PHYSICIANS’ MANUAL ON MEDICAL CERTIFICATION OF CAUSE OF DEATH

PHYSICIANS’ MANUAL ON

MEDICAL CERTIFICATION OF

CAUSE OF DEATH

OFFICE OF THE REGISTRAR GENERAL, INDIA GOVERNMENT OF INDIA, MINISTRY OF HOME AFFAIRS,

2 A, MAN SINGH ROAD, NEW DELHI

CONTENTS

DESCRIPTION

Page No.

Preface to the Fifth Edition

1. INTRODUCTION

1.1 Legal Provisions

1.2 Cause of Death

1.3 Form of Medical Certificate 1.4 Physicians’ Responsibility

2. SPECIFIC INSTRUCTION

2.1 Name of Deceased

2.2 Age

2.3 Method of Certification of Cause of Death 2.4 Accidents

2.5 Female Death

2.6 Ensuring Completeness of Information

3. EXAMPLES OF CERTIFICATION

3.1 Simple Situations

3.2 Complicated Situation

3.3 Incorrect and Correct Filling of Form

3.4 Importance of reporting sequence accurately

4. ANNEXURES

I. Examples of Incomplete Description of Cause of Death II. Form No. 4 and 4A

III. Major Groups and the Description of ICD-10 Codes IV. List of Three Character Categories

2 2-3 3-4

4 4-5 6 6 6-8

9-10 11-19 19-21 21-22

23-27 28-29 30-31 41-93

New Delhi September, 2012

PREFACE TO THE FIFTH EDITION

The Medical certification of cause of death (MCCD) scheme under Civil Registration System has been implemented in the States/UTs in a phased manner to provide data on cause of death. However, it has so far been implemented only in certain hospitals, generally in urban areas which are selected by the Chief Registrar of Births & Deaths. Thus, the scheme covers mostly those deaths, which occur in selected medical institutions located in urban areas. The coverage under the scheme in terms of percentage level of medical certification as well as the type of hospitals covered has not been uniform across the States/UTs. Some of the States have notified only the teaching hospitals attached to the medical colleges and specialized hospitals under it, whereas in others, only district hospitals and Primary Health Centers (PHCs) have been brought under its ambit. In March, 2012 instruction have been issued to all States/UTs for the implementation of MCCD Scheme in all medical institutions in the country, i.e. Government, private and non-profit making institutions.

The Chief Registrars of Births & Deaths are demanding copies of the Physicians Manual on Medical Certification of Cause of Death (MCCD) for distribution to medical personnel and their staff associated with the implementation of the MCCD scheme. Hence the fifth edition of the physician’s manual has become necessary.

The 5th edition of Physicians Manual on Medical Certification of Cause of Death is the revised version of previous edition. The suggestions received from CBHI and other Offices of the Chief Registrar of Births & Deaths have been incorporated. This manual includes Major Cause Groups, the detail descriptions of ICD-10 and National list for tabulation of Mortality & Morbidity based on the Tenth Revision of International Classification of Diseases (ICD-10). It is hoped that this edition would be helpful in improving the Medical Certification of Cause of Death.

Dr. C.Chandramouli

Registrar General & Census Commissioner, India

INTRODUCTION

Mortality statistics form an integral part of the vital statistics system. They are one of the basic components of population growth. Further, the cause specific mortality rates are key indicators of the health trends in the population and are provided on scientific basis by the system of medical certification of cause of death.

The data on cause of death contained in the certificate serve many purposes: they help in assessing the effectiveness of public health programmes and provide a feed-back for future policy and implementation. They are essential for better health planning and management and for deciding priorities of health and medical research programmes.

1.1 Legal Provisions

It is because of this importance that a provision has been made in the Registration of Birth & Deaths Act (RBD), 1969 for certification by a medical practitioner who has attended the deceased during the latter’s last illness. There is also an enabling provision in the Act which empowers the State Government to introduce the system of medical certification of cause of death in specified areas taking into consideration the facilities available and other related factors. The relevant sections of the Act are:

Section 10(2)

In any area, the State Government having regard to the facilities available therein in this behalf may require that a certificate as to the cause of death shall be obtained by the Registrar from such person and in such form as may be prescribed.

Section 10(3)

Where the State Government has required under sub-section (2) that a certificate as to the cause of death shall be obtained, in the event of the death of any person who, during his last illness was attended by a medical practitioner, the medical practitioner shall , after the death of that person, forthwith issue without charging any fee, to the person required under this Act to give information concerning the death, a certificate in the prescribed form stating to the best of his knowledge and belief the cause of death; and the certificate shall be received and delivered by such person to the Registrar as the time of giving information concerning the death as required by this Act.

The rules framed by the State Governments on the subject further describe the procedure involved in the final disposal of the certificate as:

The certificate as to the cause of death required under sub-section (3) of Section 10 shall be issued in Form No.4 for institutional deaths and 4A for non- institutional deaths and the Registrar shall, after making necessary entries in the register of births and deaths, forward all such certificates to the Chief Registrar or the officer specified by him in this behalf by the 10th of the month immediately following the month to which the certificate relate.

The Act also incorporates a clause on confidentiality of the information on cause of death available on the registration records. The relevant section of the Act reads as under:

Section 17(1) (b)

Subject to any rules made in this behalf by the State Government, including rules relating to the payment of fees and postal charges, any person may obtain an extract from such register relating to any birth or death:

Provided that no extract relating to any death, issued to any person, shall, disclose the particulars regarding the cause of death as entered in the register.

1.2 Cause of death

A cause of death is disease, abnormality, injury or poisoning that contributed directly or indirectly to death. 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 casually related to each other, that is, one condition may lead to another, which in turn leads to a third condition and so on. Where there is a sequence, the underlying cause, i.e., the disease or injury which initiated the sequence of events will get selected for the purpose of tabulation.

The underlying cause of death is:

(a) The disease or injury which initiated the train of morbid events leading directly to death;

(b) The circumstances of the accident or violence which produced the fatal injury.

All these morbid conditions or injuries consequent to the underling cause relating to death are termed as antecedent and immediate cause.

1.3 Form of medical certificate

The standard format of the certificate is incorporated in the rules made by the State Government. The format of the certificate proper (medical part) conforms to the standard prescribed by the World Health Organisation (WHO) and has the following features:

CAUSE OF DEATH

Immediate cause:

State the disease, injury or complication which caused death, not the mode of dying such as heart failure, asthenia, etc.

Antecedent cause:

Morbid conditions, if any, giving rise to the above cause, stating the underlying conditions last.

II.

Other significant conditions contributing to the death, but not related to the diseases or conditions causing it.

Interval between onset & death approx

(a)……………………………………………………. due to (or as a consequence of)

(b)…………………………………………………….. due to (or as a consequence of)

(c)…………………………………………………….. …………………………………………………………..

……………………………………………………………..

Beside the medical part, the form also includes some minimum demographic and identification particulars about the deceased. The forms have a detachable portion separated by perforation mark containing information on fact of death. Separate forms have been provided for hospital and non-hospital events which are given in the annexure.

1.4 Physician’s responsibility

The physician’s primary responsibility is to complete the medical part of the certificate regarding all diseases, morbid conditions or injuries which either resulted in or contributed to death. Causes of death are classified, coded and grouped according to the Tenth revision of the International Classification of Diseases (ICD-10) recommended by WHO. When deaths result from a single condition, such as an acute infectious disease, certification and classification present no difficulty. However, this is not the case always and the problem arises of which one of multiple causes to select as the cause of death. Some of them may be casually related to each other in a sequence. If untimely deaths are to be prevented the chain of events has to be cut, or cure instituted at some intermediate point. The most effective Public Health objective is to prevent the precipitating cause from operating and hence the relevance of the underlying cause. Responsibility is placed on the certifying physician for indicating specifically all the several conditions and the chain of events if a sequence can be identified. The certifier (physician) should record the diseases / conditions in an order leading back to the underlying cause if a sequence can be found and put any other conditions contributing to death separately if not directly forming part of the fatal sequence. The medical part of the certificate should normally be the responsibility of the attending physician and based on his individual assessment. In cases of violent deaths and other medico-legal cases

usually brought to the notice of a medical examiner at the post-mortem stage, the certificate may be filled by the medical examiner on the basis of evidence noticed by him. The fact of death in such cases should, however, be communicated to the local registrar in the prescribed format pending the final filling up and transmission of the medical certificate to the registrar concerned. The information on cause of death is kept confidential and is not indicated on death certificate that may later be issued by the Registrar of Births and Deaths. This safeguard is intended to enable the doctors to bestow sufficient care and attention in writing the certificate so that mortality statistics will reflect the best medical opinion, concerning causes of death.

The various Particulars, other than those of the medical part on cause of death, are also required for reporting the death by the hospital to the registration authority in the prescribed format. The certifier will ensure that all the necessary particulars are given, besides his own statement regarding the chain of events pinpointing the underlying cause of death and then sign the certificate. The detachable portion of form containing only the fact of death without disclosing the cause of death may either be signed by the certifier or the medical officer of the hospital or handed over to the relatives of the deceased. The form of medical certificate of cause of death is to be sent to the local Registrar of Births and Deaths along with the death report in the prescribed format within the prescribed time limit.

2. SPECIFIC INSTRUCTIONS

2.1 Name of the deceased

To be given in full. Do not use initials. Also give name of father (or husband in case of married female) after the name of the deceased, using appellation S/o or D/o or W/o. In case of infants not yet named, write son (or daughter) of, followed by names of mother and father.

2.2 Age

If more than a year old, give age in years last birthday (completed number of years). If under one year, give age in months and days. If under 24 hours, give in hours and minutes.

2.3 Method of certification of cause of death

2.3.1 The medical part of the certificate is designed by the WHO to facilitate reporting the underlying cause of death and to obtain information of the causal and pathological sequence of events leading to death. It consists of two parts, the first relating to the sequence of events leading to death, and the second to other significant conditions that contributed to the death.

2.3.2 This part should be written by the attending physician or a physician having personal knowledge of the case history. The names of the diseases should be written in full and legibly to avoid the risk of their being misread. Abbreviations and short form of disease condition should not be used. He should avoid indefinite or inadequate terms. Inadequate descriptions may put the statistical office in difficulty at the time of classification of the data. Mention of terminal events or mode of dying as the only entry in the statement leaves the certificate incomplete. Similarly, symptomatic remarks will not suffice. A properly completed certificate will show the underlying cause on the lowest used line of part I and the conditions if any, as a consequence thereof will have been entered above it in ascending casual order of sequence.

2.3.3 PART – I OF THE CAUSE OF DEATH STATEMENT

Only one cause is to be entered on each line of Part I. The underlying cause of death should be entered on the lowest line used in this part. The underlying cause of death is the condition that started the sequence of events between normal health and the (direct) immediate cause of death.

Line (a): Immediate cause

The direct or immediate cause of death is reported on line (a). This is the disease, injury or complication that directly preceded death. It can be the sole entry in the statement if only one condition was present at death. There must always be an entry on line (a).

The mode of dying (e.g. heart failure, respiratory failure) should not be stated at all since it is no more than a symptom of the fact that death occurred and provides no useful information.

In the case of a violent death, enter the result of the external cause (e.g. fracture of vault or skull, crushed chest).

Line (b): Due to (or as a consequence of)

If the condition on line (a) was the consequence of another condition, record that in line (b). This condition must be antecedent to the immediate cause of death, both with respect to time and etiological or pathological violence or circumstances of accident is antecedent to an injury entered on line (a) and should be entered on line (b), although the two events are almost simultaneous (e.g., automobile accident, fall from tree).

An antecedent condition might have just prepared the way for the immediate cause of death, by damage to tissues or impairment of function, even after a long interval.

Line (c) :

The condition, if any which gave rise to the antecedent condition on line (b) is to be reported here. The remarks given for line (b) apply here also. If the condition on line (b) is the underlying cause, nothing more be entered on this line. However, if the sequence of events comprises more than three stages, extra line (and entries) may be made in part I.

However, many conditions are involved; write the full sequence, one condition per line, with the most recent condition (immediate cause) at the top, and the earliest (the condition that started the sequence of event between normal health and death) last.

Normally the condition or circumstance on the lowest line used in part I will be taken as the basis for underlying cause statistics, though classification of it may be modified to take account of complications or other conditions entered by special provisions of the ICD.

2.3.4 PART-II OTHER SIGNIFICANT CONDITIONS

Enter, in order of significance, all other diseases or conditions believed to have unfavorably influenced the course of the morbid process and thus contributed to the total outcome but which were not related to the disease or condition directly causing death.

There will be cases where it will be difficult to decide whether a condition relevant to death should be recorded as part of the fatal sequence in part I or as a contributory condition in part II. Conditions in part I should represent a distinct sequence so that each condition may be regarded as being the consequence of the condition entered immediately below it. Where a condition does not seem to fit into such a sequence, consider whether it belongs to part II.

In certifying the causes of death for Part II, any disease, abnormality, injury or late effects of poisoning, believed to have adversely affected the decedent should be reported, including:

• Use of alcohol and/or other substances.

• Smoking history.

• Environmental factors, such as exposure to toxic fumes, history of working in the some specific industry, professional exposure to toxins, specific animals etc.

• Recent pregnancy, if believed to have contributed to the death.

• Late effects of injury, including head injury sequelae

• Surgical information, if applicable.

• Any iatrogenic underlying cause.

2.3.5 INTERVALBETWEENONSETANDDEATH

Space is provided, against each condition recorded on the certificate for the interval between the presumed onset of morbid condition and the date of death. Exact period should be written when it is known; in other cases approximate periods like “from birth”, “several years” or “unknown” should be indicated. This provides a useful check on the sequence of causes as well as useful information abut the duration of illness in certain diseases.

2.4 Accidents

If suicide or homicide is ruled out, how the fatal injury occurred should be explained indicating briefly the circumstances or cause of the accident. In case of medico-legal cases, the certificate has to be given by the police authorities. However, the Registrar should be informed of such cases, by the hospital.

2.5 Female death

Information on pregnancy and delivery is needed in case of death of women in the child- bearing age (15 to 49 years) even though the pregnancy may have had nothing to do with the death.

2.6 Ensuring completeness of information

2.6.1 While giving the casual chain of events in the statement of cause of death, a complete case history is not required but, if information is available, enough details may be given to enable proper classification of the underlying cause. The certifier cannot always be certain as to what details are required and therefore, a list giving examples of incomplete descriptions and what additional information are required is included in the annexure for guidance. The terms included in the annexure are those employed usually and are of the following types:-

(i) A symptom that may arise from different group of diseases.

(ii) A morbid condition that could result from several types of infection, known or unknown.

(iii) With connotation of any of several morbid conditions having distinctive categories in the

classification list like acute, sub-acute, chronic, simple etc.

(iv) Mention of a disease which is generally localised, without indicating the organ or part of the body affected.

(v) A morbid condition that requires for its classification, a knowledge of the circumstances in which it arose.

2.6.2 As a general rule, record diagnoses as precisely as the information permits, incorporating relevant details from histological or autopsy reports. Where an important detail is unknown the fact should be stated.

2.6.3 The following gives the pertinent details required to be spelt out in the medical part of the certificate corresponding to the major cause group of mortality;

1. Infections: Acute, sub-acute or chronic, name of the disease and/or infecting organism, the site if localised; mode of transmission, where relevant.

2. Neoplasms: The morphological type if known; malignant, benign etc., site of origin of primary growth and sites of secondary growths.

3. Endocrine disorders: Nature of disease process or disturbance of function: For thyroid diseases, whether toxic: for diabetes, nature of complication or manifestation in particular site.

4. Nutritional disorders: Type of deficiency, etc., and severity.

5. Blood disorders: Nature of disease process; type and nature of any deficiency for anemias;

whether hereditary (where relevant)

6. Nervous system disorders: Disease process; infecting organism (where relevant) whether hereditary (where relevant).

7. Circulatory diseases: Nature of disease process; site, if localized; acute or chronic where relevant, specify rheumatic or other etiology for valvular heart conditions; any complications.

8. Respiratory diseased: Nature of disease process; acute or chronic; infecting organism, any external cause.

9. Digestive diseased: Nature of disease process; site of ulcers, hernias, diverticula, etc. Acute or chronic where relevant, nature of any complication for ulcers, appendicitis, hernias.

10. Genitourinary disorders: Acute or chronic, clinical syndrome and pathological lesions; site of calculi, infecting organism and site of infections; nature of complications.

11. Maternal deaths: Nature of complication: whether obstruction occurred during labour; timing of death in relation to delivery; for abortions, whether spontaneous or induced, legal or illegal, if induced.

12. Musculoskeletal disorders: Nature of disease process, infecting organism, underlying systemic diseases (where relevant); site; complication, whether congenital or acquired for deformities.

13. Congenital anomalies: Site and type, complications.

14. Perinatal deaths : Condition in fetus or infant; conditions in mother or of placenta, cord or

membranes, if believed to have affected the fetus or infant; for deaths associated with immaturity, state length of gestation and/or birth weight; type of birth trauma; and complications, etc.

15. Injuries: Type, site, complications.

16. Poisoning: Substance involved; whether accidental (if suicide or homicide is ruled out).

17. Adverse effects of drugs in therapeutic use: State this fact and name or drug, nature of

adverse effect, complications; condition treated.

18. External cause of accidents: For transport accidents, state vehicle involved, whether deceased was driver, passenger, etc. Description of accident place of occurrence, for other accidents, specifies circumstances and place of occurrence.

19. Old age or senility: This should not be given if a more specific cause is known. If old age was a contributory factor it should be entered in part II only.

3.1 3.1.1

PART-II 3.1.2

PART-II 3.1.3

PART-II 3.1.4

PART-II 3.1.5

PART-II

Simple situations

Carcinoma of bronchus

………………………………………………………

Tuberculosis

……………………………………………..

3. EXAMPLES OF CERTIFICATION

Some examples of situations drawn from Indian experience utilizing case histories provided by the Safdarjung Hospital, New Delhi; the Directorate of Health Services, Pune; and the examples taken from the Physician’s handbook on medical certification of death of the Centre for Disease Control and Prevention, U.S. Department of Health and Human Services are categorized into simple and complicated situations and explained below.

PART – I

(a) Peritonitis

(b) Perforation of Duodenum (c) Duodenal ulcer

2 Days

3 Days

6 months

PART – I

(a) Abscess of hand (b) Incision of hand (c) Tetanus

10 Days

PART – I

(a) Toxaemia

(b) Severe anaemia of pregnancy (c) …………..

PART – I

(a) Aslphyxia (b) Drowning (c) …………..

PART – I

(a) Uraemia

(b) Chronic nephritis (c) …………..

3.1.6

PART – I

(a) Uraemia

(b) Retention of urine

PART-II …………………………………………….. 3.1.7

PART-II …………………………………………….. 3.1.8

PART-II ……………………………………………..

3.1.9

PART-II Cancer of stomach

3.1.10

PART-II ……………………………………………..

PART – I

(a) Brain Injury

(b) Fall at home

PART – I

(a) Fracture of vault of skull

(b) Collision between car he was driving

and heavy truck on road. (c) …………..

15 Min.

PART – I

(a) Carbon monoxide poisoning (b)

(c)

Unknown

PART – I

(a) Cardiac tamponade

(b) Perforation of heart

15 Minutes 20 minutes 20 minutes

3.2 Complicated situation

As an aid to write the statement properly, some cases from hospital records are abstracted here to indicate typical problems.

3.2.1 CASE HISTORY

On 03.01.1977, a 60 year old female was admitted with a “strangulated Femoral Hernia” which had started 4 days earlier. She came complaining of abdominal pain and fecal vomits. Apparently, the small intestines were perforated even before. On 4th January, she underwent a release of hernia and the recession of the intestines, with an end to end “Anastomosis”. On 5th January, she started developing signs of “peritonitis”, and following that dies on 14.01.1977.

Statement

PART-II …………………………………….

Explanation: Clearly, acute peritonitis led directly to death and therefore appears on lime (a). Perforation of small intestines gave rise to the immediate cause shown in line (a) and therefore, appears next in line (b). Strangulated Femoral Hernia was the cause of intestinal perforation and was the cause which initiated the chain of events leading to death and this is the underlying cause which is written on line (c).

3.2.2 CASE HISTORY

On 14.01.1976 an old man slipped on same level and fell down, resulting in fractures. After being admitted for care, fractures of the left Ischium and Ilium were reduced. The patient then suffered from Azotemia, general arteriosclerosis, artericlctic heart disease and pulmonary emphysema. He developed “Bronchopneumonia” on 15th February and died 6 days later. Autopsy revealed also fractured hip and pelvis, cardiac hypertophy, chronic fibrous myocarditis and coronary sclerosis.

