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UNITED REPUBLIC OF TANZANIAMINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDRENWHO Application of ICD-10 Initial cause of death collection - The Start-Up Mortality List (ICD-10-SMoL)TRAINING MANUAL FOR DATA INPUT AND CODINGlefttopTABLE OF CONTENTS TOC \o "1-3" 1Introduction PAGEREF _Toc448779027 \h 32Background PAGEREF _Toc448779028 \h 32.1The Structure of the SMoL PAGEREF _Toc448779029 \h 42.2Use of the SMoL PAGEREF _Toc448779030 \h 42.3Data flow PAGEREF _Toc448779031 \h 53International Medical Certificate of Cause of Death PAGEREF _Toc448779032 \h 64Electronic Cause of Death Entry Form PAGEREF _Toc448779033 \h 85Rules and Guidelines for Selecting the Underlying Cause of Death (UCOD) PAGEREF _Toc448779034 \h 126Rules for selecting the UCOD when using the electronic Cause of Death Entry form and the SMoL. PAGEREF _Toc448779035 \h 127Certain conditions that may not be used as single underlying cause of death. PAGEREF _Toc448779036 \h 128SMoL Rules PAGEREF _Toc448779037 \h 138.1General rules: PAGEREF _Toc448779038 \h 138.2Rules for injuries by external causes: PAGEREF _Toc448779039 \h 138.3Rules for Maternal deaths: PAGEREF _Toc448779040 \h 148.4Rules for Perinatal deaths: PAGEREF _Toc448779041 \h 148.5Rules for infections: PAGEREF _Toc448779042 \h 148.6Rules for neoplasms (cancer, tumour): PAGEREF _Toc448779043 \h 158.7Rules for body system specific conditions: PAGEREF _Toc448779044 \h 159SMoL rules with examples PAGEREF _Toc448779045 \h 179.1Examples – General Rules: PAGEREF _Toc448779046 \h 179.2Examples - Rules for Injuries by external causes: PAGEREF _Toc448779047 \h 199.3Examples - Rules for Maternal deaths: PAGEREF _Toc448779048 \h 209.4Examples - Rules for Perinatal deaths: PAGEREF _Toc448779049 \h 219.5Examples - Rules for Infections: PAGEREF _Toc448779050 \h 229.6Examples - Rules for Neoplasms (cancer, tumour): PAGEREF _Toc448779051 \h 239.7Examples - Rules for Body system specific conditions: PAGEREF _Toc448779052 \h 2410Procedure for using the electronic Cause of Death Entry form and SMoL PAGEREF _Toc448779053 \h 2811EXERCISES PAGEREF _Toc448779054 \h 2912Appendix A – ICD-10 Start-Up Mortality List (ICD-SMoL) PAGEREF _Toc448779055 \h 3213Appendix B – ICD-10 Start-Up Mortality List with ICD-10 codes PAGEREF _Toc448779056 \h 3814Appendix C – Overview of the ICD PAGEREF _Toc448779057 \h 4415Appendix D – References PAGEREF _Toc448779058 \h 4416Appendix E – Common Abbreviations PAGEREF _Toc448779059 \h 4517Appendix F – Answers to Exercises PAGEREF _Toc448779060 \h 48IntroductionReliable knowledge on the mortality and causes of death of a population is critical for policy making. Civil registration and vital statistics systems (CRVS), when functioning properly, are the most reliable source of continuous data on fertility, mortality and causes of death. Cause-specific mortality statistics by age, sex and geographic location, derived from such systems are instrumental in guiding national, regional and global policies and priorities for health and development. One of the most challenging products of the CRVS is cause-of-death information. The level of registration of deaths in some countries may be high but the information on the cause of death is often either absent or of low quality. Overall only around one-third of all the deaths in the world are recorded in civil registries with the cause-of-death information. There is a huge disparity in generating cause-of-death information across continents. Starting to collect causes of death in places in line with ICD, where the cause of death can be assessed by a physician, in hospitals, will help to build a core of knowledge that can already provide health information and be used as a resource to roll out cause of death collection and coding in the country where resources permit. This start-up mortality list will simplify the process of introducing ICD, using a simplified set of mortality rules, but drawing on the same principles and form. Information technology will further assist in coding, tabulation and analysis of data, as much as the transition to (or simultaneous use of) the full ICD-10.It is designed to be in line with the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), and informs in setting public health priorities and tracking progress towards national and international targets and goals such as the post-2015 health and development agenda. This list is designed to be a first step toward standardized reporting of causes of death. (Refer to Appendix A for the SMoL List.)BackgroundThe International Classification of Diseases (ICD),published by WHO,was first developed as a classification system of causes of death. It was used for the preparation for mortality (the incidence of death in a population) statistics and until 1948 was used solely for cause of death coding. It is a statistical classification that groups similar diseases into mutually exclusive categories using an alphanumeric code. Later, the scope of the ICD was extended to include diagnoses in morbidity. It also provides a system to enable international monitoring and comparison. The ICD consists of three volumes:Volume 1 – Tabular listVolume 2 – Instructions and guidelines manualVolume 3 – Alphabetical index.(Refer to Appendix C for more information on the ICD volumes.)It is possible for a person to die as a result of several conditions, all at the same time. Thus causes of death was defined by the Twentieth World Health Assembly (1967) as:“All those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries”.The underlying cause of death is most important for statistical comparison and public health data. WHO has defined the underlying cause of death as:“I (a) the disease or injury which initiated the train of morbid events leading directly to death;or(b) the circumstances of the accident or violence which produced the fatal injury.”Once a death has been correctly certified by a medically trained person, the cause of death has to be coded correctly according to international rules and standards. The correct and consistent application of ICD standards and rules ensures that cause of death patterns can be compared for different populations or over time in the same population.The Structure of the SMoLThe SMoL is based on the ICD general mortality tabulation list, with the addition of categories for maternal and perinatal deaths, and specific conditions that are useful for assisting with Global Burden of Disease (GBD). The List has the following columns:Reference to ICD-10 chapter – the relevant ICD-10 chapter is listed hereCode – the SMoL code to be assignedCause of death – the list of grouped conditions that are the cause of deathOptional subcategory – more specific detailed subcategoriesCoding hints – exclusion and inclusions directives for codersUse of the SMoLThe cause(s) of death are reported on a standard WHO medical certificate of cause of death. Reported causes, age, sex, location and the code of the underlying cause of death are recorded for every individual case. The underlying cause is selected following a set of simple rules that makes sure the tabulated data can be compared with information that is coded using the full ICD-10.Ideally, wherever capacity exists or completeness of reporting is sufficient, the full ICD-10 should be used, ideally in combination with electronic coding tools. However, a start-up list of causes of death can deliver data in a timely manner and keep the burden of implementing a coding system low in new mortality systems. As the SMoL is fully compatible with