World Health Organization - Family of International Classifications (WHO-FIC) Network Mortality Reference Group (MRG): Annual Report,

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1 Cape Town, South Africa 29 October - 6 November 2011 MRG Annual Report WHOFIC 2011 / C003 World Health Organization - Family of International Classifications (WHO-FIC) Network Mortality Reference Group (MRG): Annual Report, Donna L. Hoyert and Patricia Wood National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA, and Health Statistics Division, Statistics Canada, Ottawa, Canada Abstract Enter Abstract here This paper presents the activities and status of the WHO-FIC Network Mortality Reference Group (MRG) for The WHO created the MRG as a component of the International Classification of Diseases (ICD) updating process. Comprised of members from Collaborating Centres and regional offices, the MRG meets largely in person to review problems encountered in the application of ICD-10 to mortality. In its thirteenth year of work, the MRG deliberated about 55 issues and made recommendations to the Update and Revision Committee for further action. Many issues are still under review. The group discusses issues related to both updates to ICD-10 and development of the ICD-11 revision. This document is not issued to the general public, and all rights are reserved by the World Health Organization (WHO). The document may not be reviewed, abstracted, quoted, reproduced or translated, in part or in whole, without the prior written permission of WHO. No part of this document may be stored in a retrieval system or transmitted in any form or by any means - electronic, mechanical or other - without the prior written permission of WHO. The views expressed in documents by named authors are solely the responsibility of those authors

2 WHO-FIC 2011/C003 Introduction This is the thirteenth annual report of the Mortality Reference Group (MRG), established at the 1997 meeting of the Centre Heads as part of an updating mechanism for ICD-10. The first annual report was presented at the WHO Centre Heads meeting in Cardiff, Wales, October 17-22, In its first thirteen years, the MRG dealt with hundreds of issues related to updating and clarifying ICD-10 as it applies to mortality classification and coding. The MRG settled over 285 issues selected largely from the Mortality Forum (an international mortality classification discussion network) and submitted 285 recommendations to the Update and Revision Committee (URC) for consideration. This report describes the background of the MRG, the issues decided in the thirteenth year, and the issues presently under consideration. The report includes three annexes: Annex I is the Terms of Reference and work plan for the MRG, Annex II is a list of the members of the MRG, and Annex III lists the issues decided since Basis for the MRG Provisions for the MRG are described in two documents: the WHO long-term strategy document (WHO/HST/ICD/C/97.39) and the Centre Heads Report for 1997 (WHO/HST/ICD/C/97.65). Briefly, for updating ICD-10, WHO- - working with the Centre Heads- - established two separate bodies: the MRG and URC. The MRG discusses issues raised in the Mortality Forum or those referred from other sources including the Centre Heads and WHO. The MRG can make decisions regarding the application and interpretation of ICD to mortality and submit a subset as recommendations to the URC for a vote on ICD updates and changes. The decisions requiring no change in the ICD are forwarded for the URC's information and for documentation. Decisions during the entire thirteen years In the thirteen years ( ), the MRG reached over 285 decisions. Table 1 shows the subset of the decisions that were sent on to the URC for information as well as for voting. The MRG forwarded 285 decisions to the URC: 183 recommendations for changes in the ICD and 102 decisions requiring no change in the ICD. The total number of issues either withdrawn by the MRG, referred back by the URC for additional work, or rejected by the URC during the first thirteen years was 17. Decisions during the thirteenth year In the thirteenth year, the MRG met in Budapest, Hungary March 31-April 1, 2011, and Cape Town, South Africa October 29-30, The MRG relied on communication, sharepoint, and entries to the MRG closed-area of the ICD Update and Revision Platform (ICD-10+ Platform) to carry forward discussions and action between face-to-face meetings. The MRG discussed about 55 issues this year. The MRG forwarded 22 decisions to the URC (Table 1): 18 recommendations (8 major and 10 minor) to the URC for further action. Four - 2 -

3 decisions, involving no change to the ICD, were forwarded for the URC s information. Table 1. Summary of MRG decisions submitted to URC Year 1 MRG decisions submitted to URC Total Recommendations (substantive change to ICD) (clarification of ICD) No change to ICD URC approved major or minor MRG withdrew / URC referred back/ URC rejected First Second Third Fourth Fifth Sixth Seventh Eighth Ninth Tenth Eleventh Twelfth Thirteen th Total Not applicable 1 Issues may split into component parts between submission and decision by URC or decisions be deferred across years, so cells may not add up. Each decision submitted to the URC is listed in Annex III. For recent issues, more detail is

