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        Instructions for Classifying Multiple Causes of Death, 2022 – Section II
          Instructions for Classifying Multiple Causes of Death, 2022 – Section II
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                  SECTION II – GENERAL INSTRUCTIONS
                  A. Introduction
                  Code all information reported in the medical certification section of the death certificate and any other information pertaining to the medical certification, when reported elsewhere on the certificate. In Volumes 1 and 3 of ICD-10, the fourth-character subcategories of three-character categories are preceded by a decimal point. For coding purposes, omit the decimal point.
                  Enter codes in the same order and location as the entries they represent appear on the death certificate, proceeding from the entry reported uppermost in Part II downward and from the left to right. If the uppermost line in Part II is an obvious continuation of a line below, enter the codes accordingly.
                  For instructions on placement of codes when the certifier states or implies a “due to” relationship between conditions not reported in sequential order, refer to Section II, Part C, Format . For instructions on placement of nature of injury (N-code) and external cause codes (E-codes), refer to Section V, Part B, Placement of Nature of Injury and External Cause Codes .
                  When an identical code applies to more than one condition reported on the same line, enter the code for the first-mentioned of these conditions only. When conditions classifiable to the same code are reported on different lines of the certificate, enter the code for each of the reported conditions. (This does not apply to external cause of morbidity and mortality (E-codes)).
                  1. Excessive Codes
                  a. When a single line in Part I or 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:
                  (1) Delete ill-defined conditions (I461, I469, I959, I99, J960, J969, P285, R00-R94, R96, R98) except when this code is the first code on a line, proceeding right to left.
                  (2) Delete nature of injury codes (S000-T983) except for the first one entered on a line, proceeding right to left.
                  (3) If, after applying the preceding criteria, any single line still has more than eight codes, delete beginning with the last code on the line until only 8 remain.
                  I (a) I499
                  (b) I219 I739
                  (c)
                  (d)
                  II &E109 I739 T811 &Y835 R18 R33 N19 C475 N359 I490 I493 J181
                  After deleting excessive codes:
                  I (a) I499
                  (b) I219 I739
                  (c)
                  (d)
                  II &E109 I739 T811 &Y835 N19 C475 N359 I490
                  Delete (1) R33, (2) R18, (3) J181 and (4) I493
                  b. When a single record requires more than 14 codes, delete the excessive codes using the following criteria in the order listed:
                  (1) Delete ill-defined conditions (I461, I469, I959, I99, J960, J969, P285, R00 - R94, R96, R98) except when this code is the first code on a line, beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d , line c, line b, line a).
                  (1) Delete ill-defined conditions (I461, I469, I959, I99, J960, J969, P285, R00 – R94, R96, R98) except when this code is the first code on a line, beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d , line c, line b, line a).
                  (2) Delete nature of injury codes (S000-T983) except for the first one entered on a line beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d , line c, line b, line a).
                  (3) Delete repetitive codes except when it is the first code on a line beginning with the last code in Part II, proceeding right to left then upward right to left on each line (Part II, line e, line d , line c, line b, line a).
                  (4) If after applying the preceding criteria, any record still has more than 14 codes, delete beginning with the last code in Part II, proceeding upward right to left on each line (Part II, line e, line d , line c, line b, line a).
                  I (a) C80 I499 R570
                  (b) R098 R53
                  (c) R54 F09 F03
                  (d) I709 I635
                  II I119 C473 R200 I258 I251 D539 R798 I635
                  After deleting excessive codes:
                  I (a) C80 I499
                  (b) R098
                  (c) R54 F09 F03
                  (d) I709 I635
                  II I119 C473 I258 I251 D539 I635
                  Delete (1) R798, (2) R200, (3) R53 and (4) R570
                  2. Created Codes
                  To facilitate automated data processing, the following ICD-10 codes have been amended for use in coding and processing the multiple cause data. Special five character subcategories are for use in coding and processing the multiple cause data; however, they will not appear in official tabulations.
                  A169 Respiratory tuberculosis, unspecified
                  Excludes: Any term indexed to A169 not qualified as respiratory or pulmonary (A1690)
                  *A1690 Tuberculosis NOS
                  Includes: Any term indexed to A169 not qualified as respiratory or pulmonary
                  E039 Hypothyroidism, unspecified
                  Excludes: Any term indexed to E039 qualified as advanced, grave, severe, or with a similar qualifier (E0390)
                  *E0390 Advanced hypothyroidism
                  Grave hypothyroidism
                  Severe hypothyroidism
                  Includes: Any term indexed to E039 qualified as advanced, grave, severe, or with a similar qualifier
                  G122 Motor neuron disease
                  Excludes: Any term indexed to G122 qualified as advanced, grave, severe, or with a similar qualifier (G1220)
                  *G1220 Advanced motor neuron disease
                  Grave motor neuron disease
                  Severe motor neuron disease
                  Includes: Any term indexed to G122 qualified as advanced, grave, severe, or with a similar qualifier
                  G20 Parkinson disease
                  Excludes: Any term indexed to G20 qualified as advanced, grave, severe, or with a similar qualifier (G2000)
                  *G2000 Advanced Parkinson disease
                  Grave Parkinson disease
                  Severe Parkinson disease
                  Includes: Any term indexed to G20 qualified as advanced, grave, severe, or with a similar qualifier
                  I219 Acute myocardial infarction, unspecified
                  Excludes: Embolism of any site classified to I219
                  *I2190 Embolism cardiac, heart, myocardium or a synonymous site
                  Includes: Embolism of any site classified to I219
                  I420 Dilated cardiomyopathy
                  Excludes: Any term indexed to I420 qualified as familial, idiopathic, or primary (I4200)
                  *I4200 Familial dilated cardiomyopathy
                  Idiopathic dilated cardiomyopathy
                  Primary dilated cardiomyopathy
                  Includes: Any term indexed to I420 qualified as familial, idiopathic, or primary
                  I421 Obstructive hypertrophic cardiomyopathy
                  Excludes: Any term indexed to I421 qualified as familial, idiopathic, or primary (I4210)
                  *I4210 Familial obstructive hypertrophic cardiomyopathy
                  Idiopathic obstructive hypertrophic cardiomyopathy
                  Primary obstructive hypertrophic cardiomyopathy
                  Includes: Any term indexed to I421 qualified as familial, idiopathic, or primary
                  I422 Other hypertrophic cardiomyopathy
                  Excludes: Any term indexed to I422 qualified as familial, idiopathic, or primary (I4220)
                  *I4220 Familial other hypertrophic cardiomyopathy
                  Idiopathic other hypertrophic cardiomyopathy
                  Primary other hypertrophic cardiomyopathy
                  Includes: Any term indexed to I422 qualified as familial, idiopathic, or primary
                  I425 Other restrictive cardiomyopathy
                  Excludes: Any term indexed to I425 qualified as familial, idiopathic, or primary (I4250)
                  *I4250 Familial other restrictive cardiomyopathy
                  Idiopathic other restrictive cardiomyopathy
                  Primary other restrictive cardiomyopathy
                  Includes: Any term indexed to I425 qualified as familial, idiopathic, or primary
                  I428 Other cardiomyopathies
                  Excludes: Any term indexed to I428 qualified as familial, idiopathic, or primary (I4280)
                  *I4280 Familial other cardiomyopathies
                  Idiopathic other cardiomyopathies
                  Primary other cardiomyopathies
                  Includes: Any term indexed to I428 qualified as familial, idiopathic, or primary
                  I429 Cardiomyopathy, unspecified
                  Excludes: Any term indexed to I429 qualified as familial, idiopathic, or primary (I4290)
                  *I4290 Familial cardiomyopathy
                  Idiopathic cardiomyopathy
                  Primary cardiomyopathy
                  Includes: Any term indexed to I429 qualified as familial, idiopathic, or primary
                  I500 Congestive heart failure
                  Excludes: Any term indexed to I500 qualified as advanced, grave, severe, or with a similar qualifier (I5000)
                  *I5000 Advanced congestive heart failure
                  Grave congestive heart failure
                  Severe congestive heart failure
                  Includes: Any term indexed to I500 qualified as advanced, grave, severe, or with a similar qualifier
                  I514 Myocarditis, unspecified
                  Excludes: Any term indexed to I514
                  qualified as arteriosclerotic (I5140)
                  *I5140 Arteriosclerotic myocarditis
                  Includes: Any term indexed to I514 qualified as arteriosclerotic
                  I515 Myocardial degeneration
                  Excludes: Any term indexed to I515
                  qualified as arteriosclerotic (I5150)
                  *I5150 Arteriosclerotic myocardial degeneration
                  Includes: Any term indexed to I515 qualified as arteriosclerotic
                  I600 Subarachnoid hemorrhage from carotid siphon and bifurcation
                  Excludes: Ruptured carotid aneurysm (into brain) (I6000)
                  *I6000 Ruptured carotid aneurysm (into brain)
                  I606 Subarachnoid hemorrhage from other intracranial arteries
                  Excludes: Ruptured aneurysm (congenital) circle of Willis (I6060)
                  *I6060 Ruptured aneurysm (congenital) circle of Willis
                  I607 Subarachnoid hemorrhage from intracranial artery, unspecified
                  Excludes: Ruptured berry aneurysm (congenital) brain (I6070)
                  Ruptured miliary aneurysm (I6070)
                  *I6070 Ruptured berry aneurysm (congenital) brain
                  Ruptured miliary aneurysm
                  I608 Other subarachnoid hemorrhage
                  Excludes: Ruptured aneurysm brain meninges (I6080)
                  Ruptured arteriovenous aneurysm (congenital) brain (I6080)
                  Ruptured (congenital) arteriovenous aneurysm cavernous sinus (I6080)
                  *I6080 Ruptured aneurysm brain meninges
                  Ruptured arteriovenous aneurysm (congenital) brain
                  Ruptured (congenital) arteriovenous aneurysm cavernous sinus
                  I609 Subarachnoid hemorrhage, unspecified
                  Excludes: Ruptured arteriosclerotic cerebral aneurysm (I6090)
                  Ruptured (congenital) cerebral aneurysm NOS (I6090)
                  Ruptured mycotic aneurysm brain (I6090)
                  *I6090 Ruptured arteriosclerotic cerebral aneurysm
                  Ruptured (congenital) cerebral aneurysm NOS
                  Ruptured mycotic aneurysm brain
                  I610 Intracerebral hemorrhage in hemisphere, subcortical
                  Excludes: Any term indexed to I610 qualified as bilateral, multiple, or [ i ] similar term (I6100)
                  *I6100 Bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages in hemisphere, subcortical
                  Includes: Any term indexed to I610 qualified as bilateral, multiple, or [ i ] similar term
                  I611 Intracerebral hemorrhage in hemisphere, cortical
