Instructions for the Automated Classification of the Initiating and Multiple Causes of Fetal Deaths, 2024

 

 

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

National Center for Health Statistics

INSTRUCTIONS FOR THE AUTOMATED CLASSIFICATION OF THE INITIATING AND MULTIPLE CAUSES OF FETAL DEATHS, 2024

SECTION I:    General Concepts For Coding Fetal Deaths

A.      INTRODUCTION

This manual provides instructions to NCHS mortality medical coders and nosologists for coding multiple causes of fetal death reported on the 2003 Revision of the Fetal Death Reports filed in the states. These mortality coding instructions are used by the National Center for Health Statistics (NCHS), which is the Federal agency responsible for the compilation of U.S. statistics on causes of fetal death. NCHS is part of the Centers of Disease Control and Prevention.

In coding causes of fetal death, NCHS refers to the World Health Organization’s most recent revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for processing the data for fetal mortality tabulation.

Beginning with fetal deaths occurring in 1999, ICD-10 has been used for coding and classifying causes of fetal 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 sub-categories. The supplementary Z code Classification appears in Volume 1 but is not used for classifying mortality cause of death data, including fetal deaths. Optional fifth characters are provided for certain categories and an optional independent four-character coding system is provided to classify histological varieties of neoplasm, prefixed by the letter M (for morphology) and followed by a fifth character indicating behavior. These optional codes are not used at NCHS. Volume 2 includes the international rules and notes used in classifying and tabulating cause of death data including fetal death data. Volume 3 is an alphabetical index containing a comprehensive list of terms and codes for use in coding. Copies of these volumes may be purchased. See ordering information at https://www.who.int/classifications/icd/en/.

NCHS prepares updated versions of Volume 1 and Volume 3 annually https://www.cdc.gov/nchs/nvss/instruction_manuals.htm The major purpose of these updated versions is to provide and maintain a single published source of new and/or corrected code assignments including terms not indexed in Volume 3 and/or not classified in Volume 1 of ICD-10.

Each year, all the major revisions from previous manuals will be documented in the Introduction of this manual under the heading “Major Revisions from Previous Manuals”.

This manual documents concepts and instructions for coding multiple causes of fetal death consistent with the provisions of ICD-10. This manual should be used in conjunction with the latest updated versions of ICD-10, Volumes 1 and 3 and the Perinatal Subset of medical terms. The Perinatal Subset is a list of terms classified to Chapter XVI, Certain conditions originating in the perinatal period (P00-P96). It is updated annually.

ICD-10 provides for the classification of certain medical conditions according to two different axes - the etiology or initiating disease process, referred to as the “dagger” code, and the manifestation or complication code, referred to as the “asterisk” code. NCHS uses and publishes only the dagger codes. This dual system was introduced in the Ninth Revision of the ICD and remained an integral part of the ICD-10.

For example, Coxsackie myocarditis has a code (B33.2†) marked with a “dagger” in Chapter 1, Certain infectious and parasitic diseases and a different code (I41.1*) marked with an “asterisk” in Chapter 9, Diseases of the circulatory system. NCHS only codes the B33.2. Similarly, diabetic nephropathy has a dagger code (E14.2†) in Chapter IV, Endocrine, nutritional and metabolic diseases and an asterisk code (N08.3*) in Chapter XIV, Diseases of the genitourinary system. NCHS only codes the E14.2.

The fetal death multiple cause codes are used as inputs to the ACME System (Automated Classification of Medical Entities) which was developed by NCHS to automatically select the underlying cause of death and the TRANSAX System (Translation of Axes) used to produce multiple cause of death statistics, beginning with deaths occurring in 1968. ACME will be used as the automated system for selecting the initiating cause of fetal deaths. The ACME System requires codes be assigned for each condition reported on the Fetal Death Report, usually in the order the information is recorded on the report. The output data of the system are the initiating causes of fetal deaths assigned by applying the underlying cause Selection Rule 3 and Modification Rules A-E of the Classification. These rules are documented in the ICD-10, Volume 2. The same cause is selected as if one applied the manual cause of fetal death coding instructions specified in Instruction Manual 2J, Instructions for the Manual Classification of the Initiating Cause of Fetal Deaths, 2012.

https://www.cdc.gov/nchs/nvss/instruction_manuals.htm

Major revisions from previous manuals

1.       Corrections have been made to clarify instructions, spelling, and format throughout the manual. These changes are not specifically noted.

2.       Added new symbol "99" in Appendix A

3.       Added new ITOP reporting in Appendix I

Other manuals relating to coding causes of death are:

Part 2a, NCHS Instructions for Classifying the Underlying Cause of Death, 2024

Part 2b, Instructions for Classifying Multiple Causes of Death, 2024

Part 2c, ICD-10 ACME Decision Tables for Classifying the Underlying Causes of Death, 2024

Part 2s, SuperMICAR Data Entry Instruction, 2011

B.      DEFINITIONS

Fetal Death is defined as “death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.”

Induced Termination of Pregnancy (Abortion) is defined as “purposeful interruption of an intrauterine pregnancy with the intention other than to produce a liveborn infant and which does not result in a live birth.” This definition excludes management of prolonged retention of products of conception following fetal death.

Ectopic pregnancy reported with an intentional intervention An ectopic pregnancy reported with an intentional intervention, such as “removal of embryo”, is not included in the fetal death file. Records with this type of event reported will be identified by the coder and proper steps taken for removal.

Live Birth is defined as “the expulsion or extraction from its mother of a product of human conception, irrespective of the duration of the pregnancy, which, after such expulsion or extraction, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.” "

This manual only includes instructions on coding causes of fetal deaths which includes “spontaneous abortions”. Terms interpreted as spontaneous abortions are included in Appendix G.

Induced abortions and live births are not included in the fetal death file. Terms interpreted as induced abortions are included in Appendix H.

C.      Item 18. CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

The U.S. Standard Report of Fetal Death provides spaces for a certifier to record pertinent information concerning the diseases, morbid conditions, and injuries which either resulted in or contributed to a fetal death. The CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH portion of the Fetal Death Report includes items 18a and 18b. It is designed to obtain the opinion of the certifier as to the initiating cause and prompts the certifier to report specific conditions.

A cause of fetal death is the morbid condition or disease process, abnormality, injury, or poisoning leading directly to fetal death. The initiating cause of fetal death is the disease or injury, which initiated the chain of morbid events leading directly to death or the circumstances of the accident or violence, which produced fatal injury. A fetal 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 format in the 2003 Revision of the Fetal Death Report which the certifier is requested to record the causes of fetal death facilitates the selection of the initiating cause when two or more causes are reported. He or she is requested to report an initiating condition in Item 18a and all remaining causes in Item 18b.

D.      INCLUSIONS IN THE FILE

In some circumstances, the conditions reported in 18. Cause/Conditions Contributing to Fetal Death may indicate that this is not a fetal death. If the event does not meet the definition of a fetal death, the records will be removed automatically.

Induced terminations of pregnancy should be included in the fetal death file only when the fetus was known dead before the procedure and when the induction was performed for the sole purpose of removing an already-dead fetus. The term “induced termination of pregnancy” implies an induced termination of the pregnancy in progress, not one in which the fetal death has already occurred. Appendix G contains a list of terms not considered as induced abortions and that are coded as fetal deaths.

Image of US standard fetal death certificate

SECTION II:   General Instructions

A.      INTRODUCTION

EXCERPT FROM U.S. STANDARD REPORT OF FETAL DEATH (Rev. 11/2003)         

18. CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

                                                                                  

  18a. INITIATING CAUSE/CONDITION           18b. OTHER SIGNIFICANT CAUSES OR         

                                               CONDITIONS                         

 

 (AMONG THE CHOICES BELOW, PLEASE                                                 

 SELECT THE ONE WHICH MOST LIKELY         (SELECT OR SPECIFY ALL OTHER            

 BEGAN THE SEQUENCE OF EVENTS             CONDITIONS CONTRIBUTING TO DEATH        

 RESULTING IN THE DEATH OF THE FETUS)     IN ITEM 18b)                            

 

 Maternal Conditions/Diseases             Maternal Conditions/Diseases            

 (Specify)_____________________________   (Specify)_____________________________  

 

 Complications of Placenta, Cord, or      Complications of Placenta, Cord, or     

 Membranes                                Membranes                               

 

 ☐ Rupture of membranes prior to          ☐ Rupture of membranes prior to        

    onset of labor                           onset of labor                       

 ☐ Abruptio placenta                      ☐ Abruptio placenta                    

 ☐ Placental insufficiency                ☐ Placental insufficiency              

 ☐ Prolapsed cord                         ☐ Prolapsed cord                       

 ☐ Chorioamnionitis                       ☐ Chorioamnionitis                     

 ☐ Other                                  ☐ Other                                

 (Specify)_____________________________   (Specify)_____________________________  

 

 Other Obstetrical or Pregnancy           Other Obstetrical or Pregnancy          

 Complications                            Complications                           

 (Specify)_____________________________   (Specify)_____________________________  

 

 Fetal Anomaly                            Fetal Anomaly                           

 (Specify)_____________________________   (Specify)_____________________________  

 

 Fetal Injury                             Fetal Injury                            

 (Specify)_____________________________   (Specify)_____________________________  

 

 Fetal Infection                          Fetal Infection                         

 (Specify)_____________________________   (Specify)_____________________________  

 

 Other Fetal Conditions/Disorders         Other Fetal Conditions/Disorders        

 (Specify)_____________________________   (Specify)_____________________________  

 

 ☐ Unknown                                ☐ Unknown                             

                                                                                  

 

 

Code all information reported in Item 18 of the Fetal Death Report, “CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

Refer to the sex of the fetus to assign the most appropriate cause of fetal death code.

In Volumes 1 and 3 of ICD-10 and the Perinatal Subset, the fourth-character subcategories of three-character categories are preceded by a decimal point. For coding purposes, omit the decimal point.

The data will be entered in the same format for coding and entering multiple causes of fetal deaths as used for coding multiple causes of death for regular mortality data and will be processed through Underlying cause selection Rule 3 and the Modification Tables of the ACME System Decision Tables. A screen will be generated in the same format used for entering regular mortality multiple cause data. The State File Number will also be generated.

Enter codes in 18a as if reported on the uppermost line of Part I of the regular death certificate in the same order as the entries they represent, proceeding from the entry reported uppermost, downward and from the left to right. Terms requiring special formatting may affect the placement of codes. If the lower line is an obvious continuation of a line above, enter the codes accordingly. When an identical code applies to more than one condition reported, enter the code for the first-mentioned of these conditions only. If the entries are numbered, code in numeric order.

Enter codes in 18b as if reported in Part II of the regular death certificate in the same order as the entries they represent, proceeding from the entry reported uppermost, downward and from the left to right. If the lower line is an obvious continuation of a line above, enter the codes accordingly. When an identical code applies to more than one condition reported, enter the code for the first-mentioned of these conditions only.

NOTE: Repetitive (identical) codes are acceptable, if reported once in 18a (Part 1) and once in 18b (Part II). They are not acceptable if reported together in 18a (Part 1) or together in 18b (Part II).

EXAMPLE:

                                                                                  

  18a. INITIATING CAUSE/CONDITION           18b. OTHER SIGNIFICANT CAUSES OR         

                                               CONDITIONS                         

 

 (AMONG THE CHOICES BELOW, PLEASE                                                 

 SELECT THE ONE WHICH MOST LIKELY         (SELECT OR SPECIFY ALL OTHER            

 BEGAN THE SEQUENCE OF EVENTS             CONDITIONS CONTRIBUTING TO DEATH        

 RESULTING IN THE DEATH OF THE FETUS)     IN ITEM 18b)                            

 

 Maternal Conditions/Diseases             Maternal Conditions/Diseases            

 (Specify)_____________________________   (Specify)_____________________________  

 

 Complications of Placenta, Cord, or      Complications of Placenta, Cord, or     

 Membranes                                Membranes                               

 

 ☐ Rupture of membranes prior to          ☐ Rupture of membranes prior to        

    onset of labor                           onset of labor                       

 ☐ Abruptio placenta                      ☐ Abruptio placenta                    

 ☐ Placental insufficiency                ☐ Placental insufficiency              

 X Prolapsed cord                         ☐ Prolapsed cord                       

 ☐ Chorioamnionitis                       ☐ Chorioamnionitis                     

 ☐ Other                                  ☐ Other                                

 (Specify)_____________________________   (Specify)_____________________________  

 

 Other Obstetrical or Pregnancy           Other Obstetrical or Pregnancy          

 Complications                            Complications                           

 (Specify)_____________________________   (Specify)  Breech delivery              

 

 Fetal Anomaly                            Fetal Anomaly                           

 (Specify)_____________________________   (Specify)_____________________________  

 

 Fetal Injury                             Fetal Injury                            

 (Specify)_____________________________   (Specify)_____________________________  

 

 Fetal Infection                          Fetal Infection                         

 (Specify)_____________________________   (Specify)_____________________________  

 

 Other Fetal Conditions/Disorders         Other Fetal Conditions/Disorders        

 (Specify)  fetal distress                (Specify) fetal heart failure during    

                                                    delivery                      

 

 ☐ Unknown                                ☐ Unknown                              

                                                                                  

 

 

Code in this order, Part 1 (18a) prolapsed cord, fetal distress, Part II (18b) breech delivery affecting fetus and fetal heart failure.

B.      EXCESSIVE CODES

When a line in 18a (Part I) or 18b (Part II) requires more than eight codes, delete the excessive codes (any over eight) for the line using the following criteria in the order listed:

NOTE: During the deletion process, when the numbers of existing codes become eight, discontinue the deletion process. The ACME System can tolerate a record with eight codes per line.

1.   Delete ill-defined conditions, P042, P070, P071, P072, P073, P201, P209, P219, P95, and R000-R99 (except when one of these codes is the first code on the line), proceeding right to left.

2.   Delete any nature of injury codes classified to S000-T983 (except when one of these codes is the first code on the line), proceeding right to left.

