NATIONAL CENTER Serbs 4 For HEALTH STATISTICS INumber 6

VITAL and HEALTH STATISTICS

DOCUMENTS AND COMMITTEE REPORTS

Report of the UnitedStatesDelegationto the InternationalConference for the EighthRevisionof the International Classification of Diseases Geneva, Switzerland =My 6-12, 1965

Discussion and recommendations at the Conference that was concerned primarily with Eighth Revision of the International Classification of Diseases and gave some consideration to multiple-cause tabulation and analysis and to hospital sta- tistics.

DHEW Publication No. (HSM) 73-1264

Washington, D .C, September 1966

U.S. DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE Public Health Service John W. Gardner William H. Stewart Secretary Surgeon General Public Health Service Publication No. 1000-Series 4-No. 6 NATIONAL CENTER FOR HEALTH STATISTICS

FORREST E. LINDER, PH. D., Director

THEODORE D. WOOLSEY, ~@@ ~i?’eC~Or

OSWALD K. SAGEN, Pr.x.D., ~ni-rtatzt Dir#ctor

WALT R. SIMMONS, M.A., statistical Advisor

ALICE M; WATERHOUSE, M. D., ilfedical ~dvifor JAMES E. KELLY, D.D.S., Dental zfdvi.ror LOUIS R. STOLCIS, M.A,, Executive Ojiccr

OFFICE OF HEALTH STATISTICS. ANALYSIS

IWAO M. MORIYAMA, PH. D., Ckiej

DIVISION OF VITAL STATISTICS

ROBERT D. GROVE, PH. D., (Wej

DIVISION OF HEALTH INTERVIEW STATISTICS

PHXLXPS. LAWRENCE, Sc. D., (Y@

DIVISION OF HEALTH RECORDS STATISTICS

MONROE G. SIRKEN, PH. D.j Chief

DIVISION OF HEALTH EXAMINATION STATISTICS

ARTHURJ. MCDOWELL, Chief

DIVISION OF DATA PROCESSING

SIDNEY BXNDEB,Chief

Public Health Service Publication No. 1000-Series 4-No. 6 Library of Congress Catalog Card Number 66-61306 CONTENTS Page Background of the Conference ------1

Organization”of the Conference ------1

Work oftieConference ------2 Eighth Revisionof tie ICD------=------2 International Form of Medical Certificate ofCause of Death------2 Lists for Tabulation ofMorbidity and Mortali&Data------3 Nomenclature Re~lations ------3 Adaptation of the ICD for Diagnostic Index ofHospital Records ------3 Multiple-Cause Tabulation and Analysis ------3 The Role of WHO in Developing Health Statistics ------4 Hospital Statistics ------5 Implications of Advances in Automatic Data Processing ------5 National Committees on Vital and Health Statistics ------5

Future Meetings ------6

Conclusions ------6

Appendix I. Re~rtof tie Conference ------8

1. Eighth Revision of the International Classification 0?–Diseases(ICD)------9 1.1 General Structure of the Classification ------9 1.1.1 Numbering System of theClassification ------9 1.1.2 Classification ofSpptoms ------9 1.1.3 Notes Under ICDCategories ------9 1.1.4 Supplementary Classifications------9 1.2 Categories and Sub-Categories of the ICD------9 1.3 Editing of Manual ------10

2. Related Matters ------10 2.1 International Form of Medical Certificate of Cause of Mati ------10 2.2 Lists for Tabulation ofMorbidity and MortalityData------10 2.3 WHO Nomenclamre Re~lations ------10 2.4 Adaptation of the ICD for Diagnostic Indexingof Hospital Records ------11 2.5 Multiple-Cause Tabulation and Analysis------11 2.6 Rules for Selection of Cause of Bati ------11 CONTENTS—Continued

Appendix I. Report of the Conference—Continued rDam. 2.7 Definitions and Other Issues Relating to Perinatal Morbidity and Mortality ------, ------11 2.7.1 Definition of Foetal Death ------11 2,7.2 Definition of the Perinatal Period ------12 2.7.3 Recording of Causes of Perinatal Death ------12 2.7.4 Recording of Other Data Pertinent to the Perinatal Period ------12 2.8 Publication of RevisedManual ------12

3. National and International Developments in Health Statistics------13 3.1 Role of WHO in DevelopingHealth Statistics ------13 3.2 Hospital Statistics ------13 3.3 Implications of Advances in Automatic Data Processing ------13 3.4 National Committees on Vital and Health Statistics ------13

Appendix II. List of Participants at the Conference ------15

Appendix 111. International Classification of Diseases—Eighth Revision ------21

. Infective and Parasitic Diseases ------21 1;: Neoplasms ------27 III. Endocrine, Nutritional and Metabolic Diseases ------32 IV. Diseases of Blood and Blood-Forming Organs ------34 v. Mental Dsorders ------34 VI. Diseases of the Nervous System and Sense Organs------36 VII. Diseases of the Circulatory System ------39 VIII. Diseases pf the Respiratory System ------42 IX. Diseases of the Digestive System ------43 x. Diseases of Genito-Urinary System ------46 XI. Complications of Pregnancy, Child-Birth andthe Puerperium-- 48 XII. Diseases of the Skin and Subcutaneous Tissue ------50 XIII. Diseases of the Musculoskeletal System and Connective Tissue-- 52 XIV. Congenital Anomalies ------53 xv. Certain Causes of Perinatal Morbidity and Mortality------55 XVI. Symptoms and Ill-DefinedConditions ------56 E XVII. Accidents, Poisonings and Violence (External Cause) ------57 N XVII. Accidents, Poisonings and Violence (Nature of Injury, N8M-N999]------64 U.S. DELEGATION

Forrest E. Linder, Ph.D. (Chairman of Delegation) Director, National Center for Health Statistics Public Health Service Washington, D.C.

Louis N. Dakil, M.D. Physician and Surgeon 110 East Carl Albert Parkway McAlister. Oklahoma

Paul M. Densen, D.SC. Deputy Commissioner New York City Department of Health New York, New York

Robert Dyar, M.D. Chief, Division of Research California State Health Department Berkeley, California

Eugene L. Hamilton Director, Medical Statistics Agency Surgeon General’s Office Department of the Army Washington, D.C.

Iwao M. Moriyama, Ph.D. Chief, Office of Health Statistics Analysis National Center for Health Statistics I?ublic Health Service Washington, D.C.

Brian MacMahon, M.D. Professor and Chairman Department of Epidemiology Harvard School of Public Health Cambridge, Massachusetts

William H. Stewart, M.D. Assistant to Special Assistant to the Secretary (Health and Medical Affairs) Office of the Secretary Department of Health, Education, and Welfare Washington, D.C.

Franklin D. Yoder, M.D. Director of Public Health Illinois State Health Department Springfield, Illinois THIS IS A REPORT of the Inte?%ational Conference fov the Eighth Revision of the Internutiomd Classij% cation of Diseases. The revised classification represents an important advance and, with some adaptations, it is expected to meet the major needs for a disease classification in the United States. The Conference recommended that the World Health Organization publish the Eighth Re- vision of the International Classification with an alpha- betic index early in 1967. The Eighth Revision is ex- pected to go into efjiect on JanuaYy 1, 1968. REPORT OF THE U.S. DELEGATION TO THE INTERNATIONAL CONFERENCE FOR THE EIGHTH REVISION OF THE ICD

BACKGROUND OF THE the revision of the Bertillon Classification of Causes of Death and this Conference, attended CONFERENCE by delegates from 26 countries, adopted the First International Classification. The French Govern- The International Conference for the Eighth ment called conferences for the successive re- Revision of the International Classification of visions of this Classification in 1909, 1920.1929, Diseases (ICD) convened by the World Health and 1938. At the time of the 1929 and 1938 re- Organization (WHO) met in the Palais des Nations, visions, the International Statistical Institute and Geneva, from July 6-12, 1965. As is evident from the Health Organization of the League of Nations the Conference title, its primary purpose was to were active in the technical aspects of mortality agree on the Eighth Revision of the International classification problems. Classification of Diseases and related matters. Because of the activity of the League of Discussion of other topics related to health sta- Nations in this work, the responsibility for the tistics was also included on the agenda. problem was embodied in Article 21 of the The efforts of countries to achieve some Constitution of the World Health Organization, degree of standardization in the classification of which gives WHO the authority to adopt regula- disease and causes of death is perhaps one of the tions concerning ‘‘. . . (b) nomenclature with re- earliest efforts at international cooperation. The first International Statistical Congress, held at spect to disease, causes of death and public health practices. . . .“ Brussels in 1853, requested Dr. William Farr Conferences for the revision of the ICD have (England) and Dr. Marc d’Espine ‘(Switzerland) to prepare ‘‘une nomenclature uniforme des been held under the auspices of WHO in 1948 and causes de d~c>s applicable> tous les pays. ” The 1955 and now in 1965. next Congress in 1855 adopted a nomenclature with this objective in mind, and this first list was ORGANIZATION OF THE revised in 1864, 1874, 1880, and 1886 in successive sessions of the Congress. By 1891 the International CONFERENCE Statistical Institute, successor to the International Statistical Congress, had taken up the task of For the most part the Conference worked in achieving international comparability in this field. plenary sessions, establishing only one major Acceptance of the proposed classifications was working group or committee. Delegates from slow, but in 1898 the generaI principles were Australia, the United Kingdom, and the United endorsed by the American Public Health Associa- States and technical staff of the WHO Secretariat tion; and other countries had begun to use the were in this important working group. The function internationally recommended concepts. of this committee was to examine the numerous In 1900 the French Government convoked detailed revision proposals that various countries in Paris the first International Conference for submitted for consideration and to decide if the

1 proposals were minor or editorial in character digit categories were not seen as presenting or if they were important decisions calling for particular problems in the United States. A Conference action. The major” proposals as possible exception’ is the deletion of the proposed identified by this committee were submitted to fourth-digit subdivisions under diabetes mellitus the full Conference (WHO/HS/8 Rev. Conf./lO) that show various clinical manifestations and and final decisions taken at plenary sessions. complications of the disease. It is expected that It is notable that the attendance of the some adjustment will need to be made in the members of the delegations from the countries United States. The proposal for giving more was extremely high throughout every session—the prominence to the reactive psychoses would number of absences being unnoticeable. The dis- have caused difficulty, but the solution which was cussions were of a strictly technical character adopted should” not cause any problems in the with no introduction of extraneous issues or com- compilation of mental disease statistics in the ments at any time. The Conference functioned with United States. a high degree of goodwill and willingness to make At the conclusion of discussion of revision technical compromises in order to reach a con- proposals, the WHO Secretariat raised a question sensus. At no time was it necessary to take a about the status of fourth-digit subdivisions formal vote, the Chairman being able to sense which indicated a divergence of views from those ‘and express a generally acceptable conclusion expressed by the Conference. The Conference after adequate expression of differing national confirmed the notion of national options with viewpoints by the various delegations. respect to fourth-digit categories but expressed The final re~rt of the Conference (WHO/HS/ the hope that fourth-digit categories provided 8”Rev. Conf./ll.65) is given in Appimdixes I, II, in the International Classification of Diseases and III. would be used by countries electing to go to the fourth-digit level of detail. WORK OF THE CONFERENCE .There was considerable concern expressed by several delegations such as Australia, Nor- Eighth Revision of the ICD way, Canada, the United Kingdom, and the United States that WHO would not be able to publish the The Eighth Revision proposals were dis- Eighth Revision of the ICD with an alphabetic in- cussed on the assumption that the new Nomen- dex in time for its use at the beginning of 1968. clature Regulations would provide for obligatory Accordingly it was recommended in fairly strong use of the three-digit categories of the Inter- terms that WHO complete this task as early as national Classification of Diseases and leave the possible in 1967. The availability of manuals early use of the fourth-digit categories optional. It was in 1967 is particularly important for countries recognized that national needs varied and that like the United States that need to develop use of or form of fourth-digit subdivisions for training material and organize training courses national purposes would differ from country to to be offered to coders in State health depart- country. ments before January 1, 1968. The Conference reviewed the proposals sub- mitted section by section. The Chair entertained only comments of a substantive nature and re- International Form of Medical Certificate ferred all matters of an editorial nature to the of Cause of Death Secretariat. These comments were later ex- amined by a small working group established for Since no serious consideration had been this purpose. (For report see WHO/HS/8 Rev. given to changes in the basic concept of cause- cin’lf./lo.) of-death statistics, no substantive changes could By and large, the issues that were raised be proposed on the medical certificate form. concerning the proposed revision were minor The Conference stressed the importance of in nature and generally dealt with fourth-digit national studies of the completeness, reliability, subdivisions. Most of the changes involving fourth- and validity of diagnostic information reported on

2 death certificates and the need to improve the Beyond this, it was also generally recognized quality of medical certifications based on such that the Regulations were somewhat obsolete evaluation studies. and unnecessarily y detailed in various respects. The United States proposed that a thorough study be made of the Regulations preliminary to a Lists for Tabulation of general redrafting, and the Conference recom- Morbidity and Mortality Data mended that the Regulations be reexamined and revised Regulations be submitted to the World The topic concerned the development of short Health Assembly (wHA). lists of selected diagnoses to be used for special At the final session it was agreed that the tabulation purposes. WHO proposals suggested report of the Conference would indicate the two selected lists of 150 and 300 titles. sequence of steps to be followed—namely, that The U.S. delegation took the position that the draft Regulations would be circulated to countries problems of developing short lists should be for comment and that proposed new Regulations discussed at the Conference but that final endorse- would then be redrafted on the basis of such ment of such lists should not be made since WHO comment prior to their circularization as WHA proposals had not been available for study prior working documents. to the Conference. The WHO proposed lists were not generally Adaptation of the ICD for accepted by the Conference. Various discussants pointed out the need for lists with fewer numbers Diagnostic Index of Hospital Records of titles. The U.S. delegation emphasized that the lists would be more generally useful if fewer The importance of utilizing some form of the titles were used for infectious diseases in order ICD for indexing diagnostic data on hospital to expand the number of titles available for records was recognized, especially with respect chronic diseases. to its implications in terms of hospital morbidity It was generally agreed that draft lists of statistics. There was no disagreement about the 50 and 150 causes and an optional list of 250-300 desirability of an adaptation. Although a number causes should be prepared by WHOand circulated of countries had already made national adapta- to countries for comment. tions of the ICD for diagnostic indexing purposes, it was suggested that more experience was needed Nomenclature Regulations before a satisfactory international adaptation could be made. Therefore, it was suggested that There was an extended discussion of the interested countries be encouraged to experi- Nomenclature Regulations and how they should ment with ways in which an adaptation could be be modified in relation to the revised ICD. The made and that WHO keep in touch with these delegation from the’ United Kingdom was particu- experiments so that the question of developing larly concerned with this question and had sub- an international adaptation could be examinec mitted a note to the Conference stating modifica- at some time in the future. On the other hand, tions of the Regulations that were considered there were those who felt that the proposed necessary concurrent with the adoption of the Eighth Revision provided an adequate framework revised ICD. Revisions of the Regulations were of a classification suitable for hospital indexing essential to restore the right of countries to make in some countries. reservations to changes in the ICD—such a right to make reservations apparently expires at the Multiple-Cause Tabulation and Analysis time of the prior revision. The necessity for such changes in the Regula- The item was introduced by the U.S. delega- tions was generally recognized and the proposals tion with a paper outlining studies of multiple of the United Kingdom were supported by the causes appearing on U.S. death certificates (WHO/ U.S. delegation and the Conference in general. HS/ICD/75.65). The U.S. delegate noted the in- tention of the United States to prepare multiple- Two proposals for limited multiple-cause cause tabulations, the interest of other countries, analysis were made. One, put forward by WHO and the need for development of coding rules and Secretariat, provided a means for coding in a procedures. Although it is premature to seek single column selected cause combinations now to establish international regulations in this recognized as of special interest (WHO/HS/ICD/ regard, the United States would welcome an ex- 79.65). This proposal was not commented upon. pression of interest from other countries in co- The other, from Israel, proposed that a schedule operative approaches to the problems. of conditions of particular interest be set up. Interest in such studies was expressed by One or two of these conditions would be selected the delegates from Germany, Norway, and the each year and special efforts would be made by United Kingdom. Several other countries are all participating countries to assemble data on clearly in a position to participate. The Nether- the diseases associated with the condition selected lands has been coding and tabulating multiple during the year (WHO/HS/ICD/77.65). Although causes since 1961. Australia is about to begin some countries in favor of limited multiple- studies. cause work (Denmark, U.S.S.R.) referred favor- The delegates from Norway, the United ably to the Israeli proposal, no consideration was Kingdom, and the United States, as well as the given to the problems evident in the requirement WHO Secretariat, stressed continuing interest of the proposal that special efforts be made to in tabulations based on a single condition selected obtain more complete certification of the se- as the underlying cause. Such tabulations are lected diseases. necessary for the study of trends and are based The Chair proposed that countries interested on conditions of a degree of severity sufficient in development of multiple-cause statistics should to overcome some of the problems of diagnostic make their interest known to the WHO Secretariat accuracy and completeness of reporting asso- and that the Secretariat should take the initiative ciated with conditions of lesser severity. in stimulating discussions at the international The delegate from Australia suggested that level. This proposal had the agreement of the all diseases and conditions present at time of Conference. death be included in multiple-cause tabulations. It was felt that as long as the collection of multi- The Role of WHO in Developing ple-cause data was based on information available Health Statistics on death certificates, those conditions existing coincidentally, that is, not contributing to death, This item and the topics discussed below were should not be considered part of multiple-cause general topics grouped under the agenda topic of tabulations. National and International Developments in Health It was pointed out that the results of multiple- Statistics. Very little of the Conference time was cause tabulations will vary greatly according to allotted to this group of topics since the principal the form of the death certificate, the responsive- purpose of the Conference related to the Eighth ness of the medical certifiers to the possibilities Revision of the ICD and associated questions. introduced by the new procedure, and other fac- The discussion of the role of WHO was based tors (Denmark, Norway, Yugoslavia, U.S.S.R., on a document prepared by a WHO consultant Australia, and Finland). These problems will (WHO/HS/8 Rev. Conf./3.65) and comprised a require considerable investigation. Nevertheless, general review of the area of activities of the after recognizing the problems and limitations of WHO unit concerned with a critique of its effec- multiple-cause tabulations at the present time, it tiveness and program gaps. The ensuing dis- still seems necessary to maximize the use of cussion was rather discursive, although many information that is now recorded on certificates delegations made comments, and consisted to a (United States). large degree of indications of areas of work in Denmark and the U.S.S.R. expressed interest health statistics that could properly be included in undertaking multiple-cause tabulations on a in the WHO program. limited scale—perhaps on only three or four The Conference, in general, and the Secre- diseases. tariat seemed to accept the general appraisal of

4 the consultant’s report and no specific action spite of this there was widespread interest in the seemed appropriate. topic as presented in a paper prepared by the General Register Office of the United Kingdom. Hospital Statistics The U.S. delegation outlined current activities in the United States in computer usage in health This topic was introduced by a member of the fields. Recognizing the future importance of Canadian delegation who described the program these methods, the Conference recommended of hospital statistics now being developed in that WHO act as a clearinghouse for information Canada and by a U.S.S.R. paper on the development on the use of computers in health statistics. of hospital statistics in that country as related to automatic data processing methods. The U.S. National Committees on delegation described briefly the new program of Vital and Health Statistics hospital statistics being started in the United States. The discussion on National Committees on Hospital statistics may be used for planning Vital and Health Statistics was opened by the WHO purposes relating to the size and nature and Secretariat with a summary of the existence, financing of the hospital as a physical plant. They activities, and so forth of such Committees in 47 may also relate to illnesses treated in the hos- nations and a description of French experience pital which might be of value for epidemiological with a national coordinating committee for health purposes. With regard to the latter use, the statistics. The issue here, if one existed, was questions are intimately bound up with the the role of WHO in relationship to such Com- subject of the adaptation of the ICD for diagnostic mittees, particularly in stimulating their forma- indexing purposes; therefore much of that dis- tion and development and in appraising their cussion applies here. activities. There was general recognition that this Discussion by delegates from Australia, emergent area of health statistics would be of France, Yugoslavia, and the United States revealed increasing importance in many countries of the different patterns of numbers, responsibility, and world and that the field was still in a fluid state operations. Regardless of the pattern, there was as far as the technical aspects of the program general support of the U.S. point of view that such are concerned. Accordingly, WHO could make an Committees should be: (1) National organizations, important contribution at this time by completing reporting to a national agency to be determined material in the form of handbooks on methods by the government concerned (and not international and on standardization of definitions and concepts in a direct sense); (2) Advisory @ot executive), and by assisting in the clarification of concepts serving in the capacity that best suits the needs and objectives. Recommendations to this end of the government concerned, with full apprecia- had previously been made by the Expert Com- tion that advice may be accepted or rejected mittee on Heaith Statistics in its Eighth Report. (3) So characterized as to provide a representative The Conference gave general support to these national forum for the definition of problems of recommendations. health statistics, stimulation of solutions by It was also agreed that it was desirable for appropriate ad hw subcommittees, and dissem- the various countries that are developing hospital ination of information concerning their interests statistics to keep in close touch with each other and activities. so that problems affecting international compara- There was no expression of need for activity bility may be discussed. on the part of WHO beyond response to national requests for assistance in formation of a com- Implications of Advances in mittee on health statistics and collection and dissemination of information concerning their Automatic Data Processing use and accomplishments. It is a fair conclusion This topic is obviously of major interest to a to assume that those nations functioning by demo- few countries advanced enough to be using elec- cratic processes use national advisory com- tronic equipment in processing health data. In mittees on health statistics in a variety of ways

5 (coordination, policy formulation, education, tech- Furthermore, the introduction of various com- nical development, evaluation), depending on na- binations of diseases into the disease classifica- tional need and desire, and generally find them tion interferes with the use of the classification useful instruments in their national health sta- for coding multiple diagnoses as needed in tistics programs. classifying morbidity data and for securing maxi- mum use of diagnostic information reported on FUTURE MEETINGS death certificates. The preliminary draft classifications were No decisions were made or discussed in a generally unsatisfactory from the U.S. point of formal way regarding future international con- view. After successive modifications, the disease ferences dealing with the questions of this Con- classification finally adopted by the Conference fer&nce. However, it was assumed throughout provides a generally satisfactory structure for the meeting that in 1975 or earlier there would use in the United States. With certain adaptations be a Ninth Revision Conference, and many points with respect to the details of the classification were made regarding additional steps that could as provided for by the Conference agreement, it be taken to achieve greater international compara- is expected that the major needs for a disease bility of mortality and morbidity statistics by classification in the United States will be satis- that time. It was also assumed that prior to the fied. Ninth Revision Conference there would be a long The revised classification represents an program of national, bilateral, and multilateral important advance over the previous revision of studies and consultations and various WHO Ex- the International Classification of Diseases. The I pert Committee activities preparatory to the next proposed section on mental disorders is mQre revision. This would follow the established pattern closely aligned with the views of American of previous revisions. psychiatry. Greater recognition is given to dental conditions and to congenital anomalies that are CONCLUSIONS of interest in genetic studies of the human pop- ulation. The classification of nature of injury, In preparing for the Eighth Revision of the especially adverse effects of drugs, has been International Classification of Diseases begun updated to meet needs of hospitals. The revision in 1959 in the United States, the various broad proposed by the Conference goes a long way to needs for a disease classification were recog- meet increased demands in the United States nized. From the outset, the United States pressed during the coming decade for a suitable disease for a disease classification suitable for indexing classificatiofi for various purposes. hospital diagnoses and for hospital morbidity The structure of the classification provides statistics in addition to the traditional uses of the a satisfactory basic framework for adaptations ICD for classifying causes of death. This view for various purposes. The U.S. delegation is of was not shared by many countries which were the view that the option on fourth-digit categories prec@upied with the need for obtaining more should be exercised and study given to the prepa- information on causes of death by providing in ration of an adaptation of the ICD for hospital the body of the International Classification of indexing and for hospital morbidity statistics in Diseases categories dealing with combinations the United States. It would be important and of various diseases. This approach to the classifi- extremely desirable if a single adaptation would cation of causes of death was criticized by Dorn i serve all the official needs for a disease classifi- as an inflexible and otherwise unsatisfactory cation in the United States. method for producing cause-of-death statistics. The U.S. delegation suggested that a full- scale multiple-cause coding and tabulation pro- gram be undertaken in the United States on a lDom, H. F.: Some considerations in the revision of the regular basis after a study is made of methodo- International Statistical Classification, Pub. Health Rep. logical problems involved in coding and tabulating 78:175-179, Feb. 1964. multiple diagnoses reported on death certificates.