                  Excludes: Any term indexed to I611 qualified as bilateral, multiple, or [ i ] similar term (I6110)
                  *I6110 Bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages in hemisphere, cortical
                  Includes: Any term indexed to I611 qualified as bilateral, multiple, or [ i ] similar term
                  I612 Intracerebral hemorrhage in hemisphere, unspecified
                  Excludes: Any term indexed to I612 qualified as bilateral, multiple, or [ i ] similar term (I6120)
                  *I6120 Bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages, unspecified
                  Includes: Any term indexed to I612 qualified as bilateral, multiple, or [ i ] similar term
                  I613 Intracerebral hemorrhage in brain stem
                  Excludes: Any term indexed to I613 qualified as bilateral, multiple, or [ i ] similar term (I6130)
                  *I6130 Bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages in brain stem
                  Includes: Any term indexed to I613 qualified as bilateral, multiple, or [ i ] similar term
                  I614 Intracerebral hemorrhage in cerebellum
                  Excludes: Any term indexed to I614 qualified as bilateral, multiple, or [ i ] similar term (I6140)
                  *I6140 Bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages in cerebellum
                  Includes: Any term indexed to I614 qualified as bilateral, multiple, or [ i ] similar term
                  I615 Intracerebral hemorrhage, intraventricular
                  Excludes: Any term indexed to I615 qualified as bilateral, multiple, or [ i ] similar term (I6150)
                  *I6150 Bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages, intraventricular
                  Includes: Any term indexed to I615 qualified as bilateral, multiple, or [ i ] similar term
                  I618 Other intracerebral hemorrhage
                  Excludes: Any term indexed to I618 qualified as bilateral, multiple, or [ i ] similar term (I6180)
                  *I6180 Bilateral, multiple [or [ i ] similar term] other intracerebral hemorrhages
                  Includes: Any term indexed to I618 qualified as bilateral, multiple, or [ i ] similar term
                  I619 Intracerebral hemorrhage, unspecified
                  Excludes: Any term indexed to I619 qualified as bilateral, multiple, or [ i ] similar term (I6190)
                  *I6190 Bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages, unspecified
                  Includes: Any term indexed to I619 qualified bilateral, multiple, or [ i ] similar term
                  I630 Cerebral infarction due to thrombosis of precerebral arteries
                  Excludes: Any term indexed to I630 qualified as bilateral, multiple, or [ i ] similar term (I6300)
                  *I6300 Cerebral infarction due to bilateral, multiple [or [ i ] similar term] thrombi of precerebral arteries
                  Includes: Any term indexed to I630 qualified as bilateral, multiple, or [ i ] similar term
                  I631 Cerebral infarction due to embolism of precerebral arteries
                  Excludes: Any term indexed to I631 qualified as bilateral, multiple, or [ i ] similar term (I6310)
                  *I6310 Cerebral infarction due to bilateral, multiple [or [ i ] similar term] emboli of precerebral arteries
                  Includes: Any term indexed to I631 qualified as bilateral, multiple, or [ i ] similar term
                  I632 Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries
                  Excludes: Any term indexed to I632 qualified as bilateral, multiple, or [ i ] similar term (I6320)
                  *I6320 Cerebral infarction due to bilateral, multiple [or [ i ] similar term]unspecified occlusions or stenosis of precerebral arteries
                  Includes: Any term indexed to I632 qualified as bilateral, multiple, or [ i ] similar term
                  I633 Cerebral infarction due to thrombosis of cerebral arteries
                  Excludes: Any term indexed to I633 qualified as bilateral, multiple, or [ i ] similar term (I6330)
                  *I6330 Cerebral infarction due to bilateral, multiple [or [ i ] similar term] thrombi of cerebral arteries
                  Includes: Any term indexed to I633 qualified as bilateral, multiple, or [ i ] similar term
                  I634 Cerebral infarction due to embolism of cerebral arteries
                  Excludes: Any term indexed to I634 qualified as bilateral, multiple, or [ i ] similar term (I6340)
                  *I6340 Cerebral infarction due to bilateral, multiple [or [ i ] similar term] emboli of cerebral arteries
                  Includes: Any term indexed to I634 qualified as bilateral, multiple, or [ i ] similar term
                  I635 Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries
                  Excludes: Any term indexed to I635 qualified as bilateral, multiple, or [ i ] similar term(I6350)
                  *I6350 Cerebral infarction due to bilateral, multiple [or [ i ] similar term]unspecified occlusions or stenosis of cerebral arteries
                  Includes: Any term indexed to I635 qualified as bilateral, multiple, or [ i ] similar term
                  I636 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
                  Excludes: Any term indexed to I636 qualified as bilateral, multiple, or [ i ] similar term (I6360)
                  *I6360 Cerebral infarction due to bilateral, multiple [or [ i ] similar term]
                  cerebral venous thrombi, nonpyogenic
                  Includes: Any term indexed to I636 qualified as bilateral, multiple, or [ i ] similar term
                  I638 Other cerebral infarction
                  Excludes: Any term indexed to I638 qualified as bilateral, multiple, or [ i ] similar term (I6380)
                  *I6380 Bilateral, multiple [or [ i ] similar term] other cerebral infarctions
                  Includes: Any term indexed to I638 qualified bilateral, multiple, or [ i ] similar term
                  I639 Cerebral infarction, unspecified
                  Excludes: Any term indexed to I639 qualified as bilateral, multiple, or [ i ] similar term (I6390)
                  *I6390 Bilateral, multiple [or [ i ] similar term] cerebral infarctions, unspecified
                  Includes: Any term indexed to I639 qualified as bilateral, multiple, or [ i ] similar term
                  I64 Stroke, not specified as hemorrhage or infarction
                  Excludes: Any term indexed to I64 qualified as bilateral, multiple, or [ i ] similar term(I6400)
                  *I6400 Bilateral, multiple [or [ i ] similar term] strokes, not specified as hemorrhage or infarction
                  Includes: Any term indexed to I64 qualified as bilateral, multiple, or [ i ] similar term
                  I691 Sequelae of intracerebral hemorrhage
                  Excludes: Any term indexed to I691 qualified as bilateral, multiple, or [ i ] similar term (I6910)
                  *I6910 Sequela of bilateral, multiple [or [ i ] similar term] intracerebral hemorrhages
                  Includes: Any term indexed to I691 qualified as bilateral, multiple, or [ i ] similar term
                  I693 Sequelae of cerebral infarction
                  Excludes: Any term indexed to I693 qualified as bilateral, multiple, or [ i ] similar term (I6930)
                  *I6930 Sequela of bilateral, multiple [or [ i ] similar term] cerebral infarctions
                  Includes: Any term indexed to I693 qualified as bilateral, multiple, or [ i ] similar term
                  I694 Sequelae of stroke, not specified as hemorrhage or infarction
                  Excludes: Any term indexed to I694 qualified as bilateral, multiple, or [ i ] similar term (I6940)
                  *I6940 Sequela of bilateral, multiple [or [ i ] similar term] strokes, not specified as hemorrhage or infarction
                  Includes: Any term indexed to I694 qualified as bilateral, multiple, or [ i ] similar term
                  J101 Influenza with other respiratory manifestations, influenza virus identified
                  Excludes: Influenza, flu, grippe (viral), influenza virus identified (without specified manifestations) (J1010)
                  *J1010 Influenza, flu, grippe (viral), influenza virus identified (without specified manifestations)
                  J111 Influenza with other respiratory manifestations, virus not identified
                  Excludes: Influenza, flu, grippe (viral), influenza virus not identified (without specified manifestations) (J1110)
                  *J1110 Influenza, flu, grippe (viral), influenza virus not identified (without specified manifestations)
                  J849 Interstitial pulmonary disease, unspecified
                  Excludes: Interstitial pneumonia, not elsewhere classified (J8490)
                  *J8490 Interstitial pneumonia, not elsewhere classified
                  J984 Other disorders of lung
                  Excludes: Lung disease (acute) (chronic) NOS (J9840)
                  *J9840 Lung disease (acute) (chronic) NOS
                  K319 Disease of stomach and duodenum, unspecified
                  Excludes: Disease, stomach NOS (K3190)
                  Lesion, stomach NOS (K3190)
                  *K3190 Disease, stomach NOS
                  Lesion, stomach NOS
                  K550 Acute vascular disorders of intestine
                  Excludes: Any term indexed to K550 qualified as embolic (K5500)
                  *K5500 Acute embolic vascular disorders of intestine
                  Includes: Any term indexed to K550 qualified as embolic
                  K631 Perforation of intestine (nontraumatic)
                  Excludes: Intestinal penetration, unspecified part (K6310)
                  Intestinal perforation, unspecified part (K6310)
                  Intestinal rupture, unspecified part (K6310)
                  *K6310 Intestinal penetration, unspecified part
                  Intestinal perforation, unspecified part
                  Intestinal rupture, unspecified part
                  K720 Acute and subacute hepatic failure
                  Excludes: Acute hepatic failure (K7200)
                  *K7200 Acute hepatic failure
                  K721 Chronic hepatic failure
                  Excludes: Chronic hepatic failure (K7210)
                  *K7210 Chronic hepatic failure
                  K729 Hepatic failure, unspecified
                  Excludes: Hepatic failure (K7290)
                  *K7290 Hepatic failure
                  M199 Arthrosis, unspecified
                  Excludes: Any term indexed to M199 qualified as advanced, grave, severe, or with a similar qualifier (M1990)
                  *M1990 Advanced arthrosis
                  Grave arthrosis
                  Severe arthrosis
                  Includes: Any term indexed to M199 qualified as advanced, grave, severe, or with a similar qualifier
                  Q278 Other specified congenital malformations of peripheral vascular system
                  Excludes: Congenital aneurysm (peripheral) (Q2780)
                  *Q2780 Congenital aneurysm (peripheral)
                  Q282 Arteriovenous malformation of cerebral vessels
                  Excludes: Congenital arteriovenous cerebral aneurysm ( nonruptured ) (Q2820)
                  *Q2820 Congenital arteriovenous cerebral aneurysm ( nonruptured )
                  Q283 Other malformations of cerebral vessels
                  Excludes: Congenital cerebral aneurysm ( nonruptured ) (Q2830)
                  *Q2830 Congenital cerebral aneurysm ( nonruptured )
                  R58 Hemorrhage, not elsewhere classified
                  Excludes: Hemorrhage of unspecified site (R5800)
                  *R5800 Hemorrhage of unspecified site
                  R99 Other ill-defined and unspecified causes of mortality
                  Excludes: Cause unknown (R97)
                  *R97 Cause unknown
                  3.“ Dagger and asterisk” codes
                  ICD-10 provides for the classification of certain diagnostic statements according to two different axes-etiology or underlying disease process and manifestation or complication. Thus, there are two codes for diagnostic statements subject to dual classification. The etiology or underlying disease codes are marked with a dagger ( † ) and the manifestations or complication codes are marked with an asterisk (*) following the code. The terms classified to codes with an asterisk are to be coded to the dagger code for the term only. These codes will not appear in official tabulations on multiple cause data.
