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3. APPLYING ICD-10 TO VERBAL AUTOPSY
3.1 Objectives
This verbal autopsy guide aims to assist staff who conduct verbal autopsies in applying the
International statistical classification of diseases and related health problems, 10th revision (ICD-10)
rules to the diagnoses resulting from such an autopsy. The aim is to assist staff who: record
diagnoses on the standard certificate of death (certifiers), code the diagnoses (coders) and select
the cause of death (coders). This guide provides an overview of certification, coding and cause-
of-death assignment so that people working on only one aspect of the verbal autopsy procedure
will be able to understand all the steps involved. The use of this guide will ensure consistency in
verbal autopsy-based mortality statistics, and their comparability with other sources of cause-of-
death data that are coded to ICD-10. It incorporates questions and exercises aimed at acquainting
users with ICD-10 in order to help them avoid frequent pitfalls. The verbal autopsy guide,
contained in sections 3.2–3.8, should be used in conjunction with the three volumes of ICD-10.
The cause-of-death list for verbal autopsy with corresponding ICD-10 codes (the correspondence
table), in section 3.9 provides a list of verbal autopsy cause-of-death categories that are mapped
to broad three- and four-character ICD-10 categories; the correspondence table simplifies the
process of using ICD-10 for coding. It contains codes, some criteria that ensure categories are used
correctly and hints to help users avoid common mistakes. When sufficient information is
available to describe the cause of death in more detail than provided for by this table, the coder
should refer to the full ICD-10.
A separate field instruction manual must be individually compiled by those who plan to set
up a verbal autopsy project. Its content will depend largely on the local setting, and for any
particular project should describe:
• the process of verbal autopsy;
• the organization and workflow of the project;
• the collection of data;
• the use of separate interview questionnaires;
• instructions on interpreting data obtained from verbal autopsy interviews;
• the responsibilities and roles of all staff involved;
• quality assurance procedures; and
• local circumstances, such as who the contact people are, relevant telephone numbers, and
whether computers are available.
3.2 Overview
This section provides an overview on the use of mortality information, explains how such
information is usually collected by physicians and how this process differs in places where verbal
autopsy is used. It also discusses how standardization of classifications is relevant to allowing
comparability of data across peoples and over time. The instructions in this section show how to
apply these steps to the results of verbal autopsy.
3.2.1 Introduction to mortality information
In many areas of the world, a large proportion of the population has no access to health care
provided by medically qualified personnel. In these areas, health care is often provided by lay or
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paramedical personnel and is based on traditional methods or elementary medical training. In
these situations, the information on mortality that is needed to indicate the existence of a health
problem or to facilitate the management of health systems is provided by the same personnel.
Mortality information may be used to:
• develop information about epidemiology and prevention;
• manage health care;
• spend public money in the most useful way;
• compare health across different regions.
3.2.2 Sources of mortality information
Mortality information is collected using a process called “vital registration”. This describes how
a country collects information on the births and deaths of its people. This information is usually
gathered at a national centre that keeps a written record of all vital events (births and deaths) on
standardized forms.
Countries around the world have vital registration systems at different stages of development.
The proportion of vital events registered (coverage) and the detail and quality of the information
recorded vary between countries. In the development from having no system of registration to
one of full registration, a stepwise approach has proven useful.
• Sentinel registration is a system in which single diseases or groups of diseases are monitored
in samples of a population – for example, maternal mortality is measured in population
samples in urban and rural areas.
• Demographic surveillance systems are registration areas where registration practices for
births and deaths are developed, tested and validated.
• Sample registration systems register a nationally representative sample of the population
using established protocols for vital registration.
• Partial vital registration means that registration is expanded to full registration where the
necessary infrastructure exists – for example, in urban areas – and that sample registration is
maintained in other, mainly rural, sites.
• Full vital registration refers to a system in which at least 90% of a country’s deaths and
births are registered. Information collected during the registration of death includes age and
sex, the cause of death, the place of residence and the place of death.
3.2.3 Verbal autopsy
Verbal autopsy is a technique used to determine the cause of death by asking caregivers, friends
or family members about signs and symptoms exhibited by the deceased in the period before
death. This is usually done using a standardized questionnaire that collects details on signs,
symptoms, complaints and any medical history or events.
The cause of death, or the sequence of causes that led to death, are assigned based on the data
collected by this questionnaire and on any other available information. Rules and guidelines,
algorithms or computer programmes, may assist in evaluating the information.
The purpose of verbal autopsy is to describe the causes of death at the community level or
population level where no, or only limited, vital registration is completed with medical
certificates.
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3.2.4 The cause of death
Cause-of-death registration in the context of verbal autopsy aims to assign a single underlying
cause of death. It is essential to undertake four standard steps to identify the underlying cause of
death. In order to collect reliable and useful statistical information, each step must be performed
in a standard fashion.
The following sections provide the necessary detail on each of the four steps.
3.2.4.1 Step 1: Identify the cause of death
In places where doctors certify the cause of death directly, they do so by examining the body of
the deceased, interpreting medical records and other information, and/or performing an autopsy.
In situations where people die without seeing a doctor, and doctors do not have access to the
body, a verbal autopsy may be used to gather the information necessary to assign a cause of death.
3.2.4.2 Step 2: Certify the death
The conditions that led to death – the causes of death – are reported on the “international form
of the medical certificate for cause of death”.
If a verbal autopsy has been performed, the international form of the medical certificate for cause
of death is used. This allows standard ICD procedures to be used as early as possible in the process
of information collection. The person who identifies the diagnoses from the verbal autopsy is
personally responsible for recording the causes of death on a death certificate.
3.2.4.3 Step 3: Code the causes of death
The diagnoses reported on the certificate are coded. Coding means that a standard number is
assigned to represent a disease or cause of death. The code identifies the correct category in
ICD-10. ICD-10 provides rules and guidelines for assigning codes.
Assigning a code to a disease makes it possible to group similar causes of death. The coded data
can then be analysed regardless of the wording or language originally used for the certification
itself.
This coding may be done by a physician or a lay person who has received special training. In
either case good knowledge of ICD-10 codes is important. All coders should understand medical
terms and have some knowledge of how the human body works.
3.2.4.4 Step 4: Select the underlying cause of death
The rules for selecting the underlying cause of death have been defined by WHO in ICD-10. These
rules are used to identify the single underlying cause of death if there is more than one cause
reported on the death certificate.
These rules ensure that the selection process used is the same everywhere. When these rules are
followed, selection does not depend on an individual’s opinion, and the results (underlying cause
Continual training and considerable experience are essential to ensure that selection rules are
followed correctly.
In some deaths only a single cause of death is identified and reported on the death certificate. In
these cases, all that has to be done is to code this single cause.
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of death) can be compared at local, national or international levels.
In other cases, two or more causes of death may be identified and recorded on the certificate.
Where two or more causes are listed, the most relevant cause of death for coding and reporting
purposes is selected. This selected single cause is called the “underlying cause of death”.
Therefore, the underlying cause of death is the condition, event or circumstance without which
the patient would not have died.
WHO defines the underlying cause of death as: the disease or injury that initiated
the train of morbid events leading directly to death, or the circumstances of the
accident or violence that produced the fatal injury.
Example:
A cancer patient dies. The immediate cause of death was heart failure resulting from the
spread of the cancer. However, the original cancer site was in the breast. Thus, the
sequence would be: cancer (malignant neoplasm) that had spread, resulting in heart
failure.
In this example, heart failure was the final cause of death in the sequence that started with breast
cancer.
The breast cancer (malignant neoplasm) is the condition that should be coded as the underlying
cause of death.
3.3 Instructions
This section provides instructions for completing the four steps explained in section 3.2. In verbal
autopsy, the standard death certificate (Fig. 1) is often not filled in completely. However, this
standard certificate should always be used for verbal autopsy, so that the same rules as for medical
This section also provides a simplified description of ICD-10 coding guidelines and rules for
selecting the underlying cause of death. Coders will need specific training to correctly apply the
rules.
3.3.1 Assigning cause of death in verbal autopsy
The completed verbal autopsy questionnaire will contain information on diseases, signs and
symptoms, the age and sex of the deceased as well as his or her history and medical reports (if
available). This information is used to assign the causes that led to death.
3.3.1.1 Assigning diseases from signs and symptoms
The use of a standard set of diagnostic criteria ensures that the results of evaluation and selection
are determined in a standard fashion by staff involved in this step. This could be a physician or
a lay person who has been medically trained.
3.3.1.2 Diagnostic criteria (algorithms)
Diagnostic criteria may also be called algorithms. They describe which combination of symptoms,
duration and severity may lead to a specific diagnosis.
These diagnostic criteria are used to:
• provide guidance. Algorithms may be used to guide and support a physician’s decision-making
so that all of the relevant factors are taken into account when a diagnosis is made;
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certification can be followed in assigning the underlying cause of death.
• ensure stability of outcome. Algorithms help focus diagnostic possibilities on one or more
probable conditions and reduce the number of highly improbably ones.
Example:
From interview to diagnosis
The wife of a man who died 2 months ago is interviewed. She reports that he had
complained for some days of headache. He then had problems turning his head and
complained of neck pain.
She noticed that he felt increasingly hot to the touch, had chills and sweated heavily.
During his last days he was vomiting and was confused. He was tired and slept most of
the time.
The interviewer asked if the dead man had had an accident and whether he had hurt his
head during the weeks before he died. His wife reported that he had not fallen or had an
injury to his head.
The responses to the questionnaire would be evaluated using a set of criteria. After this,
one verbal autopsy category and one ICD-10 code would be assigned to the case. The
process for the example above is shown in Fig. 1.
FIG. 1. SAMPLE OF A DIAGNOSTIC ALGORITHM FOR IDENTIFYING THE DIAGNOSIS
“MENINGITIS”
Fever
Headache
Stiff neck
Neck pain
Vomiting
Confusion
DrowsinessNo fall or
injury to the
head
Some irritation of
meninges of brain
and spinal chordMost
probably
infectious
With
impairment of
brain function
Meningitis infectious serious VA-1.11; ICD G03
Nothing else
causing brain
impairment
No other frequent
similar cause
Diagnosis
Algorithms used to select one specific diagnosis during verbal autopsy may take into
account, for example, how frequently a disease occurs in a specific region. ICD-10 gives
one such example (see the note under code A09, chapter 1, volume 1).
Different sets of algorithms are in use. You need to identify which ones should be used in
your verbal autopsy project. Common agreement exists on some sets of criteria. These
criteria are included in the list at the end of Part 3.
3.3.1.3 Computers
Computers may be useful during the different steps of determining the cause of death. They may
make it easier to assign a diagnosis using information gathered during verbal autopsy; they may
assist in coding; and they may also be helpful in selecting the underlying cause of death if there
is more than one condition mentioned on the certificate.
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3.3.2 The international form of the medical certificate for cause of death
Death certificates are the main source of mortality data. A properly completed death certificate
shows clearly why and how the death occurred. The information gathered during verbal autopsy
may be used to assign one or more diagnoses to complete cause-of-death information and to fill
in the medical certificate of death.
In completing the certificate, the certifier should report any disease, abnormality, injury or
external cause that is believed to have contributed to the death. It is essential to note that modes
of death – such as respiratory failure, heart failure or brain death – should not be considered
causes of death.
The certificate has two parts (part I and part II) and a section to record the time interval between
the onset of each condition and the date of death.
FIG. 2. INTERNATIONAL FORM OF THE MEDICAL CERTIFICATE FOR CAUSE OF DEATH
INTERNATIONAL FORM OF MEDICAL CERTIFICATE OF DEATH
Cause of death
I
II
Disease or condition directly
leading to death *
Other significant conditions
contributing to the death, but
not related to the disease or
conditions causing it
Morbid conditions, if any,
giving rise to the above cause,
stating the underlying
condition last.
Antecedent causes
a)due to (or as a consequence of)
b)due to (or as a consequence of)
c)due to (or as a consequence of)
d)
Approximate
Interval between
onset and death
*This does not mean the mode of dying, e.g. heart failure, respiratory failure,
it means the disease, injury, or complication that caused death.
Part I is used to record diseases or conditions related to the sequence of events leading
directly to the death.
Part II is used to record conditions that have no direct connection with the events leading to
death but which, by their nature, contributed to the death.
3.3.2.1 Part I of the certificate
Part I of the certificate provides four lines on which the sequence of events leading to death are
recorded. This space is used for diseases that are related to the sequence of events leading directly
to death. The condition thought to be the underlying cause of death should appear on the
last completed line of part I.
The direct cause of death is entered on the first line, i.e. I(a). There must always be an entry on
line I(a). The entry on line I(a) may be the only condition reported in part I.
Where two or more conditions must be recorded, the sequence of events leading to death should
be entered. Each event in the sequence should be recorded on a separate line.
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There is an exception: two independent diseases may be occasionally thought to have contributed
equally to the sequence at a particular point. In such unusual circumstances they may be entered
on the same line.
The sequence of entries in part I is as follows:
• line (a) records the disease or condition directly leading to death;
• line (b) records other disease or condition, if any, leading to (a);
• line (c) records other disease or condition, if any, leading to (b); and
• line (d) records other disease or condition, if any, leading to (c).
The underlying cause of death is entered on the last line used.
The certifier should make every attempt to provide a clear sequence of events in part I.
If the cause of death is unknown even after investigation, it is acceptable to record “unknown”.
This is preferable to speculating about a cause of death.
3.3.2.2 Part II of the certificate
Part II is used to record conditions that have had no direct connection with the events leading
to death but which, by their nature, contributed to the death.
3.3.2.3 Reporting the duration of conditions
The duration of the disease or condition is the interval between the onset of each condition
entered on the certificate (not the time of the diagnosis of the condition) and the date of death;
the interval is recorded in the column to the right of the disease or condition.
The best estimate of the interval should be recorded when the time or date of onset is not known.
The unit of time should be entered for each diagnosis whether it is:
• years
• months
• days
• hours
• minutes or
• unknown.
In a correctly completed certificate, the duration entered on each line will not exceed the duration
entered for the condition on the line underneath (the condition that preceded it) since the causal
sequence requires that antecedent conditions are reported in reverse order of their occurrence.
On the form, this means conditions are reported in an ascending sequence (Fig. 3).
The information on duration is useful in coding certain diseases and also provides a check on the
accuracy of the reported sequence of conditions.
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FIG. 3. SAMPLE OF CERTIFICATE
INTERNATIONAL FORM OF MEDICAL CERTIFICATE OF DEATH
Cause of death
I
II
Disease or condition directly
leading to death *
Other significant conditions
contributing to the death, but
not related to the disease or
conditions causing it
Morbid conditions, if any,
giving rise to the above cause,
stating the underlying
condition last.
Antecedent causes
a)due to (or as a consequence of)
b)due to (or as a consequence of)
c)due to (or as a consequence of)
d)
Approximate
Interval between
onset and death
*This does not mean the mode of dying, e.g. heart failure, respiratory failure,
it means the disease, injury, or complication that caused death.
Pneumonia 2 weeks
Malnutrition
Diabetes
months
In this case malnutrition caused pneumonia. The pneumonia killed the person. The person also
had diabetes mellitus. Diabetes may have contributed to the death. It was not part of the sequence
of events that caused the deadly pneumonia.
3.3.2.4 The three “golden rules” of completing a certificate
The causes of death reported on a certificate provide the basis for coding and selecting the
underlying cause of death. Some well-known behaviours hamper the evaluation of certificates.
The “golden rules” address them all.
1. Write clearly and do not use abbreviations.
2. Always have an entry on line (a) of part I.
3. List all conditions in a causal sequence. The most recent condition – the
direct cause of death – should appear on the top line and the least recent
condition should appear on the bottom line.
3.4 Structure and principles of ICD-10
The ICD is an internationally agreed scheme used to code diseases in a standardized fashion. It
has been revised 10 times since its origins more than 100 years ago, so the current version is called
ICD-10.
This section is intended to be an introduction to the classification scheme. You are not expected
to become an ICD expert after reading it. You will learn how ICD is organized and how it works.
3.4.1 Overview of ICD-10 classification
In ICD-10 diseases and their causes are grouped for practical, epidemiological reasons as follows:
• communicable diseases
• general diseases that may affect the whole body
• localized diseases arranged by site
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• developmental diseases
• injuries
• external causes.
The ICD-10 has three volumes.
Volume 1: the list
• Volume 1 is the tabular list. It is an alphanumeric listing of diseases and disease groups. It
contains notes on inclusion and exclusion and some coding rules.
• It has 22 chapters and 11 400 categories enumerated to 4 characters. However, only the
1655, 3-character categories are relevant to coding a single underlying cause of mortality.
At the end of volume 1 there are five special tabulation lists. These are not designed
for coding; they are for tabulation only. They must not be used for coding or
reporting. The lists mentioned here should not be confused with the
correspondence table at the end of Part 3 of this manual, which shows the
correspondence between ICD-10 codes and those used in verbal autopsy.
Exercise:
Look up list number 1 in ICD-10 and identify differences between it and the correspondence table
at the end of this guide.
Volume 2: the manual
This provides an introduction to, and instructions on how to use, ICD-10.
• It also contains guidelines for certification and rules for mortality coding (that is, coding
causes of death).
• It contains guidelines for recording and coding morbidity (for example, for hospital
statistics).
• It also contains guidelines for tabulating statistical data and definitions (for example, for
“perinatal”).
Volume 3: index and guide
• This is an alphabetical index of the diseases and conditions found in the tabular list.
• It has a table of neoplasms.
• There is also a table of chemicals and drugs.
• There is a table of external causes.
• There is guidance on selecting appropriate codes for many conditions not displayed in the
tabular list.
Volume 1 and volume 3 are inseparable. Volumes 1 and 3 must be used together to find
codes to describe each case correctly (for example, the cause of death).
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3.4.2 The tabular list
ICD-10 has 22 chapters, each of which is identified by a Roman numeral. Chapters XIX (Injury,
poisoning and certain other consequences of external causes) and XXI (Factors influencing health
status and contact with health services) are not used for coding the underlying cause of death.
The full list of chapters is as follows.
Chapter Title Range of codes in
whole chapters
I Certain infectious and parasitic diseases A00–B99
II Neoplasms C00–D48
III Diseases of the blood and blood-forming organs and
certain disorders involving the immune mechanism
D50–D89
IV Endocrine, nutritional and metabolic diseases E00–E90
V Mental and behavioural disorders F00–F99
VI Diseases of the nervous system G00–G99
VII Diseases of the eye and adnexa H00–H59
VIII Diseases of the ear and mastoid process H60–H95
IX Diseases of the circulatory system I00–I99
X Diseases of the respiratory system J00–J99
XI Diseases of the digestive system K00–K93
XII Diseases of the skin and subcutaneous tissue L00–L99
XIII Diseases of the musculoskeletal system and connective
tissue
M00–M99
XIV Diseases of the genitourinary system N00–N99
XV Pregnancy, childbirth and the puerperium O00–O99
XVI Certain conditions originating in the perinatal period P00–P96
XVII Congenital malformations, deformations and
chromosomal abnormalities
Q00–Q99
XVIII Symptoms, signs and abnormal clinical and laboratory
findings, not elsewhere classified
R00–R99
XIX Injury, poisoning and certain other consequences of
external causes
S00–T99
XX External causes of morbidity and mortality V01–Y98
XXI Factors influencing health status and contact with health
services
Z00–Z99
XXII Codes for special purposes U00–U99a
a Only some categories in this chapter are used in mortality coding.
3.4.2.1 Blocks of related conditions in ICD-10
Each chapter is divided into blocks of related conditions. The blocks are further divided into
3-character and 4-character categories.