3.   Delete any repetitive codes (except the first one on a line) proceeding right to left.

4.   If, after applying the preceding criteria, 18a or 18b still has more than eight codes, delete beginning with the last code on the line until only eight remain.

When a single record requires more than fourteen codes, delete the excessive codes using the following criteria in the order listed:

NOTE: During the deletion process, when the number of existing codes become fourteen, discontinue the deletion process. The ACME System can tolerate a record with fourteen codes.

Begin deleting in 18b (Part II).

1.   Delete all ill-defined conditions classified to P042, P070, P071, P072, P073, P201, P209, P219, P95 and R000-R99 in 18b (Part II). Do not delete an ill-defined condition when it is the first code in 18b (Part II). Proceed deleting right to left in 18b (Part II). If there are more than fourteen codes remaining after deleting the ill-defined codes in 18b (Part II), delete any of the above ill-defined codes in 18a (Part I) applying the same criteria and order of deletion.

2.   Delete any nature of injury codes classified to S000-T983. Do not delete a nature of injury code when it is the first code in 18b (Part II). Proceed deleting right to left in 18b (Part II). If there are more than fourteen codes remaining after deleting the nature of injury codes in 18b (Part II), delete any of the above nature of injury codes in 18a (Part I) applying the same criteria and order of deletion.

3.   Delete any repetitive codes. Do not delete a repetitive code when it is the first code in 18b (Part II). If there are more than fourteen codes remaining after deleting the repetitive codes in 18b (Part II), delete repetitive codes in 18a (Part I), applying the same criteria and order of deletion. Proceed right to left until there are only fourteen codes remaining on the record.

C.      GENERAL CODING CONCEPT

The coding of cause of fetal death information consists of the assignment of the most appropriate ICD-10 code(s) for each diagnostic entity reported on the Fetal Death Report. In order to arrive at the appropriate code for a diagnostic entity, code each entity separately. Do not apply provisions in ICD-10 for linking two or more diagnostic terms to form a composite diagnosis classifiable to a single ICD-10 code.

 

Plural form of disease

Do not use the plural form of a disease or the plural form of a site to indicate “multiple”.

EXAMPLE: Congenital defects    Q899

Code Q899, Defect, congenital. Do not code Q897, multiple congenital defects.

 

Implied “disease

When an adjective or noun form of a site is entered as a separate diagnosis, i.e., it is not part of the entry immediately preceding or following it, assume the word “disease” after the site and code accordingly.

 

Drug dependent, drug dependency

When drug dependent or drug dependency modifies a condition, consider as a non-codable modifier unless indexed.

 

Conditions qualified by “rule out,” “ruled out,” “r/o”

When a condition is qualified by “rule out,” “ruled out,” or “r/o,” etc., do not enter a code for the condition.

 

Non-indexed and illegible entries

Terms not indexed

When a term is reported that is not in the index, enter “P95” on the record where a code for the non-indexed term would go. If there are other classifiable entries reported, disregard the non-indexed term and code the remaining entries as indexed.

Illegible entries

When an illegible entry is the only entry on the report, code P95. When an illegible entry is reported with other classifiable entries, disregard the illegible entry and code the remaining entries as indexed.

 

Qualifying Conditions as Acute or Chronic

Acute and chronic

Sometimes the terms acute and chronic are reported preceding two or more conditions. In these cases, use the term (“acute” or “chronic”) with the condition it immediately precedes.

 

Punctuation Marks

1.   Disregard punctuation marks such as a period, comma, semicolon, colon, dash, slash, question mark or exclamation mark when placed at the end of a line in 18a. Do not apply this instruction to a hyphen (-) which indicates a word is incomplete.

2.   When conditions are separated by a slash (/), code each condition as indexed.

3.   When a dash (-) or slash (/) is used to separate sites reported with one condition and the combination of the sites is indexed to a single ICD-10 code, disregard the punctuation and code as indexed. This does not apply to commas.

4.   When conditions are indexed together, yet separated by a comma, code the conditions separately. If the term following the comma is an adjective, refer to instructions on coding adjectival modifiers.

D.      Definitions and Types of Diagnostic Entities

A diagnostic entity is a single term or a composite term, comprised of one word or of two or more adjoining words, that is used to describe a disease, nature of injury, or other morbid condition. In this manual, diagnostic entity and diagnostic term are used interchangeably. A diagnostic entity may indicate the existence of a condition classifiable to a single ICD-10 category or it may contain elements of information that are classifiable to different ICD-10 categories. For coding purposes, it is necessary to distinguish between two different kinds of diagnostic entities - a “one-term entity,” and a “multiple one-term entity.”

One-term entity

1.   A one-term entity is a diagnostic entity classifiable to a single ICD-10 code.

2.   A diagnostic term that contains one of the following adjectival modifiers indicates the condition modified has undergone certain changes and is considered to be a one-term entity:

adenomatous     hypoxemic

anoxic          hypoxic

congestive      inflammatory

cystic          ischemic

embolic         necrotic

erosive         obstructed, obstructive

gangrenous      ruptured

hemorrhagic

          (These instructions apply to the above adjectival modifiers only.)

          For code assignment, apply the following criteria in the order stated:

a.   If the modifier and lead term are indexed together, code as indexed.

b.   If the modifier is not indexed under the lead term, but “specified” is, use the code for specified (usually .8).

c.    If neither the modifier nor “specified” is indexed under the lead term, refer to Volume 1 under the NOS code for the lead term and look for an applicable specified 4th character subcategory.

d.   If neither a, b, or c apply, code the lead term without the modifier.

Multiple one-term entity

A multiple one-term entity is a diagnostic entity consisting of two or more contiguous words on a line for which the Classification does not provide a single code for the entire entity but does provide a single code for each of the components of the diagnostic entity. Consider as a multiple one-term entity if each of the components can be considered as separate one-term entities, i.e., they can stand alone as separate diagnosis. Code each component of the multiple one-term entity as indexed and on the same line where reported.

Adjectival modifiers

NOTE: Code an adjective reported at the end of a diagnostic entity as if it preceded the entity. If indexed to a single code, use that code. If not indexed together, follow the instructions for coding multiple one-term entities.

1.   If an adjectival modifier is reported with more than one condition, modify only the first condition.

2.   If an adjectival modifier is reported with one condition and more than one site is reported, modify all sites.

3.   If an adjectival modifier precedes two different diseases that are reported with a connecting term, modify only the first disease.

4.   If the adjectival form of a word(s) or a qualifier(s) is reported in parenthesis, use the adjective to modify the term preceding it.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY   

 BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)   

 

 Maternal Conditions/Diseases                                        

 (Specify) Diabetic nephrosis and vascular disease                   

                                                                     

 

 

Code 18a (Part 1) to P701 P003.

Code 18a (Part I) P701, Maternal condition, affecting fetus or newborn, diabetes mellitus (conditions in E10-E14) and P003, Maternal condition, affecting fetus or newborn, circulatory disease, (conditions in I00-I99, Q20-Q28). Do not modify the vascular disease as diabetic since there are two separate diseases reported with a connecting term.

Parenthetical Entries

When one medical entity is reported, followed by another complete medical entity enclosed in parenthesis, disregard the parenthesis and code as separate terms.

a)   When the adjective form of words or qualifiers are reported in parenthesis, use the adjectives to modify the entity preceding it.

b)   If the term in parenthesis is not a complete term and is not a modifier, consider as part of the preceding term.

EXAMPLES:

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

  (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY    

  BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)    

 

  Maternal Conditions/Diseases                                         

 (Specify) Diabetic renal disease (Nephrosis)                        

                                                                     

 

 

Code 18a (Part 1) P701 P001.

Code 18a (Part I) P701, Maternal condition, affecting fetus or newborn, diabetes mellitus (conditions in E10-E14) and P001, Maternal condition, affecting fetus or newborn, nephritis, nephrotic syndrome and nephrosis (conditions in N00-N08). Nephrosis enclosed in parenthesis is a complete medical entity that can stand alone; therefore, code as a separate entity.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY   

 BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)   

 

 Maternal Conditions/Diseases                                        

 (Specify) Renal disease (Diabetic)                                  

                                                                     

 

 

Code 18a (Part 1) P701.

Code 18a (Part I) P701, Maternal condition, affecting fetus or newborn, diabetes mellitus (conditions in E10-E14). Code as Diabetic renal disease. Consider “Diabetic” as an adjective modifying renal disease.

E.       CODING FETAL CONDITIONS

Conditions of the fetus can be coded to almost any category in the list of valid codes (Appendix D) other than P000-P049 but will most often be coded to categories P050-P95, Perinatal conditions and Q000-Q999, Congenital anomalies.

In assigning codes for conditions of the fetus, code as indexed in this priority order:

fetus

fetal

affecting fetus or newborn

fetus or newborn

congenital

However, pay special attention to the availability of a relevant code in the Perinatal Subset. There is a subset of Volume 3, the alphabetical index, dedicated to perinatal conditions and referred to as the Perinatal Subset. NCHS provides this as a separate document to assist coders in identifying conditions indexed as “fetus and newborn” or classified to Chapter XVI. It is updated annually.

EXAMPLES:

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY   

 BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)   

 

 Fetal anomaly                                                       

 (Specify) Congenital diaphragmatic hernia                           

                                                                     

 

 

Code 18a (Part 1) Q790.

Code 18a (Part I) Q790, Hernia, diaphragm, diaphragmatic, congenital since not indexed as fetus, fetal, affecting fetus or newborn, fetus or newborn or newborn. or less than 28 days.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY   

 BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)   

 

 Other Fetal Conditions/Disorders                                    

 (Specify) Central respiratory failure                               

                                                                     

 

 

Code 18a (Part 1) G938

Code 18a (Part 1) G938, Failure, respiratory, central since central respiratory failure is not indexed as fetus, fetal, fetus or newborn or congenital. G938 is a valid fetal death code. Refer to Appendix D for a list of Valid Fetal Death Codes.

F.       CODING MATERNAL CONDITIONS

Maternal conditions affecting the fetus should be coded to categories P000-P049. When conditions of the mother directly impact the fetus and are reported on the Fetal Death Report and the condition is not indexed, refer to Volume I, Chapter XVI to categories P000-P049, Fetus and newborn affected by maternal factors and by complications of pregnancy, labor and delivery. Also, refer to the Index under:

Maternal condition, affecting fetus or newborn

Pregnancy, complicated by

Delivery, complicated by

Labor

The complication itself, such as Placenta, abnormality, affecting fetus or newborn.

EXAMPLES:

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY   

 BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)   

 

 Maternal Conditions/Diseases                                        

 (Specify) Maternal malnutrition                                     

                                                                     

 

 

Code 18a (Part I) P004

Code 18a (Part I) P004, Maternal malnutrition affecting fetus or newborn as indexed.

Assign category P008 to maternal conditions not indexed or classifiable to any other specified category. A list of all conditions not indexed and assigned code P008 will be maintained and will be added to the annual update of Volume 3 and also included in the Perinatal Subset. Please refer all conditions assigned to code P008 to Supervisor and/or a designated contact to ensure they will be incorporated into the next annual edition of Volume 3 and the Perinatal Subset.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY   

 BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)   

 

 Maternal Conditions/Diseases                                        

 (Specify) Crohn disease                                             

                                                                     

 

 

Code 18a (Part 1) P008

Code 18a (Part 1) P008, Maternal condition, affecting fetus or newborn, Crohn's disease.

Complications of Placenta, Cord, or Membranes

When the checkbox items in 18a and 18b are marked, each should be assigned codes as follows:

 Rupture of membranes prior to onset of labor

 Abruptio placenta

 Placental insufficiency

 Prolapsed cord

 Chorioamnionitis

 Other (specify)

If the checkbox for rupture of membranes prior to onset of labor is marked, assign code P011.

If the checkbox for abruptio placenta is marked, assign code P021.

If the checkbox for placental insufficiency is marked, assign code P022.

If the checkbox for prolapsed cord is marked, assign code P024.

If the checkbox for chorioamnionitis is marked, assign code P027.

If the checkbox for Other is marked ‘Y’ and no codeable condition or a condition classified to P95 is reported in the ‘Other (specify)’, assign codes P022, P026, and P029; regardless of whether any of the previous boxes have been checked.

If specified conditions are written in the ‘Other (specify)’, code the condition to the mother unless obviously of the fetus. (example, anencephaly - the absence of a large part of the brain and the skull; this is clearly a condition of the fetus.)           

☐ Fetal injury    If reported as a result of an external cause, the instructions for coding external causes on regular mortality data will apply.

☐ Unknown       code P95 (only if no other information is on record)

EXAMPLES:

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 Complications of Placenta, Cord, or Membranes                       

 

 Other:  Y                             Other:  Y                     

 

 Other (specify) Unknown        OR     Other (specify):  NONE        

                                                                     

 

 

Code 18a (Part I) P022 P026 P029

Code 18a (Part I) P022 P026 P029, complication of placenta, cord, or membranes. It seems that the certifier is saying yes, there is a complication of the placenta, cord, or membranes: they’re just not sure what the specific complication is.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 Complications of Placenta, Cord, or Membranes                       

 

 Rupture of membranes:  Y                                            

 

 Other:  Y                                                           

 

 Other (specify):  Previous Birth                                    

                                                                     

 

 

Code 18a (Part I) P011 P022 P026 P029

Code 18a (Part I) P011, Rupture of membranes and P022, P026, P029 complication of placenta, cord, or membranes since the checkbox is marked ‘Y’ and previous birth is not a codeable condition.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 Complications of Placenta, Cord, or Membranes                       

 

 Other:  Y                                                           

 

 Other (specify):  Twin-Twin Transfusion Syndrome                    

                                                                     

 

 

Code 18a (Part I) P023

Code 18a (Part I) P023, Twin-Twin Transfusion Syndrome. Since a codeable condition is reported in the ‘Other (specify)’, do not assign the 3 codes for complication of placenta, cord, or membranes.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 Complications of Placenta, Cord, or Membranes                       

 

 Other:  Y                                                           

 

 Other (specify):                                                    

 

 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS                         

 

 Other Fetal Conditions/Disorders: Fetal Demise                      

                                                                     

 

 

Code 18a (Part I) P022 P026 P029

Code 18a (Part I) P022 P026 P029, complication of placenta, cord, or membranes and leave 18b (Part II) blank since P95 is not assigned when other information is on the record.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 Complications of Placenta, Cord, or Membranes                       

 

 Other:  Y                                                           

 

 Other (specify):                                                    

 

 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS                         

 

 Complications of Placenta, Cord, or Membranes                       

 

 Other:  Y                                                           

 

 Other (specify):                                                    

                                                                     

 

 

Code 18a (Part I) P022 P026 P029/Code 18b (Part II) P022 P026 P029

Code 18a (Part I) P022 P026 P029, complication of placenta, cord, or membranes and code 18b (Part II) P022 P026 P029, complication of placenta, cord, or membranes since the checkbox is marked ‘Y’ in both places.