ICD-10, expansion into more detail at a later stage is easily possible. This compatibility also facilitates comparison of collected data with other sources.Data flowThe data collection process for causes of death is similar to the one of discharge reports.International Medical Certificate of Cause of DeathThe certificate is the main source of mortality data. Information on the certificates is best provided by an experienced medical practitioner who is well informed about the medical history of the dead person, and has carefully carried out an examination of the decedent. In the case of accidents or violent deaths, additional input may come from a coroner or other legal official. In some jurisdictions, another official (who may not be medically trained) is responsible for the completion of the medical certificate of cause of death. In circumstances where no physician or other trained official can attend the dead person, a certificate may also be based on verbal autopsy data (lay reporting) or another form of data collection.This certificate consists of: Administrative data:Used for collecting information on sex, date of birth and date of death. It can be modified to suit the needs of the country.Frame A: Medical data Part 1 and 2Part 1:used for causes related to the sequence of events leading directlyto thedeath. It is a step-by-step summary of the train of events leadingto death, with the originating cause on the lowest used line and the direct cause on the first line.Part 2:used for conditions that do not belong to the sequence but still contributedto death, for example by impairing the patient’s generalcondition.Frame B:Other medical dataused for collecting additional information on:surgeryif performedautopsyif performedmanner of deathplace of occurrence of the external causefetal and infant deathsmaternaldeathsNot all the detailed information asked for may be available. Hospital records will usually have this information, as it is also retained for medical purposes.Causes of death should be collected using the international form for medical causes of death wherever possible:Administrative Data (can be further specified by country)Sex FORMCHECKBOX Female FORMCHECKBOX Male FORMCHECKBOX UnknownDate of birthDDMMYYYYDate of deathDDMMYYYYFrame A: Medical data: Part 1 and 21Report disease or condition directly leading to death on line aReport chain of events in due to order (if applicable)State the underlying cause on the lowest used lineCause of deathTime interval from onset to deathabDue to:cDue to:dDue to:2 Other significant conditions contributing to death (time intervals can be included in brackets after the condition)Frame B: Other medical dataWas surgery performed within the last 4 weeks? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Unknown If yes please specify date of surgeryDDMMYYYYIf yes please specify reason for surgery (disease or condition)Was an autopsy requested? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Unknown If yes were the findings used in the certification? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownManner of death: FORMCHECKBOX Disease FORMCHECKBOX Assault FORMCHECKBOX Could not be determined FORMCHECKBOX Accident FORMCHECKBOX Legal intervention FORMCHECKBOX Pending investigation FORMCHECKBOX Intentional self harm FORMCHECKBOX War FORMCHECKBOX UnknownIf external cause or poisoning: Date of injuryDDMMYYYYPlease describe how external cause occurred (If poisoning please specify poisoning agent)Place of occurrence of the external cause: FORMCHECKBOX At home FORMCHECKBOX Residential institution FORMCHECKBOX School, other institution, public administrative area FORMCHECKBOX Sports and athletics area FORMCHECKBOX Street and highway FORMCHECKBOX Trade and service area FORMCHECKBOX Industrial and construction area FORMCHECKBOX Farm FORMCHECKBOX Other place (please specify): FORMCHECKBOX Unknown Fetal or infant DeathMultiple pregnancy FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownStillborn? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownIf death within 24h specify number of hours survivedBirth weight (in grams)Number of completed weeks of pregnancyAge of mother (years)If death was perinatal, please state conditions of mother that affected the fetus and newbornFor women, was the deceased pregnant? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Unknown FORMCHECKBOX At time of death FORMCHECKBOX Within 42 days before the death FORMCHECKBOX Between 43 days up to 1 year before death FORMCHECKBOX UnknownDid the pregnancy contribute to the death? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX UnknownElectronic Cause of Death Entry FormAn electronic Cause of Death entry form has been designed to assist with the collection of the UCOD and the subsequent assignment of the SMoL codes. EXAMPLE:It follows the general format of the medical certificate of cause of death and includes a drop down box in Part 1 to assist with the entering of the required information for each field.The drop down list will show the shortest matching entry first, as sometimes there may be many possible matches. Continuing to add detail (if available) will shorten the list for easier reading, otherwise browse the list for the matching entry. If a term is not available, select the closest one and inform central data management so that the list can be updated.EXAMPLE:Part 2 is completed using free text.For fields 1a-1d only one condition can be entered. If multiple conditions are reported on one line, check with the Doctor for the main one. If this is not possible select the first mentioned condition. Once the information has been entered into the various fields, the coder MUSTtick the condition that is the underlying cause of death. If this is not completed the system cannot process the certificate.EXAMPLE:Part 3 captures information via drop down lists for the following:Manner of death e.g. disease, assault accident etc.Fetal or infant deathWhether the women was pregnantTime from pregnancyWhether pregnancy contributed to the deathRules and Guidelines for Selecting the Underlying Cause of Death (UCOD)The ICDprovides a set of rules to ensure the selection of the UCODis done the same way everywhere, and data that has been generated in different places is comparable.ICD rules are very detailed and can be found in Volume 2 of ICD-10.Rules for selecting the UCOD when using the electronic Cause of Death Entry form and the SMoL.As the ICD rules are very detailed, a set of simplified rules (based on the ICD set of rules) has been developed to be followed when the SMoL is used for coding the UCOD. Following these rules will ensure comparability with data on an international and local basis. Following the SMoL Rules (SR) will assist the coder in the selection of the correct UCOD. Generally the order or hierarchy to use when identifying the UCOD will be:Injuriesby external causesas cause of deathMaternal cause of deathPerinatal cause of deathInfection as cause of deathMalignancy as cause of deathSpecific body system condition as cause of deathCertain conditions that may not be used as single underlying cause of death.These include:Organic, including symptomatic disordersOrganisms (Select the condition caused by the organism)Visual impairment (If listed as a cause of an accident, select the accident)Hearing loss (If listed as a cause of an accident, select the accident)Multiple gestation (Look for a more precise cause of death)SIRS (Look for a more precise cause of the SIRS)Injury, poisoning and certain other consequences of external causes (Select the cause