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Example:
Example of a block in chapter I
Viral hepatitis (B15–B19)
B15 Acute hepatitis A
B16 Acute hepatitis B
B17 Other acute viral hepatitis
B18 Chronic viral hepatitis
B19 Unspecified viral hepatitis
3.4.2.2 3-character categories or rubrics
Some 3-character categories are used only for single conditions. Others contain groups of diseases.
Example:
3-character category with a single disease
A71 Trachoma
Excludes: sequelae of trachoma (B94.0)
3-character category with a group of diseases
A75 Typhus fever
Excludes: rickettsiosis due to Ehrlichia sennetsu (A79.8)
A75.0 Epidemic louse-borne typhus fever due to Rickettsia prowazekii
Classical typhus (fever)
Epidemic (louse-borne) typhus
A75.1 Recrudescent typhus [Brill’s disease]
Brill-Zinsser disease
A75.2 Typhus fever due to Rickettsia typhi
Murine (flea-borne) typhus
A75.3 Typhus fever due to Rickettsia tsutsugamushi
Scrub (mite-borne) typhus
Tsutsugamushi fever
A75.9 Typhus fever, unspecified
Typhus (fever) NOS
3.4.2.3 4-character categories or rubrics
These 4-character categories are not mandatory for reporting at the international level but the
use of a fourth character adds detail and specificity to the coded data. The use of a fourth character
allows for as many as 10 subcategories.
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Example:
A01 Typhoid and paratyphoid fevers
A01.0 Typhoid fever
Infection due to Salmonella typhi
4-character categories
A01.1 Paratyphoid fever A
A01.2 Paratyphoid fever B
A01.3 Paratyphoid fever C
A01.4 Paratyphoid fever, unspecified
Infection due to Salmonella paratyphi NOS
3.4.2.4 Content structure
Most chapters are associated with particular body systems, special diseases or external factors.
The chapters on special diseases include conditions that are not found in the body-system
chapters even though they may be present in that body system. Conditions that are coded to a
special disease chapter take precedence over those that are coded to the body-system chapter.
Exercise:
Look at the titles of the chapters in ICD-10. The chapter titles indicate that the conditions included
are wide-ranging; therefore a large number of codes are required to cover all of the conditions.
Inclusion terms
Within the 3-character and 4-character rubrics, a number of other diagnostic terms, in addition
to the code title, are usually listed. These are known as “inclusion terms” and are given as examples
of diagnostic statements to be classified to that rubric. In essence, they reflect similar diseases that
may be coded to the same category or different words and terms used to describe the same disease.
Example:
A06 Amoebiasis
includes infection due to Entamoeba histolytica
The A06 category is further subdivided, and all conditions and inclusions in these subdivisions
may be coded with A06 too. This is the reason why you will always need ICD-10 and all its
subdivisions (blocks, categories) in order to code thoroughly: the fourth characters provide
additional useful specificity.
Exercise:
Look up the subdivisions of A06 in ICD-10 and see what else is included under that category.
Exclusion terms
Certain rubrics contain lists of conditions preceded by the word “excludes”. This means that the
excluded terms are to be coded elsewhere. The correct code that should be assigned is given in
parentheses following the term.
Example:
Category A06 Amoebiasis excludes other protozoal intestinal diseases mentioned under
A07.-, such as giardiasis and ascariasis (roundworm disease).
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If there is an exclusion term in a subdivision of A06, this exclusion would also be valid for A06.
Please note that exclusions also appear at the chapter level and block level, and these exclusions
are relevant to codes at the 3-character and 4-character levels.
Exercise:
Look up A06 and A04. Identify the exclusion terms.
3.4.2.5 Conventions of ICD-10
The ICD-10 tabular list (volume 1) and the alphabetical index (volume 3) make use of
abbreviations, punctuation marks, symbols and instructional terms that must be clearly
understood. These are referred to as “coding conventions”.
Dagger (†) and asterisk (*) codes
The dagger and asterisk conventions are not used when coding a single underlying cause of
mortality. A dagger code represents the etiology of the disease and must be used, where applicable.
The asterisk code is used to describe the manifestation of a disease, if desired. Asterisk codes must
not be used for coding the underlying cause of death in verbal autopsy.
Example:
B57.0† Acute Chagas’ disease with heart involvement (I41.2*, I98.1*)
Acute Chagas’ disease with:
• cardiovascular involvement NEC (I98.1*)
• myocarditis (I41.2*)
In this example there is a dagger next to B57.0. Codes with an asterisk are given in parentheses.
In verbal autopsy you would code B57.0 and ignore the codes with asterisks.
Not otherwise specified
NOS is an abbreviation for “not otherwise specified”; it implies that a cause is “unspecified” or
“unqualified”. Coders should be careful not to code a term as unqualified unless it is quite clear
that no other information is available that would permit a more specific code to be assigned from
elsewhere in the classification.
Example:
B50.0 Plasmodium falciparum malaria with cerebral complications
Cerebral malaria NOS
Not elsewhere classified
NEC stands for “not elsewhere classified”. This abbreviation serves as a warning that certain
specified types of the listed conditions may appear in other parts of the classification.
Example:
K73 Chronic hepatitis, not elsewhere classified
“Not elsewhere classified” is mentioned here because there are other categories in ICD-10
for specified chronic hepatitis, for example in chapter I:
B18 Chronic viral hepatitis
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Other conventions
There is a difference between parentheses “( )”and square brackets “[ ]”.
Parentheses enclose supplementary words that may follow a diagnostic term without changing
the code number to which the words outside the parentheses would be assigned.
Examples:
G11.1 Early-onset cerebellar ataxia
Friedrich’s ataxia (autosomal recessive)
Gonorrhoea (acute)(chronic) A54.9
Square brackets enclose synonyms, alternative words or explanatory phrases.
Examples:
A77 Spotted Fever [tick-borne rickettsioses]
B02 Zoster [herpes zoster]
When “and” is used in code titles in volume 1 it means “and/or”.
Example:
A18.4 Tuberculosis of skin and subcutaneous tissue
In this case, “tuberculosis of skin” and “tuberculosis of subcutaneous tissue” and
“tuberculosis of skin and subcutaneous tissue” can be coded to A18.4.
Certain postprocedural disorders should not be used to code the underlying cause
of mortality. They are E89.-, G97.-, H59.-, H95.-, I97.-, J95.-, K91.-, M96.-, N99.-.
Exercise:
Look up the postprocedural disorders listed above and see what the codes cover.
3.4.3 The alphabetical index
The alphabetical index contains more diagnostic terms than the tabular list.
Volume 3 is an alphabetical index of the tabular listing found in volume 1. It contains far more
diagnostic terms than the tabular list, reflecting the many and varied ways that doctors and other
clinical staff describe diseases.
By using the index, the coder can find a suggested code from a range of substitute terms. The
coder should then check the code against the tabular list to ensure there are no relevant notes or
conventions that might change the coding decision.
Volumes 1 and 3 must be used together to locate codes to describe accurately each clinical
case.
Coders should not fall into the trap of coding directly from the alphabetical index
or browsing the tabular list looking for a code that seems to fit the case being
assessed.
• Section I is an alphabetical listing of terms relating to diseases. It also incorporates a table of
neoplasms.
• Section II is an alphabetical listing of external causes of injury and poisoning.
• Section III is an alphabetically arranged table of drugs and chemicals.
3. Applying ICD-10 to verbal autopsy
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3.4.3.1 Index entries
Index entries consist of lead terms and of modifiers.
Lead terms (usually nouns) appear on the far left of each column in bold. They refer mainly to
the names of diseases or conditions. They describe either the patient’s actual pathological
condition or the reason for seeking medical attention.
Modifiers are found at different levels of indentation to the right. They usually refer to varieties
of diseases or external causes of death that affect coding. Modifiers might identify the site of the
condition (for example, leg), the stage of the condition (for example, acute or chronic) or the type
of consultation, problem or encounter. Modifiers need not be used for every statement. Modifiers
that do not affect code assignment appear in parentheses ( ) after the condition.
Examples:
Index term Lead term Modifier
Fracture of the spine fracture fracture spine (site of the condition)
Acute otitis media otitis otitis acute (stage of disease), media (site of
the condition)
Upper respiratory
infection
infection infection upper (site), respiratory (system
involved)
Blackwater fever
malaria
malaria blackwater fever (type of condition)
Congenital malaria malaria congenital (type of condition)
Acute gonorrhoea of
the cervix
gonorrhoea gonorrhoea acute (stage of disease), cervix
(site of the condition)
Septic embolism embolism embolism septic (nature of condition)
Note: In the index there are often many entries at each level of indentation. It is necessary to be careful
while following the trail of relevant entries for the diagnosis under each lead term.
Example:
Sample index
Malaise R53
Malakoplakia – see Malacoplakia
Malaria, malarial (fever) B54
– with
– – blackwater fever B50.8
– – – hemoglobinuric (bilious) B50.8
– – hemoglobinuria B50.8
– accidentally induced (therapeutically) –
see Malaria, by type
– algid B50.9
– cerebral B50.0† G94.8*
– clinically diagnosed (without
parasitological confirmation) B54
– complicating pregnancy, childbirth or
puerperium O98.6
– congenital NEC P37.4
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– – falciparum P37.3
– continued (fever) B50.9
– estivo-autumnal B50.9
– falciparum B50.9
– – with complications NEC B50.8
– – – cerebral B50.0† G94.8*
– – severe B50.8
– malariae (with) B52.9
Exercises:
Look up “haemochromatosis with refractory anaemia”.
Look up “breast cancer”.
Look up “car accident”.
Do you remember what square brackets mean?
What do you do with a † or an * in mortality coding?
3.4.4 Selecting the underlying cause of death
Once the causes of death have been assigned and reported on the international form of the
medical certificate for cause of death by clinicians, the certificate needs to be validated. First, the
sequence of events that led to death must be correct. “Sequence” refers to two or more conditions
entered on successive lines, each condition being an acceptable cause of the one entered on the
line above it.
• When only one cause of death is recorded, this cause is the underlying cause of death and is
used for tabulation.
• When more than one cause of death is recorded, the selection of the underlying cause should
be made in accordance with the rules outlined in this chapter.
Set of procedures – Selection starts with the “general principle” and a first set of rules. The
cause of death thus selected may then be modified by a second set of rules.
This manual provides a brief overview of these rules. In the rare cases when you may need to refer
to the rules during verbal autopsy, you may look up section 4.1 and 4.2 of volume 2. These
sections contain detailed explanation and examples.
Comparability – The rules ensure that the selection process is carried out the same way
everywhere and does not depend on an individual’s opinion. This makes the results comparable.
Several selection rules are meant to correct mistakes that certifiers may make while filling in the
death certificate.
3.4.4.1 The general principle
When more than one condition is entered on the certificate, the condition entered alone on the
last line used in part I should be selected but only if it could have given rise to all the conditions
entered above it.
Example:
I(a) Abscess of lung
I(b) Lobar pneumonia
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Select lobar pneumonia (J18.1) as the underlying cause since the lung abscess could have resulted
from lobar pneumonia.
3.4.4.2 Rule 1
If the general principle does not apply and there is a reported sequence terminating in the
condition first entered on the certificate – leftmost on line I(a) – select the cause of this
sequence on the last possible line. If there is more than one sequence, select the one that ends
with the first term on line I(a).
In other words, rule 1 applies when there is a reported sequence but the cause on the last line in
part I of the certificate does not explain all the diseases mentioned above it.
Example: I (a) Bronchopneumonia
(b) Cerebral infarction and hypertensive heart disease
Select cerebral infarction (I63.9). There are two reported sequences terminating in the
condition first entered on the certificate: bronchopneumonia due to cerebral
infarction and bronchopneumonia due to hypertensive heart disease. The originating
cause of the first-mentioned sequence is selected.
Example: I (a) Oesophageal varices and congestive heart failure
(b) Chronic rheumatic heart disease and cirrhosis of liver
Select cirrhosis of liver (K74.6). The sequence terminating in the condition first
entered on the certificate is oesophageal varices due to cirrhosis of liver.
Example: I (a) Acute myocardial infarction
(b) Atherosclerotic heart disease
(c) Influenza
Select atherosclerotic heart disease. The reported sequence terminating in the
condition first entered on the certificate is acute myocardial infarction due to
atherosclerotic heart disease. But modification rule C also applies.
Example: I (a) Pericarditis
(b) Uraemia and pneumonia
Select uraemia. There are two reported sequences terminating in the condition first
entered on the certificate: pericarditis due to uraemia and pericarditis due to
pneumonia. The originating cause of the first-mentioned sequence is selected. But
modification rule D also applies.
Example: I (a) Cerebral infarction and hypostatic pneumonia
(b) Hypertension and diabetes
(c) Atherosclerosis
Select atherosclerosis. There are two reported sequences terminating in the condition
first entered on the certificate: cerebral infarction due to hypertension due to
atherosclerosis, and cerebral infarction due to diabetes. The originating cause of the
first-mentioned sequence is selected. But modification rule C also applies.
If there is no logical sequence, rule 2 should be applied (see below).
3.4.4.3 Rule 2
If nothing is reported on the lower lines of the certificate that could explain the first-mentioned
condition – line I(a) – then select the condition on line I(a).
Example: I (a) Pernicious anaemia and gangrene of foot
(b) Atherosclerosis
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Select pernicious anaemia (D51.0). There is no reported sequence terminating in the
condition entered first.
Example: I (a) Rheumatic and atherosclerotic heart disease
Select rheumatic heart disease (I09.9). There is no reported sequence; both conditions
are on the same line.
Example: I (a) Fibrocystic disease of the pancreas
(b) Bronchitis and bronchiectasis
Select fibrocystic disease of the pancreas (E84.9). There is no reported sequence.
Example: I (a) Senility and hypostatic pneumonia
(b) Rheumatoid arthritis
Select senility. There is a reported sequence – hypostatic pneumonia due to
rheumatoid arthritis – but it does not terminate in the condition entered first on the
certificate. But modification rule A also applies.
Example: I (a) Bursitis and ulcerative colitis
Select bursitis. There is no reported sequence. But modification rule B also applies.
Example: I (a) Acute nephritis, scarlet fever
Select acute nephritis. There is no reported sequence. But rule 3 (see below) also
applies.
Some of the examples above contain a reference to an additional rule that also has to be applied.
Look up those rules and consider how they would modify the outcome of the selection.
3.4.4.4 Rule 3
If the condition selected by the general principle or by rule 1 or rule 2 is obviously a direct
consequence of another reported condition, whether in part I or part II, select the primary
condition. This means that in some cases there is a condition reported in part I or II of the form
that has not been selected using the general principle, rule 1 or rule 2 but which could have caused
the other conditions on the certificate. In these cases rule 3 is applied.
This rule is particularly tricky. The examples below are meant to provide guidance. The
information in volume 2, section 4.1.7 should be read carefully, and considerable experience is
needed to understand the rule. In verbal autopsy if a certificate has been completed properly you
will rarely need to apply rule 3.
Example: I (a) Kaposi’s sarcoma
II AIDS
Select HIV disease resulting in Kaposi’s sarcoma (B21.0).
Example: I (a) Cancer of ovary
II HIV disease
Select malignant neoplasm of ovary (C56).
Example: I (a) Tuberculosis
II HIV disease
Select HIV disease resulting in mycobacterial infection (B20.0).
Example: I (a) Cerebral toxoplasmosis and herpes zoster
(b) Burkitt’s lymphoma, HIV disease
Select HIV disease resulting in multiple diseases classified elsewhere (B22.7). Cerebral
toxoplasmosis, selected according to rule 2, could be considered a direct consequence
of HIV disease.
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Example: I (a) Bronchopneumonia
II Secondary anaemia and chronic lymphatic leukaemia
Select chronic lymphatic leukaemia (C91.1). Bronchopneumonia, selected by the
general principle (see rule 2, example of bursitis and ulcerative colitis), and secondary
anaemia can both be considered direct sequelae of chronic lymphatic leukaemia.
Example: I (a) Cerebral haemorrhage
(b) Hypertension
(c) Chronic pyelonephritis and prostatic obstruction
Select prostatic obstruction (N40). Chronic pyelonephritis, selected according to
rule l, can be considered a direct sequela of prostatic obstruction.
Example: I (a) Acute nephritis, scarlet fever
Select scarlet fever (A38). Acute nephritis, selected according to rule 2 (see example
below referring to hypostatic pneumonia and cerebral haemorrhage), can be
considered a direct sequela of scarlet fever.
Example: I (a) Nephrectomy
II Clear cell carcinoma of kidney
Select clear cell carcinoma of kidney (C64). There is no doubt that the nephrectomy
was performed for the malignant neoplasm of kidney.
Example: I (a) Acute anaemia
(b) Haematemesis
(c) Bleeding of oesophageal varices
(d) Portal hypertension
II Cirrhosis of liver
Select cirrhosis of liver (K74.6). Portal hypertension, selected according to the general
principle, can be considered a direct consequence of cirrhosis of liver.
Example: I (a) Hypostatic pneumonia
(b) Cerebral haemorrhage and cancer of breast
Select cerebral haemorrhage (I61.9). Hypostatic pneumonia, selected according
to rule 2, can be considered a direct sequela of either of the other conditions
reported; select the one mentioned first.
Example: I (a) Pulmonary infarction
II Left pneumonectomy for carcinoma of lung 3 weeks ago
Select carcinoma of lung (C34.9).
3.4.4.5 Rules for modification
In some cases the underlying cause that has been selected using the above rules is not the cause
that is the most useful or informative for public health or prevention purposes – for example,
senility, or a general disease process such as atherosclerosis.
In such cases modification rules may need to be applied after the general principle, rule 1, rule 2
and rule 3 have been applied.
There are six modification rules (A–F). Please note that this set of rules is particularly tricky. The
paragraphs below are meant to provide an idea of what the rules cover. The information in
volume 2, section 4.1.8 must be read carefully, and considerable experience is needed to
understand and apply the rules.
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Rule A: Senility and other “ill-defined” conditions
Where the selected cause of death is “ill defined” and another condition is reported on the
certificate, select the cause of death as if the ill-defined condition had not been reported.
Rule B: Trivial conditions
Where a serious condition is reported but the selected cause is a “trivial condition” (that is, a
condition unlikely to cause death), select the underlying cause as if the trivial condition had not
been reported.
Rule C: Linkage
ICD-10 provides a list of how to link some diseases in order to select the most relevant underlying
cause of death. You will find extensive explanation in sections 4.1.11 and 4.1.12 of volume 2.
Example:
I (a) Intestinal obstruction
(b) Femoral hernia
Code for femoral hernia with obstruction (K41.3).
Rule D: Specificity
Where the selected cause describes a disease in general terms, and a disease term that provides
more precise information about the site or nature of this condition is reported on the certificate,
prefer the more informative term. This rule often applies when the general term becomes an
adjective qualifying the more precise term.
Example:
I (a) Meningitis
(b) Tuberculosis
Code for tuberculous meningitis (A17.0). The certifier has stated that the meningitis was
due to tuberculosis.
Rule E: Early and late stages of disease
Where the selected cause is the early stage of a disease, and a more advanced stage of the same
disease is reported on the certificate, code for the more advanced stage.
This rule does not apply to a chronic form reported as being due to an acute form unless the
classification gives special instructions to that effect.
Example:
I (a) Tertiary syphilis
(b) Primary syphilis
Code for tertiary syphilis (A52.9).
Example:
I (a) Chronic nephritis
(b) Acute nephritis
Code for chronic nephritis, unspecified (N03.9), since special instruction is given to
this effect (see the following exercise).
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Exercise:
Look in volume 2 and try to find this instruction.
Rule F: Sequelae
This rule provides guidance on selection in cases where late damage from a disease (sequela) and
the causative disease (occurring a long time before death) are mentioned on the certificate.
