bugandomedicalcentre.go.tz€¦ · Web viewWHO Application of ICD-10 . I. nitial . cause of death collection - The . Start-Up. Mortality List (ICD-10-SMoL) TRAINING MANUAL FOR DATA

UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN

WHO Application of ICD-10 Initial cause of death collection - The Start-Up Mortality List

(ICD-10-SMoL)

TRAINING MANUAL FOR DATA INPUT AND CODING

TABLE OF CONTENTS1 Introduction.................................................................................................................3

2 Background..................................................................................................................32.1 The Structure of the SMoL..............................................................................................42.2 Use of the SMoL.............................................................................................................42.3 Data flow.......................................................................................................................5

3 International Medical Certificate of Cause of Death.....................................................6

4 Electronic Cause of Death Entry Form...........................................................................8

5 Rules and Guidelines for Selecting the Underlying Cause of Death (UCOD).................12

6 Rules for selecting the UCOD when using the electronic Cause of Death Entry form and the SMoL..........................................................................................................................12

7 Certain conditions that may not be used as single underlying cause of death.............12

8 SMoL Rules.................................................................................................................138.1 General rules:...............................................................................................................138.2 Rules for injuries by external causes:............................................................................138.3 Rules for Maternal deaths:...........................................................................................148.4 Rules for Perinatal deaths:...........................................................................................148.5 Rules for infections:.....................................................................................................148.6 Rules for neoplasms (cancer, tumour):.........................................................................158.7 Rules for body system specific conditions:....................................................................15

9 SMoL rules with examples..........................................................................................179.1 Examples – General Rules:............................................................................................179.2 Examples - Rules for Injuries by external causes:..........................................................199.3 Examples - Rules for Maternal deaths:.........................................................................209.4 Examples - Rules for Perinatal deaths:..........................................................................219.5 Examples - Rules for Infections:....................................................................................229.6 Examples - Rules for Neoplasms (cancer, tumour):.......................................................239.7 Examples - Rules for Body system specific conditions:..................................................24

10 Procedure for using the electronic Cause of Death Entry form and SMoL....................28

11 EXERCISES..................................................................................................................29

12 Appendix A – ICD-10 Start-Up Mortality List (ICD-SMoL).............................................32

13 Appendix B – ICD-10 Start-Up Mortality List with ICD-10 codes..................................38

14 Appendix C – Overview of the ICD..............................................................................44

15 Appendix D – References............................................................................................44

16 Appendix E – Common Abbreviations.........................................................................45

17 Appendix F – Answers to Exercises.............................................................................48

1 IntroductionReliable knowledge on the mortality and causes of death of a population is critical for policy making. Civil registration and vital statistics systems (CRVS), when functioning properly, are the most reliable source of continuous data on fertility, mortality and causes of death. Cause-specific mortality statistics by age, sex and geographic location, derived from such systems are instrumental in guiding national, regional and global policies and priorities for health and development. One of the most challenging products of the CRVS is cause-of-death information. The level of registration of deaths in some countries may be high but the information on the cause of death is often either absent or of low quality. Overall only around one-third of all the deaths in the world are recorded in civil registries with the cause-of-death information . There is a huge disparity in generating cause-of-death information across continents. Starting to collect causes of death in places in line with ICD, where the cause of death can be assessed by a physician, in hospitals, will help to build a core of knowledge that can already provide health information and be used as a resource to roll out cause of death collection and coding in the country where resources permit. This start-up mortality list will simplify the process of introducing ICD, using a simplified set of mortality rules, but drawing on the same principles and form. Information technology will further assist in coding, tabulation and analysis of data, as much as the transition to (or simultaneous use of) the full ICD-10.It is designed to be in line with the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), and informs in setting public health priorities and tracking progress towards national and international targets and goals such as the post-2015 health and development agenda. This list is designed to be a first step toward standardized reporting of causes of death.

(Refer to Appendix A for the SMoL List.)

2 BackgroundThe International Classification of Diseases (ICD),published by WHO,was first developed as a classification system of causes of death. It was used for the preparation for mortality (the incidence of death in a population) statistics and until 1948 was used solely for cause of death coding. It is a statistical classification that groups similar diseases into mutually exclusive categories using an alphanumeric code. Later, the scope of the ICD was extended to include diagnoses in morbidity. It also provides a system to enable international monitoring and comparison. The ICD consists of three volumes: Volume 1 – Tabular list Volume 2 – Instructions and guidelines manual Volume 3 – Alphabetical index.

(Refer to Appendix C for more information on the ICD volumes.)

It is possible for a person to die as a result of several conditions, all at the same time.

Thus causes of death was defined by the Twentieth World Health Assembly (1967) as:“All those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries”.

The underlying cause of death is most important for statistical comparison and public health data. WHO has defined the underlying cause of death as:“I (a) the disease or injury which initiated the train of morbid events leading directly to death;

or

(b) the circumstances of the accident or violence which produced the fatal injury.”

Once a death has been correctly certified by a medically trained person, the cause of death has to be coded correctly according to international rules and standards. The correct and consistent application of ICD standards and rules ensures that cause of death patterns can be compared for different populations or over time in the same population.

2.1 The Structure of the SMoLThe SMoL is based on the ICD general mortality tabulation list, with the addition of categories for maternal and perinatal deaths, and specific conditions that are useful for assisting with Global Burden of Disease (GBD). The List has the following columns:

Reference to ICD-10 chapter – the relevant ICD-10 chapter is listed hereCode – the SMoL code to be assignedCause of death – the list of grouped conditions that are the cause of deathOptional subcategory – more specific detailed subcategoriesCoding hints – exclusion and inclusions directives for coders

2.2 Use of the SMoLThe cause(s) of death are reported on a standard WHO medical certificate of cause of death. Reported causes, age, sex, location and the code of the underlying cause of death are recorded for every individual case.

The underlying cause is selected following a set of simple rules that makes sure the tabulated data can be compared with information that is coded using the full ICD-10.

Ideally, wherever capacity exists or completeness of reporting is sufficient, the full ICD-10 should be used, ideally in combination with electronic coding tools. However, a start-up list of causes of death can deliver data in a timely manner and keep the burden of implementing a coding system low in new mortality systems. As the SMoL is fully compatible with ICD-10, expansion into more detail at a later stage is easily possible. This compatibility also facilitates comparison of collected data with other sources.

2.3 Data flowThe data collection process for causes of death is similar to the one of discharge reports.

3 International Medical Certificate of Cause of DeathThe certificate is the main source of mortality data. Information on the certificates is best provided by an experienced medical practitioner who is well informed about the medical history of the dead person, and has carefully carried out an examination of the decedent. In the case of accidents or violent deaths, additional input may come from a coroner or other legal official. In some jurisdictions, another official (who may not be medically trained) is responsible for the completion of the medical certificate of cause of death. In circumstances where no physician or other trained official can attend the dead person, a certificate may also be based on verbal autopsy data (lay reporting) or another form of data collection.

This certificate consists of:

Administrative data:Used for collecting information on sex, date of birth and date of death. It can be modified to suit the needs of the country.