G.      Format

Conditions reported in 18a

Enter the codes for entries in 18a in the order the entries are reported, proceeding from the entry reported uppermost in 18a from left to right, if there is more than one entry on the same line. If the entries are numbered, code in numeric order.

Connecting Terms

“Due to” written in or implied in Items 18a and 18b

When the certifier has stated that one condition was due to another or has used another connecting term that implies a due to relationship between conditions in items18 and 18b, take into consideration the position of the term in 18a/18b and code the entry following the “written-in due to” directly preceding the term.

a)   The following connecting terms must be “written in” and are interpreted as meaning “due to” when the entity immediately preceding and following these terms is a disease condition, nature of injury or an external cause:

after                    incident to       received in

arising in or during     incurred after    resulting from

as (a) complication of   incurred during   resulting when

as a result of           incurred in       secondary to (2°)

because of               incurred when     subsequent to

caused by                induced by        sustained as

complication(s) of       occurred after    sustained by

during                   occurred during   sustained during

etiology                 occurred in       sustained in

following                occurred when     sustained when

for                      occurred while    sustained while

from                     origin

in                       received from

 

EXAMPLES:

                                                                      

  18a.  INITIATING CAUSE/CONDITION                                      

 

 (AMONG THE CHOICES BELOW, PLEASE SELECT THE ONE WHICH MOST LIKELY    

 BEGAN THE SEQUENCE OF EVENTS RESULTING IN THE DEATH OF THE FETUS)    

 

 Other Fetal Conditions/Disorders                                     

 (Specify) Anoxia and hemorrhage caused by hemolytic disease of fetus 

                                                                      

 

 

Code 18a (Part 1) to P209 P559 P509

Code 18a (Part 1) P209, Anoxia, fetal, fetus, P559, Disease, hemolytic (fetus) (newborn) and P509, Hemorrhage, fetal, fetus. Code the Hemolytic disease of fetus immediately preceding the hemorrhage.

                                                                     

  18a.  INITIATING CAUSE/CONDITION                                     

 

 Maternal Conditions/Diseases                                        

 

 (Specify) Fetal cardiac failure due to maternal polyhydramnios      

                                                                     

 

 

Code 18a (Part 1) P013 P298

Code 18a (Part 1) P013, Polyhydramnios, affecting fetus or newborn and P298, Failure, heart, fetal. Code maternal polyhydramnios as the first entry in 18a (Part I), directly preceding the fetal cardiac failure.

When one of the above terms is the first entry in 18b, indicating the entry following the term on the above list is a continuation of 18a, code in 18a. Take into consideration the position of the term in 18a and code the entry following the “written-in due to” in 18b directly preceding the term in 18a.

EXAMPLES:

                                                                      

  18a. INITIATING CAUSE/CONDITION     18b. OTHER SIGNIFICANT CAUSES OR   

                                         CONDITIONS                   

 

 (AMONG THE CHOICES BELOW,                                            

 PLEASE SELECT THE ONE WHICH        (SELECT OR SPECIFY ALL OTHER      

 MOST LIKELY BEGAN THE SEQUENCE     CONDITIONS CONTRIBUTING TO        

 OF EVENTS RESULTING IN THE         DEATH IN ITEM 18b)                

 DEATH OF THE FETUS)                                                  

 

 Fetal Injury                       Maternal Conditions/Diseases      

 (Specify)Fetal anoxia              (Specify)resulting from maternal  

                                             hypertension             

                                                                      

 

 

Code 18a (Part 1) P000 P209

Code 18a (Part 1) P000, Maternal condition, affecting fetus or newborn, hypertension (conditions in 010-011, 013-016) and P209, Anoxia, fetal, fetus. Code maternal hypertension in 18b directly preceding fetal anoxia in 18a.

                                                                       

  18a. INITIATING CAUSE/CONDITION      18b. OTHER SIGNIFICANT CAUSES OR   

                                          CONDITIONS                   

 (AMONG THE CHOICES BELOW,                                             

 PLEASE SELECT THE ONE WHICH         (SELECT OR SPECIFY ALL OTHER      

 MOST LIKELY BEGAN THE SEQUENCE      CONDITIONS CONTRIBUTING TO        

 OF EVENTS RESULTING IN THE          DEATH IN ITEM 18b)                

 DEATH OF THE FETUS)                                                   

 

 Maternal Conditions/Diseases                                          

 (Specify)Fetopelvic disproportion                                     

                                     Other Fetal Conditions/Disorders  

 Other Fetal Conditions/Disorders    (Specify)Breech deliver           

 (Specify) Anoxia due to 18b                                           

                                                                       

 

 

Code 18a (Part 1) P031 P030 P209

Code 18a (Part 1) P031, Disproportion (fetopelvic), affecting fetus or newborn, P030, Delivery, breech, affecting fetus or newborn, and P209, Anoxia, fetal, fetus. Code Breech delivery, affecting fetus or newborn in18b, directly preceding the anoxia in 18a.

b)   Not indicating a “due to” relationship

When conditions are separated by “and” or by another connecting term that does not imply a “due to” relationship, enter the codes for these conditions on the same line in the order the conditions are reported.

 

The following terms imply that conditions are meant to remain on the same line. They are separated by “and” or by another connecting term that does not imply a “due to” relationship”:

and                  consistent with

accompanied by       with (c)

also                 precipitated by

associated with      predisposing (to)

complicated by       superimposed on

complicating

 

EXAMPLE:

                                                                      

  18b.  OTHER SIGNIFICANT CAUSES OR CONDITIONS                          

 

 (SELECT OR SPECIFY ALL OTHER CONDITIONS CONTRIBUTING TO DEATH IN     

 ITEM 18b)                                                            

 

 Fetal Anomaly                                                        

 (Specify) Cleft palate with cleft lip                                

                                                                      

 

 

Code 18b (Part II) Q359 Q369

Code 18b (Part II) Q359, Cleft, palate and Q369, Cleft lip. Code each entity separately even though ICD-10 provides a combination code for cleft palate and cleft lip.

c)   Conditions reported in 18b

NOTE: Enter the codes for entries in 18b in the order the entries are reported, proceeding from the entry reported uppermost in 18b from left to right, if there is more than one entry on the same line. If entries are numbered, code in numeric order.

 

d)   Deletion of “18b” on Fetal Death Report

When the certifier has marked through the printed 18b, disregard the marking and code the entities as reported in 18b (Part II).

e)   Doubtful Diagnosis

1.   Doubtful qualifying expression: When expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly,” qualify any condition, disregard these expressions and code the condition as indexed.

a)   Interpretation of “either…or…”

Consider the following as a statement of “either or:”

· Two conditions reported on one line and both conditions qualified by expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly”.

· Two or more conditions connected by “or” or “versus”.

2.   Code as follows:

When more than one condition of the placenta classifiable to P020, P021,P022 is qualified by one of the expressions interpreted as “either/or,” code P022, “Unspecified morphological and functional abnormalities of the placenta”.

EXAMPLE:

Placenta previa versus abruption placenta

Code P022, Placenta, abnormal, affecting fetus or newborn.

3.   When more than one condition of the umbilical cord classifiable to P024, P025, P026 is qualified by one of the expressions interpreted as “either/or,” code P026, Unspecified condition of the umbilical cord.”

EXAMPLE:

Knot in umbilical cord or short cord

Code P026, Abnormal, abnormality, umbilical cord, affecting fetus or newborn.

4.   When more than one condition of the maternal membranes (P027, P028) is qualified by one of the expressions interpreted as “either/or,” code P029, “Unspecified abnormality of membranes”.

5.   When more than one fetal anomaly is reported and qualified by one of the terms interpreted as “either/or,” code as follows:

a) If an anomaly is reported of different parts of the same site, code Anomaly of the specified site only.

EXAMPLE:

Congenital anomaly of the tricuspid or aortic valve

Code Q248, Anomaly of heart valve NEC.

b)   When conditions are qualified by a statement of “either or” and only one site/system is involved, code to the residual category for the site/system.

EXAMPLES:

Encephalocele or hypoplasia of brain
Code Q049, Anomaly, of brain.

Anomaly of the bladder or kidney
Code Q649, Anomaly, unspecified of the urinary system.

c)   If different specified anomalies of the same system, code anomaly of the specified system only.

EXAMPLE:
Congenital stenosis of pylorus or atresia of duodenum.
Code Q459, Anomaly, gastrointestinal tract NEC.

 

NOTE: IF MORE THAN ONE CONDITION OF THE FETUS (INCLUDING MATERNAL CONDITIONS) IS REPORTED WITH A TERM INTERPRETED AS “EITHER/OR,” AND THE ABOVE INSTRUCTIONS DO NOT APPLY, REFER TO IMMEDIATE SUPERVISOR FOR A CODE ASSIGNMENT.

H.      Screening/Tests Results

When a statement is reported on the Fetal Death Report indicating a screening or diagnostic test was performed and the results of the test are not reported, do not enter a code for the screening/test. Tests are used for diagnostic purposes and not considered a diagnosis unless the results are reported. If results are reported, code as indexed.

EXAMPLES

Diagnostic imaging of the kidney performed
Liver function studies
Screened for tuberculosis

Do not enter a code for a condition when the results are reported as “negative”.

EXAMPLES:

Negative for tuberculosis
Tested negative for HIV
Tested positive for tuberculosis P370. Indexed under Tuberculosis, congenital

I.       Inclusion of additional information (AI) to Fetal Death Reports

Code supplemental information when it modifies or supplements data on the original Fetal Death Report as follows:

1.   When additional information (AI) states the initiating cause of a specified disease or condition in 18a (Part 1), code the additional information (AI) preceding the specified disease.

2.   When additional information (AI) modifies a specified disease or condition, use the AI and code the specified disease where reported.

3.   When there is a stated or implied complication of surgery and the additional information indicates the condition for which the surgery was performed, code this condition as follows:

a) If the surgical procedure was performed on the mother, code the condition for which the surgical procedure was performed following the P006 (the code used for the fetus and newborn affected by a surgical procedure on the mother).

b) If the surgical procedure was performed on the fetus, refer to your immediate supervisor for a code assignment.

4.   When the additional information (AI) states a certain condition is the initiating cause of death, code this as the first condition in 18a (Part 1).

5.   When any morphological type of neoplasm is reported in 18a (Part 1) with no mention of the “site” and additional information specifies a site, code the specified site only on the line where the morphological type is reported.

6.   When additional information states the primary site of a malignant neoplasm of the fetus, enter the code preceding where information concerning the neoplasm is reported.

7.   When the additional information does not modify a condition on the report, or does not state that this condition is the initiating cause, code the AI as the last condition(s) in 18b (Part II).

J.       Amended Reports

When an “Amended Fetal Death Report” is submitted, code the conditions reported on the amended report only.

K.      Sex Limitations

Certain categories in ICD-10 are limited to one sex:

                    For Males Only      For Females Only

B260          C51-C579

C60-C63       D06

D074-D076     D070-D073

D176          D25-D28

D29           D390-D391

D40           D397-D399

Q53-Q55       P546

Q98           Q500-Q529

              Q960-Q962

              Q964-Q979

 

L.       Plurality Limitations

Certain categories in ICD-10 are limited to one plurality. If the number in the Plurality box on the Fetal Death Record is greater than “1”, code P015 as the last entry in 18b (Part II).

For Multiples Only

P01.5

Q89.4

NOTE: Do not add/code P01.5 for “twin to twin transfusion”. Code to P02.3 as indexed.

M.      Relating and modifying conditions

1.       Implied site of disease

Certain conditions are classified in the ICD-10 according to the site affected, e.g.:

atrophy         enlargement     obstruction

calcification   failure         perforation

calculus        fibrosis        rupture

congestion      gangrene        stenosis

degeneration    hypertrophy     stones

dilatation      insufficiency   stricture

embolism        necrosis

                   (This list is not all inclusive)

Occasionally, these conditions are reported without specification of site. Relate conditions such as these for which the Classification does not provide a NOS code. Also, relate conditions which are usually reported of a site. Generally, it may be assumed that such a condition was of the same site as another condition if the Classification provides for coding the condition of unspecified site to the site of the other condition. These coding principles apply whether or not there are other conditions reported. Apply the following instructions when relating a condition of unspecified site to the site of the specified condition:

a.  General instructions for implied site of a disease

When applying the instructions for Implied site of a Disease and Relating and Modifying, consider all specified conditions for the following choices to be on the same line and apply applicable instructions for relating and modifying:

1.  Maternal Conditions/Diseases

(Specify)_____________________________

2.  Complications of Placenta, Cord, or Membranes

Rupture of membranes prior to onset of labor

Abruptio placenta

Placental insufficiency

Prolapsed cord

Chorioamnionitis

Other (Specify) _____________________________

3.  Other Obstetrical or Pregnancy Complications

     (Specify)_______________________________________

4.  Fetal Anomaly (Specify)___________________________

5.  Fetal Injury (Specify) _____________________________

6.  Fetal Infection (Specify) ___________________________

7.  Other Fetal Conditions/Disorders

     (Specify) _______________________________________

8.  Unknown

(1)        When conditions are reported on the same line, assume the condition of unspecified site was of the same site as the condition of specified site.

