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.
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
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Q740
Q741
Q742
Q743
Q748
Q749
Q750
Q751
Q752
Q753
Q754
Q755
Q758
Q759
Q760
Q761
Q762
Q763
Q764
Q765
Q766
Q767
Q769
Q770
Q771
Q772
Q773
Q774
Q775
Q776
Q777
Q778
Q779
Q780
Q781
Q782
Q783
Q784
Q785
Q786
Q788
Q789
Q790
Q791
Q792
Q793
Q794
Q795
Q796
Q798
Q799
Q800
Q801
Q802
Q803
Q804
Q808
Q809
Q810
Q811
Q812
Q818
Q819
Q820
Q821
Q822
Q823
Q824
Q825
Q828
Q829
Q830
Q831
Q832
Q833
Q838
Q839
Q840
Q841
Q842
Q843
Q844
Q845
Q846
Q848
Q849
Q850
Q851
Q858
Q859
Q860
Q861
Q862
Q868
Q870
Q871
Q872
Q873
Q874
Q875
Q878
Q890
Q891
Q892
Q893
Q894
Q897
Q898
Q899
Q900
Q901
Q902
Q909
Q910
Q911
Q912
Q913
Q914
Q915
Q916
Q917
Q920
Q921
Q922
Q923
Q924
Q925
Q926
Q927
Q928
Q929
Q930
Q931
Q932
Q933
Q934
Q935
Q936
Q937
Q938
Q939
Q951
Q952
Q954
Q955
Q958
Q959
Q960
Q961
Q962
Q963
Q964
Q968
Q969
Q970
Q971
Q972
Q973
Q978
Q979
Q980
Q981
Q982
Q983
Q984
Q985
Q987
Q988
Q989
Q990
Q991
Q992
Q998
Q999
R14
R18
R190
R220
R238
R298
R456
R75
R772
R780
R781
R782
R783
R784
R785
R786
R787
R788
R789
R81
R830
R831
R832
R833
R834
R835
R836
R837
R838
R839
R840
R841
R842
R843
R844
R845
R846
R847
R848
R849
R850
R851
R852
R853
R854
R855
R856
R857
R858
R859
R898
R99
S000
S001
S002
S003
S004
S005
S007
S008
S009
S010
S011
S012
S013
S014
S015
S017
S018
S019
S020
S021
S022
S023
S024
S025
S026
S027
S028
S029
S030
S031
S032
S033
S034
S035
S040
S041
S042
S043
S044
S045
S046
S047
S048
S049
S050
S051
S052
S053
S054
S055
S056
S057
S058
S059
S060
S061
S062
S063
S064
S065
S066
S067
S068
S069
S070
S071
S078
S079
S080
S081
S088
S089
S090
S091
S092
S097
S098
S099
S100
S101
S107
S108
S109
S110
S111
S112
S117
S118
S119
S120
S121
S122
S127
S128
S129
S130
S131
S132
S133
S134
S135
S136
S140
S141
S142
S143
S144
S145
S146
S150
S151
S152
S153
S157
S158
S159
S16
S170
S178
S179
S18
S197
S198
S199
S200
S201
S202
S203
S204
S207
S208
S210
S211
S212
S217
S218
S219
S220
S221
S222
S223
S224
S225
S228
S229
S230
S231
S232
S233
S234
S235
S240
S241
S242
S243
S244
S245
S246
S250
S251
S252
S253
S254
S255
S257
S258
S259
S260
S268
S269
S270
S271
S272
S273
S274
S275
S276
S277
S278
S279
S280
S281
S290
S297
S298
S299
S300
S301
S302
S307
S308
S309
S310
S311
S315
S317
S318
S320
S321
S322
S323
S324
S325
S327
S328
S330
S331
S332
S333
S334
S335
S336
S337
S340
S341
S342
S343
S344
S345
S346
S348
S350
S351
S352
S353
S354
S355
S357
S358
S359
S360
S361
S362
S363
S364
S365
S366
S367
S368
S369
S370
S371
S372
S373
S377
S378
S379
S380
S381
S382
S383
S390
S396
S397
S398
S399
S400
S407
S408
S409
S410
S411
S417
S418
S420
S421
S422
S423
S424
S427
S428
S429
S430
S431
S432
S433
S434
S435
S436
S437
S440
S441
S442
S443
S444
S445
S447
S448
S449
S450
S451
S452
S453
S457
S458
S459
S460
S461
S462
S463
S467
S468
S469
S47
S480
S481
S489
S497
S498
S499
S500
S501
S507
S508
S509
S510
S517
S518
S519
S520
S521
S522
S523
S524
S525
S526
S527
S528
S529
S530
S531
S532
S533
S534
S540
S541
S542
S543
S547
S548
S549
S550
S551
S552
S557
S558
S559
S560
S561
S562
S563
S564
S565
S567
S568
S570
S578
S579
S580
S581
S589
S597
S598
S599
S600
S601
S602
S607
S608
S609
S610
S611
S617
S618
S619
S620
S621
S622
S623
S624
S625
S626
S627
S628
S630
S631
S632
S633
S634
S635
S636
S637
S640
S641
S642
S643
S644
S647
S648
S649
S650
S651
S652
S653
S654
S655
S657
S658
S659
S660
S661
S662
S663
S664
S665
S666
S667
S668
S669
S670
S678
S680
S681
S682
S683
S684
S688
S689
S697
S698
S699
S700
S701
S707
S708
S709
S710
S711
S717
S718
S720
S721
S722
S723
S724
S727
S728
S729
S730
S731
S740
S741
S742
S747
S748
S749
S750
S751
S752
S757
S758
S759
S760
S761
S762
S763
S764
S767
S770
S771
S772
S780
S781
S789
S797
S798
S799
S800
S801
S807
S808
S809
S810
S817
S818
S819
S820
S821
S822
S823
S824
S825
S826
S827
S828
S829
S830
S831
S832
S833
S834
S835
S836
S837
S840
S841
S842
S847
S848
S849
S850
S851
S852
S853
S854
S855
S857
S858
S859
S860
S861
S862
S863
S867
S868
S869
S870
S878
S880
S881
S889
S897
S898
S899
S900
S901
S902
S903
S907
S908
S909
S910
S911
S912
S913
S917
S920
S921
S922
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