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Student Manual Coders Training

This document is an introduction to ICD-10 structure and classification principles from the ICD-10 Student Manual developed by the Department of Health in the Philippines. It provides a brief history of disease classification development leading up to the current International Classification of Diseases (ICD-10). It describes how ICD-10 is a statistical classification system that organizes diseases, injuries and health conditions into categories to allow for easy storage, retrieval and analysis of medical data for research and comparison purposes.

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100% found this document useful (3 votes)

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Student Manual Coders Training

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You are on page 1/ 149

This workbook has been developed by Sue Walker and Maryann Wood, National Center

for Classification in Health (Brisbane), School of Public Health, Queensland University

of Technology, Victoria Park Road, Kelvin Grove Q 4059 Australia.

The ICD-10 Revised Manual , Philippines, 2001, was developed and prepared by the
Department of Health in collaboration with other concerned agencies represented by the
following:

JUAN M. LOPEZ, MD, MPH

ICD-10 Program Coordinator
National Epidemiology Center
Department of Health

MARY ANN EVANGELISTA, MD

Medical Officer VI
Philippine Health Insurance Corporation

MS. FLORINDA TUVILLO

Development Management Officer IV
National Center for Health Facility Development

MS. FE BENEDICTA DELA CRUZ

Supervising Medical Records Analyst
Bureau of Health Facilities and Services
Department of Health

MS. THERESA TIMBANG

Supervising Health Program Officer
National Epidemilogy Center
Department of Health

Grateful acknowledgment is also extended to those who have contributed to the

development and completion of this Revised Manual, namely: the staff of the National
Epidemiology Center, Department of Health particularly the Surveys, Risk Assessment
and Evaluation Division Dr. Marissa Ricardo, CHD for Metro Manila and Dr. Roberto
Domingo, Jose Reyes Memorial Medical Center; and other members of the ICD-10
Technical Working Group.

Please direct comments to the ICD-10 Technical Working Group, National

Epidemiology Center, Department of Health, Rizal Avenue ,Manila, Philippines or via
fax to 743-1937 or by email to [email protected]

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ICD-10 Student Manual –Department of Health, Philippines
TABLE OF CONTENTS
MODULE 1: Introduction to ICD-10 Structure and Principles of Classification 1 - 4
MODULE 2: Volume 1 - Tabular List 5 - 15
MODULE 3: Volume 3 – Alphabetical Index 16 - 19
MODULE 4: Basic Coding Guidelines 20
MODULE 5: Overview of Morbidity Coding 21 - 23
MODULE 6: Overview of Mortality Coding 34 - 60
MODULE 7: Certain Infectious and Parasitic Diseases (Chapter I) 61 - 62
MODULE 8: Neoplasms (Chapter II) 63 - 66
MODULE 9: Diseases of the Blood and Blood Forming Organs and Certain
Disorders Involving the Immune Mechanism (Chapter III) 67 - 68
MODULE 10: Endocrine, Nutritional and Metabolic Diseases (Chapter IV) 69 - 71
MODULE 11: Mental and Behavioral Disorders (Chapter V) 72 - 73
MOUDLE 12: Diseases of the Nervous System (Chapter VI) 74 - 75
MODULE 13: Diseases of the Eye and Adnexa ( Chapter VII) 76 - 77
MODULE 14: Diseases of the Ear and Mastoid Process (Chapter VIII) 78 - 79
MODULE 15: Diseases of the Circulatory System (Chapter IX) 80 - 81
MODULE 16: Diseases of the Respiratory System (Chapter X) 82 - 83
MODULE 17: Diseases of the Digestive System (Chapter XI) 84 - 85
MODULE 18: Diseases of the Skin and Subcutaneous Tissue (Chapter XII) 86 - 87
MODULE 19: Diseases of the Musculoskeletal System and Connective Tissue 88 - 90
(Chapter XIII)
MODULE 20: Diseases of the Genitourinary System (Chapter XIV) 91 - 92
MODULE 21: Pregnancy, Childbirth and the Puerperium (Chapter XV) 93 - 95
MODULE 22: Certain Conditions Originating in the Perinatal Period (Chapter XVI) 96 - 99
MODULE 23: Congenital Malformations, Deformations and Chromosomal 100- 101
Abnormalities (Chapter XVII)
MODULE 24: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, 102- 104
Not Elsewhere Classified (Chapter XVIII)
MODULE 25: Injury, Poisoning and Certain Other Consequences of External Causes 105- 118
(Chapter XIX) and External Causes of Morbidity and Mortality
(Chapter XX)
MODULE 26: Factors Influencing Health Status and Contact with Health 119- 121
Services (Chapter XXI)

ANNEXES: A: Corrigenda /Updates to Volume 1(Tabular List)

B: DOH Administrative Order No. 47 dated 04 May 2000 re:
Adoption/Implementation of ICD-10 Coding in All
Hospitals
C: PHIC Circular
D: Related Laws, Rules and Events Relevant with Death
Recording and Registration
E: Instructions Manual on Civil Registry Forms
F: Improper Accomplishment of Fetal Death and Death Certificates

Clinical coding – it is the translation of diseases, health related problems and

procedural concepts from text to alphabetic/numeric codes for
storage, retrieval and analysis.

WHAT IS A STATISTICAL CLASSIFICATION?

➢ A classification is a system of categories or groupings to which diseases, injuries,

conditions, and procedures are assigned according to established criteria.

➢ The element of grouping similar terms distinguishes a statistical classification

from a nomenclature. A nomenclature requires a separate name or title for each
disease or procedure concept.

➢ ICD-10 is a statistical classification; it contains limited number of mutually

exclusive code categories which describe all disease concepts. The classification
is hierarchical in structure with subdivision to identify broad groups and specific
entities.

WHY USE A CLASSIFICATION?

➢ To allow easy storage, retrieval and analysis of data

➢ To allow comparison of data between hospitals, provinces or countries

WHAT IS THE INTERNATIONAL CLASSIFICATION OF DISEASES?

HISTORY OF ICD-10

➢ 17th Century- the theory of disease classification began when John Graunt
recognized the need to organize mortality data into some
logical form and therefore developed the first statistical
study of disease, called the “LONDON BILLS OF
MORTALITY”. Graunt classified the deaths of all children
who were born alive but who died before they reached the
age of six.

➢ 18th Century- Sauvages-attempted to systematically classify all diseases

in a work called, “NOSOLOGICA METHODICA”

➢ Further development/modification was done by William Farr to form the basis

of the “INTERNATIONAL LIST OF CAUSES OF DEATH” (1853).
➢ Modified in 1874, 1880 and 1886

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ICD-10 Student Manual –Department of Health, Philippines
➢ The Bertillon Classification of Causes of Death was developed by Dr. Jacques
Bertillon. This classification distinguishes diseases that affected the body as a
whole (systemic) from those which were localized to a particular body site.

➢ 1920- Organisation of the League of Nations took over the management

of the “CAUSES OF DEATH CLASSIFICATION”

➢ 1946- Interim Commission of the World Health Organization was given

the responsibility for the continued revision of the classification.

➢ 1948- the 6th revision included recommendation for morbidity data

collection

➢ 1955 and 1965 revisions (included 2 volumes)

➢ 1975- development of the 9th revision ICD-9, including, on a trial basis, a

procedure classification

➢ 1978- USA developed a modified, more specific version of ICD-9-CM

➢ 1983- work began on the 10th revision of the ICD

It became clear that many users wished the ICD to encompass types of data other
than simply diagnostic information. The concept was therefore developed of a
“family” of classifications, with main ICD as the core covering the traditional
mortality and morbidity statistics, while the need for more detailed or different
classification would be dealt with by other members of the family such as the
International Classification of Impairments, Disabilities and Handicaps (ICIDH)
and the Diagnostic and Statistical Manual of Mental Disorders (DSM)

Several alternative models for the restructure of the main ICD were investigated,
and the final decision was to use an alphanumeric system, which would give a
better balance to the chapters and allow sufficient space for future additions and
changes without disrupting the codes.

The alphanumeric coding scheme uses one letter followed by three numbers, at
the four character level. This has more than doubled the size of the coding frame
in comparison with the ninth revision and has enable the vast majority of chapters
to be assigned a unique letter or group of letters, each capable of providing 100
three character categories.

* Of the 26 available letters, 25 have been used – the letter U having been left
vacant for future addition and changes and for possible interim classifications
to solve difficulties
 ICD-10 is aarising between
variable revisions.
–axis classification, the epidemiological and
statistical data are grouped as follows:

• epidemic disease
• constitutional or general diseases
• local diseases arranged by site
• developmental diseases
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ICD-10 Student Manual –Department • injuriesof Health, Philippines
 THREE (3) MAIN ELEMENTS TO THE STRUCTURE
OF ICD-10
1. there are three (3) volumes
2. there are twenty-one (21) chapters
3. the structure of the code is alphanumeric

 ICD-10 is a part of the ICD Family of Classification System, which also

includes:

• Classification of Surgical Operation and Procedures

• International Classification of Diseases for Oncology (ICD-O)
• International Classification of Impairments, Disabilities and
Handicaps (ICIDH)
• International Classification of Procedures in Medicine (ICPM)
• International Coding Index for Dermatology
• Application of the International Classification of Diseases
Dentistry and Stomatology (ICD-DA)
• Application of the International Classification of Diseases to
Rheumatology and orthopedics (ICD-R & O), including the
International Classification of Musculoskeletal Disorders
(ICDMSD)
• and others

VOLUMES OF THE ICD-10

➢ VOLUME 1- Tabular List, the alphanumeric listing of diseases and disease

groups

➢ VOLUME 2- contains instructions and guidelines for Mortality and Morbidity

Coding

➢ VOLUME 3- Alphabetic Index, comprehensive listing of all conditions in the

Tabular List

CHAPTERS OF THE ICD-10

➢ ICD-10 contains 21 chapters, each of which is identified by a Roman Numeral

(e.g. I, II, III, etc.)

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ICD-10 Student Manual –Department of Health, Philippines
➢ When referring to a Chapter, one should call it by its chapter number and not by
the letters of the codes associated with it. (e.g. refer to Diseases of the Digestive
System as Chapter XI and not as the K chapter). This is because some chapter
contains more than one letter and some letters are used in more than one chapter.

STRUCTURE OF THE ICD-10 CODE:

The structure of the three (3) character category is:

A37

First character Followed by

A to Z two (2) digits
except U

The structure of the four (4) character sub-categories are:

A37.1

First character Followed by Then a point Lastly

A to Z 2 digits Another digit
except U

The preferred terminology from the International Nomenclature of Disease (IND) has
been used in category titles and inclusion terms where suitable terms are available.
Where the IND terminology is relatively new, the previously preferred terminology has
been included in the category titles in square brackets.
Reference: National Center for Classification in Health (1997), (IDC-10-AM
Implementation Kit, NCCH, Sydney)
MODULE 2:
VOLUME 1 – TABULAR LIST

 IMPORTANT POINTS FOR THIS CHAPTER:

➢ Most chapters are associated with particular body systems, special diseases or
external factors. Chapter XVIII is an exemption since it involves “Symptoms,
Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere
Classified”

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER RANGE OF
CATEGORIES
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 D50 – D89
mechanisms
IV Endocrine, nutritional and metabolic diseases E00 – E90
V Mental and behavioral 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 M00 – M99
connective tissue
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 Q00 – Q99
chromosomal abnormalities
XVIII Symptoms, signs and abnormal clinical and R00 – R99
laboratory findings, not elsewhere classified
XIX Injury, poisoning and certain other consequences of S00 – T98
external causes
XX External causes of morbidity and mortality V01 – Y98
XXI Factors influencing health status and contact with Z00 – Z99
health services

➢ Fourteen of the chapters have a single letter assigned to them and use most of
the 100 categories available. For example , Chapter XI consists of codes
ranging from K00 to K93. The codes K94 to K99 have not been used (at this
stage)

➢ Three chapters have a smaller range of categories assigned to them and share
letters.

➢ Four chapters use more than one letter in defining categories, e.g. Chapter II

EXERCISE 1:

Apart from Chapter XVIII, which chapters are used for diseases of body systems,
which to special diseases and which to external factors?

CHAPTER I _ CHAPTER XII _

CHAPTER II _________ CHAPTER XIII _________
CHAPTER III _________ CHAPTER XIV _________
CHAPTER IV _________ CHAPTER XV _________
CHAPTER V _________ CHAPTER XVI _________
CHAPTER VI _________ CHAPTER XVII _________
CHAPTER VII _________ CHAPTER XIX _________
CHAPTER VIII _________ CHAPTER XX _________
CHAPTER IX _________ CHAPTER XXI _________
CHAPTER X _________
CHAPTER XI _________

EXERCISE 2:

1. What is the range of the 3-character categories used in Chapter III?

2. One letter is split between two chapters. Which one is it?

EXERCISE 3:

1. How many letters does Chapter XX use?

Look at the titles of the chapters of the ICD-10. The chapter titles indicate that the
conditions included are wide ranging, therefore a large number of codes are required
to cover all the conditions. Using an alpha character at the beginning of the code has
allowed for 2,600 available 3 character codes. This in turn allows for a large number
of 4 character subcategories. Each character code can have up to 10 subcategories.

 CHAPTERS ARE FURTHER SUBDIVIDED INTO:

➢ BLOCKS

Each Chapter has been divided into blocks. The blocks are then divided
into three, four and five digit categories.

Example:
Chapter I “Certain Infectious and Parasitic Diseases” is divided into 21
blocks, namely:

1. Intestinal infectious diseases (A00-A09)

➢ THREE CHARACTER CATEGORIES

Within each block, some of the three-character categories are for single
conditions, selected because of their frequency, severity or susceptibility
to public health intervention, while others are for groups of diseases with
some common characteristic.

Example:
A00- Cholera
A01- Typhoid and paratyphoid fever

➢ FOUR CHARACTER CATEGORIES

Most categories are expanded by a fourth-character and occasionally by a

fifth character. A decimal point is used to separate the basic codes from its
extensions.

Example:
• A00.9 Cholera unspecified
• D64.8 Other specified anemia
• E52 Niacin deficiency is a three character code with no extension

The fourth character .8 is generally used for “other” conditions belonging to

the three-character category , and .9 is mostly used to convey the same
meaning as the three-character category title, without adding any additional
information.

Common Fourth and Fifth Character Subdivisions

There are instances within the ICD-10 where the same fourth or fifth
character subdivisions apply to a range of three or fourth character categories.
They are usually listed only once at the start of the range with a note at each
category where the details are to be found.

Example: A set of fourth character codes are to be used with F10-F19 (Mental
and Behavioral Disorders) due to psychoactive substance use to
specify the clinical state (p. 321, Vol. 1)

A set of fifth character codes are to be used in some four character

categories in Chapter XIII- Diseases of the Musculoskeletal System
and Connective Tissue, to indicate the site of Musculoskeletal

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ICD-10 Student Manual –Department of Health, Philippines
involvement (p. 628, Vol. 1) and in Chapter XX , External Causes
of Morbidity and Mortality specifically to indicate the activity code
(p. 1017, Vol. 1).

➢ CONVENTIONS

The ICD-10 Tabular List (Volume 1) makes use of certain abbreviations,

punctuations, symbols and instructional terms which must be clearly
understood. These are referred to as the coding conventions.

1. Inclusion Terms

 Within the three and four character rubrics there are usually
listed a number of other diagnostic terms. These are known as
“inclusion terms” and are given as examples of diagnostic
statements to be classified to that rubric. They may refer to
different conditions or synonyms. They are not a sub-
classification of the rubric. They are to be used as a guide to
the content of the rubric, keeping in mind that the list is not
exhaustive.

Example:
D50 Iron deficiency anaemia
Includes: anaemia:
 asiderotic
 hypochromic
G91 Hydrocephalus
Includes: acquired hydrocephalus

EXERCISE 4:

1. Does the code L03.0, Cellulitis of finger and toe include paronychia? ________

2. Exclusion Terms

 Certain rubrics contain list of conditions preceded by the word

”Excludes”. These terms are to be coded elsewhere, not
within this category as the code may suggest. The correct code
that should be assigned is in parentheses following the term.

Example:
D73.1 Hypersplenism
Excludes: Splenomegaly:
 NOS (R16.1)

Q74 Other congenital malformations of limb(s)

Excludes: polydactyly (Q69. _ )
reduction defect of limb (Q71-Q73)
syndactyly (Q70. _ )

EXERCISE 5:

1. Should reduction defects of the feet be coded within the three character category
Q66? If not, where should they be coded? ______________________________

3. Glossary Description

 Glossary descriptions are used in some chapters to indicate

accepted definitions as criteria for assigning codes from a
category. For example such definitions are found in Chapters
V, XV, and XXI. These definitions are for use of the
physician or other health care worker and are not intended for
use by the coding staff.

Example:
F22 Persistent delusional disorders
Includes a variety of disorders in which long-standing
delusions constitute the only, or the most conspicuous,
clinical characteristic and which cannot be classified as
organic, schizophrenic or affective. Delusional disorders
that have lasted for less than a few months should be
classified, at least temporarily, under F23. _.
4. Dual Coding

 The Dagger and Asterisk System

Besides the option of using the fourth and fifth characters,

another system which adds to the flexibility of the ICD-10 is
the Dagger and Asterisk system. This system provides for a
dual classification of certain diagnostic statements that include
both the generalized underlying disease and an associated
manifestation or complication. This enables a better
description of the medical care given and resources to be used
in its treatment.

The primary code is for the underlying disease and is marked

with a dagger ( †). An optional code for the manifestation is
marked with an asterisk (*).

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ICD-10 Student Manual –Department of Health, Philippines
It is a basic principle of the ICD-10 that the dagger code( †).
is the primary code and must always be used for single
condition coding. An asterisk code (*) should never be used
alone.

The asterisk codes (*) are listed at the beginning of each

chapter. These are secondary codes and, if used must be
applied with the appropriate dagger ( †) code sequenced first.

There are 83 total asterisk categories in ICD-10.

Example:
B05.2† J17.1* Measles complicated by pneumonia

EXERCISE 6:

1. How many asterisk categories are there in Chapter IX, Diseases of the
Circulatory System?

5. Parentheses ( )

 Parentheses are used in Volume 1 in four situations:

 To enclose supplementary words, which may follow a

diagnostic term without affecting the code number
which the words outside the parentheses would be
assigned

Example:
G11.1 Early onset cerebellar ataxia
Friedrich’s ataxia (autosomal recessive)

 To enclose the code to which an exclusion term refers.

Example:
B25 Cytomegaloviral disease
Excludes: Congenital cytomegalovirus
infection (P35.1)

 To enclose the three-character codes of categories in a

particular block

Example:
Disease of peritoneum (K65-K67)

Example:
K77.0* Liver disorders in infectious and parasitic
diseases classified elsewhere
Hepatitis:
 Cytomegaloviral (B25.1†)

EXERCISE 7:

1. Is N13.0 the correct code for Hydronephrosis with ureteropelvic junction

obstruction and infection? If not, what is the correct code? ___________

6. Square brackets [ ]

 Square brackets are used in the following situations:

➢ To enclose synonyms, alternative notes or explanatory

phrases.

Example:
A84.0 Far Eastern tick-borne encephalitis
[ Russian spring-summer encephalitis]

➢ To enclose a previously stated subdivision common to a

number of categories.

Example:
F10._ Mental and Behavioral disorders due to use of
alcohol
[see pages 321-323 for subdivisions]

3. To refer to a previous note.

Example:
C16.8 Overlapping lesion of stomach
[ See note 5 on page 182]

EXERCISE 8:

1. What does the note in [ ] tell us for codes in the M79 rubric?
________________________________________________

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ICD-10 Student Manual –Department of Health, Philippines
7. Colon :

 The colon [:] is used in listings of inclusion and exclusion

terms when the words that precede it are not complete terms
for assignment to the rubric.

It indicates that both the listed condition and one of its

modifiers must be present in order to complete the instruction.

Example:
G71.0 Muscular dystrophy:
autosomal recessive
benign
distal
…

8. Brace { }

 A brace is used in inclusion and exclusion terms to indicate

that neither the words that precede it nor the words after it are
complete terms.

Any of the terms before the brace should be qualified by one or

more of the terms that follow it:

Example:
I24.0 Coronary thrombosis not resulting in myocardial infarction
Coronary (artery) (vein):
• Embolism not resulting in myocardial
• Occlusion infarction
• Thromboembolism}

9. Point dash

 A point dash is used to indicate that there exist a fourth

character subdivision.

Example:
F11._ Mental and behavioral disorders due to use of opioids
[ See pages 321-323 for subdivisions]

10. NOS

 NOS is an abbreviation for “Not Otherwise Specified”. It is

used when an assumption of the cause cannot be made and it
is quite clear that no information is available in the medical

Example:
K14.9 Disease of tongue, unspecified
Glossopathy NOS

11. NEC

 NEC stands for “Not Elsewhere Classified”. When in a three

character category title, NEC serves as a warning that certain
specified variants of the listed conditions may appear in other
parts of the classification. It alerts the coder to review other
index entries to make sure that a more specific code is not
available.

Example:
K73.2 Chronic active hepatitis, not elsewhere classified
Lupoid hepatitis NEC

11. OTHER RELATIONAL TERMS:

➢ “AND”

In ICD-10, “and” stands for “and/or”

Example:
S49.9 Unspecified injury of shoulder and upper arm
This means unspecified injury of shoulder or unspecified
injury of upper arm or unspecified injury of shoulder and
upper arm

➢ “WITH” , “WITH MENTION OF”, “ASSOCIATED

WITH”, AND “IN”

These terms indicate that both elements in the title must be

present in the diagnostic statement in order to assign the code.
These terms do not necessarily indicate a cause-effect
relationship

Example:
J65 Pneumoconiosis associated with tuberculosis
E50.2 Vitamin A deficiency with corneal xerosis
G99.0* Autonomic neuropathy in endocrine and metabolic
Disease

These terms indicate a category in which the named element

must not be present.

Example:
I11.9 Hypertensive heart disease without (congestive) heart
failure

➢ “DUE TO” and “RESULTING IN”

These terms indicate a causal relationship between the

elements in the title and require the health care practitioner to
record enough information in the case record to show a cause-
effect relationship. This may be clear in the diagnostic
statement or in combinations of conditions.

Example:
B21.0 HIV disease resulting in Kaposi’s sarcoma
J62 Pneumoconiosis due to dust containing silica

➢ CORRECTION

There have been some corrections to the tabular list which have been
included in a corrigenda at the back of Volume 3.

Example:
Page 151 (Vol. 1) , category B07:
Replace bladder (D30.3) by bladder (D41.4)

 IMPORTANT POINTS FOR THIS CHAPTER:

➢ Volume 3 is an alphabetical index to the Tabular Listing of Volume 1.

➢ Volume 3 consists of:

• An Introduction, explaining the purpose of the index, its general
arrangement and conventions used in the index

• Three Sections, namely:

○ Section I- an alphabetical listing of terms relating to
diseases, nature of injury, reasons for contact with
health services and factors influencing a person’s
health
○ Section II- an alphabetical listing of external causes of injury,
morbidity and mortality
○ Section III- an alphabetically arranged table of drugs and
chemicals

EXERCISE 1:

Link the Sections of Volume 3 with the corresponding Chapters in Volume 1.

Volume 3 Volume 1

Section I _Chap 1-19,21__________

Section II _chap 22_________________

Section III chap 19-20________________

➢ INDEX ENTRIES:

Index entries in the Alphabetical Index contain:

• Lead terms

These are usually nouns to the far left of each column, in bold letters.
They refer mainly to diseases or conditions.

• Modifiers

These are terms located at different levels of indentation to the right.

They usually refer to varieties of sites or circumstances that affect
coding. Modifiers that do not affect code assignment appear in
parentheses ( ) after the condition. All modifiers appear in
alphabetical order except “with” which always appears first.

Code numbers follow the terms in the index and may appear as a
three-digit category or be subdivided with either the appropriate 4th
digit or a point dash (.-). Where the dual system of coding († and *)
applies, both codes are given in the index.

Example:
Hepatitis K75.9
- viral, virus (acute) B19.9
- - with hepatic coma B19.0
- - chronic B18.9
- - - specified NEC B18.
- - - type
- - - - B B18.1
- - - - - with delta-agent B18.0

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ICD-10 Student Manual –Department of Health, Philippines
• If the lead term cannot be located in the Index, there are a number of
standard ways to find the codes using the following “generic” lead
terms.
disease injury
complication sequelae
syndrome suicide
pregnancy legal intervention
labor war operational
delivery counseling
puerperal observation
examination history
problem screening
vaccination
maternal conditions affecting fetus or newborn

EXERCISE 2:
Identify the lead term and the modifier in the diagnosis Chronic Bronchitis.
_____lead term: bronchitis, modifier: chronic_____________________________

EXERCISE 3:

Look up for the appropriate code of the following conditions in Volume 3

(Alphabetical Index)

Code
Laryngotracheobronchitis _______________
Hippel’s Disease ____Q85.8 p.266_
Anesthesia overdose ____T41 P45_____
Mumps with orchitis __b26.3__n51.1* p.362

NOTE: American spelling is used throughout Volume 3,with cross references

wherever diphthongs appear at the beginning of a term . However, in
Volume 1 so-called English spelling is used.

➢ CONVENTIONS

• Parentheses ( )
Parentheses in Volume 3 are used in the same way as in Volume 1, to
enclose non-essential modifiers.

Example:
Dermatitis L30.9
- due to
- - cosmetics (contact) L25.0

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ICD-10 Student Manual –Department of Health, Philippines
• NEC
“Not elsewhere classified” indicates that specified variants of the listed
conditions are classified elsewhere, and that where appropriate, a more
precise term should be looked for in the Index.

Example:
Trophoneurosis NEC G96.8

Deprivation (effects) T73.9

- emotional NEC Z65.8

• Cross References

Cross references are used to avoid unnecessary duplication of terms in

the Index

“See” requires the coder to refer to the other suggested term; this
must be followed to locate the correct code .

Example:
Ingestion
- chemical – see Table of Drugs and Chemicals

“See also” directs the coder to consider another main term within the
index which may provide the specificity required.