(2)        When conditions of different sites are reported on the same line, assume the condition of unspecified site was of the same site as the condition immediately preceding it.

b.  Relating specific categories

(1)         When embolism, infarction, occlusion, thrombosis NOS is reported:

·     from a specified site, code the condition of the site reported.

·     of a site, from a specified site, code the condition to both sites reported.

(2)         Relate a condition of unspecified site to the complete term of a multiple site entity. If it is not indexed together, relate the condition to the site of the complete indexed term.

 

Non-traumatic conditions

Consider conditions that are usually but not always traumatic in origin to be qualified as non-traumatic when reported with a “written in” due to or on the same line with a disease.

SECTION III: INTENT OF CERTIFIER

A.      INTRODUCTION

In order to assign the most appropriate code for a given diagnostic entity, it may be necessary to take other recorded information into account. It is important to interpret this information properly so the meaning intended by the certifier is correctly conveyed. The objective is to code each diagnostic entity in accordance with the intent of the certifier without combining separate codable entities. The following instructions help to determine the intent of the certifier. Apply Intent of Certifier instructions to “See also” terms in the Index as well. These instructions are assumed to be for the fetus unless stated as a maternal condition or reported on the Maternal Condition line.

B.      Coding conditions classified to injuries as disease conditions

a.   Some conditions (such as injury, hematoma or laceration) of a specified organ are indexed directly to a traumatic category but may not always be traumatic in origin. Consider these types of conditions to be qualified as non-traumatic when reported:

·     with a written in due to, or on the same line with a disease or reported due to drug poisoning or drug therapy.

·     When there is provision in the Classification for coding the condition considered to be qualified as non-traumatic as “non-traumatic,” code accordingly. Otherwise, code to the category that has been provided for “Other” diseases of the organ (usually .8).

b.   Some conditions are indexed directly to a traumatic category, but the Classification also provides a non-traumatic code. When these conditions are reported of the fetus and due to or with a disease and an external cause is also reported on the record, the instructions for coding external causes on regular mortality data will apply.

c.    Some conditions are indexed directly to a traumatic category, but the Classification also provides a non-traumatic code. When these conditions are reported, code the condition as non-traumatic unless the condition is reported due to or on the same line with an injury or external cause. This instruction applies only to conditions with the term “non-traumatic” in the Index.

C.      Organisms and Infections

          Organisms

                                                  

  Escherichia coli     Cytomegalovirus     Candida  

 Staphylococcal       Streptococcal       Fungus  

                                                  

 

          Infectious conditions

                                                     

  Abscess        Infection     Sepsis, Septicemia      

 Bacteremia     Pneumonia     Septic Shock           

 Empyema        Pyemia        Words ending in “itis” 

                                                     

 

These lists are NOT all inclusive. Use them as a guide.

Infections and organisms are yet another situation in which care needs to be taken to determine if it is directly affecting the fetus or the fetus is merely impacted by a maternal condition before assigning a code. If the infection or organism is reported in the specified line for maternal conditions or if reported elsewhere but qualified as maternal, then code to a maternal code (e.g., P002 or P008). Otherwise, assume the fetus has the infection or organism and assign a fetal code. (e.g., P35-P39), if indexed.

Take into consideration that some infections and organisms of the fetus are classified to Chapter 1.

1.   Do not use HIV or AIDS to modify an infectious or inflammatory condition. Code as two separate conditions.

2.   When an infectious or inflammatory condition and a specified organism or specified non-systemic infection is reported, code the infectious or inflammatory condition and the organism or infection separately.

3.   When any condition and infection NOS is reported, code both conditions where entered on the report.

4.   When a non-infectious or non-inflammatory condition and infection NOS is reported as the initiating cause, code the non-infectious or non-inflammatory condition as indexed and code infection NOS where entered on the report.

5.   When an organism is reported preceding two or more infectious conditions reported consecutively on the same line, code each of the infectious conditions modified by the organism.

6.   When one infectious condition is modified by more than one organism, modify the condition by all organisms.

7.   When any condition is reported and a generalized infection such as bacteremia, fungemia, sepsis, septicemia, systemic infection, or viremia is reported, code both the condition and the generalized infection where entered on the report. Do not modify the condition by the infection.

D.      Drug Use NOS and Noxious Substances

The code assignment depends upon whether the fetus is directly impacted or affected by maternal behavior or exposure. For instance, code maternal drug use P044, when reported in 18a or 18b. Refer to the indexing of maternal conditions in the Perinatal Subset and Volume 1, Category P04 to assign the appropriate code for a fetus affected by maternal behavior or exposure.

SECTION IV:  CLASSIFICATION OF CERTAIN ICD-10 CATEGORIES

A.      CONGENITAL CONDITIONS

The Classification does not provide congenital and acquired codes for all conditions. When no provision is made for a distinction, disregard the statement of congenital or acquired and code the NOS code.

B.      CERTAIN FETAL CONDITIONS (P000-P969)

When reported in 18a or 18b, code the following entries as indicated:

Birth weight of         2 pounds (999 gms) or under......................................... P070
                              Over 2 pounds (1000 gms) but not more than
                              5 ½ pounds (2499 gms)................................................ P071
                              10 pounds (4500 gms) or more...................................... P080

Gestation of             Less than 28 weeks....................................................... P072
                              28 weeks but less than 37 weeks................................... P073
                              42 or more completed weeks......................................... P082

                             NOTE: 37-41 weeks, no code. This is a normal gestation period.

Premature labor or delivery NOS.................................................................. P073

When a condition classifiable to P703-P720, P722-P749 is the only cause(s) reported in 18a or 18b, code P95. If reported with other perinatal conditions, code as indexed.

C.      ILL-DEFINED AND UNKNOWN CAUSES

When any of the following terms is the only entry (or entries) on the fetal death report, code P95 everywhere terms are reported in 18a or 18b:

Cause not found                    Immediate cause unknown

Cause unknown                      Intrauterine death

Cause undetermined                 No specific etiology

Could not be determined            identified

Deadborn fetus NOS                 No specific known causes

Etiology never determined          Non-specific causes

Etiology not defined               Not known

Etiology uncertain                 Obscure etiology

Etiology unexplained               Stillborn

Etiology unknown                   Undetermined

Etiology undetermined              Uncertain

Etiology unspecified               Unclear

Fetal Death                        Unexplained cause

Fetal Demise                       Unknown

Final event undetermined           ? Cause

Immediate cause not determined     ? Etiology

 

“Unknown” reported in the checkbox, code P95, if no other information is on the record. If the checkbox for Unknown is marked in one section (either 18a or 18b) and there is also a term assigned to P95 reported in the other section, code P95 in both sections.

                                                           

  18a.  INITIATING CAUSE/CONDITION                           

 

 Unknown:  Y                                               

 

 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS               

 

 Maternal Conditions/Diseases:  Undetermined               

                                                           

 

 

Code 18a (Part I)P95/Code 18b (Part II) P95

Code 18a (Part I) P95, Ill-defined and Unknown Causes and code 18b (Part II) P95, Ill-defined and Unknown Causes for both reportings.

                                                           

  18a.  INITIATING CAUSE/CONDITION                           

 

 Complications of Placenta, Cord, or Membranes             

 Other:  Y                                                 

 Other (specify):                                          

 

 18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS               

 

 Unknown:  No specific known causes                        

                                                           

 

 

Code 18a (Part I) P022 P026 P029

Code 18a (Part I) P022 P026 P029, complication of placenta, cord, or membranes and leave 18b (Part II) blank since P95 is not assigned when other information is on the record.

D.      GENERAL CONCEPT REGARDING EXTERNAL CAUSES REPORTED ON FETAL DEATH REPORTS

If an external event is reported and it is the mother who received the injuries, code the appropriate P000-P049.

If an external event is reported and it is the fetus who received the injury, the instructions for coding external causes on regular mortality data will apply.

Refer to the following instructions on coding external causes on Fetal Death Reports.

E.       Maternal External Causes

When a complication of any type of medical care is reported, including drug therapy, surgery, or a specified type of therapy including obstetrical procedures, code the appropriate P000-P049.

Do not enter the nature of injury code, external cause code or place code. Take into consideration if the condition for which the medical care was administered is reported. If questionable, refer to Supervisor.

If any type of external event (poisonings, accident, suicide, homicide or undetermined) is reported of the mother, code to the appropriate P000-P049. Do not enter a nature of injury code, external cause code or place code.

Take into consideration where the certifier has recorded the external event and code the P000-P049 in that same position. If questionable, refer to your immediate Supervisor.

F.       Fetal Injury

When any type of medical care including drug therapy, surgery, or any other specified type of medical care is reported of the fetus, the instructions for coding external causes on regular mortality data will apply.

If any type of external event or injury is reported of the fetus, the instructions for coding external causes on regular mortality data will apply.

APPENDIX A - Standard Abbreviations and Symbols

When an abbreviation is reported on the certificate, refer to this list to determine what the abbreviation represents. If an abbreviation represents more than one term, determine the correct abbreviation by using other information on the certificate. If no determination can be made, use abbreviation for first term listed.

A2GDM          class A2 gestational diabetes mellitus

AAA            abdominal aortic aneurysm

AAS            aortic arch syndrome

AAT            alpha-antitrypsin

AAV            AIDS-associated virus

AB             abdomen; abortion; asthmatic bronchitis

ABD            abdomen

ABE            acute bacterial endocarditis

ABS            acute brain syndrome

ACA            adenocarcinoma

ACD            arteriosclerotic coronary disease

ACH            adrenal cortical hormone

ACT            acute coronary thrombosis

ACTH           adrenocorticotrophic hormone

ACVD           arteriosclerotic cardiovascular disease

ADEM           acute disseminated encephalomyelitis

ADH            antidiuretic hormone

ADS            antibody deficiency syndrome

AEG            air encephalogram

AF             auricular or atrial fibrillation; acid fast

AFB            acid-fast bacillus

AGG            agammaglobulinemia

AGL            acute granulocytic leukemia

AGN            acute glomerulonephritis

AGS            adrenogenital syndrome

AHA            acquired hemolytic anemia; autoimmune hemolytic anemia

AHD            arteriosclerotic heart disease

AHHD           arteriosclerotic hypertensive heart disease

AHG            anti-hemophilic globulin deficiency

AHLE           acute hemorrhagic leukoencephalitis

AI             aortic insufficiency; additional information

AIDS           acquired immunodeficiency syndrome

AKA            above knee amputation

ALC            alcoholism

ALL            acute lymphocytic leukemia

ALS            amyotrophic lateral sclerosis

AMI            acute myocardial infarction

AML            acute myelocytic leukemia

ANS            arteriolonephrosclerosis

AOD            arterial occlusive disease

AODM           adult onset diabetes mellitus

AOM            acute otitis media

AP             angina pectoris; anterior and posterior repair; artificial pneumothorax; anterior pituitary

A&P            anterior and posterior repair

APC            auricular premature contraction; acetylsalicylic acid, acetophenetidin, and caffeine

APE            acute pulmonary edema; anterior pituitary extract

APH            antepartum hemorrhage

AR             aortic regurgitation

ARC            AIDS-related complex

ARDS           adult respiratory distress syndrome

ARF            acute respiratory failure; acute renal failure

ARM            artificial rupture of membranes

ARV            AIDS-related virus

ARVD           arrhythmogenic right ventricular dysplasia

AS             arteriosclerotic; arteriosclerosis; aortic stenosis

ASA            acetylsalicylic acid (aspirin)

ASAD           arteriosclerotic artery disease

ASCAD          arteriosclerotic coronary artery disease

ASCD           arteriosclerotic coronary disease

ASCHD          arteriosclerotic coronary heart disease

ASCRD          arteriosclerotic cardiorenal disease

ASCVA          arteriosclerotic cerebrovascular accident

ASCVD          arteriosclerotic cardiovascular disease

ASCVR          arteriosclerotic cardiovascular renal disease

ASCVRD         arteriosclerotic cardiovascular renal disease

ASD            atrial septal defect

ASDHD          arteriosclerotic decompensated heart disease

ASHCVD         arteriosclerotic hypertensive cardiovascular disease

ASHD           arteriosclerotic heart disease; atrioseptal heart defect

ASHHD          arteriosclerotic hypertensive heart disease

ASHVD          arteriosclerotic hypertensive vascular disease

ASO            arteriosclerosis obliterans

ASPVD          arteriosclerotic peripheral vascular disease

ASVD           arteriosclerotic vascular disease

ASVH(D)        arteriosclerotic vascular heart disease

AT             atherosclerosis; atherosclerotic; atrial tachycardia; antithrombin

ATC            all-terrain cycle

ATN            acute tubular necrosis

ATS            arteriosclerosis

ATSHD          arteriosclerotic heart disease

ATV            all-terrain vehicle

AUL            acute undifferentiated leukemia

AV             arteriovenous; atrioventricular; aortic valve

AVF            arterio-ventricular fibrillation; arteriovenous fistula

AVH            acute viral hepatitis

AVNRT          atrioventricular nodal re-entrant tachycardia

AVP            aortic valve prosthesis

AVR            aortic valve replacement

AVRT           atrioventricular nodal re-entrant tachycardia

AWMI           anterior wall myocardial infarction

AZT            azidothymidine

BA             basilar artery; basilar arteriogram; bronchial asthma

B&B            bronchoscopy and biopsy

BBB            bundle branch block

B&C            biopsy and cauterization

BCE            basal cell epithelioma

BE             barium enema

BEH            benign essential hypertension

BGL            Bartholin gland

BKA            below knee amputation

BL             bladder; bucolingual; blood loss; Burkitt lymphoma

BMR            basal metabolism rate

BNA            bladder neck adhesions

BNO            bladder neck obstruction

BOMSA          bilateral otitis media serous acute

BOMSC          bilateral otitis media serous chronic

BOW            'bag of water' (membrane)