Frame A: Medical data Part 1 and 2Part 1: used for causes related to the sequence of events leading directlyto the death.

It is a step-by-step summary of the train of events leadingto death, with the originating cause on the lowest used line and the direct cause on the first line.

Part 2: used for conditions that do not belong to the sequence but still contributedto death, for example by impairing the patient’s generalcondition.

Frame B:Other medical dataused for collecting additional information on:

surgeryif performedautopsyif performedmanner of deathplace of occurrence of the external causefetal and infant deathsmaternaldeaths

Not all the detailed information asked for may be available. Hospital records will usually have this information, as it is also retained for medical purposes.

Causes of death should be collected using the international form for medical causes of death wherever possible:

Administrative Data (can be further specified by country)Sex Female Male UnknownDate of birth D D M M Y Y Y Y Date of death D D M M Y Y Y YFrame A: Medical data: Part 1 and 21Report disease or condition directly leading to death on line a

Report chain of events in due to order (if applicable)

State the underlying cause on the lowest used line

Cause of death Time interval from onset to death

a

b Due to:

c Due to:

d Due to:

2 Other significant conditions contributing to death (time intervals can be included in brackets after the condition)Frame B: Other medical dataWas surgery performed within the last 4 weeks? Yes No Unknown If yes please specify date of surgery D D M M Y Y Y YIf yes please specify reason for surgery (disease or condition)Was an autopsy requested? Yes No Unknown If yes were the findings used in the certification? Yes No UnknownManner of death:

Disease Assault Could not be determined Accident Legal intervention Pending investigation Intentional self harm War Unknown

If external cause or poisoning: Date of injury D D M M Y Y Y YPlease describe how external cause occurred (If poisoning please specify poisoning agent)Place of occurrence of the external cause:

At home Residential institution

School, other institution, public administrative area

Sports and athletics area

Street and highway Trade and service area

Industrial and construction area Farm

Other place (please specify): Unknown Fetal or infant DeathMultiple pregnancy Yes No UnknownStillborn? Yes No UnknownIf death within 24h specify number of hours survived Birth weight (in grams)Number of completed weeks of pregnancy Age of mother (years)If death was perinatal, please state conditions of mother that affected the fetus and newbornFor women, was the deceased pregnant? Yes No Unknown

At time of death Within 42 days before the death Between 43 days up to 1 year before death Unknown

Did the pregnancy contribute to the death? Yes No Unknown

4 Electronic Cause of Death Entry FormAn electronic Cause of Death entry form has been designed to assist with the collection of the UCOD and the subsequent assignment of the SMoL codes.

EXAMPLE:

It follows the general format of the medical certificate of cause of death and includes a drop down box in Part 1 to assist with the entering of the required information for each field.

The drop down list will show the shortest matching entry first, as sometimes there may be many possible matches. Continuing to add detail (if available) will shorten the list for easier reading, otherwise browse the list for the matching entry. If a term is not available, select the closest one and inform central data management so that the list can be updated.

EXAMPLE:

Part 2 is completed using free text.

For fields 1a-1d only one condition can be entered. If multiple conditions are reported on one line, check with the Doctor for the main one. If this is not possible select the first mentioned condition. Once the information has been entered into the various fields, the coder MUSTtick the condition that is the underlying cause of death. If this is not completed the system cannot process the certificate.

EXAMPLE:

Part 3 captures information via drop down lists for the following:

Manner of death e.g. disease, assault accident etc.

Fetal or infant death

Whether the women was pregnant

Time from pregnancy

Whether pregnancy contributed to the death

5 Rules and Guidelines for Selecting the Underlying Cause of Death (UCOD)The ICDprovides a set of rules to ensure the selection of the UCODis done the same way everywhere, and data that has been generated in different places is comparable.ICD rules are very detailed and can be found in Volume 2 of ICD-10.

6 Rules for selecting the UCOD when using the electronic Cause of Death Entry form and the SMoL.

As the ICD rules are very detailed, a set of simplified rules (based on the ICD set of rules) has been developed to be followed when the SMoL is used for coding the UCOD. Following these rules will ensure comparability with data on an international and local basis.

Following the SMoL Rules (SR) will assist the coder in the selection of the correct UCOD.

Generally the order or hierarchy to use when identifying the UCOD will be: Injuriesby external causesas cause of death Maternal cause of death Perinatal cause of death Infection as cause of death Malignancy as cause of death Specific body system condition as cause of death

7 Certain conditions that may not be used as single underlying cause of death.These include:

Organic, including symptomatic disorders Organisms (Select the condition caused by the organism) Visual impairment (If listed as a cause of an accident, select the accident) Hearing loss (If listed as a cause of an accident, select the accident) Multiple gestation (Look for a more precise cause of death) SIRS (Look for a more precise cause of the SIRS) Injury, poisoning and certain other consequences of external causes (Select the cause of

the injury, poisoning or accident as the underlying cause of death. See SR8.) Factors influencing health status and contact with health services (e.g. visit for

vaccination, amputation status, past history of cancer etc.)

If any of these have been listed on the certificate and another cause cannot be determined, then the person responsible for filling in the certificate should be asked for clarification.

8 SMoL Rules

8.1 General rules:SR1 – Single cause listed

When only one condition is reported on the certificate, in Part 1 or Part 2, select this as the underlying cause of death and tick the box in the column “underlying”.

SR2 – Multiple causes listedIf there is more than one condition reported in Part 1 usually the lowest used line in 1a-1d will be the underlying cause.

SR3 – Multiple causes on the same lineIf there are multiple entries on one line ask the doctor which is the relevant one.If this is not possible, only enter the first one.

SR4 – Implausible sequenceIf the sequence of listed conditions looks strange, (e.g. hypertension causing metastases) refer back to the doctor that completed the certificate for clarification. If this is not possible, code the first line from the top that is plausible.

SR5 – Consistency between sex and diagnosisIf the underlying cause conflicts with the sex of the decedent, then refer back to thedoctor. If this is not possible, and the underlying cause is fully incompatible then

enter on the lowest line “Other ill-defined and unspecified causes of mortality” and chose this as the underlying cause.

SR6 –Nonspecific modes of dyingDo not select modes of dying such as - “cardiac arrest”, “heart failure”, or “respiratory failure” – as the underlying cause if any other condition is mentioned on the form.

SR7 – Selecting precise termsIf the underlying cause on the lowest used line describes a condition in general terms and another term is reported on the certificate that provides more precise information about the site or nature of this condition, select this more precise term as the underlying cause.

8.2 Rules for injuries by external causes:SR8 – Accident, poisoning or violence

If there is an accident, poisoning, or violence mentioned in 1a-1d, then find out the cause of the accident, poisoning or violence and select this as the underlying cause.NOTE: Do not select the injury, you must add an external cause and if not known put ‘unknown external cause’.

SR9 – SuicideIf in 1a-1d there is a mention of suicide select this as the underlying cause.

8.3 Rules for Maternal deaths:SR10 – Mention of a pregnancy condition

If there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, the underlying cause of death must be from the section Pregnancy, childbirth and the puerperium.