6 In view of the interest expressed by several practices of attendants at birth as well as regis- countries in preparing multiple-cause tabulations, tration and statistical practices. Studies of defi- it was also suggested that the United States col- nitions actually used as well as completeness of laborate with interested countries with the view perinatal death registration are essential for to establishing comparable procedures and mini- assessment of the level of infant mortality rates mum tabulation specifications of associated dis- in developed countries. In other areas of mor- eases for comparative purposes. tality statistics, it is important that studies be It is expected that during the decade that the made of the validity, reliability, and completeness Eighth Revision of the ICD will be in effect ex- of diagnostic data reported on medical certifica- tensive use will be made of the classification for tion of causes of death. This is particularly true morbidity statistics. This experience will be for time-trend comparisons of national multiple- invaluable for the next revision. However, more cause information or international comparisons opportunity should be given to study revision pro- of multiple-cause data. Although international posals than was provided for the Eighth Revision. recommendations on these points did not emerge National and international work on the Ninth from the Conference, the U.S. delegation notes Revision of the International Classification of the essential nature of these evaluative studies Diseases should be started as early as possible. in the United States. In this connection, consideration should be given The question of use of electronic computers to reexamination of the concept of the underlying is an academic one for many countries represented cause of death as well as to the kind of multiple- at the Conference. For countries such as the cause data that should be collected. In prepara- United States, the United Kingdom, and Canada, tion for the Ninth Revision, it is suggested that the problem is a practical one. In fact, the where possible studies be undertaken by the United feasibility of conducting large-scale statistical States in collaboration with one or more other programs in hospital morbidity and on multiple countries. causes of death depends to some extent on the With regard to other items discussed by the future development of procedures for encoding Conference, the U.S. delegation generally en- of diagnostic information by use of computers. dorses the views expressed. In most instances, This is in areas where important developments the U.S. delegation would have Preferred stronger, may be expected. The U.S. delegation noted positive, and more far-reaching recommendations with interest the efforts devoted to this problem on the various questions under discussion. For and expressed the hope that international col- example, the question of definition of the perinatal laboration will be possible on a bilateral or period is an important one from the standpoint multilateral basis. A coordinated attack on this of producing perinatal morbidity and mortality problem is essential if satisfactory computer statistics. For the purpose of assessing perinatal encoding procedures are to be developed before and infant mortality statistics, it is necessary 1968. to go further in determining actual reporting

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7 APPENDIX I

REPORT OF THE CONFERENCE

The International Conference for the Eighth Re. 43, 44 and 45 of the Rules of Procedure of the Executive vision of the International Classification of Diseases Board apply for the conduct of the sessions. convened by the World Health Organization met in the The Conference elected the following officers: Palais des Nations, Geneva, from 6 to 12 July 1965. Chairman: Mr. M. Reed The Conference was attended by the following 36 Registrar General for England and Member States and one Associate Member: Wales, General Register Office Australia Norway United Kingdom of Great Britain and Austria Poland Northern Ireland Bulgaria Portugal Vice-Chairmen: Dr. F. E. Linder Canada Romania Director Czechoslovakia Saudi Arabia National Center for Health Statistics Denmark Spain United States of America Finland Sweden France Switzerland Dr. V. K. Ov;arov Federal Republic l%ailand Chief of Germany Togo Health Statistics Ghana Union of Soviet Department of the Semashko Institute Guatemala Socialist Republics of Health Administration and History Hungary United Kingdom of of Medicine India Great Britain and Union of Soviet Socialist Republics Iran Northern Ireland Dr. D. Curiel Israel United States of formerly Medical Chief Italy America Division of Epidemiology and Vital Japan Venezuela $tatistics Kuwait Yugoslavia Ministry of Health Madagascar Mauritius, Associate Venezuela Mali Member Netherlands Rapporteurs: Dr. M. J. Aubenque Chef Division des Statistiques sanitaires The United Nations Orgardzation and the Inter- Institut ‘national de la Statistique et national ‘Lakour Organisation as well as three inter- des Etudes economiques national non-government organizations, namely, the France International League of Dermatological Societies, ‘the International Society of Cardiology and the International Dr. R. H. C. Wells First Assistant Director-General Union against Cancer, sent representatives to partici- Commonwealth Department of Health pate in the Conference. The list of participants is Australia attached as Appendix III to this report. Dr. P. D. ~rolle, Deputy Director-General of the World Health Organization, opened tie Conference on The Conference adopted the aKenda* which, apart behalf of the Director-General. It was agreed that the from the Eighth Revision of the Int&national Classifi- sessions be public and that the Rules of Procedure for Expert Committees. except Article 3, and Articles cation of Diseases and matters related to it, included dorsed the views of the Expert Committee on this other items reflecting national and international de- subject. velopments in the field of health statistics. It was also agreed that when it was appropriate and p&+sible to include separate sub-categories for 1. EIGHTH REVISION OF THE INTERNATIONAL “Other” and “Unspecified,” they should be numbered CLASSIFICATION OF DISEASES (ICD) “consistently .8 and .9.

1.1 General structure of the Classification 1.1.2 Classification of symptoms

Before reviewing the revision proposals for the The” Conference agreed on the continuing need for various sections of the Classification, the Conference a special section of the ICD for the classification of considered some of its more general aspects. symptoms which do not point definitely to a given diagnosis and cannot therefore be asaigned to a cate- 1.1.1 Numbering system of the Classification gory in the disease sections of the code. It was appreci- ated that a final revision of this section would require The Conference recalled the comments of the a systematic review of all terms in the presmt alpha- Expert Committee on Health Statistics in its Ninth betical index in relation to this criterion. Report’: on the numbering system of the Classification and endorsed the view that the three-digit categories 1.1.3 Notes under ICD categories should form “the basic framework of the ICD in all its varied applications.” ‘In regard to the fourth digit, the The Conference requested WHO to review the notes Expert Committee had said defining the content of categories with a view to making them more immediately intelligible to coders and to “The role of the fourth digit was the identification persons using the Classification for the purpose of of greater detail within the three-digit categories. interpreting published statistics. The extent of &e detail needed would vary for different applications of the ICQ greater, for 1.1.4 Supplementary classifications example, in diagnostic indexing and special studies than in routine statistical use. Furthermore, the The Conference reviewed the functions of the fourth-digit detail required in the various sections supplementary (Y) classifications. hat for causes of of the Classification would 1differ in different stillbirth would now disappear since it “was integrated countries or regions. The ICD, therefore, should into Section XV, “Certain causes of pertiatal morbidity include the essential and desirable fourth-digit and lmortality.” The categories YOO-Y29 were regarded sub-divisions but countries should be free to use as essential to provide a full count of admissions to them or not or even to prepare their own fourth- hospital, sttendances at out-patient clinics, etc. in digit adaptations instead. The Committee con- respect of persons who were not sick and who could sidered, however, that the internationally recom- not, therefore, be classified to the main code. ?&e mended four-digit structure would be suitable Conference accordingly considered that this classifica- for most purposes and that countries would only tion, stlitably revised, should appear in the Manual of rarely need to depart from it. Any departure from the ICD. the fourth digits of the ICD must be clearly The classification of impairments in categories identified as such and must not affect the contents of the three-digit categories concerned. ” Y40-Y88 was seen as a parallel code, collecting in one group a number of conditions scattered throughout the The Conference appreciated the need for flexibill~ main code. It had been used by some countries in health at the level of the fourth digit, though it was clear that surveys and the Conference, appreciating that such in some sections, e.g. the perinatal section, meaningful surveys were likely to increase, considered that it statistics would require four-digit coding, but was con- would be useful if such a classification appeared in the cerned that the option to vary the fourth-digit break- Manual of the ICD for optional use. down should not be used more than is necessary. The Conference considered that this option need be exer- 1.2 Categories and sub-categories of the ICD cised only in exceptional circumstances, when the internationally recommended fourth digits were in- The Conference considered the recommendations appropriate for national purposes and could not be in the ninth report of the Expert Committee on Health expanded with suitable additional fourth-digit cate- Statistics (WHO/HS/ICD/74.65) and the revision pro- gories. Subject to this comment, the Conference en- posals annexed to it (WHO/HS/ICD/74.65 Add.1-17), which were the outcome of two meetings of the Sub- 2WH0/HSACD/74.65 Committee on Classification of Diseases and of com-

9 ments from countries. ‘Ihe Conference established a 2.2 Lists for tabulation of morbidity and mortality data working group to examine national amendments sub- mitted during the Conference. The Conference reviewed the lists of 100 and 300 Adopting, with a few modifications, the report of titles submitted to the Conference? which had been the working group (WHO/HS/8 Rev. Conf./lO.65), drawn up in accordance with a recommendation of the amending the revision proposals in WHO/HS/ICD/74.65 Sub-Committee on Classification of Diseases.4 Concern Add.1-17, the Conference was expressed that these lists were too long for the RECOMMENDS that the revised Detailed List of convenient publication of statistics, especially when Categories and Sub-Categories shown in Appendix 111 cross-classified with sex and age or other factors. The constitute the Eighth Revision of the International Conference considered that lists of the present length Classification of Diseases. of 50 and 150 titles were sufficient for the purposes required by the WHO Nomenclature Regulations: 1.3 Editing of Manual RECOMMENDS that WHO revise the Intermediate List of 150 Causes and the Abbreviated List of 50 me Conference recognized that certain inconsist- Causes and circulate them to countries for comment encies may come to light during the process of editing, before deciding their final form and including them in especially in preparing the list of inclusions, and agreed the Manual. that the Secretariat effect the necessary corrections. The Conference considered that a longer list, of 250 to 300 titles, might well be included in the Manual 2. RELATED MATTERS for optional use.

2.1 International Form of Medical Certificate of cause 2.3 WHO Nomenclature Regulations of death The Conference considered and supported a pro- The Conference noted that the Expert Committee posal ~ for amending the Nomenclature Regulations to on Health Statistics and its Sub-Committee did not pro- enable countries to review and restate their positions pme any change of substance in the International Form. on these Regulations following each revision of the While endorsing this view the Conference discussed the ICD. It was recognized that the adoption of the Eighth value of some editorial changes which appeared use- ICD Revision would necessitate consequential amend- ful IYom the experience of some countries. It was also ments to some of the articles of the Nomenclature stressed that explicit definitions should be given in the Regulations and that, in particular, Articles 1 and 20 Manual of the ICD for the items contained in the medical of the present Regulations did not provide in a simple certificate. Attention was called to the need for ad- manner for periodical revisions of the ICD. It was ditional questions outside the medical certificate of suggested that the Regulations should be simplified cause of death to obtain information on the type and by removing technical details concerning items such as circumstances of violent deaths which would allow age groupings flom the basic articles and by listing proper classification in the External-cause Section. them separately elsewhere within the Regulations. me ‘Ihe Conference having considered the views ex- Conference further noted that some of the articles, pressed on the medical certificate of cause’ of death such as Article 11 referring to the confidential nature RECOMMENDS that no change of substance be of medical information given on death certificates, made introduced in the In~ernational Form of Medical Certifi- mandatory international obligations on matters which cate of Cause of Deati; that the International Form be are of solely national concern. r,eviewed in respect of editorial improvement and that The Conference therefore explicit definitions be given in the Manual of the items RECOMMENDS that WHO re-examine the Nomen- in the Medical Certificate of Cause of Death. Further clature Regulations taking into account the above RECOMMENDS that countries who have not already comments, and any fimther proposals put forward by done so make provisions in the death certificate for Member countries, and prepare revised draft regula- obtaining information on the type and circumstances tions for submission to the World Health Assembly. of violent deaths. The Conference was informed that Member coun- The Conference also discussed the variations bound tries would be given an opportunity to examine and to exist in stating the cause of death in respect of comment upon a preliminary draft of the revised Regu- completeness, accuracy and reporting habits. It noted lations before preparation in a final form for sub- with satisfaction the studies made or being made on the mission to the World Health Assembly. national and international level and considered it desirable that such studies be undertaken with a view %HoAsAcD/78.65 to increasing the reliability of the basic data and to 4WEOASACDK!2& 50 improve medical certification of cause of death. %EO/HSACD/76.65

10 2,4 Adaptation of the ICD for diagnostic indexing of to supplement single-cause statistics by total counts of hospital records conditions reported on the medical certificate of cause of death and, more hrqmrtantly, by the demonstration The Conference noted that the current ICDhadbeen of syndromes of associated conditions leading to death. adapted by a number of countries for the purposea of The Conference, noting that several countiies had diagnostic indexing, and that these adaptations had been ei-tier started or were abut to start mtuapie cause welcomed and widely used in hospitals. Thefe was no tabulations, doubt that interest in this use of the ICD was both RECOMMENDS that interested countries inform strong and growing. At least one of these adaptations, WHO of their plans for introducing multiple cause however, had found it necessary to depart from the analysis and that ~0 act as the co-ordinating body three-digit structure of the ICD, and this had led to for international collaboration in developing uniform some confusion in coding. rules and procedures for coding and tabulation. The Expert Committee on Heal~ Statistics in its ‘J%e conference considered that the value of a ninth report o had recommended that WHO should pre- more limited approach should not be overlooked. pare such an adaptation on the basis of the eighth This might take the form of a thorough analysis of one revision of the ICD, using the three-digit categories as or two different diseases each year” or the continuous the framework. The view was expressed to the Con- routine identification of a small number of associations.lz ference that in some countries the same personnel The Conference stressed that the value of multiple handled records from many sources and that for them cause analysis depended on the, completeness of the there would be some advantage if the fourth digits for entries on the medical certificate of cause of death in codfng and for indexing conformed as closely as pos- respect of the “syndrome of cause of death” and sible. contributory causes. In order to obtain the full value The Conference noted that the Eighth Reyision of of multiple cause analysis certifiers need advance the ICD had been constructed with hospital indexing instruction on how to complete the certificate for this needs in mind and considered that the revised classifi- purpose. cation would be suitable in itself for hospital use in Multiple tabulation of cauaes of death should be some countries. However; it was recognized rhat the supplemented by the study of associations of diseases basic Classification may provide inadequate detail for through multiple tabulations of morbidity data. diagnostic indexing in other countries. The Conference, therefore, 2.6 Rules for selection of cause of death RECOMMENDS that WHO, taking into consideration the increased specificity required, prepare an adapta- Application of the rules of selection, and particu- tion of the revised classification more widery applfcidire larly comparisons of their uae in different coding for hospital indexing. offices, had ehown the need for some.clarification and, An essential complement to a diagnostic index is a if possible, simplification in order to reduce the code of operations and procedures. Examples of such possibili~ of differences in interpretation as stressed a code had been prepared by several countries and the by the Sub-Committee on Classificationof Diseases.la Sub-Committee on Classification of Diseases in its first Noting the experience acquiredincomparisons of coiiiiig report ? recommended that WHO should take steps to- conducted by the WHO Centres for Classification of wards developing a similar code for international use. Diseases and by Regional Offices of WHO, the Con- ‘Ihe Conference suggested that one of the national codes ference should be circulated by W40 and the comments received RECOMMENDS that WHO revise the Rules’ for used as the basis for an international code. selection of cause of death, seeking advice from the WHO Centre and the Latin-American Centre for Classi- 2.5 Multiple-cause tabulation ~d analysis fication of Diseases, from WHO Regional Offices with experience in this matter, and from other competent Papers were presented to the Conference on the sources. need for and problems concerned in full-scale multiple- cauae Snalysiss and on the possibilities of more modest 2.7 Definitions and other issues relating to perinatal. approaches;9~10 The Conference, altiough recognizing morbidity and mortali~ the hnportance of the underlying cause of death for the presentation of historical series, appreciated the need 2.7.1 IXinition of.foetal death

The Conference recognized the difficulties en- 6~o~s/f(7D/74.6 ~ countered in many countries in the practical application 7WE0/HSiICD/22 8WIi0/HSACD/75.66 llwHo~flcD/77.65 9~o~sflcD/77m6s 12WEOmSflCD/79.65 10WEO/ESflCD/79.6K 18~ons~cD/g2

11 of tie criteria of “evidence of life” in the WHO defizd- 2.7.4 Recording of other data pertinent to the perinatal tion of foetal death as had already been pointed out by period the Sub-Committee on Classification of Diseases.14 It was impossible to ensure that all birth attendants did The Conference agreed with the list of items re- in fact strictly apply the definition, but these criteria garded by the Sub-Committee ~ Classification of Dis- were intended as a guide to them in their decision as eaaes in its first report lTas the,minimum of information to whether a child waa born alive or dead. Taking alao required for a proper analysis of perinatal mortali~, into account the scant response from countries in re- cause of death, time of death (ante-, intra-, or post- spect of a change, the Conference did not see any useful pSIILUII),sex, maternal age, plurali~, birth order or pur~se in amending the definition. parity, attendant at birth, place of birth, duration of pregnancy in weeks, birth-weight. 2.7.2 Definition of the perinatal period This type of information was easier to secure in respect of foetal deaths, but was equally necessary for The Conference endorsed the definition of the the neonatal component of perinatal mortality. The perinatal period propmsed by the Sub-Committee on Conference noted that some countries used a common Classification of Diseases in its second reportls as form of certificate for the whole perinatal period extending from the 28th week of gestation to the and, while regarding this as a useful solution to the seventh day of life, While agreeing that these were problem of securing comparable information on the practical limits for international purposes, the Con- foetal and neonatal components, appreciated the dif- ference noted that some countries extended the col- ficulties attending its introduction in other countries. lection of pertinent data down to the 20th week of In some countries, the information was available on the gestation and up to the 28th day of life, preparing birth record and a process of record-matching could tabulations for both the restricted and the wider be used to relate it to the death. The Conference did period. The Conference considered that such exten- not recommend any particular solution, but stressed sions should be encouraged, since their effect was to the importance of securing the data by one method or improve coverage of registration concerning the re- snother. stricted period by removing the temptation to under- state the duration of pregnancy at and around the 28th 2.8’ Publication of revised Manual week in order to avoid the inconvenience of registering the birth. The Conference noted that the Eighth Revision of In respect of tabulationa concerning the perinatal the ICD was intended to come into use on 1 January period, the Conference urged the collection of data 1968, and recognized the large amount of work involved on the period of gestation, birth-weight, parity and in incorporating the revision changes, editing and pro- other relevant factors and their cross-tabulation by ducing the volumes of the Manual in several languages. cause of death. However, the Conference considered it essential that the revised Manual be issued in 1967 so that countries 2.7.3 Recording of causes of perinatal death could take all necessary steps for introducing the Eighth Revision into national practice by the begiming The Conference endorsed the view of the Sub- of 1968, including compilation of national adaptations in Committee on Classification of Diseases, expressed languages other than the official versions. in its second report, 18 that medical certificates of The Conference accordingly cause of foetal death should be in the same sequential RECOMMENDS that WHO should issue the revised arrangement as the normal death certificate. This Manual as early as possible during 1967. arrangement allowed the certifier to indicate his opinion The Conference suggested that consideration should on the relationship between causes in the foetua and be given to the inclusion in the Manual of the ICD of the causes in the mother, and was for this reason prefer- “Classification of Industrial Accidents According to able to the independent recording of foetal and maternal Agency”la prepared by the International Laixmr Office, conditions. for use by countries which wished to supplement the Information on maternal conditions was also needed ICD code of external causes. for the neonatal deaths included in the perinatal period. The Conference was informed that plans were ‘l%e Conference urged that where a certificate common under consideration for publishing the Manual in to the whole perinatal period was not in use, coun&ies Russian as one of the official languages in addition should make provisiona for the recording of details of to the versions in English, French and Spanish. causes in the mother on whatever form of certificate was in use for the neonatal deaths. 17wHo/HsAcD/22 18AnnexJj~ Resolutionoonoeming statistic of eIDplOpetIt,in- l%ZO/WZCD/22 juries, adopted by the Tenth InternationeZ Conference of Labour Stat- 15~OflsflcD/5(3 isticians. International Labeur Organisation, Officiaz Bulletin, Vol. l%HO/HS/ICD/EiO XL W, No. 1, January 1968.

12 3. NATIONAL AND INTERNATIONAL DEVELOPMENTS of patients according to diagnosis, length of stay, type IN HEALTH STATISTICS of care given and orher factors of interest. Considering the fast developments in hospital 3.1 Role of WHO in developing health statistics statistics programmed, the Conference supported the recommendation of the Expert Committee on Health The paper presented to the Conference19 made a Statistics in its eighth report ~Zthat WHOprepare man- critical assessment of the health statistics available uals to guide countries in the. c~mpilation of hospital to health administrations, The scope of the subject statistics. Attentton was called to the need for defini- needed to be extended beyond the traditional emphasis tions of a number of items such as hospital bed, in- on mortality statistics to include statistics on mor- patient, admission, diagnosis for primary tabulation bidity, demography, anthropology and operational as- and for measures of utilization of hospital facilities. pects of health services. Too often the same routine It was recognized that standardization of statistical statistics were produced year after year with little re~rting forms and procedures would take some time relevance to current problems. In developing countries but efforts should be made by WHO towards this ob- there was an urgent need to devise means of prepsring jective by continuing the collection of information on health statistics useful to administrators in the absence practices in various countries and by suggesting stsnd- of a sophisticated system of health statistical services. srds in the light of national experience. ‘flus Conference recognized the authoritative role played by WHO in regard to mortality statistics; in 3.3 Implications of advances in automatic data future the Organization should seek to establish a processing similar position in the wider field of health statistics as defined above. That WHO was aware of the problem In the paper presented to the Conference,28 the most was evidenced by conference held recently by the WHO important effect of automation on the use of the ICD Regional Office for Europe on the adjustment of sta- was seen as the great increase in utilization of hospital tistical activities to consumer needs. Encouragement statistics which it made possible. This might well should be given to the development of flexible and result in the replacement of mortality by morbidity experimental methods, e.g.. ad hoc surveys and sam- coding as the prime application of the ICD. Other uses pling techniques, to investigate particular problems and of electronic computers in comexion with the Classifi- to supplement the broadly descriptive picture provided cation were the much greater ease of performing by routine statistics. The needs of the developing multiple-cause analyses and, eventually, the automatic countries should be given priority by WHO; among coding of entries on records of vital events. If the their most pressing requirements were manuals for latter were ever to be adopted, a considerable simplifi- the training of personnel. The emphasis should be on cation of the coding rules would be required, tJough methods of providing sound internal statistics, having this would be compensated by a more thorough analysis in mind the desirability of. promoting international of contributory causes. comparability as progress was made. The Conference noted the interest in this subject The Conference expressed its appreciation of the already shown by WHO in the organization of confer- value of the work of WHOin the field of health statistics ences and symposia, particularly in the WHO European and its encouragement to the Organization to expand Region, and recognized the need for a regular inter- its activities on the lines indicated in the discussion. change of information in a field where rapid technical progress was being made. 3,2 Hospital statistics Accordingly, the Conference RECOMMENDS that WHO act as a clearing house The Conference took account of the growing ex- for the exchange of information on the use of com- pansion of hospital statistics progrsmmes and noted puters in health statistics, requesting details on cur- with satisfaction the attention given to this field in rent national developments and disseminating the in- developing countries under WHO projects. 20 Papers formation in a new document series devoted to this were presented on systems in two countries 2*using subject, and stimulating discussion of computer topics computer techniques to correlate data reported on hos- at meetings of appropriate bodies. pital facilities and services and to obtain a series of detailed and useful indicators on the utilization of hos- 3.4 National Committees on Vital and Health Statistics pital resources. Similar techniques were being applied to the processing of morbidity and other data reported Two papers were submitted to the Conference.on on discharged patients, allowing detailed presentation this subject24 and several delegates to the Conference

19WR0/HS/8Rev.Conf./8.65 2%ld. Wth. Org. Techu. Rep. Ser., 1968,z61 %lfO/RS/6 Rev.Conf./4.6Fi 2%R0/RS/8 Rev.Cnnf./5.65 21~O~s/8 RW.conf./l,65 ~d 8.65 2~oma18 R~V.tinf./2 awl6.65

13 reported on the experiences of their countries with cerned, and for contributing to studies of international National Committees on Vital and Health Statistics. It value. The Conference appreciated the work being appeared, as at similar previous occasions, that in done by W“O in promoting the establishment of national certain countries national committees or their equiv- committees, in stimulating their efforts, in providing alents proved an effective means for co-ordinating for an exchange of detailed information about the activities in vital and health statistics, dealing with activities in other countries and in distributing material problems of common interest to the agencies con- of a technical nature.

