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  1. Feb 15, 2005 · Examples include human immunodeficiency virus infection (the underlying cause of acquired immunodeficiency syndrome), coronary artery atherosclerosis, and metastatic breast cancer. The...

    • Overview
    • A. INTRODUCTION
    • B. MEDICAL CERTIFICATION
    • D. CREATED CODES

    Instruction Manual

    Part 2a

    Instructions for Classifying the Underlying Cause of Death, 2021

    U.S. Department of Health and Human Services

    Centers for Disease Control and Prevention

    National Center for Health Statistics

    This manual provides instructions to mortality medical coders and nosologists for coding the underlying cause of death from death certificates filed in the states. These mortality coding instructions are used by both the State vital statistics programs and the National Center for Health Statistics (NCHS), which is the Federal agency responsible for the compilation of U.S. statistics on causes of death. NCHS is part of the Centers for Disease Control and Prevention.

    In coding causes of death, NCHS adheres to the World Health Organization Nomenclature Regulations specified in the most recent revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). NCHS also uses the ICD international rules for selecting the underlying cause of death for primary mortality tabulation in accordance with the international rules.

    Beginning with deaths occurring in 1999, the Tenth Revision of the ICD (ICD-10) is being used for coding and classifying causes of death. This revision of the Classification is published by the World Health Organization (WHO) and consists of three volumes. Volume 1 contains a list of three-character categories, the tabular list of inclusions and the four-character subcategories. The supplementary Z code appears in Volume 1 but is not used for classifying mortality data. Optional fifth characters are provided for certain categories and an optional independent four-character coding system is provided to classify histological varieties of neoplasms, prefixed by the letter M (for morphology) and followed by a fifth character indicating behavior. These optional codes are not used in NCHS. Volume 2 includes the international rules and notes for use in classifying and tabulating underlying cause-of-death data. Volume 3 is an alphabetical index containing a comprehensive list of terms for use in coding. Copies of these volumes may be purchased in hardcopy or on diskettes from the following address:

    WHO Publications Center

    49 Sheridan Avenue

    Albany, New York 12210

    The U. S. Standard Certificate of Death provides spaces for the certifying physician, coroner, or medical examiner to record pertinent information concerning the diseases, morbid conditions, and injuries which either resulted in or contributed to death as well as the circumstances of the accident or violence which produced any such injuries. The medical certification portion of the death certificate is designed to obtain the opinion of the certifier as to the relationship and relative significance of the causes which he reports.

    A cause of death is the morbid condition or disease process, abnormality, injury, or poisoning leading directly or indirectly to death. The underlying cause of death is the disease or injury which initiated the train of morbid events leading directly or indirectly to death or the circumstances of the accident or violence which produced the fatal injury. A death often results from the combined effect of two or more conditions. These conditions may be completely unrelated, arising independently of each other or they may be causally related to each other, that is, one cause may lead to another which in turn leads to a third cause, etc.

    The order in which the certifier is requested to arrange the causes of death upon the certification form facilitates the selection of the underlying cause when two or more causes are reported. He is requested to report in Part I on line (a) the immediate cause of death and the antecedent conditions on lines (b), (c) and (d) which gave rise to the cause reported on line (a), the underlying cause being stated lowest in the sequence of events. However, no entry is necessary on I(b), I(c) or I(d) if the immediate cause of death stated on I(a) describes completely the sequence of events.

    Any other significant condition which unfavorably influenced the course of the morbid process and thus contributed to the fatal outcome but was not related to the immediate cause of death is entered in Part II.

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

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

    To facilitate automated data processing, the following ICD-10 codes have been amended for use in coding and processing the multiple cause data. Special five-character subcategories are for use in coding and processing the multiple cause data; however, they will not appear in official tabulations. When a created code is selected as the underlying cause it must be converted to its official ICD-10 code using Appendix B.

    A169       Respiratory tuberculosis, unspecified

    Excludes: Any term indexed to A169 not qualified as respiratory or pulmonary (A1690)

    *A1690      Tuberculosis NOS

    Includes:  Any term indexed to A169 not qualified as respiratory or pulmonary

    E039       Hypothyroidism, unspecified

  2. Aug 12, 2022 · The underlying cause is defined by the World Health Organization as “the disease or injury that initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury.”

  3. Examples would be terms such as cardiorespiratory failure or liver failure. These terms describe the physical condition of the decedent but not what caused the condition. Underlying cause of death determination requires specialized training.

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  4. The cause-of-death section consists of two parts. Part I is for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death) on Line a and the underlying cause of death (the disease or injury that initiated the chain of morbid events that

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  5. May 10, 2022 · WHO has defined the ‘underlying cause of death’ as follows: the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury.

  6. Aug 7, 2023 · An example of these three components used to create a cause of death statement would be hemopericardium with cardiac tamponade (mechanism) due to ruptured myocardial infarct (immediate cause) due to atherosclerotic coronary artery disease (underlying cause).

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