Instruction manual part 2c ICD-10 ACME Decision Tables for ...

[Pages:1222]CONTENTS

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Section I - Introduction....................................................................................................1

Section II - Guidance in Use of Decision Tables .............................................................3

Addresses and Subaddresses ........................................................................3 Asterisk Codes................................................................................................3 Created ICD-10 Categories...........................................................................3

Section III - Description and Use of Tables A - C ..........................................................12

Section IV - Description and Use of Table D..................................................................13

Section V - Description and Use of Table E ..................................................................13

Section VI - Description and Use of Table F ..................................................................16

Section VII - Description and Use of Table G..................................................................16

Section VIII -Description and Use of Table H .................................................................16

Table A - Valid Codes for Multiple and Underlying Cause Coding ........................ A-1

Table B - Valid Codes for Multiple Cause Coding .....................................................B-1

Table C - Invalid Codes for Multiple and Underlying Cause Coding for US Registration Areas, Valid for International Users of ACME ................... C-1

Table D - Causal Relationship: General Principle and Rules 1 & 2 ........................ D-1

Table E - Modification: Selection Rule 3, Modification Rules A, C, and D ....................................................................E-1

Table F - Explanation of Ambivalent Relationships in Modification Rules A, C, and D ........................................................... F-1

Table G - Code Conversions.......................................................................................... G-1

Table H - ICD-10 Trivial Conditions............................................................................ H-1

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PART 2c VITAL STATISTICS ICD-10 ACME DECISION TABLES

For CLASSIFYING UNDERLYING CAUSES OF DEATH, 2009

SECTION I - INTRODUCTION

This manual contains the decision tables used by the ICD-10 ACME system to assign the underlying causes of death within the framework of the rules and instructions contained in the Vital Statistics Instructions For Classifying the Underlying Cause of Death, 2008 (Part 2a). Corrections and refinements in the Decision Tables and/or in the ACME computer programs are incorporated at the beginning of each data year prior to processing of that year's data. Updating only annually maintains comparability throughout each data year of NCHS and State mortality medical data. Refining the accuracy of the tables at more frequent intervals is desirable from a coder's viewpoint, but data analysis considerations must take priority.

Major Revisions from Previous Manuals:

1. In each edition, all new additions/corrections are identified by an asterisk.

2. The following new categories were added by the WHO and are effective in 2009. They have been incorporated in Table A and the ACME Causal and Modification Decision Table

A09 has been expanded from a 3-character category to a 4-character category. The new 4-character categories are:

A090 Other and unspecified gastroenteritis and colitis of infectious origin A099 Gastroenteritis and colitis of unspecified origin

K523 Indeterminate colitis R263 Immobility R636 Insufficient intake of food and water due to self neglect

3. Category K51.1, Ulcerative (chronic) ileocolitis, was deleted by WHO. Ulcerative (chronic) ileocolitis will be coded K510.

4. The following codes will not be used by the US registration areas beginning in 2009. The conditions assigned to these categories are interpreted as poisoning:

F11.0, F12.0. F13.0, F14.0, F15.0, F16.0, F17.0, F18.0, F19.0

These codes have been deleted from Table A and added to Table C.

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Table A (Valid Codes for Multiple and Underlying Cause Coding) lists each ICD code that is valid for both multiple and underlying cause coding. Table B (Valid Codes for Multiple Cause Coding) lists each ICD code that is valid for multiple cause coding but invalid for underlying cause coding. Table C (Invalid Codes for Multiple and Underlying Cause Coding for US Registration Areas, Valid for International Users of ACME) lists each ICD code that is invalid for both multiple and underlying cause coding for US registration areas. Table D (Causal Relationship) shows which pairs of multiple cause codes constitute acceptable causal relationships (reported sequences). Table E (Modification) includes direct sequel, ill-defined conditions, senility, linkage, and specificity relationships. Table F (Reasons for Ambivalent Relationships in Modification Table) contains the reason for every ambivalent entry in Table E. Reasons are not included for some of the direct sequel relationships. This is further guidance to help in the selection of the most appropriate underlying cause of death. Table G (Code Conversions) cites each special code generated for multiple cause coding and the underlying cause code to which it converts. Table H (ICD-10 Trivial Conditions) lists the codes for conditions considered for coding purposes to be trivial (a condition unlikely itself to cause death).