B/P, BP        blood pressure

BPH            benign prostate hypertrophy

BSA            body surface area

BSO            bilateral salpingo-oophorectomy

BSP            Bromosulfaphthalein (test)

BTL            bilateral tubal ligation

BUN            blood, urea, and nitrogen test

BVL            bilateral vas ligation

B&W            Baldy-Webster suspension (uterine)

BX             biopsy

BX CX          biopsy cervix

Ca             cancer

CA             cancer; cardiac arrest; carotid arteriogram

CABG           coronary artery bypass graft

CABS           coronary artery bypass surgery

CAD            coronary artery disease

CAG            chronic atrophic gastritis

CAO            coronary artery occlusion; chronic airway obstruction

CAR            cardiac arrest

CAS            cerebral arteriosclerosis

CASCVD         chronic arteriosclerotic cardiovascular disease

CASHD          chronic arteriosclerotic heart disease

CAT            computerized axial tomography

CB             chronic bronchitis

CBC            complete blood count

CBD            common bile duct; chronic brain disease

CBS            chronic brain syndrome

CCF            chronic congestive failure

CCI            chronic cardiac or coronary insufficiency

CF             congestive failure; cystic fibrosis; Christmas factor (PTC)

CFT            chronic follicular tonsillitis

CGL            chronic granulocytic leukemia

CGN            chronic glomerulonephritis

CHA            congenital hypoplastic anemia

CHB            complete heart block

CHD            congestive heart disease; coronary heart disease; congenital heart disease; Chediak-Higaski Disease

CHF            congestive heart failure

C2H5OH         ethyl alcohol

CI             cardiac insufficiency; cerebral infarction

CID            cytomegalic inclusiondisease

CIS            carcinoma in situ

CJD            Creutzfeldt-Jakob Disease

CLD            chronic lung disease; chronic liver disease

CLL            chronic lymphatic leukemia; chronic lymphocytic leukemia

CMID           cytomegalic inclusion disease

CML            chronic myelocytic leukemia

CMM            cutaneous malignant melanoma

CMV            cytomegalic virus

CNHD           congenital nonspherocytic hemolytic disease

CNS            central nervous system

CO             carbon monoxide

COAD           chronic obstructive airway disease

CO2            carbon dioxide

COBE           chronic obstructive bullous emphysema

COBS           chronic organic brain syndrome

COFS           cerebro-oculo-facio-skeletal

COOMBS         test for Rh sensitivity

COLD           chronic obstructive lung disease

COPD           chronic obstructive pulmonary disease

COPE           chronic obstructive pulmonary emphysema

CP             cerebral palsy; cor pulmonale

C&P            cystoscopy and pyelography

CPB            cardiopulmonary bypass

CPC            chronic passive congestion

CPD            cephalopelvic disproportion; contagious pustular dermatitis

CPE            chronic pulmonary emphysema

CRD            chronic renal disease

CREST          calcinosis cutis, Raynaud phenomenon, sclerodactyly, and telangiectasis

CRF            cardiorespiratory failure; chronic renal failure

CRST           calcinosis cutis, Raynaud phenomenon, sclerodactyly, and telangiectasis

CS             coronary sclerosis; cesarean section; cerebro-spinal

CSF            cerebral spinal fluid

CSH            chronic subdural hematoma

CSM            cerebrospinal meningitis

CT             computer tomography; cerebral thrombosis; coronary thrombosis

CTD            congenital thymic dysplasia

CU             cause unknown

CUC            chronic ulcerative colitis

CUP            cystoscopy, urogram, pyelogram (retro)

CUR            cystocele, urethrocele, rectocele

CV             cardiovascular; cerebrovascular

CVA            cerebrovascular accident

CV accident    cerebral vascular accident

CVD            cardiovascular disease

CVHD           cardiovascular heart disease

CVI            cardiovascular insufficiency; cerebrovascular insufficiency

CVID           common variable immunodeficiency

CVRD           cardiovascular renal disease

CWP            coalworker pneumoconiosis

CX             cervix

DA             degenerative arthritis

DBI            phenformin hydrochloride

D&C            dilation and curettage

DCR            dacrocystorhinostomy

D&D            drilling and drainage; debridement and dressing

D&E            dilation and evacuation

DFU            dead fetus in utero

DIC            disseminated intravascular coagulation

DILD           diffuse infiltrative lung disease

DIP            distal interphalangeal joint; desquamative interstitial pneumonia

DJD            degenerative joint disease

DM             diabetes mellitus

DMT            dimethyltriptamine

DOA            dead on arrival

DOPS           diffuse obstructive pulmonary syndrome

DPT            diphtheria, pertussis, tetanus vaccine

DR             diabetic retinopathy

DS             Down syndrome

DT             due to; delirium tremens

D/T            due to; delirium tremens

DU             diagnosis unknown; duodenal ulcer

DUB            dysfunctional uterine bleeding

DUI            driving under influence

DVT            deep vein thrombosis

DWI            driving while intoxicated

DX             dislocation; diagnosis; disease

EBV            Epstein-Barr virus

ECCE           extracapsular cataract extraction

ECG            electrocardiogram

E coli         Escherichia coli

ECT            electric convulsive therapy

EDC            expected date of confinement

EEE            Eastern equine encephalitis

EEG            electroencephalogram

EFE            endocardial fibroelastosis

EGL            eosinophilic granuloma of lung

EH             enlarged heart; essential hypertension

EIOA           excessive intake of alcohol

EKC            epidemic keratoconjunctivitis

EKG            electrocardiogram

EKP            epikeratoprosthesis

ELF            elective low forceps

EMC            encephalomyocarditis

EMD            electromechanical dissociation

EMF            endomyocardial fibrosis

EMG            electromyogram

EN             erythema nodosum

ENT            ear, nose, and throat

EP             ectopic pregnancy

ER             emergency room

ERS            evacuation of retained secundines

ESRD           end-stage renal disease

EST            electric shock therapy

ETOH           ethyl alcohol

EUA            exam under anesthesia

EWB            estrogen withdrawal bleeding

FB             foreign body

FBS            fasting blood sugar

Fe             symbol for iron

FGD            fatal granulomatous disease

FHS            fetal heart sounds

FHT            fetal heart tone

FLSA           follicular lymphosarcoma

FME            full-mouth extraction

FS             frozen section; fracture site

FT             full term

FTA            fluorescent treponemal antibody test

FTD            fronto-temporal dementia

5FU            fluorouracil

FUB            functional uterine bleeding

FULG           fulguration

FUO            fever unknown origin

FX             fracture

FYI            for your information

GAS            generalized arteriosclerosis

GB             gallbladder; Guillain-Barre (syndrome)

GC             gonococcus; gonorrhea; general circulation (systemic)

GE             gastroesophageal

GEN            generalized

GERD           gastroesophageal reflux disease

GI             gastrointestinal

GIB            gastrointestinal bleeding

GIST           gastrointestinal stromal tumor

GIT            gastrointestinal tract

GMSD           grand mal seizure disorder

GOK            God only knows

GSW            gunshot wound

GTT            glucose tolerance test

Gtt            drop

GU             genitourinary; gastric ulcer

GVHR           graft-versus-host reaction

GYN            gynecology

HA             headache

HAA            hepatitis-associated antigen

HASCVD         hypertensive arteriosclerotic cardiovascular disease

HASCVR         hypertensive arteriosclerotic cardiovascular renal disease

HASHD          hypertensive arteriosclerotic heart disease

HBP            high blood pressure

HC             Huntington chorea

HCAP           health care associated pneumonia

HCPS           Hantivirus (cardio) pulmonary syndrome, Hantavirus cardiopulmonary syndrome

HCT            hematocrit

HCVD           hypertensive cardiovascular disease

HCVRD          hypertensive cardiovascular renal disease

HD             Hodgkin disease; heart disease

HDN            hemolytic disease of newborn

HDS            herniated disc syndrome

HEM            hemorrhage

HF             heart failure; hay fever

HGB; Hgb       hemoglobin

HHD            hypertensive heart disease

HIV            human immunodeficiency virus

HMD            hyaline membrane disease

HN2            nitrogen mustard

HNP            herniated nucleus pulposus

H/O            history of

HPN            hypertension

HPS            Hantavirus pulmonary syndrome

HPVD           hypertensive pulmonary vascular disease

HRE            high-resolution electrocardiology

HS             herpes simplex; Hurler syndrome

HSV            herpes simplex virus

HTLV           human T-cell lymphotropic virus

HTLV           human T-cell lymphotropic

III/LAV        virus-III/lymphadenopathy- associated virus

HTLV-3         human T-cell lymphotropic virus-III

HTLV-III       human T-cell lymphotropic virus-III

HTN            hypertension

HVD            hypertensive vascular disease

Hx             history of

IADH           inappropriate antidiuretic hormone

IASD           interatrial septal defect

ICCE           intracapsular cataract extraction

ICD            intrauterine contraceptive device

I&D            incision and drainage

ID             incision and drainage

IDA            iron deficiency anemia

IDD            insulin-dependent diabetes

IDDI           insulin-dependent diabetes

IDDM           insulin-dependent diabetes mellitus

IGA            immunoglobin A

IHD            ischemic heart disease

IHSS           idiopathic hypertrophic subaortic stenosis

IIAC           idiopathic infantile arterial calcification

ILD            interstitial lung disease; ischemic leg disease

IM             intramuscular; intramedullary; infectious mononucleosis

IMPP           intermittent positive pressure

INAD           infantile neuroaxonal dystrophy

INC            incomplete

INE            infantile necrotizing encephalomyelopathy

INF            infection; infected; infantile; infarction

INH            isoniazid; inhalation

INS            idiopathic nephrotic syndrome

IRDM           insulin resistant diabetes mellitus

IRHD           inactive rheumatic heart disease

IRIS           immune reconstitution inflammatory syndrome

ISD            interatrial septal defect

ITP            idiopathic thrombocytopenic purpura

IU             intrauterine

IUCD           intrauterine contraceptive device

IUD            intrauterine device (contraceptive); intrauterine death

IUFD           intrauterine fetal death

IUP            intrauterine pregnancy

IV             intervenous; intravenous

IVC            intravenous cholangiography; inferior vena cava

IVCC           intravascular consumption coagulopathy

IVD            intervertebral disc

IVH            intraventricular hemorrhage

IVP            intravenous pyelogram

IVSD           intraventricular septal defect

IVU            intravenous urethrography

IWMI           inferior wall myocardial infarction

JAA            juxtaposition of atrial appendage

JBE            Japanese B encephalitis

KFS            Klippel-Feil syndrome

KS             Klinefelter syndrome

KUB            kidney, ureter, bladder

K-W            Kimmelstiel-Wilson disease or syndrome

LAP            laparotomy

LAV            lymphadenopathy-associated virus

LAV/HTLV-III   lymphadenopathy-associated virus/human T-cell lymphotrophic virus-III

LBBB           left bundle branch block

LBNA           lysis bladder neck adhesions

LBW            low birth weight

LBWI           low birth weight infant

LCA            left coronary artery

LDH            lactic dehydrogenase

LE             lupus erythematosus; lower extremity; left eye

LKS            liver, kidney, spleen

LL             lower lobe

LLL            left lower lobe

LLQ            lower left quadrant

LMA            left mentoanterior (position of fetus)

LML            left middle lobe; left mesiolateral

LMCAT          left middle cerebral artery thrombosis

LML            left mesiolateral; left mediolateral (episiotomy)

LMP            last menstrual period; left mento-posterior (position of fetus)

LN             lupus nephritis

LOA            left occipitoanterior

LOMCS          left otitis media chronic serous

LP             lumbar puncture

LRI            lower respiratory infection

LS             lumbosacral; lymphosarcoma

LSD            lysergic acid diethylamide

LSK            liver, spleen, kidney

LUL            left upper lobe

LUQ            left upper quadrant

LV             left ventricle

LVF            left ventricular failure

LVH            left ventricular hypertrophy

MAC            mycobacterium avium complex

MAI            mycobacterium avium intracellulare

MAL            malignant

MBAI           mycobacterium avium intracellulare

MBD            minimal brain damage

MD             muscular dystrophy; manic depressive; myocardial damage

MDA            methylene dioxyamphetamine

MEA            multiple endocrine adenomatosis

MF             myocardial failure; myocardial fibrosis; mycosis fungoides

MGN            membranous glomerulonephritis

MHN            massive hepatic necrosis

MI             myocardial infarction; mitral insufficiency

MPC            meperidine, promethazine, chlorpromazine

MRS            methicillin resistant staphylococcal

MRSA           methicillin resistant staphylococcal aureus

MRSAU          methicillin resistant staphylococcal aureus

MS             multiple sclerosis; mitral stenosis

MSOF           multi-system organ failure

MT             malignant teratoma

MUA            myelogram

MVP            mitral valve prolapse

MVR            mitral valve regurgitation; mitral valve replacement

NACD           no anatomical cause of death

NAFLD          nonalcoholic fatty liver disease

NCA            neurocirculatory asthenia

NDI            nephrogenic diabetes insipidus

NEG            negative

NFI            no further information

NFTD           normal full-term delivery

NG             nasogastric

NH3            symbol for ammonia

NIDD           non-insulin-dependent diabetes

NIDDI          non-insulin-dependent diabetes

NIDDM          non-insulin-dependent diabetes mellitus

NSTEMI         non-ST-elevation myocardial infarction

N&V            nausea and vomiting

NVD            nausea, vomiting, diarrhea

OA             osteoarthritis

OAD            obstructive airway disease

OB             obstetrical

OBS            organic brain syndrome

OBST           obstructive; obstetrical

OD             overdose; oculus dexter (right eye); occupational disease

OHD            organic heart disease

OLT            orthotopic liver transplant

OM             otitis media

OMI            old myocardial infarction

OMS            organic mental syndrome

ORIF           open reduction, internal fixation

OS             oculus sinister (left eye); occipitosacral (fetal position)

OT             occupational therapy; old TB

OU             oculus uterque (each eye); both eyes

PA             pernicious anemia; paralysis agitans; pulmonary artery; peripheral arteriosclerosis

