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2008-09-02_01 Fight and hit by car

(Chapter XX)

[Question from Pavlos Pavlou, Cyprus:]

 

A man was involved in a fight outside a shop. He was punched by another person. In his attempt to defend himself, he lost his balance and fell backwards towards the street. He was hit by a passing car and thrown onto the pavement. He had a serious cranio-cerebral injury and died. There is no mention of intention to push him in front of the car. Is this an accidental fall (W19) or a traffic accident (V031) or other ?


Comments:

2008-11-04:

PAHO /Roberto Becker/:
Really a very interesting discussion.

A few weeks again I was at my daughters' law firm and comment this case with her and her collages. Despite my first idea that it was an assault, all of them said the case should be considered as traffic accident. I know we are not coding "legal cases" nor building "legal databases", but we should keep in mind that to classify a case as assault I think it should have the characteristics of a murder or assassinate. That means, clear intention to kill, rather than just to harm. If the death certificate states traffic accident, I suppose that it was the opinion of the coroner, having the information on the events. In this case I would maintain it, regardless the final Court's verdict. Anyway, it is not an easy case.

2008-10-21:

Cyprus /Pavlos Pavlou/:
Thanks to everyone for this interesting exchange of views. Regarding Lars's question, there is no legal verdict yet. The case has been referred for trial at the Criminal Court.
The death certificate was:
Ia Craniocerebral injury
Ib Road traffic accident

As you know, we have additional information from the official police press report. We take this into account. We also use other reliable sources of information.

This death will need to be coded in the next few days. What shall we do, if and when we get a different Court's verdict?

2008-09-30:

Cuba /Ana Consuelo Mesa/:
Something for the MRG perhaps? Yes!!

Sweden /Lars Age Johansson/:
I can certainly agree with Ana on that! Obviously we need better guidelines on borderline cases like this one.

2008-09-23:

Cuba /Ana Consuelo Mesa/:
My English is very bad. It is difficult to explain. The statistic of mortality is to prevent, in this case, to prevent violent acts as fights. Violence among people. See index in Spanish Puñetazo (en lucha, pelea) =Punched Y04.- Index in English: Punched doesn't exist.
Y04.- Includes: unarmed brawl or fight
I think that W50 is when the blow was not given directly, it was received in an accidental way, without previous confrontation.

I'm sorry for my English!!

Sweden /Lars Age Johansson/:
I can se Ana's point, but I still believe that Y04 is too drastic in this case. Since this is mortality statistics Y04 would imply that the other person had the intention to kill, but there is no such statement in this case. And surely it was an accident that the car happened to pass in exactly that moment and hit the victim so badly that he died? I would be very reluctant to code this as an intentional death unless there is a verdict from the police or a court of justice to that effect.

We are not much helped by the indexing in this case, as far as I can see. As Ana says, the English index doesn't have "punched", but "Struck (by) other person" is included and indexed to W50. Also, the heading of W50 includes several actions that seem intentional, for example "kicked", and "bitten or scratched" by another person. I would suggest that the difference between W50 and Y04 is the seriousness of the injury the perpetrator intended to inflict, and that Y04 is for cases where there was an intention to cause serious harm. But this is just a guess and I can't see any clear borderline between the categories. Something for the MRG perhaps?

2008-09-16:

New Zealand /Christine Fowler/:
An interesting scenario and our team couldn't all agree on selection of the underlying cause (Assault v. MVA). If the initial fall was as a direct result of the punch then probably the Assault/fight (Y04) should be selected as the underlying cause. If the punch didn't directly cause him to lose his balance (eg, he was still upright after the punch but then moved around to get in a better position to retaliate, lost his balance and fell backwards onto a moving car) then you could argue that the punch was not the direct cause of the loss of balance and subsequent fall in front of the car (perhaps he just wasn't careful enough about where he put his feet). If this was the case then maybe the motor vehicle accident (V031) could be considered to be the underlying cause of death.

Norway /Gunvor Østevold/:
I am reading the discussion with interest. The sequence in this case starts with the punch, but I'm not sure of what code to use. In my opinion there is a distinction between "punched" and "hit" by another person. "Punched" is an action, but "hit" is more incidental, W50. Therefore I mean "punched" is synonymous with intent to injure which lead us to homicide described as injuries inflicted by another person with intent to injure OR kill. Intent to injure might be manslaughter in the second degree. So I agree with Ms Mesa and her suggestion, Y04.