Example:
I (a) Hydrocephalus
(b) Tuberculous meningitis
Code for sequelae of tuberculous meningitis (B90.0).
“Sequelae of” categories are as follows: B90, B94, E64, E68, G09, I69, O97, Y85 and Y89.
Exercise:
Look up these special categories in ICD-10 to become familiar with them.
3.5 Using the data
ICD-10 provides tabulation lists for mortality and morbidity in volume 1. Other professional
groups have made different lists for grouping diseases and presenting statistics. Regardless of the
list used, deaths should be classified by sex and into the following age groups: aged < 1 year, aged
1–4 years, and then in 5-year groups from age 5 years to 84 years, followed by a group for those
aged 85 years. Volume 2, section 5.6.1, contains a full set of instructions.
The purpose of verbal autopsy is to describe the causes of death at the community level or
population level in instances where no better alternative sources exist. Therefore, it is a limited
substitute for proper medical certification. The quality of information and of the diagnoses varies
depending on the skills of the interviewer and the memory of the respondents.
The “verbal autopsy causes of death list” is found in the two left-hand columns in the tabular list
at the end of this book. The verbal autopsy list is a core mortality classification system, specifying
some of the most important causes of death in low-income and middle-income countries. It may
be seen as the “lowest common denominator” that can be used to merge data from different verbal
autopsy projects. Coding diagnoses with ICD will facilitate the merging of data and the retention
of as much detail as needed in local settings.
Note: Never merge data collected from verbal autopsy with data from full vital
registration systems and medical certification (medical postmortem examination).
The way information is collected during verbal autopsy and the way in which a diagnosis is
assigned is different from the method used during medical certification. The certainty of the
diagnosis is much lower in verbal autopsy, and some diseases cannot be diagnosed. Merging data
from these two methods will hide differences that may result from these methods and lead to
misinterpretation of the results.
3.6 Confidentiality
The verbal autopsy procedure involves collecting and storing information that, if disclosed to
third parties, might cause harm or distress to the interviewee, friends or relatives of the deceased.
Investigators should arrange to protect the confidentiality of the people providing information
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by, for example, omitting information that might lead to the identification of individual
interviewees or by limiting access to the information or anonymizing data. During the process of
obtaining informed consent the investigator should let the prospective interviewee know about
the precautions that will be taken to protect confidentiality.
The investigator must establish robust safeguards to protect the confidentiality of
interviewees and the data provided by them. Interviewees should be informed of
the limits, legal or otherwise, to the investigator’s ability to safeguard
confidentiality and the possible consequences of breaches of confidentiality.
Prospective interviewees should be informed of the limits of the ability of investigators to ensure
strict confidentiality and of any foreseeable adverse social consequences of breaches of
confidentiality. Some jurisdictions require that deaths be reported to appropriate agencies.
Anything that limits the investigator’s ability to maintain confidentiality should be anticipated
and disclosed to prospective interviewees.
Ideally the interviewee should sign a locally relevant consent form based on these principles.
3.7 Additional sources of information
3.7.1 Changes and updates to ICD
As part of the updating process for ICD-10, addenda of changes and updates to the classification
are released annually. A copy of all of the updates made since 1996 is available at http://
www.who.int/classifications/en/.
3.7.2 Information on ICD
General information about the ICD can be found at http://www.who.int/classifications/icd/en/.
Volume 2 and a certification flyer are available on this page.
3.7.3 Decision tables
Decision tables to aid in selecting the underlying cause of death, and regular updates, can be
obtained from the United States Centers for Disease Control and Prevention’s National Center
for Health Statistics. The tables can be downloaded from http://www.cdc.gov/nchs/about/major/
dvs/im.htm.
3.7.4 An overview of training opportunities
The WHO Family of International Classifications (WHO–FIC) Education Committee has
compiled lists of experts and training facilities. The information can be accessed at http://
www.cdc.gov/nchs/about/otheract/icd9/nacc_ed_committee.htm.
Links to WHO’s regional offices can be found at http://www.who.int/about/regions/en/.
3.7.5 Mortality forum
The mortality forum of the WHO–FIC Network is an international discussion network that
examines problems experienced during ICD-10 mortality coding. Issues that cannot be resolved
in the forum are referred to the Mortality Reference Group. The tasks of the Mortality Reference
Group of the WHO–FIC Collaborating Centres include making decisions about applying and
interpreting ICD-10 as it relates to mortality and preparing proposals for updates or changes.
The mortality forum can be accessed at http://www.nordclass.uu.se/verksam/mortfore.
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3.8 ICD coding in verbal autopsy – special cases
Some causes of death deserve special attention during coding. These are either frequent causes
encountered during verbal autopsy or frequent combinations of causes of death. The cases
mentioned in this manual are not exhaustive.
3.8.1 Dealing with multiple causes
Verbal autopsy may lead to the identification of more than one cause of death, since different
diagnoses may be reported by relatives or mentioned in medical records.
Several categories of ICD-10 are designed to code relevant combinations of diseases, while in other
cases guidance is provided on how to select and report the most useful cause of death. It is
important to follow the coding rules, using ICD-10’s index and tabular lists as well as the rules
and conventions specified in volume 2, in order to locate the most useful codes.
Common examples
There is no classification rule that automatically gives HIV precedence over malaria or vice versa.
Whether the cause of death is classified as HIV or malaria depends on how the death certificate
has been completed.
Example:
Where there is a mention of HIV with malaria, code to B20.8.
Example:
The table below shows solutions to common coding problems.
Conditions Code
HIV and pneumonia B23.8 (if the agent causing the pneumonia is
unknown)
Hypertension and stroke I64
Hypertension in combination with acute
myocardial infarction or heart failure
I21
Hypertension and heart failure I11.0
Diabetes and stroke E14.6
Diabetes and hypertension Which code is used depends on the way the
certificate is completed: only one code will
be retained
Prematurity and/or low birth weight and
respiratory distress
P22.0
Diarrhoea and pneumonia A09
3.8.2 Other special cases
The conditions that may cause confusion during verbal autopsy are those presenting with
multiple diagnoses or sequelae, or both. Examples of conditions that may cause confusion are
stillbirths where there are known or unknown underlying maternal causes, and external causes
of injuries.
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The following conditions need special attention when information from verbal autopsies is
coded.
3.8.2.1 Malaria
ICD-10 codes may be used when malaria is the cause of death, but the nonspecific nature of the
disease and the lack of sufficient details derived during verbal autopsy may pose special difficulties
in assigning a code. Malaria that has been clinically diagnosed is coded B54.
Cerebral malaria is a special case in coding. The diagnosis is usually based on the exclusion of
other encephalopathies (for example, HIV/AIDS encephalopathy, hypoglycaemia,
meningoencephalitis, eclampsia, intoxication, head injury, cerebrovascular accidents, metabolic
disorders and other infections) and confirmation of the presence of malaria. In the absence of
detail on the verbal autopsy form that may help to confirm malaria or exclude other forms of
encephalitis, the physician’s knowledge, local experience and information about prevailing
epidemiology are used to carefully assess the information on the dead for diagnostic purposes.
In ICD-10, the classification “cerebral malaria” falls under the category of malaria caused by
Plasmodium falciparum: B50.0 (Plasmodium falciparum malaria with cerebral complications). Since
this level of detail (a blood slide that shows P. falciparum malaria species) is unlikely to be found
by verbal autopsy (or even in medical records), coding the diagnosis or cause of death as cerebral
malaria (and most other forms of malaria) cannot, strictly speaking, be done based on symptoms
and signs alone. The possible causes of deaths from malaria in verbal autopsy settings would
therefore be B54 (unspecified malaria) or B50.0 (P. falciparum malaria with cerebral
complications) only.
Thus, in verbal autopsy it is not possible to use the following codes for malaria: B51, B52, B53.0
and B53.1. These codes require specific information on Plasmodium, which cannot found during
verbal autopsy. As a result it may be appropriate to certify and code a death from cerebral malaria
in the absence of identification of P. falciparum as B50.0 (see example below).
Example:
B54 Unspecified malaria
Clinically diagnosed malaria without parasitological confirmation
B50.0 Plasmodium falciparum malaria with cerebral complications
Cerebral malaria NOS
In this example, the justification is “not otherwise specified” (NOS).
3.8.2.2 HIV
HIV and tuberculosis
In clinical practice, it may be difficult to differentiate between an HIV infection and tuberculosis
(TB). It is only possible to be certain about the diagnosis with evidence from HIV serology testing
and sputum smear testing for TB bacilli: a patient with symptoms and signs suggestive of HIV or
TB but who has a negative HIV serology test and a positive bacteriological sputum culture has TB
but not HIV. In many cases, the two conditions coexist, but it is difficult to determine which
condition is the underlying cause of death. With the limited information that comes from verbal
autopsy, this situation presents a problem that requires following agreed guidelines.
HIV disease may present with many complications and infections, each having its own unique
cause of death, from B20 (Human immunodeficiency virus [HIV] disease resulting in infectious
and parasitic diseases) to B24 (Unspecified human immunodeficiency virus [HIV] disease). Even
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though in ICD-10 the fourth character subcategories of B20–B23 are provided for optional use, it
is important to differentiate between TB with HIV and TB alone, when possible.
Diagnosing TB from verbal autopsy may present challenges. A definitive diagnosis of TB can be
made only in cases where an acid-fast bacillus smear identifies the disease, typically from sputum.
In developing countries, such information is rarely available in the medical records of the
deceased. When deciding whether TB is an appropriate diagnosis interpret the clinical signs and
the history with caution and try to find out whether the deceased:
• was sputum-positive for acid-fast bacillus;
• had a chest X-ray that suggested pulmonary tuberculosis;
• had been taking anti-TB drugs;
• had a history suggestive of TB, for example, a cough lasting longer than 1 month, wasting, or
prolonged fever (in cases in which the deceased had fevers it is difficult to differentiate between
TB and HIV disease).
Considering the public health importance of TB, and in order to maintain uniformity in assigning
causes of death, the following 4-character categories should be used for HIV disease with TB in
cases where neither the sequence can be identified nor a single cause be selected.
Example:
I (a) Tuberculosis
(b) HIV
(c) ---
(d) ----
II ----
Select B20.0, HIV disease resulting in mycobacterial infection.
Example:
I (a) Tuberculosis
(b) ---
(c) ---
(d) ----
II HIV
Select A16.9, Tuberculosis, NOS.
Using B22.0 for HIV and dementia
The B22.0 code for cause of death is used when there is a history of confusion, dementia and loss
of consciousness lasting more than 1 day or where there are other central nervous system
manifestations, such as stroke associated with HIV.
B22.0 HIV disease resulting in encephalopathy
HIV dementia
When there is a case of HIV disease with TB and central nervous system manifestations, B22.0
should be used for the immediate cause of death.
Using B20.7 for HIV and multiple infections
The B20.7 code for cause of death should be used where there is evidence of more than a single
infection occurring in a patient with HIV; these infections may include candidiasis, mycoses or
parasitic diseases.
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B20.7 HIV disease resulting in multiple infections
Using this code for cause of death when there is more than one infection helps to avoid assigning
several causes of death (one for each type of associated infection), builds uniformity and facilitates
a consensus among coders.
Where there is evidence of TB or other disease in addition to HIV, the cause of death B20.0 (HIV
with tuberculosis) is used. In cases of HIV disease where only one infection has been identified,
such as candidiasis, then the cause of death assigned is B20.4 “HIV resulting in candidiasis”. See
the next section for information about coding for Kaposi sarcoma.
Using B21.0 for HIV and Kaposi sarcoma
Where HIV presents with Kaposi sarcoma, this complication is not coded separately but is
included in the multiple infection category. In cases where Kaposi sarcoma is the sole
complication of HIV disease, then the appropriate ICD code is used (B21.0).
B21.0 HIV disease resulting in Kaposi’s sarcoma
This code is used because Kaposi sarcoma is multicentric and is regarded as a malignancy having
a viral infectious origin.
Guidelines for paediatric HIV
ICD-10 does not provide specific codes for classifying cause of death from HIV disease in children.
Due to difficulties in diagnosing HIV in children in clinical practice, let alone during verbal
autopsy, the following guidelines should be used to assign a cause of death in children who had
HIV disease.
HIV should be assigned as a cause of death in cases in which there were:
• clinical symptoms suggesting HIV disease in the child in the absence of other obvious causes
of immune suppression (for example, malnutrition);
• clinical symptoms suggesting HIV disease and a family and social history suggesting HIV (for
example, parental death due to HIV disease) including cases where the child’s mother was sick
at the time the child died; or
• clinical symptoms suggesting HIV disease and the attending physician had requested an HIV
test to confirm the diagnosis.
3.8.2.3 Maternal mortality
Given that maternal deaths are the most frequent cause of death among women of reproductive
age in most developing countries, it is important that those who certify and code deaths are clear
about what constitutes a maternal death, and what constitutes the direct and indirect causes of
the death. The definitions related to maternal deaths are provided in volume 2, section 5.8, of
ICD-10 and, for uniformity, should always be used.
A death is classified as a “maternal death” if a woman dies while she is pregnant or within 42 days
of terminating a pregnancy, irrespective of the duration or site of pregnancy; maternal deaths
may result from any cause related to pregnancy but not from accidental and incidental causes.
“Late maternal death” refers to a death occurring from 42 days to 1 year after the termination of
a pregnancy.
A “pregnancy-related death” is one that occurs during pregnancy or within 42 days of delivery,
irrespective of the cause of death.
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Maternal deaths may be either direct or indirect (that is, they may have either direct or indirect
causes). Direct causes are obstetric complications of pregnancy, labour and the puerperium.
Direct causes also refer to deaths occurring following pregnancy with haemorrhage; or deaths
from obstructed or prolonged labour, eclampsia, or sepsis; pregnancy with an abortive outcome
or multiple gestation; or occurring from complications of caesarean section.
Example:
Direct causes of maternal death
I (a) Haemorrhagic shock
(b) Ruptured uterus
(c) Obstructed labour
In this case, select “obstructed labour” as the underlying cause of death (O66.9; obstructed labour
unspecified).
Indirect causes of maternal death are those resulting from pre-existing disease or diseases that
developed during pregnancy but are not the direct result of an obstetric cause. Such diseases
include pre-existing hypertension, diabetes mellitus, heart disease, thromboembolism, anaemia,
malaria and TB.
Maternal deaths that arise from HIV disease (B20–B24) or from obstetrical tetanus (A34) are coded
in chapter 1 of ICD-10, and care should be taken to include them in the maternal mortality
rate. Thus, it is important to specify whether the numerator in the maternal mortality rate
includes direct or indirect causes, or both.
3.8.2.4 Stillbirth or fetal death
The term “stillbirth” or “fetal death” is used (not intrauterine fetal death), when the death is
recorded after the birth of a dead fetus and not while the fetus is in utero.
There is no difference in the cause of death between stillbirths recorded as “fresh” or “macerated”.
Where a fetal death or stillbirth can be attributed to a particular cause (for example, antepartum
haemorrhage, maternal infection, eclampsia), the cause of death recorded is “stillbirth” (fetal
death) due to whatever is the appropriate obstetric cause.
Where there is no identifiable cause for the stillbirth from the history, the appropriate cause of
death will be P95 “Stillbirth due to unspecified cause”.
3.8.2.5 Neonatal deaths
Neonatal deaths are those that occur among live-born infants during the first 28 completed days
of life. The certification of perinatal death normally requires information about both the mother
and the neonate.
Sometimes difficulties arise in distinguishing between stillbirth and neonatal death. If there is
evidence in the medical records of life after birth, with death occurring later, such a death is
classified as a neonatal death. In many cases it is difficult to ascertain from those being
interviewed whether the baby was alive after birth and died shortly thereafter or was stillborn.
This causes many neonatal deaths to be labelled as stillbirths.
If the neonatal death can be attributed to a particular cause, the cause of death should be classified
and recorded as “Neonatal death due to” whatever is the appropriate cause.
3. Applying ICD-10 to verbal autopsy
79
3.8.2.6 Diarrhoea
Some difficulties arise in differentiating noninfectious diarrhoea (K52.9) from diarrhoea and
gastroenteritis presumed to be of infectious origin (A09). The distinction is important because it
has major public health implications. Several sets of guidelines aimed at identifying specific
diseases, such as cholera, have been formulated and are mentioned in the manuals of individual
verbal autopsy tools.
3.8.2.7 External causes
The intent of an event that causes injury (such as a traffic accident, knife wound or punch) may
be accidental, intentional self-harm or intentional harm to others (assault). In cases in which the
intent remains unclear, the default means of describing the event is “accidental”. In cases where
thorough legal and medical enquiries have been made and no judgement about the intent was
reached, the conditions are coded as Y10–Y34 “undetermined intent”. The index for the external
causes in volume 3 allows the appropriate code to be found rapidly.
Completely different parts of the chapter on external causes may apply when coding for the
mechanism that finally kills a person who has been in contact with animals – for example, dying
as a result of encountering a snake may be coded in different ways:
Crushed by a snake code W59
Bitten by a venomous snake X20
Exercise:
Look up the blocks W50–W64 and X20–X29 and identify the differences between them.
In cases in which a mother or a child is injured and killed by an external cause, a code from
chapter XV (Pregnancy, childbirth and the puerperium) or chapter XVI (Certain conditions
originating in the perinatal period) may take priority for tabulating a single cause of death (see
example below).
Example:
Coding for the death of a mother and child
Hypothermia newborn P80.-
Adult: Exposure to excessive natural cold X31
Mother: Complication of anaesthesia O74.- or 89.-
Exercise:
Look up O74.- and O89.-. What is the difference between them?
3.8.2.8 More special cases
Convulsions
When convulsions occur in people living in malaria-endemic areas, especially when they occur
in children and have no apparent cause, many clinicians assign a diagnosis of R 56.0 (febrile
convulsions). During coding, “febrile convulsions” is not used to represent the cause of death
because this is a diagnosis of exclusion. Instead “convulsions” is used as the lead term. If the cause
of death is unknown or undetermined, the code used is R99 (undetermined cause of mortality)
rather than R69 (undetermined cause of morbidity).
3. Applying ICD-10 to verbal autopsy
80
Coding when only signs and symptoms have been recorded
ICD-10 allows diseases and health problems to be classified even in cases where only symptoms
and signs have been recorded without a definitive clinical diagnosis. When there is no definitive
diagnosis, the main symptom, abnormal finding or problem is selected to be the main condition.
Any presenting symptom (when the cause of death could not be determined) is used for coding
(for example, abdominal pain leading to unspecified disease). This process minimizes the number
of deaths that are classified as R99 (undetermined cause of mortality).
3.9 Correspondence table between short verbal autopsy list
and ICD-10 codes
WHO proposes that the list of categories presented in the following correspondence table be used
during verbal autopsy. This list is the result of analysing existing verbal autopsy systems. Current
individual verbal autopsy systems may use only a subset of the categories proposed below.
The correspondence table makes it possible to merge data from verbal autopsies on an
international scale, and allows the categories to be coded using ICD-10. Thus, the results of
different verbal autopsy systems may be compared with data from full vital registration and
medical certification systems.
Some diagnoses mentioned in the correspondence table cannot be assigned using information
gathered during the verbal autopsy interview, but they may be found in medical records or other
sources.
The correspondence table contains verbal autopsy categories and their related ICD-10 codes. It
has been designed to allow verbal autopsy categories to be used for coding as well as for tabulation.
When the information gathered through verbal autopsy allows for more detail than that given
on the standard verbal autopsy list, the person assigning codes should use the full ICD-10. The
correspondence table allows for fast and easy access to ICD-10. The hints (“Comments”) in the
right-hand column may help coders avoid several pitfalls.