of the injury, poisoning or accident as the underlying cause of death. See SR8.)Factors influencing health status and contact with health services (e.g. visit for vaccination, amputation status, past history of cancer etc.)If any of these have been listed on the certificate and another cause cannot be determined, then the person responsible for filling in the certificate should be asked for clarification.SMoL RulesGeneral rules:SR1 – Single cause listedWhen only one condition is reported on the certificate, in Part 1 or Part 2, select this as the underlying cause of death and tick the box in the column “underlying”.SR2 – Multiple causes listedIf there is more than one condition reported in Part 1 usually the lowest used line in 1a-1d will be the underlying cause.SR3 – Multiple causes on the same lineIf there are multiple entries on one line ask the doctor which is the relevant one.If this is not possible, only enter the first one.SR4 – Implausible sequenceIf the sequence of listed conditions looks strange, (e.g. hypertension causing metastases) refer back to the doctor that completed the certificate for clarification. If this is not possible, code the first line from the top that is plausible.SR5 – Consistency between sex and diagnosisIf the underlying cause conflicts with the sex of the decedent, then refer back to thedoctor. If this is not possible, and the underlying cause is fully incompatible then enter on the lowest line “Other ill-defined and unspecified causes of mortality” and chose this as the underlying cause.SR6 –Nonspecific modes of dyingDo not select modes of dying such as - “cardiac arrest”, “heart failure”, or “respiratory failure” – as the underlying cause if any other condition is mentioned on the form.SR7 – Selecting precise termsIf the underlying cause on the lowest used line describes a condition in general terms and another term is reported on the certificate that provides more precise information about the site or nature of this condition, select this more precise term as the underlying cause.Rules for injuries by external causes:SR8 – Accident, poisoning or violenceIf there is an accident, poisoning, or violence mentioned in 1a-1d, then find out the cause of the accident, poisoning or violence and select this as the underlying cause.NOTE: Do not select the injury, you must add an external cause and if not known put ‘unknown external cause’.SR9 – SuicideIf in 1a-1d there is a mention of suicide select this as the underlying cause.Rules for Maternal deaths:SR10 – Mention of a pregnancy conditionIf there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, the underlying cause of death must be from the section Pregnancy, childbirth and the puerperium.SR11 – No mention of a pregnancy conditionIf there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, but no pregnancy condition is mentioned on lines 1a-1d, then enter on the lowest line “Indirect obstetric death” and choose this as the underlying cause.Rules for Perinatal deaths:SR12 – General rule for UCOD for perinatal deathsFor neonatal or fetal deaths, the underlying cause of death must be from the section certain conditions originating in the perinatal period, except in cases of external causes and related injuries.SR13 – Mother’s condition mentioned as UCODFor neonatal or fetal deaths, if there is a mention of a condition of the mother on the lowest used line of 1a-1d, then enter on the lowest line in 1a-1d “Fetus and newbornaffected by maternal factors” and select this as the underlying cause.SR14 – Low birth weight and prematurityFor neonatal or fetal deaths, when both low birth weight and prematurity are mentioned, priority is to be given to low birth weight.Rules for infections:SR15 – Infections to be selected as UCODIf any of the following infections are mentioned in 1a-1d, select this as the underlying cause, no matter what is written on the lowest used line:ChagasPlagueCholeraPoliomyelitisDengueRubellaDiphtheriaScarlet feverHepatitis A, B or C, acute or chronicTetanusLeishmaniasisTrachomaLeprosySmallpoxMalariaViral haemorrhagic fever (Ebola)MeaslesWhooping coughMeningococcal diseaseYellow feverSR16 - Infections to be selected as UCOD except when HIV mentionedIf any of the following infections are mentioned in 1a-1d, select this as the underlying cause:Consequences of tuberculosisShigellosesParatyphoidTuberculosisSalmonellaTyphoidEXCEPTION: If the line below any of the above mentions HIV, select HIV as the underlying cause. SR17 – HIV and TuberculosisIf HIV is mentioned and the line above mentions Tuberculosis, then correct the entry and type “HIV with Tuberculosis”.Rules for neoplasms (cancer, tumour):SR18 – General rule for selecting neoplasms as UCODIf there is a mention of a cancer in1a-1d select the cancer as the underlying cause. EXCEPTION: If the cancer is reported as due to HIV, select HIV as the underlying cause.Rules for body system specific conditions:SR19 – Diabetes mellitusIf there is a mention of Diabetes mellitus in 1a-1d, select the diabetes mellitus as the underlying cause. EXCEPTION: If Diabetes is due to pancreatitis, then select pancreatitis as the underlying cause.SR20 – Dehydration and diarrhoeal conditionsIf there is a mention of dehydration in 1a-1d and also mention of any diarrhoeal condition anywhere on the form, add the diarrhoeal condition on the lowest line and select this as the underlying cause.SR21 – Cancer and certain cardiovascular conditionsIf cancer is recorded on the lowest used line and there ismention of either Hypertension, Anginapectoris,Ischemic heart disease orArteriosclerosis, on any of the lines above the cancer, select either Hypertension, Anginapectoris, Ischemic heart diseaseorArteriosclerosis as the underlying cause. SR22 – InfluenzaIf there is mention of Influenza in 1a-1d, select Influenza as the underlying cause.SR23 – Pneumonia, Dementia and Mental retardationIf there is a mention of Pneumonia, Dementia or Mental retardation without anything entered on the line below, ask the doctor, if possible, for the cause of death and enter that in the line below and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.SR24 – Embolism, Decubitus ulcer, Cystitis, Urinary infection and CachexiaIf there is a mention of embolism, decubitus ulcer, cystitis, urinary infection or cachexia on the lowest used line (or they are mentioned as the only entry) then ask the doctor, if possible, for the cause of death. Enter that condition and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.SR25 – SurgeryIf surgery is mentioned on the lowest used line, and a surgical condition is mentioned somewhere on the certificate (e.g. infection, tumour, injury) select the surgical condition as the underlying cause. If the surgical condition is an injury, then check the cause of the injury (ask the doctor, if possible), and add that to the list and select the cause of the injury as the underlying cause.SR26 – Signs and SymptomsIf a sign or symptom is mentioned in 1a-1d, check with the doctor if there is a more specific condition and enter this condition and select it as the underlying cause. If this is not possible, just select the sign or symptom as the underlying cause.SMoL rules with examplesThe following provides examples of how to apply the SMoL Rules. Exercises to reinforce the application of these rules are located in section 13 of this manual.Examples – General Rules:SR1 – Single cause listedWhen only one condition is reported on the certificate, in Part 1 or Part 2, select this as the underlying cause of death and tick the box in the column “underlying”.