Example:
Injury (see also specified injury type) T14.9

* It is imperative that both Volumes 1 and 3 be used together in locating

codes to accurately describe each clinical case – coders should not fall into
the trap of coding straight from the Alphabetical Index

EXERCISE 4:
1. Assign codes for the following conditions using Volume 3 and Volume 1

Condition Code from Volume 3 Code from

Volume 1

a. Acute cystitis, with

Urolithiasis ____ N20.9 P 83__ N20.9 P 689

b. Triplet delivery, one

mid-forceps, two
by emergency cesarean

➢ CORRECTIONS:

* Lead Term: Biventricular Failure (heart) (p. 73, Alphabetical Index)

change I50.9 to I50.0

* Lead Term: Failure (p. 219, Alphabetical Index)

- Biventricular
change I50.9 to I50.0 MODULE 4:
BASIC CODING GUIDELINES

When coding one must use the Alphabetical Index as well as the Tabular List.
The following guidelines should be followed when coding using ICD-10:

1. Identify the type of statement to be coded and refer to the appropriate section
of Volume 3 (Alphabetical Index);

- if the statement is a disease or injury or other condition classifiable to

Chapters I – XIX or XXI, refer to Section I of the Index
- if the statement is an external cause of injury or other event classifiable to
Chapter XX, refer to Section II
- if the statement is an external cause but specific to drugs, chemicals and
other substances, refer to Section III

2. Locate the lead term in the Alphabetical Index (Volume 3). Lead terms are
usually nouns rather than adjectives or the anatomical site, although a few
adjectives and eponyms are indexed as lead terms.

3. Read and be guided by any note that appears under the lead term.

4. Read any terms enclosed in parentheses after the lead term as well as any
terms indented under the lead term, until all the terms in the diagnostic
statements have been located.

5. Follow carefully any cross-references found in the Index.

6. Refer to Volume 1 (Tabular List) to verify the suitability of the code selected.

7. Be guided by any inclusion or exclusion terms under the selected code or

under the chapter, block or category heading.

8. Assign the code. Be sure to list the main condition code first for morbidity
coding and the underlying cause code for mortality coding.

EXERCISE 1:

Hemorrhagic ulcer of the duodenum ___________________

MODULE 5:
OVERVIEW OF MORBIDITY CODING

This module covers the coding of non-fatal conditions and other reasons for contact with
health services.

Prior to 1948, the International Classification of Diseases was used only for mortality
coding. With the 6th revision of ICD in 1948 came the recognition of its potential for
morbidity coding. The 6th revision then became an expanded version which included
codes for non-fatal conditions. This has continued ever since- there has been a steady
increase in the number of categories for coding non-fatal conditions and other health-
related circumstances.

For the purposes of ICD, the term MORBIDITY means:

➢ illness, injuries and reasons for contact with health services including
screening and preventive care
➢ coding usually relates to an episode of health care in an institution
➢ may also apply to surveys

Morbidity usually relates to single episode of health care. An episode of health care may
be defined as:

➢ A period of inpatient care;

➢ A contact (or series of contacts in a specific time period) with a health care
practitioner in relation to the same condition or its immediate
consequences

EXERCISE 1:

A 75 year old woman admitted for cataract extraction (ophthalmology specialty). The
procedure was performed but the patient had a fall a few days following surgery. She
suffered a fracture hip and remained in hospital for treatment (orthopedic specialty).
How many episodes of care occurred during this admission?

➢ SOURCES OF MORBIDITY DATA

○ Hospital records
○ School medical records
○ Death certificates
○ Armed services
○ Occupational medical records
○ Health surveys
○ Outpatient records (ambulatory care)
○ Maternal and child health services records
○ Recording of occurrence of “sentinel” conditions such as congenital
anomalies, communicable diseases, etc.
○ Cancer and chronic disease registry records
○ Follow-up of people born at a specific time, those who have suffered from a
specific ”index” disease or injury
○ Other

➢ USES OF MORBIDITY DATA

○ Provides clues for causes of disease

○ Evaluation of previous treatments
○ Review of previous public health initiatives or programs
○ Aids services planning decisions

➢ CENTRAL CONCEPTS

○ At the end of an episode of care, the clinician should record ALL conditions
which affected the patient in the episode
○ Depending on policy, one or all diagnoses will be coded
○ There may be sound reasons for only single-condition coding policy
○ Even with single-condition coding, a choice must be made between all the
diagnoses for the main condition

Section 4.4 Volume 2 (page 96) concerns the rules and guidelines adopted by
the World Health assembly regarding the selection of a single cause or
condition for routine tabulation from morbidity records, and also guidelines
for the application of the rules and for coding of condition selected for
tabulation. The following is an excerpt from this section – you should read
the entire section to ensure you understand the WHO requirements for
morbidity coding.

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 The condition to be used for single-condition morbidity analysis is the
main condition treated or investigated during the relevant episode of
health care.
 The main condition is defined as the condition, diagnosed at the end of
the episode of health care, primarily responsible for the patient’s need
for treatment or investigation.
 If there is more than one condition, the one held most responsible for
the greatest use of resources should be selected.
 If no diagnosis was made, the main symptom, abnormal finding or
problem should be selected as the main condition.
 By limiting the analysis to a single condition for each episode, some
available information may be lost. It is therefore recommended,
where practicable, to carry out multiple condition coding and analysis
to supplement the routine data.

○ Clinicians and coders will have no trouble in choosing a main condition if the
patient is treated for only one condition during an episode of care but many
cases are not that simple

○ What distinguishes the main condition (MC) from the rest of the recorded
conditions?
 The main condition is the diagnosis established at the end of the
episode of health care to be the condition primarily responsible for the
patient receiving treatment or being investigated .

○ What then are other conditions (OC) which might be coded?

 Other conditions are identified as those that coexist or develop during
the episode of health care and affect the management of the patient.

○ What does “affect the management of the patient” mean?

 For coding purposes, other conditions may be interpreted as those that
affect the patient in terms of requiring any of the following:
➢ clinical evaluation
➢ therapeutic treatment
➢ diagnostic procedures
➢ extended length of hospital stay
➢ increased nursing care and/or monitoring

➢ RULES FOR RESELECTION OF MAIN CONDITION

○ 5 reselection rules available

○ to be used when:
 the condition selected by the clinician is not consistent with the WHO
definition
 no main condition has been specified

MB1- Minor condition recorded as “main condition”, more

significant condition recorded as “other condition”

☛ Reselect the more significant condition as the Main

Condition (MC)

Example:
MC Epilepsy
OC Otomycosis
Specialty Ear, nose and throat

Reselect otomycosis as the main condition and code to

B36.9† H62.2*.

EXERCISE 2:
MC Gastritis
OC Carcinoma of the intestine
Proc Colectomy
LOS 5 weeks

MC= ________________________________
ICD-10 code= ________________________________

EXERCISE 3:

MC Impacted wisdom tooth

OC Hypertensive heart disease
Neuralgia
Halitosis
Proc Dental extraction
Spec Dentistry
LOS 2 days

MC= ________________________________
ICD-10 code= ________________________________

MB2- Several conditions recorded as main condition

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☛ If other information on the record points to one of the
conditions as the main condition, select that condition
☛ Otherwise, select the first mentioned condition

Example 1:
MC Cataract
Staphylococcal meningitis
Ischaemic heart disease
OC -
Patient in hospital for 5 weeks
Specialty Neurology
Select staphylococcal meningitis as the “main condition” and code
to G00.3

Example 2
MC Mitral stenosis
Acute bronchitis
Rheumatoid arthritis
OC -
Specialty General Medicine
No information about therapy

Select mitral stenosis, the first-mentioned condition, as the “main

condition” and code to I05.0

EXERCISE 4:

MC Bilateral bunions
Secondary lesion, lymph node
Cancer of the breast
Proc Mastectomy

MC= ________________________________
ICD-10 code= ________________________________

EXERCISE 5:
MC Premature rupture of membranes
Breech presentation
Anemia in pregnancy
Proc Spontaneous vaginal delivery
MC= ________________________________
ICD-10 code= ________________________________
MB3- Condition recorded as “main condition” is presenting
symptom of diagnosed, treated condition

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☛ If a symptom or a sign (usually classifiable to Chapter
XVIII), or a problem classifiable to Chapter XXI, is
recorded as the “main condition” and this is obviously the
presenting sign, symptom or problem of a diagnosed
condition recorded elsewhere and care was given for the
latter, reselect the diagnosed condition as “the main
condition”

Example 1:
MC Abdominal pain
OC Acute appendicitis
Procedure Appendectomy

Reselect acute appendicitis as the “main condition” and code to

K35.9

Example 2:
MC Hematuria
OC Varicose veins of legs
Papillomata of posterior wall of bladder
Treatment Diathermy excision of papillomata
Specialty Urology

Reselect papillomata of posterior wall of bladder as the main

condition and code to D41.4

EXERCISE 6:

MC Coma
OC Ischemic heart disease
Otosclerosis
Diabetes mellitus, insulin dependent
Specialty Endocrinology
Care Establishment of correct dose of insulin

MC= ________________________________
ICD-10 code= ________________________________

EXERCISE 7:

MC Feacal incontinence
OC Angina
Crohn’s disease, large intestine

MC= ________________________________
ICD-10 code= ________________________________

MB4 Specificity

☛ Where the diagnosis recorded as the “main condition”

describes a condition in general terms, and a term that
provides more precise information about the site or nature
of the condition is recorded elsewhere, reselect the latter as
the “main condition”.

Example:
MC Congenital heart disease
OC Ventricular septal defect

Reselect ventricular septal defect as the “main condition” and code

to Q21.0

EXERCISE 8:

MC Cerebrovascular accident
OC Diabetes mellitus
Hypertension
Cerebral hemorrhage

MC= ________________________________
ICD-10 code= ________________________________

MB5 Alternative Main Diagnoses

☛ Where a symptom or sign is recorded as the “main

condition” with an indication that it may be due to either
one condition or another, select the symptom as the “main
condition”.
☛ Where two or more conditions are recorded as diagnostic
options for the “main condition”, select the first condition
recorded

Example:
MC Headache due to either stress and tension or acute
sinusitis
OC -

EXERCISE 9:

MC Nausea and vomiting due to food poisoning or appendicitis

OC -

MC= ________________________________
ICD-10 code= ________________________________

EXERCISE 10:

MC Acute cholecystitis or acute pacreatitis

OC -

MC= ________________________________
ICD-10 code= ________________________________

EXERCISE 11:

MC Gastroenteritis due to Salmonella or Yersinia

OC -

MC= ________________________________
ICD-10 code= ________________________________

➢ GUIDELINES FOR CODING OF MAIN AND OTHER CONDITIONS

☛ MC should be selected by clinician at the end of episode of care –

if necessary by coder, applying the rules for reselection.

☛ Once MC is selected, the case maybe coded according to normal coding

procedures and the policies of the establishment

☛ The sequence to follow for morbidity coding is:

ALL cases SINGLE-CONDITION MULTIPLE CONDITION

CODING CODING
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Code MC + other conditions
Select MC Code MC (OC)
☛ Where practicable, other conditions should be recorded, even when single-cause
coding is employed so that coder is aware of the complete clinical picture of the
case.

➢ OPTIONAL ADDITIONAL CODES

☛ Note: ICD-10 sometimes indicates when condition can be made more

specific by the addition of another code, e.g. with note such as use
additional external cause code, if desired to identify cause.

Example:

Acute pulmonary edema due to exposure to sulphur dioxide fumes

MC Acute pulmonary edema Code: J68.1

OC Accidental poisoning by and exposure to other X47.99
gases and vapours

* Instruction under J68 states ”use additional external cause code (Chapter XX), if
desired to identify cause.

☛ Coding of conditions to which the dagger and asterisk system applies (dual
system of coding)

Example:

MC Post chicken pox encephalitis

ICD-10 code: B01.1† G05.1*
* The dagger and asterisk code should be used together, where possible because they
describe different aspects of the condition. The dagger code is the preferred main
condition.

See page 100 of Volume 2 for further details

☛ External causes of morbidity and injuries

Injuries may be classified by their nature (Chapter XIX) and by the external cause
that led to the injury (Chapter XX). Both codes should be used but the nature of
injury code is the preferred “main condition” for morbidity coding.

Example:

Fracture of skull – motorcycle passenger in head –on collision with a pick-up truck.

See page 103 of Volume 2 for further details.

☛ Sequelae (Late effects) of certain conditions

The ICD-10 provides a number of categories called “sequelae of… “, that may be
used to indicate conditions which are no longer present but are the cause of a
current problem now under treatment. Such terms as “old”, “no longer present”,
healed or “late effect” may be used to designate “sequelae of … “ conditions.
There is no minimum time interval regarding when a disease may no longer be
present but is still responsible for the current condition under treatment.

The preferred code for the main condition is the nature of the sequelae itself with
the sequelae code assigned as an additional code.

Example:

Entropion due to old inactive trachoma

MC Entropion Code: H20.0

OC Sequelae of trachoma B94.0

See page 104 of Volume 2 for further details

☛ Coding of suspected conditions, unexplained symptoms and abnormal

findings and non-illness situations

Codes from Chapters XVIII and XXI should only be used if the clinician is unable
to describe the case more specifically. If, after an episode of health care, the
“main condition” is still recorded as “suspected” , “questionable” etc.., and there
is no further information or clarification, the suspected diagnosis must be coded
as if it is a certain diagnosis.

Example:

Suspected intracranial space-occupying lesion (abnormal Skull X-Ray)-not yet diagnosed

MC Abnormal findings on diagnostic Code: R90.0

imaging of central nervous system-

See page 100 of Volume 2 for further details

☛ Multiple conditions

Where multiple conditions are recorded in a category entitled “Multiple …”, and
no single condition predominates, the code for the “Multiple…” category should
be used as the preferred code, and optional additional codes may be added for
individual conditions listed.

Such coding applies mainly to conditions associated with HIV disease, to injuries
and sequelae.

Example:

Pneumocystis carinii pneumonia

Tuberculosis Due to HIV
Dementia

Single condition coding:

MC Pneumocystis carinii pneumonia Code: B20.6
resulting from HIV
OC Tuberculosis resulting from HIV B20.0
Dementia resulting from HIV B22.0

Multiple condition coding:

MC HIV resulting in multiple Code: B22.7
disease classified elsewhere
OC Pneumocystis carinii pneumonia B20.6
resulting from HIV
Tuberculosis resulting from HIV B20.0
Dementia resulting from HIV B22.0

See page 101 of Volume 2 for further details

☛ Combination categories

This is where the presence of two or more conditions (or a condition plus
associated conditions) can be represented by one code.

The Alphabetical Index indicates where such combinations are provided for,
under the indent” with”, which appears immediately after the lead term. Two or

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more conditions recorded under “main condition” may be linked if one of them
may be regarded as an adjectival modifier of the other.

Example 1:
Viral hepatitis B with hepatic coma

MC Acute Hepatitis B without delta- Code: B16.2

agent with hepatic coma

Example 2:
Kyphoscoliosis with related heart disease

MC Kyphoscoliotic heart disease Code: I27.1

See page 101 of Volume 2 for further details

☛ Acute and chronic conditions

Where the patient is suffering from an acute exacerbation of a chronic illness and
there is no combination category available, the acute aspect of the condition
should be assigned as the preferred main condition , with the chronic aspect as
an optional additional code.

Example 1:
Acute and chronic cholecystitis

MC Acute cholecystitis Code: K81.0

OC Chronic cholecystitis K81.1
Example 2:
Acute or chronic appendicitis
MC Acute appendicitis Code: K35.9
OC Chronic appendicitis K36

☛ Postprocedural conditions and complications

Categories are provided in Chapter XIX (T80-T88) for certain complications

related to surgical and other procedures. Complications coded here generally
affect the whole body. Other categories are also provided near the end of most
body system chapters for conditions which occur either as a consequence of
specific procedures and techniques or as a result of the absence of an organ or
which affect a specific body system.

Post-procedural conditions or complications are defined as:

-Conditions caused by acquired absence of an organ

-Any conditions resulting from surgical procedures
-After effect of radiotherapy or similar treatment

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Some conditions are common post-procedurally. They are coded in the normal
way but an additional code may be used to identify the relationship of the
condition to a previous procedure. Additional codes from Chapter XX (Y83 and
Y84) may be assigned.

When a post-procedural condition or complication is recorded as the main

condition, it is necessary that coders refer to modifiers in the Alphabetical Index
to be able to assign the correct code.

Example:
Post-gastrectomy dumping syndrome

MC Postgastric surgery syndrome Code: K91.1

➢ SPECIFIC NOTES

Section 4.4.4 on p. 112 of Volume 2 contains specific guidance notes for each
Chapter of ICD-10. Volume 1 (Tabular List) refers the coder to these notes where
they apply to a code. Where the coder comes across such a reference, he/she should
read the relevant note in Section 4.4.4 of Volume 2 before assigning the code.

The general guidelines and rules as discussed previously apply to all chapters unless
a specific chapter note states otherwise.

MODULE 6:
OVERVIEW OF MORTALITY CODING

 IMPORTANT POINTS FOR THIS CHAPTER:

➢ The International Classification of Diseases has its origin in the preparation of

mortality statistics.

➢ Death certificates are the main source of mortality data. Information on the
death certificates may be provided by either a health practitioner or in the case
of accidents or violent deaths a coroner. In some jurisdiction, another official
(who may not be medically trained) is responsible for the completion of the
medical certificate of cause of deaths.

➢ The person certifying the cause of death will enter the sequence of events
leading to the death on the death certificate in international format.

See page 31 of Volume 2 for further information

Cause of death Approximate

interval between
onset and death
I
Disease or condition directly (a) ………………………………….. ………………..
leading to death *
due to (or as a consequence of)

Antecedent causes (b) …………………………………... …………………

Morbid conditions, if any,
giving rise to the above cause, due to (or as a consequence of)
stating the underlying
condition last (c) ……………………………………. ………………….

due to (or as a consequence of)

(d) …………………………………… ………………….

II
Other significant conditions ……………………………………….. ………………….
contributing to death, but
not related to the disease or
condition causing it ………………………………………. ………………….

*This does not mean the mode of dying, e.g. heart failure, respiratory failure.
It means the disease, injury, or complication that caused death
➢ It is recommended that, where practicable, a separate certificate should be used to
record perinatal death. An international format is also recommended for this
certificate.

EXERCISE 1:

Mortality data in the form of ICD codes, is mainly used for a particular purpose. Is it:

a. analysis of current causes of death?

b. management of public health?
c. prevention of major causes of death?

Ans. _________________________________________________________________

CONCEPT OF UNDERLYING CAUSE OF DEATH

Many deaths certificates give only single cause of death. These are relatively simple to
deal with and all you have to do is code the single cause.

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However, in many other cases, 2 or more morbid conditions contribute to death. These
must all be recorded on the certificate. In such cases, it has been the practice in vital
statistics to select one of the causes of death for coding purposes. This single cause is
usually given the special name “UNDERLYING CAUSE OF DEATH”.

The concept of the “underlying cause of death” is central to mortality coding.

The World Health Organization (WHO) has defined the underlying cause of death as:

➢ The disease or injury which initiated the train of morbid events leading directly to
death; or
➢ The circumstances of the accident or violence which produce the fatal injury.

Therefore, the “underlying cause of death” is the condition, event or circumstances

without which the patient would not have died.

For example, a cancer patient dies and the immediate cause of death was heart failure
resulting from carcinomatosis. However, the original neoplasm site was colon. The
sequence would be malignant neoplasm resulting in carcinomatosis resulting in heart
failure. In this example, the heart failure was the final morbid event in the sequence,
starting with cancer of the colon. The malignant neoplasm of the colon is the condition
to be coded as the “underlying cause of death”.

EXERCISE 2:

Coma resulting from subdural hematoma after a fall at work.

What would be the underlying cause of death ?
Ans. __________________________________________

By the time the death certificate reaches you for coding, the health care practitioner or
certifier should have recorded:

➢ The sequence of morbid events leading to death

➢ The original cause of the sequence

Preferably the death certificate used should be the international form recommended by
the WHO. This has 2 parts.

➢ Part I - is used for diseases related to the sequence of events leading

directly to the death
➢ Part II- is used for unrelated conditions which have no direct connection
with the events leading to death but which , by their nature,
contributed to death.

EXERCISE 3:

Where do you think the underlying cause of death should be entered on the death
certificate shown on the first page of this module?

Where two or more conditions must be recorded, the certifying practitioner should record
the sequence of events leading to death. Each event in the sequence should be recorded
on the separate line, in reverse order.

➢ The direct cause of death is entered on the first line

➢ The underlying cause of death is entered on the lowest used line
➢ Any intervening causes are entered on the lines between the first line and the
lowest used line.

The complete certificate therefore contains the following information:

I (a) Direct cause

(b) Intervening cause of (a)
(c) Intervening cause of (b)
(d) Originating cause of (c)

In terms of the previous example on heart failure, carcinomatosis and cancer of the colon,
the completed certificate would look like this:

I (a) Heart failure

(b) Carcinomatosis
(c) Cancer of the colon

There are two ways of classifying injuries:

➢ By the nature of injury (Chapter XIX)
➢ By the external cause resulting in the injury (Chapter XX)

For mortality coding, it is the external cause that should be used for single-cause coding
and tabulation of the underlying cause of death.

 The codes for external causes (V01-Y89) should be used as the primary codes for single-
condition coding and tabulation of the underlying cause when and only when, the morbid
condition is classifiable to Chapter XIX. When the morbid condition is classified to
Chapters I-XVIII, the morbid condition itself should be coded as the underlying cause and
categories from Chapter for external cause may be used as supplementary codes.

It should be noted that while most of the ICD is used for coding underlying cause of
death, there are particular section and codes that should NOT be used for this purpose.
For example NO asterisk codes should be used for coding underlying cause of death.

SUMMARY OF CODES NOT TO BE USED IN UNDERLYING CAUSE MORTALITY CODING *

Codes not to be used for Not to be used if the underlying cause is

underlying cause mortality known
coding (code to item in
parentheses; if no code is
indicated, code to R99)

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B95-B97 F01-F09
E89._ F70-F79
G97._ G81._
H59._ G82._
H95._ G83._
I15._ H54._
I23._ (code to I21 or I22) H90-H91
I24.0 (code to I21 or I22) N46
I65._ (code to I63) N97._
I66._ (code to I63) O30._
I97._ P07._
J95._ P08._
K91._ T79._
M96._
N99._
O08._
O80-O84 (code to O75.9)
R69._ (code to R95-R99)
S00-T98 (code to V01-Y89)
Y90-Y98
Z00-Z99
* ICD-10 Volume 2, p. 66

EXERCISE 4:
Find the following examples of sections/blocks/categories that should not be used as
underlying cause of death:

B95-B97 ___________________________________________________
G97, H95, N99 ___________________________________________________
O80-O84 ___________________________________________________
S00-T98 ___________________________________________________

PROCEDURES FOR SELECTION OF THE UNDERLYING CAUSE OF DEATH

FOR MORTALITY TABULATION

➢ When only one cause of death is reported, this cause is used for tabulation.
➢ When more than one cause of death is recorded, the first step in selecting the
underlying cause is to determine the originating antecedent cause proper to the
lowest used line in Part I of the certificate by application of the General Principle
or of selection rules 1,2, and 3.
➢ In some circumstances the ICD allows the originating cause to be superseded by
one or more suitable for expressing the underlying cause in tabulation. For
example, there are some categories for combinations of conditions, or there
maybe overriding epidemiological reasons for giving precedence to other
conditions on the certificate.
➢ The next step is to determine whether one or more of the modification rules A to
F, which deal with the above situations, apply. The resultant code number for
tabulation is that of the underlying cause.
➢ Where the originating antecedent cause is an injury or other effect of an external
cause classified to Chapter XIX, the circumstances that gave rise to that condition

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ICD-10 Student Manual –Department of Health, Philippines
should be selected as the underlying cause for tabulation and coded to V01-Y89.
The code for the injury or effect may be used as an additional code.

SELECTING THE UNDERLYING CAUSE OF DEATH

The World Health Organization has defined a set of procedures or coding rules to be
followed for coding the underlying cause of death. This series of steps will be outlined in
the following pages. The rules should be applied in a logical sequence beginning with
the General Principle.

➢ GENERAL PRINCIPLE

When more than one condition is entered on the certificate, the condition entered
alone on the lowest used line of Part I should be selected only if it could have
given rise to all the conditions entered above it.

Example:

I (a) Abscess of lung

(b) Lobar pneumonia

Select lobar pneumonia (J18.1) as the underlying cause , the lung abscess could
have been the result of the lobar pneumonia.

EXERCISE 5:
Select the underlying cause, applying the General Principle

I (a) Hepatic failure

(b) Bile duct obstruction
(c) Carcinoma of head of pancreas

Ans. _____________________________________________________________

In about 25% of cases the General Principle cannot be applied for some reason.
Rules 1,2 and 3 need to be applied.

➢ RULE 1

If the General Principle does not apply and there is a reported sequence
terminating in the condition first entered on the certificate, select the originating
cause of this sequence. If there is more than one sequence terminating in the
condition mentioned first, select the originating cause of the first-mentioned
sequence

Select atherosclerotic heart disease. The reported sequence terminating in the

condition first-mentioned on the certificate is acute myocardial infarction due to
atherosclerotic heart disease.

EXERCISE 6:
Select the underlying cause of death
I (a) Pericarditis
(b) Uraemia and pneumonia

Ans. ________________________________________________________

If there is no logical sequence, RULE 2 should be applied.

➢ RULE 2

If there is no reported sequence terminating in the condition first entered on the

certificate, select this first-mentioned condition.

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.

EXERCISE 7:

Select the underlying cause of death:

I (a) Fibrocystic disease of the pancreas

(b) Bronchitis and bronchiectasis

Ans. ________________________________________________________________

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ICD-10 Student Manual –Department of Health, Philippines
In some cases there is a condition reported in Part I or II that has not been selected
using the General Rule or Rule 1 or 2, but which could have obviously caused the
other conditions on the certificate. In these cases RULE 3 should be applied.

➢ RULE 3

If the condition selected by the General Principle or by Rule 1 or Rule 2 is

obviously a direct consequence of other reported condition, whether in Part I or
Part II, select this primary condition.

Example:
I (a) Bronchopneumonia
II Secondary anemia and chronic lymphatic leukemia

Select chronic lymphatic leukemia. Bronchopneumonia selected by the General

Principle and secondary anemia can both be considered direct sequels of chronic
lymphatic leukemia.