SR11 – No mention of a pregnancy conditionIf there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, but no pregnancy condition is mentioned on lines 1a-1d, then enter on the lowest line “Indirect obstetric death” and choose this as the underlying cause.

8.4 Rules for Perinatal deaths:SR12 – General rule for UCOD for perinatal deaths

For neonatal or fetal deaths, the underlying cause of death must be from the section certain conditions originating in the perinatal period, except in cases of external causes and related injuries.

SR13 – Mother’s condition mentioned as UCODFor neonatal or fetal deaths, if there is a mention of a condition of the mother on the lowest used line of 1a-1d, then enter on the lowest line in 1a-1d “Fetus and newbornaffected by maternal factors” and select this as the underlying cause.

SR14 – Low birth weight and prematurityFor neonatal or fetal deaths, when both low birth weight and prematurity are mentioned, priority is to be given to low birth weight.

8.5 Rules for infections:SR15 – Infections to be selected as UCOD

If any of the following infections are mentioned in 1a-1d, select this as the underlying cause, no matter what is written on the lowest used line:

Chagas PlagueCholera PoliomyelitisDengue RubellaDiphtheria Scarlet feverHepatitis A, B or C, acute or chronic TetanusLeishmaniasis TrachomaLeprosy SmallpoxMalaria Viral haemorrhagic fever (Ebola)Measles Whooping coughMeningococcal disease Yellow fever

SR16 - Infections to be selected as UCOD except when HIV mentionedIf any of the following infections are mentioned in 1a-1d, select this as the underlying cause:

Consequences of tuberculosis ShigellosesParatyphoid TuberculosisSalmonella Typhoid

EXCEPTION: If the line below any of the above mentions HIV, select HIV as the underlying cause.

SR17 – HIV and TuberculosisIf HIV is mentioned and the line above mentions Tuberculosis, then correct the entry and type “HIV with Tuberculosis”.

8.6 Rules for neoplasms (cancer, tumour):SR18 – General rule for selecting neoplasms as UCOD

If there is a mention of a cancer in1a-1d select the cancer as the underlying cause. EXCEPTION: If the cancer is reported as due to HIV, select HIV as the underlying cause.

8.7 Rules for body system specific conditions:SR19 – Diabetes mellitus

If there is a mention of Diabetes mellitus in 1a-1d, select the diabetes mellitus as the underlying cause. EXCEPTION: If Diabetes is due to pancreatitis, then select pancreatitis as the underlying cause.

SR20 – Dehydration and diarrhoeal conditionsIf there is a mention of dehydration in 1a-1d and also mention of any diarrhoeal condition anywhere on the form, add the diarrhoeal condition on the lowest line and select this as the underlying cause.

SR21 – Cancer and certain cardiovascular conditionsIf cancer is recorded on the lowest used line and there ismention of either Hypertension, Anginapectoris,Ischemic heart disease orArteriosclerosis, on any of the lines above the cancer, select either Hypertension, Anginapectoris, Ischemic heart diseaseorArteriosclerosis as the underlying cause.

SR22 – InfluenzaIf there is mention of Influenza in 1a-1d, select Influenza as the underlying cause.

SR23 – Pneumonia, Dementia and Mental retardationIf there is a mention of Pneumonia, Dementia or Mental retardation without anything entered on the line below, ask the doctor, if possible, for the cause of death and enter that in the line below and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.

SR24 – Embolism, Decubitus ulcer, Cystitis, Urinary infection and CachexiaIf there is a mention of embolism, decubitus ulcer, cystitis, urinary infection or cachexia on the lowest used line (or they are mentioned as the only entry) then ask the doctor, if possible, for the cause of death. Enter that condition and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.

SR25 – SurgeryIf surgery is mentioned on the lowest used line, and a surgical condition is mentioned somewhere on the certificate (e.g. infection, tumour, injury) select the surgical condition as the underlying cause. If the surgical condition is an injury, then check the cause of the injury (ask the doctor, if possible), and add that to the list and select the cause of the injury as the underlying cause.

SR26 – Signs and SymptomsIf a sign or symptom is mentioned in 1a-1d, check with the doctor if there is a more specific condition and enter this condition and select it as the underlying cause. If this is not possible, just select the sign or symptom as the underlying cause.

9 SMoL rules with examplesThe following provides examples of how to apply the SMoL Rules. Exercises to reinforce the application of these rules are located in section 13 of this manual.

9.1 Examples – General Rules:SR1 – Single cause listed

When only one condition is reported on the certificate, in Part 1 or Part 2, select this as the underlying cause of death and tick the box in the column “underlying”.


Underlying

Disease or condition directly leading to death Immediate A Stroke √Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used line

Due to B

Due to C

Due to D

SR2 – Multiple causes listedIf there is more than one condition reported in Part 1 usually the lowest line in 1a-1d will be the underlying cause.


Underlying

Disease or condition directly leading to death Immediate A Hepatic failure

Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used line

Due to B Bile duct obstruction

Due to CCarcinoma of head

of pancreas √Due to D

In other words the carcinoma of the head of the pancreas recorded on the lowest used line (in this case, line c) will be the underlying cause of death.

SR3 – Multiple causes on the same lineIf there are multiple entries on one line ask the doctor which is the relevant one. If this is not possible, select the first one mentioned.

Cause of deathTime interval from onset to death

Underlying

Disease or condition directly leading to death Immediate A

Pernicious anaemia and

gangrene of foot√

Report chain of events in “due to” order (B-D) if applicable

Due to B

Due to C


Due to D

If it is not possible get clarification from the doctor then then select pernicious anaemia as the underlying cause.

SR4 – Implausible sequence

If the sequence of listed conditions looks strange, (e.g. hypertension causing metastases) refer back to the doctor that completed the certificate for clarification. If this is not possible, code the first line from the top that is plausible.


Underlying

Disease or condition directly leading to death Immediate A Bone metastases


Due to B Colon cancer √

Due to C Hypertension

Due to D

SR5 – Consistency between sex and diagnosisIf the underlying cause conflicts with the sex of the decedent, then refer back to the doctor. If this is not possible, and the underlying cause is fully incompatible then enter on the lowest line “Other ill-defined and unspecified causes of mortality” and chose this as the underlying cause.

Sex = Male Cause of death Time interval from onset to death

Underlying

Disease or condition directly leading to death

Immediate A Vaginal cancer


Due to BOther ill-defined and

unspecified causes of mortality

√

Due to C

Due to D

SR6 – Nonspecific modes of dyingDo not select modes of dying such as - “cardiac arrest”, “heart failure”, “respiratory failure” – as the underlying cause if any other condition is mentioned on the form.


Underlying


Immediate A Chronic renal failure √


Due to B Cardiac arrest

Due to C


Due to D

SR7 – Selecting precise termsIf the underlying cause on the lowest used line describes a condition in general terms and another term is reported on the certificate that provides more precise information about the site or nature of this condition, select this more precise term as the underlying cause.


Underlying

Disease or condition directly leading to death Immediate A Cerebral infarction √


Due to B Stroke

Due to C

Due to D

9.2 Examples - Rules for Injuries by external causes:

SR8 – Accident, poisoning or violenceIf there is an accident, poisoning, or violence mentioned in 1a-1d, then find out the cause of the accident, poisoning or violence and select this as the underlying cause.NOTE: Do not select the injury, you must add an external cause and if not known put ‘unknown external cause’.


