facilities. The information can be accessed at http://

www.cdc.gov/nchs/about/otheract/icd9/nacc_ed_committee.htm.

Links to WHO’s regional offices can be found at http://www.who.int/about/regions/en/.

3.7.5 Mortality forum

The mortality forum of the WHO–FIC Network is an international discussion network that

examines problems experienced during ICD-10 mortality coding. Issues that cannot be resolved

in the forum are referred to the Mortality Reference Group. The tasks of the Mortality Reference

Group of the WHO–FIC Collaborating Centres include making decisions about applying and

interpreting ICD-10 as it relates to mortality and preparing proposals for updates or changes.

The mortality forum can be accessed at http://www.nordclass.uu.se/verksam/mortfore.


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3.8 ICD coding in verbal autopsy – special cases

Some causes of death deserve special attention during coding. These are either frequent causes

encountered during verbal autopsy or frequent combinations of causes of death. The cases

mentioned in this manual are not exhaustive.

3.8.1 Dealing with multiple causes

Verbal autopsy may lead to the identification of more than one cause of death, since different

diagnoses may be reported by relatives or mentioned in medical records.

Several categories of ICD-10 are designed to code relevant combinations of diseases, while in other

cases guidance is provided on how to select and report the most useful cause of death. It is

important to follow the coding rules, using ICD-10’s index and tabular lists as well as the rules

and conventions specified in volume 2, in order to locate the most useful codes.

Common examples

There is no classification rule that automatically gives HIV precedence over malaria or vice versa.

Whether the cause of death is classified as HIV or malaria depends on how the death certificate

has been completed.

Example:

Where there is a mention of HIV with malaria, code to B20.8.

Example:

The table below shows solutions to common coding problems.

Conditions Code

HIV and pneumonia B23.8 (if the agent causing the pneumonia is

unknown)

Hypertension and stroke I64

Hypertension in combination with acute

myocardial infarction or heart failure

I21

Hypertension and heart failure I11.0

Diabetes and stroke E14.6

Diabetes and hypertension Which code is used depends on the way the

certificate is completed: only one code will

be retained

Prematurity and/or low birth weight and

respiratory distress

P22.0

Diarrhoea and pneumonia A09

3.8.2 Other special cases

The conditions that may cause confusion during verbal autopsy are those presenting with

multiple diagnoses or sequelae, or both. Examples of conditions that may cause confusion are

stillbirths where there are known or unknown underlying maternal causes, and external causes

of injuries.


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The following conditions need special attention when information from verbal autopsies is

coded.

3.8.2.1 Malaria

ICD-10 codes may be used when malaria is the cause of death, but the nonspecific nature of the

disease and the lack of sufficient details derived during verbal autopsy may pose special difficulties

in assigning a code. Malaria that has been clinically diagnosed is coded B54.

Cerebral malaria is a special case in coding. The diagnosis is usually based on the exclusion of

other encephalopathies (for example, HIV/AIDS encephalopathy, hypoglycaemia,

meningoencephalitis, eclampsia, intoxication, head injury, cerebrovascular accidents, metabolic

disorders and other infections) and confirmation of the presence of malaria. In the absence of

detail on the verbal autopsy form that may help to confirm malaria or exclude other forms of

encephalitis, the physician’s knowledge, local experience and information about prevailing

epidemiology are used to carefully assess the information on the dead for diagnostic purposes.

In ICD-10, the classification “cerebral malaria” falls under the category of malaria caused by

Plasmodium falciparum: B50.0 (Plasmodium falciparum malaria with cerebral complications). Since

this level of detail (a blood slide that shows P. falciparum malaria species) is unlikely to be found

by verbal autopsy (or even in medical records), coding the diagnosis or cause of death as cerebral

malaria (and most other forms of malaria) cannot, strictly speaking, be done based on symptoms

and signs alone. The possible causes of deaths from malaria in verbal autopsy settings would

therefore be B54 (unspecified malaria) or B50.0 (P. falciparum malaria with cerebral

complications) only.

Thus, in verbal autopsy it is not possible to use the following codes for malaria: B51, B52, B53.0

and B53.1. These codes require specific information on Plasmodium, which cannot found during

verbal autopsy. As a result it may be appropriate to certify and code a death from cerebral malaria

in the absence of identification of P. falciparum as B50.0 (see example below).

Example:

B54 Unspecified malaria

Clinically diagnosed malaria without parasitological confirmation

B50.0 Plasmodium falciparum malaria with cerebral complications

Cerebral malaria NOS

In this example, the justification is “not otherwise specified” (NOS).

3.8.2.2 HIV

HIV and tuberculosis

In clinical practice, it may be difficult to differentiate between an HIV infection and tuberculosis

(TB). It is only possible to be certain about the diagnosis with evidence from HIV serology testing

and sputum smear testing for TB bacilli: a patient with symptoms and signs suggestive of HIV or

TB but who has a negative HIV serology test and a positive bacteriological sputum culture has TB

but not HIV. In many cases, the two conditions coexist, but it is difficult to determine which

condition is the underlying cause of death. With the limited information that comes from verbal

autopsy, this situation presents a problem that requires following agreed guidelines.

HIV disease may present with many complications and infections, each having its own unique

cause of death, from B20 (Human immunodeficiency virus [HIV] disease resulting in infectious

and parasitic diseases) to B24 (Unspecified human immunodeficiency virus [HIV] disease). Even


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though in ICD-10 the fourth character subcategories of B20–B23 are provided for optional use, it

is important to differentiate between TB with HIV and TB alone, when possible.

Diagnosing TB from verbal autopsy may present challenges. A definitive diagnosis of TB can be

made only in cases where an acid-fast bacillus smear identifies the disease, typically from sputum.

In developing countries, such information is rarely available in the medical records of the

deceased. When deciding whether TB is an appropriate diagnosis interpret the clinical signs and

the history with caution and try to find out whether the deceased:

• was sputum-positive for acid-fast bacillus;

• had a chest X-ray that suggested pulmonary tuberculosis;

• had been taking anti-TB drugs;

• had a history suggestive of TB, for example, a cough lasting longer than 1 month, wasting, or

prolonged fever (in cases in which the deceased had fevers it is difficult to differentiate between

TB and HIV disease).

Considering the public health importance of TB, and in order to maintain uniformity in assigning

causes of death, the following 4-character categories should be used for HIV disease with TB in

cases where neither the sequence can be identified nor a single cause be selected.

Example:

I (a) Tuberculosis

(b) HIV

(c) ---

(d) ----

II ----

Select B20.0, HIV disease resulting in mycobacterial infection.

Example:

I (a) Tuberculosis

(b) ---

(c) ---

(d) ----

II HIV

Select A16.9, Tuberculosis, NOS.

Using B22.0 for HIV and dementia

The B22.0 code for cause of death is used when there is a history of confusion, dementia and loss

of consciousness lasting more than 1 day or where there are other central nervous system

manifestations, such as stroke associated with HIV.

B22.0 HIV disease resulting in encephalopathy

HIV dementia

When there is a case of HIV disease with TB and central nervous system manifestations, B22.0

should be used for the immediate cause of death.

Using B20.7 for HIV and multiple infections

The B20.7 code for cause of death should be used where there is evidence of more than a single

infection occurring in a patient with HIV; these infections may include candidiasis, mycoses or

parasitic diseases.


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B20.7 HIV disease resulting in multiple infections

Using this code for cause of death when there is more than one infection helps to avoid assigning

several causes of death (one for each type of associated infection), builds uniformity and facilitates

a consensus among coders.

Where there is evidence of TB or other disease in addition to HIV, the cause of death B20.0 (HIV

with tuberculosis) is used. In cases of HIV disease where only one infection has been identified,

such as candidiasis, then the cause of death assigned is B20.4 “HIV resulting in candidiasis”. See

the next section for information about coding for Kaposi sarcoma.

Using B21.0 for HIV and Kaposi sarcoma

Where HIV presents with Kaposi sarcoma, this complication is not coded separately but is

included in the multiple infection category. In cases where Kaposi sarcoma is the sole

complication of HIV disease, then the appropriate ICD code is used (B21.0).

B21.0 HIV disease resulting in Kaposi’s sarcoma

This code is used because Kaposi sarcoma is multicentric and is regarded as a malignancy having

a viral infectious origin.

Guidelines for paediatric HIV

ICD-10 does not provide specific codes for classifying cause of death from HIV disease in children.

Due to difficulties in diagnosing HIV in children in clinical practice, let alone during verbal

autopsy, the following guidelines should be used to assign a cause of death in children who had

HIV disease.

HIV should be assigned as a cause of death in cases in which there were:

• clinical symptoms suggesting HIV disease in the child in the absence of other obvious causes

of immune suppression (for example, malnutrition);

• clinical symptoms suggesting HIV disease and a family and social history suggesting HIV (for

example, parental death due to HIV disease) including cases where the child’s mother was sick

at the time the child died; or

• clinical symptoms suggesting HIV disease and the attending physician had requested an HIV

test to confirm the diagnosis.

3.8.2.3 Maternal mortality

Given that maternal deaths are the most frequent cause of death among women of reproductive

age in most developing countries, it is important that those who certify and code deaths are clear

about what constitutes a maternal death, and what constitutes the direct and indirect causes of

the death. The definitions related to maternal deaths are provided in volume 2, section 5.8, of

ICD-10 and, for uniformity, should always be used.

A death is classified as a “maternal death” if a woman dies while she is pregnant or within 42 days

of terminating a pregnancy, irrespective of the duration or site of pregnancy; maternal deaths

may result from any cause related to pregnancy but not from accidental and incidental causes.

“Late maternal death” refers to a death occurring from 42 days to 1 year after the termination of

a pregnancy.

A “pregnancy-related death” is one that occurs during pregnancy or within 42 days of delivery,

irrespective of the cause of death.


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Maternal deaths may be either direct or indirect (that is, they may have either direct or indirect

causes). Direct causes are obstetric complications of pregnancy, labour and the puerperium.

Direct causes also refer to deaths occurring following pregnancy with haemorrhage; or deaths

from obstructed or prolonged labour, eclampsia, or sepsis; pregnancy with an abortive outcome

or multiple gestation; or occurring from complications of caesarean section.

Example:

Direct causes of maternal death

I (a) Haemorrhagic shock

(b) Ruptured uterus

(c) Obstructed labour

In this case, select “obstructed labour” as the underlying cause of death (O66.9; obstructed labour

unspecified).

Indirect causes of maternal death are those resulting from pre-existing disease or diseases that

developed during pregnancy but are not the direct result of an obstetric cause. Such diseases

include pre-existing hypertension, diabetes mellitus, heart disease, thromboembolism, anaemia,

malaria and TB.

Maternal deaths that arise from HIV disease (B20–B24) or from obstetrical tetanus (A34) are coded

in chapter 1 of ICD-10, and care should be taken to include them in the maternal mortality

rate. Thus, it is important to specify whether the numerator in the maternal mortality rate

includes direct or indirect causes, or both.

3.8.2.4 Stillbirth or fetal death

The term “stillbirth” or “fetal death” is used (not intrauterine fetal death), when the death is

recorded after the birth of a dead fetus and not while the fetus is in utero.

There is no difference in the cause of death between stillbirths recorded as “fresh” or “macerated”.

Where a fetal death or stillbirth can be attributed to a particular cause (for example, antepartum

haemorrhage, maternal infection, eclampsia), the cause of death recorded is “stillbirth” (fetal

death) due to whatever is the appropriate obstetric cause.

Where there is no identifiable cause for the stillbirth from the history, the appropriate cause of

death will be P95 “Stillbirth due to unspecified cause”.

3.8.2.5 Neonatal deaths

Neonatal deaths are those that occur among live-born infants during the first 28 completed days

of life. The certification of perinatal death normally requires information about both the mother

and the neonate.

Sometimes difficulties arise in distinguishing between stillbirth and neonatal death. If there is

evidence in the medical records of life after birth, with death occurring later, such a death is

classified as a neonatal death. In many cases it is difficult to ascertain from those being

interviewed whether the baby was alive after birth and died shortly thereafter or was stillborn.

This causes many neonatal deaths to be labelled as stillbirths.

If the neonatal death can be attributed to a particular cause, the cause of death should be classified

and recorded as “Neonatal death due to” whatever is the appropriate cause.


79

3.8.2.6 Diarrhoea

Some difficulties arise in differentiating noninfectious diarrhoea (K52.9) from diarrhoea and

gastroenteritis presumed to be of infectious origin (A09). The distinction is important because it

has major public health implications. Several sets of guidelines aimed at identifying specific

diseases, such as cholera, have been formulated and are mentioned in the manuals of individual

verbal autopsy tools.

3.8.2.7 External causes

The intent of an event that causes injury (such as a traffic accident, knife wound or punch) may

be accidental, intentional self-harm or intentional harm to others (assault). In cases in which the

intent remains unclear, the default means of describing the event is “accidental”. In cases where

thorough legal and medical enquiries have been made and no judgement about the intent was

reached, the conditions are coded as Y10–Y34 “undetermined intent”. The index for the external

causes in volume 3 allows the appropriate code to be found rapidly.

Completely different parts of the chapter on external causes may apply when coding for the

mechanism that finally kills a person who has been in contact with animals – for example, dying

as a result of encountering a snake may be coded in different ways:

Crushed by a snake code W59

Bitten by a venomous snake X20

Exercise:

Look up the blocks W50–W64 and X20–X29 and identify the differences between them.

In cases in which a mother or a child is injured and killed by an external cause, a code from

chapter XV (Pregnancy, childbirth and the puerperium) or chapter XVI (Certain conditions

originating in the perinatal period) may take priority for tabulating a single cause of death (see

example below).

Example:

Coding for the death of a mother and child

Hypothermia newborn P80.-

Adult: Exposure to excessive natural cold X31

Mother: Complication of anaesthesia O74.- or 89.-

Exercise:

Look up O74.- and O89.-. What is the difference between them?

3.8.2.8 More special cases

Convulsions

When convulsions occur in people living in malaria-endemic areas, especially when they occur

in children and have no apparent cause, many clinicians assign a diagnosis of R 56.0 (febrile

convulsions). During coding, “febrile convulsions” is not used to represent the cause of death

because this is a diagnosis of exclusion. Instead “convulsions” is used as the lead term. If the cause

of death is unknown or undetermined, the code used is R99 (undetermined cause of mortality)

rather than R69 (undetermined cause of morbidity).


