TABLE OF CONTENTS

 Page 

SECTION I 

A. Introduction ....................................................................................... 1
 

 B. Medical Certification ......................................................................... 7

 C. Definitions ......................................................................................... 10 

D. Created Codes .................................................................................... 13 

SECTION II Procedures for Selection of the Underlying Cause of Death for 

 Mortality Tabulation ........................................................... 23 

Rules for selection of the originating antecedent cause .................... 24 

 General Principle ................................................................................. 26 

Rule 1. Reported sequence terminating in the condition 

 first entered on the certificate ........................................... 27 

Rule 2. No reported sequence terminating in the 

 condition first entered on the certificate ........................... 28 

Rule 3. Direct sequel ........................................................................... 29 

 Assumed direct consequences of another condition ....................... 30 

 Interpretations and examples .............................................................. 33 

 Complications of surgery ................................................................ 34 

 Modification of the selected cause ....................................................... 35 

 The Modification Rules ....................................................................... 36 

 Rule A. Senility and other ill-defined conditions ........................ 36 

 Rule B. Trivial conditions ............................................................ 38 

 Rule C. Linkage ........................................................................... 39 

 Situation 1. One linkage on the record ...................................... 40 

 Situation 2. Two or more concurrent linkages 

 (conflict in linkage) ............................................ 42

 Situation 3. Further linkage ...................................................... 44 

 Rule D. Specificity ....................................................................... 45 

 Conflict in specificity ................................................................ 46 

 Rule E. Early and late stages of disease ...................................... 47 

 Rule F. Sequela ............................................................................ 48 

 B90.- Sequela of tuberculosis ....................................... 48 

B91.- Sequela of acute poliomyelitis ........................... 50 

B92 Sequela of leprosy .............................................. 51 

B94.0 Sequela of trachoma. .......................................... 51 

B94.1 Sequela of viral encephalitis .............................. 52 

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B94.2 Sequela of viral hepatitis. ................................... 53 

B94.8 Sequela of other specified infectious and 

 parasitic diseases ............................................ 53
 
 

B94.9 Sequela of unspecified infectious and 

 parasitic diseases ............................................ 53 

 E640-E649 Sequela of malnutrition and other nutritional 

 deficiencies .................................................... 55 

E68 Sequela of hyperalimentation ............................ 56 

G09 Sequela of inflammatory diseases of central 

 nervous system .............................................. 56 

I690-I698 Sequela of cerebrovascular disease ................... 57 

O97 Sequela of direct obstetric cause ........................ 58
 

Y85-Y89 Sequela of external causes of morbidity 

 and mortality................................................... 58 

SECTION III Editing and Interpreting Entries in the Medical 

 Certification............................................................................ 60 

A. Guides for the determination of the probability of sequence .............. 60 

B. Diagnostic entities ................................................................................ 65 

C. Adjective reported at the end of a diagnostic entity ............................ 67 

D. Adjectival modifier reported with multiple conditions ....................... 67 

E. Parenthetical entries ............................................................................. 68 

F. Plural form of disease .......................................................................... 69 

G. Implied disease ..................................................................................... 69 

H. Non-traumatic conditions ..................................................................... 70 

I Relating and modifying ....................................................................... 70 

J. Coding conditions classified to injuries as disease conditions ............ 75 

K. Intent of certifier .................................................................................. 78 

1.	 Other and unspecified gastroenteritis and colitis of
 

 unspecified origin (A099) ........................................................... 78 

2. Spinal Abscess (A180) ................................................................ 79 

3.	 Charcot’s Arthropathy (A521) .................................................... 80 

4.	 General Paresis (A521) ............................................................... 81 

5.	 Viral Hepatitis (B161, B169, B171-B179) ................................. 82 

6.	 Organisms and Infections NOS (B99) ....................................... 83 

7.	 Eaton-Lambert Syndrome (C80) ................................................ 89 

8.	 Erythremia (C940) ...................................................................... 90 

9.	 Polycythemia (D45) .................................................................... 90 

10.	 Hemolytic Anemia (D589) ......................................................... 90 

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11. Sideroblastic Anemia (D643) .................................................... 91 

12. Hemorrhagic Purpura NOS (D693) ........................................... 91 

13. Thrombocytopenia (D696) ........................................................ 92 

14. Hyperparathyroidism (E213) ..................................................... 92 

15. Korsakov’s Disease, Psychosis, or Syndrome (F106) ............... 92 

16. Psychosis (any F29) ................................................................... 93 

17. Mental Disorder (any F99) ........................................................ 93 

18. Parkinson’s Disease (G20) ........................................................ 93 

19. Cerebral Sclerosis (G379) ......................................................... 94 

20. Myopathy (G729) ...................................................................... 95 

21. Paralysis (any G81, G82, or G83 excluding senile paralysis) ... 96 

22. Varices NOS and Bleeding Varices NOS (I839) ...................... 96 

23. Pneumoconiosis (J64) ................................................................ 97 

24. Alveolar Hemorrhage (diffused) (K088) ................................... 97 

25. Diaphragmatic Hernia in K44.- ................................................. 97 

26. Laennec’s Cirrhosis NOS (K703) ............................................. 98 

27. Biliary Cirrhosis NOS (K745) ................................................... 98 

28. Lupus Erythematosus (L930), Lupus (L930) ........................... 99 

29.

30.

31.	 	 

32.	 	 

33.	 	 

Gout (M109) ............................................................................. 99 

Kyphosis (M402) ....................................................................... 100 

Scoliosis (M419) ........................................................................ 100 

Osteonecrosis (M879) ................................................................ 100 

Cesarean Delivery for Inertia Uterus (O622), Hypotonic
 
 

Labor (O622), Hypotonic Uterus Dysfunction (O622), 

Inadequate Uterus (O622), Uterine Inertia during 

34.	 	 

35.	 	 I

 a

36.	 	 

37.	 	 

38.	 	 

39.	 	 

L. 

M

N.

O.

P. 

Q. 

R. 

Effect 

Labor (O622) ............................................................................. 101 

Brain Damage, Newborn (P112) ............................................... 101 

ntracranial Nontraumatic Hemorrhage of Fetus 

nd Newborn (P52) .................................................................... 102 

Hypoplasia or Dysplasia of Lung NOS (Q336) ........................ 102 

Fracture (any site) (T142) .......................................................... 103 

Starvation NOS (T730) .............................................................. 104 

Compartment Syndrome (T796) ............................................... 104 

of duration on classification ..................................................... 105 

. Effect of “age of decedent” on classification ....................................... 111 

 Sex and Age Limitations ...................................................................... 113 

 Interpretation of expressions indicating doubtful diagnoses ............... 113 

Interpretation of nonmedical connecting terms used in reporting ....... 116 

Deletion of “due to” on the death certificate ....................................... 117 

Numbering of causes reported in Part I ............................................... 119
 
 

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 Instruction Manual Part 2a 

Table of Contents (continued) 

S. 

T. Querying cause of death.....................

Terms that stop the sequence ............................................................... 120 

.................................................. 121 

SECTION IV Classification of Certain ICD Categories............................... 123
 
 

A.	 	 

B.	 	 

Infreq

Codin

A00-B99 

A15.-

 

A16.0 

 

A16.1 

 

A16.2-.9 

 

A17.-

A18.-

A22.-

A35 

A39.2 

A39.3 

A39.4 

A40.-

A41.-

A46 

A49.-

A80.9 

B16 

B17 

B20-B24 

B22.7 

 

B34 

B95-B97 

C00-D48

A

B

C

D. In

.

.

. 

uent and Rare Causes of Death in the United States ................. 123 

g Specific Categories .................................................................. 123 

Certain infectious and parasitic diseases ...................... 123 

Respiratory tuberculosis, bacteriologically or 

 histologically confirmed ........................................... 124 

Tuberculosis of lung, bacteriologically and 

 histologically negative .............................................. 124 

Tuberculosis of lung, bacteriological or histological 

 examination not done ................................................ 124 

Respiratory tuberculosis, not confirmed 

 bacteriologically or histologically ............................ 124 

Tuberculosis of nervous system ................................... 124 

Tuberculosis of other organs ........................................ 124 

Anthrax ......................................................................... 124 

Other tetanus ................................................................. 125 

Acute meningococcemia ............................................... 125 

Chronic meningococcemia ........................................... 125 

Meningococcemia, unspecified .................................... 125 

Streptococcal septicemia .............................................. 125 

Other septicemia ........................................................... 125 

Erysipelas ...................................................................... 125 

Bacterial infection of unspecified site .......................... 126 

Acute poliomyelitis, unspecified .................................. 126 

Acute hepatitis B ........................................................... 126 

Other acute viral hepatitis ............................................. 126 

Human immunodeficiency virus [HIV] disease ........... 126 

HIV disease with multiple diseases 

 classified elsewhere ................................................. 127 

Viral infection of unspecified site ................................ 127 

Bacterial, viral and other infectious agents .................. 127 

 Neoplasms ..................................................................... 127 

 Malignant neoplasms .................................................... 129 

 Neoplasms stated to be secondary ................................ 133 

 Malignant neoplasms with primary site indicated........ 133 

 dependent (primary) multiple sites (C97) ................. 134 

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 Instruction Manual Part 2a 

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 E. Multiple Sites ................................................................ 135 

 F. Implication of malignancy ............................................ 139 

 G. Metastatic neoplasm ..................................................... 140 

 H. Primary site unknown ................................................... 152 

 I. Sites with prefixes or imprecise definitions ................. 153 

 J. Doubtful diagnosis ........................................................ 153 

 K. Malignant neoplasms of unspecified site with other 

 reported conditions .................................................. 154 

 L. Mass or lesion with malignant neoplasms.................... 154 

E10-E14 Diabetes mellitus .......................................................... 155 

 E40-E46, E639-E640, E64.9 ................................................................ 157 

E86 Volume depletion .......................................................... 157 

 E89.­ Postprocedural endocrine and metabolic 

 disorders, not elsewhere classified .......................... 157 

 F03-F09 Organic, including symptomatic, mental disorders ...... 157
 

 F10-F19 Mental and behavioral disorders due to 

 psychoactive substance use ..................................... 157 

 F10.­ Mental and behavioral disorders due to use of 

 alcohol....................................................................... 157 

 F10.2 Dependence syndrome due to use of alcohol ............... 158 

 F17.­ Mental and behavioral disorders due to use of 

 tobacco..................................................................... 158 

 F11.9, F12.9 Mental and behavioral disorders due to 

 F13.9, F14.9 use of drugs.............................................................. 158 

 F15.9, F16.9
 

 F18.9, F19.9

 F70-F79 Mental retardation ......................................................... 159 

G25.5 Other chorea .................................................................. 159 

 G40-G41 Epilepsy ........................................................................ 159 

 G81.- Hemiplegia .................................................................... 159 

G82.- Paraplegia and tetraplegia ............................................. 159 

 G83.- Other paralytic syndromes............................................ 159 

 G97.­ Postprocedural disorders of nervous system, 

 not elsewhere classified ........................................... 159 

 H54.­ Visual impairment including blindness 

 (binocular or monocular) ......................................... 160 

 H59.­ Postprocedural disorders of eye and adnexa, 

 not elsewhere classified ............................................ 160 

 H90.- Conductive and sensorineural hearing loss .................. 160 

 H91.- Other hearing loss ......................................................... 160
 

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H95.­

I00-I09 

I01.­

I34.0-I38 

I05.8 

I05.9 

I08 

I09.1 

I09.9 

I10 

I11.­

I12.­

I13.­

I15.1 

I15.2 

I15.8 

I20.­

I24.­

I25.­

I21.­

I23.­

I24.0 

I25.2 

I27.9 

I44.­

I45.­

I46.­

I47.­

I48 

I49.­

I50.­

I51.4-I51.9 

I50.­

I51.9 

I50.9 

Postprocedural disorders of ear and mastoid process, 

 not elsewhere classified ............................................ 160 

Acute and chronic rheumatic heart diseases ................. 160 

Rheumatic fever with heart involvement ..................... 162 

Valvular diseases not indicated to be rheumatic .......... 164 

Other mitral valve diseases........................................... 166 

Mitral valve disease, unspecified .................................. 166 

Multiple valve diseases ................................................. 166 

Rheumatic diseases of endocardium, 

 valve unspecified ...................................................... 166 

Rheumatic heart disease, unspecified ........................... 166 

Essential (primary) hypertension .................................. 167 

Hypertensive heart disease ........................................... 167 

Hypertensive renal disease ........................................... 168 

Hypertensive heart and renal disease ............................ 168 

Hypertension secondary to other renal disorders ......... 168 

Hypertension secondary to endocrine disorders........... 168 

Other secondary hypertension ...................................... 168 

Angina pectoris ............................................................. 168 

Other acute ischemic heart diseases ............................. 168 

Chronic ischemic heart disease ..................................... 168 

Acute myocardial infarction ......................................... 169 

Certain current complications following acute 

 myocardial infarction ................................................ 169 

Coronary thrombosis not resulting in 

 myocardial infarction ................................................ 169 

Old myocardial infarction ............................................. 169 

Pulmonary heart disease, unspecified........................... 169 

Atrioventricular and left bundle-branch block ............. 169 

Other conduction disorders ........................................... 169 

Cardiac arrest ................................................................ 169 

Paroxysmal tachycardia ................................................ 169
 

Atrial fibrillation and flutter ......................................... 169 

Other cardiac arrhythmias............................................. 169 

Heart failure .................................................................. 169 

Complications and ill-defined descriptions of 

 heart disease .............................................................. 169 

Heart failure .................................................................. 170 

Heart disease, unspecified ............................................ 170 

Heart failure, unspecified.............................................. 170 

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I51.9 

I60-I69 

I65.­

I66.­

I67.2 

I70.­

I70.9 

I97.­

J00 

J06.­

J18.­

J20.­

J40 

J41.­

J42 

J43.­

J44.8-J44.9 

J45.­

J46 

J60-J64 

J81 

J95.­

K72 

K73 

K74.0 

K74.1 

K74.2 

K74.6 

K75.9 

K76.0 

K76.9 

K91.­

M41.­

Heart disease, unspecified ............................................ 170 

Cerebrovascular diseases.............................................. 170 

Occlusion and stenosis of precerebral arteries, 

 not resulting in cerebral infarction ........................... 170 

Occlusion and stenosis of cerebral arteries, 

 not resulting in cerebral infarction............................ 170 

Cerebral atherosclerosis ................................................ 170 

Atherosclerosis ............................................................. 171 

Generalized and unspecified atherosclerosis ................ 171 

Postprocedural disorders of circulatory system, 

 not elsewhere classified ........................................... 172 

Acute nasopharyngitis [common cold] ......................... 172 

Acute upper respiratory infections of multiple 

and unspecified sites ................................................ 172 

Pneumonia, organism unspecified ................................ 172 

Acute bronchitis ............................................................ 172 

Bronchitis, not specified as acute or chronic ................ 172 

Simple and mucopurulent chronic bronchitis ............... 172 

Unspecified chronic bronchitis ..................................... 172 

Emphysema ................................................................... 173 

Other and unspecified chronic obstructive 

 pulmonary disease ................................................... 173 

Asthma .......................................................................... 173 

Status asthmaticus ......................................................... 173 

Pneumoconiosis ............................................................ 173 

Pulmonary edema ......................................................... 173 

Postprocedural respiratory disorders, 

 not elsewhere classified ............................................ 174 

Hepatic failure, not elsewhere classified ...................... 174 

Chronic hepatitis, not elsewhere classified .................. 174 

Hepatic fibrosis ............................................................. 174 

Hepatic sclerosis ........................................................... 174 

Hepatic fibrosis with hepatic sclerosis ......................... 174 

Other and unspecified cirrhosis of liver ....................... 174 

Inflammatory liver disease, unspecified ....................... 175 

Fatty (change) of liver, not elsewhere classified .......... 175 

Liver disease, unspecified ............................................. 175 

Postprocedural disorders of digestive system, 

 not elsewhere classified ........................................... 176 

Scoliosis ........................................................................ 176 

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 M96.-

 

N00.-

N18.-

N19 

N26 

N46 

N97.-

N99.-

 

O00-O99

O08.-

 

O30.-

O32.-

 

O33.9 

O64.-

 

O80.0-O80.9 Sing

O81-O84

P07.­

 

P08.­

 

P70.3-P72.0

P72.2-P74.9 

P95 

R69.-

S00-T98 

 

V01-Y89 

 

 

 

Postprocedural musculoskeletal disorders, 

 not elsewhere classified ........................................... 176 

 Acute nephritic syndrome............................................. 176
 

 Chronic renal failure ..................................................... 176 

 Unspecified renal failure............................................... 176 

 Unspecified contracted kidney ..................................... 176 

 Male infertility .............................................................. 176 

 Female infertility .......................................................... 176 

 Postprocedural disorders of genitourinary system, 

 not elsewhere classified ........................................... 176 

 Pregnancy, childbirth and the puerperium .................... 177 

 Complications following abortion and ectopic 

 and molar pregnancy ............................................... 177 

 Multiple gestation ......................................................... 178 

 Maternal care for known or suspected 

 malpresentation of fetus ............................................ 178 

 Fetopelvic disproportion .............................................. 178 

 Obstructed labor due to malposition and 

 malpresentation of fetus ............................................ 178 

 le spontaneous delivery ........................................ 178 

 Method of delivery ....................................................... 178 

 Disorders related to short gestation and low birth 

 weight, not elsewhere classified .............................. 178 

 Disorders related to long gestation and high 

 birth weight .............................................................. 178 

 Transitory endocrine and metabolic disorders specific 

 to fetus and newborn ............................................... 179 

 Fetal death of unspecified cause ................................... 179 

 Unknown and unspecified causes of morbidity ............ 179

 Injury, poisoning, and certain other consequences 

 of external causes..................................................... 179 

 Classification of external causes of morbidity 

 and mortality ............................................................ 179 

 1. Suc

2. Slig

3.	 	 Acc

 o

4. Acci

5. Fou

cessive external causes.................................... 179 

 ht injuries ........................................................ 180 

ident information entered in space 

utside Part I and Part II .................................. 180 

dent due to disease condition ........................ 180 

nd injured on highway .................................... 181 

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 Instruction Manual Part 2a 

Table of Contents (continued) 

6.	 Complication of trauma for purposes of applying 

 Selection Rule 3............................................... 181 

7.	 Selecting external causes as the 

 underlying cause .............................................. 181 

8. Use of the Index and Tabular List ........................ 181 

 V01-V99 Transportation accidents ............................................... 182 

 1. General instructions .............................................. 182 

 2. Use of the Index and tabular list ........................... 183 

 3. 

4.

5. C

6. A

7.	 	 O

Classifying accidents as traffic or nontraffic ........ 185 

 Status of victim ..................................................... 186 

 oding categories V01-V89 ................................. 187 

dditional examples ............................................. 189 

ccupant of special all-terrain or other motor 

vehicle designed primarily for off-road use, 

 injured in transport accident (V86) .................. 191 

8.	 	 Traffic accident of specified type but victim’s 

mode of transport unknown (V87) 

 Non-traffic accident of specified type but victim’s 

mode of transport unknown (V88) .................. 192 

9. Water transport accidents (V90-V94) ................... 193 

10. Air and space transport accidents (V95-V97) ...... 194 

 11. Miscellaneous coding instructions (V01-V99) ..... 194 

 W18 Other fall on same level ................................................ 195 

 W19 Unspecified fall ............................................................. 195 

 W75 Accidental suffocation and strangulation in bed .......... 196 

W78 Inhalation of gastric contents ........................................ 196 

W79 Inhalation and ingestion of food 

 causing obstruction of respiratory tract ................... 196
 
 

 W80 Inhalation and ingestion of other object 

 causing obstruction of respiratory tract ................... 196 

 X30-X39 Exposure to forces of nature ......................................... 196 

 X40-X49 Accidental poisoning by and exposure to 

 noxious substances .................................................... 197 

1. Poisoning by drugs ................................................ 197 

2. Carbon monoxid

Intentional self-harm .

e poisoning ................................. 200 

X60-X84 .................................................... 200 

X85-Y09 Assault .......................................................................... 201 

Y07 Other maltreatment syndromes..................................... 201 

 Y10-Y34 Event of undetermined intent ....................................... 203 

 

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 Instruction Manual Part 2a 

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 Y40-Y59 Drugs, medicaments and biological substances 

 causing adverse effects in therapeutic use ............... 204 

1. 

2. I

Condition due to (named) drug or drug therapy ... 204 

ntoxication by drug .............................................. 206 

3. Combined effects of two or more drugs ............... 206 

Y60-Y83 Adverse effects and misadventures occurring as 

 a result of a surgical procedure ............................... 207 

 Y84 Other medical procedures as the cause of abnormal 

 reaction of the patient, or of later complication, 

 without mention of misadventure at the time 

 of procedure .............................................................. 211 

 Y60-Y69 Misadventures to patients during surgical and 

 medical care............................................................... 211 

Y85-Y89 Sequela of external causes of morbidity 

 and mortality ............................................................. 212 

Appendix A Infrequent and Rare Cause-of-Death Edits for Underlying 

 and Multiple Cause-of-Death Classification ..................... 215 

Appendix B Created Codes and Their Complimentary Valid 

 ICD-10 Codes ....................................................................... 219 

Appendix C Geographic Codes.................................................................... 221 

Appendix D Standard Abbreviations and Symbols................................... 222 

Appendix E Synonymous Sites/Terms ........................................................ 240 

Appendix F Invalid and Substitute Codes.................................................. 241 

Appendix G Codes for Special Purposes (U00-U99).................................. 242 

1. Terrorism classification (*U01-*U03) .............................. 242 

2. Severe acute respiratory syndrome [SARS] (U04) ............ 253 

Appendix H List of Conditions that Causes Diabetes................................ 254 

INDEX................................................................................................................... 255 

 x	 2a January 2011 
 

 

Section I - A. Introduction 

INSTRUCTIONS FOR CLASSIFYING THE UNDERLYING 

CAUSE OF DEATH, 2011 

A. INTRODUCTION 

This manual provides instructions to mortality medical coders and nosologists for coding 

the underlying cause of death from death certificates filed in the states. These mortality 

coding instructions are used by both the State vital statistics programs and the National 

Center for Health Statistics (NCHS), which is the Federal agency responsible for the 

compilation of U.S. statistics on causes of death. NCHS is part of the Centers for Disease 

Control and Prevention. 

In coding causes of death, NCHS adheres to the World Health Organization 

Nomenclature Regulations specified in the most recent revision of the International 

Statistical Classification of Diseases and Related Health Problems (ICD). NCHS also 

uses the ICD international rules for selecting the underlying cause of death for primary 

mortality tabulation in accordance with the international rules. 

Beginning with deaths occurring in 1999, the Tenth Revision of the ICD (ICD-10) is 

being used for coding and classifying causes of death. This revision of the Classification 

is published by the World Health Organization (WHO) and consists of three volumes. 

Volume 1 contains a list of three-character categories, the tabular list of inclusions and 

the four-character subcategories. The supplementary Z code appears in Volume 1 but is 

not used for classifying mortality data. Optional fifth characters are provided for certain 

categories and an optional independent four-character coding system is provided to 

classify histological varieties of neoplasms, prefixed by the letter M (for morphology) 

and followed by a fifth character indicating behavior. These optional codes are not used 

in NCHS. Volume 2 includes the international rules and notes for use in classifying and 

tabulating underlying cause-of-death data. Volume 3 is an alphabetical index containing 

a comprehensive list of terms for use in coding. Copies of these volumes may be 

purchased in hardcopy or on diskettes from the following address: 

WHO Publications Center 

49 Sheridan Avenue 

Albany, New York 12210 

Tel. 518-436-9686 

1 2a January 2011 
 

Section I - A. Introduction 

NCHS has prepared an updated version of Volume 1 and Volume 3 to be used for both 

underlying and multiple cause-of-death coding. The major purpose of the updated 

version is to provide a single published source of code assignments including terms not 

indexed in Volume 3 of ICD-10. NCHS has included all non-indexed terms encountered 

in the coding of deaths during 1979-1994, under the Ninth Revision of the International 

Classification of Diseases (ICD-9). Due to copyright considerations, the updated 

Volumes 1 and 3 may not be reproduced for distribution outside of NCHS and State vital 

statistics agencies. With the availability of the updated Volumes 1 and 3, NCHS will 

discontinue publishing the Part 2e manual, Non-indexed Terms, Standard Abbreviations, 

and State Geographic Codes as Used in Mortality Data Classification that was first 

published in 1983. The list of geographic codes (Appendix C), the list of abbreviations 

used in medical terminology (Appendix D), and the synonymous sites list (Appendix E) 

are included in this publication. 

ICD-10 provides for the classification of certain diagnostic statements according to two 

different axes - etiology or underlying disease process and manifestation or complication. 

Thus, there are two codes for those diagnostic statements subject to dual classification. 

The etiology or underlying disease process codes are marked with a dagger (†), and the 

manifestation or complication codes are marked with an asterisk (*) following the codes 

in ICD-10. NCHS does not use the asterisk codes in mortality coding. For example, 

cytomegaloviral pneumonia has a code marked with a dagger (B25.0†) and a different 

code, marked with an asterisk (J17.1*). In this example, only the dagger code (B25.0) 

would be used. 

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Section I - A. Introduction 

Major Revisions from Previous Manuals 

1.	 Corrections have been made to clarify instructions, spelling and format throughout the 

manual. These changes are not specifically noted. 

2.	 Section I, D. Created Codes, deleted entire entry for code J841. 

3.	 Section II, Rule 3 Direct Sequel, Assumed direct consequences of another condition, 

added paragraph regarding Pulmonary edema (J81) to instruction. 

4.	 Section II, Rule 3 Direct Sequel, Assumed direct consequences of another condition, 

added paragraph to instruction regarding conditions assumed to be a direct consequence 

of diabetes mellitus. 

5.	 Section II, Rule 3 Direct Sequel, Assumed direct consequences of another condition, 

revised paragraph regarding Dehydration. 

6.	 Section II, Rule 3 Direct Sequel, Assumed direct consequences of another condition, a 

paragraph was added to instruction regarding Primary atelectasis and to instruction 

regarding Fetus and newborn affected by premature rupture of membranes. 

7.	 Section II, Rule 3 Direct Sequel, Assumed direct consequences of another condition, an 

addition/correction was made to the instruction regarding Hemorrhage. 

8.	 Section II, Rule 3 Direct Sequel, Assumed direct consequences of another condition, 

added new instruction regarding Mental Retardation. 

9.	 Section II, Rule A, Senility and other ill-defined conditions, code I461 (Sudden cardiac 

death, so described) was added to list of ill-defined conditions. 

10.	 Section II, Rule B, Trivial conditions, (B), added cross-reference to table H. 

11.	 Section II, Rule C, Linkage, Situation 3 Further linkage, 3rd sentence of explanation, 

linkage was revised from LMC to LDC. 

12.	 Section II, Rule F, Sequela, edited code span and title for O97 in list of sequela categories 

to read O97.- Death from sequela of obstetric cause. 

13.	 Section II, Rule F, Sequela, I690-I698 Sequela of cerebrovascular disease, edited code 

spans to instruction (c) and (d) to include I600-I6400. 

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Section I - A. Introduction 

14.	 Section II, Rule F, Sequela, edited code spans and title for O97 to read O970-O979 

Sequela of obstetric cause. 

15.	 Section III, Editing and Interpreting Entries, A., 2, d., replaced paragraph. 

16.	 Section III, K, Intent of Certifier #3, edited explanation for example. 

17.	 Section III, K, Intent of Certifier #5, Added B179 to span of codes in title. Also added to 

the table B179 under Viral Hepatitis and B189 under Chronic Viral Hepatitis. 

18.	 Section III, K, Intent of Certifier #7, added new Intent of Certifier to #7 (Eaton-Lambert 

Syndrome) and re-numbered remaining entries accordingly. 

19.	 Section III, K, Intent of Certifier #18, added additional titles with code to Parkinson’s 

Disease. Added an additional instruction labeled (a) with new instruction and revised 

code in example. Pre-existing instruction re-labeled (b). 

20.	 Section III, K, Intent of Certifier #19, additional categories I690-I698 were added to 

instruction (b). 

21.	 Section III, K, Intent of Certifier #20, table added to instruction. 

22.	 Section III, K, Intent of Certifier #37, revised instruction (a) and added table. 

23.	 Section III, L, #10 Maternal conditions, revised codes and titles of O96 and O97 

categories. 

24.	 Section IV, H. Primary site unknown, Note added to bottom of page. 

25.	 Section IV, Classification of Categories, added new instruction regarding E10-E14 when 

reported as originating antecedent cause. 

26.	 Section IV, Classification of Categories, replaced information regarding F10-F19. 

27.	 Section IV, Classification of Categories, in lists following I10 and lists following I11, 

revised title of category N18.-, Chronic kidney disease. 

28.	 Section IV, Classification of Categories, I672 Cerebral Atherosclerosis, added two 

additional entries (F03) (G219) reported as original antecedent cause. 

4	 2a January 2011 
 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

Section I - A. Introduction 

29.	 Section IV, Classification of Categories, I709 Generalized atherosclerosis, edited existing 

entry and added new entry. 

30.	 Section IV, Classification of Categories, added category J18.- and related information 

31.	 Section IV, Classification of Categories, added categories J448-J449 and related 

information. 

32.	 Section IV, Classification of Categories, added new categories K72, K73, K740, K741, 

K742 K746, K759, K760, K769 and related information for each. 

33.	 Section IV, Classification of Categories, revised title of N18.-, Chronic kidney disease. 

34.	 Section IV, Classification of Categories, O00-O99 Pregnancy, childbirth and the 

puerperium, added code spans to categories O96 and O97 and revised title of O97. 

35.	 Section IV, Classification of Categories, V01-V99 Transportation Accidents, 1.(e), added 

term “street sweeper” to instruction. 

36.	 Appendix A, added B602 Naegleriasis to rare cause list. 

37.	 Appendix B, deleted codes J8410/J841 from Created Codes list. 

38.	 Appendix D, changed abbreviation ETOH to mean ethyl alcohol. 

39.	 Appendix D, added abbreviation GIB gastrointestinal bleed. 

40.	 Appendix D, added abbreviation HCAP health care associated pneumonia. 

41.	 Appendix D, added abbreviation IRDM insulin resistant diabetes mellitus. 

42.	 Appendix H, added appendix H List of Conditions that Cause Diabetes. 

5	 2a January 2011 
 

Section I - A. Introduction 

Other manuals available from NCHS which contain information related to coding causes of 

death are: 

Part 2b, NCHS Instructions for Classifying Multiple Causes of Death, 2011 

Part 2c, ICD-10 ACME Decision Tables for Classifying Underlying Causes of Death, 

2011. 

Part 2s, SuperMICAR Data Entry Instruction, 2011 

6 2a January 2011 
 

 

Section I - B. Medical Certification 

B. MEDICAL CERTIFICATION 

The U. S. Standard Certificate of Death provides spaces for the certifying physician, 

coroner, or medical examiner to record pertinent information concerning the diseases, 

morbid conditions, and injuries which either resulted in or contributed to death as well as 

the circumstances of the accident or violence which produced any such injuries. The 

medical certification portion of the death certificate is designed to obtain the opinion of 

the certifier as to the relationship and relative significance of the causes which he reports. 

A cause of death is the morbid condition or disease process, abnormality, injury, or 

poisoning leading directly or indirectly to death. The underlying cause of death is the 

disease or injury which initiated the train of morbid events leading directly or indirectly 

to death or the circumstances of the accident or violence which produced the fatal injury. 

A death often results from the combined effect of two or more conditions. These 

conditions may be completely unrelated, arising independently of each other or they may 

be causally related to each other, that is, one cause may lead to another which in turn 

leads to a third cause, etc. 

The order in which the certifier is requested to arrange the causes of death upon the 

certification form facilitates the selection of the underlying cause when two or more 

causes are reported. He is requested to report in Part I on line (a) the immediate cause of 

death and the antecedent conditions on lines (b), (c) and (d) which gave rise to the cause 

reported on line (a), the underlying cause being stated lowest in the sequence of events. 

However, no entry is necessary on I(b), I(c) or I(d) if the immediate cause of death stated 

on I(a) describes completely the sequence of events. 

Any other significant condition which unfavorably influenced the course of the morbid 

process and thus contributed to the fatal outcome but was not related to the immediate 

cause of death is entered in Part II. 

7 2a January 2011 
Section I - B. Medical Certification 

Excerpt from U.S. STANDARD CERTIFICATE OF DEATH (REV 11/2003) 

 8 2a January 2011 
Section I - B. Medical Certification 

U.S. STANDARD CERTIFICATE OF DEATH (REV 11/2003) 

 9 2a January 2011 
 

 

 

 


 

	 

Section I - C. Definitions
 

C. DEFINITIONS

 The terms defined in this section are used throughout the manual. 

A reported sequence-------------- two or more conditions on successive lines in Part I, 

each condition being an acceptable cause of the one on 

the line immediately above it. 

Accident in medical care ------- -- a misadventure or poisoning occurring during surgery 

or other medical care. 

Causation table (Table D)-------- contains address codes and subaddress codes that 

indicate an acceptable causal relationship (reported 

sequence). Table D is in Part 2c Instruction Manual. 

Combination code---------------- a third code which is the result of the merging of two 

or more codes. 

Conflict in linkage---------------- when the selected underlying cause links concurrently 

“with” or in “due to” position with two or more 

conditions. 

Contributory cause--------------- any cause of death that is neither the direct, 

intervening, originating antecedent nor underlying is a 

contributory cause of death. 

Direct cause of death------------- also known as terminal cause of death, is the condition 

entered on line I(a) in Part I. If the certifier has entered 

more than one condition on line I(a), these terms apply 

to the first one. In the selection rules themselves, the 

direct cause is often referred to as the condition first 

entered on the certificate. 

Direct sequel----------------------- a condition which is documented as one of the most 

frequent manifestations, consequences, or 

complications of another condition. 

“Due to” position----------------- when there are entries on more than one line in Part I 

with only one entity on the lowest used line in Part I, 

the single entity on the lowest used line is considered 

to be in a “due to” position of all entries entered above 

it. When there are entries on more than one line in 

Part I, each entity on the lower of two lines is 

considered to be in a “due to” position of each entity 

on the next higher line. 

10	 2a January 2011 
 

 

 

 

 

 

 

Section I - C. Definitions
 
 

Entity------------------------------- 

Error in medical care------------- 

Further linkage-------------------- 

Intervening cause----------------- 

Late maternal death-------------- 

 Maternal death-------------------- 

 Modification table 

 (Table E) -------------------------­

Multiple one-term entity--------- 

 One-term entity------------------- 

a diagnostic term or condition entered on the certificate 

of death that constitutes a codable entry. 

a misadventure or poisoning occurring during surgery 

or other medical care. 

another step in the linkage process which must be 

made to conform with the Classification after one or 

more linkages have been made. 

any causes between the originating antecedent cause 

and the direct cause of death are called intervening 

causes. 

the death of a woman from direct or indirect obstetric 

causes more than 42 days but less than one year after 

termination of pregnancy. 

the death of any woman while pregnant or within 42 

days (less than 43 days) of termination of pregnancy, 

irrespective of the duration and the site of the 

pregnancy, from any cause related to or aggravated by 

the pregnancy or its management but not from 

accidental or incidental causes.

contains address codes and subaddress codes that are 

used with Selection Rule 3 and Modification Rules A, 

C, and D. Table E is in Part 2c Instruction Manual. 

a diagnostic entity consisting of two or more words 

together on a line for which the Classification does not 

provide a single code for the entire entity but does 

provide a single code for each of the components of 

the diagnostic entity. 

a diagnostic entity that is classifiable to a single 

ICD-10 code. It can be one word or more than one 

word. 

11 2a January 2011 
 

 

 

 

Section I - C. Definitions
 
 

Originating antecedent 

cause ------------------------------- 

 Preference code------------------- 

 Perinatal period------------------- 

Properly positioned-------------- 

 Selected underlying 

 cause of death--------------------- 

 Sequence--------------------------- 

Trivial condition------------------ 

 TUC--------------------------------- 

 Underlying cause of 

 death-------------------------------- 

this term designates the condition entered on the 

lowest used line in Part I, or, if the certificate has not 

been filled out correctly, the condition that the certifier 

should have reported there. The originating antecedent 

cause is, from a medical point of view, the starting 

point of the train of events that eventually caused the 

death. 

a code which has priority over other code(s) which 

may also qualify as a combination code. 

the period which commences at 22 completed weeks 

(154 days) of gestation (the time when birth weight is 

normally 500 g), and ends seven (7) completed days 

after birth. 

 condition(s) placed in an appropriate order to form a 

 sequence of events.

a condition which is chosen either temporarily or 

finally by the application of an international selection 

rule.

two or more conditions entered on successive lines of 

Part I, each condition being an acceptable cause of the 

one entered on the line above it. 

a condition which will not of itself cause death. The 

trivial conditions are listed in Part 2c Instruction 

Manual in Table H. 

NCHS abbreviation for tentative underlying cause. 

This is the same as the originating antecedent cause. 

the disease or injury which initiated the train of morbid 

events leading directly to death or the circumstances of 

the accident or violence which produced the fatal 

injury. 

12 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

	 

Section I - D. Created Codes
 

D. CREATED CODES 

To facilitate automated data processing, the following ICD-10 codes have been amended 

for use in coding and processing the multiple cause data. Special five-character 

subcategories are for use in coding and processing the multiple cause data; however, they 

will not appear in official tabulations. When a created code is selected as the underlying 

cause it must be converted to its official ICD-10 code using Appendix B. 

A169 Respiratory tuberculosis, unspecified 

Excludes: Any term indexed to A169 not qualified as respiratory 

 or pulmonary (A1690) 

*A1690 Tuberculosis NOS 

Includes: Any term indexed to A169 not qualified as 

respiratory or pulmonary 

E039 Hypothyroidism, unspecified 

Excludes: Any term indexed to E039 qualified as advanced, grave, severe, or 

with a similar qualifier (E0390) 

*E0390 Advanced hypothyroidism 

Grave hypothyroidism

 Severe hypothyroidism 

Includes: Any term indexed to E039 qualified as advanced, grave, 

 severe, or with a similar qualifier 

G122 Motor neuron disease 

Excludes: Any term indexed to G122 qualified as advanced, grave, severe, or 

with a similar qualifier (G1220) 

*G1220 Advanced motor neuron disease 

Grave motor neuron disease 

Severe motor neuron disease 

Includes: Any term indexed to G122 qualified as advanced, grave, 

severe, or with a similar qualifier

 G20 Parkinson’s disease 

Excludes: Any term indexed to G20 qualified as advanced, grave, severe, or 

with a similar qualifier (G2000) 

*G2000 Advanced Parkinson’s disease 

Grave Parkinson’s disease 

 Severe Parkinson’s disease 

Includes: Any term indexed to G20 qualified as advanced, 

grave, severe, or with a similar qualifier 

13	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

	 

Section I - D. Created Codes
 

I219 Acute myocardial infarction, unspecified 

 Excludes: Embolism of any site classified to I219 

*I2190 Embolism cardiac, heart, myocardium or a synonymous site 

Includes: Embolism of any site classified to I219 

I420 Dilated cardiomyopathy 

Excludes: Any term indexed to I420 qualified as familial, idiopathic, 

 or primary (I4200) 

*I4200 Familial dilated cardiomyopathy 

Idiopathic dilated cardiomyopathy 

Primary dilated cardiomyopathy 

Includes: Any term indexed to I420 qualified as familial, 

 idiopathic, or primary 

I421 Obstructive hypertrophic cardiomyopathy 

Excludes: Any term indexed to I421 qualified as familial, idiopathic, 

 or primary (I4210) 

*I4210 Familial obstructive hypertrophic cardiomyopathy 

 Idiopathic obstructive hypertrophic cardiomyopathy 

Primary obstructive hypertrophic cardiomyopathy 

Includes: Any term indexed to I421 qualified as familial, 

 idiopathic, or primary 

I422 Other hypertrophic cardiomyopathy 

Excludes: Any term indexed to I422 qualified as familial, idiopathic, 

 or primary (I4220) 

*I4220 Familial other hypertrophic cardiomyopathy 

Idiopathic other hypertrophic cardiomyopathy 

Primary other hypertrophic cardiomyopathy 

Includes: Any term indexed to I422 qualified as familial, 

 idiopathic, or primary 

I425 Other restrictive cardiomyopathy 

Excludes: Any term indexed to I425 qualified as familial, idiopathic, 

 or primary (I4250) 

*I4250 Familial other restrictive cardiomyopathy 

Idiopathic other restrictive cardiomyopathy

 Primary other restrictive cardiomyopathy 

Includes: Any term indexed to I425 qualified as familial, 

 idiopathic, or primary 

14	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

	 

Section I - D. Created Codes
 

I428 Other cardiomyopathies 

Excludes: Any term indexed to I428 qualified as familial, idiopathic, 

 or primary (I4280) 

*I4280 Familial other cardiomyopathies

 Idiopathic other cardiomyopathies 

 Primary other cardiomyopathies 

Includes: Any term indexed to I428 qualified as familial, 

 idiopathic, or primary 

I429 Cardiomyopathy, unspecified 

Excludes: Any term indexed to I429 qualified as familial, idiopathic, 

 or primary (I4290) 

*I4290 Familial cardiomyopathy 

Idiopathic cardiomyopathy 

 Primary cardiomyopathy 

Includes: Any term indexed to I429 qualified as familial, 

 idiopathic, or primary 

I500 Congestive heart failure 

Excludes: Any term indexed to I500 qualified as advanced, grave, severe, or 

with a similar qualifier (I5000) 

*I5000 Advanced congestive heart failure 

Grave congestive heart failure 

 Severe congestive heart failure 

Includes: Any term indexed to I500 qualified as advanced, grave, 

severe, or with a similar qualifier

 I514 Myocarditis, unspecified 

Excludes: Any item indexed to I514 qualified as 

arteriosclerotic (I5140) 

*I5140 Arteriosclerotic myocarditis

 Includes: Any term indexed to I514 qualified as 

arteriosclerotic 

I515 Myocardial degeneration 

Excludes: Any term indexed to I515 qualified as 

arteriosclerotic (I5150)

 *I5150 Arteriosclerotic myocardial degeneration 

Includes: Any term indexed to I515 qualified as 

arteriosclerotic 

I600 Subarachnoid hemorrhage from carotid siphon and bifurcation 

Excludes: Ruptured carotid aneurysm (into brain) (I6000) 

*I6000 Ruptured carotid aneurysm (into brain) 

15	 2a January 2011 

 

 

 

 

 	 

 	 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 	 

Section I - D. Created Codes
 

I606 Subarachnoid hemorrhage from other intracranial arteries 

Excludes: Ruptured aneurysm (congenital) circle of Willis (I6060) 

*I6060 Ruptured aneurysm (congenital) circle of Willis 

I607 Subarachnoid hemorrhage from intracranial artery, unspecified 

Excludes: Ruptured berry aneurysm (congenital) brain (I6070) 

 Ruptured miliary aneurysm (I6070) 

*I6070 Ruptured berry aneurysm (congenital) brain 

 Ruptured miliary aneurysm 

I608 Other subarachnoid hemorrhage 

Excludes:	 Ruptured aneurysm brain meninges (I6080) 

 Ruptured arteriovenous aneurysm (congenital) brain (I6080) 

 Ruptured (congenital) arteriovenous aneurysm cavernous sinus I6080) 

*I6080 Ruptured aneurysm brain meninges 

 Ruptured arteriovenous aneurysm (congenital) brain 

 Ruptured (congenital) arteriovenous aneurysm cavernous sinus 

I609 Subarachnoid hemorrhage, unspecified 

Excludes:	 Ruptured arteriosclerotic cerebral aneurysm (I6090) 

 Ruptured (congenital) cerebral aneurysm NOS (I6090) 

 Ruptured mycotic brain aneurysm (I6090) 

*I6090 Ruptured arteriosclerotic cerebral aneurysm 

 Ruptured (congenital) cerebral aneurysm NOS 

 Ruptured mycotic brain aneurysm 
 

I610 Intracerebral hemorrhage in hemisphere, subcortical 

Excludes: Any term indexed to I610 qualified as bilateral, multiple, or similar 

term1

 (I6100) 

*I6100 Bilateral, multiple [or similar term1

] intracerebral hemorrhages in 

hemisphere, subcortical 

Includes: Any term indexed to I610 qualified as bilateral, multiple, 

or similar term1

 I611 Intracerebral hemorrhage in hemisphere, cortical 

 Excludes: Any term indexed to I611 qualified as bilateral, multiple, 

or similar term1

 (I6110) 

*I6110 Bilateral, multiple [or similar term1

] intracerebral hemorrhages in 

hemisphere, cortical 

Includes: Any term indexed to I611 qualified as bilateral, 

multiple, or similar term1 

1

 Similar terms include modifiers such as many, numerous, recurrent, repeated, serial, series, or several. 