—000

14 APPENDIX II

LIST OF PARTICIPANTS AT THE CONFERENCE

Au8tralia ~. L. G. Hopkins Dr. P. Parrot Director Demographer Demographic..atxt Sbcial Quebec Ministry of Health Statistics Section Quebec, P.Q. Commonwealth Bureau of Dr. A. H. Sellers Census and Statistics Director Canberra Medical’ Statistics Branch Dr. R. H. C. Wells (Rapporteur) Ontario Department of Health First Assistant Director- Toronto, Ont. General Czechoslovakia Mr. V. Dolejsi Commonwealth Department Chief of Health Health Statistics Section Canberra Ministry of Health Au8tria Dr. H. Hansluwka Prague Chief Denmark Miss I. Alsing Division of Population and Health Statistic Chief Central Office of Statistics Medical Statistics Section National Health Service Vienna Copenhagen Professor L. Popper Head Dr. J. Mosbech Fifth Department of Medical Adviser Medical Statistics Section Internal Medicine National Health Service Wilhelminenspital Vienna Copenhagen Finland Dr. A. Isotalo Bulgaria Dr. T. Pascalev Chief Physician Professor at the Institute National Board of HeaIth of Medical Specialization and Higher Studies Helsinki Sofia Miss A. Korpela Statistician Canada Mr. F. Harris Central Office of Statistics Director Helsinki Health and Welfare Division Dominion Bureau of Statistics France Dr. M. J. Aubenque Ottawa (Rapporteur) Dr. B. D. B. Layton Chef Principal Medical Officer Division des Statistiques International Health sanitaires Department of National Institut national de la Health and Welfare Statistique et des Etudes Ottawa efonomiques Paris Dr. J. Fonroget Dr. R. Leutner Directeur g~ne

16 Mr. N. Takizawa Dr, B. V. Bekker First Secretary Chief Permanent Delegation of Bureau of Epidemiology and Japan to the International Analysis Organizations Department of Chief Medical Geneva Officer , The Hague Dr. S. Watanabe Adviser Dr. M. J: W. de Groot Division of Health and Chief Welfare Statistics Division of Health Statistics Ministry of Health and Central Bureau of Statistics Welfare me Hague Tokyo Dr. V. M. Oppers Kuwait Mr. A. A. A1-Mou’nes Chief Statistician Division of Health Statistics Ministry of Public Health Municipality of Amsterdam Kuwait Amsterdam Dr. M. A. A. Abdul Salsm Dr. P. J. van der Schaar Chief Head Tuberculosis Control Psychiatric Clinic Department Dijkzigt Hospital Ministry of Public Health Rotterdam Kuwait Dr. A. van Vianen Madagascar Mine. A. M. Raoely-James Health Council of the Chef Netherlands Division des Etudes, Analyses The Hague et Recherches Norway Mrs. E. B~x Institut national de la Statistician Statistique et de la Recherche CentraI Bureau of Statistics e%onomique 0s10 Tanansrive Dr. L. Linneberg Mali Dr. J. J. Leveuf Chief Medical Adviser Conseiller technique National Social Insurance Direction g

17 Dr. L. A. C. R. Cayolla da Thailand Dr. B. Subhamani Motta Director Medical Officer Statistical Services Directorate General of Ministry of Public Health Public Health Bangkok Lisbon Dr. S. Teray+ont Dr. J. C. de Sousavaz Vieira Medical Officer Chief of Division Section of Hospital Statistics National Institute of Statistics Department of Medical Lisbon Services Ministry. of Public Health Romania Dr. G. Jelezov Bangkok Director Division of Planning and Dr. F. Vongsfak Statistics Statistician Ministry of Health Division of Vital Statistics Bucharest Ministry of Public Health Bangkok Saudi Arabia Dr. M. A. Mukim Director Togo Mr. M. Glikpo Health Services Statistician Mecca Minis/ere de la Sante publique Spain Dr. J. P. Cortazar Lom# Chief Union of Soviet Dr. V. K. 0v6arov Population Movement Section Socialist Republics (Vice-Chairman) National Institute of Statistics Chief Madrid Health Statistics Section Dr. T. Gonz?i’lez Semashko Institute of Public Chief Health Administration and Demographic Statistics Service History of Medicine National Institute of Statistics Moscow Madrid 1 United Kingdom of Dr. M. Amott Dr. F. J. Y. Grijalba Great Britain and Professor of Medicine Medical Officer Northern Ireland University of Birmingham Study Sectiop Mr. P. J. Cook General Directorate of General Register Office for Health England and Wales Madrid London Sweden Dr. P. Hall Mr. L. M. Feery Assistant Professor in Principal Medicine International Branch Karolinska Institute General Register Office Stockholm for England and Wales Mr. A. Sji5str6m London Acting Chief Mr. M. Reed (Chairman) Division of Statistics Registrar General National Board of Health General Register Office for Stockholm England and Walea Switzerland Dr. J. C. Htibscher London Chef Service des Statistiques Dr. A. H. T. Robb-Smith me’dicales Director of Pathology Bureau f

18 Dr. A. Smith Dr. W. H. Stewart Medical Statistician Assistant to Special Assistant General Registry Office for to the Secretary (Health Scotland and Medical Affairs) Edinburgh Office of the Secretary Department of HeaIth, Miss M. Markins Education, and Welfare General Register Office for Washington, D.C. England and Wales London Dr. F, D. Yoder Director of Public Health United Statea of Dr. F. E. Linder Illinois State Health Department America (Vice-Chahxnan) Springfield, Illinois Director National Center for Health Venezuela Dr. D. Curiel (Vice-Chairman) Statistics Formerly Medical Chief Public Health Service Division of Epidemiology Department of Health, and Vital Statistics Education, and Welfare Ministry of Health Washington, D.C. Caracas

Dr. L. N. Dakil Yugoslavia Professor B. Pirc Physician and Surgeon Head McAlester, Oklahoma Department of Epidemiology Dr. P. M. Densen and fhthtics Deputy Commissioner of School of Public Health Health University of Zagreb New York City, N.Y. Dr. c. Vukmsnovic Dr. R. Dyar Chief Chief Department of Health Statistics Division of Research Federal Institute of Health California State Health Belgrade Department United Nations Mr. p. J. LdtUS Berkeley, California New York Director Mr. E. L. Hamilton Statistical Office Director International Labour Mrs. R. Ducommun Medical Statistics Agency Organization Statistical Branch Office of the Surgeon-General Geneva US Army Dr. C. Msriska Washington, D.C. General Section Social Security Branch Dr. B. MacMahon Professor and Chairman Non-Governmental International League of Department of Epidemiology Organizations Dermatological Societies: Harvard School of Public Professeur W. Jadassohn Health Directeur Cambridge, Massachusetts Clinique de Dermatologie Universit~ de Ger&e Dr. I. M. Moriyama Chief International Society of Office of Health Statistics Cardiology Analysis Dr. P. W. Duchosal National Centeq for Health Professeur de M

19 WHO Centre for Dr. C. C. Spicer Dr. E. F. Krohn Classification of Chief Medical Statistician, Regional Officer for Diseases General Register Office Epidemiology and Health Chief, WHO Centre for statistics Classification of Diseases WHO Regional Office for London Eurdpe +atin American Dr. R. Fuenmayor Herrara Dr. W. P. D. Logan Center for Classi- Director Director ficationof Diseases Latin American Center for Division of Health Statistics Classification of Diseases WHo Caracas Mr. J. Nielsen Secretariat Dr. M. Cakrtova (Secretary) Statistical Adviser mief WHO Regional Office for ‘the Development of, Health Eastern Mediterranean Statistical Services Dr. R. R. Puffer WHo Chief of Health Statistics Mr. H. G. Corbett Branch Statistician WHO Regional Office for the Development of Health Americas Statistical Services WHo Professor J. Knowelden (Consultant) @partment of Preventive Medicine and Public Health Sheffield University

— ooo — APPENDIX Ill

INTERNATIONAL CLASSIFICATION EIGHTH REVISION

1. Three- and four-digit titles Fourth digits .8/.9

The following three- and four-digit categories As recommended by the Conference, fourth digits constitute The Detailed List referred to in the Report .8 and .9 were respectively reserved for “Other” and of the Conference under item 1.2. They are based on “Unspecified” where both titles conveyed a real mean- the revision proposals submitted to the Conference ing. Otherwise .9 was used for “Other and unspecified” (WHO/HS/ICD/74.65 Add. 1-17) and on the amend- or “Other” only in order to save fourth digits for fur- ments adopted by the Conference (~0/HS/8 Rev. ther sub-division. For the same reason absence of an Conf./lO.65). Editorial changes suggested during the associated condition (“without mention of . . .“) was Conference and not appearing in the amendments were given the fourth digit .9. It should be pointed out that incorporated as far as appropriate. A few changes the arrangement may still undergo some changes during of substance became advisable in the detailed review the compilation of the full tabular list in the light of the of the revised classification. inclusions to be accommodated.

2. Other indications 1. INFECTIVE AND PARASITIC DISEASES Apart from the three- and four-digit titles there are various references and notes, in order to enable This section includes diseases generally recog- countries to start work on national adaptations in nized as communicable or transmissible. It excludes languages other than those of the international versions. acute respiratory infections, influenza and pneumonia and certain localized infections. 2.1 References to ICD numbers Intestinal infectious diseases (000-009) New titles were related to the numbers of the cur- Excludes helminthiasis (120-129) rent ICD whenever the content was the same or changed in a way which could be expressed in a relatively simple 000 Cholera form. Such references were omitted in the Nature-of- .0 Classical injury classification (N-code), the larger part of which .1 El Tor corresponds to the three-digit categories of the ICD .9 Unspecified (Nos. N800-N959). No attempt was made in respect of ICD references for sections which underwent a com- 001 Typhoid fever plete revision, e.g. mental disorders. 002 Paratyphoid fever 2.2 Exclusion notes .0 Paratyphoid fever A Although not exhaustive, exclusion notes were pro- .1 Paratyphoid fever B vided for titles that would raise doubts regarding their .2 Paratyphoid fever C content. .9 Unspecified

2.3 Inclusion terms 003 Other Salmonella infections As ICD 042 Inclusion terms are as a rule not stated, although .0 Without mention of focal as vehicle of infection inclusion notes appear in some places. This particularly .1 With food as vehicle of infection applieq to diseases of the circulatory system, in view of the complexity of the classification.

21 004 Bacillary dysentery 013 Tuberculosis of meninges and central nervous system .0 Shiga .1 Flexner .0 Tuberculous meningitis .2 Boyd .9 Other ,3 Sonne ,4 Schmitz-Stutzer 014 Tuberculosis of intestines, peritoneum and mes- ,8 Other enteric glands ,9 Unspecified 015 Tuberculosis of bones and joints 005 Focal poisoning (bacterial) .0 Vertebral column Excludes Salmonella food poisoning (003.1) .1 Hip .0 Staphylococcal .2 Knee .1 Botulism .8 Other .2 Due to other clostridia .9 Unspecified .8 Other bacterial food poisoning .9 Unspecified 016 Tuberculosis of genito-urinary system

006 Amoebiasis 017 Tuberculosis of other organs .0 With liver abscess .0 Skin and subcutaneous cellular tissue .8 With othe~ manifestations .1 Peripheral lymphatic glands .9 Unqualified .2 Eye .3 Ear 607 Other protozoal intestinal diseases .9 Other .0 Balantidiasis 018 Disseminated tuberculosis .1 Giardiasis .2 Cm”cidiosis .0 Acute miliary tuberculosis specified as non- .9 Other and unspecified pulmonary .1 Acute miliary tuberculosis unspecified 008 Enteritis due to other specified organism .9 Other forms of disseminated tuberculosis .0 Escherichia coli 019 Late effects of tuberculosis .1 Arizona .2 Other bacteria .0 Respiratory tuberculosis .3 Bacterial enteritis NOS .1 Central nervous system .9 Other organism, not elsewhere classified .2 Bones and joints .3 Genito-urinary system 009 Diarrhoeal disease .9 Other specified organs .0 Dysentery NOS Without mention Zoonotic bacteyial diseases (020-02?7 .1 Diarrhoea of non-in fectiou~ .2 Gastro-enteritis and colitis 020 Plague etiology orinfect- \ .9 Other ing organism .0 Bubonic Tubemulosis (010-019) .1 Pulmonic .9 Unspecified 010 Silicotuberculosis 021 ‘lldaraemia 011 Pulmonary tuberculosis 022 Anthrax 012 Other respiratory tuberculosis Excludes respiratory tuberculosis, unqualified 023 Brucellosis (011) .0 Br. melitensis .0 Primary .1 Br. abortus .1 Pleurisy specified as tuberculous .2 Br. suis .2 Pleurisy with effusion without mention of cause .9 Unspecified .3 Tuberculous laryngitis .9 Other 024 Glanders

22 025 Melioidosis 039 Other bacterial diseases .0 Gas gangrene 026 Rat-bite fever .1 Rhinoscleroma .0 Spirillum minus .9 Other .1 Streptobacillus moniliformis Poliomyelitis and othev entewvirus diseases of central .9 Unspecified nervous system (040-046)’ 027 Other zoonotic bacterial diseases 040 Acute paralytic poliomyelitis specified as bulbar .0 Listeriosis .1 Erysipelothrix infection 041 Acute poliomyelitis with other paralysis .9 Other 042 Acute .non-paralytic poliomyelitis Other bacteyial diseases (030-039) 043 Acute poliomyelitis, unspecified Excludes bacterial venereal diseases (098, 099) and bartonellosis (089.0) 044 Late effects of acute poliomyelitis 030 Leprosy 045 Aseptic meningitis due to enterovirus .0 Lepromatous Excludes aseptic meningitis duetm Poliovirus .1 Tuberculoid (042); virus of herpes zoster (053) herpes .2 Indeterminate simplex (054); mumps (072} Qmphmytic .3 Borderline choriomeningitis (079.2) .8 Other .0 Coxsackie virus .9 Unspecified .1 ECHO VirUS 031 Other diseases due tomycobacteria .9 Aseptic meningitis, NOS

032 Diphtheria 046 Other enterovirus diseases of central nervous system 033 Whooping cough .OB. pertussis Viral diseases accompanied by exanthem (050-05?) Excludes arthropod-borne viral diseases (060-068) .1 B. parapertussis .9 Unspecified 050 Smallpox

034 Streptoccccal sore throat and scarlet fever .0 Variola major .1 Variola minor (slastrim) .0 Streptococcal sore throat .9 Unspecified .1 Scarlet fever 051 cowpox 035 Erysipelas 052 ChickenPox 036 Meningococcal infection .0 Meningococcal meningitis 053 Herpes zoster .1 Meningococcaemia witbout mention of meningitis 054 Herpes simplex .8 Other forms of meningococcal infection .9 Unspecified 055 Measles

037 Tetanus 056 Rubella (German measles)

038 Septicaemia- 057 Other viral exanthem .0 Streptococcal .0 Erythema infectiosum (fifth disease) .1 Staphylococcal .1 Exanthema subitum (Roseola infantum) (sixth .2 Pneumoccccal disease) .8 Other bacterial .8 Other .9 Unspecified .9 Unspecified

23 Arthropod-borne viral diseases (060-06& 074 Specific diseases due to Cocksackie virus Excludes aseptic meningitis (045) 060 Yellow fever .0 Herpangina .0 Sylvatic .1 Epidemic pleurodynia (Bornholm disease) .1 Urban .2 Epidemic myocarditis of newborn .9 Unspecified .9 Other

061 Dengue 075 Infectious mononucleosis Excludes hemorrhagic fever caused by dengue virus (067.8) 076 Trachoma, active

062 Mosquito-borne viral encephalitis 077 Late effects of trachoma .0 Japanese encephalitis 078 Other viral diseases of the conjunctival .1 Western equine encephalitis .2 Eastern equine encephalitis .0 Inclusion conjunctivitis .3 St. Louis encephalitis .1 Epidemic kerato-conjunctivitis .4 Murray Valley encephalitis .2 Acute adeno-viral follicular conjunctivitis .9 Other and unspecified .8 Other .9 Viral conjunctivitis NOS 063 Tick-borne viral encephalitis 079 Other viral diseases .0 Russian spring-summer (“Taiga”) .1 Louping-ill encephalitis .0 Molluscum contagiosum .2 Central-European encephalitis .1 Viral warts .9 Other and unspecified .2 Lymphocytic choriomeningitis .3 Cat-scratch disease 064 Viral encephalitis transmitted by other arthropods .4 Foot and mouth disease .5 Cytomegalic inclusion disease 065 Viral encephalitis, unspecified .8 Other .9 Viral infection NOS 066 LSte effects of viral encephalitis Rickettsioses and otker avthropod-home infectious dis- 067 Arthropod-borne hemorrhagic fever eases (080-089) .0 Crimean hemorrhagic fever Excludes arthropod-borne viral diseases (060-068) .1 Omsk hemorrhagic fever .2 Kyasanur Forest disease 080 Epidemic louse-borne typhus .3 Other tick-borne hemorrhagic fever .4 Mosquito-borne hemorrhagic fever 081 Other typhus .5 Hemorrhagic nephroso-nephritis .9 Other and unspecified .0 Endemic flea-borne (murine) .1 Brill’s disease 068 Other arthropod-borne viral diseases .2 Mite-borne (scrub) .0 Phlebotomus fever .9 Unspecified .1 Tick-borne fever 082 Tick-borne rickettsiosis .2 Mosquito-borne fever .9 Other .0 Spotted fevers .I Fi&re boutonneuse Other viral diseases (070-079) .2 North-Asian tick-borne typhus fever .9 Other 070 Infectious hepatitis . Excludes serum hepatitis (N999.2) 083 Other rickettsioses 071 Rabies .0 Rickettaialpox .1 Q fever 072 h’fumps .2 Wolhynian fever (trench fever) .8 Other 073 Psittacosis (Ornithoais) .9 Ricketteiosis NOS

24 084 Malaria 1 ,6 Late Congenital syphilis, latent (five years and over) .0 Falciparum malaria (malignant tertian) .7 Late congenital syphilis NOS .1 Vivsx malaria (benign tertian) .2 Malariae malaria (quartan) .9 Congenital syphilis NOS .3 Ovale malaria 091 Early syphilis, symptomati~ .4 Backwater fever .5 Recurrent induced malaria .0 Primary syphilis, except extragenicd chancre .8 Other forms of malaria .1 Extragenital chancre .9 Unspecified .2 Secondary syphilis of skin and mucous mem- branes 085 Leishmaniasis .3 Secondary syphilis, relapse (treated, untreated) .0 Visceral (Kala-azar and Mediterranean .8 Other recently acquired syphilis, symptomatic w) .9 Early syphilis NOS .1 Cutaneous .2 Mucocutaneous (American) 092 Early syphilis, latent .9 Unspecified .0 Early syphilis, latent, serological relapse after 086 American trypanosomiasis (Chsgasl disease) treatment .9 Early syphilis, latent NOS .0 With heart involvement .8 With other organ involvement 093 Cardiovascular syphilis .9 Without mention of organ involvement .0 Aneurysm of aorta, specified as syphilitic 087 Other trypanosomiasis .9 Other cardiovascular syphilis .0 Gambisn 094 Syphilis of central nervous system .1 Rhodesisn .8 African trypanosomiasis NOS .0 Tabes dorsalis .9 Trypanosomiasi6 NOS .1 General paresis .9 Other syphilis of central nervous system 088 Relapsing fever .0 Louse-borne 095 Other forms of late syphilis, with symptoms .1 Tick-borne 096 Late syphilis latent (duration two years and over) .9 Unspecified

089 Other arthropod-borne diseases 097 Other syphilis, and not specified .0 Late syphilis NOS .0 Bartonellosis .1 Latent syphilis NOS .9 Other .2 Syphilis NOS

Syphilis and other venereal diseases (090-099) 098 Gonococcal infections Excludes non-venereal syphilis (104.0) .0 Acute gonococcal infection of genito-urinary 090 Congeni@ syphilis system .1 Chronic gonococcal infection of genito-urinary .0 Early congenital syphilis, symptomatic (less system (over two months’ duration) than five years) .2 Gonococcal infection of eye .1 Early congenital syphilis, latent (less than five .3 Gonococcal infection of joint years) .8 Gonococcal infection of other sites .2 Early congenital syphilis, NOS .9 Gonorrhea, unspecified .3 Interstitial keratitis .4 Juvenile neurosyphilis 099 Other venereal diseases .5 Other late congenital syphilis, symptomatic (five years and over) .0 Chancroid .1 Lymphogranuloma venereum (Nicolas Favre) .2 Granuloma inguinale (Donovan) Iwhen ~Ore than ~n~ tm~ is mentioned, priority in classification .8 Other follows the order of listing of numbers in fourth digit. .9 Unspecified

25 Othev spivochaetal diseases (100-104) .2 South American .9 Unspecified 100 Leptospirosis 117 Other systemic mycosis .0 Leptospirosis ictero-haemorrhagica (Weil’s disease) .0 Rhinosporidioais .8 Other .1 Sporotrichosis .9 Unspecified .2 Chromomycosis .3 Aspergillosis 101 Vincent’s angina .4 Maduromycosis .8 Other 102 Yaws .9 Unspecified .0 Initial lesions “.1 Multiple papillomata and “wet crab” yaws Helminthiases (120-129) .2 Other early skin lesions .3 Hyperkeratosis 120 Schistosomiasis (bilharziasis) .4 Gummata, ulcers .0 S. haematobium .5 Gangosa .1 S. mansoni .6 Bone and joint lesions .2 S. japonicum .7 Other manifestations .3 Cutaneous .8 Latent yaws .8 Other .9 Yaws NOS .9 Unspecified

103 Pinta (carate) 121 Other trematode infestation .0 Primary lesions .0 Opisthorchiasis .1 Intermediate lesions .1 Clonorchiasis .2 Late lesions .2 Paragonimiasis ,3 Mixed lesions .3 Fascioliasis .9 Unspecified .4 Fasciolopsiasis .9 Other 104 Other spirochaetal infections .0 Non-venereal endemic syphilis 122 Hydatidosis .9 Other .0 Liver .1 Lung Mycoses (110-llfi” .8 Other sites 110 Dermatophytosis .9 Unspecified

111 Dermatomycosis, other and unspecified 123 Other cestode infestation .0 Pityriasis versicolor .0 Taenia solium infestation, intestinal form .1 Tinea nigra .1 Cysticercosis (larval form, Taenia solium) .2 Tinea blanca .2 Taenia saginatajinfestation .8 Other .3 Taeniasis NOS .9 NOS .4 Diphyllobothriasie intestinal .5 Sparganosis (larval diphyllobothriasis) 112 Candidiasis (moniliasis) .6 Hymenolepiasis .9 Other 113 Actinomycoais 124 Trichiniasis 114 Coccidioidomycosis 125 Filarial infestation 115 Histoplasmosis .0 Wuchereriasis .1 Brugia filariasis 116 Blastomycosis .2 Loiasis .0 European .3 Onchocercosis .1 North American .4 Acanthocheilonemiasis

26 .5 Mansonelliasis Il. NEOPLASMS .8 Other filariasis .9 Unspecified M@nant neoplasm of buccal cavity and pharynx (140-149) 126 Ancylostomiasis 140 Malignant neoplasm of lip .0 Ancylostoma duodenale Excludes malignant neoplasm of skin of lip .1 Necator americanus (172.0, 173.0) .8 Other ancyloatoma .9 Unspecified .0 Upper lip .1 Lower lip 127 Other intestinal helminthiasis .2 Both lips .0 Ascariasis .9 Lip unspecified (including commissure) .1 Strongyloidiasis 141 Malignant neoplasm of tongue .2 Trichuriaais .3 Enterobiasis .0 Base of tongue .4 Other intestinal nematode infestation .1 Dorsal surface .5 Mixed intestinal helminthiasis .2 Borders and tip .9 Intestinal helminthiasis NOS .3 Ventral surface .9 Part unspecified 128 Other and unspecified helminthiasis 142 Malignant neoplasm of salivary gland .0 Larva migrans, visceralis .7 Other .0 Parotid gland .8 Mixed .8 Other specified salivary gland .9 Unspecified .9 Unspecified salivary gland

129 Intestinal parasitism, NOS 143 Malignant neoplasm of gum .0 Upper gum Other infective andparasitic diseases (130-136i .1 @wer gum .9 Gum unspecified 130 Toxoplasmosis .0 Acquired 144 Malignant neoplasm of floor of mouth .1 Congenital active .2 Late effects of intra-uterine infection 145 Malignant neoplasm of other and unspecified parts ,9 Unspecified of mouth .0 Buccal mucosa 131 Trichomoniasis urogenitalis .1 Palate (hard) (soft) .8 Other specified parts 132 Pediculoais .9 Part unspecified 133 Acariasis 146 Malignant neoplasm of oropharynx .0 Scabies .0 Tonsil .9 Other .8 Other specified parts .9 Part unspecified 134 Other infestation .0 Myiasis 147 Malignant neoplasm of nasopharynx .1 Phthirus infestation .2 Other arthropod infestation 148 Malignant neoplasm of hypopharynx .3 Hirudiniasis .0 Postcricoid region .9 Other .1 Pyriform foasa .8 Other specified parts 135 Sarcoidoais .9 Part unspecified 136 Other infective and parasitic diseases 149 Malignant neoplasm of pharynx, unspecified

27 Malignant neoplasm of digestive organs and pem”toneum 159 Malignant neoplasm of unspecified digestive organs (150-159) Ma&zant neoplasm of vespivatoqv system (160-163) 150 Malignant neoplasm of oesophagus 160 Malignant neoplasm of nose, nasal cavities, mid- 151 Malignant neoplasm of stomach dle ear and accessory sinuses .0 Cardia .0 Nose (internal) and nasal cavities .1 Pylorus .1 Eustachian tube and middle ear , .80ther sp-ecified parts .2 Maxillary sinus .9 Part unspecified .8 Other sinus .9 Unspecified sinus (accessory) 152 Malignant neoplasm of small intestine, including duodenum 161 Malignant neoplasm of larynx .0 Duodenum .0 Glottis, true vocal cords .8 Other specified parts .8 Other specified parts .9 Part unspecified .9 Part unspecified