Underlying


Immediate A Pesticide poisoning


Due to B Accidental poisoning √

Due to C

Due to D

SR9 – SuicideIf in 1a-1d there is a mention of suicide select this as the underlying cause.


Underlying


Immediate A Head injury


Due to BSuicide by jumping

off bridge√

Due to C

Due to D

9.3 Examples - Rules for Maternal deaths:

SR10 – Mention of a pregnancy conditionIf there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, the underlying cause of death must be from the section Pregnancy, childbirth and the puerperium.


Underlying


Immediate ASevere hypertension

in pregnancy√


Due to B

Due to C

Due to D

For women,was the deceased pregnant? YesTime from pregnancy At time of deathDid the pregnancy contribute to the death? YesA code from the section Pregnancy, childbirth and the puerperium will be assigned for this case and not a code from the Circulatory section.

SR11 – No mention of a pregnancy conditionIf there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, but no pregnancy condition is mentioned on lines 1a-1d, then enter on the lowest line “Indirect obstetric death” and choose this as the underlying cause.


Underlying

Disease or condition directly leading to death Immediate A Anaemia


Due to BIndirect obstetric

death√

Due to C

Due to D

For women,was the deceased pregnant? YesTime from pregnancy At time of deathDid the pregnancy contribute to the death? Unknown

9.4 Examples - Rules for Perinatal deaths:SR12 – General rule for UCOD for perinatal deaths

For neonatal or fetal deaths, the underlying cause of death must be from the section Certain conditions originating in the perinatal period, except in cases of external causes and related injuries.

Age =5 days Cause of death Time interval from onset to death

Underlying


Immediate A Bacterial septicaemia


Due to BBacterial sepsis of

newborn √

Due to C

Due to D

SR13 – Mother’s condition mentioned as UCODFor neonatal or fetal deaths, if there is a mention of a condition of the mother on the lowest used line of 1a-1d, then enter on the lowest line in 1a-1d “Fetus and newborn affected by maternal factors” and select this as the underlying cause.

Age = 1 day Cause of death Time interval from onset to death

Underlying


Immediate A Lung immaturity



Due to B Prematurity

Due to C Maternal pre-eclampsia

Due to DFetus and newborn

affected by maternal factors

√

SR14 – Low birth weight and prematurityFor neonatal or fetal deaths, when both low birth weight and prematurity are mentioned, priority is to be given to low birth weight.

Age = 1 day Cause of death Time interval from onset to death

Underlying


Immediate A Low birthweight √


State the underlying cause on the lowest

Due to B Prematurity

Due to C

Due to D

used line

9.5 Examples - Rules for Infections:SR15 – Infections to be selected as UCOD

If any of the following infections are mentioned in 1a-1d, select this as the underlying cause, no matter what is written on the lowest used line:

Chagas PlagueCholera PoliomyelitisDengue RubellaDiphtheria Scarlet feverHepatitis A, B or C, acute or chronic TetanusLeishmaniasis TrachomaLeprosy SmallpoxMalaria Viral haemorrhagic fever (Ebola)Measles Whooping coughMeningococcal disease Yellow fever


Underlying


Immediate A Cirrhosis of liver


Due to B Hepatitis C√

Due to C

Due to D

SR16 - Infections to be selected as UCOD except when HIV mentionedIf any of the following infections are mentioned in 1a-1d, select this as the underlying cause:

Consequences of tuberculosis ShigellosesParatyphoid TuberculosisSalmonella Typhoid

EXCEPTION: If the line below any of the above mentions HIV, select HIV as the underlying cause.


Underlying


Immediate A Salmonella enteritis √

Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest

Due to B Gastroenteritis

Due to C

Due to D

used line

SR17 – HIV and TuberculosisIf HIV is mentioned and the line above mentions Tuberculosis, then correctthe entry and type “HIV with Tuberculosis”.

Certificate completed by physician


Underlying


Immediate A Tuberculosis


Due to B HIV

Due to C

Due to D

Amended certificate for electronic input


Underlying


Immediate A Tuberculosis


Due to

B

HIV

Due to C HIV with

Tuberculosis√

Due to D

9.6 Examples - Rules for Neoplasms (cancer, tumour):SR18 – General rule for selecting neoplasms as UCOD

If there is a mention of a cancer in 1a-1d select the cancer as the underlying cause. EXCEPTION: If the cancer is reported as due to HIV, select HIV as the underlying cause.


Underlying

Disease or condition directly leading to death Immediate A Respiratory failure


Due to BNon Hodgkin

lymphoma√

Due to C

Due to D

Exception:Cause of death Time interval from

onset to deathUnderlying


Immediate A Respiratory failure


Due to BNon Hodgkin

lymphomaDue to C HIV √

Due to D

9.7 Examples - Rules for Body system specific conditions:SR19 – Diabetes mellitus

If there is a mention of Diabetes mellitus in 1a-1d, select the diabetes mellitus as the underlying cause. EXCEPTION: If Diabetes is due to pancreatitis, then select pancreatitis as the underlying cause.


Underlying


Immediate A Gangrene


Due to BPeripheral artery

disease

Due to CType 1 diabetes

mellitus√

Due to D

Exception:


Underlying


Immediate AType 1 diabetes

mellitus


Due to B Pancreatitis √

Due to C

Due to D

SR20 – Dehydration and diarrhoeal conditionsIf there is a mention of dehydration in 1a-1d and also mention of any diarrhoeal condition anywhere on the form, add the diarrhoeal condition on the lowest line and select this as the underlying cause.


Underlying

Disease or condition directly leading to death Immediate A Dehydration


Due to BInfectious

gastroenteritis√

Due to C

Due to D

SR21 – Cancer and certain cardiovascular conditionsIf cancer is recorded on the lowest used line and there ismention of either Hypertension, Anginapectoris, Ischemic heart disease orArteriosclerosis, on any of the lines above the cancer, select either Hypertension, Anginapectoris, Ischemic heart diseaseorArteriosclerosis as the underlying cause.


Underlying


Immediate AIschaemic heart

disease √


Due to B Bowel cancer

Due to C

Due to D

SR22 – InfluenzaIf there is mention of Influenza in 1a-1d, select Influenza as the underlying cause.


Underlying


Immediate A Chronic asthma


Due to B Influenza√

Due to C

Due to D

SR23 – Pneumonia, Dementia and Mental retardationIf there is a mention of Pneumonia, Dementia or Mental retardation without anything entered on the line below, ask the doctor, if possible, for the cause of death and enter that in the line below and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.


Underlying


Immediate A Pneumonia √


Due to B

Due to C

Due to D

SR24 – Embolism, Decubitus ulcer, Cystitis, Urinary infection and CachexiaIf there is a mention of embolism, decubitus ulcer, cystitis, urinary infection or cachexia on the lowest used line (or they are mentioned as the only entry) then ask the doctor, if possible, for the cause of death. Enter that condition and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.