4 WHO-FIC 2011/C003 available at the ICD-10+ Platform ( The MRG continues to work on new issues as well as issues held over from previous years. Increasingly, the ongoing issues are complex and more difficult to resolve quickly. Some may become ICD-11 issues because of timing. The 18 recommendations submitted for URC decision in address a number of situations including clarifications of coding instructions (e.g., multiple injuries; conflict in linkage in Rule C), appropriate codes (e.g., carbon monoxide), improvement of indexing (e.g., smoke inhalation; hepatobiliary conditions), and change in presentation of coding instructions (e.g., Rule E and Rule F). The 4 issues for which decisions entailed no recommended change to the ICD, included improving international tools for automated coding (e.g., to incorporate coronary disease due to kidney failure decision in the Mortality Medical Data System (MMDS)) and providing additional explanation to the URC on an earlier decision. Finally, the MRG has done some work related to ICD-11 this year. The MRG has compiled a list of all issues related to ICD-11 discussed. The compilation of mortality-related issues is expected to help inform the ICD-11 revision process. Issues under review by the MRG Approximately 46 additional issues related to improving data quality are under active review by the MRG. ICD-11 is increasingly a consideration in MRG discussions, and many of the developing resolutions may end up being suggestions for ICD-11. The issues, background, and current status of the MRG issues are available on request to the one of the co-chairs of the MRG. Procedural considerations For the MRG to carry out its mission, it is essential that each issue be carefully studied and deliberated. Decisions are made through a democratic process, with attempts to achieve consensus. This requires preparing and distributing background and current information bearing on the problem, conducting discussions in real time about the issues, communicating by in the interim, using teleconferences when needed, making entries to the ICD-10+ Platform, and fully documenting meetings, actions taken, and agendas. Since the face-to-face meetings were more efficient than teleconferences, the MRG largely replaced teleconferences with face-to-face meetings in The MRG also tested a face-to-face approach in reviewing progress in implementing past MRG decisions. The face-to-face approach was also more effective than previous approaches in reviewing past decisions. Conclusion In the thirteenth year, the MRG met twice in person, communicated by , posted proposals and comments on the ICD-10+ Platform, did considerable work on a number of issues outside the committee meetings, circulated documentation for issues under consideration; and comprehensively documented all activities. During the thirteenth year, a total of about 55 issues - 4 -

5 were reviewed by the MRG. Closure was reached for many of these and 22 were forwarded to the URC. Eighteen recommendations for change were made to the URC in Decisions on 4 issues did not involve changes in the ICD.

6 WHO-FIC 2011/C003 Annex I: Mortality Reference Group Terms of Reference Purpose: The objective of the Mortality Reference Group (MRG) is to improve international comparability of mortality data by establishing standardized application of the ICD. Functions: To identify and solve problems related to the interpretation and application of ICD to coding and classification of mortality. - To establish standardized application of mortality coding rules and guidelines by a) making decisions regarding the interpretation of rules and guidelines for mortality, and b) deliberating on updates to the classification and the rules and guidelines. Such updates include both clarifications and correction of errors - To develop recommendations for ICD updates through a democratic process which attempts to achieve consensus - To submit annual recommendations to the Update and Revision Committee (URC) by the end of April. To support the development and application of international software for mortality coding and classification To address issues of analysis and assessment of mortality statistics To provide documentation of discussions and decisions in a database. Structure and working methods The MRG will endeavour to ensure that its membership reflects the widest possible representation from centres and WHO regional offices. The chair and co-chair are elected by the MRG for terms of two years. The election is submitted to the Secretariat for confirmation. The MRG will work through and the ICD Update and Revision Platform, meet in person at least twice a year, and use telephone conferences as needed. Once a recommendation to the Update and Revision Committee (URC) has been agreed to by the MRG, members will support the recommendation. Decisions from the MRG which are endorsed by the URC and the Centre Heads should be available from the WHO ICD home page. Activities for Continue to hold periodic meetings: one face-to-face meeting at WHO-FIC Network annual meeting and one roughly 6 months later, and telephone conferences as needed (2010 and 2011) - 6 -