                  I (a) Salmonella meningitis A022
                  Use only the dagger code for multiple cause-of-death coding.
                  Do not use the following ICD-10 codes for multiple cause coding:
                  D63* H03* I68* M36*
                  D77* H06* I79* M49*
                  E35* H13* I98* M63*
                  E90* H19* J17* M68*
                  F00* H22* J91* M73*
                  F02* H28* J99* M82*
                  G01* H32* K23* M90*
                  G02* H36* K67* N08*
                  G05* H42* K77* N16*
                  G07* H45* K87* N22*
                  G13* H48* K93* N29*
                  G22* H58* L14* N33*
                  G26* H62* L45* N37*
                  G32* H67* L54* N51*
                  G46* H75* L62* N74*
                  G53* H82* L86* P75*
                  G55* H94* L99*
                  G59* I32* M01*
                  G63* I39* M03*
                  G73* I41* M07*
                  G94* I43* M09*
                  G99* I52* M14*
                  B. General coding concept
                  The coding of cause-of-death information for the ACME system consists of the assignment of the most appropriate ICD-10 code(s) for each diagnostic entity that is reported on the death certificate. 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.
                  I (a) Cholecystitis with cholelithiasis K819 K802
                  Code each entity separately even though the Index has provided for a combination code for cholecystitis with cholelithiasis.
                  I (a) Malignant neoplasm of colon with rectum C189 C20
                  Code malignant neoplasm of colon and malignant neoplasm of rectum separately even though the Index has provided for a combination code for malignant neoplasm of colon with rectum.
                  Place I (a) Injury of intra-abdominal and intrathoracic organs S369 S279
                  9 II &X599
                  Code injury of each site separately even though the Index has provided for a combination code for intra-abdominal and intrathoracic injury.
                  1. 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.”
                  a. One-term entity
                  (1) A one-term entity is a diagnostic entity that is classifiable to a single ICD-10.
                  I (a) Pneumonia J189
                  (b) Arteriosclerosis I709
                  (c) Emphysema J439
                  These terms are codable one-term entities.
                  I (a) Allergic vasculitis D690
                  This condition is indexed as one-term entity under “vasculitis.”
                  I (a) Cerebral arteriosclerosis I672
                  This condition is indexed as one-term entity.
                  (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, necrotizing
                  erosive obstructed, obstructive
                  gangrenous ruptured
                  hemorrhagic
                  (These instructions apply to these 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.
                  I (a) Embolic nephritis N058
                  Code Nephritis, embolic. The adjectival modifier “embolic” is indexed under nephritis.
                  (b) If the modifier is not indexed under the lead term, but “specified” is, use the code for specified (usually .8).
                  I (a) Obstructive cystitis N308
                  Code Cystitis, specified NEC. The adjectival modifier “obstructive” is not indexed under cystitis.
                  (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 a specified 4 th character subcategory.
                  I (a) Hemorrhagic cardiomyopathy I428
                  Code hemorrhagic cardiomyopathy to I428, Other cardiomyopathies. “Hemorrhagic” is not indexed under cardiomyopathy, neither is Cardiomyopathy, specified NEC indexed. The Classification does provide a code, I428, for “Other cardiomyopathies” in Volume 1.
                  (d) If neither (a), (b), or (c) apply, code the lead term without the modifier.
                  I (a) Adenomatous bronchiectasis J47
                  “Adenomatous” is not an index term qualifying bronchiectasis. Code bronchiectasis only, since there is no provision in the Classification for coding “other bronchiectasis.”
                  b. 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.
                  I (a) Myocardial infarction I219
                  (b) Uremic acidosis N19 E872
                  (c) Chronic nephritis N039
                  “Uremic acidosis” is not indexed as a one-term entity. Code “uremia” and “acidosis” as separate one-term entities, each of which can stand alone as a diagnosis.
                  I (a) Uremia N19
                  (b) Diabetic heart disease E149 I519
                  (c)
                  “Diabetic heart disease” is not indexed as a one-term entity. Code “diabetic” and “heart disease” as separate one-term entities, each of which can stand alone as a diagnosis.
                  I (a) Senile cardiovascular disease, MI R54 I516 I219
                  (b)
                  (c)
                  “Senile cardiovascular disease.” is not indexed as a one-term entity. Code “senile” and “cardiovascular disease” as separate one-term entities each of which can stand alone as a diagnosis.
                  Exception:
                  When any condition classifiable to I20-I25, except I250, or I60-I69 is qualified as “hypertensive,” code to I20-I25 or I60-I69 only .
                  I (a) Hypertensive arteriosclerotic
                  cerebrovascular disease I672
                  I (a) Hypertensive myocardial ischemia I259
                  (1) Code an adjective reported at the end of a diagnostic entity as if it preceded the entity. This applies whether reported in Part I or II.
                  I (a) Arteriosclerosis, hypertensive I10 I709
                  (b)
                  (c)
                  The complete term is not indexed as a one-term entity. “Hypertensive” is an adjectival modifier; code as if it preceded the arteriosclerosis.
                  I (a) MI I219
                  (b)
                  (c)
                  II Coronary occlusion, arteriosclerotic I709 I219
                  “Coronary occlusion, arteriosclerotic” is not indexed as a one-term entity. Arteriosclerotic is an adjectival modifier; code as if it preceded the coronary occlusion.
                  (2) (a) When a multiple one-term entity indicates a condition involving different sites or systems for which the Classification provides different codes, code the condition of each site or system separately.
                  I (a) Cardiac, respiratory, hepatic, renal failure I509 J969 K7290 N19
                  Code each site separately since the Classification provides a different code for each site.
                  (b) Where there is provision for coding the condition of one or more but not all of the sites or systems, code the conditions of the site(s) or system(s) that are indexed. Disregard the site(s) or system(s) for which the Classification does not provide a code.
                  I (a) Cerebro -hepatic failure K7290
                  “Hepatic failure” is the only term indexed. Do not enter a code for “cerebral failure.”
                  (c) When a site is not indexed and the Classification provides an NOS code for the condition, assign this code.
                  I (a) Ischemia colon, liver and spleen K559 I99
                  (b)
                  “Ischemia colon” is the only term indexed. Since liver and spleen are not indexed and the condition has an NOS code, assign the NOS code for these terms.
                  c. Adjectival modifier reported with multiple conditions
                  (1) If an adjectival modifier is reported with more than one condition, modify only the first condition.
                  I (a) Arteriosclerotic cardiomyopathy
                  and nephritis I251 N059
                  I (a) Diabetic coma and gangrene E140 R02
                  (2) If an adjectival modifier is reported with one condition and more than one site is reported, modify all sites.
                  I (a) Diabetic gangrene of hands and feet E145
                  I (a) Arteriosclerotic cardiovascular and I250 I672
                  cerebrovascular disease
                  (3) When an adjectival modifier precedes two different diseases that are reported with a connecting term, modify only the first disease.
                  I (a) Arteriosclerotic cardiovascular disease I250 I679
                  and cerebrovascular disease
                  2. Parenthetical entries
                  a. When one medical entity is reported, followed by another complete medical entity enclosed in parenthesis, disregard the parenthesis and enter as separate terms.
                  I (a) Heart dropsy I500
                  (b) Renal failure (CVRD) N19 I139
                  Code each medical entity as indexed.
                  Place I (a) Pneumonia (aspiration) J189 T179 &W80
                  9
                  Code each medical entity as indexed.
                  b. When the adjectival form of words or qualifiers are reported in parenthesis, use these adjectives to modify the term preceding it.
                  I (a) Collapse of heart I509
                  (b) Heart disease (rheumatic) I099
                  (c)
                  Use the adjective to modify the term and code rheumatic heart disease.
                  c. If the term in parenthesis is not a complete term and is not a modifier, consider as part of the preceding term.
                  I (a) Metastatic carcinoma (ovarian) C56
                  Consider the site as part of the preceding term and code metastatic ovarian carcinoma.
                  I (a) Drug dependence (heroin) (cocaine) F112 F142
                  Consider the specified drugs as part of the preceding term and code heroin and cocaine dependence.
                  I (a) Acute combination drug intoxication including fentanyl, opiate (probably heroin) and methamphetamine T509 &X44 T404 T401 T436
                  Consider the heroin as part of the preceding term and code heroin intoxication. There’s no need to assign opiate separately.
                  3. Special diagnostic entities
                  a. When a condition is qualified as “HIV-related,” “HIV,” disregard the indexing of these conditions and code as separate one-term entities.
                  I (a) HIV-related encephalopathy B24 G934
                  I (a) AIDS-related tuberculosis B24 A1690
                  I (a) AIDS encephalopathy B24 G934
                  I (a) HIV encephalopathy B24 G934
                  b. Alzheimer dementia: Consider the following terms as one term entities and code as indicated:
                  When reported as: Code
                  Endstage Alzheimer, senile dementia
                  Senile dementia, Alzheimer G301
                  Senile dementia, Alzheimer type
                  Senile dementia of the Alzheimer
                  When reported as:
                  Alzheimer, dementia
                  Alzheimer; dementia
                  Alzheimer disease (dementia)
                  Dementia Alzheimer
                  Dementia, Alzheimer
                  Dementia-Alzheimer
                  Dementia, Alzheimer type G309
                  Dementia of Alzheimer
                  Dementia-Alzheimer type
                  Dementia; Alzheimer type
                  Dementia, probable Alzheimer (disease)
                  Dementia syndrome, Alzheimer type
                  Endstage dementia (Alzheimer)
                  4. Plural form of disease
                  Do not use the plural form of a disease or the plural form of a site to indicate multiple.
                  I (a) Cardiac arrest I469
                  (b) Congenital defects Q899
                  Code I(b) Q899 (congenital defect); do not code as multiple (Q897).
                  5. Implied “disease”
                  When an adjective or noun form of a site is entered as a separate diagnosis, i.e., it is not part of an entry immediately preceding or following it, assume the word “disease” after the site and code accordingly.
                  I (a) Congestive heart failure I500
                  (b) Myocardial I515
                  Code I(b) to I515, myocardial disease. The site “myocardial” is not indexed with congestive heart failure.