EXERCISE 8:

Select the underlying cause of death.

I (a) Nephrectomy
II Clear Cell carcinoma of kidney

Ans. _______________________________________________________________

In some cases the underlying cause that has been selected using the above rules is not
the most useful or informative, e.g. 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, 2, and 3 have been applied.

➢ MODIFICATION RULES

○ RULE A: SENILITY AND OTHER ILL-DEFINED

CONDITIONS

Where the selected cause is classified to Chapter XVIII (Symptoms, Signs

and Abnormal Clinical and Laboratory Findings, Not Elsewhere
Classified) except for R95 (Sudden infant death syndrome), and a
condition classified elsewhere than to R00-R94 or R96-R99 is reported on
the certificate, reselect the cause of death as if the condition classified to
Chapter XVIII had not been reported, except to take account of the
condition if it modifies the coding.

Code to rheumatoid arthritis . Senility , selected by Rule 2, is ignored and

General Principle applied

EXERCISE 9:

Select the underlying cause of death

I (a) Myocardial degeneration and emphysema

(b) Senility

Ans. ________________________________________________________________

○ RULE B: TRIVIAL CONDITIONS

Where the selected cause is a trivial condition unlikely to cause death, and
a more serious condition is reported, reselect the underlying cause as if the
trivial condition had not been reported. If the death was the result of an
adverse reaction to treatment of the trivial condition, select the adverse
reaction.

Example:
I (a) Dental caries
II Cardiac arrest

Code to cardiac arrest. Dental caries , selected by the General Principle is

ignored, as it may be considered a trivial condition

EXERCISE 10:

Select the underlying cause of death

I (a) Ingrowing toenail and acute renal failure

Ans. _______________________________________________________________

Where the selected cause is linked by a provision in the classification or in

the notes for use in underlying cause mortality coding with one or more of
the other conditions on the certificate, code the combination.

Where the linkage provision is only for the combination of one condition
specified as due to another, code the combination only when the correct
causal relationship is stated or can be inferred from application of the
selection rules.

Where a conflict in linkage occurs, link with the condition that would have
been selected if the cause initially selected had not been reported. Make
any further linkage that is applicable.

Example 1:
I (a) Tuberculosis (A15._, A16._)
(b) Anthracosis (J60)

Code to Pneumoconiosis associated with tuberculosis (J65). Antrhacosis

links with tuberculosis (see Section 4.1.11, Volume 2)

Summary of linkages by code number

Selected cause With mention of: As cause of: Resulting linked code
A00-B19
B25-B99 C00-C97 C00-C97
A15,-, A16.- J60-J64 J65
A17.-, A18.- A15.-, A16.- A15.-, A16.-
A39.2-A39.4 A39.0, A39.1 A39.0, A39.1
E86 A00-A09 A00-A09
F10-F19 (F1x.0) F10-F19 (F1x.2) F10-F19 (F1x.2)
(F1x.5)
F10 K70.- K70.-
F10.2 F10.4, F10.6 F10.4, F10.6,
F10.7 F10.7
F17.- C34.- C34.-
I20-I25 I20-I25
J40-J47 J40-J47
G25.5 I00-I02 I02.-
I05-I09 I02.-
I05.8
I05.9

Selected cause With mention of: As cause of: Resulting linked

code
I09.1
I09.9 I05-I08 I05-I08
I10 I11.- I11.-
I12.- I12.-
I13.- I13.-
I20-I25 I20-I25
I60-I69 I60-I69
N00.- N00.-
N01.- N03-N05
N03-N05 I12.-
N18.- I12.-
N19 I12.-
N26 I12.-
H35.0 H35.0
I05-I09
(not specified as
rheumatic) I34-I38
I34-I38 I34-I38
I50.- I11.0
I51.4-I51.9 I11.-
I11.- I12.- I13.-
I13.- I13.-
I20-I25 I20-I25
N18.- I13.-
N19 I13.-
N26 I13.-

I12.- I11.- I13.-

I13.- I13.-
I20-I25 I20-I25
I50.- I13.0
I51.4-I51.9 I13.-
I13.- I20-I25 I20-I25
I20.-
I24.- I21.- I21.-
I25.- I22.- I22.-

I21.- I22.- I22.-

I27.9 M41.- I27.1
I44-I50 B57.- B57.-
I51.4-I51.9 I20-I25 I20-I25
I50.-
I51.9 M41.- I27.1
I50.9
I51.9 J81 I50.1
I67.2 I60-I64 I60-I64
F03 F0-1.-
G20 G20
I70.- I10-I13 I10-I13
I20-I25 I20-I25
I51.4 I51.4
I51.5 I51.5
I51.6 I51.6
I51.8 I51.8
I51,9 I51.9
I60-I69 I60-I69

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ICD-10 Student Manual –Department of Health, Philippines
I05-I09
(not specified as
rheumatic) I34-I38
I34-I38 I34-I38
I71-I78 I71-I78
K55.- K55.-
N26 I12.-
I70.2
I70.9 R02 F03 F01.-
G20 G20

Selected cause With mention of: As cause of: Resulting linked

code
J00
J06.- G03.8 G03.8
G06.0 G06.0
H65-H66 H65-H66
H70.- H70.-
J10-J18 J10-J18
J20-J21 J20-J21
J40-J42 J40-J42
J44.- J44.-
N00.- N00.-
J20.- J41.- J41.-
J42 J42
J44.- J44.-
J40
J41.- J43.- J44.-
J42 J44.- J44.-
J45.- J44.-
J43.- J40 J44.-
J41.- J44.-
J42 J44.-
J60-J64 A15.- J65
A16.- J65
J81 I50.9 I50.1
M41.- I51.9 I50.1
I27.1
I27.1
N00.- N03.- N03.-
N18.-
N19.-
N26 I10 I12.-
I11.- I13.-
I12.- I12.-
O32.- O33.- O33.-
O33.9 O33.0-O33.3 O33.0-O33.3
O64.- O65.- O65.-
S06.- S02.- S02.-
T36-T50 F10-F19 (Flx.2) F10-F19 (Flx.2)
V01-X59 A35 A35
X40-X49
Y10-Y15 F10-F19 (Flx.2) F10-F19 (Flx.2)

ICD-10 Volume 2, pages 62-65

EXERCISE 11:

Select the underlying cause of death

I (a) Cerebral infarction

(b) Hypertension
(c) Atherosclerosis

○ RULE D: SPECIFICITY

Where the selected cause describe a condition in general terms and a 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 will often apply when the general term becomes an adjective,
qualifying the more precise term.

Example:
I (a) Pericarditis
(b) Uremia and pneumonia

Code to uremic pericarditis . Uremia selected by Rule 1 modifies the

pericarditis

EXERCISE 12:

Select the underlying cause of death

I (a) Rheumatic heart disease, mitral stenosis

Ans. ___________________________________________________________________

○ RULE E: EARLY AND LATE STAGES OF DISEASE

Where the selected cause is an early stage of a disease and a more

advanced stage of the same disease is reported on the certificate, code to
the more advanced stage. This rule does not apply to a “chronic” form
reported as due to an “acute” form unless the classification gives special
instructions to that effect.

Example:
I (a) Tertiary syphilis
(b) Primary syphilis

Code to tertiary syphilis

EXERCISE 13:

Select the underlying cause of death:

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ICD-10 Student Manual –Department of Health, Philippines
I (a) Chronic myocarditis
(b) Acute myocarditis
Ans. __________________________________________________________________

○ RULE F: SEQUELAE

Where the selected cause is an early form of a condition for which the
classification provides a separate “Sequelae of …” , and there is evidence
that death occurred from residual effects of this condition rather than from
those of its active phase, code to the appropriate “Sequelae of …”
category.

Example:
I (a) Pulmonary fibrosis
(b) Old pulmonary tuberculosis

Code to sequelae of respiratory tuberculosis

EXERCISE 14:

Select the underlying cause of death

I (a) Hydrocephalus
(b) Tuberculous meningitis

Ans. ____________________________________________________________

➢ ASSUMPTION OF INTERVENING CAUSE

On some medical certificates, one condition may be indicated as due to another,

but the first one is not a direct sequel of the other. In such cases you may safely
assume the intervening causes. When considering a modification to the coding,
one should only assume an intervening cause for the purpose of interpreting the
sequence.

Example:
I (a) Cerebral hemorrhage
(b) Chronic nephritis

Code to chronic nephritis. It is necessary to assume hypertension as a condition

intervening between cerebral hemorrhage as a condition and the underlying cause,
chronic nephritis.

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ICD-10 Student Manual –Department of Health, Philippines
EXERCISE 15:

Select the underlying cause of death

I (a) Mental retardation

(b) Premature separation of placenta

Ans . _________________________________________________________________

➢ HIGHLY IMPROBABLE

Sometimes the recorded sequence is highly improbable. The words “highly

improbable” are used to describe a non-acceptable sequence

See page 67 of Volume 2 for the lists of highly improbable situations and
conditions

Note: Acute or terminal circulatory diseases reported as due to malignant

neoplasm, diabetes or asthma should be accepted as possible sequences in
Part I of the certificate. (see p. 69 of Volume 2 for the list of conditions
regarded as acute or terminal circulatory diseases).

EXERCISE 16:

Using the list of highly improbable relationships on p. 69 of Volume 2, decide whether

each of the following sequence is acceptable or not:

• Tetanus due to malignant neoplasm of the lung _________________

• Diabetes due to malignant neoplasm of the pancreas _________________
• Intracranial hemorrhage due to endocarditis _________________

➢ DURATION

In evaluating the reported sequence of the direct and antecedent causes, the
interval between the onset of the disease or condition and time of death must be
considered. This would apply in the interpretation of “highly improbable”
relationships and in Modification Rule F (Sequelae).

See p. 69 of Volume 2

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ICD-10 Student Manual –Department of Health, Philippines
EXERCISE 17:

When can malformation, deformation or chromosomal abnormality be considered to be

congenital?
(a) only when it is state to be congenital by the certifier
(b) when it is clear that the condition existed from birth

Ans. __________________________________________________________________

➢ SEQUELAE

Certain categories ( B90-B94; E64._; E68; G09; I69._; O97; and Y85-Y89)in
ICD-10 have been designated for use in coding sequelae as the underlying cause
of death to indicate that death resulted from the late (residual) effects of a given
disease or injury rather than during the active phase.

Conditions reported as sequelae or residual effects of a given disease or injury

should be classified to the appropriate sequelae category, irrespective of the
interval between the onset of the disease or injury and death.

For certain conditions , deaths occurring one year or more after the onset of the
disease or injury are assumed to be due to a sequelae or residual effect of the
condition, even though no sequelae is explicitly mentioned. Guidance in
interpreting sequelae is given under most of the “Sequelae of …” categories in the
Tabular List.

EXERCISE 18:

Which Modification Rule applies to sequelae? _________________

Does the interval between the original disease and its sequelae matter, for the underlying
cause coding? _____________

➢ RHEUMATIC FEVER WITH HEART INVOLVEMENT

If there is no statement that the rheumatic process was active at the time of death,
assume activity if the heart condition (other than terminal conditions and bacterial
endocarditis) that is specified as rheumatic, or stated to be due to rheumatic
fever, is describe as acute or subacute.

In the absence of such description, the terms “carditis”, “endocarditis”, “heart

disease”, “myocarditis” and “pancarditis”can be regarded as acute if either the
interval between onset and death is less than one year or, if no interval is stated,
the age at death is under 15 years.

“Pericarditis” can be regarded as acute at any age.

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ICD-10 Student Manual –Department of Health, Philippines
EXERCISE 19:

The terms such as carditis, endocarditis, heart disease, myocarditis and pancarditis can be
regarded as acute if:

(a) at least one of the factors listed below applies

(b) both factors listed below apply
(c) neither factors listed below apply

1. the interval between onset and death is less than one year
2. No interval is stated and the age at death is under 15 years

Ans. _____________________

➢ NATURE OF INJURY

The codes for external causes (V01-Y89) should be used as the primary codes for
single condition coding and tabulation of mortality involving injury, poisoning
and certain other consequences of external causes.

It is recommended that a code from Chapter XIX (S00-T98) be used in addition

in order to identify the nature of the injury and permit relevant tabulations.

Where more than one kind of injury to a single body region in S00-S99, T08-
T35, T66-T79 is mentioned and there is no clear indication as to which caused
death, the General Principle and the Selection Rules should be applied in the
normal way.

When more than one body region is involved, coding should be made to the
relevant category of Injuries involving multiple body regions (T00-T06). This
applies both to the same type of injury and to more than one kind of injury to
different body regions.

Example:
I (a) Fat embolism
(b) Fracture of femur
(c) Laceration of thigh
(d) Road traffic accident

Select fracture of femur , since this is the starting point of the sequence
terminating in the condition first entered on the certificate. It is “highly
improbable” that laceration of the thigh would give rise to all the conditions
mentioned above it.

When combinations of medicinal agents classified differently are involved,

proceed as follows: if one component of the combination is specified as the cause
of death, code to that component; if no component is specified as the cause of
death, code to the category provided for the combination, e.g. mixed anti-
epileptics (T42.5). Otherwise, if the components are classified to the same three
character category, code to the appropriate sub-category for “Other”; if not code
to T50.9.

Combinations of medicinal agents with alcohol should be coded to the medicinal

agent.

➢ EXTERNAL CAUSES

The codes for external causes (V01-Y89) should be used as the primary codes for
single-condition coding and tabulation of the underlying cause when, and only
when, the morbid condition is classifiable to Chapter XIX.

When the morbid condition is classified to Chapters I-XVIII, the morbid

condition itself should be coded as the underlying cause and categories from the
chapter for external causes may be used, if desired, as supplementary codes.

➢ MALIGNANT NEOPLASMS

When malignancy is given as the underlying cause of death, three factors must be
taken into consideration when assigning a code. These are as follows:

 Site
 Morphology
 Behavior

Some death certificates may be ambiguous if there was doubt about the site of the
primary or imprecision in drafting the certificate. In these circumstances, if
possible the certifier should be asked to give clarification. Failing this, certain
guidelines need to be observed.

○ Implication of Malignancy

Mention on the certificate that a neoplasm has produced metastases

(secondaries) means that it must be coded as malignant, even though this
neoplasm without mention of metastases would be classified to some
other section of Chapter II.

Code to malignant neoplasm of breast.

○ Sites with prefixes or imprecise definitions

Neoplasms of sites prefixed by “peri”, “para”, “pre”, “supra”, “infra”, etc.

or described as in the “area” or “region” of a site , unless these terms are
specifically indexed, should be coded as follows:

For morphological types classifiable to one of the categories C40-C45,

C47, C49, C70-C72, code to the appropriate subdivision of that category;
otherwise code to the appropriate subdivision of C76 (other and ill-defined
sites).

Example:
I (a) Fibrosarcoma in the region of the leg

Code to malignant neoplasm of connective and soft tissue of lower limb.

○ Malignant Neoplasms of unspecified site with other reported conditions

When the site of the primary malignant neoplasm is not specified, no

assumption of the site should be made from the location of other reported
conditions such as perforation, obstruction, or hemorrhage. These
conditions may arise in sites unrelated to the neoplasm, e.g. intestinal
obstruction may be caused by the spread of an ovarian malignancy.

Example:
I (a) Obstruction of intestine
(b) Carcinoma

Code to malignant neoplasm without specification of site (C80).

○ Malignant neoplasms with primary site indicated

When malignancy is entered on the certificate and the primary site is

indicated, one should always select the primary site as the underlying
cause of death, regardless of its position on the certificate.

The primary site may be indicate in one of the following ways:

Example:
I (a) Carcinoma of the bladder
II Primary in kidney

Code to malignant neoplasm of kidney (C64).

(b) when other sites may be describe as secondary, metastases,

spread, or carcinomatosis

Example:
I (a) Carcinoma of breast
(b) Secondaries in brain

Code to malignant neoplasm of breast (C50.9), since Rule 2 applies

(c) when the morphology itself may indicate a primary

malignancy

Example:
I (a) Metastatic carcinoma
(b) Pseudomucinous adenocarcinoma

Code to malignant neoplasm of ovary (C56), since pseudomucinous

adenocarcinoma of unspecified site is assigned to the ovary in the
Alphabetical Index.

○ Primary site unknown

In cases where the primary site is stated to be unknown, one should not
make any assumption about the primary site from any other conditions
which are specified. Instead, one should consider the morphology of the
neoplasm.

Example:
I (a) Generalized metastases
(b) Melanoma of back
(c) Primary site unknown

Code to malignant melanoma of unspecified site (C43.9).

○ Independent (primary) multiple sites

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ICD-10 Student Manual –Department of Health, Philippines
The presence of more than one primary neoplasm could be indicated by
mention of two different anatomical sites or two distinct morphological
types, or by a mix of a morphological type that implies a specific site plus
a second site.
If two or more sites mentioned in Part I are not in the same organ system
and there is no indication that any is primary or secondary, code to
malignant neoplasms of independent (primary) multiple sites (C97), unless
al are classifiable to C81-C96, or one of the sites mentioned is common
site of metastases or the lung.

○ Metastatic neoplasms

A malignancy may spread to another site. This is called metastasis. The

adjective “metastatic” is frequently used ambiguously – sometimes
meaning secondary FROM a primary elsewhere and sometimes meaning a
primary which has given rise TO metastases. It is very difficult to resolve
this situation as there are no specific rules and usage . However, there are
some guidelines set out in Section 4.2.7 G of Volume 2 (p. 75) that can
be followed.

○ Multiple sites

In some cases multiple sites may be recorded with no indication as to

which is the primary site. Guidance for the selection of the underlying
cause of death is given in Section 4.2.7 H , Volume 2 (p . 81) .

○ One may find that an infectious disease has been given as a consequence
of a malignancy. This is an acceptable sequence. Malignant neoplasm can
also cause certain types of circulatory disease. The underlying cause of
death will be malignancy.

PERINATAL MORTALITY

CERTIFICATE OF CAUSE OF PERINATAL DEATH

To be completed for stillbirths and liveborn infants dying within 168 hours (1 week) from birth

Identifying particulars This child was born live on _____ at ______ hours
And died on _____ at ______ hours

This child was stillborn on _ at __ hours

And died before labor during labor not known
MOTHER CHILD

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ICD-10 Student Manual –Department of Health, Philippines
Date of birth 1st day of last Birthweight: _______ grams
Or, if unknown, age (years) menstrual period
Or, if unknown, estimated duration
Of pregnancy Sex:
(complete weeks) Boy
Girl
Indeterminate
Number of previous
Pregnancies:
Single birth
Livebirths First twin
Stillbirths Antenatal care, two or more visits Second twin
Abortions Yes Other multiple
No
Not known Attendant at birth

Outcome of last previous

Pregnancy: Physician
Trained midwife
Livebirth Other trained person (specify)
Stillbirth
Abortion
Delivery:
Other (specify)
(specify)
Normal spontaneous vertex
Other (specify)
Date

CAUSES OF DEATH
a. Main disease or condition in fetus or infant

b. Other diseases or conditions affecting fetus or infant

c. Main maternal disease or condition affecting fetus or infant

d. Other maternal diseases or conditions affecting fetus or infant

e. Other relevant circumstances

The certified cause of death has been confirmed I certify ………………………………….

By autopsy
Autopsy information may be available later
Autopsy not being held Signature and qualification

CERTIFICATION OF PERINATAL DEATHS:

Whenever possible, a separate certificate of cause of perinatal death should be

completed, in which the causes are set out as follows:

(a) Main disease or condition in fetus or infant

(b) Other diseases or conditions in fetus or infant
(c) Main maternal disease or condition affecting fetus or infant
(d) Other maternal disease or condition affecting fetus or infant
(e) Other relevant circumstances

The certificate should include identifying particulars with relevant dates and times, a
statement as to whether the baby was born alive or dead, and details of the autopsy.

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ICD-10 Student Manual –Department of Health, Philippines
For a thorough analysis of perinatal mortality, the following data on both mother and
child are needed, in addition to information about the causes of death, not only in the case
of perinatal death, but also for all live births:

Mother
Date of birth
Number of previous pregnancies: live births/stillbirths/abortions
Date and outcome of last previous pregnancy: live birth/stillbirth/abortion
Present pregnancy:

- First day of last menstrual period (if unknown, then estimated duration of
pregnancy in completed weeks)
- Antenatal care – two or more visits: yes/no/not known
- Delivery: normal /spontaneous/ vertex/other (specify)

Child
Birth weight in grams
Sex: boy/girl/indeterminate
Single birth/first twin/second twin/other multiple birth
If stillborn, when death occurred: before labor/during labor/not known

Other variables that might appear on the basic certificate include particulars of the birth
attendant, as follows: physician/trained midwife/other trained personnel (specify)/other
(specify)

The method by which the supplementary data are collected will vary according to the
civil registration system obtaining in different countries. Where they can be collected at
the registration of the stillbirth or early neonatal death, a form similar to the “Certificate
of Cause of Perinatal Death” could be used. Otherwise, special arrangements would
need to be made (for example by linking birth and death records) to bring together the
supplementary data and the cause of death.

Where civil registration requirements make it difficult to introduce a common death

certificate for liveborn and stillborn infants, the problem could be met by separate
certificates for stillbirths and early neonatal deaths, each incorporating the recommended
format for the causes of death.

STATEMENT OF CAUSES OF DEATH

The certificate has five sections for the entry of causes of perinatal deaths, labeled (a) to
(e). In sections (a) and (b) should be entered diseases or conditions of the infant or fetus,
the single most important in section (a) and the remainder, if any, in section (b). By “the
single most important” is meant the pathological condition, that in the opinion of the
certifier, made the greatest contribution to the death of the infant or fetus. The mode of
the death, e.g. heart failure, asphyxia or anoxia, should not be entered in section (a)

In sections (c) and (d) should be entered all diseases or conditions of the mother that, in
the certifier’s opinion, had some adverse effect on the infant or fetus. Again, the most
important one of these should be entered in section (c) and others, if any, in section
(d).Section (e) is for the reporting of any other circumstances that have a bearing on the
death but cannot be described as a disease or condition of the infant or mother, e.g.
delivery in the absence of an attendant.

Example 1:
A woman, whose previous pregnancies had ended in spontaneous abortions at 12 and 18
weeks, was admitted when 24 weeks pregnant, in premature labor. There was
spontaneous delivery of a 700 g infant who died during the first day of life. The main
finding at autopsy was “pulmonary immaturity”.

Causes of perinatal death:

(a) Pulmonary immaturity
(b) –
(c) Premature labor, cause unknown
(d) Recurrent aborter
(e) –

Example 2:
A primigravida aged 26 years with history of regular menstrual cycles received routine
antenatal care starting at the 10th week of pregnancy. At 30-32 weeks, fetal growth
retardation was noted clinically, and confirmed at 34 weeks. There was no evident cause
apart from symptomless bacteriuria. A caesarean section was performed and a liveborn
boy weighing 1600 g was delivered. The placenta weighed 300 g and was described as
infarcted. Respiratory distress syndrome developed which was responding to treatment.

The baby died suddenly on the third day. Autopsy revealed extensive pulmonary hyaline
membrane and massive intraventricular hemorrhage.

Causes of perinatal death:

(a) Intraventricular hemorrhage
(b) Respiratory distress syndrome
Retarded fetal growth
(c) Placental insufficiency
(d) Bacteriuria in pregnancy
Caesarean section

TABULATION OF PERINATAL MORTALITY BY CAUSE

For statistics of perinatal mortality derived from the form of the certificate shown on
p. 90 of Volume 2, full-scale multiple-case analysis of all conditions reported will yield
the maximum benefit. Where this is impracticable, analysis of the main disease or

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ICD-10 Student Manual –Department of Health, Philippines
condition in the fetus or infant (part (a)) and of the main maternal condition affecting the
fetus or infant (part (c)) with cross tabulation groups of these conditions should be
regarded as the minimum. Where it is necessary to select only one condition (for
example, when it is necessary to incorporate early neonatal deaths in single-cause tables
of deaths at all ages), the main disease or condition in the fetus or infant (part (a)) should
be selected.

CODING OF CAUSES OF DEATH

Each condition entered in sections (a), (b), (c), and (d) should be coded separately.
Maternal conditions affecting the infant or fetus, entered in sections (c) and (d), should be
coded to categories P00-P04 and these codes should not be used for sections (a) and (b).
Conditions in the infant or fetus, entered in section (a), can be coded to any categories
other than P00-P04 but will often be coded to any categories P05-P96 (Perinatal
conditions) or Q00-Q99 (Congenital anomalies). Only one code should be entered for
sections (a) and (c), but for sections (b) and (d) as many codes should be entered as there
are conditions reported.

Section (e) is for review of individual perinatal deaths and will not normally need to be
coded. If, however, statistical analysis of the circumstances entered in section (e) is
desired, some suitable categories may exist in Chapters XX and XXI, where this is not
the case, users should devise their own coding system for this information.

CODING RULES:

The selection rules for general mortality do not apply to the perinatal death certificate. It
may happen, however, that perinatal death certificates are received on which the causes
of death have not been entered in accordance with the guidelines given above. Whenever
possible, these certificates should be corrected by the certifier, but if this is not possible,
the following rules should be applied:
➢ Rule P1. Mode of Death or Prematurity entered in section (a)

If heart or cardiac failure, asphyxia or anoxia (any condition in P20._, P21._) or

prematurity (any condition in P07._) is entered in section (a) and other conditions
of the infant or fetus are entered in either section (a) or section (b), code the first-
mentioned of these other conditions as if it had been entered alone in section (a)
and code the condition actually entered in (a) as if it had been entered in section
(b).

Example:
Liveborn ; death at 4 days
(a) Prematurity
(b) Spina bifida
(c) Placenta insufficiency
(d) -

Prematurity is coded at (b) and spina bifida at (a)

If two or more conditions are entered in section (a) or section (c), code the first-
mentioned of these as if it had been entered in section (a) or (c) and code the
others as if they had been entered in sections (b) or (d).

Example:
Liveborn ; death at 2 days
(a) Traumatic subdural hemorrhage
Massive inhalation of meconium
Intrauterine anoxia
(b) Hypoglycemia
Prolonged pregnancy
(c) Forceps delivery
(d) Severe pre-eclampsia

Traumatic subdural hemorrhage is coded at (a) and the other conditions entered in
(a) are coded at (b).