Underlying


Immediate APeripheral artery

disease √


Due to B Decubitus ulcer

Due to C

Due to D

SR25 – SurgeryIf surgery is mentioned on the lowest used line, and a surgical condition is mentioned somewhere on the certificate (e.g. infection, tumour, injury) select the surgical condition as the underlying cause.


Underlying


Immediate A Chronic kidney failure √


Due to B Kidney transplant

Due to C

Due to D

If the surgical condition is an injury, but the cause of the injury is not mentioned then ask the doctor, if possible, and enterthat in the line below and select the cause of the injury as the underlying cause.


Underlying


Immediate A Hip replacement


Due to BFractured hip

Due to C Fall down stairs√

Due to D

SR26 – Signs and SymptomsIf a sign or symptom is mentioned in 1a-1d, check with the doctor if there is a more specific condition and enter this condition and select it as the underlying cause. If this is not possible, just select the sign or symptom as the underlying cause.


Underlying


Immediate A Fever√


Due to B

Due to C

Due to D

After consulting the doctor the cause of the fever was Dengue.


Underlying

Disease or condition directly leading to death Immediate A Fever


Due to B Dengue √

Due to C

Due to D

10 Procedure for using the electronic Cause of Death Entry form and SMoLAccess to the electronic entry form is via the DHIS2 training interface and requires a username and password. On the mortality dashboard open “Apps” from the top menu and select “event capture”. There may be a short delay while the system is loading. Once loaded click “register event”. “New Event” will appearwith a mandatory box for date of death. The date needs to be entered to open the form itself.

There are 3 sections: information on the deceased, causes and manner of death (medical data) and cause-of-death coding (coding automatic).

As information is being entered, some boxes will be irrelevant and blocked. For example, if there is a date of birth, then it is not possible to click on “Birth date unknown”.

1. Information on the deceased:Enter information on the sex, date of birth and date of death. However if the date of birth is unknown, check the box “Birth date unknown” and provide an estimated age if possible. Check box “Age under 24 hours”will apply tonewborns.

2. Causes and manner of death (medical data):Enter all the listed conditions from the Medical Certificate of Cause of Death in the same order as written by the certifier. Drop down lists enable the selection of possible matching conditions.However if a condition is not found in the drop down list, then select [NOT LISTED] from the same drop down list.A new box will open below where you can type the condition.

Manner of death: Select as appropriate

Sections on Fetal or infant death or maternal death will need to be completed depending on the information on the deceased entered earlier.

Then apply the SMoL Rules for selecting the UCOD.

Once the underlying cause of death has been selected, verify this selection in the SMoL (See Appendix A) to see if there are any “excludes” notes that point to a more suitable entry on the form. If so add this entry to the form and select it as the underlying cause.

3. Cause-of-death coding (coding automatic):This section is for official use only and cannot be modified. The coding is done automatically in the background by the system at set intervals, and the boxes will normally be empty during data entry. However, when editing an existing event, the result of the coding might be visible in the boxes. Whether there is data visible or not in this section does not influence the data entry.

Do not forget to check the box “Completed” and put any comments in the box “Comments”, then click on “Save and add new”.

11 EXERCISES

1. Are the following conditions in bold acceptable underlying causes of death?

CONDITION Acceptable Not AcceptableE Coli as a cause of a urinary tract infectionCaesarean section deliveryPoisoned by a snake biteVisual impairment resulting from eye cancerFractured leg from a fall out of a tree

Which is the underlying cause of death in these example? Circle the correct answer.

2. Part 1 a Heart failure b Colon cancer

3. Part 1 a Bronchopneumonia b Cerebral infarction

4. Part 1 a Appendicectomyb Postoperative wound infectionc. Appendicitis

5. Part 1 a Heart failureb Coronary artery disease

6. Part 1 a Dental cariesPart 2 Diabetes mellitus

7. Part 1 a Hydrocephalus b Tuberculosis meningitis

8. Part 1 a Asphyxiab Suicide - hangingc Strangulation

9. Part 1 a Jaundice b Prematurity

Part 3 Maternal severe pre-eclampsia

10. Part 1 a HIVb Kaposi sarcoma

11. Part 1 a Asthmab Respiratory arrest

12. Part 1 a Rabies b Open wound of armc Bitten by dog

13. Part 1 a Klebsiella pneumonia septicaemiab Septic shock

14. Part 1 a Haemorrhageb Placenta praeviac Vaginal delivery

For women, was the deceased pregnant YesTime from Pregnancy At time of deathDid the pregnancy contribute to the death Yes

15. Part 1 a Intracerebral haemorrhage b Fractured skullc Pedestrian hit by a car

Manner of death Accident

16. Part 1 a Comab Liver failurec Malaria

17. Part 1 a Comab Subdural haematomac Fall from ladder


18. Part 1 a Respiratory failureFor women, was the deceased pregnant YesTime from Pregnancy At time of deathDid the pregnancy contribute to the death Yes

19. Part 1 a Acute blood lossb Traumatic ruptured spleenc Car accident


20. Part 1 a Pneumoniab Measles

21. Part 1 a Cirrhosis of liver

22. Part 1 a Peripheral vascular disease and chronic lung disease

23. Part 1 a Acute myocardial infarctionb Coronary heart diseasec Emphysema

24. Part 1 a Ovarian cancer Sex = male

25. Part 1 a Cardiac failureb Prematurity

26. Part 1 a Angina pectorisb Lung cancer

27. Part 1 a Strokeb Severe pre-eclampsia

28. Part 1 a Respiratory failure b Influenzac. Asthma

29. Part 1 a Dementia

30. Part 1 a Peripheral artery diseaseb Embolism

31. Part 1 a Gangrene

12 Appendix A – ICD-10 Start-Up Mortality List (ICD-SMoL)For neonatal and maternal cases, look up the neonatal and maternal section first. Follow the exclusions at the beginning of the sections. Injuries are coded to the originating external cause.

Note: There is no reference to chapter 19 of ICD-10, because in single cause tabulation the external cause is tabulated, and not the injury.

Reference to ICD-10 chapter

Code Cause of death Optional subcategory Coding hints

ICD-10 chapter 1 Certain infectious and parasitic

diseases excludes respiratory infections not listed here

5-1 Cholera 5-2 Typhoid and paratyphoid

5-3 Other and unspecified diarrhoeal diseases includes gastroenteritis

5-4 Tuberculosis

excludes HIV disease, with tuberculosis

5-4.1 Respiratory tuberculosis, confirmed bacteriologically or histologically

5-4.9 Other tuberculosis 5-5 Plague 5-6 Leprosy 5-7 Tetanus 5-8 Diphtheria 5-9 Whooping cough

5-10 Meningococcal infection

includes meningococcal meningitis, excludes unspecified meningitis (see nervous section)

5-11 Septicaemia

5-12 Infections with a predominantly sexual mode of transmission

5-12.1 Syphilis

5-12.9

Other and unspecified infections with a predominantly sexual mode of transmission

5-13 Acute poliomyelitis 5-14 Rabies 5-15 Dengue 5-16 Yellow fever 5-17 Other viral haemorrhagic fevers 5-18 Measles