                  I (a) Coronary I251
                  (b) Hypertension I10
                  Code I(a) to I251, coronary disease. Coronary hypertension is not indexed.
                  I (a) Renal I129
                  (b) Hypertension
                  Code I(a) to I129, renal hypertension. Consider the site, renal, to be a part of the condition that immediately follows it on line b, since Hypertension, renal is indexed.
                  6. Drug dependent, drug dependency
                  When drug dependent or drug dependency modifies a condition, consider as a non-codable modifier unless indexed.
                  I (a) Perforated gastric ulcer K255
                  (b) Steroid-dependent COPD J449
                  Code I(a) as indexed. Code I(b) to J449, chronic obstructive pulmonary disease NOS. Consider the “steroid dependent” to be a non-codable modifier.
                  C. Format
                  1. “Due to” relationships involving more than four causally related conditions
                  Four lines, (a), (b), (c), and (d) have been provided in Part I of the death certificate for reporting conditions involved in the sequence of events leading directly to death and for indicating the causal relationship of the reported conditions. In cases where the decedent had more than four causally related conditions leading to death, certifiers have been instructed to report all of these conditions and to add line, (e), to indicate the relationship of the conditions. In the ACME system, provision has been made for identifying conditions reported on the additional “due to” line in Part I. Code conditions reported on line (e) or in equivalent “due to” positions as having been reported on separate lines. (Refer to Section II, Part I, 2, Reject code 9 - More than four “due to” statements, for instructions for coding certificates with conditions reported on more than five “due to” lines.)
                  Four lines, (a), (b), (c), and (d) have been provided in Part I of the death certificate for reporting conditions involved in the sequence of events leading directly to death and for indicating the causal relationship of the reported conditions. In cases where the decedent had more than four causally related conditions leading to death, certifiers have been instructed to report all of these conditions and to add line, (e), to indicate the relationship of the conditions. In the ACME system, provision has been made for identifying conditions reported on the additional “due to” line in Part I. Code conditions reported on line (e) or in equivalent “due to” positions as having been reported on separate lines. (Refer to Section II, Part I, 2, Reject code 9 – More than four “due to” statements, for instructions for coding certificates with conditions reported on more than five “due to” lines.)
                  I (a) Shock due to pneumonia R579
                  (b) Rupture of esophageal varices J189
                  (c) Cirrhosis of liver due to alcoholism I859
                  (d) K746
                  (e) F102
                  2. Connecting terms
                  a. “Due to” written in or implied
                  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 Part I, enter the codes as though the conditions had been reported, one due to the other, on separate lines. Code the conditions on each of the remaining lines in Part I, if there are any, as though they had been reported on the succeeding line. (Refer to Section II, Part I, 2, Reject code 9 - More than four “due to” statements, for instructions for coding certificates with more than four “due to” statements).
                  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 Part I, enter the codes as though the conditions had been reported, one due to the other, on separate lines. Code the conditions on each of the remaining lines in Part I, if there are any, as though they had been reported on the succeeding line. (Refer to Section II, Part I, 2, Reject code 9 – More than four “due to” statements, for instructions for coding certificates with more than four “due to” statements).
                  I (a) Myocardial infarction as a result of I219
                  (b) ASHD I251
                  Interpret “as a result of” as “due to” and code the ASHD on I(b).
                  I (a) Stomach hemorrhage from gastric ulcer K922
                  (b) Cholecystitis K259
                  (c) K819
                  Because of the implied “due to,” code the gastric ulcer on I(b) and the cholecystitis on I(c).
                  (1) The following connecting terms should be interpreted as meaning “due to” or “as a consequence of” 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 2/2
                  in received from
                  I (a) Myocardial infarction I219
                  (b) Nephritis due to arteriosclerosis N059
                  (c) Hypertension from toxic goiter I709
                  (d) I10
                  (e) E050
                  Both “due to” and “from” indicate the conditions following these terms are moved to the next due to position.
                  I (a) Neurological devastation due to stroke
                  (b) I64
                  Neurological devastation is a disease condition. Move stroke down to the next due to position.
                  I (a) Death from heart attack I219
                  (b)
                  Death is not a disease condition, nature of injury, or external cause. Do not reformat heart attack.
                  I (a) Complication from diabetes E149
                  Complication is not a disease condition, nature of injury, or external cause. Do not reformat diabetes.
                  I (a) Septic complications of AIDS B24
                  Since septic complications is not a disease condition, nature of injury, or external cause, do not reformat AIDS.
                  I (a) Cardiac arrest secondary to brain tumor I469
                  (b) D432
                  (c) Intracranial hemorrhage I629
                  Code the brain tumor on I(b) since “due to” indicates it is moved to the next due to position.
                  (2) When one of the previous terms is the first entry in Part II, indicating that the following entry is a continuation of Part I, code in Part I in next due to position.
                  I (a) Respiratory failure J969
                  (b) Cardiac arrest I469
                  (c) Coronary occlusion I219
                  (d) I251
                  II due to ASHD
                  Since Part II is indicated to be a continuation of Part I, code the ASHD on I(d).
                  (3) Certain connecting terms imply that the condition following the connecting term was “due to” the condition preceding it. In such cases, enter the code for the condition following the connecting term on the line above that for the condition that preceded it.
                  Interpret the following connecting terms as meaning that the condition following the term was due to the condition that preceded it:
                  as a cause of manifested by
                  cause of producing
                  caused resulted in
                  causing resulting in
                  followed by underlying
                  induced with resultant
                  leading to with resulting
                  led to
                  I (a) Myocardial infarction followed by I469
                  (b) Cardiac arrest I219
                  (c)
                  Code the cardiac arrest on I(a) since “followed by” indicates it was due to the myocardial infarction.
                  I (a) Respiratory arrest R092
                  (b) Pulmonary edema J81
                  (c) Bronchitis with resulting pneumonia J189 I469
                  (d) and cardiac arrest J40
                  Code the pneumonia and cardiac arrest on I(c) since “with resulting” indicates they were due to the bronchitis.
                  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 that the conditions are reported on the certificate.
                  The following terms imply that conditions are meant to remain on the same line
                  and (&) consistent with
                  accompanied by with ( c )
                  also precipitated by
                  associated with predisposing (to)
                  complicated by superimposed on
                  complicating
                  I (a) Acute bronchitis superimposed on J209 J439
                  (b) Emphysema
                  (c) Tobacco abuse (smokes 3 packs a day) F171 F179
                  Interpret “superimposed on” as “and.” Enter the code for the condition on I(b) as the second code on I(a). Do not enter a code on I(b).
                  I (a) MI I219
                  (b) ASHD I251
                  (c) Hypertension I10
                  (d) Diabetes E149 E142
                  II also diabetic nephropathy
                  Consider “also” as a connecting word that does not imply “due to” and code Part II as a continuation of I(d).
                  3. Condition reported as due to I(a), I(b), or I(c)
                  When a condition(s) in Part I is reported with a specific statement interpreted or stated as “due to” another on lines I(a), I(b), I(c), or I(d), rearrange the codes according to the certifier’s statement. Do not apply this instruction to such statements reported in Part II.
                  I (a) Myocardial failure I249
                  (b) Pneumonia I509
                  (c) Myocardial ischemia J189
                  due to (a) 3wks
                  Accept the certifier’s statement that the condition reported on I(c) is “due to” the condition on I(a). Move the codes for conditions reported on I(a) and I(b) downward. (Apply the duration on I(c) to the myocardial ischemia).
                  I (a) Heart failure I509 N19
                  (b) Pneumonia J189
                  (c) Uremia due to (b)
                  Take into account the certifier’s statement on I(c) and code the condition reported on I(c) as the second entry on I(a).
                  I (a) Carcinomatosis I469
                  (b) Cancer of lung C80
                  (c) Cardiorespiratory arrest due C349
                  to above
                  Take into account the certifier’s statement and code the cardiorespiratory arrest on I(a), then move the codes for the remaining conditions downward.
                  I (a) Coronary thrombosis I219
                  (b) Chronic nephritis N039
                  (c) Arteriosclerosis I709
                  II Uremia caused by above N19
                  Disregard the certifier’s statement, “caused by above,” reported in Part II.
                  I (a) Cancer of lung J189
                  (b) Pneumonia due to #1 C349
                  (c)
                  Take into account the certifier’s statement and code the pneumonia reported on I(b) as due to the cancer of lung.
                  4. Numbering of causes reported in Part I
                  a. When the certifier has numbered all causes or lines in Part I, that is 1, 2, 3, etc., code these entries as if reported on the same line. This instruction applies whether or not the numbering extends into Part II, and it also applies whether or not the “due to” below lines I(a) and/or I(b) and/or I(c) are marked through.
                  I (a) 1. Coronary thrombosis I219 I250 I10 I709 N289 J1110
                  (b) 2. ASCVD
                  (c) 3. Hypertension and arteriosclerosis
                  (d) 4. Renal disease
                  II 5. Influenza
                  Code all the entries on I(a).
                  b. When part of the causes in Part I are numbered, make the interpretation for coding such entries on an individual basis.
                  I (a) 1. Bronchopneumonia J180 C169
                  (b) 2. Cancer of stomach
                  (c) Chronic nephritis N039
                  Enter the codes for the conditions numbered “1” and “2” on I(a) in the order indicated by the certifier. Do not enter a code on I(b); however, enter the code for the condition on I(c) on that line.
                  I (a) Bronchopneumonia J180
                  (b) 1. Cancer of stomach C169 N039
                   nbsp; (c) 2. Chronic nephritis
                  Enter the codes for conditions numbered “1” and “2” on I(b) in the order indicated by the certifier. Do not enter a code on I(c).
                  I (a) Congestive heart failure I500
                  (b) Influenza J1110
                  (c) 1. Pulmonary emphysema J439 J449 C349
                  (d) 2. COPD
                  II 3. Cancer of lung
                  Enter the codes for the conditions numbered 1, 2, and 3 on I(c) in the order indicated by the certifier. Do not enter a code on I(d) or in Part II.
                  c. When the causes in Part I are numbered, and an entry is stated or implied as “due to” another, enter the code(s) connected by the stated or implied “due to” in the next “due to” position, followed by the codes for the remaining numbered causes.
                  I (a) 1. Bronchopneumonia due to J180
                  (b) influenza J1110 J841 J40
                  (c) 2. Pulmonary fibrosis 3. Bronchitis
                  Enter the code for the condition followed by the stated “due to” on I(b), followed by codes for the conditions numbered “2” and “3.” Do not enter a code on I(c).