➢ Rule P3: No entry in sections (a) or (c)

If there is no entry in section (a) but there are conditions of the infant or fetus in
section (b), code the first-mentioned of these as if it had been entered in section
(a); if there are no entries in either section (a) or section (b), either code P95
(Fetal death of unspecified cause) for stillbirths or code P96.9 (Condition
originating in the perinatal period, unspecified) for early neonatal deaths should
be used for section (a).

Similarly, if there is no entry in section (c) but there are maternal conditions
entered in section (d), code the first-mentioned of these as if it had been entered in
section (c); if there are no entries in either section (c) or section (d) use some
artificial code, i.e. xxx.x for section (c) to indicate that no maternal condition was
reported.

Example 1:
Liveborn; death at 15 minutes
(a) -
(b) Tentorial tear
(c) -
(d) -

Tentorial tear is coded at (a) ; xxx.x is coded at (c)

Example 2:
Liveborn; death at 2 days
(a) -
(b) -
(c) -

Unspecified perinatal cause is coded at (a); eclampsia is coded at (c)

➢ Rule P4: Conditions entered in wrong section

If maternal condition (i.e. conditions in P00-P04) is entered in section (a) or

section (b), or if a condition of the infant or fetus is entered in section (c) or
section (d), code the conditions as if they had been entered in the respective
correct section.

If a condition is classified as a condition of the infant or fetus or as a maternal

condition is mistakenly entered in section (e) , code it as an additional fetal or
maternal condition in section (b) or (d) , respectively.

Example:
Stillborn; death after onset of labor
(a) Severe intrauterine hypoxia
(b) Persistent occipitoposterior
(c) -
(d) -
(e) Difficult forceps delivery

Persistent occipitoposterior is coded at (c) ; difficult forceps delivery is coded at

(d)

MODULE 7:
CERTAIN INFECTIOUS AND PARASITIC
DISEASES (Chapter 1)
Chapter 1 of the ICD-10 typifies the special group chapters, in that it does not
focus on any one body system. It classifies conditions that are generally
considered to be communicable or transmissible.

 IMPORTANT POINTS FOR THIS CHAPTER

 Categories range from A00 to B99. In fact, this is one of the largest chapters in
ICD-10
 171 of the 200 available categories have been allocated.
 The chapter is divided into 21 blocks. Most blocks provide codes for a particular
causative agent except for A00-A09 and A50-A64 which include a variety of
causative agents.
 The word “certain” in the chapter title indicates that some infections are classified
elsewhere
 There are five (5) exclusions listed at chapter level. However, it should be noted
that there are some exceptions to the exclusions - they are related to obstetrical
and neonatal tetanus, congenital syphilis, perinatal gonococcal infection and
obstetric and perinatal HIV disease – which are included in Chapter 1.

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ICD-10 Student Manual –Department of Health, Philippines
 A rule exists in relation to the presumption of infectious or non-infectious origin
of diarrhea depending on the country in which the patient contracted the
condition. This rule only applies where there is no specification as to whether the
diarrhea is infectious or non-infectious. If the diarrhea is presumed to be non-
infectious, it should be coded to K52.9 (Chapter XI: Diseases of the Digestive
System ). If it is presumed to be infectious in origin, it is coded to A09 (Ch. I)
 When coding for tuberculosis (A15-A19), categories A15-A16 identify whether
the tuberculosis was confirmed and what method was used for the confirmation
(e.g. sputum microscopy, bacteriology or histology).
 Categories in block B20-B24 are provided for coding HIV disease. There is a
note at the beginning of the block concerning the use of the fourth character
subcategory. The categories have been provided for optional use when it is not
possible to use multiple condition coding.
 Exclusion notes for some categories on block B50-B64 (Protozoal diseases)
provide guidance re: coding for mixed plasmodium infections.
 Categories on block B90-B94 are to be used to indicate conditions in categories
A00-B89 as the cause of sequelae, which are themselves classified elsewhere. The
“sequelae” includes conditions specified as such; they also include late effects of
diseases classified to A00-B89 if there is evidence that the disease itself is no
longer present.
 Categories on block B95-B97 enable infectious organisms to be recorded as the
cause of conditions primarily classified to other chapters. Codes in these
categories should never be used for primary/main condition coding. They are
provided for use as supplementary or additional codes.

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER I: CERTAIN INFECTIOUS AND PARASITIC DISEASES
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Chronic Viral Hepatitis C B18.2

2. Congenital Syphilis in an 18-month old child A50.2

3. Oral candidiasis in an HIV patient
4. Acute pneumococcal tracheitis
5. Dranunculiasis B72
6. Noninfective diarrhea in a 3-week old infant P78.3 158 790
7. Tuberculosis of lung, confirmed A15.3 547 113
8. Axillary cutaneous abscess
9. Streptococcal sore throat
10. Cytomegalovirus pancreatitis
11. Internal hirudiniasis
12. Kaposi’s sarcoma of back (skin) in HIV
patient
13. Infection by schistosoma mansoni and
fasciolopsis buski causing severe abdominal
pain

14. Epidemic typhus due to Rickettsia prowazekii

15. Granular trachomatous conjunctivitis
16. Mycotic Madura Foot
17. Dwarf tapeworm infestation
18. Sequelae of leprosy
19. Classical Cholera
20. Varicella meningitis

Chapter II classifies neoplastic disease, which is defined as new or abnormal

growth. Codes should read the introductory notes for this chapter before assigning
codes from Chapter II.

It is especially important when coding neoplasms to use both Volume 1 and

Volume 3 in assigning the correct set of codes.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from C00-D48

 136 of the available categories have been allocated
 The chapter is divided into 7 blocks. The block on malignant neoplasm (C00-
C97) is further subdivided into 12 sub-blocks
 There are three specific aspects to take into account when coding for neoplasms,
namely:
➢ the site of the tumor
➢ the nature of the tumor (also known as or histological type)
➢ the behavior of the tumor

 Chapter II is organized by tumor site along the following lines, in terms of

behavior of neoplasms:

Categories Behavior code

D10-D36 /0 Benign Neoplasms

D37-D48 /1 Neoplasms of uncertain or unknown behavior
D00-D09 /2 In situ neoplasm
C00-C76 /3 Malignant neoplasms, stated or
C80-C97 presumed to be primary
C77-C79 /6 Malignant Neoplasms, stated or
presumed to be secondary

 Morphology of neoplasms refers to their histological characteristics, e.g. the form

and structure of tumor cells. Morphology codes consist of the letter M followed
by four (4) characters that identify the histological type with a slash mark and a
fifth character indicating behavior (e.g. M9593/3). Morphology codes can be
located on pages 1177-1204 of Volume 1 (Tabular List) of the ICD-10.

They are also displayed in parentheses with index for neoplasms in Volume 3
(Alphabetical Index) .

e.g. Adenocarcinoma (M8140/3) - see also Neoplasm, malignant

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but, when coding, if the clinician overrides the expected behavior then accept the
override in that particular case, e.g. adenoma is usually benign, but if the clinician
documents a case with malignant adenoma code the case as such.

The coder should be aware that if the behavior type being sought is not listed
with the histological type then the final digit can be changed (if this is clinically
correct) for example , many malignant neoplasms are listed only with the
morphology code for the primary lesion; if a secondary lesion needs to be coded,
change the final “/3” to “/6” and the code is correct.

 The alphabetic index should be referenced first by the morphological name of the
neoplasm, such as oat cell carcinoma. The index may provide a specific code,
such as Renal carcinoma (C64). If a specific code is not provided, refer to the
Table of Neoplasms (pp. 369-401 of Volume 3), using the behavior indicated by
the morphological code or the reference in the index. In this Table, sites are
listed in alphabetic order on the left side , while the columns on the right provide
the code for each type of behavior for that site.

 In Chapter II, the 4th digit .9 is for unspecified site and .8 is for overlapping
lesions of contiguous sites.

Example:

To find the correct site and morphology codes for a female patient suffering from
lobular carcinoma arising in the lower outer quadrant of the left breast.

STEP 1:
Look up the lead term, “carcinoma” in Volume 3 (Alphabetical Index)

Carcinoma
- lobular (infiltrating) (M8520/3)
- - specified site – see Neoplasm, malignant

STEP 2:
The morphology given is M8520/3. Confirm that the behavior (/3) is appropriate
for the tumor being describe. /3 indicates a primary malignancy and is therefore
appropriate for this case.

STEP 3:
Check the morphology (M8520) in the table of Morphology of Neoplasms in
Volume 1. The morphology is correct for this case.

STEP 4:

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ICD-10 Student Manual –Department of Health, Philippines
Look up the Table of Neoplasms in Volume 3. Use the alphabetical listing of
anatomical sites to find the entry for “breast”. Note the subdivisions under the
entry “ breast” for different parts of the breast. Locate lower outer quadrant.

STEP 5:
Find the code across the row that corresponds to the column malignant primary
tumor. We are told that the tumor arose in the patient’s breast; it is therefore a
primary tumor and not a metastasis. The correct site code for this case is C50.5

STEP 6:
Confirm your selected site code in Volume 1. Check whether there are any
relevant exclusion notes.

STEP 7:
The correct complete code for this case is C50.5, M8520/3

Pages 71-85 of Volume provide a large amount of information and direction for the
coder in dealing with neoplasms.

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CHAPTER II: NEOPLASMS
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Malignant bronchial adenoma

2. Cholangiocarcinoma
3. Polycythemia vera
4. Acute myelomonocytic leukemia
5. Squamous cell carcinoma cervix uteri and
upper two-thirds of vagina
6. Lesion on neck identified as metastatic to
squamous cell carcinoma of tonsil

7. Malignant fibrous histiocytoma, knee

8. Pleomorphic adenoma, salivary glands
9. Bilateral synchronous Wilm’s tumor (patient
is four years old)

10. Mycosis fungoides

11. Myxoma of larynx D14.1 M8840/0 384
12. Paget’s disease of nipple
13. Periosteal chondroma of the humerus
14. Squamous cell carcinoma of vermilion
border of lower lip
15. Burkitt’s lymphoma
16. Transitional cell papilloma of the bladder
17. Metastatic carcinoma of brain C71.9 M8010/6
18. Carcinoid tumor of small intestine C17.9 M240/3 383 191
19. Anaplastic seminoma, left testes C62.9 M9062/3
20. Secondary neoplasm in lung C78 M8000/6 385 197

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MODULE 9:
DISEASES OF THE BLOOD AND BLOOD FORMING ORGANS AND
CERTAIN DISORDERS INVOLVING THE IMMUNE
MECHANISM (Chapter III)

Located within this Chapter are the various types of anemia and other diseases of
the blood, including disorders of the white blood cells and spleen, and certain
disorders involving the immune mechanism.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from D50-D89

 34 of the 40 available categories have been used
 The Chapter is divided into 6 blocks, 3 of which relate to anemia
 This chapter is very limited and excludes several important diseases of the blood
Example:
○ All cancers of the blood are coded to Chapter II (Neoplasms)
○ Blood and blood forming organ conditions which complicate pregnancy are
coded to Chapter XV (Pregnancy, Childbirth and the Puerperium)

See page 249 of Volume 1 for the complete list of Exclusion terms

 For secondary anemia it is necessary to code the underlying disease which caused
these secondary conditions
 Anemia , unspecified (D64.9) should only be applied when there is insufficient
information to code a more specific type of anemia

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER III: DISEASES OF THE BLOOD AND BLOOD
FORMING OGANS AND CERTAIN DISORDER
INVOLVING THE IMMUNE MECHANISM
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.
1. Hypogammaglobulinemia
2. Thalassaemia major
3. Darier-Roussy sarcoid
4. Cholelithiasis in a patient with hereditary
elliptocytosis
5. Hyprochromic-microcytic anaemia

6. Deficiency of pyruvate kinase leading to

anemia
7. (Drug induced) enzyme deficiency anemia
8. Hyperimmunoglobulin E (Hyper-Ig-E)
syndrome (Job-Buckley Syndrome)
9. Thrombotic thrombocytopenic purpura
9. Antepartum hemorrhage in a 30-weeks
pregnant woman with Von Willebrand’s
disease
11. Sarcoidosis with myositis
12. Malaria anemia (plasmodium malariae)
13. Streptococcal splenic abscess arising from
blant infarction of spleen (found at autopsy)
14. Agnogenic myeloid metaplasia due to chronic
exposure to benzene (toluene)
15. Classical haemophilia
16. Congenital pancytopenia
17. Acute mesenteric lymphadenitis
18. Drug induced neutropenia
19. Congenital dysphagocytosis
20. Chronic congestive splenomegaly

MODULE 10:
ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES
(Chapter IV)
Within this Chapter are found conditions of the endocrine glands such as the
thyroid, parathyroid, adrenal, pituitary and thymus glands, as well as ovarian and
testicular dysfunctions. Also coded to this Chapter are various types of
malnutrition, vitamin deficiencies and other disorders of metabolism.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from E00-E90

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ICD-10 Student Manual –Department of Health, Philippines
 73 of the 91 available categories have been allocated
 The chapter is divided into 8 blocks
 There are 2 asterisk categories
 Appropriate codes in this Chapter can be used as additional codes to indicate
functional activity of neoplasms
 A code from categories Y40-Y59 should be assigned as an additional code to
identify the responsible drug with any code from this Chapter that represents an
adverse effect of a drug used as prescribed
 An additional code can be assigned to indicate presence of mental retardation
associated with iodine deficiency
 The block on diabetes mellitus, (E10-E14) uses insulin-dependent diabetes
mellitus (IDDM) and non-insulin diabetes mellitus (NIDDM) as preferred
terminology. Type I diabetes is equivalent to IDDM and Type II is equivalent to
NIDDM.
 At the three character level, diabetes is classified by type:
Diabetes mellitus
○ E10 Insulin dependent
○ E11 Non-insulin dependent
○ E12 Malnutrition related
○ E13 Other specified
○ E14 Unspecified
 Complications of diabetes are identified at the fourth character level

Example:

Non-insulin dependent diabetes mellitus (NIDDM) with diabetes nephropathy

The correct code would be:

E11.2

Indicates the type of Indicates the

diabetes at the 3rd complication at the
character level fourth character level
(NIDDM) (Nephropathy)

 Block E40-E46 (Malnutrition) is principally associated with chronic

insufficiency/inappropriateness of diet and is usually measured in terms of
variation in weight from a reference standard. ICD-10 provides explanatory notes
at the beginning of the block to assist in the correct classification of malnutrition.
 Cystic fibrosis category (E84) as fourth character subdivisions for pulmonary and
intestinal manifestations. Additional codes may be assigned to specify the
associated conditions.
 Dehydration, except for that of the newborn is classified to this Chapter.

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CHAPTER IV: ENDOCRINE, NUTRITIONAL
AND METABOLIC DISORDER
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Type II Diabetes mellitus with (related) E11.5†179.20*

peripheral angiopathy, left foot
2. Cystic fibrosis, admitted because of chronic E84.0, B96.5
pseudomonas bronchitis
3. Obesity associated with Prader-Willi E87.1
Syndrome
4. Medullar carcinoma of the thyroid with C73 (M8510/3) E21.3
hyperparathyroidism
5. Hyponatremia as part of syndrome of E22.2, G61.0
inappropriate secretion of antidiuretic
hormone; Guillain-Barre Syndrome
6. Gouty arthropathy, left ankle and knee M10.06, M10.060, M10.070
5. Hashimoto’s thyroiditis in 36-year old male E06.3, Q90.0
with Down’s Syndrome
8. Diabetic cataract E14.3†H28.0*
9. Angina pectoris and hypercholesterolemia I20.9, E 78.0
10. Menkes disease (inherited copper deficiency) E83.0
11. Moderate endogenous obesity E66.8
12. Post pancreatomy hyperglycemia E89.1
13. Familial amyloidosis E85.2
14. Euthyroid Sick syndrome E07.8
15. Reactive hypoglycemia E16.1
16. Myxoedema (myxedema), congenital E00.1
17. Severe malnutrition E43.0
18. Hereditary coproporphyria E80.2
19. Familial Mediterranean Fever E85.0
20. Potassium deficiency E87.6

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ICD-10 Student Manual –Department of Health, Philippines
MODULE 11:
MENTAL AND BEHAVIORAL DISORDER (Chapter V)

This Chapter contains the codes for traditional mental diseases as well as behavior
problems. This Chapter is somewhat different from other chapters within the ICD-
10, in that each category is prefaced by a comprehensive description of the
disorders included therein. These descriptions/definitions are international
standards used by the health care practitioner in selecting the diagnostic
terminology.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from F00-F99

 78 of the 100 available categories have been allocated
 There are11 blocks within this Chapter. At the beginning of each block is an
explanation of the type of mental disorders grouped within the block.
 There are 2 asterisk categories within this Chapter: Dementia in Alzheimer’s
disease and in other diseases classified elsewhere
 Excluded from this Chapter are symptoms, signs and abnormal clnical and
laboratory findings
 Block F00-F09 covers organic disorder. That is, those resulting from a physical
cause
 Block F10-F19 covers disorder due to the use of one or more psychoactive
substances. The third character of the code identifies the substance and the
fourth character specifies the clinical state.
○ The following fourth character subdivisions are for use with categories F10-
F19:

.0 Acute intoxication .6 Amnesic syndrome

.1 Harmful use .7 Residual and late
.2 Dependence syndrome onset psychotic disorder
.3 Withdrawal state .8 Other mental and behavioral

.4 Withdrawal state with delirium disorders

.5 Psychotic disorder .9 Unspecified mental and
behavioral disorder
 Block F40-F48 covers anxiety disorders
 Mental retardation categories are included in block F70-F79. The third character
identifies the degree of retardation and the fourth character specifies the extent of
impairment of the behavior
○ The following fourth character subdivisions are for use with categories F70-
F79
.0 With the statement of no, or minimal impairment of behavior
.1 Significant impairment of behavior requiring attention or treatment
.8 Other impairments of behavior
.9 Without mention of impairments of behavior

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER V: MENTAL AND BEHAVIORAL DISORDER
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Trichotillomania

2. Psychogenic impotence
3. Korsakoff’s psychosis
4. Alzheimer’s disease with dementia, 72 years
old
5. Huntington’s disease with dementia
1. Dyslexia – identified by school teacher
(grade 3)
2. Flashbacks and episodes of bizarre behavior
secondary to use of the drug LSD (Lysergic
acid diethylamide), last used 25 years ago
8. Panic attack
9. Bipolar disorder, severely depressed but not
psychotic
10. Paranoid schizophrenia
11. Anxiety state
12. Dementia (without organic cause) in HIV
patient
13. Hypomanic episode
14. Dysthymia
15. Mental retardation with autistic features
16. Acute stress reaction F43.0 511
17. Heroin dependence X62 (F11.2)
18. Acute alcohol delirium F10.4
19. Paranoid delusions F20.0
20. Psychogenic syncope F48.8

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ICD-10 Student Manual –Department of Health, Philippines
MODULE 12:
DISEASES OF THE NERVOUS SYSTEM (Chapter VI)

This Chapter provides codes for diseases and disorders of the nervous system. It
relates to both the central and peripheral nervous systems

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from G00-G99

 There are 11 blocks within this Chapter
 67 of the 100 available categories have been used
 Excluded from this Chapter are certain conditions originating in the perinatal
period and those, which complicate pregnancy, childbirth and the puerperium.
Also excluded are injuries and neoplasms
 This Chapter contains 16 asterisk categories. Most of them are the result of
infectious conditions, as well as neurological conditions resulting from other
diseases and conditions
 G00-G09 block classifies disease where the nerve tissue is attacked by various
organisms
 Meningitis is usually due to infection and is classified by a combination of a
dagger code for Chapter I and an asterisk code from G01 or G02 to provide more
information
 G09 (Sequelae of inflammatory diseases of central nervous system) would be
listed as a secondary code with the sequelae itself being listed as the main
condition
 G40-G47 block concerns disorders which occur periodically, e.g. epilepsy,
migraines and sleep disorders
 It should be noted that seizures and convulsions NOS are coded to R56.8 and are
not considered epilepsy unless the term “epilepsy” is specifically used
 Certain sleep disorders (G47) are located within this chapter while such sleep
problems as nightmares, sleep terrors, and sleep walking are all located in Chapter
V.

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER VI: DISEASES OF THE NERVOUS SYSTEM
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Diabetic polyneuropathy

2. Herpesviral encephalitis
3. Cerebro-spinal fluid (CSF) leak from lumbar
puncture (diagnostic)
4. Parkinsonism secondary to haloperidol (taken
for affective psychosis)
5. Congenital muscular dystrophy
6. Carpal tunnel syndrome
7. Chronic fatigue syndrome (post viral)
8. Grand mal seizures in known epileptic
9. Tension headache
10. Transient ischaemic attack
9. Spastic hemiplegia (sequelae of stroke 18
months ago)
12. Sleep apnoea
13. Post-herpes zoster trigeminal neuralgia
14. Intracerebral abscess, gonooccal
15. Pneumococcal meningitis
16. Tic-douloureux G50
17. Paralysis-agitans G20
18. Motor neuron disease G12.2
19. Bernard-Horner syndrome G90.2
20. Multiple sclerosis G35

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ICD-10 Student Manual –Department of Health, Philippines
MODULE 13:
DISEASES OF THE EYE AND ADNEXA (Chapter VII)

This Chapter deals exclusively with diseases of the eye and adnexa. Most
disorders of the eye are classified to this Chapter, except for eye conditions
classified in special chapters such as those due to infection, injuries and
congenital abnormalities.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from H00-H59

 There are 11 blocks within this Chapter
 47 of the available categories have been allocated
 There are 12 asterisk categories in this Chapter mainly because eye conditions are
often associated with other diseases classified elsewhere
 The first axis of classification used in this Chapter is for the site, except for
glaucoma which is classified to categories H40-H42 and visual disturbances and
blindness, classified to categories H53-H54
 Additional/optional codes should be used for categories H40.3, H40.4, H40.5 and
H40.6 to identify the cause of glaucoma
 Category H54 (Blindness and Low Vision) is an important category which has a
table detailing impairment categories. The Table below gives a classification of
severity of visual impairment recommended by a WHO Study group on the
Prevention of Blindness.

1/60 (finger counting Light perception

at 1 metre)
4 1/50 (0.02)
5/300
5 No light perception
9 Undetermined or unspecified

 A code from H54 should not be assigned as the main condition unless the episode
of care was for the purpose of treating the blindness itself

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER VII: DISEASES OF THE EYE AND ADNEXA
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Juvenile cataract

2. Tuberculous chorioretinitis
3. Progressive external ophthalmoplegia
4. Blindness right eye, with concurrent low
vision left eye
5. Chronic simple glaucoma, both eyes
6. Marginal corneal ulcer
7. Bilateral exopthalmos resulting from
cavernous sinus thrombosis
8. Left ectropion
9. Keratomalacia due to protein-calorie
malnutrition and vitamin A deficiency
10. Intermittent esotropia
11. Blepharoconjunctivitis
12. Stenosis of lacrimal duct
13. Enophthalmos
14. Pterygium
15. Fold in Descemets membrane
16. Miotic papillary cyst
17. Retinal detachment, with retinal break
18. Retained (old) foreign body in iris
19. Vitreous syndrome following cataract
surgery
20. Astigmatism

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ICD-10 Student Manual –Department of Health, Philippines
MODULE 14:
DISEASES OF THE EAR AND MASTOID PROCESS
(Chapter VIII)

This Chapter classifies diseases of the external ear, the inner ear, the middle ear
and mastoid, and various other disorders of the ear.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from H60-H95

 The Chapter is divided into 4 blocks
 24 of the available 36 categories have been used
 There are 5 asterisk categories in this Chapter, based on the type of ear problem
identified.
 The blocks are divided anatomically; external ear, middle ear and mastoid, and
inner ear.
 The final block H90-H95 (Other disorders of ear) contains categories relating to
hearing loss, symptomatic type conditions, disorders of the acoustic nerve and
post-procedural problems
 H90 classifies conductive and sensorineural hearing loss and H91 classifies other
types of hearing loss
 Congenital deafness is classified to category H90 not to the Chapter on congenital
malformations

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER VIII: DISEASES OF THE
EAR AND MASTOID PROCESS
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Acute purulent otitis media

1. Mixed conductive and sensorineural hearing
loss, bilateral
3. Glue ear
4. Aspergillosis in otitis externa
5. Malignant chemodectoma, right middle ear
6. Otitis media in scarlet fever
7. Cauliflower ear
8. Benign paroxysmal positional vertigo
9. Acute streptococcal mastoiditis
10. Stricture of Eustachian tube
11. Impacted cerumen (wax in ear)
9. Nontraumatic perforation of tympanic
membrane
10. Obliterative otosclerosis involving oval
window
14. Meniere’s disease
15. Noise induced hearing loss
16. Hyperacusis
17. Recurrent cholesteatoma of
postmastoidectomy cavity
18. Peripheral vertigo
19. Ankylosis of ear ossicles
20. Bullous myringitis

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ICD-10 Student Manual –Department of Health, Philippines
MODULE 15:
DISEASES OF THE CIRCULATORY SYSTEM (Chapter IX)

Included within this Chapter are conditions of the heart and major blood vessels
and other circulatory conditions including certain diseases of the lymphatic
vessels and lymph nodes. Special instructions are provided regarding the coding
of cerebrovascular conditions.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from I00-I99

 This Chapter is divided into 10 blocks
 77 of the available categories have been allocated
 There are 8 asterisk categories which focus on circulatory conditions that are the
result of diseases which are classified to other chapters
 Care should be taken with this Chapter because the alphabetic character “I” looks
like “1” when written or typed , and this can be confusing
 ICD-10 makes certain assumptions as to whether valvular disorders have
rheumatic origin. The coder must be very careful and read all inclusion and
exclusion notes
 Mitral valve, tricuspid valve and multiple valve disease are assumed as being due
to rheumatic disease and are coded to I05, I07 and I08, unless specifically stated
to be non-rheumatic
 Aortic valve disease is assumed to be non-rheumatic, and is classified to I06
only when it is specified to be rheumatic or mentioned in combination with mitral
valve disease. Otherwise, a code from category I35 is assigned
 Neonatal hypertension, pulmonary hypertension and hypertension that
complicates pregnancy, childbirth or the puerperium are excluded from the block
I10-I15
 High blood pressure is coded to I10, but an isolated reading without a diagnosis of
hypertension is coded to R03.0
 For morbidity coding , the duration as used with categories I20-I25 refers to the
interval that has elapsed between onset of the ischemic heart episode and
admission to care, usually four weeks or less
 For mortality coding, the interval refers to the time that has elapsed between onset
and death.
 Sequelae of cerebrovascular disease (I69) is applied as a secondary code when
the patient is being treated for a condition resulting from cerebrovascular disease
such as paralytic syndrome.