Statement

PART-II Arteriosclerotic heart with coronary sclerosis.

Explanation: Bronchopneumonia is certainly the immediate cause of death. The fracture of left Ischium and Ilium gave Arteriosclerotic Heart Disease with coronary sclerosis were no doubt, significant conditions contributing to death and are therefore given in part II.

PART – I

(a) Peritonitis, acute

(b) Perforation of small intestine (c) StrangulatedFemoralHernia

12 days 15 days.

PART – I

(a) Bronchopneumonia

(b) Fracture of left Ischium and Ilium (c)

6 days 7 days.

3.2.3 CASE HISTORY

On 25.08.1964 a 53 year old male was admitted in hospital. X-ray showed “Adenocarcinoma of the rectum” but no evidence. Syphilis was also noticed and treated. He was discharged from hospital in November 1964, as improved.

On 03.03.1966 he got x-rayed which showed pelvis apparently normal; however there was an unusual shadow to the left of the sacrum. On 19.06.1966, he was re-admitted with recurrent carcinoma of the rectum with invasion of the urinary bladder. He was discharged, unimproved on 27.07.1966.

On 04.01.1967 he was again admitted for the same ailment. Examination showed recurrent carcinoma of the rectum with invasion of the urinary bladder and “Metastases” though out the abdomen, syphilis and decubitus ulcers. Bronchopneumonia developed on 09.01.1967 and the patient died 3 days later.

Statement

PART-II Syphilis

Explanation: Since the metastatic lesions were the result of the Adeno carcinoma of the rectum, the primary site is recorded as the underlying cause of death.

3.2.4 CASE HISTORY

On February Ist, a 58 year old man presented at a clinic complaining of long duration “haemoptysis” and loss of weight. On examination he was found actually anemic and therefore admitted in hospital. The diagnosis was advanced pulmonary TB, reactivation type with cavitation, perhaps of 8 year duration. The patient also suffered from generalised arteriosclerosis, probably of long duration. He also had moderate varicose veins of the lower extremity. On admission, the patient and acute and massive pulmonary hemorrhage he died that evening.

Statement

PART-II Generalised arteriosclerosis and varicose veins of lower extremity.

PART – I

(a) Bronchopneumonia

(b) Metastatic cancer of bladder and

abdomen.

3 days

PART – I

(a) Pulmonary hemorrhage

(b) Advanced pulmonary TB

10 hours 8 years

3.2.5 CASE HISTORY

A man of 63 year had been treated for some years for malignant hypertension and developed hypertensive heart disease and chronic renal failure. While seriously ill with the heart condition, he developed acute appendicitis, and the appendix ruptured. Appendicectomy was carried out successfully but the heart condition deteriorated further and he died 2 weeks later.

Statement

PART-II Appendicectomy for acute condition and rupture of appendix, hypertensive renal failure.

3.2.6 CASE HISTORY

A 68 year-old male was admitted to the hospital with progressive right lower quadrant pain of several weeks’ duration. The patient had lost approximately 40 pounds, with progressive weakness and malaise. On physical examination, the patient had an enlarged liver span which was four finger breadths below the right costal margin. Rectal examination was normal, and stool was negative for occult blood. Routine laboratory studies were within normal limits. A chest x-ray and barium enema was negative. His EKG showed a right bundle branch block. CT scan showed numerous masses within both lobes of the liver. A needle biopsy of the liver was diagnostic of hepatocellular carincoma, and the patient was started on chemotherapy. Three months after the diagnosis, the patient developed sharp diminution of liver function as well as a deep venous thrombosis of his left thigh, and he was admitted to the hospital. On his third hospital day, the patient developed a pulmonary embolism and died 30 minutes later.

Statement

PART-II …………………………………………………………..

Explanation : Pulmonary embolism led directly to death and therefore, appears on line (a) Deep venous thrombosis , left thigh gave rise to the immediate cause shown in line (a) and therefore, appears next in line (b), Acute hepatic failure was the cause of Deep venous thrombosis, left thigh and therefore, appears next in line (c), Hepatocellular carcinoma was the actual cause which initiated the chain of events leading to death and this is the underlying cause which is written on line (d).

PART – I

(a) Congestive heart failure (b) Cardiac hypertrophy

2 Weeks Some years

PART – I

(a) Pulmonary embolism

(b) Deep venous thrombosis, left thigh (c) Acute hepatic failure

(d) Hepatocellular carcinoma

30 minutes

3 days

2 days

Over 3 months

3.2.7 CASE HISTORY

This 75 year-old male was admitted to the hospital complaining of severe chest pain. He had a 10-year history of arteriosclerotic heart disease with EKG findings of myocardial ischemia and several episodes of congestive heart failure controlled by digitalis preparations and diuretics. Five months before this admission, the patient was found to be anemic, with a hematocrit of 17, and to have occult blood in the stool. A barium enema revealed a large polypoid mass in the cecum diagnosed as carcinoma by biopsy.

Because of the patient’s cardiac status, he was not considered to be a surgical candidate. Instead he was treated with a 5-week course of radiation therapy and periodic packed red cell transfusions. He completed this course 3 months before this hospital admission. On this admission the EKG was diagnostic of an acute anterior wall myocardial infarction. He expired 2 days later.

Statement

PART-II Carcinoma of cecum, congestive heart failure

Explanation: Acute myocardial infarction, listed in Part 1 line (a) as the immediate cause of death, is a direct consequence of arteriosclerotic heart disease; the underlying cause listed in Part 1 line (b). Carcinoma of cecum is listed in Part II because it caused anemia and weakened the patient, but it did not cause arteriosclerotic heart disease. Congestive heart failure is listed in Part II because it also weakened the patient, and although it was caused by the arteriosclerotic heart disease, it was not part of the casual sequence leading to the acute myocardial infarction.

3.2.8 CASE HISTORY

A 68-year-old female wad admitted to the ICU with dyspnea and moderate retrosternal pain of 5-hours duration, which did not respond to nitroglycerin. There was a past history of obesity, noninsulin-dependent diabetes mellitus, hypertension and episodes of nonexertional chest pain, diagnosed as angina pectoris, for 8 years. Over the past 72 hours, she developed a significant elevation of the MB isoenzyme of creatinc phosphokinase, confirming an acute myocardial infraction. A Type II second-degree AV block developed and a temporary pacemaker was put in place. She subsequently developed dyspnea with fluid retention and cariomegaly on chest radiograph. She improved with diuretics. On the seventh hospital day, during ambulation, she suddenly developed chest pain and increased dyspnea. An acute pulmonary embolism was suspected and intravenous heparin was started.

The diagnosis of pulmonary embolism was confirmed by a ventilation/perfusion scan as well as arterial blood gas measurements. One hour later, she became unresponsive and resuscitation efforts were unsuccessful.

PART – I

(a) Acute myocardial infarction (b) Arteriosclerotic heart disease (c) …………………………………………….

2 days 10 days

Statement

PART – I

(a) Pulmonary embolism

(b) Acute myocardial infarction

1 hour 7 days 8 years

PART-II Non-insulin-dependent diabetes mellitus, obesity, hypertension, congestive heart failure

Explanation: Non-insulin-dependent diabetes mellitus, obesity, hypertension, congestive heart failure would all be considered factors that contributed to the death. However, they would not be in the direct casual sequence of Part I, so they would be placed in Part II.

3.2.9 CASE HISTORY

A 78-year-old female with a temperature of 102.6F was admitted to the hospital from nursing home. She first became a resident of the nursing home 2 years earlier following a cerebrovascular accident, which left her with a residual left hemiparesis. Over the next year, she became increasingly dependent on other to help with her activities of daily living, eventually requiring an in-dwelling bladder catheter 6 months before the current admission. For the 3 days prior to admission, she was noted to have lost her appetite and to have become increasingly withdrawn. On admission to the hospital her leukocyte count was 19,700, she had pyuria and gram-negative rods were seen on a Gram stain of her urine. Ampicillin and gentamicin were administered intravenously. On the third hospital day, admission blood cultures turned positive for pseudomonas aeruginosa, which was resistant to ampicillin and gentamicin. Antibiotic therapy was changed to ticarcillin clavulanate, to which the organism was sensitive. Despite the antibiotics and intravenous fluid support, the patient’s fever persisted. On the fourth hospital day, she became hypotensive and died.

This case illustrates that additional lines may be added to Part I

Statement

PART – I

(a) Pseudomonas aeruginosa sepsis

(b) Pseudomonas aeruginosa urinary tract infection (c) In-dwelling bladder catheter

(d) Left hemiparesis

(e) Old cerebrovascular accident

days days

6 months 2 years

2 years

Part – II …………………………………………..

3.2.10 CASE HISTORY

A 34-year-old male was admitted to the hospital with severe shortness of breath. He had a 9- month history of unintentional weight loss, night sweats and diarrhea. The patient had no history of any medical condition that would cause immunodeficiency. An Elisa test and confirmatory Western Blot test for human immunodeficiency virus (HIV) were positive. T-Iymphocyte tests indicated a low T helper-suppressor ratio. A lung biopsy was positive for Pneumocystis carinii pneumonia (PCP), indicating a diagnosis of acquired immunodeficiency syndrome (AIDS). The patient’s pneumonia responded to pentamidine therapy, and the patient was discharged. The patient had two additional admissions for PCP. Seventeen months after the patient was first discovered to be HIV positive, he again developed PCP but did not respond to therapy. He died 2 weeks later.

Statement

PART-II ……………………………………………………………….

Explanation: By definition AIDs is due to HIV infection, even though it may seem redundant to specify HIV infection in the causal sequence death, it is desirable to do so. HIV infection and AIDS are not synonymous, and there is a variable clinical course between the time of HIV infection and the onset of AIDS.

3.2.11 CASE HISTORY

A 75-year-old male had a 10-year history of chronic bronchitis associated with smoking two packs of cigarettes a day for more than 40 years. When seen by his physician approximately 2 years prior to his terminal episode, he had moderately reduced FEV and FVC with no response to bronchodilators. During his last year, he required corticosteroids to prevent wheezing and coughing at night, however, he was unable to reduce his smoking to less than one pack of cigarettes per day. When seen 3 months prior to his terminal episode, he had significantly reduced FEV and FVC with no response to bronchodilators. He awoke one evening complaining his wife about coughing and worsening shortness of breath. He was taken to the emergency room where he was found to have an acute exacerbation of obstructive airways disease. He was admitted to the hospital. At the patient’s request, no mechanical ventilation was employed, and he died 12 hours later in respiratory arrest.

Statement

PART – I

(a) Pneumocystis carinii pneumonia

(b) Acquired Immunodeficiency Syndrome (c) HIVinfection

2 weeks

17 months Over 17 months

PART – I

(a) Acute exacerbation of obstructive airways disease. (b) Chronic bronchitis.

12 hours 10 years

PART-II Cigarette smoking

Explanation: In this case, respiratory arrest is considered a mode of dying, and it would not be listed as the Immediate Cause of Death.

3.2.12 CASE HISTORY

A 75-year-old female had a 15- year history of noninsulin-dependent diabetes mellitus, a 13- year history of mild hypertension treated with thiazide diuretics, and an uncomplicated myocardial infarction 6 years prior to the present illness. She was found disoriented in her apartment and brought to the hospital. On admission she was noted to be unresponsive, without focal neurologic signs, and severely dehydrated with a blood pressure of 90/60. Initial laboratory tests disclosed severe hyperglycemia, hyperosmolarity, azotemia and mild ketosis without acidosis. A diagnosis of hyperosmolar nonketotic coma was made.

The patient was vigorously treated with fluids, electrolytes, insulin, and broadspectrum antibiotics, although no source for infection was documented. Within 72 hours, the patient’s hyperosmolar, hyperglycemic state was resolved. However, she remained anuric with progressive azotemia. Attempts at renal dialysis were unsuccessful, and the patient died on the 8th hospital day in severe renal failure.

Statement

PART-II Hypertension, previous myocardial infarction

Explanation: Hypertension and a previous myocardial infarction would both be considered factors that contributed to the death. However, they would not be in the direct causal sequence of Part I, so they would be placed in Part II.

3.2.13 CASE HISTORY

This 53-year-old male was admitted to the hospital following 2 days of intermittent midepigastric and left-sided chest pain. The pain radiated to his left arm and was accompanied by nausea and vomiting. He gave a history that included 2 years of occasional chest discomfort, a near syncopal episode 6 months prior, hypertension, a 30 year history of one-pack-per-day cigarette smoking, congenital blindness, and insulin-dependent diabetes mellitus. He was not to be markedlyobese and to have severe hyperholesterolemia.

At the time of admission, his enzyme studies were normal, but the EKG suggested myocardial ischemia. Two days later, he experienced an episode of severe chest chain that did not respond to nitroglycerin and was accompanied by ST-segment elevation. A cardiac catheterization demonstrated severe multivessel coronary artery stenosis. He underwent quadruple coronary artery bypass surgery. Shortly after being taken off the cardiopulmonary bypass machine, he went into cardiac

PART – I

(a) Acute renal failure

(b) Hyperosmolar nonketotic coma

5 days

8 days 15 Years

arrest. As resuscitation was being attempted by open cardiac massage, a rupture developed in his left ventricular wall which resulted in rapid exsanguination and death.

Statement

PART-II Insulin-dependent diabetes mellitus, cigarette smoking, hypertension, hypercholesterolemia

Explanation: Insulin-dependent diabetes mellitus, cigarette smoking, hypertension, and hypercholesterolemia would all be considered factors that contributed to the death. However, they would not be in the direct causal sequence of Part I, so they would be placed in Part II.

3.2.14 CASE HISTORY

A 1,480-gram male infant was born at 32-weeks gestation to a 20-year old primiparous woman. The infant developed respiratory distress syndrome and required mechanical ventilation for 7 days. Despite receiving adequate calories for growth, the infant gained weight poorly and had persistent diarrhea with steatorthea. The patient had an elevated sweat chloride concentration. On the 37th day after birth, the infant became lethargic and was noted to be edematous. Escherichia coli was cultured from the infant’s cerebral spinal fluid, total serum proteins were reported to be low, and clotting studies were prolonged. The infant died at 45 days of age despite appropriate life-saving efforts. Gross autopsy confirmed the clinical impression of cystic fibrosis.

Statement

PART-II Prematurity, malabsorption, respiratory distress syndrome

Explanation: Prematurity, malabsorption, respiratory distress syndrome would all be considered factors that contributed to the death. However, they would not be in the direct causal sequence of Part I, so they would be placed in Part II.

3.2.15 CASE HISTORY

A 30-year-old, gravida-six, para-five woman with gestational hypertension, reported to the emergency room at 36 weeks into her pregnancy. She had experienced 12 hours of abdominal cramping and vaginal bleeding with the passage of large clots. A presumptive diagnosis of abruption placenta was made. She continued to bleed from her vagina as well as from phlebotomy sites, and she rapidly went into profound shock. No fetal heart sounds were audible. The patient was experiencing disseminated intravascular coagulation. Despite administration of blood and clotting

PART – I

(a) Coronary artery bypass surgery (b) Myocardial infarction

Minutes Days Years

PART – I

(a) Escherichia coli meningitis (b) Cystic fibrosis

7 days 45 days

factors, intravascular pressure could not be maintained. The mother and fetus both died 1 hour after admission. Autopsy findings confirmed the clinical diagnosis.

Statement

PART – I

(a) Disseminated intravascular coagulation (b) Haemorrhage

Hour

13 hours

Over 13 hours

PART-II Gestational hypertension

Explanation: Gestational hypertension would be considered a factor that contributed to the death. However, it would not be in the direct casual sequence of Part I, so they would be placed in Part II.

3.3 Incorrect filling and correct filling of the medial part of the certificate.

The following few illustrative examples of certification will give the Medical Officers an understanding to fill in the causes in Part I and Part II of the Form of Medical Certificate of Cause of Death.

Example 1:

Incorrect Certificate Correct Certificate

PART II …………………………………. ……………………………………….

ILLUSTRATION: In the above mentioned example, the underlying cause of death is Primary Bronchogenic Carcinoma of Rt. Lung because it has given rise to the conditions reported in the Incorrect Certificate. The certificate should have been recorded by the Medical Officer as in the Correct Certificate.

Example 2:

Incorrect Certificate Correct Certificate

PART II …………………………………. Chronic Bronchitis

ILLUSTRATON: The attending Physician should have recorded the conditions as mentioned in the correct certificate keeping in view the reported sequence and unrelated conditions (significant conditions) should have been recorded in Part-II.

PART I

(a) Primary Bronchogenic Carcinoma of Rt. Lung

(b) Emaciation

(a)Emaciation

(b)Metastasis to Lymph nodes and liver (c) Bronchogenic Carcinoma of Rt. Lung.

PART I

(a) Diabetes

(b) Gangrene Foot

bronchitis

(a) Gangrene Foot

(b) Diabetes

Example 3:

Incorrect Certificate Correct Certificate

PART II …………………………………. Cataract, Ischaemic Heart Disease

ILLUSTRATION: In this example, the Medical Officer should have mentioned the train of events in Part-I and other significant conditions in Part-II, as mentioned in the correct certificate.

Example 4:

Incorrect Certificate Correct Certificate

PART II Embryoma of Kidney …………………………

ILLISTRATION: The medical Officer has recorded operative procedure “Nephrectomy” in Part-I and other conditions “Edema Face and Foot” which is due to the disease “Embroyoma of Kidney” stated in Part-II, should have been written according to the sequence and operative procedure should have been recorded in the column made for “Operation Performed”.

Example 5:

Incorrect Certificate Correct Certificate

PART II …………………………….. Ischaemic Heart Disease

ILLUSTRATION : The certificate should have been got completed by the medical Officer in the correct certificate because Renal Failure, Antecedent direct cause and terminated by the condition mentioned at (c) of Part-I as the underlying cause of death and unrelated cause Intestinal “Ischaemic Heart Disease” in Part-II.

Example 6:

Incorrect Certificate Correct Certificate

PART I

(a) Retention of urine with Hypertrophy of Prostate with Uremia

(b) Cataract

(a)Uremia

(b)Retention of Urine (c)Hypertrophy of Prostate

PART I

(a) Nephrectomy

(b) Edema Face, Foot (c) …………………

(a)Edema Face, foot (b)Embroyomia of Kidney (c)…………………….

PART I

(a) Polycystic Kidney

(b) Renal Failure and Hypertension (c) Ischaemic Heart Disease

(a)Renal failure (b)Hypertension (c)Polycystic Kidney

PART I

(a) Intestinal Obstruction (b) Femoral Hernia

(a)Femoral Hernia with obstruction (b)………………………………………..

PART II …………………………… …………………………

ILLUSTRATION: In this example all the conditions recorded by the Medical officer are co-related but it should have been mentioned as in the correct certificate because ICD provides a combined code for these conditions.

Keeping in view the above mentioned examples, with their illustrations, all the Medical Officers are requested mainly to know the contents, as under, Part-I and Part-II of International Form of Medical Certificate of Cause of Death.

“In Part-I is reported cause leading directly to death at line (a) and also the antecedent conditions at line (b) and (c) which gave rise to the cause reported in line (a), the underlying cause being stated last in the sequence of events. However, no entry is necessary in line (b) and (c) if the disease or condition directly leading to death, stated in line (a), describes completely the train of events”.

In Part-II is entered any other significant condition which unfavorably influenced the course of the morbid process and thus contributed to the fatal outcome, but which was not related to the disease or condition directly causing death”.

3.4 Importance of reporting sequence accurately

The following illustrates the importance of accurately stating the sequence of morbid conditions in order to allow selection of the cause considered “underlying” by the attending physician.

A diabetic man who had been under insulin control for many years developed ischemic heart disease and died suddenly from a myocardial infarction. Most people consider there to be a relationship between diabetes and ischemic heart disease but its nature is not yet fully understood. Depending on the role, the doctor considers to have been played in the fatal outcome by one or the other conditions, the following certification are possible.

1. If the doctor considered that the heart condition resulted from the long-standing diabetes, the sequence would be:-

and the statistical office would select diabetes as the underlying cause of death.

2. If the doctor considered that the heart condition developed independently of the diabetes, the certification would be:-

PART-II Diabetes mellitus 12 years. and the heart condition would be recorded as the underlying cause.