If an ICD code with 4 characters is mentioned it means more detailed codes are available in
ICD-10. A code ending in “9” and mentioning “unspecified” can usually be used interchangeably
with the 3-character code.
If a 3-character category is mentioned alone, this means that ICD-10 cannot provide more detail
(unless the additional subdivisions of some chapters are used to code the site of a disease and
activity of an external cause). Volume 1 of ICD-10 should always be consulted to check whether
better alternatives exist.
The information in the correspondence table that is relevant to diagnosis should be tested and
updated as necessary by verbal autopsy projects in conjunction with WHO. The diagnostic
information may be included in questionnaires, algorithms or case descriptions, and it may be
useful to those who assign a diagnosis or design new diagnostic tools. The inclusion of diagnostic
information ensures that categories are used in the same fashion by all verbal autopsy projects.
The information relevant to diagnosis usually is of no relevance to those who assign a code or
select the underlying cause of death (that is, to coders).
3. Applying ICD-10 to verbal autopsy
81
Corresp
ondence table: cause
-of-death
list fo
r verbal auto
psy
with corresp
ondin
g b
road ICD-1
0 codes
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-01
Infe
ctio
us
an
d
para
siti
c d
isea
ses
Importa
nt diffe
rences fr
om
ICD-1
0
In I
CD
-10, m
enin
git
is i
s fo
un
d i
n c
hap
ter
I (C
erta
in
infe
ctio
us
an
d p
ara
siti
c d
isea
ses)
an
d i
n c
hap
ter
VI
(Dis
ease
s o
f th
e n
ervo
us
syst
em)
dep
end
ing o
n t
he
un
der
lyin
g i
nfe
ctio
n.
Acu
te r
esp
irato
ry i
nfe
ctio
ns
are
ass
ign
ed t
o c
hap
ter
X
(Dis
ease
s o
f th
e re
spir
ato
ry s
yst
em).
So
me
infe
ctio
us
dis
ease
s o
ccu
r as
a c
on
seq
uen
ce o
f
oth
er i
nfe
ctio
us
dis
ease
s. F
or
rele
van
t co
mb
inati
on
s
ther
e ex
ist
ap
pro
pri
ate
cate
go
ries
in
IC
D-1
0.
VA
-01.0
1In
test
inal
infe
ctio
us
dis
ease
s (i
ncl
ud
ing
dia
rrh
oea
l d
isea
ses)
A029
Salm
on
ella
in
fect
ion
, u
nsp
ecif
ied
Relevant in
form
ation
Incr
ease
d l
iqu
idit
y o
f st
oo
l fo
r <
3 w
eeks
Blo
od
in
sto
ol
Mu
cus
in s
too
l
Fev
er
Ab
do
min
al
pain
/ten
esm
us
Wei
gh
t lo
ss
Vo
mit
ing
A0
39
Sh
igel
losi
s, u
nsp
ecif
ied
A0
49
Bact
eria
l in
test
inal
infe
ctio
n,
un
spec
ifie
d
A0
59
Bact
eria
l fo
od
bo
rne
into
xic
ati
on
,
un
spec
ifie
d
A069
Am
oeb
iasi
s, u
nsp
ecif
ied
A0
79
Pro
tozo
al
inte
stin
al
dis
ease
,
un
spec
ifie
d
A084
Vir
al in
test
inal in
fect
ion
, u
nsp
ecif
ied
A0
9D
iarr
ho
ea a
nd
gast
roen
teri
tis
of
pre
sum
ed i
nfe
ctio
us
ori
gin
VA
-01
.02
Typ
ho
id a
nd
Para
typ
ho
idA
01
4P
ara
typ
ho
id f
ever
, u
nsp
ecif
ied
Dis
ease
s in
VA
-01
.02
may b
e ea
sily
co
nfu
sed
wit
h o
ther
dia
rrh
oea
l d
isea
ses”
in
VA
-01.0
.
Relevant in
form
ation
Sto
ols
lik
e “p
uré
ed p
eas”
3. Applying ICD-10 to verbal autopsy
82
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-01
.03
Tu
ber
culo
sis
A1
59
Res
pir
ato
ry t
ub
ercu
losi
s, u
nsp
ecif
ied
,
con
firm
ed b
act
erio
logic
all
y a
nd
his
tolo
gic
all
y
Ch
ron
ic d
isea
ses
freq
uen
tly h
ave
sim
ilar
featu
res
to
som
e ty
pes
of
can
cer;
fo
r ex
am
ple
, lu
ng c
an
cer
an
d
pu
lmo
nary
tu
ber
culo
sis
share
mo
st s
ign
s an
d
sym
pto
ms.
Th
is i
ncr
ease
s th
e ri
sk o
f m
iscl
ass
ific
ati
on
du
rin
g v
erb
al
au
top
sy f
or
such
case
s.A
16
9R
esp
irato
ry t
ub
ercu
losi
s, u
nsp
ecif
ied
,
wit
ho
ut m
enti
on
of b
act
erio
logic
al o
r
his
tolo
gic
al
con
firm
ati
on
A1
79
Tu
ber
culo
sis
of
ner
vo
us
syst
em,
un
spec
ifie
d
A1
89
A1
92
Acu
te m
ilia
ry t
ub
ercu
losi
s,
un
spec
ifie
d
A1
99
Mil
iary
tu
ber
culo
sis,
un
spec
ifie
d
VA
-01.0
4T
etan
us
(excl
ud
ing
teta
nu
s n
eon
ato
rum
)
A3
4O
bst
etri
cal
teta
nu
sN
eon
ata
l te
tan
us
(tet
an
us
of
the
new
bo
rn)
is a
ssig
ned
to V
A-1
0 T
he
sam
e gro
up
sh
ou
ld b
e u
sed
fo
r an
y o
ther
infe
ctio
n o
ccu
rrin
g i
n t
he
new
bo
rn.
A3
5O
ther
tet
an
us
VA
-01
.05
Per
tuss
is (
wh
oo
pin
g
cou
gh
)
A3
79
Wh
oo
pin
g c
ou
gh
, u
nsp
ecif
ied
VA
-01
.06
Art
hro
po
d-b
orn
e vir
al
fever
s an
d v
iral
haem
orr
hagic
fev
ers
A9
0D
engu
e fe
ver
(cl
ass
ical
den
gu
e)
A91
Den
gu
e h
aem
orr
hagic
fev
er
A9
29
Mo
squ
ito
-bo
rne
vir
al
fever
,
un
spec
ifie
d
A9
3O
ther
art
hro
po
d-b
orn
e vir
al
fever
s,
NE
C
A9
4U
nsp
ecif
ied
art
hro
po
d-b
orn
e vir
al
fever
s
A95
Yel
low
fev
er,
un
spec
ifie
d
A96
Are
navir
al
haem
orr
hagic
fev
er,
un
spec
ifie
d
3. Applying ICD-10 to verbal autopsy
83
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
A98
Oth
er s
pec
ifie
d v
iral
haem
orr
hagic
fever
s
A9
9U
nsp
ecif
ied
vir
al
haem
orr
hagic
fev
er
VA
-01
.07
Mea
sles
B0
59
Mea
sles
Mea
sles
NO
S
Relevant in
form
ation
Skin
rash
(m
acu
lop
ap
ula
r, s
tart
s o
n f
ace
an
d p
roce
eds
do
wn
ward
an
d o
utw
ard
s) r
equ
ired
fo
r d
iagn
osi
s
Fev
er,
hig
h-g
rad
e
Co
ugh
Red
, sw
oll
en e
yes
No
t vacc
inate
d a
gain
st m
easl
es
Ph
oto
ph
ob
ia
VA
-01
.08
Vir
al
hep
ati
tis
B1
59
Hep
ati
tis
AT
he
sign
s an
d s
ym
pto
ms
of
vir
al
hep
ati
tis
are
no
nsp
ecif
ic;
the
clin
ical
pic
ture
is
extr
emel
y v
ari
ab
le;
an
d, u
nle
ss f
ulm
inan
t d
isea
se d
evel
op
s, t
he
illn
ess
is
oft
en a
sym
pto
mati
c u
nti
l o
r u
nle
ss s
equ
elae
occ
ur.
If
inte
rvie
wee
men
tio
ns
that
the
dec
ease
d h
ad
a p
art
ner
wit
h h
epati
tis
B,
it m
ay h
elp
in
rea
chin
g a
dia
gn
osi
s.
B1
69
Acu
te h
epati
tis
B
B179
Oth
er s
pec
ifie
d a
cute
hep
ati
tis
B1
89
Ch
ron
ic v
iral
hep
ati
tis,
un
spec
ifie
d
B1
99
Un
spec
ifie
d v
iral
hep
ati
tis
VA
-01
.09
HIV
/AID
SB
20
9H
IV d
isea
se r
esu
ltin
g i
n u
nsp
ecif
ied
infe
ctio
us
or
para
siti
c d
isea
se
HIV
/AID
S m
ay c
au
se s
pec
ific
mali
gn
an
t tu
mo
urs
(fo
r
exam
ple
, K
ap
osi
sarc
om
a).
In
su
ch c
ase
s it
sh
ou
ld b
e
cod
ed h
ere
an
d i
n I
CD
-10 u
sin
g t
he
ap
pro
pri
ate
cate
go
ry u
nd
er B
21.
B219
HIV
dis
ease
res
ult
ing i
n u
nsp
ecif
ied
mali
gn
an
t n
eop
lasm
B2
27
Hu
man
im
mu
no
def
icie
ncy
vir
us
[HIV
] d
isea
se r
esu
ltin
g i
n m
ult
iple
dis
ease
s cl
ass
ifie
d e
lsew
her
e
B2
38
Hu
man
im
mu
no
def
icie
ncy
vir
us
[HIV
] d
isea
se r
esu
ltin
g i
n o
ther
spec
ifie
d c
on
dit
ion
s
B24
Un
spec
ifie
d h
um
an
imm
un
od
efic
ien
cy v
iru
s [H
IV]
dis
ease
3. Applying ICD-10 to verbal autopsy
84
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-01
.10
Mala
ria
B5
09
B5
0.0
B5
19
Pla
smodiu
m f
alc
iparu
m m
ala
ria,
un
spec
ifie
d
Cer
ebra
l m
ala
ria
Pla
smodiu
m v
ivax m
ala
ria
Relevant in
form
ation
Fev
er,
hig
h g
rad
e
Fev
er, o
n a
nd
off
Un
con
scio
usn
ess
Bla
ck u
rin
e
Co
nvu
lsio
ns
Lo
w u
rin
e o
utp
ut
Nau
sea
Sh
akin
g o
r ch
ills
B5
29
Pla
smodiu
m m
ala
riae
mala
ria
B5
38
Oth
er p
ara
sito
logic
all
y c
on
firm
ed
mala
ria
B5
4U
nsp
ecif
ied
mala
ria
VA
-01
.10
Lei
shm
an
iasi
sB
55
9Lei
shm
an
iasi
s, u
nsp
ecif
ied
VA
-01
.11
Men
ingit
isG
00
9B
act
eria
l m
enin
git
is,
un
spec
ifie
dO
ther
dis
ease
s o
f th
e b
rain
can
be
fou
nd
un
der
VA
-04
.03
an
d V
A-0
8.
Sev
eral
oth
er i
nfe
ctio
ns
may m
an
ifes
t w
ith
men
ingit
is
or
ence
ph
ali
tis,
bu
t in
th
ese
case
s th
e m
enti
on
of
the
infe
ctio
n i
s m
ore
sp
ecif
ic t
han
th
e m
enti
on
of
men
ingit
is.
Fo
r a d
etail
ed l
ist
of
such
dis
ease
s se
e th
e
“d
agger
co
des
” (
†)
men
tio
ned
in
IC
D-1
0 u
nd
er G
02
*
an
d G
05
*.
Relevant in
form
ation
Hea
dach
e
Sti
ff n
eck
Nec
k p
ain
Fev
er
Vo
mit
ing
Co
nfu
sio
n
Dro
wsi
nes
s
No
fall
or
inju
ry t
o t
he
hea
d
G0
39
Men
ingit
is d
ue
to o
ther
an
d
un
spec
ifie
d c
au
ses
G0
49
En
cep
hali
tis,
myel
itis
an
d
ence
ph
alo
myel
itis
, u
nsp
ecif
ied
VA
-01
.12
Infl
uen
zaJ0
9In
flu
enza
du
e to
id
enti
fied
avia
n
infl
uen
za v
iru
s
J109
Infl
uen
za d
ue
to o
ther
id
enti
fied
infl
uen
za v
iru
s
3. Applying ICD-10 to verbal autopsy
85
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
J11
9In
flu
enza
, vir
us
no
t id
enti
fied
VA
-01
.13
Acu
te l
ow
er r
esp
irato
ry
infe
ctio
ns
(in
clu
din
g
pn
eum
on
ia a
nd
acu
te
bro
nch
itis
)
J12
9V
iral
pn
eum
on
ia,
un
spec
ifie
dO
ther
res
pir
ato
ry i
nfe
ctio
ns
are
men
tio
ned
un
der
VA
-05
.02
.
Relevant in
form
ation
Co
ugh
fo
r <
3 w
eeks
Fev
er
Dysp
no
ea <
3 w
eeks
Incr
ease
d s
pu
tum
pro
du
ctio
n <
3 w
eeks
Pu
rule
nt
spu
tum
< 3
wee
ks
Ch
est
pain
Oed
ema
J15
9B
act
eria
l p
neu
mo
nia
, u
nsp
ecif
ied
J18
0B
ron
cho
pn
eum
on
ia,
un
spec
ifie
d
J181
Lo
bar
pn
eum
on
ia,
un
spec
ifie
d
J18
2H
yp
ost
ati
c p
neu
mo
nia
, u
nsp
ecif
ied
J18
9P
neu
mo
nia
, u
nsp
ecif
ied
VA
-01
.98
Oth
er s
pec
ifie
d i
nfe
ctio
us
an
d p
ara
siti
c d
isea
ses
B8
89
Infe
stati
on
, u
nsp
ecif
ied
VA
-01
.99
Infe
ctio
us
dis
ease
s,
un
spec
ifie
d
B9
9O
ther
an
d u
nsp
ecif
ied
in
fect
iou
s
dis
ease
s
VA
-02
Neo
pla
sms
VA
-02
.01
Mali
gn
an
t n
eop
lasm
of
lip
, o
ral
cavit
y a
nd
ph
ary
nx
C00
2M
ali
gn
an
t n
eop
lasm
: ex
tern
al
lip
,
un
spec
ifie
d
Th
e sp
ecif
ic a
spec
ts t
o t
ake
into
acc
ou
nt
wh
en c
od
ing
neo
pla
sms
are
:
•th
e si
te o
f th
e tu
mo
ur
•th
e b
ehavio
ur
of
the
tum
ou
r.
A t
ab
le o
f n
eop
lasm
s is
in
clu
ded
in
vo
lum
e 3
of IC
D-1
0.
It c
on
tain
s th
e co
des
fo
r ea
ch a
nato
mic
al
site
of
tum
ou
r. F
or
each
sit
e, t
her
e are
fiv
e p
oss
ible
co
de
nu
mb
ers
div
ided
acc
ord
ing t
o t
he
beh
avio
ur
of
the
tum
ou
r.
If t
he
dia
gn
osi
s yo
u a
re c
od
ing d
oes
no
t all
ow
th
e
beh
avio
ur
of
the
tum
ou
r to
be
des
crib
ed,
yo
u s
ho
uld
loo
k u
p t
he
mo
rph
olo
gy d
escr
ipti
on
. It
wil
l p
rovid
e
gu
idan
ce a
s to
ho
w t
he
tum
ou
r sh
ou
ld b
e co
ded
(fo
r
exam
ple
, “M
eso
nep
hro
ma -
see
Neo
pla
sm,
C00
5M
ali
gn
an
t n
eop
lasm
: li
p,
un
spec
ifie
d,
inn
er a
spec
t
C009
Mali
gn
an
t n
eop
lasm
: li
p, u
nsp
ecif
ied
C02
9M
ali
gn
an
t n
eop
lasm
: to
ngu
e,
un
spec
ifie
d
C03
9M
ali
gn
an
t n
eop
lasm
: gu
m,
un
spec
ifie
d
C04
9M
ali
gn
an
t n
eop
lasm
: fl
oo
r o
f m
ou
th,
un
spec
ifie
d
C05
9M
ali
gn
an
t n
eop
lasm
: p
ala
te,
un
spec
ifie
d
3. Applying ICD-10 to verbal autopsy
86
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
C06
9M
ali
gn
an
t n
eop
lasm
: m
ou
th,
un
spec
ifie
d
mali
gn
an
t”).
Yo
u w
ou
ld t
her
efo
re u
se t
he
cod
e fo
r
mali
gn
an
t p
rim
ary
tu
mo
ur
or
mali
gn
an
t se
con
dary
tum
ou
r, d
epen
din
g o
n t
he
dia
gn
osi
s.
Du
rin
g v
erb
al au
top
sy, in
form
ati
on
ab
ou
t m
orp
ho
logy
is u
nli
kel
y t
o b
e avail
ab
le.
In t
his
case
yo
u m
ust
ass
ign
the
cod
e fo
r “u
nce
rtain
or
un
kn
ow
n” b
ehavio
ur
for
the
spec
ifie
d s
ite.
If y
ou
kn
ow
th
e tu
mo
ur
was
mali
gn
an
t an
d y
ou
can
no
t
esta
bli
sh a
sit
e, u
se c
od
e C
80
.
If y
ou
kn
ow
nei
ther
th
e b
ehavio
ur
no
r th
e si
te t
hen
cod
e D
48
.9, “N
eop
lasm
of
un
cert
ain
or
un
kn
ow
n
beh
avio
ur,
un
spec
ifie
d”.
So
me
tum
ou
rs m
ay lo
ok lik
e co
ngen
ital m
alf
orm
ati
on
s.
So
me
typ
ical si
gn
s o
f tu
mo
urs
are
: gro
wth
or
chan
ge
in
the
ap
pea
ran
ce o
f th
e tu
mo
ur
an
d w
eigh
t lo
ss.
HIV
/AID
S c
an
cau
se s
pec
ific
mali
gn
an
t tu
mo
urs
, (f
or
exam
ple
, K
ap
osi
sarc
om
a).
In
su
ch a
case
it
sho
uld
be
cod
ed t
o V
A-1
.8 a
nd
in
IC
D-1
0 t
o t
he
ap
pro
pri
ate
cate
go
ry u
nd
er B
21.