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER IX: DISEASES OF THE CIRCULATORY
SYSTEM
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Syphilitic aneurysm of aorta

2. Acute cor pulmonale
3. Old myocardial infarction (six weeks ago)
4. Biventricular failure
4. Cocaine induced coronary thrombosis;
patient died on Day 2 of admission
6. Dissection of abdominal aorta
7. Strangulated internal haemorrhoids
1. Bleeding oesophageal varices in chronic
(continuous) alcoholic
9. Right bundle branch block
10. Left ventricular failure after cardiac
catheterization
11. 2 Acute Myocardial infarctions – one
precipitating admission (anterolateral) and
one Day 5 (inferolateral)
12. Unstable angina pectoris
13. Paroxysmal ventricular tachycardia
9. Rupture of a cerebral aneurysm
10. Mitral regurgitation

16. Aortic valve insufficiency

17. Hypertensive renal failure
17. Occlusion of right internal carotid artery
with infarction
19. Deep vein thrombosis of right leg
20. Mitral stenosis with aortic insufficiency

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MODULE 16:
DISEASES OF THE RESPIRATORY SYSTEM (Chapter X)

Chapter X covers diseases of the respiratory system including those caused by

infection and external agents such as occupational hazards

 IMPORTANT POINTS FOR THIS CHAPTER:

 Diseases of the respiratory system is classified to categories J00-J99

 This Chapter is divided into 10 blocks
 63 of the 100 available categories have been allocated
 Three asterisk categories are provided in this chapter for additional codes with
the appropriate dagger code from other Chapters.
 When a respiratory condition is described as occurring in more than one site and
that combination is not specifically indexed, it should be classified to the lower
anatomical site; e.g. a diagnosis of tracheobronchitis is classified as bronchitis
 Block J00-J06 (Acute upper respiratory infections) is arranged anatomically, from
nose down to larynx
 Influenza is classified to J10 when the influenza virus is identified or to J11 when
the virus is not identified with fourth character subdivisions for other
manifestations.
 Acute lower respiratory conditions are classified to categories J20-J25 and
chronic lower respiratory conditions are classified to J40-J47. Bronchitis not
specified as acute or chronic is assumed to be acute only if the patient is under 15
years of age otherwise it should be coded to J40 (Bronchitis not specified as acute
or chronic)
 Aspiration pneumonias are classified to category J69, with fourth character
indicating the type of material aspirated.
 Block J60-J70 covers lung diseases due to external agents
 Abscess of lung with pneumonia (causative organism , unspecified) is classified
as J85.1. If the causative organism is specified, the condition is classified to
block J10-J16.
 Pleurisy without mention of effusion or current tuberculosis is classified to the
Symptoms chapter (R09.1). Pleurisy with pleural effusion is classified to J90
Pleural effusion, not elsewhere classified.

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CHAPTER X: DISEASES OF THE RESPIRATORY
SYSTEM
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Subglottic edema

2. Bronchitis (10 year old female)

1. Aspiration pneumonitis after inhaling food
whilst eating in a restaurant
2. Anthrocosis and Tuberculosis of lung
(confirmed by chest X-ray and sputum
microscopy)
5. Nasopharyngeal polyp
6. Legionnaire’s disease (bacterial pneumonia)
7. Rheumatoid lung disease
5. Bronchopneumonia due to pseudomonas
infection
9. Bronchopneumonia NOS
10. Pneumonia in acute coccidiodomycosis
11. Pneumonia, left lower lobe (LLL) of lung,
pneumococcal
12. Peritonsillar abscess, acute tonsilitis due to
klebsiella infection
13. Acute exacerbation of Chronic Obstructive
Airways Disease
14. Occupational bronchitis due to epoxy resins
15. Acute maxillary sinusitis
16. Emphysema with chronic bronchitis
17. Allergic rhinitis due to bee pollen
18. Acute pulmonary oedema
19. Chronic obstructive pulmonary disease
20. Deviated nasal septum

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MODULE 17:
DISEASES OF THE DIGESTIVE SYSTEM (Chapter XI)

Chapter XI involves diseases and disorders of the digestive system including the
oral cavity

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from K00-K93

 This Chapter is divided into 10 blocks
 71 of the 94 available categories have been used
 There are 5 asterisk categories in this Chapter, indicating digestive system
disorders in diseases classified elsewhere
 Except for block K40-K46 (Hernias), the codes in categories K00-K63 are
arranged anatomically from mouth to anus
 The following 4th character subdivisions are for use with categories K25-K28:
.0 Acute with hemorrhage
.1 Acute with perforation
.2 Acute with both hemorrhage and perforation
.3 Acute without hemorrhage or perforation
.4 Chronic or unspecified with hemorrhage
.5 Chronic or unspecified with perforation
.6 Chronic or unspecified with both hemorrhage and perforation
.7 Chronic without hemorrhage or perforation
.9 Unspecified as acute or chronic, without hemorrhage or perforation

 Block K40-K46 (Hernia) includes both acquired and congenital hernias except for
congenital diaphragmatic hernia Q79.0 and Congenital hiatus hernia Q40.1.
Hernias described as being recurrent are also included. The first axis for
classifying hernias within the K40-K46 block is the site of the hernia. A 4th
character subclassification is used to indicate whether there is associated
obstruction and/or gangrene.
.0 Bilateral, with obstruction, without gangrene
.1 Bilateral, with gangrene
.2 Bilateral, without obstruction or gangrene
.3 Unilateral or unspecified, with obstruction , without gangrene
.4 Unilateral or unspecified, with gangrene
.8 Other specified, without obstruction or gangrene
.9 Unilateral or unspecified, without obstruction or gangrene
 A hernia with both obstruction and gangrene is classified to hernia with gangrene
this being the outcome of obstruction
 Block K57 (Diverticular disease of the intestine) includes diverticulosis,
diverticulum and diverticulitis. The fourth character level is used to specify the
presence of perforation or abscess.
.0 Small intestine, with perforation and abscess .5 Both small and large intestine, without
.1 Small intestine, without perforation or abscess perforation or abscess
.2 Large intestine, with perforation and abscess .8 Part unspecified, with perforation and
.3 Large intestine, without perforation or abscess abscess

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.4 Both small and large intestine, with perforation .9 Part unspecified, without perforation or
and abscess abscess

CHAPTER XI: DISEASES OF THE DIGESTIVE SYSTEM

CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Adenomatous rectal polyp

2. Chronic gastrojejunal ulcer

3. Obstructed left inguinal hernia
4. Diverticulitis of jejunum and ileum with
perforation
5. Postgastrectomy dumping syndrome
6. Anal fissure with perianal abscess
7. Dental caries, involving dentine of 4 teeth,
chronic periodontitis
8. Portal hypertension in schistosomiasis
9. Cholestatic hepatitis, pruritis trunk
10. Temporomandibular joint pain-dysfunction
syndrome
11. Calculus bile duct, cholangitis and
cholecystitis
12. Gastrointestinal hemorrhage
13. Protein intolerance leading to malabsorption
14. Crohn’s disease of small intestine
15. Bleeding gastric ulcer
16. Alcoholic hepatitis
17. Reflux oesophagitis
18. Acute ruptured appendicitis
19. Anorectal fistula
20. Gastroenteritis

MODULE 18:
DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE
(Chapter XII)
Chapter XII classifies diseases of the skin and subcutaneous tissue, but it is
important to note that many conditions affecting specified sites are classified to
other chapters.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from L00-L99

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 This Chapter is divided into 8 blocks
 72 of the 100 available categories have been allocated
 There are 10 exclusions listed at the start of the Chapter, these have
corresponding cross-references which the coders need to follow carefully to be
able to assign the correct code
 There are 6 asterisk categories
 An additional code from categories B95-B97 can be assigned with codes from
this Chapter to identify the organism responsible for an infection classified to this
Chapter.
 The terms dermatitis and eczema are used synonymously and are interchangeable
 Contact dermatitis is classified according to whether it is allergic, irritant or
unspecified. The three categories do not have identical subdivisions, so care must
be taken when assigning codes for conditions in these categories. Take special
note of the exclusions and cross references within these codes.
 L55 (Sunburn)is classified according to the depth of skin which is affected.
○ First degree/erythema -affecting epidermis only
○ Second degree/partial thickness -affecting both epidermis and dermis
causing possible blistering
○ Third degree/full thickness -affecting epidermis, dermis and
subcutaneous layers, usually causing
extensive damage

The following are the fourth character subclassifications to indicate the degree of
sunburn:
.0 First degree
.1 Second degree
.2 Third degree
.8 Other sunburn
.9 Unspecified

CHAPTER XII: DISEASES OF THE

SKIN AND SUBCUTANEOUS TISSUE
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Trichorrhexis invaginata

2. Drug induced androgenic alopecia

3. Contact dermatitis due to cosmetics
4. Arthropathic psoriasis
5. Perforating granuloma annulare

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6. Discoid lupus erythematosus
7. Focal oral mucinosis
7. Acute dermatitis following a meal of fresh sea
food
9. Severe keloid scarring due to acne
10. Epidermal thickening due to a hypertrophic
skin disorder
11. Plastic surgery for scars from burns received
in a house fire 2 years previous
12. Scrotal cyst
13. Pilonidal sinus with abscess
14. Keloid scar
15. Acne rosacea
16. Abscess of right trunk
17. Decubitus ulcer
18. Seborrheic keratosis
19. Infected ingrown toenail
20. Hidradenitis supprativa

MODULE 19:
DISEASES OF THE MUSCULOSKELETAL
SYSTEM AND CONNECTIVE TISSUE
(Chapter XIII)
This Chapter covers diseases and conditions relating to the spine, joint, muscles
and connective tissue of the body. It also covers deformities acquired after birth.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from M00-M99

 There are 6 major blocks in this Chapter, 4 of which are broken down into smaller
blocks making a total of 15 blocks
 79 of the 100 available categories have been allocated
 There are 12 asterisk categories
 The Site of the Musculoskeletal Involvement (located on pages 628-629 of
Volume 1, at the beginning of the Chapter) is an additional optional
subclassification provided to indicate the site of involvement of a condition
where this is appropriate. Notes referring the coders to valid fifth digit
subclassifications are provided in square brackets after each categories/blocks.
0 Multiple sites
1 Shoulder region Clavicle acromioclavicular
scapula glenohumeral joints
sternoclavicular

2 Upper arm humerus elbow joint

3 Forearm radius wrist joint

ulna

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4 Hand carpus joints between these bones
fingers
metacarpus

5 Pelvic region and buttock hip (joint)

thigh femur sacroiliac joint
pelvis

6 Lower leg fibula knee joint

tibia

7 Ankle and foot metatarsus ankle joint

tarsus other joints in foot
toes

8 Other head
neck
ribs
skull
trunk
vertebral column
9 Site unspecified

 The following supplementary subclassification to indicate the site of involvement

is provided for optional use with appropriate subcategories in M23 (Internal
derangement of knee):

0 Multiple sites
1 Anterior cruciate ligament or Anterior horn of medical meniscus
2 Posterior cruciate ligament or Posterior horn of medical meniscus
3 Medical collateral ligament or Other and unspecified medical meniscus
4 Lateral collateral ligament or Anterior horn of lateral meniscus
5 Posterior horn of lateral meniscus
6 Other and unspecified lateral meniscus
7 Capsular ligament
9 Unspecified ligament or Unspecified meniscus

 The following supplementary subclasification to indicate the site of involvement

is provided for optional use with appropriate categories in the block on
dorsopathies, except categories M50 and M51:

1 Multiple sites in spine 5 Thoracolumbar region

2 Occipito-atlanto-axial region 6 Lumbar region
3 Cervical region 7 Lumbosacral region
4 Cervicothoracic region 8 Sacral and sacrococcygeal region
5 Thoracic region 9 Site unspecified

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 The following supplementary subclassification to indicate the site of lesions is
provided for optional use with appropriate subcategories in M99 Biomechanical
lesions, not elsewhere classified)

0 Head region occipitocervical

1 Cervical region cervicothoracic
2 Thoracic region thoracolumbar
3 Lumbar region lumbosacral
4 Sacral region sacrococcygeal, sacroiliac
5 Pelvic region hip, pubic
6 Lower extremity
7 Upper extremity acromioclavicular, sternoclavicular
8 Rib cage costochondral, costovertebral, sternochondral
9 Abdomen and other

 Block M00-M03 (Infectious arthrophathies) comprises arthropathies due to

microbiological agents. Distinction is made between the following types of
etiological relationship:
- direct infection of joint, where organism invade synovial tissue and microbial
antigen is present in the joint
- indirect infection, which may be of two types: a reactive arthropathy, where
microbial infection of the body is established but neither organism nor antigens
can be identified in the joint, and a post infective arthropathy , where microbial
antigen is present but recovery of an organism is inconstant and evidence of
local multiplication is lacking.

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CHAPTER XIII: DISEASES OF THE MUSCULOSKELETAL
SYSTEM AND CONNECTIVE TISSUE
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Rubella arthritis

2. Gout of the big toe

3. Bilateral post-traumatic coxarthrosis
4. Osteolysis
5. Tuberculous arthritis
6. Erosive osteoarthritis
7. Charcot’s arthropathy
8. Bursitis of shoulder
9. Myalgia
10. Flail elbow joint
11. 10 year old boy suffering from juvenile
arthritis for the past twelve months
12. 55 year lady was admitted with
postmenopausal osteoporosis of the spine
13. Abscess of the tendon sheath of elbow.
Cultures grew staphylococcus aureus
14. Osteoporotic crush fracture of T8-T9
15. Herniated intervertebral disc
16. Synovitis of right knee
17. Chronic rheumatoid arthritis
18. Scoliosis
19. Left second and third hammer toes
20. Right hallux valgus

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MODULE 20:
DISEASES OF THE GENITOURINARY
SYSTEM (Chapter XIV)

Chapter XIV provides codes for classifying urinary system conditions,

inflammatory and non-inflammatory disorders of both the male and female genital
systems, and disorders of both the male and female breast.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from N00-N99

 There are 11 blocks
 82 of the 100 available categories have been allocated
 There are 9 asterisk codes in this Chapter, indicating various urogenital disorders
in disease classified elsewhere, primarily infectious disease
 There are 8 exclusion notes listed at Chapter level
 For categories N00-N07 (Glomerular diseases), the 3-character categories relate
to clinical syndromes while the 4th character subdivisions indicate associated
morphological changes, but .0 to .8 are not ordinarily used unless they have been
specifically identified, (e.g. by renal biopsy or autopsy)
 Category N08 provides asterisk codes that classify the glomerular disorders in
other disease; the 4th character specifies the condition with which it is associated.
 For categories N17-N19 (Renal Failure), an additional code from Chapter XX
(External causes) may be used to identify external agent
 Chronic or unspecified renal failure with hypertension is classified to I12.0
(Hypertensive renal disease) with the 4th character indicating the presence of renal
failure.
 If hypertensive renal failure is associated with hypertensive heart disease, a code
from category I13 is used, with 4th character indicating whether heart failure or
renal failure or both is present.
 Combination codes for renal failure and hypertension do not apply when the renal
failure is described as acute. In this case, a code from N17 and code I10,
essential hypertension are assigned.
 Inflammatory disease of female pelvic organs are classified to categories N70-
N77
 Categories N80-N98 classify non-inflammatory disorders of the female genital
tract
 Disorders of the female genital tract that complicate abortion, pregnancy, delivery
or the puerperium are excluded from this Chapter
 Dysplasia of the cervix, vagina and vulva are classified by severity in categories
N87, N89 and N90
CINI, VINI, VAINI are equivalent to mild dysplasia
CINII, VINII, VAINII are equivalent to moderate dysplasia
CINIII, VINIII, VAINIII are equivalent to severe dysplasia or carcinoma in situ

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CIN Cervical intraephithelial neoplasia
VIN Vulvar intraephithelial neoplasia
VAIN Vaginal intraephithelial neoplasia

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CHAPTER XIV: DISEASES OF THE GENITOURINARY
SYSTEM

CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Habitual aborter (without current pregnancy)

2. Postprocedural irradiation cystitis

3. Postprocedural renal failure
4. Renal tubulo-interstitial disorder due to
brucellosis
5. Acute diffuse membraneous glomerulonephritis
6. Acute cystitis with urolithiasis
7. Incomplete uterovaginal prolapse
8. Glomerulitis in diabetes mellitus
9. Decubitus ulcer of the cervix with cervicitis
10. Leukoplakia of penis
11. Interstitial cystitis
11. Hydronephrosis with obstruction of the
ureteropelvic juncion due to infection by
echovirus
12. Newborn baby diagnosed as having congenital
renal failure
13. Escherichia Coli urinary tract infection
14. End stage renal failure
15. Urethral stricture due to infection
16. Chronic cystitis
17. Staghorn calculus of kidney
18. Phimosis
19. Benign prostatic hypertrophy

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MODULE 21:
PREGNANCY, CHILDBIRTH AND THE PUERPERIUM
(Chapter xv)

This Chapter covers disorders and complications related to pregnancy, childbirth

and the puerperium.

This Chapter uses the alpha letter “O’ as the first character with the numeric (0) in
the other positions. Care must be taken to clearly distinguish the alpha character
from the numeric character when transmitting data coded from this Chapter.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from O00 to O99

 75 of the 100 available categories have been allocated
 There are 8 blocks
 The first 3 blocks are mostly concerned with pregnancy
 Inclusion and exclusion notes are found at the beginning of each block or
category
 Many of the categories in this Chapter contain definitional statements which
indicate limits and contents of the category. The coder must read all notes in
order to assign the correct code.
 Block O00-O08 (Pregnancy with abortive outcome) covers all abortions, but
excludes continuing pregnancy in multiple gestation after abortion of one fetus or
more. Complications related to abortions are specified by fourth character
subdivisions. Category O08 also has a note to indicate that this category is
primarily for morbidity coding.
 All hypertension associated with pregnancy is classified to block O10-O16
(Edema, Proteinuria and hypertensive disorders in pregnancy, childbirth and the
puerperium), not to Chapter IX. Even if there is no specific statement that the
hypertension complicates the pregnancy, it should be assumed that it does.
 Category O21 classifies excessive vomiting that starts before the end of the
twenty-second week of gestation as hyperemis gravidarum. A fourth character
indicates whether there is associated metabolic disturbances. Excessive vomiting
that begins after the first twenty-two weeks of pregnancy is classified as late
vomiting
 A code for category O30 (Multiple gestation) should always be applied when
multiple pregnancy is present. While this may not be the main condition, multiple
gestation is always considered a complication of pregnancy
 Complications of anesthesia are classified to:
O29 - for complications during pregnancy
O74 - for complications during labor and delivery
O89 - for complications during the puerperium
O00-O08- for complications of anesthesia in abortion or ectopic pregnancy

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ICD-10 Student Manual –Department of Health, Philippines
 Block O60-O75 (Complications of labor and delivery) is structured to follow the
progress of labor
 Codes from categories O80-O83 are for use as main condition for morbidity
coding only when no other condition classifiable to Chapter XV is recorded. The
use of these codes to describe the main condition should be limited to situations in
which the only information recorded is a statement of delivery or method of
delivery.
 Category O84 classifies multiple delivery with the fourth character indicating the
type of delivery. Additional codes from O80-O83 can be assigned to indicate the
type of delivery for each fetus or newborn. However, a code from category O84
would not be assigned as the main condition; a code from category O30 (Multiple
gestation) would be used instead.
 Block O85-O92 (Complications predominantly related to the puerperium)
classifies conditions that usually occur in the puerperium, which is defined as the
six weeks following delivery
 Codes from the final block in this chapter, O95-O99, are assigned for maternal
conditions that are ordinarily classified elsewhere but are reclassified to Chapter
XV when they complicate the pregnant state, are aggravated by the pregnancy, or
are the reason for obstetric care. In such instances, category codes O98 and O99
should be used as main condition codes if no other code from Chapter XV are
assigned.
 Categories O95-O97 are provided primarily for mortality coding.

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER XV: PREGNANCY, CHILDBIRTH AND THE
PUERPERIUM
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Spontaneous abortion

2. Varicose veins, lower legs, in pregnancy

3. Live twin delivery
4. Cardiomyopathy in the puerperium
5. Fetal distress affecting labor and delivery
6. Premature separation of the placenta
7. Puerperal sepsis
8. Obstetrical tetanus
9. Gestational mammary abscess
10. Post-partum acute renal failure
11. Complete spontaneous abortion complicated
by embolism
12. Severe pre-eclampsia with significant
proteinuria
13. Protein deficiency anemia complicating her
pregnancy
14. Normal spontaneous delivery following two
previous caesarean sections
15. Hyperemesis gravidarum
16. Breech presentation
17. Pernicious anaemia in pregnancy
18. Post partum hemorrhage
17. Retention of products of conception, with
haemorrhage following delivery
20. Rupture right tubal pregnancy

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MODULE 22:
CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL
PERIOD (Chapter XVI)
This Chapter covers certain conditions that may have their origin in the
perinatal period even though morbidity or death occur later. Therefore, the codes
from this Chapter can appropriately be used for either an infant or an adult who
continues to suffer from a condition that began during the perinatal period.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Range of categories is from P00 to P96

 59 of the 97 available categories have been allocated
 There are 10 blocks and 1 asterisk category
 Excluded from this chapter are congenital malformations, injuries and tetanus
neonatorum
 Located within the block P00-P04 are those conditions of the mother which
affect the fetus and newborn. If the newborn is affected by some maternal
condition, these codes are applicable and, if needed, an additional code may be
applied to show the actual effect itself. These codes are not to be used on the
maternal record, as they apply to the fetus and newborn.
 Within the block P05-P08 (Disorders related to length of gestation and fetal
growth) are the codes for disorders of growth and gestation resulting in abnormal
birth weight. These codes are very useful for fetal and newborn death records.
The coders should read the definitions provided in certain categories for guidance.
 When both birth weight and gestational age are available, priority of assignment
should be given to birth weight
 Block P10-P15 (Birth Trauma) covers all possible injuries that can occur to the
fetus or newborn during the birth process. Note that such injuries as those listed
in P14 Birth Injury to peripheral nervous system not only could affect the
newborn but may continue into adulthood. The same code would be used, as an
additional code , for the adult who suffers from some conditions as the result of
birth injury to the peripheral nervous system
 Block P35-P39 (Infections specific to the perinatal period) covers only
congenital infections and parasitic disease and those infections acquired in utero
or which are present at birth. There are some exceptions to this and these are
clearly noted in the appropriate category.
 Most of the categories in block P50-P61 are reasons for fetal death and are
useful for perinatal death certificates.
 Category P95 Fetal death of unspecified cause is useful for certifying stillborn
(fetal death) when no specific reason for the fetal death can be determined
 Coders should refer to pages 1235-1238 of the Tabular List (Volume 1) for
definitions related to perinatal deaths for proper guidance prior to coding.

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ICD-10 Student Manual –Department of Health, Philippines
 Definitions:

Live birth
Live birth is the complete expulsion or extraction from its mother of a product of conception,
irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any
other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite
movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is
attached; each product of such a birth is considered liveborn.

Fetal Death [deadborn fetus]

Fetal death is death prior to the complete expulsion or extraction from its mother of a product of
conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after
such separation the fetus does not breathe or show any other evidence of life, such as beating of
the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

Birth weight
The first weight of the fetus or newborn obtained after birth.

For live births, birth weight should preferably be measured within the first hour of life before
significant postnatal weight loss has occurred. While statistical tabulations include 500g groupings
for birth weight, weights should not be recorded in those groupings. The actual weight should be
recorded to the degree of accuracy to which it is measured.

The definitions of “low”, “very low”, and “extremely low” birth weight do not constitute
mutually exclusive categories. Below the set limits they are all inclusive and therefore overlap
(i.e. “low” includes “very low” and “extremely low” while “very low” includes “extremely low”).

Low birth weight:

Less than 2500g (up to and including 2499g)

Very low birth weight:

Less than 1500g (up to and including 1499g)

Extremely low birth weight

Less than 1000g (up to and including 999g)

Gestational age:
The duration of gestation is measured from the first day of the last normal menstrual period.
Gestational age is expressed in completed days or completed weeks (e.g. events occurring 280 to
286 completed days after the onset of the last normal menstrual period are considered to have
occurred at 40 weeks of gestation).

Gestation age is frequently a source of confusion, when calculations are based on menstrual dates.
For the purposes of calculation of gestational age from the date of the first day of the last normal
menstrual period and the date of delivery, it should be borne in mind that the first day is day zero
and not day one; days 0–6 therefore correspond to “completed week zero”; days 7-13 to
“completed week one”; and the 40th week of actual gestation is synonymous with “completed

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ICD-10 Student Manual –Department of Health, Philippines
week 39”. Where the date of the last normal menstrual period is not available, gestational age
should be based on the best clinical estimate. In order to avoid misunderstanding, tabulations
should indicate both weeks and days.

Pre-term
Less than 37 completed weeks (less than 259 days) of gestation.

Term
From 37 completed weeks to less than 42 completed weeks (259-293 days) of gestation.

Post-term
42 completed weeks or more (294 days or more) of gestation.

Perinatal period
The perinatal period commences at 22 completed weeks (154 days) of gestation (the time when
birth weight is normally 500g), and end seven completed days after birth.

Neonatal period
The neonatal period commences at birth and ends 28 completed days after birth. Neonatal deaths
(deaths among livebirths during the first 28 completed days of life) may be subdivided into early
neonatal deaths, occurring after the seventh day but before 28 competed days of life.

Age at death during the first day of life (day zero) should be recorded in units of completed
minutes or hours of life. For the second (day 1), third (day 2) and through 27 completed days of
life, age at death should be recorded in days.