80

Coding when only signs and symptoms have been recorded

ICD-10 allows diseases and health problems to be classified even in cases where only symptoms

and signs have been recorded without a definitive clinical diagnosis. When there is no definitive

diagnosis, the main symptom, abnormal finding or problem is selected to be the main condition.

Any presenting symptom (when the cause of death could not be determined) is used for coding

(for example, abdominal pain leading to unspecified disease). This process minimizes the number

of deaths that are classified as R99 (undetermined cause of mortality).

3.9 Correspondence table between short verbal autopsy list

and ICD-10 codes

WHO proposes that the list of categories presented in the following correspondence table be used

during verbal autopsy. This list is the result of analysing existing verbal autopsy systems. Current

individual verbal autopsy systems may use only a subset of the categories proposed below.

The correspondence table makes it possible to merge data from verbal autopsies on an

international scale, and allows the categories to be coded using ICD-10. Thus, the results of

different verbal autopsy systems may be compared with data from full vital registration and

medical certification systems.

Some diagnoses mentioned in the correspondence table cannot be assigned using information

gathered during the verbal autopsy interview, but they may be found in medical records or other

sources.

The correspondence table contains verbal autopsy categories and their related ICD-10 codes. It

has been designed to allow verbal autopsy categories to be used for coding as well as for tabulation.

When the information gathered through verbal autopsy allows for more detail than that given

on the standard verbal autopsy list, the person assigning codes should use the full ICD-10. The

correspondence table allows for fast and easy access to ICD-10. The hints (“Comments”) in the

right-hand column may help coders avoid several pitfalls.

If an ICD code with 4 characters is mentioned it means more detailed codes are available in

ICD-10. A code ending in “9” and mentioning “unspecified” can usually be used interchangeably

with the 3-character code.

If a 3-character category is mentioned alone, this means that ICD-10 cannot provide more detail

(unless the additional subdivisions of some chapters are used to code the site of a disease and

activity of an external cause). Volume 1 of ICD-10 should always be consulted to check whether

better alternatives exist.

The information in the correspondence table that is relevant to diagnosis should be tested and

updated as necessary by verbal autopsy projects in conjunction with WHO. The diagnostic

information may be included in questionnaires, algorithms or case descriptions, and it may be

useful to those who assign a diagnosis or design new diagnostic tools. The inclusion of diagnostic

information ensures that categories are used in the same fashion by all verbal autopsy projects.

The information relevant to diagnosis usually is of no relevance to those who assign a code or

select the underlying cause of death (that is, to coders).


81

Corresp

ondence table: cause

-of-death

list fo

r verbal auto

psy

with corresp

ondin

g b

road ICD-1

0 codes

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-01

Infe

ctio

us

an

d

para

siti

c d

isea

ses

Importa

nt diffe

rences fr

om

ICD-1

0

In I

CD

-10, m

enin

git

is i

s fo

un

d i

n c

hap

ter

I (C

erta

in

infe

ctio

us

an

d p

ara

siti

c d

isea

ses)

an

d i

n c

hap

ter

VI

(Dis

ease

s o

f th

e n

ervo

us

syst

em)

dep

end

ing o

n t

he

un

der

lyin

g i

nfe

ctio

n.

Acu

te r

esp

irato

ry i

nfe

ctio

ns

are

ass

ign

ed t

o c

hap

ter

X

(Dis

ease

s o

f th

e re

spir

ato

ry s

yst

em).

So

me

infe

ctio

us

dis

ease

s o

ccu

r as

a c

on

seq

uen

ce o

f

oth

er i

nfe

ctio

us

dis

ease

s. F

or

rele

van

t co

mb

inati

on

s

ther

e ex

ist

ap

pro

pri

ate

cate

go

ries

in

IC

D-1

0.

VA

-01.0

1In

test

inal

infe

ctio

us

dis

ease

s (i

ncl

ud

ing

dia

rrh

oea

l d

isea

ses)

A029

Salm

on

ella

in

fect

ion

, u

nsp

ecif

ied

Relevant in

form

ation

Incr

ease

d l

iqu

idit

y o

f st

oo

l fo

r <

3 w

eeks

Blo

od

in

sto

ol

Mu

cus

in s

too

l

Fev

er

Ab

do

min

al

pain

/ten

esm

us

Wei

gh

t lo

ss

Vo

mit

ing

A0

39

Sh

igel

losi

s, u

nsp

ecif

ied

A0

49

Bact

eria

l in

test

inal

infe

ctio

n,

un

spec

ifie

d

A0

59

Bact

eria

l fo

od

bo

rne

into

xic

ati

on

,

un

spec

ifie

d

A069

Am

oeb

iasi

s, u

nsp

ecif

ied

A0

79

Pro

tozo

al

inte

stin

al

dis

ease

,

un

spec

ifie

d

A084

Vir

al in

test

inal in

fect

ion

, u

nsp

ecif

ied

A0

9D

iarr

ho

ea a

nd

gast

roen

teri

tis

of

pre

sum

ed i

nfe

ctio

us

ori

gin

VA

-01

.02

Typ

ho

id a

nd

Para

typ

ho

idA

01

4P

ara

typ

ho

id f

ever

, u

nsp

ecif

ied

Dis

ease

s in

VA

-01

.02

may b

e ea

sily

co

nfu

sed

wit

h o

ther

dia

rrh

oea

l d

isea

ses”

in

VA

-01.0

.

Relevant in

form

ation

Sto

ols

lik

e “p

uré

ed p

eas”


82

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-01

.03

Tu

ber

culo

sis

A1

59

Res

pir

ato

ry t

ub

ercu

losi

s, u

nsp

ecif

ied

,

con

firm

ed b

act

erio

logic

all

y a

nd

his

tolo

gic

all

y

Ch

ron

ic d

isea

ses

freq

uen

tly h

ave

sim

ilar

featu

res

to

som

e ty

pes

of

can

cer;

fo

r ex

am

ple

, lu

ng c

an

cer

an

d

pu

lmo

nary

tu

ber

culo

sis

share

mo

st s

ign

s an

d

sym

pto

ms.

Th

is i

ncr

ease

s th

e ri

sk o

f m

iscl

ass

ific

ati

on

du

rin

g v

erb

al

au

top

sy f

or

such

case

s.A

16

9R

esp

irato

ry t

ub

ercu

losi

s, u

nsp

ecif

ied

,

wit

ho

ut m

enti

on

of b

act

erio

logic

al o

r

his

tolo

gic

al

con

firm

ati

on

A1

79

Tu

ber

culo

sis

of

ner

vo

us

syst

em,

un

spec

ifie

d

A1

89

A1

92

Acu

te m

ilia

ry t

ub

ercu

losi

s,

un

spec

ifie

d

A1

99

Mil

iary

tu

ber

culo

sis,

un

spec

ifie

d

VA

-01.0

4T

etan

us

(excl

ud

ing

teta

nu

s n

eon

ato

rum

)

A3

4O

bst

etri

cal

teta

nu

sN

eon

ata

l te

tan

us

(tet

an

us

of

the

new

bo

rn)

is a

ssig

ned

to V

A-1

0 T

he

sam

e gro

up

sh

ou

ld b

e u

sed

fo

r an

y o

ther

infe

ctio

n o

ccu

rrin

g i

n t

he

new

bo

rn.

A3

5O

ther

tet

an

us

VA

-01

.05

Per

tuss

is (

wh

oo

pin

g

cou

gh

)

A3

79

Wh

oo

pin

g c

ou

gh

, u

nsp

ecif

ied

VA

-01

.06

Art

hro

po

d-b

orn

e vir

al

fever

s an

d v

iral

haem

orr

hagic

fev

ers

A9

0D

engu

e fe

ver

(cl

ass

ical

den

gu

e)

A91

Den

gu

e h

aem

orr

hagic

fev

er

A9

29

Mo

squ

ito

-bo

rne

vir

al

fever

,

un

spec

ifie

d

A9

3O

ther

art

hro

po

d-b

orn

e vir

al

fever

s,

NE

C

A9

4U

nsp

ecif

ied

art

hro

po

d-b

orn

e vir

al

fever

s

A95

Yel

low

fev

er,

un

spec

ifie

d

A96

Are

navir

al

haem

orr

hagic

fev

er,

un

spec

ifie

d


83

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

A98

Oth

er s

pec

ifie

d v

iral

haem

orr

hagic

fever

s

A9

9U

nsp

ecif

ied

vir

al

haem

orr

hagic

fev

er

VA

-01

.07

Mea

sles

B0

59

Mea

sles

Mea

sles

NO

S

Relevant in

form

ation

Skin

rash

(m

acu

lop

ap

ula

r, s

tart

s o

n f

ace

an

d p

roce

eds

do

wn

ward

an

d o

utw

ard

s) r

equ

ired

fo

r d

iagn

osi

s

Fev

er,

hig

h-g

rad

e

Co

ugh

Red

, sw

oll

en e

yes

No

t vacc

inate

d a

gain

st m

easl

es

Ph

oto

ph

ob

ia

VA

-01

.08

Vir

al

hep

ati

tis

B1

59

Hep

ati

tis

AT

he

sign

s an

d s

ym

pto

ms

of

vir

al

hep

ati

tis

are

no

nsp

ecif

ic;

the

clin

ical

pic

ture

is

extr

emel

y v

ari

ab

le;

an

d, u

nle

ss f

ulm

inan

t d

isea

se d

evel

op

s, t

he

illn

ess

is

oft

en a

sym

pto

mati

c u

nti

l o

r u

nle

ss s

equ

elae

occ

ur.

If

inte

rvie

wee

men

tio

ns

that

the

dec

ease

d h

ad

a p

art

ner

wit

h h

epati

tis

B,

it m

ay h

elp

in

rea

chin

g a

dia

gn

osi

s.

B1

69

Acu

te h

epati

tis

B

B179

Oth

er s

pec

ifie

d a

cute

hep

ati

tis

B1

89

Ch

ron

ic v

iral

hep

ati

tis,

un

spec

ifie

d

B1

99

Un

spec

ifie

d v

iral

hep

ati

tis

VA

-01

.09

HIV

/AID

SB

20

9H

IV d

isea

se r

esu

ltin

g i

n u

nsp

ecif

ied

infe

ctio

us

or

para

siti

c d

isea

se

HIV

/AID

S m

ay c

au

se s

pec

ific

mali

gn

an

t tu

mo

urs

(fo

r

exam

ple

, K

ap

osi

sarc

om

a).

In

su

ch c

ase

s it

sh

ou

ld b

e

cod

ed h

ere

an

d i

n I

CD

-10 u

sin

g t

he

ap

pro

pri

ate

cate

go

ry u

nd

er B

21.

B219

HIV

dis

ease

res

ult

ing i

n u

nsp

ecif

ied

mali

gn

an

t n

eop

lasm

B2

27

Hu

man

im

mu

no

def

icie

ncy

vir

us

[HIV

] d

isea

se r

esu

ltin

g i

n m

ult

iple

dis

ease

s cl

ass

ifie

d e

lsew

her

e

B2

38

Hu

man

im

mu

no

def

icie

ncy

vir

us

[HIV

] d

isea

se r

esu

ltin

g i

n o

ther

spec

ifie

d c

on

dit

ion

s

B24

Un

spec

ifie

d h

um

an

imm

un

od

efic

ien

cy v

iru

s [H

IV]

dis

ease


84

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-01

.10

Mala

ria

B5

09

B5

0.0

B5

19

Pla

smodiu

m f

alc

iparu

m m

ala

ria,

un

spec

ifie

d

Cer

ebra

l m

ala

ria

Pla

smodiu

m v

ivax m

ala

ria

Relevant in

form

ation

Fev

er,

hig

h g

rad

e

Fev

er, o

n a

nd

off

Un

con

scio

usn

ess

Bla

ck u

rin

e

Co

nvu

lsio

ns

Lo

w u

rin

e o

utp

ut

Nau

sea

Sh

akin

g o

r ch

ills

B5

29

Pla

smodiu

m m

ala

riae

mala

ria

B5

38

Oth

er p

ara

sito

logic

all

y c

on

firm

ed

mala

ria

B5

4U

nsp

ecif

ied

mala

ria

VA

-01

.10

Lei

shm

an

iasi

sB

55

9Lei

shm

an

iasi

s, u

nsp

ecif

ied

VA

-01

.11

Men

ingit

isG

00

9B

act

eria

l m

enin

git

is,

un

spec

ifie

dO

ther

dis

ease

s o

f th

e b

rain

can

be

fou

nd

un

der

VA

-04

.03

an

d V

A-0

8.

Sev

eral

oth

er i

nfe

ctio

ns

may m

an

ifes

t w

ith

men

ingit

is

or

ence

ph

ali

tis,

bu

t in

th

ese

case

s th

e m

enti

on

of

the

infe

ctio

n i

s m

ore

sp

ecif

ic t

han

th

e m

enti

on

of

men

ingit

is.

Fo

r a d

etail

ed l

ist

of

such

dis

ease

s se

e th

e

“d

agger

co

des

” (

†)

men

tio

ned

in

IC

D-1

0 u

nd

er G

02

*

an

d G

05

*.

Relevant in

form

ation

Hea

dach

e

Sti

ff n

eck

Nec

k p

ain

Fev

er

Vo

mit

ing

Co

nfu

sio

n

Dro

wsi

nes

s

No

fall

or

inju

ry t

o t

he

hea

d

G0

39

Men

ingit

is d

ue

to o

ther

an

d

un

spec

ifie

d c

au

ses

G0

49

En

cep

hali

tis,

myel

itis

an

d

ence

ph

alo

myel

itis

, u

nsp

ecif

ied

VA

-01

.12

Infl

uen

zaJ0

9In

flu

enza

du

e to

id

enti

fied

avia

n

infl

uen

za v

iru

s

J109

Infl

uen

za d

ue

to o

ther

id

enti

fied

infl

uen

za v

iru

s


85

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

J11

9In

flu

enza

, vir

us

no

t id

enti

fied

VA

-01

.13

Acu

te l

ow

er r

esp

irato

ry

infe

ctio

ns

(in

clu

din

g

pn

eum

on

ia a

nd

acu

te

bro

nch

itis

)

J12

9V

iral

pn

eum

on

ia,

un

spec

ifie

dO

ther

res

pir

ato

ry i

nfe

ctio

ns

are

men

tio

ned

un

der

VA

-05

.02

.

