Targeted Training Module 1 2011

1. Targeted Training Module 1 2011 Welcome to the first Targeted Training Module With 2011 data, coding of MICAR rejects will be completed exclusively by coders at the NCHS–RTP facility and by remote contractors employed by the same. 3/23/2011

2. The shift in reject coding also allows for a change in the approach to training. Rather than focusing on only basic courses, training can be prepared to address specific topics. In-house technicians and specialists submitted topics and examples to be addressed during these quarterly modules. 3/23/2011

3. Module 1 Topics The topics selected for Module 1: • Assumption of N-code • Check boxes • Durations • Either / or • Format • Ill-defined • Place codes 3/23/2011

4. Assumption of “N” Codes Sometimes an external cause may be reported on a record without a Nature of Injury code. For these situations we must assume a Nature of Injury code of “Injury NOS” and code T149. The 2b manual instructions also tell coders to place the T149 preceding the external cause code. Remember if there is a Nature of Injury reported elsewhere on the certificate, do not assume the T149 preceding the external cause code. 3/23/2011

5. There are 4 exceptions to the instruction for assumption of an “N” code: • second hand smoke • anthrax • conditions in J680-J709 due to external causes not • considered to be medical care • pathological fractures with an external event reported • More detailed instructions are given for these types of records in Instruction Manual 2b (Section V, Part F). No Nature of Injury is required for these exceptions. 03/23/2011

6. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: • a) I219 • b) F439 • c) T149 & X37 001 Acute myocardial infarctiojn Stress from hurricane Code T149 preceding the external cause code because no nature of injury was reported on the certificate. 3/23/2011

7. CHECKBOXEScan play a significant role in the placement of a code and how a condition is coded (or not). Therefore, all data should be properly entered in and checked before coding anything on the death certificate. 3/23/2011

8. Check Boxes Check boxes that need to be considered or keyed in for QC/Rejects Place of Injury How Injury Occurred • Manner of Death • Intentional Rejects • Pregnancy • Tobacco • Autopsy 3/23/2011

9. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: 001 Head wound Accident Cerebral laceration. GSW of head The manner of death box states ‘accident’ so code the external cause code first in Part II. Since the external cause of Injury is classified to W34 and there are S codes on the record, a place of occurrence must be entered in. • a) S019 • b) • II. &W34 S062 S019 MOD: A Place: 9 3/23/2011

10. Duration When assigning codes, always take into account durations. There are several commonly overlooked rules that apply to duration when coding records. 03/23/2011

11. Duration Here are a few things to look for when the record contains durations: • Two conditions with one duration on the same line: Disregard the duration and code as indexed. • When the duration of a condition in a “due to” position is shorter than that of the condition on the line above it, and only 1 codable condition is reported on each of these lines, enter a reject code (1-5) in the appropriate data position (Section II, Part I, 1). • Do not enter a reject code if the only inconsistency is the duration between malignant neoplasms. • When the certifier’s entries or reformatting result in more than 4 statements of “due to”, enter the remaining codes horizontally on the 5th line and enter reject code “9”. • Usually duration should not be used to qualify conditions as acuteand chronic (Section II, Part N,1,a.) 03/23/2011

12. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: 001 Cardiopulmonary arrest App 30 mins Cancer of Spleen 2 years Metastatic Cancer of lung 3 months NIDDM – hypertension • a) I469 • b) C261 • c) C780 • II. E119 I10 Do not use a reject code 2 since the inconsistent duration is between malignant neoplasms. 03/23/2011

13. Doubtful Diagnosis Sometimes the certifier isn’t sure which condition a decedent had and so will use an expression such as “or” or “vs”. This is referred to as a doubtful diagnosis and those instructions are in the 2b, Section II, Part D. 3/23/2011

14. When coding a doubtful diagnosis, identify what the conditions in question have in common and assign the common element. For example, if a certifier says MI or Pulmonary embolism, both conditions fall within the circulatory system, so Disease, circulatory (I99) would be the code assigned. 03/23/2011

15. Neither of the conditions in question are coded on the record but only what they have in common. This way the decedent is not assigned a disease condition they may truly not have had. 03/23/2011

16. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: • a) R99 • b) • c) 001 Carcinoma or generalized disease Assign R99. There are several codes that could be considered for this type of reporting, but the safest approach is R99 so that the decedent is not attributed with conditions he truly may not have had. The Underlying Cause is R99. 3/23/2011

17. Format The word ‘format’ indicates the position or arrangement of conditions on a certificate. It is particularly important because codes entered erroneously will result in • High error rates for coders • ACME not performing accurately • Selection of the wrong UC 3/23/2011

18. Lines (a-d) have been provided in Part I of the death certificate for certifiers to report conditions. If a decedent has more than four causally related conditions leading to death, certifiers can add line (e) to indicate the relationship of the conditions. Certifiers use connecting terms, punctuation marks, write in between lines, cross out linesand 1number conditions on death certificates. Use the format section in the 2b Instruction Manual as a guide to help interpret what the certifier is saying. See Instruction Manual 2b, Section II, Part C. 3/23/2011

19. To avoid costly errors, pay close attention to everything written in or implied on the death certificate before coding. Many mistakes are made from simply overlooking connecting terms, deletions and punctuation. Reformat only when the connecting term is precededand followed by a disease condition, nature of injury, or an external cause. 3/23/2011

20. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: 001 ASHD causing coronary thrombosis NIDDM – hypertension Do not reformat ↑ since the connecting term ‘causing’ is not preceded by a disease condition, nature of injury, or external cause. • a) I251 • b) I219 • II. E119 I10 3/23/2011

21. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: • a) I64 • b) I633 • c) 002 CVA as a result of cerebral thrombosis Reformat ↓ since the connecting term is preceded and followed by a disease condition 3/23/2011

22. Ill-defined There are a number of conditions that are considered ill-defined. Instructions for specific ill-defined categories are located in the 2b, Section IV, Part G. Please review these carefully as they are quite specific. 03/23/2011

23. Ill-defined Note that there is a list containing terms assigned to R99 and a separate one for terms assigned to R97. The NOTE following the R99 list explains that whenever terms from each of these lists are reported side-by-side on a certificate, only an R99 is assigned. 03/23/2011

24. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: Natural Causes; etiology unknown Assign R99 only. Since there is a term from the R99 list followed by a term from the R97 list, the NOTE applies and no R97 is required. • a) R99 • b) • II. The Underlying Cause is R99. 03/23/2011

25. Place Codes The Place Code instruction is located in the 2b, Section V, Part A, 3 and the list of Place Codes is in Appendix D. 03/23/2011

26. Place Codes Although WHO suggests adding the Place Code as an additional digit to the external cause code (pg XX-3, Volume 1), NCHS has chosen to assign the Place Code in a separate blank created just for that purpose. 03/23/2011

27. Place Codes Read the Place Code instruction in the 2b. There are 2 criteria that must exist for a place code to be assigned: 1 – S or T code on the record 2 – E-code in the span W00-Y34 (except for Y06 & Y07) 03/23/2011

28. Place Codes W00-Y34 (except Y06 & Y07) Note that the transport categories (V-codes) are not in the span and so no place code is required for transport accidents. 03/23/2011

29. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: • a) T07 • b) &V892 • Place: -- 001 Multiple injuries MVA Highway Since the category V892 is not included in the span that requires a place code W00-Y34, no place code is assigned. The Underlying Cause is V892. 03/23/2011

30. EXAMPLE # 2. SEX 4a. AGE–Last Birthday 4b. UNDER 1 YEAR 4c. UNDER 1 DAY 29. ACTUAL OR PRESUMED DATE OF DEATH (Years) Months Days Hours Minutes CAUSE OF DEATH (See instructions and examples) Approximate interval: Onset to death. 32. PART I. a. b. c. d. 37. MANNER OF DEATH: PART II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in PART I 38. DATE OF INJURY 40. PLACE OF INJURY 43. DESCRIBE HOW INJURY OCCURRED: • a) &J690 • b) W78 • Place: -- 002 Pneumonia Aspiration of vomitus Since there is no S or T code on the record, no place code is assigned. The Underlying Cause is J690. 03/23/2011

31. Conclusion You are now ready to complete the Targeted Training 2011 Q1 coding module. It is accessed by clicking on the Training dropdown menu and then clicking Courses and Modules. Remember to send in any specific questions to icd10@cdc.gov Best of luck! 03/23/2011