Sweden /Lars Age Johansson/:
It seems from the description of the event that the whole thing started when the person got punched in the chest - it was when he tried to defend himself that he lost his balance and fell. I certainly understand Ana's and Gunvor's point that these two people were having a fight and if you fight there is always an intention to cause injury. On the other hand I can't help thinking that the discrepancy between the initial event (the punch in the chest) and the final outcome (killed by a bypassing car) is so great that this surely must be seen as an accident.

Now, of course, there is an instruction in the updated version of Chapter XX to follow the legal verdict, if available. Pavlos, what happened in this case? Was there an inquest or a trial, and what was the outcome?

2008-09-09:

Cuba /Ana Consuelo Mesa/:
The prevention should be address to the act of violence that preceded the accident. To judge the driver of the vehicle, it should be considered the previous circumstance and it can be accidental, but to code the cause of death, it should be Y04. When there is a succession of external events, the first one should be used.

Norway /Gunvor Østevold/:
The man was punched by another person and we must assume with intent to injure, unfortunately he died. According to guidance for Assault (X85-Y099) this will be included by homicide which is described as "injuries inflicted by another person with intent to injure or kill, by any means." From a juridical point of view this might be a death due to criminal negligence.

Otherwise we have to say this was bad luck and a series of incidents leaded up to death so the most grave one, the traffic accident, is the correct underlying cause.

Malta /Kathleen England/:
Regarding Pavlos question - quite complex - must be the heat: I personally would code the traffic accident as the cause of death, as even though he fell backwards he had not sustained an injury from the fall.

Sweden /Lars Age Johansson/:
The concept of sequence applies to injuries as well as to diseases, although it isn't often that we see a sequence of external events on a death certificate. Here, however, I think that we have got an example, and the sequence starts with the decedent being punched by someone else. There was no intention to kill, so I would suggest W50, "hit, struck, kicked, twisted, bitten or scratched by another person" as underlying cause. It would be possible to add V031 as a multiple cause of death, of course.

2008-09-16_01 Pulmonary embolism and oral contraceptives

(Rule R3)

[Question from Norway /Gunvor Østevold/:] [Gunvor has pointed out to me that the first question is similar to A 2008-04-15 Q2 which was also about protein C resistance. However, this case also involves oral contraceptives and I think it would be interesting to discuss what we see as the underlying cause. /Lars Age]

I have two death certificates I would like to discuss:
Female, 27 years old:
1a. Pulmonary embolism
1b. Activated protein C resistance, factor V Leiden II Oral contraceptives.

Do you agree that the underlying cause of death is 1b? By using contraceptives the risk for thromboembolism will increase among women with V Leiden mutation. How can the statistic indicate this or how to code the information in part II?


[Comments:]

2008-10-21:

Canada /Patricia Wood/:
a)I269
b)D688
II Y424

Robert's reply to 2008-04-15 Q1 included some relevant information for Gunvor's case ...

"APC (Activated Protein C) is co-factor to protein S. In several cases, resistance seems to be inherited, and is due to a defect of factor V that inhibits the action of APC; and it might be coded to D68.2. Acquired forms exist as well, e.g. from oral contraceptives, post menopausal and as a consequence of inflammatory diseases. Where the cause is specified, it might be appropriate to code to the underlying disease, unless there is a specific mention under D68 (lupus) or cross reference (pregnancy/abortion)."

The mention of oral contraceptives in Part II is difficult to interpret; is the APC resistance acquired as a result of the use of the oral contraceptives? Since the oral contraceptives are not mentioned in a due to position, I would lean away from interpreting a causal relationship and select the APC resistance as the underlying cause.

If  I were considering a causal relationship, here's what I might do ... when there is an adverse effect of medications in therapeutic use we usually select the condition necessitating the medication as the underlying cause but, in this case, there would be no underlying "disease" to code. That leaves us to choose between the adverse effect (APC resistance) and the drug causing it (oral contraceptives). When the adverse effect is classified to Chapters I - XVII rather than to an S or T code, the adverse effect is selected as the underlying cause.

Either way, I would select APC resistance which is included in the new (2010) code D68.5, Primary Thrombophilia so I favour the use of D68.8 in the mean time.