PART – I

(a) Myocardial Infarction

(b) Chronic Ischaemic heart disease (c) Diabetes mellitus

1 hour

5 Years 12 Years

PART – I

(a) Myocardial infarction

(b) Chronic ischaemic heart disease

1 hour 5 years

3. If the man had instead died from some other complication of the diabetes, such as nephropathy, the heart condition playing only a subsidiary part in the death and the doctor being uncertain that it arose from the diabetes at all the certificate should be in the form :-

PART-II Chronic ischaemic heart disease 5 years. The underlying cause is “Diabetic nephropathy”

PART – I

(a) Acute renal faiure (b) Nephropathy

1 week 4 years 12 years

4. ANNEXURES

EXAMPLES OF INCOMPLETE DESCRIPTIONS OF CAUSE OF DEATH

_________________________________________________________________________________________

Term Additional Information needed for satisfactory coding according to international classification.

_________________________________________________________________________________________

Abortion

Abscess Anaemia Aneurysm

Angina Apoplxy Appendicitis Arteriosclerosis

Arteritis Arthritis

Ascites Asphyxia Atheroma

Boil

Bright’s disease Bronchitis

Burn

Calculus

Spontaneous or induced and reason if induced, period of gestation, Whether sepsis or toxaemia.

Site and cause (e.g. tuberculous) Variety if primary; cause if secondary.

Aortic (abdominal or thoracic), Arterial, arteriovenous, cardiac; arterioscleratic or syphilitic.

Agranulocytic, diptheritic, faucium, streptococcal, Vincent’s; pectoris

Site of lesion;recent or late effects

Acute, chronic or perforated

Whether hypertensive (benign or malignant) nature of cardiac, cerebral or renal manifestation, if any.

Arteriosclerotic, syphilitic; cerebral,coronary

Acute, gonococcal, gouty, osteoarthritic, tuberculous, due to rheumatic fever Or rheumatoid

Cause of the condition Cause of the condition Aorta, artery, valve of heart Site

Acute, sub-acute or chronic

Acute, chronic; allergic, capillary, emphysematous

Site(s) and whether by fire, explosion, hot object, liquid chemical or radiation.

Site

ANNEXURE-I

______________________________________________________

Term Additional Information needed for satisfactory coding according to international classification.

___________________________________________________________________________________________

Caner, carcinoma

Carbuncle

Cardiac failure Cardiovascular disease Carditis

Caries

Cellutitis

Child birth

Chorea

Cirrhosis of liver Convulsion, Croup Crushing

Curvature of spine Cyst

Debility

Dermatitis

Dementia

Diabetes

Diarrhoea Dysentery

Site of primary, if known, otherwise sites of secondary, part where it originated

If of lip, tongue, mouth, throat, intestine, colon, uterus; histological type, if known

Site

Disease causing the condition

Whether hypertensive, coronary or renal involvement

Endo, myo or per, acute, rheumatic

Cause, part affected

Complication and whether apparent before delivery

Rheumatic, Huntington’s gravidarum

Cause ( e.g. alcoholic)

Cause

Whether fracture, internal injury, external cause

Cause, congenital or acquired

Site, congenital, multiple, hydatid, dermoid retention

Disease causing the condition

Variety

Disease causing the condition

Complication or independent disease, causing death (particular care should be taken to differentiate between diabetes as the underlying cause and as a contributory condition

Cause

Bacterial, Amoebic or other protozoal

___________________________________________________________________________________________

Term Additional Information needed for satisfactory coding according to international classification.

___________________________________________________________________________________________

Eclampsia Embolism

Encephalitis

Endocarditis

Endometritis Fits

Fracture Gangrene Gestritis Glioma

Goitre Haematemesis Haemoptysis Haemorrhage Hemiplegia Hepatitis

Hydrocephalus Hypertension

Immaturity

Cause and whether apparent before delivery

Site and cause; associated child-birth or abortion; if following operation; state Condition for which operation was performed.

Acute infectious, late effect of infectious; post vaccinal, post-exenthematous, idiopathic, meningococcal, supportive or tuberculous.

Acute or chronic; arteriosclerotic, hypertensive, rheumatic or other, if rheumatic, whether rheumatic fever was present at death.

Whether puerperal infection

Apoplectic, epileptic, eclampsia or hysteria

Bone; part of skull or lemur; compound; external cause

Site and cause (diabetic, gas bacillus, senile)

Cause

Variety if known; site

Simple or toxic; diffuse or nodular

Disease causing the condition

Whether tuberculous

Site and cause

Cause and duration

Acute infective, chronic, alcoholic of new born of pregnancy, puerperal, post- immunization, post-transfusion.

Congenital, tuberculous or other cause

Benign or malignant, whether associated arteriosclerosis, cerebrovascular, Cardiacor renal manifestation or pregnancy.

Cause; gestation period, birth weight; associated abnormality or disease, if any.

_________________________________________________________________________________________

Term Additional Information needed for satisfactory coding according to international classification.

_________________________________________________________________________________________

Influenza Injury

Insanity

Jaundice

Laryngitis Leukaemia Malaria Malformation Malnutrition Marasmus Myocarditis

Neoplasm Nephritis

Neuritis Paraplegia Pneumonia

Pneumothorax

Complications, if any

Nature of injuries and parts of body injured whether accident, suicide, homicide, war injury; place and circumstances of accident

Form of mental disorder, direct cause of death, underlying congenital condition, cerebral disease, arteriosclerosis, syphilis

Catarrhal, epidemic, haematogenous, obstructive, toxic , cause of obstruction or toxaemia, if any, and whether occurring during pregnancy or the Puerperium of following immunization or transfusion. Avoid the term “malignant” jaundice.

Acute, chronic or tuberculous

Lymphatic, myeloid, monocytic; acute or chronic

Benign, tertian, malignant tertian, quartan, ovale black water fever

Congenital or acquired, type and organ involved

Congeintal or due to inadequate diet, disease or lack of care

Cause

Acute rhematic, acute non-rheumatic chronic rheumatic, other chronic (but avoid using chronic “Myocarditis” to describe degeneration of the myocardium)

Benign or malignant; type and location; if malignant, see cancer

Acute or sub-acute with oedema; chronic; Infective or toxic; cause if known. Associated hypertension, artersclerosis, heart disease or pregnancy

Location; cause (e.g. alchol, lead, rheumatism)

Spastic due to birth injury, due to cerebral, lesion; due to spinal lesion

Broncho; lobar, atypical, chronic interstitial hypostatic, influenza, neonatal, tuberculous following measles

Cause of the condition

__________________________________________________________________________________________

Term Additional Information needed for satisfactory coding according to international classification.

__________________________________________________________________________________________

Rheumatic fever

Rickets Salpingitis Septicemia Spondylitis Suffocation

Syphilis Tetanus Tuberculosis Ulcers Uraemia

Distinguish heart affections with active rheumatic fever at death from old heart lesions left by rheumatic fever

Active, late effects (e.g. genuvalgum ) foetal, renal or scurvy

Acute chronic, gonococcal, tuberculous, post-abortive, puerperal

Cause and site if localized

Ankylosing; deformans, sacro-iliac, genococcal, tuberculous

Cause e.g. bedclothes, inhaling food, foreign body or smoke, chemical, mechanical, submersion, during birth

Congenital, early or late, organ affected

Mode of infection if known, e.g. slight injury, major injury, puerperal Organs affected including pleura and parts of respiratory system Site and cause, whether perforated

Cause, if known- e.g. acute, sub-acute, or chronic, nephritis, associated Pregnancy or child-birth.

FORM NO. 4

(See Rule 7)

MEDICAL CERTIFICATE OF CAUSE OF DEATH

(Hospital In-patients. Not to be used for still births)

To be sent to Registrar along with Form No. 2 (Death Report)

Name of the Hospital ……………………………………………………………….

I hereby certify that the person whose particulars are given below died in the hospital in Ward No……………….. On …………………….. At ………AM/PM

ANNEXURE-II

For Hospital Events

NAMEOFDECEASED

Sex

1. Male 2. Female

If 1 year or more, age in years

If less than 1 year, age in month

Age at Death

If less than one month, age

in days

If less than one day, age in hours

For useof Statistical Office

Immediate cause

(a) ……………………………………..

due to (or as a consequences of)

(b) ……………………………………..

due to (or as a consequences of)

State the disease, injury or complication which caused death, not the mode of dying such as heart failure, asthenia, etc.

Antecedent cause

Morbid conditions, if any, giving rise to the above cause, stating underlying conditions last

Other significant conditions contributing to the death but not related to the disease or condition causing it

CAUSE OF DEATH

Interval between onset and death approx.

Manner of Death

1. Natural 2. Accident 5. Pending investigation

How did the injury occur?

3. Suicide

4. Homicide

If deceased was a female, was pregnancy the death associated with? If yes, was there a delivery? 1. Yes 2. No

1. Yes

2. No

Name and signature of the Medical Attendant certifying the cause of death Date of verification ……………………………………………………………….

(To be detached and handed over to the relative of the deceased)

Certified that Shri/Smt/Kum…………………………………………………………….. S/W/D of Shri …… ……………………………………

R/O …………………………………………………………………………………… was admitted to this hospital on ………………………… and expired on …………………………………………..

Doctor……………………………….. (Medical Superintendent & Name of Hospital)

For Non-Hospital Events

FORM NO. 4A

(See Rule 7)

MEDICAL CERTIFICATE OF CAUSE OF DEATH

(For non-institutional deaths. Not to be used for still births) To be sent to Registrar along with Form No. 2 (Death Report)

I hereby certify that the deceased Shri/Smt/Km…………………………………………………… son/wife/daughter of ……………………… resident of ……………………………………………………………………… was under my treatment from ……………………… to …… …………………………. and he/she died on …………………………………… at ……………….A.M./P.M.

NAME OF DECEASED

Sex

3. Male 4. Female

If 1 year or more, age in years

If less than 1 year, age in month

Age at Death

If less than one month, age in

days

If less than one day, age in hours

For use of Statistic al Office

Immediate cause

(a) ……………………………………..

due to (or as a consequences of)

(b) ……………………………………..

due to (or as a consequences of)

State the disease, injury or complication which caused death, not the mode of dying such as heart failure, asthenia, etc.

Antecedent cause

Morbid conditions, if any, giving rise to the above cause, stating underlying conditions last

Other significant conditions contributing to the death but not related to the disease or condition causing it

CAUSE OF DEATH

Interval between onset and death approx.

If deceased was a female, was pregnancy the death associated with? If yes, was there a delivery? 1. Yes 2. No

1. Yes

2. No

Name and signature of the Medical Practitioner certifying the cause of death Date of verification ………………………………………………………………….

(To be detached and handed over to the relative of the deceased)

Certified that Shri/Smt/Kum…………………………………………………….. S/W/D of Shri …… ……………………………………………..

R/O ………………………………………………………… was under my treatment from …………………………………. ………………………….. to ………………………………. and he/she expired on ………………………………………………………… at …………………………. A.M./P.M.

Doctor ……………………………………..

Signature and address of Medical Practitioner/ Medical attendant with Registration No.

ANNEXURE-III

Major Groups and the description of ICD-10 Codes

The classification of diseases may be defined as a system of categories to which morbid entities are assigned according to established criteria. The Tenth Revision of International Classification of Diseases (ICD-10)is a single coded list of three-character categories, each of which can be further divided into up to ten four-character subcategories. In place of the purely numeric coding system of ICD-9, ICD-10 uses alphanumeric code with a letter in the first position and a number in the second, third and fourth positions; the fourth character follows a decimal point. The code numbers can range from A00.0 to Z99.9. The letter U is not used and is kept blank for use in future. Codes U00-U49 is kept reserved to be used for the provisional assignment of new diseases of uncertain etiology. Codes U50- U99 may be used in research, e.g. when testing an alternative sub-classification for a special project.

2. The National list for tabulation of Morbidity and Mortality based on the Ninth Revision of ICD- 9, 1975 was adopted in MCCD from 1980 to 1998. Subsequently, the World Health Organization (WHO) brought out 10th Revision of International Classification of Diseases (ICD) and the National List for tabulation of Morbidity and Mortality data, based on ICD-10 has been finalized in consultation with the states to meet their requirements and has been adopted from 1999 onward for MCCD Report. The list based on ICD-10 comprises of 20 major Groups, 69 categories and 193 sub-categories of causes as compared to 18 major groups including supplementary classification of Injury & poisoning, 66 categories and 194 sub-categories of causes (includes few single causes) of national list based on ICD-9. Chapters, Blocks of three-character categories and group of three/four-character categories of ICD-10 have been considered as Major Groups, Categories and sub-categories respectively in the national list.

3. As per the recommendations of the ICD-10, data on “Medical Certification of Cause of Death” have been tabulated for a total of 69 categories of causes under Major Groups I to XX of National List including External Causes of morbidity and mortality.

National List based on ICD-10

Major Groups I to XIX:

1. Categories-58 (Group of three-character categories)

2. Sub-categories-177 (Group of 3/4–character categories and 3/4 -character single category)

Major Group XX: External Causes of Morbidity & Mortality

3. Categories-11 (Group of three-character categories)

4. Sub-categories-16 (Group of 3/4–character categories and 3/4 -character single category)

The descriptions for all Major Groups of the National list based on ICD-10 are as under:

I Certain Infectious and parasitic diseases (A00-B99)

II Neoplasms (C00-D48)

III Diseases of the blood and blood forming organs and certain disorders involving the

immune mechanism (D50-D89)

IV Endocrine, nutritional and metabolic diseases (E00-E89)

V Mental and behavioural disorders (F01-F99)

VI Diseases of the nervous system (G00-G98)

VII Diseases of the eye and Adnexa (H00-H59)

VIII Diseases of the ear and mastoid process (H60-H95)

IX Diseases of the circulatory system (I00-I99)

X Diseases of the respiratory system (J00-J98)

XI Diseases of the digestive system (K00-K92)

XII Diseases of the skin and subcutaneous tissue (L00-L98)

XIII Diseases of the musculoskeletal system and connective tissue (M00-M99)

XIV Diseases of the genitourinary system (N00-N99)

XV Pregnancy, childbirth and the puerperium (O00-O99)

XVI Certain conditions originating in the perinatal period (P00-P96)

XVII Congenital malformation, deformation and chromosomal abnormalities (Q00-Q99)

XVIII Symptoms, signs and abnormal clinical and laboratory findings, n.e.c. (R00-R99)

XIX Injury, poisoning and certain other consequences of external causes (S00-T98)

XX External causes of morbidity and mortality (V01-Y89)

XXI* Factors influencing health status and contact with health services (Z00-Z99) *: Not in use in India.

Major Cause Groups

Description and ICD codes

ANNEXURE-IV

List of Three Character Categories

Chapter I

Certain infectious and parasitic diseases (A00-B99)

Intestinal infectious diseases (A00-A09)

A00 Cholera

A01 Typhoid and paratyphoid fevers

A02 Other salmonella infections

A03 Shigellosis

A04 Other bacterial intestinal infections

A05 Other bacterial foodborne intoxications

A06 Amoebiasis

A07 Other protozoal intestinal diseases

A08 Viral and other specified intestinal infections

A09 Diarrhoea and gastroenteritis of presumed infectious origin

Tuberculosis (A15-A19)

A15 Respiratory tuberculosis, bacteriologically and histologically confirmed

A16 Respiratory tuberculosis, not confirmed bacteriologically or histologically

A17† Tuberculosis of nervous system

A18 Tuberculosis of other organs

A19 Miliary tuberculosis

Certain zoonotic bacterial diseases (A20-A28)

A20 Plague

A21 Tularaemia

A22 Anthrax

A23 Brucellosis

A24 Glanders and melioidosis

A25 Rat-bite fevers

A26 Erysipeloid

A27 Leptospirosis

A28 Other zoonotic bacterial diseases, not elsewhere classified

Other bacterial diseases (A30-A49)

A30 Leprosy [Hansen’s disease]

A31 Infection due to other mycobacteria

A32 Listeriosis

A33 Tetanus neonatorum

A34 Obstetrical tetanus

A35 Other tetanus

A36 Diphtheria

A37 Whooping cough

A38 Scarlet fever

A39 Meningococcal infection

A40 Streptococcal septicaemia

A41 Other septicaemia

A42 Actinomycosis

A43 Nocardiosis

A44 Bartonellosis

A46 Erysipelas

A48 Other bacterial diseases, not elsewhere classified

A49 Bacterial infection of unspecified site

Infections with a predominantly sexual mode of transmission (A50-A64)

A50 Congenital syphilis

A51 Early syphilis

A52 Late syphilis

A53 Other and unspecified syphilis

A54 Gonococcal infection

A55 Chlamydial lymphogranuloma (venereum)

A56 Other sexually transmitted chlamydial diseases

A57 Chancroid

A58 Granuloma inguinale

A59 Trichomoniasis

A60 Anogenital herpesviral [herpes simplex] infection

A63 Other predominantly sexually transmitted diseases, not elsewhere classified

A64 Unspecified sexually transmitted disease

Other spirochaetal diseases (A65-A69)

A65 Nonvenereal syphilis

A66 Yaws

A67 Pinta [carate]

A68 Relapsing fevers

A69 Other spirochaetal infections

Other diseases caused by chlamydiae (A70-A74)

A70 Chlamydia psittaci infection

A71 Trachoma

A74 Other diseases caused by chlamydiae

Rickettsioses (A75-A79)

A75 Typhus fever

A77 Spotted fever [tick-borne rickettsioses]

A78 Q fever

A79 Other rickettsioses

Viral infections of the central nervous system (A80-A89)

A80 Acute poliomyelitis

A81 Atypical virus infections of central nervous system

A82 Rabies

A83 Mosquito-borne viral encephalitis

A84 Tick-borne viral encephalitis

A85 Other viral encephalitis, not elsewhere classified

A86 Unspecified viral encephalitis

A87 Viral meningitis

A88 Other viral infections of central nervous system, not elsewhere classified

A89 Unspecified viral infection of central nervous system

Arthropod-borne viral fevers and viral haemorrhagic fevers (A90-A99)

A90 Dengue fever [classical dengue]

A91 Dengue haemorrhagic fever

A92 Other mosquito-borne viral fevers

A93 Other arthropod-borne viral fevers, not elsewhere classified

A94 Unspecified arthropod-borne viral fever

A95 Yellow fever

A96 Arenaviral haemorrhagic fever

A98 Other viral haemorrhagic fevers, not elsewhere classified

A99 Unspecified viral haemorrhagic fever

Viral infections characterized by skin and mucous membrane lesions (B00-B09)

B00 Herpesviral [herpes simplex] infections

B01 Varicella [chickenpox]

B02 Zoster [herpes zoster]

B03 Smallpox

B04 Monkeypox

B05 Measles

B06 Rubella [German measles]

B07 Viral warts

B08 Other viral infections characterized by skin and mucous membrane lesions, not elsewhere

classified

B09 Unspecified viral infection characterized by skin and mucous membrane lesions

Viral hepatitis (B15-B19)

B15 Acute hepatitis A

B16 Acute hepatitis B

B17 Other acute viral hepatitis

B18 Chronic viral hepatitis

B19 Unspecified viral hepatitis

Human immunodeficiency virus [HIV] disease (B20-B24)

B20 Human immunodeficiency virus [HIV] disease resulting in infectious and parasitic diseases

B21 Human immunodeficiency virus [HIV] disease resulting in malignant neoplasms

B22 Human immunodeficiency virus [HIV] disease resulting in other specified diseases

B23 Human immunodeficiency virus [HIV] disease resulting in other conditions

B24 Unspecified human immunodeficiency virus [HIV] disease

Other viral diseases (B25-B34)

B25 Cytomegaloviral disease

B26 Mumps

B27 Infectious mononucleosis

B30 Viral conjunctivitis

B33 Other viral diseases, not elsewhere classified

B34 Viral infection of unspecified site

Mycoses (B35-B49)

B35 Dermatophytosis

B36 Other superficial mycoses

B37 Candidiasis

B38 Coccidioidomycosis

B39 Histoplasmosis

B40 Blastomycosis

B41 Paracoccidioidomycosis

B42 Sporotrichosis

B43 Chromomycosis and phaeomycotic abscess

B44 Aspergillosis

B45 Cryptococcosis

B46 Zygomycosis

B47 Mycetoma

B48 Other mycoses, not elsewhere classified

B49 Unspecified mycosis

Protozoal diseases (B50-B64)

B50 Plasmodium falciparum malaria

B51 Plasmodium vivax malaria

B52 Plasmodium malariae malaria

B53 Other parasitologically confirmed malaria

B54 Unspecified malaria

B55 Leishmaniasis

B56 African trypanosomiasis

B57 Chagas’ disease

B58 Toxoplasmosis

B59† Pneumocystosis

B60 Other protozoal diseases, not elsewhere classified B64 Unspecified protozoal disease

Helminthiases (B65-B83)

B65 Schistosomiasis [bilharziasis]