5-19 Viral hepatitis 5-19.1 Hepatitis B 5-19.8 Other viral hepatitis 5-19.9 Unspecified viral hepatitis

5-20 Human immunodeficiency virus [HIV] disease

5-20.1 HIV disease with tuberculosis 5-20.2 Other and unspecified HIV disease 5-21 Malaria includes malaria in neonates

5-21.1 Malaria, parasitologically confirmed

5-21.9 Other and unspecified malaria 5-22 Leishmaniasis 5-23 Trypanosomiasis 5-24 Schistosomiasis

5-25 Other and unspecified infectious diseases

ICD-10 chapter 2 Neoplasms includes all neoplasms and

cancers of all organ systems

5-26 Malignant neoplasm of lip, oral cavity and pharynx

5-27 Malignant neoplasm of Oesophagus

5-28 Malignant neoplasm of stomach

5-29 Malignant neoplasm of colon, rectum and anus

5-30 Malignant neoplasm of liver and intrahepatic bile ducts

5-31 Malignant neoplasm of pancreas 5-32 Malignant neoplasm of larynx

5-33 Malignant neoplasm of trachea, bronchus and lung

5-34 Malignant melanoma of skin 5-35 Malignant neoplasm of breast

5-36 Malignant neoplasm of cervix uteri

5-37 Malignant neoplasm of other and unspecified parts of uterus

5-38 Malignant neoplasm of ovary 5-39 Malignant neoplasm of prostate 5-40 Malignant neoplasm of bladder

5-41Malignant neoplasm of meninges, brain and other parts of central nervous system

5-42 Non-Hodgkin lymphoma

5-43 Multiple myeloma and malignant plasma cell neoplasms

5-44 Leukaemia

5-45 Other and unspecified malignant neoplasms

5-46 Benign neoplasms

ICD-10 chapter 3

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

excludes neoplasms andcancers

5-47 Anaemias

5-48

Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

ICD-10 chapter 4 Endocrine, nutritional and

metabolic diseases excludes neoplasms andcancers

5-49 Diabetes mellitus 5-50 Protein-energy malnutrition

5-51Other and unspecified endocrine, nutritional and metabolic diseases

ICD-10 chapter 5 Mental and behavioural

disorders

5-52 Alcohol use disorders 5-53 Drug use disorders

5-54 Other mental and behavioural disorders

ICD-10 chapter 6 Diseases of the nervous system excludes neoplasms and

cancers 5-55 Meningitis 5-56 Alzheimer's disease, dementias

5-57 Other diseases of the nervous system

ICD-10 chapter 7 5-58 Diseases of the eye and adnexa excludes neoplasms

andcancers

ICD-10 chapter 8 5-59 Diseases of the ear and mastoid

process excludes neoplasms and cancers

ICD-10 chapter 9 Diseases of the circulatory

system excludes neoplasms, cancers and cardiac arrest (see 5-95)

5-60 Acute rheumatic fever and chronic rheumatic heart diseases

5-61 Hypertensive heart diseases

5-62 Ischaemic heart diseases includes myocardial infarction

5-63 Other heart diseases 5-64 Cerebrovascular diseases

5-65 Other and unspecified diseases of the circulatory system

ICD-10 chapter 10 Diseases of the respiratory

system excludes neoplasms andcancers

5-66 Influenza

5-67 Pneumonia includes neonatal pneumonia

5-68 Other acute lower respiratory infections

excludes infections specified in the infectious disease section

5-69 Chronic lower respiratory diseases includes chronic obstructive

lung disease, asthma

5-70 Other and unspecified diseases of the respiratory system

ICD-10 chapter 11 Diseases of the digestive system excludes neoplasms and

cancers 5-71 Gastric and duodenal ulcer 5-72 Appendicitis 5-73 Liver cirrhosis

5-74 Other diseases of the digestive system

ICD-10 chapter 12 5-75 Diseases of the skin and

subcutaneous tissue excludes neoplasms, cancers and melanoma of skin

ICD-10 chapter 13 5-76 Diseases of the musculoskeletal

system and connective tissue excludes neoplasms and cancers

ICD-10 chapter 14 Diseases of the genitourinary

system excludes neoplasms and cancers

5-77 Glomerular and renal tubulo-interstitial diseases includes pyelonephritis

5-78 Other and unspecified diseases of the genitourinary system

includes urinary tract infection, excludes pyelonephritis

ICD-10 chapter 15 Pregnancy, childbirth and the

puerperium excludes tetanus, external causes

5-79 Pregnancy with abortive outcome 5-80 Maternal hypertensive disorders 5-81 Obstructed labour 5-82 Maternal haemorrhage 5-83 Maternal sepsis 5-84 Other direct obstetric deaths excludes tetanus 5-85 Indirect obstetric deaths

ICD-10 chapter 16 Certain conditions originating in

the perinatal period

excludes tetanus, external causes, malformations, neoplasms, cancers, endocrine diseases (e.g. diabetes mellitus)

5-86

Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery

5-87 Disorders relating to length of gestation and fetal growth

5-87.1 Prematurity 5-87.2 Low birth weight

5.87.9Other and unspecified disorders relating to length of gestation and fetal growth

5-88 Birth trauma

5-89 Intrauterine hypoxia and birth asphyxia

5-201 Sepsis and other infectious conditions of the newborn

excludes malaria, pneumonia

5-90 Other and unspecified perinatal conditions

ICD-10 chapter 17

Congenital malformations, deformations and chromosomal abnormalities

5-91 Congenital hydrocephalus and spina bifida

5-92 Congenital malformations of the heart

5-93 Down syndrome and other chromosomal abnormalities

5-94 Other and unspecified congenital malformations

ICD-10 chapter 18 5-95

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

includescause of death not specified, or when only 'respiratory arrest' or 'cardiac arrest' is reported

ICD-10 chapter 20 External causes of morbidity and

mortality

5-96 Road traffic accidents 5-97 Other transport accidents 5-98 Falls

5-99 Accidental drowning and submersion

5-100 Exposure to smoke, fire and flames

5-101 Exposure to forces of nature includes earthquake, tsunami, storm and flood

5-102 Accidental poisoning by and

exposure to noxious substances

excludes foodborne infections (see infectious diseases)

5-102.1 Alcohol poisoning

5-102.2 Drug poisoning

5-102.9 Other and unspecified poisoning includesnoxious substances eaten as food

5-103 Intentional self-harm 5-104 Assault 5-105 Conflict and war

5-106 Other and unspecified external causes

13 Appendix B – ICD-10 Start-Up Mortality List with ICD-10 codesThis table provides the link from the ICD-10 SMoL List codes to the ICD-10 codes.