Relevant in

form

ation

Co

ugh

fo

r <

3 w

eeks

Fev

er

Dysp

no

ea <

3 w

eeks

Incr

ease

d s

pu

tum

pro

du

ctio

n <

3 w

eeks

Pu

rule

nt

spu

tum

< 3

wee

ks

Ch

est

pain

Oed

ema

J15

9B

act

eria

l p

neu

mo

nia

, u

nsp

ecif

ied

J18

0B

ron

cho

pn

eum

on

ia,

un

spec

ifie

d

J181

Lo

bar

pn

eum

on

ia,

un

spec

ifie

d

J18

2H

yp

ost

ati

c p

neu

mo

nia

, u

nsp

ecif

ied

J18

9P

neu

mo

nia

, u

nsp

ecif

ied

VA

-01

.98

Oth

er s

pec

ifie

d i

nfe

ctio

us

an

d p

ara

siti

c d

isea

ses

B8

89

Infe

stati

on

, u

nsp

ecif

ied

VA

-01

.99

Infe

ctio

us

dis

ease

s,

un

spec

ifie

d

B9

9O

ther

an

d u

nsp

ecif

ied

in

fect

iou

s

dis

ease

s

VA

-02

Neo

pla

sms

VA

-02

.01

Mali

gn

an

t n

eop

lasm

of

lip

, o

ral

cavit

y a

nd

ph

ary

nx

C00

2M

ali

gn

an

t n

eop

lasm

: ex

tern

al

lip

,

un

spec

ifie

d

Th

e sp

ecif

ic a

spec

ts t

o t

ake

into

acc

ou

nt

wh

en c

od

ing

neo

pla

sms

are

:

•th

e si

te o

f th

e tu

mo

ur

•th

e b

ehavio

ur

of

the

tum

ou

r.

A t

ab

le o

f n

eop

lasm

s is

in

clu

ded

in

vo

lum

e 3

of IC

D-1

0.

It c

on

tain

s th

e co

des

fo

r ea

ch a

nato

mic

al

site

of

tum

ou

r. F

or

each

sit

e, t

her

e are

fiv

e p

oss

ible

co

de

nu

mb

ers

div

ided

acc

ord

ing t

o t

he

beh

avio

ur

of

the

tum

ou

r.

If t

he

dia

gn

osi

s yo

u a

re c

od

ing d

oes

no

t all

ow

th

e

beh

avio

ur

of

the

tum

ou

r to

be

des

crib

ed,

yo

u s

ho

uld

loo

k u

p t

he

mo

rph

olo

gy d

escr

ipti

on

. It

wil

l p

rovid

e

gu

idan

ce a

s to

ho

w t

he

tum

ou

r sh

ou

ld b

e co

ded

(fo

r

exam

ple

, “M

eso

nep

hro

ma -

see

Neo

pla

sm,

C00

5M

ali

gn

an

t n

eop

lasm

: li

p,

un

spec

ifie

d,

inn

er a

spec

t

C009

Mali

gn

an

t n

eop

lasm

: li

p, u

nsp

ecif

ied

C02

9M

ali

gn

an

t n

eop

lasm

: to

ngu

e,

un

spec

ifie

d

C03

9M

ali

gn

an

t n

eop

lasm

: gu

m,

un

spec

ifie

d

C04

9M

ali

gn

an

t n

eop

lasm

: fl

oo

r o

f m

ou

th,

un

spec

ifie

d

C05

9M

ali

gn

an

t n

eop

lasm

: p

ala

te,

un

spec

ifie

d


86

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

C06

9M

ali

gn

an

t n

eop

lasm

: m

ou

th,

un

spec

ifie

d

mali

gn

an

t”).

Yo

u w

ou

ld t

her

efo

re u

se t

he

cod

e fo

r

mali

gn

an

t p

rim

ary

tu

mo

ur

or

mali

gn

an

t se

con

dary

tum

ou

r, d

epen

din

g o

n t

he

dia

gn

osi

s.

Du

rin

g v

erb

al au

top

sy, in

form

ati

on

ab

ou

t m

orp

ho

logy

is u

nli

kel

y t

o b

e avail

ab

le.

In t

his

case

yo

u m

ust

ass

ign

the

cod

e fo

r “u

nce

rtain

or

un

kn

ow

n” b

ehavio

ur

for

the

spec

ifie

d s

ite.

If y

ou

kn

ow

th

e tu

mo

ur

was

mali

gn

an

t an

d y

ou

can

no

t

esta

bli

sh a

sit

e, u

se c

od

e C

80

.

If y

ou

kn

ow

nei

ther

th

e b

ehavio

ur

no

r th

e si

te t

hen

cod

e D

48

.9, “N

eop

lasm

of

un

cert

ain

or

un

kn

ow

n

beh

avio

ur,

un

spec

ifie

d”.

So

me

tum

ou

rs m

ay lo

ok lik

e co

ngen

ital m

alf

orm

ati

on

s.

So

me

typ

ical si

gn

s o

f tu

mo

urs

are

: gro

wth

or

chan

ge

in

the

ap

pea

ran

ce o

f th

e tu

mo

ur

an

d w

eigh

t lo

ss.

HIV

/AID

S c

an

cau

se s

pec

ific

mali

gn

an

t tu

mo

urs

, (f

or

exam

ple

, K

ap

osi

sarc

om

a).

In

su

ch a

case

it

sho

uld

be

cod

ed t

o V

A-1

.8 a

nd

in

IC

D-1

0 t

o t

he

ap

pro

pri

ate

cate

go

ry u

nd

er B

21.

C0

89

Mali

gn

an

t n

eop

lasm

: m

ajo

r sa

livary

gla

nd

, u

nsp

ecif

ied

C09

9M

ali

gn

an

t n

eop

lasm

: to

nsi

l,

un

spec

ifie

d

C10

9M

ali

gn

an

t n

eop

lasm

: o

rop

hary

nx

,

un

spec

ifie

d

C1

19

Mali

gn

an

t n

eop

lasm

: n

aso

ph

ary

nx,

un

spec

ifie

d

C13

9M

ali

gn

an

t n

eop

lasm

: h

yp

op

hary

nx,

un

spec

ifie

d

C14

0M

ali

gn

an

t n

eop

lasm

: p

hary

nx,

un

spec

ifie

d

VA

-02

.02

Mali

gn

an

t n

eop

lasm

of

oes

op

hagu

s

C15

9M

ali

gn

an

t n

eop

lasm

: o

eso

ph

agu

s,

un

spec

ifie

d

Relevant in

form

ation

Dif

ficu

lty s

wall

ow

ing s

oli

d f

oo

d

Wei

gh

t lo

ss

Ho

ars

enes

s

Fati

gu

e

VA

-02

.03

Mali

gn

an

t n

eop

lasm

of

sto

mach

C1

65

Mali

gn

an

t n

eop

lasm

: le

sser

cu

rvatu

re

of

sto

mach

, u

nsp

ecif

ied

Relevant in

form

ation

Mass

in

up

per

ab

do

men


87

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

Pain

in

up

per

ab

do

men

> 3

wee

ks

Wei

gh

t lo

ss

Vo

mit

ing a

fter

eati

ng >

3 w

eeks

Earl

y s

ati

ety

Fati

gu

e

C16

6M

ali

gn

an

t n

eop

lasm

: gre

ate

r

curv

atu

re o

f st

om

ach

, u

nsp

ecif

ied

C16

9M

ali

gn

an

t n

eop

lasm

: st

om

ach

,

un

spec

ifie

d

VA

-02

.04

Mali

gn

an

t n

eop

lasm

of

small

an

d l

arg

e in

test

ine

C17

9M

ali

gn

an

t n

eop

lasm

: sm

all

in

test

ine,

un

spec

ifie

d

Relevant in

form

ation

Mass

in

ab

do

men

Dif

ficu

lty p

ass

ing s

too

l >

3 w

eeks

Ch

an

ges

in

bo

wel

hab

its

Incr

ease

d l

iqu

idit

y (

or

freq

uen

cy >

3 t

imes

a d

ay)

of

sto

ol

for

> 3

wee

ks

alt

ern

ate

s w

ith

co

nst

ipati

on

Bla

ck t

arr

y s

too

ls

Red

blo

od

in

sto

ol

Wei

gh

t lo

ss

Ab

do

min

al

pain

(co

lick

y)

Pale

nes

s

Fati

gu

e

C18

9M

ali

gn

an

t n

eop

lasm

: co

lon

,

un

spec

ifie

d

VA

-02

.05

Mali

gn

an

t n

eop

lasm

of

rect

um

an

d a

nu

s

C19

Mali

gn

an

t n

eop

lasm

of

rect

osi

gm

oid

jun

ctio

n

C20

Mali

gn

an

t n

eop

lasm

of

rect

um

C21

0M

ali

gn

an

t n

eop

lasm

: an

us,

un

spec

ifie

d

Relevant in

form

ation

Per

sist

ent

an

al

ulc

erati

on

An

al

mass

An

al

pain

Dif

ficu

lty p

ass

ing s

too

l >

3 w

eeks

Wei

gh

t lo

ss


88

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-02

.06

Mali

gn

an

t n

eop

lasm

of

liver

an

d h

epati

c d

uct

C22

9M

ali

gn

an

t n

eop

lasm

: li

ver

,

un

spec

ifie

d

Relevant in

form

ation

Mass

in

ab

do

men

(u

pp

er a

bd

om

en)

Mass

in

ab

do

men

gro

win

g q

uic

kly

(u

pp

er a

bd

om

en)

Ab

do

min

al

pain

(le

ft q

uad

ran

t),

sever

e, p

erm

an

ent

Asc

ites

Wei

gh

t lo

ss

Fati

gu

e

Yel

low

eyes

Yell

ow

skin

Itch

y s

kin

Pain

(ri

gh

t u

pp

er a

bd

om

en,

rad

iati

ng t

o t

he

back

)

VA

-02

.07

Mali

gn

an

t n

eop

lasm

of

trach

ea,

bro

nch

us

an

d

lun

g

C33

C34

9

Mali

gn

an

t n

eop

lasm

of

trach

ea

Mali

gn

an

t n

eop

lasm

: b

ron

chu

s o

r

lun

g,

un

spec

ifie

d

Tu

mo

urs

co

ded

un

der

VA

02

.07

may c

au

se s

ym

pto

ms

sim

ilar

to i

nfe

ctio

ns

in t

his

part

of

the

bo

dy.

Th

e d

ura

tio

n o

f co

ugh

may a

llo

w i

nte

rvie

wer

to

dis

tin

gu

ish

bet

wee

n i

nfe

ctio

n a

nd

tu

mo

ur.

Relevant in

form

ation

Co

ugh

> 4

week

s

Dysp

no

ea >

4 w

eeks

Wei

gh

t lo

ss

Blo

od

in

sp

utu

m

Ch

est

pain

His

tory

of

cigare

tte

smo

kin

g

Ho

ars

enes

s

Dif

ficu

lty o

pen

ing o

ne

eye

Sw

elli

ng o

f h

ead

an

d n

eck

Hea

dach

e

Fati

gu

e

VA

-02

.08

Mali

gn

an

t n

eop

lasm

of

bre

ast

C50

9M

ali

gn

an

t n

eop

lasm

of

bre

ast

,

un

spec

ifie

d

Relevant in

form

ation

Bre

ast

mass

Ulc

erati

on

of

bre

ast

skin

> 3

wee

ks

Ulc

erati

on

of

nip

ple

> 3

wee

ks

Red

, p

ain

ful

bre

ast

skin

> 3

wee

ks


89

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

Wei

gh

t lo

ssN

ew r

etra

ctio

n o

f n

ipp

leD

isch

arg

e fr

om

nip

ple

Fati

gu

e

VA

-02

.09

Mali

gn

an

t n

eop

lasm

of

cerv

ix

C53

9M

ali

gn

an

t n

eop

lasm

of

cerv

ix u

teri

,

un

spec

ifie

d

Relevant in

form

ation

Irre

gu

lar

vagin

al

ble

edin

gM

ass

in

lo

wer

ab

do

men

Vagin

al

dis

charg

e > 3

wee

ks

(blo

od

y/p

uru

len

t/n

on

pru

riti

c)P

ain

in

lo

wer

ab

do

men

Wei

gh

t lo

ssE

arl

y o

nse

t o

f se

xu

al

act

ivit

yM

ult

iple

sex

ual

part

ner

sFati

gu

eL

ow

uri

ne

ou

tpu

tB

ack

pain

(se

ver

e)

VA

-02

.10

Mali

gn

an

t n

eop

lasm

of

ute

rus

(excl

ud

ing c

ervix

)

C55

Mali

gn

an

t n

eop

lasm

of

ute

rus,

part

un

spec

ifie

d

Relevant in

form

ation

Irre

gu

lar

vagin

al

ble

edin

gV

agin

al

ble

edin

g i

n p

ost

men

op

au

sal

wo

man

Mass

in

lo

wer

ab

do

men

Pain

in

lo

wer

ab

do

men

Wei

gh

t lo

ssA

ge

> 4

5 y

ears

Has

no

t h

ad

ch

ild

ren

Fati

gu

e

VA

-02

.11

Mali

gn

an

t n

eop

lasm

of

ovari

es

C56

Mali

gn

an

t n

eop

lasm

of

ovary

Relevant in

form

ation

Mass

in

lo

wer

ab

do

men

Un

ilate

ral

mass

in

lo

wer

ab

do

men

Asc

ites

(w

ate

r in

ab

do

men

, in

crea

sin

g a

bd

om

inal

circ

um

fere

nce

)

Pain

in

lo

wer

ab

do

men

Wei

gh

t lo

ss

Pel

vic

pre

ssu

re

Old

age


90

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-02

.12

Mali

gn

an

t n

eop

lasm

of

pro

state

C61

VA

-02

.13

Mali

gn

an

t m

elan

om

a o

f

skin

C43

VA

-2.1

4M

ali

gn

an

t n

eop

lasm

of

lym

ph

oid

,

haem

ato

po

ieti

c an

d

rela

ted

tis

sue

C96

.9M

ali

gn

an

t n

eop

lasm

of

lym

ph

oid

,

haem

ato

po

ieti

c an

d r

elate

d t

issu

e

VA

-02

.98

Oth

er s

pec

ifie

d n

eop

lasm

sN

o s

uch

cate

go

ry e

xis

ts i

n I

CD

Sel

ect

the

ap

pro

pri

ate

co

de

wit

h t

he

aid

of

the

ICD

ind

ex.