C0
89
Mali
gn
an
t n
eop
lasm
: m
ajo
r sa
livary
gla
nd
, u
nsp
ecif
ied
C09
9M
ali
gn
an
t n
eop
lasm
: to
nsi
l,
un
spec
ifie
d
C10
9M
ali
gn
an
t n
eop
lasm
: o
rop
hary
nx
,
un
spec
ifie
d
C1
19
Mali
gn
an
t n
eop
lasm
: n
aso
ph
ary
nx,
un
spec
ifie
d
C13
9M
ali
gn
an
t n
eop
lasm
: h
yp
op
hary
nx,
un
spec
ifie
d
C14
0M
ali
gn
an
t n
eop
lasm
: p
hary
nx,
un
spec
ifie
d
VA
-02
.02
Mali
gn
an
t n
eop
lasm
of
oes
op
hagu
s
C15
9M
ali
gn
an
t n
eop
lasm
: o
eso
ph
agu
s,
un
spec
ifie
d
Relevant in
form
ation
Dif
ficu
lty s
wall
ow
ing s
oli
d f
oo
d
Wei
gh
t lo
ss
Ho
ars
enes
s
Fati
gu
e
VA
-02
.03
Mali
gn
an
t n
eop
lasm
of
sto
mach
C1
65
Mali
gn
an
t n
eop
lasm
: le
sser
cu
rvatu
re
of
sto
mach
, u
nsp
ecif
ied
Relevant in
form
ation
Mass
in
up
per
ab
do
men
3. Applying ICD-10 to verbal autopsy
87
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
Pain
in
up
per
ab
do
men
> 3
wee
ks
Wei
gh
t lo
ss
Vo
mit
ing a
fter
eati
ng >
3 w
eeks
Earl
y s
ati
ety
Fati
gu
e
C16
6M
ali
gn
an
t n
eop
lasm
: gre
ate
r
curv
atu
re o
f st
om
ach
, u
nsp
ecif
ied
C16
9M
ali
gn
an
t n
eop
lasm
: st
om
ach
,
un
spec
ifie
d
VA
-02
.04
Mali
gn
an
t n
eop
lasm
of
small
an
d l
arg
e in
test
ine
C17
9M
ali
gn
an
t n
eop
lasm
: sm
all
in
test
ine,
un
spec
ifie
d
Relevant in
form
ation
Mass
in
ab
do
men
Dif
ficu
lty p
ass
ing s
too
l >
3 w
eeks
Ch
an
ges
in
bo
wel
hab
its
Incr
ease
d l
iqu
idit
y (
or
freq
uen
cy >
3 t
imes
a d
ay)
of
sto
ol
for
> 3
wee
ks
alt
ern
ate
s w
ith
co
nst
ipati
on
Bla
ck t
arr
y s
too
ls
Red
blo
od
in
sto
ol
Wei
gh
t lo
ss
Ab
do
min
al
pain
(co
lick
y)
Pale
nes
s
Fati
gu
e
C18
9M
ali
gn
an
t n
eop
lasm
: co
lon
,
un
spec
ifie
d
VA
-02
.05
Mali
gn
an
t n
eop
lasm
of
rect
um
an
d a
nu
s
C19
Mali
gn
an
t n
eop
lasm
of
rect
osi
gm
oid
jun
ctio
n
C20
Mali
gn
an
t n
eop
lasm
of
rect
um
C21
0M
ali
gn
an
t n
eop
lasm
: an
us,
un
spec
ifie
d
Relevant in
form
ation
Per
sist
ent
an
al
ulc
erati
on
An
al
mass
An
al
pain
Dif
ficu
lty p
ass
ing s
too
l >
3 w
eeks
Wei
gh
t lo
ss
3. Applying ICD-10 to verbal autopsy
88
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-02
.06
Mali
gn
an
t n
eop
lasm
of
liver
an
d h
epati
c d
uct
C22
9M
ali
gn
an
t n
eop
lasm
: li
ver
,
un
spec
ifie
d
Relevant in
form
ation
Mass
in
ab
do
men
(u
pp
er a
bd
om
en)
Mass
in
ab
do
men
gro
win
g q
uic
kly
(u
pp
er a
bd
om
en)
Ab
do
min
al
pain
(le
ft q
uad
ran
t),
sever
e, p
erm
an
ent
Asc
ites
Wei
gh
t lo
ss
Fati
gu
e
Yel
low
eyes
Yell
ow
skin
Itch
y s
kin
Pain
(ri
gh
t u
pp
er a
bd
om
en,
rad
iati
ng t
o t
he
back
)
VA
-02
.07
Mali
gn
an
t n
eop
lasm
of
trach
ea,
bro
nch
us
an
d
lun
g
C33
C34
9
Mali
gn
an
t n
eop
lasm
of
trach
ea
Mali
gn
an
t n
eop
lasm
: b
ron
chu
s o
r
lun
g,
un
spec
ifie
d
Tu
mo
urs
co
ded
un
der
VA
02
.07
may c
au
se s
ym
pto
ms
sim
ilar
to i
nfe
ctio
ns
in t
his
part
of
the
bo
dy.
Th
e d
ura
tio
n o
f co
ugh
may a
llo
w i
nte
rvie
wer
to
dis
tin
gu
ish
bet
wee
n i
nfe
ctio
n a
nd
tu
mo
ur.
Relevant in
form
ation
Co
ugh
> 4
week
s
Dysp
no
ea >
4 w
eeks
Wei
gh
t lo
ss
Blo
od
in
sp
utu
m
Ch
est
pain
His
tory
of
cigare
tte
smo
kin
g
Ho
ars
enes
s
Dif
ficu
lty o
pen
ing o
ne
eye
Sw
elli
ng o
f h
ead
an
d n
eck
Hea
dach
e
Fati
gu
e
VA
-02
.08
Mali
gn
an
t n
eop
lasm
of
bre
ast
C50
9M
ali
gn
an
t n
eop
lasm
of
bre
ast
,
un
spec
ifie
d
Relevant in
form
ation
Bre
ast
mass
Ulc
erati
on
of
bre
ast
skin
> 3
wee
ks
Ulc
erati
on
of
nip
ple
> 3
wee
ks
Red
, p
ain
ful
bre
ast
skin
> 3
wee
ks
3. Applying ICD-10 to verbal autopsy
89
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
Wei
gh
t lo
ssN
ew r
etra
ctio
n o
f n
ipp
leD
isch
arg
e fr
om
nip
ple
Fati
gu
e
VA
-02
.09
Mali
gn
an
t n
eop
lasm
of
cerv
ix
C53
9M
ali
gn
an
t n
eop
lasm
of
cerv
ix u
teri
,
un
spec
ifie
d
Relevant in
form
ation
Irre
gu
lar
vagin
al
ble
edin
gM
ass
in
lo
wer
ab
do
men
Vagin
al
dis
charg
e > 3
wee
ks
(blo
od
y/p
uru
len
t/n
on
pru
riti
c)P
ain
in
lo
wer
ab
do
men
Wei
gh
t lo
ssE
arl
y o
nse
t o
f se
xu
al
act
ivit
yM
ult
iple
sex
ual
part
ner
sFati
gu
eL
ow
uri
ne
ou
tpu
tB
ack
pain
(se
ver
e)
VA
-02
.10
Mali
gn
an
t n
eop
lasm
of
ute
rus
(excl
ud
ing c
ervix
)
C55
Mali
gn
an
t n
eop
lasm
of
ute
rus,
part
un
spec
ifie
d
Relevant in
form
ation
Irre
gu
lar
vagin
al
ble
edin
gV
agin
al
ble
edin
g i
n p
ost
men
op
au
sal
wo
man
Mass
in
lo
wer
ab
do
men
Pain
in
lo
wer
ab
do
men
Wei
gh
t lo
ssA
ge
> 4
5 y
ears
Has
no
t h
ad
ch
ild
ren
Fati
gu
e
VA
-02
.11
Mali
gn
an
t n
eop
lasm
of
ovari
es
C56
Mali
gn
an
t n
eop
lasm
of
ovary
Relevant in
form
ation
Mass
in
lo
wer
ab
do
men
Un
ilate
ral
mass
in
lo
wer
ab
do
men
Asc
ites
(w
ate
r in
ab
do
men
, in
crea
sin
g a
bd
om
inal
circ
um
fere
nce
)
Pain
in
lo
wer
ab
do
men
Wei
gh
t lo
ss
Pel
vic
pre
ssu
re
Old
age
3. Applying ICD-10 to verbal autopsy
90
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-02
.12
Mali
gn
an
t n
eop
lasm
of
pro
state
C61
VA
-02
.13
Mali
gn
an
t m
elan
om
a o
f
skin
C43
VA
-2.1
4M
ali
gn
an
t n
eop
lasm
of
lym
ph
oid
,
haem
ato
po
ieti
c an
d
rela
ted
tis
sue
C96
.9M
ali
gn
an
t n
eop
lasm
of
lym
ph
oid
,
haem
ato
po
ieti
c an
d r
elate
d t
issu
e
VA
-02
.98
Oth
er s
pec
ifie
d n
eop
lasm
sN
o s
uch
cate
go
ry e
xis
ts i
n I
CD
Sel
ect
the
ap
pro
pri
ate
co
de
wit
h t
he
aid
of
the
ICD
ind
ex.
VA
-02
.99
Neo
pla
sm o
f u
nce
rtain
or
un
kn
ow
n b
ehavio
ur,
un
spec
ifie
d
D4
89
Neo
pla
sm o
f u
nce
rtain
or
un
kn
ow
n
beh
avio
ur,
of
oth
er a
nd
un
spec
ifie
d
site
s
VA
-03
Nu
trit
ion
al an
d e
nd
ocr
ine
dis
ord
ers
En
do
crin
e d
iso
rder
s co
mp
rise
sev
eral
ver
y d
iffe
ren
t
dis
ease
s ea
ch o
f w
hic
h h
as
spec
ific
fact
ors
. T
he
dis
ease
s
of
majo
r p
ub
lic
hea
lth
im
po
rtan
ce a
re l
iste
d i
n s
pec
ific
cate
go
ries
of
the
VA
mo
rtali
ty c
lass
ific
ati
on
syst
em (
for
exam
ple
, d
iab
etes
mel
litu
s).
Sev
eral
oth
er e
nd
ocr
ine
dis
ease
s m
ay b
e cl
ass
ifie
d u
nd
er “
oth
er s
pec
ifie
d
end
ocr
ine
dis
ease
s”.
VA
-03
.01
Nu
trit
ion
al
an
aem
iaD
50
9Ir
on
def
icie
ncy
an
aem
ia,
un
spec
ifie
dRelevant in
form
ation
Pale
skin
Pale
scl
erae
Pale
palm
s
Exer
tio
nal
dysp
no
ea
Diz
zin
ess
Palp
itati
on
s
Tir
es e
asi
ly
D5
19
Vit
am
in B
12
def
icie
ncy
an
aem
ia,
un
spec
ifie
d
D5
29
Fo
late
def
icie
ncy
an
aem
ia,
un
spec
ifie
d
D5
39
Nu
trit
ion
al
an
aem
ia,
un
spec
ifie
d
VA
-03
.02
Sev
ere
maln
utr
itio
nE
40
Kw
ash
iork
or
E4
1N
utr
itio
nal
mara
smu
s
E42
Mara
smic
kw
ash
iork
or
3. Applying ICD-10 to verbal autopsy
91
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
E4
3U
nsp
ecif
ied
sev
ere
pro
tein
-en
ergy
maln
utr
itio
n
Relevant in
form
ation
Dec
rease
d f
oo
d i
nta
ke
Bre
ast
feed
ing s
top
ped
Asc
ites
Red
dis
h h
air
Sw
oll
en l
egs
Skin
fla
kes
off
Ver
y t
hin
Ver
y s
mall
Dif
ficu
lt t
o f
eed
VA
-03
.03
Dia
bet
es m
elli
tus
E1
0In
suli
n-d
epen
den
t d
iab
etes
mel
litu
sIn
IC
D-1
0, t
he
blo
ck o
n d
iab
etes
mel
litu
s (E
10
-E1
4) u
ses
insu
lin
-dep
end
ent
dia
bet
es m
elli
tus
an
d n
on
-in
suli
n-
dep
end
ent
dia
bet
es m
elli
tus
as
pre
ferr
ed t
erm
ino
logy.
Wit
h p
rogre
ss in
med
ical sc
ien
ce t
he
usa
ge
of
the
term
s
has
chan
ged
. T
yp
e 1
dia
bet
es i
s eq
uiv
ale
nt
to i
nsu
lin
-
dep
end
ent
dia
bet
es m
elli
tus,
an
d t
yp
e 2 i
s eq
uiv
ale
nt
to n
on
-in
suli
n-d
epen
den
t d
iab
etes
mel
litu
s.
Co
mp
lica
tio
ns
of
the
dia
bet
es a
re i
den
tifi
ed a
t th
e
fou
rth
ch
ara
cter
lev
el.
E11
No
n-i
nsu
lin
-dep
end
ent
dia
bet
es
mel
litu
s
E1
2M
aln
utr
itio
n-r
elate
d d
iab
etes
mel
litu
s
E1
3O
ther
sp
ecif
ied
dia
bet
es m
elli
tus
E1
4U
nsp
ecif
ied
dia
bet
es m
elli
tus
VA
-03
.98
Oth
er s
pec
ifie
d e
nd
ocr
ine
dis
ord
ers
E3
48
Oth
er s
pec
ifie
d e
nd
ocr
ine
dis
ord
ers
Oth
er d
isea
ses
of
met
ab
oli
sm a
re a
ssig
ned
to
VA
-98
,
exce
pt
for
pre
gn
an
cy-r
elate
d (
VA
-09
.-)
or
dis
ord
ers
n
the
new
bo
rn (
VA
-10
.-).
Oth
er e
nd
ocr
ine
dis
ord
ers
are
sp
ecif
ied
in
IC
D-1
0 in
th
e
blo
ck E
20
-E3
5.
VA
-03
.99
En
do
crin
e d
iso
rder
s,
un
spec
ifie
d
E3
49
En
do
crin
e d
iso
rder
, u
nsp
ecif
ied
3. Applying ICD-10 to verbal autopsy
92
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-04
Dis
ease
s o
f th
e ci
rcu
lato
ry
syst
em
Th
is g
rou
p c
over
s th
e o
rgan
s an
d s
yst
ems
invo
lved
in
the
circ
ula
tio
n o
f b
loo
d a
nd
lym
ph
, b
ut
no
t th
e b
loo
d
itse
lf. A
naem
ia i
s co
ver
ed i
n G
rou
p V
A-3
; m
ost
of
the
dis
ease
s o
f th
e b
loo
d a
re a
ssig
ned
to
VA
-98
. T
um
ou
rs o
f
the
blo
od
are
ass
ign
ed t
o V
A-2
.-
VA
-04
.01
Hyp
erte
nsi
ve
dis
ease
sI1
0
I11
.9
I12
.9
I13
.9
I15
.9
Hyp
erte
nsi
ve
hea
rt a
nd
ren
al d
isea
se,
un
spec
ifie
d
Hyp
erte
nsi
ve
hea
rt d
isea
se N
OS
Hyp
erte
nsi
ve
ren
al
dis
ease
NO
S
Hyp
erte
nsi
ve
hea
rt a
nd
ren
al d
isea
se,
un
spec
ifie
d
Sec
on
dary
hyp
erte
nsi
on
, u
nsp
ecif
ied
No
te: h
yp
erte
nsi
on
rel
ate
d t
o p
regn
an
cy is
cod
ed u
nd
er
VA
-09
.02
.
Relevant in
form
ation
Dysp
no
ea >
4 w
eeks
(dif
ficu
lty b
reath
ing)
Dif
ficu
lty b
reath
ing i
n r
ecu
mb
ent
po
siti
on
No
isy b
reath
ing
Sw
oll
en a
nkle
s o
r le
gs
Neck
vei
n d
iste
nsi
on
Asc
ites
Co
ugh
Incr
ease
d p
ass
ing o
f u
rin
e at
nig
ht
Exer
cise
in
tole
ran
ce
VA
-04.0
2Is
chaem
ic h
eart
dis
ease
I209
An
gin
a p
ecto
ris,
un
spec
ifie
dV
A-0
4.0
2 (
or
I209 in
IC
D-1
0)
ap
pli
es t
o lif
e-th
reate
nin
g
form
s o
f an
gin
a p
ecto
ris.
I219
Acu
te m
yo
card
ial
infa
rcti
on
,
un
spec
ifie
d
I24
9A
cute
isc
haem
ic h
eart
dis
ease
,
un
spec
ifie
d
I25
9C
hro
nic
isc
haem
ic h
eart
dis
ease
,
un
spec
ifie
d
VA
-04
.03
Cer
ebro
vasc
ula
r d
isea
seI6
79
Cer
ebro
vasc
ula
r d
isea
se,
un
spec
ifie
dO
ther
dis
ease
s o
f th
e b
rain
are
ass
ign
ed t
o V
A-0
8.0
2.
Relevant in
form
ation
Su
dd
enly
un
ab
le t
o m
ove
arm
an
d/o
r le
g o
n o
ne
sid
e
Su
dd
en w
eakn
ess
of
arm
an
d/o
r le
g o
n o
ne
sid
e
Su
dd
en s
enso
ry c
han
ges
Su
dd
en f
ace
pals
y o
n o
ne
sid
e
Co
nfu
sio
n
I607
Su
bara
chn
oid
haem
orr
hage
fro
m
intr
acr
an
ial
art
ery,
un
spec
ifie
d
I609
Su
bara
chn
oid
haem
orr
hage,
un
spec
ifie
d
I61
2In
trace
reb
ral
haem
orr
hage
in
hem
isp
her
e, u
nsp
ecif
ied
3. Applying ICD-10 to verbal autopsy
93
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
I61
9H
ead
ach
e
Su
dd
en l
oss
of
spee
ch
Lo
ss o
f co
nsc
iou
snes
s
Age
> 4
5 y
ears
Has
hyp
erte
nsi
on
Is a
sm
oker
Wei
gh
t lo
ss
No
hea
d i
nju
ry (
exce
pt
sub
du
ral
haem
ato
ma)
Intr
ace
reb
ral
haem
orr
hage,
un
spec
ifie
d
I629
Intr
acr
an
ial
haem
orr
hage
(no
ntr
au
mati
c),
un
spec
ifie
d
I639
Cer
ebra
l in
farc
tio
n,
un
spec
ifie
d
I69
8Seq
uel
ae
of
oth
er a
nd
un
spec
ifie
d
cere
bro
vasc
ula
r d
isea
ses
VA
-04
.04
Ch
ron
ic r
heu
mati
c h
eart
dis
ease
s
I05
9
I06
9
I07
9
I08
9
I09
9
Mit
ral
valv
e d
isea
se,
un
spec
ifie
d
Rh
eum
ati
c ao
rtic
valv
e d
isea
se,
un
spec
ifie
d
Tri
cusp
id v
alv
e d
isea
se,
un
spec
ifie
d
Mu
ltip
le v
alv
e d
isea
se,
un
spec
ifie
d
Rh
eum
ati
c h
eart
dis
ease
, u
nsp
ecif
ied
Co
ngen
ital h
eart
valv
e d
isea
se c
od
es a
re fo
un
d in
VA
-98
an
d I
CD
-10
ch
ap
ter
XV
II (
Co
ngen
ital
malf
orm
ati
on
s,
def
orm
ati
on
s an
d c
hro
mo
som
al
ab
no
rmali
ties
).
Co
des
fo
r rh
eum
ato
id h
eart
dis
ease
are
fo
un
d in
VA
-98
an
d I
CD
-10
cate
go
ry M
05
3.
VA
-04
.05
Co
nges
tive
hea
rt f
ail
ure
I50
0C
on
ges
tive
hea
rt f
ail
ure
“H
eart
fail
ure
” s
ho
uld
be
use
d o
nly
if
ther
e is
str
on
g
evid
ence
th
at
pro
ble
ms
wit
h t
he
hea
rt w
ere
the
cau
se
of
dea
th.
If t
his
is
no
t th
e ca
se,
pre
fer
VA
-99.
VA
-04
.98
Oth
er s
pec
ifie
d d
isea
ses
of
circ
ula
tory
syst
em
Sel
ect
the
ap
pro
pri
ate
cate
go
ry f
rom
ICD
“C
ard
iac
arr
est”
sh
ou
ld b
e u
sed
on
ly i
f th
ere
is s
tro
ng
evid
ence
th
at
pro
ble
ms
wit
h t
he
hea
rt w
ere
the
cau
se
of
dea
th.
If t
his
is
no
t th
e ca
se,
pre
fer
VA
-99.
Ever
y e
ffo
rt s
ho
uld
be
mad
e to
id
enti
fy t
he
reaso
n f
or
card
iac
arr
est.
It
is im
po
rtan
t to
no
te th
at
an
y c
on
dit
ion
that
cau
ses
dea
th u
ltim
ate
ly c
au
ses
card
iac
arr
est.
