TABLE OF CONTENTS Page SECTION I – INTRODUCTION A. Introduction ........................................................................................ 1 Major Revisions from Previous Manuals ............................................. 4 B. Medical Certification .......................................................................... 8 Excerpt from U.S. Standard Certificate of Death ................................ 9 U.S. Standard Certificate of Death ....................................................... 10 SECTION II – GENERAL INSTRUCTIONS A. Introduction......................................................................................... 13 1. Excessive Codes ........................................................................... 13 2. Created Codes .............................................................................. 15 3. “Dagger and asterisk” codes ........................................................ 26 B. General coding concept ..................................................................... 27 1. Definitions and types of diagnostic entities .................................. 27 a. One-term entity ........................................................................ 27 b. Multiple one-term entity .......................................................... 29 c. Adjectival modifier reported with multiple conditions ........... 31 2. Parenthe tical entries ...................................................................... 32 3. Special diagnostic entities ............................................................. 33 4. Plural form of disease .................................................................... 34 5. Implie d “disease” .......................................................................... 34 6. Non-trauma tic conditions .............................................................. 34 7. Drug dependent, drug dependency ................................................ 35 C. Format.................................................................................................. 36 1. “Due to” relationships involving more than four causally related conditions .................................................... 36 2. Connec ting terms .......................................................................... 36 a. “Due to” written in or implied ................................................. 36 b. Not indicating a “due to” relationship ..................................... 39 3. Condition entered above line I(a) ................................................. 39 4. Condition reported between lines in Part I ................................... 40 5. Condition reported as due to I(a), I(b), or I(c) .............................. 41 6. Conditions reported in Part II ........................................................ 42 7. Deletion of “due to” on the death certificate ................................ 42 8. Deletion of “Part II” on death certificate ...................................... 43 9. Numbering of causes reported in Part I ........................................ 44 10. Punctu ation marks ......................................................................... 45 11. Conditions in the duration box ...................................................... 47 i 2b January 2010 Instruction Manual Part 2b Table of Contents (continued) D. Doubtful diagnosis .............................................................................. 48 1. Doubtful qualifying expression ..................................................... 48 2. Interpretation of “either…or…” .................................................... 49 E. Conditions specified as “healed” or “history of” ............................. 52 F. Coding entries such as “same,” “ditto ("),” “as above”.................. 53 G. Conditions qualified by “postmortem, ” “rule out,” “ruled out,” “r/o” .......................................................................... 54 H. Nonindexed and illegible entries........................................................ 55 1. Terms that are not indexed ............................................................ 55 2. Illegible entries .............................................................................. 55 I. Coding one-character reject codes .................................................... 56 1. Reject code 1-5 – Inconsistent duration ........................................ 56 2. Reject code 9 – More than four “due to” statements .................... 58 J. Inclusion of additional information (AI) to mortality source documents........................................................................... 59 K. Amended certificates ......................................................................... 62 L. Effect of age of decedent on classification ........................................ 63 1. NEWBORN OR NEONATAL means less than 28 days of age at the time of death ..................................................... 63 2. INFANT OR INFANTILE means less than 1 year of age at the time of death .................................................................... 63 3. CHILD or CHILDHOOD means less than 18 years of age at the time of death .................................................................... 64 4. Congenital anomalies (Q00-Q99) ................................................. 64 a. Less than 28 days .................................................................. 64 b. Less than 1 year ..................................................................... 64 5. Congenital syphilis ........................................................................ 65 6. Age limitation ................................................................................ 66 M. Sex limitations ..................................................................................... 68 N. Effect of duration on assignment of codes........................................ 69 1. Qualifying conditions as acute or chronic .................................... 69 2. Subacute ........................................................................................ 70 3. Exacerbation .................................................................................. 71 4. Acute and chronic ......................................................................... 71 5. Qualifying conditions as congenital or acquired .......................... 72 6. Two conditions with one duration ................................................ 72 7. Conflict in durations ...................................................................... 73 8. Span of dates ................................................................................. 73 ii 2b January 2010 Instruction Manual Part 2b Table of Contents (continued) O. Relating and modifying conditions.................................................... 74 1. Implied site of disease ................................................................... 74 a. General instructions for implied site of a disease. ................... 74 b. Relating specific categories .................................................... 77 c. Exceptions to relating and modifying instructions .................. 79 2. Coding conditions classified to injuries as disease conditions ..... 81 SECTION III – INTENT OF CERTIFIER........................................................ 85 1. Other and unspecified gastroenteritis and colitis of unspecified origin (A090) ........................................................................................ 86 2. Spinal Abscess (A180) .......................................................................... 87 3. Charcot’s Arthropathy (A521) .............................................................. 88 4. Gener al Paresis (A521) ......................................................................... 89 5. Viral Hepatitis (B161, B169, B171-B178) ........................................... 91 6. Organisms and Infection NOS (B99) ................................................... 92 7. Erythrem ia (C940) ................................................................................ 98 8. Polycythem ia (D45) .............................................................................. 99 9. Hem olytic Anemia (D589) ................................................................... 100 10. Sideroblastic Anemia (D643) ............................................................... 101 11. Hem orrhagic Purpura NOS (D693) ...................................................... 102 12. Throm bocytopenia (D696) ................................................................... 103 13. Hyperparathyr oidism (E213) ................................................................ 105 14. Hyperaldosteronism (E269) .................................................................. 106 15. Lactase Deficiency (E730) .................................................................... 107 16. Korsakov’s Disease, Psychosis, or Syndrome (F106) .......................... 108 17. Drug Use NOS - Named Drug Use (F11-F16, F18-F19) ..................... 109 18. Tobacco Use (F179) .............................................................................. 112 19. Psychotic Episode NOS (F239) ............................................................ 113 20. Psychosis (any F29) .............................................................................. 114 21. Dissociative Disorder (F449) ................................................................ 115 22. Personality Disorder (F609), Personality Change (Enduring) (F629)