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CHAPTER XVI: CERTAIN CONDITIONS ORIGINATING
IN THE PERINATAL PERIOD
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.
1. Low birth weight-baby weighed 900g

2. Fetal death
3. Congenital hydrocele
4. Feeding problems of newborn
5. Birth injury to spine
6. Fetal malnutrition
7. Congenital renal failure
8. Congenital tuberculosis
9. Termination of pregnancy (newborn)
10. Transient neonatal thrombocytopenia
11. Neonatal jaundice due to an inborn error of
metabolism, known as Classical
phenylketonuria
12. Baby born 42 weeks gestation weighing 4000 g
13. Baby born showing ill-effects from the
mother’s chemotheraphy treatments (for
cancer)
14. Premature baby (1450 grams) with an Apgar
score of 3 at 1 minute, subsequently develop
pneumothorax, respiratory distress
syndrome and physiological jaundice
11. Congenital left hip subluxation
12. Hyaline membrane disease of newborn
17. ABO incompatibility affecting newborn
18. Fetal sepsis
19. Partial facial paralysis of newborn
20. Erythroblastosis fetalis

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ICD-10 Student Manual –Department of Health, Philippines
MODULE 23:
CONGENITAL MALFORMATIONS, DEFORMATIONS AND
CHROMOSOMAL ABNORMALITIES
(Chapter XVII)
This Chapter covers congenital malformations, deformations and chromosomal
abnormalities. Congenital anomalies are those that are present at birth. However,
codes are not related to age, because some congenital conditions, although present
at birth, may not manifest themselves until later in life. Other congenital
anomalies are often not correctable and persist throughout life.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from Q00 to Q99

 87 of the available categories have been allocated
 There are 11 blocks
 Excluded from this Chapter are inborn errors of metabolism which are classified
to categories E70-E90.
 The blocks of categories are organized around the body system in which the
anomaly presents, except that cleft palate and cleft lip are classified to Q35-Q37.
 Category Q35 classifies congenital cleft palate, Q36 classifies congenital cleft lip,
and Q37 classifies conditions that involve both a cleft palate and a cleft lip. The
category code for the cleft palate uses a fourth character to indicate whether the
hard palate, soft palate, or both are involved, as well as indicating whether the
condition is unilateral or bilateral.
 Fourth characters for cleft lip category indicate whether it is unilateral, bilateral or
medial
 Categories Q90-Q99 are used for chromosomal abnormalities, not elsewhere
classified. This block provides codes for such syndromes as Down’s syndrome
and Turner’s syndrome.

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CHAPTER XVII: CONGENITAL MALFORMATIONS,
DEFORMATIONS AND CHROMOSOMAL
ABNORMALITIES
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.
1. Patent ductus arteriosus

2. Cervical spina bifida with hydrocephalus

3. Von Recklinghausen’s disease
4. Pentalogy of Fallot
5. Laryngocele
6. Marfan’s syndrome
7. Cyclopia
8. Down’s Syndrome
9. Extra marker chromosome
10. Chimera 46, XX/46, XY
11. Mother contracted rubella during pregnancy.
Baby born with cortical cataracts.
12. Medial cleft palate
13. Clubfoot
11. Ventricular septal defect with pulmonary
stenosis, dextraposition of aorta and
hypertrophy of the righ ventricle (Tetralogy
of Fallot)
15. Congenital polycystic kidneys
16. Accessory toe of left foot, congenital
17. Congenital ventricular septal defect
18. Prader-Willi Syndrome
19. Cystic lung, congenital
20. Pyloric stenosis, congenital

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MODULE 24:
SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND
LABORATORY FINDINGS, NOT
ELSEWHERE CLASSIFIED (Chapter XVIII)

This Chapter covers:

 Ill-defined conditions
 Signs
 Symptoms
 Abnormal results of clinical or other investigative procedures for which no
diagnosis classifiable elsewhere is recorded.

The conditions and signs or symptoms included in categories R00-R99 consist of:
 Cases for which no more specific diagnosis can be made even after all the
facts bearing on the case have been investigated
 Signs or symptoms existing at the time of initial encounter that proved to
be transient and whose causes could not be determined
 Provisional diagnoses in a patient who failed to return for further
investigation or care
 Cases referred elsewhere for investigation or treatment before the
diagnosis was made
 Cases in which a more precise diagnosis was not available for any other
reason
 Certain symptoms, for which supplementary information is provided, that
represent important problems in medical care in their own right.

 IMPORTANT POINTS FOR THIS CHAPTER:

 Categories range from R00 to R99

 90 of the available categories have been allocated
 The Chapter is divided into 12 blocks
 Excluded from this Chapter are:
- abnormal findings on antenatal screening of mother
- certain conditions originating in the perinatal period
 Block R00-R09 (Symptoms and signs involving the circulatory and respiratory
systems) includes codes for ill-defined symptoms such as tachycardia NOS,
bradycardia and other unspecified abnormalities of the heart beat
 Codes from category R10 Abdominal and pelvic pain would be applied only
when a more definitive diagnosis was not made. This category is subdivided
according to the site of the pain, e.g. Pain localized to the upper abdomen
 R47-R49 categories classify signs and symptoms involving speech and voice, and
conditions such as speech disturbance not elsewhere classified, and voice
disturbance

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 Block R50-R69 (General symptoms and signs) contains many ill-defined
symptoms which cannot be assigned to any one body system. The code R69
Unknown and unspecified causes of morbidity should rarely be used. It would
include such vague statements as “illness NOS” and undiagnosed disease, not
specified as to the site or system involved
 Included within the block R70-R79 are numerous abnormal results from blood
test as the reason for contact with the health care system. Of specific interest is
R75 Laboratory evidence of HIV without virus infection status and without HIV
disease. This category should be used only when there is an inconclusive test
finding such as that of newborns.
 Categories R80-R82 include abnormal findings on examination of urine without
diagnosis
 Block R95-R99 Ill-defined and unknown causes of mortality , as the title suggest
are only applicable for mortality coding. These codes are to be used only if no
other specific code can be assigned.

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTER XXVIII: SYMPTOMS,
SIGNS AND ABNORMAL CLINICAL
FINDINGS, NOT ELSEWHERE
CLASSIFIED
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Pyrexia of unknown origin

1. False-positive Wassermann reaction for

syphilis
3. Hyperglycaemia
4. Scaling of skin of the hands
5. Petechiae
6. Hallucinations (visual)
7. Anorexia
8. Intracranial space-occupying lesion
9. Abnormal Glucose tolerance test
10. 25 year old patient was admitted for
investigation of debilitating malaise and
fatigue
11. Elderly woman admitted because of her
concern with her heart palpitations
12. Abnormal findings on semen tests
13. Swelling and tenderness of the glands in his
Neck
14. Syncope, cause undetermined
15. Right upper quadrant abdominal pain
16. Instantaneous death
17. Urinary incontinence
18. Dysphagia
19. Abnormal papanicolaou smear of cervix
20. Haematuria

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ICD-10 Student Manual –Department of Health, Philippines
MODULE 25:
INJURY ,POISONING AND CERTAIN OTHER
CONSEQUENCES OF EXTERNAL CAUSES
(Chapter XIX) AND
EXTERNAL CAUSES OF MORBIDITY
AND MORTALITY (Chapter XX)

These two Chapters cover injury, poisoning and certain other consequences of
external causes and the classification of environmental events and circumstances as
the causes of injury, poisoning and other adverse effects.

THE EXTERNAL CAUSE CONCEPT

 The use of Chapter XX (External Causes of Morbidity and Mortality) codes permits
the classification of environmental events and circumstances as the cause of injury ,
poisoning and other adverse effects. The use of Chapter XX codes along with
Chapter XIX (Injury, poisoning and certain other consequences of external causes)
provides additional information of particular concern to industrial medicine, national
safety programs and national health agencies. Injury prevention programs are often
based on the information coded in these Chapters.

 The codes for external causes (V01-Y89) should be used as the primary codes for
single-condition coding and tabulation of the underlying cause when and only
when, the morbid condition is classifiable to Chapter XIX. When the morbid
condition is classified to Chapters I-XVIII, the morbid condition itself should be
coded as the underlying cause and categories from Chapter for external cause
may be used as supplementary codes. For morbidity coding, codes from chapter
for external cause are used only as additional codes, never as the main condition
codes.

 IMPORTANT POINTS FOR CHAPTER XIX (INJURY, POISOING AND

CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES):

 The S- section of this Chapter provides codes for different types of injuries
affecting a single body region; the T-section s used to classify injuries to multiple
or unspecified body regions, poisoning and certain other consequences of external
cause.
 Birth and obstetric traumas are excluded from this Chapter
 Categories range from S00-T98
 195 of the total 199 available categories have been allocated
 This Chapter is subdivided into 21 blocks

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ICD-10 Student Manual –Department of Health, Philippines
 The first axis for coding injuries is the site; the second axis is the type of injury.
The general categories for injury, with some variations are:

○ Superficial injuries
○ Fracture
○ Dislocation, sprain and strain
○ Injuries of nerves and spinal cord
○ Injuries to blood vessels
○ Injuries of muscles and tendons
○ Crushing injury
○ Traumatic amputation
○ Injury to internal organs
○ Other unspecified injuries

 Fifth character subdivisions are provided to indicate whether a fracture is open or

closed. When it was not specified whether the fracture is open or closed, the
fracture is presumed to be closed.
Fracture:
○ closed
• comminuted
• depressed
• elevated
• fissured
• greenstick
• impacted with or without delayed healing
• linear
• march
• simple
• slipped epiphysis
• spiral
○ dislocated
○ displaced
○ open
• compound
• infected
• missile with or without delayed healing
• puncture
• with foreign body

 In this Chapter, the term “burns” covers thermal burns, including friction burns
and scalds by non-caustic liquids and vapors. Corrosions are chemical burns
caused by caustic substances such as acids and alkalis.
 When coding burns or corrosions that are the reason for the health care
encounter, the most serious degree should be designated as the main condition.
Additional codes can be assigned to identify other burns of a lesser degree

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ICD-10 Student Manual –Department of Health, Philippines
 Although separate category codes are provided for multiple injuries, it is
preferable to code injuries individually unless neither the diagnostic statement nor
the medical record provides sufficient details. If one injury is clearly more severe
and demands more resources, that injury should be designated the main condition.
Internal injuries are assigned as he main condition when listed with other injuries,
including open wounds. If multiple injuries are recorded and no individual injury

appears to meet said criteria, code to one of the special categories provided for
multiple injuries.
 When injuries are of the same type and in the same body region, the fourth
character .7 is usually assigned with codes in categories S00-S99.
 When injuries are of different types but in the same body region, the fourth
character .7 is usually assigned with the last category of the block (for example
S09, S19, S29)
 When injuries are of the same type but in different body regions, a code from
categories T00-T05 is assigned.
 Special Rules in Certain Combinations of Injuries
○ In the case of a fracture with an open wound of same location, code the
fracture as the main condition.
○ In the case of a fracture of skull or facial bones with associated intacranial
injury, code the intracranial injury as the main condition with an additional
code for the fracture
○ In the case of an intracranial hemorrhage with superficial injury and/or
open wound, code to internal injury as the main condition.
 In coding conditions due to drugs, medication and biological substances, the first
determination to be made is whether it is a poisoning or an adverse effect due to
the proper administration of a correct substance. These conditions may be
identical; the assignment to poisoning or adverse effect depends entirely on
whether the correct drug was properly administered or if there was some error in
its use.
 A poisoning code from categories T36-T50 is assigned if the condition is due to
one of the following:
○ Wrong dosage given or taken
○ Wrong medication given or taken
○ Medication given to or taken by the wrong person
○ Intoxication (other than cumulative effect)
○ Overdose
○ Correct medicine taken with alcohol or nonprescription drug
 Statements such as the following ordinarily indicate an adverse effect rather than
a poisoning
○ Allergic reaction

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ICD-10 Student Manual –Department of Health, Philippines
○ Cumulative effect of drug taken or given correctly (toxicity)
○ Hypersensitivity to drugs
○ Idiosyncratic reaction
○ Paradoxical or synergistic reaction
 Locating Codes for Poisoning and Adverse Effects
Codes for poisoning due to drugs, medications, and biological substances can be
located in Section III (Table of Drugs and Chemicals) of the Alphabetical Index
(Volume III). Drugs are listed in alphabetical order at the far left. The first of the
five columns to the right provides the poisoning code and the remaining columns
provide external cause code that reflect intent.

 When the condition represents poisoning, the poisoning code is assigned as the
main condition with an additional code for the resulting condition and a code for
the external cause of the poisoning.
 When the resulting condition is an adverse effect due to a correct drug used
correctly, a code form one of the other chapters is assigned to indicate the nature
of the adverse effect. An external cause code from the therapeutic use column of
the drug table should be selected to indicate the responsible drug.. Note,
however, that codes for anaphylactic shock due to the adverse effect of a correct
drug correctly administered, and unspecified adverse effect of a correct substance
properly administered are classified to the injury chapter (T88.6-T88.7)
 Complications of medical or surgical care are classified to categories T80-T88.
Note the extensive exclusion list at the beginning of this block . Codes from this
block should be assigned only when there is specific documentation by the health
care provider.
 Categories T80-T81 classify complications of infusions, transfusions, other
therapeutic injections, and other procedures with the fourth character indicating
the nature of the complication.
 Complications of prosthetic devices, implants, and grafts are classified to
categories T82-T85, with the third character indicating the general type.
 Category T 86 classifies failure or rejection of transplanted organs and tissues,
with the fourth character indicating the organ.
 T87 category classifies complications complication peculiar to reattachment and
amputation.

 IMPORTANT POINTS FOR CHAPTER XX ( EXTERNAL CAUSES OF

MORBIDITY AND MORTALITY):

 Four letters of the alphabet – V,W,X and Y, have been assigned to this Chapter
making it the largest chapter in ICD-10.
 Categories ranged from V01 – Y98
 372 of the total available categories have been used
 There are 8 major blocks
 The first axis for coding external causes is the intent:
○ Accidental (V01-X59)

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ICD-10 Student Manual –Department of Health, Philippines
○ Intentional self-harm or suicide (X60-X84)
○ Assault (X85-Y09)
○ Legal intervention and war operations (Y35-Y36)
○ Complications of medical and surgical care (Y40-Y84)
○ Undetermined intent (Y10-Y34)
 Codes Y10-Y34 are used only when available information is not sufficient to
permit medical or legal authorities to make a distinction regarding intent. It does
not include poisoning, which is considered to be accidental unless otherwise
specified.

 Locating External Cause Codes

The codes for external cause are located in a separate index in Section II of the
Alphabetical Index (Volume III) of the ICD-10. Lead terms may be general, such

as accident or complication or they may be more specific, such as drowning,

jumped or kicked. Terms to be aware when searching the index for the external
cause are exposure and contact if the person comes in contact with an object or
instrument; or is exposed to an element. (eg. The injury was due to being cut by
a knife, look under exposure). The format and conventions are the same as those
used elsewhere in Volume III.

 Place of Occurrence codes

The following fourth-character subdivisions are for use with categories W00-Y34
except Y06.- and Y07.- to identify the place of occurrence of the external cause
where relevant:
.0 Home
Apartment
Boarding-house
Caravan [trailer] park, residential
Farmhouse
Home premises
House (residential)
Noninstitutional place of residence
Private:
• driveway to home
• garage
• garden to home
• yard to home
Swimming-pool in private house or garden

Excludes: abandoned or derelict house (.8)

home under construction but not yet occupied (.6)
institutional place of residence (.1)

.1 Residential institution
Children’s home
Dormitory
Home for the sick
Hospice
Military camp
Nursing home
Old people’s home
Orphanage
Pensioner’s home

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Prison
Reform school

.2 School, other institution and public administrative area

Building (including adjacent grounds) used by the general public or by a particular group
of the public such as:
• assembly hall
• campus
• church
• cinema
• clubhouse
• college
• court-house
• dancehall
• day nursery
• gallery
• hospital
• institute for higher education
• kindergarten
• library
• movie-house

• museum
• music-hall
• opera-house
• post office
• public hall
• school (private)(public)(state)
• theatre
• university
• youth center
Excludes: building under construction (.6)
residential institution (.1)
sports and athletics area (.3)

.3 Sports and athletics area

Baseball field
Basketball-court
Cricket ground
Football field
Golf-course
Gymnasium
Hockey field
Riding-school
Skating-rink
Squash-court
Stadium
Swimming-pool public
Tennis-court

Excludes: swimming-pool or tennis- court in private home or garden (.0)

.4 Street and highway

Freeway
Motorway
Pavement
Road
Sidewalk

.5 Trade and service area

Airport
Bank
Cafe
Casino
Garage (commercial)
Gas station

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Hotel
Market
Office building
Petrol station
Radio or television station
Restaurant
Service station
Shop (commercial)
Shopping mall
Station (bus)(railway)
Store
Supermarket
Warehouse

Excludes: garage in private home (.0)

.6 Industrial and construction area

Building [any] under construction
Dockyard
Dry dock
Factory:
• building
• premises
Gasworks

Industrial yard
Mine
Oil rig and other offshore installations
Pit (coal)(grave)(sand)
Power-station (coal)(nuclear)(oil)
Shipyard
Tunnel under construction
Workshop

.7 Farm
Farm:
• building
• land under cultivation
Ranch

Excludes: farmhouse and home premises of farm (.0)

.8 Other specified places

Beach
Campsite
Canal
Caravan site NOS
Derelict house
Desert
Dock NOS
Forest
Harbour
Hill
Lake
Marsh
Military training ground
Mountain
Park (amusement) (public)
Parking-lot and parking-place
Pond or pool
Prairie
Public place NOS
Railway line
River

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Sea
Seashore
Stream
Swamp
Water reservoir
Zoo

.9 Unspecified place

 Activity codes
The following subclassification is provided for optional use in a supplementary
character position with categories V01-Y34 to indicate the activity of the injured
person at the time the event occurred. This subclassification should not be used
instead of, thee recommended fourth-character subdivisions provided to indicate
the place of occurrence of events classifiable to W00-Y34.
0 While engaged in sports activity
Physical exercise with a described functional element such as:
• golf
• jogging
• riding
• school athletics
• skiing
• swimming
• trekking
• water-skiing

1 While engaged in leisure activity

Hobby activities
Leisure-time activities with an entertainment element such as going to the cinema, to a dance
or to a party
Participation in sessions and activities of voluntary organizations

Excludes: sports activities (0)

2 While working for income

Paid work (manual)(professional)
Transportation (time) to and from such activities
Work for salary, bonus and other types of income

3 While engaged in other types of work

Domestic duties such as:
• caring for children and relatives
• cleaning
• cooking
• gardening
• household maintenance
Duties for which one would not normally gain an income
Learning activities, e.g. attending school session or lesson
Undergoing education

4 While resting, sleeping, eating or engaging in other vital activities

Personal hygiene
8 While engaged in other specified activities
9 During unspecified activity

• Transport accidents
Note: This section is structured in 12 groups. Those relating to land transport accidents
(V01-V89) reflect the victim’s mode of transport and are subdivided to identify the
victim’s “counterpart” or the type of event. The vehicle of which the injured

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ICD-10 Student Manual –Department of Health, Philippines
person is an occupant is identified in the first two characters since it is seen as the
most important factor to identify for prevention purposes.
Excludes: assault by crashing of motor vehicle (Y03.-)
event of undetermined intent (Y32-Y33)
intentional self-harm (X82-X83)
transport accidents due to cataclysm (X34-X38)

• Definitions related to transport accidents

(a) A transport accident (V01-V99) is any accident involving a device designed primarily for, or being used at the time
primarily for, conveying persons or goods from one place to another.

(b) A public highway [trafficway] or street is the entire width between property lines (or other boundary lines) of land open to
the public as a matter of right or custom for purposes of moving persons or property from one place to another. A roadway
is that part of the public highway designed, improved and customarily used for vehicular traffic.

(c) A traffic accident is any vehicle accident occurring on the public highway [i.e. originating on, terminating on, or involving
a vehicle partially on the highway]. A vehicle accident is assumed to have occurred on the public highway unless another
place is specified, except in the case of accidents involving only off-road motor vehicles, which are classified as nontraffic
accidents unless the contrary us stated.

(d) A nontraffic accident us any vehicle accident that occurs entirely in any place other than a public highway.

(e) A pedestrian accident is any person in an accident who was not at the time of the accident riding in or on a motor vehicle,
railway train, streetcar or animal-drawn or other vehicle, or on a pedal cycle or animal.

Includes: person:
• changing wheel of vehicle
• making adjustment to motor of vehicle
• on foot
• user of a pedestrian conveyance such as:

• baby carriage
• ice-skates
• perambulator
• push-cart
• push-chair
• roller-skates
• scooter
• skateboard
• skis
• sled
• wheelchair (powered)

(f) A driver is an occupant of a transport vehicle who is operating or intending to operate it:

(g) A passenger is any occupant of a transport vehicle other than the driver.

Excludes: person traveling on outside of vehicle – see definition (h)

(h) A person on outside of vehicle is any person being transported by a vehicle but not occupying the space normally reserved
for the driver or passengers, or the space intended for the transport of property.

Includes: person (traveling on):

• bodywork
• bumper [fender]
• hanging on outside
• roof (rack)
• running-board
• step

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ICD-10 Student Manual –Department of Health, Philippines
(i) A pedal cycle is any land transport vehicle operated solely by pedals.

Includes: bicycle
Tricycle

Excludes: motorized bicycle—see definition (k)

(j) A pedal cyclist is any person riding on a pedal cycle or in a sidecar or trailer attached to such
a vehicle.
(k) A motorcycle is a two-wheeled motor vehicle with one or two riding saddles and sometimes with a third wheel for the
support of a sidecar. The sidecar is considered part of the motorcycle.

Includes: moped
motor scooter
motorcycle:
• NOS
• combination
• with sidecar
• motorized bicycle
• speed-limited motor-driven cycle

Excludes: motor-driven tricycle—see definition (m)

(k) A motorcycle rider is any person riding on a motorcycle or in a sidecar or trailer attached to such a vehicle.

(l) A three-wheeled motor vehicle is a motorized tricycle designed primarily for on-road use.

Includes: motor-driven tricycle

motorized rickshaw
three-wheeled motor car

Excludes: motorcycle with sidecar—see definition (k)

Special all-terrain vehicle—see definition (w)

(m) A car [automobile] is a four-wheeled motor vehicle designed primarily for carrying up to 10 persons.

Includes: minibus

(n) A pick-up truck or van is a four- or six-wheeled motor vehicle designed primarily for carrying primarily property,
weighing less than the local limit for classification as a heavy goods vehicle, and not requiring a special driver’s license.

(o) A heavy transport vehicle is a motor vehicle designed primarily for carrying property, meeting local criteria for
classification as a heavy goods vehicle in terms of kerbside weight (usually above 3500 kg), and requiring a special
driver’s license.

(p) A bus is a motor vehicle designed or adapted primarily for carrying more than 10 persons, and requiring a special driver’s
license.

Includes: coach
(r) A railway train or railway vehicle is any device, with or without cars coupled to it, designed for traffic on a railway.

Includes: interurban:
• electric car (operated chiefly on its own right-of-way,
• streetcar not open to other traffic)
• railway train, any power [diesel] [electric] [steam]:
• funicular
• monorail or two-rail
• subterranean or elevate

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• other vehicle designed to run on a railway track
Excludes: interurban electric cars [streetcars] specified to be operating on a right-of-
way that forms part of the public street or highway—see definition (s)

(s) A streetcar is a device designed and used primarily for transporting persons within a municipality, running on rails, usually
subject to normal traffic control signals, and operated principally on a right-of-way that forms part of the roadway. A
trailer being towed by a streetcar is considered a part of the streetcar.

Includes: interurban electric car or streetcar, when specified to be operating on a street or

public highway
tram (car)
trolley (car)

(t) A special vehicle mainly used on industrial premises is a motor vehicle designed primarily
for use within the buildings and premises of industrial or commercial establishments.

Includes: battery-powered:
• airport passenger vehicle
• truck (baggage)(mail)
• coal-car in mine
• forklift (truck)
• logging car
• self-propelled truck, industrial
• station baggage truck (powered)
• tram, truck or tub (powered) in mine or quarry

(s) A special vehicle mainly used in agriculture is a motor vehicle designed specifically for use in farming and agriculture
(horticulture), for example to work the land, tend and harvest crops and transport materials on the farm.

Includes: combine harvester

self-propelled farm machinery
tractor (and trailer)

(t) A special construction vehicle is a motor vehicle designed specifically for use in the construction(and demolition) of roads,
buildings, and other structures.

Includes: bulldozer
digger
dumper truck
earth-leveller
mechanical shovel
road-roller

(u) A special all-terrain vehicle is a motor vehicle of special design to enable it to negotiate rough or soft terrain or snow.
Examples of special design are high construction, special wheels and tyres, tracks, and support on a cushion of air.

Includes: hovercraft on land or swamp

snowmobile

Excludes: hovercraft on open water – see definition (x)

(v) A watercraft is any device for transporting passenger or goods on water.

Includes: hovercraft NOS

(w) An aircraft is any device for transporting passengers or goods in the air.

• Classification and coding instructions for transport accidents

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ICD-10 Student Manual –Department of Health, Philippines
1. If an event is unspecified as to whether it was a traffic or a nontraffic accident, it is assumed to be:

(a) A traffic accident when the event is classifiable to categories V10-V82 and V87.
(b) A nontraffic accident when the event is classifiable to categories V83-V86. For these categories the victim is either a
pedestrian, or an occupant of a vehicle designed primarily for off-road use.

1. When accidents involving more then one kind of transport are reported, the following order of precedence should be
used:

aircraft and spacecraft (V95-V97)

watercraft (V90-V94)
other modes of transport (V01-V89, V98-V99)

2. Where transport accident descriptions do not specify the victim as being a vehicle occupant
and the victim is described as:
animal being ridden
animal-drawn vehicle
bicycle
bulldozer
bus
crushed car
dragged motorcycle
hit motorized tricycle
injured by any vehicle including pick-up (truck)
killed recreational vehicle
knocked down streetcar
run over tractor
train
tram
truck
van
classify the victim as a pedestrian (categories V01-V09)

3. Where transport accident descriptions do not indicate the victim’s role, such as:
airplane
bicycle
boat
bulldozer
bus
car
motorcycle
motorized tricycle accident
pick-up (truck) collision
recreational vehicle crash NOS
spacecraft wreck
streetcar
tractor
train
tram
truck
van
watercraft

classify the victim as an occupant or rider of the vehicle mentioned.