7 Prioritise issues and problems for review (2011 and 2012) Make recommendations to the Update and Revision Committee (by April 2012) Prepare annual report for WHO-FIC Network meeting (August 1, 2012) Respond to URC requests to review material on URC platform (2011 and 2012) Develop and disseminate quality assurance procedures and best practices for mortality classification. Develop and disseminate best practices or instructions for multiple cause-of-death coding. Annex II: Mortality Reference Group Members and Associates North American Centre: Ms. Patricia Wood [Canada] (Co-Chair) Dr. Donna Hoyert [USA] (Co-Chair) Dr. Robert Anderson [USA] Ms. Tyringa Crawford [USA] Ms. Donnamaria Pickett [USA] Brazilian Centre: Professor Ruy Laurenti Maria Teresa Cravo Australian Centre: Ms. Sue Walker Anneke Schmider Japanese Centre: Ms. Kazuko Takemura Dr. Kayo Takimura Ms. Emiko Oikawa German Centre: Dr. Stefanie Weber Dr. Olivia Peikert Other members: WHO: Dr. Robert Jakob Ms. Doris Ma Fat Mr. Andre L'Hours (retired) EURO: Enrique Loyal Nordic Countries: Dr. Lars Age Johansson [Sweden] Gunvor Østevold [Norway] Dr. Lilja Jónsdóttir [Iceland] UK: Ms. Elaine Tower Susan Fletcher French Centre: Gerard Pavillon Dr. Albertine Aouba Italian Centre:

8 WHO-FIC 2011/C003 Dutch Center: Jan Kardaun Mexican: Dr. Luis Torres South Africa: Dr. Debbie Bradshaw Pam Renaud Thai: Dr. Wansa Paion Dr. Monica Pace Jordan: Dr. Majed Asad Algeria: Soraya Belamri Korean Centre: Dr. Kyung Seo Annex III: Decisions Made by the WHO Mortality Reference Group Year Discussed and Issue Type of Change Action : Rule A Recommended to URC in 1999 and approved by URC : Coding maternal conditions (revived in ) : Applying Rule 3 for pneumonia : Rule A, additional condition : Highly Improbable: Diseases causing suicide : Highly Improbable: Infections due to neoplasms : Highly Improbable: Inconsistent durations No change No change in 1999 not communicated; recommended change in 2001 was withdrawn; Informed URC in 2002 of no change decision Recommended to URC in 2000 and approved by URC in 2000 Recommended to URC in 2000 and approved by URC in 2000 Recommended to URC in 2000 and approved by URC in 2000 Recommended to URC in 2000 and approved by URC in 2000 Recommended to URC in 2001 and approved by URC in

9 : Coding perinatal conditions Recommended to URC in 2001 and approved in principle by URC in 2001 (URC/MRG working on details in 2002 and URC approved in 2002) : Highly Improbable: Angina due to Bronchitis : Highly Improbable: Diseases causing accident No change Informed URC in 2002 Recommended to URC in 2000, returned to MRG by URC in 2000, modification resubmitted 2001 and approved by URC in : HIV due to blood transfusion Recommended to URC in 2001 and approved by URC in : Trivial list Recommended to URC in 2001 and approved by URC in : Forced lists Recommended to URC in 2001 and approved by URC in : List distribution Recommended to URC in 2001 (folded into other initiatives) 2001: Congenital anomalies Recommended to URC in 2002 and approved by URC in : Restore consolidated section of recommendations Submitted to URC in 2002 and approved by URC in Trivial rule Submitted to URC in 2002 and approved by URC in Intestinal obstruction Submitted to URC in 2002 and approved by URC in Intoxication Submitted to URC in 2002 and approved by URC in Poisoning Submitted to URC in 2002 and approved by URC in Embolism due to digestive diseases Submitted to URC in 2002 and approved by URC in 2002

10 WHO-FIC 2011/C Transitory conditions Submitted to URC in 2002 and approved by URC in Drug treatment No change Informed URC in SIDS detail No change Informed URC in Peripheral vascular disease causes Ischaemic due to pulmonary conditions No change Informed URC in 2002 No change Informed URC in Newborn/neonatal terms No change Informed URC in Circulatory insufficiency No change Informed URC in : Literal or liberal interpretation of ICD 2002: Recent complications caused by past surgery 2002: I20.- (Angina pectoris) more specific than I : J21 Apply the same linkages for acute bronchitis (J20) and acute bronchiolitis (J21)? 2002: Insufficiency vs. failure codes 2002: Code for narcotism 2002: Accident assumed cause of injury 2002: Different expressions for the same time limit 2002: Cerebral haemorrhage an obvious consequence of Waldenstrom s macroglobulinaemia? 2002: Wording: Can be- mayshould