PAC            premature auricular contraction; phenacetin, aspirin, caffeine

PAF            paroxysmal auricular fibrillation

PAOD           peripheral arterial occlusive disease; peripheral arteriosclerosis occlusive disease

PAP            primary atypical pneumonia

PAS            pulmonary artery stenosis

PAT            pregnancy at term; paroxysmal auricular tachycardia

Pb             chemical symbol for lead

PCD            polycystic disease

PCF            passive congestive failure

PCP            pentachlorophenol; pneumocystis carinii pneumonia

PCT            porphyria cutanea tarda

PCV            polycythemia vera

PDA            patent ductus arteriosus

PE             pulmonary embolism; pleural effusion; pulmonary edema

PEG            percutaneous endoscopic gastrostomy; pneumoencephalography

PEGT           percutaneous endoscopic gastrostomy tube

PET            pre-eclamptic toxemia

PG             pregnant; prostaglandin

PGH            pituitary growth hormone

PH             past history; prostatic hypertrophy; pulmonary hypertension

PI             pulmonary infarction

PID            pelvic inflammatory disease; prolapsed intervertebral disc

PIE            pulmonary interstitial emphysema

PIP            proximal interphalangeal joint

PKU            phenylketonuria

PMD            progressive muscular dystrophy

PMI            posterior myocardial infarction; point of maximum impulse

PML            progressive multifocal leukoencephalopathy

PN             pneumonia; periarteritis nodosa; pyelonephritis

PO             postoperative; by mouth

POC            product of conception

POE            point (or portal) of entry

PP             postpartum

POSS           possible; possibly

PPD            purified protein derivative test for tuberculosis

PPH            postpartum hemorrhage

PPLO           pleuropneumonia-like organism

PPROM          preterm premature rupture of membranes

PPS            postpump syndrome

PPT            precipitated; prolonged prothrombin time

PREM           prematurity

PROB           probably

PROM           premature rupture of membranes

PSVT           paroxysmal supraventricular tachycardia

PT             paroxysmal tachycardia; pneumothorax; prothrombin time

PTA            persistent truncus arteriosus

PTC            plasma thromboplastin component

PTCA           percutaneous transluminal coronary angioplasty

PTL            preterm labor

PTLA           percutaneous transluminal laser angioplasty

PU             peptic ulcer

PUD            peptic ulcer disease; pulmonary disease

PUO            pyrexia of unknown origin

P&V            pyloroplasty and vagotomy

PVC            premature ventricular contraction

PVD            peripheral vascular disease; pulmonary vascular disease

PVI            peripheral vascular insufficiency

PVL            periventricular leukomalacia

PVT            paroxysmal ventricular tachycardia

PVS            premature ventricular systole (contraction)

PWI            posterior wall infarction

PWMI           posterior wall myocardial infarction

PX             pneumothorax

R              right

RA             rheumatoid arthritis; right atrium; right auricle

RAAA           ruptured abdominal aortic aneurysm

RAD            rheumatoid arthritis disease; radiation absorbed dose

RAI            radioactive iodine

RBBB           right bundle branch block

RBC            red blood cells

RCA            right coronary artery

RCS            reticulum cell sarcoma

RD             Raynaud disease; respiratory disease

RDS            respiratory distress syndrome

RE             regional enteritis

REG            radioencephalogram

RESP           respiratory

RHD            rheumatic heart disease

RLF            retrolental fibroplasia

RLL            right lower lobe

RLQ            right lower quadrant

RMCA           right middle cerebral artery

RMCAT          right middle cerebral artery thrombosis

RML            right middle lobe

RMLE           right mediolateral episiotomy

RNA            ribonucleic acid

RND            radical neck dissection

R/O            rule out

RSA            reticulum cell sarcoma

RSR            regular sinus rhythm

Rt             right

RT             recreational therapy; right

RTA            renal tubular acidosis

RUL            right upper lobe

RUQ            right upper quadrant

RV             right ventricle

RVH            right ventricular hypertrophy

RVT            renal vein thrombosis

RX             drugs or other therapy or treatment

SA             sarcoma; secondary anemia

SACD           subacute combined degeneration

SARS           severe acute respiratory syndrome

SBE            subacute bacterial endocarditis

SBO            small bowel obstruction

SBP            spontaneous bacterial peritonitis

SC             sickle cell

SCC            squamous cell carcinoma

SCI            subcoma insulin; spinal cord injury

SD             spontaneous delivery; septal defect; sudden death

SDAT           senile dementia Alzheimer type

SDII           sudden death in infancy

SDS            sudden death syndrome

SEPT           septicemia

SF             scarlet fever

SGA            small for gestational age

SH             serum hepatitis

SI             saline injection

SIADH          syndrome of inappropriate antidiuretic hormone

SICD           sudden infant crib death

SID            sudden infant death

SIDS           sudden infant death syndrome

SIRS           systemic inflammatory response syndrome

SLC            short leg cast

SLE            systemic lupus erythematosus; Saint Louis encephalitis

SMR            submucous resection

SNB            scalene node biopsy

SO or S&O      salpingo-oophorectomy

SOB            shortness of breath

SOM            secretory otitis media

SOR            suppurative otitis, recurrent

S/P            status post

SPD            sociopathic personality disturbance

SPP            suprapubic prostatectomy

SQ             subcutaneous

S/R            schizophrenic reaction; sinus rhythm

S/p P/T        schizophrenic reaction, paranoid type

SSE            soapsuds enema

SSKI           saturated solution potassium iodide

SSPE           subacute sclerosing panencephalitis

STAPH          staphylococcal; staphylococcus

STB            stillborn

STREP          streptococcal; streptococcus

STS            serological test for syphilis

STSG           split thickness skin graft

SUBQ           subcutaneous

SUD            sudden unexpected death

SUDI           sudden unexplained death of an infant

SUID           sudden unexpected infant death

SVC            superior vena cava

SVD            spontaneous vaginal delivery

SVT            superventricular tachycardia

Sx             symptoms

SY             syndrome

T&A            tonsillectomy and adenoidectomy

TAH            total abdominal hysterectomy

TAL            tendon achilles lengthening

TAO            triacetyloleandomycin (antibiotic); thromboangiitis obliterans

TAPVR          total anomalous pulmonary venous return

TAR            thrombocytopenia absent radius (syndrome)

TAT            tetanus anti-toxin

TB             tuberculosis; tracheobronchitis

TBC, Tbc       tuberculosis

TCI            transient cerebral ischemia

TEF            tracheoesophageal fistula

TF             tetralogy of Fallot

TGV            transposition great vessels

THA            total hip arthroplasty

TI             tricuspid insufficiency

TIA            transient ischemic attack

TIE            transient ischemic episode

TL             tubal ligation

TM             tympanic membrane

TOA            tubo-ovarian abscess

TP             thrombocytopenic purpura

TR             tricuspid regurgitation, transfusion reaction

TSD            Tay-Sachs disease

TTP            thrombotic thrombocytopenic purpura

TUI            transurethral incision

TUR            transurethral resection (NOS) (prostate)

TURP           transurethral resection of prostate

TVP            total anomalous venous return

UC             ulcerative colitis

UGI            upper gastrointestinal

UL             upper lobe

UNK            unknown

UP             ureteropelvic

UPJ            ureteropelvic junction

URI            upper respiratory infection

UTI            urinary tract infection

VAMP           vincristine, amethopterine, 6-mercaptopurine, and prednisone

VB             vinblastine

VC             vincristine

VD             venereal disease

VDRL           venereal disease research lab

VEE            Venezuelan equine encephalomyelitis

VF             ventricular fibrillation

VH             vaginal hysterectomy; viral hepatitis

VL             vas ligation

VM             viomycin

V&P            vagotomy and pyloroplasty

VPC, VPCS      ventricular premature contractions

VR             valve replacement

VSD            ventricular septal defect

VT             ventricular tachycardia

WBC            white blood cell

WC             whooping cough

WE             Western encephalomyelitis

W/O            without

WPW            Wolfe-Parkinson-White syndrome

YF             yellow fever

ZE             Zollinger-Ellison (syndrome)

'              minute

"              second(s)

<              less than

>              greater than

⬇              decreased

⬆              increased, elevated

c              with

s              without

00             secondary to

11

00             secondary to

11 to

99             means unknown when reported in duration block, such as "99 years" = unknown number of years

APPENDIX B
Synonymous Sites/Terms

When a condition of a stated anatomical site is indexed in Volume 3, code condition of stated site as indexed. If stated site is not indexed, code condition of synonymous site.

                                                                           

  Alimentary canal           Gastrointestinal tract                           

                                                                           

 Body                      Torso, trunk                                    

                                                                           

 Brain                     Anterior fossa, basal ganglion, central nervous 

                           system, cerebral, cerebrum, frontal, occipital, 

                           parietal, pons, posterior fossa, prefrontal,    

                           temporal, III and IV ventricle                  

                           Note: Do not use brain when ICD provides for    

                           CNS under the reported condition.               

                                                                           

  Cardiac                    Heart                                            

                                                                           

 Chest                     Thorax                                          

                                                                           

 Geriatric                 Senile                                          

                                                                           

 Greater sac               Peritoneum                                      

                                                                           

 Hepatic                   Liver                                           

                                                                           

 Hepatocellular            Liver                                           

                                                                           

  Intestine                  Bowel, colon                                     

                                                                           

 Kidney                    Renal                                           

                                                                           

 Larynx                    Epiglottis, glottis, subglottis, supraglottis,  

                           vocal cords                                     

                                                                           

 Lesser sac                Peritoneum                                      

                                                                           

 Nasopharynx, pharynx      Throat                                          

                                                                           

  Pulmonary                  Lung                                             

                                                                           

 Right\left hemispheric    Code brain                                      

                                                                           

 Hemispheric NOS           Do not assume brain                             

                                                                           

 Right\left ventricle      Heart                                           

                                                                           

 Third\fourth ventricle    Brain                                           

                                                                           

 LLL, LUL, RLL, RML, RUL   Lobes of the lungs when reported with           

                           lobectomy, pneumonia, etc                       

                                                                           

 

APPENDIX C
Code for Place of Occurrence of Fetal Death Injuries and External Causes

0.       Home

Excludes:        Abandoned or derelict house (8)
Home under construction, but not yet occupied (6)
Institutional place of residence (1)
Office in home (5)

About home

Apartment

Bed and breakfast

Boarding house

Cabin (any type)

Caravan (trailer) park - residential

Condominium

Farm house

Dwelling

Hogan

Home premises

Home sidewalk

Home swimming pool

House (residential) (trailer)

Noninstitutional place of residence

Penthouse

Private driveway to home

Private garage

Private garden to home

Private walk to home

Private wall to home

Residence

Rooming house

Storage building at apartment

Swimming pool in private home, private garden, apartment or residence

Townhome

Trailer camp or court

Yard (any part) (area) (front) (residential)

Yard to home

1.       Residential institution

Almshouse

Army camp

Assisted Living

Board and care facility

Children’s home

Convalescent home

Correctional center

Detox center

Dormitory

Fraternity house

Geriatric center

Halfway house

Home for the sick

Hospice

Institution (any type)

Jail

Mental Hospital

Military (camp) (reservation)

Nurse’s home

Nursing home

Old people’s home

Orphanage

Penitentiary

Pensioner’s home

Prison

Prison camp

Reform school

Retirement home

Sorority house

State hospital

2.       School, other institution and public administrative area

Excludes:        Building under construction (6)
Residential institution (1)
Sports and athletic areas (3)

          Armory                           Police station or cell

          Assembly hall                    Post office

          Campus                           Private club

          Child center                     Public building

          Church                           Public hall

          Cinema                           Salvation army

          Clubhouse                        School (grounds) (yard)

          College                          School (private) (public) (state)

          Country club (grounds)           Theatre

          Court house                      Turkish bath

          Dance hall                       University

          Day nursery (day care)           YMCA

          Drive in theater                 Youth center

          Fire house                       YWCA

          Gallery

          Health club

          Health resort

          Health spa

          Hospital (parking lot)

          Institute of higher learning

          Kindergarten

          Library

          Mission

          Movie house

          Museum

          Music hall

          Night club

          Opera house

          Playground, school

          Police precinct

 

3.       Sports and athletics area

Excludes:        Swimming pool or tennis court in private home or garden (0)

Baseball field

Basketball court

Cricket ground

Dude ranch

Fives court

Football field

Golf course

Gymnasium

Hockey field

Ice palace

Racecourse

Riding school

Rifle range - NOS

Skating rink

Sports ground

Sports palace

Squash court

Stadium

Swimming pool (private) (public)

Tennis court

4.       Street and highway

Alley

Border crossing

Bridge NOS

Freeway

Interstate

Motorway

Named street/highway/interstate

Pavement

Road (public)

Roadside

Sidewalk NOS

          Walkway

 

5.       Trade and service area

Excludes:        Garage in private home (0)

Airport

Animal hospital

Bank

Bar

Body shop

Cafe

Car dealership

Casino

Electric company

Filling station

Funeral home

Garage - place of work

Garage away from highway except home

Garage building (for car storage)

Garage NOS

Gas station

Hotel (pool)

Laundry Mat

Loading platform - store

Mall

Market (grocery or other commodity)

Motel

Office (building) (in home)

Parking garage

Radio/television broadcasting station

Restaurant

Salvage lot, named

Service station

Shop, commercial

Shopping center (shopping mall)

Spa

Station (bus) (railway)

Storage Unit

Store

Subway (stairs)

Tourist court

Tourist home

Warehouse

6.       Industrial and construction areas

Building under construction

Coal pit

Coal yard

Construction (area, job or site)

Dairy processing plant

Dockyard

Dry dock

Electric tower

Factory (building) (premises)

Foundry

Gas works

Grain elevator

Gravel pit

Highway under construction

Industrial yard

Loading platform - factory

Logging operation area

Lumber yard

Mill pond

Oil field

Oil rig and other offshore installations

Oil well

Plant, industrial

Power-station (coal) (nuclear) (oil)