VA

-02

.99

Neo

pla

sm o

f u

nce

rtain

or

un

kn

ow

n b

ehavio

ur,

un

spec

ifie

d

D4

89

Neo

pla

sm o

f u

nce

rtain

or

un

kn

ow

n

beh

avio

ur,

of

oth

er a

nd

un

spec

ifie

d

site

s

VA

-03

Nu

trit

ion

al an

d e

nd

ocr

ine

dis

ord

ers

En

do

crin

e d

iso

rder

s co

mp

rise

sev

eral

ver

y d

iffe

ren

t

dis

ease

s ea

ch o

f w

hic

h h

as

spec

ific

fact

ors

. T

he

dis

ease

s

of

majo

r p

ub

lic

hea

lth

im

po

rtan

ce a

re l

iste

d i

n s

pec

ific

cate

go

ries

of

the

VA

mo

rtali

ty c

lass

ific

ati

on

syst

em (

for

exam

ple

, d

iab

etes

mel

litu

s).

Sev

eral

oth

er e

nd

ocr

ine

dis

ease

s m

ay b

e cl

ass

ifie

d u

nd

er “

oth

er s

pec

ifie

d

end

ocr

ine

dis

ease

s”.

VA

-03

.01

Nu

trit

ion

al

an

aem

iaD

50

9Ir

on

def

icie

ncy

an

aem

ia,

un

spec

ifie

dRelevant in

form

ation

Pale

skin

Pale

scl

erae

Pale

palm

s

Exer

tio

nal

dysp

no

ea

Diz

zin

ess

Palp

itati

on

s

Tir

es e

asi

ly

D5

19

Vit

am

in B

12

def

icie

ncy

an

aem

ia,

un

spec

ifie

d

D5

29

Fo

late

def

icie

ncy

an

aem

ia,

un

spec

ifie

d

D5

39

Nu

trit

ion

al

an

aem

ia,

un

spec

ifie

d

VA

-03

.02

Sev

ere

maln

utr

itio

nE

40

Kw

ash

iork

or

E4

1N

utr

itio

nal

mara

smu

s

E42

Mara

smic

kw

ash

iork

or


91

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

E4

3U

nsp

ecif

ied

sev

ere

pro

tein

-en

ergy

maln

utr

itio

n

Relevant in

form

ation

Dec

rease

d f

oo

d i

nta

ke

Bre

ast

feed

ing s

top

ped

Asc

ites

Red

dis

h h

air

Sw

oll

en l

egs

Skin

fla

kes

off

Ver

y t

hin

Ver

y s

mall

Dif

ficu

lt t

o f

eed

VA

-03

.03

Dia

bet

es m

elli

tus

E1

0In

suli

n-d

epen

den

t d

iab

etes

mel

litu

sIn

IC

D-1

0, t

he

blo

ck o

n d

iab

etes

mel

litu

s (E

10

-E1

4) u

ses

insu

lin

-dep

end

ent

dia

bet

es m

elli

tus

an

d n

on

-in

suli

n-

dep

end

ent

dia

bet

es m

elli

tus

as

pre

ferr

ed t

erm

ino

logy.

Wit

h p

rogre

ss in

med

ical sc

ien

ce t

he

usa

ge

of

the

term

s

has

chan

ged

. T

yp

e 1

dia

bet

es i

s eq

uiv

ale

nt

to i

nsu

lin

-

dep

end

ent

dia

bet

es m

elli

tus,

an

d t

yp

e 2 i

s eq

uiv

ale

nt

to n

on

-in

suli

n-d

epen

den

t d

iab

etes

mel

litu

s.

Co

mp

lica

tio

ns

of

the

dia

bet

es a

re i

den

tifi

ed a

t th

e

fou

rth

ch

ara

cter

lev

el.

E11

No

n-i

nsu

lin

-dep

end

ent

dia

bet

es

mel

litu

s

E1

2M

aln

utr

itio

n-r

elate

d d

iab

etes

mel

litu

s

E1

3O

ther

sp

ecif

ied

dia

bet

es m

elli

tus

E1

4U

nsp

ecif

ied

dia

bet

es m

elli

tus

VA

-03

.98

Oth

er s

pec

ifie

d e

nd

ocr

ine

dis

ord

ers

E3

48

Oth

er s

pec

ifie

d e

nd

ocr

ine

dis

ord

ers

Oth

er d

isea

ses

of

met

ab

oli

sm a

re a

ssig

ned

to

VA

-98

,

exce

pt

for

pre

gn

an

cy-r

elate

d (

VA

-09

.-)

or

dis

ord

ers

n

the

new

bo

rn (

VA

-10

.-).

Oth

er e

nd

ocr

ine

dis

ord

ers

are

sp

ecif

ied

in

IC

D-1

0 in

th

e

blo

ck E

20

-E3

5.

VA

-03

.99

En

do

crin

e d

iso

rder

s,

un

spec

ifie

d

E3

49

En

do

crin

e d

iso

rder

, u

nsp

ecif

ied


92

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-04

Dis

ease

s o

f th

e ci

rcu

lato

ry

syst

em

Th

is g

rou

p c

over

s th

e o

rgan

s an

d s

yst

ems

invo

lved

in

the

circ

ula

tio

n o

f b

loo

d a

nd

lym

ph

, b

ut

no

t th

e b

loo

d

itse

lf. A

naem

ia i

s co

ver

ed i

n G

rou

p V

A-3

; m

ost

of

the

dis

ease

s o

f th

e b

loo

d a

re a

ssig

ned

to

VA

-98

. T

um

ou

rs o

f

the

blo

od

are

ass

ign

ed t

o V

A-2

.-

VA

-04

.01

Hyp

erte

nsi

ve

dis

ease

sI1

0

I11

.9

I12

.9

I13

.9

I15

.9

Hyp

erte

nsi

ve

hea

rt a

nd

ren

al d

isea

se,

un

spec

ifie

d

Hyp

erte

nsi

ve

hea

rt d

isea

se N

OS

Hyp

erte

nsi

ve

ren

al

dis

ease

NO

S

Hyp

erte

nsi

ve

hea

rt a

nd

ren

al d

isea

se,

un

spec

ifie

d

Sec

on

dary

hyp

erte

nsi

on

, u

nsp

ecif

ied

No

te: h

yp

erte

nsi

on

rel

ate

d t

o p

regn

an

cy is

cod

ed u

nd

er

VA

-09

.02

.

Relevant in

form

ation

Dysp

no

ea >

4 w

eeks

(dif

ficu

lty b

reath

ing)

Dif

ficu

lty b

reath

ing i

n r

ecu

mb

ent

po

siti

on

No

isy b

reath

ing

Sw

oll

en a

nkle

s o

r le

gs

Neck

vei

n d

iste

nsi

on

Asc

ites

Co

ugh

Incr

ease

d p

ass

ing o

f u

rin

e at

nig

ht

Exer

cise

in

tole

ran

ce

VA

-04.0

2Is

chaem

ic h

eart

dis

ease

I209

An

gin

a p

ecto

ris,

un

spec

ifie

dV

A-0

4.0

2 (

or

I209 in

IC

D-1

0)

ap

pli

es t

o lif

e-th

reate

nin

g

form

s o

f an

gin

a p

ecto

ris.

I219

Acu

te m

yo

card

ial

infa

rcti

on

,

un

spec

ifie

d

I24

9A

cute

isc

haem

ic h

eart

dis

ease

,

un

spec

ifie

d

I25

9C

hro

nic

isc

haem

ic h

eart

dis

ease

,

un

spec

ifie

d

VA

-04

.03

Cer

ebro

vasc

ula

r d

isea

seI6

79

Cer

ebro

vasc

ula

r d

isea

se,

un

spec

ifie

dO

ther

dis

ease

s o

f th

e b

rain

are

ass

ign

ed t

o V

A-0

8.0

2.

Relevant in

form

ation

Su

dd

enly

un

ab

le t

o m

ove

arm

an

d/o

r le

g o

n o

ne

sid

e

Su

dd

en w

eakn

ess

of

arm

an

d/o

r le

g o

n o

ne

sid

e

Su

dd

en s

enso

ry c

han

ges

Su

dd

en f

ace

pals

y o

n o

ne

sid

e

Co

nfu

sio

n

I607

Su

bara

chn

oid

haem

orr

hage

fro

m

intr

acr

an

ial

art

ery,

un

spec

ifie

d

I609

Su

bara

chn

oid

haem

orr

hage,

un

spec

ifie

d

I61

2In

trace

reb

ral

haem

orr

hage

in

hem

isp

her

e, u

nsp

ecif

ied


93

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

I61

9H

ead

ach

e

Su

dd

en l

oss

of

spee

ch

Lo

ss o

f co

nsc

iou

snes

s

Age

> 4

5 y

ears

Has

hyp

erte

nsi

on

Is a

sm

oker

Wei

gh

t lo

ss

No

hea

d i

nju

ry (

exce

pt

sub

du

ral

haem

ato

ma)

Intr

ace

reb

ral

haem

orr

hage,

un

spec

ifie

d

I629

Intr

acr

an

ial

haem

orr

hage

(no

ntr

au

mati

c),

un

spec

ifie

d

I639

Cer

ebra

l in

farc

tio

n,

un

spec

ifie

d

I69

8Seq

uel

ae

of

oth

er a

nd

un

spec

ifie

d

cere

bro

vasc

ula

r d

isea

ses

VA

-04

.04

Ch

ron

ic r

heu

mati

c h

eart

dis

ease

s

I05

9

I06

9

I07

9

I08

9

I09

9

Mit

ral

valv

e d

isea

se,

un

spec

ifie

d

Rh

eum

ati

c ao

rtic

valv

e d

isea

se,

un

spec

ifie

d

Tri

cusp

id v

alv

e d

isea

se,

un

spec

ifie

d

Mu

ltip

le v

alv

e d

isea

se,

un

spec

ifie

d

Rh

eum

ati

c h

eart

dis

ease

, u

nsp

ecif

ied

Co

ngen

ital h

eart

valv

e d

isea

se c

od

es a

re fo

un

d in

VA

-98

an

d I

CD

-10

ch

ap

ter

XV

II (

Co

ngen

ital

malf

orm

ati

on

s,

def

orm

ati

on

s an

d c

hro

mo

som

al

ab

no

rmali

ties

).

Co

des

fo

r rh

eum

ato

id h

eart

dis

ease

are

fo

un

d in

VA

-98

an

d I

CD

-10

cate

go

ry M

05

3.

VA

-04

.05

Co

nges

tive

hea

rt f

ail

ure

I50

0C

on

ges

tive

hea

rt f

ail

ure

“H

eart

fail

ure

” s

ho

uld

be

use

d o

nly

if

ther

e is

str

on

g

evid

ence

th

at

pro

ble

ms

wit

h t

he

hea

rt w

ere

the

cau

se

of

dea

th.

If t

his

is

no

t th

e ca

se,

pre

fer

VA

-99.

VA

-04

.98

Oth

er s

pec

ifie

d d

isea

ses

of

circ

ula

tory

syst

em

Sel

ect

the

ap

pro

pri

ate

cate

go

ry f

rom

ICD

“C

ard

iac

arr

est”

sh

ou

ld b

e u

sed

on

ly i

f th

ere

is s

tro

ng

evid

ence

th

at

pro

ble

ms

wit

h t

he

hea

rt w

ere

the

cau

se

of

dea

th.

If t

his

is

no

t th

e ca

se,

pre

fer

VA

-99.

Ever

y e

ffo

rt s

ho

uld

be

mad

e to

id

enti

fy t

he

reaso

n f

or

card

iac

arr

est.

It

is im

po

rtan

t to

no

te th

at

an

y c

on

dit

ion

that

cau

ses

dea

th u

ltim

ate

ly c

au

ses

card

iac

arr

est.

Its

men

tio

n in

sta

tist

ical re

po

rts

is o

f li

ttle

hel

p in

dec

idin

g

on

mea

sure

s to

im

pro

ve

hea

lth

.

Yo

u w

ou

ld a

lso

use

th

is c

ate

go

ry t

o c

od

e d

isea

ses

of

the

blo

od

ves

sels

.

No

te t

hat

dra

cun

culi

asi

s (g

uin

ea-w

orm

dis

ease

) sh

ou

ld

be

cod

ed u

nd

er i

nfe

ctio

us

dis

ease

s.


94

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-04

.99

Dis

ease

s o

f ci

rcu

lato

ry

syst

em,

un

spec

ifie

d

I99

Oth

er a

nd

un

spec

ifie

d d

iso

rder

s o

f

circ

ula

tory

syst

em

VA

-05

Res

pir

ato

ry d

iso

rder

sT

his

gro

up

ad

dre

sses

dis

ease

s an

d d

iso

rder

s o

f th

e

resp

irato

ry o

rgan

s an

d s

om

e ex

tern

al

agen

ts,

such

as

tho

se t

hat

ari

se f

rom

occ

up

ati

on

al

exp

osu

re.