16 2a January 2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I - D. Created Codes
 

I612 Intracerebral hemorrhage in hemisphere, unspecified 

 Excludes: Any term indexed to I612 qualified as bilateral, 

multiple, or similar term1 (I6120)1

 *I6120 Bilateral, multiple [or similar term1] intracerebral hemorrhages, 

unspecified 

Includes: Any term indexed to I612 qualified as bilateral, 

multiple, or similar term1

 I613 Intracerebral hemorrhage in brain stem 

 Excludes: Any term indexed to I613 qualified as bilateral, 

multiple, or similar term1 (I6130) 

*I6130 Bilateral, multiple [or similar term1] intracerebral hemorrhages in 

brain stem 

Includes: Any term indexed to I613 qualified as bilateral, 

 multiple, or similar term1

 I614 Intracerebral hemorrhage in cerebellum 

 Excludes: Any term indexed to I614 qualified as bilateral, 

multiple, or similar term1 (I6140) 

*I6140 Bilateral, multiple [or similar term1

] intracerebral hemorrhages 

 in cerebellum 

Includes: Any term indexed to I614 qualified as bilateral, 

 multiple, or similar term1

 I615 Intracerebral hemorrhage, intraventricular 

 Excludes: Any term indexed to I615 qualified as bilateral, 

multiple, or similar term1

 (I6150) 

*I6150 Bilateral, multiple [or similar term1

] intracerebral hemorrhages, 

intraventricular 

Includes: Any term indexed to I615 qualified as bilateral, 

 multiple, or similar term1 

I618 Other intracerebral hemorrhage 

 Excludes: Any term indexed to I618 qualified as bilateral, 

multiple, or similar term1

 (I6180) 

*I6180 Bilateral, multiple [or similar term1

] other intracerebral hemorrhages 

Includes: Any term indexed to I618 qualified as bilateral, 

 multiple, or similar term1 

1 Similar terms include modifiers such as many, numerous, recurrent, repeated, serial, series, or several. 

17 2a January 2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I - D. Created Codes
 

I619 Intracerebral hemorrhage, unspecified 

 Excludes: Any term indexed to I619 qualified as bilateral, 

multiple, or similar term1 (I6190) 

*I6190 Bilateral, multiple [or similar term1

] intracerebral hemorrhages, 

unspecified 

Includes: Any term indexed to I619 qualified bilateral,

 multiple, or similar term 1 

I630 Cerebral infarction due to thrombosis of precerebral arteries 

 Excludes: Any term indexed to I630 qualified as bilateral, 

multiple, or similar term1 (I6300) 

*I6300 Cerebral infarction due to bilateral, multiple [or similar term1]

 thrombi of precerebral arteries 

Includes: Any term indexed to I630 qualified as bilateral, 

multiple, or similar term1

 I631 Cerebral infarction due to embolism of precerebral arteries 

 Excludes: Any term indexed to I631 qualified as bilateral, 

multiple, or similar term1 (I6310) 

*I6310 Cerebral infarction due to bilateral, multiple [or similar term1

] 

emboli of precerebral arteries 

Includes: Any term indexed to I631 qualified as bilateral, 

multiple, or similar term1

 I632 Cerebral infarction due to unspecified occlusion or stenosis of precerebral 

arteries

 Excludes: Any term indexed to I632 qualified as bilateral, 

multiple, or similar term1 (I6320) 

*I6320 Cerebral infarction due to bilateral, multiple [or similar term1

] 

 unspecified occlusions or stenosis of precerebral arteries 

Includes: Any term indexed to I632 qualified as bilateral, multiple, 

or similar term1 

I633 Cerebral infarction due to thrombosis of cerebral arteries 

 Excludes: Any term indexed to I633 qualified as bilateral, 

multiple, or similar term1

 (I6330) 

*I6330 Cerebral infarction due to bilateral, multiple [or similar term1]

 thrombi of cerebral arteries

 Includes: Any term indexed to I633 qualified as bilateral, 

multiple, or similar term1 

1 Similar terms include modifiers such as many, numerous, recurrent, repeated, serial, series, or several. 

18 2a January 2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I - D. Created Codes
 

I634 Cerebral infarction due to embolism of cerebral arteries 

 Excludes: Any term indexed to I634 qualified as bilateral, 

multiple, or similar term1 (I6340) 

*I6340 Cerebral infarction due to bilateral, multiple [or similar term1

] 

emboli of cerebral arteries 

Includes: Any term indexed to I634 qualified as bilateral, 

 multiple, or similar term1

 I635 Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries 

 Excludes: Any term indexed to I635 qualified as bilateral, 

multiple, or similar term1 (I6350) 

*I6350 Cerebral infarction due to bilateral, multiple [or similar term1]

 unspecified occlusions or stenosis of cerebral arteries 

Includes: Any term indexed to I635 qualified as bilateral, 

multiple, or similar term1

 I636 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic 

 Excludes: Any term indexed to I636 qualified as bilateral, 

multiple, or similar term1 (I6360) 

*I6360 Cerebral infarction due to bilateral, multiple [or similar term1

] 

cerebral venous thrombi, nonpyogenic 

Includes: Any term indexed to I636 qualified as bilateral, 

multiple, or similar term1

 I638 Other cerebral infarction 

 Excludes: Any term indexed to I638 qualified as bilateral, 

multiple, or similar term1

 (I6380) 

*I6380 Bilateral, multiple [or similar term1

] other cerebral infarctions 

Includes: Any term indexed to I638 qualified bilateral, 

multiple, or similar term1

 I639 Cerebral infarction, unspecified 

 Excludes: Any term indexed to I639 qualified as bilateral, 

multiple, or similar term1

 (I6390) 

*I6390 Bilateral, multiple [or similar term1] cerebral infarctions, unspecified 

Includes: Any term indexed to I639 qualified as bilateral, 

multiple, or similar term1 

1 Similar terms include modifiers such as many, numerous, recurrent, repeated, serial, series, or several 

19 2a January 2011 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I - D. Created Codes
 

I64 Stroke, not specified as hemorrhage or infarction 

 Excludes: Any term indexed to I64 qualified as bilateral, 

multiple, or similar term1 (I6400) 

*I6400 Bilateral, multiple [or similar term1

] strokes, not specified as 

hemorrhage or infarction 

Includes: Any term indexed to I64 qualified as bilateral,

 multiple, or similar term1

 I691 Sequelae of intracerebral hemorrhage 

 Excludes: Any term indexed to I691 qualified as bilateral, 

multiple, or similar term1 (I6910) 

*I6910 Sequela of bilateral, multiple [or similar term1] intracerebral

 hemorrhages 

Includes: Any term indexed to I691 qualified as bilateral, 

 multiple, or similar term1

 I693 Sequelae of cerebral infarction 

 Excludes: Any term indexed to I693 qualified as bilateral, 

multiple, or similar term1 (I6930) 

*I6930 Sequela of bilateral, multiple [or similar term1

] cerebral infarctions 

Includes: Any term indexed to I693 qualified as bilateral, 

multiple, or similar term1

 I694 Sequelae of stroke, not specified as hemorrhage or infarction 

 Excludes: Any term indexed to I694 qualified as bilateral, 

multiple, or similar term1 (I6940) 

*I6940 Sequela of bilateral, multiple [or similar term1] strokes, not specified 

as hemorrhage or infarction 

Includes: Any term indexed to I694 qualified as bilateral, 

multiple, or similar term1

 J101 Influenza with other respiratory manifestations, influenza virus identified 

Excludes: Influenza, flu, grippe (viral), influenza virus identified (without 

specified manifestations) (J1010) 

*J1010 Influenza, flu, grippe (viral), influenza virus identified (without 

specified manifestations)

 J111 Influenza with other respiratory manifestations, virus not identified 

Excludes: Influenza, flu, grippe (viral), influenza virus not identified (without 

specified manifestations) (J1110) 

*J1110 Influenza, flu, grippe (viral), influenza virus not identified (without 

specified manifestations) 

1

 Similar terms include modifiers such as many, numerous, recurrent, repeated, serial, series, or several 

20 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I - D. Created Codes
 
 

J849 Interstitial pulmonary disease, unspecified 

Excludes: Interstitial pneumonia, not elsewhere classified (J8490) 

*J8490 Interstitial pneumonia, not elsewhere classified 

J984 Other disorders of lung 

Excludes: Lung disease (acute) (chronic) NOS (J9840) 

*J9840 Lung disease (acute) (chronic) NOS 

K319 Disease of stomach and duodenum, unspecified 

Excludes: Disease, stomach NOS (K3190) 

 Lesion, stomach NOS (K3190) 

*K3190 Disease, stomach NOS 

 Lesion, stomach NOS 

K550 Acute vascular disorders of intestine 

Excludes: Any term indexed to K550 qualified as 

embolic (K5500) 

*K5500 Acute embolic vascular disorders of intestine 

Includes: Any term indexed to K550 qualified as 

embolic

 K631 Perforation of intestine (nontraumatic) 

Excludes: Intestinal penetration, unspecified part (K6310) 

 Intestinal perforation, unspecified part (K6310) 

 Intestinal rupture, unspecified part (K6310) 

*K6310 Intestinal penetration, unspecified part 

 Intestinal perforation, unspecified part 

 Intestinal rupture, unspecified part

 K720 Acute and subacute hepatic failure 

Excludes: Acute hepatic failure (K7200) 

*K7200 Acute hepatic failure 

K721 Chronic hepatic failure 

Excludes: Chronic hepatic failure (K7210) 

*K7210 Chronic hepatic failure 

K729 Hepatic failure, unspecified 

Excludes: Hepatic failure (K7290) 

*K7290 Hepatic failure 

21	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section I - D. Created Codes
 
 

M199 Arthrosis, unspecified 

Excludes: Any term indexed to M199 qualified as advanced, grave, severe, or 

with a similar qualifier (M1990) 

*M1990 Advanced arthrosis 

 Grave arthrosis

 Severe arthrosis 

Includes: Any term indexed to M199 qualified as advanced, 

grave, severe, or with a similar qualifier

 Q278 Other specified congenital malformations of peripheral vascular system 

Excludes: Congenital aneurysm (peripheral) (Q2780) 

*Q2780 Congenital aneurysm (peripheral) 

Q282 Arteriovenous malformation of cerebral vessels 

Excludes: Congenital arteriovenous cerebral aneurysm (nonruptured) (Q2820) 

*Q2820 Congenital arteriovenous cerebral aneurysm (nonruptured) 

Q283 Other malformations of cerebral vessels 

Excludes: Congenital cerebral aneurysm (nonruptured) (Q2830) 

*Q2830 Congenital cerebral aneurysm (nonruptured) 

R58 Hemorrhage, not elsewhere classified 

Excludes: Hemorrhage of unspecified site (R5800) 

*R5800 Hemorrhage of unspecified site 

R99 Other ill-defined and unspecified causes of mortality 

Excludes: Cause unknown (R97) 

*R97 Cause unknown 

22	 2a January 2011 
 


 

Section II - Procedures for Selection 

SECTION II
 

PROCEDURES FOR SELECTION OF THE UNDERLYING CAUSE 

OF DEATH FOR MORTALITY TABULATION 

The following are the international rules for selecting the underlying cause of death for 

mortality tabulation. Some examples have been omitted and additional examples and 

explanations presented. 

When only one cause of death is reported, this cause is used for tabulation. 

When more than one cause of death is recorded, the first step in selecting the underlying 

cause is to determine the originating antecedent cause by application of the General 

Principle or of Selection Rules 1, 2 and 3. 

In some circumstances, the ICD allows the originating cause to be superseded by one 

more suitable for expressing the underlying cause in tabulation. For example, there are 

some categories for combinations of conditions, or there may be overriding 

epidemiological reasons for giving precedence to other conditions on the certificate. 

The next step, therefore, is to determine whether one or more of the Modification Rules 

A to F, which deal with the above situations, apply. The resultant code number for 

tabulation is that of the underlying cause. 

Where the originating antecedent cause is an injury or other effect of an external cause 

classified to Chapter XIX, the circumstances that gave rise to that condition should be 

selected as the underlying cause for tabulation and coded to V01-Y89. 

23 2a January 2011 
 

 

 

 

 

 

 


 

Section II - Procedures for Selection 

Rules for selection of the originating antecedent cause 

Sequence 

The term “sequence” refers to two or more conditions entered on successive lines of 

Part I, each condition being an acceptable cause of the one entered on the line above it. 

I (a) Bleeding of esophageal varices 

 (b) Portal hypertension

 (c) Liver cirrhosis

 (d) Hepatitis B 

If there is more than one cause of death on a line of the certificate, it is possible to have 

more than one reported sequence. In the following example, four sequences are 

reported: 

I (a) Coma

 (b)Myocardial infarction and cerebrovascular accident 

(c) Atherosclerosis hypertension 

 The sequences are: 

coma due to myocardial infarction due to atherosclerosis
 

coma due to cerebrovascular accident due to atherosclerosis 

coma due to myocardial infarction due to hypertension 

coma due to cerebrovascular accident due to hypertension 

General Principle 

The General Principle states that when more than one condition is entered on the 

certificate, the condition entered alone on the lowest used line of Part I should be 

selected only if it could have given rise to all the conditions entered above it. 

24 2a January 2011 
	 

	 

	 

 

 

 

 

 

 

 

 

 

 

 	 

Section II - Procedures for Selection 

Selection Rules: 

Rule 1. If the General Principle does not apply and there is a reported sequence 

terminating in the condition first entered on the certificate, select the 

originating cause of this sequence. If there is more than one sequence 

terminating in the condition mentioned first, select the originating cause of the 

first-mentioned sequence. 

 Rule 2. If there is no reported sequence terminating in the condition first entered on 

the certificate, select this first-mentioned condition. 

 Rule 3. If the condition selected by the General Principle or by Rule l or Rule 2 is 

obviously a direct consequence of another reported condition, whether in Part I 

or Part II, select this primary condition. 

 Some considerations on selection rules: 

In a properly completed certificate, the originating antecedent cause will have been 

entered alone on the lowest used line of Part I and the conditions, if any, that arose as a 

consequence of this initial cause will have been entered above it, one condition to a line 

in ascending causal order. 

I (a) Uremia 

(b) Hydronephrosis 

(c) Retention of urine 

(d)Hypertrophy of prostate 

I (a) Bronchopneumonia 

 (b) Chronic bronchitis

 II Chronic myocarditis 

In a properly completed certificate the General Principle will apply. However, even if the 

certificate has not been properly completed, the General Principle may still apply 

provided that the condition entered alone on the lowest used line of Part I could have 

given rise to all the conditions above it, even though the conditions entered above it have 

not been entered in the correct causal order. 

I (a) Generalized metastases 5 weeks

 (b)Bronchopneumonia 3 days 

(c) Lung cancer 11 months 

The General Principle does not apply when more than one condition has been entered on 

the lowest used line of Part I, or if the single condition entered could not have given rise 

to all the conditions entered above it. Guidance on the acceptability of different 

sequences is given at the end of the rules, but it should be borne in mind that the medical 

25 2a January 2011 
 

 

 

 

 

 

 	 

Section II - Procedures for Selection 

certifier’s statement reflects an informed opinion about the conditions leading to death 

and about their interrelationships, and should not be disregarded lightly. 

Where the General Principle cannot be applied, clarification of the certificate should be 

sought from the certifier whenever possible, since the selection rules are somewhat 

arbitrary and may not always lead to a satisfactory selection of the underlying cause. 

Where further clarification cannot be obtained, however, the selection rules must be 

applied. Rule l is applicable only if there is a reported sequence, terminating in the 

condition first entered on the certificate. If such a sequence is not found, Rule 2 applies 

and the first-entered condition is selected. 

The condition selected by the above rules may, however, be an obvious consequence of 

another condition that was not reported in a correct causal relationship with it; e.g., in 

Part II or on the same line in Part I. If so, Rule 3 applies and the originating primary 

condition is selected. It applies, however, only when there is no doubt about the causal 

relationship between the two conditions; it is not sufficient that a causal relationship 

between them would have been accepted if the certifier had reported it. 

Examples of the General Principle and Selection Rules 

General Principle 

When more than one condition is entered on the certificate, select the condition entered 

alone on the lowest used line of Part I only if it could have given rise to all the 

conditions entered above it. 

 Interpretations and Examples 

The General Principle is the rule under which the certifier’s report is accepted using the 

following criteria in the order stated: 

A. One condition is entered on the lowest used line and all the conditions entered above 

it must be entered in a “reported sequence” and there must be only one condition per 

line.

 Codes for Record 

I (a) Cerebral hemorrhage 1 mo I619 

(b) Nephritis 6 mos N059 

(c) Cirrhosis of liver 2 yrs K746 

Select cirrhosis of liver. This is a reported sequence. Each condition on the 

successive lines in Part I is an acceptable cause of the one entered on the line 

above it. The sequence is cerebral hemorrhage due to nephritis due to cirrhosis of 

liver. 

26	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 	 

Section II - Procedures for Selection 

B. Or it must be probable that the condition reported alone on the lowest used line 

could have given rise to all the conditions entered above it. 

 Codes for Record

 I (a) Apoplexy with pneumonia 8 days I64 J189 

 (b)

 (c) Diabetes 3 yrs E149 

II Myocarditis I514 

Select diabetes. Diabetes can give rise to both conditions reported on I(a). 

Apoplexy is due to diabetes and pneumonia is due to diabetes. 

 Codes for Record

 I (a) Congestive heart failure 1 yr I500 

(b) Cerebral hemorrhage 2 days I619 

(c) Chronic alcoholism F102 

 II Large bowel obstruction K566 

Select chronic alcoholism. It is not necessary for the conditions on (a) and (b) to 

be causally related since the condition entered alone on (c) can give rise to both 

conditions. Congestive heart failure is due to chronic alcoholism and cerebral 

hemorrhage is due to chronic alcoholism. 

Rule 1. Reported sequence terminating in the condition first entered on the certificate 

If the General Principle does not apply and there is a reported sequence terminating in 

the condition first entered on the certificate, select the originating cause of this 

sequence. If there is more than one sequence terminating in the condition mentioned 

first, select the originating cause of the first-mentioned sequence. 

Interpretations and Examples 

Codes for Record

 I (a) Pulmonary embolism I269 

(b)Arteriosclerotic heart disease I251 

(c) Influenza J1110 

Select arteriosclerotic heart disease (ASHD). The General Principle is not applicable 

because influenza cannot cause ASHD. The reported sequence terminating in the 

condition first entered on the certificate is pulmonary embolism due to arteriosclerotic 

heart disease. 

27	 2a January 2011 
 

 

 

 

	 

 

 

 

 

 

 	 

Section II - Procedures for Selection 

Codes for Record

 I (a) Bronchopneumonia J180 

(b) Cerebral infarction and I639 I119 

 hypertensive heart disease 

Select cerebral infarction. The General Principle is not applicable since there are two 

conditions on the lowest used line in Part I. There are two reported sequences 

terminating in the condition first entered on the certificate; bronchopneumonia due to 

cerebral infarction, and bronchopneumonia due to hypertensive heart disease. The 

originating cause of the first-mentioned sequence is selected. 

 Codes for Record 

I (a) Cerebral hemorrhage & hypostatic I619 J182 

(b) pneumonia

 (c) Prostate hypertrophy, diabetes N40 E149 

Select diabetes. The General Principle is not applicable since there are two conditions 

on the lowest used line. Cerebral hemorrhage is not due to prostate hypertrophy; 

therefore, diabetes is selected by Rule 1. 

Rule 2.	 No reported sequence terminating in the condition first entered on the 

certificate 

If there is no reported sequence terminating in the condition first entered on the 

certificate, select this first-mentioned condition. 

Interpretations and Examples

 Codes for Record

 I (a) Pernicious anemia and gangrene of foot D510 R02 

(b) Atherosclerosis I709 

Select pernicious anemia. Neither the General Principle nor Rule 1 is applicable. 

Pernicious anemia due to atherosclerosis is not an acceptable sequence. There is a 

reported sequence, gangrene of foot due to atherosclerosis, but does not terminate in the 

condition first entered on the certificate. 

28	 2a January 2011 
 

 

 

 

 

 

 

 

 	 

Section II - Procedures for Selection 

Codes for Record

 I (a) Rheumatic and atherosclerotic I099 I251 

heart disease 

Select rheumatic heart disease. There is no reported sequence; both conditions are on 

the same line. 

Codes for Record 

I (a) Coronary occlusion I219 

(b) Cerebrovascular disease I679 

(c) HCVD, chronic bronchitis I119 J42 

Select coronary occlusion. Neither the General Principle nor Rule 1 is applicable. 

Since cerebrovascular disease is an unacceptable cause of coronary occlusion, or any 

other ischemic heart disease, there is no reported sequence terminating in the condition 

first entered on the certificate. 

Rule 3. Direct sequel 

If the condition selected by the General Principle or by Rule l or Rule 2 is obviously a 

direct consequence of another reported condition, whether in Part I or Part II, select 

this primary condition. 

Abbreviations 

The following abbreviations are used to identify different types of direct sequel code 

relationships: 

DS: (Direct sequel) When the tentative underlying cause is considered a direct sequel 

of another condition on the certificate in Part I (must be on same or lower line as 

tentative underlying cause) or Part II, and the code for the other condition is 

preferred over the code for the tentative underlying cause. 

DSC: (Direct sequel combination) When the tentative underlying cause is considered 

a direct sequel of another condition on the certificate in Part I (must be on same 

or lower line as tentative underlying cause) or Part II, and the codes for the 

tentative underlying cause and the other condition combine into a third code. 

29	 2a January 2011 
 

Section II - Procedures for Selection 

Assumed direct consequences of another condition 

Kaposi’s sarcoma, Burkitt’s tumor and any other malignant neoplasm of lymphoid, 

hematopoietic, and related tissue, classifiable to C46.- or C81-C96, should be considered 

to be a direct consequence of HIV disease, where this is reported. No such assumption 

should be made for other types of malignant neoplasm. 

Any infectious disease classifiable to A000-A310, A318-A427, A429-A599, 

A601-A70, A748-B001, B003-B004, B007, B009-B069, B080, B082-B085, 

B09-B199, B250-B279, B330-B349, B370-B49, B580-B64, B99 or J12-J18 should be 

considered to be a direct consequence of reported HIV disease. 

Heart failure (I50.-) and unspecified heart disease (I519) should be considered an obvious 

consequence of other heart conditions. 

Pulmonary edema (J81) should be considered an obvious consequence of heart disease 

(including pulmonary heart disease); of conditions affecting the lung parenchyma, such as 

lung infections, aspiration and inhalation, respiratory distress syndrome, high altitude, and 

circulating toxins; of conditions causing fluid overload, such as renal failure and 

hypoalbuminemia; and of congenital anomalies affecting the pulmonary circulation, such 

as congenital stenosis of pulmonary veins. 

Lobar pneumonia, unspecified (J18.1) should be considered an obvious consequence of 

dependence syndrome due to use of alcohol (F10.2). Pneumonia in J12-J18 should be 

considered an obvious consequence of conditions that impair the immune system. 

Pneumonia in J150-J156, J158-J159, J168, J180 and J182-J189 should be assumed to be an 

obvious consequence of wasting diseases (such as malignant neoplasm and malnutrition) 

and diseases causing paralysis (such as cerebral hemorrhage or thrombosis), as well as 

serious respiratory conditions, communicable diseases, and serious injuries. Pneumonia in 

J150-J156, J158-J159, J168, J180, J182-J189, J690, and J698 should be considered an 

obvious consequence of conditions that affect the process of swallowing. Pneumonia in 

J18.- (except lobar pneumonia) reported with immobility or reduced mobility should be 

coded to J18.2. Other common secondary conditions (such as pulmonary embolism, 

decubitus ulcer, and cystitis) should be considered an obvious consequence of wasting 

diseases (such as malignant neoplasm and malnutrition) and diseases causing paralysis 

(such as cerebral hemorrhage or thrombosis) as well as communicable diseases, and 

serious injuries. However, such secondary conditions should not be considered an obvious 

consequence of respiratory conditions. 

30 2a January 2011 
 

Section II - Procedures for Selection 

Acidosis (E87.2); Other specified metabolic disorders (E88.8); Other mononeuropathies 

(G58.-); Polyneuropathy, unspecified (G62.9); Other disorders of peripheral nervous 

system (G64); amyotrophy, not otherwise specified, in Other primary disorders of muscles 

(G71.8), Disorder of autonomic nervous system, unspecified (G90.9), and Neuralgia and 

neuritis, unspecified (M79.2); Iridocyclitis (H20.9); Cataract, unspecified (H26.9); 

Chorioretinal inflammation, unspecified (H30.9); Retinal vascular occlusions (H34.-); 

Background retinopathy and retinal vascular changes (H35.0); Other proliferative 

retinopathy (H35.2); Retinal haemorrhage (H35.6); Retinal disorder, unspecified (H35.9); 

Peripheral vascular disease, unspecified (I73.9); Atherosclerosis of arteries of extremities 

(I70.2); Necrobiosis lipoidica (L92.1); Ulcer of lower limb (L97); Arthritis, unspecified 

(M13.9); Nephrotic syndrome (N03- N05); Chronic kidney disease (N18.-); Unspecified 

kidney failure (N19); Unspecified contracted kidney (N26); renal disease in Disorder of 

kidney and ureter, unspecified (N28.9); Persistent proteinuria, unspecified (N39.1); 

Gangrene, not elsewhere classified (R02); Coma, unspecified (R40.2); and Other specified 

abnormal findings of blood chemistry (R79.8) for acetonemia, azotemia, and related 

conditions should be considered an obvious consequence of Diabetes mellitus (E10-E14). 

Embolism (any site) or any disease described or qualified as “embolic” may be assumed to 

be a direct consequence of venous thrombosis, phlebitis or thrombophlebitis, valvular heart 

disease, childbirth or any operation. However, there must be a clear route from the place 

where the thrombus formed and the place of the embolism. Thus, venous thrombosis or 

thrombophlebitis may cause pulmonary embolism. Thrombi that form in the left side of 

the heart (for example on mitral or aortic valves), or are due to atrial fibrillations, may 

cause embolism to the arteries of the body circulation. Similarly, thrombi that form around 

the right side heart valves (tricuspid and pulmonary valves) may give rise to embolism in 

the pulmonary arteries. Also, thrombi that form in the left side of the heart could pass to 

the right side if a cardiac septal defect is present. Arterial embolism in the systemic 

circulation should be considered an obvious consequence of artrial fibrillation. 

When pulmonary embolism is reported due to atrial fibrillation, the sequence should be 

accepted. However, pulmonary embolism should not be considered an obvious 

consequence of atrial fibrillation. 

Dementia without a mention of specified cause, should be considered a consequence of 

conditions that typically involve irreversible brain damage. However, when a specified 

cause is given, only a condition that may lead to irreversible brain damage should be 

accepted as cause of the dementia, even if irreversible brain damage is not a typical feature 

of the condition. 

Any disease described as secondary should be assumed to be a direct consequence of the 

most probable primary cause entered on the certificate. 

31 2a January 2011 
 

Section II - Procedures for Selection 

Secondary or unspecified anemia, malnutrition, marasmus or cachexia may be assumed to 

be a consequence of any malignant neoplasm, paralytic disease, or disease which limits the 

ability to care for oneself, including dementia and degenerative diseases of the nervous 

system. 

Any pyelonephritis may be assumed to be a consequence of urinary obstruction from 

conditions such as hyperplasia of prostate or ureteral stenosis. 

Nephritic syndrome may be assumed to be a consequence of any streptococcal infection 

(scarlet fever, streptococcal sore throat, etc). Acute renal failure should be assumed as an 

obvious consequence of a urinary tract infection, provided that there is no indication that 

the renal failure was present before the urinary tract infection. 

Dehydration should be considered an obvious consequence of any intestinal infectious 

disease. 

Primary atelectasis of newborn (P28.0) should be considered an obvious consequence of 

congenital kidney conditions (Q60, Q61.0-Q61.1, Q61.3-Q61.9, Q62.1, Q62.3, Q62.4), 

premature rupture of membranes (P01.1), and oligohydramnios (P01.2). 

Fetus and newborn affected by premature rupture of membranes or oligohydramnios 

(P01.1-P01.2) should be assumed to be a direct consequence of congenital kidney 

conditions (Q60, Q61.0-Q61.1, Q61.3-Q61.9, Q62.1, Q62.3, Q62.4). 

An operation on a given organ should be considered a direct consequence of any surgical 

condition (such as malignant tumor or injury) of the same organ reported anywhere on the 

certificate. 

Hemorrhage should be considered an obvious consequence of anticoagulant poisoning or 

overdose. However, hemorrhage should not be considered an obvious consequence of 

anticoagulant therapy without mention of poisoning or overdose. Gastric hemorrhage 

should be considered an obvious consequence of steroid, aspirin, and non-steroidal antiinflammatory drugs (NSAIDs). 

Mental Retardation should be considered an obvious consequence of perinatal conditions 

in P00-P04 (Fetus and newborn affected by maternal factors and by complications of 

pregnancy, labor and delivery), P05 (Slow fetal growth and fetal malnutrition), P07 

(Disorders related to short gestation and low birth weight, not elsewhere classified), P10 

(Intracranial laceration and hemorrhage due to birth injury), P11.0 (Cerebral edema due to 

birth injury), P11.1 (Other specified brain damage due to birth injury), P11.2 (Unspecified 

brain damage due to birth injury), P11.9 (Birth injury to central nervous system, 

unspecified), P15.9 (Birth injury, unspecified), P20 (Intrauterine hypoxia), P21 (Birth 

asphyxia), P35 (Congenital viral disease), P37 (Other congenital infectious and parasitic 

diseases), P52 (Intracranial nontraumatic hemorrhage of fetus and newborn), P57 

(Kernicterus), P90 (Convulsions of newborn) and P91 (Other disturbances of cerebral 

status of newborn). 

32 2a January 2011 
 

 

 

 

 

 

 


 

Section II - Procedures for Selection 

Interpretations and examples 

Rule 3 is applicable when the condition selected by the General Principle, Rule 1, or Rule 

2 is obviously the result of another condition reported on the same line, on a lower line in 

Part I, or in Part II. It applies only when there is no doubt about the causal relationship 

between the two conditions; it is not sufficient that a causal relationship between them 

would have been accepted if the certifier had reported it. If the selected cause is 

considered a direct sequel of two or more conditions on the record, the priority order for 

re-selection is from left to right, (1) on the same line, (2) on a lower line in Part I, and (3) 

in Part II. Conditions reported above the selected cause are not considered in the 

application of Rule 3. 

For assistance in determining whether a selected condition is a direct sequel of another, 

refer to Part 2c, ICD-10 ACME Decision Tables for Classifying Underlying Causes of 

Death, 2011. The symbol “DS” identifies Direct Sequel, and the symbol “DSC” identifies 

Direct Sequel Combination. 

 Codes for Record 
 

I (a) Bronchopneumonia J180 

(b)Congestive heart failure and I500 I050 

 (c) mitral stenosis 

Select mitral stenosis. Congestive heart failure, selected by Rule 1, is considered a 

 direct sequel of mitral stenosis. 

 Codes for Record

 I (a) Cardiac arrest I469 

(b)Gastric hemorrhage K922 

 (c)

 II Gastric ulcer K259 

Select gastric ulcer, chronic or unspecified with hemorrhage (K254). The hemorrhage 

is considered a direct sequel (DSC) of the gastric ulcer and combines gastric ulcer with 

gastric hemorrhage. 

33 2a January 2011 
 

 

 

Section II - Procedures for Selection 

Complications of surgery 

Certain conditions that are common postoperative complications can be considered as 

direct sequels to an operation unless the surgery is stated to have occurred 28 days or more 

before death. Use Rule 3 for the complications listed below: 

Acute renal failure 

Aspiration 

Atelectasis 

Bacteremia 

Cardiac arrest (any I469) 

Disseminated intravascular coagulopathy (DIC) 

Embolism (any site) 

Gas gangrene 

Hemolysis, hemolytic infection 

Hemorrhage NOS 

Infarction (any site) 

Infection NOS 

Occlusion (any site) 

Phlebitis (any site) 

Phlebothrombosis (any site) 

Pneumonia (J120-J168, J180-J189, J690, J698) 

Pneumothorax 

Pulmonary insufficiency 

Renal failure (acute) NOS 

Septicemia (any A400-A419) 

Shock (R570-R579) 

Thrombophlebitis (any site) 

Thrombosis (any site) 

Consider Peritonitis or Intestinal obstruction (K560-K567) to be a direct sequel of 

abdominal or pelvic surgery unless surgery is stated to have occurred 28 days or more 

before death. 

Consider Hemorrhage of a site or Fistula of site(s) to be a direct sequel of surgery of 

same site or region unless surgery is stated to have occurred 28 days or more before death. 

Consider Adhesions to be a direct sequel of surgery regardless of date of surgery. 

34 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

Section II - Procedures for Selection 

 Codes for Record

 I (a) Mesenteric thrombosis K918 

 (b)

 (c)

 II Colectomy for cancer of sigmoid Y836 C187 

Code to cancer of sigmoid (C187). Thrombosis is a common post-operative 

complication and the surgery is not stated to have occurred 28 days or more before death. 

Codes for Record

 I (a) Coronary thrombosis I219 

 (b)

 (c)

 II Removal of gallbladder K802 

 (gallstones) 2 months ago 

Code to coronary thrombosis (I219). The operation is stated to have occurred more 

than 28 days before death. 

Codes for Record

 I (a) Renal failure N19 
 

(b) 

(c) Adhesions K918 

 II Surgery - for diverticulitis Y839 K579 

 Code to diverticulitis K579, the condition necessitating surgery. 

Modification of the selected cause 

The selected cause of death is not necessarily the most useful and informative condition for 

tabulation. For example, if senility or some generalized disease such as hypertension or 

atherosclerosis has been selected, this is less useful than if a manifestation or result of 

aging or disease had been chosen. It may sometimes be necessary to modify the selection 

to conform with the requirements of the Classification, either for a single code for two or 

more causes jointly reported or for preference for a particular cause when reported with 

certain other conditions. 

The modification rules that follow are intended to improve the usefulness and precision of 

mortality data and should be applied after selection of the originating antecedent cause. 

The interrelated processes of selection and modification have been separated for clarity. 

Some of the modification rules require further application of the selection rules, which will 

not be difficult for experienced coders, but it is important to go through the process of 

selection, modification and, if necessary, re-selection. 

After application of the modification rules (A-F), selection Rule 3 should be reapplied. 

35	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

Section II - Procedures for Selection 

The modification rules

 Rule A. Senility and other ill-defined conditions 

 Rule B. Trivial conditions 

 Rule C. Linkage 

 Rule D. Specificity

 Rule E. Early and late stages of disease 

 Rule F. Sequela 

Rule A. Senility and other ill-defined conditions 

Where the selected cause is ill-defined and a condition classified elsewhere is 

reported on the certificate, reselect the cause of death as if the ill-defined condition 

had not been reported, except to take account of that condition if it modifies the 

coding. 

The following conditions are regarded as ill-defined: 

I461 (Sudden cardiac death, so described) 

I469 (Cardiac arrest, unspecified) 

I959 (Hypotension, unspecified) 

I99 (Other and unspecified disorders of circulatory system) 

J960 (Acute respiratory failure) 

J969 (Respiratory failure, unspecified) 

P285 (Respiratory failure, newborn) 

R00-R94 or R96-R99 (Symptoms, signs and abnormal clinical and laboratory 

findings, not elsewhere classified). Note that R95 (Sudden infant death) is 

not regarded as ill-defined. 

 Abbreviations 

The following abbreviations are used when coding senility and other ill-defined 

conditions: 

IDDC: (Ill-defined “due to” combination) When the tentative underlying cause 

is an ill-defined condition in the due to position to another condition, and 

the codes for the tentative underlying cause and the other condition 

combine into a third code. 

SENMC: (Senility with mention of combination) When the tentative underlying 

cause is senility (R54), and is reported with mention of another condition 

on the certificate, and the codes for the tentative underlying cause and 

the other condition combine into a third code. 

36 2a January 2011 
Section II - Procedures for Selection 

SENDC: (Senility “due to” combination) When the tentative underlying cause is 

senility (R54) and is reported in a due to position to another condition, 

and the codes for the tentative underlying cause and the other condition 

combine into a third code. 

Interpretation and Examples

 Codes for Record

 I (a) Senility and hypostatic pneumonia R54 J182 

 (b) Rheumatoid arthritis M069 

Code to rheumatoid arthritis (M069). Senility, selected by Rule 2, is ignored and 

the General Principle applied.

 Codes for Record

 I (a) Anemia D649 

 (b) Splenomegaly R161 

Code to splenomegalic anemia (D648). Splenomegaly, selected by the General 

Principle, is ignored by Rule A. Anemia, reselected by the General Principle, is 

modified by the ill-defined cause. The Modification Table E entry R161 is 

identified as IDDC “maybe” with anemia D649. The reporting on this certificate 

satisfies the maybe reason defined in Table F, Reasons for Ambivalent 

Relationships in Modification Table, and the modification is made. 

 Codes for Record

 I (a) Myocardial degeneration and I515 J439 

 (b) emphysema

 (c) Senility R54 

Code to myocardial degeneration (I515). Senility, selected by the General 

Principle, is ignored and Rule 2 applied. 

 Codes for Record

 I (a) Cough and hematemesis R05 K920 

 

Code to hematemesis (K920). Cough, selected by Rule 2, is ignored. 

 

Codes for Record

 I (a) Terminal pneumonia J189 

 (b) Spreading gangrene and R02 I639 

 (c) cerebrovascular infarction 

Code to cerebrovascular infarction (I639). Gangrene, selected by Rule 1, is 

ignored and the General Principle is applied. 

 37	 2a January 2011 
Section II - Procedures for Selection 

Rule B. Trivial conditions 

(A) Where the selected cause is a trivial condition unlikely to cause death (see 

Table H) and a more serious condition (any condition except an ill-defined or 

another trivial condition) is reported, reselect the underlying cause as if the 

trivial condition had not been reported. 

 Codes for Record

 I (a) Dental caries K029 

 II Diabetes E149 

Code to diabetes (E149). Dental caries, selected by the General Principle, is 

ignored. 

 

Codes for Record

 I (a) Ingrowing toenail and L600 N179 

 acute renal failure 

 

Code to acute renal failure (N179). Ingrowing toenail, selected by Rule 2, is 

ignored. 

(B) If the death was the result of an adverse reaction to treatment of the trivial 

condition, select the adverse reaction. 

Codes for Record

 I (a) Intraoperative hemorrhage T810 Y600 

 (b) Tonsillectomy 

 (c) Hypertrophy of tonsils J351 

Code to hemorrhage during surgical operation (Y600). Code to the adverse 

reaction to treatment of the hypertrophy of tonsils, selected by General Principle. 

 Codes for Record

 I (a) Acute renal failure N179 

(b) Aspirin taken for Y451 

 (c) Migraines G439 

Code to acute renal failure (N179), the adverse reaction to the drug taken for 

treatment of a trivial condition. The external cause code for the drug is not used 

as the underlying cause since the adverse reaction is not classifiable to 

Chapter XIX. 

 38 2a January 2011 
 

 

 

 

 

 

 

 


 

Section II - Procedures for Selection 

(C) When a trivial condition is reported as causing any other condition, the trivial 

condition is not discarded (i.e. Rule B is not applicable). 

 Codes for Record 
 

I (a) Septicemia A419 

(b)Impetigo L010 

Code to impetigo (L010). The trivial condition selected by the General Principle 

is not discarded since it is reported as the cause of another condition. 

 Codes for Record

 I (a) Respiratory insufficiency R068 

(b)Upper respiratory infection J069 

Code to upper respiratory infection (J069). The trivial condition selected by the 

General Principle is not discarded since it is reported as the cause of another 

condition. 

Rule C. Linkage 

Where the selected cause is linked by a provision in the Classification or in the 

notes for use in underlying cause mortality coding with one or more of the other 

conditions on the certificate, code the combination. 

Where the linkage provision is only for the combination of one condition specified 

as due to another, code the combination only when the correct causal relationship 

is stated or can be inferred from application of the selection rules. 

Where a conflict in linkages occurs, link with the condition that would have been 

selected if the cause initially selected had not been reported. Make any further 

linkage that is applicable. 

Interpretations and Examples 

Linkage is the assignment of a preference or combination code for two or more 

jointly reported causes of death in accordance with a provision in the ICD. The 

provision may be for linking one condition with mention of the other, or for linking 

one condition when reported as “due to” the other. 

Guideline notes and instruction for applying the mandatory international linkages are 

listed in category order, Volume 2, Edition 2010, pages 47-69. They have been 

repeated in this manual along with other preferences and instructions pertinent to 

coding practices in the United States. In addition, the codes for specific linkages are 

contained in Part 2c, Modification Table (Table E). These decision tables present the 

linkages as described below for use in classifying the underlying cause of death. 

39 2a January 2011 
 

 

	 

Section II - Procedures for Selection 

Application of the linkage rule, as with the use of all other international rules for 

determining the underlying cause of death, must be carried out in a sequential stepby-step process to comply with the intention of ICD and to achieve standardization 

of data. This is particularly essential in the linkage rule. It is the most complex step 

in determining the underlying cause of death and is used more than any other 

modification rule. 

The following abbreviations identify the linkages in Part 2c, Modification Table 

(Table E): 

LMP: (Linkage with mention of preference) is used when another condition is 

preferred over the selected underlying cause regardless of the placement of 

either of the two conditions on the record. 

LMC: (Linkage with mention of combination) is used when the selected 

underlying cause and another condition link to become a combination code 

regardless of the placement of either of the two conditions on the record. 

LDP: (Linkage “due to” preference) is used when another condition stated as “due 

to” the selected underlying cause is preferred. 

LDC: (Linkage “due to” combination) is used when the selected underlying cause 

is merged with another condition stated as “due to” the selected underlying 

cause into a combination code. 

Placement of Condition for “due to” Linkages 

Placement of the conditions on the record is of paramount importance in determining 

when “due to” linkages (LDP, LDC) may be made. For this purpose, the following 

criteria are to be applied. If the General Principle is applied, every condition on 

every line above it is considered to have a “due to” relationship with the selected 

underlying cause. If Rule 1 is applied, only the conditions on the next higher line are 

in “due to” relationship with the selected underlying cause. 

Situation 1: One linkage on the record 

This is the most straightforward kind of linkage wherein the selected underlying 

cause links with only one other condition on the record through any one of the four 

types of linkages. 

40	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section II - Procedures for Selection 

 Codes for Record

 I (a) Coronary thrombosis I219 

(b) Old myocardial degeneration I515 

(c) Arteriosclerotic heart disease I251 

II Hypertension, arteriosclerosis I10 I709 

Code to coronary thrombosis (I219). Arteriosclerotic heart disease, selected by 

the General Principle, links (LMP) with coronary thrombosis. 

 Codes for Record

 I (a) Pneumonia and emphysema J189 J439 

(b) 

 (c) Bronchitis J40

 II Cerebral arteriosclerosis I672 

Code to other specified chronic obstructive pulmonary disease (J448). 

Bronchitis, selected by the General Principle, links (LMC) with emphysema into a 

combination code of J448. 

 Codes for Record

 I (a) Bronchopneumonia J180 

(b)Heart disease I519 

(c) Hypertension and arteriosclerosis I10 I709 

 Code to hypertensive heart disease without (congestive) heart failure (I119). 

Hypertension, selected by Rule 1, links (LDC) in “due to” position with heart 

disease into a combination code. 

 Codes for Record

 I (a) Thrombotic mesenteric infarction K550 

(b) Arteriosclerosis I709 

Code to acute vascular disorder of intestine (K550). Arteriosclerosis, selected by 

the General Principle, links (LDP) in “due to” position with mesenteric infarction. 

41 2a January 2011 
Section II - Procedures for Selection 

Situation 2: Two or more concurrent linkages (conflict in linkage) 

When the selected underlying cause links with more than one condition on the 

record, a conflict in linkage exists. When there is a conflict, linkage is with the 

condition that would have been selected if the selected cause had not been reported. 

Therefore, prefer a linkage in Part I over one in Part II. If the conflict is in Part I, 

reapply the selection rules as though the selected cause had not been reported. If the 

reselected cause is one of the linkage conditions, make this linkage. If the reselected 

cause is not one of the linkage conditions, again apply the selection rules as though 

the initially selected and reselected causes had not been reported. Continue this 

process until a reselected cause is one of the conditions to which the initially selected 

underlying cause links. Then link the initially selected underlying cause to that 

condition. 

 Codes for Record

 I (a) Stroke I64

 (b) Hypertension I10

 II CAD I251 

Code to stroke (I64). Hypertension selected by General Principle links (LMP) 

with stroke and also links (LMP) with coronary artery disease. Even though 

hypertension links with two conditions, a linkage in Part I is preferred over one in 

Part II. 

 

I (a) CVA 

 (b) Aortic aneurysm

 (c) Arteriosclerosis

 Codes for Record Linkage Record

 I (a) I64 I64 

 (b) I719 I719 

 (c) I709 

 Code to Aortic aneurysm (I719). 

Arteriosclerosis, selected by the General Principle, links (LDP) in “due to” 

position with aortic aneurysm and also links (LMP) with mention of CVA.
 
 

The linkage record is constructed and the selection rules applied. Aortic 

aneurysm would have been selected by the General Principle and is, therefore, the 

condition that is preferred. 

 42 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section II - Procedures for Selection 

I (a) Cardiac arrest and pneumonia 

 (b) Cerebrovascular accident, ischemic heart disease 

 (c) Arteriosclerosis

 II Hypertension and contracted kidney 

Codes for Record

 I (a) I469 J189 

(b) I64 I259 

(c) I709 

 II I10 N26

 Linkage Record

 I469 J189 

I64 I259 

 I10 N26

 Code to cerebrovascular accident (I64). 

Arteriosclerosis, selected by the General Principle, links (LMP) with 

cerebrovascular accident; (LMP) with ischemic heart disease; and (LMP) with 

hypertension. 

The linkage record is constructed, consisting of all conditions except the selected 

underlying cause and the selection rules are reapplied to the linkage record. 

Cerebrovascular accident would have been selected by Rule 1 and is thus 

identified as the condition to be linked with the initially selected cause. 

I (a) Pneumonia 

(b)Congestive heart failure, chronic myocarditis 

 (c) Hypertension and arteriosclerosis

 Codes for Record Linkage Record

 I (a) J189 J189 

(b)I500 I514 I500 I514 

(c) I10 I709 I709 

 Code to hypertensive heart disease with (congestive) heart failure (I110) 

Hypertension, selected by Rule 1, links (LDC) in “due to” position with 

congestive heart failure and also links (LDC) in “due to” position with the term 

chronic myocarditis. 

Construct the linkage record with all conditions except the selected underlying 

cause of death and apply the selection rules to this record. 

Reselect arteriosclerosis. Since this is not one of the linkage conditions, the 

selection rules are reapplied. Select congestive heart failure (I500). Congestive 

heart failure is identified as the condition to be linked with the initially selected 

underlying cause into the combination code I110. 

43 2a January 2011 
Section II - Procedures for Selection 

Situation 3: Further linkage 

After initial linkage is made, the preferred condition or combination category may 

further link with another condition on the record to create a sequence of linkages. 

 

Codes for Record 

I (a) Pneumonia, hypertension J189 I10 

 (b) Arteriosclerosis & renal sclerosis I709 N26 

(c) Cancer of lung C349 

Code to hypertensive renal disease (I129). Arteriosclerosis, selected by Rule 1, 

links (LMP) with hypertension. Hypertension further links (LMC) with renal 

sclerosis into a combination code of I129. 

 Codes for Record

 I (a) Ventricular aneurysm I253 

 (b) Hypertensive heart disease I119 

 (c) Chronic renal failure N189 

Code to aneurysm of heart (I253). Chronic renal failure, selected by the General 

Principle, links (LMC) with hypertensive heart disease into a combination code of 

I131, hypertensive heart and renal disease with renal failure. This combination 

(I131) further links (LMP) with ventricular aneurysm (I253). 

I (a) Heart and renal failure

 (b) Renal atrophy

 (c) Arteriosclerosis and hypertension 

 Codes for Record Linkage Record

 I (a) I509 N19 I509 N19 

 (b) N26 N26

 (c) I709 I10 I10 

Code to hypertensive heart and renal disease with both (congestive) heart failure 

and renal failure (I132). Arteriosclerosis, selected by Rule 1, links (LMP) with 

hypertension, (LMP) with heart failure, and (LDC) in “due to” position with renal 

atrophy. This is a conflict in linkage; therefore, construct the linkage record 

consisting of all conditions except the selected underlying cause and apply the 

selection rules to this linkage record. 

Since hypertension would have been selected by the General Principle, it is thus 

identified as the condition to be linked. Make this linkage (---I709---LMP I10). 

Conditions classifiable to I10 further link (LMC) with renal atrophy and (LDC) in 

“due to” position with heart failure, and (LMC) with renal failure. This conflict in 

linkage requires that a second linkage record be constructed. 

 44 2a January 2011 
 

 

 

 

Section II - Procedures for Selection 

Linkage Record

 I (a) I509 N19 

 (b) N26

 (c) 

Apply the selection rules to the new linkage record. Renal atrophy would have 

been selected by the General Principle and is identified as the term to be linked 

with hypertension into the combination code of I129. This further links (LDC) 

with heart failure into the combination code of I130 and further links (LMC) with 

the renal failure into the combination code of I132 by continuing to apply the 

“conflict in linkage rule.” 

Rule D. Specificity 

Where the selected cause describes a condition in general terms and a term that 

provides more precise information about the site or nature of this condition is 

reported on the certificate, prefer the more informative term. This rule will often 

apply when the general term becomes an adjective, qualifying the more precise 

term. 

The following abbreviations identify selected levels of specificity: 

SMP: (Specificity with mention of preference) When the tentative underlying 

cause describes a condition in general terms, and a condition which 

provides more precise information about the site or nature of this condition 

is reported anywhere on the certificate, and the code for the more precise 

condition is preferred over the code for the tentative underlying cause. 

SMC: (Specificity with mention of combination) When the tentative underlying 

cause describes a condition in general terms, and a condition which 

provides more precise information about the site or nature of this condition 

is reported anywhere on the certificate, and the codes for the tentative 

underlying cause and the other condition combine into a third code. 

SDC: (Specificity “due to” combination) When the tentative underlying cause is 

reported in the due to position to another condition, and can be regarded as 

an adjective modifying this condition, and the codes for the tentative 

underlying cause and the other conditions combine into a third code. 

45 2a January 2011 
 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

Section II - Procedures for Selection 

 Codes for Record

 I (a) Cerebral thrombosis I633 

 (b) CVA I64 

Code to cerebral thrombosis (I633). Cerebrovascular accident selected by the 

General Principle, is considered a general term and cerebral thrombosis is 

preferred as the more informative term. 

 Codes for Record

 I (a) Meningitis G039 

(b) Tuberculosis A1690 

Code to tuberculous meningitis (A170). The conditions are stated in the correct 

causal relationship. 

 Code for Record

 I (a) Pneumonia J13

 (b) Pneumococcus 

Code to pneumococcal pneumonia (J13). Since an infection is reported due to a 

specific organism, use the organism on (b) to modify the infection on (a). 

Refer to Section III, J, 6 for further instructions regarding organisms and 

infections. 

Conflict in Specificity 

When there are two or more conditions on the certificate to which the specificity rule 

applies, reapply the selection rules as though the general term had not been reported. 

If the reselected condition is not one of the more specified conditions to which 

Rule D applies, again apply the selection rules as though the general term and the 

reselected condition had not been reported. Continue this reselection process until 

the reselected condition is one of the more specified terms that would take preference 

over the general term. After the more specified condition has been identified, any 

applicable linkage (Rule C) may be made. 

 Codes for Record

 I (a) Pulmonary fibrosis J841 

(b) Chronic lung disease and J9840 J439 

(c) emphysema 

Code to emphysema (J439). Chronic lung disease is selected by Rule 1. Both 

emphysema and pulmonary fibrosis are more specified lung diseases. 

Emphysema would have been selected if chronic lung disease had not been 

mentioned and is, therefore, identified as the condition that would take preference. 

46 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section II - Procedures for Selection 

 Codes for Record 

I (a) Urinary tract obstruction N139 

(b) Kidney stones N200 

(c) Renal disease N289 

Code to calculus of kidney (N200). Renal disease (N289) is selected by the 

General Principle. Both urinary tract obstruction and kidney stones are specified 

renal diseases. Kidney stones (N200) would have been selected if renal disease 

had not been reported and is, therefore, the preferred condition. 

Rule E. Early and late stages of disease 

Where the selected cause is an early stage of a disease and a more advanced stage 

of the same disease is reported on the certificate, code to the more advanced stage. 

This rule does not apply to a “chronic” form reported as due to an “acute” form 

unless the classification gives special instructions to that effect.

 Codes for Record

 I (a) Tertiary syphilis A529 

(b)Primary syphilis A510 

 Code to tertiary syphilis (A529), a more advanced stage of syphilis.

 Codes for Record

 I (a) Eclampsia during pregnancy O150 

(b)Pre-eclampsia O149 

 Code to eclampsia in pregnancy (O150), a more advanced stage of pre-eclampsia. 

Codes for Record

 I (a) Chronic myocarditis I514 

(b)Acute myocarditis I409 

Code to acute myocarditis (I409). Acute myocarditis is selected by the General 

Principle. No “special instruction” is given to prefer chronic myocarditis over 

acute myocarditis. 

Codes for Record

 I (a) Chronic nephritis N039 

(b)Acute nephritis N009 

Code to chronic nephritis, unspecified (N039). Chronic nephritis is preferred 

when it is reported as secondary to acute nephritis. The General Principle and 

linkage are applicable. 