11 2002: Cases when Rule 3 should not be applied 2002: D84.9 (Immunodeficiency, unspecified) due to D45 (Polycythaemia vera) sequence 2002: Acute or terminal circulatory diseases due to diabetes 2002: I77.6 (Arteritis, unspecified) due to I64 (Stroke) 2002: Cardiac arrhythmia, unspecified and Cardiac arrest, unspecified linkage 2002: Conditions in Part I regarded as a part of the natural history of a disease reported in Part II 2002: May an ill-defined condition block the application of Rule : Renal failure- obvious consequence of urinary infection? 2002: K74.6 (Cirrhosis of liver) due to D73.5 (Infarction of spleen) sequence : Indexing of coronary disease and coronary heart disease 2003: Code for euthanasia 2003: Code for stillborn due to maternal diabetes 2003: Hemiplegia due to hypertensionassume and code cerebrovascular disease : Dilated cardiomyopathy reported as due to any other disease : Exposure to substances (Agent Orange, asbestos, dust, pesticide) resulting in disease

12 WHO-FIC 2011/C : Other diseases of pharynx due to Degenerative disease of the nervous system, unspecified, an acceptable sequence : Assume an unspecified infarction to be transmural 2003: Aspiration a direct consequence of poisonings and intoxication 2003: Pancreatitis an obvious consequence of alcoholism : Vascular dementia Submitted to URC in 2003; : Cardiac categories with priority over atherosclerosis / : Persons repairing transport vehicles (2 related recommendations) Submitted to URC in 2003; Submitted to URC in 2003; URC 0153 approved by URC in 2003; MRG submit further recommendation responding to 2003 URC comments in 2004 (URC 0255) ; Approved by URC in : Legal intervention Submitted to URC in 2003; : Priority between adverse & abnormal incidents & reactions and misadventure Submitted to URC in 2003 (URC 0155); held over for the MRG to provide more clarification and resubmitted in 2004; Approved by URC in : Embolic conditions Submitted to URC in 2003; : Reapply Rule 3 after Rule D Submitted to URC in 2003; : Should Chapter XV be used for all maternal conditions Submitted to URC in 2003;

13 : Puerperal sepsis Submitted to URC in 2003; : F10 and K70 coding Submitted to URC in 2003; : Unspecified self-inflicted poisoning : Underlying cause in face of multiple chronic lower respiratory diseases Submitted to URC in 2003; Submitted to URC in 2003; : Priorities in stroke span Submitted to URC in 2003; : No reason for surgery and therapeutic misadventure : (Acute) pseudomembraneous colitis Submitted to URC in 2003; Submitted to URC in 2003; : Bacterial hepatitis Submitted to URC in 2003 (URC 0166); held over to address comments and resubmitted in 2004; Approved by URC in : Food-borne intoxication due to Clostridium difficile : Sequelae of TB link with pneumoconiosis : Dementia, anemia, & malnutrition : Arteriosclerotic chronic nephritis- how many lines : Malignant pleural effusion, NOS Submitted to URC in 2003; Submitted to URC in 2003; Submitted to URC in 2003; Submitted to URC in 2003; Submitted to URC in 2003;

14 WHO-FIC 2011/C : Hypoxic ischaemic encephalopathy of newborn : Hepatitis with reported complications Submitted to URC in 2003; Submitted to URC in 2003; : Fractures and osteoporosis Submitted to URC in 2003; : Dementia, subtypes Submitted to URC in 2003; : Value of combination codes Submitted to URC in 2003; Withdrew in 2003 to do more work : Term motor vehicle Submitted to URC in 2003; : Multiple neoplasm sites in Part II Submitted to URC in 2003; Withdrew in 2003 to continue work : Neuro-endocrine neoplasm Submitted to URC in 2003; : Thrombosis or embolism and atrial fibrillation : Renal failure and urinary infections Submitted to URC in 2003; Submitted to URC in 2003; : Meconium ileus Submitted to URC in 2003; : Postoperative complications : Alcoholic and non-alcoholic cirrhosis Submitted to URC in 2003; Withdrew in 2003 to complete additional work Submitted to URC in 2003;