VA

-05

.01

Ch

ron

ic o

bst

ruct

ive

lun

g

dis

ease

J40

Bro

nch

itis

, n

ot

spec

ifie

d a

s acu

te o

r

chro

nic

Rel

evan

t in

form

ati

on

Dysp

no

ea >

21

days

Co

ugh

mo

st t

imes

of

the

yea

r fo

r > 2

yea

rs

Sp

utu

m

Sm

okin

g

No

isy b

reath

ing

Incr

ease

in

ch

est

size

Dis

ease

slo

wly

pro

gre

ssin

g

Wei

gh

t lo

ss

Blu

e ti

nge

to s

kin

J41

Sim

ple

an

d m

uco

pu

rule

nt

chro

nic

bro

nch

itis

J42

Un

spec

ifie

d c

hro

nic

bro

nch

itis

J439

Em

ph

yse

ma,

un

spec

ifie

d

J44

1C

hro

nic

ob

stru

ctiv

e p

ulm

on

ary

dis

ease

wit

h a

cute

exace

rbati

on

,

un

spec

ifie

d

J44

9C

hro

nic

ob

stru

ctiv

e p

ulm

on

ary

dis

ease

, u

nsp

ecif

ied

J47

Bro

nch

iect

asi

s

VA

-05

.02

Ast

hm

aJ4

5.9

J46

Ast

hm

a,

un

spec

ifie

d

Sta

tus

ast

hm

ati

cus

VA

.05

.03

Oth

er s

pec

ifie

d d

isea

ses

of

the

resp

irato

ry s

yst

em

J98

8O

ther

sp

ecif

ied

res

pir

ato

ry d

iso

rder

s

Ass

ign

mo

re s

pec

ific

co

des

wh

en

mo

re i

nfo

rmati

on

is

avail

ab

le.

Res

pir

ato

ry i

nfe

ctio

ns

are

excl

ud

ed f

rom

th

is g

rou

p.

Th

ey a

re m

enti

on

ed i

n V

A-1

.

In I

CD

-10

so

me

resp

irato

ry i

nfe

ctio

ns,

su

ch a

s

pn

eum

on

ia, are

part

of

chap

ter

X (

Dis

ease

s o

f th

e

resp

irato

ry s

yst

em).

Pn

eum

on

ia h

as

bee

n g

rou

ped

in

VA

-01

.02

.

Tu

mo

urs

of

the

resp

irato

ry t

ract

are

ass

ign

ed t

o g

rou

p

VA

-2.-


95

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-05

.98

Res

pir

ato

ry f

ail

ure

, n

ot

else

wh

ere

class

ifie

d

J96

9R

esp

irato

ry f

ail

ure

, u

nsp

ecif

ied

Ever

y e

ffo

rt s

ho

uld

be

mad

e to

id

enti

fy t

he

reaso

n f

or

resp

irato

ry f

ail

ure

. A

ny c

on

dit

ion

th

at

cau

ses

dea

th

ult

imate

ly c

au

ses

resp

irato

ry f

ail

ure

.

Asp

hyxia

of

the

new

bo

rn i

s gro

up

ed i

n V

A-1

0.0

5.

Th

is s

ho

uld

no

t b

e co

nfu

sed

wit

h I

CD

-10

co

de

R9

9 (

ill-

def

ined

cau

ses

of

dea

th i

ncl

ud

ing,

for

exam

ple

,

resp

irato

ry a

rres

t) o

r V

A-9

9.

VA

-05

.99

Res

pir

ato

ry d

iso

rder

,

un

spec

ifie

d

J98

9R

esp

irato

ry d

iso

rder

, u

nsp

ecif

ied

VA

-06

Gast

roin

test

inal

dis

ord

ers

Th

e in

test

inal

tract

sta

rts

wit

h t

he

teet

h a

nd

en

ds

wit

h

the

an

us.

Fo

r th

is r

easo

n, in

ad

dit

ion

to

dis

ease

s o

f th

e

teet

h a

nd

mo

uth

, th

ose

dir

ectl

y r

elati

ng t

o t

he

sto

mach

, th

e gu

t an

d t

he

liver

are

men

tio

ned

her

e.

VA

-06

.01

Gast

ric

an

d d

uo

den

al

ulc

er

K2

59

Gast

ric

ulc

er,

un

spec

ifie

d a

s acu

te o

r

chro

nic

, w

ith

ou

t h

aem

orr

hage

or

per

fora

tio

n

Relevant in

form

ation

Pain

in

ep

igast

riu

m (

sto

mach

)

Vo

mit

ing b

loo

d

Vo

mit

ing c

off

ee-g

rou

nd

mate

rial

Bla

ck t

arr

y s

too

ls

Po

ssib

le w

eigh

t lo

ss

No

mass

palp

ab

le

No

asc

ites

No

in

crea

sed

ble

edin

g f

rom

sm

all

wo

un

ds

K2

69

Du

od

enal

ulc

er,

un

spec

ifie

d a

s acu

te

or

chro

nic

, w

ith

ou

t h

aem

orr

hage

or

per

fora

tio

n

K2

79

Pep

tic

ulc

er,

un

speci

fied

as

acu

te o

r

chro

nic

, w

ith

ou

t h

aem

orr

hage

or

per

fora

tio

n

VA

-06

.02

Ch

ron

ic l

iver

dis

ease

K7

21

Ch

ron

ic h

epati

c fa

ilu

re

K7

39

Ch

ron

ic h

epati

tis,

un

spec

ifie

dA

liv

er d

isea

se lik

ely t

o b

e ca

use

d b

y in

fect

iou

s h

epati

tis

sho

uld

be

cod

ed t

o V

A-1

.7. In

IC

D-1

0 t

he

cod

e fo

r

chro

nic

vir

al

hep

ati

tis

is B

18

.

K7

46

Oth

er a

nd

un

spec

ifie

d c

irrh

osi

s o

f

liver

K7

69

Liv

er d

isea

se,

un

spec

ifie

dT

he

no

tio

n o

f u

nsp

ecif

ied

ch

ron

ic l

iver

dis

ease

can

no

t

be

des

crib

ed w

ith

in I

CD

-10.

Acc

ord

ingly

, all

un

clea

r

case

s sh

ou

ld b

e co

ded

to

K7

6.9

(li

ver

dis

ease

,


96

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

un

spec

ifie

d)

if t

he

sym

pto

ms

all

ow

th

e li

ver

to

be

ass

esse

d a

s th

e ca

use

.

VA

-06

.03

Para

lyti

c il

eus

an

d

inte

stin

al

ob

stru

ctio

n

without hernia

K5

66

Oth

er a

nd

un

spec

ifie

d i

nte

stin

al

ob

stru

ctio

n

Relevant in

form

ation

Ab

do

min

al

pain

(se

ver

e, c

ram

pin

g,

per

ium

bil

ical)

Vo

mit

ing (

sever

e)

Vo

mit

ing f

aec

es

Dis

ten

ded

, h

ard

ab

do

men

No

t p

ass

ing a

ny s

too

l

K5

67

Ileu

s, u

nsp

ecif

ied

VA

-06

.04

Per

ito

nit

isK

65

No

t to

be

con

fuse

d w

ith

“ab

do

min

al

pain

”.

VA

-06

.05

Her

nia

sK

40

9

K4

19

K4

29

K4

39

K4

49

K4

5.-

K4

69

Ingu

inal

her

nia

(u

nil

ate

ral)

NO

S

Fem

ora

l h

ern

ia (

un

ilate

ral)

NO

S

Um

bil

ical

her

nia

NO

S

Ven

tral

her

nia

NO

S

Dia

ph

ragm

ati

c h

ern

ia N

OS

Oth

er a

bd

om

inal

her

nia

Ab

do

min

al

her

nia

NO

S

If t

her

e is

in

form

ati

on

ab

ou

t gan

gre

ne

or

ob

stru

ctio

n,

sele

ct a

mo

re s

pec

ific

co

de

fro

m I

CD

-10

, su

ch a

s K

40

.4

(un

ilate

ral

or

un

spec

ifie

d i

ngu

inal

her

nia

, w

ith

gan

gre

ne)

.

VA

-06

.06

Acu

te a

bd

om

enR

10.0

Acu

te a

bd

om

enRelevant in

form

ation

Ab

do

min

al

pain

(se

ver

e)

Hard

ab

do

men

Nau

sea

Vo

mit

ing

No

dia

rrh

oea

VA

-06

.98

Oth

er d

isea

ses

of

inte

stin

eK

63

.8O

ther

sp

ecif

ied

dis

ease

s o

f in

test

ine

Ass

ign

mo

re s

pec

ific

co

des

wh

en

mo

re i

nfo

rmati

on

is

avail

ab

le.

An

y o

ther

dis

ease

s re

lati

ng t

o t

eeth

, o

eso

ph

agu

s,

sto

mach

, gu

t, liv

er, b

ilia

ry s

yst

em a

nd

pan

crea

s m

ust

be

cod

ed h

ere.

VA

-06

.99

Dis

ease

of

inte

stin

e,

un

spec

ifie

d

K6

39

Dis

ease

of

inte

stin

e, u

nsp

ecif

ied


97

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-07

Ren

al

dis

ord

ers

Th

is g

rou

p i

ncl

ud

es o

nly

dis

ease

s o

f th

e kid

ney

s.

Uri

nary

in

fect

ion

s an

d o

ther

dis

ease

s o

f th

e u

rin

ary

tract

are

ass

ign

ed t

o V

A-9

8.

Tu

mo

urs

of

the

kid

ney

sho

uld

be

ass

ign

ed t

o V

A-2

.-.

VA

-07

.01

Ren

al

fail

ure

N1

9U

nsp

ecif

ied

ren

al

fail

ure

Mo

st d

iso

rder

s o

f th

e kid

ney

s an

d t

he

uri

nary

tra

ct a

re

no

t ch

ara

cter

ized

by a

sp

ecif

ic c

lin

ical

pic

ture

; th

is

incr

ease

s th

e ch

an

ce o

f m

iscl

ass

ific

ati

on

occ

urr

ing

wit

hin

th

e gro

up

of

ren

al

dis

ease

s as

wel

l as

am

on

g

oth

er d

isea

se c

ate

go

ries

.

Nep

hro

lith

iasi

s is

lis

ted

bec

au

se i

t h

as

dis

tin

ct c

lin

ical

featu

res

an

d i

s li

kel

y t

o b

e d

iagn

ose

d d

uri

ng v

erb

al

au

top

sy.

N1

79

Acu

te r

enal

fail

ure

, u

nsp

ecif

ied

N1

89

Ch

ron

ic r

enal

fail

ure

, u

nsp

ecif

ied

VA

-07

.98

Oth

er s

pec

ifie

d r

enal

dis

ord

ers

N2

88

Oth

er d

iso

rder

of

kid

ney

an

d u

rete

r

Ass

ign

mo

re s

pec

ific

co

des

wh

en

mo

re i

nfo

rmati

on

is

avail

ab

le.

VA

-07

.99

Dis

ord

ers

of

kid

ney

an

d

ure

ter,

un

spec

ifie

d

N2

89

Dis

ord

er o

f kid

ney

an

d u

rete

r,

un

spec

ifie

d

VA

-08

Men

tal

an

d n

ervo

us

syst

em d

iso

rder

s

VA

-08

.01

Alz

hei

mer

dis

ease

G3

0.9

Alz

hei

mer

dis

ease

, u

nsp

ecif

ied

VA

-08

.02

Ep

ilep

syG

40

6

G4

07

G4

09

G4

19

Gra

nd

mal se

izu

res,

un

spec

ifie

d (w

ith

or

wit

ho

ut

pet

it m

al)

Pet

it m

al,

un

spec

ifie

d, w

ith

ou

t gra

nd

mal

seiz

ure

s

Ep

ilep

sy,

un

spec

ifie

d

Sta

tus

epil

epti

cus,

un

spec

ifie

d

Relevant in

form

ation

Co

nvu

lsio

ns

an

d/o

r fi

ts

Lo

ss o

f co

nsc

iou

snes

s, w

ith

fall

ing

No

fev

er

No

sti

ff n

eck

No

rec

ent

hea

d i

nju

ry

VA

-08.9

6O

ther

sp

ecif

ied

dis

ord

ers

of

the

ner

vo

us

syst

em

G5

49

G5

89

Ner

ve

roo

t an

d p

lexu

s d

iso

rder

,

un

spec

ifie

d

Mo

no

neu

rop

ath

y,

un

spec

ifie

d

If t

her

e is

mo

re i

nfo

rmati

on

avail

ab

le u

se t

he

mo

re

spec

ific

co

des

of

ICD

-10

.


98

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

G9

09

G9

39

G9

59

G9

69

Dis

ord

er o

f au

ton

om

ic n

ervo

us

syst

em,

un

spec

ifie

d

Dis

ord

er o

f b

rain

, u

nsp

ecif

ied

Dis

ease

of

spin

al

cord

, u

nsp

ecif

ied

Dis

ord

er o

f ce

ntr

al

ner

vo

us

syst

em,

un

spec

ifie

d

Dis

ease

s ari

sin

g f

rom

th

e b

loo

d v

esse

ls o

f th

e b

rain

are

ass

ign

ed t

o V

A-0

4.0

3.

So

me

dis

ease

s o

f th

e m

usc

les

are

co

ded

her

e (G

70

–G

73

);

myo

siti

s sh

ou

ld b

e co

ded

to

VA

-12.

Men

ingit

is i

s a d

iso

rder

of

the

ner

vo

us

syst

em u

suall

y

cau

sed

by a

n i

nfe

ctio

n. Fo

r th

is r

easo

n i

t h

as

bee

n

pla

ced

in

th

e V

A g

rou

p f

or

infe

ctio

us

dis

ease

s.

In IC

D-1

0 m

enin

git

is c

an

be

fou

nd

in

ch

ap

ter

I (C

erta

in

infe

ctio

us

an

d p

ara

siti

c d

isea

ses)

an

d i

n c

hap

ter

VI

(Dis

ease

s o

f th

e n

ervo

us

syst

em)

dep

end

ing o

n t

he

un

der

lyin

g i

nfe

ctio

n.

VA

-08

.97

Ner

vo

us

syst

em d

iso

rder

s,

no

t o

ther

wis

e cl

ass

ifie

d

G9

8O

ther

dis

ord

ers

of

ner

vo

us

syst

em,

no

t el

sew

her

e cl

ass

ifie

d

VA

-08

.98

Sp

ecif

ied

men

tal d

iso

rder

sF0

0 -

F9

8N

o s

ingle

co

de

for

“o

ther

sp

ecif

ied

men

tal

dis

ord

er” e

xis

ts i

n I

CD

-10.

Th

e ap

pro

pri

ate

co

de

mu

st b

e

sele

cted

fro

m t

he

cate

go

ries

men

tio

ned

in

th

e ri

gh

t-h

an

d

colu

mn

.