153 Malignant neoplasm of large intestine, except 162 Malignant neoplasm of trachea bronchus and lung rectum .0 Trachea .0 Caecum, appendix and ascending colon .1 Bronchus and lung .1 Transverse colon, including hepatic and splenic flexures 163 Malignant neoplasm of other and unspecified .2 Descending colon respiratory organs .3 Sigmoid colon .0 Pleura .8 Large intestine (including colon), part un- .1 Mediastinum specified .9 Site unspecified .9 Intestinal tract, part unspecified Malignant neoplasm of bone, connective tissue, skin and 154 Malignant neoplasm of rectum and rectosigmoid breast (170-174) junction .0 Rectosigmoid junction 17(JMalignant neoplasm of bone .1 Rectum .0 Bones of skull and face .2 Anal canal .1 Lower jaw bone .2 Vertebral columxi(excluding sacrum and CCCCYX) 155 Malignant neoplasm of liver and intrahepatic bile .3 Ribs, sternum and clavicle ducts, specified as primary .4 Long bones of upper limb and scapula .0 Liver .5 Upper limb, short bones .1 Intrahepatic bile ducts .6 Pelvic bones, sacrum, coccyx .7 Lower limb, long bones 156 Malignant neoplasm of gall-bladder and bile ducts .8 Lower limb, short bones .9 Site unspecified .0 Gall-bladder .1 Extrahepatic bile ducts 171 Malignant neoplasm of connective and other soft .2 Ampulla of Vater tissue .9 Biliary tract NOS .0 Head, face and neck 157 Malignant neoplasm of pancreas .1 Trunk .2 Upper limb (including shoulder) .0 Head .3 Lower limb (including hip) .8 Other specified parts .9 Site unspecified .9 Unspecified 172 Malignant melanoma of skin 158 Malignant neoplasm of peritoneum and retro- peritoneal tissue .0 Lips .1 Eyelids, including canthi .0 Retroperitoneal tissue .2 Ear and external auricular canal .9 Other and unspecified parts .3 Other and unspecified parts of face A Scalp and neck 189 Malignantneoplasm of other and unspecified .5 Scrotum Urblary organs .6 Trunk, except scrotum .0 Kidney, except pelvis .7 Upper limb .1 Pelvis of kidney .8 Lower limb .2 Ureter .9 Site unspecified .9 Other and unspecified 173 Other malignant neoplasm of skin Malignant neoplasm of other and unspem”fiedsites .0 Lips (190-199) .1 Eyelids, including canthi .2 Ear and external aurictdar canal 190 Malignant neoplasm of eye .3 Other and unspecified parts of face .4 Scalp and neck 191 Malignant neoplasm of brain .5 Scrotum .6 Trunk, except scrotum 192 Malignant neoplasm of other parts of nervous .7 Upper limb system .8 Lower limb .0 Spinal cord .9 Site unspecified .1 Meninges .2 Peripheral nerves 174 Malignant neoplasm of breast .3 Sympathetic nervous system .9 Site unspecified Malignant neoplasm of genito-uti?uavyoygans (180-189) 193 Malignant neoplasm of thyroid gland 180 Malignant neoplasm of cervix uteri 194 Malignant neoplasm of other endocrine glands 181 Chorionepithelioma .0 Suprarenal gland .1 Parathyroid gland 182 Other malignant neoplasm of uterus .2 Thymus .0 Corpus uteri .3 Pituitary gland and craniopbaryngeal duct .9 Uterus unspecified .4 I?ineal giand .8 Other 183 Malignant neoplasm of ovary, Fallopian tube, .9 Unspecified endocrine gland and broad ligament 195 Malignant neoplasm of ill-defined sites .0 Ovary .1 Fallopian tube and broad ligament .0 Abdomen, intra-abdominal cancer .9 Part unspecified .1 Pelvis. pelvic viscera, rectovaginal septum .9 Other 184 Malignant neoplasm of other and unspecified fe- male genital organs 196 Secondary and unspecified malignant neoplasm of lymph nodes .0 Vagina .1 Vulva .0 Head, face and neck .8 Other specified sites .1 Intrathoracic .9 Site unspecified .2 Intra-abdominal .3 Axillary and upper limb 185 Malignant neoplasm of prostate .4 Ingubml and lower limb .7 Other specified sites 186 Malignant neoplasm of testis .8 Multiple sites .9 Site unspecified 187 Malignant neoplasm of other and unspecified male genital organs 197 Other secondary malignant neoplasm, primary site unspecified .0 Penis .8 Other specified sites ,0 Lung, specified as secondary .9 Site unspecified .1 Liver, specified as seccdary .2 Liver, unspecified as prixnary or secondary 188 Malignant neoplasm of bladder .3 Brain, specified as secondary

29 .4 Bone, specified as secondary .2 Acute erythraemia (Di Guglielmo’s disease) .9 Other sites, specified as secondary .9 Leukaemia, unspecified

198 Malignant neoplasm without specification of site 208 Polycythaemia vera Excludes secondary polycythaemia (289.0) and .0 Multiple acute erythraemia (207,2) .1 Other 209 Myelofibrosis 199 Seconclarymaligqant neoplasm, primary site known Not to be used for primary mortality classifica- Benigw neoplasm (210-228) tion .0 Lymph nodes 210 Benign neoplasm of buccal cavity and pharynx .1 Thoracic organs Excludes cyst of jaw (526) and oral soft tissues .2 Liver (528) .3 Brain .0 Lip .4 Bone .1 Tongue. .9 Other .2 Salivary gland .3 Floor of mouth Neoplasms of lymphatic and haernatopm”etic tissue .4 Other and unspecified parts of mouth (2?00-209) .5 Tonsil .6 Other parts of oropharynx 200 Lymphosarcoma and reticulosarcoma .7 Nasopharynx .0 Reticulum-cell sarcoma .8 Hypopharynx .1 Lymphosarcoma .9 Pharynx unspecified

201 Hodgkin’s disease 211 Benign neoplasm of other parts of digestive system .0 Oesophagus 202 Other neoplasms of lymphoid tissue .1 Stomach .0 Giant follictdar Iymphoma (Brill-Symmers’ .2 Small intestine disease) .3 Large intestine, except rectum .1 Mycosis fungoides .4 Rectum .2 Other primary malignant neoplasms of lymphoid .5 Liver and biliary passages tissue .6 Pancreas .9 Other forms of Iymphoma (reticulosis) .7 Peritoneum and retroperitoneal tissue .9 Unspecified site 203 Multiple myeloma (plasmacytoma) 212 Benign neoplasm of respiratory system 204 Lymphatic leukaemia .0 Nose, nasal cavities, middle ear and accessory .0 Acute sinuses” .1 Chronic .1 Larynx .9 Unspecified .2 Trachea .3 Bronchus and lung 205 Myeloid Ieukaemia .4 Pleura .5 Mediastinum .0 Acute .9 Unspecified site .1 Chronic .9 Unspecified 213 Benign neoplasm of bone and cartilage

206 Monocytic Ieukaemia 214 Lipoma .0 Acute .1 chronic 215 Other benign neoplasm of muscular and connective .9 Unspecified tissue

216 Benign neoplasm of skin 207 Other and unspecified leukaemia .0 Epidermis .0 Leukaemia, acute .1 Hair follicles and sebaceous glands .1 Leukaemia, chronic .2 Sweat glands and sweat ducts

30 .8 Other 226 Benign neoplasm of endocrine glands Excludes benign melanoma (757.1) Excludes the listed conditions with endocrine .9 Unspecified hyperfunction (253, 254, 255, 258) .0 Suprarenal gland 217 Benign neoplasm of breast .1 Thymus .2 Pituitary gland and craniopharyngeal duct 218 Uterine fibromyoma .3 PineaI gland .8 Other specified endocrine glands 219 Other benign neoplasm of uterus .9 Unspecified site .0 Endometriosis, endometrioma ,1 Adenomyosis, adenomyoma 227 Haemangioma and lymphangioma .2 Papilloma, polyp .3 Benign cyst 228 Benign neoplasm of other and unspecified organs .9 Other and unspecified and tissues

220 Benign neoplasm of ovary Neoplasm of unspecified natwe (230-239) Excludes the listed conditions with ovarian hyperfunction (256.0) 230 Neoplasm of unspecified nature of digestive organs

221 Benign neoplasm of other female genital organs .0 Oesophagus .1 Stomach ,0 Fallopian tube and broad ligament .2 Small intestine ,1 Vagina .3 Large intestine .2 Vulva .4 Rectum .8 Other specified sites .5 Liver and biliary passages .9 Unspecified site .6 Pancreas .7 Peritoneum 222 Benign neoplasm of male genital organs .9 Unspecified site .0 Testis Excludes the listed conditions with testicular 231 Neoplasm of unspecified nature of respiratory hyperfunction (257.0) organs ,I Penis .0 Nose, nasal cavities, middle ear and accessory .8 Other specified sites sinuses .9 Unspecified site .1 Larynx .2 Trachea 223 Benign neoplasm of kidney and other urinary .3 Bronchus and lung organs .4 Pleura .0 Kidney, except pelvis .5 Mediastinum .1 Pelvis of kidney .9 Unspecified site .2 Ureter .3 Bladder 232 Neoplasm of unspecified nature of skin and ,8 Other specified sites musculo-skeletal system .9 Unspecified site ,0 Bone and cartilage .1 Muscular and connective tissue 224 Benign neoplasm of eye .2 Skin

225 Benign neoplasm of brain and other parts of 233 Neoplasm of unspecified nature of breast nervous system Excludes neurofibromatosis (743.3) 234 Neoplasm of unspecified nature of uterus ,0 Brain .0 Carcinoma in situ of cervix uteri .1 Spinal cord .2 Meninges .1 Cervix uteri, other ,3 Peripheral nerves .9 Othe~ and unspecified parts ,4 Sympathetic nervous system 235 Neoplasm of unspecified nature of ovary .9 Unspecified site 236 Neoplasm of unspecified nature of other female .1 Toxic nodular goitre genital organs AS ICD 252.1 .2 Thyrotoxicosis without mention of goitre O Fallopian tube and broad ligament .1 Vagina 243 Cretinism of congenital origin .2 Vulva .8 Other specified sites 244 Myxoedema .9 Unspecified site 245 Thyroiditis 237 Neoplasm of unspecified nature of other genito- urinary organs 246 Other diseases of thyroid gland .0 Testis As ICD 254 except thyroiditis (245) .1 Penis .2 Other and unspecified male genital organs Diseases of othev endocvine glands (250-258) .3 Kidney, except pelvis .4 Pelvis of kidney 250 Diabetes mellitus .5 Ureter AS ICD 260 .6 EUmider .9 Other and unspecified urinary organs 251 Disorders of pancreatic internal secretion other than diabetes mellitus 238 Neoplasm of unspecified nature of eye, brain and AS ICD 270 other parts of nervous system 252 Diseases of parathyroid gland .0 Eye AS ICD 271 .1 Brain .2 Spinal cord .0 Hyperparathyroidism .3 Meninges .1 Hypoparathyroidism .4 Peripheral nerves .9 Other and unspecified .5 Sympathetic nervous system .9 Unspecified site 253 Diseases of pituitary gland As ICD 272 with sub-divisions: 239 Neoplasm of unspecified nature of other and un- .0 Anterior pituitary hyperfunction specified organs .1 Anterior pituitary hypofunction .0 Buccal cavity and pharynx .2 Chromophobe adenoma, pituitary .1 Endccrine glands .9 Other and unspecified .9 Other and unspecified sites Remainder of ICD 272

Ill. ENDOCRINE. NIITRITIONAL 254 Diseases of thymus gland AND METABOLIC DISEASES AS ICD 273

Diseases of thyroid gtand (240-246). 255 Diseases of adrenal glands .0 Adrenal cortical hyperfunction 240 Simple goitre Excludes congenital hyperadrenocorticism As ICD 250 with sub-divisions: (272.0) .0 Endemic .1 Adrenal cortical hypofunction .1 Sporadic .2 P~ecchromocytoma .9 Unspecified .9 Other and unspecified

241 Non-toxic ncdular goitre 256 Ovarian dysfunction AS ICD 251 With SUb-diViSiOIM3: As ICD,275 with sub-divisions: .0 Endemic .0 Hyperfunction .1 Sporadic .1 Hypofunction .9 Unspecified .9 Ovarian dysfunction NOS

242 ThYrotoxicosis with or without goitre 257 Testicular dysfunction .0 Toxic diffuse goitre As ICD 276 with sub-divisions: As ICD 252.0 except for 242.2 below .0 Hyperfunction

32 .1 Hypofunction Other metabolic diseases (270-279) .9 T&ticular dysfunction NOS 270 Congenital disorder of amino-acid metabolism 258 Polyglandular dysfunction and other diseases of .0 Phenylketonuria endocrine glands .1 Cystinuria .0 “Pituitary basopbilism .2 Other disorders of amino-acid renal transport .1 Polyglandular dysfunction .3 Cystinosis .9 Other and unspecified diseases of endocrine .4 Maple syrup disease system .5 Disorders of purine andpyrimidine metabolism Remainder of ICD 277 excepti .6 Alcaptonuria .8 Other Congenital dwarfism (7S6.6) .9 Unspecified Cushing’s syndrome (255.0) 271 Congenital disorders of carbohydrate metabcdfsm Avitaminoses and other nutritional deficiency (260-269) Excludes deficiency anaemias (280, 281) .0 Glycogen storage disease .1 Galactosaemia 260 Vitamin A deficiency .2 Von Gierke’s disease .8 Other .0 Night blindness .9 Unspecified .1 Xerophthalmia, keratomalacia ,8 Other manifestation 272 Congenital disorders of lipid metabolism .9 Unspecified Excludes amaurotic familial idiocy (342.0) and leukodystrophy (342.1) 261 Thiamine deficiency (including beriberi) .0 Disorders of steroid metabolism 262 Niacin deficiency (including pellagra) .1 Xanthomatosis .8 Other 263 Other vitamin B deficiency .9 Unspecified

.0 Ariboflavinosis 273 Other and unspecified congenital disorders of .1 Vitamin B6 deficiency metabolism .8 Other .9 Unspecified .0 Cystic fibrosis (mucoviscidosis) .1 Disorders of porphyrin metaklism 264 Ascorbic acid deficiency (including scurvy) .2 Haemochromatosis .3 Hepatolenticular degeneration 265 Vitamin D deficiency .4 Other disorders involving metabolism of min- erals .0 Rickets, active .5 Defective bilirubin excretion .1 Rickets, late effect .8 Other .2 Osteomalacia .9 Unspecified .9 Unspecified 274 Gout 266 Other vitamin deficiency states AS ICD 288 .II Vitamin K deficiency .8 Other 275 Plasma protein abnormalities .9 Unspecified .0 Agammaglobulinaemia .1 Hypogammaglobulinaemia 267 Protein malnutrition .2 Analbuminaemia .3 Bisalbuminaemia 268 Nutritional marasmus .4 Cryoglobulinaemia .5 Macroglobulinaetnia 269 Other nutritional deficiency .9 Other and unspecified .0 Sprue and steatorrhoea .1 Malabsorption syndrome NOS 276 Amyloidosis .9 Other and unspecified AS ICD 289.1

33 277 ObesiW not specified as of endocrine origin .2 PTA &ficiency As ICD 287 .3 Vascular hemophilia .4 Hemorrhagic flbrinolysis (fibrinogenolyais) 278 Other hyperalimentation .5 Circulating anticoagulants Excludes conditions due to excess administra. .9 Other tion of drugs (N963.6) 287 Purpura and oth& hemorrhagic conditions .0 Hypervitaminosis A ] .1 Carotinaemia .0 Allergic purpura of dietary origin .2 Hypervitaminosis D .1 llrombocytopenia .9 Other and unspecified I .2 Hemorrhagic thrombocythaemia .9 Other 279 Other and unspecified metabolic diseases Excludes congenital metabolic defects (270-273) 288 Agramdocytosis AS ICD 297

‘IV. DISEASES OF BLOOD AND 289 Other diseases of blood and blood-forming organa BLOOD-FORMING ORGANS .0 Polycythaemia, secondary .1 Diseases of spleen 280 Iron deficiency anaemias As ICD 298 except hepatolienalfibrosis (571) AS ICD 29i .2 Chronic Iymphadenitis AS ICD 468.0 281 Other deficiency anaemias .3 Non-specific mesenteric lymphadenitis .0 Pernicious anaemia AS ICD 468.1 .1 Other vitamin B12 deficiency anaemia .4 Lymphadenitis, unspecified .2 Folic acid deficiency anaemia & ICD 468.2 .3 Vitamin B6 deficiency anaemia .8 Other .4 Protein deficiency anaemia .9 Unspecified .9 Other and unspecified deficiency anaemia V. MENTAL DISORDERS 282 Hereditary haemolytic anaemias This section is intended primarily for the classifi- .0 Familial acholuric jaundice cation of admissions to mental hospitals, psychiatric .1 Heredkarynon-spherccytic haemolytic anaemia clinics, mental deficiency institutions, etc. For this .2 Hereditary elliptocytosis reason, all forms, of mental disorder are claasifled .3 Mediterranean anaemia here, even though associated with or secondary to .4 Haemoglobinopathies physical conditions as in categories 290-294, 309, 310- .5 Anaemia due to glucose-6-phoaphste dehydro- 315. For primary mortaliW classification and for mor- genase deficiency bidity classification where the mafn interest is not in .9 Other the mental state, these categories should not he used but assignment made to the underlying cause. 283 Acquired haemolytic anaemias .0 Acute Psychoses (2%)-299) .9 Other Acquired acholuric jaundice 290 Senile and pre-senile dementia .0 Senile dementia 284 Aplastic anaemias .1 Pre-senile dementia

285 Other and unspecified anaemias 291 AIcohdic psychosis .0 Hypochromic anaemia with iron loading .0 Delirium tremens .8 Other specified anaemias .1 Korsakoff’s psychosis (alcoholic) ..9 Anaemia unspecified .2 Other alcoholic hallucinosis As ICD 293 .3 Alcoholic paranoia .9 Other and unspecified 286 Coagulation defects .0 Hemophilia 292 Psychosis associated with intracranial infection .1 Christmas disease .0 With general paralysis

34 .1 With other syphilis of central nervous system 298 Other psychoses .2 With epidemic encephalitis .0 Reactive depressive psychosis .3 With other and unspecified encephalitis .1 Reactive excitation .9 With other and unspecified intracranial infection .2 Reactive confusion .3 Acute paranoid reaction 293 Psychosis associated with other cerebral condition .9 Reactive psychosis unspecified .0 With cerebral arteriosclerosis .1 With other cerebrovascular disturbances 299 Unspecified psychosis .2 With epilepsy .3 With intracranial neoplasm Newosis, penwnulity disorders and othey non-psychotic .4 With degenerative diseases of central nervous mental disordeys (300-309) system .5 With brain trauma 300 Neuroses .9 With other and unspecified cerebral condition .0 Anxiety neurosis .1 Hysterical neurosis 294 Psychosis associated with other physical condition .2 Phobic neurosis .0 With endocrine disorders .3 Obsessive compulsive neurosis .1 With metabolic and nutritional disorders .4 Expressive neurosis .2 With systemic infections .5 Neurasthenia .3 With drug or poison intoxication .6 Depersonalization syndrome Excludes alcoholic psychosis (291) .7 Hypochondriacal neurosis .4 With childbirth .8 Other Excludes psychosis of specified type arising .9 Unspecified neurosis during the puerperium (295-298) .8 With other physical conditions 301 PersonaliW disorders .9 With physical condition, NOS .0 Paranoid .1 Affective (cyclothymic) 295 Schizophrenia .2 Schizoid .0 Simple type .3 Explosive .1 Hebephrenic type .4 Anancastic (obsessive-compulsive) .2 Catatonic type .5 Hysterical .3 Paranoid type .6 Asthenic .4 Acute schizophrenic episode .7 Antisocial Excludes acute schizophrenia of the types .8 Other listed above .9 Unspecified .5 Latent schizophrenia .6 Residual schizophrenia 302 Sexual deviation .7 Schizo-affective type .0 Homosexuality .8 Other .1 Fetishism .9 Unspecified type .2 Pedopbilia .3 Transvestitism 296 Affective psychoses .4 Exhibitionism .0 Involutional melancholia .8 Other .1 Manic-depressive psychosis, manic type .9 Unspecified .2 Manic-depressive psychosis, depressed type Includes endogenous depression 303 Alcoholism .3 Manic-depressive psychosis, circular type Excludes alcoholic psychosis (291J acute poi- .8 Other soning by alcohol (E860, N980). For primary ,9 Unspecified cause classification it excludes alcoholic cir- rhosis of the liver (571.0) 297 Paranoid states Excludes acute paranoid reaction (298.3) .0 Episodic excessive drinking .1 Habitual excessive drinking .0 Paranoia .2 Alcoholic addiction .1 Involutional parap~enia .9 Other and unspecified alcoholism .9 Other

35 304 Drug dependence .8 With degenerative diseases of central nervous system alkaloids and their derivatives .00pium, opium .9 With other and unspecified physical conditions .1 Synthetic analgesics with morphine-like effecta .2 Barbiturates Mental retardation (310-315) .3 Other hypnotics andsedatives or’’tianquilizers” .4 Cocaine 310 Borderline mental retardation ,5 Cannabis sativa (hashish, marihuana) IQ 68-85 .6 Other psycho-stimulants .7 Hallucinogenic 311 I@d mental retardation .8 Other IQ 52-67 .9 Unspecified 312 Moderate mental retardation 305 Physical disorders of presumably psychogenic IQ 36-51 origin .0 Skin 313 Severe mental retar&tion .1 Musculo-skeletal IQ 20-35 .2 Respiratory .3 Cardiovascular 314 Profound mental retardation .4 Haemic and lymphatic IQ under 20 .5 Gastro-intestinal .6 Genito-urinary 315 Unspecified mental retardation .7 Endocrine .8 Organs of special sense The following fourth-digit sub-divisions should .9 Other be used with each of the almve categories: .0 Following infections and intoxications 306 Special symptoms not elsewhere classified .1 Following trauma or physical agents .0 Speech disturbance .2 With disorders of metabolism, growth ornutri- .1 Specific learning disturbance tion .2 Tics .3 Associated with gross brain disease (post- .3 Other psychomotor disorders natal) .4 Disorders of sleep .4 Associated with diseases and conditions due to .5 Feeding disturbances (unknown) pre-natal influence .6 Enuresis .5 With chromosome abnormalities .7 Encopresis .6 Associated with prematurity .8 Cephalalgia .7 Following major psychiatric disorder .9 Other .8 With psycho-social (environmental) deprivation .9 other and unspecified 307 Transient situational disturbances V1. DISEASES OF THE NERVOUS SYSTEM 308 Behaviour disorders of childhood AND SENSE ORGANS

309 Mental disorders not specified as psychotic asso- InjlammatoYy diseases of centval nervow system ciated with ‘physical conditions (J20-324) .0 With intracranial infections 320 Meningitis, except meningococcal, tuberculous and .1 With drug, poison of systemic ~intoxication viral Excludes alcoholism (303) and drug de. pendence (304) ,0 H. influenza .2 Witi brain trauma .1 Pneumococcus .3 With circulatory disturbance .8 Due to other specified organism .4 With epilepsy .9 With no organism specified as cause .5 With disturbance of metabolism, growth or nutrition 321 Phlebitis and thrombophlebitis of intracranial .6 With senile or pre-senile brain disease venous sinuses .7 With intracranial neoplasm As ICD 341

36 322 Intracranial and intraspinal abscess 345 Epilepsy As ICD 342 .0 Generalized non-convulsive .1 Generalized convulsive myelitis, and encephalomyelitis 323 Encephalitis, .2 Partial (focalized) (except acute infectious) .3 Status epileptics As ICD 343 .9 Other and unspecified 324 Late effects of intracranial abscess or pyogenic 346 Migraine infection As ICD 354 As ICD 344

Hereditary and familial diseases of nervous system 347 Other diseases of brain (330-333) .0 Cataplexy and narcolepsy 330 Heredi@ry neuromuscular disorders .9 Other ,0 Neuropathic muscular atrophy 348 Motor neurone disease .1 Familial progressive spinal muscular atrophy .2 Amyotonia congenita .0 Amyotrophic lateral sclerosis .3 Progressive muscular dystrophy AS ICD 356.1 .9 Other .1 Progressive bulbar palsy .2 Other progressive muscular atrophy 331 Hereditary diseases of the striato-pallidal system .9 Other and unspecified manifestations Excludes hepatolenticular degeneration (273.3) As ICD 356.3 except primary muscular atrophy (733. 1) ,0 Hereditary chores .1 Dystonia musculorum deformans 349 Other diseases of spinal cord .2 Progressive familial myoclonic epilepsy (Unverricht-Lundberg) .0 Syringomyelia and syringobulbia .9 Other .9 Other Excludes Landry’s paralysis (354) 332 Hereditary ataxia Diseases of nerves and pen”pheral ganglti (350-358) .0 Hereditary spinal ataxia ,1 Hereditary cerebella ataxia 350 Facial paralysis .9 Other and unspecified As ICD 360

333 Other hereditary and familial diseases of nervous 351 Trigeminal neuralgia system J’% ICD 361 .0 Amaurotic familial idiocy .1 Progressive cerebral leukodystrophy 352 Brachial neuritis .9 Other and unspecified As ICD 362 except brachial radiculitis (728-3)

Other diseases of central nervous system (340-349) 353 Sciatica As ICD 363 except Iumbosacral radiculitis 340 Multiple sclerosis (728-8) Excludes diffuse cerebral sclerosis (341) As ICD 345 354 Polyneuritis and polyradiculitis

341 Other demyelinating diseases of central nervous 355 Other and unspecified forms of neuralgia and system neuritis As ICD 366 342 Paralysis agitans As ICD 350 356 Other diseases of cranial nerves AS ICD 367 343 Cerebral spastic infantile paralysis As ICD 351 357 Other diseases of peripheral nerves except auto- nomic 344 Other cerebral paralysis As ICD 368 except vertebrogenic conditions AS ICD 352 (728)