B66 Other fluke infections

B67 Echinococcosis

B68 Taeniasis

B69 Cysticercosis

B70 Diphyllobothriasis and sparganosis

B71 Other cestode infections

B72 Dracunculiasis

B73 Onchocerciasis

B74 Filariasis

B75 Trichinellosis

B76 Hookworm diseases

B77 Ascariasis

B78 Strongyloidiasis

B79 Trichuriasis

B80 Enterobiasis

B81 Other intestinal helminthiases, not elsewhere classified

B82 Unspecified intestinal parasitism

B83 Other helminthiases

Pediculosis, acariasis and other infestations (B85-B89)

B85 Pediculosis and phthiriasis

B86 Scabies

B87 Myiasis

B88 Other infestations

B89 Unspecified parasitic disease

Sequelae of infectious and parasitic diseases (B90-B94)

B90 Sequelae of tuberculosis

B91 Sequelae of poliomyelitis

B92 Sequelae of leprosy

B94 Sequelae of other and unspecified infectious and parasitic diseases

Bacterial, viral and other infectious agents (B95-B97)

B95 Streptococcus and staphylococcus as the cause of diseases classified to other chapters

B96 Other bacterial agents as the cause of diseases classified to other chapters

B97 Viral agents as the cause of diseases classified to other chapters

Other infectious diseases (B99)

B99 Other and unspecified infectious diseases

Chapter II

Neoplasms (C00-D48)

Malignant neoplasms (C00-C97)

Malignant neoplasms of lip, oral cavity and pharynx (C00-C14)

C00 Malignant neoplasm of lip

C01 Malignant neoplasm of base of tongue

C02 Malignant neoplasm of other and unspecified parts of tongue

C03 Malignant neoplasm of gum

C04 Malignant neoplasm of floor of mouth

C05 Malignant neoplasm of palate

C06 Malignant neoplasm of other and unspecified parts of mouth

C07 Malignant neoplasm of parotid gland

C08 Malignant neoplasm of other and unspecified major salivary glands

C09 Malignant neoplasm of tonsil

C10 Malignant neoplasm of oropharynx

C11 Malignant neoplasm of nasopharynx

C12 Malignant neoplasm of piriform sinus

C13 Malignant neoplasm of hypopharynx

C14 Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx

Malignant neoplasms of digestive organs (C15-C26)

C15 Malignant neoplasm of oesophagus

C16 Malignant neoplasm of stomach

C17 Malignant neoplasm of small intestine

C18 Malignant neoplasm of colon

C19 Malignant neoplasm of rectosigmoid junction

C20 Malignant neoplasm of rectum

C21 Malignant neoplasm of anus and anal canal

C22 Malignant neoplasm of liver and intrahepatic bile ducts

C23 Malignant neoplasm of gallbladder

C24 Malignant neoplasm of other and unspecified parts of biliary tract

C25 Malignant neoplasm of pancreas

C26 Malignant neoplasm of other and ill-defined digestive organs

Malignant neoplasms of respiratory and intrathoracic organs (C30-C39)

C30 Malignant neoplasm of nasal cavity and middle ear

C31 Malignant neoplasm of accessory sinuses

C32 Malignant neoplasm of larynx

C33 Malignant neoplasm of trachea

C34 Malignant neoplasm of bronchus and lung

C37 Malignant neoplasm of thymus

C38 Malignant neoplasm of heart, mediastinum and pleura

C39 Malignant neoplasm of other and ill-defined sites in the respiratory system and

intrathoracic organs

Malignant neoplasms of bone and articular cartilage (C40-C41)

C40 Malignant neoplasm of bone and articular cartilage of limbs

C41 Malignant neoplasm of bone and articular cartilage of other and unspecified sites

Melanoma and other malignant neoplasms of skin (C43-C44)

C43 Malignant melanoma of skin

C44 Other malignant neoplasms of skin

Malignant neoplasms of mesothelial and soft tissue (C45-C49)

C45 Mesothelioma

C46 Kaposi’s sarcoma

C47 Malignant neoplasm of peripheral nerves and autonomic nervous system

C48 Malignant neoplasm of retroperitoneum and peritoneum

C49 Malignant neoplasm of other connective and soft tissue

Malignant neoplasm of breast (C50)

C50 Malignant neoplasm of breast

Malignant neoplasms of female genital organs (C51-C58)

C51 Malignant neoplasm of vulva

C52 Malignant neoplasm of vagina

C53 Malignant neoplasm of cervix uteri

C54 Malignant neoplasm of corpus uteri

C55 Malignant neoplasm of uterus, part unspecified

C56 Malignant neoplasm of ovary

C57 Malignant neoplasm of other and unspecified female genital organs

C58 Malignant neoplasm of placenta

Malignant neoplasms of male genital organs (C60-C63)

C60 Malignant neoplasm of penis

C61 Malignant neoplasm of prostate

C62 Malignant neoplasm of testis

C63 Malignant neoplasm of other and unspecified male genital organs

Malignant neoplasms of urinary tract (C64-C68)

C64 Malignant neoplasm of kidney, except renal pelvis

C65 Malignant neoplasm of renal pelvis

C66 Malignant neoplasm of ureter

C67 Malignant neoplasm of bladder

C68 Malignant neoplasm of other and unspecified urinary organs

Malignant neoplasms of eye, brain and other parts of central nervous system (C69-C72)

C69 Malignant neoplasm of eye and adnexa

C70 Malignant neoplasm of meninges

C71 Malignant neoplasm of brain

C72 Malignant neoplasm of spinal cord, cranial nerves and other parts of central nervous

system

Malignant neoplasms of thyroid and other endocrine glands (C73-C75)

C73 Malignant neoplasm of thyroid gland

C74 Malignant neoplasm of adrenal gland

C75 Malignant neoplasm of other endocrine glands and related structures

Malignant neoplasms of ill-defined, secondary and unspecified sites (C76-C80)

C76 Malignant neoplasm of other and ill-defined sites

C77 Secondary and unspecified malignant neoplasm of lymph nodes

C78 Secondary malignant neoplasm of respiratory and digestive organs

C79 Secondary malignant neoplasm of other sites

C80 Malignant neoplasm without specification of site

Malignant neoplasms of lymphoid, haematopoietic and related tissue (C81-C96)

C81 Hodgkin’s disease

C82 Follicular [nodular] non-Hodgkin’s lymphoma

C83 Diffuse non-Hodgkin’s lymphoma

C84 Peripheral and cutaneous T-cell lymphomas

C85 Other and unspecified types of non-Hodgkin’s lymphoma

C88 Malignant immunoproliferative diseases

C90 Multiple myeloma and malignant plasma cell neoplasms

C91 Lymphoid leukaemia

C92 Myeloid leukaemia

C93 Monocytic leukaemia

C94 Other leukaemias of specified cell type

C95 Leukaemia of unspecified cell type

C96 Other and unspecified malignant neoplasms of lymphoid, haematopoietic and related

tissue

Malignant neoplasms of independent (primary) multiple sites (C97)

C97 Malignant neoplasms of independent (primary) multiple sites

In situ neoplasms (D00-D09)

D00 Carcinoma in situ of oral cavity, oesophagus and stomach

D01 Carcinoma in situ of other and unspecified digestive organs

D02 Carcinoma in situ of middle ear and respiratory system

D03 Melanoma in situ

D04 Carcinoma in situ of skin

D05 Carcinoma in situ of breast

D06 Carcinoma in situ of cervix uteri

D07 Carcinoma in situ of other and unspecified genital organs

D09 Carcinoma in situ of other and unspecified sites

Benign neoplasms (D10-D36)

D10 Benign neoplasm of mouth and pharynx

D11 Benign neoplasm of major salivary glands

D12 Benign neoplasm of colon, rectum, anus and anal canal

D13 Benign neoplasm of other and ill-defined parts of digestive system

D14 Benign neoplasm of middle ear and respiratory system

D15 Benign neoplasm of other and unspecified intrathoracic organs

D16 Benign neoplasm of bone and articular cartilage

D17 Benign lipomatous neoplasm

D18 Haemangioma and lymphangioma, any site

D19 Benign neoplasm of mesothelial tissue

D20 Benign neoplasm of soft tissue of retroperitoneum and peritoneum

D21 Other benign neoplasms of connective and other soft tissue

D22 Melanocytic naevi

D23 Other benign neoplasms of skin

D24 Benign neoplasm of breast

D25 Leiomyoma of uterus

D26 Other benign neoplasms of uterus

D27 Benign neoplasm of ovary

D28 Benign neoplasm of other and unspecified female genital organs

D29 Benign neoplasm of male genital organs

D30 Benign neoplasm of urinary organs

D31 Benign neoplasm of eye and adnexa

D32 Benign neoplasm of meninges

D33 Benign neoplasm of brain and other parts of central nervous system

D34 Benign neoplasm of thyroid gland

D35 Benign neoplasm of other and unspecified endocrine glands

D36 Benign neoplasm of other and unspecified sites

Neoplasms of uncertain or unknown behaviour (D37-D48)

D37 Neoplasm of uncertain or unknown behaviour of oral cavity and digestive organs

D38 Neoplasm of uncertain or unknown behaviour of middle ear and respiratory and

intrathoracic organs

D39 Neoplasm of uncertain or unknown behaviour of female genital organs

D40 Neoplasm of uncertain or unknown behaviour of male genital organs

D41 Neoplasm of uncertain or unknown behaviour of urinary organs

D42 Neoplasm of uncertain or unknown behaviour of meninges

D43 Neoplasm of uncertain or unknown behaviour of brain and central nervous system

D44 Neoplasm of uncertain or unknown behaviour of endocrine glands

D45 Polycythaemia vera

D46 Myelodysplastic syndromes

D47 Other neoplasms of uncertain or unknown behaviour of lymphoid, haematopoietic and

related tissue

D48 Neoplasm of uncertain or unknown behaviour of other and unspecified sites

Chapter III

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)

Nutritional anaemias (D50-D53)

D50 Iron deficiency anaemia

D51 Vitamin B12 deficiency anaemia

D52 Folate deficiency anaemia

D53 Other nutritional anaemias

Haemolytic anaemias (D55-D59)

D55 Anaemia due to enzyme disorders

D56 Thalassaemia

D57 Sickle-cell disorders

D58 Other hereditary haemolytic anaemias

D59 Acquired haemolytic anaemia

Aplastic and other anaemias (D60-D64)

D60 Acquired pure red cell aplasia [erythroblastopenia]

D61 Other aplastic anaemias

D62 Acute posthaemorrhagic anaemia

D63? Anaemia in chronic diseases classified elsewhere D64 Other anaemias

Coagulation defects, purpura and other haemorrhagic conditions (D65-D69)

D65 Disseminated intravascular coagulation [defibrination syndrome]

D66 Hereditary factor VIII deficiency

D67 Hereditary factor IX deficiency

D68 Other coagulation defects

D69 Purpura and other haemorrhagic conditions

Other diseases of blood and blood-forming organs (D70-D77)

D70 Agranulocytosis

D71 Functional disorders of polymorphonuclear neutrophils

D72 Other disorders of white blood cells

D73 Diseases of spleen

D74 Methaemoglobinaemia

D75 Other diseases of blood and blood-forming organs

D76 Certain diseases involving lymphoreticular tissue and reticulohistiocytic system

D77? Other disorders of blood and blood-forming organs in diseases classified elsewhere

Certain disorders involving the immune mechanism (D80-D89)

D80 Immunodeficiency with predominantly antibody defects

D81 Combined immunodeficiencies

D82 Immunodeficiency associated with other major defects

D83 Common variable immunodeficiency

D84 Other immunodeficiencies

D86 Sarcoidosis

D89 Other disorders involving the immune mechanism, not elsewhere classified

Chapter IV

Endocrine, nutritional and metabolic diseases (E00-E90)

Disorders of thyroid gland (E00-E07)

E00 Congenital iodine-deficiency syndrome

E01 Iodine-deficiency-related thyroid disorders and allied conditions

E02 Subclinical iodine-deficiency hypothyroidism

E03 Other hypothyroidism

E04 Other nontoxic goitre

E05 Thyrotoxicosis [hyperthyroidism]

E06 Thyroiditis

E07 Other disorders of thyroid

Diabetes mellitus (E10-E14)

E10 Insulin-dependent diabetes mellitus

E11 Non-insulin-dependent diabetes mellitus

E12 Malnutrition-related diabetes mellitus

E13 Other specified diabetes mellitus

E14 Unspecified diabetes mellitus

Other disorders of glucose regulation and pancreatic internal secretion (E15-E16)

E15 Nondiabetic hypoglycaemic coma

E16 Other disorders of pancreatic internal secretion

Disorders of other endocrine glands (E20-E35)

E20 Hypoparathyroidism

E21 Hyperparathyroidism and other disorders of parathyroid gland

E22 Hyperfunction of pituitary gland

E23 Hypofunction and other disorders of pituitary gland

E24 Cushing’s syndrome

E25 Adrenogenital disorders

E26 Hyperaldosteronism

E27 Other disorders of adrenal gland

E28 Ovarian dysfunction

E29 Testicular dysfunction

E30 Disorders of puberty, not elsewhere classified

E31 Polyglandular dysfunction

E32 Diseases of thymus

E34 Other endocrine disorders

E35? Disorders of endocrine glands in diseases classified elsewhere

Malnutrition (E40-E46)

E40 Kwashiorkor

E41 Nutritional marasmus

E42 Marasmic kwashiorkor

E43 Unspecified severe protein-energy malnutrition

E44 Protein-energy malnutrition of moderate and mild degree

E45 Retarded development following protein-energy malnutrition

E46 Unspecified protein-energy malnutrition

Other nutritional deficiencies (E50-E64)

E50 Vitamin A deficiency

E51 Thiamine deficiency

E52 Niacin deficiency [pellagra]

E53 Deficiency of other B group vitamins

E54 Ascorbic acid deficiency

E55 Vitamin D deficiency

E56 Other vitamin deficiencies

E58 Dietary calcium deficiency

E59 Dietary selenium deficiency

E60 Dietary zinc deficiency

E61 Deficiency of other nutrient elements

E63 Other nutritional deficiencies

E64 Sequelae of malnutrition and other nutritional deficiencies

Obesity and other hyperalimentation (E65-E68)

E65 Localized adiposity

E66 Obesity

E67 Other hyperalimentation

E68 Sequelae of hyperalimentation

Metabolic disorders (E70-E90)

E70 Disorders of aromatic amino-acid metabolism

E71 Disorders of branched-chain amino-acid metabolism and fatty-acid metabolism

E72 Other disorders of amino-acid metabolism

E73 Lactose intolerance

E74 Other disorders of carbohydrate metabolism

E75 Disorders of sphingolipid metabolism and other lipid storage disorders

E76 Disorders of glycosaminoglycan metabolism

E77 Disorders of glycoprotein metabolism

E78 Disorders of lipoprotein metabolism and other lipidaemias

E79 Disorders of purine and pyrimidine metabolism

E80 Disorders of porphyrin and bilirubin metabolism

E83 Disorders of mineral metabolism

E84 Cystic fibrosis

E85 Amyloidosis

E86 Volume depletion

E87 Other disorders of fluid, electrolyte and acid-base balance

E88 Other metabolic disorders

E89 Postprocedural endocrine and metabolic disorders, not elsewhere classified

E90? Nutritional and metabolic disorders in diseases classified elsewhere

Chapter V

Mental and behavioural disorders (F00–F99)

Organic, including symptomatic, mental disorders (F00-F09)

F00? Dementia in Alzheimer’s disease

F01 Vascular dementia

F02? Dementia in other diseases classified elsewhere

F03 Unspecified dementia

F04 Organic amnesic syndrome, not induced by alcohol and other psychoactive substances

F05 Delirium, not induced by alcohol and other psychoactive substances

F06 Other mental disorders due to brain damage and dysfunction and to physical disease

F07 Personality and behavioural disorders due to brain disease, damage and dysfunction

F09 Unspecified organic or symptomatic mental disorder

Mental and behavioural disorders due to psychoactive substance use (F10-F19)

F10 Mental and

F11 Mental and

F12 Mental and

F13 Mental and

F14 Mental and

F15 Mental and

F16 Mental and

F17 Mental and

F18 Mental and

F19 Mental and

substances

Schizophrenia, schizotypal and delusional disorders (F20-F29)

F20 Schizophrenia

F21 Schizotypal disorder

F22 Persistent delusional disorders

F23 Acute and transient psychotic disorders

F24 Induced delusional disorder

behavioural disorders due to use of alcohol

behavioural disorders due to use of opioids

behavioural disorders due to use of cannabinoids behavioural disorders due to use of sedatives or hypnotics behavioural disorders due to use of cocaine

behavioural disorders due to use of other stimulants, including caffeine behavioural disorders due to use of hallucinogens

behavioural disorders due to use of tobacco

behavioural disorders due to use of volatile solvents

behavioural disorders due to multiple drug use and use of other psychoactive

F25 Schizoaffective disorders

F28 Other nonorganic psychotic disorders

F29 Unspecified nonorganic psychosis

Mood [affective] disorders (F30-F39)

F30 Manic episode

F31 Bipolar affective disorder

F32 Depressive episode

F33 Recurrent depressive disorder

F34 Persistent mood [affective] disorders

F38 Other mood [affective] disorders

F39 Unspecified mood [affective] disorder

Neurotic, stress-related and somatoform disorders (F40-F48)

F40 Phobic anxiety disorders

F41 Other anxiety disorders

F42 Obsessive-compulsive disorder

F43 Reaction to severe stress, and adjustment disorders

F44 Dissociative [conversion] disorders

F45 Somatoform disorders

F48 Other neurotic disorders

Behavioural syndromes associated with physiological disturbances and physical factors (F50-F59)

F50 Eating disorders

F51 Nonorganic sleep disorders

F52 Sexual dysfunction, not caused by organic disorder or disease

F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classified

F54 Psychological and behavioural factors associated with disorders or diseases classified

elsewhere

F55 Abuse of non-dependence-producing substances

F59 Unspecified behavioural syndromes associated with physiological disturbances and

physical factors

Disorders of adult personality and behaviour (F60-F69)

F60 Specific personality disorders

F61 Mixed and other personality disorders

F62 Enduring personality changes, not attributable to brain damage and disease

F63 Habit and impulse disorders

F64 Gender identity disorders

F65 Disorders of sexual preference

F66 Psychological and behavioural disorders associated with sexual development and

orientation

F68 Other disorders of adult personality and behaviour

F69 Unspecified disorder of adult personality and behaviour

Mental retardation (F70-F79)

F70 Mild mental retardation

F71 Moderate mental retardation

F72 Severe mental retardation

F73 Profound mental retardation

F78 Other mental retardation

F79 Unspecified mental retardation

Disorders of psychological development (F80-F89)

F80 Specific developmental disorders of speech and language

F81 Specific developmental disorders of scholastic skills

F82 Specific developmental disorder of motor function

F83 Mixed specific developmental disorders

F84 Pervasive developmental disorders

F88 Other disorders of psychological development

F89 Unspecified disorder of psychological development

Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98)

F90 Hyperkinetic disorders

F91 Conduct disorders

F92 Mixed disorders of conduct and emotions

F93 Emotional disorders with onset specific to childhood

F94 Disorders of social functioning with onset specific to childhood and adolescence

F95 Tic disorders

F98 Other behavioural and emotional disorders with onset usually occurring in childhood and

adolescence

Unspecified mental disorder (F99)

F99 Mental disorder, not otherwise specified

Chapter VI

Diseases of the nervous system (G00-G99)

Inflammatory diseases of the central nervous system (G00-G09)

G00 Bacterial meningitis, not elsewhere classified

G01? Meningitis in bacterial diseases classified elsewhere

G02? Meningitis in other infectious and parasitic diseases classified elsewhere

G03 Meningitis due to other and unspecified causes

G04 Encephalitis, myelitis and encephalomyelitis

G05? Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere

G06 Intracranial and intraspinal abscess and granuloma

G07? Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere

G08 Intracranial and intraspinal phlebitis and thrombophlebitis

G09 Sequelae of inflammatory diseases of central nervous system

Systemic atrophies primarily affecting the central nervous system (G10-G13)

G10 Huntington’s disease

G11 Hereditary ataxia

G12 Spinal muscular atrophy and related syndromes

G13? Systemic atrophies primarily affecting central nervous system in diseases classified

elsewhere

Extrapyramidal and movement disorders (G20-G26)

G20 Parkinson’s disease

G21 Secondary parkinsonism

G22? Parkinsonism in diseases classified elsewhere

G23 Other degenerative diseases of basal ganglia

G24 Dystonia

G25 Other extrapyramidal and movement disorders

G26? Extrapyramidal and movement disorders in diseases classified elsewhere

Other degenerative diseases of the nervous system (G30-G32)