Produce building

Railroad track or trestle

Railway yard

Sand pit

Sawmill

Sewage disposal plant

Shipyard

Shop

Substation (power)

Subway track

Tannery

Tunnel under construction             

Water filtration plant

Wharf  

Workshop         

7.       Farm

Excludes:        Farm house and home premises of farm (0)

Barn NOS

Barnyard

Corncrib

Cornfield

Dairy (farm) NOS

Farm buildings

Farm pond or creek

Farmland under cultivation

Field, numbered or specialized

Gravel pit on farm

Orange grove

Orchard

Pasture

Ranch NOS

Range NOS

Silo

State Farm

8.       Other specified places

Abandoned gravel pit                  Military training ground

Abandoned public building or home     Mountain

Air force firing range                Mountain resort

Balcony                               Named city

Bar pit or ditch                      Named lake

Beach NOS (named) (private)           Named room

Beach resort                          Named town

Boy’s camp                            Nursery NOS

Building NOS                          Open field

Bus stop                              Park (amusement) (any) (public)

Camp                                  Parking lot

Camping grounds                       Parking place

Campsite                              Pier

Canal                                 Pipeline (oil)

Caravan site NOS                      Place of business NOS

Cemetery                              Playground NOS

City dump                             Pond or pool (natural)

Community jacuzzi                     Porch

Creek (bank) (embankment)             Power line pole

Damsite                               Prairie

Derelict house                        Private property

Desert                                Public place NOS

Ditch                                 Public property

Dock NOS                              Railway line

Driveway                              Reservoir (water)

Excavation site                       Resort NOS

Fairgrounds                           River

Field NOS                             Room (any)

Forest                                Sea

Fort                                  Seashore NOS

Hallway                               Seashore resort

Harbor                                Sewer

Hill                                  Specified address

Holiday camp                          Stream

Irrigation canal or ditch             Swamp

Junkyard                              Trail (bike)

Kitchen                               Vacation resort

Lake NOS                              Woods

Lake resort                           Zoo

Manhole

Marsh

 

9.       Unspecified place

Bathtub

Bed

Camper (trailer)

Commode

Country

Downstairs

Fireplace

Hot tub

Jobsite

Near any place

On job

Outdoors NOS

Parked car

Rural

Sofa

Table

Tree

Vehicle (any)

 