47 2a January 2011 
 

 

 

 

 

 

 

	 

Section II - Procedures for Selection 

Rule F. Sequela 

Where the selected cause is an early form of a condition for which the 

Classification provides a separate “Sequela of ...” category, and there is evidence 

that death occurred from residual effects of this condition rather than from those 

of its active phase, code to the appropriate “Sequela of ...” category. 

 “Sequela of ...” categories are as follows: 

B90.- Sequela of tuberculosis 

B91 Sequela of acute poliomyelitis 

B92 Sequela of leprosy 

B94.- Sequela of other and unspecified infectious and parasitic diseases 

E64.- Sequela of malnutrition and other nutritional deficiencies 

E68 Sequela of hyperalimentation 

G09 Sequela of inflammatory diseases of central nervous system 

I69.- Sequela of cerebrovascular disease 

O97.- Death from sequela of obstetric causes 

Y85-Y89 Sequela of external causes 

NOTE: When conditions in categories A000-A310, A318-A427, A429-A599, 

A601-A70, A748-B001, B003-B004, B007, B009-B069, B080, B082-B085, 

B09-B199, B25-B279, B330-B349, B370-B49, B58-B64, B99 are 

mentioned on the record with HIV (B20-B24, R75), do not consider the 

infectious or parasitic condition as a sequela. 

Interpretations and Examples 

These sequela categories are to be used for underlying cause mortality coding to 

indicate that death resulted from late (residual) effects of a given disease or injury 

rather than during the active phase. Rule F applies in such circumstances. 

B90.- Sequela of tuberculosis 

Use these subcategories for the classification of tuberculosis (conditions 

in A162-A199) if: 

(a) A statement of a late effect or sequela of the tuberculosis is reported. 

Codes for Record

 I (a) Calcification lung J984 

(b)Sequela of pulmonary B909 

 tuberculosis 

Code to sequela of pulmonary tuberculosis (B909) since “sequela 

of” is stated. 

48	 2a January 2011 
Section II - Procedures for Selection 

(b) The tuberculosis is stated to be ancient, arrested, cured, healed, 

history of, inactive, old, quiescent, or remote, whether or not the 

residual (late) effect is specified, unless there is evidence of active 

tuberculosis. 

 

 Code for Record

 I (a) Arrested pulmonary tuberculosis B909 

Code to arrested pulmonary tuberculosis (B909), since there is no 

evidence of active tuberculosis. 

(c) When there is evidence of active and inactive (arrested, cured, 

healed, history of, old, quiescent) tuberculosis of different sites, 

consider as active or inactive tuberculosis as stated. 

 Codes for Record

 I (a) Acute miliary tuberculosis A190 

(b) of bone 6 mos 

II Old pulmonary tuberculosis B909 

 

Code to active acute miliary tuberculosis of bone (A190) as 

selected by the General Principle. Evidence of inactive 

tuberculosis of a different site does not change the status of the 

active tuberculosis. 

(d) When there is evidence of active and inactive (arrested, cured, 

healed, history of, old, quiescent) tuberculosis of the same site, 

consider as active tuberculosis. 

 Codes for Record

 I (a) Recurrent pulmonary tuberculosis A162 

(b) Old pulmonary tuberculosis A162 

 (c) 

 

Code to active pulmonary tuberculosis (A162). Evidence of 

inactive and active tuberculosis of the same site is coded to active 

tuberculosis of the site. 

NOTE: Do not use duration to code sequela of tuberculosis. 

 

 Codes for Record

 I (a) Respiratory failure J969 

(b) Pneumonia J189 

(c) Pulmonary tuberculosis 2 years A162 

 

Code to pulmonary tuberculosis (A162). Do not use duration of 

the tuberculosis to code the tuberculosis as sequela. 

 49 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

	 

	 

Section II - Procedures for Selection 

B91 Sequela of acute poliomyelitis 

Use this category for the classification of poliomyelitis (conditions in 

A800-A809) if: 

(a)	 A statement of a late effect or sequela of the poliomyelitis is 

reported. 

 Code for Record 

I (a) Sequela of acute poliomyelitis B91 

Code to sequela of poliomyelitis (B91) as indexed. 

(b) A chronic condition or a condition with a duration of one year or 

more that was due to poliomyelitis is reported. 

Codes for Record

 I (a) Paralysis - 1 year G839 

(b) Acute poliomyelitis B91 

Code to sequela of poliomyelitis (B91), since the paralysis has a 

duration of 1 year. 

(c) The poliomyelitis is stated to be old, history of, or the interval 

between onset of the poliomyelitis and death is indicated to be one 

year or more whether or not the residual (late) effect is specified. 

Code for Record

 I (a) Old polio B91 

Code to old polio (B91). 

(d) The poliomyelitis is not stated to be acute or active and the interval 

 between the onset of the poliomyelitis and death is not reported. 

 Code for Record

 I (a) Poliomyelitis B91 

 (b)

 (c) 

Code to sequela of poliomyelitis (B91) since the poliomyelitis is 

not stated to be acute or active and there is no duration reported. 

50	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

Section II - Procedures for Selection 

 Codes for Record

 I (a) Poliomyelitis with B91 G839 

 (b) paralysis

 (c) 

Code to sequela of poliomyelitis (B91) since the poliomyelitis is not 

stated to be acute or active and there is no duration reported. 

B92 Sequela of leprosy 

 Use this category for the classification of leprosy (conditions in A30) if: 

(a) A statement of a late effect or sequela of the leprosy is reported. 

(b) A chronic condition or a condition with a duration of one year or 

more that was due to leprosy is reported. 

B94.0 Sequela of trachoma

 Use this subcategory for the classification of trachoma (conditions in 

A710-A719) if: 

(a) A statement of a late effect or sequela of the trachoma is reported. 

 Code for Record

 I (a) Late effects of trachoma B940 

(b) The trachoma is stated to be healed or inactive, whether or not the 

residual (late) effect is specified. 

Code for Record 

I (a) Healed trachoma B940 

 Code to sequela of trachoma (B940) since it is stated “healed.” 

(c) A chronic condition such as blindness, cicatricial entropion or 

conjunctival scar that was due to the trachoma is reported unless 

there is evidence of active infection.

 Codes for Record

 I (a) Conjunctival scar H112 

(b)Trachoma B940 

 Code to sequela of trachoma (B940) since it caused the chronic 

 condition, conjunctival scar, and there is no evidence of active 

infection. 

51	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

	 

Section II - Procedures for Selection 

B94.1 Sequela of viral encephalitis 

Use this subcategory for the classification of viral encephalitis 

(conditions in A830-A839, A840-A849, A850-A858, A86) if: 

(a) A statement of a late effect or sequela of the viral encephalitis is 

reported. 

 Code for Record

 I (a) Late effects of viral B941 

 encephalitis 

Code to sequela of viral encephalitis (B941) as indexed. 

(b) A chronic condition or a condition with a duration of one year or 

more that was due to the viral encephalitis is reported. 

Codes for Record

 I (a) Chronic brain syndrome F069 

(b)Viral encephalitis B941 

Code to sequela of viral encephalitis (B941), since a resultant 

chronic condition is reported. 

(c) The viral encephalitis is stated to be ancient, history of, old, remote, 

or the interval between onset of the viral encephalitis and death is 

indicated to be one year or more whether or not the residual (late) 

effect is specified. 

Code for Record

 I (a) St. Louis encephalitis-1 yr B941 

Code to sequela of viral encephalitis (B941), since a duration of 1 

year is reported. 

Code for Record

 I (a) Old viral encephalitis B941 

Code to sequela of viral encephalitis (B941), since it is stated 

“old.” 

52	 2a January 2011 
 

 

 

 

 

 

Section II - Procedures for Selection 

(d) Brain damage, CNS damage, cerebral fungus, epilepsy, 

hydrocephalus, mental retardation, paralysis (G810-G839) is 

reported due to the viral encephalitis. 

Codes for Record

 I (a) Paralysis G839 

(b)Viral encephalitis B941 

Code to sequela of viral encephalitis (B941) since paralysis is 

reported due to viral encephalitis. 

B94.2 Sequela of viral hepatitis 

Use this category for the classification of viral hepatitis (conditions in 

B150-B199) if: 

A statement of a late effect or sequela of the viral hepatitis is reported. 

B94.8 Sequela of other specified infectious and parasitic diseases 

B94.9 Sequela of unspecified infectious and parasitic diseases 

Use B948 for the classification of specified infectious and parasitic 

diseases (conditions in A000-A099, A200-A289, A310-A70, A740­

A799, A811-A829, A870-B09, B250-B89) 

AND 

Use B949 for the classification of only the terms “infectious disease 

NOS” and “parasitic disease NOS” if: 

(a) A condition that is stated to be a late effect or sequela of the 

infectious or parasitic disease is reported. 

(b) The infectious or parasitic disease is stated to be ancient, arrested, 

cured, healed, history of, inactive, old, quiescent, or remote, whether 

or not the residual (late) effect is specified, unless there is evidence 

of activity of the disease. 

53 2a January 2011 
 

 

 

 

 

	 

Section II - Procedures for Selection 

(c) A chronic condition or a condition with a duration of one year or 

more that was due to the infectious or parasitic disease is reported. 

Codes for Record

 I (a) Reye’s syndrome - 1 yr. G937 

(b) Chickenpox B948 

Code to sequela of other specified infectious and parasitic 

diseases (B948) since chickenpox caused a condition with a 

duration of one year or more. 

Codes for Record

 I (a) Chronic brain syndrome F069 

(b)Meningococcal encephalitis B948 

Code to sequela of other specified infectious and parasitic 

diseases (B948) since the infectious disease caused a chronic 

condition. 

(d) There is indication that the interval between onset of the infectious 

or parasitic disease and death was one year or more, whether or not 

the residual (late) effect is specified. 

54	 2a January 2011 
 

 

 

 

 

	 

Section II - Procedures for Selection 

E640-E649 Sequela of malnutrition and other nutritional deficiencies 

Use Sequela Code For Categories 

E640 E40-E46 

E641 E500-E509 

E642 E54 

E643 E550-E559 

E648 E51-E53 

E56-E60 

E610-E638 

E649 E639 

Use these subcategories for the classification of malnutrition and other 

nutritional deficiencies (conditions in E40-E639) if: 

(a) A statement of a late effect or sequela of malnutrition and other 

nutritional deficiencies is reported. 

 Codes for Record

 I (a) Cardiac arrest I469 

(b)Sequela of malnutrition E640 

Code to sequela of protein-energy malnutrition (E640) since I(b) is 

stated as “sequela of.” 

(b) A condition with a duration of one year or more is qualified as 

rachitic or that was due to rickets is reported. 

Codes for Record

 I (a) Thyroid disorder - 3 years E079 

(b) Rickets E643 

 Code to sequela of rickets (E643) since rickets caused a condition 

 with a duration of one year or more. 

55	 2a January 2011 
 

 

 

 

 

 

	 

	 

Section II - Procedures for Selection 

E68 Sequela of hyperalimentation 

Use this category for the classification of hyperalimentation (conditions 

in E67 and hyperalimentation NOS in R632) if: 

(a)	 A statement of a late effect or sequela of the hyperalimentation is 

reported. 

(b) A condition with a duration of one year or more that was due to 

hyperalimentation is reported. 

G09 Sequela of inflammatory diseases of central nervous system 

Use this category for the classification of intracranial abscess or 

pyogenic infection (conditions in G000-G009, G030-G049, G060-G069, 

G08) if: 

(a) A statement of a late effect or sequela of the condition in G000­

G009, G030-G049, G060-G069, G08 is reported. 

(b) A condition with a duration of one year or more that was due to the 

condition in G000-G009, G030-G049, G060-G069, G08 is reported. 

(c) The condition in G000-G009, G030-G049, G060-G069, G08 is 

stated to be ancient, history of, old, remote, or the interval between 

onset of this condition and death is indicated to be one year or more, 

whether or not the residual (late) effect is specified. 

 Codes for Record 

I (a) Compression of brain G935 

 (b) Old cerebral abscess G09

 Code to sequela of cerebral abscess since stated as old. 

(d) Brain damage, CNS damage, cerebral fungus, epilepsy, 

hydrocephalus, mental retardation, paralysis (G810-G839) is 

reported due to a condition in G000-G009, G030-G049, G060­

G069, G08. 

 Codes for Record

 I (a) Hydrocephalus G919 

 (b) Meningitis G09 

Code to sequela of inflammatory diseases of CNS (G09) since 

meningitis (G039) is reported as causing hydrocephalus. 

56	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

	 

	 

Section II - Procedures for Selection 

I690-I698 Sequela of cerebrovascular disease 

Use this category for the classification of cerebrovascular disease 

(conditions in I600-I6400, I670-I671, I674-I679) if: 

(a)	 A statement of late effect or sequela of a cerebrovascular disease is 

reported. 

 Code for Record

 I (a) Sequela of cerebral infarction I693 

Code to sequela of cerebral infarction (I693) since “sequela of” is 

stated. 

(b) A condition with a duration of one year or more was due to one of 

these cerebrovascular diseases.

 Codes for Record

 I (a) Hemiplegia 1 year G819 

(b)Intracranial hemorrhage I692 

Code to sequela of other nontraumatic intracranial hemorrhage 

(I692) since the residual effect (hemiplegia) has a duration of one 

year. 

(c) The condition in I600-I6400, I670-I671, I674-I679 is stated to be 

ancient, history of, old, remote, or the interval between onset of this 

condition and death is indicated to be one year or more, whether or 

not the residual (late) effect is specified. 

 Codes for Record

 I (a) Brain damage G939 

(b)Remote cerebral thrombosis I693 

 Code to sequela of cerebral thrombosis (I693) since the cerebral 

 thrombosis is reported as remote.

 Code for Record

 I (a) Old intracerebral hemorrhage I691 

Code to sequela of intracerebral hemorrhage (I691) since the 

intracerebral hemorrhage is stated as old. 

57	 2a January 2011 
 

 

 

 

 

Section II - Procedures for Selection 

Code for Record

 I (a) Cerebrovascular occlusion 6 years I693 

Code to sequela of cerebrovascular occlusion since the duration 

is one year or more. 

 Code for Record

 I (a) History of CVA 9 mos I694 

 Code to sequela of CVA (I694) since history of CVA is reported. 

(d) The condition in I600-I6400, I670-I671, I674-I679 is reported with 

paralysis (any) stated to be ancient, history of, old, remote, or the 

interval between onset of this condition and death is indicated to be 

one year or more whether or not the residual (late) effect is 

specified. 

 Codes for Record

 I (a) CVA with old hemiplegia I694 G819 

 Code to sequela of CVA (I694) since it is reported with 

hemiplegia stated as old. 

O970-O979 Sequela of obstetric cause 

Use this category for the classification of a direct obstetric cause 

(conditions in O00-O927) if: 

(a) A statement of a late effect or sequela of the direct obstetric cause is 

reported. 

(b) A condition with a duration of one year or more that was due to the 

direct obstetric cause is reported. 

(c) The direct obstetric cause has a duration of one year or more. 

Y85-Y89 Sequela of external causes of morbidity and mortality. 

Refer to Section IV, Y85-Y89, Sequela of external causes of morbidity 

and mortality. 

58 2a January 2011 
 

 

 

Section II - Procedures for Selection 

NOTE: After application of the modification rules (A-F), selection Rule 3 should be 

reapplied. 

 Codes for Record

 I (a) Generalized arteriosclerosis I709 

 II Cerebral embolism, endocarditis I634 I38 

Code to endocarditis (I38). Arteriosclerosis, selected by the General 

Principle links (LMP) with cerebral embolism. Cerebral embolism is 

considered a direct sequel (DS) of the endocarditis. 

59 2a January 2011 
 

 

 

 

 

 

	 

 Section III - Editing and Interpreting Entries 

SECTION III 

EDITING AND INTERPRETING ENTRIES IN THE MEDICAL 

CERTIFICATION 

Selection of the underlying cause is based on selecting a single condition on the lowest used 

line in Part I since this condition is presumed to indicate the certifier’s opinion about the 

sequence of events leading to the immediate cause of death. However, it is recognized that 

certifiers do not always report a single condition on the lowest used line, nor do they always 

enter the related conditions in a proper order of sequence. Therefore, it is necessary to edit 

the conditions reported during the selection process. For this reason, standardized rules and 

guides are set forth in this manual. 

The international coding guides are provided in this section. Also included are instructions 

for use in the United States designed to bring assignments resulting from reporting practices 

particular to the United States into closer alignment with the intent of the International 

Classification procedures. 

The interpretations and instructions in this section are general in nature and are to be used 

whenever applicable. Those in Section IV apply to specific categories. 

A. Guides for the determination of the probability of sequence 

1. Assumption of intervening cause. Frequently on the medical certificate, one 

condition is indicated as due to another, but the first one is not a direct consequence 

of the second one. For example, hematemesis may be stated as due to cirrhosis of the 

liver, instead of being reported as the final event of the sequence, liver cirrhosis →

portal hypertension → ruptured esophageal varices → hematemesis. 

The assumption of an intervening cause in Part I is permissible in accepting a 

sequence as reported, but it must not be used to modify the coding. 

Codes for Record

 I (a) Cerebral hemorrhage I619 

(b)Chronic nephritis N039 

Code to chronic nephritis (N03.9). It is necessary to assume hypertension as a 

condition intervening between cerebral hemorrhage and the underlying cause, 

chronic nephritis. 

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 Codes for Record

 I (a) Mental retardation F79

 (b) Premature separation P021 

 (c) of placenta 

Code to premature separation of placenta affecting fetus or newborn (P02.1). It is 

necessary to assume birth trauma, anoxia or hypoxia as a condition intervening 

between mental retardation and the underlying cause, premature separation of 

placenta. 

2. Interpretation of “highly improbable.” The expression “highly improbable” has been 

used since the Sixth Revision of the ICD to indicate an unacceptable causal 

relationship. As a guide to the acceptability of sequences in the application of the 

General Principle and the selection rules, the following relationships should be 

regarded as “highly improbable”: 

a. an infectious or parasitic disease (A00-B99) reported as “due to” any disease 

outside this chapter, except that: 

• septicemia (A40-A41, B94.8) 

 

 May be accepted as “due to” 

8) any other disease 

) 

• erysipelas (A46, B94.8) 

• gas gangrene (A48.0, B94.8) 

• bacteremia (A49.0-A49.9, B94.

• Vincent’s angina (A69.1, B94.8

• mycoses (B35-B49, B94.8) 

•	 any infectious disease may be accepted as “due to” disorders of the immune 

mechanism such as human immunodeficiency virus [HIV] disease or AIDS 

•	 any infectious disease may be accepted as “due to” immunosuppression by 

chemicals (chemotherapy) and radiation 

•	 any infectious disease classified to A000-A090, A162-B199 or B250-B64 

reported as “due to” a malignant neoplasm will also be an acceptable 

sequence 

•	 varicella and zoster infections (B01-B02) may be accepted as “due to” 

diabetes, tuberculosis and lymphoproliferative neoplasms; 

b.	 a malignant neoplasm reported as “due to” any other disease, except human 

immunodeficiency virus [HIV] disease; 

c. hemophilia (D66, D67, D68.0-D68.2) reported as “due to” any other disease; 

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d. diabetes (E10-E14) reported as “due to” any other disease except: 

•	 diabetes type 1 (E10) should not be accepted as “due to” any other disease 

except for conditions causing autoimmune destruction of ß-cells. 

•	 diabetes type 2 (E11) should not be accepted as “due to” any other disease 

except for conditions casusing insulin resistance. 

•	 other and specified diabetes (E13-E14) should not be accepted as “due to” 

any other disease except for conditions causing damage to the pancreas. 

See Appendix H for a list of conditions that can cause diabetes. 

e.	 rheumatic fever (I00-I02) or rheumatic heart disease (I05-I09) reported as “due 

to” any disease other than scarlet fever (A38), streptococcal septicemia (A40.-), 

streptococcal sore throat (J02.0) and acute tonsillitis (J03.-); 

f.	 any hypertensive condition reported as “due to” any neoplasm except: 

•	 endocrine neoplasms, 

•	 renal neoplasms, 

•	 carcinoid tumors; 

g.	 chronic ischemic heart disease (I20, I25) reported as “due to” any neoplasm; 

h. (1) cerebrovascular diseases (I60-I69) reported as “due to” a disease of the 

digestive system (K00-K92), except Cerebral hemorrhage (I61.-) due to 

Diseases of liver (K70-K76); 

(2) cerebral infarction due to thrombosis of precerebral arteries (I63.0) 

cerebral infarction due to unspecified occlusion of precerebral arteries (I63.2) 

cerebral infarction due to thrombosis of cerebral arteries (I63.3) 

cerebral infarction due to unspecified occlusion of cerebral arteries (I63.5) 

cerebral infarction due to cerebral venous thrombosis, nonpyogenic (I63.6) 

other cerebral infarction (I63.8) 

cerebral infarction, unspecified (I63.9) 

stroke, not specified as hemorrhage or infarction (I64) 

other cerebrovascular disease (I67) 

sequela of stroke, not specified as hemorrhage or infarction (I69.4) 

sequela of other and unspecified cerebrovascular diseases (I69.8) 

reported as “due to” endocarditis (I05-I08, I09.1, I33-I38); 

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(3) occlusion and stenosis of precerebral arteries, not resulting in cerebral 

infarction (I65), except embolism 

occlusion and stenosis of cerebral arteries, not resulting in cerebral 

infarction (I66) except embolism 

sequela of cerebral infarction (I69.3), except embolism 

reported as “due to” endocarditis (I05-I08, I09.1, I33-I38); 

i.	 any condition described as arteriosclerotic [atherosclerotic] reported as “due to” 

any neoplasm; 

j.	 influenza (J09-J11) reported as “due to” any other disease; 

k.	 a congenital anomaly (Q00-Q99) reported as “due to” any other disease of the 

individual, except for: 

•	 a congenital anomaly reported as “due to” a chromosome abnormality or a 

 congenital malformation syndrome 

•	 pulmonary hypoplasia reported as “due to” a congenital anomaly 

l.	 a condition of stated date of onset “X” reported as “due to” a condition of stated 

date of onset “Y,” when “X” predates “Y”; 

m. any accident (V01-X59) reported as “due to” any other cause outside this chapter 

except: 

(1)	 any accident (V01-X59) reported as due to epilepsy (G40-G41) 

(2)	 a fall (W00-W19) due to a disorder of bone density (M80-M85) 

(3)	 a fall (W00-W19) due to a (pathological) fracture caused by a disorder 

of bone density 

(4)	 asphyxia reported as due to aspiration of mucus, blood (W80) or 

vomitus (W78) as a result of disease conditions 

(5)	 aspiration of food (liquid or solid) of any kind (W79) reported as due to 

a disease which affects the ability to swallow 

n.	 suicide (X60-X84) reported as “due to” any other cause. 

The preceding list does not cover all “highly improbable” sequences, but in other 

cases the General Principle should be followed unless otherwise indicated. 

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Acute or terminal circulatory diseases reported as “due to” malignant neoplasm, 

diabetes or asthma should be accepted as possible sequences in Part I of the 

certificate. The following conditions are regarded as acute or terminal circulatory 

diseases: 

I21-I22 Acute myocardial infarction 

I24.- Other acute ischemic heart diseases 

I26.- Pulmonary embolism 

I30.- Acute pericarditis 

I33.- Acute and subacute endocarditis 

I40.- Acute myocarditis 

I44.- Atrioventricular and left bundle-branch block 

I45.- Other conduction disorders 

I46.- Cardiac arrest 

I47.- Paroxysmal tachycardia 

I48 Atrial fibrillation and flutter 

I49.- Other cardiac arrhythmias 

I50.- Heart failure 

I51.8 Other ill-defined heart diseases 

I60-I68 Cerebrovascular diseases except I67.0-I67.5 and I67.9 

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B. Diagnostic entities 

1. One-term entity: A one-term entity is a diagnostic entity that is classifiable to a 

single ICD-10 code. 

a. A diagnostic term that contains one of the following adjectival modifiers indicates 

the condition modified has undergone certain changes and is considered to be a 

one-term entity. 

adenomatous embolic hypoxemic necrotic 

anoxic erosive hypoxic obstructed 

congestive gangrenous inflammatory obstructive 

cystic hemorrhagic ischemic ruptured

 (Apply this instruction to these adjectival modifiers only) 

 For code assignment, apply the following criteria in the order stated. 

(1) If the modifier and lead term are indexed together, code as indexed. 

Code for Record 

I (a) Embolic nephritis N058 

Code to embolic nephritis (N058). The adjectival modifier “embolic” is 

 indexed under Nephritis. 

(2) If the modifier is not indexed under the lead term, but “specified” is, use the 

code for specified (usually .8) 

Code for Record

 I (a) Obstructive cystitis N308 

 Code to cystitis, specified NEC (N308). The adjectival modifier

 “obstructive” is not indexed under Cystitis, but “specified NEC” is indexed. 

(3) If neither the modifier nor “specified” is indexed under the lead term, refer to 

Volume 1 under the NOS code for the lead term and look for a specified 

fourth character category. 

 Code for Record

 I (a) Hemorrhagic cardiomyopathy I428 

Code to the category for other cardiomyopathies (I428). “Hemorrhagic” is 

not indexed under cardiomyopathy, neither is cardiomyopathy, specified, 

NEC indexed. The Classification does provide a code, I428, for “Other 

cardiomyopathies” in Volume 1. 

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(4) If neither (1), (2) nor (3) apply, code the lead term without the modifier. 

 Code for Record

 I (a) Adenomatous bronchiectasis J47 

Code to bronchiectasis NOS (J47). “Adenomatous” is not an index term 

qualifying bronchiectasis. Code bronchiectasis only, since there is no 

provision in the Classification for coding “other bronchiectasis.” 

b.	 Alzheimer’s dementia: Consider the following terms as one term entities and 

code as indicated: 

 When reported as: Code 

Endstage Alzheimer’s, senile dementia 

Senile dementia, Alzheimer’s 
 G301 

Senile dementia, Alzheimer’s type 

Senile dementia of the Alzheimer’s 

When reported as: Code 

G309 

 

 

 

 

 

ease) 

e

Alzheimer’s, dementia 

Alzheimer’s; dementia 

Alzheimer’s disease (dementia) 

Alzheimer’s disease-dementia 

Dementia Alzheimer’s 

Dementia, Alzheimer’s 

Dementia-Alzheimer’s 

Dementia, Alzheimer’s type 
 

Dementia of Alzheimer’s 
 

Dementia-Alzheimer’s type 
 

Dementia; Alzheimer’s type 
 

Dementia, probable Alzheimer’s (dis

Dementia syndrome, Alzheimer’s typ

Endstage dementia (Alzheimer’s) 

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2. Multiple one-term entity: A multiple one-term entity is a diagnostic entity consisting 

of two or more contiguous words on a line for which the Classification does not 

provide a single code for the entire entity but does provide a single code for each of 

the components of the diagnostic entity. Consider as a multiple one-term entity if 

each of the components can be considered as separate one-term entities, i.e., they can 

stand alone as separate diagnoses. 

 Codes for Record 

I (a) Hypertensive arteriosclerosis I10 I709 

Code to hypertension (I10). The complete term is not indexed as a one-term 

entity. Code “hypertensive” and “arteriosclerosis” as separate one-term 

entities. 

EXCEPTION: When any condition classifiable to I20-I25 (except I250) or 

I60-I69 is qualified as “hypertensive,” code to I20-I25 or I60-I69 only. 

 Code for Record

 I (a) Hypertensive myocardial ischemia I259 

Code to myocardial ischemia (I259). Disregard “hypertensive” since it is 

modifying an ischemic heart condition. 

C. Adjective reported at the end of a diagnostic entity 

Code an adjective reported at the end of a diagnostic entity as if it preceded the entity. 

This applies whether reported in Part I or Part II.

 Codes for Record 

I (a) Arteriosclerosis, hypertensive I10 I709 

Code to hypertension (I10). The complete term is not indexed as a one-term entity. 

“Hypertensive” is an adjectival modifier; code as if it preceded the arteriosclerosis. 

D. Adjectival modifier reported with multiple conditions 

1. If an adjectival modifier is reported with more than one condition, modify only the 

first condition. 

 Codes for Record

 I (a) Arteriosclerotic nephritis and cardiomyopathy I129 I429 

Code to arteriosclerotic nephritis (I129). The modifier is applied only to the first 

condition. 

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2. If an adjectival modifier is reported with one condition and more than one site is 

reported, modify all sites. 

 Codes for Record

 I (a) Arteriosclerotic cardiovascular and I250 I672 

 cerebrovascular disease 

Code to arteriosclerotic cardiovascular disease (I250). The modifier is applied to 

both conditions, but in this case the selected cause is not modified by the other 

condition on the record. 

3. When an adjectival modifier precedes two different diseases that are reported with a

 connecting term, modify only the first disease. 

Codes for Record

 I (a) Arteriosclerotic cardiovascular disease I250 I679 

 and cerebrovascular disease 

Code to arteriosclerotic cardiovascular disease (I250). The modifier is applied 

only to the first condition. 

E. Parenthetical entries 

1. When one medical entity is reported followed by another complete medical entity

 enclosed in parenthesis, disregard the parenthesis and code as separate terms. 

Codes for Record

 I (a) Heart dropsy I500 

 (b) Renal failure (CVRD) N19 I139 

 (c) 

Code to hypertensive heart and renal disease (I132). Consider line (b) as two 

separate terms, both of which are complete medical entities. 

2. When the adjectival form of words or qualifiers are reported in parenthesis, use these 

adjectives to modify the term preceding it.

 Codes for Record

 I (a) Collapse of heart I509 

(b) Heart disease (rheumatic) I099 

 Code to rheumatic heart disease (I099). Use “rheumatic” as a modifier. 

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3. If the term in parenthesis is not a complete term and is not a modifier, consider as 

part of the preceding term. 

 Code for Record

 I (a) Metastatic carcinoma (ovarian) C56

 Code to primary ovarian carcinoma (C56). 

F. Plural form of disease 

Do not use the plural form of a disease or the plural form of a site to indicate multiple. 

Codes for Record 

I (a) Cardiac arrest I469 

(b)Congenital defects Q899 

 Code to congenital defect (Q899); do not code as multiple (Q897). 

G. Implied disease 

When an adjective or noun form of a site is entered as a separate diagnosis, i.e., it is not 

part of an entry immediately preceding or following it, assume the word “disease” after 

the site and code accordingly. 

Code for Record

 I (a) Myocardial I515 

 (b)

 (c) 

Code to myocardial disease (I515). 

Codes for Record 

I (a) Coronary I251 

 (b) Hypertension I10

 (c) 

Code to coronary disease (I251). Line I(a) is coded as coronary disease since 

coronary hypertension is not indexed. 

I (a) Renal I129 

(b) Hypertension 

Code to renal hypertension (I129). Consider the site, renal, to be a part of 

the condition that immediately follows it on line b, since Hypertension, renal is 

indexed. 

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H. Non-traumatic conditions 

Consider conditions that are usually but not always traumatic in origin to be qualified as 

non-traumatic when reported due to or on the same line with a disease. 

I (a) Fat embolism I749 

(b)Pathological fracture M844 

Code line I(a) as non-traumatic since reported due to a disease. 

I.	 Relating and modifying 

Certain conditions are classified in the ICD-10 according to the site affected, e.g. 

atrophy enlargement obstruction 

calcification failure perforation 

calculus fibrosis rupture 

congestion gangrene stenosis 

degeneration hypertrophy stones 

dilatation insufficiency stricture 

embolism necrosis 

 (This list is not all inclusive) 

Occasionally, these conditions are reported without specification of site. Relate 

conditions such as these for which the Classification does not provide an NOS code and 

conditions which are usually reported of a site. Generally, it may be assumed that such a 

condition was of the same site as another condition if the Classification provides for 

coding the condition of unspecified site to the site of the other condition. These coding 

principles apply whether or not there are other conditions reported on other lines in Part I. 

Use the following generalizations as a guide in assuming a site: 

1. General instructions for implied site of a disease 

a.	 Conditions of unspecified site reported on the same line 

(1) When conditions are reported on the same line with or without a connecting 

term that implies a due to relationship, assume the condition of unspecified 

site was of the same site as the condition of a specified site. 

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Codes for Record 

I (a) Aspiration pneumonia J690 

 (b) Cerebrovascular accident due to I64

 (c) thrombosis I633 

Code to cerebral thrombosis (I633). Since thrombosis (of unspecified site) 

is reported on the same line with a condition of a specified site, relate to 

the specified site. 

(2) When conditions of different sites are reported on the same line with the 

condition of unspecified site, assume the condition of unspecified site was of 

the same site as the condition immediately preceding it. 

 Codes for Record 

I (a) ASHD, infarction, CVA I251 I219 I64 

 (b) 

Code to heart infarction (I219). Since infarction (of unspecified site) is 

reported on same line with two conditions of specified sites, relate to the 

specified site immediately preceding the condition. ASHD links (LMP) 

with heart infarction. 

b. Conditions of unspecified site reported on a separate line 

(1) If there is only one condition of a specified site reported on the line above or 

below it, code to this site. 

 Codes for Record

 I (a) Cholecystitis K819 

(b) Calculus K802 

Code to calculus of gallbladder with other cholecystitis (K801). Calculus 

of an unspecified site is reported on line (b). The condition on the line 

above is of a stated site (gallbladder). Therefore, consider line (b) as 

calculus of gallbladder (K802). This code links (LMC) with cholecystitis. 

(2) If there are conditions of different specified sites on the lines above and 

below it and the Classification provides for coding the condition of 

unspecified site to only one of these sites, code to that site. 

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Codes for Record 

I (a) Intestinal fistula K632 

 (b) Obstruction K566 

(c) Adhesions of peritoneum K660 

Code to intestinal adhesions with obstruction (K565). Since the 

Classification does not provide a code for obstruction of the peritoneum, 

relate to the site reported on the line above (intestinal). Adhesions of 

peritoneum links (LMC) with intestinal obstruction. 

(3) If there are conditions of different specified sites on the lines above and 

below and the Classification provides for coding the condition of unspecified 

site to both of these sites, code the condition unspecified as to site. 

 Codes for Record 

I (a) CVA I64

 (b) Thrombosis I829 

(c) ASHD I251 

Code to ASHD (I251). Since the thrombosis is classified to both sites 

(reported above and below), do not relate. 

(4) Do not relate conditions which are not reported in the first position on

 a line to the line above. It is acceptable to relate conditions not 

 reported as the first condition on a line to the line below. 

Codes for Record

 I (a) Kidney failure N19

 (b) Vascular insufficiency with thrombosis I99 I219 

(c) ASHD I251 

 Code to cardiac thrombosis (I219). Relate thrombosis to line below. 

 ASHD links (LMP) with heart thrombosis. 

2. Relating specific categories 

a. When ulcer, site unspecified or peptic ulcer NOS is reported causing, due to, or on 

the same line with gastrointestinal hemorrhage, code peptic ulcer NOS (K279). 

Codes for Record 

I (a) Gastrointestinal hemorrhage K922 

(b) Peptic ulcer K279 

Code to peptic ulcer with hemorrhage (K274). Do not relate peptic ulcer 

to gastrointestinal. Peptic ulcer links (LMC) with gastrointestinal 

hemorrhage. 

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b. When ulcer NOS (L984) is reported causing, due to, or on the same line with 

diseases classifiable to K20-K22, K30-K31, and K65, code peptic ulcer NOS 

(K279). 

I (a) Peritonitis 

(b) Ulcer 

 Codes for Record 

K659 

K279 

 Code to peptic ulcer (K279). 

c. When hernia (K40-K46) is reported with disease(s) of unspecified site(s), relate 

the disease of unspecified site to the intestine.

 Codes for Record

 I (a) Hernia with obstruction K469 K566 

Code to hernia with obstruction (K460). Relate obstruction to intestine. 

Hernia links (LMC) with intestinal obstruction. 

d. When calculus NOS or stones NOS is reported with pyelonephritis, code 

to N209 (urinary calculus). 

Codes for Record 

I (a) Calculus with pyelonephritis N209 N12 

 Code to urinary calculus (N209). 

e. When arthritis (any type) is reported with 

• Contracture  code contracture of the site 

• Deformity  code deformity acquired of the site 

If no site is reported or if site is not indexed, code contracture or deformity, joint. 

Codes for Record 

I (a) Phlebitis I809 

(b) Deformities M219 

(c) Osteoarthritis lower limbs M199 

 Code to osteoarthritis lower limbs (M199). 

f. When embolism, infarction, occlusion, thrombosis NOS is reported 

• from a specified site  code the condition of the site reported 

• of a site from a specified site  code the condition to both sites reported 

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Codes for Record 

I (a) Congestive heart failure I500 

(b) Embolism from heart I2190 

(c) Arteriosclerosis I709 

 Code to cardiac embolism (I219). Relate embolism to site reported. 

g. Relate a condition of unspecified site to the complete term of a multiple site 

entity. If it is not indexed together, relate the condition to the site of the complete 

indexed term. 

Codes for Record 

I (a) Cardiorespiratory arrest with I469 I509 

 (b) insufficiency 

Code to heart failure (I509). Since cardiorespiratory arrest is indexed to a 

heart condition, relate insufficiency to heart. 

h. When vasculitis NOS is reported, apply the general instructions for relating and 

modifying. 

Codes for Record 

I (a) Renal failure N19 

(b) Vasculitis I778 

Code Vasculitis, kidney (I778). Relate vasculitis to the site reported on line 

I (a). 

3. Exceptions to relating and modifying instructions: 

a. Do not relate the following conditions: 

 Arteriosclerosis

 Congenital anomaly NOS 

 Hypertension

 Infection NOS (refer to Section III, Part K, #6) 

 Neoplasms

 Paralysis

 Vascular disease NOS 

Codes for Record 

I (a) Cardiac arrest I469 

(b) Congenital anomaly Q899 

 Code to congenital anomaly NOS (Q899). Do not relate to cardiac. 

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b. Do not relate hemorrhage when causing a condition of a specified site. Relate 

hemorrhage to site of disease reported on same line or line below only. 

 Codes for Record

 I (a) Respiratory failure J969 

(b)Hemorrhage R5800 

Code to hemorrhage NOS (R58). Do not relate to respiratory. 

c. Do not relate conditions classified to R00-R99 except: 

Gangrene and necrosis R02

 Hemorrhage R5800 

 Regurgitation R11 

Stricture and stenosis R688 

Codes for Record 

I (a) Pneumonia with gangrene J189 J850 

 Code to gangrene of lung (J850). Relate gangrene to pulmonary, the 

 site of the disease reported on the same line, since gangrene is one of 

 the exceptions. Pneumonia is a direct sequel (DS) of pulmonary gangrene. 

d. Do not relate a disease condition that, by the name of the disease, implies a 

disease of a specified site unless it is obviously an erroneous code. If not certain, 

refer to supervisor.

 Codes for Record

 I (a) Encephalopathy, cirrhosis G934 K746 

Code to encephalopathy (G934). Do not relate encephalopathy to liver 

since the name of the disease implies a disease of a specific site, brain. 

J. Coding conditions classified to injuries as disease conditions 

1.	 Some conditions (such as injury, hematoma or laceration) of a specified organ are 

indexed directly to a traumatic category but may not always be traumatic in origin. 

Consider these types of conditions to be qualified as nontraumatic and code as 

nontraumatic when reported: 

•	 due to or on the same line with a disease 

•	 due to: drug poisoning 

 drug therapy 
 

If there is provision in the Classification for coding the condition that is considered 

to be qualified as nontraumatic as such, code accordingly. Otherwise, code to the 

category that has been provided for "Other" diseases of the organ (usually .8). 

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 Codes for Record

 I (a) Laceration heart I518 

(b) Myocardial infarction I219 

 (c) 

Code to myocardial infarction (I219) selected by General Principle. Since 

laceration heart is reported due to myocardial infarction, consider the laceration to 

be nontraumatic. 

 Codes for Record

 I (a) Subdural hematoma I620 

 (b) CVA I64

 (c) 

Code to nontraumatic subdural hematoma (I620) since reported due to CVA. 

Cerebrovascular accident, selected by the General Principle, is considered a 

general term and nontraumatic subdural hematoma is preferred as the more 

informative term by application of Rule D (SMP). 

 Codes for Record 

I (a) Cardiorespiratory failure R092 

(b) Intracerebral hemorrhage I619 

(c) Subdural hematoma, cerebral meningioma I620 D320 

Code to cerebral meningioma (D320). Subdural hematoma is considered to be 

nontraumatic since it is reported on the same line with cerebral meningioma. The 

nontraumatic subdural hematoma selected by Rule 1 is a direct sequel (Rule 3) to 

cerebral meningioma. 

 

2. Some conditions are indexed directly to a traumatic category but the Classification 

also provides a nontraumatic category. When these conditions are reported due to or 

with a disease and an external cause is reported on the record or the Manner of 

 Death box is checked as Accident, Homicide, Suicide, Pending Investigation or 

 Could not be determined, consider the condition as traumatic. 

 Codes for Record

 I (a) Subdural hematoma S065 

 (b) CVA I64 

 (c) 

 II W18 
 

 Accident Fell while walking 

Code to other fall on the same level (W18). Subdural hematoma is considered to 

 be traumatic as indexed since “accident” is reported in the Manner of Death box. 

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 Codes for Record 

I (a) Cerebral hematoma with S068 I672 

 (b) cerebral arteriosclerosis

 (c) 

 II X599 

Accident 

Code to accident NOS (X599). Cerebral hematoma is considered traumatic as 

indexed since “accident” is reported in the Manner of Death box. 

3.	 Some conditions are indexed directly to a traumatic category, but the Classification 

also provides a nontraumatic category. When these conditions are reported and the 

Manner of Death box is checked as Natural, consider these conditions as 

nontraumatic unless the condition is reported due to or on the same line with an 

injury or external cause. This instruction applies only to conditions with the term 

“nontraumatic” in the Index. 

 Code for Record 

I (a) Subdural hematoma I620 

 (b) 

 II 
 

Natural 

Code to nontraumatic subdural hematoma (I620). The subdural hematoma is 

considered to be nontraumatic since “Natural” is reported in the Manner of Death 

box and is selected by application of General Principle. 

 

Codes for Record 

I (a) Subdural hematoma I620 

 (b) 

 (c) 

II Fracture hip S720

 Natural Fell in hospital 

Code to nontraumatic subdural hematoma (I620). The subdural he

considered to be nontraumatic since “Natural” is reported in the 

box and is selected by application of General Principle. 

 

 

 W19 

matoma is 

Manner of Death 

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I (a) Subdural hematoma 

(b) Open wound of head 

II Fell in hospital

 Codes for Record 

S065 

S019 

 W19 

Natural 

Code to unspecified fall (W19). Even though Natural is reported in the Manner of 

Death box, the subdural hematoma is reported due to an injury. 

K. Intent of certifier 

In order to assign the most appropriate code for a given diagnostic entity, it may be 

necessary to take other recorded information and the order in which the information is 

reported into account. It is important to interpret this information properly so the 

meaning intended by the certifier is correctly conveyed. The following instructions help 

to determine the intent of the certifier. Apply Intent of Certifier instructions to “See also” 

terms in the Index as well. 

For the following conditions, use the causation tables to determine if the NOS code from 

the title or the alternative code listed below the title should be used in determining a 

sequence. If the alternative code forms an acceptable sequence with the condition 

reported below it, then that sequence should be accepted. 

1. Other and unspecified gastroenteritis and colitis of unspecified origin (A099) 

a. Code A090 (Gastroenteritis and colitis of infectious origin) 

When reported due to: 

A000-B99 

R75 

Y431-Y434 

Y632 

Y842 

 Codes for Record 

I (a) Enteritis A090 

(b) Listeriosis A329 

Code I(a) gastroenteritis and colitis of infectious origin, A090, since enteritis is 

reported due to a condition classified to A329. 

EXCEPTION: When the enteritis is reported due to another infectious 

condition or an organism classified to A49 or B34, refer to Section III, 

6. Organisms and Infections. 

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b. Code K529 (Noninfective gastroenteritis and colitis, unspecified) when reported 

due to conditions listed in the causation table under address code K529. 

Codes for Record 

I (a) Enteritis K529 

(b)Abscess of intestine K630 

Code to K630. The code K630 is listed as a subaddress to K529 in the causation 

table, so this sequence is accepted. 

2. Spinal Abscess (A180)

 Code M462 (Nontuberculous spinal abscess): 

When reported due to: 

A400-A419 H650-H669 M910-M939 

A500 H950-H959 M960-M969 

A509 J00-J399 N10-N12 

A527 J950-J959 N136 

A539 K650-K659 N151 

B200-B24 K910-K919 N159 

B89 L00-L089 N288 

B99 M000-M1990 N340-N343 

C412 M320-M351 N390 

C760 M359 N700-N768 

C795 M420-M429 N990-N999 

C810-C969 M45-M519 R75 

D160-D169 M600 S000-T983 

D480 M860-M889 

D550-D589 M894 

 Codes for Record 

I (a) Spinal Abscess M462 

(b)Staphylococcal septicemia A412 

 Code I(b) A412, staphylococcal septicemia. The code A412 is listed as a 

 subaddress to M462 in the causation table; therefore, this sequence is 

accepted. 

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3.	 Charcot’s Arthropathy (A521) 

Code G98 (Arthropathy, neurogenic, neuropathic (Charcot’s), nonsyphilitic): 

When reported due to: 

A30 Leprosy 

E10-E14 Diabetes mellitus 

E538 Subacute combined 

degeneration (of spinal 

cord) 

F101 Alcohol abuse 

F102 Alcoholism 

G608 

G901 

G950 

Q059 

Y453 

Y453 

Y427 

Hereditary sensory neuropathy 

Familial dysautonomia 

Syringomyelia 

Spina bifida, unspecified 

Indomethacin 

Phenylbutazone 

Corticosteroids 

G600 Hypertrophic interstitial 

neuropathy 

G600 Peroneal muscular atrophy 

 Codes for Record

 I (a) Charcot’s arthropathy

 (b) Diabetes 

 G98

E149 

Code to diabetes with other specified complications (E146). Since the E149 is 

listed as a subaddress under G98 in the Causation Table, use G98 for the 

Charcot’s arthropathy. The diabetes selected by general principle links (LDC) 

with Charcot’s arthropathy. 

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4. General Paresis (A521)

 a. 	 Code G839 (Paralysis) when reported due to or on the same line with conditions 

listed in the causation table under G839. 

 Codes for Record

 I (a) General paresis and CVA G839 I64 

 (b)

 (c) 

Code to CVA (I64). Since I64 is listed as a subaddress to G839 in the 

causation table, use G839 as the code for general paresis. The paresis 

selected by Rule 2 is a direct sequel (DS) to CVA. 

b. Code T144 (Paralysis, traumatic) when reported due to or on the same line with a 

nature of injury or external cause. 

 Codes for Record

 I (a) General paresis T144 

(b) Brain injury S069 

 (c)

 II Auto accident V499 

Code to auto accident (V499). General paresis due to S069 is coded as 

traumatic. The codes S00-T98 are invalid for underlying cause so the 

external cause code is selected. 

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5.	 Viral Hepatitis (B161, B169, B171-B179) 

Code: 

For Viral Hepatitis in Categories Chronic Viral Hepatitis 

B161 B180 

B169 B181 

B171 B182 

B172 B188 

B178 B188 

B179 B189 

When reported as causing liver conditions in: 

K721, K7210 

K740-K742 

K744-K746 

Codes for Record 

I (a) Cirrhosis of liver K746 

(b)Viral hepatitis B B181 

Code to chronic viral hepatitis B (B181). Code I(b) as chronic viral 

hepatitis B, since reported as causing a condition classified to K746. 

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6. Organisms and Infections NOS (B99) 

To code organisms and infections correctly, it is necessary to recognize organisms 

and infectious conditions. In order to apply the correct instruction, it is also 

necessary to know how the organisms are classified. There are separate instructions 

depending on whether the organism is bacterial, viral or other organisms. Listed 

below are examples of organisms and infectious conditions. 

Organisms 

Bacterial organisms 

classified to A49.-

Viral organisms 

classified to B34.-

Organisms classified other 

than A49.- or B34.-

Escherichia coli 

Haemophilus influenzae 

Pneumococcal 

Staphylococcal 

Streptococcal 

Adenovirus 

Coronavirus 

Coxsackie 

Enterovirus 

Parvovirus 

Aspergillus 

Candida 

Cytomegalovirus 

Fungus 

Meningococcal 

Infectious conditions 

Abscess Infection Sepsis, Septicemia 

Bacteremia Pneumonia Septic shock 

Empyema Pyemia Words ending in “itis” 

These lists are NOT all inclusive. Use them as a guide. 

In order to arrive at the correct underlying cause, the medical entities must first be 

coded correctly. The following instructions demonstrate how to assign the codes for 

the record when dealing with infectious conditions. Once the codes for the record 

are assigned, the selection and modification rules are applied to determine the 

underlying cause. 