Code Cause of death Optional subcategoryReference to ICD-10 code (transcode to ICD-10)

Certain infectious and parasitic diseases ICD-10 chapter 1

5-1 Cholera A005-2 Typhoid and paratyphoid A01

5-3 Other and unspecified diarrhoeal diseases

A02-A09

5-4 Tuberculosis

A15-A19

5-4.1 Respiratory tuberculosis, confirmed bacteriologically or histologically A15-A16

5-4.9 Other tuberculosis A17-A195-5 Plague A205-6 Leprosy A305-7 Tetanus A33-A355-8 Diphtheria A365-9 Whooping cough A37

5-10 Meningococcal infection A39

5-11 Septicaemia A40-A41

5-12 Infections with a predominantly sexual mode of transmission A50-A64

5-12.1 Syphilis A50-A53

5-12.9

Other and unspecified infections with a predominantly sexual mode of transmission

A54-A64

5-13 Acute poliomyelitis A805-14 Rabies A825-15 Dengue A975-16 Yellow fever A955-17 Other viral haemorrhagic fevers A92-A94, A96, A985-18 Measles B05

5-19 Viral hepatitis B15-B19

5-19.1 Hepatitis B B16

5-19.8 Other viral hepatitis B15, B17-B18

5-19.9 Unspecified viral hepatitis B19

5-20 Human immunodeficiency virus [HIV] disease

B20-B24

5-20.1 HIV disease with tuberculosis B20

5-20.2 Other and unspecified HIV disease B21-B24

5-21 Malaria B50-B54, P37.3, P37.4

5-21.1 Malaria, parasitologically confirmed

B50-B53

5-21.9 Other and unspecified malaria B54, P37.3, P37.4

5-22 Leishmaniasis B55

5-23 Trypanosomiasis B56-B57

5-24 Schistosomiasis B65

5-25 Other and unspecified infectious diseases

A21-A32, A38, A42-A49, A65-A79, A81, A83-A89, B00-B04, B06-B09, B25-B49, B58-B64, B66-B99

Neoplasms ICD-10 chapter 2

5-26 Malignant neoplasm of lip, oral cavity and pharynx C00-C14

5-27 Malignant neoplasm of Oesophagus C15

5-28 Malignant neoplasm of stomach C16

5-29 Malignant neoplasm of colon, rectum and anus C18-C21

5-30 Malignant neoplasm of liver and intrahepatic bile ducts C22

5-31 Malignant neoplasm of pancreas C255-32 Malignant neoplasm of larynx C32

5-33 Malignant neoplasm of trachea, bronchus and lung C33-C34

5-34 Malignant melanoma of skin C435-35 Malignant neoplasm of breast C50

5-36 Malignant neoplasm of cervix uteri C53

5-37 Malignant neoplasm of other and unspecified parts of uterus C54-C55

5-38 Malignant neoplasm of ovary C565-39 Malignant neoplasm of prostate C615-40 Malignant neoplasm of bladder C67

5-41Malignant neoplasm of meninges, brain and other parts of central nervous system

C70-C72

5-42 Non-Hodgkin lymphoma C82-C85

5-43 Multiple myeloma and malignant plasma cell neoplasms C90

5-44 Leukaemia C91-C95

5-45 Other and unspecified malignant neoplasms

C17, C23-C24, C26-C31, C37-C41, C44-C49, C51-C52, C57-C60, C62-C66, C68-C69, C73-C81, C86-C88, C96-C97

5-46 Benign neoplasms D00-D48

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

ICD-10 chapter 3

5-47 Anaemias D50-D64

5-48

Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

D65-D89

Endocrine, nutritional and metabolic diseases ICD-10 chapter 4

5-49 Diabetes mellitus E10-E145-50 Protein-energy malnutrition E40-E46

5-51Other and unspecified endocrine, nutritional and metabolic diseases

E00-E07, E15-E35, E50-E90

Mental and behavioural disorders ICD-10 chapter 5

5-52 Alcohol use disorders F105-53 Drug use disorders F11-F19

5-54 Other mental and behavioural disorders F00-F09, F20-F99

Diseases of the nervous system ICD-10 chapter 6 5-55 Meningitis G00-G035-56 Alzheimer's disease, dementias G30

5-57 Other diseases of the nervous system G04-G26, G31-G99

5-58 Diseases of the eye and adnexa ICD-10 chapter 7 H00-H59

5-59 Diseases of the ear and mastoid process ICD-10 chapter 8

H60-H95

Diseases of the circulatory system ICD-10 chapter 9

5-60 Acute rheumatic fever and chronic rheumatic heart diseases I00-I09

5-61 Hypertensive heart diseases I10-I155-62 Ischaemic heart diseases I20-I255-63 Other heart diseases I26-I45, I47-I525-64 Cerebrovascular diseases I60-I69

5-65 Other and unspecified diseases of the circulatory system I70-I99

Diseases of the respiratory system ICD-10 chapter 10

5-66 Influenza J09-J115-67 Pneumonia J12-J18, P23

5-68 Other acute lower respiratory infections J20-J22

5-69 Chronic lower respiratory diseases J40-J47

Certain conditions originating in the perinatal period ICD-10 chapter 16

5-86

Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery

P00-P04

5-87 Disorders relating to length of gestation and fetal growth

P05-P08

5-87.1 Prematurity P07.2-P07.3, P22 5-87.2 Low birth weight P05, P07.0-P071

5.87.9Other and unspecified disorders relating to length of gestation and fetal growth

P08

5-88 Birth trauma P10-P15

5-89 Intrauterine hypoxia and birth asphyxia P20-P21, P24

5-201 Sepsis and other infectious conditions of the newborn P35-P39 (exclude P37.3, P37.4)

5-90 Other and unspecified perinatal conditions P50-P96

Congenital malformations, deformations and chromosomal abnormalities

ICD-10 chapter 17

5-91 Congenital hydrocephalus and spina bifida Q03, Q05

5-92 Congenital malformations of the heart Q20-Q24

5-93 Down syndrome and other chromosomal abnormalities Q90-Q99

5-94 Other and unspecified congenital malformations Q00-Q02, Q04, Q06-Q18, Q25-Q89

5-95Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

ICD-10 chapter 18

I46, R00-R99

External causes of morbidity and mortality ICD-10 chapter 20

5-96 Road traffic accidents V01-V04, V06, V09-V80, V87, V89, V99

5-97 Other transport accidents V05,V07-V08, V81-V86, V88, V90-V98

5-98 Falls W00-W19

5-99 Accidental drowning and submersion W65-W74

5-100 Exposure to smoke, fire and flames X00-X09

5-101 Exposure to forces of nature X30-X39

5-102 Accidental poisoning by and exposure to noxious substances X40-X49

5-102.1 Alcohol poisoning X45

5-102.2 Drug poisoning

X40-X44

5-102.9 Other and unspecified poisoning X46-X495-103 Intentional self-harm X60-X845-104 Assault X85-Y095-105 Conflict and war Y35-Y36

5-106 Other and unspecified external causes

W21-W64, W75-W99, X10-X29, X50-X59, Y10-Y29, Y30-Y34, Y37-Y59, Y60-Y99

14 Appendix C – Overview of the ICDBrief overview of the International Statistical Classification of Diseases and Related Health Problems(ICD)

Volume 1 – Tabular listVolume 1 of the ICD-10 has 22 chapters, most of which are related to specific body systems (e.g. Diseases of the circulatory system). The chapters not specific to a body system include six specialty chapters where the listed conditions can occur over multiple body system (e.g. Infectious and parasitic diseases). There is also a separate chapter for external causes of morbidity and mortality.