Its
men
tio
n in
sta
tist
ical re
po
rts
is o
f li
ttle
hel
p in
dec
idin
g
on
mea
sure
s to
im
pro
ve
hea
lth
.
Yo
u w
ou
ld a
lso
use
th
is c
ate
go
ry t
o c
od
e d
isea
ses
of
the
blo
od
ves
sels
.
No
te t
hat
dra
cun
culi
asi
s (g
uin
ea-w
orm
dis
ease
) sh
ou
ld
be
cod
ed u
nd
er i
nfe
ctio
us
dis
ease
s.
3. Applying ICD-10 to verbal autopsy
94
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-04
.99
Dis
ease
s o
f ci
rcu
lato
ry
syst
em,
un
spec
ifie
d
I99
Oth
er a
nd
un
spec
ifie
d d
iso
rder
s o
f
circ
ula
tory
syst
em
VA
-05
Res
pir
ato
ry d
iso
rder
sT
his
gro
up
ad
dre
sses
dis
ease
s an
d d
iso
rder
s o
f th
e
resp
irato
ry o
rgan
s an
d s
om
e ex
tern
al
agen
ts,
such
as
tho
se t
hat
ari
se f
rom
occ
up
ati
on
al
exp
osu
re.
VA
-05
.01
Ch
ron
ic o
bst
ruct
ive
lun
g
dis
ease
J40
Bro
nch
itis
, n
ot
spec
ifie
d a
s acu
te o
r
chro
nic
Rel
evan
t in
form
ati
on
Dysp
no
ea >
21
days
Co
ugh
mo
st t
imes
of
the
yea
r fo
r > 2
yea
rs
Sp
utu
m
Sm
okin
g
No
isy b
reath
ing
Incr
ease
in
ch
est
size
Dis
ease
slo
wly
pro
gre
ssin
g
Wei
gh
t lo
ss
Blu
e ti
nge
to s
kin
J41
Sim
ple
an
d m
uco
pu
rule
nt
chro
nic
bro
nch
itis
J42
Un
spec
ifie
d c
hro
nic
bro
nch
itis
J439
Em
ph
yse
ma,
un
spec
ifie
d
J44
1C
hro
nic
ob
stru
ctiv
e p
ulm
on
ary
dis
ease
wit
h a
cute
exace
rbati
on
,
un
spec
ifie
d
J44
9C
hro
nic
ob
stru
ctiv
e p
ulm
on
ary
dis
ease
, u
nsp
ecif
ied
J47
Bro
nch
iect
asi
s
VA
-05
.02
Ast
hm
aJ4
5.9
J46
Ast
hm
a,
un
spec
ifie
d
Sta
tus
ast
hm
ati
cus
VA
.05
.03
Oth
er s
pec
ifie
d d
isea
ses
of
the
resp
irato
ry s
yst
em
J98
8O
ther
sp
ecif
ied
res
pir
ato
ry d
iso
rder
s
Ass
ign
mo
re s
pec
ific
co
des
wh
en
mo
re i
nfo
rmati
on
is
avail
ab
le.
Res
pir
ato
ry i
nfe
ctio
ns
are
excl
ud
ed f
rom
th
is g
rou
p.
Th
ey a
re m
enti
on
ed i
n V
A-1
.
In I
CD
-10
so
me
resp
irato
ry i
nfe
ctio
ns,
su
ch a
s
pn
eum
on
ia, are
part
of
chap
ter
X (
Dis
ease
s o
f th
e
resp
irato
ry s
yst
em).
Pn
eum
on
ia h
as
bee
n g
rou
ped
in
VA
-01
.02
.
Tu
mo
urs
of
the
resp
irato
ry t
ract
are
ass
ign
ed t
o g
rou
p
VA
-2.-
3. Applying ICD-10 to verbal autopsy
95
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-05
.98
Res
pir
ato
ry f
ail
ure
, n
ot
else
wh
ere
class
ifie
d
J96
9R
esp
irato
ry f
ail
ure
, u
nsp
ecif
ied
Ever
y e
ffo
rt s
ho
uld
be
mad
e to
id
enti
fy t
he
reaso
n f
or
resp
irato
ry f
ail
ure
. A
ny c
on
dit
ion
th
at
cau
ses
dea
th
ult
imate
ly c
au
ses
resp
irato
ry f
ail
ure
.
Asp
hyxia
of
the
new
bo
rn i
s gro
up
ed i
n V
A-1
0.0
5.
Th
is s
ho
uld
no
t b
e co
nfu
sed
wit
h I
CD
-10
co
de
R9
9 (
ill-
def
ined
cau
ses
of
dea
th i
ncl
ud
ing,
for
exam
ple
,
resp
irato
ry a
rres
t) o
r V
A-9
9.
VA
-05
.99
Res
pir
ato
ry d
iso
rder
,
un
spec
ifie
d
J98
9R
esp
irato
ry d
iso
rder
, u
nsp
ecif
ied
VA
-06
Gast
roin
test
inal
dis
ord
ers
Th
e in
test
inal
tract
sta
rts
wit
h t
he
teet
h a
nd
en
ds
wit
h
the
an
us.
Fo
r th
is r
easo
n, in
ad
dit
ion
to
dis
ease
s o
f th
e
teet
h a
nd
mo
uth
, th
ose
dir
ectl
y r
elati
ng t
o t
he
sto
mach
, th
e gu
t an
d t
he
liver
are
men
tio
ned
her
e.
VA
-06
.01
Gast
ric
an
d d
uo
den
al
ulc
er
K2
59
Gast
ric
ulc
er,
un
spec
ifie
d a
s acu
te o
r
chro
nic
, w
ith
ou
t h
aem
orr
hage
or
per
fora
tio
n
Relevant in
form
ation
Pain
in
ep
igast
riu
m (
sto
mach
)
Vo
mit
ing b
loo
d
Vo
mit
ing c
off
ee-g
rou
nd
mate
rial
Bla
ck t
arr
y s
too
ls
Po
ssib
le w
eigh
t lo
ss
No
mass
palp
ab
le
No
asc
ites
No
in
crea
sed
ble
edin
g f
rom
sm
all
wo
un
ds
K2
69
Du
od
enal
ulc
er,
un
spec
ifie
d a
s acu
te
or
chro
nic
, w
ith
ou
t h
aem
orr
hage
or
per
fora
tio
n
K2
79
Pep
tic
ulc
er,
un
speci
fied
as
acu
te o
r
chro
nic
, w
ith
ou
t h
aem
orr
hage
or
per
fora
tio
n
VA
-06
.02
Ch
ron
ic l
iver
dis
ease
K7
21
Ch
ron
ic h
epati
c fa
ilu
re
K7
39
Ch
ron
ic h
epati
tis,
un
spec
ifie
dA
liv
er d
isea
se lik
ely t
o b
e ca
use
d b
y in
fect
iou
s h
epati
tis
sho
uld
be
cod
ed t
o V
A-1
.7. In
IC
D-1
0 t
he
cod
e fo
r
chro
nic
vir
al
hep
ati
tis
is B
18
.
K7
46
Oth
er a
nd
un
spec
ifie
d c
irrh
osi
s o
f
liver
K7
69
Liv
er d
isea
se,
un
spec
ifie
dT
he
no
tio
n o
f u
nsp
ecif
ied
ch
ron
ic l
iver
dis
ease
can
no
t
be
des
crib
ed w
ith
in I
CD
-10.
Acc
ord
ingly
, all
un
clea
r
case
s sh
ou
ld b
e co
ded
to
K7
6.9
(li
ver
dis
ease
,
3. Applying ICD-10 to verbal autopsy
96
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
un
spec
ifie
d)
if t
he
sym
pto
ms
all
ow
th
e li
ver
to
be
ass
esse
d a
s th
e ca
use
.
VA
-06
.03
Para
lyti
c il
eus
an
d
inte
stin
al
ob
stru
ctio
n
without hernia
K5
66
Oth
er a
nd
un
spec
ifie
d i
nte
stin
al
ob
stru
ctio
n
Relevant in
form
ation
Ab
do
min
al
pain
(se
ver
e, c
ram
pin
g,
per
ium
bil
ical)
Vo
mit
ing (
sever
e)
Vo
mit
ing f
aec
es
Dis
ten
ded
, h
ard
ab
do
men
No
t p
ass
ing a
ny s
too
l
K5
67
Ileu
s, u
nsp
ecif
ied
VA
-06
.04
Per
ito
nit
isK
65
No
t to
be
con
fuse
d w
ith
“ab
do
min
al
pain
”.
VA
-06
.05
Her
nia
sK
40
9
K4
19
K4
29
K4
39
K4
49
K4
5.-
K4
69
Ingu
inal
her
nia
(u
nil
ate
ral)
NO
S
Fem
ora
l h
ern
ia (
un
ilate
ral)
NO
S
Um
bil
ical
her
nia
NO
S
Ven
tral
her
nia
NO
S
Dia
ph
ragm
ati
c h
ern
ia N
OS
Oth
er a
bd
om
inal
her
nia
Ab
do
min
al
her
nia
NO
S
If t
her
e is
in
form
ati
on
ab
ou
t gan
gre
ne
or
ob
stru
ctio
n,
sele
ct a
mo
re s
pec
ific
co
de
fro
m I
CD
-10
, su
ch a
s K
40
.4
(un
ilate
ral
or
un
spec
ifie
d i
ngu
inal
her
nia
, w
ith
gan
gre
ne)
.
VA
-06
.06
Acu
te a
bd
om
enR
10.0
Acu
te a
bd
om
enRelevant in
form
ation
Ab
do
min
al
pain
(se
ver
e)
Hard
ab
do
men
Nau
sea
Vo
mit
ing
No
dia
rrh
oea
VA
-06
.98
Oth
er d
isea
ses
of
inte
stin
eK
63
.8O
ther
sp
ecif
ied
dis
ease
s o
f in
test
ine
Ass
ign
mo
re s
pec
ific
co
des
wh
en
mo
re i
nfo
rmati
on
is
avail
ab
le.
An
y o
ther
dis
ease
s re
lati
ng t
o t
eeth
, o
eso
ph
agu
s,
sto
mach
, gu
t, liv
er, b
ilia
ry s
yst
em a
nd
pan
crea
s m
ust
be
cod
ed h
ere.
VA
-06
.99
Dis
ease
of
inte
stin
e,
un
spec
ifie
d
K6
39
Dis
ease
of
inte
stin
e, u
nsp
ecif
ied
3. Applying ICD-10 to verbal autopsy
97
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-07
Ren
al
dis
ord
ers
Th
is g
rou
p i
ncl
ud
es o
nly
dis
ease
s o
f th
e kid
ney
s.
Uri
nary
in
fect
ion
s an
d o
ther
dis
ease
s o
f th
e u
rin
ary
tract
are
ass
ign
ed t
o V
A-9
8.
Tu
mo
urs
of
the
kid
ney
sho
uld
be
ass
ign
ed t
o V
A-2
.-.
VA
-07
.01
Ren
al
fail
ure
N1
9U
nsp
ecif
ied
ren
al
fail
ure
Mo
st d
iso
rder
s o
f th
e kid
ney
s an
d t
he
uri
nary
tra
ct a
re
no
t ch
ara
cter
ized
by a
sp
ecif
ic c
lin
ical
pic
ture
; th
is
incr
ease
s th
e ch
an
ce o
f m
iscl
ass
ific
ati
on
occ
urr
ing
wit
hin
th
e gro
up
of
ren
al
dis
ease
s as
wel
l as
am
on
g
oth
er d
isea
se c
ate
go
ries
.
Nep
hro
lith
iasi
s is
lis
ted
bec
au
se i
t h
as
dis
tin
ct c
lin
ical
featu
res
an
d i
s li
kel
y t
o b
e d
iagn
ose
d d
uri
ng v
erb
al
au
top
sy.
N1
79
Acu
te r
enal
fail
ure
, u
nsp
ecif
ied
N1
89
Ch
ron
ic r
enal
fail
ure
, u
nsp
ecif
ied
VA
-07
.98
Oth
er s
pec
ifie
d r
enal
dis
ord
ers
N2
88
Oth
er d
iso
rder
of
kid
ney
an
d u
rete
r
Ass
ign
mo
re s
pec
ific
co
des
wh
en
mo
re i
nfo
rmati
on
is
avail
ab
le.
VA
-07
.99
Dis
ord
ers
of
kid
ney
an
d
ure
ter,
un
spec
ifie
d
N2
89
Dis
ord
er o
f kid
ney
an
d u
rete
r,
un
spec
ifie
d
VA
-08
Men
tal
an
d n
ervo
us
syst
em d
iso
rder
s
VA
-08
.01
Alz
hei
mer
dis
ease
G3
0.9
Alz
hei
mer
dis
ease
, u
nsp
ecif
ied
VA
-08
.02
Ep
ilep
syG
40
6
G4
07
G4
09
G4
19
Gra
nd
mal se
izu
res,
un
spec
ifie
d (w
ith
or
wit
ho
ut
pet
it m
al)
Pet
it m
al,
un
spec
ifie
d, w
ith
ou
t gra
nd
mal
seiz
ure
s
Ep
ilep
sy,
un
spec
ifie
d
Sta
tus
epil
epti
cus,
un
spec
ifie
d
Relevant in
form
ation
Co
nvu
lsio
ns
an
d/o
r fi
ts
Lo
ss o
f co
nsc
iou
snes
s, w
ith
fall
ing
No
fev
er
No
sti
ff n
eck
No
rec
ent
hea
d i
nju
ry
VA
-08.9
6O
ther
sp
ecif
ied
dis
ord
ers
of
the
ner
vo
us
syst
em
G5
49
G5
89
Ner
ve
roo
t an
d p
lexu
s d
iso
rder
,
un
spec
ifie
d
Mo
no
neu
rop
ath
y,
un
spec
ifie
d
If t
her
e is
mo
re i
nfo
rmati
on
avail
ab
le u
se t
he
mo
re
spec
ific
co
des
of
ICD
-10
.
3. Applying ICD-10 to verbal autopsy
98
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
G9
09
G9
39
G9
59
G9
69
Dis
ord
er o
f au
ton
om
ic n
ervo
us
syst
em,
un
spec
ifie
d
Dis
ord
er o
f b
rain
, u
nsp
ecif
ied
Dis
ease
of
spin
al
cord
, u
nsp
ecif
ied
Dis
ord
er o
f ce
ntr
al
ner
vo
us
syst
em,
un
spec
ifie
d
Dis
ease
s ari
sin
g f
rom
th
e b
loo
d v
esse
ls o
f th
e b
rain
are
ass
ign
ed t
o V
A-0
4.0
3.
So
me
dis
ease
s o
f th
e m
usc
les
are
co
ded
her
e (G
70
–G
73
);
myo
siti
s sh
ou
ld b
e co
ded
to
VA
-12.
Men
ingit
is i
s a d
iso
rder
of
the
ner
vo
us
syst
em u
suall
y
cau
sed
by a
n i
nfe
ctio
n. Fo
r th
is r
easo
n i
t h
as
bee
n
pla
ced
in
th
e V
A g
rou
p f
or
infe
ctio
us
dis
ease
s.
In IC
D-1
0 m
enin
git
is c
an
be
fou
nd
in
ch
ap
ter
I (C
erta
in
infe
ctio
us
an
d p
ara
siti
c d
isea
ses)
an
d i
n c
hap
ter
VI
(Dis
ease
s o
f th
e n
ervo
us
syst
em)
dep
end
ing o
n t
he
un
der
lyin
g i
nfe
ctio
n.
VA
-08
.97
Ner
vo
us
syst
em d
iso
rder
s,
no
t o
ther
wis
e cl
ass
ifie
d
G9
8O
ther
dis
ord
ers
of
ner
vo
us
syst
em,
no
t el
sew
her
e cl
ass
ifie
d
VA
-08
.98
Sp
ecif
ied
men
tal d
iso
rder
sF0
0 -
F9
8N
o s
ingle
co
de
for
“o
ther
sp
ecif
ied
men
tal
dis
ord
er” e
xis
ts i
n I
CD
-10.
Th
e ap
pro
pri
ate
co
de
mu
st b
e
sele
cted
fro
m t
he
cate
go
ries
men
tio
ned
in
th
e ri
gh
t-h
an
d
colu
mn
.
Men
tal
dis
ord
ers
can
no
t gen
erall
y b
e ass
esse
d u
sin
g
dia
gn
ost
ic c
rite
ria d
uri
ng v
erb
al
au
top
sy.
Ho
wev
er i
f
the
dec
ease
d w
as
trea
ted
fo
r a m
enta
l d
iso
rder
in
ho
spit
al,
th
en i
t m
ay b
e p
oss
ible
to
ret
riev
e a d
iagn
osi
s
fro
m m
edic
al
reco
rds.
In
th
ese
case
s se
lect
th
e
ap
pro
pri
ate
co
de
in I
CD
-10 a
nd
ass
ign
th
e V
A c
od
e.
Th
e re
levan
t IC
D-1
0 c
od
es a
re l
iste
d b
elo
w.
F0
0–F09
Org
an
ic,
incl
ud
ing s
ym
pto
mati
c, m
enta
l
dis
ord
ers
F1
0–F1
9 M
enta
l an
d b
ehavio
ura
l d
iso
rder
s d
ue
to
psy
cho
act
ive
sub
stan
ce u
se
F2
0–F2
9 S
chiz
op
hre
nia
, sc
hiz
oty
pal
an
d d
elu
sio
nal
dis
ord
ers
F30–F39 M
oo
d [
aff
ecti
ve]
dis
ord
ers
F4
0–F4
8 N
euro
tic,
str
ess-
rela
ted
an
d s
om
ato
form
dis
ord
ers
F50–F59 B
ehavio
ura
l sy
nd
rom
es a
sso
ciate
d w
ith
ph
ysi
olo
gic
al
dis
turb
an
ces
an
d p
hysi
cal
fact
ors
3. Applying ICD-10 to verbal autopsy
99
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
F6
0–F69
Dis
ord
ers
of
ad
ult
per
son
ali
ty a
nd
beh
avio
ur
F7
0–F7
9 M
enta
l re
tard
ati
on
F8
0–F8
9 D
iso
rder
s o
f p
sych
olo
gic
al
dev
elo
pm
ent
F9
0–F98
Beh
avio
ura
l an
d e
mo
tio
nal
dis
ord
ers
wit
h
on
set
usu
all
y o
ccu
rrin
g i
n c
hil
dh
oo
d a
nd
ad
ole
scen
ce
VA
-08
.99
Men
tal
dis
ord
ers,
un
spec
ifie
d
F9
9M
enta
l d
iso
rder
, n
ot
oth
erw
ise
spec
ifie
d
Sp
ecif
ied
men
tal
dis
ord
ers
can
be
cod
ed u
nd
er V
A-1
2.
VA
-09
Pre
gn
an
cy-,
ch
ild
-bir
th
an
d p
uer
per
ium
-rel
ate
d
dis
ord
ers
Rem
em
ber it is the m
oth
er’s
record you are codin
g.
Th
ese
cod
es s
ho
uld
be
use
d f
or
the
mo
ther
. T
her
e is
a
sep
ara
te g
rou
p f
or
the
new
bo
rn (
VA
-10
). S
om
e
infe
ctio
us
dis
ease
s m
ust
be
cod
ed t
o V
A-1
.-.
When codin
g, rem
em
ber the d
efinitio
ns fo
r
mate
rnal death
s in
this m
anual.