These tables provide guidance on acceptable sequences, highly improbable sequences, and modifications in assigning underlying causes of death in compliance with the International Rules set forth in ICD-10. The tables are designed in accordance with the selection and modification rules contained in Part 2a and the rules for coding conditions contained in Part 2b of the Vital Statistics Instruction Manual series. When the decision tables are used in the process of assigning underlying causes of death, the applicable pair of conditions should be viewed within the framework of the basic coding principles in Part 2b. Otherwise, error in the underlying cause of death can result.

The decision tables have been tested and reviewed. Test results have established that the ACME system will produce the same underlying cause of death as that assigned in the manual coding process in approximately 99 percent of the cases. Nonetheless, there are certain considerations that must be taken into account in their use.

First, an undertaking that attempts to deal with such a mass body of data with an objective of making firm conclusions on each code relationship with each other code for each decision table will, by its very nature, contain some inconsistent entries and oversight. As these are detected through use of the ACME system, corrections will be made in subsequent issues of this manual.

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Secondly, the tables provide decisions used by NCHS in applying selection and modification rules in arriving at underlying causes of death. These decisions are intended to provide guidance to coders and to further standardize the mortality medical classification process. The tables are not intended to convey any conclusive medical judgment or knowledge. It is recognized that many of these relationships involve conditions about which medical opinion is divided.

SECTION II - GUIDANCE IN USE OF DECISION TABLES

Addresses and Subaddresses - Tables D, E, and F contain address and subaddress codes. The address always consists of a single 3 - 5 digit code enclosed in dashes e.g. "--- G08 ---." The subaddress is given under the address code and may consist of a single code or a span of codes. Interpretation is as follows for subaddresses:

G10

is a single 3 digit code

I800-I809 includes any valid 4th digit contained in category I80

K20-K219 includes all valid codes contained in categories K20 thru K219

Asterisk codes ? 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 code in ICD-10. NCHS does not use the asterisk codes in multiple cause coding.

The asterisk codes have not been used for underlying cause coding; they are therefore, not in the decision tables. It is noted that certain codes in ICD-10 can be regarded as asterisk or dagger codes depending on the inclusion term being referenced. When such codes are contained in the decision tables, they are defined as dagger codes.

Created ICD-10 Categories - In ICD-10 a number of categories contain inclusion terms which are dissimilar in terms of how they causally relate to or combine with other categories. This dissimilarity in effect dictates that the causal relationship must be designated as having an ambivalent ("maybe") relationship in the ACME decision tables. As a result, the ACME underlying cause of death assignment for such cases is conditional in nature and must be reviewed by a nosologist. A number of the affected categories are relatively high in frequency and, therefore, reduce systems throughput capability of the automated assignment. NCHS has chosen to eliminate ambivalent systems rejects for 58 high frequency ICD categories by modifying the inclusion terms which are assigned to such categories. This has been accomplished by removing certain inclusion terms from an existing category and creating an artificial category not currently used by the ICD for those terms. This isolates the affected terms into separate categories so causal and modification relationships can be specifically stated as

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"yes" or "no." The resultant set of special codes thus includes existing ICD-10 codes, in which inclusion terms have been modified, and newly assigned defined artificial codes not currently in ICD-10.

Prior to using Decision Tables D and E, any term indexed to one of the ICD categories being modified must be recoded to its corresponding special category. All table entries (address, subaddress, and recodes) in both tables employ these special codes in lieu of the regular ICD codes. When the final underlying cause is one of the special artificial codes, that underlying cause must be converted back to its regular ICD category (see Table G).

The following list includes each original ICD category which has been modified, the corresponding special code which was used in the decision tables, and the definition of the special code. In general, for the special codes already in ICD-10, the definition merely cites the extent to which the category is being modified (usually with an "excludes" statement). For created codes, the definition cites the contents of the artificial category.

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

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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

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

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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

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 term indexed to I514 qualified as arteriosclerotic (I5140) *I5140 Arteriosclerotic myocarditis Includes: Any term indexed to I514 qualified as arteriosclerotic

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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)

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 aneurysm brain (I6090) *I6090 Ruptured arteriosclerotic cerebral aneurysm Ruptured (congenital) cerebral aneurysm NOS Ruptured mycotic aneurysm brain

I610 Intracerebral hemorrhage in hemisphere, subcortical Excludes: Any term indexed to I610 qualified as bilateral or multiple (I6100) *I6100 Bilateral or multiple intracerebral hemorrhages in hemisphere, subcortical Includes: Any term indexed to I610 qualified as bilateral or multiple

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