Men

tal

dis

ord

ers

can

no

t gen

erall

y b

e ass

esse

d u

sin

g

dia

gn

ost

ic c

rite

ria d

uri

ng v

erb

al

au

top

sy.

Ho

wev

er i

f

the

dec

ease

d w

as

trea

ted

fo

r a m

enta

l d

iso

rder

in

ho

spit

al,

th

en i

t m

ay b

e p

oss

ible

to

ret

riev

e a d

iagn

osi

s

fro

m m

edic

al

reco

rds.

In

th

ese

case

s se

lect

th

e

ap

pro

pri

ate

co

de

in I

CD

-10 a

nd

ass

ign

th

e V

A c

od

e.

Th

e re

levan

t IC

D-1

0 c

od

es a

re l

iste

d b

elo

w.

F0

0–F09

Org

an

ic,

incl

ud

ing s

ym

pto

mati

c, m

enta

l

dis

ord

ers

F1

0–F1

9 M

enta

l an

d b

ehavio

ura

l d

iso

rder

s d

ue

to

psy

cho

act

ive

sub

stan

ce u

se

F2

0–F2

9 S

chiz

op

hre

nia

, sc

hiz

oty

pal

an

d d

elu

sio

nal

dis

ord

ers

F30–F39 M

oo

d [

aff

ecti

ve]

dis

ord

ers

F4

0–F4

8 N

euro

tic,

str

ess-

rela

ted

an

d s

om

ato

form

dis

ord

ers

F50–F59 B

ehavio

ura

l sy

nd

rom

es a

sso

ciate

d w

ith

ph

ysi

olo

gic

al

dis

turb

an

ces

an

d p

hysi

cal

fact

ors


99

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

F6

0–F69

Dis

ord

ers

of

ad

ult

per

son

ali

ty a

nd

beh

avio

ur

F7

0–F7

9 M

enta

l re

tard

ati

on

F8

0–F8

9 D

iso

rder

s o

f p

sych

olo

gic

al

dev

elo

pm

ent

F9

0–F98

Beh

avio

ura

l an

d e

mo

tio

nal

dis

ord

ers

wit

h

on

set

usu

all

y o

ccu

rrin

g i

n c

hil

dh

oo

d a

nd

ad

ole

scen

ce

VA

-08

.99

Men

tal

dis

ord

ers,

un

spec

ifie

d

F9

9M

enta

l d

iso

rder

, n

ot

oth

erw

ise

spec

ifie

d

Sp

ecif

ied

men

tal

dis

ord

ers

can

be

cod

ed u

nd

er V

A-1

2.

VA

-09

Pre

gn

an

cy-,

ch

ild

-bir

th

an

d p

uer

per

ium

-rel

ate

d

dis

ord

ers

Rem

em

ber it is the m

oth

er’s

record you are codin

g.

Th

ese

cod

es s

ho

uld

be

use

d f

or

the

mo

ther

. T

her

e is

a

sep

ara

te g

rou

p f

or

the

new

bo

rn (

VA

-10

). S

om

e

infe

ctio

us

dis

ease

s m

ust

be

cod

ed t

o V

A-1

.-.

When codin

g, rem

em

ber the d

efinitio

ns fo

r

mate

rnal death

s in

this m

anual.

VA

-09

.01

Ect

op

ic p

regn

an

cyO

00

9E

cto

pic

pre

gn

an

cy,

un

spec

ifie

d

VA

-09

.02

Sp

on

tan

eou

s ab

ort

ion

O0

19

Hyd

ati

dif

orm

mo

le,

un

spec

ifie

dIC

D-1

0 c

od

ers

sho

uld

be

ver

y c

are

ful

in d

isti

ngu

ish

ing

the

lett

er “

O” f

rom

th

e n

um

ber

“0

” i

n t

his

ch

ap

ter.

Bef

ore

beg

inn

ing c

od

ing,

refe

r to

th

e la

st p

ages

of

vo

lum

e 1

in

IC

D-1

0 f

or

def

init

ion

s re

late

d t

o o

bst

etri

c

dea

ths.

Th

rou

gh

ou

t th

is c

hap

ter

in IC

D-1

0 t

her

e are

qu

ite

a few

no

tes,

so

me

of

wh

ich

ref

er e

ith

er t

o m

orb

idit

y o

r

mo

rtali

ty g

uid

elin

es i

n v

olu

me

2.

Make

sure

yo

u r

ead

thes

e b

efo

re a

ssig

nin

g a

co

de

fro

m t

his

ch

ap

ter.

Mate

rnal

con

dit

ion

s ass

ign

ed t

o t

he

ICD

-10

cate

go

ries

O96–O

99 a

re n

ot

incl

ud

ed i

n t

his

VA

gro

up

. T

hey

are

gro

up

ed u

nd

er V

A-1

2.

O0

29

Ab

no

rmal

pro

du

ct o

f co

nce

pti

on

,

un

spec

ifie

d

O0

33

Sp

on

tan

eou

s ab

ort

ion

, in

com

ple

te,

wit

h o

ther

an

d u

nsp

ecif

ied

com

pli

cati

on

s

O0

38

Sp

on

tan

eou

s ab

ort

ion

, co

mp

lete

or

un

spec

ifie

d,

wit

h o

ther

an

d

un

spec

ifie

d c

om

pli

cati

on

s

VA

-09

.03

Med

ical

ab

ort

ion

O0

43

Med

ical

ab

ort

ion

, in

com

ple

te,

wit

h

oth

er a

nd

un

spec

ifie

d c

om

pli

cati

on

s

O0

48

Med

ical

ab

ort

ion

, co

mp

lete

or

un

spec

ifie

d,

wit

h o

ther

an

d

un

spec

ifie

d c

om

pli

cati

on

s

VA

-09.0

4O

ther

an

d u

nsp

ecif

ied

ab

ort

ion

O0

53

Oth

er a

bo

rtio

n, in

com

ple

te,

wit

h

oth

er a

nd

un

spec

ifie

d c

om

pli

cati

on

s


100

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

O0

58

Oth

er a

bo

rtio

n, co

mp

lete

or

un

spec

ifie

d,

wit

h o

ther

an

d

un

spec

ifie

d c

om

pli

cati

on

s

O0

63

Un

spec

ifie

d a

bo

rtio

n,

inco

mp

lete

,

wit

h o

ther

an

d u

nsp

ecif

ied

com

pli

cati

on

s

O0

69

Un

spec

ifie

d a

bo

rtio

n, co

mp

lete

or

un

spec

ifie

d,

wit

ho

ut

com

pli

cati

on

O0

79

Oth

er a

nd

un

spec

ifie

d f

ail

ed

att

emp

ted

ab

ort

ion

, w

ith

ou

t

com

pli

cati

on

VA

-09

.05

Hyp

erte

nsi

ve

dis

ord

ers

of

pre

gn

an

cy

O1

6U

nsp

ecif

ied

mate

rnal

hyp

erte

nsi

on

Relevant in

form

ation

Pre

gn

an

t >

5 m

on

ths

Del

iver

y <

6 w

eeks

ago

Sw

oll

en u

pp

er e

xtr

emit

y a

nd

/or

face

Co

nvu

lsio

ns

Vis

ual

dis

turb

an

ces

Hyp

erte

nsi

on

Fir

st b

irth

Gast

ric

pain

Hea

dach

e

No

fev

er

O1

09

Un

spec

ifie

d p

re-e

xis

tin

g

hyp

erte

nsi

on

co

mp

lica

tin

g

pre

gn

an

cy, ch

ild

bir

th a

nd

th

e

pu

erp

eriu

m

O11

Pre

-exis

tin

g h

yp

ert

ensi

ve

dis

ord

er

wit

h s

up

erim

po

sed

pro

tein

uri

a

O1

2G

esta

tio

nal

[pre

gn

an

cy-i

nd

uce

d]

oed

ema a

nd

pro

tein

uri

a w

ith

ou

t

hyp

erte

nsi

on

O1

3G

esta

tio

nal

[pre

gn

an

cy-i

nd

uce

d]

hyp

erte

nsi

on

wit

ho

ut

sign

ific

an

t

pro

tein

uri

a

O1

49

Ges

tati

on

al

[pre

gn

an

cy-i

nd

uce

d]

hyp

erte

nsi

on

wit

h s

ign

ific

an

t

pro

tein

uri

a

O1

59

Ecl

am

psi

a, u

nsp

ecif

ied

as

to t

ime

per

iod


101

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-09

.06

An

tep

art

um

haem

orr

hage

O4

41

Pla

cen

ta p

raev

ia w

ith

haem

orr

hage

Relevant in

form

ation

Lab

ou

r p

ain

Pre

gn

an

cy >

8 m

on

ths

Sev

ere

vagin

al

ble

edin

g s

ho

rtly

bef

ore

del

iver

y

O4

59

Pre

matu

re s

epara

tio

n o

f p

lace

nta

,

un

spec

ifie

d

O4

69

An

tep

art

um

haem

orr

hage,

no

t

else

wh

ere

class

ifie

d

VA

-09

.07

Po

stp

art

um

haem

orr

hage

O7

09

Per

inea

l la

cera

tio

n d

uri

ng d

eliv

ery,

un

spec

ifie

d

Relevant in

form

ation

Del

iver

y <

3 d

ays

ago

Pre

gn

an

cy >

8 m

on

ths

Sev

ere

vagin

al

ble

edin

g

Be

care

ful

in t

ab

ula

tio

ns:

th

e n

oti

on

of

po

stp

art

um

haem

orr

hage

in V

A i

s m

uch

bro

ad

er t

han

in

IC

D-1

0.

O7

19

O7

2.-

Ob

stet

ric

trau

ma,

un

spec

ifie

d

Po

stp

art

um

hem

orr

hage

VA

-09

.08

Intr

ap

art

um

haem

orr

hage

O6

79

Intr

ap

art

um

haem

orr

hage,

un

spec

ifie

d

VA

-09

.09

Ob

stru

cted

lab

ou

rO

64

9O

bst

ruct

ed lab

ou

r d

ue

to m

alp

osi

tio

n

an

d m

alp

rese

nta

tio

n,

un

spec

ifie

d

Relevant in

form

ation

Th

e w

om

an

die

d d

uri

ng l

ab

ou

r an

d w

as

un

del

iver

ed.

Len

gth

of

lab

ou

r >

24

ho

urs

Th

is d

iagn

osi

s is

mo

re l

ikel

y a

fter

del

iver

y o

f st

illb

orn

fetu

s.

O6

54

Ob

stru

cted

lab

ou

r d

ue

to f

eto

pel

vic

dis

pro

po

rtio

n,

un

spec

ifie

d

O6

59

Ob

stru

cted

lab

ou

r d

ue

to m

ate

rnal

pel

vic

ab

no

rmali

ty, u

nsp

ecif

ied

O664

Fail

ed t

rial

of

lab

ou

r, u

nsp

ecif

ied

O6

65

Fail

ed a

pp

lica

tio

n o

f vacu

um

extr

act

or

an

d f

orc

eps,

un

spec

ifie

d

O6

69

Ob

stru

cted

lab

ou

r, u

nsp

ecif

ied

VA

-09

.10

Pu

erp

eral

sep

sis

O8

5P

uer

per

al

sep

sis

Relevant in

form

ation

Vagin

al

del

iver

y >

1 d

ay a

go

Caes

are

an

sec

tio

n >

1 d

ay a

go

Hig

h f

ever

O8

68

Oth

er s

pec

ifie

d p

uer

per

al

infe

ctio

ns

VA

-09

.98

Oth

er s

pec

ifie

d d

irec

t

mate

rnal

cau

ses

Sel

ect

the

ap

pro

pri

ate

cate

go

ry f

rom

ICD

-10

.

Th

is c

ate

go

ry i

ncl

ud

es s

ever

al

con

dit

ion

s th

at

occ

ur

du

rin

g p

regn

an

cy b

ut

no

rmall

y a

re c

od

ed t

o o

ther

chap

ters

, su

ch a

s d

iab

etes

mel

litu

s, a

nd

so

me

infe

ctio

ns


102

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

an

d c

on

dit

ion

s o

f th

e m

oth

er t

hat

are

cau

sed

by t

he

fetu

s.

Ple

ase

ref

er t

o t

he

def

init

ion

of “d

irec

t m

ate

rnal ca

use

s”

earl

ier

in t

his

man

ual.

VA

-09

.99

Oth

er d

irec

t m

ate

rnal

cau

ses,

un

spec

ifie

d

O9

5O

bst

etri

c d

eath

of

un

spec

ifie

d c

au

seR

efer

to

mo

rtali

ty r

ule

s an

d g

uid

elin

es i

n v

olu

me

2 o

f

ICD

-10

if

yo

u w

an

t to

ass

ign

th

is c

od

e.

VA

-10

Per

inata

l ca

use

s o

f d

eath

Rem

em

ber it is the b

aby’s

record you are codin

g.

Th

ese

cod

es a

re t

o b

e u

sed

fo

r th

e n

ewb

orn

. T

her

e is

a

sep

ara

te g

rou

p f

or

the

mo

ther

(V

A-9

).

When codin

g, rem

em

ber the d

efinitio

ns fo

r

perin

ata

l cause

s in

this m

anual.