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In order to determine which infection instruction to use, refer to the Index under the 

named organism or under Infection, named organism. 

a. Bacterial organisms and infections classified to A49 and Viral organisms and 

infections classified to B34 

(1) When an infectious or inflammatory condition is reported and 

(a) Is preceded or followed by a condition classified to A49 or B34 or 

(b) A condition classifiable to A49 or B34 is reported as the only entry or 

the first entry on the next lower line or 

(c) Is followed by a condition classified to A49 or B34 separated by a 

connecting term not indicating a due to relationship 

(i)	 If a single code is provided for the infectious or inflammatory 

condition modified by the condition classified to A49 or B34, use 

this code. Do not assign a separate code for the condition 

classifiable to A49 or B34. It may be necessary to use “due to” or 

“in” in the Index to assign the appropriate code. 

 Code for Record

 I (a) E. Coli diarrhea A044 

Code to other intestinal E. coli infections (A044). Code as 

indexed under Diarrhea, due to, Escherichia coli.

 Code for Record

 I (a) Pneumonia J129 

 (b) Viral infection 

Code to viral pneumonia, unspecified (J129). Code as indexed 

under Pneumonia, viral. 

 Codes for Record

 I (a) Meningitis and sepsis G000 A413 

 (b) H. Influenzae 

Code to Haemophilus meningitis (G000). Assign the codes for 

the record following the Index under Meningitis, Haemophilus 

 (influenzae) and Septicemia, Haemophilus influenzae. 

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 Code for Record

 I (a) Sepsis with staph A412 

Code to septicemia due to unspecified staphylococcus (A412). 

Code as indexed under Septicemia, staphylococcus. 

 Code for Record 

I (a) Pneumonia ⎯c MRSA J152 

Code to pneumonia due to staphylococcus (J152). Code as 

indexed under Pneumonia, MRSA (methicillin resistant 

staphylococcus aureus). 

(ii) If (i) does not apply, and the Index provides a code for the 

infectious or inflammatory condition qualified as “bacterial,” 

“infectious,” “infective” or “viral,” assign the appropriate code 

based on the reported type of organism. Do not assign a separate 

code for the condition classified to A49 or B34. 

 Code for Record

 I (a) Coxsackie virus pneumonia J128 

Code to other viral pneumonia (J128). Since Coxsackie virus is 

not specifically listed under pneumonia, code as indexed under 

 Pneumonia, viral, specified NEC.

 Code for Record

 I (a) Peritonitis K650 

 (b) Campylobacter 

Code to acute peritonitis (K650). Since Campylobacter is not 

specifically listed under peritonitis, code as indexed under 

Peritonitis, bacterial.

 Code for Record 

I (a) Pneumonia with coxsackie virus J128 

Code to other viral pneumonia (J128). Since coxsackie virus is 

not specifically listed under pneumonia, code as indexed under 

Pneumonia, viral, specified NEC. 

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(iii) If (i) and (ii) do not apply, assign the NOS code for the infectious 

or inflammatory condition . Do not assign a separate code for the 

 condition classified to A49 or B34. 

 Code for Record

 I (a) Klebsiella urinary tract infection N390 

Code to urinary tract infection (N390). The Index does not 

provide a code for Infection, urinary tract specified as bacterial, 

infectious, infective, or Klebsiella; therefore, code as indexed 

under Infection, urinary tract. 

Code for Record

 I (a) Pyelonephritis N12 

(b) Staphylococcus 

Code to pyelonephritis, unspecified (N12). The Index does 

not provide a code for pyelonephritis specified as bacterial, 

infectious, infective, or staphylococcal; therefore, code 

pyelonephritis NOS. 

Code for Record 

I (a) Pyelonephritis and pseudomonas N12 

Code to pyelonephritis, unspecified (N12). The index does 

not provide a code for pyelonephritis specified as bacterial, 

infectious, infective, or pseudomonas; therefore, code to 

pyelonephritis NOS. 

b. Organisms and infections classified to categories other than A49 and B34 

(1) When an infectious or inflammatory condition is reported and 

(a) Is preceded by a condition classifiable to Chapter I other than A49 or 

B34 

(i) Refer to the Index under the infectious or inflammatory condition. 

If a single code is provided for this condition, modified by the 

condition from Chapter I, use this code. It may be necessary to use 

“due to” or “in” in the Index to assign the appropriate code. 

 Code for Record 

I (a) Cytomegaloviral pneumonia B250 

Code to cytomegaloviral pneumonitis (B250). Code as indexed 

under Pneumonia, cytomegaloviral. 

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(ii) If (i) does not apply, refer to Volume 1, Chapter I to determine if 

the Classification provides an appropriate fourth character. 

Indications of appropriate fourth characters for sites would be 

“of other sites,” “other specified organs,” or “other organ 

involvement.” 

 Code for Record

 I (a) Candidiasis peritonitis B378 

 Code to candidiasis of other sites (B378). Since this term is 

not indexed together, refer to Volume 1 and select the fourth 

character .8, candidiasis of other sites. 

(iii) If (i) and (ii) does not apply, code as two separate conditions. 

Codes for Record

 I (a) Mononucleosis pharyngitis B279 J029 

Code to infectious mononucleosis, unspecified (B279). To 

assign the codes for the record, note that this term is not indexed 

together and Volume 1 does not provide an appropriate fourth 

character under B27.-; therefore, consider as two separate 

conditions. 

(b) A condition from Chapter I other than A49 or B34 is reported as the only 

entry or the first entry on the next lower line

 (i) Code each condition as indexed where reported.

 Codes for Record

 I (a) Peritonitis K659 

(b) Candidiasis B379 

Code to candidiasis of other sites (B378). Candidiasis is 

selected by the General Principle, and is a (SDC) with 

peritonitis. To assign the codes for the record, note that 

candidiasis is classified to a condition other than A49 or B34. 

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 Section III - Editing and Interpreting Entries 

(c) A condition from Chapter I other than A49 or B34 is reported separated 

by a connecting term not indicating a due to relationship 

(i) Code each condition as indexed where reported. 

 Codes for Record

 I (a) Pneumonia with candidiasis J189 B379 

Code to candidiasis, unspecified (B379). Pneumonia, selected 

by Rule 2 is a direct sequel (DS) of the candidiasis. To assign 

codes for the record, note that candidiasis is classified to a 

condition other than A49 or B34. 

c. Do not use HIV or AIDS to modify an infectious or inflammatory condition. 

 Consider as two separate conditions. 

 Codes for Record

 I (a) HIV pneumonia B24 J189 

Code to HIV disease with other infectious and parasitic diseases (B208). 

HIV, selected by Rule 2, links (LMC) with pneumonia into a combination 

code of B208. 

d. When an infectious or inflammatory condition is reported and 

(1) Infection NOS is reported as the only entry or the first entry on the next lower 

line 

 Code the infectious or inflammatory condition where it is entered 

on the certificate and do not enter a code for infection NOS, but 

take into account if it modifies the infectious condition.

 Codes for Record

 I (a) Cholecystitis & hepatitis K819 B159 

 (b) Infection 

Code to cholecystitis, unspecified (K819). To assign the codes 

for the record, note that infection is the only condition on (b). 

Code cholecystitis as indexed. Cholecystitis modified by 

infection is coded to cholecystitis NOS. Take into account that 

infection also modifies hepatitis and code as indexed under 

Hepatitis, infectious. 

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 Codes for Record

 I (a) Meningitis G039 

(b)Infection & brain tumor D432 

Code to neoplasm of uncertain or unknown behavior of brain 

(D432). To assign the codes for the record, note that infection is 

the first entry on (b). Code meningitis as indexed. Meningitis 

modified by infection is coded to meningitis NOS. 

e. When any condition is reported and a generalized infection such as bacteremia, 

fungemia, sepsis, septicemia, systemic infection, viremia is reported on a lower 

line, do not modify the condition by the generalized infection. 

 Codes for Record

 I (a) Bronchopneumonia J180 

(b)Septicemia A419 

 Code to septicemia, unspecified (A419) by General Principle. To assign the 

codes for the record, note that septicemia is a generalized infection and 

doesn’t modify the bronchopneumonia. 

7. Eaton-Lambert syndrome (C80)

 Code G708 (Eaton-Lambert syndrome unassociated with neoplasm)

 When reported on a record without a condition from the following categories also 

 reported:

 C000-D489 

Male, 57 years old Codes for Record 

I (a) Aspiration pneumonia J690 

(b)Eaton-Lambert syndrome G708 

Code Eaton-Lambert syndrome unassociated with neoplasm (G708) since there is no 

condition from categories C000 – D489 reported anywhere on the record. 

Female, 69 years old Codes for Record 

I (a) Eaton-Lambert syndrome C80

 (b)Small cell lung cancer C349 

Code to malignant neoplasm of lung (C349). Code I(a) Eaton-Lambert syndrome 

(C80) since there is a condition from categories C000-D489 reported on the record. 

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8. Erythremia (C940) 

Code D751 (Secondary erythremia) when reported due to conditions listed in the 

causation table under address code D751. 

 Codes for Record

 I (a) Septicemia A419 

(b) Erythremia D751 

 (c) Polycythemia D45 

Code to D45. The code D45 is listed as a subaddress to D751 in the causation 

table so this sequence is accepted. 

9. Polycythemia (D45) 

Code D751 (Secondary polycythemia) when reported due to conditions listed in the 

causation table under address code D751. 

Codes for Record

 I (a) Polycythemia D751 

(b)Pneumonia J189 

Code to J189. The code J189 is listed as a subaddress to D751 in the causation 

table so this sequence is accepted. 

10. Hemolytic Anemia (D589) 

Code D594 (Secondary hemolytic anemia) when reported due to conditions listed in 

the causation table under address code D594. 

 Codes for Record 

I (a) Hemolytic anemia D594 

(b) Hairy cell leukemia C914 

 (c) 

Code to C914. The code C914 is listed as a subaddress to D594 in the causation 

 table so this sequence is accepted. 

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11. Sideroblastic Anemia (D643) 

a. Code D641 (Secondary sideroblastic anemia due to disease) when reported due to 

conditions listed in the causation table under address code D641. 

Codes for Record

 I (a) Pneumonia J189 

(b) Sideroblastic anemia D641 

(c) Alcoholic cirrhosis K703 

Code to K703. The code K703 is listed as a subaddress to D641 in the 

causation table so this sequence is accepted. 

b. Code D642 (Secondary sideroblastic anemia due to drugs or toxins) when 

reported due to conditions listed in the causation table under address code D642. 

Codes for Record

 I (a) CHF I500 

(b)Sideroblastic anemia D642 

(c) Chloramphenicol Y402 

Code to D642. The code Y402 is listed as a subaddress to D642 in the 

causation table so this sequence is accepted. Since the condition being treated 

is not stated for this drug therapy and the complication is indexed to Chapters 

I-XVIII, select the complication as the underlying cause. 

12. Hemorrhagic Purpura NOS (D693) 

Code D690 (Hemorrhagic purpura not due to thrombocytopenia) when reported 

due to conditions listed in the causation table under address code D690. 

 Codes for Record

 I (a) CVA I64

 (b)Hemorrhagic purpura D690 

(c) Leukemia C959 

Code to C959. The code C959 is listed as a subaddress to D690 in the causation 

table so this sequence is accepted. 

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13. Thrombocytopenia (D696) 

Code D695 (Secondary thrombocytopenia) when reported due to conditions listed in 

the causation table under address code D695. 

Codes for Record

 I (a) Multiple hemorrhages R5800 

(b) Thrombocytopenia D695 

 (c) Cancer lung C349 

Code to C349. The code C349 is listed as a subaddress to D695 in the causation 

table so this sequence is accepted. 

14. Hyperparathyroidism (E213) 

Code E211 (Secondary hyperparathyroidism) when reported due to conditions listed 

in the causation table under address code E211. 

 Codes for Record

 I (a) Hypercalcemia E835 

 (b) Hyperparathyroidism E211 

 (c) Cancer parathyroid gland C750 

Code to C750. The code C750 is listed as a subaddress to E211 in the causation 

table so this sequence is accepted. 

15. Korsakov’s Disease, Psychosis or Syndrome (F106) 

Code F04 (nonalcoholic Korsakov’s disease) when reported due to conditions listed 

in the causation table under address code F04. 

 

Codes for Record 

I (a) Korsakoff’s psychosis F04

 (b) Wernicke’s encephalopathy E512 

 (c) 

 

Code to E512. The code E512 is listed as a subaddress to F04 in the causation 

table so this sequence is accepted. 

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16. Psychosis (any F29) 

Code F09 (Psychosis, organic NEC) when reported due to or on the same line with 

conditions listed in the causation table under address code F09. 

 Codes for Record

 I (a) Pneumonia 

(b) Psychosis - cerebrovascular 

 (c) arteriosclerosis

 (d) Arteriosclerosis 

J189 

F09 I672 

I709 

Code to I672. The code I709 is listed as a subaddress to F09 in the causation 

table so this sequence is accepted. Arteriosclerosis will link (LMP) with 

cerebrovascular arteriosclerosis in the modification table. 

17. Mental Disorder (any F99) 

Code F069 (Organic mental disorder) 

When reported due to or on the same line with conditions listed in the causation table 

under address code F069. 

 Codes for Record 

I (a) Cardiorespiratory arrest 

(b) Heart failure 

(c) Mental disorder 

(d) Multiple sclerosis 

I469 

I509 

F069 

G35 

Code to G35. The code G35 is listed as a subaddress to F069 in the causation 

table so this sequence is accepted. 

18. Parkinson’s Disease (G20) 

Advanced Parkinson’s Disease (G2000)

 Grave Parkinson’s Disease (G2000)

 Severe Parkinson’s Disease (G2000) 

a. Code G214 (Vascular parkinsonism) when reported due to conditions listed in the 

causation table under address code G214. 

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b. Code G219 (Secondary parkinsonism) when reported due to: 

A170-A179 B060 B949 R75 Y20-Y369 

A504-A539 B200-B24 F200-F209 S000-T357 Y600-Y849 

A810-A819 B261 G000-G039 T66-T876 Y850-Y872 

A870-A89 B375 G041-G09 T900-T982 Y881-Y899 

B003 B900 G20-G2000 T983 

B010 B902 G218-G219 X50-X599 

B021-B022 B91 G300-G309 X70-X84 

B051 B941 I950-I959 X91-Y09 

 

1. I (a) Parkinsonism G214 

 (b) Arteriosclerosis I709 

 (c) 

Code to G214 (Vascular parkinsonism) when reported due to conditions 

listed in the causation table under G214. 

2. I (a) Parkinson’s disease G219 

 (b) Tuberculous meningitis A170 

 (c) 

Code to G219 (Secondary parkinsonism) when reported due to conditions 

listed in the causation table under G219. 

3. I (a) Secondary Parkinson’s disease G219 

 (b) 

 (c) 

Code to G219 as indexed. 

19. Cerebral Sclerosis (G379) 

 

Code I672 (Cerebrovascular atherosclerosis) 

 a. When reported due to or on the same line with conditions listed in the causation

 table under address code I672. 

 Codes for Record 

I (a) Cerebral sclerosis I672 

 (b) Diabetes E149 

Code to E149. The code E149 is listed as a subaddress to I672 in the 

causation table so this sequence is accepted 

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b. When reported as causing: 

I600-I679 

I690-I698 

Codes for Record 

I (a) Cerebral thrombosis I633 

 (b) Cerebral sclerosis I672 

Code to I633. Code (b) as cerebrovascular atherosclerosis since reported as 

causing a cerebral thrombosis. Cerebrovascular atherosclerosis will link 

(LMP) with cerebral thrombosis. 

20. Myopathy (G729)

 Code I429 (Cardiomyopathy) 

 

 When reported due to: 

 

A150-A1690 E648-E649 R54 

A178 E660-E669 R75 

A181 E740 T360-T66 

A188 E760-E769 T97 

B332 E831 X45 

B560-B575 E880-E889 X65 

B948 I00-I259 Y15 

D500-D649 I300-I4290 Y400-Y599 

D758 I514-I5150 Y842 

E100-E149 I700-I709 Y86-Y872 

E40-E519 P200-P220 Y883 

E639 P916 

E641 R31 

Codes for Record 

I (a) Myopathy I429 

 (b) ASHD I251 

 (c) 

Code to I251. The code I251 is listed as a subaddress to I429 in the causation 

table so this sequence is accepted. 

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21. Paralysis (any G81, G82, or G83 excluding senile paralysis) 

Code the paralysis for decedent age 28 days and over to G80 (Infantile cerebral 

palsy) with appropriate fourth character: 

When reported due to: 

P000- P969 

 Female, 3 months Codes for Record

 I (a) Pneumonia 1 wk J189 

(b) Paraplegia 3 mos G808 

(c) Injury spinal cord since birth P115 

 Code to P115. Code the paraplegia to infantile cerebral palsy when reported 

 due to a newborn condition. 

22. Varices NOS and Bleeding Varices NOS (I839)

 a. Code I859 (Esophageal varices) or 

b. Code I850 (Bleeding esophageal varices) 

When reported due to or on same line with: 

Alcoholic disease classified to: F101-F109 

 Liver diseases classified to: B150-B199, B251, B942, K700-K769 

 Toxic effect of alcohol classified to: T510-T519, T97 

Codes for Record

 I (a) Varices I859 

(b)Cirrhosis of liver K746 

Code to K746. The code K746 is listed as a subaddress to I859 in the 

causation table; therefore, this sequence is accepted. 

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23. Pneumoconiosis (J64)

 Code J60 (Coal worker’s pneumoconiosis) 

When Occupation is reported as: 

Coal miner 

Coal worker 

Miner

 Occupation: Coal Miner Codes for Record

 I (a) Bronchitis J40

 (b) Pneumoconiosis J60 

Code to J60. Pneumoconiosis becomes coal worker’s pneumoconiosis when 

occupation is reported as coal miner. 

24. Alveolar Hemorrhage (diffused) (K088) 

Code R048 (Lung hemorrhage) when reported with conditions listed in the causation 

table under address R048. 

Codes for Record 

I (a) Respiratory failure J969 

(b)Alveolar hemorrhage R048 

Code to R048. The alveolar hemorrhage is reported on the record with a 

condition listed in the causation table under address R048. 

25. Diaphragmatic Hernia in K44.­

Code Q790 (Congenital diaphragmatic hernia) when reported as causing hypoplasia 

or dysplasia of lung NOS (Q336). 

I (a) Lung dysplasia 

(b) Diaphragmatic hernia 

 (c) 

 Codes for Record 

Q336 

Q790 

Code to congenital diaphragmatic hernia (Q790). The code Q790 is listed as 

a subaddress to Q336 in the causation tables; therefore, this sequence is 

accepted. 

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26. Laennec’s Cirrhosis NOS (K703) 

 Code K746 (Nonalcoholic Laennec’s cirrhosis) 

 When reported due to: 

A000-B99 K710-K718 Y574-Y599 

C000-D539 K730-K760 Y640 

D730-D739 K761 Y86 

E02-E0390 K763 Y870-Y872 

E100-E149 K768-K851 Y880 

E500-E519 K853-K859 Y881 

E52 K861-K909 

E530-E849 Q410-Q459 

F110-F169 Q900-Q999 

F180-F199 R75 

I050-I099 T360-T509 

I110-I119 T520-T659 

I130-I4250 T97 

I427-I519 X40-X44 

I81 X46-X49 

K500-K519 Y400-Y572 

K630-K639 Y573 

 

 Codes for Record 

I (a) Cardiac arrest I469 

 (b) Laennec’s cirrhosis K746 

 (c) Diabetes E149 

Code to E149. The code E149 is listed as a subaddress to K746 in the 

causation table; therefore, this sequence is accepted. 

27. Biliary Cirrhosis NOS (K745) 

Code K744 (Secondary biliary cirrhosis) 

When reported due to conditions listed in the causation table under address 

code K744. 

 Codes for Record

 I (a) Biliary cirrhosis K744 

(b) Carcinoma pancreas C259 

 (c) 

Code to C259. The code C259 is listed as a subaddress to K744 in the causation 

table; therefore, this sequence is accepted. 

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28. Lupus Erythematosus (L930)

 Lupus (L930)
 
 

Code M321 (Systemic lupus erythematosus with organ or system involvement) 

When reported as causing a disease of the following systems: 

 

Anemia 

 Circulatory (including cardiovascular, 

 lymph nodes, spleen) 

 Gastrointestinal 

 Musculoskeletal

 Respiratory

 Thrombocytopenia 

 Urinary 
 

 

Codes for Record

 I (a) Nephritis N059 

(b) Lupus erythematosus M321 

 (c) 

Code to M321. Lupus is reported as causing a disease of the urinary system; 

therefore, it is coded as systemic lupus erythematosus. 

29. Gout (M109) 

Code M104 (Secondary gout) 

When reported due to conditions listed in the causation table under address 

code M104. 

Codes for Record

 I (a) Perforated gastric ulcer K255 

(b) Gout M104 

 (c) Waldenstrom’s macroglobulinemia C880 

Code to C880. The code C880 is listed as a subaddress to M104 in the causation 

table; therefore, this sequence is accepted. 

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30. Kyphosis (M402) 

Code M401 (Secondary kyphosis) 

When reported due to conditions listed in the causation table under address 

code M401. 

Codes for Record

 I (a) COPD J449 

(b) Kyphosis M401 

(c) Spinal osteoarthritis M479 

Code to M479. The code M479 is listed as a subaddress to M401 in the causation 

table; therefore, this sequence is accepted. 

31. Scoliosis (M419) 

Code M415 (Secondary scoliosis) 

When reported due to conditions listed in the causation table under address 

code M415. 

Codes for Record

 I (a) Pneumonia J189 

(b) Scoliosis M415 

(c) Progressive systemic sclerosis M340 

Code to M340. The code M340 is listed as a subaddress to M415 in the causation 

table; therefore, this sequence is accepted. 

32. Osteonecrosis (M879) 

Code M873 (Secondary osteonecrosis) 

When reported due to conditions listed in the causation table under address 

code M873. 

Codes for Record

 I (a) Septicemia A419 

(b)Osteonecrosis hip M873 

(c) Infective myositis M600 

Code to M600. The code M600 is listed as a subaddress to M873 in the causation 

table; therefore, this sequence is accepted. 

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33. Cesarean Delivery for Inertia Uterus (O622)

 Hypotonic Labor (O622)

 Hypotonic Uterus Dysfunction (O622)

 Inadequate Uterus Contraction (O622)

 Uterine Inertia During Labor (O622)
 

Code O621 (Secondary uterine inertia) 

When reported due to conditions listed in the causation table under address 

code O621. 

Codes for Record

 I (a) Uterine inertia O621 

(b)Diabetes mellitus of pregnancy O249 

Code to O249. The code O249 is listed as a subaddress to O621 in the causation 

table; therefore, this sequence is accepted. 

34. Brain Damage, Newborn (P112) 

Code P219 (Anoxic brain damage, newborn) when reported due to conditions listed 

in the causation table under address P219. 

 Male, 9 hours Codes for Record 

I (a) Brain damage P219 

(b)Congenital heart disease Q249 

 Code to Q249. The code Q249 is listed as a subaddress to P219 in the 

 causation table; therefore, this sequence can be accepted. 

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35. Intracranial Nontraumatic Hemorrhage of Fetus and Newborn (P52) 

Code P10 (Intracranial laceration and hemorrhage due to birth injury) with the 

appropriate fourth character. 

When reported due to conditions listed in the causation table under address 

code P10: 

 Male, 9 hours Codes for Record

 I (a) Cerebral hemorrhage P101 

(b)Fractured skull during birth P130 

Code to P130. The code P130 is listed as a subaddress to P101 in the causation 

table; therefore, this sequence is accepted. 

36. Hypoplasia or Dysplasia of Lung NOS (Q336) 

Code P280 (Primary atelectasis of newborn) 

When reported anywhere on the record with the following codes and not reported 

due to diaphragmatic hernia in K44.- or in Q790, and there is no indication that the 

condition was congenital: 

A500-A509 P280 

B200-B24 P350-P399 

P000-P009 P612 

P011-P013 Q600-Q611 

P050-P073 Q613-Q649 

P220-P229 R75 

 Codes for Record

 I (a) Hypoplasia lung P280 

 (b)

 (c)

 II Prematurity P073 

 Code to primary atelectasis of newborn (P280). 

 Female, 5 hrs. Codes for Record

 I (a) Dysplasia of lung 5 hrs Q336 

 (b)

 (c)

 II Hyaline membrane disease P220 

Code to Q336 since the duration and age are the same indicating that the 

condition was congenital. 

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37. Fracture (any site) (T142) 

Code M844 (Pathological fracture) 

a. When reported due to: 

A180 

A500-A509 

A521 

A527-A539 

A666 

C000-C97 

D160-D169 

D480 

D489 

E210-E215 

E550-E559 

E896-E899 

G120-G129 

M000-M1990 

M320-M351 

M359 

M420-M429 

M45-M519 

M600 

M800-M839 

M843-M851 

M854-M889 

M893-M895 

M898-M939 

M941-M949 

M960 

M966-M969 

Q770-Q789 

Q799 

T810-T819 

T840-T849 

T870-T889 

b. When reported on the same line with: 

C40-C41 

C795 

M80-M81 

M83 

M88 

NOTE: If a fracture qualifies as pathological, code all fractures reported of the 

 same site pathological as well.

 Codes for Record

 I (a) Fracture hip M844 

(b) Osteoarthritis M199 

 Code to M199. The code M199 is listed as a subaddress to M844 in the 

 causation table; therefore, this sequence is accepted. 

 Codes for Record

 I (a) Aspiration pneumonia J690 

(b)Left hip fracture M844 

 II Hip fracture, anemia, osteoporosis M844 D649 M819 

Code to M809. Hip fracture in Part II is reported on the same line with 

osteoporosis and is coded as pathological. Since fracture of the same site is 

reported on (b), it is coded as pathological as well. The sequence is accepted 

and Rule C is applied. 

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38. Starvation NOS (T730) 

Code E46 (Malnutrition NOS) 

When reported due to conditions listed in the causation table under address 

code E46. 

Codes for Record

 I (a) Anemia D649 

 (b) Starvation E46

 (c) Cancer of esophagus C159 

Code to C159. Code I(b) as malnutrition since reported due to cancer of 

esophagus. 

39. Compartment Syndrome (T796)

 Code M622 (Nontraumatic compartment syndrome) 

When reported due to conditions listed in the causation table under address 

code M622. 

Codes for Record 

I (a) Compartment syndrome M622 

(b)Hemorrhagic pancreatitis K859 

 Code to K859. Code I (a) M622 since reported due to pancreatitis. 

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L. Effect of duration on classification 

In evaluating the reported sequence of the direct and antecedent causes, the interval 

between the onset of the disease or condition and time of death must be considered. This 

would apply in the interpretation of “highly improbable” relationships (Section III, A, 2) 

and in Modification Rule F (Sequela). 

1.	 Duration on a lower line in Part I shorter than that of one reported above it 

If a condition in a “due to” position is reported as having a duration which is shorter 

than that of one above it, the condition on the lower line is not accepted as the cause. 

Codes for Record

 I (a) Congestive heart failure 2 days I500 

(b) Pneumonia 10 days J189 

 (c) Cerebral embolism 3 days I634 

Code to pneumonia (J189), selected by Rule 1. The duration on I(c) prevents the 

selection of cerebral embolism as the underlying cause of the condition on I(b). 

 Codes for Record

 I (a) Congestive heart failure 1-10-99 I500 

(b) Pneumonia 2-08-99 J189 

 (c) Cerebral embolism 1-20-99 I634 

Code to congestive heart failure (I500), selected by Rule 2. The stated date for the 

condition reported on I(a) predates those reported on I(b) and I(c); therefore, 

neither is accepted as the cause of the condition on I(a). 

 

2.	 Two conditions with one duration 

When two or more conditions are entered on the same line with one duration, the 

duration is disregarded since there is no way to establish the condition to which the 

duration relates. 

 

 Codes for Record

 I (a) Chronic myocarditis 2 yrs I514 

 (b) Chronic nephritis 2 mos N039 N19 

 (c) with renal failure 

Code to chronic nephritis (N039), selected by Rule 1. The duration for the 

conditions reported on I(b) is disregarded. 

 

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 Codes for Record

 I (a) Myocardial ischemia 

 (b) and myocardial 

 (c) infarction 

 2 yrs I259 I219 

 

Code to I219. The duration is disregarded. Myocardial ischemia (I259), selected 

by Rule 2, links (LMP) with myocardial infarction (I219). 

3. Qualifying conditions as acute or chronic

 a. Usually the interval between onset of a condition and death should not be used 

to qualify the condition as “acute” or “chronic.” However, when assigning codes 

to certain conditions classified as “Ischemic heart diseases” the Classification 

provides the following specific guidelines for classifying a condition with a 

stated duration as acute or chronic: 

 - acute or with a stated duration of 4 weeks or less 

 - chronic or with a stated duration of over 4 weeks 

 Code for Record

 I (a) Nephritis 2 years N059 

 

 Code to nephritis, unqualified (N059). Do not use duration to 

 qualify as chronic.

 Code for Record

 I (a) Acute myocardial infarction 3 mos. I258 

 (b)

 (c) 

Code to infarction, myocardium, acute, with a stated duration of over 4 

weeks, I258. 

 

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b. For the purpose of interpreting these instructions: 

Consider these terms: To mean: 

brief 

days 

hours 

immediate 

instant 

minutes 

recent 

short 

sudden 

weeks (few) (several) 

4 weeks or less 

or acute 

longstanding 

1 month 

over 4 weeks 

or chronic 

Duration Code for Record

 I (a) Aneurysm heart weeks I219 

 (b)

 (c) 

Code to aneurysm, heart, with a stated duration of 4 weeks or less, I219. 

“Weeks” is interpreted to mean 4 weeks or less. 

When the interval between onset of a condition and death is stated to be 

“acute” or “chronic,” consider the condition to be specified as acute or 

chronic. 

Duration Codes for Record

 I (a) Heart failure 1 hour I509 

(b) Bronchitis acute J209 

 Code to “acute” bronchitis (J209) since “acute” is reported in the duration 

 block. 

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c. Exacerbation 

Interpret “exacerbation” as an acute phase of a disease. Code “exacerbation” of a 

chronic specified disease to the acute and chronic stage of the disease if the 

Classification provides separate codes for “acute” and “chronic.” 

Codes for Record

 I (a) Exacerbation of chronic J441 J449 

 obstructive lung disease 

Code to the acute and chronic stages of the specified disease since the 

Classification provides separate codes for the “acute” and “chronic.” The 

underlying cause code is J441, selected by Rule 2. 

 Codes for Record

 I (a) Chronic obstructive lung disease exacerbation J449 J441 

Code to J441, chronic obstructive lung disease with acute exacerbation. 

d. Acute and chronic 

Sometimes the terms, acute and chronic, are reported preceding two or more 

diseases. In these cases, use the term (“acute” or “chronic”) with the condition it 

immediately precedes.

 Codes for Record

 I (a) Chronic renal and liver failure N189 K7290 

Code to renal failure, chronic and liver failure NOS. The underlying cause is 

N189, selected by Rule 2. 

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4. Conflict in durations

 When conflicting durations are entered for a condition, give preference to the 

 duration entered in the space for interval between onset and death.

 Duration Code for Record

 I (a) Ischemic ht dis - 2 weeks years I259 

Use the duration in the block to qualify the ischemic heart disease. Code the 

underlying cause to I259, selected by the General Principle. 

5. Span of dates 

Interpret dates entered in the spaces for interval between onset and death that are 

separated by a slash (/), dash (-), etc., as meaning from the first date to the second 

date. Disregard such dates if they extend from one line to another and there is a 

condition reported on both of these lines since the span of dates could apply to either 

condition. 

 Date of death 10-6-98 Duration Codes for Record

 I (a) MI 10/1/98 - I219 

(b) Ischemic heart disease 10/6/98 I259 

 Disregard duration and code each condition as indexed since the dates extend 

 from I(a) to I(b). Code the underlying cause to I219. Ischemic heart disease 

 (I259), selected by the General Principle, links (LMP) with myocardial 

 infarction (I219). 

 Date of death 10-6-98 Duration Code for Record 

I (a) Aneurysm of heart 10/1/98 - 10/6/98 I219 

 (b) 

Since there is only one condition reported, apply the duration to this condition. 

The underlying cause is aneurysm, heart, acute or with a stated duration of 4 

weeks or less, I219. 

 Date of death l0-6-98 Duration Codes for Record

 I (a) Ischemic heart disease 10/1/98 - 10/6/98 I249 

(b) Arteriosclerosis I709 

Apply the duration to I(a). The underlying cause is I249. Arteriosclerosis, I709, 

selected by General Principle, links (LMP) with ischemic heart disease (I249). 

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6. Congenital malformations 

Conditions classified as congenital malformations, deformations and chromosomal 

abnormalities (Q00-Q99), even when not specified as congenital on the death 

certificate, should be coded as such if the interval between onset and death and the 

age of the decedent indicate the condition existed from birth.

 Female, 45 years Duration Codes for Record

 I (a) Heart failure I509 

(b) Stricture of aortic Q230 

 (c) valve 45 years 

Code to congenital aortic stricture (Q230) because the interval between onset and 

death and the age of the decedent indicates the condition existed from birth. 

7. Congenital conditions 

When a sequence is reported involving a condition specified as congenital due to 

another condition not so specified, both conditions may be considered as having 

existed from birth provided the sequence is a probable one. 

Codes for Record

 I (a) Renal failure since birth P960 

(b) Hydronephrosis Q620 

Code to congenital hydronephrosis (Q620) since this condition resulted in a 

condition reported as existing since birth. 

Do not use the interval between onset and death to qualify conditions classified to 

categories Q00-Q99, congenital anomalies, as acquired. 

Male, 62 years Duration Codes for Record

 I (a) Renal failure 3 months N19

 (b) Pulmonary stenosis 5 years Q256 

Code to Q256, Stenosis, pulmonary. Do not use the duration to qualify the 

pulmonary stenosis as acquired. 

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8. Sequela 

See Modification Rule F. 

9.	 Subacute 

In general, where ICD provides for acute forms of a disease but not for 

subacute, the subacute forms are classified as for acute. For example, subacute

 renal failure is coded to acute renal failure (N179). 

10. Maternal conditions 

Categories O95 (Obstetric death of unspecified cause), O960-O969 (Death from any 

obstetric cause occurring more than 42 days but less than one year after delivery), 

and O970-O979 (Death from sequela of obstetric causes) classify obstetric deaths 

according to the time elapsed between the obstetric event and the death of the 

woman. 

Category O95 is to be used when a woman dies during pregnancy, labor, delivery, or 

the puerperium and the only information provided is “maternal” or “obstetric” death. 

If the obstetric cause of death is specified, code to the appropriate category. 

Categories O960-O969 are used to classify deaths from direct or indirect obstetric 

causes that occur more than 42 days but less than a year after termination of the 

pregnancy. Categories O970-O979 are used to classify deaths from direct or indirect 

obstetric causes which occur one year or more after termination of the pregnancy. 

M. Effect of “age of decedent” on classification 

1.	 Age of the decedent should always be noted at the time the cause of death is 

being coded. Certain groups of categories are provided for certain age groups. There 

are many conditions within certain categories which cannot be properly classified 

unless the age is taken into consideration. 

 Generally the following definitions will apply to age at time of death: 

Newborn, Neonatal, Neonatorum - less than 28 days, even though death may 

have occurred later 

Infant or Infantile - less than 1 year 

Child - less than 18 years 

Male, 27 days Code for Record

 I (a) G.I. hemorrhage P543 

 Code to gastrointestinal hemorrhage of newborn (P543). 

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2. Congenital malformations 

Age at the time of death may be used for certain conditions to consider them 

congenital in origin. Assume the following conditions are congenital provided there 

is no indication that they were acquired after birth: 

If the age of the decedent is: 

a. Less than 28 days: 

 heart disease NOS

 hydrocephalus NOS 

 Female, 27 days Codes for Record

 I (a) Cerebral edema P524 

(b) Hydrocephalus Q039 

Code to congenital hydrocephalus (Q039) since the age of decedent is less 

than 28 days. 

b. Less than l year: 

aneurysm (aorta, aortic) (brain) (cerebral) (circle of Willis) (coronary) 

(peripheral) (racemose) (retina) (venous) 

aortic stenosis 

atresia 

atrophy of brain 

cyst of brain 

deformity 

displacement of organ 

ectopia of organ 

hypoplasia of organ 

malformation 

pulmonary stenosis 

valvular heart disease (any valve) 

 Male, 2 months Codes for Record

 I (a) Cardiac failure I509 

(b) Aortic stenosis Q230 

Code to congenital aortic stenosis (Q230) since the age of decedent is less 

than 1 year. 

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N. Sex and age limitations 

Where the underlying cause of death is inconsistent with the sex or appears to be 

inconsistent with the age, the accuracy of the underlying cause of death should be 

re-examined and the age and/or sex should be verified. 

If the sex and cause are inconsistent, the accuracy of the sex entry on the death certificate 

should be determined through examination of name, occupation, and other items on the 

certificate. If the sex is determined to be incorrect, correct the data record. If the sex 

entry is correct but not consistent with the underlying cause of death, the death should be 

coded to “Other ill-defined and unspecified causes of mortality” (R99). 

If the age and cause are inconsistent, the age should be verified by subtracting the date of 

birth from the date of death and the coded entry should be corrected. Care should be 

exercised in selecting the correct underlying cause of death in terms of age restrictions 

in ICD. 

Detailed ICD category-age-sex cross edits are contained in the NCHS Instruction 

Manual, Part 11 (Computer Edits for Mortality Data). These edits are carried out through 

computer applications that provide listings for correcting data records to resolve data 

inconsistencies. These listings contain both absolute edits for which age-cause and/or 

sex-cause must be consistent and conditional edits of age-cause which are unlikely but 

acceptable following reverification of coding accuracy. 

O. Interpretation of expressions indicating doubtful diagnoses 

1. Doubtful qualifying expressions 

Conditions qualified by expressions such as “apparently,” “presumably,” “?,” 

“perhaps,” and “possibly” which throw doubt on the statement of cause of death are to 

be accepted as though no such qualifications were made. The rules for selection will 

be followed in determining the underlying cause, with no special preference given to 

conditions which are not qualified by these expressions. When a condition is qualified 

by “rule out,” “ruled out,” “r/o,” etc., do not assign a code for the condition. When two 

conditions are reported on one line and both are preceded by one of these doubtful 

expressions, consider as a statement of either/or. 

Codes for Record

 I (a) Hemorrhage of stomach K922 

 (b) Probable ulcers of the stomach K259 

 Code to ulcer of stomach with hemorrhage (K254). 

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 Section III - Editing and Interpreting Entries 

2. Interpretation of ‘either...or...” 

a. When the condition is qualified by “either ... or ...” with respect to anatomical site, 

assign to the residual category for the group or anatomical system in which the sites 

are classified. 

 Code for Record

 I (a) Cancer of kidney or bladder C689 

Code to malignant neoplasm of unspecified urinary organs (C689). 

b. When the condition is qualified by “either ... or ...” with respect to sites in different 

anatomical systems, assign to the residual category for the disease or condition 

specified. 

Code for Record

 I (a) Cancer of adrenal or kidney C80 

Code to malignant neoplasm without specification of site (C80) since adrenal 

and kidney are in different anatomical systems. 

c. When different diseases or conditions are qualified by “either ... or ...,” and only 

one anatomical site/system is involved, assign to the residual category relating to 

the anatomical site/system. 

Code for Record

 I (a) Tuberculosis or cancer of lung J9840 

Code to disease of lung (J984). Both conditions involve the lung. 

Code for Record

 I (a) Stroke or heart attack I99 

Code to disease, circulatory system (I99). Both conditions are in the 

 circulatory system. 

NOTE: When embolism and thrombosis are qualified by a statement of 

“either...or...”, code to Clot (I749). 

 Code for Record 

I (a) Cardiac thrombosis vs pulmonary embolism I749 

Code to I749, clot (blood). Embolism and thrombosis are both blood clots, and 

Clot NOS is a more specific category than Disease, circulatory system. 

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d. When different diseases or conditions are classifiable to the same three character 

category with different fourth characters, assign to the three character category with 

fourth character “9.” 

Code for Record

 I (a) ASCVD or ASHD I259 

Code to the residual category for ischemic heart disease (I259). 

e. When different diseases or conditions are classifiable to different three character 

categories and Volume 1 provides a residual category for the disease in general, 

assign the residual category. 

Code for Record

 I (a) MI or coronary aneurysm I259 

 Code to the residual category for ischemic heart disease (I259) using Volume 1. 

f. When different diseases or conditions involving different anatomical systems are 

qualified by “either ... or ...,” assign to “other specified general symptoms and 

signs (R688). 

Code for Record

I (a) Gallbladder colic or R688 

 (b) coronary thrombosis 

 Code to other specified general symptoms and signs (R688). 

g. When diseases and injuries are qualified by “either ... or ...,” assign to “other illdefined and unspecified causes of mortality” (R99). 

 Code for Record

 I (a) Coronary occlusion or R99

 (b) war injuries

 Code to other ill-defined and unspecified causes of mortality (R99). 

For doubtful diagnosis involving accidents, suicides, and homicides, refer to Section

 IV, B, Y10-Y34. 

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P. Interpretation of nonmedical connecting terms used in reporting 

The following connecting terms should be interpreted as meaning “due to, or as a 

consequence of” when the entity immediately preceding and following these terms is a 

disease condition, nature of injury or an external cause: 

after 

arising in or during 

as (a) complication of 

as a result of 

because of 

caused by 

complication(s) of 

during

etiology

following 

for 

from 

in 

incident to 

incurred after 

incurred during 

incurred in 

incurred when 

induced by 

occurred after 

occurred during 

occurred in 

occurred when 

occurred while 

origin 

 received from 

 received in 

resulting from 

resulting when 

secondary to (2°) 

subsequent to 

sustained as 

sustained by 

sustained during 

sustained in 

sustained when 

 sustained while 

The following terms are interpreted to mean that the condition following the term was 

due to the condition that preceded it: 

as a cause of led to 

cause of manifested by 

caused producing 

causing resulted in 

followed by resulting in 

induced underlying 

leading to with resultant 

 with resulting 

The following terms are interpreted to mean “or”: 

and/or 

 versus 

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The following terms imply that the conditions are meant to remain on the same line. They 

are separated by “and” or by another connecting term that does not imply a “due to” 

relationship: 

_ and with ( c ) 

accompanied by precipitated by 

also predisposing (to) 

associated with superimposed on 

complicated by 

complicating 

consistent with 

Q. Deletion of “due to” on the death certificate 

When the certifier has indicated conditions in Part I were not causally related by marking 

through items I(a), I(b), I(c) and/or I(d), or through the printed “due to, or as a 

consequence of” which appears below items I(a), I(b), and I(c) on the death certificate, 

proceed as follows: 

1. If the deletion(s) indicates none of the conditions in Part I were causally related, 

consider as though all of the conditions had been reported on the uppermost used line. 

Codes for Record

 I (a) Heart disease I519 I10 N039 

 (b) Malignant hypertension 

 (c) Chronic nephritis 

 II Cancer of kidney C64 

Code to heart disease, unspecified (I519), by Selection Rule 2. 

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 Codes for Record

 I (a) Congestive heart failure I500 I251 

 (b) ASHD 

 (c)

 II Pneumonia J189 

Code to arteriosclerotic heart disease (I251). Congestive heart failure, selected by 

Rule 2, links (LMP) with ASHD. 

2. If only item, I(c) or the printed “due to, or as a consequence of” (which appears below 

line I(b)) is marked through, consider the condition(s) reported on line I(c) as though 

reported as the last entry (or entries) on the preceding line. 

 Codes for Record

 I (a) Heart block I459 

 (b) Chronic myocarditis I514 I619 

 (c) Cerebral hemorrhage 

II Bronchopneumonia J180 

 Code to myocarditis, unspecified (I514) by Selection Rule 1. 

3. If only one item, for example, “I(b)” or the printed “due to, or as a consequence of” 

 (which appears below line I(a)) is marked through, consider the condition(s) 

 reported on line I(b) as though reported as the last entry (or entries) on the 

 preceding line. 

 

Codes for Record

 I (a) Cardiac arrest I469 K746 

 (b) 	 Cirrhosis of liver 

(c) Alcoholism F102 

 

Code to alcoholic cirrhosis of liver (K703). Alcoholism is selected by the 

General Principle, and is linkage with mention of combination (LMC) with 

cirrhosis of liver. 

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 4. If the “due to, or as a consequence of” is partially deleted, consider as if 

 completely deleted.

 Codes for Record

 I (a) Cardiorespiratory failure R092 Due to, or as a consequence of

 (b) Infarction of brain I639 I251 Due to or, as a consequence of

 (c) Coronary arteriosclerosis 

 

Code to infarction of brain (I639) by applying Rule 1. Consider coronary 

 arteriosclerosis as the second entry on I(b). 

R. Numbering of causes reported in Part I 

Where the certifier has numbered all causes or lines in Part I, that is, 1, 2, 3, etc., the 

originating antecedent is selected by applying Selection Rule 2. In the application of this 

rule, consideration is given to all causes which are numbered whether or not the 

numbering is extended into Part II. This provision applies whether or not the “due to” on 

lines I(b), I(c), and/or I(d) are marked through. 

 Codes for Record 

I (a) 1. Coronary occlusion I219 E149 I10 I709 N289 J1110 

(b) 2. Diabetes, chronic, severe 

(c) 3. Hypertension and arteriosclerosis 

 4. Renal disease 
 

II 5. Influenza, 1 week 

 Code to coronary occlusion (I219) by applying Selection Rule 2. 

Where part of the causes in Part I are numbered, the interpretation is made on an 

individual basis. 

 

Codes for Record 

I (a) Bronchopneumonia J180 

 (b) 1. Cancer of stomach C169 E149 

 (c) 2. Diabetes 

 

Code to cancer of stomach (C169) by applying Selection Rule 1. The conditions 

 numbered 1. and 2. are considered as if they were reported on I(b). 

 119	 2a January 2011 
 

 

 

 

 

 

 

 

 Section III - Editing and Interpreting Entries 

S . Terms that stop the sequence

 Includes: 

Cause not found 

Cause unknown 

Cause undetermined 

Could not be determined 

Etiology never determined 

Etiology not defined 

Etiology uncertain 

Etiology unexplained 

Etiology unknown 

Etiology undetermined 

Etiology unspecified 

Final event undetermined 

Immediate cause not determined 

I (a) Cardiac arrest 

(b) Stroke

(c) Cause unknown 

(d) Diabetes 

Immediate cause unknown 

No specific etiology identified 

No specific known causes 

Nonspecific causes 

Not known 

Obscure etiology 

Undetermined 

Uncertain 

Unclear 

Unexplained cause 

Unknown 

? Cause 

? Etiology

 Codes for Record 

I469 

 I64 

E149 

 Code to stroke (I64) using Rule 1. “Cause unknown” on line (c) stops the sequence. 

 Codes for Record

 I (a) Pneumonia J189 

(b) Intestinal obstruction K566 

(c) Undetermined 

(d) Ulcerative colitis K519 

Code to ulcerative colitis (K519). “Undetermined” on line (c) stops the sequence. 

Intestinal obstruction, selected by Rule 1, is considered a direct sequel (DS) of the 

ulcerative colitis. 

Codes for Record 

I (a) Gastric ulcer, cause unknown K259 

(b) Rheumatoid arthritis 

(c) M069 

 Code to gastric ulcer (K259). “Cause unknown” on line (a) stops the sequence. 

120 2a January 2011 
 

 

 

 

 

 

 

 

 

 Section III - Editing and Interpreting Entries 

T. Querying cause of death 

Because the selection of the underlying cause of death is based on how the physician 

reports causes of death as well as what he reports, State and local vital statistics offices 

should query certifying physicians where there is doubt that the manner of reporting 

reflects the true underlying cause of death. Querying is most valuable when carried out by 

persons who are thoroughly familiar with mortality medical classification. 

It is possible to choose a presumptive underlying cause for any cause-of-death 

certification no matter how poorly reported. However, selecting the cause by arbitrary 

rules (Rules 1-3) is not only difficult and time consuming, but the end results often are not 

satisfactory. No set of arbitrary procedures can deduce what was in the physician’s mind 

when he certified the cause of death. Querying can be used to great advantage to inform 

physicians of the proper method of reporting causes of death. It is hoped that intensive 

querying and other educational efforts will reduce the necessity of resorting to arbitrary 

rules, and at the same time improve the quality and completeness of the reporting. 

When a certifier is queried about a particular cause or for inadequate or missing 

information he may or may not have at hand, the query should be specific. It should be 

worded in such a manner that it requires a minimum amount of the certifier’s time. When 

the queries are sufficiently specific to elicit specific replies, the final coding should reflect 

this additional information from the certifier. 

The NCHS uses the additional information (AI) filmed following the record or received on 

a separate supplemental document in assigning the underlying cause of death. 

 Codes for Record

 I (a) Congestive heart failure I500 

(b)Renal disease N059 

AI Renal disease was nephritis 

Code to N059, unspecified nephritic syndrome. It is assumed the query was to 

establish the specific renal disease.

 Codes for Record

 I (a) Congestive heart failure I500 

(b)Hypostatic pneumonia J182 

(c) C349 

AI Underlying cause was cancer of lung 

Code to C349, cancer of lung. It is assumed the query was to establish the cause of 

the hypostatic pneumonia. 