G30 Alzheimer’s disease

G31 Other degenerative diseases of nervous system, not elsewhere classified

G32? Other degenerative disorders of nervous system in diseases classified elsewhere

Demyelinating diseases of the central nervous system (G35-G37)

G35 Multiple sclerosis

G36 Other acute disseminated demyelination

G37 Other demyelinating diseases of central nervous system

Episodic and paroxysmal disorders (G40-G47)

G40 Epilepsy

G41 Status epilepticus

G43 Migraine

G44 Other headache syndromes

G45 Transient cerebral ischaemic attacks and related syndromes

G46? Vascular syndromes of brain in cerebrovascular diseases G47 Sleep disorders

Nerve, nerve root and plexus disorders (G50-G59)

G50 Disorders of trigeminal nerve

G51 Facial nerve disorders

G52 Disorders of other cranial nerves

G53? Cranial nerve disorders in diseases classified elsewhere G54 Nerve root and plexus disorders

G55? Nerve root and plexus compressions in diseases classified elsewhere

G56 Mononeuropathies of upper limb

G57 Mononeuropathies of lower limb

G58 Other mononeuropathies

G59? Mononeuropathy in diseases classified elsewhere

Polyneuropathies and other disorders of the peripheral nervous system (G60-G64)

G60 Hereditary and idiopathic neuropathy

G61 Inflammatory polyneuropathy

G62 Other polyneuropathies

G63? Polyneuropathy in diseases classified elsewhere G64 Other disorders of peripheral nervous system

Diseases of myoneural junction and muscle (G70-G73)

G70 Myasthenia gravis and other myoneural disorders

G71 Primary disorders of muscles

G72 Other myopathies

G73? Disorders of myoneural junction and muscle in diseases classified elsewhere

Cerebral palsy and other paralytic syndromes (G80-G83)

G80 Infantile cerebral palsy

G81 Hemiplegia

G82 Paraplegia and tetraplegia

G83 Other paralytic syndromes

Other disorders of the nervous system (G90-G99)

G90 Disorders of autonomic nervous system

G91 Hydrocephalus

G92 Toxic encephalopathy

G93 Other disorders of brain

G94? Other disorders of brain in diseases classified elsewhere

G95 Other diseases of spinal cord

G96 Other disorders of central nervous system

G97 Postprocedural disorders of nervous system, not elsewhere classified

G98 Other disorders of nervous system, not elsewhere classified

G99? Other disorders of nervous system in diseases classified elsewhere

Chapter VII

Diseases of the eye and adnexa (H00-H59)

Disorders of eyelid, lacrimal system and orbit (H00-H06)

H00 Hordeolum and chalazion

H01 Other inflammation of eyelid

H02 Other disorders of eyelid

H03? Disorders of eyelid in diseases classified elsewhere

H04 Disorders of lacrimal system

H05 Disorders of orbit

H06? Disorders of lacrimal system and orbit in diseases classified elsewhere

Disorders of conjunctiva (H10-H13)

H10 Conjunctivitis

H11 Other disorders of conjunctiva

H13? Disorders of conjunctiva in diseases classified elsewhere

Disorders of sclera, cornea, iris and ciliary body (H15-H22)

H15 Disorders of sclera

H16 Keratitis

H17 Corneal scars and opacities

H18 Other disorders of cornea

H19? Disorders of sclera and cornea in diseases classified elsewhere

H20 Iridocyclitis

H21 Other disorders of iris and ciliary body

H22? Disorders of iris and ciliary body in diseases classified elsewhere

Disorders of lens (H25-H28)

H25 Senile cataract

H26 Other cataract

H27 Other disorders of lens

H28? Cataract and other disorders of lens in diseases classified elsewhere

Disorders of choroid and retina (H30-H36)

H30 Chorioretinal inflammation

H31 Other disorders of choroid

H32? Chorioretinal disorders in diseases classified elsewhere

H33 Retinal detachments and breaks

H34 Retinal vascular occlusions

H35 Other retinal disorders

H36? Retinal disorders in diseases classified elsewhere

Glaucoma (H40-H42)

H40 Glaucoma

H42? Glaucoma in diseases classified elsewhere

Disorders of vitreous body and globe (H43-H45)

H43 Disorders of vitreous body

H44 Disorders of globe

H45? Disorders of vitreous body and globe in diseases classified elsewhere

Disorders of optic nerve and visual pathways (H46-H48)

H46 Optic neuritis

H47 Other disorders of optic [2nd] nerve and visual pathways

H48? Disorders of optic [2nd] nerve and visual pathways in diseases classified elsewhere

Disorders of ocular muscles, binocular movement, accommodation and refraction (H49-H52)

H49 Paralytic strabismus

H50 Other strabismus

H51 Other disorders of binocular movement

H52 Disorders of refraction and accommodation

Visual disturbances and blindness (H53-H54)

H53 Visual disturbances

H54 Blindness and low vision

Other disorders of eye and adnexa (H55-H59)

H55 Nystagmus and other irregular eye movements

H57 Other disorders of eye and adnexa

H58? Other disorders of eye and adnexa in diseases classified elsewhere H59 Postprocedural disorders of eye and adnexa, not elsewhere classified

Chapter VIII

Diseases of the ear and mastoid process (H60-H95)

Diseases of external ear (H60-H62)

H60 Otitis externa

H61 Other disorders of external ear

H62? Disorders of external ear in diseases classified elsewhere

Diseases of middle ear and mastoid (H65-H75)

H65 Nonsuppurative otitis media

H66 Suppurative and unspecified otitis media

H67? Otitis media in diseases classified elsewhere

H68 Eustachian salpingitis and obstruction

H69 Other disorders of Eustachian tube

H70 Mastoiditis and related conditions

H71 Cholesteatoma of middle ear

H72 Perforation of tympanic membrane

H73 Other disorders of tympanic membrane

H74 Other disorders of middle ear and mastoid

H75? Other disorders of middle ear and mastoid in diseases classified elsewhere

Diseases of inner ear (H80-H83)

H80 Otosclerosis

H81 Disorders of vestibular function

H82? Vertiginous syndromes in diseases classified elsewhere H83 Other diseases of inner ear

Other disorders of ear (H90-H95)

H90 Conductive and sensorineural hearing loss

H91 Other hearing loss

H92 Otalgia and effusion of ear

H93 Other disorders of ear, not elsewhere classified

H94? Other disorders of ear in diseases classified elsewhere

H95 Postprocedural disorders of ear and mastoid process, not elsewhere classified

Chapter IX

Diseases of the circulatory system(I00-I99)

Acute rheumatic fever (I00-I02)

I00 Rheumatic fever without mention of heart involvement

I01 Rheumatic fever with heart involvement

I02 Rheumatic chorea

Chronic rheumatic heart diseases (I05-I09)

I05 Rheumatic mitral valve diseases

I06 Rheumatic aortic valve diseases

I07 Rheumatic tricuspid valve diseases

I08 Multiple valve diseases

I09 Other rheumatic heart diseases

Hypertensive diseases (I10-I15)

I10 Essential (primary) hypertension

I11 Hypertensive heart disease

I12 Hypertensive renal disease

I13 Hypertensive heart and renal disease

I15 Secondary hypertension

Ischaemic heart diseases (I20-I25)

I20 Angina pectoris

I21 Acute myocardial infarction

I22 Subsequent myocardial infarction

I23 Certain current complications following acute myocardial infarction

I24 Other acute ischaemic heart diseases

I25 Chronic ischaemic heart disease

Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)

I26 Pulmonary embolism

I27 Other pulmonary heart diseases

I28 Other diseases of pulmonary vessels

Other forms of heart disease (I30-I52)

I30 Acute pericarditis

I31 Other diseases of pericardium

I32? Pericarditis in diseases classified elsewhere

I33 Acute and subacute endocarditis

I34 Nonrheumatic mitral valve disorders

I35 Nonrheumatic aortic valve disorders

I36 Nonrheumatic tricuspid valve disorders

I37 Pulmonary valve disorders

I38 Endocarditis, valve unspecified

I39? Endocarditis and heart valve disorders in diseases classified elsewhere I40 Acute myocarditis

I41? Myocarditis in diseases classified elsewhere

I42 Cardiomyopathy

I43? Cardiomyopathy in diseases classified elsewhere

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 Complications and ill-defined descriptions of heart disease

I52? Other heart disorders in diseases classified elsewhere

Cerebrovascular diseases (I60-I69)

I60 Subarachnoid haemorrhage

I61 Intracerebral haemorrhage

I62 Other nontraumatic intracranial haemorrhage

I63 Cerebral infarction

I64 Stroke, not specified as haemorrhage or infarction

I65 Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction

I66 Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction

I67 Other cerebrovascular diseases

I68? Cerebrovascular disorders in diseases classified elsewhere I69 Sequelae of cerebrovascular disease

Diseases of arteries, arterioles and capillaries (I70-I79)

I70 Atherosclerosis

I71 Aortic aneurysm and dissection

I72 Other aneurysm

I73 Other peripheral vascular diseases

I74 Arterial embolism and thrombosis

I77 Other disorders of arteries and arterioles

I78 Diseases of capillaries

I79? Disorders of arteries, arterioles and capillaries in diseases classified elsewhere

Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89)

I80 Phlebitis and thrombophlebitis

I81 Portal vein thrombosis

I82 Other venous embolism and thrombosis

I83 Varicose veins of lower extremities

I84 Haemorrhoids

I85 Oesophageal varices

I86 Varicose veins of other sites

I87 Other disorders of veins

I88 Nonspecific lymphadenitis

I89 Other noninfective disorders of lymphatic vessels and lymph nodes

Other and unspecified disorders of the circulatory system (I95-I99)

I95 Hypotension

I97 Postprocedural disorders of circulatory system, not elsewhere classified

I98 Other disorders of circulatory system in diseases classified elsewhere

I99 Other and unspecified disorders of circulatory system

Chapter X

Diseases of the respiratory system (J00-J99)

Acute upper respiratory infections (J00-J06)

J00 Acute nasopharyngitis [common cold]

J01 Acute sinusitis

J02 Acute pharyngitis

J03 Acute tonsillitis

J04 Acute laryngitis and tracheitis

J05 Acute obstructive laryngitis [croup] and epiglottitis

J06 Acute upper respiratory infections of multiple and unspecified sites

Influenza and pneumonia (J10-J18)

J10 Influenza due to identified influenza virus

J11 Influenza, virus not identified

J12 Viral pneumonia, not elsewhere classified

J13 Pneumonia due to Streptococcus pneumoniae

J14 Pneumonia due to Haemophilus influenzae

J15 Bacterial pneumonia, not elsewhere classified

J16 Pneumonia due to other infectious organisms, not elsewhere classified

J17? Pneumonia in diseases classified elsewhere

J18 Pneumonia, organism unspecified

Other acute lower respiratory infections (J20-J22)

J20 Acute bronchitis

J21 Acute bronchiolitis

J22 Unspecified acute lower respiratory infection

Other diseases of upper respiratory tract (J30-J39)

J30 Vasomotor and allergic rhinitis

J31 Chronic rhinitis, nasopharyngitis and pharyngitis

J32 Chronic sinusitis

J33 Nasal polyp

J34 Other disorders of nose and nasal sinuses

J35 Chronic diseases of tonsils and adenoids

J36 Peritonsillar abscess

J37 Chronic laryngitis and laryngotracheitis

J38 Diseases of vocal cords and larynx, not elsewhere classified

J39 Other diseases of upper respiratory tract

Chronic lower respiratory diseases (J40-J47)

J40 Bronchitis, not specified as acute or chronic

J41 Simple and mucopurulent chronic bronchitis

J42 Unspecified chronic bronchitis

J43 Emphysema

J44 Other chronic obstructive pulmonary disease

J45 Asthma

J46 Status asthmaticus

J47 Bronchiectasis

Lung diseases due to external agents (J60-J70)

J60 Coalworker’s pneumoconiosis

J61 Pneumoconiosis due to asbestos and other mineral fibres

J62 Pneumoconiosis due to dust containing silica

J63 Pneumoconiosis due to other inorganic dusts

J64 Unspecified pneumoconiosis

J65 Pneumoconiosis associated with tuberculosis

J66 Airway disease due to specific organic dust

J67 Hypersensitivity pneumonitis due to organic dust

J68 Respiratory conditions due to inhalation of chemicals, gases, fumes and vapours

J69 Pneumonitis due to solids and liquids

J70 Respiratory conditions due to other external agents

Other respiratory diseases principally affecting the interstitium (J80-J84)

J80 Adult respiratory distress syndrome

J81 Pulmonary oedema

J82 Pulmonary eosinophilia, not elsewhere classified

J84 Other interstitial pulmonary diseases

Suppurative and necrotic conditions of lower respiratory tract (J85-J86)

J85 Abscess of lung and mediastinum

J86 Pyothorax

Other diseases of pleura (J90-J94)

J90 Pleural effusion, not elsewhere classified

J91? Pleural effusion in conditions classified elsewhere

J92 Pleural plaque

J93 Pneumothorax

J94 Other pleural conditions

Other diseases of the respiratory system (J95-J99)

J95 J96 J98 J99?

Postprocedural respiratory disorders, not elsewhere classified Respiratory failure, not elsewhere classified

Other respiratory disorders

Respiratory disorders in diseases classified elsewhere

Chapter XI

Diseases of the digestive system (K00-K93)

Diseases of oral cavity, salivary glands and jaws (K00-K14)

K00 Disorders of tooth development and eruption

K01 Embedded and impacted teeth

K02 Dental caries

K03 Other diseases of hard tissues of teeth

K04 Diseases of pulp and periapical tissues

K05 Gingivitis and periodontal diseases

K06 Other disorders of gingiva and edentulous alveolar ridge

K07 Dentofacial anomalies [including malocclusion]

K08 Other disorders of teeth and supporting structures

K09 Cysts of oral region, not elsewhere classified

K10 Other diseases of jaws

K11 Diseases of salivary glands

K12 Stomatitis and related lesions

K13 Other diseases of lip and oral mucosa

K14 Diseases of tongue

Diseases of oesophagus, stomach and duodenum (K20-K31)

K20 Oesophagitis

K21 Gastro-oesophageal reflux disease

K22 Other diseases of oesophagus

K23? Disorders of oesophagus in diseases classified elsewhere

K25 Gastric ulcer

K26 Duodenal ulcer

K27 Peptic ulcer, site unspecified

K28 Gastrojejunal ulcer

K29 Gastritis and duodenitis

K30 Dyspepsia

K31 Other diseases of stomach and duodenum

Diseases of appendix (K35-K38)

K35 Acute appendicitis

K36 Other appendicitis

K37 Unspecified appendicitis

K38 Other diseases of appendix

Hernia (K40-K46)

K40 Inguinal hernia

K41 Femoral hernia

K42 Umbilical hernia

K43 Ventral hernia

K44 Diaphragmatic hernia

K45 Other abdominal hernia

K46 Unspecified abdominal hernia

Noninfective enteritis and colitis (K50-K52)

K50 Crohn’s disease [regional enteritis]

K51 Ulcerative colitis

K52 Other noninfective gastroenteritis and colitis

Other diseases of intestines (K55-K63)

K55 Vascular disorders of intestine

K56 Paralytic ileus and intestinal obstruction without hernia

K57 Diverticular disease of intestine

K58 Irritable bowel syndrome

K59 Other functional intestinal disorders

K60 Fissure and fistula of anal and rectal regions

K61 Abscess of anal and rectal regions

K62 Other diseases of anus and rectum

K63 Other diseases of intestine

Diseases of peritoneum (K65-K67)

K65 Peritonitis

K66 Other disorders of peritoneum

K67? Disorders of peritoneum in infectious diseases classified elsewhere

Diseases of liver (K70-K77)

K70 Alcoholic liver disease

K71 Toxic liver disease

K72 Hepatic failure, not elsewhere classified

K73 Chronic hepatitis, not elsewhere classified

K74 Fibrosis and cirrhosis of liver

K75 Other inflammatory liver diseases

K76 Other diseases of liver

K77? Liver disorders in diseases classified elsewhere

Disorders of gallbladder, biliary tract and pancreas (K80-K87)

K80 Cholelithiasis

K81 Cholecystitis

K82 Other diseases of gallbladder

K83 Other diseases of biliary tract

K85 Acute pancreatitis

K86 Other diseases of pancreas

K87? Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere

Other diseases of the digestive system (K90-K93)

K90 Intestinal malabsorption

K91 Postprocedural disorders of digestive system, not elsewhere classified

K92 Other diseases of digestive system

K93? Disorders of other digestive organs in diseases classified elsewhere

Chapter XII

Diseases of the skin and subcutaneous tissue (L00-L99)

Infections of the skin and subcutaneous tissue (L00-L08)

L00 Staphylococcal scalded skin syndrome

L01 Impetigo

L02 Cutaneous abscess, furuncle and carbuncle

L03 Cellulitis

L04 Acute lymphadenitis

L05 Pilonidal cyst

L08 Other local infections of skin and subcutaneous tissue

Bullous disorders (L10-L14)

L10 Pemphigus

L11 Other acantholytic disorders

L12 Pemphigoid

L13 Other bullous disorders

L14? Bullous disorders in diseases classified elsewhere

Dermatitis and eczema (L20-L30)

L20 Atopic dermatitis

L21 Seborrhoeic dermatitis

L22 Diaper [napkin] dermatitis

L23 Allergic contact dermatitis

L24 Irritant contact dermatitis

L25 Unspecified contact dermatitis

L26 Exfoliative dermatitis

L27 Dermatitis due to substances taken internally

L28 Lichen simplex chronicus and prurigo

L29 Pruritus

L30 Other dermatitis

Papulosquamous disorders (L40-L45)

L40 Psoriasis

L41 Parapsoriasis

L42 Pityriasis rosea

L43 Lichen planus

L44 Other papulosquamous disorders

L45? Papulosquamous disorders in diseases classified elsewhere

Urticaria and erythema (L50-L54)

L50 Urticaria

L51 Erythema multiforme

L52 Erythema nodosum

L53 Other erythematous conditions

L54? Erythema in diseases classified elsewhere

Radiation-related disorders of the skin and subcutaneous tissue (L55-L59)

L55 Sunburn

L56 Other acute skin changes due to ultraviolet radiation

L57 Skin changes due to chronic exposure to nonionizing radiation

L58 Radiodermatitis

L59 Other disorders of skin and subcutaneous tissue related to radiation

Disorders of skin appendages (L60-L75)

L60 Nail disorders

L62? Nail disorders in diseases classified elsewhere

L63 Alopecia areata

L64 Androgenic alopecia

L65 Other nonscarring hair loss

L66 Cicatricial alopecia [scarring hair loss]

L67 Hair colour and hair shaft abnormalities

L68 Hypertrichosis

L70 Acne

L71 Rosacea

L72 Follicular cysts of skin and subcutaneous tissue

L73 Other follicular disorders

L74 Eccrine sweat disorders

L75 Apocrine sweat disorders

Other disorders of the skin and subcutaneous tissue (L80-L99)

L80 Vitiligo

L81 Other disorders of pigmentation

L82 Seborrhoeic keratosis

L83 Acanthosis nigricans

L84 Corns and callosities

L85 Other epidermal thickening

L86? Keratoderma in diseases classified elsewhere

L87 Transepidermal elimination disorders

L88 Pyoderma gangrenosum

L89 Decubitus ulcer

L90 Atrophic disorders of skin

L91 Hypertrophic disorders of skin

L92 Granulomatous disorders of skin and subcutaneous tissue

L93 Lupus erythematosus

L94 Other localized connective tissue disorders

L95 Vasculitis limited to skin, not elsewhere classified

L97 Ulcer of lower limb, not elsewhere classified

L98 Other disorders of skin and subcutaneous tissue, not elsewhere classified

L99? Other disorders of skin and subcutaneous tissue in diseases classified elsewhere

Chapter XIII

Diseases of the musculoskeletal system and connective tissue (M00-M99)

Arthropathies (M00-?M25) Infectious arthropathies (M00-M03)

M00 Pyogenic arthritis

M01? Direct infections of joint in infectious and parasitic diseases classified elsewhere M02 Reactive arthropathies

M03? Postinfective and reactive arthropathies in diseases classified elsewhere

Inflammatory polyarthropathies (M05-M14)

M05 Seropositive rheumatoid arthritis

M06 Other rheumatoid arthritis

M07? Psoriatic and enteropathic arthropathies

M08 Juvenile arthritis

M09? Juvenile arthritis in diseases classified elsewhere

M10 Gout

M11 Other crystal arthropathies

M12 Other specific arthropathies

M13 Other arthritis

M14? Arthropathies in other diseases classified elsewhere

Arthrosis (M15-M19)

