TABLE OF CONTENTS Page SECTION I – INTRODUCTION A. Introduction ........................................................................................ 1 Major Revisions from Previous Manuals ............................................. 4 B. Medical Certification .......................................................................... 7 Excerpt from U.S. Standard Certificate of Death ................................ 8 U.S. Standard Certificate of Death ....................................................... 9 SECTION II – GENERAL INSTRUCTIONS A. Introduction......................................................................................... 12 1. Excessive Codes ........................................................................... 12 2. Created Codes .............................................................................. 14 3. “Dagger and asterisk” codes ........................................................ 25 B. General coding concept ..................................................................... 26 1. Definitions and types of diagnostic entities .................................. 26 a. One-term entity ........................................................................ 26 b. Multiple one-term entity .......................................................... 28 c. Adjectival modifier reported with multiple conditions ........... 30 2. Parenthe tical entries ...................................................................... 31 3. Special diagnostic entities ............................................................. 32 4. Plural form of disease .................................................................... 33 5. Implie d “disease” .......................................................................... 33 6. Non-trauma tic conditions .............................................................. 33 7. Drug dependent, drug dependency ................................................ 34 C. Format.................................................................................................. 35 1. “Due to” relationships involving more than four causally related conditions .................................................... 35 2. Connec ting terms .......................................................................... 35 a. “Due to” written in or implied ................................................. 35 b. Not indicating a “due to” relationship ..................................... 35 3. Condition entered above line I(a) ................................................. 38 4. Condition reported between lines in Part I ................................... 39 5. Condition reported as due to I(a), I(b), or I(c) .............................. 40 6. Conditions reported in Part II ........................................................ 41 7. Deletion of “due to” on the death certificate ................................ 41 8. Deletion of “Part II” on death certificate ...................................... 42 9. Numbering of causes reported in Part I ........................................ 43 10. Punctu ation marks ......................................................................... 44 11. Conditions in the duration box ...................................................... 46 i 2b January 2011 Instruction Manual Part 2b Table of Contents (continued) D. Doubtful diagnosis .............................................................................. 47 1. Doubtful qualifying expression ..................................................... 47 2. Interpretation of “either…or…” .................................................... 48 E. Conditions specified as “healed” or “history of” ............................. 51 F. Coding entries such as “same,” “ditto ("),” “as above”.................. 52 G. Conditions qualified by “postmortem, ” “rule out,” “ruled out,” “r/o” .......................................................................... 53 H. Nonindexed and illegible entries........................................................ 54 1. Terms that are not indexed ............................................................ 54 2. Illegible entries .............................................................................. 54 I. Coding one-character reject codes .................................................... 55 1. Reject code 1-5 – Inconsistent duration ........................................ 55 2. Reject code 9 – More than four “due to” statements .................... 57 J. Inclusion of additional information (AI) to mortality source documents........................................................................... 58 K. Amended certificates ......................................................................... 61 L. Effect of age of decedent on classification ........................................ 62 1. NEWBORN OR NEONATAL means less than 28 days of age at the time of death ..................................................... 62 2. INFANT OR INFANTILE means less than 1 year of age at the time of death .................................................................... 62 3. CHILD or CHILDHOOD means less than 18 years of age at the time of death .................................................................... 63 4. Congenital anomalies (Q00-Q99) ................................................. 63 a. Less than 28 days .................................................................. 63 b. Less than 1 year ..................................................................... 63 5. Congenital syphilis ........................................................................ 64 6. Age limitation ................................................................................ 65 M. Sex limitations ..................................................................................... 67 N. Effect of duration on assignment of codes........................................ 68 1. Qualifying conditions as acute or chronic .................................... 68 2. Subacute ........................................................................................ 69 3. Exacerbation .................................................................................. 70 4. Acute and chronic ......................................................................... 70 5. Qualifying conditions as congenital or acquired .......................... 71 6. Two conditions with one duration ................................................ 71 7. Conflict in durations ...................................................................... 72 8. Span of dates ................................................................................. 72 ii 2b January 2011 Instruction Manual Part 2b Table of Contents (continued) O. Relating and modifying conditions.................................................... 73 1. Implied site of disease ................................................................... 73 a. General instructions for implied site of a disease. ................... 73 b. Relating specific categories .................................................... 76 c. Exceptions to relating and modifying instructions .................. 78 2. Coding conditions classified to injuries as disease conditions ..... 80 SECTION III – INTENT OF CERTIFIER........................................................ 84 1. Other and unspecified gastroenteritis and colitis of unspecified origin (A090) ........................................................................................ 85 2. Spinal Abscess (A180) .......................................................................... 86 3. Charcot’s Arthropathy (A521) .............................................................. 87 4. General Paresis (A521) ......................................................................... 88 5. Viral Hepatitis (B161, B169, B171-B178) ........................................... 90 6. Organisms and Infection NOS (B99) ................................................... 91 7. Eaton-Lambert Syndrome (C80) .......................................................... 97 8. Erythrem ia (C940) ................................................................................ 97 9. Polycythem ia (D45) .............................................................................. 98 10. Hemolytic Anemia (D589) ................................................................... 99 11. Sideroblastic Anemia (D643) ............................................................... 100 12. Hemorrhagic Purpura NOS (D693) ...................................................... 101 13. Thrombocytope nia (D696) ................................................................... 102 14. Hyperparathyr oidism (E213) ................................................................ 104 15. Hyperaldosteronism (E269) .................................................................. 105 16. Lactase Deficiency (E730) .................................................................... 106 17. Korsakov’s Disease, Psychosis, or Syndrome (F106) .......................... 107 18. Drug Use NOS - Named Drug Use (F11-F16, F18-F19) ..................... 108 19. Tobacco Use (F179) .............................................................................. 111 20. Psychotic Episode NOS (F239) ............................................................ 112 21. Psychosis (any F29) .............................................................................. 113 22. Dissociative Disorder (F449) ...............................................................