TABLE OF CONTENTS Page SECTION I – INTRODUCTION A. Introduction ........................................................................................ 1 Major Revivisions from Previous Manuals.......................................... 4 B. Medical Certification .......................................................................... 6 Excerpt from U.S. Standard Certificate of Death ................................ 7 U.S. Standard Certificate of Death....................................................... 8 SECTION II – GENERAL INSTRUCTIONS A. Introduction......................................................................................... 11 1. Excessi ve Codes ........................................................................... 11 2. Created Codes .............................................................................. 13 3. “Dagger and asterisk” codes ........................................................ 23 B. General coding concept ..................................................................... 24 1. Definitions and types of diagnostic entities .................................. 24 a. One-term entity ........................................................................ 24 b. Multiple one-term entity .......................................................... 26 c. Adjectival modifier reported with multiple conditions ........... 28 2. Parenthe tical entries ...................................................................... 29 3. Special diagnostic entities............................................................. 30 4. Plural form of disease.................................................................... 31 5. Implie d “disease” .......................................................................... 31 C. Format.................................................................................................. 32 1. “Due to” relationships involving more than four causally related conditions .................................................................. 32 2. Connec ting terms .......................................................................... 32 a. “Due to” written in or implied ................................................. 32 b. Not indicating a “due to” relationship ..................................... 35 3. Condition entered above line I(a) ................................................. 35 4. Condition reported between lines in Part I ................................... 36 5. Condition reported as due to I(a), I(b), or I(c) .............................. 37 6. Conditions reported in Part II........................................................ 38 7. Deletion of “due to” on the death certificate ................................ 38 8. Deletion of “Part II” on death certificate ...................................... 39 9. Numbering of causes reported in Part I ........................................ 40 10. Punctu ation marks......................................................................... 41 11. Conditions in the duration box...................................................... 42 i 2b January 2008 Instruction Manual Part 2b Table of Contents (continued) D. Doubtful diagnosis .............................................................................. 43 1. Doubtful qualifying expression..................................................... 43 2. Interpretation of “either…or…”.................................................... 44 E. Conditions specified as “healed” or “history of” ............................. 47 F. Coding entries such as “same,” “ditto ("),” “as above”.................. 48 G. Conditions qualified by “postmortem, ” “rule out,” “ruled out,” “r/o” .......................................................................... 49 H. Nonindexed and illegible entries........................................................ 50 1. Terms that are not indexed............................................................ 50 2. Illegible entries.............................................................................. 50 I. Coding one-character reject codes .................................................... 51 1. Reject code 1-5 – Inconsistent duration........................................ 51 2. Reject code 9 – More than four “due to” statements .................... 53 J. Inclusion of additional information (AI) to mortality source documents........................................................................... 54 K. Amended certificates ......................................................................... 57 L. Effect of age of decedent on classification ........................................ 58 1. NEWBORN OR NEONATAL means less than 28 days of age at the time of death ..................................................... 58 2. INFANT OR INFANTILE means less than 1 year of age at the time of death .................................................................... 58 3. CHILD or CHILDHOOD means less than 18 years of age at the time of death .................................................................... 59 4. Congenital anomalies (Q00-Q99) ................................................. 59 5. Congenital syphilis........................................................................ 60 6. Age limitation................................................................................ 61 M. Sex limitations ..................................................................................... 63 N. Effect of duration on assignment of codes........................................ 64 1. Qualifying conditions as acute or chronic .................................... 64 2. Subacute ........................................................................................ 65 3. Exacerbation.................................................................................. 66 4. Acute and chronic ......................................................................... 66 5. Qualifying conditions as congenital or acquired .......................... 67 6. Two conditions with one duration ................................................ 67 7. Conflict in durations...................................................................... 68 8. Span of dates ................................................................................. 68 ii 2b January 2008 Instruction Manual Part 2b Table of Contents (continued) O. Relating and modifying conditions.................................................... 69 1. Implied site of disease................................................................... 69 a. General instructions for implied site of a disease.................... 69 b. Relating specific categories .................................................... 72 c. Exceptions to relating and modifying instructions .................. 74 2. Coding conditions classified to injuries as disease conditions ..... 76 SECTION III – INTENT OF CERTIFIER........................................................ 80 1. Spinal Abscess (A180).......................................................................... 81 2. Charcot’s Arthropathy (A521)…………………..…………………… 82 3. General Paresis (A521)......................................................................... 83 4. Viral Hepatitis (B161, B169, B171-B178) ........................................... 85 5. Organisms and Infection NOS (B99) ................................................... 86 6. Erythremia (C940) ................................................................................ 92 7. Polycythemia (D45).............................................................................. 93 8. Hemolytic Anemia (D589) ................................................................... 94 9. Sideroblastic Anemia (D643) ............................................................... 95 10. Hemorrhagic Purpura NOS (D693) ...................................................... 96 11. Thrombocytopenia (D696) ................................................................... 97 12. Hyperparathyroidism (E213) ................................................................ 99 13. Hyperaldosteronism (E269).................................................................. 100 14. Lactase Deficiency (E730).................................................................... 101 15. Korsakov’s Disease, Psychosis, or Syndrome (F106).......................... 102 16. Drug Use NOS - Named Drug Use (F11-F16, F18-F19) ..................... 103 17. Tobacco Use (F179).............................................................................. 106 18. Psychotic Episode NOS (F239) ............................................................ 107 19. Psychosis (any F29) .............................................................................. 108 20. Dissociative Disorder (F449)................................................................ 109 21. Personality Disorder (F609), Personality Change (Enduring) (F629).. 110 22. Mental Disorder (any F99) ................................................................... 111 23. Parkinson’s Disease (G20).................................................................... 112 24. Cerebral Sclerosis (G379)..................................................................... 113 25. Myopathy (G729).................................................................................. 114 26. Brain Damage, child (G809)................................................................. 115 27. Paralysis (any G81, G82, or G83 excluding senile paralysis).............. 116 28. Cataract