121 2a January 2011 
 

 

 

 

 Section III - Editing and Interpreting Entries 

Codes for Record

 I 

AI 

(a) Pulmonary embolism

(b) Myocarditis 

(c) Arteriosclerosis 

(d) 

 Underlying cause was cancer of g.i. tract 

I269 

I514 

I709 

C269 

Code to I514, myocarditis. The additional information cannot be used to replace the 

reported underlying cause. The reply alone is not sufficient. If this case was 

queried, either the question or the circumstances of why the AI was included should 

also have been reported. If the AI had included “the conditions on (b) and (c) 

should be in Part II,” the reply would have been self-explanatory. 

122 2a January 2011 
 

 

 


 


 

Section IV - Classification of Categories 

SECTION IV
 

CLASSIFICATION OF CERTAIN ICD CATEGORIES
 

A. Infrequent and Rare Causes of Death in the United States 

The ICD contains conditions which are infrequent causes of death in the United States. If 

one of these conditions (see Appendix A) is reported as a cause of death, the 

diagnosis should have been confirmed by the certifier or the State Health Officer when it 

was first reported. A notation of confirmation should be recorded on the copy of the 

certificate sent to NCHS. In the absence of this notation, the NCHS coder will code the 

disease as stated; the State Health Officer will be contacted at the time of reconciliation of 

rejected data record by control cycle to confirm the accuracy of the certification. 

B. Coding Specific Categories 

The following are the international linkages and notes with expansions and additions 

concerning the selection and modification of conditions classifiable to certain categories. 

They are listed in tabular order. Notes dealing with linkages appear at the category from 

which the combination is EXCLUDED. Therefore, reference should be made to the 

category or code within parentheses before making the final code assignment. For a more 

complete listing, refer to NCHS Instruction Manual, Part 2c, ICD-10 ACME Decision 

Tables for Classifying the Underlying Causes of Death, 2011. 

The following notes often indicate that if the provisionally selected code, as indicated in 

the left-hand column, is present with one of the conditions listed below it, the code to be 

used is the one shown in bold type. There are two types of combination: 

“with mention of” means that the other condition may appear anywhere on the certificate; 

“when reported as the originating antecedent cause of” means that the other condition 

must appear in a correct causal relationship or be otherwise indicated as being “due to” the 

originating antecedent cause. 

A00-B99 Certain infectious and parasitic diseases 

Except for human immunodeficiency virus [HIV] disease (B20-B24), 

when reported as the originating antecedent cause of a malignant 

neoplasm, code C00-C97. 

123 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

A15.­ Respiratory tuberculosis, bacteriologically and histologically confirmed 

Not to be used for underlying cause mortality coding. 

A16.0 

A16.1 

 Tuberculosis of lung, bacteriologically and histologically negative 

 Tuberculosis of lung, bacteriological and histological examination not 

done 

 Not to be used for underlying cause mortality coding. 

A16.2-.9 Respiratory tuberculosis, not confirmed bacteriologically or histologically 

with mention of: 

J60-J64 (Pneumoconiosis), code J65

 A17.­

A18.­

 Tuberculosis of nervous system

 Tuberculosis of other organs 

with mention of: 

A16.­ (Respiratory tuberculosis), code A16.-, unless reported as the 

originating antecedent cause of and with a specified duration exceeding 

that of the condition in A16.- 

A22.­ Anthrax 

Not to be used as the underlying cause if reported with accident, 

homicide, suicide anywhere on the record, could not be determined in the 

Manner of Death box only, or designated as an act of terrorism. Code 

accident (X58), homicide (Y08), suicide (X83), could not be 

determined (Y33), or terrorism (U016) 

124 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

A35 Other tetanus

 INCLUDES: accidents with mention of tetanus 

I (a) Tetanus

 (b) Contusion, foot 

 II Accident: Fall 

Codes for Record

 A35

 S903 

 W19

 Code to tetanus (A35). 

I (a) Tetanus

 (b) Fracture of hip 

II 

Codes for Record

 A35

 S720 

X590 

Code to tetanus (A35). 

A39.2 

A39.3 

A39.4 

 Acute meningococcemia 

 Chronic meningococcemia

 Meningococcemia, unspecified 

with mention of:

 A39.0 (Meningococcal meningitis), code A39.0 

A39.1 (Waterhouse-Friderichsen syndrome), code A39.1

 A40.­

A41.­

 A46

 Streptococcal septicemia 

 Other septicemia

 Erysipelas 

Code to these diseases when they follow a superfi 

condition in S00, S10, S20, S30, S40, S50, S60, S 

T09.0, T11.0), or first degree burn; when they foll 

injury, code to the external cause of the injury. 

cial injury (any 

70, S80, S90, T00, 

ow a more serious 

I (a) Septicemia 

(b) Contusion, foot 

 II Accident: Fall 

Codes for Record

 A419 

S903 

 W19

 Code to septicemia, unspecified (A419). 

125 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

 Codes for Record

 I (a) Septicemia A419 

(b)Fracture of hip S720 

II X590 

 Code to external event causing fracture of hip (X590). 

A49.- Bacterial infection of unspecified site 

This category INCLUDES infection by bacterial organisms unspecified as 

to location or disease and not classified elsewhere. Specific disease 

conditions indicated to have been bacterial in origin are classified to the 

specified disease rather than to A49. Examples: staphylococcal enteritis 

is classified to A04.8 and pseudomonas pneumonia is classified to J15.1. 

A80.9 Acute poliomyelitis, unspecified 

This category INCLUDES poliomyelitis specified as acute unless there is 

clear indication that death occurred more than one year after the onset of 

poliomyelitis. It also INCLUDES poliomyelitis not specified as acute if it 

is clearly indicated that death occurred less than one year after onset of 

the poliomyelitis. Otherwise, poliomyelitis should be assigned to Sequela 

of poliomyelitis (B91). 

 B16 Acute hepatitis B

 B17 Other acute viral hepatitis 

when reported as the originating antecedent cause of: 

 K72.1 (Chronic hepatic failure), code B18.- 

 K74.0-K74.2, K74.4-K74.6 (Fibrosis and cirrhosis of liver), code B18.- 

B20-B24 Human immunodeficiency virus [HIV] disease 

Modes of dying, ill-defined and trivial conditions reported as 

complications of HIV infection should not be linked to categories in 

B20-B24 and R75, unless there is a specific entry in Volume 3 to that 

effect. 

Conditions classifiable to two or more subcategories of the same category 

should be coded to the .7 subcategory of the relevant category (B20 or B21). 

If a condition classifiable to categories A00-B19, B25-B49, B58-B64, 

B99, to which sequela rules apply, is mentioned on the record with HIV 

(B200-B24, R75), use the active phase of the condition in the application 

of selection and modification rules. 

126 2a January 2011 
 

 

 

 

Section IV - Classification of Categories 

When a blood transfusion is given as treatment for any condition (e.g. a 

hematological disorder) and an infected blood supply results in a HIV 

infection, code the HIV as the underlying cause and not the treated 

condition. 

B22.7 HIV disease with multiple diseases classified elsewhere 

This subcategory should be used when conditions classifiable to two or 

more categories from B20-B22 are listed on the certificate. 

B34 Viral infection of unspecified site 

This category INCLUDES viral infections unspecified as to location or 

disease and not classified elsewhere. Specific disease conditions 

indicated to have been viral in origin are classified to the specific disease 

rather than to B34. Examples: adenovirus enteritis is classified to A082, 

and acute viral bronchitis is classified to J208. 

B95-B97 Bacterial, viral and other infectious agents 

Not to be used for underlying cause mortality coding. 

C00-D48 Neoplasms 

Separate categories are provided for coding malignant primary and 

secondary neoplasms (C00-C96), Malignant neoplasms of independent 

(primary) multiple sites (C97), carcinoma in situ (D00-D09), benign 

neoplasms (D10-D36), and neoplasms of uncertain or unknown behavior 

(D37-D48). Categories and subcategories within these groups identify 

sites and/or morphological types. 

Morphology describes the type and structure of cells or tissues (histology) 

as seen under the microscope and the behavior of neoplasms. The ICD 

classification of neoplasms consists of several major morphological 

groups (types) including the following: 

Carcinomas including squamous cell carcinoma and adenocarcinoma 

Sarcomas and other soft tissue tumors including mesotheliomas 

Lymphomas including Hodgkin’s lymphoma and non-Hodgkin’s 

lymphoma 

Site-specific types (types that indicate the site of the primary 

neoplasm) 

Leukemias 

Other specified morphological groups 

127 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 


 

Section IV - Classification of Categories 

The morphological types of neoplasms are listed following Chapter XX in 

Volume 1. They are also described in Volume 3 (the Alphabetical Index) 

with their morphology code and with an indication as to the coding by 

site. The morphological code numbers consist of five characters: the first 

four identify the histological type of the neoplasm and the fifth, following 

a slash, indicates its behavior. These morphological codes (M codes) are 

not used by NCHS for coding purposes. 

The behavior of a neoplasm is an indication of how it will act. The 

following terms describe the behavior of neoplasms: 

Malignant, primary site (capable of rapid growth 

and of spreading to nearby and distant sites) 

C00-C76, 

C80-C97 

Malignant secondary (spread from another 

site; metastasis) 

C77-C79 

In-situ (confined to one site) D00-D09 

Benign (non-malignant) D10-D36 

Uncertain or unknown behavior 

(undetermined whether benign or malignant) 

D37-D48 

Morphology, behavior, and site must all be considered when coding 

neoplasms. Always look up the morphological type in the Alphabetical 

Index before referring to the listing under “Neoplasm” for the site. This 

may take the form of a reference to the appropriate column in the 

“Neoplasm” listing in the Index when the morphological type could 

occur in several organs. For example: 

Adenoma, villous (M8261/1) - see Neoplasm, uncertain behavior 

Or to a particular part of that listing when the morphological type 

originates in a particular type of tissue. For example: 

Fibromyxoma (M8811/0) - see Neoplasm, connective tissue, benign. 

The Index may give the code for the site assumed to be most likely when 

no site is reported in a morphological type. For example: 

Adenocarcinoma 

- pseudomucinous (M8470/3) 

- - specified site - see Neoplasm, malignant 

 - - unspecified site C56 

128 2a January 2011 
 

 

 

 

	 

	 

Section IV - Classification of Categories 

Or the Index may give a code to be used regardless of the reported site 

when the vast majority of neoplasms of that particular morphological type 

occur in a particular site. For example: 

Nephroma (M8960/3) C64 

Unless it is specifically indexed, code a morphological term ending in 

“osis” in the same way as the tumor name to which “osis” has been added 

is coded. For example, code neuroblastomatosis in the same way as 

neuroblastoma. However, do not code hemangiomatosis which is 

specifically indexed to a different category in the same way as 

hemangioma. 

All combinations of the order of prefixes in compound morphological 

terms are not indexed. For example, the term “chondrofibrosarcoma” 

does not appear in the Index, but “fibrochondrosarcoma” does. Since the 

two terms have the same prefixes (in a different order), code the 

chondrofibrosarcoma the same as fibrochondrosarcoma. 

A. Malignant neoplasms 

When a malignant neoplasm is considered to be the underlying cause of death, it is most 

important to determine the primary site. Morphology and behavior should also be taken 

into consideration. Cancer is a generic term and may be used for any morphological 

group, although it is rarely applied to malignant neoplasms of lymphatic, hematopoietic 

and related tissues. Carcinoma is sometimes used incorrectly as a synonym for cancer. 

Some death certificates may be ambiguous if there was doubt about the primary site or 

imprecision in drafting the certificate. In these circumstances, if possible, the certifier 

should be asked to give clarification. 

The categories that have been provided for the classification of malignant neoplasms 

distinguish between those that are stated or presumed to be primary (originate in) of the 

particular site or types of tissue involved, those that are stated or presumed to be 

secondary (deposits, metastasis, or spread from a primary elsewhere) of specified sites, 

and malignant neoplasms without specification of site. 

These categories are the following: 

C00-C75	 Malignant neoplasms, stated or presumed to be primary, of specified sites 

and different types of tissue, except lymphoid, hematopoietic, and related 

tissue 

C76 Malignant neoplasms of other and ill-defined sites 

129	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

	 
 


 

	 


 

	 

Section IV - Classification of Categories 

C77-C79	 Malignant secondary neoplasm, stated or presumed to be spread from 

another site, metastases of sites, regardless of morphological type of 

neoplasm 

C80 Malignant neoplasm of unspecified site (primary) (secondary) 

C81-C96	 Malignant neoplasms, stated or presumed to be primary, of lymphoid, 

hematopoietic, and related tissue 

C97 Malignant neoplasms of independent (primary) multiple sites 

In order to determine the appropriate code for each reported neoplasm, a number of factors 

must be taken into account including the morphological type of neoplasm and qualifying 

terms. Assign malignant neoplasms to the appropriate category for the morphological 

type of neoplasm, e.g. to the code shown in the Index for the reported term. 

Morphological types of neoplasm include categories C40-C41, C43, C44, C45, C46, 

C47, C49, C70-C72, and C80. Specific morphological types include: 

C40-C41 Malignant neoplasm of bone and articular cartilage of other and 

unspecified sites 

Osteosarcoma

 Osteochondrosarcoma

 Osteofibrosarcoma

 Any neoplasm cross-referenced as “See also Neoplasm, bone, malignant” 

 Code for Record

 I (a) Osteosarcoma of leg C402 

Code to osteosarcoma leg (C402). Code the morphological type 

“Osteosarcoma” to Neoplasm, bone, malignant. 

C43 Malignant melanoma of skin 

Melanosarcoma 

Melanoblastoma 

Any neoplasm cross-referenced as “See also Melanoma” 

Code for Record

 I (a) Melanoma C439 

 Code to melanoma, (C439) unspecified site as indexed. 

130	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Code for Record 

I (a) Melanoma of arm C436 

Code to melanoma of arm (C436) as indexed under site classification. 

Code for Record

 I (a) Melanoma of stomach C169 

Code to melanoma of stomach (C169). Since stomach is not found 

under Melanoma in the Index, the term should be coded by site under 

Neoplasm, malignant, stomach. 

C44 Other malignant neoplasm of skin 

Basal cell carcinoma 

Sebaceous cell carcinoma 

Any neoplasm cross-referenced as “See also Neoplasm, skin, malignant” 

Code for Record 

I (a) Sebaceous cell carcinoma nose C443 

Code to sebaceous cell carcinoma nose (C443). Code the 

morphological type “Sebaceous cell carcinoma” to Neoplasm, skin, 

malignant. 

C49 Malignant neoplasm of other connective and soft tissue 

Liposarcoma 

Rhabdomyosarcoma 

Any neoplasm cross-referenced as “See also Neoplasm, connective tissue, 

malignant” 

Code for Record 

I (a) Rhabdomyosarcoma abdomen C494 

Code to rhabdomyosarcoma abdomen (C494). Code the 

morphological type “Rhabdomyosarcoma” to Neoplasm, connective 

tissue, malignant.

 Code for Record 

I (a) Sarcoma pancreas C259 

Code to sarcoma pancreas (C259). Code the morphological type 

“Sarcoma” to Neoplasm, connective tissue, malignant. Refer to the 

“Note” under Neoplasm, connective tissue, malignant, concerning sites 

which do not appear on this list. 

131 2a January 2011 
 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Code for Record 

I (a) Angiosarcoma of liver C223 

Code angiosarcoma of liver as indexed. 

Code for Record 

I (a) Kaposi’s sarcoma of lung C467 

Code Kaposi’s sarcoma of lung to Kaposi’s, sarcoma, specified 

site (C467). 

C80 Malignant neoplasm without specification of site 

Cancer 

Carcinoma 

Malignancy 

Malignant tumor or neoplasm 

Any neoplasm cross-referenced as “See also Neoplasm, malignant” 

Code for Record

 I (a) Carcinoma of stomach C169 

Code to carcinoma of stomach (C169) as indexed. 

C81-C96 Malignant neoplasms of lymphoid, hematopoietic and related tissue 

 Leukemia

 Lymphoma

 Code for Record

 I (a) Lymphoma of brain C859 

Code to lymphoma NOS (C859). Neoplasms in C81-C96 are coded by 

morphological type and not by site. 

132 2a January 2011 
 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

B. Neoplasm stated to be secondary 

Categories C77-C79 include secondary neoplasms of specified sites regardless of the 

morphological type of the neoplasm. The Index contains a listing of secondary neoplasms 

of specified sites under “Neoplasm.” If a secondary neoplasm of specified site is reported, 

code to the morphological type, unless it is a C80 morphological type. If the 

morphological type is C80, code to the secondary neoplasm. 

I (a) Secondary carcinoma of intestine 

 Code for Record 

C785 

 Code to secondary carcinoma of intestine (C785). 

I (a) Secondary melanoma of lung 

 Codes 

C439 

for Record 

C780 

Code to melanoma of unspecified site (C439). 

C. Malignant neoplasms with primary site indicated 

If a particular site is indicated as primary, it should be selected, regardless of the position 

on the certificate or whether in Part I or Part II. If the primary site is stated to be 

unknown, see Section H. The primary site may be indicated in one of the following ways: 

1. Two or more sites with the same morphology are reported and one site is specified as 

primary in either Part I or Part II.

 Codes for Record

 I (a) Carcinoma of bladder C791 

 II Primary in kidney C64

 Code to malignant neoplasm of kidney (C64). 

2. The specification of other sites as “secondary,” “metastases,” “metastasis,” 

 “spread” or a statement of “metastasis NOS” or “metastases NOS.” 

Codes for Record 

I (a) Carcinoma of breast C509 

(b)Secondaries in brain C793 

Code to malignant neoplasm of breast (C509), since another site is specified as 

secondary. 

133	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

3. Morphology indicates a primary malignant neoplasm. 

If a morphological type implies a primary site, such as hepatoma, consider this as if 

the word “primary” had been included. 

 Codes for Record

 I (a) Metastatic carcinoma C80

 (b)Pseudomucinous C56 

 adenocarcinoma 

Code to malignant neoplasm of ovary (C56), since pseudomucinous 

adenocarcinoma of unspecified site is assigned to the ovary in the Alphabetical 

Index. 

If two or more primary sites or morphologies are indicated, these should be 

coded according to Sections D, E and G. 

D. Independent (primary) multiple sites (C97) 

The presence of more than one primary neoplasm could be indicated in one of the 

 following ways: 

• mention of two different anatomical sites 

• two distinct morphological types (e.g. hypernephroma and intraductal carcinoma) 

• by a mix of a morphological type that implies a specific site, plus a second site 

It is highly unlikely that one primary would be due to another primary malignant 

neoplasm except for a group of malignant neoplasms of lymphoid, hematopoietic, and 

related tissue (C81 - C96), within which, one form of malignancy may terminate in 

another (e.g. leukemia may follow non-Hodgkin’s lymphoma). 

If two or more sites mentioned in Part I are in the same organ system, see Section E. If the 

sites are not in the same organ system and there is no indication that any is primary or 

secondary, code to malignant neoplasms of independent (primary) multiple sites (C97), 

unless all are classifiable to C81-C96, or one of the sites mentioned is a common site of 

metastases or the lung (see Section G). 

 Codes for Record 

I (a) Cancer of stomach 3 months C169 

(b)Cancer of breast 1 year C509 

Code to malignant neoplasms of independent (primary) multiple sites (C97), since 

two different anatomical sites are mentioned and it is unlikely that one primary 

malignant neoplasm would be due to another. 

134	 2a January 2011 
 

 

 

 

 

 

 

Section IV - Classification of Categories 

 Codes for Record 

I (a) Hodgkin’s disease C819 

(b)Carcinoma of bladder C679 

Code to malignant neoplasms of independent (primary) multiple sites (C97), since 

two distinct morphological types are mentioned. 

 Codes for Record 

I (a) Acute lymphocytic leukemia C910 

(b)Non-Hodgkin’s lymphoma C859 

Code to non-Hodgkin’s lymphoma (C859), since both are classifiable to 

C81-C96 and the sequence is acceptable. 

Codes for Record 

I (a) Leukemia C959 

(b) Non-Hodgkin’s lymphoma C859 

 (c) Carcinoma of ovary C56 

Code to malignant neoplasms of independent (primary) multiple sites (C97), since, 

although two of the neoplasms are classifiable to C81-C96, there is mention of 

another morphology. 

Codes for Record 

I (a) Leukemia C959 

II Carcinoma of breast C509 

Code to leukemia (C959) because the carcinoma of breast is in Part II. When dealing 

with multiple sites, only sites in Part I of the certificate should be considered (see 

Section E). 

E. Multiple sites 

When dealing with multiple sites, generally only sites reported together in Part I or 

together in Part II of the certificate should be considered except for linkages provided for 

in the Classification. 

If malignant neoplasms of more than one site are entered on the certificate, the site listed 

as primary should be selected. If there is no indication whether primary or secondary, see 

Sections C, D and G. 

135 2a January 2011 
 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

1. More than one neoplasm of lymphoid, hematopoietic or related tissue 

If two or more morphological types of malignant neoplasm occur in lymphoid, 

hematopoietic or related tissue (C81-C96), code according to the sequence given 

since these neoplasms sometimes terminate as another entity within C81-C96. Acute 

exacerbation of, or blastic crisis (acute) in, chronic leukemia should be coded to the 

chronic form. 

I (a) Acute lymphocytic leukemia

 (b) Non-Hodgkin’s lymphoma

 Codes 

C910 

C859 

for Record 

Code to non-Hodgkin’s lymphoma (C859). 

I (a) Acute and chronic 

 lymphocytic leukemia 

Codes

 C910 

for Record 

C911 

 Code to chronic lymphocytic leukemia (C911). 

2. Multiple sites in the same organ/organ system 

Malignant neoplasm categories providing for overlapping sites designated by .8 are 

not used unless a site is specifically indexed to one of these categories, e.g. anorectum 

cancer. 

If the sites mentioned are in the same organ/organ system .9 subcategories should be 

used. This applies when the certificate describes the sites as one site “and” another or 

if the sites are mentioned on separate lines. If one or more of the sites reported is a 

common site of metastases, see Section G. 

a. If there is mention of two subsites in the same organ, code to the .9 subcategory of 

that three-character category. 

 Codes for Record 

I (a) Carcinoma of descending C186 C187 

 colon and sigmoid 

Code to malignant neoplasm of colon (C189) since both sites are subsites of 

the same organ. 

136	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

Codes for Record 

I (a) Carcinoma of head of C250 

 pancreas

 (b) Carcinoma of tail of pancreas C252 

Code to malignant neoplasm of pancreas, unspecified (C259) since both sites 

are subsites of the same organ. 

b. If two or more sites are mentioned and all are in the same organ system, code to 

 the .9 subcategory of that organ system, as in the following list: 

C150-C269 Digestive system 

C300-C399 Respiratory system 

C400-C419 Bone and articular cartilage of limbs, other and unspecified sites 

C490-C499 Connective and soft tissue 

C510-C579 Female genital organ 

C600-C639 Male genital organ 

C64-C689 Urinary organ 

C700-C729 Central nervous system 

C73-C759 Thyroid and other endocrine glands 

Codes for Record 

I (a) Pulmonary embolism I269 

(b)Cancer of stomach C169 

 (c) Cancer of gallbladder C23 

Code to ill-defined sites within the digestive system (C269). Stomach and 

gallbladder are in the same organ system and reported together in the same 

part. 

 Codes for Record

 I (a) Carcinoma of vagina C52 C539 

 and cervix 

Code to malignant neoplasm of female genital organs (C579). Vagina and 

cervix are in the same organ system and are reported together in the same part. 

c. If there is no available .9 subcategory or different organ systems are reported, 

 code to malignant neoplasms of independent (primary) multiple sites (C97). 

Codes for Record

 I (a) Cardiac arrest I469 

(b)Carcinoma of prostate C61 C679 

 and bladder 

Code to malignant neoplasms of independent (primary) multiple sites (C97), 

since there is no available .9 subcategory. 

137	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

d. Although, generally only sites in Part I should be considered, the Classification 

 provides linkages for certain sites when reported anywhere on the certificate. 

Codes for Record 

I (a) Carcinoma of esophagus C159 

 (b)

 (c) 

II Carcinoma of stomach C169 

Code to malignant neoplasm of esophagus and stomach (C160). Combine 

other parts of esophagus, C152 or C155 and stomach, C169 to code C160 in 

the same manner.

 Codes for Record 

I (a) Cancer of sigmoid colon C187 

 (b)

 (c)

 II Cancer of rectum C20 

Code to malignant neoplasm of rectum and colon (C19). Combine 

colon NOS, C189 and rectum, C20 to code C19 in the same manner. 

3. Other exceptions to the multiple sites concept 

The following examples are exceptions to the multiple sites concept. Even though the 

malignant neoplasms are reported in Part I and Part II, apply the linkage as provided 

by the Classification and Part 2c, Modification Table (Table E). 

Codes for Record

 I (a) Cholangiocarcinoma C221 

II Hepatoma C220 

 Code to hepatoma (C220). 

Codes for Record

 I (a) Kaposi’s sarcoma of C462 

 soft palate

 II Kaposi’s sarcoma of skin C460 

 Code to Kaposi’s sarcoma of multiple organs (C468). 

138 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Codes for Record

 I (a) Carcinoma of facial C770 

 lymph nodes 

 II Carcinoma of axillary lymph nodes C773 

Code to malignant neoplasm of lymph nodes of multiple regions (C778).

 Codes for Record

 I (a) Cleaved cell C831 

 diffuse lymphoma

 II Large cell follicular lymphoma C822 

Code to mixed small cleaved and large cell follicular lymphoma (C821). 

Also, in the same manner, combine C820 and C822 to code C821; combine C833 

and C830 to code C832; and combine C830 and C833 to code C832. 

F. Implication of malignancy 

Mention on the certificate (anywhere) that a neoplasm (D00-D449, D480-D489) has 

produced secondaries (C77-C79) according to the Index or instructions, or is stated as 

metastases NOS, or metastases of a site means that the neoplasm must be coded as 

malignant, even though this neoplasm without mention of metastases would be classified 

to some other section of Chapter II. 

Codes for Record 

I (a) Brain metastasis C793 

(b) Lung tumor C349 

 Code to malignant lung tumor (C349). 

Codes for Record 

I (a) Metastatic involvement of chest wall C798 

(b) Carcinoma in situ of breast C509 

 Code to malignant carcinoma of breast (C509). 

139 2a January 2011 
 

 

 

 

 

 

Section IV - Classification of Categories 

G. Metastatic neoplasm 

When a malignant neoplasm spreads or metastasizes it generally retains the same 

morphology even though it may become less differentiated. Some metastases have such a 

characteristic microscopic appearance that the pathologist can infer the primary site with 

confidence, e.g. thyroid. Widespread metastasis of a carcinoma is often called 

carcinomatosis. The adjective “metastatic” is used in two ways - sometimes meaning a 

secondary from a primary elsewhere and sometimes denoting a primary that has given rise 

to metastases. Neoplasms qualified as metastatic are always malignant, either primary or 

secondary. 

Although malignant cells can metastasize anywhere in the body, certain sites are more 

common than others and must be treated differently (see list of common sites of 

metastases). However, if one of these sites appears alone on a death certificate and is not 

qualified by the word “metastatic,” it should be considered primary. 

Common sites of metastases 

Bone Lymph nodes 

Brain Mediastinum 

Central nervous system Meninges 

Diaphragm Peritoneum 

Heart Pleura 

Ill-defined sites (sites classifiable to C76) Retroperitoneum 

Liver Spinal cord 

Lung 

Code for Record 

I (a) Cancer of brain C719 

Code to primary cancer of brain since it is reported alone on the certificate. 

 Special instruction: lung 

The lung poses special problems in that it is a common site for both metastases and 

primary malignant neoplasms. Lung should be considered as a common site of 

metastases whenever it appears in Part I with sites not on this list. If lung is 

mentioned anywhere on the certificate and the only other sites are on the list of 

common sites of metastases, consider lung primary. However, when the bronchus or 

bronchogenic cancer is mentioned, this neoplasm should be considered primary. 

140 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

 Code for Record 

I (a) Carcinoma of lung C349 

Code to malignant neoplasm of lung since it is reported alone on the certificate. 

Codes for Record 

I (a) Cancer of bone C795 

(b) Carcinoma of lung C349 

Code to primary malignant neoplasm of lung (C349) since bone is on the list of 

common sites of metastases and lung can, therefore, be assumed to be primary. 

Codes for Record

 I (a) Carcinoma of bronchus C349 

(b) Carcinoma of breast C509 

Code to malignant neoplasms of independent (primary) multiple sites (C97) 

because bronchus is excluded from the list of common sites. 

 Special Instruction: lymph node 

Malignant neoplasm of lymph nodes not specified as primary should be assumed to 

be secondary. 

Code for Record 

I (a) Cancer of cervical lymph nodes C770 

 Code to secondary malignant neoplasm of cervical lymph nodes (C770). 

1. Only one site reported and it’s a common site of metastases 

If one of the common sites of metastases, except lung, is described as metastatic 

and no other site or morphology is mentioned, code to secondary neoplasm of the site 

(C77-C79). If the single site is lung, qualified as metastatic, code to primary of lung. 

Code for Record 

I (a) Metastatic brain cancer C793 

Code to secondary malignant neoplasm of brain (C793). 

141	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Code for Record 

I (a) Metastatic carcinoma C349 

 of lung 

 Code to malignant neoplasm of lung (C349). 

2. All sites reported are common sites of metastases 

If all sites reported (anywhere on the record) are on the list of common sites of 

metastases, code to unknown primary site of the morphological type involved, unless 

lung is mentioned, in which case code to malignant neoplasm of lung (C349). 

 Codes for Record

 I (a) Cancer of liver C787 

(b)Cancer of abdomen C798 

 Code to malignant neoplasm without specification of site (C80), since both are 

 on the list of common sites of metastases. (Abdomen is one of the ill-defined 

 sites included in C76.-.) 

Codes for Record 

I (a) Cancer of brain C793 

(b)Cancer of lung C349 

Code to cancer of lung (C349), since lung in this case is considered to be primary, 

because brain, the only other site mentioned, is on the list of common sites of 

metastases. 

3. One of the sites reported is a common site of metastases 

If only one of the sites mentioned is on the list of common sites of metastases or lung, 

code to the site not on the list.

 Codes for Record 

I (a) Cancer of lung C780 

(b)Cancer of breast C509 

Code to malignant neoplasm of breast (C509). In this case, lung is considered to 

be a common site because breast is not on the list of common sites of metastases. 

142 2a January 2011 
 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

4. Common sites reported with other sites or morphological types 

If one or more of the sites mentioned is a common site of metastases (see list of 

common sites of metastases) but two or more sites or different morphological types 

are also mentioned, code to malignant neoplasms of independent (primary) multiple 

sites (C97) (see Section D). If sites are in the same organ system see Section E. 

Codes for Record 

I (a) Cancer of liver C787 

(b) Cancer of bladder C679 

(c) Cancer of colon C189 

Code to malignant neoplasms of independent (primary) multiple sites (C97), since 

liver is on the list of common sites of metastases and there are still two other 

independent sites. 

5. Multiple sites with none specified as primary 

If one of the common sites of metastases, excluding lung, is reported anywhere on the 

certificate with one or more site(s), or one or more morphological type(s), none 

specified as primary, code to the site or morphological type not on list of common 

sites. 

Codes for Record 

I (a) Cancer of stomach C169 

(b) Cancer of liver C787 

Code to malignant neoplasm of stomach (C169). The cancer of liver is presumed 

secondary because it is on the list of common sites. 

Codes for Record 

I (a) Peritoneal cancer C786 

 II Mammary carcinoma C509 

Code to malignant neoplasm of breast (C509). The peritoneal cancer is presumed 

secondary because it is on the list of common sites. 

143 2a January 2011 
 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Codes for Record 

I (a) Brain carcinoma C793 

II Melanoma of scalp C434 

Code to melanoma of scalp (C434). The brain carcinoma is presumed secondary 

because it is on the list of common sites. 

NOTE: If a malignant neoplasm of lymphatic, hematopoietic, or related tissue 

(C81-C96) is reported in one part and one of the common sites of 

metastases is mentioned in the other part, code to the malignant 

neoplasm reported in Part I. 

Codes for Record 

I (a) Brain cancer C719 

II Lymphoma C859 

Code to malignant brain cancer (C719). Since the condition in Part II is a 

malignant neoplasm of lymphatic, hematopoietic, or related tissue, only Part I 

conditions are considered. 

Codes for Record

 I (a) Brain cancer C793 

(b)Lymphoma C859 

Code to lymphoma (C859). Brain cancer is presumed secondary, because it is 

reported in the same part as a malignant neoplasm of lymphatic, hematopoietic, or 

related tissue. 

If lung is mentioned in the same part with another site(s), not on the list of common 

sites, or one or more morphological types(s), consider the lung as secondary and the 

other site(s) as primary. If lung is mentioned in one part, and one or more site(s), not 

on the list of common sites, or one or more morphological type(s) is mentioned in the 

other part, code to the malignant neoplasm reported in Part I. 

Codes for Record 

I (a) Lung cancer C780 

(b) Stomach cancer C169 

Code to malignant stomach cancer (C169). Lung cancer is presumed secondary 

because it is reported in the same part as another site. 

144 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Codes for Record

 I (a) Lung cancer C780 

(b) Leukemia C959 

Code to leukemia (C959). Lung cancer is presumed secondary because it is 

reported in the same part as another morphological type. 

Codes for Record

 I (a) Bladder carcinoma C679 

II Lung cancer, breast cancer C780 C509 

Code to malignant bladder carcinoma (C679) because lung cancer and breast 

cancer are reported in Part II.

 Codes for Record

 I (a) Lung cancer C349 

II Stomach cancer C169 

Code to malignant lung cancer (C349), since lung cancer is reported in Part I and 

stomach is reported in Part II. 

6. Metastatic from 

Malignant neoplasm described as “metastatic from” a specified site should be 

interpreted as primary of that site. 

I (a)

 (b)

 Metastatic teratoma from

 ovary

Codes for Record 

 C80

 C56 

Code to malignant neoplasm of ovary (C56). 

7. Metastatic to 

Malignant neoplasm described as “metastatic to” a specified site should be interpreted 

as primary of the site or morphological type that produced the metastasis (metastatic 

to) and all other sites should be coded as secondary unless stated as primary, whether 

in Part I or Part II.

 Malignant neoplasm described as metastatic of a specified site to a specified site 

 should be interpreted as primary of the site specified as “of a site.” 

145 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Code for Record 

I (a) Metastatic carcinoma C785 

 to the rectum 

Code to secondary malignant neoplasm of rectum (C785). The word “to” indicates 

that rectum is secondary. 

Codes for Record 

I (a) Metastatic osteosarcoma C419 C793 

 to brain 

Code to malignant neoplasm of bone (C419) since this is the code for unspecified 

site of osteosarcoma. 

Codes for Record

 I (a) Metastatic cancer of C229 C793 

 liver to brain

 II Esophageal cancer C788 

Code to primary cancer of liver (C229). The word “to” indicates that the liver is 

primary. 

8. A single malignant neoplasm described as “metastatic (of)” 

The terms “metastatic” and “metastatic of” should be interpreted as follows: 

a. If one site is mentioned and this is qualified as metastatic, code to malignant 

primary of that particular site if the morphological type is C80 and the site is not a 

common metastatic site excluding the lung. 

Code for Record

 I (a) Cervix cancer, metastatic C539 

Code to malignant neoplasm of cervix (C539). 

 Code for Record 

I (a) Metastatic cancer of lung C349 

 Code to primary malignant neoplasm of lung since no other site is mentioned. 

b. If no site is reported but the morphological type is qualified as metastatic, code 

 as for primary site unspecified of the particular morphological type involved. 

146 2a January 2011 
Section IV - Classification of Categories 

Code for Record 

I (a) Metastatic oat cell carcinoma C349 

 

 Code to malignant neoplasm of lung (C349) since oat cell carcinoma of 

 unspecified site is assigned to the lung in the Alphabetical Index. 

c. If a single morphological type and a site, other than a common metastatic site 

(see list of common sites of metastases), are mentioned as metastatic, code to the 

specific category for the morphological type and site involved. 

Code for Record 

I (a) Metastatic melanoma of arm C436 

 

Code to malignant melanoma of arm (C436), since in this case the ill-defined 

site of arm is a specific site for melanoma, not a common site of metastases 

classifiable to C76. 

d. If a single morphological type is qualified as metastatic and the site mentioned 

is one of the common sites of metastases except lung, code the unspecified site for 

the morphological type, unless the unspecified site is classified to C80 (malignant 

neoplasm without specification of site), in which case, code to secondary 

malignant neoplasm of the site mentioned. 

 Codes for Record

 I (a) Metastatic osteosarcoma of brain C419 C793 

Code to malignant neoplasm of bone, unspecified (C419), since brain is on the 

list of common sites of metastases. 

Code for Record 

I (a) Metastatic cancer of peritoneum C786 

Code to secondary cancer of peritoneum (C786), since peritoneum is on the 

list of common sites of metastases and the morphological type of neoplasm is 

classified to C80. 

 

Codes for Record

 I (a) Metastatic rhabdomyosarcoma C499 C771 

(b) of hilar lymph nodes 

 

 Code to unspecified site for rhabdomyosarcoma (C499). 

 

 147 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

	 

	 

Section IV - Classification of Categories 

Code for Record

 I (a) Metastatic sarcoma of lung C349 

Code to malignant neoplasm of lung (C349), since lung is not considered a 

common site for this instruction. 

EXCEPTION: Metastatic mesothelioma or metastatic Kaposi’s sarcoma. 

1.	 If site IS indexed under “Mesothelioma or Kaposi’s sarcoma,” assign that 

code. 

Code for Record 

I (a) Metastatic mesothelioma of liver C457 

Code to mesothelioma, liver (C457). 

 Code for Record

 I (a) Metastatic mesothelioma of mesentery C451 

Code to mesothelioma of mesentery (C451). 

2. If site is NOT indexed under “Mesothelioma or Kaposi’s sarcoma” and the 

site reported is NOT a common site of metastasis, code to specified site NEC. 

 Code for Record

 I (a) Metastatic mesothelioma of kidney C457 

Code to mesothelioma specified site NEC. Kidney is not a common site of 

metastases. 

3. If site is NOT indexed under “Mesothelioma or Kaposi’s sarcoma” and site 

reported IS a common site of metastasis, code to unspecified site NEC. 

Codes for Record

 I (a) Metastatic mesothelioma of C459 C779 

(b) lymph nodes 

Code to mesothelioma (C459). Lymph nodes is on the list of common sites 

and is not indexed under mesothelioma. 

Codes for Record

 I (a) Metastatic Kaposi’s sarcoma of brain C469 C793 

Code to Kaposi’s sarcoma (C469). Brain is on the list of common sites and 

is not indexed under Kaposi’s sarcoma. 

148	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

 Code for Record

 I (a) Kaposi’s sarcoma of brain C467 

Code to specified site of Kaposi’s sarcoma (C467) since not qualified as 

 metastatic. 

e. If there is a mixture of several sites qualified as metastatic and several other 

sites are mentioned, refer to the rules for multiple sites (see Sections D and E). 

9. More than one malignant neoplasm qualified as metastatic 

a. If two or more sites with the same morphology, not on the list of common sites 

of metastases, are reported and all are qualified as “metastatic,” code as primary 

site unspecified of the anatomical system and/or of the morphological type 

involved. 

Codes for Record 

I (a) Metastatic carcinoma C798 

 of prostate

 (b) Metastatic carcinoma C792 

 of skin 

Code to malignant neoplasm without specification of site (C80), since two or 

more sites of the same morphology, not on the list of common sites of 

metastases, are reported and all are qualified as metastatic.

 Codes for Record

 I (a) Metastatic stomach C169 

 carcinoma

 (b)Metastatic pancreas C259 

 carcinoma 

Code to ill-defined sites within the digestive system (C269) since both sites are 

in the same anatomical system. 

149	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

b. If two or more morphological types are qualified as metastatic, code to 

 malignant neoplasms of independent (primary) multiple sites (C97) (see 

 Section D). 

Codes for Record 

I (a) Bowel obstruction 

(b) Metastatic adenocarcinoma

 of bowel

 K566 

C260 

 (c) Metastatic sarcoma

 of uterus 

 C55 

Code to malignant neoplasms of independent (primary) multiple sites (C97). 

c. If a morphology implying site and an independent anatomical site are both 

qualified as metastatic, code to malignant neoplasm without specification of 

site (C80).

 Codes for Record 

I (a) Metastatic colonic and C785 C790 

 renal cell carcinoma 

Code to malignant neoplasm without specification of site (C80). 

d. If more than one site with the same morphology is mentioned and all but one 

are qualified as metastatic or appear on the list of common sites of metastases, 

code to the site that is not qualified as metastatic, irrespective of the order of entry 

or whether it is in Part I or Part II. If all sites are qualified as metastatic or on the 

list of common sites of metastases, including lung, code to malignant neoplasm 

without specification of site (C80). 

Codes for Record

 I (a) Metastatic carcinoma C788 

 of stomach

 (b) Carcinoma of gallbladder C23

 (c) Metastatic carcinoma C785 

 of colon 

Code to malignant neoplasm of gallbladder (C23). 

150	 2a January 2011 
 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

Codes for Record 

I (a) Metastatic carcinoma 

 of stomach

C788 

II 

(b) Metastatic carcinoma 

 of lung 

Carcinoma of colon 

C780 

C189 

Code to malignant neoplasm of colon (C189), since this is the only diagnosis 

not qualified as metastatic, even though it is in Part II. 

Codes for Record 

I (a) Metastatic carcinoma C796 

 of ovary

 (b) Carcinoma of lung C780 

(c) Metastatic cervical C798 

 carcinoma 

Code to malignant neoplasm without specification of site (C80). 

Codes for Record

 I (a) Metastatic carcinoma C788 

 of stomach

 (b)Metastatic carcinoma C798 

 of breast

 (c) Metastatic carcinoma C780 

 of lung 

Code to malignant neoplasm without specification of site (C80), since breast 

and stomach do not belong to the same anatomical system and lung is on the 

list of common sites of metastases. 

151	 2a January 2011 
 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

H. Primary site unknown 

If the statement, “primary site unknown,” or its equivalent, appears anywhere on a 

certificate, code to the category for unspecified site for the morphological type involved 

(e.g. adenocarcinoma C80, fibrosarcoma C499, osteosarcoma C419), regardless of the 

site(s) mentioned elsewhere on the certificate. 

Consider the following terms as equivalent to “primary site unknown”: 

? Origin (Questionable origin) 

? Primary (Questionable primary) 

? Site (Questionable site) 

? Source (Questionable source) 

Undetermined origin 

Undetermined primary 

Undetermined site 

Undetermined source 

Unknown origin 

Unknown primary 

Unknown site 

Unknown source 

Codes

 I (a) Secondary carcinoma C80 

 of liver

 (b) Primary site unknown 

 (c)

 for Record

 C787 

 Code to carcinoma without specification of site (C80). 

Codes for Record 

I (a) Generalized metastases C80

 (b)Melanoma of back C439 C798 

(c) Primary site unknown 

 Code to malignant melanoma of unspecified site (C439). 

NOTE: When “primary site unknown” or its equivalent appears on the certificate 

and a doubtful expression such as presumed or probably is reported 

qualifying a specific site(s), interpret the primary to be the site(s) following 

the doubtful qualifying expression and code as primary. 

I (a) Cancer unk primary, presumed lung C349 

Code to primary lung cancer (C349). 

152 2a January 2011 
 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

I. Sites with prefixes or imprecise definitions 

Neoplasms of sites prefixed by “peri,” “para,” “pre,” “supra,” “infra,” etc. or described as 

in the “area” or “region” of a site, unless these terms are specifically indexed, should be 

coded as follows: for morphological types classifiable to one of the categories C40, C41 

(bone and articular cartilage), C43 (malignant melanoma of skin), C44 (other malignant 

neoplasms of skin), C45 (mesothelioma), C47 (peripheral nerves and autonomic nervous 

system), and C49 (connective and soft tissue), C70 (meninges), C71 (brain), and C72 

(other parts of central nervous system), code to the appropriate subdivision of that 

category; otherwise code to the appropriate subdivision of C76 (other and ill-defined 

sites).

 Code for Record

 I (a) Fibrosarcoma in the region C492 

of the leg 

Code to malignant neoplasm of connective and soft tissue of lower limb (C492). 

Code for Record

 I (a) Carcinoma in the lung area C761 

Code to malignant neoplasm of other and ill-defined sites within the thorax. 

J. Doubtful diagnosis 

Malignant neoplasms described as one site “or” another, or if “or” is implied, should be 

coded to the category that embraces both sites. If no appropriate category exists, code to 

the unspecified site of the morphological type involved. This rule applies to all sites 

whether they are on the list of common sites of metastases or not. 

I (a) Carcinoma of ascending or descending colon 

 Code to malignant neoplasm of colon, unspecified (C189). 

I (a) Osteosarcoma of lumbar vertebrae or sacrum

 Code to malignant neoplasm of bone, unspecified (C419). 

153 2a January 2011 
 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

K. Malignant neoplasms of unspecified site with other reported conditions 

When the site of a primary malignant neoplasm is not specified, no assumption of the site 

should be made from the location of other reported conditions such as perforation, 

obstruction, or hemorrhage. These conditions may arise in sites unrelated to the neoplasm, 

e.g. intestinal obstruction may be caused by the spread of an ovarian malignancy. 

Codes for Record

 I (a) Obstruction of intestine K566 

 (b) Carcinoma C80

 Code to malignant neoplasm without specification of site (C80). 

L. Mass or lesion with malignant neoplasms 

When mass or lesion is reported with malignant neoplasms, code the mass or lesion as 

indexed. 

I (a) Lung mass 

 (b) Carcinomatosis

 Codes for Record

 R91 

 C80

 Code to carcinomatosis (C80). 

154 2a January 2011 
Section IV - Classification of Categories 

E10-E14 Diabetes mellitus 

 

with mention of: 

E87.2 (Acidosis), code E10-E14 with fourth character .1 

R02 (Gangrene, not elsewhere classified), code E10-E14 with 

 fourth character .5 

R40.2 (Coma, unspecified), code E10-E14 with fourth character .0 

R79.8 (Other specified abnormal findings of blood chemistry), if 

 acetonemia, azotemia, and related conditions, code E10-E14 

 with fourth character .1
 
 

 when reported as the originating antecedent cause of: 

E15 (Nondiabetic hypoglycaemic coma), if unspecified 

 hypoglycemic coma, code to E1x.0 

E88.8 (Other specified metabolic disorders), code E10-E14 with 

 fourth character .1
 
 

G58.- (Other mononeuropathies), code E10-E14 with fourth 

 character .4
 
 

G62.9 (Polyneuropathy, unspecified), code E10-E14 with fourth 

 character .4
 
 

G64 (Other disorders of peripheral nervous system), code E10-E14
 
 

 with fourth character .4
 
 

G70.9 (Myoneural disorder, unspecified), code E10-E14 with 

 fourth character .4
 
 

G71.8 (Other primary disorders of muscles), code E10-E14 with 

 fourth character .4
 
 

G90.9 (Disorder of autonomic nervous system, unspecified), 

 code E10-E14 with fourth character .4
 
 

G98 (Other disorders of the nervous system, not elsewhere 

classified), except Charcot’s arthropathy, non-syphilitic, code 

to E1x.4 

G98 (Other disorders of the nervous system, not elsewhere 

classified), if Charcot’s arthropathy, non-syphilitic, code to 

E1x.6 

H20.9 (Iridocyclitis, unspecified), code E10-E14 with fourth 

character .3
 
 

H26.9 (C

H30.9 (C

ataract, unspecified), code E10-E14 with fourth character .3
 
 

horioretinal inflammation, unspecified), code E10-E14 with 

 fourth character .3
 
 

H34.- (Retinal vascular occlusions), code E10-E14 with fourth 

character .3
 

H35.0 (Background retinopathy and retinal vascular changes), code 

E10-E14 with fourth character .3
 
 

 155	 	 2a January 2011 
 

 

 

 

	 

Section IV - Classification of Categories 

H35.2 (Other proliferative retinopathy), code E10-E14 with fourth 

character .3 

H35.6 (Retinal haemorrhage), code E10-E14 with fourth character .3 

H35.9 (Retinal disorder, unspecified), code E10-E14 with fourth 

character .3 

H49.9 (Paralytic strabismus, unspecified), code E10-E14 with fourth 

character .3 

H54.- (Visual impairment including blindness (binocular or 

 monocular)), code E10-E14 with fourth character .3 

I70.2 (Atherosclerosis of arteries of extremities), code E10-E14 with 

 fourth character .5 

I73.9 (Peripheral vascular disease, unspecified), code E10-E14 with 

 fourth character .5 

I99 (Other and unspecified disorders of circulatory system), if 

 angiopathy, code E10-E14 with fourth character .5 

K31.8 (Other specified diseases of stomach and duodenum), if 

gastroparesis, code to E1x.4 

L30.9 (Dermatitis, unspecified), code E10-E14 with fourth character .6 

L92.1 (Necrobiosis lipoidica, not elsewhere classified), code E10-E14

 with fourth character .6 

L97 (Ulcer of lower limb, not elsewhere classified), code to E1x.5 

L98.4 (Chronic ulcer of skin, not elsewhere classified), code to E1x.5 

M13.9 (Arthritis, unspecified), code E10-E14 with fourth character .6 

M79.2 (Neuralgia and neuritis, unspecified), code E10-E14 with 

fourth character .6 

M89.9 (Disorder of bone, unspecified), code E10-E14 with

 fourth character .6 

N03- N05 (Nephrotic syndrome), code E10-E14 with fourth character .2 

N18.- (Chronic kidney disease), code E10-E14 with fourth

 character.2 

N19 (Unspecified kidney failure), code E10-E14 with fourth 

character .2 

N26 (Unspecified contracted kidney), code E10-E14 with fourth 

character .2 

N28.9 (Disorder of kidney and ureter, unspecified), code E10-E14

 with fourth character .2 

N39.0 (Urinary tract infection, site not specified), code E10-E14 with 

 fourth character .6 

N39.1 (Persistent proteinuria, unspecified), code E10-E14 with fourth 

character .2 

156	 2a January 2011 
 

 

 

 

 

 

 

Section IV - Classification of Categories 

E40-E46, E63.9, E64.0, E64.9 

when reported as the originating antecedent cause of: 

E10.0-E10.9 

E11.0-E11.9 

E14.0-E14.9 

(Insulin-dependent diabetes mellitus), code to E12 

(Non-insulin dependent diabetes mellitus), code to E12 

(Unspecified diabetes mellitus), code to E12 

E86 Volume depletion 

with mention of:

 A00-A09 (Intestinal infectious diseases), code A00-A09 

E89.- Postprocedural endocrine and metabolic disorders, not elsewhere 

classified

 Not to be used for underlying cause mortality coding. 