                  I (a) 1. Pneumonia J189
                  (b) MI I219 I251
                  (c) 2. ASHD
                  Code the condition numbered “2” as a continuation of I(b). Leave I(c) blank.
                  5. Punctuation marks
                  a. Disregard punctuation marks such as a period, comma, question mark, or exclamation mark when placed at the end of a line in Part I. Do not apply this instruction to a hyphen (-), which indicates a word is incomplete.
                  I (a) Myocardial infarct, I219
                  (b) Meningitis, mastoiditis G039 H709
                  (c) Otitis media H669
                  Disregard the punctuation marks and code the conditions reported on I(a), I(b), and I(c) as indicated by the certifier.
                  I (a) Chronic rheu - I099 I958
                  I (a) Chronic rheu – I099 I958
                  (b) matic heart disease, chronic hypotension
                  (c) Cancer C80
                  Regard the conditions reported on I(b) as a continuation of I(a). Do not enter a code on I(b).
                  b. When conditions are separated by a slash (/), code each condition as indexed.
                  I (a) Cardiac arrest/respiratory I469 R092 J189
                  arrest/pneumonia
                  (b) ASHD I251
                  Disregard the slash and code conditions as indexed.
                  c. 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.
                  I (a) Cardiac-respiratory arrest I469
                  Code as one code assignment since the 2 sites are indexed as Arrest, cardiorespiratory.
                  I (a) Cardiac, respiratory arrest I469 R092
                  Code each site separately since this instruction does not apply to commas.
                  I (a) Cardiac respiratory arrest I469
                  Code as one code assignment since the 2 sites are indexed as Arrest, cardiorespiratory.
                  d. When conditions are indexed together yet separated by a comma, code conditions separately. If the term following the comma is an adjective, refer to Section II, Part B, 1, b (1).
                  I (a) Cancer, cachexia C80 R64
                  (b) Anxiety, depression F419 F329
                  Code each term separately even though indexed together.
                  6. Conditions in the duration box
                  When a condition is entered in the duration block, code the condition on the same line where it is reported.
                  Duration
                  I (a) Arteriosclerotic heart disease CVA I251 I64
                  (b)
                  (c)
                  II Arteriosclerosis I709
                  Code the condition reported in the duration block as the last entry on I(a).
                  D. Doubtful diagnosis
                  1. Doubtful qualifying expression
                  a. When expressions such as “apparently,” “presumably,” “?,” “perhaps,” and “possibly,” qualify any condition, disregard these expressions and code condition as indexed.
                  I (a) ? hemorrhage of stomach K922
                  (b) Possible ulcer of stomach K259
                  Disregard “?” and code hemorrhage of stomach on I(a) as reported.
                  Disregard “possible” and code ulcer of stomach on I(b) as reported.
                  I (a) Heart disease, probable ASHD I519 I251
                  Disregard “probable” and code heart disease and ASHD on I(a).
                  Place I (a) Pneumonia, probably aspiration J189 T179 &W80
                  9
                  Disregard the “probably” and code both pneumonia and aspiration as indexed.
                  b. When these expressions are reported at the end of a line in Part I, do not consider to be a continuation of the next lower line.
                  I (a) Heart disease probably I519
                  (b) Acute myocardial infarction I219
                  Disregard “probably” and code heart disease on I(a) and acute myocardial infarction on I(b).
                  I (a) Cardiovascular disease presumably I516
                  (b) Cerebral thrombosis I633
                  Disregard “presumably” and code each condition on the line where it is reported.
                  c. When these expressions are reported at the beginning of a line in Part I, do not consider to be a continuation of the line above it.
                  I (a) Heart disease I519
                  (b) Possibly acute myocardial infarction I219
                  Disregard “possibly” and code each condition on the line where it is reported.
                  d. When these expressions are reported at the beginning of Part II, do not consider to be a continuation of Part I.
                  I (a) Heart disease probably I519
                  (b)
                  (c)
                  II Probably MI I219
                  Disregard “probably” and code heart disease on I(a) and MI in Part II.
                  2. 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”
                  Code using the following instructions:
                  a. When a condition of more than one site is qualified by a statement of “either…or…” and both sites are classified to the same system , code the condition to the residual category for the system .
                  I (a) Pneumonia J189
                  (b) Cancer of kidney or bladder C689
                  Code I(b) C689, malignant neoplasm of other and unspecified urinary organs.
                  I (a) Heart failure I509
                  (b) Coronary or pulmonary blood clot I749
                  Code I(b) I749, blood clot.
                  b. When a condition of more than one site is qualified by a statement of “either…or…” and these sites are in different systems, code to the residual category for the disease or condition specified.
                  I (a) Cardiac arrest I469
                  (b) Carcinoma of gallbladder C80
                  or kidney
                  Code I(b) C80, malignant neoplasm without specification of site.
                  I (a) Respiratory failure J969
                  (b) Congenital anomaly of heart Q899
                  or lungs
                  Code I(b) Q899, anomaly, congenital, unspecified.
                  c. 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.
                  I (a) Apparently stroke, perhaps heart attack I99
                  Since both conditions are preceded by a doubtful qualifying expression, consider as a statement of “either…or….” Stroke and heart attack are classified to the circulatory system. Code to Disease, circulatory system, NEC.
                  I (a) Pulmonary edema J81
                  (b) Tuberculosis or cancer of lung J9840
                  Code I(b) J9840, lung disease NOS.
                  Note: When embolism and thrombosis are qualified by a statement of “either…or…,” code to Clot (I749)
                  I (a) Cardiac thrombosis vs pulmonary embolism I749
                  Code I(a) I749, Clot (blood). Embolism and thrombosis are both blood clots, and Clot NOS is a more specific category than Disease, circulatory system.
                  d. When conditions are classified to the same three character category with different fourth characters, code to the three character category with fourth character “9.”
                  I (a) ASCVD vs ASHD I259
                  Code to I259 the residual category. ASCVD and ASHD are both classified to 125.-, chronic ischemic heart disease.
                  e. When conditions are classified to different three character categories and Volume 1 provides a residual category for the diseases in general, code to that residual category.
                  I (a) MI vs coronary aneurysm I259
                  Code to I259 the residual category for ischemic heart disease. MI and coronary aneurysm are both classified as “ischemic heart diseases.”
                  f. When conditions involving different systems are qualified by “either… or…,” and cannot be classified to the residual category for the disease, code R688, other specified general symptoms and signs.
                  I (a) Coma R402
                  (b) ? gallbladder colic ? coronary R688
                  thrombosis
                  Code I(b) R688, other ill-defined conditions. (Consider the two question marks on a single line as “either…or…”).
                  g. When diseases and injuries are qualified by “either… or…,” code R99, other unknown and unspecified cause, provided this is the only entry on the certificate. When other classifiable entries are reported, omit R99.
                  I (a) Head injury or CVA R99
                  Code I(a) R99, other unknown and unspecified cause.
                  h. For doubtful diagnosis in reference to “either… or…” accidents , suicides , and homicides , refer to Section V, Part A, External Cause Code Concept .
                  E. Conditions specified as “healed” or “history of”
                  The Classification provides sequela categories for certain conditions qualified as “healed” or “history of.” Refer to Section IV, Part F, Sequela . When the Classification does not provide a code or a sequela category for a condition qualified as “healed” or “history of,” code the condition as though not qualified by this term. Note that terms qualified as “family history of” are indexed to Z-codes which are invalid for mortality and so are not coded.
                  I (a) Myocardial infarction I219
                  (b)
                  (c)
                  II Gastritis, healed K297
                  Code K297, gastritis NOS in Part II.
                  F. Coding entries such as “same,” “ ditto ("),” “as above”
                  When the certifier enters “same,” “ditto mark ("),” “as above,” etc., in a “due to” position to a specified condition, do not enter a code for that line.
                  I (a) Coronary occlusion I219
                  (b) Same
                  (c) Hypertension I10
                  Do not enter a code on I(b) for the entry “same.”
                  I (a) Pneumonia J189
                  (b) "
                  (c) Emphysema J439
                  Do not enter a code on I(b) for the “ ditto mark (").”
                  G. Conditions qualified by “postmortem,” “rule out,” “ruled out,” “r/o”
                  When a condition is qualified by “postmortem,”, “rule out,” “ruled out”, or “r/o,” etc., do not enter a code for the condition.
                  H. Nonindexed and illegible entries
                  1. Terms that are not indexed
                  When a term is reported that does not appear in the ICD-10 Index, refer the term to the supervisor.
                  2. Illegible entries
                  When an illegible entry is the only entry on the certificate, code R99. When an illegible entry is reported with other classifiable entries, disregard the illegible entry and code the remaining entries as indexed.
                  I. Coding one-character reject codes
                  When a death record qualifies for more than one reject code, code only one in this order: 1, 2, 3, 4, 5, 9.
                  1. Reject code 1-5–Inconsistent duration
                  When a duration of an entity in a “due to” position is shorter than that of an entity reported on a line above it and only one codable entity is reported on each of these lines, enter a reject code (1-5) in the appropriate data position. When more than one codable entity is reported on the same line, disregard the duration entered on that line. Use the appropriate reject code even though there are lines without a duration or with more than one codable entity between the entities with the inconsistent duration; in such cases, consider the inconsistency to be between the line immediately above and the line with the shorter duration.
                  If the inconsistent duration is between:
                  Lines ............................................................................................. Enter Reject Code
                  Lines ………………………………………………………………………………… Enter Reject Code
                  I (a) and I (b)......................................................................................................... 1
                  I (a) and I (b)…………………………………………………………………………………………… 1
                  I (b) and I (c)......................................................................................................... 2
                  I (b) and I (c)…………………………………………………………………………………………… 2
                  I (c) and I (d)......................................................................................................... 3
                  I (c) and I (d)…………………………………………………………………………………………… 3
                  I (d) and I (e)......................................................................................................... 4
                  I (d) and I (e)…………………………………………………………………………………………… 4
                  Inconsistent durations between more than two lines in Part I,
                  or any situation where reject codes 1-4 would not be applicable...................................... 5
                  or any situation where reject codes 1-4 would not be applicable……………………………….. 5
                  Do not enter a reject code if the only inconsistency is between the durations of malignant neoplasms classifiable to C00-C96.
                  I (a) ASHD 10 yrs. I251
                  (b) Chronic nephritis and hypertension 5 yrs. N039 I10
                  (c) Diabetes 5 yrs. E149
                  Reject 2
                  Disregard the duration on I(b), since more than one codable entity is reported on this line. Only one codable entity is reported on lines I(a) and I(c) and the duration of the diabetes was shorter than that of ASHD. For the purposes of assigning the reject code, consider the duration on I(b) to be at least as long as the duration on I(a). Therefore, enter reject code 2 denoting an inconsistency between I(b) and I(c).