2008-09-23:

Cuba /Ana Consuelo Mesa/:
I think UC D68.2 or Y42.4.

2008-09-16_02 Subdural hematoma, hepatic failure and alcohol

(Rule R3)

[Question from Norway /Gunvor Østevold/:] [Gunvor has pointed out to me that the first question is similar to A 2008-04-15 Q2 which was also about protein C resistance. However, this case also involves oral contraceptives and I think it would be interesting to discuss what we see as the underlying cause. /Lars Age]

I have two death certificates I would like to discuss:
Male, 55 years old:
1a. Subdural haemorrhage
1b. Hepatic failure
II Alcoholic

Either you use hepatic failure or alcoholic hepatic failure in 1b ACME will select I620. If we put alcoholic in 1c the alcoholic or alcoholic hepatic failure will be UC. The problem is that physicians very often put the alcoholic in part II of the certificate. I think subdural haemorrhage is due to hepatic failure. What do you think?


[Comments:]

2008-10-21:

Canada /Patricia Wood/:
Lars Age is right; MMDS selects I620 as the underlying cause of death on this record as it is certified (with alcoholic in Part II). If clinically-speaking there is a causal relationship between subdural hemorrhage and hepatic failure perhaps NCHS would add it to ACME Decision Table D?

2008-09-23:

Cuba /Ana Consuelo Mesa/:
1.- I accept the sequence.
2.- A new modification to vol 2. says: K72 Hepatic failure, not elsewhere classified with mention of F10.- (................) code K70.4 3. UC K70.4

Sweden /Lars Age Johansson/:
ACME selects I620 in the first case because it doesn't accept that subdural haemorrhage can be due to liver failure. Since the sequence is broken ACME selects I620 according to Rule 2.

With the second coding (alcohol on line 1C) ACME can apply the General Principle since alcohol can explain both the subdural haemorrhage and the liver failure. All that the General Principle requires is that the condition on the lowest used line can explain everything that has been mentioned on the lines above, so it doesn't matter whether subdural haemorrhage can be due to liver failure or not.

But I agree with Gunvor and Ana that the sequence should be accepted and I too would select K704 as underlying cause.

2008-09-30_01 Blood viscosity

(Chapter III, XVII)

[Questions from Ana Consuelo Mesa, Cuba:]

1. Man, 39 years old
Ia) Pulmonary embolism 3 hours
b) Hypertensive emergency 3 days
c) Blood viscosity 20 years

How to code? GP D75.8 or R70.1 (I don' t use Rule A in these cases). Or Rule 1, I10? Or something else?


[Comments:]

2008-10-21:

Canada /Patricia Wood/:
I think that I would code Ana's record as:
a) I269
b) I10
c) R701 (coding blood viscosity as "hyperviscosity" which is included in the NCHS index) and then apply Rule 1 (NCHS Decision Table D does not show a causal relationship between I10 and R701) to select I10. Conversely, if there is a causal relationship between lines b) and c), the General Principle would be applied to select R701 as the tentative underlying cause and then Rule A to reselect I10 as the underlying cause of death. I think that either way I10 will be selected as the underlying cause of death.

2008-09-30_02 Vasculitis obliterans of central nervous system

(Chapter VI, IX)

[Questions from Ana Consuelo Mesa, Cuba:]

2. Woman, 45 years old
I a) Vasculitis obliterans of nervous central system

How to code: I67.7 or I77.6 or G96.8 or I70.8 something else?


[Comments:]

2008-10-21:
Canada /Patricia Wood/:

I did a little bit of internet research on "vasculitis obliterans of central nervous system" and was very confused by what I read! There is no shortage of material on this condition but exactly how best to code it is unclear.

Maybe some of our clinical experts can advise us. In the mean time I think that I677 is good provisional code for vasculitis obliterans of the central nervous system.

2008-10-08_01 Perinatal causes in a 12 years old

(Chapter XVI)

[Question from Pavlos Pavlou, Cyprus:]
Dear Mortality Forum,

I have another case for discussion:
12 year old
1a) cardiac arrest
1b) cerebral palsy; bronchiectasis
1c) hypoxia during pregnancy leading to severe cerebral palsy; abruptio placentae
II -

When we have perinatal conditions (fetal and/or maternal) as antecedent causes in a 12 old, do we apply perinatal coding rules for multiple causes and underlying cause selection?