VA
-09
.01
Ect
op
ic p
regn
an
cyO
00
9E
cto
pic
pre
gn
an
cy,
un
spec
ifie
d
VA
-09
.02
Sp
on
tan
eou
s ab
ort
ion
O0
19
Hyd
ati
dif
orm
mo
le,
un
spec
ifie
dIC
D-1
0 c
od
ers
sho
uld
be
ver
y c
are
ful
in d
isti
ngu
ish
ing
the
lett
er “
O” f
rom
th
e n
um
ber
“0
” i
n t
his
ch
ap
ter.
Bef
ore
beg
inn
ing c
od
ing,
refe
r to
th
e la
st p
ages
of
vo
lum
e 1
in
IC
D-1
0 f
or
def
init
ion
s re
late
d t
o o
bst
etri
c
dea
ths.
Th
rou
gh
ou
t th
is c
hap
ter
in IC
D-1
0 t
her
e are
qu
ite
a few
no
tes,
so
me
of
wh
ich
ref
er e
ith
er t
o m
orb
idit
y o
r
mo
rtali
ty g
uid
elin
es i
n v
olu
me
2.
Make
sure
yo
u r
ead
thes
e b
efo
re a
ssig
nin
g a
co
de
fro
m t
his
ch
ap
ter.
Mate
rnal
con
dit
ion
s ass
ign
ed t
o t
he
ICD
-10
cate
go
ries
O96–O
99 a
re n
ot
incl
ud
ed i
n t
his
VA
gro
up
. T
hey
are
gro
up
ed u
nd
er V
A-1
2.
O0
29
Ab
no
rmal
pro
du
ct o
f co
nce
pti
on
,
un
spec
ifie
d
O0
33
Sp
on
tan
eou
s ab
ort
ion
, in
com
ple
te,
wit
h o
ther
an
d u
nsp
ecif
ied
com
pli
cati
on
s
O0
38
Sp
on
tan
eou
s ab
ort
ion
, co
mp
lete
or
un
spec
ifie
d,
wit
h o
ther
an
d
un
spec
ifie
d c
om
pli
cati
on
s
VA
-09
.03
Med
ical
ab
ort
ion
O0
43
Med
ical
ab
ort
ion
, in
com
ple
te,
wit
h
oth
er a
nd
un
spec
ifie
d c
om
pli
cati
on
s
O0
48
Med
ical
ab
ort
ion
, co
mp
lete
or
un
spec
ifie
d,
wit
h o
ther
an
d
un
spec
ifie
d c
om
pli
cati
on
s
VA
-09.0
4O
ther
an
d u
nsp
ecif
ied
ab
ort
ion
O0
53
Oth
er a
bo
rtio
n, in
com
ple
te,
wit
h
oth
er a
nd
un
spec
ifie
d c
om
pli
cati
on
s
3. Applying ICD-10 to verbal autopsy
100
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
O0
58
Oth
er a
bo
rtio
n, co
mp
lete
or
un
spec
ifie
d,
wit
h o
ther
an
d
un
spec
ifie
d c
om
pli
cati
on
s
O0
63
Un
spec
ifie
d a
bo
rtio
n,
inco
mp
lete
,
wit
h o
ther
an
d u
nsp
ecif
ied
com
pli
cati
on
s
O0
69
Un
spec
ifie
d a
bo
rtio
n, co
mp
lete
or
un
spec
ifie
d,
wit
ho
ut
com
pli
cati
on
O0
79
Oth
er a
nd
un
spec
ifie
d f
ail
ed
att
emp
ted
ab
ort
ion
, w
ith
ou
t
com
pli
cati
on
VA
-09
.05
Hyp
erte
nsi
ve
dis
ord
ers
of
pre
gn
an
cy
O1
6U
nsp
ecif
ied
mate
rnal
hyp
erte
nsi
on
Relevant in
form
ation
Pre
gn
an
t >
5 m
on
ths
Del
iver
y <
6 w
eeks
ago
Sw
oll
en u
pp
er e
xtr
emit
y a
nd
/or
face
Co
nvu
lsio
ns
Vis
ual
dis
turb
an
ces
Hyp
erte
nsi
on
Fir
st b
irth
Gast
ric
pain
Hea
dach
e
No
fev
er
O1
09
Un
spec
ifie
d p
re-e
xis
tin
g
hyp
erte
nsi
on
co
mp
lica
tin
g
pre
gn
an
cy, ch
ild
bir
th a
nd
th
e
pu
erp
eriu
m
O11
Pre
-exis
tin
g h
yp
ert
ensi
ve
dis
ord
er
wit
h s
up
erim
po
sed
pro
tein
uri
a
O1
2G
esta
tio
nal
[pre
gn
an
cy-i
nd
uce
d]
oed
ema a
nd
pro
tein
uri
a w
ith
ou
t
hyp
erte
nsi
on
O1
3G
esta
tio
nal
[pre
gn
an
cy-i
nd
uce
d]
hyp
erte
nsi
on
wit
ho
ut
sign
ific
an
t
pro
tein
uri
a
O1
49
Ges
tati
on
al
[pre
gn
an
cy-i
nd
uce
d]
hyp
erte
nsi
on
wit
h s
ign
ific
an
t
pro
tein
uri
a
O1
59
Ecl
am
psi
a, u
nsp
ecif
ied
as
to t
ime
per
iod
3. Applying ICD-10 to verbal autopsy
101
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-09
.06
An
tep
art
um
haem
orr
hage
O4
41
Pla
cen
ta p
raev
ia w
ith
haem
orr
hage
Relevant in
form
ation
Lab
ou
r p
ain
Pre
gn
an
cy >
8 m
on
ths
Sev
ere
vagin
al
ble
edin
g s
ho
rtly
bef
ore
del
iver
y
O4
59
Pre
matu
re s
epara
tio
n o
f p
lace
nta
,
un
spec
ifie
d
O4
69
An
tep
art
um
haem
orr
hage,
no
t
else
wh
ere
class
ifie
d
VA
-09
.07
Po
stp
art
um
haem
orr
hage
O7
09
Per
inea
l la
cera
tio
n d
uri
ng d
eliv
ery,
un
spec
ifie
d
Relevant in
form
ation
Del
iver
y <
3 d
ays
ago
Pre
gn
an
cy >
8 m
on
ths
Sev
ere
vagin
al
ble
edin
g
Be
care
ful
in t
ab
ula
tio
ns:
th
e n
oti
on
of
po
stp
art
um
haem
orr
hage
in V
A i
s m
uch
bro
ad
er t
han
in
IC
D-1
0.
O7
19
O7
2.-
Ob
stet
ric
trau
ma,
un
spec
ifie
d
Po
stp
art
um
hem
orr
hage
VA
-09
.08
Intr
ap
art
um
haem
orr
hage
O6
79
Intr
ap
art
um
haem
orr
hage,
un
spec
ifie
d
VA
-09
.09
Ob
stru
cted
lab
ou
rO
64
9O
bst
ruct
ed lab
ou
r d
ue
to m
alp
osi
tio
n
an
d m
alp
rese
nta
tio
n,
un
spec
ifie
d
Relevant in
form
ation
Th
e w
om
an
die
d d
uri
ng l
ab
ou
r an
d w
as
un
del
iver
ed.
Len
gth
of
lab
ou
r >
24
ho
urs
Th
is d
iagn
osi
s is
mo
re l
ikel
y a
fter
del
iver
y o
f st
illb
orn
fetu
s.
O6
54
Ob
stru
cted
lab
ou
r d
ue
to f
eto
pel
vic
dis
pro
po
rtio
n,
un
spec
ifie
d
O6
59
Ob
stru
cted
lab
ou
r d
ue
to m
ate
rnal
pel
vic
ab
no
rmali
ty, u
nsp
ecif
ied
O664
Fail
ed t
rial
of
lab
ou
r, u
nsp
ecif
ied
O6
65
Fail
ed a
pp
lica
tio
n o
f vacu
um
extr
act
or
an
d f
orc
eps,
un
spec
ifie
d
O6
69
Ob
stru
cted
lab
ou
r, u
nsp
ecif
ied
VA
-09
.10
Pu
erp
eral
sep
sis
O8
5P
uer
per
al
sep
sis
Relevant in
form
ation
Vagin
al
del
iver
y >
1 d
ay a
go
Caes
are
an
sec
tio
n >
1 d
ay a
go
Hig
h f
ever
O8
68
Oth
er s
pec
ifie
d p
uer
per
al
infe
ctio
ns
VA
-09
.98
Oth
er s
pec
ifie
d d
irec
t
mate
rnal
cau
ses
Sel
ect
the
ap
pro
pri
ate
cate
go
ry f
rom
ICD
-10
.
Th
is c
ate
go
ry i
ncl
ud
es s
ever
al
con
dit
ion
s th
at
occ
ur
du
rin
g p
regn
an
cy b
ut
no
rmall
y a
re c
od
ed t
o o
ther
chap
ters
, su
ch a
s d
iab
etes
mel
litu
s, a
nd
so
me
infe
ctio
ns
3. Applying ICD-10 to verbal autopsy
102
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
an
d c
on
dit
ion
s o
f th
e m
oth
er t
hat
are
cau
sed
by t
he
fetu
s.
Ple
ase
ref
er t
o t
he
def
init
ion
of “d
irec
t m
ate
rnal ca
use
s”
earl
ier
in t
his
man
ual.
VA
-09
.99
Oth
er d
irec
t m
ate
rnal
cau
ses,
un
spec
ifie
d
O9
5O
bst
etri
c d
eath
of
un
spec
ifie
d c
au
seR
efer
to
mo
rtali
ty r
ule
s an
d g
uid
elin
es i
n v
olu
me
2 o
f
ICD
-10
if
yo
u w
an
t to
ass
ign
th
is c
od
e.
VA
-10
Per
inata
l ca
use
s o
f d
eath
Rem
em
ber it is the b
aby’s
record you are codin
g.
Th
ese
cod
es a
re t
o b
e u
sed
fo
r th
e n
ewb
orn
. T
her
e is
a
sep
ara
te g
rou
p f
or
the
mo
ther
(V
A-9
).
When codin
g, rem
em
ber the d
efinitio
ns fo
r
perin
ata
l cause
s in
this m
anual.
VA
-10
.01
Tet
an
us
neo
nato
rum
A3
3T
etan
us
neo
nato
rum
Relevant in
form
ation
Bab
y a
ble
to
su
ck n
orm
all
y i
n t
he
firs
t 2
days
of
life
Sto
pp
ed s
uck
ing
No
t ab
le t
o o
pen
mo
uth
Had
co
nvu
lsio
ns
or
spasm
s
Had
back
arc
hin
g
VA
-10.0
2P
rem
atu
rity
(in
clu
din
g
resp
irato
ry d
istr
ess)
P0
10
P0
11
Fet
us
an
d n
ewb
orn
aff
ecte
d b
y
inco
mp
eten
t ce
rvix
Fet
us
an
d n
ewb
orn
aff
ecte
d b
y
pre
matu
re r
up
ture
of
mem
bra
nes
Relevant in
form
ation
Pre
gn
an
cy l
ast
ed <
8 m
on
ths
Bab
y v
ery s
mall
at
bir
th
Dry
, p
eeli
ng s
kin
an
d l
oss
of
sub
cuta
neo
us
tiss
ue
Dif
ficu
lty b
reath
ing s
tart
ed o
n t
he
firs
t d
ay o
f li
fe
No
t ab
le t
o f
eed
sin
ce b
irth
Mate
rnal
dis
ease
pre
sen
t (p
re-e
clam
psi
a o
r ec
lam
psi
a,
dia
bet
es m
elli
tus,
oth
er s
ever
e m
edic
al
pro
ble
m)
Mo
ther
had
an
tep
art
um
haem
orr
hage
P0
7D
iso
rder
s re
late
d t
o s
ho
rt g
esta
tio
n
an
d l
ow
bir
th w
eigh
t, n
ot
else
wh
ere
class
ifie
d
P22–P
25
Res
pir
ato
ry d
istr
ess
of
new
bo
rn a
nd
mo
re s
pec
ific
co
nd
itio
ns
3. Applying ICD-10 to verbal autopsy
103
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
P5
29
Intr
acr
an
ial
(no
ntr
au
mati
c)
haem
orr
hage
of
fetu
s an
d n
ewb
orn
,
un
spec
ifie
d
P590
Neo
nata
l ja
un
dic
e, u
nsp
ecif
ied
P6
12
An
aem
ia o
f p
rem
atu
rity
P7
7N
ecro
tizi
ng e
nte
roco
liti
s o
f fe
tus
an
d
new
bo
rn
VA
-10
.03
Lo
w b
irth
wei
gh
tP
05
9Slo
w f
etal
gro
wth
, u
nsp
ecif
ied
VA
-10
.04
Bir
th t
rau
ma
P1
09
P1
19
Un
spec
ifie
d i
ntr
acr
an
ial
lace
rati
on
an
d h
aem
orr
hage
du
e to
bir
th i
nju
ry
Bir
th i
nju
ry t
o c
entr
al
ner
vo
us
syst
em,
un
spec
ifie
d
P1
29
Bir
th i
nju
ry t
o s
calp
, u
nsp
ecif
ied
P1
39
Bir
th i
nju
ry t
o s
kel
eto
n,
un
spec
ifie
d
P149
Bir
th i
nju
ry t
o p
erip
her
al
ner
vo
us
syst
em,
un
spec
ifie
d
P1
59
Bir
th i
nju
ry,
un
spec
ifie
d
VA
-10.0
5B
irth
asp
hyxia
an
d
per
inata
l re
spir
ato
ry
dis
ord
ers
P0
21
P0
24
P0
26
P0
29
Fet
us
an
d n
ewb
orn
aff
ecte
d b
y
com
pli
cati
on
s o
f p
lace
nta
, co
rd a
nd
mem
bra
nes
Relevant in
form
ation
No
t ab
le t
o c
ry o
r b
reath
e at
bir
th
Nee
ded
ass
ista
nce
to
bre
ath
e
Aged
< 7
days
at
death
No
t ab
le t
o s
uck
sin
ce b
irth
No
fev
er
If d
eath
occ
urr
ed a
fter
fir
st d
ay o
f li
fe, h
ad
so
me
of
the
foll
ow
ing s
ym
pto
ms:
co
nvu
lsio
ns,
irr
itab
ilit
y,
stif
f
lim
bs,
let
harg
y o
r u
nre
spo
nsi
ven
ess
Mo
ther
had
an
tep
art
um
haem
orr
hage
Ob
stet
ric
com
pli
cati
on
s (i
ntr
ap
art
um
haem
orr
hage,
ob
stru
cted
lab
ou
r, m
alp
rese
nta
tio
n)
P0
39
Fet
us
an
d n
ewb
orn
aff
ecte
d b
y
com
pli
cati
on
of
lab
ou
r an
d d
eliv
ery,
un
spec
ifie
d
P2
09
Intr
au
teri
ne
hyp
oxia
, u
nsp
ecif
ied
P219
Bir
th a
sph
yxia
, u
nsp
ecif
ied
P2
49
Neo
nata
l asp
irati
on
syn
dro
me,
un
spec
ifie
d
P5
09
Fet
al
blo
od
lo
ss,
un
spec
ifie
d
P9
0C
on
vu
lsio
ns
of
new
bo
rn
3. Applying ICD-10 to verbal autopsy
104
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
P9
19
Dis
turb
an
ce o
f ce
reb
ral
statu
s o
f
new
bo
rn,
un
spec
ifie
d
VA
-10
.06
Neo
nata
l Pn
eum
on
iaP
23
9C
on
gen
ital
pn
eum
on
ia,
un
spec
ifie
d
VA
-10
.07
Co
ngen
ital
vir
al
dis
ease
sP
35
9C
on
gen
ital
vir
al
dis
ease
, u
nsp
ecif
ied
VA
-10
.08
Bact
eria
l se
psi
s o
f
new
bo
rn
P3
69
Bact
eria
l se
psi
s o
f n
ewb
orn
,
un
spec
ifie
d
Relevant in
form
ation
Age
at
on
set
of
sym
pto
ms
> 1
day
Fast
bre
ath
ing,
ches
t in
dra
win
g o
r gru
nti
ng l
ast
ing a
t
least
1 d
ay b
efo
re d
eath
Fev
er
Bo
dy c
old
to
to
uch
Let
harg
ic o
r u
nre
spo
nsi
ve
Sto
pp
ed s
uck
ing
Pu
s d
isch
arg
e fr
om
um
bil
icu
s
Skin
rash
wit
h p
us
Co
nvu
lsio
ns
Mo
ther
had
fev
er a
nd
/or
dia
rrh
oea
du
rin
g l
ab
ou
r
VA
-10
.09
Co
ngen
ital
malf
orm
ati
on
s o
f th
e
ner
vo
us
syst
em
Q0
0
Q0
19
Q0
2
Q0
39
Q0
49
Q0
59
Q0
69
Q0
79
An
ence
ph
aly
an
d s
imil
ar
malf
orm
ati
on
s
En
cep
halo
cele
, u
nsp
ecif
ied
Mic
roce
ph
aly
Co
ngen
ital
hyd
roce
ph
alu
s,
un
spec
ifie
d
Co
ngen
ital
malf
orm
ati
on
of
bra
in,
un
spec
ifie
d
Sp
ina b
ifid
a,
un
spec
ifie
d
Co
ngen
ital
malf
orm
ati
on
of
spin
al
cord
, u
nsp
ecif
ied
Co
ngen
ital
malf
orm
ati
on
of
ner
vo
us
syst
em,
un
spec
ifie
d
Relevant in
form
ation
Vis
ible
majo
r co
ngen
ital
malf
orm
ati
on
of
hea
d o
r
spin
e, s
uch
as
hea
d n
ot
form
ed, h
ead
ver
y s
mall
or
ver
y
larg
e, d
efec
t o
r m
ass
at
the
back
of
hea
d o
r sp
ine
Oth
er m
ajo
r co
ngen
ital
def
ects
: n
o a
nu
s, m
ajo
r li
mb
def
ects
, ab
do
min
al
or
tho
raci
c d
efec
ts
VA
-10.1
0C
on
gen
ital m
alf
orm
ati
on
,
oth
er a
nd
un
spec
ifie
d
Q8
99
Q9
99
Co
ngen
ital
malf
orm
ati
on
,
un
spec
ifie
d
Sev
eral
chro
mo
som
al
an
om
ali
es s
ho
w u
p a
s
malf
orm
ati
on
s. D
uri
ng v
erb
al
au
top
sy a
n u
nd
erly
ing
chro
mo
som
al
an
om
aly
wo
uld
no
t n
orm
all
y b
e
3. Applying ICD-10 to verbal autopsy
105
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
Ch
rom
oso
mal
ab
no
rmali
ty,
un
spec
ifie
d
Sel
ect
a m
ore
sp
ecif
ic c
od
e w
hen
mo
re i
nfo
rmati
on
ex
ists
revea
led
; in
stea
d t
he
man
ifes
tati
on
wo
uld
be
cod
ed –
that
is, th
e m
alf
orm
ati
on
.
VA
-10
.97
Sti
llb
irth
sP
95
Fet
al
dea
th o
f u
nsp
ecif
ied
cau
se
Dea
db
orn
fet
us
NO
S
Sti
llb
irth
NO
S
En
sure
th
at
the
dea
th w
as
no
t th
e re
sult
of
sud
den
infa
nt
dea
th s
yn
dro
me
(VA
10
.12
) o
r d
id n
ot
foll
ow
an
y
oth
er t
yp
e o
f li
ve
bir
th.