If more than one vehicle is mentioned, do not make any assumption as to which vehicle was occupied by the victim unless the
vehicles are the same. Instead, code to the appropriate categories V87-V88, V90-V94, V95-V97, taking into account the
order of precedence given in note 2 above.

4. Where a transport accident, such as:

vehicle (motor)(nonmotor):
 failing to make curve
 going out of control (due to):
 burst tire [blowout]
 driver falling asleep
 driver inattention
 excessive speed
 failure of mechanical part
resulted in a subsequent collision, classify the accident as a collision. If an accident other than a collision resulted, classify it
as a noncollision accident according to the vehicle type involved.
``
1. Where a transport accident involving a vehicle in motion, such as:
accidental poisoning from exhaust gas generated by
breakage of any part of

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ICD-10 Student Manual –Department of Health, Philippines
explosion of any part of
fall, jump or being accidentally pushed from
fire starting in vehicle in
hit by object thrown into or onto motion
injured by being thrown against some part of, or
object in
injury from moving part of
object falling in or on

resulted in a subsequent collision, classify the accident as a collision. If an accident other than a collision resulted, classify it as
a noncollision accident according to the vehicle type involved.

2. Land transport accidents described as:

collision (due to loss of control)(on highway) between vehicle and:
abutment (bridge)(overpass)
fallen stone
guard rail or boundary fence
inter-highway divider
landslide (not moving) are included in V17.-,
object thrown in front of motor vehicle V27.-, V37.-, V47.-,
safety island V57.-, V67.- and V77.-
tree
traffic sign or marker (temporary)
utility pole
wall of cut made for road
other object, fixed, movable or moving

overturning (without collision) are included in V18.-, V28.-, V38.-, V48.-,V58.-, V68.- and V78.-
collision with animal (herded)(unattended) are included in V10.-, V20.-, V30.-, V40.-, V50.-, V60.-, and V70.-
collision with animal-drawn vehicle or animal being ridden are included in V16.-, V26.-, V36.-, V46.-,
V56.-, V66.-, and V76.-

Table of land transport accidents

In collision with or involved in:

Pedes- Pedal Two-or Car Heavy Other Railway Other Fixed or Noncollis Other or
trian or cycle three- (automo- transport motor train or nonmotor stationary sion unspecified
Victim and mode
animal wheeled bile) pick- vehicle or vehicle vehicle vehicle object transport transport
of transport
motor up bus including accident accident
vehicle truck (coach) animal-
or van drawn
vehicle
Pedestrian (W51.-) V01.- V02.- V03.- V04.- V09._ V05.- V06.- (W22.5) - V09.-

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ICD-10 Student Manual –Department of Health, Philippines
Pedal cyclist V10.- V11.- V12.- V13.- V14.- V19.- V15.- V16.- V17.- V18.- V19.-

Motorcycle rider V20.- V21.- V22.- V23.- V24.- V29.- V25.- V26.- V27.- V28.- V29.-

Occupant of:
-three-wheeled
V30.- V31.- V32.- V33.- V34.- V30.- V35.- V36.- V37.- V38.- V39.-
motor vehicle

-car (automobile) V40.- V41.- V42.- V43.- V44.- V49.- V45.- V46.- V47.- V48.- V49.-

-pick-up truck or
V50.- V51.- V52.- V53.- V54.- V59.- V55.- V56.- V57.- V58.- V59.-
van

-heavy transport
V60.- V61.- V62.- V63.- V64.- V69.- V65.- V66.- V67.- V68.- V69.-
vehicle

-bus (coach) V70,.- V71.- V72.- V73.- V74.- V79.- V75.- V76.- V77.- V78.- V79.-

- animal-drawn
vehicle (or
animal V80.1 V80.2 V80.3 V80.4 V80.4 V80.5 V80.6 V80.7 V80.8 V80.0 V80.9
rider)

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ICD-10 Student Manual –Department of Health, Philippines
CHAPTERS XIX & XX: INJURY, POISONING AND CERTAIN
OTHER CONSQUENCES OF EXTERNAL
CAUSES & EXTERNAL CAUSES OF
MORBIDITY & MORTALITY
CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Multiple lacerations to abdomen, inflicted by

a knife during a fight in a bar. The victim
was a bar attendant working in the bar.
2. Peritonitis as a result of swab being left in
wound, following operation to remove an
appendix
3. Cerebral contusion due to fall from bed onto
floor, whilst sleeping, at home
4. Adverse reaction to anaesthetic
1. Jockey fractured his temporal bone following
being thrown from a horse, at the race track
2. Late effect of fracture of ulna from tripping
over child’s toy at home two months previously
3. Sprained ankle during recreational football
game at park, after colliding with another person
4. Accidental perforation of eardrum by
knitting needle at home, - 2 year old
5. A 4 year old fractured her fibula after falling
from a child’s tricycle in the driveway at home.
6. 19 year old professional golfer sustained a twisting
injury to his left knee on the golf course.
Arthroscopy revealed a tear of the medial cartilage
7. This 15 year old boy sustained a knife
laceration to the left thumb one month
previously, whilst gutting a fish on a pier.
Exploration was carried out at that time but
it was subsequently felt that deeper structure
were involved and the patient was
readmitted. Exploration of the muscles of the
left thumb was carried out and the damaged
flexor pollicis muscle was repaired. Patient is
a recreational fisherman
8. The final diagnosis for this 24 year motorcycle
rider who was involved in a collision with a car
was a closed fracture mid shaft right femur,
compound fracture mid shaft right tibia
9. Patient admitted with scar contractures of
wrist wounds as a late effect of trying to slash
her wrist 6 months ago
10. Patient admitted in comatose state. She was found
on kitchen floor by her husband with an empty
bottle of Diazepam next to her. The patients
stomach was pumped and she regained
consciousness and was referred for psychiatric
counseling for attempted suicide.
11. Second degree burns to leg from an
uncontrolled house fire

118

MODULE 26:
FACTORS INFLUENCING HEALTH STATUS AND
CONTACT WITH HEALTH SERVICES
(Chapter XXI)

65
Encounters for health care or other contact with health services are not restricted
to the treatment of illness or injury. They may also occur when a patient who
may or may not be currently sick requires a special service. Examples of such
encounters would be for the purpose of:
○ Monitoring a previously treated condition
○ Surveillance of persons at risk and administration of immunizations
○ Advice and counseling
○ Examination of a healthy person
○ Reproductive management
○ Normal antenatal and postpartum care

Except for encounters for special types of therapy, such as rehabilitation or

chemotherapy, codes in this Chapter are applied only when circumstances other
than a disease or injury are listed as diagnoses or problems. These can occur in
three ways.

1. When a person who may or may not be sick encounters the health
services for some specific purpose, such as to receive limited care or
service for a current condition or to discuss a problem which is in
itself not a disease or injury, codes for these situations are ordinarily
designated as the main condition.
2. When some circumstance or problem is present which influences the
person’s health status but is not in itself a current illness or injury,
codes for such factors may be assigned as additional diagnoses that
may influence the patient’s care for an illness or injury
3. When codes from this Chapter are used to classify the details of the
episode where there is no investigation or treatment of an illness,
these codes will be listed as the main condition. When the patient
receives care for an illness or injury, codes from this Chapter may
also be applicable as additional codes.

Note: Codes from this Chapter are never used for mortality coding

 IMPORTANT POINTS FOR THIS CHAPTER:

 Range of categories is from Z00 to Z99

 84 of the available100 categories have been used
 There are 7 blocks

 Lead terms for locating a code from this Chapter do not reflect conditions,
disease, or injury as they do for other chapters; instead the lead term will indicate
a service, health care problem or status, or other problem that indicates the reason
the patient was seen by the health care provider, or a problem or status that may
be significant for the patient’s care. It may be helpful to review the following
lead terms in the alphabetical index when encountering difficulties locating the
appropriate Z codes:
66
Admission for Donor (organ or tissue) Rehabilitation
Aftercare Examination (general) (routine) Refusal (of)
Attention (to) Fitting (of0 Screening (for)
Boarder Health, healthy Status (post)
Care (of) (for) (following) History (personal) (of) Supervision (of)
Carrier (suspected) of Maintenance Surveillance (of) (for)
Checking (of) Maladjustment Test (of)
Check-up, health (routine) Observation (for) Transplant (ed) (status)
Contact (with) Problem (related to) (with) Vaccination
Contraception Prophylactic
Counseling Replacement by artificial or
Dialysis (intermittent) mechanical device

 Z00-Z13 Pesons encountering health services for examination and investigation,

has many exclusions throughout the block, both to their categories within the
block and other categories outside of the block.
 Codes from categories Z20-Z29 classify various problems and procedures
surrounding the prevention of communicable diseases.
 A code for asymptomatic HIV infection is provided in this Chapter
 Z30-Z39 persons encountering health services in circumstances related to
reproduction, covers all aspects of reproduction, including contraceptive
management, procreative management and pregnancy and antenatal are. Of
particular note is the use of Z37 Outcome of delivery, which should be used as an
additional code to identify the outcome of delivery on the mother’s record.
 Z38 Liveborn infants according to place of birth, is used to code healthy infants
who are occupying a cot, but are not sick.

CHAPTER XXI: FACTORS INFLUENCING HEALTH

STATUS AND CONTACT WITH HEALTH
SERVICES

CODING EXERCISES:
DIAGNOSIS/CONDITION/DISEASE ICD-10 CODE A. I. T. L.

1. Incidental pregnancy

2. Convalescence following surgery

3. Reversal of vasectomy (also known as
vasoplasty)
4. Patient “has been in contact with cholera”

67
5. Outcome of delivery: single live birth (coding
the mothers record)
4. Routine follow-up after surgery for
malignant bladder papilloma
5. Routine general health check-up of armed
Forces
8. Chemotherapy session
9. Attention to tracheostomy
10. Fitting and adjustment of external breast
prosthesis

121

68
ANNEX A:

CORRIGENDA TO VOLUME 1 (TABULAR LIST):

Page 151, category B07:

replace · bladder (D30.3) by · bladder (D41.4)

Page 190:
delete C14.1 Laryngopharynx

Page 377, category F84.4, line 3 of glossary definition:

replace IQ below 50 by IQ below 34

Page 494, category I50.9:

delete biventricular failure

Page 517, category J02.8:

replace all exclusion terms by:

Excludes: pharyngitis (due to):

·enteroviral vesicular (B08.5)
·herpesviral [herpes simplex] (B00.2)
·infectious mononucleosis (B27._ )
·influenza virus:
· identified (J10.1)
· not identified (J11.1)

Page 564, subcategory K22.0

replace congenital cardiospasm (Q40.2)
by congenital cardiospasm (Q39.5)

Page 639, subcategory M19.2:

change title to: Other secondary arthrosis

Page 651, subcategory M43.6:

replace · due to birth injury (P15.8)
by ·· due to birth injury (P15.2)

Page 682, subcategory N05:

replace first two exclusion terms by :
nephropathy NOS with no stated morphological lesion (N28.9)
renal disease NOS with no stated morphological lesion (N28.9)

Page 729, category O15:

add as inclusion term:
eclampsia with pregnancy-induced or pre-existing hypertension

Page 793, category P93:

replace first exclusion term by
jaundice due to drugs or toxins transmitted from mother or
given to newborn (P58.4)

Page 818, subcategory Q40.2:

delete · cardiospasm

69
Page 894, categories S00-S09:
replace · mandibular joint area by ·temporomandibular joint area

Page 934, category S78:

replace traumatic amputation of leg level unspecified (T13.6)
by traumatic amputation of lower limb, level unspecified (T13.6)

Page 1100:
subcategory Y35.0: delete Gunshot wound and Shot NOS
replace Injury by by Legal intervention with

subcategory Y35.1: replace Injury by by Legal Intervention with

subcategory Y35.2: replace all inclusion terms by

Asphyxiation by gas
Injury by tear gas due to legal intervention
Poisoning by gas

subcategory Y35.3: replace all inclusion terms by

Hit, struck by:
· baton
· blunt object due to legal intervention
· stave

Page 1101, subcategory Y35.4:

Replace all inclusion terms by
Cut
Injured by bayonet due to legal intervention
Stabbed

Page 1102, subcategory Y36.2:

delete Blast NOS and · NOS
add to all inclusion terms: during war operations

Page 1107, subcategory Y45.8:

change title to Other analgesics and antipyretics

Page 1184, code M8160/0:

replace (D13.4) by (D13.4, D13.5)

Page 1188, code M8522/2:

replace (D05.1) by (D05.7)

Page 1190:
code M8761/1: replace (D22._ ) by (D48.5)
code M6773/3: replace (C69._ ) by (C69.4)
code M8774/3: replace (C69._ ) by (C69.4)

Page 1193:
code M8930/3: replace (C54.1 ) by (C54._ )
code M8941/3: replace C07._ by C07

Page 1195:

70
code M9124/3: replace (C22.0 ) by (C22.3)
code M9141/0: delete (D18.0)
code M9150/0: delete (D18.0)
code M9160/0: delete (D18.0)

Page 1196, code M9261/3:

delete C41._

Page 1197, code M9350/1:

replace (D44.4) by (D44.3, D44.4)

Page 1200:
code M9590/3: replace (C85.9) by (C84.5, C85.9)
code M9593/3: replace (C83.9) by (C83.3, C83.9)

Page 1201, code M9686/3:

replace (C83.0) by (C83.0, C83.6)

Page 1203:
code M9870/3: replace (C94.7) by (C92._ )
code M9880/3: replace (C94.7) by (C92._ )

Page 1209, code 1-066

replace I10-I14 by I10-I13

Page 1212, code 2-052:

replace I10-I14 by I10-I13

1999UPDATES TO VOLUME 1 (TABULAR LIST)

Page 142, category A81:
change title to Atypical virus infections of central nervous system
add inclusion note Includes: prion diseases of the central nervous system

subcategory A81.8:
change title to Other atypical virus infections of central nervous system

subcategory A81.9:
change title to Atypical virus infection of central nervous system unspecified
replace Slow virus infection NOS by Prion disease of central nervous system NOS

Page 168, category B60:

add exclusion term intestinal microsporidiosis (A07.8)

Page 281:
add subcategory and inclusion terms
E16.4 Abnormal secretion of gastrin

71
Hypergastrinaemia
Zollinger-Ellison syndrome

Subcategory E16.8:
delete subterms
Hypergastrinaemia
Zollinger-Ellison syndrome

Page 317, subcategory F06.3:

line 4 of description: replace … (see F30-32)… by … (see F30-38) …

Page 334, category F31:

line 6 of description:: delete code reference (F31.8)

Page 335, subcategory F31.8:

replace Recurrent manic episodes by Recurrent manic episodes NOS

Page 348, subcategory F45.0:

add inclusion term Briquet’s disorder

Page 351, subcategory F48.8:

Delete inclusion term Briquet’s disorder

Page 453, subcategory H50.2:

add inclusion terms
Hypertropia
Hypotropia

subcategory H50._
delete inclusion terms
Hypertropia
Hypotropia

Page 529, subcategory J34.1:

change title to Cyst and mucocele of nose and nasal sinus

Page 569:
add subcategory and exclusion note
K31.7 Polyp of stomach and duodenum
Excludes: adenomatous polyp of stomach (D13.1)

Page 582, category K63:

add subcategory and exclusion notes:
K63.5 Polyp of colon
Excludes: adenomatous polyp of colon (D12.6)
Polyposis of colon (D12.6)

Page 588:
add subcategory K75.4 Autoimmune hepatitis

Page 803, subcategory Q15.0:

replace Keratoglobus, congenital by Keratoglobus, congenital with glaucoma
add inclusion term Macrocornea with glaucoma
replace megalocornea by Megalocornea with glaucoma

Page 815:
delete subcategory Q35.0 Cleft hard palate bilateral

72
subcategory Q35.1:
change title to Cleft hard palate
delete inclusion term Cleft hard palate, NOS

delete subcategory Q35.2: Cleft soft palate, bilateral

subcategory Q35.3:
change title to Cleft soft palate
delete inclusion term Cleft soft palate NOS

delete subcategory Q35.4 Cleft hard palate with cleft soft palate, bilateral

subcategory Q35.5:
change title to Cleft hard palate with cleft soft palate
delete inclusion term Cleft hard palate with cleft soft palate NOS

delete subcategory Q35.8: Cleft palate, unspecified, bilateral

subcategory Q35.9:
change title to Cleft palate, unspecified

Page 816:
subcategory Q37.0: change title to Cleft hard palate with bilateral cleft lip
subcategory Q37.1: change title to Cleft hard palate with unilateral cleft lip
subcategory Q37.2: change title to Cleft soft palate with bilateral cleft lip
subcategory Q37.3: change title to Cleft soft palate with unilateral cleft lip
subcategory Q37.4: change title to Cleft hard and soft palate with bilateral cleft lip
subcategory Q37.5: change title to Cleft hard and soft palate with unilateral cleft lip
subcategory Q37.8: change title to Unspecified cleft palate with bilateral cleft lip
subcategory Q37.9: change title to Unspecified cleft palate with unilateral cleft lip

Page 837, subcategory Q75.4:

add inclusion terms
Syndrome:
· Francescherti
· Treacher Collins

Page 845, subcategory Q87.0

Under Syndrome delete inclusion term · Treacher Collins

Page 916, category S37:

change title to Injury of urinary and pelvic organs

Page 1149, category Z52:

add subcategories
Z52.6 Liver donor
Z52.7 Heart donor

ANNEX B

73
ANNEX C

74
ANNEX D:

75
RELATED LAWS, RULES AND EVENTS RELEVANT WITH DEATH
RECORDING AND REGISTRATION

In 1698

The Church required every parish to keep the books of records of events in their parochial archives
– the cause of death was omitted especially in the register outside the City of Manila
– and when given, it indicated that the deceased had died a natural death even if it is a result of
accident or some other violent means

1 July 1895

1st issue of Statistical Bulletin with Vital Statistics

18 June 1898

Creation of the delegate of Justice and Civil Region

Section 3 of the DECREE

On June 18, 1898 reorganizing the towns under its control mandated the election of delegate of Justice
and Civil registration whose duty was to assist the town chief in the initiation of court proceeding and the
preparation of the record books of birth, deaths and marriages.

1917 Revised Administrative Code, Section 2214 (during the American Regime)
– regulated the registration of births and deaths making it the responsibility of physician and
midwives to submit to the municipal secretary reports of births and deaths they attended to for
entry into the Civil Registry.

Revised Administrative Code section 1087

– provided the need for certificates of death to be accomplished either by the attending physician, if
there is any, or if there is none, by any physician or the local health officer

Revised Administrative Code section 1090

– requires the burial and transfer permits in all cases of death

27 February 1931, Act No. 3753

– civil registration was made compulsory by virtue of Civil Registry Law

Act 3753, Section 6

– no human body shall be buried unless the proper death certificate has been presented and recorded

– the physician who attended the deceased or, in his default, the health officer concerned, or in
default of the later, any member of the family of the deceased, or any person having knowledge of
death shall report the same to the local health authorities, who shall issue a death certificate and
shall order the same to be recorded in the office of the local civil registrar.

Some Pertinent provisions of NSO Administrative Order No. 1, series of

1993:

76
Rule 33. Persons Responsible to Report the Event – (1) It shall be the
responsibility of the Physicians who last attended the deceased or the Administrator of the
hospital or clinic where the person died to prepare the proper death certificate and certify as to the
cause of death . The death certificate shall then be forwarded within forty-eight (48) hours after
death, to the health officer who shall examine the Certificate of Death and then affix his signature
in the appropriate box and shall order its registration in the Office of the Civil Registrar.

(2) It shall be the responsibility of the nearest relative or person who has knowledge of
the death to report the same within forty-eight (48) hours if the deceased died
without medical attendance. The health officer shall examine the deceased and shall
certify as to the cause of death and direct the registration of the death certificate to
the Office of the Civil Registrar within the reglementary period of thirty (30) days .

(3) Where the death occurs in a vehicle/vessel/airplane, the driver/ship captain/pilot, as the
case maybe, shall report such death to the concerned health officer. In
accidents where there are no survivors, it is the responsibility of the owner of
the vehicle/vessel/airplane to make the report of death
(4) In the absence of a health officer or his authorized representative in the
place of registration, or when it is a non-working day and the health
officer or his authorized representative is not expected to be in his office,
the death should be reported within forty-eight (48) hours after its
occurrence by the nearest kin of the deceased or by any person having
knowledge of the death to the mayor or to any member of the
Sangguniang Bayan, or to the municipal secretary, who shall issue the
Certificate of death for burial purposes.

(5) The mayor, any member of the Sangguniang Bayan or the municipal
secretary, as the case may be, shall sign the medical certification portion of the Certificate of Death
and the same shall be accepted for registration by the civil registrar concerned, provided that the Certificate
of Death and the Register of Deaths shall carry a remark that registration was made pursuant to
Section 91 of PD No. 856 also known as the Sanitation Code of the Philippines (to be written in the
box located at the upper right hand portion of the Certificate of Death).

ANNEX E

INSTRUCTIONS MANUAL
CIVIL REGISTRY FORMS
(Accomplishment and Coding)

77
(an excerpt on Death Registration)

2.2.3 CERTIFICATE OF DEATH

ITEM NO. ITEM TITLE DISCUSSIONS/INSTRUCTIONS

1 NAME • This item is used to identify the deceased.
• It is very important that the name of the deceased is correctly
spelled out and entered in full.
• Enter the full name of the deceased in the following manner: first,
middle and last name.
• If the deceased cannot be identified, leave this item blank. In the
remarks portion, enter the annotation “Body Not Identified” and
give a brief description that may help identify the deceased.
2 SEX • This item is used in determining sex-specific mortality rates.
• Place “X” before the appropriate sex of the deceased
3 RELIGION • This item is used to determine the incidence of deaths in certain
religion.
• Enter the faith professed by the deceased such as “Roman Catholic”,
“Aglipayan”, “Iglesia ni Kristo”, etc.
4 AGE • This information is used to study the age-specific mortality
differentials for planning and evaluation of public health programs.
• In reporting age, classification s made for:
○ individuals who died at age 1 year or over
○ those who lived for less than a year but more than 1 day;
and
○ those who lived for less than a day
• Only the appropriate column shall have entries. Leave the other
columns blank.
○ One year or above: enter the exact age of the deceased in
completed years as of his last birthday.
○ Under 1 year: enter the exact age in months and/or days at
the time of death of infant who had survived for at least a
day but less than a year
○ Under 1 day: enter the exact number of hours, minutes or
seconds the infant had lived for infants who died within 24
hours.
 If the infant ha lived for 23 hours or below enter
the age in completed hours.
 If the infant had lived for less than 1 hour enter
the age in minutes.
 Entries should be indicated in hours, minutes or
seconds, as the case maybe.
5 PLACE OF DEATH • Information on place of death is necessary in determining if the
document was registered in the proper place and whether the
document has been approved by the authorized health officer.
• For deaths in hospital/clinic or other similar institutions, enter the
complete name of the hospital or the institution, followed by the
complete address (no., street/barangay, city/municipality and
province).
• If death occurred at the house of the deceased, enter the exact
address (house number, street/barangay, city/municipality and
province).
• As to the following case, enter the place of death a indicated:
○ If death occurred in a vehicle, vessel or airplane and the
exact place of death cannot be ascertained, enter the name,
route, place number/voyage number/flight number, as the
case may be, and other necessary description of the
vehicle/vessel/airplane and the description of the location
where the accident happened.
6 DATE OF DEATH • This item helps in verifying the age of the deceased at the time of
his death.

78
• Enter the exact day, month and year when the person died.
Abbreviated name of the month as “Jan” is acceptable; numerical
entry for the month like “1’ for January, “2” for February, etc. is
not acceptable since this can easily be confused with the entry for
day.
• If the exact date of death is not known, enter the most probable date
of death.
7 CITIZENSHIP • Citizenship is the status that entitles a person to the rights and
privileges of a subject in a chosen country. Citizenship is acquired
by birth, by naturalization or by election.
• Enter the citizenship of the deceased like “Filipino”, “American”,
etc.
8 RESIDENCE • Mortality data by residence are used with population data to
compute death rates which are important in environmental studies.
Data on deaths by place of residence of the deceased are also used
to prepare population estimates and projections.
• Enter the complete address of the place where the deceased
habitually resides at the time of death.
9 CIVIL STATUS • This information is used in determining differences in mortality by
civil status. The classifications of civil status are defined as
follows:
○ single- if never been married
○ married- legally married only. A person classified as
“married” includes one who remarried after having been
widowed, separated or divorced or one temporarily
separated from spouse owing to the nature of work, illness
or service in the Armed Forces. Persons also considered
married are those separated from their spouse either legally
or otherwise, due to marital discord.
○ widowed- a person whose spouse died and who has not
remarried at the time of death.
○ divorced- if bond of matrimony has been dissolved
through a court decree and is therefore free to remarry.
○ unknown- if civil or marital status is either not known to
the informant , or the informant himself refuses to reveal
the marital status of such person.
• Place “X” before the appropriate answer.
10 OCCUPATION • This item is useful in studying occupation related-mortality and in
identifying job-related risk areas.
• Occupation refers to the type or work activity that the deceased was
mostly engaged in prior to his death or confinement to an
institution.
• For 15 years old and over, enter the occupation of the deceased.
The entry should adequately describe the occupation, such as “palay
farmer”, “mason”, “carpenter”, etc. Not acceptable are vague
descriptions like employee, agent, etc.