Each chapter is divided into blocks of related conditions which are then subdivided into three-character categories and four-character subcategories. Codes are alphanumeric with a letter being used for the first character and numerals for the second and subsequent characters.

Volume 2 – Instructions and guidelines manualVolume 2 of the ICD-10 is the key to understanding the rules and regulations that govern the classification of conditions. It provides guidance on the use of Volumes 1 and 3, and on the rules of mortality and morbidity coding

Volume 3 – Alphabetical indexVolume 3 of the ICD is a comprehensive alphabetical index of all the diseases and conditions found in the full tabular list of Volume 1. It contains far more diagnostic terms than the tabular list, reflecting the wide variety of ways in which clinicians describe diseases. Volume 3 consists of:

• Section I – an alphabetical listing of terms relating to diseases, nature of injury, reasons for contact with health services and to the factors influencing a person’s health;• Section II – an alphabetical listing of external causes of injury, morbidity and mortality;• Section III – an alphabetically arranged table of drugs and chemicals.

15 Appendix D– ReferencesWHO WEBSITE FOR ICDhttp://www.who.int/classifications/icd/en/

ICD-10 Online Training Toolhttp://apps.who.int/classifications/apps/icd/icd10training/

http://apps.who.int/classifications/apps/icd/icd10training/

http://www.who.int/classifications/icd/en/

16 Appendix E – Common AbbreviationsMedical certifiers are strongly advised NOT to use abbreviations as there is the possibility for ambiguous meanings. Clarification should be sort from the person completing the certificate as to the full name of the condition. If this is not possible, the following is a list of commonly used abbreviations:

NOTE: This list is not exhaustive1.AAA abdominal aortic aneurysmABE acute bacterial endocarditisACTH adrenocorticotrophic hormoneAF atrial fibrillationAFB acid-fast bacillusAGN acute glomerulonephritisAIDS Acquired immune deficiency syndromeALL acute lymphocytic leukaemiaALTE acute life threatening eventAMI acute myocardial infarctionAML acute myelocytic leukaemiaAP angina pectorisAPH antepartum haemorrhageAR aortic regurgitationARC AIDS-related complexARDS adult respiratory distress syndromeARF acute renal failureAS aortic stenosisASD atrial septal defectBBB bundle branch blockBCC basal cell carcinomaBNO bladder neck obstructionBP blood pressureBPH benign prostate hypertrophyBSA body surface areaCa cancerCAD coronary artery diseaseCCF chronic congestive failureCHB complete heart blockCIS carcinoma in situCLL chronic lymphocytic (lymphatic) leukaemiaCML chronic myelocyticleukaemiaCMV cytomegalic virusCNS central nervous systemCOAD chronic obstructive airway diseaseCOPD chronic obstructive pulmonary diseaseCRF chronic renal failureCVA cerebrovascular accidentDIC disseminated intravascular coagulationDJD degenerative joint diseaseDM diabetes mellitus

1Based on the US CDC training materials and the Australian classification standards abbreviation list.

DOA dead on arrivalDS Down syndromeDUB dysfunctional uterine bleedingDVT deep vein thrombosisEBV Epstein-Barr virusESRD end-stage renal diseaseFB foreign bodyGERD gastroesophageal reflux diseaseGSW gunshot woundHIV human immunodeficiency virusHMD hyaline membrane diseaseHSV herpes simplex virusHTLV human T-cell lymphotropic virusHTLV-3 human T-cell lymphotropic virus-IIIHTN hypertensionIADH inappropriate antidiuretic hormoneIDDM insulin-dependent diabetes mellitusIGA immunoglobin AIHD ischemic heart diseaseITP idiopathic thrombocytopenic purpuraIUD intrauterine deathIVH intraventricular haemorrhageJBE Japanese B encephalitisLBBB left bundle branch blockLBW low birth weightLMP last menstrual periodLRI lower respiratory infectionMAC mycobacterium avium complexMAI mycobacterium aviumintracellulareMGN membranous glomerulonephritisMRSA methicillin resistant staphylococcal aureusNIDDM non-insulin-dependent diabetes mellitusNSTEMI non-ST-elevation myocardial infarctionOA osteoarthritisOD overdosePDA patent ductusarteriosusPET pre-eclamptic toxaemiaPMD progressive muscular dystrophyPOC product of conceptionPPH postpartum haemorrhagePREM prematurityPROM premature rupture of membranesPU peptic ulcerPUO pyrexia of unknown originPVD peripheral vascular diseaseRDS respiratory distress syndromeRHD rheumatic heart diseaseSARS severe acute respiratory syndromeSBE subacute bacterial endocarditisSBO small bowel obstructionSCC squamous cell carcinomaSGA small for gestational ageSIADH syndrome of inappropriate antidiuretic hormoneSIDS sudden infant death syndrome

SIRS systemic inflammatory response syndromeSLE systemic lupus erythematosusSOB shortness of breathSVD spontaneous vaginal deliverySVT supraventricular tachycardiaTAPVR total anomalous pulmonary venous returnTB tuberculosisTBC tuberculosisTIA transient ischemic attackUC ulcerative colitisURI upper respiratory infectionUTI urinary tract infectionVD venereal diseaseVF ventricular fibrillationVSD ventricular septal defectVT ventricular tachycardiaWC whooping coughWPW Wolfe-Parkinson-White syndromeYF yellow fever

17 Appendix F – Answers to Exercises1.

CONDITION Acceptable Not AcceptableE Coli as a cause of a urinary tract infection √Caesarean section delivery √Poisoned by a snake bite √Visual impairment resulting from eye cancer √Fractured leg from a fall out of a tree √

Hints: Certain conditions that may not be used for underlying cause of death,Rules SR8, SR18, SR25

2. Colon cancer Hint: SR183. Cerebral infarction Hint: SR24. Appendicitis Hint: SR255. Coronary artery disease Hint: SR66. Diabetes mellitus Hint: SR197. Tuberculosis meningitis Hint: SR168. Suicide – hanging Hint: SR99. Fetus and newborn affected by maternal factors Hint: SR1310. HIV Hint: SR1811. Asthma Hint: SR612. Bitten by dog Hint: Injuries take priority over infections13. Klebsiella pneumonia septicaemia Hint: SR714. Placenta praevia Hint: SR10, SR2515. Traffic accident – Pedestrian struck by car Hint: SR816. Malaria Hint: SR1517. Fall from ladder Hint: SR818. Indirect obstetric death Hint: SR1119. Car accident Hint: SR820. Measles Hint: SR1521. Cirrhosis of liver Hint SR122. Peripheral vascular disease Hint SR323. Coronary artery disease Hint SR424. Other ill-defined and unspecified causes of mortality Hint SR525. Neonatal cardiac failure Hint SR1226. Angina pectoris Hint SR2127. Severe pre-eclampsia Hint SR1028. Influenza Hint SR2229. Dementia Hint SR2330. Peripheral artery disease Hint SR2431. Gangrene Hint SR2632. Indirect obstetric death Hint SR1133. Colon cancer Hint SR1834. Influenza Hint SR22

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