F03-F09 Organic, including symptomatic, mental disorders 

Not to be used if the underlying physical condition is known. 

F10-F19 Mental and behavioral disorders due to psychoactive substance use 

 with mention of: 

X40-X49 

X60-X69 

X85-X90 

Y10-Y19 

(Accidental poisoning by and exposure to noxious 

substances), code X40-X49 

(Intentional self-poisoning by and exposure to noxious 

substances), code X60-X69 

(Assault by noxious substances), code X85-X90 

(Poisoning by and exposure to drugs, chemicals and noxious 

substances), code Y10-Y19 

F10.­ Mental and behavioral disorders due to use of alcohol 

with mention of: 

K70.­ (Alcoholic liver disease), code K70.-

157 2a January 2011 
 

 

 

 

 

Section IV - Classification of Categories 

F10.2 Dependence syndrome due to use of alcohol 

 with mention of: 

F10.4, F10.6, F10.7 (Withdrawal state with delirium), (Amnesic 

syndrome), (Residual and late-onset psychotic disorder), code F10.4, 

F10.6, F10.7 

F17.- Mental and behavioral disorders due to use of tobacco 

 Not to be used if the resultant physical condition is known. 

F11.9, F12.9 Mental and behavioral disorders due to use of drugs 

F13.9, F14.9 

F15.9, F16.9 

F18.9, F19.9 

INCLUDES: “drug use NOS” and “named drug use” of named drugs 

indexed under Addiction\Dependence, Volume 3 

EXCLUDES: “drug use NOS” and “named drug use” when reported as 

causing a complication. If there is a resulting complication, consider as 

drug therapy and apply instructions under Y40-Y59, Drugs, medicaments 

and biological substances causing adverse effects in therapeutic use. 

Codes for Record

 I (a) Heroin use F119 

 (b)

 II Acute intravenous drug use F199 

 Code to heroin use (F119). 

Codes for Record 

I (a) Melanoma of back C435 

 (b)

 II Use of hypnotics F139 

 Code to melanoma of back (C435). 

158 2a January 2011 
 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

I 

II 

(a) Intravenous drug use 

(b) (morphine) 

Accident 

Code for Record 

F119 

Code to intravenous morphine use (F119). 

F70-F79 Mental retardation 

Not to be used if the underlying physical condition is known. 

G25.5 Other chorea 

with mention of: 

I00-I02 

I05-I09 

(Acute rheumatic fever), code I02.-

 (Chronic rheumatic heart disease), code I02.-

G40-G41 Epilepsy 

INCLUDES: accidents resulting from epilepsy 

EXCLUDES: epilepsy stated as traumatic (code to the appropriate 

category in Chapter XX; if the nature and cause of the injury are not 

known, code Y86) 

G81.­

G82.­

G83.­

 Hemiplegia 

 Paraplegia and tetraplegia 

 Other paralytic syndromes 

 Not to be used if the cause of the paralysis is known. 

G97.­ Postprocedural disorders of nervous system, not elsewhere classified 

 Not to be used for underlying cause mortality coding. 

159 2a January 2011 
 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

H54.- Visual impairment including blindness (binocular or monocular) 

 Not to be used if the antecedent condition is known. 

H59.- Postprocedural disorders of eye and adnexa, not elsewhere classified 

 Not to be used for underlying cause mortality coding. 

H90.- Conductive and sensorineural hearing loss 

H91.- Other hearing loss 

 Not to be used if the antecedent condition is known. 

H95.- Postprocedural disorders of ear and mastoid process, not elsewhere 

classified

 Not to be used for underlying cause mortality coding. 

I00-I09 Acute and chronic rheumatic heart diseases 

A. Multiple heart conditions with one heart condition specified as 

rheumatic: 

If rheumatic fever or any disease of the heart is stated to be of 

rheumatic origin or is specified to be rheumatic, such qualifications 

will apply to each specific heart condition reported (classified to 

I300-I319, I339, I340-I38, I400-I409, I429, I514-I519), even though it 

is not so qualified, unless another origin such as arteriosclerosis is 

mentioned. 

Codes for Record

 I (a) Acute bacterial endocarditis I330 

(b)Mitral insufficiency I051 

(c) Rheumatic endocarditis I091 

Code to rheumatic mitral insufficiency (I051). Rheumatic 

endocarditis, selected by the General Principle, links (LMP) with 

rheumatic mitral insufficiency. The mitral insufficiency is coded 

as rheumatic since it is reported with a heart disease specified as 

rheumatic. 

160 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

B. 

C. 

 When a condition listed in category I50.- is indicated to be “due to” 

rheumatic fever and there is no mention of another heart disease that 

is classifiable as rheumatic, consider the condition in I50.- to be 

described as rheumatic. 

 Codes for Record

 I (a) Heart failure I099 

 (b) Rheumatic fever I00 

Code to rheumatic heart disease (I099). Consider the heart failure 

to be rheumatic since it is due to rheumatic fever and there is no 

other heart disease on the record classifiable as rheumatic. 

 Codes for Record

 I (a) Acute congestive failure I500 

(b)Hypertensive myocarditis I119 

(c) Rheumatic endocarditis I091 

Code to hypertensive heart disease with congestive heart failure 

(I110). Even though rheumatic is stated on the record, it cannot be 

applied to the heart diseases reported. 

When diseases of the mitral, aortic, and tricuspid valves, not qualified 

as rheumatic, are jointly reported, whether on the same line or on 

separate lines, code the disease of all valves as rheumatic unless there 

is indication to the contrary. 

Codes for Record 

I (a) Mitral endocarditis⎯c I059 I051 I050 

 (b) insufficiency and stenosis

 (c) Aortic endocarditis I069 

Code to disorders of both mitral and aortic valves (I080). 

Conditions of both valves are considered as rheumatic since the 

diseases of the mitral and aortic valves are jointly reported. 

Codes for Record

 I (a) Aortic and tricuspid regurgitation I061 I071 

(b)Aortic stenosis I060 

Code to disorders of both aortic and tricuspid valves (I082). 

Conditions of both valves are considered as rheumatic since the 

diseases of the aortic and the tricuspid valves are jointly reported. 

161 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

 D. When mitral insufficiency, incompetence, or regurgitation are jointly 

reported with mitral stenosis NOS (or synonym), code all these 

conditions as rheumatic unless there are indications to the contrary. 

 Codes for Record

 I (a) Mitral stenosis I050 

(b)Mitral insufficiency I051 

Code to mitral stenosis with insufficiency (I052). Mitral 

insufficiency is considered as rheumatic since it is reported jointly 

with mitral stenosis.

 I01.- Rheumatic fever with heart involvement 

This category INCLUDES active rheumatic heart disease. If there is no 

statement that the rheumatic process was active at the time of death, 

assume activity (I010-I019) for each rheumatic heart disease (I050-I099) 

on the certificate in any one of the following situations: 

A. Rheumatic fever or any rheumatic heart disease is stated to be active 

or recurrent.

 Codes for Record

 I (a) Mitral stenosis I011 

(b)Active rheumatic myocarditis I012 

Code to other acute rheumatic heart disease (I018). Active 

rheumatic mitral stenosis is classified to I011 when it is reported 

with an active rheumatic heart disease. Therefore, the underlying 

cause is I018 since this category includes multiple types of heart 

involvement. 

B. The duration of rheumatic fever is less than 1 year. 

 Codes for Record

 I (a) Congestive heart failure I018 

 (b) Rheumatic fever 2 months I00 

Code to other acute rheumatic heart disease (I018) since the 

rheumatic fever is less than 1 year duration. 

162	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

C. One or more of the heart diseases is stated to be acute or subacute 

(this does not apply to “rheumatic fever” stated to be acute or 

subacute).

 Codes for Record

 I (a) Acute myocardial dilatation I018 

 (b) Rheumatic fever I00 

Code to other acute rheumatic heart disease (I018) since the 

myocardial dilatation is stated as acute.

 Codes for Record 

I (a) Acute myocardial insufficiency I012 

 (b) Rheumatic fever I00 

Code to acute rheumatic myocarditis (I012) since the myocardial 

insufficiency is stated to be acute. 

D. The term “pericarditis” is mentioned. 

 Codes for Record 

I (a) Acute pericarditis I010 

(b)Rheumatic mitral stenosis I011 

Code to other acute rheumatic heart disease (I018) which includes 

multiple heart involvement since pericarditis is mentioned. 

E. The term(s) “carditis,” “endocarditis (any valve),” “heart disease,” 

“myocarditis,” or “pancarditis,” with a stated duration of less than 1 

year is mentioned. 

 Codes for Record 

I (a) Congestive heart failure I500 

(b) Endocarditis 6 mos I011 

 (c) Rheumatic fever 10 yrs I00 

Code to acute rheumatic endocarditis (I011) since the endocarditis 

is of less than 1 year duration. 

163	 2a January 2011 
 

 

 

 

 

 

	 

	 

Section IV - Classification of Categories 

F. The term(s) in instruction E without a duration is mentioned and the 

age of the decedent is less than 15 years.

 Codes for Record

 Age 5 years

 I (a) Mitral and aortic endocarditis I011 

 (b) Rheumatic fever I00 

Code to acute rheumatic endocarditis (I011) since the age of the 

decedent is less than 15 years. 

I34.0-I38 Valvular diseases not indicated to be rheumatic 

A.	 In the Classification, certain valvular diseases, i.e., disease of mitral 

valve (except insufficiency, incompetence, and regurgitation without 

stenosis) and disease of tricuspid valve are included in the rheumatic 

categories even though not indicated to be rheumatic. This 

classification is based on the assumption that the vast majority of such 

diseases are rheumatic in origin. 

Do not use these diseases to qualify other heart diseases as rheumatic. 

Code these diseases as nonrheumatic if reported due to one of the 

nonrheumatic causes on the following list: 

When valvular heart disease (I050-I079, I089 and I090) not stated to 

be rheumatic is reported due to: 

A1690 C73-C759 E804-E806 J030 

A188 C790-C791 E840-E859 J040-J042 

A329 C797-C798 E880-E889 J069 

A38 C889 F110-F169 M100-M109 

A399 D300-D301 F180-F199 M300-M359 

A500-A549 D309 I10-I139 N000-N289 

B200-B24 D34-D359 I250-I259 N340-N399 

B376 D440-D45 I330-I38 Q200-Q289 

B379 E02-E0390 I420-I4290 Q870-Q999 

B560-B575 E050-E349 I511 R75 

B908 E65-E678 I514-I5150 T983 

B909 E760-E769 I700-I710 Y400-Y599 

B948 E790-E799 J00 Y883 

C64-C65 E802 J020 

Code nonrheumatic valvular disease (I340-I38) with appropriate fourth 

 character. 

164	 2a January 2011 
 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

Codes for Record

 I (a) Mitral insufficiency I340 

(b)Goodpasture’s syndrome & RHD M310 I099 

Code to Goodpasture’s syndrome (M310). Mitral insufficiency is 

considered as nonrheumatic since it is reported due to 

Goodpasture’s syndrome (M310) by Rule 1. 

B. Consider diseases of the aortic, mitral, and tricuspid valves to be 

nonrheumatic if they are reported on the same line due to a 

nonrheumatic cause in the previous list. Similarly, consider diseases 

of these three valves to be nonrheumatic if any of them are reported 

due to the other and that one, in turn, is reported due to a 

nonrheumatic cause in the previous list. 

Codes for Record 

I (a) Mitral stenosis and aortic stenosis I342 I350 

 (b) Hypertension I10 

Code to mitral stenosis (I342). Conditions of both valves are 

considered as nonrheumatic since they are reported due to 

hypertension (I10). 

Codes for Record

 I (a) Mitral disease 

(b) Aortic stenosis 

(c) Arteriosclerosis 

I349 

I350 

I709 

Code to aortic (valve) stenosis (I350). Consider mitral disease as 

nonrheumatic since it is reported due to aortic stenosis which is, in 

turn, reported due to arteriosclerosis (I709). 

Codes for Record

 I (a) Congestive heart failure I500 

(b)Mitral stenosis I342 

(c) Congenital cardiomyopathy I424 

Code to congenital cardiomyopathy (I424). Mitral stenosis is 

considered as nonrheumatic since it is reported due to congenital 

cardiomyopathy (I424). 

165	 2a January 2011 
 

 

 

 

 

Section IV - Classification of Categories 

I05.8 Other mitral valve diseases 

I05.9 Mitral valve disease, unspecified 

 when of unspecified cause with mention of: 

I34.- (Nonrheumatic mitral valve disorders), code I34.-

I08.- Multiple valve diseases 

Not to be used for multiple valvular diseases of specified, but 

nonrheumatic origin. When multiple valvular diseases of nonrheumatic 

origin are reported on the same death certificate, the underlying cause 

should be selected by applying the General Principle or Rules 1, 2 or 3 in 

the usual way. 

I09.1 Rheumatic diseases of endocardium, valve unspecified 

I09.9 Rheumatic heart disease, unspecified 

with mention of:

 I05-I08 (Chronic rheumatic heart disease), code I05-I08 

166 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

I10 Essential (primary) hypertension 

with mention of: 

I11.- (Hypertensive heart disease), code I11.-

I12.- (Hypertensive renal disease), code I12.-

I13.- (Hypertensive heart and renal disease), code I13.-

I20-I25 (Ischemic heart diseases), code I20-I25 

I60-I69 (Cerebrovascular diseases), code I60-I69 

N00.- (Acute nephritic syndrome), code N00.-

N01.- (Rapidly progressive nephritic syndrome), code N01.-

N03.- (Chronic nephritic syndrome), code N03.-

N04.- (Nephrotic syndrome), code N04.-

N05.- (Unspecified nephritic syndrome), code N05.-

N18.- (Chronic kidney disease), code I12.-

N19 (Unspecified kidney failure), code I12.-

N26 (Unspecified contracted kidney), code I12.-

when reported as the originating antecedent cause of: 

H35.0 (Background retinopathy and other vascular changes), 

code H35.0 

I05-I09 (Conditions classifiable to I05-I09 but not specified as 

rheumatic), code I34-I38 

I34-I38 (Nonrheumatic valve disorders), code I34-I38 

I50.- (Heart failure), code I11.0 

I51.4- (Complications and ill-defined descriptions of heart disease), 

I51.9 code I11.-

I11.- Hypertensive heart disease 

with mention of: 

I12.- (Hypertensive renal disease), code I13.-

I13.- (Hypertensive heart and renal disease), code I13.-

I20-I25 (Ischemic heart diseases), code I20-I25 

N18.- (Chronic kidney disease), code I12.-

N19 (Unspecified kidney failure), code I13.-

N26 (Unspecified contracted kidney), code I13.-

167 2a January 2011 
 

 

 

 

 

 

 

Section IV - Classification of Categories 

I12.- Hypertensive renal disease 

with mention of: 

I11.- (Hypertensive heart disease), code I13.-

I13.- (Hypertensive heart and renal disease), code I13.-

I20-I25 (Ischemic heart diseases), code I20-I25 

when reported as the originating antecedent cause of: 

I50.- (Heart failure), code I13.0 

I51.4- (Complications and ill-defined 

I51.9 descriptions of heart disease), code I13.-

I13.- Hypertensive heart and renal disease 

with mention of:

 I20-I25 (Ischemic heart disease), code I20-I25 

I15.1 Hypertension secondary to other renal disorders 

Not to be used for underlying cause mortality coding. Code to reported 

renal disorder.

 I15.2 Hypertension secondary to endocrine disorders 

 Not to be used for underlying cause mortality coding. Code to reported 

 endocrine disorder. 

I15.8 Other secondary hypertension 

Not to be used for underlying cause mortality coding. Code to reported 

underlying cause. If the cause is not stated, code to Other ill-defined and 

unspecified causes of mortality (R99). 

I20.- Angina pectoris 

I24.- Other acute ischemic heart diseases 

I25.- Chronic ischemic heart disease 

with mention of:

 I21.­ (Acute myocardial infarction), code I21.-

I22.­ (Subsequent myocardial infarction), code I22.-

168 2a January 2011 
 

 

 

 

 

 

 

Section IV - Classification of Categories 

I21.­

I23.­

I24.0 

I25.2 

I27.9 

I44.­

I45.­

I46.­

I47.­

I48 

I49.­

I50.­

I51.4-I51.9 

 Acute myocardial infarction 

with mention of:

 I22.- (Subsequent myocardial infarction), code I22.-

 Certain current complications following acute myocardial infarction 

Not to be used for underlying cause mortality coding. Use code I21.- or 

I22.- as appropriate. 

 Coronary thrombosis not resulting in myocardial infarction 

Not to be used for underlying cause mortality coding. For mortality, the 

occurrence of myocardial infarction is assumed and assignment made to 

I21.- or I22.- as appropriate. 

 Old myocardial infarction 

Not to be used for underlying cause mortality coding. If the cause is not 

stated, code to Other forms of chronic ischemic heart disease (I25.8). 

 Pulmonary heart disease, unspecified 

 with mention of: 

M41.- (Scoliosis), code I27.1 

 Atrioventricular and left bundle-branch block 

 Other conduction disorders 

 Cardiac arrest 

 Paroxysmal tachycardia 

 Atrial fibrillation and flutter 

 Other cardiac arrhythmias 

 Heart failure 

Complications and ill-defined descriptions of heart disease 

with mention of:

 B57.- (Chagas’ disease), code B57.­

 I20-I25 (Ischemic heart diseases), code I20-I25 

169 2a January 2011 
 

 

 

 

 

 

 

 

 


 

	 

Section IV - Classification of Categories 

I50.- Heart failure 

I51.9 Heart disease, unspecified 

with mention of:

 M41.- (Scoliosis), code I27.1

 I50.9 Heart failure, unspecified 

I51.9 Heart disease, unspecified 

with mention of:

 J81 (Pulmonary edema), code I50.1 

I60-I69 Cerebrovascular diseases 

when reported as the originating antecedent cause of conditions in: 

F01-F03, code F01 

I65.- Occlusion and stenosis of precerebral arteries, not resulting in cerebral 

infarction 

I66.- Occlusion and stenosis of cerebral arteries, not resulting in cerebral 

infarction 

Not to be used for underlying cause mortality coding. For mortality, the 

occurrence of cerebral infarction is assumed and assignment made 

to I63.-. 

I67.2 Cerebral atherosclerosis 

with mention of: 

I60-I64 (Cerebral hemorrhage, cerebral infarction, or stroke, 

occlusion and stenosis of precerebral and cerebral arteries), 

code I60-I64 

when reported as the originating antecedent cause of conditions in: 

F03 (Unspecified dementia), code F01.-

G20 (Parkinson’s disease), code G21.4 

G21.9 (Secondary parkinsonism, unspecified), code G21.4 

170	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

170.- Atherosclerosis 

with mention of:

 I10-I13 (Hypertensive disease), code I10-I13 

 I20-I25 (Ischemic heart diseases), code I20-I25

 I50.- (Heart failure), code I50.-

I51.4 (Myocarditis, unspecified), code I51.4

 I51.5 (Myocardial degeneration), code I51.5

 I51.6 (Cardiovascular disease, unspecified), code I51.6

 I51.8 (Other ill-defined heart diseases), code I51.8

 I60-I69 (Cerebrovascular diseases), code I60-I69 

when reported as the originating antecedent cause of: 

I05-I09 (Conditions classifiable to I05-I09 but not specified as

 rheumatic), code I34-I38

 I34-I38 (Nonrheumatic valve disorders), code I34-I38

 I51.9 (Heart disease, unspecified), code I25.1 

I71-I78 (Other diseases of arteries, arterioles and capillaries), 

code I71-I78

 K55.- (Vascular disorders of intestine), code K55.-

 N03 (Chronic nephritis), code I12.-

N26 (Unspecified contracted kidney), code I12.-

I70.9 Generalized and unspecified atherosclerosis 

with mention of:

 R02 (Gangrene, not elsewhere classified), code I70.2 

when reported as the originating antecedent cause of: 

F01.- (Vascular dementia), code F01.-

F03 (Unspecified dementia), code F01.-

G20 (Parkinson’s disease), code G21.4

 G21.9 (Secondary parkinsonism, unspecified), code G21.4 

171 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

I97.- Postprocedural disorders of circulatory system, not elsewhere classified 

Not to be used for underlying cause mortality coding. 

J00 Acute nasopharyngitis [common cold] 

J06.- Acute upper respiratory infections of multiple and unspecified sites 

when reported as the originating antecedent cause of: 

G03.8 (Meningitis), code G03.8 

G06.0 (Intracranial abscess and granuloma), code G06.0

 H65-H66 (Otitis media), code H65-H66

 H70.- (Mastoiditis and related conditions), code H70.-

J09-J18 (Influenza and pneumonia), code J09-J18

 J20-J21 (Bronchitis and bronchiolitis), code J20-J21

 J40-J42 (Unspecified and chronic bronchitis), code J40-J42

 J44.- (Other chronic obstructive pulmonary disease), code J44.-

N00.- (Acute nephritic syndrome), code N00.-

J18.- Pneumonia, organism unspecified 

with mention of: 

R26.3 (Immobility), code to J18.2 

J20.- Acute bronchitis 

with mention of:

 J41.- (Simple and mucopurulent chronic bronchitis), code J41.-

J42 (Unspecified chronic bronchitis), code J42

 J44.- (Other chronic obstructive pulmonary disease), code J44 .-

J40 Bronchitis, not specified as acute or chronic 

J41.- Simple and mucopurulent chronic bronchitis 

J42 Unspecified chronic bronchitis 

with mention of:

 J43.- (Emphysema), code J44.-

J44.- (Other chronic obstructive pulmonary disease), code J44.-

when reported as the originating antecedent cause of: 

J45.- (Asthma), code J44.- (but see also note at J45.-, J46) 

172 2a January 2011 
 

 

 

 

 

 

 

 

 


 


 


 

Section IV - Classification of Categories 

J43.- Emphysema 

with mention of:

 J40 (Bronchitis, not specified as acute or chronic), code J44.-

J41.- (Simple and mucopurulent chronic bronchitis), code J44.-

J42 (Unspecified chronic bronchitis), code J44.-

J44.8-J44.9 Other and unspecified chronic obstructive pulmonary disease 

With mention of: 

J12-J18 (Pneumonia), code J44.0 

J20-J22 (Other acute lower respiratory infections), code J44.0 

J45.- Asthma
 

J46 Status asthmaticus 
 

When asthma and bronchitis (acute) (chronic) or other chronic obstructive 

pulmonary disease are reported together on the medical certificate of 

cause of death, the underlying cause should be selected by applying the 

General Principle or Rules 1, 2, or 3 in the normal way. Neither term 

should be treated as an adjectival modifier of the other. 

J60-J64 Pneumoconiosis 

with mention of:

 A15-A16 (Respiratory tuberculosis), code J65 

 J81 Pulmonary edema 
 

with mention of:

 I50.9 (Heart failure, unspecified), code I50.1

 I51.9 (Heart disease, unspecified), code I50.1 

173 2a January 2011 
 

 

 

 

 

 

 

 

 


 


 

Section IV - Classification of Categories 

J95.- Postprocedural respiratory disorders, not elsewhere classified 

Not to be used for underlying cause mortality coding. See Operations, p 71. 

K72 Hepatic failure, not elsewhere classified 

with mention of: 

F10.- (Mental and behavioral disorders due to use of alcohol), 

code K70.4
 

K73 Chronic hepatitis, not elsewhere classified
 

with mention of: 

F10.- (Mental and behavioral disorders due to use of alcohol), 

code K70.1 

K74.0 Hepatic fibrosis 

with mention of: 

F10.- (Mental and behavioral disorders due to use of alcohol), 

code K70.2 

K74.1 Hepatic sclerosis 

with mention of: 

F10.- (Mental and behavioral disorders due to use of alcohol), 

code K70.2 

K74.2 Hepatic fibrosis with hepatic sclerosis 

 with mention of: 

F10.- (Mental and behavioral disorders due to use of alcohol), 

 code K70.2 

K74.6 Other and unspecified cirrhosis of liver 

 with mention of:

 F10.- (Mental and behavioral disorders due to use of alcohol), 

 code K70.3 

174	 2a January 2011 
 

 

 

 

	 

Section IV - Classification of Categories 

K75.9 Inflammatory liver disease, unspecified 

 with mention of:

 F10.- (Mental and behavioral disorders due to use of alcohol), code K70.1 

K76.0 Fatty (change) of liver, not elsewhere classified 

with mention of: 

F10.- (Mental and behavioral disorders due to use of alcohol), code 

K70.0 

K76.9 Liver disease, unspecified 

 with mention of: 

F10.- (Mental and behavioral disorders due to use of alcohol), 

code K70.9 

175	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

K91.- Postprocedural disorders of digestive system, not elsewhere classified 

 Not to be used for underlying cause mortality coding. 

M41.- Scoliosis 

with mention of:

 I27.9 (Pulmonary heart disease, unspecified), code I27.1 

I50.- (Heart failure), code I27.1

 I51.9 (Heart disease, unspecified), code I27.1 

M96.- Postprocedural musculoskeletal disorders, not elsewhere classified 

 Not to be used for underlying cause mortality coding. 

N00.- Acute nephritic syndrome 

when reported as the originating antecedent cause of: 

N03.- (Chronic nephritic syndrome), code N03.-

N18.- Chronic kidney disease 

 N19 Unspecified renal failure

 N26 Unspecified contracted kidney 

with mention of:

 I10 (Essential (primary) hypertension), code I12.-

I11.- (Hypertensive heart disease), code I13.-

I12.- (Hypertensive renal disease), code I12.-

 N46 Male infertility

 N97.- Female infertility 

 Not to be used if the causative condition is known. 

N99.- Postprocedural disorders of genitourinary system, not elsewhere classified 

Not to be used for underlying cause mortality coding. 

176 2a January 2011 
 

 

 

 Pregnant at time of death 

 

 Not pregnant, but pregnant within 42 days of death 

 Not pregnant, but pregnant 43 days to 1 year before death 

Section IV - Classification of Categories 

O00-O99 Pregnancy, childbirth, and the puerperium 

Conditions classifiable to categories O00-O99 are limited to deaths of 

females of childbearing age. Some of the maternal conditions are also the 

cause of death in newborn infants. Always refer to the age and sex of the 

decedent before assigning a condition to O00-O99. 

Obstetric deaths are classified according to time elapsed between the 

obstetric event and the death of the woman: 

 O95 Obstetric death of unspecified cause 

O960-O969 Death from any obstetric cause occurring more than 42 

days but less than one year after delivery 

O970-O979 Death from sequela of obstetric causes (deaths occurring 

one year or more after delivery) 

The standard certificate of death contains a separate item regarding 

pregnancy. Any positive response to one of the following items should be 

taken into consideration when coding pregnancy related deaths. 

If the third option for the previous list is marked and the decedent is 

greater than 54 years old, code as a pregnancy record only when there is a 

condition reported which indicates the person was pregnant either at the 

time of death or pregnant 43 days to 1 year before death. 

Consider the pregnancy to have terminated 42 days or less prior to death 

unless a specified length of time is written in by the certifier. Take into 

consideration the length of time elapsed between pregnancy and death if 

reported as more than 42 days. 

If an indirect maternal cause is selected as the originating antecedent 

cause, reselect any direct maternal cause on the line immediately above 

the indirect cause. If no direct cause is reported, the indirect cause will be 

accepted as the cause of death. 

O08.- Complications following abortion and ectopic and molar pregnancy 

Not to be used for underlying cause mortality coding. Use 

categories O00-O07. 

177	 2a January 2011 
 

 

 

 

 

 

	 

Section IV - Classification of Categories 

O30.- Multiple gestation 

Not to be used for underlying cause mortality coding if a more specific 

complication is reported. 

O32.- Maternal care for known or suspected malpresentation of fetus 

with mention of : 

O33.- (Maternal care for known or suspected disproportion), 

code O33.-

O33.9 Fetopelvic disproportion 

with mention of:

 O33.0-O33.3 (Disproportion due to abnormality of maternal pelvis),

 code O33.0-O33.3 

O64.- Obstructed labor due to malposition and malpresentation of fetus 

with mention of: 

O65.- (Obstructed labor due to maternal pelvic abnormality), 

code O65.-

O80.0-O80.9 Single spontaneous delivery 

Not to be used for underlying cause mortality coding. If no other cause of 

maternal mortality is reported, code to Obstetric death of unspecified 

cause (O95). 

O81-O84 Method of delivery 

Not to be used for underlying cause mortality coding. If no other cause of 

maternal mortality is reported, code to Complication of labor and 

delivery, unspecified (O759). 

P07.- Disorders related to short gestation and low birth weight, not elsewhere 

classified

 P08.- Disorders related to long gestation and high birth weight 

Not to be used if any other cause of perinatal mortality is reported. This 

does not apply if the only other cause of perinatal mortality reported is 

respiratory failure of newborn (P28.5). 

178	 2a January 2011 
 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

P70.3-P72.0 Transitory endocrine and metabolic disorders specific to fetus and 

P72.2-P74.9 newborn 

 Not to be used for underlying cause mortality coding. If no other 

 perinatal cause of mortality is reported, code to Condition 

 originating in the perinatal period, unspecified (P96.9). If another 

 perinatal cause is reported, prefer this cause. If more than one 

 perinatal cause is reported, apply the rules for conflict in linkage in 

 selection of the other perinatal cause. 

P95 Fetal death of unspecified cause 

Not to be used for underlying cause mortality coding. Use P96.9 for fetal 

death in mortality coding. 

R69.- Unknown and unspecified causes of morbidity 

Not to be used for underlying cause mortality coding. Use R95-R99 as 

appropriate. 

S00-T98 Injury, poisoning, and certain other consequences of external causes 

Not to be used for underlying cause mortality coding. 

V01-Y89 Classification of external causes of morbidity and mortality 

The codes for external causes permit the classification of environmental 

events and circumstances as the cause of injury, poisoning and other 

adverse effects. 

1. Successive external causes. Where successive external events occur 

and cause death, assignment is to the initiating event except where 

this was a trivial accident leading to a more serious one. In the latter 

case, the trivial event may be disregarded. 

179	 2a January 2011 
 

 


 

	 

	 

	 


 

	 

	 

	 

	 

Section IV - Classification of Categories 

2.
 

3. 

4. 

Slight injuries. When a slight injury is involved as a cause of death, the 

Rules for Selection are applied. Slight injuries are trivial conditions 

rarely causing death unless a more serious condition such as tetanus 

resulted from the slight injury. Therefore, where a slight injury is 

selected, Rule B, Trivial conditions, is usually applied. For the purpose 

of these rules, slight injuries comprise superficial injuries such as: 

abrasions	 exposure NOS 

bite of insect minor cut 

(non-venomous) prick 

blister	 puncture except 

bruise trunk 

burn of first degree scratch 

contusion (external) splinter 

For slight injury resulting in streptococcal septicemia, septicemia, or 

erysipelas refer to Section IV, B, categories A40.-, A41.-, A46. 

Accident information entered in space outside Part I and Part II. 

When information concerning an accident is reported only in a space 

specifically provided for such information outside of Parts I and II of 

the Medical Certification Section, inquiry should be made concerning 

the relationship of the accident to the death and to the other causes 

reported. If no information is received from the inquiry, the 

assignment is made by application of the Rules for Selection to the 

causes reported in Parts I and II. 

Accident due to disease condition. When a disease condition, such as 

cerebral hemorrhage, heart attack, diabetic coma, or alcoholism is 

indicated by the certifier to be the underlying cause of an accident, 

the assignment is made to the accidental cause unless there is 

evidence that the death occurred prior to the accident. Thus, 

accidents are generally not accepted due to disease conditions. 

However, there are some exceptions to this concept: 

a.	 asphyxia from aspiration of mucus or vomitus as a result of a 

disease condition
 

b.	 a fall from a pathological fracture or disease of the bone 

c.	 aspiration of milk or other food due to diseases which presumably 

affect the ability to control the process of swallowing, for 

example, cancer of the throat or a disease resulting in paralysis 

d.	 accidents resulting from epilepsy (G40-G41) 

180	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

5. 

6. 

7. 

8. 

 Found injured on highway. See category V892 in Volume 1. 

Complication of trauma for purposes of applying Selection Rule 3. 

Refer to Section II, Selection Rule 3, Direct Sequel. 

Selecting external causes as the underlying cause. External causes will 

be coded as the underlying cause even though a Chapter XIX code is 

not reported. When selecting the sequence responsible for death, no 

preference is given to the external cause. Apply selection and 

modification rules in the usual way. 

Use of the Index and Tabular List. ICD-10 provides separate indexing 

in Volume 3, Section II for the external causes of injury, with frequent 

references to Volume 1. The External Causes of Injury Index provides 

a double axis of indexing—descriptions of the circumstances under 

which the accident or violence occurred and the agent involved in the 

occurrence. Usually, the “lead terms” in the External Causes of Injury 

Index describe the circumstances of the injury with a secondary 

(indented) entry naming the agent involved. 

 Fall from building

 Code for Term

 W13

 Locate the E-code for “fall”:

 Fall

 - from

 - - building W13.- 

After locating the external cause code in the Index, always refer to 

Volume 1 since certain external cause codes require a fourth 

character. 

The ICD provides a fourth character for use with categories W00 - 

Y34, except Y06.- and Y07.-, to identify the place of occurrence of the 

external cause. NCHS uses a separate field for this purpose. Only the 

three-character category codes are assigned in underlying cause 

coding. 

Code for Term

 House fire X00 

Locate the E-code for “House fire”: 

 House fire (uncontrolled) X00.- 

181 2a January 2011 
 

 

 

 

 

	 

	 

	 

Section IV - Classification of Categories 

V01-V99 Transportation Accidents 

1.	 General Instructions 

The main axis of classification for land transports (V01-V89) is the 

victim’s mode of transportation. The vehicle of which the injured 

person is an occupant is identified in the first two characters since 

it is seen as the most important for prevention purposes. 

Definitions and examples relating to transport accidents are in 

Volume 1, pages XX-9 - XX-18. Refer to these definitions when 

any means of transportation (aircraft and spacecraft, watercraft, 

motor vehicle, railway, other road vehicle) is involved in causing 

death. 

For classification purposes, a motor vehicle not otherwise specified 

is NOT equivalent to a car. Motor vehicle accidents where the 

type of vehicle is unspecified are classified to V87-V89. 

A vehicle not otherwise specified is NOT equivalent to a motor 

vehicle unless the accident occurred on the street, highway, 

road(way), etc. Vehicle accidents where the type of vehicle is 

unspecified are classified to V87-V89. 

Additional information about type of transports is given below: 

a. Car (automobile) includes blazer, jeep, minivan, sport utility 

vehicle 

b.	 Pick-up truck or van includes ambulance, motor home, truck (farm) 

(utility) 

c. Heavy transport vehicle includes armored car, dump truck, fire 

truck, panel truck, semi, tow truck, tractor-trailer, 18-wheeler 

d. A special all-terrain vehicle (ATV) or motor vehicle designed 

primarily for off-road use includes dirt bike, dune buggy, fourwheeler, go cart, golf cart, racecar, snowmobile, three-wheeler 

e. Motor vehicle includes passenger vehicle (private), street 

sweeper 

182	 2a January 2011 
 

 

 

 

 

 

Section IV - Classification of Categories 

2. Use of the Index and tabular list 

ICD-10 provides a Table of land transport accidents in Volume 3, 

Section II. This table is referenced with any land transport accident 

if the mode of transportation is known. Since the Index does not 

always provide a complete code, reference to Volume 1, Chapter 

XX is required. 

For V01-V09, the fourth character indicates whether a pedestrian 

was injured in a nontraffic accident, traffic accident, or unspecified 

whether traffic or nontraffic accident. 

For V10-V79, the fourth character represents the status of the 

victim, i.e., whether the decedent was driver, passenger, etc. For 

each means of transportation, there is a different set of fourth 

characters. Each means of transportation is preceded by its set of 

fourth characters in Volume 1. 

• Car overturned, killing driver 

 Code for Term 

V485 

 In the Index, refer to:

 Overturning

 - transport vehicle NEC (see also Accident, transport) V89.9 

 Accident

 - transport (involving injury to) (see also Table of land 

transport accidents) V99 

In the Table of land transport accidents, select the intersection 

of: 

Under Victim and mode of transport, select 

Occupant of: 

- car (automobile) 

Under In Collision with or involved in: select 

Noncollision transport accident 

The code is V48.-. From Volume 1 the fourth character is 5, 

driver injured in traffic accident. 

183 2a January 2011 
 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Code for Term 

• Auto collision with animal V409 

In the Index, refer to: 

Collision (accidental) NEC (see also Accident, 

transport) V89.9 

Accident 

- transport (involving injury to) (see also Table of land 

 transport accidents) V99 

In the Table of land transport accidents, select the intersection 

of: 

Under Victim and mode of transport, select 

 Occupant of:

 - car (automobile)

 Under In collision with or involved in: select 

 Pedestrian or animal

 The code is V40.-. From Volume 1, determine the fourth 

character is 9, unspecified car occupant injured in traffic 

accident. 

184 2a January 2011 
 

	 

Section IV - Classification of Categories 

3.	 Classifying accidents as traffic or nontraffic 

If an event is unspecified as to whether it is a traffic or nontraffic 

accident, it is assumed to be: 

a. A traffic accident when the event is classifiable to categories 

V02-V04, V10-V82, and V87. 

b. A nontraffic accident when the event is classifiable to 

categories V83-V86. These vehicles are designed primarily for 

off-road use. 

c. Consider category V05 to be unspecified whether traffic or 

nontraffic if no place is indicated or if the place is railroad 

(tracks). 

d. Consider category V05 to be traffic if place is railway crossing. 

e. Consider accidents involving occupants of motor vehicles as 

traffic when the place is railroad (tracks).

 Codes for Record

 I (a) Laceration lung S273 

(b) 

 (c) 

 II V575 

 

Accident Truck struck bridge - Driver 

 

Code to occupant of pick up truck or van injured in collision 

with fixed or stationary object, driver (V575). When a 

motor vehicle strikes another vehicle or object, assume the 

collision occurred on the highway unless otherwise stated. 

 

Codes for Record

 I (a) Fractured skull S029 

(b) 

 (c) 

 II V866 

 

 Accident Farm Dune buggy overturned - passenger 

 

Code to passenger of all-terrain or other off road vehicle 

injured in nontraffic accident (V866). 

 

185	 2a January 2011 
Section IV - Classification of Categories 

Codes for Record 

I (a) Drowning T751 V863 

 II 

 Accident Snowmobile ran off road and went into pond 

Code to unspecified occupant of all-terrain or other off road 

motor vehicle injured in traffic accident (V863). Code as 

traffic accident since the accident originated on the road. 

 

4. Status of victim 

 

 

 

 

 

 

 

 

 

 

a. General coding instructions relating to transport accidents are in 

Volume 1, Chapter XX. Refer to these instructions for 

 clarification of the status of the victim when not clearly stated.

 Codes for Record

 I (a) Multiple internal injuries T065 

(b)Crushed by car on highway T147 V031 

Code to pedestrian injured in collision with car, pickup truck 

or van, traffic (V031). Refer to Volume 1, Chapter XX, 

instruction #3, Crushed by car. The victim is classified as a 

pedestrian. Refer to Table of land transport accidents. 

Victim and mode of transport, pedestrian, in collision (with) 

car (V03.-). Refer to Volume 1 for fourth character. 

b. In classifying motor vehicle traffic accidents, a victim of less 

than 14 years of age is assumed to be a passenger provided there 

is evidence the decedent was an occupant of the motor vehicle. 

A statement such as “thrown from car,” “fall from” “struck head 

on dashboard,” “drowning,” or “carbon monoxide poisoning” is 

sufficient.

 Female, 4 years old Codes for Record

 I (a) Fractured skull S029 

(b) Struck head on windshield when V476 

 (c) car struck tree that had fallen across road 

Code to car occupant injured in collision with fixed or 

stationary object, passenger (V476). 

186 2a January 2011 
 

 

 

pedestrian versus (vs) any vehicle (car, truck, etc.) 

any vehicle (car, truck, etc.) versus (vs) pedestrian 

classify the victim as a pedestrian (V01-V09). 

5.	 Coding categories V01-V89 

a. When drowning occurs as a result of a motor vehicle accident 

NOS, code as noncollision transport accident. The assumption 

is the motor vehicle ran off the highway into a body of water. 

If drowning results from a specified type of motor vehicle 

accident, code the appropriate E-code for the specified type of 

motor vehicle accident. 

 Codes for Record 

I (a) Drowning T751 V589 

 II 

 Accident Street Truck accident 

 

Code to occupant of truck injured in noncollision transport 

accident (V589). 

 Codes for Record 

I (a) Drowning T751 V435 

 II 

 Accident Street Driver-2 car collision 

 Code to occupant of car injured in collision with car, 

driver (V435). 

 

 

	 

Section IV - Classification of Categories 

c. When the transport accident descriptions do not specify the 

victim as being a vehicle occupant and the victim is described 

as: 

187	 2a January 2011 
 

 

 

 

 

 

 

Accident Street Fell alighting from bus 

	 

Section IV - Classification of Categories 

b. When falls from transport vehicles occur, apply the following 

 instructions: 

(1) Consider a transport vehicle to be in motion unless there 

is clear indication the vehicle was not in transit. Refer to 

Table of land transport accidents, specified type of 

vehicle reported, noncollision. Refer to Volume 1 for 

appropriate fourth character. 

 Codes for Record

 I (a) Multiple injuries T07 

II V583 

Accident Home Fell from truck in driveway 

Code to occupant of truck injured in noncollision 

transport accident (V583). Refer to Table of land 

transport accidents under Victim and mode of 

transport. Select occupant of pick-up truck, 

noncollision transport accident, (V58.-). Refer to 

Volume 1 for fourth character and select 3, 

unspecified occupant of pick-up truck, nontraffic 

accident. 

 (2) Consider a transport vehicle to be stationary when 

statements such as these are reported: 

(a) When alighting, boarding, entering, leaving, exiting, 

getting in or out of vehicle 

(b) Stated as stationary, parked, not in transit, not in 

motion 

 Codes for Record 

I (a) Head injury S099 

II V784 

Code to occupant of bus injured in noncollision 

transport accident (V784). Refer to Table of land 

transport accidents under Victim and mode of 

transport. Select occupant of bus, noncollision 

transport accident, (V78.-). Refer to Volume 1 for 

fourth character and select 4, person injured while 

boarding or alighting. 

188	 2a January 2011 
 Codes for Record 

I (a) Head Injury S099 

II V892 

Accident Street Fell on curb as he was 

exiting his daughter's 

vehicle 

 

 

 

 

Accident Street Fell from parked car 

6. Additional examples 

 

Codes for Record

 I (a) Fracture of ribs S223 

(b) 

 (c) 

 II V234 

 Accident Was driver of motorcycle which collided with 

taxicab 

 

 

 

 

 

 

Section IV - Classification of Categories 

Code to occupant of motor vehicle in noncollision 

transport accident (V892). Refer to Table of land 

transport accidents under Victim and mode of 

transport. Select occupant of motor vehicle (traffic), 

noncollision transport accident (V892). 

 Codes for Record 

I (a) Head injury S099 

II W17 

Code to other fall from one level to another (W17). 

Code as indexed under Fall, from, vehicle, stationary. 

Code to motorcycle rider injured in collision with car, pick-up 

truck or van, driver (V234). 

 Codes for Record

 I (a) Third degree burns T303 

(b) Auto accident - car overturned V489 

 (c) 

Code to car occupant injured in noncollision transport accident, 

unspecified (V489). 

189	 2a January 2011 
 

 

 

Codes for Record 

I (a) Fracture of ribs S223 

 (b) 

 (c) 

II V892 

 

Accident Street Vehicle accident 

 

 

 

Section IV - Classification of Categories 

Code to person injured in unspecified motor vehicle accident, 

traffic (V892). Code as motor vehicle accident since the 

accident occurred on the street. 

190 2a January 2011 
 

 

 

 

 

 

 

 

 

 

	 

	 

Section IV - Classification of Categories 

7.	 Occupant of special all-terrain or other motor vehicle designed 

primarily for off-road use, injured in transport accident (V86) 

This category includes accidents involving an occupant of any offroad vehicle. The fourth character indicates whether the decedent 

was injured in a nontraffic or traffic accident. Unless stated to the 

contrary, these accidents are assumed to be nontraffic. 

Codes for Record

 I (a) Multiple injuries T07 

(b) Driver of snowmobile which V860 

 (c) collided with auto 

Code to driver of all-terrain or other off-road motor vehicle 

injured in traffic accident since the collision occurred with an 

automobile (V860). 

 Codes for Record

 I (a) Injuries of head S099 

(b)Driver of ATV V865 

Code to driver of all-terrain or other off-road motor vehicle 

injured in nontraffic accident (V865). 

Codes for Record

 I (a) Head injuries S099 

(b)Overturning snowmobile V869 

Code to unspecified occupant of all-terrain or other off-road 

motor vehicle injured in nontraffic accident (V869). 

Codes for Record

 I (a) Fracture skull S029 

(b)ATV accident V869 

Code to unspecified occupant of all-terrain or other off-road 

motor vehicle injured in nontraffic accident (V869). 

191	 2a January 2011 
 

 

 

 

 

 

 

 

	 

	 

	 

	 

	 

Section IV - Classification of Categories 

8.	 Traffic accident of specified type but victim’s mode of transport 

unknown (V87) 

Non-traffic accident of specified type but victim’s mode of 

transport unknown (V88) 

a. If more than one vehicle is mentioned, do not make any 

assumptions as to which vehicle was occupied by the victim 

unless the vehicles are the same. Instead, code to the 

appropriate categories V87-V88. Statements such as these do 

not indicate status of victim. 

•	 Auto (passenger) vs. truck • Passenger car vs. truck 

•	 Car vs. truck-driver • Car vs. truck, driver 

•	 Driver, car vs. truck • Driver-car vs. truck

 Codes for Record 

I (a) Intrathoracic injury S279 

 (b)

 (c) Auto vs. motor bike accident V870 

Do not make any assumption as to which vehicle the victim 

was occupying. Using the Index, code: 

Accident 

- transport (involving injury to) (see also Table of land 

transport accidents) V99 

 - - person NEC (unknown means of transportation) (in) V99 

 - - - collision (between)

 - - - - car (with)

 - - - - - two-or three-wheeled motor vehicle (traffic) V87.0 

192	 2a January 2011 
Codes for Record

 I (a) Drowning T751 V929 

 (b) Fell over-board 

 (c)

 II

Code to Drowning, due to fall overboard (V929). Use fourth 

character “9,” unspecified watercraft. 

 	 2a January 2011 

Section IV - Classification of Categories 

 Codes for Record 

I (a) Head injuries S099 

(b) Driver - collision of car and bus V873 

 (c) 

Do not make any assumption as to which vehicle the victim 

was driving. Using the Index, code: 

 

Accident 

- transport (involving injury to) (see also Table of land 

transport accidents) V99 

 - - person NEC (unknown means of transportation) (in) V99 

 - - - collision (between) 

- - - - car (with) 

- - - - - bus V87.3 

b. If reported types of vehicles are not indexed under Accident, 

transport, person, collision, code V877 for traffic and V887 for 

nontraffic. 

 Codes for Record

 I (a) Head injuries S099 

 (b) Bus and pick-up truck collision, driver V877 

 (c) 

 

Do not make any assumption as to which vehicle the victim 

was driving. Collision between bus and pick-up is not indexed 

under Accident, transport, person, collision. Code V877. 

 

9.
 	 Water transport accidents (V90-V94) 

The fourth character subdivision indicates the type of watercraft. 

Refer to Volume 1, Chapter XX, Water transport accidents for a 

list of the fourth character subdivisions. 

193
 

 

 

 

 

 

 

Section IV - Classification of Categories 

10. Air and space transport accidents (V95-V97) 

For air and space transport accidents, the victim is only classified 

as an occupant. 