                  I (a) ASHD 5 yrs I251
                  (b) Chronic nephritis and hypertension 10 yrs N039 I10
                  (c) Diabetes 5 yrs E149
                  Do not enter reject code 2. The duration on I(b) is disregarded. The duration of diabetes on I(c) was not shorter than that of ASHD on I(a).
                  I (a) Cardiac arrest I469
                  (b) Congestive heart failure 1 week I500
                  (c) Cancer of stomach 1 year C169
                  (d) Metastatic cancer of lung 6 months C780
                  Do not use reject code 3 since the inconsistent duration is between malignant neoplasms.
                  I (a) Basilar artery thrombosis 7 weeks I630
                  (b) Renal failure 4 weeks N19
                  (c) Pneumonia 1 week J189
                  Reject 5
                  Enter reject code 5 since the inconsistent durations are between more than 2 lines.
                  Age 1 yr.
                  I (a) Congenital nephrosis life N049
                  (b)
                  (c) Intestinal hemorrhage 1 day K922
                  Reject 5
                  Enter reject code 5 since reject codes 1-4 are not applicable.
                  2. Reject code 9 – More than four “due to” statements
                  When certifier’s entries or reformatting result in more than four statements of “due to,” continue the remaining codes horizontally on the fifth line and enter reject code 9 in the appropriate position.
                  I (a) Terminal pneumonia J189
                  (b) Congestive heart failure I500
                  (c) Myocardial infarction I219
                  (d) ASHD I251
                  (e) Generalized arteriosclerosis I709 E039
                  (f) Myxedema
                  Reject 9
                  Enter the code for the myxedema reported on the fifth “due to” line, I(f), following the code for the condition reported on this line (generalized arteriosclerosis). Enter reject code 9 in the appropriate data position.
                  If there are more than four “due to” statements in Part I and there is no codable condition reported on one or more lines, consider the condition(s) on each subsequent “due to” line as though reported on the preceding line. Enter reject code 9 only if, after reformatting, there are codable conditions on more than five lines.
                  I (a) Pneumonia J189
                  (b) Extended illness G839
                  (c) Paralysis following CVA I64
                  (d) Hypertension due to I10
                  (e) adrenal adenoma D350
                  Do not enter reject code 9. Since extended illness is not a codable condition, enter the code for paralysis on I(b), the code for CVA on I(c), etc. As a result of the rearrangement of the conditions, there are codable conditions on only five lines.
                  When a death record qualifies for more than one reject, prefer a reject code for inconsistent durations over reject code 9.
                  J. Inclusion of additional information (AI) to mortality source documents
                  Code supplemental information when it modifies or supplements data on the original mortality source document.
                  1. When additional information (AI) states the underlying cause of a specified disease in Part I , code the additional information (AI) in a “due to” position to the specified disease.
                  I (a) Pulmonary edema J81
                  (b) Congestive heart failure I500
                  (c) Arteriosclerosis I251
                  (d) I709
                  II
                  AI The underlying cause of the congestive heart failure was ASHD.
                  Since the certifier states the underlying cause of the congestive heart failure is ASHD, code I251 on I(c) and move the condition on I(c) to the next “due to” position.
                  2. When additional information (AI) modifies a disease condition, use the AI and code the disease modified by the AI in the position first indicated by the certifier.
                  I (a) Pneumonia J181
                  (b)
                  (c)
                  AI Lobar pneumonia
                  Code lobar pneumonia as the specified type of pneumonia on I(a) only .
                  3. When there is a stated or implied complication of surgery and the additional information indicates the condition for which surgery was performed, code this condition in a “due to” position to the surgery when reported in Part I and following the surgery when reported in Part II. Precede this code with an ampersand (&).
                  I (a) Coronary occlusion T818
                  (b) Gastrectomy &Y836
                  (c) &nbsnbsp; &K259
                  AI Gastrectomy done for gastric ulcer.
                  Code the condition necessitating the surgery on I(c) and precede this code with an ampersand.
                  I (a) Respiratory arrest R092
                  (b) Septicemia T814
                  (c)
                  II Uremia, cholecystectomy N19 &Y836 &K802
                  AI Surgery for gallstones
                  Code the condition necessitating the surgery following the E-code for surgery in Part II.
                  4. When additional information (AI) states a certain condition is the underlying cause of death, code this condition in Part I in a “due to” position (on a separate line) to the conditions reported on the original death record.
                  I (a) Cardiac arrest I469
                  (b) MI I219
                  (c) ASHD I251
                  (d) E149
                  II
                  AI U.C. was diabetes
                  Accept the certifier’s statement that the underlying cause of death was “diabetes,” and code this condition on I(d) in a “due to” position to the conditions originally reported in Part I.
                  5. When any morphological type of neoplasm is reported in Part I with no mention of a “site” and additional information specifies a site, code the specified site only on the line where the morphological type is reported.
                  I (a) Cancer C349
                  (b)
                  (c)
                  II
                  AI Cancer of lung
                  Code only the specified cancer (lung) on I(a).
                  6. When additional information states the primary site of a malignant neoplasm, code this condition in a “due to” position to the other malignant neoplasms reported in Part I.
                  I (a) Metastatic neoplasm C80
                  (b) Metastasis to liver C787
                  (c) C189
                  II
                  AI Colon was primary site.
                  Code the stated primary site on I(c) in a “due to” position to the other neoplasms reported in Part I.
                  I (a) Carcinomatosis C80
                  (b) C61
                  (c)
                  II
                  AI Prostate was probably the primary site.
                  Code the presumptive primary site (prostate) on I(b) in a “due to” position to the stated neoplasm reported on the original death certificate.
                  7. When the additional information does not modify a condition on the certificate, or does not state that this condition is the underlying cause, code the AI as the last condition(s) in Part II. Code AI reported on the certificate beginning with the uppermost downward and from left to right.
                  I (a) Coronary thrombosis I219
                  (b) HASCVD I119
                  (c)
                  II Hypertension I10 I709 I64 I258
                  AI Arteriosclerosis, CVA, old MI
                  The additional information does not modify conditions on the certificate. Code as the last entries in Part II.
                  Male, 30 minutes-Twin B
                  I (a) Immature P073
                  600 gm (b)
                  (c)
                  II Atelectasis P281 P015 P070
                  Code the additional information in the order reported, uppermost downward and from left to right.
                  K. Amended certificates
                  When an “amended certificate” is submitted, code the conditions reported on the amended certificate only.
                  L. Effect of age of decedent on classification
                  Always note the age of the decedent at the time the causes of death are being coded. Certain groups of categories are provided for certain age groups. There are several conditions within certain categories which cannot be properly classified unless the age is taken into consideration. Use the following terms to identify certain age groups:
                  1. NEWBORN OR NEONATAL means less than 28 days of age at the time of death.
                  Code any index term with the indention of “newborn,” “neonatal,” “neonatorum,” “perinatal,” “perinatal period,” “fetus or newborn,” or “fetal” (in this priority order) to the newborn category if the decedent is less than 28 days of age or there is evidence the condition originated in the first 27 days of life, even though death may have occurred later.
                  Female, 4 hours
                  I (a) Anoxia P219
                  (b) Cerebral hemorrhage P524
                  Since the age of decedent is less than 28 days, code anoxia of newborn, and cerebral hemorrhage of newborn.
                  Male, 31 days Duration
                  I (a) Pulmonary hemorrhage 26 days P269
                  (b)
                  Since the condition originated in the first 27 days of life, code as a newborn.
                  2. INFANT or INFANTILE means less than 1 year of age at the time of death
                  Male, 9 months
                  I (a) Pneumonia J189
                  (b) Osteomalacia E550
                  Since the decedent is less than 1 year of age at the time of death, code Osteomalacia , infantile.
                  3. CHILD or CHILDHOOD means less than 18 years of age at the time of death
                  Male, 11 years
                  I (a) Asthma J450
                  Code as Asthma, childhood.
                  4.Congenital anomalies (Q00-Q99)
                  Regard the conditions listed below as congenital and code to the appropriate congenital category if death occurred within the age limitations stated, provided there is no indication that they were acquired after birth.
                  a. Less than 28 days:
                  heart disease NOS
                  hydrocephalus NOS
                  Male, 27 days
                  I (a) Renal failure N19
                  (b) Hydrocephalus Q039
                  Code the hydrocephalus as congenital since the decedent was less than 28 days of age at the time of death.
                  b. Less than 1 year:
                  aneurysm (aorta) (aortic) cyst of brain
                  (brain) (cerebral) (circle of deformity
                  Willis) (coronary) displacement of organ
                  (peripheral) (racemose) ectopia of organ
                  (retina) (venous) hypoplasia of organ
                  aortic stenosis pulmonary stenosis
                  atresia valvular heart disease (any valve)
                  atrophy of brain
                  Female, 3 months
                  I (a) Pneumonia J189
                  (b) Cyst of brain Q046
                  Code cyst of brain as congenital since the age of the decedent is less than 1 year.
                  5. Congenital syphilis
                  Regard syphilis and conditions that are qualified as syphilitic as congenital and code to the appropriate congenital syphilis category if the decedent was less than two years of age.
                  Male, 16 mos
                  I (a) Syphilitic pneumonia A500
                  (b)
                  (c)
                  Code congenital syphilitic pneumonia since age is less than 2 years.
                  6. Age limitation
                  Some categories in ICD-10 are limited by provisions of the Classification to certain ages. Code the categories listed below only if the age at the time of death was as follows:
                  a. Age 28 days or over
                  A32 E14 J13 R00
                  A35 E162 J14 R01
                  A40 E561 J15 R048
                  A41 E63 J16 R090
                  A56 E834 J18 R092
                  A74 E835 J43 R11
                  B30 F10 J80 R17
                  B370 F11 J849 R230
                  B371 F12 J96 R233
                  B372 F13 J981 R290
                  B373 F14 J982 R40
                  B374 F15 J984 R50
                  B375 F16 J988 R53
                  B376 F17 K27 R56
                  B377 F18 K631 R58
                  B378 &nbsnbsp; F19 K65 R60
                  B379 G473 K92 R633
                  D65 G700 L01 R680
                  D751 I48 L10 R681
                  E05 I49 L50
                  E10 I50 L530
                  E11 I61 M34
                  E12 I62 N390
                  E13 J12 N61
                  Male, age 25 days
                  I (a) Urinary tract infection P393
                  (b)
                  Code urinary tract infection, newborn since age is less than 28 days.
                  Female, age 27 days
                  I (a) Respiratory failure P285
                  (b)
                  (c)
                  Code respiratory failure, newborn since age is less than 28 days.