37 358 Diseases of peripheral autonomic nervous system .0 Primary acute As ICD 369 except vertebr~enic conditions .1 Chronic (primary) (728) .2 Secondary .9 Unspecified Inflamm,atov diseases of the eye (360-369) 376 Detachment of retina 360 Conjunctivitis and ophthalmia AS ICD 386 Excludes viral conjunctivitis (078) and gono- CWCiC (098.2) 377 Other diseases of retina and optic nerve .0 Vascular lesions of retina 361 Blepharitis .1 Degeneration of retina As ICD 371 .2 Amblyopia .3 Colour blindness 362 Hordeolum (sty) .8 Other AS ICD 372 .9 Unspecified 363 Iritis 378 Other diseases of eye 364 Keratitis .0 Chalazion .9 Other .0 With ulceration AS ICD 381 379 Blindness .9 Without mention of ulcer AS ICD 389 As ICD 374 .0 Blindness, both eyes, specifically defined 365 Choroiditis .1 Blindness, both eyes, not specifically defined As ICD 375 .2 Blindness, one eye, specifically defined .3 Blindness, one eye, not specifically defined 366 Other inflammation of uveal tract As ICD 376 except cyclitis and iridccyclitis Diseases of the ear and mastoid process (380-389) (363) 380 Otitis externa 367 Inflammation of optic nerve and retina As ICD 390 As ICD 377 368 Inflammation of lachrymal glands and ducts 381 Otitis media without mention of mastoiditis AS ICD 3/5 As ICD 391 .0 Acute ,369 Other inflammatory diseases of eye .1 Chronic As ICD 379 .2 Unspecified

Other diseases and conditions of eye (370-379) 382 O~itis media with mastoiditis AS ICD 392 370 Refractive errors AS ICD 380 .0 Acute .1 Chronic 371 Corneal opacity .2 Unspecified AS ICD 382 383 Mastoiditis without mention of otitis media 372 Pterygium As ICD 393 AS ICD 383 .0 Acute .1 Chronic 373 Strabismus .2 Unspecified AS ICD 384 384 Other inflammatory diseases of ear 374 Cataract As ICD 394 h ICD 385 385 M&i&e’s disease 375 Glaucoma As ICD 395 As ICD 387 with sub-divisions:

38 386 Otoscleroais pulmonary or tricuspid valves As ICD 411 387 Other diseases of ear and mastoid prcwess 396 Diseases of mitral and aortic valves .0 Cholesteatoma of ear Includes the listed conditions with disease of .1 Wax in ear pulmonary or tricuspid valves .9 Other and unspecified .0 Specified as rheumatic 388 Deaf mutism .9 Not specified as rheumatic As ICD 397 397 Diseases of other endocardial structures, speci- 389 Other deafness fied as rheumatic AS ICD 398 As ICD 412-414, specified as rheumatic .0 Deafness, both ears 398 Other heart disease, specified as rheumatic .1 Deafness, one ear, and partial deafness in other .2 Deafness, one ear .3 Impairment of hearing, one or both ears Hypertensive disease (400-404) Categories 400-404 include the listed conditions WI. DISEASES OF THE CIRCULATORY SYSTEM with arteriosclerosis; they exclude them with ischaemic heart disease (410-414) Active Yheumatic fever (390-392) 400 Malignant hypertension 390 Rheumatic fever without mention of heart involve- Includes any condition in 401-404 if specified ment as malignant or associated with malignant As ICD 400 hypertension

391 Rheumatic fever with heart involvement .0 Without mention of organ damage Excludes chronic heart diseases of rheumatic .1 With heart involvement (any condition in 427- origin (393-398) unless rheumatic fever is 429) also present or there is evidence of recru- .2 With cerebrovascular involvement (any condi- descence or activity of the rheumatic process. tion in 430-438) In cases where there is doubt as to rheumatic .3 With renal involvement (any condition in 580- activity at the time of death, see Rules for 584, 593.2, 792) Classification .9 With multiple organ involvement

.0 Active rheumatic pericarditis 401 Essential benign hypertension .1 Active rheumatic endocarditis As ICD 444, 447 .2 Active rheumatic myocarditis Excludes the listed conditions with cerebro- .9 Other active rheumatic heart disease vascular disease (430-438)

392 Chorea 402 Hypertensive heart disease .0 With heart involvement Includes any condition in 427-429 with hyper- h ICD 402.1 tension (benign) Excludes the listed conditions with any condi- .9 Without mention of heart involvement h ICD 402.0 tions in 403, 584 (404)

Chvonic vheumatic heart disease (393-398) 403 Hypertensive renal disease k ICD 446 393 Diseases of pericardium, specified as rheumatic Excludes the listed conditions with any condition in 402, 427-429 (404) 394 Diseases of mitral valve Includes the listed conditions with disease of 404 Hypertensive heart and renal disease pulmonary or tricuspid valves Includes any condition in 402 with any condition in 403 .0 Specified as rheumatic .9 Not specified as rheumatic Ischaemic heart disease (410-414) Categories 410-414 include the listed conditions ., Diseases of aortic valve, specified as rhetimatic with arteriosclerosis, hypertension (benign) Includes the listed conditions with disease of (malignant), or any condition in 427-429. The

39 following fourth-&git sub-divisions should be 426 Pulmonary heart disease used with these categories: For primary mortality classification, excludes the listed conditions when the underlying .0 With hypertension (benign) (malignant) pulmonary condition is known .9 Without mention of hypertension 427 Symptomatic heart disease 410 Acute myosardial infarction Excludes the listed conditions with malignant Includes any condition in 412 specified as acute hypertension (400.1), other hypertension (402) or with a stated duration of eight weeks or and ischaemic heart disease (410-414) less. Excludes the listed conditions specified as chronic or with a stated duration of over .0 Congestive heart failure eight weeks (412). Includes them with condi- .1 Left ventricular failure tions in 411-413 .2 Heart block .9 Other disorders of heart rhythm 411 Other acute and sub-acute forms of ischaemic heari disease 428 Other myocardial insufficiency Excludes the listed conditions with malignant 412 Chronic ischaemic heart disease hypertension (400.1), other hypertension (402) Includes any condition in 410 specified as and ischaemic heart disease (410-414) chronic or with a stated duration of over .0 With arteriosclerosis eight weeks. Excludes the listed conditions .9 Other specified as acute or with a stated duration Excludes the listed conditions with arterio- of eight weeks or less (410). Includes thenx sclerosis (428.0) with conditions in 413 429 Ill-defined heart disease 413 Angina pectoris E’xcludes the listed conditions with malignant hypertension ‘(400.1), other hypertension (402) 414 Asympmmatic ischaemic heart disease and ischaemic heart disease (410-414)

Other forms of heart disease (42V-429) Cevebrovascular disease (430-438) Categories 430-438 include the listed conditions 420 Acute pericarditis with arteriosclerosis or hypertension (benign). They exclude them with malignant hypertension 421 Acute and sub-acute endccarditis (400.2). The following fourth-digit sub-divisions should be used with these categories: .0 Acute and sub-acute bacterial endocarditis As ICD 430.0 .0 With hypertension (benign) .9 Other acute endocarditis .9 Without mention of hypertension ‘As ICD 430.1 430 Subarachnoid hemorrhage 422 Acute myocardjtis As ICD 330 I As ICD 431 431 Cerebral hemorrhage 423 Chronic disease of pericardium As ICD 331 I

424 Chronic disease of endocardium, not specified as 432 Occlusion of pre-cerebral arteries I rheumatic Includes the listed conditions when specified as 433 Cerebral thrombosis I due to hypertension (benign) or arterioscle- rosis. When more than one valve is menticmed, 434 Cerebral embolism priority in classification is in the order mitral Includes cerebral infarction NOS, cerebral valve, agrtic valve, other (artery) ooclusion NOS .0 Mitral valvk, specified as non-rheumatic 435 Transient cerebral ischae”mia .1 Aortic valve .9 Other endocardial structures 436 Acute but ill-defined cerebrovascular disease 425 Cardiomyopathy 437 Generalized ischaemic cerebrovascular diseast=

40 438 Other and ill-defined cerebrovascular disease. .0 Arteriosclerotic gangrene Excludes hemiplegia (old orlong-standing)of .9 Gangrene not elsewhere classified uncertain origin (344) but Includes hemiplegia specified as duetohyper- 446 Other diseases of arteries and arterioles tension or arteriosclerosis .0 Polyarteritis nodosa .1 Hypersensitivity angiitis Diseases of arteties, atferioles andcapillaties (440-44?7 .2 Rheumatic arteritis .3 Wegener’s gramdomatosis 440 Arterioacleroais .4 Cranial arteritis Excludes the listed conditions with anycondi- .5 Thrombotic microangiopathy tion in 400-404,410-414,430-438 (assign to .9 Other these conditions), 428.9 (428.0) and 445.9 (445.0), and when reported asthe underlying 447 Diseases of capillaries cause of any condition in 342,424,427,441- AS ICD 467.1 444 (assign to these conditions) or of the terms nephritis (chronic) (interstitial) and Diseases of veins and lymphatic, and other diseases Bright’s disease (chronic) (403) of circulatory system (450-458) .0 Of aorti .1 Of renal artery 450 Pulmonary embolism and infarction .2 Of peripheral arteries AS ICD 465 .3 Of other specified arteries Excludes arteriosclerosis, coronary (412) 451 Phlebitis and thrombopblebitis and cerebral (437) .0 Of lower extremities .9 Generalized and unspecified i% ICD 463 .9 Of other sites 441 Aortic aneurysm (non-syphilitic) & ICD 464 Includes the listed conditions when specified as due to hypertension or arteriosclerosis 452 Portal vein thrombosis .0 Dissecting aneurysm of aorta (any part) .1 Aneurysm of aorta, thoracic or unspecified 453 Other venous embolism and thrombosis .2 Aneurysm of aorta, abdominal i% ICD 466 .9 Other 454 Varicose veins of lower extremities 442 Other aneurysm .0 With ulcer AS ICD 452 .9 Without mention of ulcer 443 Other peripheral vascular disease 455 Hemorrhoids As ICD 453 h ICD 461 .0 Raynaud’s syndrome .1 Thrombo-angiitis obliterans (Buerger’s 456 Varicoae veins of other sites disease) AS ICD 462 .2 Chilblains .0 Of oesophagus .9 Other .1 Of scrotum .9 Of other sites 444 Arterial embolism and thrombosis .0 Mesenteric 457 Non-infective disease of lymphatic channels .1 Renal AS ICD 468.3 .2 Peripheral arteries Excludes Iymphangitis with celhditis (682) and .9 Other arteries, not els?where classified lymphadenitis, acute (683), chronic (289.2), mesenteric (289.3), unqualified (289.4) 445 Gangrene Excludes diabetic gangrene (250), gas gangrene 458 Other diseases of circulatory system (039.0), and gangrene of certain sites (see As ICD 467 except diseases of capillaries (447) Alphabetical Index) .0 Hypotension .9 Other and unspecified circulatory diseases .

41 ViIl. DISEASES OF THE RESPIRATORY SYSTEM .3 Staphylococcus .9 Other

Acizterespiratory infections (except influenzd (460-466) 483 Pneumonia due to other specified organism Excludes pneumonia in coccidioidomycosis 460 Acute nasopharyngitis (common cold) (114); histoplasmosis (115); Q-fever (083.1); As ICD 470 and other diseases classified as infectious (000-136) 461 Acute sinusitis As ICD 471 484 Acute interstitial pneumonia

462 Acute pharyngitis 485 Bronchopneumonia, unspecified As ICD 472 without sub-divisions Excludes bronchiolitis (466) and lipoid pneu- monia (519.2) 463 Acute tonsillitis As ICD 473 486 Pneumonia, unspecified

464 Acute laryngitis and tracheitis Bronchitis, emphysema and asthma (490-493) As ICD 474 Excludes acute bronchitis (466)

465 Acute upper respiratory infection of multiple 490 Bronchitis, unqualified or unspecified sites As ICD S01 As ICD 475 Excludes the listed conditions with emphysema (491) 466 Acute bronchitis and bronchiolitis As ICD 500 and bronchiolitis 491 Chronic bronchitis As ICD 502 without sub-divisions Influenzq (470-474) 492 Emphysema 470 Influenza unqualified AS ICD 527.1 Excludes the listed conditions with bronchitis, 471 Influenza with pneumonia chronic or unqualified (491) AS ICD 480 493 Asthma 472 Influenza with other respiratory manifestations AS ICD 241 Excludes the listed conditions with bronchitis: 473 Influenza with digestive manifestations acute (466), chronic (491 ), unqualified (490) AS ICD 482 and emphysema (492)

474 Influenza with nervous manifestations Othev diseases of upper vespivatory tract (500-508J AS ICD 483 500 Hypertrophy of tonsils and adenoids Pneumonia (480-486) As ICD 510.0 Excludes lipid pneumonias and eosinophilic pneu- monitis (519.2) 501 Peritonsillar abscess (quinsy) As ICD 511 480 Viral pneumonia Excludes influenza virus pneumonia (471~ .502 Chronic pbaryngitis and nasopharyngitis measles pneumonia (055); psittacotic pneu- AS ICD 512 monia (073) .0 Chronic pharyngitis .1 Chronic nasopharyngitis 481 Pneumococcal pneumonia 503 Chronic sinusitis 482 Other bacterial pneumonia As ICD 513 .0 Friedltinder’s bacillus .1 Haemopbilus influenza 504 Deflected nasal septum .2 Streptomxcus As ICD 514 505 Nasal polyp .2 Other diseases of lung As ICD 515 .9 Other As ICD 527.2, except acute oedema of lung 506 Chronic laryngitis (519.1) AS ICD 516

507 Hay fever IX. DISEASES OF THE DIGESTIVE SYSTEM As ICD240 Diseases of oral cavity, salivary glands and jaws 508 Other diseases of upper respiratory tract (520-529) As ICD 517 520 Disorders of tooth development and eruption Other diseases of respiyatovy system (510-519) .0 Anodontia Excludes missing tooth with abnormal 510 Empyema spacing (524 ,3) AS ICD 518 ,1 Supernumerary teeth Excludes supernumerary teeth causing 511 Pleurisy crowding (524.3) As ICD S19 .2 Abnormalities of size and form .0 Without mention of effusion or tuberculosis .3 Mottled teeth .1 With effusion, with mention of a bacterial cause .4 Enamel hypoplasia other than tuberculosis .5 Hereditary disturbances in tooth structure NEC .2 Other specified forms of effusion, except tuber- .6 Disturbances in tooth eruption Culous Excludes impacted, embedded teeth with ab- normal position of such teeth or adjacent 512 Spontaneous pneumothorax teeth (524.3) AS ICD 520 .7 Teething syndrome .9 Other and unspecified 513 Abscess of lung h ICD 521 521 Diseases of hard tissues of the teeth .0 Dental caries 514 Pulmonary congestion and hypostasis .1 Attrition AS ICD 522 .2 Abrasion .3 Erosion 515 Pneumoconiosis due to siiica and silicates .4 Resorption Excludes silicotuberculosis (010) .5 Hypercementosis .0 Silicosis .6 hkylosis .1 Anthracosilicosis .7 Posteruptive colour changes .2 Asbestosis .8 Irradiated enamel .9 Other, including pneumoconiosis unspecified .9 Other and unspecified

516 Other pneumoconioses and related diseases 522 Diseases of pulp and periapical tissues .0 Due to inhalation of other inorganic dust .0 Pulpitis .1 Due to inhalation of other dust .1 Necrosis of the pulp .2 Due to inhalation of fumes .2 Pulp degenerations .3 Abnormal hard tissue formation in pulp 517 Other chronic interstitial pneumonia .4 Acute apical periodontitis As ICD 525 (with deletion of note) .5 Periapical abscess .6 Chronic apical periodontitis (granuloma) 518 Bronchiectasis .7 Fistula from periapical lesions .4s ICD 526 .8 Radicular cyst .9 Other and unspecified 519 Other diseases of respiratory system 523 Periodontal diseases .0 Pulmonary collapse AS ICD 527.0 .0 Acute gingivitis .1 Acute oedema of lung without mention of heart .1 Chronic gingivitis

43 .2 Gingival recession .5 Diseases pf lips .3 Acute periodontitis Excludes angular cheilosis in vitamin defi- .4 Chronic periodontitis ciency (262, 263) .5 Periodontosis .6 Leukoplakia .6 Accretions on teeth .7 Other disturbances of keratinisation .9 Other and unspecified .8 Oral submucous fibrosis .9 Other and unspecified 524 Dento-facial anomalies including malocclusion 529 Diseases of the ton~e and other oral conditions .0 Major anomalies of jaw size .1 Anomalies of jaw-cranial base relationship .0 Median rhomboid glossitis .2 Anomalies of dental arch relationship .1 Geqyapical tongue (benign, rnigratoryglossitis) .3”Anomalies of tooth position .2 Other gloesitis .4 Malocclusion NOS .3 Hypertrophy of tongue papillae .5 Dento-facial functional abnormalities .4 Atrophy of tongue papillae .9 Other and unspecified .5 Plfcated tongue .6 GIossodynia (ghxmopyrosis) 525 ~er diseases and conditions of the teeth and .9 Other and unspecified supporting structures Diseases of oesophqgus, stonuzch and duodenum (530- .0 Acquired absence of teeth 53i7 Excludes missing teeth causing malocclusion (524.3) 530 Diseases of oesophagus .1 Atrophy of edentulous alveolar ridge As ICD 539 .9 Other and unspecified .0 Functional disorders of oesophagus 526 Diseases of the jaws .9 Other .0 Developmental dental cysts 531 Ulcer of stomach Excludes radicular cyst (522.8) As ICD 540 except peptic ulcer NOS (533) .1 Fissural cysts .2 Other cysts .0 With perforation .3 Reparative giant cell granuloma .9 Without menti”m of perforatim .4 Inflammatory conditions .5 Alveolitis (dry socket) 532 Ulcer of duodenum .9 Other and unspecified As ICD 541 .0 With perforation 527 Diseases of the salivary glands .9 Without mention of perforation .0 Atrophy .1 Hypertrophy 533 Peptic ulcer, site unspecified .2 Sialoadenitis .0 With perforation .3 Abscess .4 Fistula .9 Without mention of perforation .5 Sialolithiasis 534 Gastrojejunal ulcer .6 Mucocele (ranula) As ICD 542 .7 Disturbances of salivary secretion .8 Sialosis .0 With perforation .9 Other and unspecified .9 Withoutmention of perforation

528 Diseases of the oral soft tissues, excluding gingiva 535 Gastritis and duodenitis and tongue As ICD 543 .0 Stomatitis 536 Disorders of function of stomach Excludes Vincen~s stomatitis (101) .1 Cancrum oris (noms) As ICD 544 .2 Oral aphthous ulceration .0 Disorders of gastric secretion .3 Celhditis and abscess .1 Disorders of gastric mot@y .4 cysts .9 Other

44 537 Other diseases of stomach and d.ucdenum .8 Of other specified sites As ICD 545 As ICD 561.4 except diaphragmatic hernia above Appendicitis (540-543) .9 Of unspecified site f% ICD 561.5 540 Acute appendicitis As ICD 550 Other diseases of intestine and peritoneum (560-569) .0 With peritonitis 560 Intestinal obstruction without mention of hernia ,9 Without mention of peritonitis As ICD 570 except mesenteric infarction (447.0)

541 Appendicitis, unqualified .0 Intussusception As ICD 551 .1 Paralytic ileus .2 Volvulus 542 Other appendicitis .3 Impaction of intestine As ICD 552 .9 Other and unspecified

543 Other diseases of appendix 561 Gastro-enteritis and colitis, except ulcerative, of As ICD 553 non-infectious origin Excludes colitis, diarrhoea, enteritis, gastro- enteritis, infectious or unspecified (009) Hernia of abdominal cavity (550-553)

5S0 Inguinal hernia without mention of obstruction 562 Diverticula of intestine As ICD 560.0 .0 Small intestine .1 GoIon 551 Other hernias of abdominal cavity without men- tion of obstruction 563 Chronic enteritis and ulcerative colitis .0 Femoral .0 Regional enteritis AS ICD 560.1 i% ICD 572.0 .1 Umbilical .1 Ulcerative colitis h ICD 560.2 AS ICD 572.2 .2 Ventral (incisional) .9 Other AS ICD 560.3 AS ICD 572.3 .3 Diaphragmatic. Excludes hernias due to gross congenital 564 Functional disorders of intestines defect of diaphragm (756.8) .8 Of other specified sites ;0 Constipation As ICD 560.4 except diaphragmatic hernia As ICD 573.0 above .1 Irritable colon .9 Of unspecified site .9 Other except membranous colitis AS ICD 560.5 As ICD 573.3 (564.1) 552 Inguinal hernias with obstruction AS ICD 561.0 565 Anal fissure and fistula .0 Anal fissure 553 Other hernia of abdominal cavity with obstruction .1 Anal fistula .0 Femoral AS ICD 561.1 566 Abscess of anal and rectal regions .1 Umbilical As ICD 575 AS ICD 561.2 ,2 Ventral (incisional) 567 Peritonitis h ICD 561.3 & ICD 576 .3 Diaphragmatic Excludes hernia due to gross congenital 568 Peritoneal adhesions defect of diaphragm (756.8) As ICD 577

45 5690ther diseases of intestines and peritoneum NOS” when specified as arteriosclerotic or AS ICD 578 due to any condition in440 (403)

Diseases of liver, gallbladder and pancyeas (570-577) 584 Renal sclerosis, unqualified Excludes the conditions when specified as 570 Acute and subacute necrosis of liver arteriosclerotic or due to any condition in 401, I% ICD 580 403 (403), 402, (404) or malignant hypertension (400.3). It also excludes contracted kidney, 571 Cirrhosis of liver hydronephrotic (591) and pyelonephritic(590 .0) .0 Alcoholic Other diseases of winary system (590-599) .9 Other

590 Infections of kidney 572 Suppurative hepatitis and liver abscess f% ICD 582 .0 Chronic pyelonephritis .1 Other pyelonepbritis, pyelitis and pyelocystitis 573 Other diseases of liver Remainder of ICD 600.0 As ICD 583 except portal vein obstruction .2 Abscess of kidney and perirenal tissue (452) AS ICD 600.1 .9 Other 574 Cholelithiasis AS ICD 600.2 AS ICD 584 591 Hydronephrosis 575 Cholecystitis and cholangitis, without mention of AS ICD 601 calculi As ICD 585 592 Calculi of kidney and ureter AS ICD 602 576 Other diseases of gallbladder and biliary ducts AS ICD 586 593 Other diseases of kidney and ureter .0 Renal dwarfism 577 Diseases of pancreas .1 Acute tubular nephrosis .0 Acute pancreatitis Excludes traumatic anuria (crush syndrome) AS ICD 587.0 (N996.7) .1 Chronic pancreatitis .2 Other renal disease i% ICD587.1 .3 Obstruction of ureter, not elsewhere classified .9 Other diseases of pancreas .4 Other diseases of ureter As ICD 587.2 except fibrocystic disease Rest of ICD 603 of pancreas (273.0) 594 Calculi of other parts of the urinary system X. DISEASES OF GENITO-URINARY SYSTEM As ICD 604

Nephritis andnephYosis (580-584) 595 Cystitis Categories 580-583 (but not 584) include thelisted AS ICD 605 conditions with hypertension (benign) butexclude them with malignant hypertension (400.3) 596 Other diseases of bladder As ICD 606 580 Acute nephritis 597 Urethritis (non-venereal) 581 Nephrotic syndrome h ICD 607

582 Chronic nephritis 598 Stricture of urethra Excludes the terms’ ‘chronic Bright’s disease, ” As ICD 608 “chronic interstitial nephritis” and “chronic nephritis NOS” when specified as arterio- 599 Other diseases of urinary tract sclerotic or due to any condition in 440 (403) Diseases of male genital ovgans (600-60~ 583 Nephritis unqualified Excludes the terms “Bright’s disease, NOS,” 600 Hyperplasia of prostate “interstitial nephritis NOS” and “nephritis AS ICD 610

46 601 Prostatitis 615 Other diseases of ovary and Fallopian tube AS ICD 611 As ICD 625 with sub-divisions: .0 Prolapse of ovary 602 Other diseases of prostate .1 Hydrosalpinx. i% ICD 612 .2 Ovarian cyst, retention .9 Other 603 Hydrocele Remainder of ICD 625 As ICD 613 616 Diseases of parametrium and pelvic peritoneum 604 Orchitis and epididymitis (female) AS ICD 614 As ICD 626 with sub-divisions:

605 Redundant prepuce and phimosis .0 Pelvic inflammatory disease AS ICD 615 .1 Pelvic peritoneal adhesions, female .2 Pelvic congestion, female 606 Sterility, male .9 Other As ICD 616 Remainder” of ICD 626 except rectovaginal fistula (629.8) 607 Other diseases of male genital organs As ICD 617 with sub-divisions: Diseases of uterus and othey female genital oygans (620-629) .0 Leukoplakia of penis .1 Erythroplasia of penis 620 Infective diseases of cervix uteri .2 Chronic ulceration of penis Excludes trichomonal infections (131) .3 Balanitis .4 Seminal vesiculitis .0 Chronic cervicitis .5 Other inflammatory diseases .1 Other cervicitis .6 Spermatocele .7 Torsion of testis 621 Other diseases of cervix .8 Atrophy of testicle .0 Leukoplakia of cervix .9 Other .1 Erytbroplasia of cervix Remainder of ICD 617 .2 Hyperplastic endometritis of cervix .3 Chronic erosion and ulceration of cervix Diseases Of breast, ovary, Fallopian tube and pava- .4 Old laceration of cervix metvium (610-616) .5 Stricture of cervix .6 Atrophy of cervix 610 Chronic cystic disease of breast .9 Other AS ICD 620