FOR DECEASED PERSONS AGED 0 TO 7 DAYS:

➢ Accomplish items 11 to 17 located at the back portion of the Certificate of Death before proceeding to
accomplish item 18 onwards

B11 DATE OF BIRTH • This item is used to know the exact age of the deceased.
• Enter the exact day, month and year the deceased was born.
• Enter the full or abbreviated name of the month; do not use number
to designate the month.
B12 AGE OF MOTHER • This item is one of the most important factors in he study of
childbearing and pregnancy outcome.
• Enter the mother’s age in completed years as of her last birthday
B13 METHOD OF • This information is used to establish the trend in obstetric practice
DELIVERY and to determine which groups of women are likely to have
caesarean delivery

79
• Classification between the surgical and other procedures to identify
the method of delivery are given below:
a) Normal, spontaneous vertex vaginal delivery, occipitoanterior
b) Classified as “Others” in this item are as follows:
○ cephalic vaginal delivery with abnormal presentation of
head at delivery, without instruments, with or without
manipulation;
○ forceps, low application, without manipulation like forceps
delivery NOS;
○ other forceps delivery such as forceps with manipulation,
high forceps and mid forceps;
○ vacuum extraction which includes ventouse;
○ beech delivery, spontaneous assisted or unspecified like
partial breech extraction;
○ breech extraction including NOS and total version with
breech extraction;
○ elective caesarean section like caesarean section before, or
at onset of labor;
○ other and unspecified caesarean section; and
○ other and unspecified method of delivery that includes
application of weight to leg in breech delivery, destructive
operation to facilitate delivery and other surgical or
instrumental delivery.
B14 LENGTH OF • This gives information on the effect of gestational age on the
PREGNANCY weight, maturity and health condition of the fetus.
• Enter the length of pregnancy or gestation period in number of
completed weeks as estimated by the attendant at birth.
• If the attendant has not done a clinical estimate of gestation, place
the word “Don’t Know” or “D. K” in the space provided
B15 TYPE OF BIRTH • Type of birth has important health implications
• Place “X” before the appropriate code whether the child was born
single, or a product of multiple birth such as twin, triplet, etc.
B16 IF MULTIPLE BIRTH, • The occurrence of multiple births is related to the age of the mother
CHILD WAS and birth order.
• Survival differences related to order of delivery exist in multiple
births.
• This item plays an important role in maters relative to testate
succession or matters of inheritance.
• If multiple birth, specify the order in which the child was born, i.e.
first, second, etc.
• Place “X” before the appropriate code.
• If “X” is placed before “Others”, specify the order of his birth, i.e.,
“third”, “fourth”, etc
• Each deceased multiple births should have a separate certificate.
•

B17 CAUSES OF DEATHS • “Cause of Death” is the most important statistical and research item
on the death certificate.
• It provides medical information that serves as basis for describing
trends in human health and mortality and for analyzing the
conditions leading to death.

• Mortality statistics provide the basis for medical studies that focus
on leading causes of death by age and sex and also provide a basis
for research in the study of diseases and diagnostic techniques.
• The item on “Causes of Deaths” for deceased infants aged 0-7 days
consist of:
a) main disease/condition of infant
b) other diseases/conditions of infant
c) main maternal disease/condition affecting the infant
d) other maternal diseases/conditions affecting infant

80
e) other relevant circumstances
• Main disease/ condition of infant is that which directly caused his
death.
• Other diseases/conditions of infants are those that gave rise to the
main disease/condition.
• The mode of death, e.g., “heart failure”, “asphyxia”, “anoxia”,
should not be entered in line “a” unless it was the only fetal or
infant condition known.
• The entries in lines “c” and “d” refer to the diseases/conditions, if
any, of the mother which in the opinion of the certifier had some
advance effect on the infant.
• The entry in line “c’ should be the maternal diseases or condition
that caused the death of the infant.

• Enter in line “a” the main disease or condition of the infant directly
causing his death.
• Enter in line “b” the other diseases or conditions that gave rise to the
immediate cause in line “a’.
• Enter in line “c” the main maternal disease or condition affecting
the infants death.
• Enter in line “d’ the other maternal diseases or conditions tat gave
rise to the immediate cause in line “a”
• Enter other relevant circumstances contributing to the infant’s death
on line “e”.

FOR DECEASED PERSONS AGED 8 DAYS AND OVER:

➢ Accomplish items 17 onwards located in front of the Certificate of Death
17 CAUSES OF DEATH • Causes of death refer to the kinds of disease, illness or morbid
condition that led to the death of the deceased.
• N many case, death may not be due to a single cause but to multiple
or joint causes.
• This item should include the causal and chronological sequences of
disease/condition that caused the death
• Immediate cause of death is the disease or morbid condition that had
directly led to death.
• Antecedent cause gave rise to the immediate cause of death.
• The underlying cause of death is that which initiated the train of
morbid events leading directly to death or the circumstances of the
accident or violence which produced the fatal injury.
• Queries on other significant conditions contributing to death but not
necessarily related to the entries given in Part I are indicated in Part
II.
• The duration or interval between onset and death refers to the
duration of each morbid conditions that led to death.
• Duration of each morbid condition is used to obtain a more accurate
account of the cause of death.
• This item should always have an entry.
• Enter the diseases, injuries or complications that caused the death.
• Entries such as cardiac or respiratory arrest, shock or heart failure
are not acceptable.
• Entries in lines “a”, “b, and “c” the immediate , antecedent and
underlying cause of death, respectively.
• Enter the interval between the onset of each condition and death. If
not known, leave it blank.
18 DEATH BY NON- • Indicating the cause of death by non-natural causes as enumerated
NATURAL CAUSES in this item is an important information to justify the payment of
double indemnity on life insurance policies.
• It is also used to obtain a more accurate determination of cause of
death.
• On the manner of death, place “X” before the appropriate answer on
the line whether the death that is due to external cause is a case of a
homicide, a suicide, an accident, or others like legal intervention.
• On the place of occurrence, indicate whether death occurred at

81
home, office, factory, etc.
19 ATTENDANT • If the deceased had been medically attended to, the exclusive dates
during which the deceased sought medical attendance for the
disease, illness, or injury that caused his death is to be indicated in
this item.
• Place “X” before the appropriate answer.
20 CERTIFICATION • This item is used to identify the person who gave the information in
the medical certificate portion..
• Enter “X” before the appropriate answer.
• If “X” is placed in the second box, enter the exact time when the
death occurred.
• Print the name, title or position, address and date in the
corresponding lines.
• Affix the signature of the certifying officer in the space provided.
• Print the name of the health officer who reviewed the medical
certificate and date.
• The health officer should affix his signature on the space provided.
• If the certifying officer is also the health officer, his name should
appear twice.

21 CORPSE DISPOSAL • The manner by which the body of the deceased is to be disposed,
whether by cremation or burial should be indicated.
• Enter “X” on the space provided for the appropriate answer.
• If the answer is “Others”, specify the manner by which the corpse
was disposed such as “Donation”, etc.
22 BURIAL/CREMATION • Enter he number and he date of issuance of the burial/cremation
PERMIT permit.
• If “Others” in Item 21 is marked with “X”, enter the “Not
Applicable” or “NA” on the space provided for this item.

• This item is particularly important in arriving at the immediate and

23 AUTOPSY underlying causes especially if death is caused by non-natural cause.
• Enter “X” before the appropriate answer.
24 NAME AND ADDRESS • This information indicates whether the body was properly disposed
OF CEMETERY OR of as required by law.
CREMATORY • Enter in the space provided the name and complete address of
cemetery/crematory where the deceased was buried or cremated.
• If in Item 21 “Others” is marked with “X” , enter “Not Applicable”
or “NA” in this item.
25 INFORMANT • The name and address of the informant can help in case question or
problems regarding the content of the Certificate of Death arises.
• Enter the name of the person who provided the information, his
address and the date when the information were supplied. His
signature should be affixed.
26 PREPARED BY • Enter the name, title/position of the person who prepared the
certificate and the date when the certificate was prepared.
• He should affix his signature on the space provided.
27 RECEIVED AT THE • After checking he completeness and correctness of entries, the civil
OFFICE OF THE registrar or his authorized deputy or assistant shall affix his
CIVIL REGISTRAR signature over his printed name.
• His title or position and the date when the document was received at
his office must also be indicated.
• The signature affixed in this item indicates that the certificate was
filed and accepted by the civil registrar.

• The date indicates whether the birth certificate was filed within the
reglementary period.

• The absence of the necessary signature in this item an be a basis for

questioning the validity of the certificate.

82
• Facsimile signature is not accepted.
➢ The following certifications and affidavits are located at the back potion of the
Certificate of Death
POSTMORTEM CERTIFICATE OF • This is accomplished only if an autopsy has been performed on the
DEATH deceased.
• This should be accomplished and signed by the medico-legal officer
who shall likewise fill up the item on cause of death and the one to
sign the certification portion of the Certificate of Death.
CERTIFICATE OF EMBALMER • This certification is accomplished by the person who embalms the
deceased.
• Enter the name in print, address, title/designation an license number
including the date of issuance, he place of issuance and expiry date
of said license of the person who embalmed the deceased. His
signature must also be affixed.
AFFIDAVIT FOR DELAYED • For death registered after the reglementary period, the affidavit for
REGISTRATION OF DEATH Delayed Registration should be executed.
• The affidavit should be carefully and completely filled-up.
• This should be subscribed and sworn to before an administering
officer who maybe the civil registrar.

2.2.3 CERTIFICATE OF FETAL DEATH

ITEM NO. ITEM TITLE DISCUSSIONS/INSTRUCTIONS

➢ This portion contains the information about the fetus

1 NAME • This item is used to identify the fetus.
• Enter the name of the fetus if a name has been provided.
• Otherwise, enter “No Name”.
• Entries such as “Baby Boy” or “Baby Girl” followed by the fetus’
surname is acceptable.
2 SEX • This information is used to measure the fetal and perinatal mortality
by sex.
• It helps to identify differences in the impact of environmental and
biological factors between sexes.
• Some fetus are delivered full term or close to full term and its sex
can already be determined.
• If such is the case, the sex of the fetus should be indicated by
marking with “X” the appropriate code
• In case the sex of the fetus cannot be determined, mark code 3 for
“Undetermined”
3 DATE OF DELIVERY • Enter the exact day, month, and year when the fetus was delivered
in the order specified.
• Enter the full or abbreviated name of the month, e.g., “January”,
“February”, “Jan”, etc.
• Do not use a number to indicate a month
4 PLACE OF • If the place of delivery is a hospital, clinic or similar institution,
DELIVERY enter the complete name of the hospital, clinic or institution and the
complete address (No. , Street, Barangay, City/Municipality, and
Province).
• Otherwise, enter the complete address of the place where the
delivery took place.
5a TYPE OF DELIVERY • Type of delivery refers to whether the delivery is single, twin,
triplet, etc.
• This information has important health implications.
• Place “X” before the appropriate answer.
• For multiple delivery wherein all the fetuses are death, a separate
certificate for each fetus shall be accomplished.
5b IF MULTIPLE • Place “X” before the appropriate answer.
DELIVERY, FETUS • If “Others” is marked with “X”, specify if “triplet”, “quadruplet”,
WAS etc.

83
5c METHOD OF • For the different methods of delivery, refer to the same item in the
ELIVERY Certificate of Death.
• Place “X” before the appropriate answer.
5d BIRTH ORDER • The birth order of the child, i.e., first, second, etc., is determined by
considering all previous deliveries of the mother including fetal
deaths and those delivered during previous marriages of mother
• A distinction in the order of births should be made with multiple
births; thus, one twin is classified as being born first before the
other, no matter how close they come to being delivered
simultaneously.
• Enter the order y which the child was born such as “first”,
“second”, and so on.
5e WEIGHT OF FETUS • This is the most important information that can be associated with
viability of the fetus.
• It can also be related to socioeconomic status, marital status, and
other factors surrounding the delivery.
• Consequently, it is used with other information to plan for and
evaluate the effectiveness of health care.
• Enter the weight of the fetus in grams in the space provided.
➢ Information about the mother at the time of the delivery of the fetus
6 MAIDEN NAME • The mother’s maiden name is used to establish her identity.
• Enter the maiden name of the mother.
• Initials are not acceptable.
• Do not include the title/position of the mother like “Dr.”, Engr”, etc.

• If the mother is married or divorced, enter her maiden name , that is

her full name before marriage
7 CITIZENSHIP • This is the status that entitles the mother to the rights and privileges
of her country.
• Citizenship is acquired by birth, by naturalization or by election.
• Rite the citizenship of the mother. For example, “Filipino”, if a
citizen of the Philippines, “American” , if a citizen of the United
States, etc.
8 RELIGION • Enter the faith professed by the mother such as “Roman Catholic”,
“Aglipayan”, “Iglesia ni Kristo”, etc.
9 OCCUPATION • Information on this item is useful in studying occupation related
fetal mortality and in identifying job-related risk areas.
• This tem is used to obtain information on the potential impact of the
work environment on the fetus.
• Researchers believe that the occupational hazards (exposures to the
mother which have the most deleterious effect on the fetus are those
that occur during pregnancy, particularly in the early times of
pregnancy.
• Enter the occupation or profession of the mother at the time of this
delivery. For example dressmaker”, “elementary school teacher”,
“palay farm worker”, etc.
10 AGE AT THE TIME • Age is one of the most important factors in the study of
OF DELIVERY childbearing and pregnancy outcome.
• Enter the age of the mother in completed years at the time of the
delivery of he fetus.
11a TOTAL NUMBER OF • Items 11a, 11b and 11c are used to determine total birth order,
CHILDREN BORN which is important in studying trends in childbearing and child
ALIVE spacing.
• These are also used in studying health problems associated with
birth order, for example, first birth orders to older women and
determining the relationship of birth order to perinatal mortality.
• Total number of children born alive refers to all children born alive
up to this delivery expressed in such a way as to distinguish
children who are still living and children born alive but have since
died.
• Enter the total number of children born alive.
11b NO. OF CHILDREN • Enter the number of children who are still living at the time of the

84
STILL LIVING delivery of this fetal death
11c NO. OF CHILDREN • Enter the number of children born alive to this mother, who are no
STILL LIVING longer living at the time of the delivery of this fetal death
12 RESIDENCE • Statistics on fetal deaths are tabulated by place of residence of the
mother
• These data are used in planning and evaluating community services
and facilities, including maternal health programs.
• Enter the house no., street, barangay, city/municipality and province
where the mother habitually resides at the time of birth of the child
.
• It is not necessary that the mother’s residence is the same as the
place where the delivery occurred.
➢ Information about the father at the time of the delivery of the fetus
13 NAME • Type or print the full first, middle and last name of he father.
• Initials are not acceptable.
• Entries as “Jr.”, “Sr.”, and so forth, following the first name are
acceptable.
• Do not include the title/position of the father like “Dr.”, “Engr”,
etc.
• The items provided for the father hall be filled-up by the following
rules stated below:
○ If the ;parents of the fetus are married at the time of
delivery, write the name of the father on the space
provided and fill-up the other items provided for the father
of the fetus.
○ If the fetus was conceived and born out of wedlock and the
delivery occurred on or after 03 August 1988, write the
name of the father provided he executes an affidavit of
admission of paternity. If he refuses to execute said
affidavit, enter “Unknown” in Item 13 and “Not
Applicable” or “NA” in items 14 to 17.
○ If the fetus was conceived and born out of wedlock, and
the delivery occurred before 03 August 1988, enter the
name of the father provided he executes an affidavit of
acknowledgement. If he refuses to acknowledge the fetus,
enter “Unknown” in item 13 and “Not applicable” or “NA”
in items 14 to 17 .
14 CITIZENSHIP • Refer to the instructions for Item 7 of the Certificate of Death.
15 RELIGION • Refer to the instructions for Item 8 of the Certificate of Death.
16 OCCUPATION • Refer to the instructions for Item 9 of the Certificate of Death.
17 AGE AT THE TIME • Enter the age of the father in completed years at the time of the
OF THIS DELIVERY delivery of the fetus.
18 DATE AND PLACE OF • It is extremely important that this item is not left blank.
MARIAGE OF • Otherwise, the legitimacy of the fetus will be questioned.
PARENTS • Enter the exact date and place of marriage if the parents are legally
married at the time of birth.
• If the parents have forgotten the exact date of their marriage, enter
the approximate year.
• If they cannot approximate the year, enter “Forgotten”
• Enter “Not Applicable” if the child has unknown father or mother.
• Enter “Unknown”, “Don’t Know” or “D.K” if the informant could
not supply the information.
• Enter “Not Married” if the parents of the child are not legally
married on or before the birth of the child and their names appeared
in Item 6 and Item 13.
19 CAUSES OF FETAL • Causes of fetal death is he most important statistical and research
DEATH item on the fetal death certificate.
• It provides medical information that serves as basis for describing
trends in fetus’ health and mortality and for analyzing the
conditions leading to fetal death and in a particular area.
• Fetal mortality statistics provide the basis for medical studies that
focus on leading causes of fetal death by age of mother and type of

85
attendance and also provide a basis for research in the study of
diseases and diagnostic techniques.
• The item “Causes of Fetal Death” consists of:
a) main disease/condition of fetus
b) other diseases/conditions of the fetus
c) main maternal disease/condition affecting fetus
d) other maternal diseases/conditions affecting fetus
e) other relevant circumstances
• Main disease/condition of fetus is that which directly caused its
death while other diseases/conditions of fetus are those that gave
rise to the main disease/condition.
• Prematurity should not be entered in line “a” unless it was the only
fetal condition known.
• Stillbirth is also not acceptable as an entry.
• The entries in lines “c” and “d” refer to the diseases/conditions, if
any, of the mother of the fetus. The entry in line “c” should be the
maternal disease or condition that caused the death of the fetus.
• Enter in line “a” the main disease or condition of fetus directly
causing its death.
• Enter in line “b” the other diseases or conditions that gave rise to he
immediate cause in line “a”.
• Enter in line “c” the main maternal disease or condition affecting
the fetus death.
• Enter in line “d” the other maternal diseases or conditions that gave
rise to the immediate cause in line “a”.
• Enter other relevant circumstances contributing to fetal death on
line “e”.
20 FETUS DIED • This item is used to check whether what was reported is a fetal
death
• I is also used as a basis for the formulation of plans for maternal
and child health.
• Indicate when the fetus died by placing “X” before the appropriate
code
21 LENGTH OF • Refer to the instructions for Item B14 of the Certificate of Death.
PREGNANCY
22a ATTENDANT • Refer to the instructions for Item 19 of the Certificate of Death.
22b CERTIFICATION • Refer to the instructions for Item 20 of the Certificate of Death.
23 CORPSE DISPOSAL • Refer to the instructions for Item 21 of the Certificate of Death.
24 BURIAL/CREMATION • Refer to the instructions for Item 22 of the Certificate of Death.
PERMIT
25 AUTOPSY • Refer to the instructions for Item 23 of the Certificate of Death.
26 NAME AND ADDRESS • Refer to the instructions for Item 24 of the Certificate of Death.
OF CEMETERY OR
CREMATORY
27 INFORMANT • Refer to the instructions for Item 25 of the Certificate of Death.
28 PREPARED BY • Refer to the instructions for Item 26 of the Certificate of Death.
29 RECEIVED AT THE • Refer to the instructions for Item 27 of the Certificate of Death.
OFFICE OF THE
CIVIL REGISTRAR
➢ The following certifications and affidavits are located at the back portion of the
Certificate of Fetal Death
AFFIDAVIT OF • The Affidavit of Acknowledgement/Admission of Paternity at the
ACKNOWLDGEMENT/ADMISSION back of the certificate must be accomplished if the parents are not
OF PATERNITY legally married.
• The affidavit of Acknowledgement is applicable if the child was
born prior to 03 August 1988. It may be accomplished by both
parents or either party if one of them refuses.
• The Affidavit of Admission of paternity, on the other hand, shall be
accomplished by the father if the child was born on or after 03
august 1988.
POST MORTEM CERTIFICATE OF • Refer to the instructions in filling-up the Postmortem Certificate in
DEATH the Certificate of Death

86
ANNEX F:

IMPROPER ACCOMPLISHMENTS
OF FETAL DEATH AND DEATH CERTIFICATES

I. CERTIFICATE OF DEATH

A. not in accordance with implementing rules and regulations

1. not the proper certificate

(pertains to the use of a certificate which is not the prescribed form for the
event)
2. not a registrable event
(refers to a recording of occurrence which does not meet the definition)
3. blank medical certificate
(indicates that the certifier ailed to state the cause of death of the person
concerned)
4. other certifier not mentioned
(pertains to the designation of other laymen not indicated in the rules and
regulation)

B. inconsistent entries
(a transcribed entry to one item contradicts the entry in the same or
another item in the certificate)

1. other items
(indicates the discrepancies between items not necessarily connected with the
medical certificate portion)

a. name vs. sex vs. occupation

(this gives contrasting entries on the identification of the deceased based
on the given first name, the marked gender and the given occupation )

b. age

87
(refers to the improper transcription of yr/mo/day that the deceased has
survived)

c. attendant vs. certifier

(pertains to the inconsistency of item on attendant at death as against the
marked entry at the certificate)

1. items related to medical certificate

(portion whether the deceased was attended or not by the certifier)

a. name vs. sex vs. cause of death

(this gives contrasting entries on the identification of the deceased , the
marked gender and the written cause of death)

b. age vs. medical certificate

(the inconsistency lies in not filling-up the supplementary portion at the
back of the certificate which calls for the relevant entries when the
deceased was less than 8 days old)

c. manner of death vs. cause of death

(the inconsistency in these two items are marked by the absence of an
entry in the manner by which non-natural or external cause has
inflicted to the person THAT CAUSED HIS DEATH)

a. attendant vs. cause of death

(this shows the inconsistency indicated in these two items especially
the failure of certificate to indicate the cause of death)

C. improper accomplishments of the medical certificate

(this describes the transcription of diseases, illnesses or causes which are short of the
description or ineligible to other user of the certificate)

1. incorrect
(the entry is not classifiable as a cause of death)

2. incomplete
(the statement fall short to a rather complete description of cause of death, i.e.
the reported condition is a direct consequence of another condition not
included in the certifier’s statement)

3. vague
(refers to the acronyms and terminologies that are easily understood only by
one signing the medical certificate)

4. not legible
(the entry is unreadable)

5. incorrect sequence
(negates the recommendation of sating the cause of death in sequence)

D. terms supposedly not to be used as cause of death

(these terms are described as the mode of dying and these were recommended not to be
used as the immediate cause of death, but in these exercises , this mode of death are
singly reported as cause of death)

88
II. CERTIFICATE OF FETAL DEATH

A. cause of death is not specified

(there is no disease, illness or non-natural cause of death written in the certificate)

B. inconsistent entries of birth order and number of children born alive

(the birth order entry does not coincide with the given number of children born alive)

C. blank items
a. method of delivery
b. birth order
c. weight at birth
d. timing of delivery
e. length of pregnancy
f. attendant

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Student Manual Coders Training

Uploaded by

Student Manual Coders Training

Uploaded by

This workbook has been developed by Sue Walker and Maryann Wood, National Center

for Classification in Health (Brisbane), School of Public Health, Queensland University

JUAN M. LOPEZ, MD, MPH

MARY ANN EVANGELISTA, MD

MS. FLORINDA TUVILLO

MS. FE BENEDICTA DELA CRUZ

MS. THERESA TIMBANG

Grateful acknowledgment is also extended to those who have contributed to the

Please direct comments to the ICD-10 Technical Working Group, National

ANNEXES: A: Corrigenda /Updates to Volume 1(Tabular List)

Clinical coding – it is the translation of diseases, health related problems and

WHAT IS A STATISTICAL CLASSIFICATION?

➢ A classification is a system of categories or groupings to which diseases, injuries,

➢ The element of grouping similar terms distinguishes a statistical classification

➢ ICD-10 is a statistical classification; it contains limited number of mutually

WHY USE A CLASSIFICATION?

➢ To allow easy storage, retrieval and analysis of data

WHAT IS THE INTERNATIONAL CLASSIFICATION OF DISEASES?

➢ 18th Century- Sauvages-attempted to systematically classify all diseases

➢ Further development/modification was done by William Farr to form the basis

➢ 1920- Organisation of the League of Nations took over the management

➢ 1946- Interim Commission of the World Health Organization was given

➢ 1948- the 6th revision included recommendation for morbidity data

➢ 1955 and 1965 revisions (included 2 volumes)

➢ 1975- development of the 9th revision ICD-9, including, on a trial basis, a

➢ 1978- USA developed a modified, more specific version of ICD-9-CM

➢ 1983- work began on the 10th revision of the ICD

 ICD-10 is a part of the ICD Family of Classification System, which also

• Classification of Surgical Operation and Procedures

VOLUMES OF THE ICD-10

➢ VOLUME 1- Tabular List, the alphanumeric listing of diseases and disease

➢ VOLUME 2- contains instructions and guidelines for Mortality and Morbidity

➢ VOLUME 3- Alphabetic Index, comprehensive listing of all conditions in the

CHAPTERS OF THE ICD-10

➢ ICD-10 contains 21 chapters, each of which is identified by a Roman Numeral

STRUCTURE OF THE ICD-10 CODE:

The structure of the three (3) character category is:

First character Followed by

The structure of the four (4) character sub-categories are:

First character Followed by Then a point Lastly

 IMPORTANT POINTS FOR THIS CHAPTER:

CHAPTER I _________ CHAPTER XII _________

1. What is the range of the 3-character categories used in Chapter III?

2. One letter is split between two chapters. Which one is it?

1. How many letters does Chapter XX use?

 CHAPTERS ARE FURTHER SUBDIVIDED INTO:

1. Intestinal infectious diseases (A00-A09)

➢ THREE CHARACTER CATEGORIES

➢ FOUR CHARACTER CATEGORIES

Most categories are expanded by a fourth-character and occasionally by a

The fourth character .8 is generally used for “other” conditions belonging to

Common Fourth and Fifth Character Subdivisions

A set of fifth character codes are to be used in some four character

The ICD-10 Tabular List (Volume 1) makes use of certain abbreviations,

 Certain rubrics contain list of conditions preceded by the word

Q74 Other congenital malformations of limb(s)

 Glossary descriptions are used in some chapters to indicate

 The Dagger and Asterisk System

Besides the option of using the fourth and fifth characters,

The primary code is for the underlying disease and is marked

The asterisk codes (*) are listed at the beginning of each

There are 83 total asterisk categories in ICD-10.

 Parentheses are used in Volume 1 in four situations:

 To enclose supplementary words, which may follow a

 To enclose the code to which an exclusion term refers.

 To enclose the three-character codes of categories in a

1. Is N13.0 the correct code for Hydronephrosis with ureteropelvic junction

 Square brackets are used in the following situations:

➢ To enclose synonyms, alternative notes or explanatory

➢ To enclose a previously stated subdivision common to a

3. To refer to a previous note.

 The colon [:] is used in listings of inclusion and exclusion

It indicates that both the listed condition and one of its

 A brace is used in inclusion and exclusion terms to indicate

Any of the terms before the brace should be qualified by one or

 A point dash is used to indicate that there exist a fourth

CHAPTER I _ CHAPTER XII _

Section I _Chap 1-19,21__________

Section II _chap 22_________________

Section III chap 19-20________________