[Comments:]

2008-10-21:

Canada /Patricia Wood/:
The perinatal coding rules (Section 4.3.5, Volume 2, ICD-10 Second Edition) are designed to classify information reported on an actual certificate of cause of perinatal death form (as per page 97, Volume 2, ICD-10 Second Edition). I don't think we need to, or should try to, apply the perinatal coding rules to information reported on a standard medical certificate of cause of death.

Coders are sometimes reluctant to use P codes for older decedents so, as Dr.

Laurenti points out, it is very important to appreciate the inclusion note indicating that Chapter XVI includes conditions that have their origin in the perinatal period even when death occurs later.

In this case it seems that the hypoxia that occurred during pregnancy (and lead to cerebral palsy) was a consequence of the abruptio placenta. I would select P02.1 as the underlying cause of death, using the regular selection and modification rules.

Cuba /Ana Mesa Machado/:
Correct P02.1

The professors P20._ Gunvor and me P02.1 (tied play)! What does Lars say?

Sweden /Lars Age Johansson/:
I agree with Patricia: it seems reasonable to assume that the hypoxia was due to the abruptio placentae, and I too would select P02.1 as underlying cause.

2008-10-14:

Cuba /Ana Mesa Machado/:
R1:Hypoxia during pregnancy P20.0 (consequence of)
R3: Abruptio placentae P02.0 (UC)Fetus and newborn affected by placenta praevia

Sao Paulo Classification Centre /Ruy Laurenti/:
According to the General Principle "hypoxia" is the underlying cause. Code P20. There are no instructions about the use of the codes P in other ages than the first year of life. Thus the code of the U.C is P20. See the inclusion note under the title of the Chapter XVI.

Norway /Gunvor Østevold/:
In former years we used G809 for cases like this. Nowadays we also use codes from chapter XVI for deceased more than one year old. That's because of medical improvement and high tech treatment among infants. So the underlying cause should be P021. The brain damage was caused by abruptio placentae.

PAHO /Roberto Becker/:
I do not use perinatal coding rules in any case. Very few countries use them. In this case I would simply select hypoxia during pregnancy as underlying cause. Doesn't matter that the death occurred at the age of 12.

Seems to be P20.0 (Intrauterine hypoxia first noted before onset of labour), but maybe P20.9 (unspecified). This is another case of bad code wording to be fixed in ICD-11: P20.0 "first noted before..." implies that it was originated before labour, but P20.1 "first noted during labour" is ambiguous. It could have started before and only "noted" later. Or not.

In this (wording) case, I "first noted" the problem right now, but it clearly "originated" before the "labour and delivery" of ICD-10!

2008-11-04_01 Toxic shock in pregnancy

(Chapter XV)

[Questions from Eduard Salakhov, Moscow Classification Centre:]
Please find below the three questions that we have received from Belarus. We distributed it to our experts but received contradictory opinions as information is not enough. Our colleagues from Belarus are asking for help in coding the causes of death for pregnant women who died of the causes listed below and to clarify if these causes of death are related to maternal mortality.

42 years of age, 20 weeks of gestation age, other diseases: chorioamnionitis, basal deciduitis, intervilusitis, retroplacental hematoma.
Death Certificate
a. Toxic shock syndrome
b.
c.
d. Cryptogenic sepsis


[Comments:]

2008-12-09:

Canada /Patricia Wood/:
As Lars Age, Ana and Dr. Laurenti have already pointed out, Eduard's case is poorly certified. However, when using all the information available it seems clear that this death was a direct obstetrical death best coded to O41.1.

2008-12-02

Brazil /Ruy Laurenti/:
I agree with Ana from Cuba. The DC "is very bad"! The information "other diseases" was declared in the DC?? Taking in account all information the U.C is 041.1

2008-11-18:

Cuba /Ana C. Mesa Machado/:
I think that the certificate is very bad. I code UC O41.1 (obstetric direct maternal death).

Sweden /Lars Age Johansson/:
If we combine the causes reported on the certificate with the additional information there is little doubt that this is a direct maternal death. I agree with Ana's UC, O41.1.