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAStroke√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBDue toCDue toDSR2 – Multiple causes listedIf there is more than one condition reported in Part 1 usually the lowest line in 1a-1d will be the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAHepatic failureReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBBile duct obstructionDue toCCarcinoma of head of pancreas√Due toDIn other words the carcinoma of the head of the pancreas recorded on the lowest used line (in this case, line c) will be the underlying cause of death.SR3 – Multiple causes on the same lineIf there are multiple entries on one line ask the doctor which is the relevant one.If this is not possible, select the first one mentioned.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAPernicious anaemia and gangrene of foot√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBDue toCDue toDIf it is not possible get clarification from the doctor then then select pernicious anaemia as the underlying cause.SR4 – Implausible sequenceIf the sequence of listed conditions looks strange, (e.g. hypertension causing metastases) refer back to the doctor that completed the certificate for clarification. If this is not possible, code the first line from the top that is plausible.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateABone metastasesReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBColon cancer√Due toCHypertensionDue toDSR5 – Consistency between sex and diagnosisIf the underlying cause conflicts with the sex of the decedent, then refer back to the doctor. If this is not possible, and the underlying cause is fully incompatible then enter on the lowest line “Other ill-defined and unspecified causes of mortality” and chose this as the underlying cause.Sex = MaleCause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAVaginal cancer Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBOther ill-defined and unspecified causes of mortality√Due toCDue toDSR6 – Nonspecific modes of dyingDo not select modes of dying such as - “cardiac arrest”, “heart failure”, “respiratory failure” – as the underlying cause if any other condition is mentioned on the form.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAChronic renal failure √Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBCardiac arrestDue toCDue toDSR7 – Selecting precise termsIf the underlying cause on the lowest used line describes a condition in general terms and another term is reported on the certificate that provides more precise information about the site or nature of this condition, select this more precise term as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateACerebral infarction√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBStrokeDue toCDue toDExamples - Rules for Injuries by external causes:SR8 – Accident, poisoning or violenceIf there is an accident, poisoning, or violence mentioned in 1a-1d, then find out the cause of the accident, poisoning or violence and select this as the underlying cause.NOTE: Do not select the injury, you must add an external cause and if not known put ‘unknown external cause’.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAPesticide poisoningReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBAccidental poisoning√Due toCDue toDSR9 – SuicideIf in 1a-1d there is a mention of suicide select this as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAHead injuryReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBSuicide by jumping off bridge√Due toCDue toDExamples - Rules for Maternal deaths:SR10 – Mention of a pregnancy conditionIf there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, the underlying cause of death must be from the section Pregnancy, childbirth and the puerperium.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateASevere hypertension in pregnancy√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBDue toCDue toDFor women,was the deceased pregnant?YesTime from pregnancyAt time of deathDid the pregnancy contribute to the death?YesA code from the section Pregnancy, childbirth and the puerperium will be assigned for this case and not a code from the Circulatory section.SR11 – No mention of a pregnancy conditionIf there is a mention of pregnancy on the form, and the tick box confirms that the pregnancy influenced the death, but no pregnancy condition is mentioned on lines 1a-1d, then enter on the lowest line “Indirect obstetric death” and choose this as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAAnaemiaReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBIndirect obstetric death√Due toCDue toDFor women,was the deceased pregnant?YesTime from pregnancyAt time of deathDid the pregnancy contribute to the death?UnknownExamples - Rules for Perinatal deaths:SR12 – General rule for UCOD for perinatal deathsFor neonatal or fetal deaths, the underlying cause of death must be from the section Certain conditions originating in the perinatal period, except in cases of external causes and related injuries.Age =5 daysCause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateABacterial septicaemiaReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBBacterial sepsis of newborn√Due toCDue toDSR13 – Mother’s condition mentioned as UCODFor neonatal or fetal deaths, if there is a mention of a condition of the mother on the lowest used line of 1a-1d, then enter on the lowest line in 1a-1d “Fetus and newborn affected by maternal factors” and select this as the underlying cause.Age = 1 dayCause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateALung immaturityReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBPrematurityDue toCMaternal pre-eclampsiaDue toDFetus and newborn affected by maternal factors√SR14 – Low birth weight and prematurityFor neonatal or fetal deaths, when both low birth weight and prematurity are mentioned, priority is to be given to low birth weight.Age = 1 dayCause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateALow birthweight√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBPrematurityDue toCDue toDExamples - Rules for Infections:SR15 – Infections to be selected as UCODIf any of the following infections are mentioned in 1a-1d, select this as the underlying cause, no matter what is written on the lowest used line:ChagasPlagueCholeraPoliomyelitisDengueRubellaDiphtheriaScarlet feverHepatitis A, B or C, acute or chronicTetanusLeishmaniasisTrachomaLeprosySmallpoxMalariaViral haemorrhagic fever (Ebola)MeaslesWhooping coughMeningococcal diseaseYellow feverCause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateACirrhosis of liverReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBHepatitis C√Due toCDue toDSR16 - Infections to be selected as UCOD except when HIV mentionedIf any of the following infections are mentioned in 1a-1d, select this as the underlying cause:Consequences of tuberculosisShigellosesParatyphoidTuberculosisSalmonellaTyphoidEXCEPTION: If the line below any of the above mentions HIV, select HIV as the underlying cause. Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateASalmonella enteritis√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBGastroenteritisDue toCDue toDSR17 – HIV and TuberculosisIf HIV is mentioned and the line above mentions Tuberculosis, then correctthe entry and type “HIV with Tuberculosis”.Certificate completed by physicianCause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateATuberculosisReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBHIVDue toCDue toDAmended certificate for electronic inputCause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateATuberculosisReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBHIVDue toC HIV with Tuberculosis√Due toDExamples - Rules for Neoplasms (cancer, tumour):SR18 – General rule for selecting neoplasms as UCODIf there is a mention of a cancer in 1a-1d select the cancer as the underlying cause. EXCEPTION: If the cancer is reported as due to HIV, select HIV as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateARespiratory failureReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBNon Hodgkin lymphoma√Due toCDue toDException:Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateARespiratory failureReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBNon Hodgkin lymphomaDue toCHIV√Due toDExamples - Rules for Body system specific conditions:SR19 – Diabetes mellitusIf there is a mention of Diabetes mellitus in 1a-1d, select the diabetes mellitus as the underlying cause. EXCEPTION: If Diabetes is due to pancreatitis, then select pancreatitis as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAGangreneReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBPeripheral artery diseaseDue toCType 1 diabetes mellitus√Due toDException:Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAType 1 diabetes mellitus Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBPancreatitis√Due toCDue toDSR20 – Dehydration and diarrhoeal conditionsIf there is a mention of dehydration in 1a-1d and also mention of any diarrhoeal condition anywhere on the form, add the diarrhoeal condition on the lowest line and select this as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateADehydrationReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBInfectious gastroenteritis√Due toCDue toDSR21 – Cancer and certain cardiovascular conditionsIf cancer is recorded on the lowest used line and there ismention of either Hypertension, Anginapectoris, Ischemic heart disease orArteriosclerosis, on any of the lines above the cancer, select either Hypertension, Anginapectoris, Ischemic heart diseaseorArteriosclerosis as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAIschaemic heart disease√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBBowel cancerDue toCDue toDSR22 – InfluenzaIf there is mention of Influenza in 1a-1d, select Influenza as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAChronic asthmaReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBInfluenza√Due toCDue toDSR23 – Pneumonia, Dementia and Mental retardationIf there is a mention of Pneumonia, Dementia or Mental retardation without anything entered on the line below, ask the doctor, if possible, for the cause of death and enter that in the line below and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAPneumonia√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBDue toCDue toDSR24 – Embolism, Decubitus ulcer, Cystitis, Urinary infection and CachexiaIf there is a mention of embolism, decubitus ulcer, cystitis, urinary infection or cachexia on the lowest used line (or they are mentioned as the only entry) then ask the doctor, if possible, for the cause of death. Enter that condition and select it as the underlying cause. If no further information is available select the mentioned condition as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAPeripheral artery disease√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBDecubitus ulcerDue toCDue toDSR25 – SurgeryIf surgery is mentioned on the lowest used line, and a surgical condition is mentioned somewhere on the certificate (e.g. infection, tumour, injury) select the surgical condition as the underlying cause. Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAChronic kidney failure√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBKidney transplantDue toCDue toDIf the surgical condition is an injury, but the cause of the injury is not mentioned then ask the doctor, if possible, and enterthat in the line below and select the cause of the injury as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAHip replacementReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBFractured hipDue toCFall down stairs√Due toDSR26 – Signs and SymptomsIf a sign or symptom is mentioned in 1a-1d, check with the doctor if there is a more specific condition and enter this condition and select it as the underlying cause. If this is not possible, just select the sign or symptom as the underlying cause.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAFever√Report chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBDue toCDue toDAfter consulting the doctor the cause of the fever was Dengue.Cause of deathTime interval from onset to deathUnderlyingDisease or condition directly leading to deathImmediateAFeverReport chain of events in “due to” order (B-D) if applicableState the underlying cause on the lowest used lineDue toBDengue√Due toCDue toDProcedure for using the electronic Cause of Death Entry form and SMoLAccess to the electronic entry form is via the DHIS2 training interface and requires a username and password. On the mortality dashboard open “Apps” from the top menu and select “event capture”. There may be a short delay while the system is loading. Once loaded click “register event”. “New Event” will appearwith a mandatory box for date of death. The date needs to be entered to open the form itself.There are 3 sections: information on the deceased, causes and manner of death (medical data) and cause-of-death coding (coding automatic).As information is being entered, some boxes will be irrelevant and blocked. For example, if there is a date of birth, then it is not possible to click on “Birth date unknown”.1. Information on the deceased:Enter information on the sex, date of birth and date of death. However if the date of birth is unknown, check the box “Birth date unknown” and provide an estimated age if possible. Check box “Age under 24 hours”will apply tonewborns.2. Causes and manner of death (medical data):Enter all the listed conditions from the Medical Certificate of Cause of Death in the same order as written by the certifier. Drop down lists enable the selection of possible matching conditions.However if a condition is not found in the drop down list, then select [NOT LISTED] from the same drop down list.A new box will open below where you can type the condition.Manner of death: Select as appropriateSections on Fetal or infant death or maternal death will need to be completed depending on the information on the deceased entered earlier.Then apply the SMoL Rules for selecting the UCOD.Once the underlying cause of death has been selected, verify this selection in the SMoL (See Appendix A) to see if there are any “excludes” notes that point to a more suitable entry on the form. If so add this entry to the form and select it as the underlying cause.3. Cause-of-death coding (coding automatic):This section is for official use only and cannot be modified. The coding is done automatically in the background by the system at set intervals, and the boxes will normally be empty during data entry. However, when editing an existing event, the result of the coding might be visible in the boxes.?Whether there is data visible or not in this section does not influence the data entry.Do not forget to check the box “Completed” and put any comments in the box “Comments”, then click on “Save and add new”.EXERCISES1.Are the following conditions in bold acceptable underlying causes of death?CONDITIONAcceptableNot AcceptableE Coli as a cause of a urinary tract infectionCaesarean section deliveryPoisoned by a snake