# Presentation: 329166

## Classification of death and injury due to terrorism

- Lois A. Fingerhut & NCHS Colleagues....
- May, 2002
- National Center for Health Statistics, CDC

**Notes:**
September 11th had many repercussions in the US -  Within NCHS 

## NCHS Colleagues....

- Donna Pickett
- Donna Hoyert
- Donna Glenn
- Harry Rosenberg
-  Bob Anderson
- Cathy Burt, Bob Pokras, Amy Blum
- Mary Anne Freedman,Marjorie Greenberg, Ed Hunter
- Office of the Center Director, NCHS

## Proposal circulated to:

- Department of Justice- FBI
- Department of Justice- Bureau of Justice Statistics
- Centers within CDC
- WHO:
- Mortality Reference Group
- WHO Update Reference Committee
- Heads of WHO Collaborating Centres for the Classification of Diseases
- Individuals developing the National Violent Death Reporting System
- Injury Control and Emergency Health Services Section of the American Public Health Association
- President of the National Association of Medical Examiners

## FBI definition of terrorism

-   “...the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”
- Code of Federal Regulations (28 C.F.R. Section 0.85)

## Classification guidance..	

- Neither medical examiners nor medical record coders will be responsible for determining whether or not a death or injury resulted from terrorism.
- All decisions will be made by ‘the federal government’ (FBI).
- This will be more difficult for morbidity data if an “event” is labeled “terrorist” after the fact.

## Guidelines for Mortality

-  Classify terrorism with new ICD-10 codes for mortality and tabulate as an underlying cause of death within the categories of homicide or suicide, as appropriate.
- Place terrorism-related ICD-10 codes for mortality in the “U” Chapter of ICD-10, which has been reserved for “future additions and changes and for possible interim classifications to solve difficulties arising at the national and international levels between revisions.”

## Guidelines for Mortality

-   New ICD-10 terrorism codes for mortality are to be tabulated for statistical purposes within the category of homicide, thus expanding the current codes from X85-Y09, Y87.1 to include *U01 and *U02.
-   ICD-10 Codes *U03.1 and *U03.9 are to be tabulated for statistical purposes within the category of suicide, expanding the current codes from X60-X84, Y87.0 to include *U03.

## Guidelines for Mortality

-  Use ICD-10 code(s) Y08- Assault by other specified means, or Y09- Assault (homicide) by unspecified means, or X83 or X84, Intentional self-harm (suicide) by other specified or unspecified means, respectively for deaths for which terrorism has not been established at the time the death certificate is initially filed.

## New terrorism ICD-10 codes for mortality

*******U01 Terrorism**
***	****U01.0 Terrorism involving explosion of marine weapons
- 	*U01.1 Terrorism involving destruction of aircraft
- 	*U01.2 Terrorism involving other explosions and fragments
- 	*U01.3 Terrorism involving fires, conflagration and hot    substances
- 	*U01.4 Terrorism involving firearms
- 	*U01.5 Terrorism involving nuclear weapons
- 	*U01.6 Terrorism involving biological weapons
- 	*U01.7 Terrorism involving chemical weapons
- 	*U01.8 Terrorism, other specified
- 	*U01.9 Terrorism, unspecified

## New terrorism codes...

***U02 Sequelae of terrorism**
***U03 Terrorism**
- 		*U03.0 Terrorism involving explosions and fragments
- 		*U03.9 Terrorism by other and unspecified means

## Illustration of inclusion terms

- *U01.7 Terrorism involving chemical weapons
- 		Gases, fumes and chemicals
- 		Hydrogen cyanide
- 		Phosgene
- 		Sarin

## Selected part of 113-cause list 

- _Current_
**Accidents (unintentional injuries) (V01-X59, Y85-Y86)**
- 	Transport accidents (V01-V99, Y85)
- 	**“****	****“****	****“**
**Intentional self-harm (suicide) (X60-X84, Y87.0)**
- 	Intentional self-harm (suicide) by
- 	   discharge of firearms (X72-X74)
- 	Intentional self-harm (suicide) by other
- 	   and unspecified means and their
- 	  sequelae (X60-X71, X75-X85, Y87.0)
**Assault (homicide) (X85-Y09, Y87.1)**
- 	Assault (homicide) by discharge of
- 	   firearms ( X93-X95)
- 	Assault (homicide) by other and
- 	   unspecified means and their
- 	  sequelae (X85-X92, X96-Y09, Y87.1)
**Legal intervention (Y35, Y89.0)**

- _Plus terrorism codes_
**Accidents (unintentional injuries) (V01-X59, Y85-Y86)**
- 	Transport accidents (V01-V99, Y85)
**	****“****	****“****	****“**
**Intentional self-harm (suicide) (X60-X84, Y87.0, *****U03****)**
- 	Intentional self-harm (suicide) by
- 	   discharge of firearms (X72-X74)
- 	Intentional self-harm (suicide) by other	   and unspecified means and their
- 	   sequelae (X60-X71, X75-X85, Y87.0, *U03)
- Assault (homicide)(X85-Y09, Y87.1, *U01-*U02)
- 	Assault (homicide) by discharge of
- 	   firearms (X93-X95)
- 	Assault (homicide) by other and
- 	   unspecified means and their sequelae (X85-
- 	   X92, X96-Y09, Y87.1, *U01-*U02)
**Legal intervention (Y35, Y89.0)**

## Implementation-Mortality

- Through the Division of Vital Statistics
- To State vital statistics offices for immediate implementation through an addendum to its vital statistics instruction manuals
- Beginning with September 11 deaths
- NCHS will recode those deaths that have not been classified using new codes
- Amended tabulation lists will appear in NCHS reports for 2001 data year

## Guidelines for Morbidity

- Place terrorism codes for morbidity within the framework of ICD-9-CM.
- Unlike the placement of the mortality codes, which are in a new chapter (“U”), the codes for morbidity are within the existing chapter for External Causes of Morbidity.

## Guidelines for Morbidity

- Use the new ICD-9-CM codes
- 	E979.0-E979.9 and E999.0-E999.1 for nonfatal injuries resulting from terrorism.
- For statistical purposes these codes will be tabulated within the category for assault, expanding the current category from E960-E969 to include E979 and E999.
- At this time, NCHS is not recommending a parallel category for self-inflicted injury.

## Terrorism Codes   ICD-9 CM E979, E999

- E979.0 Terrorism involving explosion of marine weapons
- E979.1 Terrorism involving destruction of aircraft
- E979.2 Terrorism involving other explosions and fragments
- E979.3 Terrorism involving fires, conflagration, and hot substances
- E979.4 Terrorism involving firearms
- E979.5 Terrorism involving nuclear weapons
- E979.6 Terrorism involving biological weapons
- E979.7 Terrorism involving chemical weapons
- E979.8 Terrorism involving other means
- E979.9 Terrorism, secondary effects
- E999 Late effect of injury due to war operations and terrorism
- E999.0 Late effect of injury due to war operations
- E999.1 Late effect of injury due to terrorism

## Implementation-Morbidity

- Through its Data Policy and Standards Staff
- Notice to be published in the *Federal Register* to announce the availability of the new codes to the health care community.
- Codes become effective Oct.1, 2002
- Dissemination to the American Hospital Association, the American Health Information Management Association, State health information professional organizations, book publishers, and data system vendors.

## Complete documentation can be found:

**NCHS web site**
**Disease Classification**
**http://www.cdc.gov/nchs/about/otheract/icd9/terrorism_code.htm**