VA

-10

.01

Tet

an

us

neo

nato

rum

A3

3T

etan

us

neo

nato

rum

Relevant in

form

ation

Bab

y a

ble

to

su

ck n

orm

all

y i

n t

he

firs

t 2

days

of

life

Sto

pp

ed s

uck

ing

No

t ab

le t

o o

pen

mo

uth

Had

co

nvu

lsio

ns

or

spasm

s

Had

back

arc

hin

g

VA

-10.0

2P

rem

atu

rity

(in

clu

din

g

resp

irato

ry d

istr

ess)

P0

10

P0

11

Fet

us

an

d n

ewb

orn

aff

ecte

d b

y

inco

mp

eten

t ce

rvix

Fet

us

an

d n

ewb

orn

aff

ecte

d b

y

pre

matu

re r

up

ture

of

mem

bra

nes

Relevant in

form

ation

Pre

gn

an

cy l

ast

ed <

8 m

on

ths

Bab

y v

ery s

mall

at

bir

th

Dry

, p

eeli

ng s

kin

an

d l

oss

of

sub

cuta

neo

us

tiss

ue

Dif

ficu

lty b

reath

ing s

tart

ed o

n t

he

firs

t d

ay o

f li

fe

No

t ab

le t

o f

eed

sin

ce b

irth

Mate

rnal

dis

ease

pre

sen

t (p

re-e

clam

psi

a o

r ec

lam

psi

a,

dia

bet

es m

elli

tus,

oth

er s

ever

e m

edic

al

pro

ble

m)

Mo

ther

had

an

tep

art

um

haem

orr

hage

P0

7D

iso

rder

s re

late

d t

o s

ho

rt g

esta

tio

n

an

d l

ow

bir

th w

eigh

t, n

ot

else

wh

ere

class

ifie

d

P22–P

25

Res

pir

ato

ry d

istr

ess

of

new

bo

rn a

nd

mo

re s

pec

ific

co

nd

itio

ns


103

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

P5

29

Intr

acr

an

ial

(no

ntr

au

mati

c)

haem

orr

hage

of

fetu

s an

d n

ewb

orn

,

un

spec

ifie

d

P590

Neo

nata

l ja

un

dic

e, u

nsp

ecif

ied

P6

12

An

aem

ia o

f p

rem

atu

rity

P7

7N

ecro

tizi

ng e

nte

roco

liti

s o

f fe

tus

an

d

new

bo

rn

VA

-10

.03

Lo

w b

irth

wei

gh

tP

05

9Slo

w f

etal

gro

wth

, u

nsp

ecif

ied

VA

-10

.04

Bir

th t

rau

ma

P1

09

P1

19

Un

spec

ifie

d i

ntr

acr

an

ial

lace

rati

on

an

d h

aem

orr

hage

du

e to

bir

th i

nju

ry

Bir

th i

nju

ry t

o c

entr

al

ner

vo

us

syst

em,

un

spec

ifie

d

P1

29

Bir

th i

nju

ry t

o s

calp

, u

nsp

ecif

ied

P1

39

Bir

th i

nju

ry t

o s

kel

eto

n,

un

spec

ifie

d

P149

Bir

th i

nju

ry t

o p

erip

her

al

ner

vo

us

syst

em,

un

spec

ifie

d

P1

59

Bir

th i

nju

ry,

un

spec

ifie

d

VA

-10.0

5B

irth

asp

hyxia

an

d

per

inata

l re

spir

ato

ry

dis

ord

ers

P0

21

P0

24

P0

26

P0

29

Fet

us

an

d n

ewb

orn

aff

ecte

d b

y

com

pli

cati

on

s o

f p

lace

nta

, co

rd a

nd

mem

bra

nes

Relevant in

form

ation

No

t ab

le t

o c

ry o

r b

reath

e at

bir

th

Nee

ded

ass

ista

nce

to

bre

ath

e

Aged

< 7

days

at

death

No

t ab

le t

o s

uck

sin

ce b

irth

No

fev

er

If d

eath

occ

urr

ed a

fter

fir

st d

ay o

f li

fe, h

ad

so

me

of

the

foll

ow

ing s

ym

pto

ms:

co

nvu

lsio

ns,

irr

itab

ilit

y,

stif

f

lim

bs,

let

harg

y o

r u

nre

spo

nsi

ven

ess

Mo

ther

had

an

tep

art

um

haem

orr

hage

Ob

stet

ric

com

pli

cati

on

s (i

ntr

ap

art

um

haem

orr

hage,

ob

stru

cted

lab

ou

r, m

alp

rese

nta

tio

n)

P0

39

Fet

us

an

d n

ewb

orn

aff

ecte

d b

y

com

pli

cati

on

of

lab

ou

r an

d d

eliv

ery,

un

spec

ifie

d

P2

09

Intr

au

teri

ne

hyp

oxia

, u

nsp

ecif

ied

P219

Bir

th a

sph

yxia

, u

nsp

ecif

ied

P2

49

Neo

nata

l asp

irati

on

syn

dro

me,

un

spec

ifie

d

P5

09

Fet

al

blo

od

lo

ss,

un

spec

ifie

d

P9

0C

on

vu

lsio

ns

of

new

bo

rn


104

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

P9

19

Dis

turb

an

ce o

f ce

reb

ral

statu

s o

f

new

bo

rn,

un

spec

ifie

d

VA

-10

.06

Neo

nata

l Pn

eum

on

iaP

23

9C

on

gen

ital

pn

eum

on

ia,

un

spec

ifie

d

VA

-10

.07

Co

ngen

ital

vir

al

dis

ease

sP

35

9C

on

gen

ital

vir

al

dis

ease

, u

nsp

ecif

ied

VA

-10

.08

Bact

eria

l se

psi

s o

f

new

bo

rn

P3

69

Bact

eria

l se

psi

s o

f n

ewb

orn

,

un

spec

ifie

d

Relevant in

form

ation

Age

at

on

set

of

sym

pto

ms

> 1

day

Fast

bre

ath

ing,

ches

t in

dra

win

g o

r gru

nti

ng l

ast

ing a

t

least

1 d

ay b

efo

re d

eath

Fev

er

Bo

dy c

old

to

to

uch

Let

harg

ic o

r u

nre

spo

nsi

ve

Sto

pp

ed s

uck

ing

Pu

s d

isch

arg

e fr

om

um

bil

icu

s

Skin

rash

wit

h p

us

Co

nvu

lsio

ns

Mo

ther

had

fev

er a

nd

/or

dia

rrh

oea

du

rin

g l

ab

ou

r

VA

-10

.09

Co

ngen

ital

malf

orm

ati

on

s o

f th

e

ner

vo

us

syst

em

Q0

0

Q0

19

Q0

2

Q0

39

Q0

49

Q0

59

Q0

69

Q0

79

An

ence

ph

aly

an

d s

imil

ar

malf

orm

ati

on

s

En

cep

halo

cele

, u

nsp

ecif

ied

Mic

roce

ph

aly

Co

ngen

ital

hyd

roce

ph

alu

s,

un

spec

ifie

d

Co

ngen

ital

malf

orm

ati

on

of

bra

in,

un

spec

ifie

d

Sp

ina b

ifid

a,

un

spec

ifie

d

Co

ngen

ital

malf

orm

ati

on

of

spin

al

cord

, u

nsp

ecif

ied

Co

ngen

ital

malf

orm

ati

on

of

ner

vo

us

syst

em,

un

spec

ifie

d

Relevant in

form

ation

Vis

ible

majo

r co

ngen

ital

malf

orm

ati

on

of

hea

d o

r

spin

e, s

uch

as

hea

d n

ot

form

ed, h

ead

ver

y s

mall

or

ver

y

larg

e, d

efec

t o

r m

ass

at

the

back

of

hea

d o

r sp

ine

Oth

er m

ajo

r co

ngen

ital

def

ects

: n

o a

nu

s, m

ajo

r li

mb

def

ects

, ab

do

min

al

or

tho

raci

c d

efec

ts

VA

-10.1

0C

on

gen

ital m

alf

orm

ati

on

,

oth

er a

nd

un

spec

ifie

d

Q8

99

Q9

99

Co

ngen

ital

malf

orm

ati

on

,

un

spec

ifie

d

Sev

eral

chro

mo

som

al

an

om

ali

es s

ho

w u

p a

s

malf

orm

ati

on

s. D

uri

ng v

erb

al

au

top

sy a

n u

nd

erly

ing

chro

mo

som

al

an

om

aly

wo

uld

no

t n

orm

all

y b

e


105

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

Ch

rom

oso

mal

ab

no

rmali

ty,

un

spec

ifie

d

Sel

ect

a m

ore

sp

ecif

ic c

od

e w

hen

mo

re i

nfo

rmati

on

ex

ists

revea

led

; in

stea

d t

he

man

ifes

tati

on

wo

uld

be

cod

ed –

that

is, th

e m

alf

orm

ati

on

.

VA

-10

.97

Sti

llb

irth

sP

95

Fet

al

dea

th o

f u

nsp

ecif

ied

cau

se

Dea

db

orn

fet

us

NO

S

Sti

llb

irth

NO

S

En

sure

th

at

the

dea

th w

as

no

t th

e re

sult

of

sud

den

infa

nt

dea

th s

yn

dro

me

(VA

10

.12

) o

r d

id n

ot

foll

ow

an

y

oth

er t

yp

e o

f li

ve

bir

th.

Relevant in

form

ation

Nev

er b

reath

ed, c

ried

or

mo

ved

(ev

en a

lit

tle)

aft

er b

irth

Sti

llb

irth

was

fres

h o

r m

ace

rate

d

Co

ngen

ital

malf

orm

ati

on

s p

rese

nt

Mate

rnal

dis

ease

pre

sen

t (p

re-e

clam

psi

a o

r ec

lam

psi

a,

dia

bet

es m

elli

tus,

oth

er s

ever

e m

edic

al

pro

ble

m)

Mo

ther

had

an

tep

art

um

haem

orr

hage

Ob

stet

ric

com

pli

cati

on

s p

rese

nt

(in

trap

art

um

haem

orr

hage,

ob

stru

cted

lab

ou

r, m

alp

rese

nta

tio

n)

VA

-10

.98

Oth

er s

pec

ifie

d d

iso

rder

s

rela

ted

to

per

inata

l p

erio

d

P0

22

Fet

us

an

d n

ewb

orn

aff

ecte

d b

y o

ther

an

d u

nsp

ecif

ied

mo

rph

olo

gic

al

an

d

fun

ctio

nal

ab

no

rmali

ties

of

pla

cen

ta

Sel

ect

a m

ore

sp

ecif

ic c

od

e w

hen

mo

re i

nfo

rmati

on

ex

ists

.

VA

-10

.99

Oth

er d

isea

ses

rela

ted

to

the

per

inata

l p

erio

d,

un

spec

ifie

d

P9

69

Co

nd

itio

n o

rigin

ati

ng i

n t

he

per

inata

l p

erio

d,

un

spec

ifie

d

VA

-11

Exte

rnal

cau

ses

of

dea

thE

xte

rnal

cau

ses

no

t ap

pea

rin

g i

n t

his

gro

up

sh

ou

ld b

e

cod

ed t

o V

A-1

2.

VA

-11

.01

Ped

estr

ian

in

jure

d i

n

traff

ic a

ccid

ent

V0

9P

edes

tria

n i

nju

red

in

oth

er a

nd

un

spec

ifie

d t

ran

spo

rt a

ccid

ent

Co

nsu

lt V

01-V

08 f

or

mo

re d

etail

ed c

od

es.

VA

-11.0

2O

ther

tra

nsp

ort

acc

iden

tV

19

Ped

al

cycl

ist

inju

red

in

oth

er a

nd

un

spec

ifie

d t

ran

spo

rt a

ccid

ent


106

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

V29

Mo

torc

ycl

e ri

der

in

jure

d in

oth

er a

nd

un

spec

ifie

d t

ran

spo

rt a

ccid

ent

Po

ssib

le c

od

es i

n I

CD

-10

are

V1

0-V

99

.

V3

9O

ccu

pan

t o

f th

ree-

wh

eele

d m

oto

r

veh

icle

in

jure

d i

n o

ther

an

d

un

spec

ifie

d t

ran

spo

rt a

ccid

ent

Inju

ries

sh

ou

ld b

e re

cord

ed w

her

ever

po

ssib

le a

nd

tab

ula

ted

to

get

her

wit

h e

xte

rnal

cau

ses.

In t

hes

e ca

ses,

take

care

to

rep

ort

th

e ex

tern

al ca

use

an

d

inju

ry i

n s

epara

te f

ield

s in

ord

er t

o a

vo

id c

ou

nti

ng

dea

ths

twic

e.

Co

des

fro

m I

CD

-10 c

hap

ter

XIX

(In

jury

, p

ois

on

ing a

nd

cert

ain

oth

er c

on

seq

uen

ces

of

exte

rnal

cau

ses)

sh

ou

ld

no

t b

e u

sed

fo

r ta

bu

lati

ng s

ingle

un

der

lyin

g c

au

se o

f

dea

th.

Th

e ca

use

of

the

inju

ry h

as

pri

ori

ty.

Co

nd

itio

ns

men

tio

ned

in

ch

ap

ters

I-X

VII

I as

bei

ng d

ue

to e

xte

rnal

cau

ses

take

pri

ori

ty o

ver

th

e ex

tern

al

cau

se.

V4

9C

ar

occ

up

an

t in

jure

d i

n o

ther

an

d

un

spec

ifie

d t

ran

spo

rt a

ccid

ent

V59

Occ

up

an

t o

f p

ick-u

p t

ruck

or

van

inju

red

in

oth

er a

nd

un

spec

ifie

d

tran

spo

rt a

ccid

ent

V69

Occ

up

an

t o

f h

eavy t

ran

spo

rt v

ehic

le

inju

red

in

oth

er a

nd

un

spec

ifie

d

tran

spo

rt a

ccid

ent

V7

9B

us

occ

up

an

t in

jure

d i

n o

ther

an

d

un

spec

ifie

d t

ran

spo

rt a

ccid

ent

V8

0R

ider

or

occ

up

an

t in

jure

d i

n

tran

spo

rt a

ccid

ent

V9

0A

ccid

ent

to w

ate

rcra

ft c

au

sin

g

dro

wn

ing a

nd

su

bm

ersi

on

V9

1A

ccid

ent

to w

ate

rcra

ft c

au

sin

g o

ther

inju

ry

V9

2W

ate

r-tr

an

spo

rt-r

elate

d d

row

nin

g

an

d s

ub

mer

sio

n w

ith

ou

t acc

iden

t to

wate

rcra

ft

V93

Acc

iden

t o

n b

oard

wate

rcra

ft w

ith

ou

t

acc

iden

t to

wate

rcra

ft,

no

t ca

usi

ng

dro

wn

ing a

nd

su

bm

ersi

on

V940

Oth

er a

nd

un

spec

ifie

d w

ate

r

tran

spo

rt a

ccid

ent,

mer

chan

t sh

ip


107

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

V941

Oth

er a

nd

un

spec

ifie

d w

ate

r

tran

spo

rt a

ccid

ent,

pass

enger

sh

ip

V942

Oth

er a

nd

un

spec

ifie

d w

ate

r

tran

spo

rt a

ccid

ent,

fis

hin

g b

oat

V943

Oth

er a

nd

un

spec

ifie

d w

ate

r

tran

spo

rt a

ccid

ent,

oth

er p

ow

ered

wate

rcra

ft

V944

Oth

er a

nd

un

spec

ifie

d w

ate

r

tran

spo

rt a

ccid

ent,

sail

bo

at

V945

Oth

er a

nd

un

spec

ifie

d w

ate

r

tran

spo

rt a

ccid

ent,

can

oe

or

kayak

V9

46

Oth

er a

nd

un

spec

ifie

d w

ate

rtr

an

spo

rt a

ccid

ent,

in

flata

ble

cra

ft(n

on

po

wer

ed)

V9

47

Oth

er a

nd

un

spec

ifie

d w

ate

rtr

an

spo

rt a

ccid

ent,

wate

r-sk

is

V9

48

Oth

er a

nd

un

spec

ifie

d w

ate

rtr

an

spo

rt a

ccid

ent,

oth

er u

np

ow

ered

wate

rcra

ft

V9

49

Oth

er a

nd

un

spec

ifie

d w

ate

rtr

an

spo

rt a

ccid

ent,

un

spec

ifie

dw

ate

rcra

ft

V9

5A

ccid

ent

to p

ow

ered

air

craft

in

juri

ng

occ

up

an

t

V9

9U

nsp

ecif

ied

tra

nsp

ort

acc

iden

t

VA

-11

.03

Acc

iden

tal

fall

W19

Un

spec

ifie

d f

all

Po

ssib

le c

od

es i

n I

CD

-10

are

W0

0-W

19

.