biteVisual impairment resulting from eye cancerFractured leg from a fall out of a treeWhich is the underlying cause of death in these example? Circle the correct answer.2.Part 1aHeart failure bColon cancer 3.Part 1aBronchopneumonia bCerebral infarction 4.Part 1aAppendicectomybPostoperative wound infectionc.Appendicitis5.Part 1aHeart failurebCoronary artery disease 6.Part 1aDental cariesPart 2Diabetes mellitus7.Part 1aHydrocephalus bTuberculosis meningitis 8.Part 1aAsphyxiabSuicide - hangingcStrangulation 9.Part 1aJaundice bPrematurityPart 3Maternal severe pre-eclampsia10.Part 1aHIVbKaposi sarcoma11.Part 1aAsthmabRespiratory arrest12.Part 1aRabies bOpen wound of armcBitten by dog13.Part 1aKlebsiella pneumonia septicaemiabSeptic shock14.Part 1aHaemorrhagebPlacenta praeviacVaginal deliveryFor women, was the deceased pregnantYesTime from PregnancyAt time of deathDid the pregnancy contribute to the death Yes15.Part 1aIntracerebral haemorrhage bFractured skullcPedestrian hit by a carManner of deathAccident16.Part 1aComabLiver failurecMalaria17.Part 1aComabSubdural haematomacFall from ladderManner of deathAccident18.Part 1aRespiratory failureFor women, was the deceased pregnantYesTime from PregnancyAt time of deathDid the pregnancy contribute to the death Yes19.Part 1aAcute blood lossbTraumatic ruptured spleencCar accidentManner of deathAccident20.Part 1aPneumoniabMeasles21.Part 1aCirrhosis of liver22.Part 1aPeripheral vascular disease and chronic lung disease23.Part 1aAcute myocardial infarctionbCoronary heart diseasecEmphysema24.Part 1aOvarian cancer Sex = male25.Part 1aCardiac failurebPrematurity26.Part 1aAngina pectorisbLung cancer27.Part 1aStrokebSevere pre-eclampsia28.Part 1aRespiratory failure bInfluenzac.Asthma29.Part 1aDementia 30.Part 1aPeripheral artery diseasebEmbolism 31.Part 1aGangreneAppendix A – ICD-10 Start-Up Mortality List (ICD-SMoL)For neonatal and maternal cases, look up the neonatal and maternal section first. Follow the exclusions at the beginning of the sections. Injuries are coded to the originating external cause.Note: There is no reference to chapter 19 of ICD-10, because in single cause tabulation the external cause is tabulated, and not the injury.Reference to ICD-10 chapterCodeCause of death Optional subcategoryCoding hintsICD-10 chapter 1 ?Certain infectious and parasitic diseases?excludes respiratory infections not listed here?5-1Cholera???5-2Typhoid and paratyphoid???5-3Other and unspecified diarrhoeal diseases?includes gastroenteritis?5-4Tuberculosis?excludes HIV disease, with tuberculosis? 5-4.1?Respiratory tuberculosis, confirmed bacteriologically or histologically?? 5-4.9?Other tuberculosis??5-5Plague???5-6Leprosy???5-7Tetanus???5-8Diphtheria???5-9Whooping cough???5-10Meningococcal infection?includes meningococcal meningitis, excludes unspecified meningitis (see nervous section)?5-11Septicaemia???5-12Infections with a predominantly sexual mode of transmission???? 5-12.1?Syphilis???? 5-12.9?Other and unspecified infections with a predominantly sexual mode of transmission??5-13Acute poliomyelitis???5-14Rabies???5-15Dengue???5-16Yellow fever???5-17Other viral haemorrhagic fevers???5-18Measles???5-19Viral hepatitis??? 5-19.1?Hepatitis B?? 5-19.8?Other viral hepatitis?? 5-19.9?Unspecified viral hepatitis??5-20Human immunodeficiency virus [HIV] disease??? 5-20.1?HIV disease with tuberculosis?? 5-20.2?Other and unspecified HIV disease??5-21Malaria?includes malaria in neonates? 5-21.1?Malaria, parasitologically confirmed?? 5-21.9?Other and unspecified malaria??5-22Leishmaniasis???5-23Trypanosomiasis???5-24Schistosomiasis???5-25Other and unspecified infectious diseases??ICD-10 chapter 2 ?Neoplasms?includes all neoplasms and cancers of all organ systems5-26Malignant neoplasm of lip, oral cavity and pharynx???5-27Malignant neoplasm of Oesophagus???5-28Malignant neoplasm of stomach???5-29Malignant neoplasm of colon, rectum and anus???5-30Malignant neoplasm of liver and intrahepatic bile ducts???5-31Malignant neoplasm of pancreas???5-32Malignant neoplasm of larynx???5-33Malignant neoplasm of trachea, bronchus and lung???5-34Malignant melanoma of skin???5-35Malignant neoplasm of breast???5-36Malignant neoplasm of cervix uteri???5-37Malignant neoplasm of other and unspecified parts of uterus???5-38Malignant neoplasm of ovary???5-39Malignant neoplasm of prostate???5-40Malignant neoplasm of bladder???5-41Malignant neoplasm of meninges, brain and other parts of central nervous system???5-42Non-Hodgkin lymphoma???5-43Multiple myeloma and malignant plasma cell neoplasms???5-44Leukaemia???5-45Other and unspecified malignant neoplasms??5-46Benign neoplasms ??ICD-10 chapter 3 ?Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism?excludes neoplasms andcancers?5-47Anaemias???5-48Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism??ICD-10 chapter 4 ?Endocrine, nutritional and metabolic diseases?excludes neoplasms andcancers?5-49Diabetes mellitus???5-50Protein-energy malnutrition???5-51Other and unspecified endocrine, nutritional and metabolic diseases??ICD-10 chapter 5 ?Mental and behavioural disorders???5-52Alcohol use disorders???5-53Drug use disorders???5-54Other mental and behavioural disorders??ICD-10 chapter 6 ?Diseases of the nervous system?excludes neoplasms and cancers?5-55Meningitis???5-56Alzheimer's disease, dementias???5-57Other diseases of the nervous system??ICD-10 chapter 7 5-58Diseases of the eye and adnexa?excludes neoplasms andcancersICD-10 chapter 8 5-59Diseases of the ear and mastoid process?excludes neoplasms and cancersICD-10 chapter 9 ?Diseases of the circulatory system?excludes neoplasms, cancers and cardiac arrest (see 5-95)?5-60Acute rheumatic fever and chronic rheumatic heart diseases???5-61Hypertensive heart diseases???5-62Ischaemic heart diseases?includes myocardial infarction?5-63Other heart diseases???5-64Cerebrovascular diseases???5-65Other and unspecified diseases of the circulatory system??ICD-10 chapter 10 ?Diseases of the respiratory system?excludes neoplasms andcancers?5-66Influenza???5-67Pneumonia?includes neonatal pneumonia?5-68Other acute lower respiratory infections?excludes infections specified in the infectious disease section?5-69Chronic lower respiratory diseases?includes chronic obstructive lung disease, asthma?5-70Other and unspecified diseases of the respiratory system??ICD-10 chapter 11 ?Diseases of the digestive system?excludes neoplasms and cancers?5-71Gastric and duodenal ulcer???5-72Appendicitis???5-73Liver cirrhosis???5-74Other diseases of the digestive system??ICD-10 chapter 12 5-75Diseases of the skin and subcutaneous tissue?excludes neoplasms, cancers and melanoma of skinICD-10 chapter 13 5-76Diseases of the musculoskeletal system and connective tissue?excludes neoplasms and cancersICD-10 chapter 14 ?Diseases of the genitourinary system?excludes neoplasms and cancers?5-77Glomerular and renal tubulo-interstitial diseases?includes pyelonephritis?5-78Other and unspecified diseases of the genitourinary system?includes urinary tract infection, excludes pyelonephritisICD-10 chapter 15 ?Pregnancy, childbirth and the puerperium?excludes tetanus, external causes?5-79Pregnancy with abortive outcome???5-80Maternal hypertensive disorders???5-81Obstructed labour???5-82Maternal haemorrhage???5-83Maternal sepsis???5-84Other direct obstetric deaths??excludes tetanus?5-85Indirect obstetric deaths??ICD-10 chapter 16 ?Certain conditions originating in the perinatal period?excludes tetanus, external causes, malformations, neoplasms, cancers, endocrine diseases (e.g. diabetes mellitus)?5-86Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery???5-87Disorders relating to length of gestation and fetal growth??? 