Relevant in
form
ation
Nev
er b
reath
ed, c
ried
or
mo
ved
(ev
en a
lit
tle)
aft
er b
irth
Sti
llb
irth
was
fres
h o
r m
ace
rate
d
Co
ngen
ital
malf
orm
ati
on
s p
rese
nt
Mate
rnal
dis
ease
pre
sen
t (p
re-e
clam
psi
a o
r ec
lam
psi
a,
dia
bet
es m
elli
tus,
oth
er s
ever
e m
edic
al
pro
ble
m)
Mo
ther
had
an
tep
art
um
haem
orr
hage
Ob
stet
ric
com
pli
cati
on
s p
rese
nt
(in
trap
art
um
haem
orr
hage,
ob
stru
cted
lab
ou
r, m
alp
rese
nta
tio
n)
VA
-10
.98
Oth
er s
pec
ifie
d d
iso
rder
s
rela
ted
to
per
inata
l p
erio
d
P0
22
Fet
us
an
d n
ewb
orn
aff
ecte
d b
y o
ther
an
d u
nsp
ecif
ied
mo
rph
olo
gic
al
an
d
fun
ctio
nal
ab
no
rmali
ties
of
pla
cen
ta
Sel
ect
a m
ore
sp
ecif
ic c
od
e w
hen
mo
re i
nfo
rmati
on
ex
ists
.
VA
-10
.99
Oth
er d
isea
ses
rela
ted
to
the
per
inata
l p
erio
d,
un
spec
ifie
d
P9
69
Co
nd
itio
n o
rigin
ati
ng i
n t
he
per
inata
l p
erio
d,
un
spec
ifie
d
VA
-11
Exte
rnal
cau
ses
of
dea
thE
xte
rnal
cau
ses
no
t ap
pea
rin
g i
n t
his
gro
up
sh
ou
ld b
e
cod
ed t
o V
A-1
2.
VA
-11
.01
Ped
estr
ian
in
jure
d i
n
traff
ic a
ccid
ent
V0
9P
edes
tria
n i
nju
red
in
oth
er a
nd
un
spec
ifie
d t
ran
spo
rt a
ccid
ent
Co
nsu
lt V
01-V
08 f
or
mo
re d
etail
ed c
od
es.
VA
-11.0
2O
ther
tra
nsp
ort
acc
iden
tV
19
Ped
al
cycl
ist
inju
red
in
oth
er a
nd
un
spec
ifie
d t
ran
spo
rt a
ccid
ent
3. Applying ICD-10 to verbal autopsy
106
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
V29
Mo
torc
ycl
e ri
der
in
jure
d in
oth
er a
nd
un
spec
ifie
d t
ran
spo
rt a
ccid
ent
Po
ssib
le c
od
es i
n I
CD
-10
are
V1
0-V
99
.
V3
9O
ccu
pan
t o
f th
ree-
wh
eele
d m
oto
r
veh
icle
in
jure
d i
n o
ther
an
d
un
spec
ifie
d t
ran
spo
rt a
ccid
ent
Inju
ries
sh
ou
ld b
e re
cord
ed w
her
ever
po
ssib
le a
nd
tab
ula
ted
to
get
her
wit
h e
xte
rnal
cau
ses.
In t
hes
e ca
ses,
take
care
to
rep
ort
th
e ex
tern
al ca
use
an
d
inju
ry i
n s
epara
te f
ield
s in
ord
er t
o a
vo
id c
ou
nti
ng
dea
ths
twic
e.
Co
des
fro
m I
CD
-10 c
hap
ter
XIX
(In
jury
, p
ois
on
ing a
nd
cert
ain
oth
er c
on
seq
uen
ces
of
exte
rnal
cau
ses)
sh
ou
ld
no
t b
e u
sed
fo
r ta
bu
lati
ng s
ingle
un
der
lyin
g c
au
se o
f
dea
th.
Th
e ca
use
of
the
inju
ry h
as
pri
ori
ty.
Co
nd
itio
ns
men
tio
ned
in
ch
ap
ters
I-X
VII
I as
bei
ng d
ue
to e
xte
rnal
cau
ses
take
pri
ori
ty o
ver
th
e ex
tern
al
cau
se.
V4
9C
ar
occ
up
an
t in
jure
d i
n o
ther
an
d
un
spec
ifie
d t
ran
spo
rt a
ccid
ent
V59
Occ
up
an
t o
f p
ick-u
p t
ruck
or
van
inju
red
in
oth
er a
nd
un
spec
ifie
d
tran
spo
rt a
ccid
ent
V69
Occ
up
an
t o
f h
eavy t
ran
spo
rt v
ehic
le
inju
red
in
oth
er a
nd
un
spec
ifie
d
tran
spo
rt a
ccid
ent
V7
9B
us
occ
up
an
t in
jure
d i
n o
ther
an
d
un
spec
ifie
d t
ran
spo
rt a
ccid
ent
V8
0R
ider
or
occ
up
an
t in
jure
d i
n
tran
spo
rt a
ccid
ent
V9
0A
ccid
ent
to w
ate
rcra
ft c
au
sin
g
dro
wn
ing a
nd
su
bm
ersi
on
V9
1A
ccid
ent
to w
ate
rcra
ft c
au
sin
g o
ther
inju
ry
V9
2W
ate
r-tr
an
spo
rt-r
elate
d d
row
nin
g
an
d s
ub
mer
sio
n w
ith
ou
t acc
iden
t to
wate
rcra
ft
V93
Acc
iden
t o
n b
oard
wate
rcra
ft w
ith
ou
t
acc
iden
t to
wate
rcra
ft,
no
t ca
usi
ng
dro
wn
ing a
nd
su
bm
ersi
on
V940
Oth
er a
nd
un
spec
ifie
d w
ate
r
tran
spo
rt a
ccid
ent,
mer
chan
t sh
ip
3. Applying ICD-10 to verbal autopsy
107
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
V941
Oth
er a
nd
un
spec
ifie
d w
ate
r
tran
spo
rt a
ccid
ent,
pass
enger
sh
ip
V942
Oth
er a
nd
un
spec
ifie
d w
ate
r
tran
spo
rt a
ccid
ent,
fis
hin
g b
oat
V943
Oth
er a
nd
un
spec
ifie
d w
ate
r
tran
spo
rt a
ccid
ent,
oth
er p
ow
ered
wate
rcra
ft
V944
Oth
er a
nd
un
spec
ifie
d w
ate
r
tran
spo
rt a
ccid
ent,
sail
bo
at
V945
Oth
er a
nd
un
spec
ifie
d w
ate
r
tran
spo
rt a
ccid
ent,
can
oe
or
kayak
V9
46
Oth
er a
nd
un
spec
ifie
d w
ate
rtr
an
spo
rt a
ccid
ent,
in
flata
ble
cra
ft(n
on
po
wer
ed)
V9
47
Oth
er a
nd
un
spec
ifie
d w
ate
rtr
an
spo
rt a
ccid
ent,
wate
r-sk
is
V9
48
Oth
er a
nd
un
spec
ifie
d w
ate
rtr
an
spo
rt a
ccid
ent,
oth
er u
np
ow
ered
wate
rcra
ft
V9
49
Oth
er a
nd
un
spec
ifie
d w
ate
rtr
an
spo
rt a
ccid
ent,
un
spec
ifie
dw
ate
rcra
ft
V9
5A
ccid
ent
to p
ow
ered
air
craft
in
juri
ng
occ
up
an
t
V9
9U
nsp
ecif
ied
tra
nsp
ort
acc
iden
t
VA
-11
.03
Acc
iden
tal
fall
W19
Un
spec
ifie
d f
all
Po
ssib
le c
od
es i
n I
CD
-10
are
W0
0-W
19
.
VA
-11
.04
Acc
iden
tal
dro
wn
ing a
nd
sub
mer
sio
n
W74
Un
spec
ifie
d d
row
nin
g a
nd
sub
mer
sio
n
Po
ssib
le c
od
es i
n I
CD
-10
are
W6
5-W
74
.
VA
-11
.05
Acc
iden
tal
exp
osu
re t
o
smo
ke,
fir
e an
d f
lam
es
X09
Exp
osu
re t
o u
nsp
ecif
ied
sm
oke,
fir
e
an
d f
lam
es
Po
ssib
le c
od
es i
n I
CD
-10
are
X0
0-X
09
.
3. Applying ICD-10 to verbal autopsy
108
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-11
.06
Co
nta
ct w
ith
ven
om
ou
s
an
imals
an
d p
lan
ts
X2
9C
on
tact
wit
h u
nsp
ecif
ied
ven
om
ou
s
an
imal
or
pla
nt
Po
ssib
le c
od
es i
n I
CD
-10
are
X2
0-X
29
.
VA
-11
.07
Ex
po
sure
to
fo
rce
of
natu
re
X3
9E
xp
osu
re t
o o
ther
an
d u
nsp
ecif
ied
forc
es o
f n
atu
re
Po
ssib
le c
od
es i
n I
CD
-10
are
X3
0-X
39
.
VA
-11.0
8A
ccid
enta
l p
ois
on
ing a
nd
exp
osu
re t
o n
oxio
us
sub
stan
ce
X4
4A
ccid
enta
l p
ois
on
ing b
y a
nd
exp
osu
re t
o o
ther
an
d u
nsp
ecif
ied
dru
gs,
med
icam
ents
an
d b
iolo
gic
al
sub
stan
ces
Po
ssib
le c
od
es i
n I
CD
-10
are
X4
0-X
49
.
X4
9A
ccid
enta
l p
ois
on
ing b
y a
nd
exp
osu
re t
o o
ther
an
d u
nsp
ecif
ied
chem
icals
an
d n
oxio
us
sub
stan
ces
VA
-11
.09
Lack
of
foo
d a
nd
/or
wate
rX
53
X5
4
Lack
of
foo
d
Lack
of
wate
r
VA
-11
.10
Inte
nti
on
al
self
-harm
X6
4In
ten
tio
nal
self
-po
iso
nin
g b
y a
nd
exp
osu
re t
o o
ther
an
d u
nsp
ecif
ied
dru
gs,
med
icam
ents
an
d b
iolo
gic
al
sub
stan
ces
Po
ssib
le c
od
es i
n I
CD
-10
are
X6
0-X
84
.
X6
9In
ten
tio
nal
self
-po
iso
nin
g b
y a
nd
exp
osu
re t
o o
ther
an
d u
nsp
ecif
ied
chem
icals
an
d n
oxio
us
sub
stan
ces
X7
4In
ten
tio
nal
self
-harm
by o
ther
an
d
un
spec
ifie
d f
irea
rm d
isch
arg
e
X8
4In
ten
tio
nal
self
-harm
by u
nsp
ecif
ied
mea
ns
VA
-11
.11
Ass
au
ltX
90
Ass
au
lt b
y u
nsp
ecif
ied
ch
emic
al
or
no
xio
us
sub
stan
ce
Po
ssib
le c
od
es i
n I
CD
-10
are
X8
5-Y
09
.
X9
2A
ssau
lt b
y d
row
nin
g a
nd
su
bm
ersi
on
X9
5A
ssau
lt b
y o
ther
an
d u
nsp
ecif
ied
fire
arm
dis
charg
e
Y0
5Sex
ual
ass
au
lt b
y b
od
ily f
orc
e
Y0
6N
egle
ct a
nd
ab
an
do
nm
ent
3. Applying ICD-10 to verbal autopsy
109
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
Y0
7O
ther
malt
reatm
ent
syn
dro
mes
Y0
9A
ssau
lt b
y u
nsp
ecif
ied
mea
ns
VA
-11
.12
Leg
al
inte
rven
tio
nY
35
7L
egal
inte
rven
tio
n, m
ean
s
un
spec
ifie
d
VA
-11
.13
War
dea
ths
Y3
69
War
op
erati
on
s, u
nsp
ecif
ied
VA
-11
.97
Acc
iden
t, u
nsp
ecif
ied
X5
99
Exp
osu
re t
o u
nsp
ecif
ied
fact
or
cau
sin
g o
ther
an
d u
nsp
ecif
ied
in
jury
VA
-11
.98
Oth
er s
pec
ifie
d e
ven
t,
un
det
erm
ined
in
ten
t
Y3
3O
ther
sp
ecif
ied
even
ts,
un
det
erm
ined
in
ten
t
VA
-11
.99
Un
spec
ifie
d e
ven
t,
un
det
erm
ined
in
ten
t
Y3
4U
nsp
ecif
ied
even
t, u
nd
eter
min
ed
inte
nt
VA
-12
Mis
ad
ven
ture
to
pati
ent
du
rin
g s
urg
ical
an
d
med
ical
care
Y6
9U
nsp
ecif
ied
mis
ad
ven
ture
du
rin
g
surg
ical
an
d m
edic
al
care
Po
ssib
le c
od
es i
n I
CD
-10
are
Y6
0-Y
69
.
Th
is c
ate
go
ry e
xcl
ud
es:
bre
akd
ow
n o
r m
alf
un
ctio
nin
g
of
med
ical
dev
ice
(du
rin
g p
roce
du
re)
(aft
er
imp
lan
tati
on
) (o
ngo
ing u
se)
(Y70-Y
82 )
; su
rgic
al
an
d
med
ical
pro
ced
ure
s as
the
cau
se o
f ab
no
rmal
react
ion
of
the
pati
ent,
wit
ho
ut
men
tio
n o
f m
isad
ven
ture
at
the
tim
e o
f th
e p
roce
du
re (
Y8
3-Y
84
).
VA
-13
Dru
gs,
med
icam
ents
an
d
bio
logic
al
sub
stan
ces
cau
sin
g a
dver
se e
ffec
ts i
n
ther
ap
euti
c u
se
Y5
79
Y5
99
Dru
g o
r m
edic
am
ent,
un
spec
ifie
d
Vacc
ine
or
bio
logic
al
sub
stan
ce,
un
spec
ifie
d
Po
ssib
le c
od
es i
n I
CD
-10
are
Y4
0-Y
59
.
3. Applying ICD-10 to verbal autopsy
110
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
VA
-98
Oth
er s
pec
ifie
d c
au
ses
of
dea
th
This elem
ent of th
e verbal auto
psy
tool does not m
ap to any sin
gle elem
ent of
ICD-1
0
Th
is g
rou
p c
over
s all
dis
ease
s th
at
cou
ld n
ot
be
ass
ign
ed
to a
no
ther
gro
up
or
cate
go
ry in
th
e ver
bal au
top
sy t
oo
l.
Ple
ase
no
te t
hat
ICD
-10 c
od
es s
tart
ing w
ith
A o
r B
are
all
ass
ign
ed t
o V
A-1
; all
IC
D-1
0 c
od
es s
tart
ing w
ith
C
are
ass
ign
ed t
o V
A-2
.
Disease
s of th
e eye and its adnexa
A s
et o
f co
des
is
pro
vid
ed b
y I
CD
-10 (
H00-H
59).
H54 b
lin
dn
ess
an
d lo
w v
isio
n is
an
im
po
rtan
t ca
tego
ry,
wh
ich
has
a t
ab
le d
etail
ing i
mp
air
men
t ca
tego
ries
.
Disease
s of th
e ear and m
astoid
process
A s
et o
f co
des
is
pro
vid
ed b
y I
CD
-10 (
H60-H
95).
H90 c
lass
ifie
s co
nd
uct
ive
an
d s
enso
rin
eura
l h
eari
ng
loss
by u
nil
ate
ral
an
d b
ilate
ral
imp
air
men
t.
Disease
s of th
e skin
and subcuta
neous tissue
In I
CD
-10
th
e ch
ap
ter
rela
tin
g t
o d
isea
ses
of
the
skin
an
d s
ub
cuta
neo
us
tiss
ue
has
man
y e
xcl
usi
on
s an
d
incl
usi
on
s. T
hey
are
list
ed a
t th
e st
art
of ch
ap
ters
, blo
cks
an
d c
ate
go
ries
an
d u
suall
y a
pp
ly t
o a
ll t
he
level
s b
elo
w
the
hea
din
g.
Rem
emb
er t
hat
excl
usi
on
no
tes
iden
tify
elem
ents
or
cod
es c
lass
ifie
d e
lsew
her
e.
If y
ou
have
to c
od
e a d
isea
se o
f th
e sk
in y
ou
sh
ou
ld u
se
ICD
-10
to
ch
eck w
het
her
it
sho
uld
be
ass
ign
ed t
o a
spec
ific
ver
bal au
top
sy g
rou
p r
ath
er t
han
to
VA
-98
. T
he
pre
face
of
chap
ter
XII
(D
isea
ses
of
the
skin
an
d
sub
cuta
neo
us
tiss
ue)
pro
vid
es a
go
od
over
vie
w.
Disease
s and conditio
ns rela
ting to the spin
e,
join
t, m
usc
les and connective tissu
e of th
e body
inclu
din
g d
efo
rm
ities acquired after b
irth
3. Applying ICD-10 to verbal autopsy
111
Verbal
auto
psy
code
Verbal auto
psy
title
ICD code
ICD title
Com
ments
Def
orm
itie
s o
r co
ngen
ital
malf
orm
ati
on
s m
ust
be
cod
ed t
o t
he
gro
up
VA
-10
.- (
Per
inata
l ca
use
s o
f d
eath
).
Th
e sa
me
ap
pli
es t
o c
od
ing w
ith
IC
D-1
0 c
hap
ter
XII
.
Urin
ary system
and the m
ale and fem
ale
reproductive system
s
Fo
r th
e p
urp
ose
s o
f ver
bal au
top
sy r
enal d
iso
rder
s m
ust
be
cod
ed t
o t
he
gro
up
VA
-7.-
.
Obstetr
ic d
eath
s
Th
e o
bst
etri
c co
nd
itio
ns
ass
ign
ed t
o I
CD
-10
cate
go
ries
O9
6-O
99
are
in
clu
ded
her
e. O
ther
mate
rnal co
nd
itio
ns
are
gro
up
ed u
nd
er V
A-9
.
Pri
or
to b
egin
nin
g c
od
ing,
refe
r to
pages
at
the
end
of
vo
lum
e 1
of
ICD
-10
fo
r d
efin
itio
ns
rela
ted
to
ob
stet
ric
dea
ths.
Sym
pto
ms, sig
ns and abnorm
al clinical and
laborato
ry fin
din
gs
ICD
-10 c
hap
ter
XV
III
sho
uld
no
t b
e u
sed
to
co
de
un
der
lyin
g c
au
ses
of
dea
th.
If a
sig
n i
s th
e o
nly
th
ing
rep
ort
ed a
s a r
esu
lt o
f a v
erb
al
au
top
sy i
nte
rvie
w,
it
sho
uld
be
cod
ed.
Nev
erth
eles
s, s
om
e R
-co
des
are
use
d;
Th
ese
are
usu
all
y
R9
5 f
or
sud
den
in
fan
t d
eath
syn
dro
me
(VA
-10.1
2)
an
d
R99 f
or
un
spec
ifie
d c
au
se o
f d
eath
(V
A-1
3).
VA
-99
Un
spec
ifie
d c
au
ses
of
dea
th
R9
9O
ther
ill
-def
ined
an
d u
nsp
ecif
ied
cau
ses
of
mo
rtali
ty
Use
th
is c
od
e w
hen
th
e an
swer
s p
rovid
ed d
uri
ng t
he
inte
rvie
w d
o n
ot
all
ow
yo
u t
o a
ssig
n a
ny s
pec
ific
cau
se
of
dea
th o
r a s
ym
pto
m (
VA
-98
). I
n t
his
in
stan
ce, d
o n
ot
leave
the
cert
ific
ate
bla
nk:
ass
ign
th
is c
od
e.
VA
, ver
bal
au
top
sy; N
EC
, n
ot
else
wh
ere
class
ifie
d; N
OS, n
ot
oth
erw
ise
speci
fied
; H
IV, h
um
an
im
mu
no
def
icie
ncy
vir
us;
AID
S, acq
uir
ed i
mm
un
od
efic
ien
cy s
yn
dro
me.
3. Applying ICD-10 to verbal autopsy
112