M15 Polyarthrosis

M16 Coxarthrosis [arthrosis of hip]

M17 Gonarthrosis [arthrosis of knee]

M18 Arthrosis of first carpometacarpal joint

M19 Other arthrosis

Other joint disorders (M20-M25)

M20 Acquired deformities of fingers and toes

M21 Other acquired deformities of limbs

M22 Disorders of patella

M23 Internal derangement of knee

M24 Other specific joint derangements

M25 Other joint disorders, not elsewhere classified

Systemic connective tissue disorders (M30-M36)

M30 Polyarteritis nodosa and related conditions

M31 Other necrotizing vasculopathies

M32 Systemic lupus erythematosus

M33 Dermatopolymyositis

M34 Systemic sclerosis

M35 Other systemic involvement of connective tissue

M36? Systemic disorders of connective tissue in diseases classified elsewhere

Dorsopathies (M40-M54)

Deforming dorsopathies (M40-M43)

M40 Kyphosis and lordosis

M41 Scoliosis

M42 Spinal osteochondrosis

M43 Other deforming dorsopathies

Spondylopathies (M45-M49)

M45 Ankylosing spondylitis

M46 Other inflammatory spondylopathies

M47 Spondylosis

M48 Other spondylopathies

M49? Spondylopathies in diseases classified elsewhere

Other dorsopathies (M50-M54)

M50 Cervical disc disorders

M51 Other intervertebral disc disorders

M53 Other dorsopathies, not elsewhere classified

M54 Dorsalgia

Soft tissue disorders (M60-M79)

Disorders of muscles (M60-M63)

M60 Myositis

M61 Calcification and ossification of muscle

M62 Other disorders of muscle

M63? Disorders of muscle in diseases classified elsewhere

Disorders of synovium and tendon (M65-M68)

M65 Synovitis and tenosynovitis

M66 Spontaneous rupture of synovium and tendon

M67 Other disorders of synovium and tendon

M68? Disorders of synovium and tendon in diseases classified elsewhere

Other soft tissue disorders (M70-M79)

M70 Soft tissue disorders related to use, overuse and pressure

M71 Other bursopathies

M72 Fibroblastic disorders

M73? Soft tissue disorders in diseases classified elsewhere

M75 Shoulder lesions

M76 Enthesopathies of lower limb, excluding foot

M77 Other enthesopathies

M79 Other soft tissue disorders, not elsewhere classified

Osteopathies and chondropathies (M80-M94)

Disorders of bone density and structure (M80-M85)

M80 Osteoporosis with pathological fracture

M81 Osteoporosis without pathological fracture

M82? Osteoporosis in diseases classified elsewhere M83 Adult osteomalacia

M84 Disorders of continuity of bone

M85 Other disorders of bone density and structure

Other osteopathies (M86-M90)

M86 Osteomyelitis

M87 Osteonecrosis

M88 Paget’s disease of bone [osteitis deformans]

M89 Other disorders of bone

M90? Osteopathies in diseases classified elsewhere

Chondropathies (M91-M94)

M91 Juvenile osteochondrosis of hip and pelvis

M92 Other juvenile osteochondrosis

M93 Other osteochondropathies

M94 Other disorders of cartilage

Other disorders of the musculoskeletal system and connective tissue (M95-M99)

M95 Other acquired deformities of musculoskeletal system and connective tissue

M96 Postprocedural musculoskeletal disorders, not elsewhere classified

M99 Biomechanical lesions, not elsewhere classified

Chapter XIV

Diseases of the genitourinary system (N00-N99)

Glomerular diseases (N00-N08)

N00 Acute nephritic syndrome

N01 Rapidly progressive nephritic syndrome

N02 Recurrent and persistent haematuria

N03 Chronic nephritic syndrome

N04 Nephrotic syndrome

N05 Unspecified nephritic syndrome

N06 Isolated proteinuria with specified morphological lesion

N07 Hereditary nephropathy, not elsewhere classified

N08? Glomerular disorders in diseases classified elsewhere

Renal tubulo-interstitial diseases (N10-N16)

N10 Acute tubulo-interstitial nephritis

N11 Chronic tubulo-interstitial nephritis

N12 Tubulo-interstitial nephritis, not specified as acute or chronic

N13 Obstructive and reflux uropathy

N14 Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions

N15 Other renal tubulo-interstitial diseases

N16? Renal tubulo-interstitial disorders in diseases classified elsewhere

Renal failure (N17-N19)

N17 Acute renal failure

N18 Chronic renal failure

N19 Unspecified renal failure

Urolithiasis (N20-N23)

N20 Calculus of kidney and ureter

N21 Calculus of lower urinary tract

N22? Calculus of urinary tract in diseases classified elsewhere N23 Unspecified renal colic

Other disorders of kidney and ureter (N25-N29)

N25 Disorders resulting from impaired renal tubular function

N26 Unspecified contracted kidney

N27 Small kidney of unknown cause

N28 Other disorders of kidney and ureter, not elsewhere classified

N29? Other disorders of kidney and ureter in diseases classified elsewhere

Other diseases of urinary system (N30-N39)

N30 Cystitis

N31 Neuromuscular dysfunction of bladder, not elsewhere classified

N32 Other disorders of bladder

N33? Bladder disorders in diseases classified elsewhere

N34 Urethritis and urethral syndrome

N35 Urethral stricture

N36 Other disorders of urethra

N37? Urethral disorders in diseases classified elsewhere N39 Other disorders of urinary system

Diseases of male genital organs (N40-N51)

N40 Hyperplasia of prostate

N41 Inflammatory diseases of prostate

N42 Other disorders of prostate

N43 Hydrocele and spermatocele

N44 Torsion of testis

N45 Orchitis and epididymitis

N46 Male infertility

N47 Redundant prepuce, phimosis and paraphimosis

N48 Other disorders of penis

N49 Inflammatory disorders of male genital organs, not elsewhere classified

N50 Other disorders of male genital organs

N51? Disorders of male genital organs in diseases classified elsewhere

Disorders of breast (N60-N64)

N60 Benign mammary dysplasia

N61 Inflammatory disorders of breast

N62 Hypertrophy of breast

N63 Unspecified lump in breast

N64 Other disorders of breast

Inflammatory diseases of female pelvic organs (N70-N77)

N70 Salpingitis and oophoritis

N71 Inflammatory disease of uterus, except cervix

N72 Inflammatory disease of cervix uteri

N73 Other female pelvic inflammatory diseases

N74? Female pelvic inflammatory disorders in diseases classified elsewhere

N75 Diseases of Bartholin’s gland

N76 Other inflammation of vagina and vulva

N77? Vulvovaginal ulceration and inflammation in diseases classified elsewhere

Noninflammatory disorders of female genital tract (N80-N98)

N80 Endometriosis

N81 Female genital prolapse

N82 Fistulae involving female genital tract

N83 Noninflammatory disorders of ovary, fallopian tube and broad ligament

N84 Polyp of female genital tract

N85 Other noninflammatory disorders of uterus, except cervix

N86 Erosion and ectropion of cervix uteri

N87 Dysplasia of cervix uteri

N88 Other noninflammatory disorders of cervix uteri

N89 Other noninflammatory disorders of vagina

N90 Other noninflammatory disorders of vulva and perineum

N91 Absent, scanty and rare menstruation

N92 Excessive, frequent and irregular menstruation

N93 Other abnormal uterine and vaginal bleeding

N94 Pain and other conditions associated with female genital organs and menstrual cycle

N95 Menopausal and other perimenopausal disorders

N96 Habitual aborter

N97 Female infertility

N98 Complications associated with artificial fertilization

Other disorders of the genitourinary system (N99)

N99 Postprocedural disorders of genitourinary system, not elsewhere classified

Chapter XV

Pregnancy, childbirth and the puerperium (O00-O99)

Pregnancy with abortive outcome (O00-O08)

O00 Ectopic pregnancy

O01 Hydatidiform mole

O02 Other abnormal products of conception

O03 Spontaneous abortion

O04 Medical abortion

O05 Other abortion

O06 Unspecified abortion

O07 Failed attempted abortion

O08 Complications following abortion and ectopic and molar pregnancy

Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium (O10-O16)

O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium

O11 Pre-existing hypertensive disorder with superimposed proteinuria

O12 Gestational [pregnancy-induced] oedema and proteinuria without hypertension

O13 Gestational [pregnancy-induced] hypertension without significant proteinuria

O14 Gestational [pregnancy-induced] hypertension with significant proteinuria

O15 Eclampsia

O16 Unspecified maternal hypertension

Other maternal disorders predominantly related to pregnancy (O20-O29)

O20 Haemorrhage in early pregnancy

O21 Excessive vomiting in pregnancy

O22 Venous complications in pregnancy

O23 Infections of genitourinary tract in pregnancy

O24 Diabetes mellitus in pregnancy

O25 Malnutrition in pregnancy

O26 Maternal care for other conditions predominantly related to pregnancy

O28 Abnormal findings on antenatal screening of mother

O29 Complications of anaesthesia during pregnancy

Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)

O30 Multiple gestation

O31 Complications specific to multiple gestation

O32 Maternal care for known or suspected malpresentation of fetus

O33 Maternal care for known or suspected disproportion

O34 Maternal care for known or suspected abnormality of pelvic organs

O35 Maternal care for known or suspected fetal abnormality and damage

O36 Maternal care for other known or suspected fetal problems

O40 Polyhydramnios

O41 Other disorders of amniotic fluid and membranes

O42 Premature rupture of membranes

O43 Placental disorders

O44 Placenta praevia

O45 Premature separation of placenta [abruptio placentae]

O46 Antepartum haemorrhage, not elsewhere classified

O47 False labour

O48 Prolonged pregnancy

Complications of labour and delivery (O60-O75)

O60 Preterm delivery

O61 Failed induction of labour

O62 Abnormalities of forces of labour

O63 Long labour

O64 Obstructed labour due to malposition and malpresentation of fetus

O65 Obstructed labour due to maternal pelvic abnormality

O66 Other obstructed labour

O67 Labour and delivery complicated by intrapartum haemorrhage, not elsewhere classified

O68 Labour and delivery complicated by fetal stress [distress]

O69 Labour and delivery complicated by umbilical cord complications

O70 Perineal laceration during delivery

O71 Other obstetric trauma

O72 Postpartum haemorrhage

O73 Retained placenta and membranes, without haemorrhage

O74 Complications of anaesthesia during labour and delivery

O75 Other complications of labour and delivery, not elsewhere classified

Delivery (O80-O84)

O80 Single spontaneous delivery

O81 Single delivery by forceps and vacuum extractor

O82 Single delivery by caesarean section

O83 Other assisted single delivery

O84 Multiple delivery

Complications predominantly related to the puerperium (O85-O92)

O85 Puerperal sepsis

O86 Other puerperal infections

O87 Venous complications in the puerperium

O88 Obstetric embolism

O89 Complications of anaesthesia during the puerperium

O90 Complications of the puerperium, not elsewhere classified

O91 Infections of breast associated with childbirth

O92 Other disorders of breast and lactation associated with childbirth

Other obstetric conditions, not elsewhere classified (O95-O99)

O95 Obstetric death of unspecified cause

O96 Death from any obstetric cause occurring more than 42 days but less than one year after

delivery

O97 Death from sequelae of direct obstetric causes

O98 Maternal infectious and parasitic diseases classifiable elsewhere but complicating

pregnancy, childbirth and the puerperium

O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and

the puerperium

Chapter XVI

Certain conditions originating in the perinatal period (P00-P96)

Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery (P00-P04)

P00 Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy

P01 Fetus and newborn affected by maternal complications of pregnancy

P02 Fetus and newborn affected by complications of placenta, cord and membranes

P03 Fetus and newborn affected by other complications of labour and delivery

P04 Fetus and newborn affected by noxious influences transmitted via placenta or breast milk

Disorders related to length of gestation and fetal growth (P05-P08)

P05 Slow fetal growth and fetal malnutrition

P07 Disorders related to short gestation and low birth weight, not elsewhere classified

P08 Disorders related to long gestation and high birth weight

Birth trauma (P10-P15)

P10 Intracranial laceration and haemorrhage due to birth injury

P11 Other birth injuries to central nervous system

P12 Birth injury to scalp

P13 Birth injury to skeleton

P14 Birth injury to peripheral nervous system

P15 Other birth injuries

Respiratory and cardiovascular disorders specific to the perinatal period (P20-P29)

P20 Intrauterine hypoxia

P21 Birth asphyxia

P22 Respiratory distress of newborn

P23 Congenital pneumonia

P24 Neonatal aspiration syndromes

P25 Interstitial emphysema and related conditions originating in the perinatal period

P26 Pulmonary haemorrhage originating in the perinatal period

P27 Chronic respiratory disease originating in the perinatal period

P28 Other respiratory conditions originating in the perinatal period

P29 Cardiovascular disorders originating in the perinatal period

Infections specific to the perinatal period (P35-P39)

P35 Congenital viral diseases

P36 Bacterial sepsis of newborn

P37 Other congenital infectious and parasitic diseases

P38 Omphalitis of newborn with or without mild haemorrhage

P39 Other infections specific to the perinatal period

Haemorrhagic and haematological disorders of fetus and newborn (P50-P61)

P50 Fetal blood loss

P51 Umbilical haemorrhage of newborn

P52 Intracranial nontraumatic haemorrhage of fetus and newborn

P53 Haemorrhagic disease of fetus and newborn

P54 Other neonatal haemorrhages

P55 Haemolytic disease of fetus and newborn

P56 Hydrops fetalis due to haemolytic disease

P57 Kernicterus

P58 Neonatal jaundice due to other excessive haemolysis

P59 Neonatal jaundice from other and unspecified causes

P60 Disseminated intravascular coagulation of fetus and newborn

P61 Other perinatal haematological disorders

Transitory endocrine and metabolic disorders specific to fetus and newborn (P70-P74)

P70 Transitory disorders of carbohydrate metabolism specific to fetus and newborn

P71 Transitory neonatal disorders of calcium and magnesium metabolism

P72 Other transitory neonatal endocrine disorders

P74 Other transitory neonatal electrolyte and metabolic disturbances

Digestive system disorders of fetus and newborn (P75-P78)

P75? Meconium ileus

P76 Other intestinal obstruction of newborn

P77 Necrotizing enterocolitis of fetus and newborn

P78 Other perinatal digestive system disorders

Conditions involving the integument and temperature regulation of fetus and newborn (P80-P83)

P80 Hypothermia of newborn

P81 Other disturbances of temperature regulation of newborn

P83 Other conditions of integument specific to fetus and newborn

Other disorders originating in the perinatal period (P90-P96)

P90 Convulsions of newborn

P91 Other disturbances of cerebral status of newborn

P92 Feeding problems of newborn

P93 Reactions and intoxications due to drugs administered to fetus and newborn

P94 Disorders of muscle tone of newborn

P95 Fetal death of unspecified cause

P96 Other conditions originating in the perinatal period

Chapter XVII

Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

Congenital malformations of the nervous system (Q00-Q07)

Q00 Anencephaly and similar malformations

Q01 Encephalocele

Q02 Microcephaly

Q03 Congenital hydrocephalus

Q04 Other congenital malformations of brain

Q05 Spina bifida

Q06 Other congenital malformations of spinal cord

Q07 Other congenital malformations of nervous system

Congenital malformations of eye, ear, face and neck (Q10-Q18)

Q10 Congenital malformations of eyelid, lacrimal apparatus and orbit

Q11 Anophthalmos, microphthalmos and macrophthalmos

Q12 Congenital lens malformations

Q13 Congenital malformations of anterior segment of eye

Q14 Congenital malformations of posterior segment of eye

Q15 Other congenital malformations of eye

Q16 Congenital malformations of ear causing impairment of hearing

Q17 Other congenital malformations of ear

Q18 Other congenital malformations of face and neck

Congenital malformations of the circulatory system (Q20-Q28)

Q20 Congenital malformations of cardiac chambers and connections

Q21 Congenital malformations of cardiac septa

Q22 Congenital malformations of pulmonary and tricuspid valves

Q23 Congenital malformations of aortic and mitral valves

Q24 Other congenital malformations of heart

Q25 Congenital malformations of great arteries

Q26 Congenital malformations of great veins

Q27 Other congenital malformations of peripheral vascular system

Q28 Other congenital malformations of circulatory system

Congenital malformations of the respiratory system (Q30-Q34)

Q30 Congenital malformations of nose

Q31 Congenital malformations of larynx

Q32 Congenital malformations of trachea and bronchus

Q33 Congenital malformations of lung

Q34 Other congenital malformations of respiratory system

Cleft lip and cleft palate (Q35-Q37)

Q35 Cleft palate

Q36 Cleft lip

Q37 Cleft palate with cleft lip

Other congenital malformations of the digestive system (Q38-Q45)

Q38 Other congenital malformations of tongue, mouth and pharynx

Q39 Congenital malformations of oesophagus

Q40 Other congenital malformations of upper alimentary tract

Q41 Congenital absence, atresia and stenosis of small intestine

Q42 Congenital absence, atresia and stenosis of large intestine

Q43 Other congenital malformations of intestine

Q44 Congenital malformations of gallbladder, bile ducts and liver

Q45 Other congenital malformations of digestive system

Congenital malformations of genital organs (Q50-Q56)

Q50 Congenital malformations of ovaries, fallopian tubes and broad ligaments

Q51 Congenital malformations of uterus and cervix

Q52 Other congenital malformations of female genitalia

Q53 Undescended testicle

Q54 Hypospadias

Q55 Other congenital malformations of male genital organs

Q56 Indeterminate sex and pseudohermaphroditism

Congenital malformations of the urinary system (Q60-Q64)

Q60 Renal agenesis and other reduction defects of kidney

Q61 Cystic kidney disease

Q62 Congenital obstructive defects of renal pelvis and congenital malformations of ureter

Q63 Other congenital malformations of kidney

Q64 Other congenital malformations of urinary system

Congenital malformations and deformations of the musculoskeletal system (Q65-Q79)

Q65 Congenital deformities of hip

Q66 Congenital deformities of feet

Q67 Congenital musculoskeletal deformities of head, face, spine and chest

Q68 Other congenital musculoskeletal deformities

Q69 Polydactyly

Q70 Syndactyly

Q71 Reduction defects of upper limb

Q72 Reduction defects of lower limb

Q73 Reduction defects of unspecified limb

Q74 Other congenital malformations of limb(s)

Q75 Other congenital malformations of skull and face bones

Q76 Congenital malformations of spine and bony thorax

Q77 Osteochondrodysplasia with defects of growth of tubular bones and spine

Q78 Other osteochondrodysplasias

Q79 Congenital malformations of the musculoskeletal system, not elsewhere classified

Other congenital malformations (Q80-Q89)

Q80 Congenital ichthyosis

Q81 Epidermolysis bullosa

Q82 Other congenital malformations of skin

Q83 Congenital malformations of breast

Q84 Other congenital malformations of integument

Q85 Phakomatoses, not elsewhere classified

Q86 Congenital malformation syndromes due to known exogenous causes, not elsewhere

classified

Q87 Other specified congenital malformation syndromes affecting multiple systems

Q89 Other congenital malformations, not elsewhere classified

Chromosomal abnormalities, not elsewhere classified (Q90-Q99)

Q90 Down’s syndrome

Q91 Edwards’ syndrome and Patau’s syndrome

Q92 Other trisomies and partial trisomies of the autosomes, not elsewhere classified

Q93 Monosomies and deletions from the autosomes, not elsewhere classified

Q95 Balanced rearrangements and structural markers, not elsewhere classified

Q96 Turner’s syndrome

Q97 Other sex chromosome abnormalities, female phenotype, not elsewhere classified

Q98 Other sex chromosome abnormalities, male phenotype, not elsewhere classified

Q99 Other chromosome abnormalities, not elsewhere classified

Chapter XVIII

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Symptoms and signs involving the circulatory and respiratory systems (R00-R09)

R00 Abnormalities of heart beat

R01 Cardiac murmurs and other cardiac sounds

R02 Gangrene, not elsewhere classified

R03 Abnormal blood-pressure reading, without diagnosis

R04 Haemorrhage from respiratory passages

R05 Cough

R06 Abnormalities of breathing

R07 Pain in throat and chest

R09 Other symptoms and signs involving the circulatory and respiratory systems

Symptoms and signs involving the digestive system and abdomen (R10-R19)

R10 Abdominal and pelvic pain

R11 Nausea and vomiting

R12 Heartburn

R13 Dysphagia

R14 Flatulence and related conditions

R15 Faecal incontinence

R16 Hepatomegaly and splenomegaly, not elsewhere classified

R17 Unspecified jaundice

R18 Ascites

R19 Other symptoms and signs involving the digestive system and abdomen

Symptoms and signs involving the skin and subcutaneous tissue (R20-R23)