5-87.1?Prematurity?? 5-87.2?Low birth weight? 5.87.9Other and unspecified disorders relating to length of gestation and fetal growth?5-88Birth trauma???5-89Intrauterine hypoxia and birth asphyxia??5-201Sepsis and other infectious conditions of the newbornexcludes malaria, pneumonia?5-90Other and unspecified perinatal conditions??ICD-10 chapter 17 ?Congenital malformations, deformations and chromosomal abnormalities???5-91Congenital hydrocephalus and spina bifida???5-92Congenital malformations of the heart???5-93Down syndrome and other chromosomal abnormalities???5-94Other and unspecified congenital malformations??ICD-10 chapter 18 5-95Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified?includescause of death not specified, or when only ?'respiratory arrest' or 'cardiac arrest' is reportedICD-10 chapter 20 ?External causes of morbidity and mortality???5-96Road traffic accidents???5-97Other transport accidents???5-98Falls???5-99Accidental drowning and submersion???5-100Exposure to smoke, fire and flames???5-101Exposure to forces of nature?includes earthquake, tsunami, storm and flood?5-102Accidental poisoning by and exposure to noxious substances?excludes foodborne infections (see infectious diseases)? 5-102.1?Alcohol poisoning?? 5-102.2?Drug poisoning? 5-102.9?Other and unspecified poisoningincludesnoxious substances eaten as food?5-103Intentional self-harm???5-104Assault???5-105Conflict and war???5-106Other and unspecified external causes??Appendix B – ICD-10 Start-Up Mortality List with ICD-10 codesThis table provides the link from the ICD-10 SMoL List codes to the ICD-10 codes.CodeCause of death Optional subcategoryReference to ICD-10 code (transcode to ICD-10)?Certain infectious and parasitic diseases?ICD-10 chapter 1 5-1Cholera?A005-2Typhoid and paratyphoid?A015-3Other and unspecified diarrhoeal diseases??A02-A095-4Tuberculosis?A15-A19 5-4.1?Respiratory tuberculosis, confirmed bacteriologically or histologically?A15-A16 5-4.9?Other tuberculosis?A17-A195-5Plague?A205-6Leprosy?A305-7Tetanus?A33-A355-8Diphtheria?A365-9Whooping cough?A375-10Meningococcal infection?A395-11Septicaemia?A40-A415-12Infections with a predominantly sexual mode of transmission??A50-A64? 5-12.1?Syphilis?A50-A53?? 5-12.9?Other and unspecified infections with a predominantly sexual mode of transmission?A54-A645-13Acute poliomyelitis?A805-14Rabies?A825-15Dengue?A975-16Yellow fever?A955-17Other viral haemorrhagic fevers?A92-A94, A96, A985-18Measles?B055-19Viral hepatitis?B15-B19 5-19.1?Hepatitis BB16 5-19.8?Other viral hepatitisB15, B17-B18 5-19.9?Unspecified viral hepatitisB195-20Human immunodeficiency virus [HIV] disease?B20-B24 5-20.1?HIV disease with tuberculosisB20 5-20.2?Other and unspecified HIV diseaseB21-B245-21Malaria?B50-B54, P37.3, P37.4 5-21.1?Malaria, parasitologically confirmedB50-B53 5-21.9?Other and unspecified malariaB54, P37.3, P37.45-22Leishmaniasis?B555-23Trypanosomiasis?B56-B575-24Schistosomiasis?B655-25Other and unspecified infectious diseases?A21-A32, A38, A42-A49, A65-A79, A81, A83-A89, B00-B04, B06-B09, B25-B49, B58-B64, B66-B99?Neoplasms?ICD-10 chapter 25-26Malignant neoplasm of lip, oral cavity and pharynx?C00-C145-27Malignant neoplasm of Oesophagus?C155-28Malignant neoplasm of stomach?C165-29Malignant neoplasm of colon, rectum and anus?C18-C215-30Malignant neoplasm of liver and intrahepatic bile ducts?C225-31Malignant neoplasm of pancreas?C255-32Malignant neoplasm of larynx?C325-33Malignant neoplasm of trachea, bronchus and lung?C33-C345-34Malignant melanoma of skin?C435-35Malignant neoplasm of breast?C505-36Malignant neoplasm of cervix uteri?C535-37Malignant neoplasm of other and unspecified parts of uterus?C54-C555-38Malignant neoplasm of ovary?C565-39Malignant neoplasm of prostate?C615-40Malignant neoplasm of bladder?C675-41Malignant neoplasm of meninges, brain and other parts of central nervous system?C70-C725-42Non-Hodgkin lymphoma?C82-C855-43Multiple myeloma and malignant plasma cell neoplasms?C905-44Leukaemia?C91-C955-45Other and unspecified malignant neoplasms?C17, C23-C24, C26-C31, C37-C41, C44-C49, C51-C52, C57-C60, C62-C66, C68-C69, C73-C81, C86-C88, C96-C975-46Benign neoplasms ?D00-D48?Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism?ICD-10 chapter 3 5-47Anaemias?D50-D645-48Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism??D65-D89?Endocrine, nutritional and metabolic diseases?ICD-10 chapter 4 5-49Diabetes mellitus?E10-E145-50Protein-energy malnutrition?E40-E465-51Other and unspecified endocrine, nutritional and metabolic diseases?E00-E07, E15-E35, E50-E90?Mental and behavioural disorders?ICD-10 chapter 5 5-52Alcohol use disorders?F105-53Drug use disorders?F11-F195-54Other mental and behavioural disorders?F00-F09, F20-F99?Diseases of the nervous system?ICD-10 chapter 6 5-55Meningitis?G00-G035-56Alzheimer's disease, dementias?G305-57Other diseases of the nervous system?G04-G26, G31-G995-58Diseases of the eye and adnexa?ICD-10 chapter 7 H00-H595-59Diseases of the ear and mastoid process?ICD-10 chapter 8 H60-H95?Diseases of the circulatory system?ICD-10 chapter 9 5-60Acute rheumatic fever and chronic rheumatic heart diseases?I00-I095-61Hypertensive heart diseases?I10-I155-62Ischaemic heart diseases?I20-I255-63Other heart diseases?I26-I45, I47-I525-64Cerebrovascular diseases?I60-I695-65Other and unspecified diseases of the circulatory system?I70-I99?Diseases of the respiratory system?ICD-10 chapter 10 5-66Influenza?J09-J115-67Pneumonia?J12-J18, P235-68Other acute lower respiratory infections?J20-J225-69Chronic lower respiratory diseases?J40-J475-70Other and unspecified diseases of the respiratory system?J00-J06, J30-J39, J60-J99?Diseases of the digestive system?ICD-10 chapter 11 5-71Gastric and duodenal ulcer?K25-K275-72Appendicitis?K35-K385-73Liver cirrhosis?K745-74Other diseases of the digestive system?K00-K23,K28-K31, K40-K73, K75-K935-75Diseases of the skin and subcutaneous tissue?ICD-10 chapter 12 L00-L995-76Diseases of the musculoskeletal system and connective tissue?ICD-10 chapter 13 M00-M99?Diseases of the genitourinary system?ICD-10 chapter 14 5-77Glomerular and renal tubulo-interstitial diseases?N00-N165-78Other and unspecified diseases of the genitourinary system?N17-N99?Pregnancy, childbirth and the puerperium?ICD-10 chapter 15 5-79Pregnancy with abortive outcome?O00-O085-80Maternal hypertensive disorders?O10-O11, O13-O165-81Obstructed labour?O64-O665-82Maternal haemorrhage?O20, O67, O725-83Maternal sepsis?O855-84Other direct obstetric deaths??O12, O21-O63, O68-O71, O73-O84, O86-O975-85Indirect obstetric deaths?O98-O99?Certain conditions originating in the perinatal period?ICD-10 chapter 16 5-86Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery?P00-P045-87Disorders relating to length of gestation and fetal growth?P05-P08 5-87.1?PrematurityP07.2-P07.3, P22 5-87.2Low birth weightP05, P07.0-P071 5.87.9Other and unspecified disorders relating to length of gestation and fetal growthP085-88Birth trauma?P10-P155-89Intrauterine hypoxia and birth asphyxia?P20-P21, P245-201Sepsis and other infectious conditions of the newbornP35-P39 (exclude P37.3, P37.4)5-90Other and unspecified perinatal conditions?P50-P96?Congenital malformations, deformations and chromosomal abnormalities?ICD-10 chapter 17 5-91Congenital hydrocephalus and spina bifida?Q03, Q055-92Congenital malformations of the heart?Q20-Q245-93Down syndrome and other chromosomal abnormalities?Q90-Q995-94Other and unspecified congenital malformations?Q00-Q02, Q04, Q06-Q18, Q25-Q895-95Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified?ICD-10 