15 : Drug combinations Submitted to URC in 2003; 2003: Fournier s syndrome- females Submitted to URC in 2003; 2003: Acute coronary syndrome Submitted to URC in 2003; 2003: Non-traumatic compartment syndrome Submitted to URC in 2003; : Place of occurrence Submitted to URC in 2003; : What is I22? Submitted to URC in 2003 (URC 0198); Held over for MRG to liaise with WHO in getting more info from MONICA and WHO cardiovascular disease group; Submitted to URC in 2005 (URC 0337); referred to Nordic Centre to resubmit : Multiple valvular conditions Submitted to URC in 2003; 2003: Hepatitis C not specified as acute or chronic : Fractures of unspecified cause and E : Unspecified HIV and illdefined conditions Submitted to URC in 2003; Submitted to URC in 2003; Submitted to URC in 2003; : Subdividing K85 Submitted to URC in 2003 (URC 0203); held over for German Centre to draft list of subcategories and resubmit in 2004; Approved by URC in 2004

16 WHO-FIC 2011/C : SARS code Submitted to URC in 2003; 2003: Laennec s cirrhosis Submitted to URC in 2003; : Tobacco use as a multiple cause Submitted to URC in 2004; Approved by URC in : Secondary hypertension Submitted to URC in 2004; Approved by URC in : Lewy body disease Submitted to URC in 2004; Approved by URC in : Heroin vapour leukencephalopathy : Lobar pneumonia in alcoholism Submitted to URC in 2004; Approved by URC in 2004 Submitted to URC in 2004; Approved by URC in : Changes to Rule 3 Submitted to URC in 2004; Approved by URC in : Old/healed myocardial infarction : Intracerebral haemorrhage & warfarin use Submitted to URC in 2004; Approved by URC in 2004 Submitted to URC in 2004; Approved by URC in : Chronic respiratory failure No change Informed URC in : Rule 3 tables & Alzheimer s disease & dementia No change Informed URC in : White matter disease Submitted to URC in 2005; Approved by URC in : Sudden death Submitted to URC in 2005; Approved by URC in : Unspecified gastroenteritits Submitted to URC in 2005; Approved by URC with modifications in

17 : Note (b) Infections in A00-B : Note (d) Diabetes due to any other disease Submitted to URC in 2005; Approved by URC with modifications in 2005 Submitted to URC in 2005; Approved by URC in : Transport accidents Submitted to URC in 2005; Approved by URC in : Viral gastritis Submitted to URC in 2005; Approved by URC with modifications in : Vascular parkinsonism Submitted to URC in 2005; Approved by URC in : Expanding the list for pneumonia : Pulmonary oedema consequence of heart disease Submitted to URC in 2005; Approved by URC in 2005 Submitted to URC in 2005; Approved by URC in : Cardiovascular disease and hypercholesterolaemia : Subacute sclerosing panencephalitis No change Informed URC in 2005 No change Informed URC in : Laennec s cirrhosis No change Informed URC in : Final code for SARS No change Informed URC in : Longstanding tuberculosis No change Informed URC in : Injuries with no nature-ofinjury code : Underlying cause and record axis fields No change Informed URC in 2005 No change Informed URC in : R95 due to J00 No change Informed URC in : Refractory anemia and myelodysplastic syndrome : Influenza and cardiomyopathy No change Informed URC in 2005 No change Informed URC in 2005

18 WHO-FIC 2011/C : Cerebrovascular diseases and myocardial infarction : Accidents due to natural causes : Valvular diseases and myocardial infarction No change Informed URC in 2005 No change Informed URC in 2005 No change Informed URC in : Multiple drug combination deaths : Modification of 3 cancer codes Submitted to URC in 2006; URC approved in 2006 Submitted to URC in 2006; URC approved in general in 2006 but referred back to MRG for work on index; MRG resubmitted in : Self neglect Submitted to URC in 2006; URC approved in 2006 with modifications : Exacerbation of respiratory disease Submitted to URC in 2006; URC approved in : Inclusion body myositis Submitted to URC in 2006; URC approved in 2006 with modifications : Immaturity vs respiratory failure in newborn Submitted to URC in 2006; URC approved in : C22 code Submitted to URC in 2006; URC referred back in 2006 for more work : Acute alcoholic pancreatitis and use of alcohol Submitted to URC in 2006; URC approved in : C-section as cause of death Submitted to URC in 2006; URC approved in : Code for ischaemic heart failure Submitted to URC in 2006; URC approved in 2006 with modifications 2005: Subarachnoid haemorrhage due to aneurysm of basilar artery Submitted to URC in 2006; URC approved in : Hypostatic pneumonia Submitted to URC in 2006; URC approved in