Military aircraft is coded to V958, Other aircraft accidents injuring 

occupant, since a military aircraft is not considered to be either a 

private aircraft or a commercial aircraft. Where death of military 

personnel is reported with no specification as to whether the 

airplane was a commercial or private craft, code V958. 

11. Miscellaneous coding instructions (V01-V99) 

a. When multiple deaths occur from the same transportation 

accident, all the certifications should be examined, and when 

appropriate, the information obtained from one may be applied 

to all. There may be other information available such as 

newspaper articles. A query should be sent to the certifier if 

necessary to obtain the information. 

b. When classifying accidents which involve more than one kind 

of transport, use the following order of precedence: 

 aircraft and spacecraft (V95-V97) 

 watercraft (V90-V94)

 other modes of transport (V01-V89, V98-V99) 

 Codes for Record

 I (a) Multiple fractures T029 

(b) Driver of car killed when V973 

 (c) a private plane collided with

 (d) car on highway after forced

 landing 

Code to person on ground injured in air transport accident 

following order of precedence. Refer to Volume 3, 

Accident, transport, aircraft, person, on ground (V973). 

194 2a January 2011 
 

Codes for Record

 I (a) Head injuries and fracture S099 S029 

II V892 

Accident Highway 

 

 

 

 

 

 

 

 

 

 

 

 

 


 


 


 


 

Section IV - Classification of Categories 

c. When no external cause information is reported and the place 

of occurrence of the injuries was highway, street, road(way), or 

alley, assign the external cause code to person injured in 

unspecified motor vehicle accident, traffic. 

Code to person injured in unspecified motor vehicle 

accident, traffic (V892). 

W18 Other fall on same level 

This category includes falls when other or additional information about 

the fall is reported such as: 

Fell from standing height 

 Fell moving from wheelchair to bed 

Fell striking head 

 Fell striking object 

Fell to floor

 Fell while transferring from chair to bed 

Fell while walking

 Lost balance and fell 

Codes for Record

 I (a) Fractured right hip S720 

 II Lost balance and fell to floor W18

 Code to other fall on same level (W18). 

W19 Unspecified fall

 This category includes: fall, fell, or fell at a place. 

Codes for Record

 I (a) Fractured right hip S720 

 II Fell at nursing home W19 

Code to unspecified fall (W19) since the only information is the place 

it occurred. 

195 2a January 2011 
 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

W75 Accidental suffocation and strangulation in bed 

This category INCLUDES suffocation of infants “while asleep” NOS. 

W78 Inhalation of gastric contents 

W79 Inhalation and ingestion of food causing obstruction of respiratory 

tract 

W80 Inhalation and ingestion of other object causing obstruction of 

respiratory tract 

EXCLUDES conditions in the above categories when reported as the 

underlying cause of: 

J180 Bronchopneumonia, unspecified, code Pneumonitis due to solids 

and liquids, J69.­

J181 Lobar Pneumonia, unspecified, code Pneumonitis due to solids 

and liquids, J69.­

J189 Pneumonia, unspecified, code Pneumonitis due to solids and 

liquids, J69.­

J69 Pneumonitis due to solids and liquids, code J69.- 

X30-X39 Exposure to forces of nature 

These categories INCLUDE accidents resulting directly from forces over 

which man has no control, but EXCLUDES those resulting indirectly 

through a second event which is classified to the causative agent involved 

in the subsequent accident. 

Codes for Record

 I (a) Drowned T751 X37 

(b)Car which decedent was driving was washed 

 (c) away with bridge during hurricane

 Code to victim of cataclysmic storm (X37). The drowning 

was a direct result of the hurricane. 

Codes for Record

 I (a) Suffocation T71 X36

 (b) Covered by landslide

 Code to victim of avalanche, landslide and other earth 

movements (X36). 

196	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Codes for Record

 I (a) Suffocated by smoke T598 X00 

 (b) Home burned after being

 (c) struck by lightning 

Code to exposure to uncontrolled fire in building or structure (X00). 

Category X33 includes only those injuries resulting from direct contact 

with lightning. 

Codes for Record

 I (a) Ruptured diaphragm S278 

(b)Driver of auto which struck V475 

 (c) landslide covering road

 Code to car occupant injured in collision with fixed or stationary 

object, driver (V475). 

X40-X49 Accidental poisoning by and exposure to noxious substances 

1. Poisoning by drugs 

a. When the following statements are reported, see Table of drugs 

and chemicals for the external cause code and code as accidental 

poisoning unless otherwise indicated. 

Interpret all these statements to mean poisoning by drug and code 

as poisoning whether or not the drug was given in treatment: 

 drug taken inadvertently

 lethal (amount) (dose) (quantity) of a drug 

overdose of drug 

 poisoning by a drug

 toxic effects of a drug

 toxic reaction to a drug

 toxicity (of a site) by a drug

 wrong dose taken accidentally 

wrong drug given in error 

Male, 2 years Codes for Record

 I (a) Overdose of aspirin T390 X40 

(b) Flu and cold J1110 J00 

 (c)

 II Aspirin given for fever - 10 days T390 R509 

Code to X40, accidental poisoning by and exposure to 

nonopioid analgesics, antipyretics, and antirheumatics. 

197 2a January 2011 
 

 

 

 

 

	 

	 

Section IV - Classification of Categories 

Codes for Record

 I (a) Poisoning by barbiturates T423 X41 

Code to X41, accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, anti-parkinsonism and 

psychotropic drugs, not elsewhere classified.

 b. 	 Interpret “intoxication by drug” to mean poisoning by drug unless 

indicated or stated to be due to drug therapy or as a result of 

treatment for a condition. Refer to Section IV, B, Y40-Y59 for 

instructions regarding intoxication by drug. 

Codes for Record

 I (a) Respiratory failure J969 

(b) Digitalis intoxication T460 X44 

Code to X44, digitalis intoxication as poisoning when there is 

no indication the drug was given for therapy. 

198	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

c. When components of combinations of medicinal agents 

classifiable to X40-X44 are involved, proceed as follows: 

(1) When accidental poisoning from a single drug is reported in 

Part I with a combination of drugs in Part II, code the external 

cause code for the drug reported in Part I. 

Codes for Record

 I (a) Acute barbiturate intoxication T423 X41 

 II Accident - Took unknown amount T423 T390 

of barbiturates and aspirin 

Code to X41, accidental poisoning by barbiturates since 

certifier indicated this drug was the cause of death. 

(2) When accidental poisoning by a combination of drugs 

classified to different external cause codes is reported and 

(1) does not apply, code the external cause code to X44, 

accidental poisoning and exposure to other and unspecified 

drugs, medicaments, and biological substances. Note that this 

applies to accidental manner of death only. Use the following 

codes for the different manners of death: Suicide X64, 

Homicide X85 and Undetermined Y14. 

Codes for Record

 I (a) Drug intoxication T509 X44 

(b)Digitalis & cocaine intoxication T460 T405 

Code to X44, accidental poisoning by and exposure to other 

and unspecified drugs, medicaments, and biological 

substances. 

(3) Combinations of medicinal agents with alcohol should be 

coded to the medicinal agent. 

Codes for Record

 I (a) Acute respiratory failure J960 

(b) due to synergistic action T519 X45 T404 X42 

(c) of alcohol and darvon 

Code to X42, accidental poisoning by and exposure to 

narcotics and psychodysleptics (hallucinogens), not 

elsewhere classified. Synergistic action of alcohol and a 

medicinal agent is classified to poisoning by the medicinal 

agent. 

199 2a January 2011 
 

 

 

 

 

 

Section IV - Classification of Categories 

Codes for Record

 I (a) Alcohol and barbiturate T519 X45 T423 X41 

 intoxication 

Code to X41, accidental poisoning by and exposure to 

antiepileptic, sedative-hypnotic, antiparkinsonism and 

psychotropic drugs, not elsewhere classified. Alcoholic 

intoxication or poisoning reported in combination with 

medicinal agents is classified to poisoning by the medicinal 

agents. 

2. Carbon monoxide poisoning 

Code carbon monoxide poisoning from motor vehicle exhaust gas to 

noncollision motor vehicle accident (traffic) according to type of 

motor vehicle involved unless there is indication the motor vehicle 

was not in transit. Consider statements of “sleeping in car,” “sitting 

in car,” “in parked car” or place stated as “garage” to indicate the 

motor vehicle was “not in transit.” Assume “not in transit” in selfharm (intentional) and self-inflicted cases. 

X60-X84 Intentional self-harm 

The categories X60-X84 include intentionally self-inflicted poisoning or 

injury as well as deaths specified as suicide (attempted). The codes are 

indexed under the event as well as under “Suicide” in the External causes 

of injury index. 

 Codes for Record 

I (a) Hanging T71 X70 

Suicide 

Code to intentional self-harm by hanging, strangulation and 

suffocation (X70). 

200 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

	 

	 

Section IV - Classification of Categories 

X85-Y09 Assault 

The categories X85-Y09 include injuries inflicted by another person with 

intent to injure or kill by any means as well as deaths specified as 

homicide. The codes are indexed under the event as well as under 

“Assault” in the External causes of injury index. 

 Codes for Record

 I (a) Gunshot wound T141 X95 

Homicide 

 Code to assault by other and unspecified firearm discharge (X95). 

Y07 Other maltreatment syndromes 

1.	 Code to category Y070-Y079, if the age of the decedent is under 18 

years and the cause of death meets one of the following criteria: 

a. The certifier specifies abuse, beating, battering, or other 

maltreatment, even if homicide is not specified. 

 Male, 3 years Codes for Record

 I (a) Traumatic head injuries S099 

 (b)

 (c)

 II Deceased had been beaten Y079 

Home 

Code to other maltreatment syndromes by unspecified 

person (Y079). 

201	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

b. The certifier specifies homicide and injury or injuries with 

indication of more than one episode of injury, i.e., current injury 

coupled with old or healed injury consistent with a history of 

child abuse.

 Male, 1-1/2 years

 I (a) Anoxic encephalopathy 

(b) Subdural hematoma

 (c) Old and recent contusions 

 of body 

II 

 Codes 

G931 

S065 

T910 

Y079 

for Record 

T090 

Homicide 

Code to other maltreatment syndromes by unspecified 

person (Y079). 

c. The certifier specifies homicide and multiple injuries consistent 

with an assumption of beating or battering, if assault by a peer, 

intruder, or by someone unknown to the child cannot be 

reasonably inferred from the reported information. 

Female, 1 year Codes for Record

 I (a) Massive internal bleeding T148 

(b) Multiple internal injuries T065 

 (c)

 II Injury occurred by child T149 Y079 

 being struck 

Homicide 

Code to other maltreatment syndromes by unspecified 

 person (Y079). 

2.	 Deaths at ages under 18 years for which the cause of death 

certification specifies homicide and an injury occurring as an isolated 

episode, with no indication of previous mistreatment, should not be 

classified to Y070-Y079. This excludes from Y070-Y079 deaths due 

to injuries specified to be the result of events such as shooting, 

stabbing, hanging, fighting, or involvement in robbery or other crime, 

because it cannot be assumed that such injuries were inflicted simply 

in the course of punishment or cruel treatment. 

202	 2a January 2011 
 Female, 1 year Codes for Record

 I (a) Hypovolemic shock T794 

 (b) Laceration of heart S268 

 (c) Multiple stab wounds anterior chest S217 X99 

 II Stabbed with kitchen knife by mother T141 

 Homicide Home 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

Code to assault by sharp object (X99). 

Y10-Y34 Event of undetermined intent 

Y10-Y34 are for use when it is stated that an investigation by a medical or 

legal authority has not determined whether the injuries are accidental, 

suicidal, or homicidal. They include such statements as “jumped or fell,” 

“don’t know,” “accidental or homicidal,” “accidental or suicide,” 

“undetermined.” They also include self-inflicted injuries, other than 

poisoning, when not specified whether accidental or with intent to harm. 

Codes for Record

 I (a) Fx. skull, laceration of brain S029 S062 

 II Y34 

Unknown whether accidental or homicide 

Code to unspecified event, undetermined intent (Y34). 

Codes for Record

 I (a) Barbiturate overdose T423 Y11 

 II 

Undetermined 

Code to poisoning by and exposure to antiepileptic, sedative-hypnotic, 

antiparkinsonism and psychotropic drugs, not elsewhere classified, 

undetermined intent (Y11). 

Codes for Record

 I (a) Cerebral hemorrhage S062 

(b)Shot self in head S019 Y24 

 Code to other and unspecified firearm discharge, undetermined 

intent (Y24). 

203 2a January 2011 
 

 

 

 

 

 

 

	 

	 

	 

	 

Section IV - Classification of Categories 

Y40-Y59 Drugs, medicaments and biological substances causing adverse effects in 

therapeutic use 

1. Condition due to (named) drug or drug therapy 

When a condition is reported due to a (named) drug or drug therapy, 

consider the condition to be a complication of a correct drug and 

medicinal substance properly administered providing the sequence is 

acceptable. This instruction also includes a condition reported due to 

drug use or named drug use unless: 

•	 The drug is one which is not used for medical purposes, e.g., 

LSD or heroin. 

or 

•	 It was an analgesic, sedative, narcotic or psychotropic drug (or 

combination thereof) or drug NOS 

AND the certifier indicated the death was due to an “accident”, 

“suicide”, or it occurred under “undetermined circumstances,” 

or 

•	 One or more of these drugs was taken in conjunction with 

alcohol 

If one of the exceptions apply, code to poisoning (refer to 

Section IV, B, X40-X49). Use the following instructions to select 

the correct underlying cause if a condition is reported due to a 

(named) drug or drug therapy. 

a. If the condition for which the drug is being administered is stated, 

code this condition as the underlying cause applying any 

appropriate modification rule(s). 

 Codes for Record 

I (a) Allergic reaction T887 

(b)Drug therapy Y579 

 (c) Pyelitis N12 

Code to pyelitis (N12), the condition requiring treatment. 

 Codes for Record 

I (a) Diabetes E139 

(b)Steroid Use Y427 

 II Rheumatoid Arthritis M069 

Code to rheumatoid arthritis (M069), the condition requiring 

treatment. 

204	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

 Codes for Record

 I (a) Pulmonary insufficiency J984 

(b)Drug given for tachycardia Y579 

(c) R000 

Code to pulmonary insufficiency (J984), the complication of 

the drug. Tachycardia is selected as the condition for which the 

drug was administered, then disregarded by Rule A and the 

complication of the drug is reselected. 

b. If the condition being treated is not stated, and the complication of 

the drug therapy is indexed to Chapters I-XVIII, code this condition 

as the underlying cause applying any appropriate modification 

rule(s).

 Codes for Record 

I (a) Respiratory arrest R092 

(b)Ulcer of stomach K259 

(c) Cortisone therapy Y420 

Code to ulcer of stomach (K259), the complication of the drug 

therapy as classified in Chapters I-XVIII. 

Codes for Record

 I (a) Cardiac arrest I469 

(b)Drug therapy Y579 

Code to Y579, drug or medicament unspecified. Cardiac arrest, 

the complication of the therapy, is selected as the TUC since 

the condition being treated is not stated. Rule A is applied and 

the code for the drug is reselected. 

c. If the condition being treated is not stated, and the complication is 

indexed to Chapter XIX, code external cause Y40-Y59 as the 

 underlying cause. 

Codes for Record

 I (a) Allergic reaction to T887 Y400 

 (b) penicillin

 Code to adverse effect of penicillin in correct usage (Y400) 

since Allergic (reaction), drug is indexed T887 in Chapter XIX. 

205 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 


 

	 

Section IV - Classification of Categories 

2. Intoxication by drug 

When “intoxication by drug” is reported or indicated to be due to 

 treatment for a condition or due to drug therapy, consider as a 

 complication of drug therapy, not poisoning. 

Codes for Record

 I (a) Cardiac arrest I469 

(b) Digitalis intoxication T887 Y520 

(c) ASHD I251 

Code to ASHD (I251), the condition requiring treatment. Digitalis 

intoxication is indicated to be drug therapy since it is reported due 

to a condition for which it could have been given. 

3. Combined effects of two or more drugs 

When a complication is reported due to the combined effects of 

two or more drugs: 

a. When the drugs are classified to different fourth characters of 

the same three-character category, code the appropriate E-code 

with the fourth character for “other.”

 Codes for Record 

I (a) Adverse reaction T887 

(b)Valium and sleeping pills Y478 

 Code to other sedatives, hypnotics and antianxiety drugs, the 

 combination code for valium and sleeping pills (Y478). 

b. When the drugs are classified to different three-character 

 categories, code the E-code to Y578, “Other drugs and 

 medicaments.” 

Codes for Record

 I (a) Adverse reaction T887 

(b)Anticoagulant and Y578 

aspirin 

Code to other drugs and medicaments, the combination code 

for anticoagulant and aspirin (Y578). 

206	 2a January 2011 
 	 

Section IV - Classification of Categories 

Y60-Y83 Adverse effects and misadventures occurring as a result of a surgical 

procedure 

In determining a sequence of conditions involving surgery, first determine 

if a complication is reported. Therefore, it is necessary to know if a 

condition can be due to the surgery and thus be regarded as a 

complication. Although almost any condition reported due to surgery is 

regarded as a complication, there are a few diseases that are not 

considered complications. The following are not regarded as 

complications of surgery: 

Infectious and parasitic diseases A000-A309, A320-A329, A360-A399, 

A420-A449, A481-A488, A500-A690, 

A692-B349, B500-B949 

Neoplasms C000-D489 

Hemophilia D66, D67, D680, D681, D682 

Diabetes E10-E14 

Alcoholic disorders E52, E244, F101-F109, G312, G405, G621, 

G721, I426, K292, K700-K709, K860, L278, 

R780, R826, R893 

Rheumatic fever or rheumatic heart 

disease 

I00-I099 

Hypertensive diseases I11-I139 

Coronary artery disease 

Coronary disease 

I251 

Ischemic cardiomyopathy I255 

Chronic or degenerative myocarditis I514 

Arteriosclerosis and arteriosclerotic 

conditions except those classified 

to I219 

Calculus or stones of any kind 

Influenza J09-J118 

207	 2a January 2011 
 

 

 

 

 

 

 

Section IV - Classification of Categories 

Hernia except ventral (incisional) K400-K429, K440-K469 

Diverticulitis K570-K579 

Rheumatoid arthritis M050-M089 

Collagen disease M300-M359 

Congenital malformations Q000-Q999 

This is not an all inclusive list. 

Codes for Record

 I (a) Myocardial infarction I219 

(b) Arteriosclerosis I709 

 (c) Surgery 

Code to myocardial infarction (I219) by Rules 1 and C, since arteriosclerosis is not 

accepted as due to surgery. 

 Code for Record

 I (a) Diabetic gangrene E145 

 (b) Leg amputation 

Code to diabetic gangrene (E145) since diabetes is not accepted as due to surgery. 

When a sequence of conditions involving an operation is responsible for a death, the 

cause for which the operation was performed is coded, unless it is the result of another 

condition. In the latter case, the original cause is coded. If the reason for the operation 

is not stated or implied, select the external cause code for the operation as the 

underlying cause. However, when selecting the sequence responsible for death, no 

preference is given because an operation was involved. 

208 2a January 2011 
 

 

 

 

	 

	 

Section IV - Classification of Categories 

If a term denoting an operation is selected as the cause of death without mention of the 

condition for which it was performed, or of the findings of the operation, and the Index 

provides no assignment for it: 

1.	 It is assumed that the condition for which the operation is usually 

performed was present and assignment will be made in accordance with the rules 

for selection of the cause of death (e.g. code “appendectomy” to K37). 

Use the following codes when these surgical procedures are reported and the 

condition necessitating the surgery is not reported: 

Aorta (with any other vessel NEC) bypass or graft ........................... I779 

Aorta coronary bypass or graft .......................................................... I251 

Atrio-ventricular shunt ...................................................................... G919 

Bariatric surgery ................................................................................ E668 

Billroth (I or II) .................................................................................. K3190 

Brock valvulotomy ............................................................................ Q223 

Cardiac revascularization .................................................................. I251 

Carotid endarterectomy ..................................................................... I679 

Choledochoduodenostomy ................................................................ K839 

Cholecystectomy ............................................................................... K829 

Cholelithotomy .................................................................................. K802 

Colostomy ......................................................................................... K639 

Coronary artery bypass graft (CABG) .............................................. I251 

Coronary endarterectomy .................................................................. I251 

Coronary revascularization ................................................................ I251 

Endarterectomy (artery) (aorta) ......................................................... I779 

Femoral bypass .................................................................................. I779 

Femoral-popliteal bypass .................................................................. I779 

Gastrectomy ....................................................................................... K3190 

Gastric stapling .................................................................................. E668 

Gastroenterostomy ............................................................................. K929 

Gastro-intestinal surgery NOS .......................................................... K929 

Gastrojejunostomy ............................................................................. K929 

Gastrojejunectomy ............................................................................. K929 

Herniorrhaphy ....................................................................... code hernia 

Hip fixation ........................................................................ code hip fracture 

Hip pinning ........................................................................ code hip fracture 

Hip prosthesis .................................................................................... M259 

Hip replacement ................................................................................ M259 

Hysterectomy ..................................................................................... N859 

Ileal conduit ....................................................................................... N399 

Ileal loop ............................................................................................ N399 

Iliofemoral bypass ............................................................................. I779 

Lobectomy - when indicating lung .................................................... J9840 

Mammary artery (internal) implant ................................................... I251 

209	 2a January 2011 
 

 

 

 

 

	 

	 

	 

	 

	 

	 

	 

	 

	 


 

Section IV - Classification of Categories 

Revascularization of heart ................................................................. I251 

Revascularization, myocardial .......................................................... I251 

T and A .............................................................................................. J359 

Thoracoplasty .................................................................................... J989 

Tonsillectomy .................................................................................... J359 

Ureterosigmoid bypass ...................................................................... N399 

Ureterosigmoidostomy ...................................................................... N399 

Vein stripping .................................................................................... I839 

Ventricular peritoneal shunt .............................................................. G919 

Vineberg operation ............................................................ .............. I251 

2.	 However, if the name of the operation leaves in doubt what specific morbid 

 condition was present, additional information is to be sought. 

3.	 If there is no further information concerning the condition for which the surgery was 

performed, code to the residual category for disease of the site indicated by 

the name of the operation. Do not assume a disease condition for other medical care. 

4.	 When neither the organ nor the site is indicated in the operative term, code the 

 appropriate external cause code for the surgery. 

5.	 If the reason for the operation is not stated or implied, code the appropriate 

external cause code for the surgery. 

6.	 When the only reported condition indicates an operation and the record cannot 

be classified by the previous instructions, code to “Other ill-defined and 

unspecified causes of mortality” (R99). 

These procedures include: 

amputation pelvic exenteration 

arteriovenous shunt portocaval shunt 

chordotomy radical neck dissection 

craniotomy rhizotomy 

cystostomy sympathectomy 

D & C tracheotomy 

gastrostomy tracheostomy 

laminectomy tubal ligation 

laparotomy vagotomy 

lobectomy NOS vasectomy 

lobotomy vas ligation 

If one of these types of procedures is the only entry on the certificate, code R99. 

7.	 For complications of operations for purposes of applying Rule 3, Direct sequel, 

 refer to Section II, Selection Rule 3. 

210 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

Section IV - Classification of Categories 

Y84 Other medical procedures as the cause of abnormal reaction of the 

patient, or of later complication, without mention of misadventure at the 

time of procedure. 

This category is not to be used if the reason for treatment is indicated. 

However, do not assume a condition for the reason medical care was 

administered. 

Y60-Y69 Misadventures to patients during surgical and medical care 

These categories are limited to deaths explicitly indicated to be the result 

of an error or accident during medical care. These categories are not to 

be used if the condition requiring treatment is indicated. When the 

condition requiring treatment is not stated or implied, code the 

underlying cause to Y60-Y69. This does not apply when serum hepatitis 

is reported as a complication of blood transfusion, in this case code the 

underlying cause to serum hepatitis provided the reason for treatment is 

not reported. 

 Codes for Record

 I (a) Shock R579 

(b)Laceration of liver T812 

(c) Needle biopsy Y606 

Code to accidental cut (laceration) during needle biopsy (Y606). 

“Laceration” is an explicit indication of accident during medical care. 

The condition requiring treatment is not stated. 

 Codes for Record

 I (a) Peritonitis K659 

(b)Perforated jejunum T812 

(c) Laparotomy for Y600 

(d) carcinoma of small bowel C179 

 Code to carcinoma of small bowel (C179), the reason for the surgery. 

Codes for Record

 I (a) Laceration of heart T812 

(b)Open heart surgery Y600 I519 

Code to I519, Disease, heart, as the condition for which the surgery 

was performed. 

211	 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV - Classification of Categories 

 Codes for Record

 I (a) Hemorrhage during T810 

(b) craniotomy Y600 

Code to hemorrhage during surgical and medical care (Y600). 

Interpret hemorrhage stated as “intraoperative” or “during” medical 

and surgical care as a misadventure during surgical and medical care. 

Codes for Record

 I (a) Serum hepatitis B169 

(b)Blood transfusion Y640 

 Code to serum hepatitis (B169). The E-code for blood transfusion is 

not used since serum hepatitis is the complication. 

Codes for Record 

I (a) Rib fracture T818 

(b)Cardiopulmonary resuscitation Y658 

Code to Y658, Other specified misadventure during surgical and 

medical care. Interpret fracture (thoracic area) reported due to 

cardiopulmonary resuscitation as a misadventure during medical care. 

Y85-Y89 Sequela of external causes of morbidity and mortality 

A sequela is a late effect, an after effect, or a residual of a nature of 

injury or external cause. The Classification provides categories 

Y850-Y899 for sequela of external causes. If either the nature of injury 

or the external cause requires a sequela code, the selected external cause 

must be coded to a sequela category. Use the following guidelines to 

determine when the external cause should be coded to a sequela 

category. 

Y850 Sequela of motor vehicle accident (includes V01-V89) 

Y859 Sequela of other and unspecified transport accidents (includes 

 V90-V99) 

Y86 Sequela of other accidents (excludes W78-W80) 

Y870 Sequela of intentional self-harm 

Y871 Sequela of assault 

Y872 Sequela of events of undetermined intent 

Y880 Sequela of adverse effects caused by drugs, medicaments, and 

biological substances in therapeutic use 

Y881 Sequela of misadventures to patients during surgical and 

medical procedures 

Y882 Sequela of adverse incidents associated with medical devices in 

diagnostic and therapeutic use 

212 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

	 

	 

	 

Section IV - Classification of Categories 

Y883 Sequela of surgical and medical procedures as the cause of 

abnormal reaction of the patient, or of later complication, 

without mention of misadventure at the time of the procedure 

Y890 Sequela of legal intervention 

Y891 Sequela of war operations 

Y899 Sequela of unspecified external cause 

1.	 Stated sequela of external causes, injuries or trauma unless the 

interval between date of external cause and date of death is less 

than 1 year. 

 Codes for Record

 I (a) Sequela of hip fracture T931 

 (b)

 (c)

 II Y86 

Code to Y86 since a sequela of hip fracture is reported. 

2.	 Injuries described as ancient, healed, history of, late effect of, old, 

remote or delayed union, malunion or nonunion of a fracture 

regardless of duration. 

Codes for Record

 I (a) Old head injuries T909 

(b)Gunshot wound T941 Y870 

 II Attempted suicide 

Code to Y870, sequela of intentional self-harm, since injuries are 

“old.” 

3.	 External causes described as ancient, history of, old, remote, 

regardless of reported duration. 

Codes for Record

 I (a) Old fall, fractured hip 6 months T931 Y86 

 (b)

 (c)

 II Accident Fell and fractured hip T931 

6 months ago 

Code to Y86, sequela of other accidents, since the external 

cause is stated as “old.” 

213	 2a January 2011 
 

 

 

 

 

 

 

 

 

	 

	 

	 

Section IV - Classification of Categories 

4.	 External causes, injuries, or trauma when interval between 

occurrence and death is 1 year or more. 

Codes for Record

 I (a) Fractured spine T911 

(b)Automobile accident, 18 mos ago Y850 

Code to Y850, sequela of automobile accident, since duration is 

one year or more. 

Codes for Record

 I (a) Renal failure

 (b) Intestinal obstruction 

(c) Adhesions 

 II Surgery – 16 months ago 

 N19

K566 

K918 

Y883 

Code to Y883, sequela of surgical and medical procedures, since 

surgery was performed one year or more before death. 

5.	 A condition with a duration of one year or more reported due to the 

external cause, injuries, or trauma. 

 Codes for Record

 I (a) Respiratory failure J969 

(b) Paraplegia 2 years T913 

(c) Motorcycle accident Y850 

Code to Y850, sequela of motor vehicle accident, since a 

condition with a duration of one year or more is reported due to 

the external cause. Category Y850 includes categories classified 

to V01-V89. 

214	 2a January 2011 
 

 

 

 

APPENDIX A 

Infrequent and Rare Cause-of-Death Edits for Underlying and Multiple 

Cause-of-Death Classification 

Conditions classifiable to A00-B99 are NOT to be considered as rare when reported with 

human immunodeficiency virus (HIV) B20-B24. 

A00 Cholera 

A01 Typhoid and paratyphoid fevers 

A05.1 Botulism (botulism, infant botulism, wound botulism) 

A07.0-.2, .8-.9 Other protozoal intestinal diseases, excluding coccidiosis 

A20 Plague 

A21 Tularemia 

A22 Anthrax 

A23 Brucellosis 

A24.0 Glanders 

A24.1-.4 Melioidosis 

A25 Rat-bite fever 

A27 Leptospirosis 

A30 Leprosy 

A33 Tetanus neonatorum 

A34 Obstetrical tetanus 

A35 Other tetanus (tetanus) 

A36 Diphtheria 

A37 Whooping cough 

A44 Bartonellosis 

A49.1 Streptococcus pneumoniae - less than 5 years of age 

215 2a January 2011 
 

 

 

 

APPENDIX A 

Infrequent and Rare Cause-of-Death Edits for Underlying and Multiple 

Cause-of-Death Classification 

A65 Nonvenereal syphilis 

A66 Yaws 

A67 Pinta 

A68 Relapsing fever 

A69 Other spirochetal infection 

A70 Chlamydia psittaci infection (ornithosis) 

A75 Typhus fever 

A77.1 Spotted fever due to Rickettsia conorii (Boutonneuse fever) 

A77.2 Spotted fever due to Rickettsia siberica (North Asian tick fever) 

A77.3 Spotted fever due to Rickettsia australis (Queensland tick typhus) 

A77.8 Other spotted fevers (other tick-borne rickettsioses) 

A77.9 Unspecified spotted fevers (unspecified tick-borne rickettsioses) 

A78 Q fever 

A79 Other rickettsioses 

A80 Acute poliomyelitis 

A81 Atypical virus infections of central nervous system 

A82 Rabies 

A84 Tick-borne viral encephalitis 

A85.2 Arthropod-borne viral encephalitis, unspecified (viral 

encephalitis transmitted by other and unspecified arthropods) 

A90 Dengue fever 

A91 Dengue hemorrhagic fever 

216 2a January 2011 
 

 

 

 

APPENDIX A 

Infrequent and Rare Cause-of-Death Edits for Underlying and Multiple 

Cause-of-Death Classification 

A92 Other mosquito-borne viral fevers 

A93 Other arthropod-borne viral fevers including Oropouche fever, 

sandfly fever, Colorado tick fever and other specified 

A94 Unspecified arthropod-borne viral fever 

A95 Yellow fever 

A96 Arenaviral hemorrhagic fever 

A98-A99 Other viral hemorrhagic fevers including Crimean-Congo, Omsk, 

Kyasanur Forest, Ebola virus, Hanta virus 

B01 Varicella (chickenpox) 

B03 Smallpox 

B04 Monkeypox 

B05 Measles 

B06 Rubella 

B08.0 Other orthopoxvirus (cowpox and paravaccinia) 

B15 Acute hepatitis A - less than 20 years of age 

B16 Acute hepatitis B - less than 20 years of age 

B26 Mumps 

B33.0 Epidemic myalgia (epidemic pleurodynia) 

B33.4 Hantavirus (cardio-)-pulmonary syndrome [HPS] [HCPS] 

B50-B54 Malaria 

B55 Leishmaniasis 

B56 African trypanosomiasis (trypanosomiasis) 

B57 Chagas’ disease (trypanosomiasis) 

217 2a January 2011 
 

 

 

APPENDIX A 

Infrequent and Rare Cause-of-Death Edits for Underlying and Multiple 

Cause-of-Death Classification 

B602 Naegleriasis 

B65 Schistosomiasis 

B66 Other fluke infections (other trematode infection) 

B67 Echinococcosis 

B68 Taeniasis 

B69 Cysticercosis 

B70 Diphyllobothriasis and sparganosis 

B71 Other cestode infections 

B72 Dracunculiasis (dracontiasis) 

B73 Onchocerciasis 

B74 Filariasis (filarial infection) 

J09 Influenza due to identified avian influenza virus 

P35.0 Congenital rubella syndrome 

U04.9 Severe acute respiratory syndrome (SARS), unspecified 

W88-W91 Exposure to radiation 

Y36.5 War operation involving nuclear weapons 

Causing adverse effects in therapeutic use: 

Y58 Bacterial vaccines 

Y59.0 Viral vaccines 

Y59.1 Rickettsial vaccines 

Y59.2 Protozoal vaccines 

Y59.3 Immunoglobulin 

218 2a January 2011 
 

 

 

 

 APPENDIX B 

 Created Codes and Their Complimentary Valid ICD-10 Codes 

Created Code 

A1690 

E0390 

G1220 

G2000 

I2190 

I4200 

I4210 

I4220 

I4250 

I4280 

I4290 

I5000 

I5140 

I5150 

I6000 

I6060 

I6070 

I6080 

I6090 

I6100 

I6110 

I6120 

I6130 

I6140 

I6150 

I6180 

I6190 

I6300 

I6310 

I6320 

I6330 

I6340 

I6350 

I6360 

I6380 

I6390 

I6400 

I6910 

Valid ICD-10 Code 

A169 

E039 

G122 

G20 

I219 

I420 

I421 

I422 

I425 

I428 

I429 

I500 

I514 

I515 

I600 

I606 

I607 

I608 

I609 

I610 

I611 

I612 

I613 

I614 

I615 

I618 

I619 

I630 

I631 

I632 

I633 

I634 

I635 

I636 

I638 

I639 

I64 

I691 

219 2a January 2011 
 

 

 

 APPENDIX B 

 Created Codes and Their Complimentary Valid ICD-10 Codes 

Created Code Valid ICD-10 Code 

I6930 I693 

I6940 I694 

J1010 J101 

J1110 J111 

J8490 J849 

J9840 J984 

K3190 K319 

K5500 K550 

K6310 K631 

K7200 K720 

K7210 K721 

K7290 K729 

M1990 M199 

Q2780 Q278 

Q2820 Q282 

Q2830 Q283 

R5800 R58 

R97 R99 

220 2a January 2011 
 

 

 APPENDIX C 

Geographic Codes 

State FIPS Alpha 

Alabama AL 

Alaska AK 

Arizona AZ 

Arkansas AR 

California CA 

Colorado CO 

Connecticut CT 

Delaware DE 

District of Columbia DC 

Florida FL 

Georgia GA 

Hawaii HI 

Idaho ID 

Illinois IL 

Indiana IN 

Iowa IA 

Kansas KS 

Kentucky KY 

Louisiana LA 

Maine ME 

Maryland MD 

Massachusetts MA 

Michigan MI 

Minnesota MN 

Mississippi MS 

Missouri MO 

Montana MT 

State FIPS Alpha 

Nebraska NE 

Nevada NV 

New Hampshire NH 

New Jersey NJ 

New Mexico NM 

New York NY 

North Carolina NC 

North Dakota ND 

Ohio OH 

Oklahoma OK 

Oregon OR 

Pennsylvania PA 

Puerto Rico PR 

Rhode Island RI 

South Carolina SC 

South Dakota SD 

Tennessee TN 

Texas TX 

Utah UT 

Vermont VT 

Virginia VA 

Virgin Islands VI 

Washington WA 

West Virginia WV 

Wisconsin WI 

Wyoming WY 

Territories and Outlying Areas 

American Samoa 

Federated States of Micronesia 

Guam 

Marshall Islands 

Northern Mariana Islands 

Palau 

Puerto Rico 

Virgin Islands (US) 

AS 

FM 

GU 

MH 

MP 

PW 

PR 

VI 

US Minor Outlying Islands

 Baker Island

 Howland Island

 Jarvis Island

 Johnston Atoll 

 Kingman Reef 

 Midway Islands 

 Navassa Island

 Palmyra Atoll 

 Wake Island 

UM* 

*Not recognized as a valid USPS State abbreviation 

221 2a January 2011 
 

APPENDIX D 

Standard Abbreviations and Symbols 

When an abbreviation is reported on the certificate, refer to this list to determine what the 

abbreviation represents. If an abbreviation represents more than one term, determine the 

correct abbreviation by using other information on the certificate. If no determination can 

be made, use abbreviation for first term listed. 

AAA abdominal aortic aneurysm AF auricular or atrial fibrillation; acid fast 

AAS aortic arch syndrome AFB acid-fast bacillus 

AAT alpha-antitrypsin AGG agammaglobulinemia 

AAV AIDS-associated virus AGL acute granulocytic leukemia 

AB abdomen; abortion; asthmatic AGN acute glomerulonephritis 

bronchitis 

AGS adrenogenital syndrome 

ABD abdomen 

AHA acquired hemolytic anemia; 

ABE acute bacterial endocarditis autoimmune hemolytic anemia 

ABS acute brain syndrome AHD arteriosclerotic heart disease 

ACA adenocarcinoma AHHD arteriosclerotic hypertensive heart 

disease 

ACD arteriosclerotic coronary disease 

AHG anti-hemophilic globulin deficiency 

ACH adrenal cortical hormone 

AHLE acute hemorrhagic leukoencephalitis 

ACT acute coronary thrombosis 

AI aortic insufficiency; additional 

ACTH adrenocorticotrophic hormone information 

ACVD arteriosclerotic cardiovascular AIDS acquired immunodeficiency 

disease syndrome 

ADEM acute disseminated AKA above knee amputation 

encephalomyelitis 

ALC alcoholism 

ADH antidiuretic hormone 

ALL acute lymphocytic leukemia 

ADS antibody deficiency syndrome 

ALS amyotrophic lateral sclerosis 

AEG air encephalogram 

AMI acute myocardial infarction 

222 2a January 2011 
 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

AML 

ANS 

AOD 

AODM 

AOM 

AP 

A&P 

APC 

APE 

APH 

AR 

ARC 

ARDS 

ARF 

ARM 

ARV 

ARVD 

AS 

acute myelocytic leukemia 

arteriolonephrosclerosis 

arterial occlusive disease 

adult onset diabetes mellitus 

acute otitis media 

angina pectoris; anterior and 

posterior repair; artificial 

pneumothorax; anterior pituitary 

anterior and posterior repair 

auricular premature contraction; 

acetylsalicylic acid, 

acetophenetidin, and caffeine 

acute pulmonary edema; anterior 

pituitary extract 

antepartum hemorrhage 

aortic regurgitation 

AIDS-related complex 

adult respiratory distress 

syndrome 

acute respiratory failure; acute 

renal failure 

artificial rupture of membranes 

AIDS-related virus 

arrhythmogenic right ventricular 

dysplasia 

arteriosclerotic; arteriosclerosis; 

aortic stenosis 

ASA 

ASAD 

ASCAD 

ASCD 

ASCHD 

ASCRD 

ASCVA 

ASCVD 

ASCVR 

ASCVRD 

ASD 

ASDHD 

ASHCVD 

ASHD 

ASHHD 

ASHVD 

acetylsalicylic acid (aspirin) 

arteriosclerotic artery disease 

arteriosclerotic coronary artery 

disease 

arteriosclerotic coronary 

disease 

arteriosclerotic coronary heart 

disease 

arteriosclerotic cardiorenal 

disease 

arteriosclerotic cerebrovascular 

accident 

arteriosclerotic cardiovascular 

disease 

arteriosclerotic cardiovascular 

renal disease 

arteriosclerotic cardiovascular 

renal disease 

atrial septal defect 

arteriosclerotic 

decompensated heart disease 

arteriosclerotic hypertensive 

cardiovascular disease 

arteriosclerotic heart disease; 

atrioseptal heart defect 

arteriosclerotic hypertensive 

heart disease 

arteriosclerotic hypertensive 

vascular disease 

223 2a January 2011 
 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

ASO 

ASPVD 

ASVD 

ASVH(D) 

AT 

ATC 

ATN 

ATS 

ATSHD 

ATV 

AUL 

AV 

AVF 

AVH 

AVP 

AVR 

AWMI 

AZT 

arteriosclerosis obliterans 

arteriosclerotic peripheral 

vascular disease 

arteriosclerotic vascular 

disease 

arteriosclerotic vascular heart 

disease 

atherosclerosis; atherosclerotic; 

atrial tachycardia; antithrombin 

all-terrain cycle 

acute tubular necrosis 

arteriosclerosis 

arteriosclerotic heart disease 

all-terrain vehicle 

acute undifferentiated leukemia 

arteriovenous; atrioventricular; 

aortic valve 

arterio-ventricular fibrillation; 

arteriovenous fistula 

acute viral hepatitis 

aortic valve prosthesis 

aortic valve replacement 

anterior wall myocardial 

infarction 

azidothymidine 

BA 

B&B 

BBB 

B&C 

BCE 

BE 

BEH 

BGL 

BKA 

BL 

BMR 

BNA 

BNO 

BOMSA 

BOMSC 

BOW 

B/P, BP 

BPH 

basilar artery; basilar 

arteriogram; bronchial asthma 

bronchoscopy and biopsy 

bundle branch block 

biopsy and cauterization 

basal cell epithelioma 

barium enema 

benign essential hypertension 

Bartholin’s gland 

below knee amputation 

bladder; bucolingual; blood 

loss; Burkitt’s lymphoma 

basal metabolic rate 

bladder neck adhesions 

bladder neck obstruction 

bilateral otitis media serous 

acute 

bilateral otitis media serous 

chronic 

“bag of water” (membrane) 

blood pressure 

benign prostate hypertrophy 

224 2a January 2011 
 

 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

BSA 

BSO 

BSP 

BTL 

BUN 

BVL 

B&W 

BX 

BX CX 

Ca 

CA 

CABG 

CABS 

CAD 

CAG 

CAO 

CAS 

CASCVD 

body surface area 

bilateral salpingo-oophorectomy 

Bromosulfaphthalein (test) 

bilateral tubal ligation 

blood, urea, and nitrogen test 

bilateral vas ligation 

Baldy-Webster suspension 

(uterine) 

biopsy 

biopsy cervix 

cancer 

cancer; cardiac arrest; carotid 

arteriogram 

coronary artery bypass graft 

coronary artery bypass surgery 

coronary artery disease 

chronic atrophic gastritis 

coronary artery occlusion; 

chronic airway obstruction 

cerebral arteriosclerosis 

chronic arteriosclerotic 

cardiovascular disease 

CASHD 

CAT 

CB 

CBC 

CBD 

CBS 

CCF 

CCI 

CF 

CFT 

CGL 

CGN 

CHA 

CHB 

CHD 

chronic arteriosclerotic heart 

disease 

computerized axial tomography 

chronic bronchitis 

complete blood count 

common bile duct; chronic 

brain disease 

chronic brain syndrome 

chronic congestive failure 

chronic cardiac or coronary 

insufficiency 

congestive failure; cystic 

fibrosis; Christmas factor (PTC) 

chronic follicular tonsillitis 

chronic granulocytic leukemia 

chronic glomerulonephritis 

congenital hypoplastic anemia 

complete heart block 

congestive heart disease; 

coronary heart disease; 

congenital heart disease; 

Chediak-Higaski Disease 

225 2a January 2011 
 

 

 

 

 

 

 

 

CI 

APPENDIX D 

Standard Abbreviations and Symbols 

CHF 

C2H5OH 

CID 

CIS 

CJD 

CLD 

CLL 

CMID 

CML 

CMM 

CMV 

CNHD 

CNS 

CO 

COAD 

CO2 

COBE 

COBS 

congestive heart failure 

ethyl alcohol 

cardiac insufficiency; cerebral 

infarction 

cytomegalic inclusion disease 

carcinoma in situ 

Creutzfeldt-Jakob Disease 

chronic lung disease; chronic 

liver disease 

chronic lymphatic leukemia; 

chronic lymphocytic leukemia 

cytomegalic inclusion disease 

chronic myelocytic leukemia 

cutaneous malignant melanoma 

cytomegalic virus 

congenital nonspherocytic 

hemolytic disease 

central nervous system 

carbon monoxide 

chronic obstructive airway 

disease 

carbon dioxide 

chronic obstructive bullous 

emphysema 

chronic organic brain 

syndrome 

COFS 

COOMBS 

COLD 

COPD 

COPE 

CP 

C&P 

CPB 

CPC 

CPD 

CPE 

CRD 

CREST 

CRF 

CRST 

CS 

cerebro-oculo-facio-skeletal 

test for Rh sensitivity 

chronic obstructive lung 

disease 

chronic obstructive 

pulmonary disease 

chronic obstructive 

pulmonary emphysema 

cerebral palsy; cor pulmonale 

cystoscopy and pyelography 

cardiopulmonary bypass 

chronic passive congestion 

cephalopelvic disproportion; 

contagious pustular dermatitis 

chronic pulmonary 

emphysema 

chronic renal disease 

calcinosis cutis, Raynaud’s 

phenomenon, sclerodactyly, 

and telangiectasis 

cardiorespiratory failure; 

chronic renal failure 

calcinosis cutis, Raynaud’s 

phenomenon, sclerodactyly, 

and telangiectasis 

coronary sclerosis; cesarean 

section; cerebro-spinal 

226 2a January 2011 
 

 

 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

CSF 

CSH 

CSM 

CT 

CTD 

CU 

CUC 

CUP 

CUR 

CV 

CVA 

CV accident 

CVD 

CVHD 

CVI 

CVRD 

CWP 

CX 

cerebral spinal fluid 

chronic subdural hematoma 

cerebrospinal meningitis 

computer tomography; 

cerebral thrombosis; 

coronary thrombosis 

congenital thymic dysplasia 

cause unknown 

chronic ulcerative colitis 

cystoscopy, urogram, 

pyelogram (retro) 

cystocele, urethrocele, rectocele 

cardiovascular; cerebrovascular 

cerebrovascular accident 

cerebral vascular accident 

cardiovascular disease 

cardiovascular heart disease 

cardiovascular insufficiency; 

cerebrovascular insufficiency 

cardiovascular renal disease 

coal worker’s pneumoconiosis 

cervix 

DA 

DBI 

D&C 

DCR 

D&D 

D&E 

DFU 

DIC 

DILD 

DIP 

DJD 

DM 

DMT 

DOA 

DOPS 

DPT 

DR 

DS 

degenerative arthritis 

phenformin hydrochloride 

dilation and curettage 

dacrocystorhinostomy 

drilling and drainage; 

debridement and dressing 

dilation and evacuation 

dead fetus in utero 

disseminated intravascular 

coagulation 

diffuse infiltrative lung disease 

distal interphalangeal joint; 

desquamative interstitial 

pneumonia 

degenerative joint disease 

diabetes mellitus 

dimethyltriptamine 

dead on arrival 

diffuse obstructive pulmonary 

syndrome 

diphtheria, pertussis, tetanus 

vaccine 

diabetic retinopathy 

Down’s syndrome 

227 2a January 2011 
 

 

APPENDIX D 

Standard Abbreviations and Symbols 

DT 

D/T 

DU 

DUB 

DUI 

DVT 

DWI 

DX 

EBV 

ECCE 

ECG 

E coli 

ECT 

EDC 

EEE 

EEG 

EFE 

EGL 

EH 

EIOA 

EKC 

due to; delirium tremens 

due to; delirium tremens 

diagnosis unknown; duodenal 

ulcer 

dysfunctional uterine bleeding 

driving under influence 

deep vein thrombosis 

driving while intoxicated 

dislocation; diagnosis; disease 

Epstein-Barr virus 

extracapsular cataract extraction 

electrocardiogram 

Escherichia coli 

electric convulsive therapy 

expected date of confinement 

Eastern equine encephalitis 

electroencephalogram 

endocardial fibroelastosis 

eosinophilic granuloma of lung 

enlarged heart; essential 

hypertension 

excessive intake of alcohol 

epidemic keratoconjunctivitis 

EKG 

EKP 

ELF 

EMC 

EMD 

EMF 

EMG 

EN 

ENT 

EP 

ER 

ERS 

ESRD 

EST 

ETOH 

EUA 

EWB 

FB 

FBS 

Fe 

FGD 

electrocardiogram 

epikeratoprosthesis 

elective low forceps 

encephalomyocarditis 

electromechanical 

dissociation 

endomyocardial fibrosis 

electromyogram 

erythema nodosum 

ear, nose, and throat 

ectopic pregnancy 

emergency room 

evacuation of retained 

secundines 

end-stage renal disease 

electric shock therapy 

ethyl alcohol 

exam under anesthesia 

estrogen withdrawal bleeding 

foreign body 

fasting blood sugar 

symbol for iron 

fatal granulomatous disease 

FHS fetal heart sounds 

228 2a January 2011 
 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

FHT 

FLSA 

FME 

FS 

FT 

FTA 

5FU 

FUB 

FULG 

FUO 

FX 

FYI 

GAS 

GB 

GC 

GE 

GEN 

GERD 

GI 

GIB 

GIST 

fetal heart tone 

follicular lymphosarcoma 

full-mouth extraction 

frozen section; fracture site 

full term 

fluorescent treponemal 

antibody test 

fluorouracil 

functional uterine bleeding 

fulguration 

fever unknown origin 

fracture 

for your information 

generalized arteriosclerosis 

gallbladder; 