2008-11-04_02 Medianecrosis of aorta in pregnancy

(Chapter XV)

[Questions from Eduard Salakhov, Moscow Classification Centre:]
Please find below the three questions that we have received from Belarus. We distributed it to our experts but received contradictory opinions as information is not enough. Our colleagues from Belarus are asking for help in coding the causes of death for pregnant women who died of the causes listed below and to clarify if these causes of death are related to maternal mortality.

28 years of age, 33-34 weeks of gestation age.
Death Certificate
a. Hemopericardium
b. Aorta rupture above valve
c.
d. Medianecrosis of aorta


[Comments:]

2008-12-09:

Canada /Patricia Wood/:
At this time, I would code this as an indirect obstetrical death too, using O994, Diseases of the circulatory system (because medionecrosis of aorta is
I710) complicating pregnancy, childbirth and the puerperium.

2008-12-02:

Brazil /Ruy Laurenti/:
For me is an indirect obstetric death. Four years ago I discussed a similar case in the Maternal Mortality Committee. UC 099.1

2008-11-25:

Cuba /Ana C. Mesa Machado/:
About the maternal death, it will be different from 2009. But now??

Sweden /Lars Age Johansson/:
Well, that is not easy to say. If we decide to use a code in Chapter XV it would be O99.4 (Diseases of the circulatory system complicating pregnancy, childbirth and the puerperium) as Ana says. On the other hand, from the data we have got on this case it is really not possible to know if the pregnancy caused a rupture of a weakened aortic wall, or if the medianecrosis was serious enough to cause the rupture regardless of the pregnancy. It was precisely to avoid this kind of uncertainty that the MRG developed the new instruction. Coding maternal deaths is notoriously difficult, and I am quite sure that some people will not like this new coding instruction. Still, I think it is better to have a clear instruction on how to code these cases.

2008-11-18:

Cuba /Ana C. Mesa Machado/:
28 years of age (congenital aneurysm)????
U.C O99.4 (indirect obstetric death)

Sweden /Lars Age Johansson/:
This is a more tricky case. There is no mention in the medical part of the certificate that the pregnancy contributed to the death, so this is not a direct maternal death. According to the latest instructions in Vol 2 (ratified by the Update Reference Committee in 2007 and to be implemented by January 2009), - "it is often difficult to identify a maternal death, particularly in cases of indirect obstetric causes. If there is any doubt that the cause of death is obstetrical, for example if the conditions entered in Part I are not obstetrical but there is a mention of pregnancy or delivery in Part II, additional information should be sought from the certifier. This is particularly important in countries where maternal mortality rate is high.

If no additional information can be found, deaths with a mention of pregnancy and delivery in Part I should be considered obstetrical, but not deaths where pregnancy or delivery is mentioned in Part II only."

Since the pregnancy is not mentioned in Part I, this is not an obstetrical death according to this new definition. Consequently I would select I71.0 (mediancrosis of aorta) as underlying cause of death.

2008-11-04_03 Sudden death in pregnancy

(Chapter XV)

[Questions from Eduard Salakhov, Moscow Classification Centre:]
Please find below the three questions that we have received from Belarus. We distributed it to our experts but received contradictory opinions as information is not enough. Our colleagues from Belarus are asking for help in coding the causes of death for pregnant women who died of the causes listed below and to clarify if these causes of death are related to maternal mortality.

30 year of age, 25 weeks of gestation age
a. Sudden death
b.
c.
d.


[Comments:]

2008-12-09:

Canada /Patricia Wood/:
Certainly the best thing in this very sad situation would be to get further specification of the circumstances and causes of this death. Failing that, at this time I would likely code this death to O95 too because the inclusion note at code O95 says "maternal death from unspecified cause occurring during pregnancy, labour and delivery, or the puerperium.

2008-12-02:

Brazil /Ruy Laurenti/:
Frequently the physician does not declare the maternal condition in the DC.

Among us all the deaths of women 10-49 years old is investigated and when we have information about pregnancy we accept and use it for the selection of UC. In this case the UC is 095.

2008-11-18:

Cuba /Ana C. Mesa Machado/:
a. Sudden death O95.X (direct obstetric death)(In Cuba)

Sweden /Lars Age Johansson/:
As in Eduard's second question, there is no mention of the pregnancy in Part I of the certificate. Applying the new instruction for classification of deaths in pregnancy, I conclude that this is not a maternal death. Since there is nothing else than "sudden death" reported on the death certificate, I have to select R96.0 as underlying cause of death.