APPENDIX D
ICD-10 Codes Valid for Causes of Fetal Death

A000

A001

A009

A010

A011

A012

A013

A014

A020

A021

A022

A028

A029

A030

A031

A032

A033

A038

A039

A040

A041

A042

A043

A044

A045

A046

A047

A048

A049

A050

A051

A052

A053

A058

A059

A060

A061

A062

A063

A064

A065

A066

A067

A068

A069

A072

A073

A078

A079

A082

A083

A084

A085

A090

A099

A162

A163

A164

A165

A167

A168

A169

A170

A171

A178

A179

A180

A181

A182

A183

A184

A185

A186

A187

A188

A190

A191

A192

A198

A199

A200

A201

A202

A203

A207

A208

A209

A210

A211

A212

A213

A217

A218

A219

A220

A221

A222

A227

A228

A229

A230

A231

A232

A233

A238

A239

A240

A241

A242

A243

A244

A250

A251

A259

A260

A267

A268

A269

A270

A278

A279

A280

A281

A282

A288

A289

A300

A301

A303

A305

A308

A309

A310

A311

A318

A319

A320

A321

A327

A328

A329

A360

A361

A362

A363

A368

A369

A370

A371

A378

A379

A38

A390

A391

A392

A393

A394

A395

A398

A399

A420

A421

A422

A427

A428

A429

A430

A431

A438

A439

A440

A441

A448

A449

A46

A480

A482

A483

A484

A488

A490

A491

A492

A493

A498

A499

A500

A502

A503

A504

A505

A509

A540

A541

A542

A543

A544

A545

A546

A548

A549

A600

A601

A609

A65

A660

A661

A662

A663

A664

A665

A666

A667

A669

A670

A671

A673

A679

A680

A681

A689

A690

A691

A692

A698

A699

A70

A750

A751

A752

A753

A759

A770

A771

A772

A773

A778

A779

A78

A790

A791

A798

A799

A800

A802

A803

A804

A809

A810

A811

A812

A818

A819

A820

A821

A829

A830

A831

A832

A833

A834

A835

A836

A838

A839

A840

A841

A848

A849

A850

A851

A852

A858

A86

A870

A871

A872

A878

A879

A880

A881

A888

A89

A90

A91

A920

A921

A922

A923

A924

A928

A929

A930

A931

A932

A938

A94

A950

A951

A959

A960

A961

A962

A968

A969

A980

A981

A982

A983

A984

A985

A988

A99

B000

B001

B002

B003

B004

B005

B007

B008

B009

B010

B011

B012

B018

B019

B020

B021

B022

B023

B027

B028

B029

B03

B04

B050

B051

B052

B053

B054

B058

B059

B080

B150

B159

B160

B161

B162

B169

B170

B171

B178

B179

B180

B181

B182

B188

B189

B190

B199

B200

B201

B202

B203

B204

B205

B206

B208

B209

B210

B211

B212

B220

B221

B222

B230

B231

B232

B238

B24

B250

B251

B252

B258

B259

B260

B261

B262

B263

B268

B269

B270

B271

B278

B279

B330

B331

B332

B333

B334

B338

B340

B341

B342

B343

B344

B348

B349

B380

B381

B382

B383

B384

B387

B388

B389

B390

B391

B392

B393

B394

B395

B399

B400

B401

B402

B403

B407

B408

B409

B410

B417

B418

B419

B420

B421

B427

B428

B429

B430

B431

B432

B438

B439

B440

B441

B442

B447

B448

B449

B450

B451

B452

B453

B457

B458

B459

B460

B461

B462

B463

B464

B465

B468

B469

B470

B471

B479

B480

B481

B482

B483

B484

B487

B488

B49

B500

B508

B509

B510

B518

B519

B520

B528

B529

B530

B531

B538

B54

B550

B551

B552

B559

B560

B561

B569

B570

B571

B572

B573

B574

B575

B580

B581

B582

B583

B588

B589

B59

B600

B601

B602

B608

B64

B650

B651

B652

B653

B658

B659

B660

B661

B662

B663

B664

B665

B668

B669

B670

B671

B672

B673

B674

B675

B676

B677

B678

B679

B680

B681

B689

B690

B691

B698

B699

B700

B701

B710

B711

B718

B719

B72

B73

B740

B741

B743

B744

B748

B749

B75

B760

B761

B768

B769

B770

B778

B779

B780

B781

B787

B789

B79

B80

B810

B811

B812

B813

B814

B818

B820

B829

B830

B831

B832

B833

B834

B838

B839

B870

B871

B872

B873

B874

B878

B879

B880

B881

B882

B883

B888

B889

B89

B99

C000

C001

C002

C003

C004

C005

C006

C008

C009

C01

C020

C021

C022

C023

C024

C028

C029

C030

C031

C039

C040

C041

C048

C049

C050

C051

C052

C058

C059

C060

C061

C062

C068

C069

C07

C080

C081

C088

C089

C090

C091

C098

C099

C100

C101

C102

C103

C104

C108

C109

C110

C111

C112

C113

C118

C119

C12

C130

C131

C132

C138

C139

C140

C142

C148

C150

C151

C152

C153

C154

C155

C158

C159

C160

C161

C162

C163

C164

C165

C166

C168

C169

C170

C171

C172

C173

C178

C179

C180

C181

C182

C183

C184

C185

C186

C187

C188

C189

C19

C20

C210

C211

C212

C218

C220

C221

C222

C223

C224

C227

C229

C23

C240

C241

C248

C249

C250

C251

C252

C253

C254

C257

C259

C260

C261

C268

C269

C300

C301

C310

C311

C312

C313

C318

C319

C321

C322

C323

C328

C329

C33

C340

C341

C342

C343

C348

C349

C37

C380

C381

C382

C383

C384

C388

C390

C398

C399

C400

C401

C402

C403

C408

C409

C410

C411

C412

C413

C414

C419

C430

C431

C432

C433

C434

C435

C436

C437

C438

C439

C440

C441

C442

C443

C444

C445

C446

C447

C448

C449

C450

C451

C452

C457

C459

C460

C461

C462

C463

C467

C468

C469

C470

C471

C472

C473

C474

C475

C476

C478

C479

C480

C481

C482

C488

C490

C491

C492

C493

C494

C495

C496

C498

C499

C500

C501

C502

C503

C504

C505

C506

C508

C509

C510

C511

C512

C518

C519

C52

C530

C531

C538

C539

C540

C541

C542

C543

C548

C549

C55

C56

C570

C571

C572

C573

C574

C577

C578

C579

C600

C601

C602

C608

C609

C61

C620

C621

C629

C630

C631

C632

C637

C638

C639

C64

C65

C66

C670

C671

C672

C673

C674

C675

C676

C677

C678

C679

C680

C681

C688

C689

C690

C691

C692

C693

C694

C695

C696

C698

C699

C700

C701

C709

C710

C711

C712

C713

C714

C715

C716

C717

C718

C719

C720

C721

C722

C723

C724

C725

C728

C729

C73

C740

C741

C749

C750

C751

C752

C753

C754

C755

C758

C759

C760

C761

C762

C763

C764

C765

C767

C768

C80

C810

C811

C812

C813

C817

C819

C820

C821

C822

C827

C829

C830

C831

C832

C833

C834

C835

C836

C837

C838

C839

C840

C841

C842

C962

C963

C967

C969

D000

D001

D002

D010

D011

D012

D013

D014

D015

D017

D019

D020

D021

D022

D023

D024

D030

D031

D032

D033

D034

D035

D036

D037

D038

D039

D040

D041

D042

D043

D044

D045

D046

D047

D048

D049

D050

D051

D057

D059

D060

D061

D067

D069

D070

D071

D072

D073

D074

D075

D076

D090

D091

D092

D093

D097

D099

D100

D101

D102

D103

D104

D105

D106

D107

D109

D110

D117

D119

D120

D121

D122

D123

D124

D125

D126

D127

D128

D129

D130

D131

D132

D133

D134

D135

D136

D137

D139

D140

D141

D142

D143

D144

D150

D151

D152

D157

D160

D161

D162

D163

D164

D165

D166

D167

D168

D169

D170

D171

D172

D173

D174

D175

D176

D177

D179

D180

D181

D190

D191

D197

D199

D200

D201

D210

D211

D212

D213

D214

D215

D216

D219

D220

D221

D222

D223

D224

D225

D226

D227

D229

D230

D231

D232

D233

D234

D235

D236

D237

D239

D24

D250

D251

D252

D259

D260

D261

D267

D269

D27

D280

D281

D282

D287

D289

D290

D291

D292

D293

D294

D297

D299

D300

D301

D302

D303

D304

D307

D309

D310

D311

D312

D313

D314

D315

D316

D319

D320

D321

D329

D330

D331

D332

D333

D334

D337

D339

D34

D350

D351

D352

D353

D354

D355

D356

D357

D358

D359

D360

D361

D367

D369

D370

D371

D372

D373

D374

D375

D376

D377

D379

D380

D381

D382

D383

D384

D385

D386

D390

D391

D397

D399

D400

D401

D407

D409

D410

D411

D412

D413

D414

D417

D419

D420

D421

D429

D430

D431

D432

D433

D434

D437

D439

D440

D441

D442

D443

D444

D445

D446

D447

D448

D449

D45

D460

D461

D462

D463

D464

D467

D469

D470

D471

D472

D473

D477

D479

D480

D481

D482

D483

D484

D485

D486

D487

D489

D501

D508

D509

D510

D511

D512

D513

D518

D519

D520

D521

D528

D529

D530

D531

D532

D538

D539

D550

D551

D552

D553

D558

D559

D560

D561

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S923

S924

S925

S927

S929

S930

S931

S932

S933

S934

S935

S936

S940

S941

S942

S943

S947

S948

S949

S950

S951

S952

S957

S958

S959

S960

S961

S962

S967

S968

S969

S970

S971

S978

S980

S981

S982

S983

S984

S997

S998

S999

T002

T003

T008

T009

T012

T013

T019

T021

T022

T023

T024

T025

T028

T029

T031

T032

T033

T038

T039

T041

T042

T043

T048

T049

T050

T052

T053

T055

T058

T059

T062

T063

T064

T065

T07

T08

T090

T091

T092

T093

T094

T095

T096

T098

T099

T10

T110

T111

T112

T113

T114

T115

T116

T118

T119

T12

T130

T131

T132

T133

T134

T135

T136

T138

T139

T140

T141

T142

T143

T144

T145

T146

T147

T148

T149

T150

T151

T158

T159

T16

T170

T171

T172

T173

T174

T175

T178

T179

T180

T181

T182

T183

T184

T185

T188

T189

T190

T191

T192

T193

T198

T199

T200

T201

T202

T203

T204

T205

T206

T207

T210

T211

T212

T213

T214

T215

T216

T217

T220

T221

T222

T223

T224

T225

T226

T227

T230

T231

T232

T233

T234

T235

T236

T237

T240

T241

T242

T243

T244

T245

T246

T247

T250

T251

T252

T253

T254

T255

T256

T257

T260

T261

T262

T263

T264

T265

T266

T267

T268

T269

T270

T271

T272

T273

T274

T275

T276

T277

T280

T281

T282

T283

T284

T285

T286

T287

T288

T289

T300

T301

T302

T303

T304

T305

T306

T307

T310

T311

T312

T313

T314

T315

T316

T317

T318

T319

T320

T321

T322

T323

T324

T325

T326

T327

T328

T329

T330

T331

T332

T333

T334

T335

T336

T337

T338

T339

T340

T341

T342

T343

T344

T345

T346

T347

T348

T349

T350

T351

T352

T353

T354

T355

T356

T357

T360

T361

T362

T363

T364

T365

T366

T367

T368

T369

T370

T371

T372

T373

T374

T375

T378

T379

T380

T381

T382

T383

T386

T387

T388

T389

T390

T391

T392

T393

T394

T398

T399

T400

T401

T402

T403

T404

T405

T406

T407

T408

T409

T410

T411

T412

T413

T414

T415

T420

T421

T422

T423

T424

T425

T426

T427

T428

T430

T431

T432

T433

T434

T435

T436

T438

T439

T440

T441

T442

T443

T444

T445

T446

T447

T448

T449

T450

T451

T452

T453

T454

T455

T456

T457

T458

T459

T460

T461

T462

T463

T464

T465

T466

T467

T468

T469

T470

T471

T472

T473

T474

T475

T476

T477

T478

T479

T480

T481

T482

T483

T484

T485

T486

T487

T490

T491

T492

T493

T494

T495

T496

T497

T498

T499

T500

T501

T502

T503

T504

T505

T506

T507

T508

T509

T510

T511

T512

T513

T518

T519

T520

T521

T522

T523

T524

T528

T529

T530

T531

T532

T533

T534

T535

T536

T537

T539

T540

T541

T542

T543

T549

T55

T560

T561

T562

T563

T564

T565

T566

T567

T568

T569

T570

T571

T572

T573

T578

T579

T58

T590

T591

T592

T593

T594

T595

T596

T597

T598

T599

T600

T601

T602

T603

T604

T608

T609

T610

T611

T612

T618

T619

T620

T621

T622

T628

T629

T630

T631

T632

T633

T634

T635

T636

T638

T639

T64

T650

T651

T652

T653

T654

T655

T656

T658

T659

T66

T670

T671

T672

T673

T674

T675

T676

T677

T678

T679

T68

T690

T691

T698

T699

T700

T701

T702

T703

T704

T708

T709

T71

T730

T731

T732

T733

T738

T739

T740

T741

T742

T743

T748

T749

T750

T751

T752

T753

T754

T758

T780

T781

T782

T783

T784

T788

T789

T790

T791

T792

T793

T794

T795

T796

T797

T798

T799

T800

T801

T802

T803

T804

T805

T806

T808

T809

T810

T811

T812

T813

T814

T815

T816

T817

T818

T819

T820

T821

T822

T823

T824

T825

T826

T827

T828

T829

T830

T831

T832

T834

T835

T836

T838

T839

T840

T841

T842

T843

T844

T845

T846

T847

T848

T849

T850

T851

T852

T853

T854

T855

T856

T857

T858

T859

T860

T861

T862

T863

T864

T868

T869

T870

T871

T872

T873

T874

T875

T876

T880

T881

T882

T883

T884

T885

T886

T887

T888

T889

T900

T901

T902

T903

T904

T905

T908

T909

T910

T911

T912

T913

T914

T915

T918

T919

T920

T921

T922

T923

T924

T925

T926

T928

T929

T930

T931

T932

T933

T934

T935

T936

T938

T939

T940

T941

T950

T951

T952

T953

T954

T958

T959

T96

T97

T980

T981

T982

T983

V191

V195

V201

V205

V211

V215

V221

V225

V231

V235

V241

V245

V251

V255

V261

V265

V271

V275

V281

V285

V291

V295

V301

V306

V311

V316

V321

V326

V331

V336

V341

V346

V351

V356

V361

V366

V371

V376

V381

V386

V391

V395

V401

V406

V411

V416

V421

V426

V431

V436

V441

V446

V451

V456

V461

V466

V471

V476

V481

V486

V491

V495

V501

V506

V511

V516

V521

V526

V531

V536

V541

V546

V551

V556

V561

V566

V571

V576

V581

V586

V591

V595

V601

V606

V611

V616

V621

V626

V631

V636

V641

V646

V651

V656

V661

V666

V671

V676

V681

V686

V691

V695

V701

V706

V711

V716

V721

V726

V731

V736

V741

V746

V751

V756

V761

V766

V771

V776

V781

V786

V791

V795

V800

V801

V802

V803

V804

V805

V806

V807

V808

V809

V810

V811

V812

V813

V815

V816

V817

V818

V819

V820

V821

V822

V823

V825

V826

V827

V828

V829

V831

V836

V841

V846

V851

V856

V861

V866

V870

V871

V872

V873

V874

V875

V876

V877

V878

V879

V880

V881

V882

V883

V884

V885

V886

V887

V888

V889

V890

V891

V892

V893

V899

V910

V911

V912

V913

V914

V915

V916

V917

V918

V919

V930

V931

V932

V933

V934

V935

V936

V937

V938

V939

V940

V941

V942

V943

V944

V945

V946

V947

V948

V949

V950

V951

V952

V953

V954

V958

V959

V960

V961

V962

V968

V969

V970

V973

V978

V98

V99

W20

W21

W22

W23

W24

W25

W26

W27

W28

W29

W30

W31

W32

W33

W34

W35

W36

W37

W38

W39

W40

W41

W42

W43

W44

W45

W49

W50

W51

W52

W55

W58

W64

W85

W86

W87

W88

W89

W90

W91

W92

W93

W99

X19

X30

X31

X32

X33

X340

X341

X348

X349

X35

X36

X37

X39

X40

X41

X42

X43

X44

X45

X46

X47

X48

X49

X52

X57

X58

X590

X599

X85

X87

X88

X89

X90

X93

X94

X95

X96

X97

X98

X99

Y00

Y02

Y18

Y19

Y22

Y23

Y24

Y25

Y26

Y27

Y28

Y29

Y32

Y33

Y34

Y360

Y361

Y362

Y364

Y365

Y366

Y367

Y368

Y369

*U010

*U011

*U012

*U013

*U014

*U015

*U016

*U017

*U018

*U019

U071

 

APPENDIX E
Invalid and Substitute Fetal Death Codes

The following categories are invalid for NCHS fetal cause of death coding. Substitute code(s) for fetal cause of death coding appears to the right.

Use the substitute codes when conditions classifiable to the following codes are reported

                                                             

  Invalid       Substitute Codes              Substitute Codes   

 Codes        Fetal Death                  Maternal Death    

                                                             

 A150-A153    P370                         P002              

                                                             

 A154         P370                         P002              

                                                             

 A155         P370                         P002              

                                                             

 A156         P370                         P002              

                                                             

  A157          P370                          P002               

                                                             

 A158         P370                         P002              

                                                             

 A159         P370                         P002              

                                                             

 B95-B97      Code the disease(s) classified to other        

              chapters modified by the organism. Do not      

              enter a code for the organism.                 

                                                             

  F70.-         P95                           P008               

                                                             

 F71.-        P95                          P008              

                                                             

 F72.-        P95                          P008              

                                                             

 F73.-        P95                          P008              

                                                             

 F78.-        P95                          P008              

                                                             

 F79.-        P95                          P008              

                                                             

 I151-I158    R95                          R99               

                                                             

  I23.-         I21 or I22                    P003               

                                                             

 I240         I21 or I22                   P003              

                                                             

 I65- I66     I63                          P003              

                                                             

 R69          R95                          R99               

                                                             

 T000, T001,  Superficial injuries of      P005              

 T006         specified sites                                

                                                             

 T010, T011,  Open wound of                P005              

 T016, T018   specified sites                                

                                                             

  T020, T026,   Fractures of specified        P005               

 T027         sites                                          

                                                             

 T030, T034   Dislocations, sprains, and   P005              

              strains of specified sites                     

                                                             

 T040, T044,  Crushing injuries of         P005              

 T047         specified sites                                

                                                             

 T051, T054,  Traumatic amputations of     P005              

 T056         specified site                                 

                                                             

 T060, T061,  Injuries of specified        P005              

 T068         sites                                          

                                                             

 T29.-        Burns of specified sites     P005              

                                                             

 

APPENDIX F
Conditions Considered Ill-defined for Fetal Deaths

P04.2

P07.0

P07.1

P07.2

P07.3

P20.1

P20.9

P21.9

P95

R00-R99

APPENDIX G
Spontaneous Abortions

Abortion terms interpreted as “spontaneous” and coded as fetal deaths

                                  

  Accidental abortion        P018    

                                  

 Complete abortion         P018   

                                  

 Early pregnancy failure   P018   

                                  

 Habitual abortion         P018   

                                  

 Idiopathic abortion       P018   

                                  

 Incomplete abortion       P018   

                                  

  Inevitable abortion        P018    

                                  

 Infected abortion *       P018   

                                  

 Miscarriage               P018   

                                  

  Missed abortion            P018    

                                  

 Natural abortion          P018   

                                  

 Recurrent abortion        P018   

                                  

 Retained abortion         P018   

                                  

 Septic abortion *         P018   

                                  

 Spontaneous abortion      P018   

                                  

  Tubal abortion             P014    

                                  

 Unavoidable abortion      P018   

                                  

 Unintended abortion       P018   

                                  

 


 

*With no statement that a D and C was performed.

APPENDIX H
Terms Interpreted as “Induced abortions” and Not Coded as Fetal Death

1.   Abortifacient Use

2.   Consensual abortion

3.   Convenience

4.   Demand abortion 

5.   Dilation and curettage (D & C)

6.   Dilation and curettage for termination of pregnancy psychiatric indications (D & C for T. O. P.)

7.   Dilation and evacuation (D & E)

8.   Dilatation and suction curettage (D & SC)

9.   Early uterine evacuation

10.  Elective abortion (E. A.)

11.  Elective termination

12.  Endometrial aspiration

13.  Extra-amniotic injection

14.  Fetacidal Injection

15.  Hypersalinezation

16.  Hysterotomy

17.  Hysterectomy for termination of pregnancy (hysterectomy)

18.  Iatrogenic interruptions of pregnancy (iatrogenic)

19.  Inconvenience

20.  Indicated abortion social economic reason

21.  Induced abortion

22.  Induced by instrumentation prior to admission

23.  Induced preg. termination

24.  Induced termination of pregnancy (ITOP)

25.  Infective abortion*

26.  Intentional termination of pregnancy

27.  Interrupted first trimester

28.  Interrupted pregnancy

29.  Intra-amniotic injection

30.  Intra-amniotic instillation

31.  Intracardiac injection

32.  Intra-uterine prostaglandin instillation

33.  Intra-uterine saline instillation

34.  KCL injection

35.  Laminaria

36.  Legal abortion

37.  Legally induced abortion

38.  Maternal ingestion of abortifacient agent (cytotec) (misoprostol)

39.  Medically induced abortion

40.  Medically indicated termination of pregnancy

41.  Medical interruption of pregnancy

42.  Medical termination of pregnancy

43.  Menstrual aspiration

44.  Menstrual extraction

45.  Menstrual induction

46.  Menstrual regulation

47.  Oxytocin induction

48.  Pitocin induction

49.  Prophylactic abortion

50.  Potassium Chloride

51.  Prostaglandin injection

52.  Prostaglandin amniocentesis

53.  Requested abortion

54.  Saline induction (saline) (salting out procedure) (salinezation)

55.  Saline amniocentesis

56.  Saline amnio-infusion

57.  Saline amniotic fluid exchange

58.  Self-Induced Abortion

59.  Septic abortion *

60.  Septic criminal abortion

61.  Sharp curettage

62.  Sodium chloride injection

63.  Sociologic termination

64.  Suction abortion

65.  Suction curettage (S. & C.)

66.  Suction D & C

67.  Sulting out procedure

68.  Surgical abortion (S. A.)

69.  Surgical curettage

70.  Surgical excision of pregnancy

71.  Surgical interruption of pregnancy

72.  Termination

73.  Termination in utero

74.  Termination of fetal life

75.  Termination of pregnancy

76.  Therapeutic abortion (T. A., ther ab, Tab)

77.  Therapeutic interruption (T. I.)

78.  Undesired pregnancy

79.  Vacuum aspiration

80.  Vacuum extraction

81.  Vacuum induction

82.  Vaginal suppository prostaglandin

83.  Voluntary abortion (V. A. or V. I. A.)

84.  Voluntary evacuation (incomplete)

85.  Voluntary interruption of pregnancy

86.  Voluntary termination pregnancy (VTP)

* Must have a statement that a D and C was performed. If no statement that a

 D and C was performed, consider as a spontaneous abortion/fetal death.

APPENDIX I
ITOP reportings interpreted as Fetal Deaths

A statement from Part D describes when a record containing an ITOP term can be included in the fetal death file:

 

“Induced terminations of pregnancy should be included in the fetal death file only when the fetus was known dead before the procedure and when the induction was performed for the sole purpose of removing an already-dead fetus.”

 

To help aid in this often difficult determination, consider reportings such as the below to be indications that the fetus was deceased and the procedure was to remove the already-dead fetus (note:reportings can be in either part). Records such as the below will remain as part of the fetal death file.

 

                                                              

                18a                             18b              

                                                              

 D and C for retained placenta                                

                                                              

 Incomplete abortion after Cytotec                            

 for missed abortion                                          

                                                              

 Induction of pregnancy for                                   

 stillborn                                                    

                                                              

 Induction of labor for IUFD -                                

 stillborn                                                    

                                                              

                                   Retained placenta/ +/ D    

                                   and C                      

                                                              

  Retained placenta, D & C / +                                   

 /post preterm hemorrhage                                     

                                                              

 Retained placenta D and E                                    

                                                              

 Missed abortion / suction                                    

 curettage                                                    

                                                              

 Fetal demise /+/ ITP              ITP                        

                                                              

 Missed AB /+/ D&C                                            

                                                              

 Missed AB, suction D&C                                       

                                                              

 Hysterotomy of IUFD                                          

                                                              

  Induction of labor for                                         

 intrauterine fetal demise /+/                                

 hydropic, cleft lip, clubbed                                 

 feet                                                         

                                                              

 Continued bleeding                 Dilation and evacuation  

                                                              

 Retained products of conception                              

 for D&C with suction                                         

                                                              

 Lethal abnormalities, uncertain    Termination of            

 diagnosis                          pregnancy/+/None          

                                                              

 Cord accident                      Dilation and evacuation   

                                                              

 Fetal demise                       Pregnancy termination