19 2005: Code for long QT syndrome Submitted to URC in 2006; URC approved in : Code for immobility Submitted to URC in 2006; URC approved in 2006 with modifications 2005: Can cerebral haemorrhage be due to liver disease Submitted to URC in 2006; URC approved in : Code for immune compromised Submitted to URC in 2006; URC approved in 2006 with modifications 2005: Code for sclerosing mesenteritis Submitted to URC in 2006; URC approved in : Code for multiple system atrophy 2005: Code for mesenteric arterial occlusive disease 2005: Fall in tub, not resulting in drowning 2005: Code for cerebrovascular hemorrhagic infarction Submitted to URC in 2006; URC approved in 2006 with modifications Submitted to URC in 2006; URC approved in 2006 with modifications Submitted to URC in 2006; URC approved in 2006 Submitted to URC in 2006; URC approved in : Code for hip infection Submitted to URC in 2006; MRG withdrew in : Tsunami victims Submitted to URC in 2006; URC referred back in 2006; MRG resubmit in : Succession of accidents Submitted to URC in 2006; URC approved in 2006 with modifications : Cerebrovascular lesion due to Parkinson s disease : Malignant neuroleptic syndrome 2005: Cerebral infarction and valvular diseases No change Informed URC in 2006 No change Informed URC in 2006 No change Informed URC in 2006

20 WHO-FIC 2011/C : Neoplastic disease and mastectomy No change Informed URC in : Water intoxication No change Informed URC in : Identifying nosocomial infections No change Informed URC in : Food allergy No change Informed URC in : Unspecified diabetes and age of onset No change Informed URC in : Toxic shock syndrome No change Informed URC in : Lung & chest infection approved in : Anaphylactoid syndrome of pregnancy approved in : Learning difficulties approved in : Lung immaturity & congenital & perinatal kidney disease 2006: Additional synonyms raised in discussion of URC 1027 approved in 2007 approved in : Barrett's oesophagus cancer & Barrett's oesophagus Submitted to URC in : Antineutrophil cytoplasmic antibody (ANCA) nephritis rejected in : Tumor lysis syndrome approved in 2007 with modification : Conditions considered secondary : Viagra & coronary heart disease : Revise term highly improbable approved in 2007 approved in 2007 approved in

21 : Mortality coding instructions for malignant neoplasm : Wernicke Korsakov syndrome : Diabetes complications and obvious consequences approved in 2007 with modification approved in 2007 with modification approved in : Intoxication & liver disease approved in 2007 with modification : GIST tumour approved in : Interpretation of sequelae approved in : Change pregnancy-related death term to death occurring during pregnancy & puerperium : Inclusion of subcategories on O96 & O : Additional about obstetric causes : Modification of excludes note at beginning of Chapter XV approved in 2007 with modification approved in 2007 with modification approved in 2007 with modification approved in 2007 with modification : Metastatic liver cancer also secondary : Additional line in training material No change Informed URC in 2007 No change Informed URC in : Autoimmune hepatitis No change Informed URC in : Diseases causing paralysis or inability to control bladder : Review of rule 3 & pneumonia rules No change Informed URC in 2007 No change Informed URC in : Dementia No change Informed URC in 2007

22 WHO-FIC 2011/C : Four wheel motorcycles No change Informed URC in : Valvular diseases No change Informed URC in : Causes of chronic obstructive lung disease : Relationship between N94.8 and C52 and C53.9 No change Informed URC in 2007 No change Informed URC in : Rule A inclusion of I46.1 Submitted to URC in 2008; Approved in : Gastric haemorrhage an obvious consequence of steroid therapy Submitted to URC in 2008; Approved in : Chronic pneumonia Submitted to URC in 2008; Approved in : SIDS codes Submitted to URC in 2008; Withdrew in 2009; Resubmitted in 2009; Approved in : Birth damage and mental retardation 2004,2008: External cause of injury matrix Submitted to URC in 2008; Approved in 2008 Submitted to URC in 2008; Approved in : Aspiration and pneumonia No change Informed URC in : Ritual or cultural practice as cause of death No change Informed URC in : IHD and sigmoid carcinoma No change Informed URC in : Hypostatic pneumonia an obvious consequence of aspiration pneumonia : Emphysema due to metastatic liver tumour : Alzheimer an acceptable cause of G21.9 No change Informed URC in 2008 No change Informed URC in 2008 No change Informed URC in