2008-11-04_04 Status post transplantation of liver

(Rule R2, Chapter II)

[Question from Tanja Coric, Croatia:]
I have a query about underlying cause of death in 51 year old man who had these diseases:
Status post transplantation of liver due to liver cell carcinoma Acute peritonitis Thrombosis of hepatic arteries Acute renal failure Sepsis


[Comments:]

2008-12-09:

Canada /Patricia Wood/:
Of course I agree with the others that the underlying cause of death is C22.0, liver cell carcinoma!

Just a comment on Ana's question about the external cause code for the surgery (Y830 or Y620). If the certificate were written the way she has proposed, we would code the liver transplant to Y830 as the cause of complication(s), rather than to Y620 (a misadventure), because no failure of sterile precautions was specified. Ana's right; there's no Rule 12, Errors and accidents in medical care, in ICD-10 so either way the underlying cause ends up at C220.

Also, I know it's difficult to code, and to get consensus on the codes for complications of surgery, but I might consider coding line d) to T86.4, Liver transplant failure and rejection. Or, maybe T81.4, Infection following a procedure, not elsewhere classified ... maybe no one wants to discuss and debate postoperative complication codes!

2008-12-02:

Brazil /Ruy Laurenti/:
Very good the solution presented by Ana/Cuba. I agree (totally) with her.
UC: C22.0

2008-11-18:

Cuba /Ana C. Mesa Machado/:
I think that the certificate has sequence of causes review:
a) Sepsis A41.9 (T85.7)
b)Acute renal failure N17.9 (N99.0)(T88.8) c)Thrombosis of hepatic arteries I74.8 (T85.8) d)Acute peritonitis K65.0 (T81.6) e)Status post transplantation of liver (Y83.0)or (Y62.0)??due to liver cell carcinoma (C22.0) UC C22.0 (rules 12, it doesn't exist) C22.0 (not trivial)

Sweden /Lars Age Johansson/:
The sequence Ana proposes seems very probable, but even if we don't try to rearrange the lines we will get liver cell carcinoma as underlying cause of death. The first mentioned condition, transplantation of liver, is reported as due to liver cell carcinoma. The carcinoma cannot be due to anything else on the certificate, so liver cell carcinoma is UC according to Rule 1.

2008-11-18_01 Femoral fracture at tip of prosthesis

(Chapter XIX)

[Question from Lars Age Johansson, Sweden:]
On a couple of recent death certificates we have seen "femoral fracture at prosthetic tip" and similar expressions. Apparently this sometimes happen to people with a hip prosthesis if they have another fall - the prosthesis is strong enough, but the bone breaks where the prosthesis ends.

Would you code that as a complication of prosthesis or as a "normal" fracture?


[Comments:]

2008-12-09:

Canada /Patricia Wood/:
Like Dr. Laurenti, Gunvor and Colin, I would code a "femoral fracture at prosthetic tip" certified as due to a fall to S72, rather than as a complication of the surgery to implant the artificial hip. To me, the important factor here is the mention of a fall. As Colin suggests, it seems likely that the femur would be fractured with or without the hip prosthesis. The prosthesis may only influence the actual location of the fracture.

Ana Mesa makes a good point too. There may be circumstances where a femoral fracture could be the result of an abnormal reaction or later complication of the hip replacement surgery. I think though that such deaths would be certified in a different (and hopefully clear) manner and would likely be missing the specification of a fall as the cause of the fracture.

2008-12-02:

Brazil /Ruy Laurenti/:
For me if the person has another fall it is not a "complication" of the prosthesis" but a fracture due to the fall. Note: I do not understand what Lars call as "normal".
[Sorry for the sloppy expression - I meant to say: do we assign the usual fracture code or the code for complication of prosthesis?]

Cuba /Ana Mesa Machado/:
I will explain, but is very difficult, problems with the language. It is important know the age, because a prosthesis can be contraindicated in some people at an advanced age with a serious osteoporosis. It is very important to know the frequency!

I think that it might be a complication of surgery, but...........???