611 Other diseases of breast 622 Infective diseases of uterus (except cervix), va- gina and vulva .0 Acute mastitis not associated with lactation Excludes trichomonal infections (131) AS ICD 621.0 .1 Hypertrophy of breast .0 Infective disease of uterus, except cervix AS ICD 621.1 f% ICD 630.1 .2 Fissure of nipple .1 Vaginitis and vulvitis .9 Other AS ICD 630.2 Remainder of ICD 621.2 623 Uterovaginal prolapse 612 Acute salpingitis and oophoritis .0 Cystocele AS ICD 622 .1 Rectocele .2 Uretbrocele 613 Chronic salpingitis and oophoritis .3 Vaginal enterocele AS ICD 623 .9 Other Remainder of ICD 631 614 Salpingitis and oophoritis, unqualified AS ICD 624

47 624 Malposition of uterus 631 Ectopic pregnancy As ICD 632 with sub-divisions: .0 Abdominal pregnancy, without mention of sepsis .0 Retroversion and retroflexion .1 Tubal pregnancy, without mention of sepsis .8 Other .2 Ovarian pregnancy, without mention of sepsis .9 Unspecified .3 Other or unspecified ectopic pregnancy, with- Remainder of ICD 632 out mention of sepsis .4 Abdominal pregnancy, with sepsis 625 Other diseases of uterus .5 Tubal pregnancy, with sepsis .6 Ovarian pregnancy, with sepsis .0 Hyperplasia of endometrium .9 Other or unspecified ectopic pregnancy, with .1 Atrophy of uterus sepsis .2 Subinvolution of uterus .9 Other 632 Hemorrhage of pregnancy 626 Disorders of menstruation .0 Placenta praevia As ICD 634 with sub-divisions: .1 Premature separation of placenta .2 Hemorrhage from marginal sinus .0 Absent .3 Threatened abortion .1 Scanty ,4 Due to afibrinogenaemia .2 Excessive .9 Other and unspecified .3 Painful .4 Frequent 633 Anaemia of pregnancy .5 Irregular As ICD 646 with sub-divisions: .6 Iiwermenstrual bleeding .7 Postmenopausal bleeding .0 Macrocytic anaemia of pregnancy .9 Other .1 Iron deficiency anaemia of pregnancy Remainder of ICD 634 .9 Other and unspecified anaemia of pregnancy

627 Menopausal symptoms 634 Other complications of pregnancy h ICD 635 .0 Malposition of foetus in uterus Excludes delivery with abnormal presenta- 628 Sterility, female tion (656) As ICD 636 .1 Rupture of pregnant uterus .2 Hydatidiform mole 629 Other diseases of female genital organs .3 Placental abnormalities not elsewhere classi- .0 Leukoplakia of vagina fied .1 Erythroplasia of vagina and vulva .4 Hydramnios .2 Kraurosis of vulva .5 Air embolism during pregnancy .3 Leukorrhoea .6 Molar pregnancy, undelivered /%s ICD 637.0 .9 Other .4 Unspecified infection .5 Vaginal bleeding Urinat-y infections and toxaemias of pregnancy and the .6 Old laceration puevperium (635-639)’ .7 Stricture or atresia of vagina and hymen .8 Rectovaginal fistula 635 Urinary infections arising during pregnancy and .9 Other the puerperium .0 Pyelitis and pyelonephritis Xl. COMPLICATIONS OF PREGNANCY, .9 Other urinary infection CHILD-BIRTH AND THE PUERPERIUM 636 Renal disease arising during pregnancy and the Complications of pyegnancy (630-634) puerperium Any condition in 580, 581 or 583 arising during 630 Infections of genital tract during pregnancy pregnancy and the puerperium. Excludes the Any condition in 612, 613, 614, 616, 620 or listed conditions with pre-eclampsia (637.0) 622 arising during pregnancy or eclampsia (637.1)

48 637 Pre-eclampsia, eclsmpsia and toxaemia, un- .1 Manipulation without instruments specified .2 Forceps, mid and high .3 Forceps, low .0 Pre-eclampsia .4 Forceps, unspecified .1 Eclampsia .5 Vacuum extractor .9 Toxaemia, unspecified .6 Caesarian section .8 Other surgical or instrumental 638 Hyperemesis gravidarum .9 Unspecified type of delivery .0 With neuritis .9 Without. mention of neuritis 650 Delivery without mention of complication As ICD 660 639 Orher toxaemias of pregnancy and the puerperium 651 Delivery complicated by placenta praevia or .0 Acute and subacute necrosis of liver antepartum hemorrhage .9 Other AS ICD 670

Abo~tion (640-645) 652 Delivery complicated by retained placenta Categories 640-645 include aQy interruption of AS ICD 671 pregnancy before 28 weeks of gestation with a dead foetus. The following fourth-digit sub-divi- 653 Delivery complicated by other postpartum sions should be used with categories 640, 641, hemorrhage 643-645 AS ICD 672 .0 With sepsis With mention of sepsis or any condition 654 Delivery complicated by abnormality of bony in 635, 670, 671 or 673.9 pelvis .1 With toxaemia AS ICD 673 With mention of toxaemia or any condition in 636-639 655 Delivery complicated by foetopelvic disproportion .2 With sepsis and toxaemia Excludes the conditions with mention of abnor- .9 Without mention of sepsis or toxaemia mality of bony pelvis (654)

640 Abortion induced for medical indications 656 Delivery complicated by malpresentation of foetus For primary mortality tabulations, excludes Excludes the conditions with mention of dis- the listed conditions if the complication of proportion (655) pregnancy or other pre-existing disease re- quiring the induction ia known 657 Delivery complicated by prolonged labour of other origin 641 Abortion induced for other legal indications AS ICD 675

&2 Abortion induced for other reasons 658 Delivery with laceration of perineum, without mention of other laceration .0 With sepsis AS ICD 676 .1 With hemorrhage .2 With sepsis and hemorrhage 659 Delivery with rupture of uterus .3 With laceration of pelvic organ (with or with- out mention of sepsis and hemorrhage) 660 Delivery with other obstetrical trauma .9 Without mention of sepsis, hemorrhage or As ICD 677 except rupture of uterus (659) laceration 661 Delivery with other complications 643 Abortion specified as spontaneous As ICD 678

644 Abortion not specified as induced or spontaneous 662 Anesthetic death in uncomplicated delivery Excludes anesthetic death in complicated 645 Other abortion deliveries (651-661)

Delive?y (650-662) Complications of the puerpen”um (670-678) The following fourth-digit sub-divisions should be used with these categories: 670 Sepsis of child-birth and the puerperium .0 Spontaneous As ICD 681

49 671 Puerperal phlebitis and thrombosis .2 Of upper arm and forearm AS ICD 682 .3 Of hand, exceut fingers .4 Of leg 672 Pyrexia of unknown origin during the puerperium .5 Of foot, except toes AS ICD 683 .9 Of other, multiple, and unspecified sites

673 Puerperal pulmonary embolism 683 Acute lymphadenitis h ICD 694 .0 Air embolism .i Amniotic fluid embolism 684 Impetigo .9 Other and unspecified i% ICD 695 674 Cerebral hemorrhage in the puerperium 685 Pilonidal cyst AS ICD 687 As ICD 221 675 Puerperal blood dyscrasias 686 Other local infections of skin and subcutaneous tissue 676 Anaemia of puerperium As ICD 698 with sub-divisions: As ICD 688.0 .0 Pyoderma 677 Other and unspecified complications of the puer- .1 Pyogenic granuloma perium .9 Other .0 Sudden death from unknown cause in the puer- perium Other inflammatory conditions of skin and subcutaneous tissue (690-698) AS ICD 688.2 .9 Other 690 Seborrhoeic dermatitis AS ICD 688.3 As ICD 700 678 Mastitis and other disorders of lactation 691 Infantile eczema and related conditions AS ICD 689 692 Other eczema and dermatitis X11. DISEASES OF THE SKIN AND Includes allergic eczema and contact dermatitis SUBCUTANEOUS TISSUE .0 Due to detergents Infections of skin and subcutaneous tissue (680-686) .1 Due to oils and greases Excludes viral warts (079. 1) and molluscum con- As ICD 703.1 tagiosum (079.0) .2 Due to solvents AS ICD 703.2 680 Boil and carbuncle .3 Due to drugs AS ICD 690 As ICD 703.3 .4 Due to other chemicals .0 Of face As ICD 703.4 ,1 Of neck .5 Due to food .2 Of trunk .6 Due to plants (except fcod) .3 Of upper arm and forearm As ICD 703.0 .4 Of hand .7 Due to radiation, except sunburn .5 Of buttock As ICD 703.5 .6 Of other parts of lower extremity .8 13ueto other specified agents .8 Of other and multiple sites AS ICD 703.6 phls SLUlbUITl .9 Of unspecified site .9 Unspecified cause

681 Cellulitis of finger and toe 693 Dermatitis herpetiformis AS ICD 691 As ICD 704.0

682 Other cellulitis and abscess 694 Pemphigus As ICD. 692 and 693 As ICD 704.1 .0 Of head and neck .1 Of trunk

50

* U. S. (20VSS,NMSNT PRINTING OFFICE :1973 515-214/69 695 Erythematous conciitiona .0 Circumscribed scleroderma As ICD 705 .1 Keratoderma As ICD 710.1 .0 Toxic erythema Except congenital conditions (757.1 ) sebor- ,1 Erythema multiform (erytbema iris) rhoeic warts and seborrhoeic keratosis ,2 Erythema nodosum (216.0) .3 Rosacea .2 Striae atropliicae .4 Lupus erythematosus As ICD 710.3 .9 Other and unqualified .3 KeIoid scar As ICD 710.4 696 Psoriasis and similar disorders .9 Other hypertrophic and atrophic conditions of .0 Psoriatic arthropathy skin .1 Other psoriasis As ICD 710.5 h ICD 706.0 .2 Parapsoriasis 702 other dermatoses AS ICD 706.1 As ICD 711 except congenital conditions (757.2) .3 Pityriasis rosea and senile wart (216.0) AS ICD 706.2 .4 Pityriasis rubra pilaris 703 Diseases of nail .5 Other and unspecified pityriasis As ICD 712 except congenital conditions (757.4) Remainder of ICD 706.3 .9 Other 704 Diseases of hair and hair follicles i% ICD 706.4 As ICD713 except congenital conditions (757.3)

697 Lichen 705 Diseases of sweat glands .0 Lichen planus .0 Anhidrosis .1 Lichen nitidus .1 Prickly heat .9 Other and unspecified .9 Other Remainder of ICD 707 Remainder of ICD714.0 except hidrocystoma (216.2) 698 Pruritus and related conditions .0 Pruritus ani 706 Diseases of sebaceous glands /% ICD 708.0 .1 Acne varioliformis .1 Pruritus of genital organs .2 Other acne AS ICD 708.1 Remainder. of ICD 714.1 .2 Prurigo .3 Sebaceous cyst J% ICD 708.2 .4 Seborrhoea .3 Lichenification and lichen simplex chronicus .9 Other As ICD 708.3 except diffuse neurodermatitis Remainder of ICD 714.2 (Brocq) and atopic eczema (691) .4 Dermatitis factitia (artefacta) 707 Chronic ulcer of skin As ICD 708.4 As ICD 715 .9 Other pruritic conditions AS ICD 708.5 708 Urticaria

Other diseases of skin and avbcutaneaus tisane (700- .0 Angioneurotic oedema 709) AS ICD 242 .9 Other 700 Corns and callosities f% ICD 243 As ICD 709 709 other diseases of skin 701 Other hypertrophic and atrophic conditions of skin As ICD 716 except congenital conditions (757.2, Excludes hereditary oedema of legs (757.0); 757.9) scleroderma (generalized) (737.0} and der- matomyositis (716.0)

51 X111. DISEASES OF THE MUSCULOSKELETAL Osteomyelitis and othev diseases of bone and @int 1 SYSTEM AND CONNECTIVE TISSkJE (720-729)

A?thn”tis and rheumatism, except vheumatic fever 720 Osteomyelitis and periostitis (710-718) As ICD 730 except osteomyelitis and periostitis of the jaw (526.4) 710 Acute arthritis due to pyogenic organisms .0 Acute osteomyelitis AS XCD720 .1 Chronic osteomyelitis .2 Unspecified o~teomyelitis 711 Acute non-pyogenic arthritis .3 Periostitis without mention of osteomyelitis AS ICD 721 721 Osteitis deformans 712 Rheumatoid arthritis and allied conditions As ICD 731 .0 Juvenile rheumatoid arthritis .1 Rheumatoid arthritis with spleno-adenomegaly 722 Osteochondrosis and leukopenia .0 Juvenile osteochondrosis of spine ,2 Palindromic rheumatism .1 Juvenile osteochondrosis of hip .3 Other rheumatoid arthritis .2 Other juvenile osteochondrosis. Remainder of ICD 722.0 .8 Other specified forms of osteochondrosis .4 Spondylitis ankylopoietica .9 Unspecified AS ICD 722.1 .5 Chronic rheumatic nodular fibrositis 723 other diseases of bne h ICD 722;2 .0 Osteoporosis 713 Osteo-arthritis (arthrosis) and allied conditions .1 Hypertrophic pulmonary osteo-arthropathy .9 Other .0 Osteo-arthritis (arthrosis) Remainder of 733 excepc Polyostotic fibrous z% ICD 723.0 dysplasia of bone (756.6); Cyst of jaw .1 Spondylitis osteo-arthritica (spondylarthrosis) (526.0-526.2); Granuloma of jaw (526.3); .2 Traumatic spondylopathy Prognathism retrognathia (524.1) 714 other specified forms of arthritis 724 Internal derangement of joint .0 Traumatic arthritis .0 Elbow .9 Other .1 Knee Remainder of ICD 724 .9 Other

715 Arthritis, unspecified 725 Displacement of intervertebral disc As ICD 725 As ICD 735 with sub-divisions: .0 Cervical 716 Myositis .1 Lumbar and lumkosacrsl Excludes infective myositis (732) .8 Other .0 Dermatomyositis .9 Unspecified .1 Chronic polymyositis .9 Other 726 Affection of sacroiliac joint AS ICD 736 717 Other non-articular rheumatism 727 Ankylosis of joint .0 Lumbago As ICD 737 with sub-divisions: As ICD 726.0 .1 Myofibrosis scapulohumeral .0 Of spine .2 Torticollis not specified as congenital, psycho- .1 Of shoulder genic, or traumatic .2 Of elbow AS ICD 726.2 .3 of wrist .9 Other muscular Rheumatism, fibrositis, and .4 Of finger myalgia .5 Of hip .6 Of knee 718 Rheumatism, unspecified .7 Of ankle AS ICD 727 .8 Of other and multiple sites .9 Of unspecified site 52 728 Vertebrogenic’ pain syndromes 737 Hallux valgus and varus Excludes the conditions stated as due to dis- As ICD 747 except congenital (755.9) placement of intervertebral disc (725); rheu- matoid arthritis (712); spondyloarthrosis 738 Other deformities (713.1); spondylitis (713.2) .0 Cervicalgia XIV. CONGENITAL ANOMALIES .1 Cervico-cranial syndrome .2 Cervico-brachial diffuse syndrome 740 Anencephalus .3 Radicular syndrome of upper limbs Excludes brachial neuritis NOS (352) 741 Spina bifida .4 Cervical myelopathy Excludes spina bifida occults (756.1) ,5 Pain in thoracic spine (with radicular and .0 With hydrocephalus visceral pain) .9 Without mention of hydrocephalus .6 Thoracic myelopathy .7 Lumbalgia 742 Congenital hydrocephalus .8 Radicular syndrome of lower limbs Excludes the listed conditions with spins bifida Excludes sciatic neuritis NOS (353) (741.0) .9 Compression syndrome of cauda equina 743 Other congenital anomalies of nervous system 729 Other diseases of joint As ICD 738 except peri-arthritis (717) .0 Encephalocele .1 Microcephalus Other diseases of m.usculoskeletal system (730-738) .2 Other specified anomalies of brain .3 Other specified anomalies of spinal cord 730 Bunion .4 Neurofibromatosis As ICD 740 .8 Other anomalies of peripheral nervous system .9 Unspecified anomalies of brain, spinal cord 731 Synovitis, bursitis and tenosynovitis or nervous system As ICD 741 and 742 744 Congenital anomalies of eye 732 Infective myositis and other inflammatory diseases .0 Anophthalmoa of tendon and fascia .1 Microphthalmos As ICD 743 .2 Buphthalmos .3 Congenital cataract 733 Other diseases of muscle, tendon and fascia .4 ColoLmma Excludes inborn defects of muscle (330); myo- .5 Aniridia sitis (716); myofibrosis (717) .8 Other specified anomalies of eye .0 Myasthenia gravis .9 Unspecified anomalies of eye As ICD 744.0 ,1 Muscular atrophy (idiopathic) 745 Congenital anomalies of ear, face and neck .9 Other Excludes: cleft lip (749.1), anomalies of cer- Remainder of ICD 744.2 vical spine (756.1), thyroid gland (758.2), parathyroid gland (758.3) and larynx (748.3) 734 Diffuse diseases of connective tissue .0 Anomalies of ear causing impairment of hear- Excludes polyarteritis nodosa (446.0) ing. .0 Progressive systemic sclerosis .1 Accessory auricle .1 Systemic lupus erythematosus .2 Other specified anomalies of ear .9 Other .3 Unspecified anomalies of ear .4 Branchial cleft, cyst or fistula; pre-auricular 735 Curvature of spine sinus As ICD 745 except congenital (756.1) .5 Webbing of neck ,8 Other specified anomalies of face and neck 736 Flat foot .9 Unspecified anomalies of face and neck As ICD 746 except congenital (755.9)

53 746 Congenital. anomalies of heart .5 Other anomalies 0? intestine .6 Anomalies of gallbladder, bile ducts and liver .0 Common truncus .7 Anomalies of pancreas .1 Transposition of great vessels .8 Other specified anomalies of digestive system .2 Tetralogy of Fallot .9 Unspecified anomalies of digestive system .3 Ventricular septal defect .4 Atrial septal defect 752 Congenital anomalies of genital organs .5 Ostium atrioventriculare commune Excludes: male hypogonadism (Klinefelter’s .6 Anomalies of heart valves .7 Fibroelastosis cordis syndrome) (759.5), gonadal agenesis (Tur- ner’s syndrome) (759.5) .8 Other specified anomalies of heart .9 Unspecified anomalies of heart .0 Indeterminate sex .1 Undescended testicle 747 Other congenital anomalies of circulatory system .2 Hypspadias .3 Epispadias .0 Patent ductus arteriosus .4 Hydrocele .1 Coarctation of aorta .5 Anomalies of ovary, Fallopian tube and uterus .2 Other anomalies of aorta .6 Anomalies of vagina and external female gen- .3 Stenosis or atresia of pulmonary artery italia .4 Anomalies of great veins .7 Pseudohermaphroditism .5 Absence . or hypoplasia of umbilical artery .8 Other specified anomalies of genital organs .6 Other anomalies of peripheral vascular system .9 Unspecified anomalies of genital organs .8 Other specified anomalies of circulatory system .9 Unspecified anomalies of circulatory system 753 Congenital anomalies of urinary system 748 Congenital anomalies of respiratory syStem .0 Renal agenesis .1 Cystic kidney disease .0 Choanal atresia .2 Obstructive defects of urinary tract .1 Other anomalies of nose .3 Other specified anomalies of kidney .2 Web of larynx .4 Other specified anomalies of ureter .3 Other anomalies of larynx, trachea and bronchus .5 Extrophy of urinary bladder .4 Congenital cystic lung .6 Atresia and stenosis of urethra and bladder .5 Agenesis of lung neck .6 Other anomalies of lung .8 Other specified anomalies of bladder and .8 Other specified anomalies of respiratory system urethra .9 Unspecified anomalies of respiratory system .9 Unspecified anomalies of urinary system 749 Cleft palate and cleft lip 754 Congenital clubfoot .0 Cleft palate .1 Cleft lip 755 Other congenital anomalies of limbs .2 Cleft palate with cleft lip .0 Polydactyly 750 Other congenital anomalies of upper alimentary .1 Syndactyly tract .2 Reduction deformity confined to hand .3 Reduction deformity of arm (and hand) .0 Tracheoesophageal fistula, oesophageal atreaia .4 Reduction deformi~ of leg and foot and stenosis .5 Reduction deformity, unspecified limb .1 Pyloric stenosis .6 Other anomaly of upper limb (including shoul- .2 Anomalies of tongue der girdle) .8 Other specified anomalies of upper alimentary .7 Dislocation of hip tract .8 Other anomaly of lower limb (including pelvic .9 Unspecified anomalies of upper alimentary tract girdle) .9 Other and unspecified anomaly of unspecified 751 Other congenital anomalies of digestive system limb .0 Meckel’s diverticulum .1 Atresia and stenosis of small intestine 756 Other congenital anomalies of musculoskeletal .2 Atresia and stenosis of rectum and anal canal system .3 Hirschsprung’s disease .0 Anomalies of skull and face bones .4 Anomalies of intestinal fixation Excludes anomalies of jaw (524.0)

54 .1 Anomalies of spine 761 Other maternal conditions unrelated to pregnancy .2 Cervical rib Includes the listed conditions with asphyxia, .3 Other anomalies of ribs and sternum anoxia or hypoxia in the foetus or infant .4 Chondrodystrophy .0 Syphilis .5 Osteogenesis imperfects .1 Diabetes mellitus .6 Other generalized anomalies of skeleton .2 Influenza .8 Other specified anomalies of muscle, tendon .3 Rubella and fascia .4 Toxoplasmosis .9 Unspecified anomalies of musculoskeletal sys- .S Injury tem .6 Operation .7 Chemical substances transmitted through pla- 757 Congenital anomalies of skin, hair and nails centa .9 Other maternal causes .0 Hereditary oedema of legs (Milroy’s disease) .1 Pigmented naevus 762 Toxaemias of pregnancy .2 Other specified anomalies of skin Includes the listed conditions with asphyxia, .3 Specified anomalies of hair anoxia or hypoxia in the foetus or infant .4 Specified anomalies of nails .9 Unspecified anomalies of skin, hair and nails .0 Renal disease arising during pregnancy .1 Pre-eclampsia of pregnancy 758 Other and unspecified congenital anomalies .2 Eclampsia of pregnancy .3 Toxaemia unspecified .0 Anomalies of spleen .4 Hyperemesis gravidarum .1 Anomalies of adrenal gland .5 Acute and subacute necrosis of liver arising .2 Anomalies of thyroid gland during pregnancy .3 Anomalies of other endocrine glands .9 Other toxaemia of pregnancy .8 Other specified congenital anomaly .9 Unspecified congenital anomaly 763 Matetial ante- and intra-partum infection Includes the listed conditions with asphyxia, 759 Congenital syndromes affecting multiple systems anoxia or hypoxia in the foetus or infant .0 Sims inversus .0 Pyelitis and pyelonephritis of pregnancy .1 Conjoined twins .1 Other infections of genito-urinary tract during .2 Other forms of monster pregnancy Excludes anencephaly (740) .9 Other .3 Langdon-Down disease .4 Other syndromes due to autosomal abnormality 7& Difficult labour with abnormality of bones, organs .5 Syndromes due to sex chromosome abnormality or tissues of pelvis .6 Tuberous sclerosis .8 Other specified syndromes .0 With birth injury to brain .9 Multiple congenital anomalies NOS .1 With birth injury to spinal cord .2 With birth injury to bone or nerve .3 With other or unspecified birth injury XV, CERTAIN CAUSES OF PERINATAL .4 With asphyxia, anoxia or hypoxia MORBIDITY AND MORTALITY .9 Without mention of birth injury, asphyxia, an- oxia or hypoxia 760 Chronic circulatory and genito-urinary disease in mother 765 Difficult labour with disproportion, but no men- Includes the listed conditions with asphyxia, tion of abnormality of pelvis anoxia or hypoxia in the foetus or infant .0 With birth injury to brain .0 Chronic rheumatic heart disease .1 With birth injury to spinal cord .1 Congenital heart disease .2 With birth injury to bone or nerve ,2 Chronic hypertension .3 With other or unspecified birth injury .3 Other chronic diseaae of circulatory system .4 With asphyxia, anoxia or hypoxia .4 Chronic nephritis .9 Without mention of birth injury, asphyxia, an- .5 Other chronic disease of genito-urinary system oxia or hypoxia