R20 Disturbances of skin sensation

R21 Rash and other nonspecific skin eruption

R22 Localized swelling, mass and lump of skin and subcutaneous tissue

R23 Other skin changes

Symptoms and signs involving the nervous and musculoskeletal systems (R25-R29)

R25 Abnormal involuntary movements

R26 Abnormalities of gait and mobility

R27 Other lack of coordination

R29 Other symptoms and signs involving the nervous and musculoskeletal systems

Symptoms and signs involving the urinary system (R30-R39)

R30 Pain associated with micturition

R31 Unspecified haematuria

R32 Unspecified urinary incontinence

R33 Retention of urine

R34 Anuria and oliguria

R35 Polyuria

R36 Urethral discharge

R39 Other symptoms and signs involving the urinary system

Symptoms and signs involving cognition, perception, emotional state and behaviour (R40-R46)

R40 Somnolence, stupor and coma

R41 Other symptoms and signs involving cognitive functions and awareness

R42 Dizziness and giddiness

R43 Disturbances of smell and taste

R44 Other symptoms and signs involving general sensations and perceptions

R45 Symptoms and signs involving emotional state

R46 Symptoms and signs involving appearance and behaviour

Symptoms and signs involving speech and voice (R47-R49)

R47 Speech disturbances, not elsewhere classified

R48 Dyslexia and other symbolic dysfunctions, not elsewhere classified

R49 Voice disturbances

General symptoms and signs (R50-R69)

R50 Fever of unknown origin

R51 Headache

R52 Pain, not elsewhere classified

R53 Malaise and fatigue

R54 Senility

R55 Syncope and collapse

R56 Convulsions, not elsewhere classified

R57 Shock, not elsewhere classified

R58 Haemorrhage, not elsewhere classified

R59 Enlarged lymph nodes

R60 Oedema, not elsewhere classified

R61 Hyperhidrosis

R62 Lack of expected normal physiological development

R63 Symptoms and signs concerning food and fluid intake

R64 Cachexia

R68 Other general symptoms and signs

R69 Unknown and unspecified causes of morbidity

Abnormal findings on examination of blood, without diagnosis (R70-R79)

R70 Elevated erythrocyte sedimentation rate and abnormality of plasma viscosity

R71 Abnormality of red blood cells

R72 Abnormality of white blood cells, not elsewhere classified

R73 Elevated blood glucose level

R74 Abnormal serum enzyme levels

R75 Laboratory evidence of human immunodeficiency virus [HIV]

R76 Other abnormal immunological findings in serum

R77 Other abnormalities of plasma proteins

R78 Findings of drugs and other substances, not normally found in blood

R79 Other abnormal findings of blood chemistry

Abnormal findings on examination of urine, without diagnosis (R80-R82)

R80 Isolated proteinuria

R81 Glycosuria

R82 Other abnormal findings in urine

Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89)

R83 Abnormal findings in cerebrospinal fluid

R84 Abnormal findings in specimens from respiratory organs and thorax

R85 Abnormal findings in specimens from digestive organs and abdominal cavity

R86 Abnormal findings in specimens from male genital organs

R87 Abnormal findings in specimens from female genital organs

R89 Abnormal findings in specimens from other organs, systems and tissues

Abnormal findings on diagnostic imaging and in function studies, without diagnosis (R90-R94)

R90 Abnormal findings on diagnostic imaging of central nervous system

R91 Abnormal findings on diagnostic imaging of lung

R92 Abnormal findings on diagnostic imaging of breast

R93 Abnormal findings on diagnostic imaging of other body structures

R94 Abnormal results of function studies

Ill-defined and unknown causes of mortality (R95-R99)

R95 Sudden infant death syndrome

R96 Other sudden death, cause unknown

R98 Unattended death

R99 Other ill-defined and unspecified causes of mortality

Chapter XIX

Injury, poisoning and certain other consequences of external causes (S00-T98)

Injuries to the head (S00-S09)

S00 Superficial injury of head

S01 Open wound of head

S02 Fracture of skull and facial bones

S03 Dislocation, sprain and strain of joints and ligaments of head

S04 Injury of cranial nerves

S05 Injury of eye and orbit

S06 Intracranial injury

S07 Crushing injury of head

S08 Traumatic amputation of part of head

S09 Other and unspecified injuries of head

Injuries to the neck (S10-S19)

S10 Superficial injury of neck

S11 Open wound of neck

S12 Fracture of neck

S13 Dislocation, sprain and strain of joints and ligaments at neck level

S14 Injury of nerves and spinal cord at neck level

S15 Injury of blood vessels at neck level

S16 Injury of muscle and tendon at neck level

S17 Crushing injury of neck

S18 Traumatic amputation at neck level

S19 Other and unspecified injuries of neck

Injuries to the thorax (S20-S29)

S20 Superficial injury of thorax

S21 Open wound of thorax

S22 Fracture of rib(s), sternum and thoracic spine

S23 Dislocation, sprain and strain of joints and ligaments of thorax

S24 Injury of nerves and spinal cord at thorax level

S25 Injury of blood vessels of thorax

S26 Injury of heart

S27 Injury of other and unspecified intrathoracic organs

S28 Crushing injury of thorax and traumatic amputation of part of thorax

S29 Other and unspecified injuries of thorax

Injuries to the abdomen, lower back, lumbar spine and pelvis (S30-S39)

S30 Superficial injury of abdomen, lower back and pelvis

S31 Open wound of abdomen, lower back and pelvis

S32 Fracture of lumbar spine and pelvis

S33 Dislocation, sprain and strain of joints and ligaments of lumbar spine and pelvis

S34 Injury of nerves and lumbar spinal cord at abdomen, lower back and pelvis level

S35 Injury of blood vessels at abdomen, lower back and pelvis level

S36 Injury of intra-abdominal organs

S37 Injury of urinary and pelvic organs

S38 Crushing injury and traumatic amputation of part of abdomen, lower back and pelvis

S39 Other and unspecified injuries of abdomen, lower back and pelvis

Injuries to the shoulder and upper arm (S40-S49)

S40 Superficial injury of shoulder and upper arm

S41 Open wound of shoulder and upper arm

S42 Fracture of shoulder and upper arm

S43 Dislocation, sprain and strain of joints and ligaments of shoulder girdle

S44 Injury of nerves at shoulder and upper arm level

S45 Injury of blood vessels at shoulder and upper arm level

S46 Injury of muscle and tendon at shoulder and upper arm level

S47 Crushing injury of shoulder and upper arm

S48 Traumatic amputation of shoulder and upper arm

S49 Other and unspecified injuries of shoulder and upper arm

Injuries to the elbow and forearm (S50-S59)

S50 Superficial injury of forearm

S51 Open wound of forearm

S52 Fracture of forearm

S53 Dislocation, sprain and strain of joints and ligaments of elbow

S54 Injury of nerves at forearm level

S55 Injury of blood vessels at forearm level

S56 Injury of muscle and tendon at forearm level

S57 Crushing injury of forearm

S58 Traumatic amputation of forearm

S59 Other and unspecified injuries of forearm

Injuries to the wrist and hand (S60-S69)

S60 Superficial injury of wrist and hand

S61 Open wound of wrist and hand

S62 Fracture at wrist and hand level

S63 Dislocation, sprain and strain of joints and ligaments at wrist and hand level

S64 Injury of nerves at wrist and hand level

S65 Injury of blood vessels at wrist and hand level

S66 Injury of muscle and tendon at wrist and hand level

S67 Crushing injury of wrist and hand

S68 Traumatic amputation of wrist and hand

S69 Other and unspecified injuries of wrist and hand

Injuries to the hip and thigh (S70-S79)

S70 Superficial injury of hip and thigh

S71 Open wound of hip and thigh

S72 Fracture of femur

S73 Dislocation, sprain and strain of joint and ligaments of hip

S74 Injury of nerves at hip and thigh level

S75 Injury of blood vessels at hip and thigh level

S76 Injury of muscle and tendon at hip and thigh level

S77 Crushing injury of hip and thigh

S78 Traumatic amputation of hip and thigh

S79 Other and specified injuries of hip and thigh

Injuries to the knee and lower leg (S80-S89)

S80 Superficial injury of lower leg

S81 Open wound of lower leg

S82 Fracture of lower leg, including ankle

S83 Dislocation, sprain and strain of joints and ligaments of knee

S84 Injury of nerves at lower leg level

S85 Injury of blood vessels at lower leg level

S86 Injury of muscle and tendon at lower leg level

S87 Crushing injury of lower leg

S88 Traumatic amputation of lower leg

S89 Other and unspecified injuries of lower leg

Injuries to the ankle and foot (S90-S99)

S90 Superficial injury of ankle and foot

S91 Open wound of ankle and foot

S92 Fracture of foot, except ankle

S93 Dislocation, sprain and strain of joints and ligaments at ankle and foot level

S94 Injury of nerves at ankle and foot level

S95 Injury of blood vessels at ankle and foot level

S96 Injury of muscle and tendon at ankle and foot level

S97 Crushing injury of ankle and foot

S98 Traumatic amputation of ankle and foot

S99 Other and unspecified injuries of ankle and foot

Injuries involving multiple body regions (T00-T07)

T00 Superficial injuries involving multiple body regions

T01 Open wounds involving multiple body regions

T02 Fractures involving multiple body regions

T03 Dislocations, sprains and strains involving multiple body regions

T04 Crushing injuries involving multiple body regions

T05 Traumatic amputations involving multiple body regions

T06 Other injuries involving multiple body regions, not elsewhere classified

T07 Unspecified multiple injuries

Injuries to unspecified part of trunk, limb or body region (T08-T14)

T08 Fracture of spine, level unspecified

T09 Other injuries of spine and trunk, level unspecified

T10 Fracture of upper limb, level unspecified

T11 Other injuries of upper limb, level unspecified

T12 Fracture of lower limb, level unspecified

T13 Other injuries of lower limb, level unspecified

T14 Injury of unspecified body region

Effects of foreign body entering through natural orifice (T15-T19)

T15 Foreign body on external eye

T16 Foreign body in ear

T17 Foreign body in respiratory tract

T18 Foreign body in alimentary tract

T19 Foreign body in genitourinary tract

Burns and corrosions (T20-T32)

Burns and corrosions of external body surface, specified by site (T20-T25)

T20 Burn and corrosion of head and neck

T21 Burn and corrosion of trunk

T22 Burn and corrosion of shoulder and upper limb, except wrist and hand

T23 Burn and corrosion of wrist and hand

T24 Burn and corrosion of hip and lower limb, except ankle and foot

T25 Burn and corrosion of ankle and foot

Burns and corrosions confined to eye and internal organs (T26-T28)

T26 Burn and corrosion confined to eye and adnexa

T27 Burn and corrosion of respiratory tract

T28 Burn and corrosion of other internal organs

Burns and corrosions of multiple and unspecified body regions (T29-T32)

T29 Burns and corrosions of multiple body regions

T30 Burn and corrosion, body region unspecified

T31 Burns classified according to extent of body surface involved

T32 Corrosions classified according to extent of body surface involved

Frostbite (T33-T35)

T33 Superficial frostbite

T34 Frostbite with tissue necrosis

T35 Frostbite involving multiple body regions and unspecified frostbite

Poisoning by drugs, medicaments and biological substances (T36-T50)

T36 Poisoning by systemic antibiotics

T37 Poisoning by other systemic anti-infectives and antiparasitics

T38 Poisoning by hormones and their synthetic substitutes and antagonists, not elsewhere

classified

T39 Poisoning by nonopioid analgesics, antipyretics and antirheumatics

T40 Poisoning by narcotics and psychodysleptics [hallucinogens]

T41 Poisoning by anaesthetics and therapeutic gases

T42 Poisoning by antiepileptic, sedative-hypnotic and antiparkinsonism drugs

T43 Poisoning by psychotropic drugs, not elsewhere classified

T44 Poisoning by drugs primarily affecting the autonomic nervous system

T45 Poisoning by primarily systemic and haematological agents, not elsewhere classified

T46 Poisoning by agents primarily affecting the cardiovascular system

T47 Poisoning by agents primarily affecting the gastrointestinal system

T48 Poisoning by agents primarily acting on smooth and skeletal muscles and the respiratory

system

T49 Poisoning by topical agents primarily affecting skin and mucous membrane and by ophthalmological, otorhinolaryngological and dental drugs

T50 Poisoning by diuretics and other and unspecified drugs, medicaments and biological substances

Toxic effects of substances chiefly nonmedicinal as to source (T51-T65)

T51 Toxic effect of alcohol

T52 Toxic effect of organic solvents

T53 Toxic effect of halogen derivatives of aliphatic and aromatic hydrocarbons

T54 Toxic effect of corrosive substances

T55 Toxic effect of soaps and detergents

T56 Toxic effect of metals

T57 Toxic effect of other inorganic substances

T58 Toxic effect of carbon monoxide

T59 Toxic effect of other gases, fumes and vapours

T60 Toxic effect of pesticides

T61 Toxic effect of noxious substances eaten as seafood

T62 Toxic effect of other noxious substances eaten as food

T63 Toxic effect of contact with venomous animals

T64 Toxic effect of aflatoxin and other mycotoxin food contaminants

T65 Toxic effect of other and unspecified substances

Other and unspecified effects of external causes (T66-T78)

T66 Unspecified effects of radiation

T67 Effects of heat and light

T68 Hypothermia

T69 Other effects of reduced temperature

T70 Effects of air pressure and water pressure

T71 Asphyxiation

T73 Effects of other deprivation

T74 Maltreatment syndromes

T75 Effects of other external causes

T78 Adverse effects, not elsewhere classified

Certain early complications of trauma (T79)

T79 Certain early complications of trauma, not elsewhere classified

Complications of surgical and medical care, not elsewhere classified (T80-T88)

T80 Complications following infusion, transfusion and therapeutic injection

T81 Complications of procedures, not elsewhere classified

T82 Complications of cardiac and vascular prosthetic devices, implants and grafts

T83 Complications of genitourinary prosthetic devices, implants and grafts

T84 Complications of internal orthopaedic prosthetic devices, implants and grafts

T85 Complications of other internal prosthetic devices, implants and grafts

T86 Failure and rejection of transplanted organs and tissues

T87 Complications peculiar to reattachment and amputation

T88 Other complications of surgical and medical care, not elsewhere classified

Sequelae of injuries, of poisoning and of other consequences of external causes (T90-T98)

T90 Sequelae of injuries of head

T91 Sequelae of injuries of neck and trunk

T92 Sequelae of injuries of upper limb

T93 Sequelae of injuries of lower limb

T94 Sequelae of injuries involving multiple and unspecified body regions

T95 Sequelae of burns, corrosions and frostbite

T96 Sequelae of poisoning by drugs, medicaments and biological substances

T97 Sequelae of toxic effects of substances chiefly nonmedicinal as to source

T98 Sequelae of other and unspecified effects of external causes

Chapter XX

External causes of morbidity and mortality (V01-Y98)

Transport accidents (V01-V99)

Pedestrian injured in transport accident (V01-V09)

V01 Pedestrian injured in collision with pedal cycle

V02 Pedestrian injured in collision with two- or three-wheeled motor vehicle

V03 Pedestrian injured in collision with car, pick-up truck or van

V04 Pedestrian injured in collision with heavy transport vehicle or bus

V05 Pedestrian injured in collision with railway train or railway vehicle

V06 Pedestrian injured in collision with other nonmotor vehicle

V09 Pedestrian injured in other and unspecified transport accidents

Pedal cyclist injured in transport accident (V10-V19)

V10 Pedal cyclist injured in collision with pedestrian or animal

V11 Pedal cyclist injured in collision with other pedal cycle

V12 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle

V13 Pedal cyclist injured in collision with car, pick-up truck or van

V14 Pedal cyclist injured in collision with heavy transport vehicle or bus

V15 Pedal cyclist injured in collision with railway train or railway vehicle

V16 Pedal cyclist injured in collision with other nonmotor vehicle

V17 Pedal cyclist injured in collision with fixed or stationary object

V18 Pedal cyclist injured in noncollision transport accident

V19 Pedal cyclist injured in other and unspecified transport accidents

Motorcycle rider injured in transport accident (V20-V29)

V20 Motorcycle rider injured in collision with pedestrian or animal

V21 Motorcycle rider injured in collision with pedal cycle

V22 Motorcycle rider injured in collision with two- or three-wheeled motor vehicle

V23 Motorcycle rider injured in collision with car, pick-up truck or van

V24 Motorcycle rider injured in collision with heavy transport vehicle or bus

V25 Motorcycle rider injured in collision with railway train or railway vehicle

V26 Motorcycle rider injured in collision with other nonmotor vehicle

V27 Motorcycle rider injured in collision with fixed or stationary object

V28 Motorcycle rider injured in noncollision transport accident

V29 Motorcycle rider injured in other and unspecified transport accidents

Occupant of three-wheeled motor vehicle injured in transport accident (V30-V39)

V30 Occupant of three-wheeled motor vehicle injured in collision with pedestrian or animal

V31 Occupant of three-wheeled motor vehicle injured in collision with pedal cycle

V32 Occupant of three-wheeled motor vehicle injured in collision with two- or three-wheeled

motor vehicle

V33 Occupant of three-wheeled motor vehicle injured in collision with car, pick-up truck or

van

V34 Occupant of three-wheeled motor vehicle injured in collision with heavy transport vehicle

or bus

V35 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle

V36 Occupant of three-wheeled motor vehicle injured in collision with other nonmotor vehicle

V37 Occupant of three-wheeled motor vehicle injured in collision with fixed or stationary

object

V38 Occupant of three-wheeled motor vehicle injured in noncollision transport accident

V39 Occupant of three-wheeled motor vehicle injured in other and unspecified transport

accidents

Car occupant injured in transport accident (V40-V49)

V40 Car occupant injured in collision with pedestrian or animal

V41 Car occupant injured in collision with pedal cycle

V42 Car occupant injured in collision with two- or three-wheeled motor vehicle

V43 Car occupant injured in collision with car, pick-up truck or van

V44 Car occupant injured in collision with heavy transport vehicle or bus

V45 Car occupant injured in collision with railway train or railway vehicle

V46 Car occupant injured in collision with other nonmotor vehicle

V47 Car occupant injured in collision with fixed or stationary object

V48 Car occupant injured in noncollision transport accident

V49 Car occupant injured in other and unspecified transport accidents

Occupant of pick-up truck or van injured in transport accident (V50-V59)

V50 Occupant of pick-up truck or van injured in collision with pedestrian or animal

V51 Occupant of pick-up truck or van injured in collision with pedal cycle

V52 Occupant of pick-up truck or van injured in collision with two- or three-wheeled motor

vehicle

V53 Occupant of pick-up truck or van injured in collision with car, pick-up truck or van

V54 Occupant of pick-up truck or van injured in collision with heavy transport vehicle or bus

V55 Occupant of pick-up truck or van injured in collision with railway train or railway vehicle

V56 Occupant of pick-up truck or van injured in collision with other nonmotor vehicle

V57 Occupant of pick-up truck or van injured in collision with fixed or stationary object

V58 Occupant of pick-up truck or van injured in noncollision transport accident

V59 Occupant of pick-up truck or van injured in other and unspecified transport accidents

Occupant of heavy transport vehicle injured in transport accident (V60-V69)

V60 Occupant of heavy transport vehicle injured in collision with pedestrian or animal

V61 Occupant of heavy transport vehicle injured in collision with pedal cycle

V62 Occupant of heavy transport vehicle injured in collision with two- or three-wheeled motor

vehicle

V63 Occupant of heavy transport vehicle injured in collision with car, pick-up truck or van

V64 Occupant of heavy transport vehicle injured in collision with heavy transport vehicle or bus

V65 Occupant of heavy transport vehicle injured in collision with railway train or railway vehicle

V66 Occupant of heavy transport vehicle injured in collision with other nonmotor vehicle

V67 Occupant of heavy transport vehicle injured in collision with fixed or stationary object

V68 Occupant of heavy transport vehicle injured in noncollision transport accident

V69 Occupant of heavy transport vehicle injured in other and unspecified transport accidents

Bus occupant injured in transport accident (V70-V79)