2008-11-25:

Norway /Gunvor Østevold/:
Since it is not a complication of the prosthesis itself, I think it should be considered as a new/"normal" fracture. I now and then see similar death certificates with the diagnosis "dislocation of hip prosthesis". In this case it is a complication of prosthesis and I code to X590 (underlying cause of death) T720 or to a more specific code if it's known. More likely the accident was long time ago and I use Y86 T931. But coxarthrosis could also be the reason for the prosthesis. What do you do in cases like this if you don't ask the certifier for additional information? This is usually a problem for people more than 80 years of age.

Scotland /Colin Fischbacher/:
I don't think this is a complication of the prosthesis as seems to be no indication that the prosthesis caused or worsened the fracture. I assume that if the prosthesis had not been present the fall would still have been sufficient to cause a fracture, though perhaps the fracture would have been of a different type. I would regard this as a specific kind of fracture rather than as a complication of a prosthesis.

2008-12-02_01 Urinary tract infection and brain cancer

(Rule R3)

[Questions from Gunvor Østevold, Norway:]
I have a comment about urinary tract infection, site not specified, N390. I think that N390 more often than ACME does, should be considered as an obvious consequence of other conditions. When N390 is mentioned alone in part I of the certificate with a serious condition in part II, ACME selects N390 as the underlying cause.

1a) urinary tract infection
II cancer cerebri
I think cancer cerebri should be the underlying cause in this example

When a patient is bedridden it is very likely to be infected. I would like to hear your comments!

2008-12-02_02 Urinary tract infection and cancer of pancreas

(Rule R3)

[Questions from Gunvor Østevold, Norway:]
I have a comment about urinary tract infection, site not specified, N390. I think that N390 more often than ACME does, should be considered as an obvious consequence of other conditions. When N390 is mentioned alone in part I of the certificate with a serious condition in part II, ACME selects N390 as the underlying cause.

Even though when a sequence is mentioned in part I of the certificate, I think the serious condition in part II should be the underlying cause. ACME selects N390, I prefer cancer pancreas

1a) pneumonia
1b) urinary tract infection
II cancer pancreas

When a patient is bedridden it is very likely to be infected. I would like to hear your comments!

2008-12-02_03 Code for Otahara's syndrome

(Chapter VI)

[Question from Lars Age Johansson, Sweden:]
We recently got a death certificate mentioning "early infantile epileptic encephalopathy, Ohtahara's syndrome" and do not know how to code it.

Tentatively we assigned G40.3, but are there any better suggestions?


[Comments:]

2008-12-09:

Canada /Patricia Wood/:
"Ohtahara Syndrome" sounded familiar to me so I did some digging; we talked about it many years ago and I found a reference on the Mortality Forum website (http://www.nordclass.uu.se/verksam/mortforum/mortindex.htm):

2002-02-11_02 Code for "Ohtahara syndrome"
[Question from Patricia Wood, Canada:]
I would like to submit for the consideration of the mortality forum, two syndromes that are not indexed in ICD-9 or ICD-10.
The first one is OHTAHARA SYNDROME, certified this way:
Male, 5 months old
a) cardiopulmonary failure hours
b) intractable seizures hours
c) Ohtahara syndrome 5 months

I did not find a thing on this syndrome in any of my reference material or on the internet (although that doesn't mean there isn't something there!)

[Suggested coding:]
Belgium G404

[Comments:]
2002-02-18:
Belgium /Josiane Mornie:/
Last year, we've contacted (neuro-psychiatric) Prof Dr Demeirleir at the V.U.B.(Brussels): Otahara = neonatal West syndrome or early-infantile epileptic encephalopathy with suppression-bursts(EIEE) we code it as G40.4
Well, there is lots more information on the internet now than there was then! I found some interesting information at these two websites but I think that G404 may still be the best code to use.
http://www.ninds.nih.gov/disorders/ohtahara/ohtahara.htm
www.orpha.net/data/patho/GB/uk-EIEE.pdf

2008-12-09_01 Suicide reported as due to other conditions

(Rule GP)

[Question from Sam Rubin, Israel:]
It has been our common practice never to assign any other underlying cause of death , when suicide is stated. We shall not accept any "sequence" that leads to suicide. In other words , no cancer nor any other condition, will ever be considered as cause of suicide. Please let us know whether you agree with me or have a different view.

 

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