                  Female, age 28 days
                  I (a) Atelectasis J981
                  (b)
                  (c)
                  Code atelectasis, J981 since age is reported as 28 days.
                  b. Age under 1 year:
                  R95
                  c. Age 1 year or over:
                  R960
                  Age 1 year
                  I (a) Sudden infant death syndrome R960
                  d. Age 5 years or over:
                  X60-X84
                  Age 4 years
                  Place I (a) GSW to head Suicide S019 &W34
                  9
                  M. Sex limitations
                  Certain categories in ICD-10 are limited to one sex:
                  For Males Only For Females Only
                  B260 A34 M830
                  C60-C63 B373 N70-N98
                  D074-D076 C51-C58 N992-N993
                  D176 C796 O00-O99
                  D29.- D06.- P546
                  D40.- D070-D073 Q50-Q52
                  E29.- D25-D28 Q96
                  E895 D39.- Q97
                  F524 E28.- R87
                  I861 E894 S314
                  L291 F525 S374-S376
                  N40-N50 F53.- T192-T193
                  Q53-Q55 I863 T833
                  Q98 L292 Y424
                  R86 L705 Y425
                  S312-S313 M800-M801 Y76.-
                  M810-M811
                  __________________________________________________________________________
                  If the cause of death is inconsistent with the sex, code the cause of death to the minimum necessary to be acceptable for either gender.
                  If the cause of death is inconsistent with the sex, code the cause of death to the minimum necessary to be acceptable for either sex.
                  Female, age 32
                  I (a) Cancer of prostate C80
                  (b)
                  (c)
                  Code to cancer NOS C80, which is acceptable for both male and female.
                  N. Effect of duration on assignment of codes
                  Before assigning codes, take into account any statements entered on the certificate in the spaces for duration since these statements may affect the code assignments for certain conditions.
                  1. Qualifying conditions as acute or chronic
                  a. Usually the duration should not be used to qualify the condition as “acute” or “chronic.”
                  Duration
                  I (a) Nephritis 2 years N059
                  Code nephritis as indexed. Do not use the duration to qualify the nephritis as chronic.
                  b. However, when assigning codes to certain conditions classified as “ischemic heart diseases” the Classification provides the following specific guidelines for classifying a condition with a stated duration as acute or chronic:
                  - acute or with a stated duration of 4 weeks or less
                  – acute or with a stated duration of 4 weeks or less
                  - chronic or with a stated duration of over 4 weeks
                  – chronic or with a stated duration of over 4 weeks
                  Duration
                  I (a) Acute myocardial infarction 3 mos. I258
                  (b)
                  (c)
                  Code Infarction, myocardium, chronic or with a stated duration of over 4 weeks, I258.
                  (1) For the purpose of interpreting these instructions:
                  Consider these terms: To mean:
                  brief
                  days
                  hours
                  immediate
                  instant 4 weeks or less
                  minutes or acute
                  recent
                  short
                  sudden
                  weeks (few) (several)
                  longstanding over 4 weeks
                  1 month or chronic
                  Duration
                  I (a) Aneurysm heart weeks I219
                  (b)
                  (c)
                  Code Aneurysm, heart, acute or with a stated duration of 4 weeks or less, I219. “Weeks” is interpreted to mean 4 weeks or less.
                  c. When the duration is stated to be “acute” or “chronic,” consider the condition to be specified as acute or chronic.
                  Duration
                  I (a) Heart failure 1 hour I509
                  (b) Bronchitis acute J209
                  Code “acute” bronchitis on I(b).
                  2. Subacute
                  In general, code a disease that is specified as subacute as though qualified as acute if there is provision in the Classification for coding the acute form of the disease but not for the subacute form.
                  I (a) Subacute pyelonephritis N10
                  Code subacute pyelonephritis to N10, acute pyelonephritis since there is no code for subacute pyelonephritis.
                  3. Exacerbation
                  Interpret "exacerbation" as an acute phase of a disease. Code "exacerbation" of a chronic specified disease to the acute and chronic stage of the disease if the Classification provides separate codes for "acute" and "chronic."
                  I (a) Exacerbation of leukemia C950
                  (b) Chronic lymphocytic leukemia C911
                  I (a) Exacerbation of chronic C910 C911
                  (b) lymphocytic leukemia
                  I (a) Chronic leukemia with conversion to C951 C950
                  (b) acute phase
                  I (a) Exacerbation of chronic N10 N119
                  (b) pyelonephritis
                  I (a) Exacerbation of bronchitis J209
                  (b)
                  I (a) Acute exacerbation of chronic J209 J42
                  (b) bronchitis
                   nbsp;
                  I (a) Chronic obstructive lung disease exacerbation J449 J441
                  (b)
                  Code the preceding examples to the acute and chronic stages of each specified disease since the Classification provides separate codes for the “acute” and “chronic.”
                  4. Acute and chronic
                  Sometimes the terms acute and chronic are reported preceding two or more diseases. In these cases, use the term (“acute” or “chronic”) with the condition it immediately precedes.
                  I (a) Chronic renal and liver failure N189 K7290
                  Code renal failure, chronic and liver failure NOS.
                  5. Qualifying conditions as congenital or acquired
                  Code conditions classified as congenital in the Classification as congenital, even when not specified as congenital if the interval between onset and death and the age of the decedent indicate that the condition existed from birth.
                  Female, age 2 years Duration
                  I (a) Pneumonia 1 week J189
                  (b) Heart disease 2 years Q249
                  Code the condition on I(b) as congenital since the age of the decedent and the duration of the condition indicate that the heart disease existed at birth.
                  Do not use the interval between onset and death to qualify conditions that are classified to categories Q00-Q99, congenital anomalies, as acquired.
                  Male, 62 years Duration
                  I (a) Renal failure 3 months N19
                  (b) Pulmonary stenosis 5 years Q256
                  Do not use the duration to qualify the pulmonary stenosis as acquired.
                  6. Two conditions with one duration
                  When two or more conditions are entered on the same line with one duration, disregard the duration and code the conditions as indexed.
                  Duration
                  I (a) Myocardial ischemia and 3 weeks I259 I500
                  congestive heart failure
                  (b) Hypertension 5 years I10
                  Disregard the duration on I(a) and code the myocardial ischemia as indexed.
                  Duration
                  I (a) MI due to nephritis 3 months I219
                  (b) Arteriosclerosis N059
                  (c) I709
                  Disregard the duration on I(a) and code myocardial infarction as indexed.
                  7. Conflict in durations
                  When conflicting durations are entered for a condition, give preference to the duration entered in the space for interval between onset and death.
                  Duration
                  I (a) Ischemic heart disease 2 weeks years I259
                  Use the duration in the block to qualify the ischemic heart disease.
                  8. Span of dates
                  Interpret dates that are entered in the spaces for interval between onset and death separated by a slash (/), dash (-), etc., as meaning from the first date to the second date. Disregard such dates if they extend from one line to another and there is a condition reported on both of these lines since the span of dates could apply to either condition.
                  Date of death 10-6-98 Duration
                  I (a) MI 10/1/98 - I219
                  I (a) MI 10/1/98 – I219
                  (b) Ischemic heart disease 10/6/98 I259
                  Disregard duration and code each condition as indexed since the dates extend from I(a) to I(b).
                  Date of death 10-6-98 Duration
                  I (a) Aneurysm of heart 10/1/98 - 10/6/98 I219
                  I (a) Aneurysm of heart 10/1/98 – 10/6/98 I219
                  (b)
                  Since there is only one condition reported, apply the duration to this condition.
                  Date of death 10-6-98 Duration
                  I (a) Ischemic heart disease 10/1/98 - 10/6/98 I249
                  I (a) Ischemic heart disease 10/1/98 – 10/6/98 I249
                  (b) Arteriosclerosis I709
                  Apply the duration to I(a).
                  O. 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 on other lines in Part I. Apply the following instructions when relating a condition of unspecified site to the site of a specified condition:
                  a. General instructions for implied site of a disease
                  (1) Conditions of unspecified site reported on the same line:
                  (a) When conditions are reported on the same line, with or without a connecting term that implies a due to relationship, assume the condition of unspecified site was of the same site as the condition of specified site.
                  I (a) Congestive heart failure I500
                  (b) Infarction with myocardial I219 I515
                  (c) degeneration
                  (d) Coronary sclerosis I251
                  Code the infarction as myocardial, the site of the condition reported on the same line.
                  I (a) Aspiration pneumonia J690
                  (b) Cerebrovascular accident due to I64
                  (c) thrombosis I633
                  Code the thrombosis as cerebral, the site of the condition reported on the same line.
                  I (a) Duodenal ulcer with internal hemorrhage K269 K922
                  Code Hemorrhage, duodenal (K922). Relate the internal hemorrhage to the site of the condition reported on the same line.
                  I (a) CVA with hemorrhage I64 I619
                  (b) MI I219
                  Code Hemorrhage, cerebral (I619). Relate the hemorrhage to the site of the condition reported on the same line.
                  (b) 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.
                  I (a) ASHD, infarction, CVA I251 I219 I64
                  (b)
                  (c)
                  Code Infarction, heart (I219). Relate the infarction to the site of the condition immediately preceding it.
                  (2) Conditions of unspecified site reported on a separate line:
                  (a) If there is only one condition of a specified site reported either on the line above or below it, code to this site.
                  I (a) Massive hemorrhage K922
                  (b) Gastric ulceration K259
                  Code the hemorrhage as gastric. Relate hemorrhage to the site of the condition reported on I(b).
                  I (a) Uremia N19
                  (b) Chronic prostatitis N411
                  (c) Benign hypertrophy N40
                  Code the hypertrophy as prostatic. Relate hypertrophy to prostate, the site of the condition reported on I (b).
                  I (a) Internal hemorrhage K868
                  (b) Pancreatitis K859
                  Code Hemorrhage, pancreas (K868). Relate the internal hemorrhage to the site of the condition reported on I(b).
                  (b) If there are conditions of different specified sites on the lines above and below it and the Classification provides for coding the condition of unspecified site to only one of these sites, code to that site.
                  I (a) Intestinal fistula K632
                  (b) Obstruction K566
                  (c) Carcinoma of peritoneum C482
                  Code the obstruction as intestinal since the Classification does not provide for coding obstruction of the peritoneum.
                  (c) If there are conditions of different specified sites on the lines above and below it and the Classification provides for coding the condition of unspecified site to both of these sites, code the condition unspecified as to site.
                  I (a) CVA I64
                  (b) Thrombosis I829
                  (c) ASHD I251
                  Code Thrombosis NOS on I(b). Do not relate the thrombosis since the Classification provides codes for both sites reported.