23 : Causality between chronic obstructive lung disease and heart failure : Calculus of kidney obvious consequence of multiple sclerosis : Urinary tract infection an obvious consequence of osteogenesis imperfecta : P95 and validity in mortality statistics : Electrically powered indooroutdoor conveyance deaths : Lithium treatment and bipolar affective disorder No change Informed URC in 2008 No change Informed URC in 2008 No change Informed URC in 2008 No change Informed URC in 2008 No change Informed URC in 2008 No change Informed URC in : Instructions on reapplying rule 3 in cause of death coding : Accidental rupture and other such situations : Rule 3 & postoperative complications Submitted to URC in 2009; Approved in 2009 Submitted to URC in 2009; Approved in 2009 Submitted to URC in 2009; Approved in : Hypertension & heart failure Submitted to URC in 2009; Approved in : Inconsistency in volume 2 sections Submitted to URC in 2009; Approved in : Helium codes Submitted to URC in 2009; Approved in : Cat eye syndrome Submitted to URC in 2009; Approved in 2009 with modification 2009: Rasmussen syndrome Submitted to URC in 2009; Approved in 2009 with modification : Pleural effusion relationships No change Informed URC in : Ill-defined codes No change Informed URC in 2009

24 WHO-FIC 2011/C : Motor neuron disease No change Informed URC in : J44.9 due to Y83.9 No change Informed URC in : A19.9 an obvious consequence of A15-A : F10.4 due to anything other than F10 No change Informed URC in 2009 No change Informed URC in : K65 due to I50 No change Informed URC in : J96.1 vs E66.2 No change Informed URC in : Progressive supranuclear palsy Submitted to URC in 2010; Approved in : Code for hip infection Submitted to URC in 2010; Approved in : Value of combination codes Submitted to URC in 2010; Approved in : First mentioned sequence Submitted to URC in 2010; Approved with modification in : Multiple drug examples Submitted to URC in 2010; Approved in : One cause vs no rule vs general principle Submitted to URC in 2010; Approved in : Sepsis indexing Submitted to URC in 2010; Approved in : Clostridium difficile and antibiotics Submitted to URC in 2010; Approved in : Nervous debility Submitted to URC in 2010; Approved with modification in : Hodgkin s disease that escaped detection : Code for fall from mobile elevated work platform Submitted to URC in 2010; Approved in 2010 Submitted to URC in 2010; Approved in

25 : F80 & F81 note Submitted to URC in 2010; Approved in : Cerebral oedema due to peritonitis No change Informed URC in : Osteomyelitis and gangrene No change Informed URC in : Paralytic syndromes and neoplasms 2010: Aortic aneurysm and giant cell arteritis No change Informed URC in 2010 No change Informed URC in : H1N1 and pregnancy No change Informed URC in : Multiple injuries Submitted to URC in : Deaths from smoke inhalation Submitted to URC in : Carbon monoxide sources Submitted to URC in : Additional index terms related to URC : Consistency & infectious disease paragraph : Consistency & neoplasm paragraph : Typo in Volume 2 Section Submitted to URC in 2011 Submitted to URC in 2011 Submitted to URC in 2011 Submitted to URC in : Rule C Submitted to URC in : Rule F Submitted to URC in : Dementia and Down s syndrome : Oesophageal varices and liver disease Submitted to URC in 2011 Submitted to URC in : Rule E Submitted to URC in 2011

26 WHO-FIC 2011/C : Further refinement of section Submitted to URC in : Hepatobiliary conditions Submitted to URC in : Resolving either or coding scenarios : Further updates to URC 281 and : Diabetes complications and modifications : Diabetes and section modifications : Hypoproteinemia due to ulcerative colitis : Deep vein thrombosis and V leiden mutation : Coronary disease and kidney failure : More explanation on past decision Submitted to URC in 2011 Submitted to URC in 2011 Submitted to URC in 2011 Submitted to URC in 2011 No change Inform URC in 2011 No change Informed URC in 2011 No change Informed URC in 2011 No change Informed URC in