55 766 Difficult labour with mal~sition of foetus 772 Birth injury without mention of cause Excludes the listed conditions with dispro- .0 To brain portion (765) .1 To spinal cord .0 With birth injury to brain .2 To Lmneor nerve .1 With birth injury to spinal cord .9 Other and unspecified .2 With birth injury to bone or nerve .3 With other or unspecified birth injury 773 Termination of pregnancy .4 With asphyxia, anoxia or hypoxia Not to be used for primary mortality classi- .9 Without mention of birth injury, asphyxia, an- fication if reason for termination is known oxia or hypoxia and is classifiable elsewhere in this section 767 Difficult labour with abnormality of forces of 774 Haemolytic disease of newborn with kernicterus lalmur .0 With Rh incompatibility .0 With birth injury to brain .1 With ABO incompatibility .1 With birth injury to spinal cord .2 With other or unspecified blood incompatibility .2 With birth injury to bone or nerve .9 Without mention of cause .3 With other or unspecified birth injury .4 With asphyxia, anoxia or hypoxia 775 Haemolytic disease of newborn without mention .9 Without mention of birth injury, asphyxia, an- of kernicterus oxia or hypoxia .0 With Rh incompatibility 768 Difficult labour with other and unspecified compli- .1 With ABO incompatibility cations .2 With other or unspecified blood incompatibility .9 Without mention of cause .0 With birth injury to brain .1 With birth injury to spinal cord 776 Anoxic and h~xic conditions not elsewhere .2 With birth injury to lmne or nerve classified .3 With other or unspecified birth injury .4 With asphyxia, anoxia or hypoxia .0 Aspiration of content of birth canal .9 Without mention of birth injury, asphyxia, .1 Hyaline membrane disease anoxia or hypoxia .2 Respiratory distress syndrome .3 Foetal distress 769 Other complications of pregnancy and child-birth .4 Intra-uterine anoxia Includes the listed conditions with asphyxia, .9 Asphyxia of newborn unspecified anoxia or hypoxia in the foetus or infant .0 Incompetent cervix 777 Immaturity NOS .1 Premature rupture of membranes .2 Hydramnios 778 Other conditions of foetus .3 Ectopic pregnancy .0 Foetal blood loss before birth .4 Multiple pregnancy .1 Chorio-amnionitis .5 Maternal death unspecified .2 Post-maturity .9 Other .3 Hemorrhagic disease of nevkorn .4 Cold injury syndrome 77o Conditions of placenta .9 Other Includes the listed conditions with asphyxia, anoxia or hypoxia in the foetus or infant 779 Foetal death of unknown cause .0 Placenta praevia .0 Maceration .1 Premature separation of placenta .9 Other .2 Placental infarction .9 Other

771 Conditions of umbilical cord XVI. SYMPTOMS AND ILL-DEFINED CONDITIONS Includes the listed conditions with asphyxia, anoxia or hypoxia in the foetus or infant There had not been a document prepared on the .0 Compression of cord revision of the section as its form is dependent to some .1 Prolapse of cord without mention of compres- extent “on the final arrangement and contxsmt of the sion disease sections I-XV. A separate three-digit category .9 Other will be provided for 795.2 sudden death (cause unknown). % Certain transfers may already bs considered accepted, MotoY vehicle traflc accidents (E81O-E819) either of sub-categories or of inclusion terms. Trans- To identify the injured person, the following fers of sub-categories from Section XVI involve ICD fourth digits are for use with categories E810- 780.3 Jacksonian epilepsy (to Section VI), ICD 785.6 E819: Diarrhoea, age two years and over (to Section I, with- .0 Driver of motor vehicle other than motorcycle out age distinction); ICD 787.5 Pain in back (to Section .1 Passenger in motor vehicle other than motor- X111).In respect of inclusion terms it has been agreed cycle to reclassify “Cerebella ataxia” (from ICD 780.5 .2 Motorcyclist Disturbance of co-ordination, to Section VI); “Narco- .3 Passenger on motorcycle lepsy” (from ICD 780.7 Disturbance of sleep, to Sec- .4 Occupant of streetcar tion VI). Transfers into Section XVI affect ICD 534 .5 Rider of animal; occupant of animal-drawn Toothache from unspecified cause, and inclusion term vehicle “Earache of unknown cause” in ICD 394 O,ther inflam- .6 Pedal cyclist matory diseases of ear. other transfers have been .7 Pedestrian suggested such as that of ICD 784.6 Excessive sali- .8 Other specified person vation (to Section IX) or of ICD 789.1 Albuminuria .9 Unspecified person ortbostatic (to Section X). However, only systematic review of all terms in the present alphabetical index assigned to Section XVI as well aa other sections will E81O Motor vehicle traffic accident involving collision with train allow conclusions on the merits’ of a few additional transfers and facilitate consistent decisions. E811 Motor vehicle traffic accident involving collision with streetcar E XVII. ACCIDENTS, POISONINGS AND VIOLENCE E812 Motor vehicle traffic accident involving collision (EXTERNAL CAUSE) with another motor vehicle

Railway accidents (E800-E8077 E813 Motor vehicle traffic accident involving collision To identify the injured person, the following with other vehicle fourth digits are for use with categories E800- E807: E814 Motor vehicle traffic accident involving collision .0 Railway employee with pedestrian .1 Passenger on railway .2 Pedestrian E815 Other motor vehicle traffic accident involving .3 Pedal cyclist collision .8 Other specified person .9 Unspecified person E816 Non-collision motor vehicle traffic accident due to loss of control E800 Railway accident involving collision with rolling stock E817 Non-collision motor vehicle traffic accident while Lmarding or alighting E801 Railway accident involving collision with stationary object E818 Other non-collision motor vehicle traffic accident

E802 Railway accident involving derailment without E819 Motor vehicle traffic accident of unspecified na- antecedent collision ture Motor vehicle non-trafic accidents (E820-E823) E803 Railway accident involving explosion, fire, burning To identify the injured person the following fourth digits are for use with categories E820- E804 Fall in, on, or from train E823:

E805 Hit by rolling stock .0 Driver of motor vehicle other than motorcycle .1 Passenger in motor vehicle other than motor- E806 Other specified railway accident cycle .2 Motorcyclist E807 Railway accident of unspecified nature .3 Passenger on motorcycle

57 .4 Occupant of streetcar E831 Accident to water craft causing other injury .5 Rider of animal; occupant of animal-drawn vehicle E832 Other accidental submersion or drowning in water .6 Pedal cyclist transport .7 Pedestrian .8 Other specified person E833”Fall on stairs or ladders in water transport .9 Unspecified person i% ICD E852

E820 Motor vehicle non-traffic accident involving col- E834 Other fall from one level to another in water lision with moving object transport AS ICD E853 E821 Motor vehicle non-traffic accident involving col- lision with stationary object E835 Other and unspecified fall in water transport As ICD E854 and E855 E822 Motor vehicle non-traffic accident while boarding or alighting E836 Machinery accident in water transport AS ICD E856 E823 Motor vehicle non-traffic accident of other and unspecified nature E837 Explosion, fire, burning, in water transport

Othey Yoad vehicle accidents (E825-E827) E838 Other and unspecified water transport accident

E825 Streetcar accident, except collision with motor AiY and space transport accidents (E8@-E845) vehicle To identify the injured person, the following fourth digits are for use with categories E840-E846: .0 Injury to pedestrian .1 Injury to pedal cyclist .0 Occupant of space craft .2 Injury to occupant of streetcar .1 Occupant of military aircraft .8 Injury to other specified person .2 Occupant of commercial aircraft, crew .9 Injury to unspecified person .3 Other occupant of commercial aircraft .4 Occupant of other and unspecified aircraft E826 Pedal cycle accident, except collision with motor .5 Ground crew, airline employee vehicle or streetcar .8 Other specified person .9 Unspecified person .0 Injury to pedestrian .1 Injury to pedal cyclist E840 Accident to powered aircraft at take-off or landing .8 Injury to other specified person .9 Injury to unspecified person E841 Accident to powered aircraft, other and unspecified E827 Other non-motor road vehicle accidents E842 Accident to unpowered aircraft .0 Injury to pedestrian .8 Injury to other specified person E843 Fall in, on, or from aircraft .9 Injury to unspecified person E844 Other specified air transport accidents Water transport accidents (E830-E838) To identify the injured person, the following fourth E845 Accident involving spacecraft digits are for use with categories E830-E838: Accidental poisoni~ by dvugs and rnedicaments ,(E850- .0 Occupant of small boat E859) .1 Occupant of other water craft-crew Excludes (contact) dermatitis due to drugs and .2 Occupant of other water craft-other than crew medicaments (692.3), complication and mis- ,3 Bckers, stevedores adventures in administration of anesthetics for .8 Other specified person purposes of medical care (E930-E936), and .9 Unspecified person idiosyncratic and hypersensitive reactions to drugs (E930-E936) E830 Accident to water craft causing submersion

58 E850 Accidental poisoning by antibiotics and other anti- E855 Accidental poisonirig by autonomic nervous sys- mfectives tem and psychotherapeutic drugs .0 Penicillin, any .0 Antidepressants .1 Antifungal antibiotic .1 Tranquilizers .2 Chloramphenicol .2 Other psychotherapeutic agents ,3 Erythromycins, stxeptomycins, tetracycline .3 Parasympathomimetics (cholinergics) .4 Other antibiotics .4 Parasympathol@cs (snticholinergics) .5 Sulfonamides .5 Sympathomimetics (adrenergics) .6 Arsenic anti-infectives .6 Autonomic nervous system relaxants .7 Silver and its compounds .9 Other .8 Quinoline and hydroxyquinoline derivatives .9 Other anti-infectives E856 Accidental poisoning by other central nervous system depressants and stimulants E851 Accidental poisoning by hormones and synthetic .0 Anticonvulsants substitutes .1 Skeletal muscle relaxants .0 Adrenals .2 Anesthetic gases .1 Androgens and anabolic congeners .3 Other CNS depressants .2 Oestrogens .4 Amphetamine .3 Insulins and antidiabetic agents .8 Other CNS stimulants .4 Anterior pituitary extracts .9 Other and unspecified .5 Posterior pituitary extracts .6 Progestogens E857 Accidental poisoning by cardiovascular drugs .7 ‘l%yroid and thyroid derivatives .0 Cardiac depressants .8 Antithyroid agents .1 Cardiac tonics .9 Other hormones and synthetic substitutes .2 Cholesterol lowering agents .3 Ganglionic blocking agents E852 Accidental poisoning by primarily systemic and .4 Vasodilators haematologic agents .5 Other hypotensive agents .0 Antihiatsmine and anti-emetic drugs .6 Sclerosing agents .1 Antineoplastic agents .9 Other .2 Other electrolytic. caloric and water balance agents E858 Accidental ~isoning by gastro-intestinal drugs .3 Vitamins .0 Antacids and antidiarrhoeal agents .4 Other primarily systemic agents .1 Intestinal irritant cathartics .5 Iron and its compounds. .2 Emollient cathartics .6 Anticoagulants .3 Saline cathartics .7 Vitamin K products .4 Faecal softeners .8 Other coagulant .5 Other cathartics .9 Other primarily haematologic agents .6 Emetics .9 Other E853 Accidental poisoning by analgesics and antipyretics

.0 Opiates and synthetic analogues. E859 Accidental poisoning by other and unspecified .1 Salicylates and congeners drugs and medicaments .2 Cinchophen and congeners .0 Local anesthetics .3 Colchicine .1 Mercurial diuretics .4 Aniline derivatives .2 Xanthine derivatives .8 Other coal tar derivatives .3 Other diuretics .9 Other analgesics and antipyretics .4 Agents acting directly on musculo-skeletal E854 Accidental poisoning by other sedatives and hyp- system notics .5 Liniments .6 Ointments .0 Barbiturates .7 Other medicinal for external use .1 Chloral hydrate .8 Other specified drugs .2 Paraldehyde .9 Drug NOS .3 Bromides .9 Other sedatives and hypnotics

59 Accidental @m-sm”w by other so&t and liquid eub- E876 Accidental poisoning by other gases and vapors stances (E860-E869) As ICD E893 and E894 Excludes (contact) dermatitis due to detergents (692.0), oils and greases (692.1), solvents (692.2), E877 Accidental poisoning by unspecified gases and and other chemicals (692.4) vapors AS ICD E895 E860 Accidental poisoning by alcohol As ICD 1%880 Accidental falls (E880-E88?j

E861 Accidental poisoning by cleansing and polishing E880 Fall on or from stairs or steps agents E881 Fall on or from ladders or scaffolding E862 Accidental poisoning by disinfectants E882 Fall from or out of building or other structure E863 Accidental poisoning by paints and varnishes E883 Fall into hole or other opening in surface E864 Accidental poisoning by petroleum products and other solvents E884 Other fall from one level to another As ICD E881 and E882 E885 Fag on same level from slipping, tripping or E865 Accidental poisoning by pesticides, fertilizers, stumbling plant foods E886 Fall on same level from collision, pushing or E866 Accidental poisoning by heavy metals and their shoving by or with other person fumes E887 Otlier and unspecified fall E867 Accidental ~isoning by corrosives and caustics, not elsewhere classified Accidetits caused by fires (E890-E899)

E868 Accidental poisoning by noxious foodstuffs aid E890 Accident caused by conflagration in private dwell- poisonous plants ing

E869 Accidental poisoning by other and unspecified E891 Accident caused by conflagration in other building solid and liquid substances m- structure

Acm”dental pm”soniqg by gases and vapors (E870-E87ZJ E892 Accident caused by conflagration not in building or structure E870 Accidental poisoning by gas distributed by pipe. line E893 Accident caused by ignition of clothing

E871 Accidental poisoning by liquified petroleum gas E894 Accident caused by ignition of highly inflammable distributed in mobile containers material

E872 Accidental poisoning by other utility gas E895 Accident caused by controlled fire in private dwelling E873 Accidental poisoning by motor vehicle exhaust gas E896 Accident caused by controlled fire in other building f% ICD E891 or structure

E874 Accidental poisoning by carlmn monoxide from E897 Accident caused by controlled fire not in building incomplete combustion of domestic fuels or structure

E87S Accidental poisoning by other carbon monoxide E898 Accident caused by other specified fires

E899 Accident caused by unspecified fire

60 Accidents due to natural and environmental factors E915 Foreign body entering accidentally other orifice (E900-E909) h ICD E923

E900 Excessive heat E916 Struck accidentally by falling object As ICD E931 except sunburn (692.8) E917 Striking against or struck accidentally by objects E901 Excessive cold AS ICD E932 E918 Caught accidentally in or between objects

E902 High and low air pressure E919 Over-exertion and strenuous movements AS ICD E930 E920 Accident caused by cutting or piercing instru- E903 Effects of travel and motion ments As ICD E913 with sub-divisions: E904 Hunger, thirst, exposure and neglect ,0 Powered hand tools As ICD E926 and E933 ,1 Other hand tools ,2 Other machinery E905 Bites and stings of venomous animals and insects ,8 Other AS ICD E927 .9 Unspecified

E906 Other accidents caused by animals E921 Accident caused by explosion of pressure vessel AS ICD E928 As ICD E915 with sub-divisions:

E907 Lighming .0 Boilers AS ICD E935 .1 Gas cylinders ,8 Other E908 Cataclysm ,9 Unspecified J% ICD E934 E922 Accident caused by firearms wea~ns E909 Accident due to other natural and environmental As ICD E919 with sub-divisions: factors .0 Accidentally self-inflicted .9 Other and unspecified Other accidents (E91O-E929) E923 Accident caused by explosive material E910 Accidental drowning and submersion Excludes drowning and submersion in trans- .0 Fireworks port accidents .1 Blasting materials .2 Explosive gases .0 In recreational activities .8 Other .9 Other and unspecified .9 Unspecified E911 Inhalation and ingestion of food causing obstruction E924 Accident caused by hot substance, corrosive liquid, or suffocation and steam AS ICD E921 As ICD E917 except burns NOS (E899) E912 Inhalation and ingestion of other object causing E925 Accident caused by electric current obstruction or suffocation As ICD E914 with sub-divisions: AS ICD E922 .0 Home wiring or appliances IZ913 Accidental mechanical suffocation .1 Industrial wiring or appliances .8 Other .0 In bed or cradle .9 Unspecified AS ICD E924 .9 Other and unspecified E926 Accident caused by radiation AS ICD E925 As ICD E918 with sub-divisions: E914 Foreign l.mdy entering accidentally eye and adnexa .0 Non-ionizing AS ICD E920 .1 Ionizing E927 Vehicle accidents not elsewhere classifiable .5 Diphtheria vaccine .6 Pertussis vaccine, including combinations with E928 Machinery accidents not elsewhere classifiable a pertussis component .8 Other and unspecified bacterial vaccines E929 Other and unspecified accidents .9 Mixed bacterial vaccine, except combinations with a pertussis component 3ur@”cal and medical complications and misadventures (E930-E936) E934 Complications and misadventures in prophylaxis Excludes (contact) dermatitis due to drugs and with other vaccines medicaments (692.3) and accidental overdose .0 Smallpox vaccine of drugs and wrong drug given in error (E850- .1 Rabies vaccine E859) .2 Typhus vaccine .3 Yellow fever vaccine E930 Complications and misadventures in operative .4 Measles vaccine therapeutic procedures .5 Poliomyelitis vaccine Not to be used for primary death classification .6 Other and unspecified viral or rickettsial vac- if the condition for which the treatment was cines given is known .7 Mixed viral/rickettsial and bacterial vaccines, .0 In surgical treatment, excluding effects of except combinations with a pertussis com- anesthetic management ponent .1 In anesthesia during operative treatment .9 Other and unspecified vaccines ,2 In infusion or transfusion during operative treatment E935 Complications and misadventures in other prophy. .9 In other procedures during operative treatment lactic procedures .0 In surgical procedures, excluding effects of E931 Complications and misadventures in other and un- anesthetic management specified therapeutic procedures .1”In anesthesia during prophylactic procedures Not to be used for primary death classification .2 In use of X-rays and radioactive substances if the condition for which treatment was given .3 In administration of drugs and biological is known .9 In other and unspecified prophylactic proce- .0 In use of X-rays and radioactive substances dures .1 In administration of drugs and biological .2 In infusion and transfusion E936 Complications and misadventures in other non- .3 In local applications therapeutic procedures .8 In other therapeutic procedures .0 In surgical procedures, excluding effects of .9 In unspecified therapeutic procedures anesthetic management .1 In anesthesia E932 Complications and misadventures in diagnostic .9 In other and unspecified procedures procedures Not to be used for primary death classification Late effects of aca”dental injury (E940-E949) if a diagnosis was made .0 In surgical procedures, excluding effects of E940 Late effect of motor vehicle accident anesthetic management .1 In anesthesia E941 Late effect of other transport accident .2 In use of X-rays or radioactive substances .3 In administration of drugs and biological E942 Late effect of accidental poisoning .8 In other diagnostic procedures .9 In unspecified diagnostic procedures E943 Late effect of accidental fall

E933 Complications and misadventures in prophylaxis E944 Late effect of accident caused by fire with bacterial vaccines .0 BCG vaccine E945 Late effect of accident due to natural and environ- .1 Typhoid and paratyphoid vaccine mental factors .2 Cholera vaccine .3 Plague vaccine E946 Late effect of other accident .4 Tetanus vaccine

62 E947 Late effect of surgical operation E960 Fight, brawl, rape Excludes . strangulation (E963), submersion E948 Late effect of irradiation (E964), and injuries caused by weapons (E965, . E966) E949 Late effect of other surgical and medical proce- dures E961 Assault by corrosive or caustic substance, except poisoning Suicide and self-injlicted injury (E950-E959) Categories E950-E959 include injuries in suicide E962 Assault by p-aisoning and attempted suicide and other self-inflicted AS ICD E980 injuries when specified as intentional. Suicide said to be “due to” any disease is to be classi- E963 Assault by hanging and strangulation fied as suicide E964 Assault by submersion (drowning) E950 Suicide and self-inflicted poisoning by solid or liquid substances E965 Assault by firearms and explosives As ICD E970, E971 h ICD E981

E951 Suicide and self-inflicted poisoning by gases in E966 Assault by cutting and piercing instruments domestic use AS ICD E982 AS ICD E972 E967 Assault by pushing from high place E952 Suicide and self-inflicted poisoning by other gases AS ICD E973 E968 Assault by other and unspecified means

E953 Suicide and self-inflicted injury by hanging and E969 Late effect of injury purposely inflicted by other strangulation person As ICD E974 AS ICD E964

E954 Suicide and self-inflicted injury by submersion Legal intervention (E970-E978) (drowning) Categories E970-E979 include injuries during Aa ICD E975 legal action by police or other law-enforcing agents, including military on duty E955 Suicide dnd self-inflicted injury by firearms and explosives E970 Injury due to legal intervention by firearms AS ICD E976 E971 Injury due to legal intervention by explosives E956 Suicide and self-inflicted injury by cutting and piercing instruments E972 Injury due to legal intervention by gas AS ICD E977 E973 Injury due to legal intervention by blunt object E957 Suicide and self-inflicted injury by jumping from high place E974 Injury due to legal intervention by cutting and h ICD ’978 piercing instruments

E958 Suicide and self-inflicted injury by other and un- E975 Injury due to legal intervention by other specified specified means means k ICD E979 E976 Injury due to legal intervention Iiy unspecified E959 Late effect of suicide and self-inflicted injury means AS ICD E963 E977 Late effect of injuries due to legal intervention Homicide and injwy purposely inflicted by other per- sons (E960-E969) E978 Legal execution Categories E960-E969 exclude injuries due to legal intervention (E970-E979) and to war operations (E990-E999)

63 Injtq undetermined wizethey accidentally OYpuvposely E993 Injury due to war operations by other explosion inflicted (E980-E989) Categories E980-E989 are for use when it is not E994 Injury due to war operations by destruction of air- determined whether the injuries were accidental, craft suicidal or homicidal. ‘hey include self-inflicted AS ICD E997 injuries not specified either as accidental or as intentional E995 Injury due to war operations by other and un- specified forms of conventional warfare E980 Poisoning by solid or liquid substances, undeter- i’% ICD E998 mined whether accidentally or purposely inflicted E996 Injury due to war operations by nuclear weapons E981 Poisoning hy gases in domestic use, undetermined whether accidentally or purposely inflicted E997 Injury due to war operations by other forms of unconventional warfare E982 Poisoning by other gases, undetermined whether accidentally or purposely inflicted E998 Injuries due to war operations but occurring after cessation of hostilities E983 Hanging and strangulation, undetermined whether h ICD E999 accidentally or purposely inflicted E999 Late effect of injury due to war operations E984 Submersion (drowning), undetermined whether AS ICD E965 accidentally or purposely inflicted N XVII. ACCIDENTS, POISONINGS AND VIOLENCE E985 Injury by firearms and explosives, undetermined (NATURE OF INJURY, N800-N999) whether accidentally or purposely inflicted FRACTURES (N800-N829) E986 Injury by cutting and piercing instruments, unde- termined whether accidentally or purposely The following fourth digits are applicable for cate- inflicted gories N800-N829 unless otherwise indicated:

E987 Falling from high place, undetermined whether .0 Closed fracture accidentally or purposely inflicted .1 Open fracture .9 Late effect E988 Injury by other and unspecified means, undeter- mined whether accidentally or purposely in- Fracture of skull, spine, and trunk (N800-N809) flicted N800 Fracture of vault of skull E989 Late effect of injury, undetermined whether acci- dentally or purposely inflicted N801 Fracture of base of skull

InjuYy resultiqg from operations of war (E990-E999) N802 Fracture of face bones Categories E990-E999 include injuries caused by .0 Nasal bones, closed war and civil insurrections, but exclude acci- .1 Nasal bones, open dents during training of military personnel, .2 Mandible, closed manufacture of war material and transport, un- .3 Mandible, open less attributable to enemy action. Injuries by .4 Other, closed explosion of bombs and mines placed during the .5 Other, open war, if the explosion occurred after cessation of .9 Late effect, any facial tines hostilities, are included in category E998 N803 Other and unqualified skull fractures E990 Injury due to war operations by fires and confla- grations N804 Multiple fractures involving skull or face with other bones E991 Injury due to war operations by bullets and frag- ments N805 Fracture and fracture dislocation of vertebral column without mention of spinal cord lesion E992 Injury due to war operations by explosion of marine weapons .0 Cervical, closed .1 Cervical, open

64 .2 Dorsal or thoracic, closed .5 Lower extremity, open .3 Dorsal or thoracic, open .9 Late effect, any part .4 Lumbar, closed .5 Lumbar, open N814 Fracture of carpal bone(s) .6 Sacrum and coccyx, closed .7 Sacrum and coccyx, open N815 Fracture of metacarpal /mne(s) .8 Late effect, any vertebra N816 Fracture of one or more phalanges of hand N806 Fracture and fracture dislocation of vertebral col- umn with spinal cord lesion N817 Multiple fractures of hand bones Excludes: spinal cord lesion without fracture (N958) N818 Other, multiple, and ill-defined fractures of upper limb .0 Cervical, closed .1 Cervical, open N819 Multiple fractures both upper limbs, and upper .2 Dorsal or thoracic, closed limb with rib(s) and sternum .3 Dorsal or thoracic, open .4 Lumbar, closed Fracture of lower limb (N820-N829) .5 Lumbar, open ,6 Sacrum and coccyx, closed .7 Sacrum and coccyx, open N820 Fracture of neck of femur .9 Late effect, any vertebra N821 Fracture of other and unspecified parts of femur N807 Fracture of rib(s), sternum and larynx .0 Shaft or unspecified part, closed .1 Shaft or unspecified part, open .0 Rib, closed .2 Lower extremity, closed .1 Rib, open .3 Lower extremity, open .2 Sternum, closed .9 Late effect, either part .3 Sternum, open .4 Larynx, closed N822 Fracture of patella .5 Larynx, open .9 Late effect, rib(s), sternum or larynx N823 Fracture of tibia and fibula (either or both) N808 Fracture of pelvis .0 Upper extremity or unspecified part, closed ,1 Upper extremity or unspecified part, open N809 Multiple and ill-defined fractures of trunk ,2 Shaft, closed .3 Shaft, open Fractwe of upper limb (N81O-N819) ,9 Late effect, either part