                  (3) Do not relate conditions which are not reported in the first position on a line to the line above. It is acceptable to relate conditions not reported as the first condition on a line to the line below.
                  I (a) Kidney failure N19
                  (b) Vascular insufficiency c thrombosis I99 I219
                  (c) ASHD I251
                  Code Thrombosis, cardiac (I219). Relate thrombosis to line below.
                  (4) When relating conditions to sites start at the top of the certificate and work down.
                  I (a) Hemorrhage R5800
                  (b) Necrosis K729
                  (c) Hepatoma C220
                  The hemorrhage cannot be related. Relate necrosis to liver (K729), the site of the hepatoma.
                  b. Relating specific categories
                  (1) When ulcer, site unspecified or peptic ulcer NOS is reported causing, due to, or on the same line with gastrointestinal hemorrhage, code peptic ulcer NOS (K279).
                  I (a) Gastrointestinal hemorrhage K922
                  (b) Peptic ulcer K279
                  (c)
                  Code peptic ulcer (K279). Do not relate to gastrointestinal.
                  I (a) Ulcer causing gastrointestinal hemorrhage K922
                  (b) K279
                  Code ulcer to peptic ulcer (K279).
                  (2) When ulcer NOS (L984) is reported causing, due to, or on the same line with diseases classifiable to K20-K22, K30-K31, and K65, code peptic ulcer NOS (K279).
                  I (a) Peritonitis K659
                  (b) Ulcer K279
                  Code Ulcer, peptic (K279).
                  (3) When hernia (K40-K46) is reported with disease(s) of unspecified site(s), relate the disease of unspecified site to the intestine.
                  I (a) Hernia with hemorrhage K469 K922
                  Code Hemorrhage, intestine.
                  (4) When calculus NOS or stones NOS is reported with pyelonephritis, code to N209 (urinary calculus).
                  I (a) Pyelonephritis with calculus N12 N209
                  Code calculus (N209) since it is reported with pyelonephritis.
                  (5) When arthritis (any type) is reported with
                  • contracture – code contracture of the site
                  • deformity – code deformity acquired of the site
                  If no site is reported or if site is not indexed, code contracture or deformity, joint.
                  I (a) Phlebitis I809
                  (b) Contractures M245
                  (c) Osteoarthritis lower limbs M199
                  Code Contracture, joint (M245) since contracture lower limb is not indexed.
                  I (a) Pulmonary embolism I269
                  (b) Multiple deformities M219
                  (c) Arthritis in both hips M139
                  Code deformity (acquired) of hip.
                  (6) When embolism, infarction, occlusion, thrombosis NOS is reported
                  • from a specified site - code the condition of the site 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
                  I (a) Congestive heart failure I500
                  (b) Embolism from heart I2190
                  (c) Arteriosclerosis I709
                  Code I(b) embolism of heart (I2190).
                  I (a) Pulmonary embolism from leg veins I269
                  (b) I803
                  (c)
                  Code I(a) pulmonary embolism (I269) and I(b) leg veins embolism (I803).
                  (7) 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.
                  I (a) Cardiorespiratory arrest c failure I469 R092
                  Code Failure, cardiorespiratory (R092). Relate failure to the complete term.
                  I (a) Cardiorespiratory arrest I469 I509
                  (b) c insufficiency
                  Code Insufficiency, heart (I509) since cardiorespiratory arrest is indexed to a heart condition. Relate insufficiency to the site of the complete term.
                  (8) When vasculitis NOS is reported, apply the general instructions for relating and modifying.
                  I (a) Renal failure N19
                  (b) Vasculitis I778
                  Code Vasculitis, kidney (I778). Relate vasculitis to the site reported on line I(a).
                  c. Exceptions to relating and modifying instructions
                  (1) Do not relate the following conditions:
                  Arteriosclerosis Neoplasms
                  Congenital anomaly NOS Paralysis
                  Hypertension Vascular disease NOS
                  Infection NOS (refer to Section III, #7)
                  I (a) Arteriosclerosis with CVA I709 I64
                  (b)
                  (c)
                  Code Arteriosclerosis NOS (I709).
                  I (a) Cardiac arrest I469
                  (b) Congenital anomaly Q899
                  (c)
                  Code congenital anomaly NOS (Q899).
                  I (a) Pneumonia J189
                  (b) Infection
                  (c)
                  Code Pneumonia (J189) on I(a). Do not enter a code on I(b).
                  I (a) Perforation esophagus K223
                  (b) Cancer C80
                  (c)
                  Code cancer NOS (C80).
                  (2) Do not relate hemorrhage when causing a condition of a specified site. Relate hemorrhage to site of disease reported on same line or on line below only.
                  I (a) Respiratory failure J969
                  (b) Hemorrhage R5800
                  Code Hemorrhage NOS. Do not relate to respiratory.
                  I (a) Respiratory failure J969
                  (b) Hemorrhage K922
                  (c) Gastric ulcer K259
                  Relate hemorrhage on I(b) to gastric on I(c) and code gastric hemorrhage.
                  (3) Do not relate conditions classified to R00-R99 except:
                  Gangrene and necrosis R02
                  Hemorrhage R5800
                  Regurgitation R11
                  Stricture and stenosis R688
                  I (a) Myocardial infarction with anoxia I219 R090
                  Code anoxia as indexed. Do not relate to heart since anoxia is classified to R090.
                  I (a) Pneumonia with gangrene J189 J850
                  Code the gangrene as pulmonary, the site of the disease reported on the same line since gangrene is one of the exceptions.
                  (4) Do not relate a disease condition that, by the name of the disease, implies a disease of a specified site unless it is obviously an erroneous code. If not certain, refer to supervisor.
                  I (a) Cirrhosis, encephalopathy K746 G934
                  Do not relate encephalopathy to liver since the name of the disease implies a disease of a specific site, brain.
                  I (a) Pulmonary embolism I269
                  (b) Thrombophlebitis I809
                  Code thrombophlebitis (I809) as indexed. Do not relate thrombophlebitis since it is not usually reported of any site other than extremities.
                  I (a) Cerebral hemorrhage with herniation I619 G935
                  Relate herniation to brain since hernia NOS is classified to a disease of the digestive system (K469) and it seems illogical to have a brain disease paired with a digestive system disease.
                  Refer to Section V, Part D, Implied site of injury for instructions on relating the site of injuries to another site.
                  2. 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 nontraumatic when reported as below, unless a statement on the certificate indicates the condition was traumatic:
                  • due to or on the same line with a disease
                  • due to: drug poisoning
                  drug therapy
                  If there is provision in the Classification for coding the condition that is considered to be qualified as nontraumatic as such, code accordingly. Otherwise, code to the category that has been provided for "Other" diseases of the organ (usually .8).
                  I (a) Laceration heart I518
                  (b) Myocardial infarction I219
                  (c)
                  Consider laceration of heart as nontraumatic and code to other ill-defined heart diseases.
                  I (a) Subdural hematoma I620
                  (b) CVA I64
                  (c)
                  Code Hematoma, subdural, nontraumatic (I620) as indexed.
                  I (a) Acute kidney injury N179
                  (b) Kidney disease N289
                  (c)
                  Code acute kidney injury to nontraumatic as indexed under Injury, kidney, acute.
                  I (a) MRSA sepsis A410
                  (b)
                  (c)
                  II AKI N179
                  Code Part I(a) as indexed under Septicemia, Staphylococcus, aureus. Code acute kidney injury in Part II to nontraumatic as indexed under Injury, kidney, acute.
                  I (a) Cardiorespiratory failure R092
                  (b) Intracerebral hemorrhage I619
                  (c) Meningioma, subdural hematoma D329 I620
                  Code subdural hematoma as nontraumatic since it is reported on the same line with a disease.
                  I (a) Liver failure K7290
                  (b) Cirrhosis with injury to liver K746 K768
                  (c)
                  Code injury to liver as nontraumatic since it is reported on the same line with a disease.
                  I (a) Cerebral arteriosclerosis with I672 I620
                  (b) subdural hematoma
                  Code subdural hematoma as nontraumatic since it is reported on the same line with a disease.
                  Place I (a) OBS F069
                  9 (b)
                  (c)
                  II HTN, diabetes, Traumatic brain injury I10 E149 S069 &X599
                  Code traumatic brain injury as indexed. Since qualified as traumatic, prefer the certifier’s statement and do not apply the instruction.
                  I (a) Fat embolism I749
                  (b) Pathological fracture M844
                  Code line (a) as non-traumatic since reported due to disease.
                  b. Some conditions are indexed directly to a traumatic category but the Classification also provides a nontraumatic code. When these conditions are reported due to or with a disease and an external cause is reported on the record or the Manner of Death box is checked as Accident, Homicide, Suicide, Pending Investigation or could not be determined, code the condition as traumatic.
                  Place I (a) Subdural hematoma S065
                  9 (b) CVA I64
                  (c)
                  MOD II &W18
                  A
                      Accident    Fell while walking
                    Code the subdural hematoma as traumatic since the manner of death is accidental.
                    Place I (a) Cardiorespiratory arrest I469
                    0 (b) Subdural hematoma S065
                    (c) Arteriosclerosis I709
                    MOD II Advanced age R54 &W18
                    A
                        Accident    Home    Fell in her room striking head
                      Code the subdural hematoma as traumatic since the manner of death is accidental.
                      Place I (a) Cerebral hematoma with S068 I672
                      9 (b) cerebral arteriosclerosis
                      (c)
                      MOD II &X599
                      A
                          Accident
                        Code the cerebral hematoma as traumatic since the manner of death is accidental.
                        c. Some conditions are indexed directly to a traumatic category, but the Classification also provides a nontraumatic code. When these conditions are reported and the Manner of Death is Natural, code condition as nontraumatic 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 “nontraumatic” in the Index. It does not apply to conditions in Section III, Intent of Certifier.
                        I (a) Subdural hematoma I620
                        (b)
                        MOD II
                        N
                            Natural
                          Code I(a) as nontraumatic since Manner of Death box states “Natural.”
                          Place I (a) Subdural hematoma I620
                          2 (b)
                          (c)
                          MOD II Hip fracture S720 &W19
                          N
                              Natural    Fell in hospital
                            Code I(a) as nontraumatic since Manner of Death box states “Natural.”
                            Place I (a) Subdural hematoma S065
                            2 (b) Open wound of head S019
                            MOD II Fell in hospital &W19
                            N
                                Natural
                              Code subdural hematoma as traumatic since it is reported due to an injury, disregarding Natural in the Manner of Death box.
                  Last Reviewed: February 1, 2022
                    Source: National Center for Health Statistics
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