Guillain-Barre (syndrome) 

gonococcus; gonorrhea; general 

circulation (systemic) 

gastroesophageal 

generalized 

gastroesophageal reflux disease 

gastrointestinal 

gastrointestinal bleeding 

gastrointestinal stromal tumor 

GIT 

GMSD 

GOK 

GSW 

GTT 

Gtt 

GU 

GVHR 

GYN 

HA 

HAA 

HASCVD 

HASCVR 

HASHD 

HC 

HCAP 

HCPS 

HCT 

HCVD 

gastrointestinal tract 

grand mal seizure disorder 

God only knows 

gunshot wound 

glucose tolerance test 

drop 

genitourinary; gastric ulcer 

graft-versus-host reaction 

gynecology 

headache 

hepatitis-associated antigen 

hypertensive arteriosclerotic 

cardiovascular disease 

hypertensive arteriosclerotic 

cardiovascular renal disease 

hypertensive arteriosclerotic 

heart disease 

Huntington’s chorea 

health care associated 

pneumonia 

Hantivirus (cardio) pulmonary 

syndrome, Hantavirus 

cardiopulmonary syndrome 

hematocrit 

hypertensive cardiovascular 

disease 

229 2a January 2011 
 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

HCVRD 

HD 

HDN 

HDS 

HEM 

HF 

HGB; Hgb 

HHD 

HIV 

HMD 

HN2 

HNP 

H/O 

HPN 

HPS 

HPVD 

HRE 

HS 

HSV 

HTLV 

hypertensive cardiovascular 

renal disease 

Hodgkin’s disease; heart disease 

hemolytic disease of newborn 

herniated disc syndrome 

hemorrhage 

heart failure; hay fever 

hemoglobin 

hypertensive heart disease 

human immunodeficiency virus 

hyaline membrane disease 

nitrogen mustard 

herniated nucleus pulposus 

history of 

hypertension 

Hantavirus pulmonary syndrome 

hypertensive pulmonary vascular 

disease 

high-resolution electrocardiology 

herpes simplex; Hurler’s 

syndrome 

herpes simplex virus 

human T-cell lymphotropic virus 

HTLVIII/LAV 

HTLV-3 

HTLV-III 

HTN 

HVD 

Hx 

IADH 

IASD 

ICCE 

ICD 

I&D 

ID 

IDA 

IDD 

IDDI 

IDDM 

human T-cell lymphotropic 

virus- III/lymphadenopathy- associated virus 

human T-cell lymphotropic 

virus-III 

human T-cell lymphotropic 

virus-III 

hypertension 

hypertensive vascular 

disease 

history of 

inappropriate antidiuretic 

hormone 

interatrial septal defect 

intracapsular cataract 

extraction 

intrauterine contraceptive 

device 

incision and drainage 

incision and drainage 

iron deficiency anemia 

insulin-dependent diabetes 

insulin-dependent diabetes 

insulin-dependent diabetes 

mellitus 

230 2a January 2011 
 

 

 

 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

IGA 

IHD 

IHSS 

ILD 

IM 

IMPP 

INAD 

INC 

INE 

INF 

INH 

INS 

IRDM 

IRHD 

ISD 

ITP 

IU 

IUCD 

IUD 

immunoglobin A IUP 

ischemic heart disease IV 

idiopathic hypertrophic subaortic IVC 

stenosis 

ischemic leg disease 

IVCC 

intramuscular; intramedullary; 

infectious mononucleosis 

IVD 

intermittent positive pressure 

IVH 

infantile neuroaxonal dystrophy 

IVP 

incomplete 

IVSD 

infantile necrotizing 

encephalomyelopathy IVU 

infection; infected; infantile; IWMI 

infarction 

isoniazid; inhalation JBE 

idiopathic nephrotic syndrome KFS 

insulin resistant diabetes mellitus KS 

inactive rheumatic heart disease KUB 

interatrial septal defect K-W 

idiopathic thrombocytopenic 

purpura LAP 

intrauterine LAV 

intrauterine contraceptive device 

LAV/HTLV

intrauterine device (contraceptive); III 

intrauterine death 

231 

­

intrauterine pregnancy 

intervenous; intravenous 

intravenous 

cholangiography; 

inferior vena cava 

intravascular consumption 

coagulopathy 

intervertebral disc 

intraventricular hemorrhage 

intravenous pyelogram 

intraventricular septal defect 

intravenous urethrography 

inferior wall myocardial 

infarction 

Japanese B encephalitis 

Klippel-Feil syndrome 

Klinefelter’s syndrome 

kidney, ureter, bladder 

Kimmelstiel-Wilson disease 

or syndrome 

laparotomy 

lymphadenopathy-associated 

virus 

lymphadenopathy-associated 

virus/human T-cell 

lymphotrophic virus-III 

2a January 2011 
 

 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

LBBB 

LBNA 

LBW 

LBWI 

LCA 

LDH 

LE 

LKS 

LL 

LLL 

LLQ 

LMA 

LML 

LMCAT 

LML 

LMP 

LN 

LOA 

left bundle branch block 

lysis bladder neck adhesions 

low birth weight 

low birth weight infant 

left coronary artery 

lactic dehydrogenase 

lupus erythematosus; lower 

extremity; left eye 

liver, kidney, spleen 

lower lobe 

left lower lobe 

lower left quadrant 

left mentoanterior (position of 

fetus) 

left middle lobe; left mesiolateral 

left middle cerebral artery 

thrombosis 

left mesiolateral; 

left mediolateral (episiotomy) 

last menstrual period; left 

mento- posterior (position of 

fetus) 

lupus nephritis 

left occipitoanterior 

LOMCS 

LP 

LRI 

LS 

LSD 

LSK 

LUL 

LUQ 

LV 

LVF 

LVH 

MAC 

MAI 

MAL 

MBAI 

MBD 

MD 

MDA 

MEA 

MF 

left otitis media chronic serous 

lumbar puncture 

lower respiratory infection 

lumbosacral; lymphosarcoma 

lysergic acid diethylamide 

liver, spleen, kidney 

left upper lobe 

left upper quadrant 

left ventricle 

left ventricular failure 

left ventricular hypertrophy 

mycobacterium avium complex 

mycobacterium avium intracellulare 

malignant 

mycobacterium avium intracellulare 

minimal brain damage 

muscular dystrophy; manic 

depressive; myocardial damage 

methylene dioxyamphetamine 

multiple endocrine adenomatosis 

myocardial failure; myocardial 

fibrosis; mycosis fungoides 

232 2a January 2011 
 

 

 

 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

MGN 

MHN 

MI 

MPC 

MRS 

MRSA 

MRSAU 

MS 

MSOF 

MT 

MUA 

MVP 

MVR 

NACD 

NAFLD 

NCA 

NDI 

NEG 

NFI 

membranous glomerulonephritis 

massive hepatic necrosis 

myocardial infarction; mitral 

insufficiency 

meperidine, promethazine, 

chlorpromazine 

methicillin resistant 

staphylococcal 

methicillin resistant 

staphylococcal aureus 

methicillin resistant 

staphylococcal aureus 

multiple sclerosis; mitral 

stenosis 

multi-system organ failure 

malignant teratoma 

myelogram 

mitral valve prolapse 

mitral valve regurgitation; mitral 

valve replacement 

no anatomical cause of death 

nonalcoholic fatty liver disease 

neurocirculatory asthenia 

nephrogenic diabetes insipidus 

negative 

no further information 

NFTD 

NG 

NH3 

NIDD 

NIDDI 

NIDDM 

NSTEMI 

N&V 

NVD 

OA 

OAD 

OB 

OBS 

OBST 

OD 

OHD 

OLT 

OM 

OMI 

OMS 

ORIF 

normal full-term delivery 

nasogastric 

symbol for ammonia 

non-insulin-dependent diabetes 

non-insulin-dependent diabetes 

non-insulin-dependent diabetes 

mellitus 

non-ST-elevation myocardial 

infarction 

nausea and vomiting 

nausea, vomiting, diarrhea 

osteoarthritis 

obstructive airway disease 

obstetrical 

organic brain syndrome 

obstructive; obstetrical 

overdose; oculus dexter (right 

eye); occupational disease 

organic heart disease 

orthotopic liver transplant 

otitis media 

old myocardial infarction 

organic mental syndrome 

open reduction, internal fixation 

233 2a January 2011 
 

 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

OS 

OT 

OU 

PA 

PAC 

PAF 

PAOD 

PAP 

PAS 

PAT 

Pb 

PCD 

PCF 

PCP 

PCT 

PCV 

PDA 

PE 

oculus sinister (left eye); 

occipitosacral (fetal position) 

occupational therapy; old TB 

oculus uterque (each eye); both eyes 

pernicious anemia; paralysis agitans; 

pulmonary artery; peripheral 

arteriosclerosis 

premature auricular contraction; 

phenacetin, aspirin, caffeine 

paroxysmal auricular fibrillation 

peripheral arterial occlusive disease; 

peripheral arteriosclerosis occlusive 

disease 

primary atypical pneumonia 

pulmonary artery stenosis 

pregnancy at term; paroxysmal 

auricular tachycardia 

chemical symbol for lead 

polycystic disease 

passive congestive failure 

pentachlorophenol; pneumocystis 

carinii pneumonia 

porphyria cutanea tarda 

polycythemia vera 

patent ductus arteriosus 

pulmonary embolism; pleural 

effusion; pulmonary edema 

PEG 

PEGT 

PET 

PG 

PGH 

PH 

PI 

PID 

PIE 

PIP 

PKU 

PMD 

PMI 

PML 

PN 

PO 

percutaneous endoscopic 

gastrostomy; 

pneumoencephalography 

percutaneous endoscopic 

gastrostomy tube 

pre-eclamptic toxemia 

pregnant; prostaglandin 

pituitary growth hormone 

past history; prostatic 

hypertrophy; pulmonary 

hypertension 

pulmonary infarction 

pelvic inflammatory disease; 

prolapsed intervertebral disc 

pulmonary interstitial 

emphysema 

proximal interphalangeal joint 

phenylketonuria 

progressive muscular dystrophy 

posterior myocardial infarction; 

point of maximum impulse 

progressive multifocal 

leukoencephalopathy 

pneumonia; periarteritis nodosa; 

pyelonephritis 

postoperative 

234 2a January 2011 
 

 

 
 


 


 


 

APPENDIX D 

Standard Abbreviations and Symbols 

POC 

POE 

PP 

POSS 

PPD 

PPH 

PPLO 

PPS 

PPT 

PREM 

PROB 

PROM 

PSVT 

PT 

PTA 

PTC 

PTCA 

PTLA 

PU 

product of conception 

point (or portal) of entry 

postpartum
 

possible; possibly 

purified protein derivative test for 

tuberculosis 

postpartum hemorrhage 

pleuropneumonia-like organism
 

postpump syndrome
 

precipitated; prolonged prothrombin 

time 

prematurity 

probably 

premature rupture of membranes 

paroxysmal supraventricular 

tachycardia 

paroxysmal tachycardia; 

pneumothorax; 

prothrombin time 

persistent truncus arteriosus 

plasma thromboplastin component
 

percutaneous transluminal coronary 

angioplasty 

percutaneous transluminal laser 

angioplasty 

peptic ulcer 

PUD 

PUO 

P&V 

PVC 

PVD 

PVI 

PVL 

PVT 

PVS 

PWI 

PWMI 

PX 

R 

RA 

RAAA 

RAD 

RAI 

RBBB 

peptic ulcer disease; pulmonary 

disease 

pyrexia of unknown origin 

pyloroplasty and vagotomy 

premature ventricular contraction 

peripheral vascular disease; 

pulmonary vascular disease 

peripheral vascular insufficiency 

periventricular leukomalacia 

paroxysmal ventricular 

tachycardia 

premature ventricular systole 

(contraction) 

posterior wall infarction 

posterior wall myocardial 

infarction 

pneumothorax 

right 

rheumatoid arthritis; right 

atrium; right auricle 

ruptured abdominal aortic 

aneurysm 

rheumatoid arthritis disease; 

radiation absorbed dose 

radioactive iodine 

right bundle branch block 

235 2a January 2011 
 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

RBC 

RCA 

RCS 

RD 

RDS 

RE 

REG 

RESP 

RHD 

RLF 

RLL 

RLQ 

RMCA 

RMCAT 

RML 

RMLE 

RNA 

RND 

R/O 

RSA 

red blood cells 

right coronary artery 

reticulum cell sarcoma 

Raynaud’s disease; respiratory 

disease 

respiratory distress syndrome 

regional enteritis 

radioencephalogram 

respiratory 

rheumatic heart disease 

retrolental fibroplasia 

right lower lobe 

right lower quadrant 

right middle cerebral artery 

right middle cerebral artery 

thrombosis 

right middle lobe 

right mediolateral episiotomy 

ribonucleic acid 

radical neck dissection 

rule out 

reticulum cell sarcoma 

RSR 

Rt 

RT 

RTA 

RUL 

RUQ 

RV 

RVH 

RVT 

RX 

SA 

SACD 

SARS 

SBE 

SBO 

SBP 

SC 

SCC 

SCI 

SD 

regular sinus rhythm 

right 

recreational therapy; right 

renal tubular acidosis 

right upper lobe 

right upper quadrant 

right ventricle 

right ventricular hypertrophy 

renal vein thrombosis 

drugs or other therapy or 

treatment 

sarcoma; secondary anemia 

subacute combined degeneration 

severe acute respiratory syndrome 

subacute bacterial endocarditis 

small bowel obstruction 

spontaneous bacterial peritonitis 

sickle cell 

squamous cell carcinoma 

subcoma insulin; spinal cord 

injury 

spontaneous delivery; septal 

defect; sudden death 

236 2a January 2011 
 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

SDAT 

SDII 

SDS 

SEPT 

SF 

SGA 

SH 

SI 

SIADH 

SICD 

SID 

SIDS 

SIRS 

SLC 

SLE 

SMR 

SNB 

SO or S&O 

SOB 

SOM 

senile dementia Alzheimer’s 

type 

sudden death in infancy 

sudden death syndrome 

septicemia 

scarlet fever 

small for gestational age 

serum hepatitis 

saline injection 

syndrome of inappropriate 

antidiuretic hormone 

sudden infant crib death 

sudden infant death 

sudden infant death syndrome 

systemic inflammatory 

response syndrome 

short leg cast 

systemic lupus erythematosus; 

Saint Louis encephalitis 

submucous resection 

scalene node biopsy 

salpingo-oophorectomy 

shortness of breath 

secretory otitis media 

SOR 

S/P 

SPD 

SPP 

SQ 

S/R 

S/p P/T 

SSE 

SSKI 

SSPE 

STAPH 

STB 

STREP 

STS 

STSG 

SUBQ 

SUD 

SUDI 

suppurative otitis, recurrent 

status post 

sociopathic personality 

disturbance 

suprapubic prostatectomy 

subcutaneous 

schizophrenic reaction; sinus 

rhythm 

schizophrenic reaction, paranoid 

type 

soapsuds enema 

saturated solution potassium 

iodide 

subacute sclerosing 

panencephalitis 

staphylococcal; staphylococcus 

stillborn 

streptococcal; streptococcus 

serological test for syphilis 

split thickness skin graft 

subcutaneous 

sudden unexpected death 

sudden unexplained death of an 

infant 

237 2a January 2011 
 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

SUID 

SVC 

SVD 

SVT 

Sx 

SY 

T&A 

TAH 

TAL 

TAO 

TAPVR 

TAR 

TAT 

TB 

TBC, Tbc 

TCI 

TEF 

TF 

sudden unexpected infant death 

superior vena cava 

spontaneous vaginal delivery 

superventricular tachycardia 

symptoms 

syndrome 

tonsillectomy and 

adenoidectomy 

total abdominal hysterectomy 

tendon achilles lengthening 

triacetyloleandomycin (antibiotic); 

thromboangiitis obliterans 

total anomalous pulmonary 

venous return 

thrombocytopenia absent 

radius (syndrome) 

tetanus anti-toxin 

tuberculosis; tracheobronchitis 

tuberculosis 

transient cerebral ischemia 

tracheoesophageal fistula 

tetralogy of Fallot 

TGV 

THA 

TI 

TIA 

TIE 

TL 

TM 

TOA 

TP 

TR 

TSD 

TTP 

TUI 

TUR 

TURP 

TVP 

UC 

UGI 

transposition great vessels 

total hip arthroplasty 

tricuspid insufficiency 

transient ischemic attack 

transient ischemic episode 

tubal ligation 

tympanic membrane 

tubo-ovarian abscess 

thrombocytopenic purpura 

tricuspid regurgitation, 

transfusion reaction 

Tay-Sachs disease 

thrombotic thrombocytopenic 

purpura 

transurethral incision 

transurethral resection (NOS) 

(prostate) 

transurethral resection of 

prostate 

total anomalous venous return 

ulcerative colitis 

upper gastrointestinal 

238 2a January 2011 
 

 

 

 

 

APPENDIX D 

Standard Abbreviations and Symbols 

UL upper lobe VSD 

UNK unknown VT 

UP ureteropelvic WBC 

UPJ ureteropelvic junction WC 

URI upper respiratory infection WE 

UTI urinary tract infection W/O 

VAMP vincristine, amethopterine, WPW 

6-mercaptopurine, and prednisone 

VB vinblastine YF 

VC vincristine ZE 

VD venereal disease ' 

VDRL venereal disease research lab " 

VEE Venezuelan equine < 

encephalomyelitis 

> 

VF ventricular fibrillation 

VH vaginal hysterectomy; viral 

hepatitis 

VL vas ligation ⎯c 

VM viomycin ⎯s 

V&P vagotomy and pyloroplasty 00 

11 

VPC, VPCS ventricular premature contractions 

00 

VR valve replacement 11 to 

ventricular septal defect 

ventricular tachycardia 

white blood cell 

whooping cough 

Western encephalomyelitis 

without 

Wolfe-Parkinson-White 

syndrome 

yellow fever 

Zollinger-Ellison (syndrome) 

minute 

second(s) 

less than 

greater than 

decreased 

increased; elevated 

with 

without 

secondary to 

secondary to 

239 2a January 2011 
 

 

APPENDIX E 

Synonymous Sites/Terms 

When a condition of a stated anatomical site is indexed in Volume 3, code condition of stated 

site as indexed. If stated site is not indexed, code condition of synonymous site. 

Alimentary canal Gastrointestinal tract 

Body Torso, trunk 

Brain Anterior fossa, basal ganglion, central nervous system, 

cerebral, cerebrum, frontal, occipital, parietal, pons, 

posterior fossa, prefrontal, temporal, III and IV ventricle 

NOTE: Do not use brain when ICD provides for CNS 

under the reported condition. 

Cardiac Heart 

Chest Thorax 

Geriatric Senile 

Greater sac Peritoneum 

Hepatic Liver 

Hepatocellular Liver 

Intestine Bowel, colon 

Kidney Renal 

Larynx Epiglottis, subglottis, supraglottis, vocal cords 

Lesser sac Peritoneum 

Nasopharynx, pharynx Throat 

Pulmonary Lung 

Right\left hemispheric Code brain 

Hemispheric NOS Do not assume brain 

Right\left ventricle Heart 

Third\fourth ventricle Brain 

LLL, LUL, RLL, RML, RUL Lobes of the lungs when reported with lobectomy, 

pneumonia, etc. 

240 2a January 2011 
 

 

APPENDIX F 

Invalid and Substitute Codes 

The following categories are invalid for underlying cause coding in the United States 

registration areas. Substitute code(s) for use in underlying cause coding appears to the right. 

Use the substitute codes when conditions classifiable to the following codes are reported: 

Invalid 

Codes 

Substitute Codes 

A150-A153 A162 

A154 A163 

A155 A164 

A156 A165 

A157 A167 

A158 A168 

A159 A169 

A160-A161 A162 

B95-B97 Code the disease(s) classified 

 to other chapters modified by 

 the organism. Do not enter a 

 code for the organism. 

F70.­ F70 (3-characters only) 

F71.­ F71 (3-characters only) 

Invalid 

Codes 

Substitute Codes 

F72.­ F72 (3-characters only) 

F73.­ F73 (3-characters only) 

F78.­ F78 (3-characters only) 

F79.­ F79 (3-characters only) 

I151-I158 R99 

I23.­ I21 or I22 

I240 I21 or I22 

I252 I258 

I65-I66 I63 

O08.­ O00 - O07 

O80.­ O95 

O81-O84 O759 

P95 P969 

R69 R95-R99 

241 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

Provisional assignment of new codes (U00-U99) 

1. Terrorism Classification (*U01-*U03) 

NCHS has developed a set of new codes within the framework of the ICD that will allow the 

identification of deaths from terrorism reported on death certificates through the National 

Vital Statistics System. Terrorism-related ICD-10 codes for mortality have been assigned to 

the “U” category which has been designated by WHO for use by individual countries. The 

asterisk preceding the alphanumeric code indicates the code was introduced by the United 

States and is not officially part of the ICD. 

To classify a death as terrorist-related, it is necessary for the incident to be designated as 

such by the Federal Bureau of Investigation (FBI). Neither a medical examiner nor a coroner 

who would be completing/certifying the death certificate, nor the nosologist coding the 

death certificate would determine that an incident is an act of terrorism. If an incident or 

event is confirmed by the FBI as terrorism, it may be so described on the certificate. If the 

incident is confirmed as terrorism after the death certificate is completed, the certificate can 

be recoded at a later date. 

Not to be used unless notified by NCHS

 Tabular List 

Assault (homicide) 

*U01-*U02 

*U01 Terrorism 

Includes: assault-related injuries resulting from 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 

*U01.0 Terrorism involving explosion of marine weapons 

Depth-charge 

 Marine mine

 Mine NOS, at sea or in harbor

 Sea-based artillery shell

 Torpedo

 Underwater blast 

242 2a January 2011 
APPENDIX G 

Codes for Special Purposes (U00-U99) 

*U01.1 Terrorism involving destruction of aircraft 

 Includes: aircraft used as a weapon 

 Aircraft: 

• burned 

• exploded 

• shot down 

Crushed by falling aircraft 

*U01.2 Terrorism involving other explosives and fragments 

 Antipersonnel bomb (fragments)

 Blast NOS

 Explosion (of): 
 

• NOS 

• artillery shell 

• breech-block 

• cannon block 

• mortar bomb 

• munitions being used in terrorism 

• own weapons 

Fragments from: 

• artillery shell 

• bomb 

• grenade 

• guided missile 

• land-mine 

• rocket 

•

• shrapnel 

Mine NOS 

 

shell 

 

 

 243 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 of

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t 

n

 

 

jury

rns

her in

 or

 fi

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trol bomb

llapse of

ll from

lling from

t by objec

mp from

nflagratio

e

elting

oldering

 

 

 

 

 

 

rning building or structure 

 fittings or furniture

 

s

t

iginating from fire caused directly by 

re-producing device or indirectly by any

nventional weapon 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

*U01.3 Terrorism involving fires, conflagration and hot substances

 A

 Bu

 O

 Pe

 Co

 Fa

 Fa

Hi

 Ju

 Co

 Fir

 M

 Sm

*U01.4 Terrorism involving firearms 

 Bullet: 

• carbine 

• machine gun 

• pistol 

• rifle 

• rubber (rifle) 

Pellets (shotgun) 

 *U01.5 Terrorism involving nuclear weapons 

 Blast effects

 Exposure to ionizing radiation from nuclear weapon 

 Fireball effects

 Heat

 Other direct and secondary effects of nuclear weapons 

244 2a January 2011 
 

 

 

 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

*U01.6 Terrorism involving biological weapons 

Anthrax 

 Cholera

 Smallpox 

*U01.7 Terrorism involving chemical weapons

 Gases, fumes and chemicals: 

• Hydrogen cyanide 

• Phosgene 

• Sarin 

*U01.8 Terrorism, other specified 

Lasers 

Battle wounds 

Drowned in terrorist operations NOS 

Piercing or stabbing object injuries 

*U01.9 Terrorism, unspecified 

*U02 Sequelae of terrorism 

245 2a January 2011 
APPENDIX G 

Codes for Special Purposes (U00-U99) 

Intentional self-harm (suicide) 

*U03 

*U03 Terrorism 

*U03.0 Terrorism involving explosions and fragments 

 Includes: destruction of aircraft used as a weapon 

 

 Aircraft: 

• burned 

• exploded 

• shot down 

Antipersonnel bomb (fragments) 

Blast NOS 

Explosion (of): 

• 
 

• artillery shell 

• breech-block 

• cannon block 

• mortar bomb 

• munitions being u

• own weapons 

Fragments from:
 
 

• artillery shell 

• bomb
 

• grenade 

NOS

sed in terrorism
 

• guided missile 

• land-mine 

• rocket 

• shell 

• shrapnel 

Mine NOS 

*U03.9 Terrorism by other and unspecified means 

 246 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

SECTION II – External causes of injury 

Air 

- blast in terrorism U01.2 

Asphyxia, asphyxiation 

- by 

- - chemical in terrorism U01.7 

- - fumes in terrorism (chemical weapons) U01.7 

 - - gas (see also Table of drugs and chemicals) 

- - - in terrorism (chemical weapons) U01.7 

- from 

 - - fire (see also Exposure, fire) 

- - - in terrorism U01.3 

Bayonet wound 

- in 

- - terrorism U01.8 

Blast (air) in terrorism U01.2 

- from nuclear explosion U01.5 

- underwater U01.0 

Burn, burned, burning (by) (from) (on) 

- chemical (external) (internal) 

- - in terrorism (chemical weapons) U01.7 

- in terrorism (from fire-producing device) NEC U01.3 

- - nuclear explosion U01.5 

- - petrol bomb U01.3 

Casualty (not due to war) NEC 

- terrorism U01.9 

Collapse 

- building 

- - burning (uncontrolled fire) 

- - - in terrorism U01.3 

- structure 

- - burning (uncontrolled fire) 

- - - in terrorism U01.3 

Crash 

- aircraft (powered) 

- - in terrorism U01.1 

247 2a January 2011 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 


 


 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

Crushed 

- by, in 

- - falling 

- - - aircraft 

- - - - in terrorism U01.1 

Cut, cutting (any part of body) (by) (see also Contact, with, by object or machine) 

- terrorism U01.8 

Drowning

 - in 
 

- - terrorism U01.8 

Effect(s) (adverse) of 

- nuclear explosion or weapon in terrorism (blast) (direct) (fireball) (heat) (radiation) 

(secondary) U01.5 

Explosion (in) (of) (on) (with secondary fire) 

- terrorism U01.2 

Exposure to 

- fire (with exposure to smoke or fumes or causing burns, or secondary explosion) 

- - in, of, on, starting in 

- - - terrorism (by fire-producing device) U01.3 

- - - - fittings or furniture (burning building) (uncontrolled fire) U01.3 

- - - - from nuclear explosion U01.5 

Fall, falling 

- from, off 

- - building
 

- - - burning (uncontrolled fire) 

- - - - in terrorism U01.3 

 - - structure NEC 

- - - burning (uncontrolled fire) 

- - - - in terrorism U01.3 

Fireball effects from nuclear explosion in terrorism U01.5
 

Heat (effects of) (excessive) 

- from 

- - nuclear explosion in terrorism U01.5 

Injury, injured NEC 

- by, caused by, from 

- - terrorism – see Terrorism 

- due to 

- - terrorism – see Terrorism 

248 2a January 2011 
 

 

 


 


 


 


 


 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

Jumped, jumping 

- from 

- - building (see also Jumped, from, high place) 

- - - burning (uncontrolled fire) 

- - - - in terrorism U01.3 

- - structure (see also Jumped, from, high place) 

- - - burning (uncontrolled fire) 

- - - - in terrorism U01.3 

Poisoning (by) (see also Table of drugs and chemicals) 

- in terrorism (chemical weapons) U01.7 

Radiation (exposure to) 

- in 

- - terrorism (from or following nuclear explosion) (direct) (secondary) U01.5 

- - - laser(s) U01.8 

- laser(s) 

- - in terrorism U01.8 

Sequelae (of) 

- in terrorism U02 

Shooting, shot (see also Discharge, by type of firearm)
 

- in terrorism U01.4 

Struck by 

- bullet (see also Discharge, by type of firearm)
 

- - in terrorism U01.4 

- missile
 

- - in terrorism – see Terrorism, missile
 

- object 

- - falling
 

- - - from, in, on 

- - - - building 

- - - - - burning (uncontrolled fire) 

- - - - - - in terrorism U01.3 

Suicide, suicidal (attempted) (by) 

- explosive(s) (material) 

- - in terrorism U03.0 

- in terrorism U03.9 

Terrorism (by) (in) (injury) (involving) U01.9 

- air blast U01.2 

- aircraft burned, destroyed, exploded, shot down U01.1 

- - used as a weapon U01.1 

- anthrax U01.6 

249 2a January 2011 
 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

Terrorism----continued 

- asphyxia from 

- - chemical (weapons) U01.7 

- - fire, conflagration (caused by fire-producing device) U01.3 

- - - from nuclear explosion U01.5 

- - gas or fumes U01.7 

- bayonet U01.8 

- biological agents (weapons) U01.6 

- blast (air) (effects) U01.2 

- - from nuclear explosion U01.5 

- - underwater U01.0 

- bomb (antipersonnel) (mortar) (explosion) (fragments) U01.2 

- - petrol U01.3 

- bullet(s) (from carbine, machine gun, pistol, rifle, rubber (rifle), shotgun) U01.4 

- burn from 

- - chemical U01.7 

- - fire, conflagration (caused by fire-producing device) U01.3 

- - - from nuclear explosion U01.5 

- - gas U01.7 

- burning aircraft U01.1 

- chemical (weapons) U01.7 

- cholera U01.6 

- conflagration U01.3 

- crushed by falling aircraft U01.1 

- depth-charge U01.0 

- destruction of aircraft U01.1 

- disability as sequelae one year or more after injury U02 

- drowning U01.8 

- effect (direct) (secondary) of nuclear weapon U01.5 

- - sequelae U02 

- explosion (artillery shell) (breech-block) (cannon block) U01.2 

- - aircraft U01.1 

- - bomb (antipersonnel) (mortar) U01.2 

- - - nuclear (atom) (hydrogen) U01.5 

- - depth-charge U01.0 

- - grenade U01.2 

- - injury by fragments (from) U01.2 

- - land-mine U01.2 

- - marine weapon(s) U01.0 

250 2a January 2011 
 

 

 

 

 

 


 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

Terrorism----continued 

- - mine (land) U01.2 

- - - at sea or in harbor U01.0 

- - - marine U01.0 

- - missile (explosive) (guided) NEC U01.2 

- - munitions (dump) (factory) U01.2
 

- - nuclear (weapon) U01.5 

- - other direct and secondary effects of U01.5 

- - own weapons U01.2 

- - sea-based artillery shell U01.0 

- - torpedo U01.0 

- exposure to ionizing radiation from nuclear explosion U01.5 

- falling aircraft U01.1 

- fire or fire-producing device U01.3 

- firearms U01.4 

- fireball effects from nuclear explosion U01.5 

- fragments from artillery shell, bomb NEC, grenade, guided missile, land-mine, rocket, 

shell, shrapnel U01.2 

- gas or fumes U01.7 

- grenade (explosion) (fragments) U01.2 

- guided missile (explosion) (fragments) U01.2 

- - nuclear U01.5 

- heat from nuclear explosion U01.5 

- hot substances U01.3 

- hydrogen cyanide U01.7 

- land-mine (explosion) (fragments) U01.2 

- laser(s) U01.8 

- late effect (of) U02 

- lewisite U01.7 

- lung irritant (chemical) (fumes) (gas) U01.7 

- marine mine U01.0 

- mine U01.2 

- - at sea U01.0 

- - in harbor U01.0 

- - land (explosion) (fragments) U01.2 

- - marine U01.0 

- missile (explosion) (fragments) (guided) U01.2 

- - marine U01.0 

- - nuclear U01.5 

251 2a January 2011 
 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

Terrorism----continued 

- mortar bomb (explosion) (fragments) U01.2 

- mustard gas U01.7 

- nerve gas U01.7 

- nuclear weapons U01.5 

- pellets (shotgun) U01.4 

- petrol bomb U01.3 

- piercing object U01.8 

- phosgene U01.7 

- poisoning (chemical) (fumes) (gas) U01.7 

- radiation, ionizing from nuclear explosion U01.5 

- rocket (explosion) (fragments) U01.2 

- saber, sabre U01.8 

- sarin U01.7 

- screening smoke U01.7 

- sequelae effect (of) U02 

- shell (aircraft) (artillery) (cannon) (land-based) (explosion) (fragments) U01.2 

- - sea-based U01.0 

- shooting U01.4 

- - bullet(s) U01.4 

- - pellet(s) (rifle) (shotgun) U01.4 

- shrapnel U01.2 

- smallpox U01.6 

- stabbing object(s) U01.8 

- submersion U01.8 

- torpedo U01.0 

- underwater blast U01.0 

- vesicant (chemical) (fumes) (gas) U01.7 

- weapon burst U01.2 

252 2a January 2011 
 

 Date of death 9/11/2001 

 PLACE I (a) Burns T300 

 5 (b) Terrorist attack on the Pentagon &U011 

 MOD II 

 H Homicide The Pentagon Date of injury 9/11/2001 

Code as terrorism involving destruction of aircraft. The FBI declared the 

Pentagon incident an act of terrorism. 

 

 Date of death 9/11/2001 

 PLACE I (a) Chest trauma S299 

 5 (b) 

 MOD II World Trade Center Disaster &U011 

 H Homicide World Trade Center Date of injury 9/11/2001 

Code as terrorism involving destruction of aircraft. The FBI declared the 

World Trade Center incident an act of terrorism. 

 

 

 

 

 

 

 

APPENDIX G 

Codes for Special Purposes (U00-U99) 

2. Severe Acute Respiratory Syndrome [SARS] (U04) 

 Tabular List 

U04 Severe acute respiratory syndrome [SARS]

 U04.9 Severe acute respiratory syndrome [SARS], unspecified 

SECTION I – Alphabetical index to diseases and nature of injury

 Syndrome 

 - respiratory

 - - severe acute U04.9 

- severe acute respiratory syndrome (SARS) U04 

253 2a January 2011 
 

 

APPENDIX H 

List of Conditions that Causes Diabetes 

Acceptable sequences for diabetes “due to” other diseases 

Selected Cause As Cause of 

M35.9 E10, E11, E14 

E40-E46, E63.9, E64.0, E64.9 E10-E12, E14 

B25.2 E10, E13-E14 

P35.0 E10, E11 

E24 E11 

O24.4 E11 

B26.3 E13-E14 

C25 E13-E14 

C78.8 (for pancreas only) E13-E14 

D13.6-D13.7 E13-E14 

D35.0 E13-E14 

E05-E06 E13-E14 

E22.0 E13-E14 

E24 E13-E14 

E80.0-E80.2 E13-E14 

E83.1 E13-E14 

E84 E13-E14 

E89.1 E13-E14 

F10.1-F10.2 E13-E14 

G10 E13-E14 

G11.1 E13-E14 

G25.8 E13-E14 

G71.1 E13-E14 

K85 E13-E14 

K86.0-K86.1 E13-E14 

Selected Cause As Cause of 

K86.8-K86.9 E13-E14 

M35.9 E13-E14 

O24.4 E13-E14 

P35.0 E13-E14 

Q87.1 E13-E14 

Q90 E13-E14 

Q96 E13-E14 

Q98 E13-E14 

Q99.8 E13-E14 

S36.2 E13-E14 

T37.3 E13-E14 

T37.5 E13-E14 

T38.0-T38.1 E13-E14 

T42.0 E13-E14 

T46.5 E13-E14 

T46.7 E13-E14 

T50.2 E13-E14 

Y41.3 E13-E14 

Y41.5 E13-E14 

Y42.0-Y42.1 E13-E14 

Y46.2 E13-E14 

Y52.5 E13-E14 

Y52.7 E13-E14 

Y54.3 E13-E14 

254 2a January 2011 
   
 


 

    
 

    
 


 

    
 


 


 


 


 


 

   
 


 

   
 


 


 


 

   
 


 


 

    
 


 


 


 


 


 


 


 

    
 

    
 


 


 


 


 


 


 


 


 


 


 


 


 

    
 

   
 


 

 

C

INDEX 

A

Abbreviations

Standard Abbreviations & Symbols ........................................................................................................................... 222
 

Adjectival Reporting
 

Adjectival Modifier with Multiple Conditions...........................................................................................................ii, 67
 

Adjective Reported at end of Diagnostic Entity........................................................................................................ii, 67
 

Adverse Effects............................................................................................................................................................... 207
 

Adverse Effects of Drugs (Therapeutic).................................................................................................................. 158, 204
 

Age
 

Congenital Malformations......................................................................................................................................... 112
 

Appendix A (Rare Causes)............................................................................................................................................... 215
 

Appendix B (Created Codes)................................................................................................................................... 219, 220
 

Appendix C (Geographic Codes) ..................................................................................................................................... 221
 

Appendix D (Standard Abbreviations & Symbols) .......................................................................................................... 222
 

Appendix E (Synonymous Sites)...................................................................................................................................... 240
 

Appendix G (Codes for Special Purposes)....................................................................................................................... 242
 

Assault ............................................................................................................................................................................ 201
 

asterisk (*) .................................................................................................................................................................. 2, 242
 

Causation Table ................................................................................................................................................................ 10
 

CDC (Centers for Disease Control and Prevention) ............................................................................................................ 1
 

Coding Causes of Death
 

nomenclature............................................................................................................................................................. 1, 6
 

Coding Conditions Classified to Injuries as Disease Conditions.....................................................................................ii, 75
 

Combination Code............................................................................................................................................................ 10
 

Complications of Surgery................................................................................................................................................i, 34
 

Conflict in Linkage............................................................................................................................................................. 10
 

Contributory Cause........................................................................................................................................................... 10
 

Created Codes .................................................................................................................................... i, x, 3, 5, 13, 219, 220
 

D

dagger (†)............................................................................................................................................................................ 2
 

Definition of terms ........................................................................................................................................................... 10
 

Deletion of..................................................................................................................................................................iii, 117
 

Determining Probability of Sequence............................................................................................................................ii, 60
 

Diagnostic Entities
 

Multiple One‐Term Entity ............................................................................................................................................ 67
 

One‐term Entity ........................................................................................................................................................... 65
 

Diagnostic Term Chart...................................................................................................................................................... 65
 

Direct Cause of Death....................................................................................................................................................... 10
 

Doubtful Diagnoses
 

Doubtful Qualifying Expressions................................................................................................................................ 113
 

Interpretation of Either/Or........................................................................................................................................ 114
 

Duration
 

Conflict in Durations.................................................................................................................................................. 109
 

Congenital Conditions................................................................................................................................................ 110
 

Congenital Malformations......................................................................................................................................... 110
 

Effect of Duration on Classification .......................................................................................................................iii, 105
 

Lower Line Shorter than one Reported Above .......................................................................................................... 105
 

Qualifying as Acute or Chronic................................................................................................................................... 106
 

255 2a January 2011 
   
 


 


 

   
 


 

   
 

    
 


 

    
 

   
 

   
 


 

   
 

    
 

    
 

   
 


 


 

    
 

    
 

    
 


 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 

    
 


 

    
 

    
 

    
 

    
 

    
 

    
 

 

I

INDEX 

Sequela (see Modification Rule F) ............................................................................................................................. 111
 

Span of Dates............................................................................................................................................................. 109
 

Subacute .................................................................................................................................................................... 111
 

Two Conditions with one Duration............................................................................................................................ 105
 

E

Editing and Interpreting Entries ....................................................................................................................................... 60
 

Examples of General Principle and Selection Rules.......................................................................................................... 26
 

Exposure .....................................................................................................................................................................ix, 196
 

External Causes............................................................................................................................................................... 179
 

Accident due to Disease Condition...................................................................................................................... viii, 180
 

Accident Information Entered Outside Part I and II................................................................................................... 180
 

Complication of Trauma (Rule 3)............................................................................................................................... 181
 

Found Injured on Highway......................................................................................................................................... 181
 

Selecting External Causes as Underlying Cause ......................................................................................................... 181
 

Slight Injuries .......................................................................................................................................................viii, 180
 

Successive External Causes..................................................................................................................................viii, 179
 

Use of the Index and Tabular List .............................................................................................................................. 181
 

G

Geographic Codes........................................................................................................................................................... 221
 

H

Homicide......................................................................................................................................................................... 201
 

Implied Disease..............................................................................................................................................................ii, 69
 

Infrequent...................................................................................................................................................................iv, 123
 

Inhalation....................................................................................................................................................................ix, 196
 

Intent of Certifier
 

Biliary Cirrhosis NOS ................................................................................................................................................iii, 98
 

Cerebral Sclerosis.....................................................................................................................................................iii, 94
 

Cervical Dystocia....................................................................................................................................................iii, 101
 

Cesarean Delivery for Inertia Uterus .....................................................................................................................iii, 101
 

Diaphragmatic Hernia..............................................................................................................................................iii, 97
 

Erythremia ................................................................................................................................................................ii, 90
 

Fracture..................................................................................................................................................................iii, 103
 

General Paresis.........................................................................................................................................................ii, 81
 

Gout.........................................................................................................................................................................iii, 99
 

Hemolytic Anemia.....................................................................................................................................................ii, 90
 

Hemorrhagic Purpura NOS ......................................................................................................................................iii, 91
 

Hyperparathyroidism...............................................................................................................................................iii, 92
 

Hypoplasia or Dysplasia of Lung ............................................................................................................................iii, 102
 

Hypotonic Labor.....................................................................................................................................................iii, 101
 

Hypotonic Uterus Dysfunction...............................................................................................................................iii, 101
 

Inadequate Uterus Contraction .............................................................................................................................iii, 101
 

Intracranial Nontraumatic Hemorrhage of Fetus and Newborn ............................................................................... 102
 

Kyphosis.................................................................................................................................................................iii, 100
 

Lupus........................................................................................................................................................................iii, 99
 

Lupus Erythematosus...............................................................................................................................................iii, 99
 

Mental Disorder.......................................................................................................................................................iii, 93
 

Myopathy.................................................................................................................................................................iii, 95
 

Organisms and Infections NOS .................................................................................................................................ii, 83
 

256 2a January 2011 
Osteonecrosis ........................................................................................................................................................iii, 100
 

Paralysis...................................................................................................................................................................iii, 96
 

Pneumoconiosis.......................................................................................................................................................iii, 97
 

Polycythemia ............................................................................................................................................................ii, 90
 

Psychosis..................................................................................................................................................................iii, 93
 

Scoliosis..................................................................................................................................................................iii, 100
 

Sideroblastic Anemia ...............................................................................................................................................iii, 91
 

Starvation NOS.......................................................................................................................................................iii, 104
 

Thrombocytopenia ..................................................................................................................................................iii, 92
 

Uterine Inertia During Labor..................................................................................................................................iii, 101
 

Varices NOS, Bleeding Varices NOS .........................................................................................................................iii, 96
 

Intervening Cause............................................................................................................................................................. 11
 

Introduction........................................................................................................................................................................ 1
 

M

Major Revisions.................................................................................................................................................................. 3
 

Maternal Death ................................................................................................................................................................ 11
 

Medical Certification .......................................................................................................................................................... 7
 

Misadventures (Surgeries)...................................................................................................................................... 207, 211
 

Modification of the Selected Cause................................................................................................................................i, 35
 

Modification Rules...................................................................................................................................................... 35, 36
 

Modification Table............................................................................................................................................................ 11
 

N

NCHS (National Center for Health Statistics)...................................................................................................................... 1
 

Neoplasms
 
 

Common Sites of Metastases .................................................................................................................................... 140
 

Doubtful Diagnosis..................................................................................................................................................... 153
 

Implication of Malignancy ......................................................................................................................................v, 139
 

Malignant Neoplasms................................................................................................................................................ 129
 

Malignant Neoplasms of Unspecified Site ................................................................................................................. 154
 

Malignant Neoplasms, Primary Site Indicated.......................................................................................................iv, 133
 

Mass or Lesion with Malignant Neoplasms............................................................................................................v, 154
 

Metastatic.................................................................................................................................................................. 140
 

Metastatic From......................................................................................................................................................... 145
 

Metastatic Neoplasm................................................................................................................................................. 140
 

Metastatic To............................................................................................................................................................. 145
 

Multiple Sites............................................................................................................................................................. 135
 

Neoplasms Stated Secondary .................................................................................................................................... 133
 

Prefixes or Imprecise Definitions............................................................................................................................v, 153
 

Primary Site Unknown ............................................................................................................................................... 152
 

Nonmedical Connecting Terms...................................................................................................................................iii, 116
 

Numbering of Causes Reported...................................................................................................................................... 119
 

O

Originating Antecedent Cause.......................................................................................................................................... 12
 

P

Parenthetical Entries .....................................................................................................................................................ii, 68
 

Perinatal Period ................................................................................................................................................................ 12
 

Plural Form ....................................................................................................................................................................ii, 69
 

Poisoning
 

Carbon Monoxide ..................................................................................................................................................ix, 200
 

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INDEX 
Drugs......................................................................................................................................................................ix, 197
 

Preference Code ............................................................................................................................................................... 12
 

Q

Query
 

Querying Cause of Death.......................................................................................................................................iv, 121
 

R

Rare Causes .................................................................................................................................................................... 215
 

Rare Causes of Death..................................................................................................................................................iv, 123
 

Relating and Modifying..................................................................................................................................................ii, 70
 

Exceptions.................................................................................................................................................................... 74
 

Implied Site .................................................................................................................................................................. 70
 

Relating Specific Categories......................................................................................................................................... 72
 

Reported Sequence .......................................................................................................................................................... 10
 

Rule 1................................................................................................................................................................................ 27
 

Rule 2................................................................................................................................................................................ 28
 

Rule 3................................................................................................................................................................................ 29
 

Rule A (Senility and other Ill‐Defined Conditions)......................................................................................................i, 3, 36
 
 

Rule C (Linkage) ................................................................................................................................................................ 39
 

Rule D (Specificity)............................................................................................................................................................ 45
 

Conflict in Specificity.................................................................................................................................................... 46
 

Rule E (Early and Late Stages of Disease) ......................................................................................................................... 47
 

Rule F (Sequela)................................................................................................................................................................ 48
 

S

SARS................................................................................................................................................................................ 253
 

Selecting Originating Antecedent Cause ........................................................................................................................i, 24
 
 

Selection of Underlying Cause of Death ........................................................................................................................... 23
 

Selection Rules.................................................................................................................................................................. 25
 

Self‐harm ............................................................................................................................................................ix, 200, 246
 
 

Sequela of External Causes....................................................................................................................................... 58, 212
 
 

Sequence
 

Table of Terms that Stop the Sequence.................................................................................................................iv, 120
 

Sex and Age Limitations.................................................................................................................................................. 113
 

Standard Abbreviations.................................................................................................................................................. 222
 

Suffocation (accidental)..............................................................................................................................................ix, 196
 

Suicide ................................................................................................................................................................ix, 200, 246
 
 

Synonymous Sites........................................................................................................................................................... 240
 

T

Tentative Underlying Cause...................................................................................................................................... 12, 205
 
 

Terminal Cause of Death .................................................................................................................................................. 10
 

Terrorism ........................................................................................................................................................................ 242
 

Transports
 

Additional Examples .......................................................................................................................................... 189, 190
 

Air and Space Transport Accidents........................................................................................................................ix, 194
 

Classifying Accidents Traffic or Nontraffic .............................................................................................................ix, 185
 

General Instructions .................................................................................................................................................. 182
 

Miscellaneous Coding Instructions........................................................................................................................ix, 194
 

Occupant of ATV or Other Motor Vehicle.................................................................................................................. 191
 

Status of Victim.......................................................................................................................................................... 186
 

Use of  Index and Tabular List.................................................................................................................................... 183
 
 

 258 2a January 2011 

INDEX 
INDEX 

V01‐V89 .................................................................................................................................................................ix, 187
 

Victim’s Mode of Transport Unknown....................................................................................................................... 192
 
 

Water Transport Accidents....................................................................................................................................ix, 193
 
 

Trivial Condition......................................................................................................................................i, 3, 12, 36, 38, 180
 
 

U

U.S. Standard Certificate of Death...................................................................................................................................... 7
 
 

UC
 
 

Underlying Cause international rules ............................................................................................................................ 1
 
 

Underlying Cause of Death............................................................................................................................................... 12
 
 

Undetermined Intent..................................................................................................................................................ix, 203
 
 

W

W18 ......................................................................................................................................................................ix, 76, 195
 
 

W19 .................................................................................................................................................. ix, 63, 77, 78, 125, 195
 
 

WHO (World Health Organization)............................................................................................................................. 1, 242
 
 

 259 2a January 2011