chapter 18 I46, R00-R99?External causes of morbidity and mortality?ICD-10 chapter 20 5-96Road traffic accidents?V01-V04, V06, V09-V80, V87, V89, V995-97Other transport accidents?V05,V07-V08, V81-V86, V88, V90-V985-98Falls?W00-W195-99Accidental drowning and submersion?W65-W745-100Exposure to smoke, fire and flames?X00-X095-101Exposure to forces of nature?X30-X395-102Accidental poisoning by and exposure to noxious substances?X40-X49 5-102.1?Alcohol poisoningX45 5-102.2?Drug poisoningX40-X44 5-102.9?Other and unspecified poisoningX46-X495-103Intentional self-harm?X60-X845-104Assault?X85-Y095-105Conflict and war?Y35-Y365-106Other and unspecified external causes?W21-W64, W75-W99, X10-X29, X50-X59, Y10-Y29, Y30-Y34, Y37-Y59, Y60-Y99Appendix C – Overview of the ICDBrief overview of the International Statistical Classification of Diseases and Related Health Problems(ICD)Volume 1 – Tabular listVolume 1 of the ICD-10 has 22 chapters, most of which are related to specific body systems (e.g. Diseases of the circulatory system). The chapters not specific to a body system include six specialty chapters where the listed conditions can occur over multiple body system (e.g. Infectious and parasitic diseases). There is also a separate chapter for external causes of morbidity and mortality.Each chapter is divided into blocks of related conditions which are then subdivided into three-character categories and four-character subcategories. Codes are alphanumeric with a letter being used for the first character and numerals for the second and subsequent characters.Volume 2 – Instructions and guidelines manualVolume 2 of the ICD-10 is the key to understanding the rules and regulations that govern the classification of conditions. It provides guidance on the use of Volumes 1 and 3, and on the rules of mortality and morbidity codingVolume 3 – Alphabetical indexVolume 3 of the ICD is a comprehensive alphabetical index of all the diseases and conditions found in the full tabular list of Volume 1. It contains far more diagnostic terms than the tabular list, reflecting the wide variety of ways in which clinicians describe diseases. Volume 3 consists of:? Section I – an alphabetical listing of terms relating to diseases, nature of injury, reasons for contact with health services and to the factors influencing a person’s health;? Section II – an alphabetical listing of external causes of injury, morbidity and mortality;? Section III – an alphabetically arranged table of drugs and chemicals.Appendix D– ReferencesWHO WEBSITE FOR ICD Online Training Tool E – Common AbbreviationsMedical certifiers are strongly advised NOT to use abbreviations as there is the possibility for ambiguous meanings. Clarification should be sort from the person completing the certificate as to the full name of the condition. If this is not possible, the following is a list of commonly used abbreviations:NOTE: This list is not exhaustive.AAA abdominal aortic aneurysmABE acute bacterial endocarditisACTH adrenocorticotrophic hormoneAF atrial fibrillationAFB acid-fast bacillusAGNacute glomerulonephritisAIDSAcquired immune deficiency syndromeALL acute lymphocytic leukaemiaALTEacute life threatening eventAMIacute myocardial infarctionAMLacute myelocytic leukaemiaAP angina pectorisAPH antepartum haemorrhageAR aortic regurgitationARCAIDS-related complexARDSadult respiratory distress syndromeARFacute renal failureASaortic stenosisASDatrial septal defectBBBbundle branch blockBCCbasal cell carcinomaBNO bladder neck obstructionBP blood pressureBPHbenign prostate hypertrophyBSAbody surface areaCacancerCADcoronary artery diseaseCCFchronic congestive failureCHBcomplete heart blockCIScarcinoma in situCLLchronic lymphocytic (lymphatic) leukaemiaCMLchronic myelocyticleukaemiaCMVcytomegalic virusCNScentral nervous systemCOADchronic obstructive airway diseaseCOPDchronic obstructive pulmonary diseaseCRFchronic renal failureCVAcerebrovascular accidentDICdisseminated intravascular coagulationDJDdegenerative joint diseaseDMdiabetes mellitusDOAdead on arrivalDSDown syndromeDUBdysfunctional uterine bleedingDVTdeep vein thrombosisEBVEpstein-Barr virusESRD end-stage renal diseaseFBforeign bodyGERDgastroesophageal reflux diseaseGSWgunshot woundHIV human immunodeficiency virusHMDhyaline membrane diseaseHSVherpes simplex virusHTLV human T-cell lymphotropic virusHTLV-3 human T-cell lymphotropic virus-IIIHTNhypertensionIADH inappropriate antidiuretic hormoneIDDMinsulin-dependent diabetes mellitusIGA immunoglobin AIHDischemic heart diseaseITP idiopathic thrombocytopenic purpuraIUDintrauterine deathIVHintraventricular haemorrhageJBE Japanese B encephalitisLBBB left bundle branch blockLBW low birth weightLMP last menstrual periodLRI lower respiratory infectionMAC mycobacterium avium complexMAImycobacterium aviumintracellulareMGN membranous glomerulonephritisMRSA methicillin resistant staphylococcal aureusNIDDM non-insulin-dependent diabetes mellitusNSTEMInon-ST-elevation myocardial infarctionOA osteoarthritisOD overdosePDA patent ductusarteriosusPET pre-eclamptic toxaemiaPMD progressive muscular dystrophyPOC product of conceptionPPH postpartum haemorrhagePREMprematurityPROM premature rupture of membranesPU peptic ulcerPUO pyrexia of unknown originPVD peripheral vascular diseaseRDS respiratory distress syndromeRHD rheumatic heart diseaseSARS severe acute respiratory syndromeSBE subacute bacterial endocarditisSBOsmall bowel obstructionSCC squamous cell carcinomaSGA small for gestational ageSIADH syndrome of inappropriate antidiuretic hormoneSIDS sudden infant death syndromeSIRS systemic inflammatory response syndromeSLEsystemic lupus erythematosusSOB shortness of breathSVD spontaneous vaginal deliverySVT supraventricular tachycardiaTAPVR total anomalous pulmonary venous returnTB tuberculosisTBCtuberculosisTIA transient ischemic attackUC ulcerative colitisURIupper respiratory infectionUTIurinary tract infectionVD venereal diseaseVF ventricular fibrillationVSDventricular septal defectVTventricular tachycardiaWC whooping coughWPWWolfe-Parkinson-White syndromeYFyellow feverAppendix F – Answers to Exercises1.CONDITIONAcceptableNot AcceptableE Coli as a cause of a urinary tract infection√Caesarean section delivery√Poisoned by a snake bite√Visual impairment resulting from eye cancer√Fractured leg from a fall out of a tree√Hints: Certain conditions that may not be used for underlying cause of death,Rules SR8, SR18, SR252.Colon cancerHint: SR183.Cerebral infarctionHint: SR24.AppendicitisHint: SR255.Coronary artery diseaseHint: SR66.Diabetes mellitusHint: SR197.Tuberculosis meningitis Hint: SR168.Suicide – hangingHint: SR99.Fetus and newborn affected by maternal factorsHint: SR1310.HIVHint: SR1811.AsthmaHint: SR612.Bitten by dogHint: Injuries take priority over infections13.Klebsiella pneumonia septicaemiaHint: SR714.Placenta praeviaHint: SR10, SR2515.Traffic accident – Pedestrian struck by carHint: SR816.MalariaHint: SR1517.Fall from ladderHint: SR818.Indirect obstetric deathHint: SR1119.Car accidentHint: SR820.MeaslesHint: SR1521.Cirrhosis of liverHint SR122.Peripheral vascular diseaseHint SR323.Coronary artery diseaseHint SR424.Other ill-defined and unspecified causes of mortalityHint SR525.Neonatal cardiac failureHint SR1226.Angina pectorisHint SR2127.Severe pre-eclampsiaHint SR1028.InfluenzaHint SR2229.DementiaHint SR2330.Peripheral artery diseaseHint SR2431.GangreneHint SR2632.Indirect obstetric deathHint SR1133.Colon cancerHint SR1834.InfluenzaHint SR22 ................
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