V70 Bus occupant injured in collision with pedestrian or animal

V71 Bus occupant injured in collision with pedal cycle

V72 Bus occupant injured in collision with two- or three-wheeled motor vehicle

V73 Bus occupant injured in collision with car, pick-up truck or van

V74 Bus occupant injured in collision with heavy transport vehicle or bus

V75 Bus occupant injured in collision with railway train or railway vehicle

V76 Bus occupant injured in collision with other nonmotor vehicle

V77 Bus occupant injured in collision with fixed or stationary object

V78 Bus occupant injured in noncollision transport accident

V79 Bus occupant injured in other and unspecified transport accidents

Other land transport accidents (V80-V89)

V80 Animal-rider or occupant of animal-drawn vehicle injured in transport accident

V81 Occupant of railway train or railway vehicle injured in transport accident

V82 Occupant of streetcar injured in transport accident

V83 Occupant of special vehicle mainly used on industrial premises injured in transport

accident

V84 Occupant of special vehicle mainly used in agriculture injured in transport accident

V85 Occupant of special construction vehicle injured in transport accident

V86 Occupant of special all-terrain or other motor vehicle designed primarily for off-road use,

injured in transport accident

V87 Traffic accident of specified type but victim’s mode of transport unknown

V88 Nontraffic accident of specified type but victim’s mode of transport unknown

V89 Motor- or nonmotor-vehicle accident, type of vehicle unspecified

Water transport accidents (V90-V94)

V90 Accident to watercraft causing drowning and submersion

V91 Accident to watercraft causing other injury

V92 Water-transport-related drowning and submersion without accident to watercraft

V93 Accident on board watercraft without accident to watercraft, not causing drowning and

submersion

V94 Other and unspecified water transport accidents

Air and space transport accidents (V95-V97)

V95 Accident to powered aircraft causing injury to occupant

V96 Accident to nonpowered aircraft causing injury to occupant

V97 Other specified air transport accidents

Other and unspecified transport accidents (V98-V99)

V98 Other specified transport accidents

V99 Unspecified transport accident

Other external causes of accidental injury (W00-X59)

Falls (w00-w19))

W00 Fall on same level involving ice and snow

W01 Fall on same level from slipping, tripping and stumbling

W02 Fall involving ice-skates, skis, roller-skates or skateboards

W03 Other fall on same level due to collision with, or pushing by, another person

W04 Fall while being carried or supported by other persons

W05 Fall involving wheelchair

W06 Fall involving bed

W07 Fall involving chair

W08 Fall involving other furniture

W09 Fall involving playground equipment

W10 Fall on and from stairs and steps

W11 Fall on and from ladder

W12 Fall on and from scaffolding

W13 Fall from, out of or through building or structure

W14 Fall from tree

W15 Fall from cliff

W16 Diving or jumping into water causing injury other than drowning or submersion

W17 Other fall from one level to another

W18 Other fall on same level

W19 Unspecified fall

Exposure to inanimate mechanical forces (w20-w49)

W20 Struck by thrown, projected or falling object

W21 Striking against or struck by sports equipment

W22 Striking against or struck by other objects

W23 Caught, crushed, jammed or pinched in or between objects

W24 Contact with lifting and transmission devices, not elsewhere classified

W25 Contact with sharp glass

W26 Contact with knife, sword or dagger

W27 Contact with nonpowered hand tool

W28 Contact with powered lawnmower

W29 Contact with other powered hand tools and household machinery

W30 Contact with agricultural machinery

W31 Contact with other and unspecified machinery

W32 Handgun discharge

W33 Rifle, shotgun and larger firearm discharge

W34 Discharge from other and unspecified firearms

W35 Explosion and rupture of boiler

W36 Explosion and rupture of gas cylinder

W37 Explosion and rupture of pressurized tyre, pipe or hose

W38 Explosion and rupture of other specified pressurized devices

W39 Discharge of firework

W40 Explosion of other materials

W41 Exposure to high-pressure jet

W42 Exposure to noise

W43 Exposure to vibration

W44 Foreign body entering into or through eye or natural orifice

W45 Foreign body or object entering through skin

W49 Exposure to other and unspecified inanimate mechanical forces

Exposure to animate mechanical forces (w50-w64)

W50 Hit, struck, kicked, twisted, bitten or scratched by another person

W51 Striking against or bumped into by another person

W52 Crushed, pushed or stepped on by crowd or human stampede

W53 Bitten by rat

W54 Bitten or struck by dog

W55 Bitten or struck by other mammals

W56 Contact with marine animal

W57 Bitten or stung by nonvenomous insect and other nonvenomous arthropods

W58 Bitten or struck by crocodile or alligator

W59 Bitten or crushed by other reptiles

W60 Contact with plant thorns and spines and sharp leaves

W64 Exposure to other and unspecified animate mechanical forces

Accidental drowning and submersion (W65-?W74)

W65 Drowning and submersion while in bath-tub

W66 Drowning and submersion following fall into bath-tub

W67 Drowning and submersion while in swimming-pool

W68 Drowning and submersion following fall into swimming-pool

W69 Drowning and submersion while in natural water

W70 Drowning and submersion following fall into natural water

W73 Other specified drowning and submersion

W74 Unspecified drowning and submersion

Other accidental threats to breathing (w75-w84)

W75 Accidental suffocation and strangulation in bed

W76 Other accidental hanging and strangulation

W77 Threat to breathing due to cave-in, falling earth and other substances

W78 Inhalation of gastric contents

W79 Inhalation and ingestion of food causing obstruction of respiratory tract

W80 Inhalation and ingestion of other objects causing obstruction of respiratory tract

W81 Confined to or trapped in a low-oxygen environment

W83 Other specified threats to breathing

W84 Unspecified threat to breathing

Exposure to electric current, radiation and extreme ambient air temperature and pressure (W85-?W99)

W85 Exposure to electric transmission lines

W86 Exposure to other specified electric current

W87 Exposure to unspecified electric current

W88 Exposure to ionizing radiation

W89 Exposure to man-made visible and ultraviolet light

W90 Exposure to other nonionizing radiation

W91 Exposure to unspecified type of radiation

W92 Exposure to excessive heat of man-made origin

W93 Exposure to excessive cold of man-made origin

W94 Exposure to high and low air pressure and changes in air pressure

W99 Exposure to other and unspecified man-made environmental factors

Exposure to smoke, fire and flames (X00-X09)

X00 Exposure to uncontrolled fire in building or structure

X01 Exposure to uncontrolled fire, not in building or structure

X02 Exposure to controlled fire in building or structure

X03 Exposure to controlled fire, not in building or structure

X04 Exposure to ignition of highly flammable material

X05 Exposure to ignition or melting of nightwear

X06 Exposure to ignition or melting of other clothing and apparel

X08 Exposure to other specified smoke, fire and flames

X09 Exposure to unspecified smoke, fire and flames

Contact with heat and hot substances (X10-X19)

X10 Contact with hot drinks, food, fats and cooking oils

X11 Contact with hot tap-water

X12 Contact with other hot fluids

X13 Contact with steam and hot vapours

X14 Contact with hot air and gases

X15 Contact with hot household appliances

X16 Contact with hot heating appliances, radiators and pipes

X17 Contact with hot engines, machinery and tools

X18 Contact with other hot metals

X19 Contact with other and unspecified heat and hot substances

Contact with venomous animals and plants (X20-X29)

X20 Contact with venomous snakes and lizards

X21 Contact with venomous spiders

X22 Contact with scorpions

X23 Contact with hornets, wasps and bees

X24 Contact with centipedes and venomous millipedes (tropical)

X25 Contact with other specified venomous arthropods

X26 Contact with venomous marine animals and plants

X27 Contact with other specified venomous animals

X28 Contact with other specified venomous plants

X29 Contact with unspecified venomous animal or plant

Exposure to forces of nature (X30-X39)

X30 Exposure to excessive natural heat

X31 Exposure to excessive natural cold

X32 Exposure to sunlight

X33 Victim of lightning

X34 Victim of earthquake

X35 Victim of volcanic eruption

X36 Victim of avalanche, landslide and other earth movements

X37 Victim of cataclysmic storm

X38 Victim of flood

X39 Exposure to other and unspecified forces of nature

Accidental poisoning by and exposure to noxious substances (X40-X49)

X40 Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics

X41 Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified

X42 Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified

X43 Accidental poisoning system

X44 Accidental poisoning biological substances

X45 Accidental poisoning

X46 Accidental poisoning

and their vapours

X47 Accidental poisoning

X48 Accidental poisoning

X49 Accidental poisoning

substances

by and exposure to other drugs acting on the autonomic nervous by and exposure to other and unspecified drugs, medicaments and

by and exposure to alcohol

by and exposure to organic solvents and halogenated hydrocarbons

by and exposure to other gases and vapours

by and exposure to pesticides

by and exposure to other and unspecified chemicals and noxious

Overexertion, travel and privation (X50-X57)

X50 Overexertion and strenuous or repetitive movements

X51 Travel and motion

X52 Prolonged stay in weightless environment

X53 Lack of food

X54 Lack of water

X57 Unspecified privation

Accidental exposure to other and unspecified factors (X58-X59)

X58 Exposure to other specified factors

X59 Exposure to unspecified factor

Intentional self-harm (X60-X84)

X60 Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics

X61 Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified

X62 Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified

X63 Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system

X64 Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances

X65 Intentional self-poisoning by and exposure to alcohol

X66 Intentional self-poisoning by and exposure to organic solvents and halogenated

hydrocarbons and their vapours

X67 Intentional

X68 Intentional

X69 Intentional

substances

X70 Intentional

X71 Intentional

X72 Intentional

X73 Intentional

X74 Intentional

X75 Intentional

X76 Intentional

X77 Intentional

X78 Intentional

X79 Intentional

X80 Intentional

X81 Intentional

X82 Intentional

X83 Intentional

X84 Intentional

self-poisoning by and exposure to other gases and vapours

self-poisoning by and exposure to pesticides

self-poisoning by and exposure to other and unspecified chemicals and noxious

self-harm by hanging, strangulation and suffocation self-harm by drowning and submersion

self-harm by handgun discharge

self-harm by rifle, shotgun and larger firearm discharge self-harm by other and unspecified firearm discharge self-harm by explosive material

self-harm by smoke, fire and flames

self-harm by steam, hot vapours and hot objects self-harm by sharp object

self-harm by blunt object

self-harm by jumping from a high place

self-harm by jumping or lying before moving object self-harm by crashing of motor vehicle

self-harm by other specified means

self-harm by unspecified means

Assault (X85-Y09)

X85 Assault by drugs, medicaments and biological substances

X86 Assault by corrosive substance

X87 Assault by pesticides

X88 Assault by gases and vapours

X89 Assault by other specified chemicals and noxious substances

X90 Assault by unspecified chemical or noxious substance

X91 Assault by hanging, strangulation and suffocation

X92 Assault by drowning and submersion

X93 Assault by handgun discharge

X94 Assault by rifle, shotgun and larger firearm discharge

X95 Assault by other and unspecified firearm discharge

X96 Assault by explosive material

X97 Assault by smoke, fire and flames

X98 Assault by steam, hot vapours and hot objects

X99 Assault by sharp object

Y00 Assault by blunt object

Y01 Assault by pushing from high place

Y02 Assault by pushing or placing victim before moving object

Y03 Assault by crashing of motor vehicle

Y04 Assault by bodily force

Y05 Sexual assault by bodily force

Y06 Neglect and abandonment

Y07 Other maltreatment syndromes

Y08 Assault by other specified means

Y09 Assault by unspecified means

Event of undetermined intent (Y10-Y34)

Y10 Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined intent

Y11 Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent

Y12 Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent

Y13 Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent

Y14 Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent

Y15 Poisoning by and exposure to alcohol, undetermined intent

Y16 Poisoning by and exposure to organic solvents and halogenated hydrocarbons and their

vapours, undetermined intent

Y17 Poisoning by and exposure to other gases and vapours, undetermined intent

Y18 Poisoning by and exposure to pesticides, undetermined intent

Y19 Poisoning by and exposure to other and unspecified chemicals and noxious substances,

undetermined intent

Y20 Hanging, strangulation and suffocation, undetermined intent

Y21 Drowning and submersion, undetermined intent

Y22 Handgun discharge, undetermined intent

Y23 Rifle, shotgun and larger firearm discharge, undetermined intent

Y24 Other and unspecified firearm discharge, undetermined intent

Y25 Contact with explosive material, undetermined intent

Y26 Exposure to smoke, fire and flames, undetermined intent

Y27 Contact with steam, hot vapours and hot objects, undetermined intent

Y28 Contact with sharp object, undetermined intent

Y29 Contact with blunt object, undetermined intent

Y30 Falling, jumping or pushed from a high place, undetermined intent

Y31 Falling, lying or running before or into moving object, undetermined intent

Y32 Crashing of motor vehicle, undetermined intent

Y33 Other specified events, undetermined intent

Y34 Unspecified event, undetermined intent

Legal intervention and operations of war (Y35-Y36)

Y35 Legal intervention

Y36 Operations of war

Complications of medical and surgical care (Y40-Y84)

Drugs, medicaments and biological substances causing adverse effects in therapeutic use (Y40-Y59)

Y40 Systemic antibiotics

Y41 Other systemic anti-infectives and antiparasitics

Y42 Hormones and their synthetic substitutes and antagonists, not elsewhere classified

Y43 Primarily systemic agents

Y44 Agents primarily affecting blood constituents

Y45 Analgesics, antipyretics and anti-inflammatory drugs

Y46 Antiepileptics and antiparkinsonism drugs

Y47 Sedatives, hypnotics and antianxiety drugs

Y48 Anaesthetics and therapeutic gases

Y49 Psychotropic drugs, not elsewhere classified

Y50 Central nervous system stimulants, not elsewhere classified

Y51 Drugs primarily affecting the autonomic nervous system

Y52 Agents primarily affecting the cardiovascular system

Y53 Agents primarily affecting the gastrointestinal system

Y54 Agents primarily affecting water-balance and mineral and uric acid metabolism

Y55 Agents primarily acting on smooth and skeletal muscles and the respiratory system

Y56 Topical agents primarily affecting skin and mucous membrane and ophthalmological,

otorhinolaryngological and dental drugs

Y57 Other and unspecified drugs and medicaments

Y58 Bacterial vaccines

Y59 Other and unspecified vaccines and biological substances

Misadventures to patients during surgical and medical care (Y60-Y69)

Y60 Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care

Y61 Foreign object accidentally left in body during surgical and medical care

Y62 Failure of sterile precautions during surgical and medical care

Y63 Failure in dosage during surgical and medical care

Y64 Contaminated medical or biological substances

Y65 Other misadventures during surgical and medical care

Y66 Nonadministration of surgical and medical care

Y69 Unspecified misadventure during surgical and medical care

Medical devices associated with adverse incidents in diagnostic and therapeutic use (Y70-Y82)

Y70 Anaesthesiology devices associated with adverse incidents

Y71 Cardiovascular devices associated with adverse incidents

Y72 Otorhinolaryngological devices associated with adverse incidents

Y73 Gastroenterology and urology devices associated with adverse incidents

Y74 General hospital and personal-use devices associated with adverse incidents

Y75 Neurological devices associated with adverse incidents

Y76 Obstetric and gynaecological devices associated with adverse incidents

Y77 Ophthalmic devices associated with adverse incidents

Y78 Radiological devices associated with adverse incidents

Y79 Orthopaedic devices associated with adverse incidents

Y80 Physical medicine devices associated with adverse incidents

Y81 General- and plastic-surgery devices associated with adverse incidents

Y82 Other and unspecified medical devices associated with adverse incidents

Surgical and other 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 (Y83-Y84)

Y83 Surgical operation and other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure

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 the procedure

Sequelae of external causes of morbidity and mortality (Y85-Y89)

Y85 Sequelae of transport accidents

Y86 Sequelae of other accidents

Y87 Sequelae of intentional self-harm, assault and events of undetermined intent

Y88 Sequelae with surgical and medical care as external cause

Y89 Sequelae of other external causes

Supplementary factors related to causes of morbidity and mortality classified elsewhere (Y90-Y98)

Y90 Evidence of alcohol involvement determined by blood alcohol level

Y91 Evidence of alcohol involvement determined by level of intoxication

Y95 Nosocomial condition

Y96 Work-related condition

Y97 Environmental-pollution-related condition

Y98 Lifestyle-related condition

Chapter XXI

Factors influencing health status and contact with health services (Z00–?Z99)

Persons encountering health services for examination and investigation (Z00-Z13)

Z00 General examination and investigation of persons without complaint and reported diagnosis

Z01 Other special examinations and investigations of persons without complaint or reported diagnosis

Z02 Examination and encounter for administrative purposes

Z03 Medical observation and evaluation for suspected diseases and conditions

Z04 Examination and observation for other reasons

Z08 Follow-up examination after treatment for malignant neoplasms

Z09 Follow-up examination after treatment for conditions other than malignant neoplasms

Z10 Routine general health check-up of defined subpopulation

Z11 Special screening examination for infectious and parasitic diseases

Z12 Special screening examination for neoplasms

Z13 Special screening examination for other diseases and disorders

Persons with potential health hazards related to communicable diseases (z20-z29)

Z20 Contact with and exposure to communicable diseases

Z21 Asymptomatic human immunodeficiency virus [HIV] infection status

Z22 Carrier of infectious disease

Z23 Need for immunization against single bacterial diseases

Z24 Need for immunization against certain single viral diseases

Z25 Need for immunization against other single viral diseases

Z26 Need for immunization against other single infectious diseases

Z27 Need for immunization against combinations of infectious diseases

Z28 Immunization not carried out

Z29 Need for other prophylactic measures

Persons encountering health services in circumstances related to reproduction (Z30-Z39)

Z30 Contraceptive management

Z31 Procreative management

Z32 Pregnancy examination and test

Z33 Pregnant state, incidental

Z34 Supervision of normal pregnancy

Z35 Supervision of high-risk pregnancy

Z36 Antenatal screening

Z37 Outcome of delivery

Z38 Liveborn infants according to place of birth

Z39 Postpartum care and examination

Persons encountering health services for specific procedures and health care (Z40-?Z54)

Z40 Prophylactic surgery

Z41 Procedures for purposes other than remedying health state

Z42 Follow-up care involving plastic surgery

Z43 Attention to artificial openings

Z44 Fitting and adjustment of external prosthetic device

Z45 Adjustment and management of implanted device

Z46 Fitting and adjustment of other devices

Z47 Other orthopaedic follow-up care

Z48 Other surgical follow-up care

Z49 Care involving dialysis

Z50 Care involving use of rehabilitation procedures

Z51 Other medical care

Z52 Donors of organs and tissues

Z53 Persons encountering health services for specific procedures, not carried out

Z54 Convalescence

Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55–Z65)

Z55 Problems related to education and literacy

Z56 Problems related to employment and unemployment

Z57 Occupational exposure to risk-factors

Z58 Problems related to physical environment

Z59 Problems related to housing and economic circumstances

Z60 Problems related to social environment

Z61 Problems related to negative life events in childhood

Z62 Other problems related to upbringing

Z63 Other problems related to primary support group, including family circumstances

Z64 Problems related to certain psychosocial circumstances

Z65 Problems related to other psychosocial circumstances

Persons encountering health services in other circumstances (Z70-?Z76)

Z70 Counselling related to sexual attitude, behaviour and orientation

Z71 Persons encountering health services for other counselling and medical advice, not

elsewhere classified

Z72 Problems related to lifestyle

Z73 Problems related to life-management difficulty

Z74 Problems related to care-provider dependency

Z75 Problems related to medical facilities and other health care

Z76 Persons encountering health services in other circumstances

Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z80-Z? 99)

Z80 Family history of malignant neoplasm

Z81 Family history of mental and behavioural disorders

Z82 Family history of certain disabilities and chronic diseases leading to disablement

Z83 Family history of other specific disorders

Z84 Family history of other conditions

Z85 Personal history of malignant neoplasm

Z86 Personal history of certain other diseases

Z87 Personal history of other diseases and conditions

Z88 Personal history of allergy to drugs, medicaments and biological substances

Z89 Acquired absence of limb

Z90 Acquired absence of organs, not elsewhere classified

Z91 Personal history of risk-factors, not elsewhere classified

Z92 Personal history of medical treatment

Z93 Artificial opening status

Z94 Transplanted organ and tissue status

Z95 Presence of cardiac and vascular implants and grafts

Z96 Presence of other functional implants

Z97 Presence of other devices

Z98 Other postsurgical states

Z99 Dependence on enabling machines and devices, not elsewhere classified

Chapter XXII

Codes for special purposes (U00-U99)

Provisional assignment of new diseases of uncertain etiology (U00-U49)

U04 Severe acute respiratory syndrome [SARS]

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deemag and chest clinic

PHYSICIANS’ MANUAL ON MEDICAL CERTIFICATION OF CAUSE OF DEATH

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SEARCH THIS SITE

Recent Posts

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