VA

-11

.04

Acc

iden

tal

dro

wn

ing a

nd

sub

mer

sio

n

W74

Un

spec

ifie

d d

row

nin

g a

nd

sub

mer

sio

n

Po

ssib

le c

od

es i

n I

CD

-10

are

W6

5-W

74

.

VA

-11

.05

Acc

iden

tal

exp

osu

re t

o

smo

ke,

fir

e an

d f

lam

es

X09

Exp

osu

re t

o u

nsp

ecif

ied

sm

oke,

fir

e

an

d f

lam

es

Po

ssib

le c

od

es i

n I

CD

-10

are

X0

0-X

09

.


108

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-11

.06

Co

nta

ct w

ith

ven

om

ou

s

an

imals

an

d p

lan

ts

X2

9C

on

tact

wit

h u

nsp

ecif

ied

ven

om

ou

s

an

imal

or

pla

nt

Po

ssib

le c

od

es i

n I

CD

-10

are

X2

0-X

29

.

VA

-11

.07

Ex

po

sure

to

fo

rce

of

natu

re

X3

9E

xp

osu

re t

o o

ther

an

d u

nsp

ecif

ied

forc

es o

f n

atu

re

Po

ssib

le c

od

es i

n I

CD

-10

are

X3

0-X

39

.

VA

-11.0

8A

ccid

enta

l p

ois

on

ing a

nd

exp

osu

re t

o n

oxio

us

sub

stan

ce

X4

4A

ccid

enta

l p

ois

on

ing b

y a

nd

exp

osu

re t

o o

ther

an

d u

nsp

ecif

ied

dru

gs,

med

icam

ents

an

d b

iolo

gic

al

sub

stan

ces

Po

ssib

le c

od

es i

n I

CD

-10

are

X4

0-X

49

.

X4

9A

ccid

enta

l p

ois

on

ing b

y a

nd

exp

osu

re t

o o

ther

an

d u

nsp

ecif

ied

chem

icals

an

d n

oxio

us

sub

stan

ces

VA

-11

.09

Lack

of

foo

d a

nd

/or

wate

rX

53

X5

4

Lack

of

foo

d

Lack

of

wate

r

VA

-11

.10

Inte

nti

on

al

self

-harm

X6

4In

ten

tio

nal

self

-po

iso

nin

g b

y a

nd

exp

osu

re t

o o

ther

an

d u

nsp

ecif

ied

dru

gs,

med

icam

ents

an

d b

iolo

gic

al

sub

stan

ces

Po

ssib

le c

od

es i

n I

CD

-10

are

X6

0-X

84

.

X6

9In

ten

tio

nal

self

-po

iso

nin

g b

y a

nd

exp

osu

re t

o o

ther

an

d u

nsp

ecif

ied

chem

icals

an

d n

oxio

us

sub

stan

ces

X7

4In

ten

tio

nal

self

-harm

by o

ther

an

d

un

spec

ifie

d f

irea

rm d

isch

arg

e

X8

4In

ten

tio

nal

self

-harm

by u

nsp

ecif

ied

mea

ns

VA

-11

.11

Ass

au

ltX

90

Ass

au

lt b

y u

nsp

ecif

ied

ch

emic

al

or

no

xio

us

sub

stan

ce

Po

ssib

le c

od

es i

n I

CD

-10

are

X8

5-Y

09

.

X9

2A

ssau

lt b

y d

row

nin

g a

nd

su

bm

ersi

on

X9

5A

ssau

lt b

y o

ther

an

d u

nsp

ecif

ied

fire

arm

dis

charg

e

Y0

5Sex

ual

ass

au

lt b

y b

od

ily f

orc

e

Y0

6N

egle

ct a

nd

ab

an

do

nm

ent


109

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

Y0

7O

ther

malt

reatm

ent

syn

dro

mes

Y0

9A

ssau

lt b

y u

nsp

ecif

ied

mea

ns

VA

-11

.12

Leg

al

inte

rven

tio

nY

35

7L

egal

inte

rven

tio

n, m

ean

s

un

spec

ifie

d

VA

-11

.13

War

dea

ths

Y3

69

War

op

erati

on

s, u

nsp

ecif

ied

VA

-11

.97

Acc

iden

t, u

nsp

ecif

ied

X5

99

Exp

osu

re t

o u

nsp

ecif

ied

fact

or

cau

sin

g o

ther

an

d u

nsp

ecif

ied

in

jury

VA

-11

.98

Oth

er s

pec

ifie

d e

ven

t,

un

det

erm

ined

in

ten

t

Y3

3O

ther

sp

ecif

ied

even

ts,

un

det

erm

ined

in

ten

t

VA

-11

.99

Un

spec

ifie

d e

ven

t,

un

det

erm

ined

in

ten

t

Y3

4U

nsp

ecif

ied

even

t, u

nd

eter

min

ed

inte

nt

VA

-12

Mis

ad

ven

ture

to

pati

ent

du

rin

g s

urg

ical

an

d

med

ical

care

Y6

9U

nsp

ecif

ied

mis

ad

ven

ture

du

rin

g

surg

ical

an

d m

edic

al

care

Po

ssib

le c

od

es i

n I

CD

-10

are

Y6

0-Y

69

.

Th

is c

ate

go

ry e

xcl

ud

es:

bre

akd

ow

n o

r m

alf

un

ctio

nin

g

of

med

ical

dev

ice

(du

rin

g p

roce

du

re)

(aft

er

imp

lan

tati

on

) (o

ngo

ing u

se)

(Y70-Y

82 )

; su

rgic

al

an

d

med

ical

pro

ced

ure

s as

the

cau

se o

f ab

no

rmal

react

ion

of

the

pati

ent,

wit

ho

ut

men

tio

n o

f m

isad

ven

ture

at

the

tim

e o

f th

e p

roce

du

re (

Y8

3-Y

84

).

VA

-13

Dru

gs,

med

icam

ents

an

d

bio

logic

al

sub

stan

ces

cau

sin

g a

dver

se e

ffec

ts i

n

ther

ap

euti

c u

se

Y5

79

Y5

99

Dru

g o

r m

edic

am

ent,

un

spec

ifie

d

Vacc

ine

or

bio

logic

al

sub

stan

ce,

un

spec

ifie

d

Po

ssib

le c

od

es i

n I

CD

-10

are

Y4

0-Y

59

.


110

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

VA

-98

Oth

er s

pec

ifie

d c

au

ses

of

dea

th

This elem

ent of th

e verbal auto

psy

tool does not m

ap to any sin

gle elem

ent of

ICD-1

0

Th

is g

rou

p c

over

s all

dis

ease

s th

at

cou

ld n

ot

be

ass

ign

ed

to a

no

ther

gro

up

or

cate

go

ry in

th

e ver

bal au

top

sy t

oo

l.

Ple

ase

no

te t

hat

ICD

-10 c

od

es s

tart

ing w

ith

A o

r B

are

all

ass

ign

ed t

o V

A-1

; all

IC

D-1

0 c

od

es s

tart

ing w

ith

C

are

ass

ign

ed t

o V

A-2

.

Disease

s of th

e eye and its adnexa

A s

et o

f co

des

is

pro

vid

ed b

y I

CD

-10 (

H00-H

59).

H54 b

lin

dn

ess

an

d lo

w v

isio

n is

an

im

po

rtan

t ca

tego

ry,

wh

ich

has

a t

ab

le d

etail

ing i

mp

air

men

t ca

tego

ries

.

Disease

s of th

e ear and m

astoid

process

A s

et o

f co

des

is

pro

vid

ed b

y I

CD

-10 (

H60-H

95).

H90 c

lass

ifie

s co

nd

uct

ive

an

d s

enso

rin

eura

l h

eari

ng

loss

by u

nil

ate

ral

an

d b

ilate

ral

imp

air

men

t.

Disease

s of th

e skin

and subcuta

neous tissue

In I

CD

-10

th

e ch

ap

ter

rela

tin

g t

o d

isea

ses

of

the

skin

an

d s

ub

cuta

neo

us

tiss

ue

has

man

y e

xcl

usi

on

s an

d

incl

usi

on

s. T

hey

are

list

ed a

t th

e st

art

of ch

ap

ters

, blo

cks

an

d c

ate

go

ries

an

d u

suall

y a

pp

ly t

o a

ll t

he

level

s b

elo

w

the

hea

din

g.

Rem

emb

er t

hat

excl

usi

on

no

tes

iden

tify

elem

ents

or

cod

es c

lass

ifie

d e

lsew

her

e.

If y

ou

have

to c

od

e a d

isea

se o

f th

e sk

in y

ou

sh

ou

ld u

se

ICD

-10

to

ch

eck w

het

her

it

sho

uld

be

ass

ign

ed t

o a

spec

ific

ver

bal au

top

sy g

rou

p r

ath

er t

han

to

VA

-98

. T

he

pre

face

of

chap

ter

XII

(D

isea

ses

of

the

skin

an

d

sub

cuta

neo

us

tiss

ue)

pro

vid

es a

go

od

over

vie

w.

Disease

s and conditio

ns rela

ting to the spin

e,

join

t, m

usc

les and connective tissu

e of th

e body

inclu

din

g d

efo

rm

ities acquired after b

irth


111

Verbal

auto

psy

code

Verbal auto

psy

title

ICD code

ICD title

Com

ments

Def

orm

itie

s o

r co

ngen

ital

malf

orm

ati

on

s m

ust

be

cod

ed t

o t

he

gro

up

VA

-10

.- (

Per

inata

l ca

use

s o

f d

eath

).

Th

e sa

me

ap

pli

es t

o c

od

ing w

ith

IC

D-1

0 c

hap

ter

XII

.

Urin

ary system

and the m

ale and fem

ale

reproductive system

s

Fo

r th

e p

urp

ose

s o

f ver

bal au

top

sy r

enal d

iso

rder

s m

ust

be

cod

ed t

o t

he

gro

up

VA

-7.-

.

Obstetr

ic d

eath

s

Th

e o

bst

etri

c co

nd

itio

ns

ass

ign

ed t

o I

CD

-10

cate

go

ries

O9

6-O

99

are

in

clu

ded

her

e. O

ther

mate

rnal co

nd

itio

ns

are

gro

up

ed u

nd

er V

A-9

.

Pri

or

to b

egin

nin

g c

od

ing,

refe

r to

pages

at

the

end

of

vo

lum

e 1

of

ICD

-10

fo

r d

efin

itio

ns

rela

ted

to

ob

stet

ric

dea

ths.

Sym

pto

ms, sig

ns and abnorm

al clinical and

laborato

ry fin

din

gs

ICD

-10 c

hap

ter

XV

III

sho

uld

no

t b

e u

sed

to

co

de

un

der

lyin

g c

au

ses

of

dea

th.

If a

sig

n i

s th

e o

nly

th

ing

rep

ort

ed a

s a r

esu

lt o

f a v

erb

al

au

top

sy i

nte

rvie

w,

it

sho

uld

be

cod

ed.

Nev

erth

eles

s, s

om

e R

-co

des

are

use

d;

Th

ese

are

usu

all

y

R9

5 f

or

sud

den

in

fan

t d

eath

syn

dro

me

(VA

-10.1

2)

an

d

R99 f

or

un

spec

ifie

d c

au

se o

f d

eath

(V

A-1

3).

VA

-99

Un

spec

ifie

d c

au

ses

of

dea

th

R9

9O

ther

ill

-def

ined

an

d u

nsp

ecif

ied

cau

ses

of

mo

rtali

ty

Use

th

is c

od

e w

hen

th

e an

swer

s p

rovid

ed d

uri

ng t

he

inte

rvie

w d

o n

ot

all

ow

yo

u t

o a

ssig

n a

ny s

pec

ific

cau

se

of

dea

th o

r a s

ym

pto

m (

VA

-98

). I

n t

his

in

stan

ce, d

o n

ot

leave

the

cert

ific

ate

bla

nk:

ass

ign

th

is c

od

e.

VA

, ver

bal

au

top

sy; N

EC

, n

ot

else

wh

ere

class

ifie

d; N

OS, n

ot

oth

erw

ise

speci

fied

; H

IV, h

um

an

im

mu

no

def

icie

ncy

vir

us;

AID

S, acq

uir

ed i

mm

un

od

efic

ien

cy s

yn

dro

me.


112

Documents

verbal autopsy standards - WHO | World Health …. APPLYING ICD-10 TO VERBAL AUTOPSY 3.1 Objectives This verbal autopsy guide aims to assist staff who conduct verbal autopsies in applying