N81O Fracture of clavicle N824 Fracture of ankle

N811 Fracture of scapula N825 Fracture of one or more tarsal and metatarsal bones N812 Fracture of humerus N826 Fracture of one or more phalanges of foot .0 Upper extremi~, closed .1 Upper extremity, open N827 Other, multiple, and ill-defined fractures of lower .2 Shaft, or unspecified part, closed limb .3 Shaft, or unspecified part, open .4 Lower extremity, closed N828 Multiple fractures involving both lower limbs, .5 Lower extremity, open lower with upper limb, and lower limb(s) with .9 Late effect, any part rib(s) and sternum N813 Fracture of radius and ulna (either or both) N829 Fracture of unspecified bones .0 Upper extremity or unspecified part, closed .1 Upper extremity or unspecified part, open DISLOCATION WITHOUT FRACTURE (N830-N839) ,2 Shaft, closed .3 Shaft, open Excludes: congenital dislocation (755, 756) .4 Lower extremity, closed fracture dislocation (N800-N829)

65 recurrent or pathological dislocation N847 Sprains and strains of other and unspecified parts (729) of back .0 Neck The following fourth digits are applicable for cate- .8 Other gories N830-N839 unless otherwise indicated: .9 Unspecified .0 Simple dislocation .1 Compound dislocation N848 Other and ill-defined sprains and strains ,Q Late effect INTRACRANIAL INJURY (EXCLUDING THOSE WITH N830 Dislocation of jaw SKULL FRACTURE) (N850-N854)

N831 Dislocation of shoulder Excludes: nerve injury (N950, N951)

N832 Dislocation of elbow The following fourth digits are applicable for cate- gories N850-N854 unless otherwise indicated: N833 Dislocation of wrist .0 Without mention of open intracranial wound .1 With open intracranial wound N834 Dislocation of finger .9 Late effect N835 Dislocation of hip N850 Concussion N836 Dislocation of knee .0 Current or unspecified .9 Late effect N837 Dislocation of ankle N851 Cerebral laceration and contusion N838 Dislocation of foot N852 Subarachnoid, subdural and extramural hemorr- N839 Other, multiple, and ill-defined dislocations hage, following injury (without mention of cere- .0 Cervical vertebra, simple bral laceration or contusion) .1 Cervical vertebra, compound .5 Other location, simple N853 Other and unspecified intracranial hemorrhage following injury (without mention of cerebral .6 Other location, compound laceration or contusion) .7 Multiple and ill-defined, simple .8 Multiple and ill-defined, compound N854 Intracranial injury of other and unspecified na- .9 Late effect, cervical vertebra or other ture SPRAINS AND STRAINS OF JOINTS AND ADJACENT MUSCLES (N840-N848) INTERNAL INJURY OF CHEST, ABDOMEN AND PELVIS (N860-N869) Excludes: tear, rupture or laceration of muscle as- sociated with open wound (N870-N908) Excludes: foreign body entering through orifice (N934-N939) N840 Sprains and strains of shoulder arid upper arm N860 Traumatic pneumothorax and haemothorax N841 Sprains and strains of elbow and forearm .0 Without mention of open wound into thorax .1 With open wound into thorax N842 Sprains and strains of wrist and hand .9 Late effect

N843 Sprains and strains of hip and thigh N861 Injury to heart and lung

N844 Sprains and strains of knee and leg .0 Heart without mention of open wound into thorax .1 Heart with open wound into thorax N845 Sprains and strains of ankle and foot .2 Lung without mention of open wound into thorax .3 Lung with open wound into thorax N846 Sprains and strains of sacro-iliac region .9 Late effect, either organ

66 N862 Injury to other and unspecified intrathoracic LACERATION AND OPEN WOUND (N870-N908) organs Excludes: burn (N940-N949) .0 Withaut mention of open wound into thorax crushing without open wound .1 With open wound into thorax (N920-N929) .9 Late effect foreign lmdy entering through orifice (N930-N939) N863 Injury to gastro-intestinal tract late amputation stump complication (following surgical amputation) .0 Without mention of open wound into abdominal (N998.1) cavity superficial injury (N91O-N918) .1 With open wound into abdominal cavity that incidental to: .9 Late effect cerebral injury (N850-N854) dislocation (N830-N839) N864 Injury to liver fracture (N800-N829) .0 Without mention of open wound into alxlominal internal injury (N860-N869) cavity nerve injury (N950-N959) .1 With open wound into abdominal cavity Laceration and open wound of head, neck and trunk .9 Late effect (N870-N879)

N865 Injury to spleen N870 Open wound of eye and orbit ,0 Without mention of open wound into abdominal .0 Without mention of complication cavity .1 Complicated .1 With open wound into abdominal cavity .9 Late effect .9 Late effect N871 Enucleation of eye N866 Injury to kidney N872 Open wound of ear .0 Without mention of open wound into abdominal cavity .0 Without mention of complication ,1 With open wound into abdominal cavity .1 Complicated .9 Late effect .9 Late effect N873 Other and unspecified laceration of head N867 Injury to pelvic organs .0 Without mention of open wound into akdominal .0 Scalp without mention of complication cavity .1 Scalp complicated .2 Nose without mention of complication .1 With open wound into abdominal cavity .3 Nose complicated .9 Late effect .7 Other face without mention of complication .8 Other face complicated N868 [njury to other and unspecified intra-abdominal organs .9 Late effect, nose, other face and scalp .0 Without mention of open wound into abdominal N874 open wound of neck cavity .0 Without mention of complication ,1 With open wound into abdominal cavity .1 Complicated ,9 Late effect .9 Late effect N869 Internal injury, unspecified or involving intratho- racic and intra-abdominsl organs N875 Open wound of chest (wall) .0 Without mention of complication .0 Without mention of open wound into thoracic or abdominal cavity .1 Complicated .9 Late effect .1 With open wound into thoracic or alxIominal cavity .9 Late effect N876 Open wound of back .0 Without mention of complication .1 Complicated .9 Late effect

67 N877 Open wound of buttock N885 Traumatic amputation of thumb (complete) (partial) .0 Without mention of complication .0 Without mention of complication .1 Complicated .1 Complicated .9 Late effect .!2Late effect

N878 Open wound of genital organs (external) including N886 Traumatic amputation of other finger(s) (com- traumatic amputation plete) (partial) .0 Without mention of complication .0 Without mention of complication .1 Complicated .1 Complicated .9 Late effect .9 Late effect

N879 Other, multiple and unapecifietl open wounds of N887 Traumatic amputation of arm and hand (complete) head, neck and trunk (partial) .0 Other specified sites of trunk without mention .0 Without mention of complication of complication .1 Complicated .1 Other specified sites of trunk complicated .9 Late effect .7 Multiple and unspecified sites without mention of complication Laceration and open wound of lower limbs (N890-N89?) .8 Multiple and unspecified sites complicated .9 Late effect, other ,specified, multiple and-un- N890 Open wound of hip and thigh specified sites .0 Without mention of complication .1 Complicated Laceration and open wound of uppev limb (N880-N88~ .2 With tendon involvement .9 Late effect N880 Open wound of shoulder and upper arm .0 Without mention of complication N891 Open wound of knee, leg (except thigh) and ankle .1 Complicated .0 Without mention of complication .2 With tendon involvement .1 Complicated .9 Late effect .2 With tendon involvement .9 Late effect N881 Open wound of elbow, forearm and wrist .0 Without mention of complication N892 Open wound of foot except toe(a) alone .1 Complicated .0 Without mention of complication .2 With tendon involvement .1 Complicated .9 Late effect .2 With tendon involvement .9 Late effect N882 Open wound of hand(s) except finger(s) alone .0 Without mention of complication N893 Open wound of toe(s) .1 Complicated .0 Without mention of complication .2 With tendon involvement .1 Complicated .9 Late effect .2 With tendon involvement .9 Late effect N883 Open wound of finger(s) .0 Without mention of complication N894 Multiple and unspecified open wound of lower limb .1 Complicated .0 Without mention of complication .2 With tendon involvement .1 Complicated .9 Late effect .2 With tendon involvement .9 Late effect N884 Multiple and unspecified open wound of upper limb N895 Traumatic amputation of toe(s) (complete) (partial) .0 Without mention of complication .0 Without mention of complication .1 Complicated .1 Complicated .2 With tendon involvement .9 Late effect .9 Late effect

68 N896 Traumatic amputation of foot (complete) (partial) .2 With tendon involvement .9 Late effect .0 Without mention of complication .1 Complicated N907 Multiple open wounds of face and other sites .9 Late effect .0 Without mention of complication N897 Traumatic amputation of leg(s) (complete) (partial) 1 Complicated .2 With tendon involvement .0 Without mention of complication .9 Late effect .1 Complicated .9 Late effect N908 Multiple open wounds of other and unspecified location Laceration and open wounds of multiple location (N900- N908) .0 Without mention of complication .1 Complicated N900Multiple open wounds of both upper limbs .9 Late effect .0 Without mention of complication SUPERFICIAL INJURY (N91O-N918) ,1 Complicated .2 With tendon involvement Excludes: burn (N940-N949) .9 Late effect contusion (N920-N929) insect bite, venomous (N989.4) N901 Multiple open wounds of both lower limbs ,0 Without mention of complication The following fourth digits are applicable to cate- .1 Complicated gories N91O-N918 unless otherwise indicate& .2 With tendon involvement .0 Without mention of infection .9 Late effect .1 Infected N902 Multiple open wounds of both upper and lower limb(s) N91O Superficial injury of face, neck, scalp

,0 Without mention of complication N911 Superficial injury of trunk ,1 Complicated .2 With tendon involvement N912 Superficial injury of shoulder and upper arm .9 Late effect N913 Superficial injury of elbow, forearm and wrist N903 Multiple open wounds of both hands .0 Without mention of complication N914 Superficial injury of hand(s) except finger(s) alone .1 Complicated .2 With tendon involvement N915 Superficial injury of finger(s) .9 Late effect N916 Superficial injury of hip, thigh, leg and ankle N904 Multiple open wounds of both head and limb(s) N917 Superficial injury of foot and toe(s) ,0 Without mention of complication .1 Complicated N918 Superficial injury of other, multiple and unspecified .2 With tendon involvement sites .9 Late effect

N905 Multiple open wounds of both head and trunk CONTUSION AND CRUSHING WITH INTACT SKIN SURFACE (N920-N929) .0 Without mention of complication .1 Complicated Excludes: concussion (N850, N860-N869) .2 With tendon involvement that incidental to: ,9 Late effect cerebral injury (N850-N854) dislocation (N830-N839) N906 Multiple open wounds of both trunk and limb(s) fracture (N800-N829) .0 Without mention of complication internal injury (N860-N869) .1 Complicated nerve injury (N950-N959)

69 N920 Contusion of face, scalp, and neck except eye(s) lighming (N994.0) radiation other than burn (N990) “N921 Contusion of eye and orbit The following fourth digits are applicable to N922 Contusion of trunk categories N940-N949 unless otherwise indi- cated N923 Contusion of shoulder and upper arm .0 Burn, unspecified degree, without mention of complication N924 Contusion of elbow, forearm and wrist .1 Burn, first degree, without mention of compli- cation N925 Contusion of hand(s) except finger(s) alone .2 Burn, second degree, without mention of compli- cation N926 Contusion of finger(s) .3 Bum, third degree, without mention of compli- cation N927 Contusion of hip, thigh, leg and ankle .8 Complicated burn .9 Late effect N928 Contusion of foot and toe(s) N940 Bum confined to eye N929 Contusion of other, multiple and unspecified sites N941 Burn confined to face, head and neck

FOREIGN BODY ENTERING THROUGH ORIFICE N942 Bum confined to trunk (N930-N939) N943 Bum confined to upper limb except wrist and hand Excludes: foreign lwdy in open wound (N800-N839, N851-N908) N944 Bum confined to wrist(s) and hand(s) foreign body inadvertently left in opera- tion wound (N998.6) N945 Burn confined to lower limb(s)

N930 Foreign body in eye and adnexa N946 Bum involving face, head and neck with limb(s)

N931 Foreign body in ear N947 Bum involving trunk with limb(s)

N932 Foreign body in nose N948 Burn involving face, head and neck with trunk and limb(s) N933 Foreign l.mdy in pharynx and larynx N949 Burn involving other and unspecified parts N934 Foreign body in bronchus and lung INWRY TO NERVES AND SPINAL CORD (N950-N959) N935 Foreign body in mouth, oesophagus, stomach The following fourth iTigit!ppiicsble for cate- N936 Intestine and colon gories N950-N959 unless otherwise indicated .0 Injury to nerve, without mention of open wound N937 Anus and rectum .1 Injury to nerve, with open wound .9 Late effect N938 Digestive system, unspecified N950 Injury to optic nerve(s) N939 Foreign body in genito-urinsry tract N951 Injury to other cranial nerve(s)

BURN (N940-N949) N952 Injury to nerve(s) in upper arm

Excludes: blister (N91O-N918) N953 Injury to nerve(s) in forearm burn due to swallowing corrosive sub- stance (N983) N954 Injury to nerve(s) in wrist and hand effect ofi electricity (N995.6) N955 Injury to nerve(s) in thigh

70 N956 Injury to nerve(s) in lower leg .2 Oestrogens .3 Insulins and antidiabetic agents N957 Injury to nerve(s) in ankle and foot .4 Anterior pituitary extracts .5 Posterior pituitary extracta N958 Spinal cord lesion without evidence of spinal kme .6 Progestogens injury .7 Thyroid and thyroid derivatives .8 Antithyroid agents .0 Cervical without mention of open wound .9 Other hormones and synthetic substitutes .1 Cervical with open wound .2 Dorsal or thoracic without mention of open N963 Adverse effect of primarily systemic agents wound .3 Dorsal or thoracic with open wound .0 Antihistaminic and anti-emetic drugs .4 Lumbar without mention of open wound .1 Antineoplastic agents .5 Lumbar with open wound .2 Acidifying agents ,7 Sacral without mention of open wound .3 Alkalinizing agents .8 Sacral with open wound .4 Other electrolytic, caloric and water balance .9 Late effect, any part agents .5 Enzymes N959 Other nerve injury including nerve injury in sev- .6 Vitamins eral parts .9 Systemic agents, not elsewhere classified

.0 Cervical sympathetic without mention of open N964 Adverse effect of agents primarily affecting blood wound constituents .1 Cervical sympathetic with open wound .6 Other and in several parts without mention of .0 Iron and its compounds open wound .1 Liver and liver extracts .7 Other and in several parts with open wound .2 Anticoagulants .9 Late effect, either .3 Vitamin K products .4 Other coagulant ADVERSE EFFECTS OF CHEMICAL SUESTANCES .9 Other agents primarily affecting blood constit- (N960-N989) uents

Excludes: dermatitis due to contact (692) N965 Adverse effect of analgesics and antipyretics external chemical burns (N940-N949) .0 Opiates and synthetic analogs .1 Salicylates and congeners Advevse effect of medicinal agents (N960-I?979) .2 Cinchophen and congeners .3 Colchicine N960 Adverse effect of antibiotics .4 Aniline derivatives .0 Penicillin, any .5 Other coal-tar derivatives .1 Antifungal antibiotics .9 Other analgesics and antipyretics .2 Chloramphenicol .3 Erythromycins N966 Adverse effect of anticonvulsants .4 Streptomycin .0 Dione derivatives .5 Tetracycline .1 Hydantoin derivatives ,9 Other antibiotics .9 Other anticonvulsants

N961 Adverse effect of other anti-infectives N967 Adverse effect of other sedatives and hypnotics .0 Sulfonamides .0 Barbiturates .1 Arsenic anti-infectives .1 Chloral hydrate .2 Silver and its compounds .2 Paraldehyde .3 Quinoline and hydroxyquinoline derivatives .3 Bromides .9 Other anti-infectives .9 Other sedatives and hypnotics

N962 Adverse effect of hormones and synthetic sub- N968 Adverse effect of other central nervous system stimtes depressants .0 Adrenals .0 Central nervous system muscle relaxants .1 Androgens and anabolic congeners .1 Anesthetic gases .9 Other

71 N969 Adverse effect of local anesthetics .1 Pharmaceutical dyes, not elsewhere classified .2 Diagnostic agents N970 Adverse effect of psychotherapeutics ,8 Other specified drugs, not elsewhere classified .9 Drugs, unspecified .0 Antidepressants .1 Tranquilizers N978 Adverse effect of two or more medicinal agents .9 Other psychotherapeutic agents in specified combinations

N971 Adverse effect of other central nervous system .0 Opium derivatives with barbiturates or tran- stimulants quilizers .1 Salicylates with decongestants, antihistamines, N972 Adverse effect of agents primarily affecting the autonomic nervous system etc. .2 Barbiturates with salicylates or other non- .0 Parasympathomimetics (cholinergics) addicting analgesics .1 Parasympatholytics (anticholinergics) .3 Non-barbiturate sedatives with salicylates or .2 Sympathomimetics (adrenergics) other non-addicting analgesics .3 Autonomic nervous system relaxants .4 Psychopharmacologic agents with barbiturates .9 Other N979 Alcohol in combination with specified medicinal N973 Adverse effect of agents primarily affecting agents cardiovascular system .0 Opium derivatives .0 Cardiac depressants .1 Barbiturates .3 Cardiac tonics .2 Non-barbiturate sedatives .4 Cholesterol lowering agents .3 Antihistamines .5 Ganglionic blocking agents .4 Psychopharmacologic agents .6 Vasodilators .7 Other hypotensive agents Tom-c effect of substances chiefly non-medicinal as to .8 Sclerosing agents sowce. (N980-N989) .9 Other N980 -Loxlc- ettect‘- or- alvullui‘l--L-l N974 Adverse effect of drugs primarily affecting gastro- intestinal system .0 Ethyl alcohol .1 Methyl alcohol .0 Antacids and antidiarrheal agents .2 Isopropyl alcohol .1 Intestinal irritant cathartics .9 Other .2 Emollient cathartics .3 Saline cathartics N981 Toxic effect of petroleum products .4 Faecal softeners .0 Kerosene .5 Other cathartics .1 Gasoline .6 Emetics .2 Petroleum naphtha .9 Other. .9 Other N975 Adverse effect of diuretics N982 Toxic effect of industrial solvents .0 Mercurial diuretics Excludes petroleum products N981 .1 Xanthine derivatives .0 Benzine and homologies .2 Carbonic acid anbydrase inhibitors .1 Carbon tetrachloride .3 Saluretics .2 Carbon disulfide .9 Other diuretic agents .9 Other N976 Adverse effect of agents acting dfrectly upon N983 Toxic effect of corrosive aromatics, acids and musculoskeletal system caustic alkalis .0 Oxytocics .0 Corrosive aromatics .1 Spasmolytics .1 Acids .2 Gold and its compounds .2 Caustic alkalis .9 Other .9 Caustic NOS N977 Adverse effect of other and unspecified drugs N984 Toxic effect of lead and its compounds (including .0 External medicinal, not elsewhere classified fumes)

72 N985 Toxic effect of other metals chiefly non-medicinal N991 Effects of reduced temperature as to source .0 Frostbite of face .0 Mercury and its compounds .1 Frostbite of hand .1 Arsenic and its compounds .2 Frostbite of foot ,2 Manganese and its compounds .3 Frostbite of other and unspecified sites ,3 Beryllium and its compounds .4 Immersion foot .9 Other .9 Other

N986 Toxic effect of carbon monoxide N992 Effects of heat Excludes sunburn (692.8) N987 Toxic effect of other gases, fumes or vapours .0 Heat stroke (heat pyrexia) .0 Liquefied petroleum gases (butane, propane) .1 Heat syncope .1 Other hydrocarbon gas (methane, water-gas, .2 Heat cramps acetylene) .3 Heat exhaustion, anhydrous .2 Nitrogen dioxide .4 Heat exhaustion, salt snd/or water depletion .3 Sulfur dioxide .5 Heat exhaustion, NOS .4 Frion .6 Heat fatigue, transient .9 Other .7 Heat oedema .9 Other heat effects ~988 Toxic effect of noxious food-stuffs .0 Shellfish N993 Effects of air pressure .1 Mushrooms .0 Barotrauma, otitic .2 Other plants used as food .1 Barotrauma, sinus .9 Other .2 Other and unspecified effects of high altitude .3 Caisson disease N989 Toxic effect of other substances chiefly non- medicinal as to source N994 Effects of exposure and deprivation .0 Cyanide (including gas) .0 Effects of lighming .1 Strychnine .1 Drowning and non-fatal submersion .2 Chlorinated pesticides .2 Effects of hunger .3 Other pesticides .3 Effects of thirst .4 Venom .9 Other effects of exposure, not elsewhere classi- .5 Soaps and detergents fied .9 Other N995 Other general effects of external causes OTHER ADVERSE EFFECTS (N990-N999) .0 Effects of excessive exertion N990 Effect of radiation .1 Motion (sea) sickness Excludes: dermatitis due to radiation (692.7) .2 Car and train sickness sunburn (692.8) .3 Air sickness burns (N940-N949) .4 Other motion (travel) sickness .5 Asphyxiation and strangulation .0 Effect of radioactivity, neither diagnostic nor .6 Electrocution and non-fatal effects of electric therapeutic current .1 Adverse effect of diagnostic X-ray .9 Other general effects of external causes not .2 Adverse effect of radioactive isotope or tracer elsewhere classified substance .3 Other radiation N996 Certain early complications of trauma .4 Adverse effect of radiotherapy, external .5 Adverse effect of radiotherapy, internal .0 Air emlmlism .6 Adverse effect of other radiotherapy .1 Fat embolism .9 Unspecified radiation .2 Secondary and recurrent hemorrhage

73 .3 Traumatic aneuryam and arterial injury .3 Post-operative hemorrhage or haematoma .4 Nerve injury complicating bone injury (fracture) .4 Accidental puncture or laceration .5 Local infection of wound .5 Disruption of operation wound .6 “Shock” .6 Foreign body inadvertently left in operation .7 Traumatic anuria (crush syndrome) wound .8 Volkmam’s ischemic contracture .7 Post-operative wound infection .9 Other early complications of trauma .8 Persistent post-operative fistula .9 Other complications of surgical procedures N997 Injury other and unspecified N999 Other complications of medical care .0 Face and neck, except eyes .1 Trunk .0 Generalized vaccinia .2 Shoulder and upper arm .1 Post-immunization encephalitis .3 Elbow, forearm and wrist .2 Serum hepatitis .4 Hand except finger(s) .3 Other infection .5 Finger(s) .4. Anaphylactic shock .6 Hip and thigh .5 Other serum reaction .7 Knee, leg, ankle and foot .6 ABO incompatibility reaction .8 Other specified site, including multiple .7 Rh incompatibility reaction .9 Unspecified site .8 Other transfusion reaction .9 Other N998 Complications of surgical procedures Excludes: contact dermatitis due to drugs (692.3) .0 Reaction to lumbar or spinal puncture adverse effects due to drugs .1 Late amputation stump complication (N960-N979) .2 Post-operative shock

000

74 OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS

Public Health Service Publication No. 1000

Series 1. I+ogvams and collection procedures. —Reports which describe the general programs of the National Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and other material necessary for understanding the data. Reports number 1-4

Series 2. Data evaluation and methods research. —Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, contributions to statistical theory. Reports number 1-19

Series 3. Analytical studies. — Reports presenting analytical or interpretive studies based on vital and health sta- tistics, carrying the analysis further than the expository types of reports in the other series. Reports number 1-4

SeVies 4. Documents and committee reports. —Final reports of major committees concerned with vital and health statistics, and documents such as recommended mcdel vital registration laws and revised birth and death certificates. Reports number 1-6

Seyies 10. Data From the Health Interuiew Sur6,ey .—Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other health-related topics, based on data collected in a continuing national household interview survey. Reports number 1-32

Series 11. Data F~om the Health Examination SuYvey.— Statistics based on the direct examination, testing, and measurement of national samples of the population, including the medically defined prevalence of spe- cific diseases, and distributions of the population with respect to various physical and physiological measurements. Reports number 1-19

Series 12. Data From the Health Records Survey. —Statistics from records of hospital discharges and statistics relating to the health characteristics of persons in institutions, and on hospital, medical, nursing, and personal care received, based on national samples of establishments providing these services and samples of the residents or patients. Reports number 1-5

SeYies 20. Data on movtality. —Various statistics on mortality other than as included in annual or monthly reports- special analyses by cause of death, age, and other demographic variables, also geographic and time series analyses. Reports number 1-3

Series 21. Data on ruztality, marriage, and divorce. —Various statistics on natality, marriage, and divorce other than as included in annual or monthly reports— special analyses by demagrapbic variables, also geo- graphic and time series analyses, studies of fertility. Reports number 1-9

Series 22. Data Fvom the National Natality and Mortality surveys. —Statistics on characteristics of birtha and deaths not available from the vital records, based on sample surveys stemming from these records, including such topics as mortality by socioeconomic class, medical experience in the last year of life, characteristics of pregnancy, etc. Reports number. 1-3

For a list of titles of reparts publisbed in these series, write to: National Center for Health Statistics U.S. Public Health Service Washington, D.C. 20201 IIBIII I,,,,,,, ,,,, (J.S,, [) EPA F{TMENT OF II HEALTH, EDUCATION, AND WELFARE p ~ PosTAGE AN[) FEES PAID U.S. D= ARTMENT OF HEW 9 Public Hlealth Service -1111 Ii ih Usml,l 1111. ,mllll IllIml HEALT’H SER\/lCES AND MENTAL HEALTH ADMINISTRATION HEW 396 r1‘: !560(1 Fishers Lane lRoclwil le. Mawland 20852

IOFFIC IAL B(JSINESS THIRDC LASS BLK. RT. I>enallty for Private Use, $300

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