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Classification of death and injury due to terrorism. Lois A. Fingerhut & NCHS Colleagues…. May, 2002 National Center for Health Statistics, CDC. NCHS Colleagues…. Donna Pickett Donna Hoyert Donna Glenn Harry Rosenberg Bob Anderson Cathy Burt, Bob Pokras, Amy Blum

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Classification of death and injury due to terrorism l.jpg

Classification of death and injury due to terrorism

Lois A. Fingerhut & NCHS Colleagues….

May, 2002

National Center for Health Statistics, CDC


Nchs colleagues l.jpg
NCHS Colleagues….

  • Donna Pickett

  • Donna Hoyert

  • Donna Glenn

  • Harry Rosenberg

  • Bob Anderson

  • Cathy Burt, Bob Pokras, Amy Blum

  • Mary Anne Freedman,Marjorie Greenberg, Ed Hunter

  • Office of the Center Director, NCHS


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Proposal circulated to:

  • Department of Justice- FBI

  • Department of Justice- Bureau of Justice Statistics

  • Centers within CDC

  • WHO:

    • Mortality Reference Group

    • WHO Update Reference Committee

    • Heads of WHO Collaborating Centres for the Classification of Diseases

  • Individuals developing the National Violent Death Reporting System

  • Injury Control and Emergency Health Services Section of the American Public Health Association

  • President of the National Association of Medical Examiners


  • Fbi definition of terrorism l.jpg
    FBI definition of terrorism

    • “…the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”

    • Code of Federal Regulations (28 C.F.R. Section 0.85)


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    Classification guidance..

    • Neither medical examiners nor medical record coders will be responsible for determining whether or not a death or injury resulted from terrorism.

    • All decisions will be made by ‘the federal government’ (FBI).

    • This will be more difficult for morbidity data if an “event” is labeled “terrorist” after the fact.


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    Guidelines for Mortality

    • Classify terrorism with new ICD-10 codes for mortality and tabulate as an underlying cause of death within the categories of homicide or suicide, as appropriate.

    • Place terrorism-related ICD-10 codes for mortality in the “U” Chapter of ICD-10, which has been reserved for “future additions and changes and for possible interim classifications to solve difficulties arising at the national and international levels between revisions.”


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    Guidelines for Mortality

    • New ICD-10 terrorism codes for mortality are to be tabulated for statistical purposes within the category of homicide, thus expanding the current codes from X85-Y09, Y87.1 to include *U01 and *U02.

    • ICD-10 Codes *U03.1 and *U03.9 are to be tabulated for statistical purposes within the category of suicide, expanding the current codes from X60-X84, Y87.0 to include *U03.


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    Guidelines for Mortality

    • Use ICD-10 code(s) Y08- Assault by other specified means, or Y09- Assault (homicide) by unspecified means, or X83 or X84, Intentional self-harm (suicide) by other specified or unspecified means, respectively for deaths for which terrorism has not been established at the time the death certificate is initially filed.


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    New terrorism ICD-10 codes for mortality

    • *U01 Terrorism

    • *U01.0 Terrorism involving explosion of marine weapons

    • *U01.1 Terrorism involving destruction of aircraft

    • *U01.2 Terrorism involving other explosions and fragments

    • *U01.3 Terrorism involving fires, conflagration and hot substances

    • *U01.4 Terrorism involving firearms

    • *U01.5 Terrorism involving nuclear weapons

    • *U01.6 Terrorism involving biological weapons

    • *U01.7 Terrorism involving chemical weapons

    • *U01.8 Terrorism, other specified

    • *U01.9 Terrorism, unspecified


    New terrorism codes l.jpg
    New terrorism codes…

    • *U02 Sequelae of terrorism

    • *U03 Terrorism

    • *U03.0 Terrorism involving explosions and fragments

    • *U03.9 Terrorism by other and unspecified means


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    Illustration of inclusion terms

    • *U01.7 Terrorism involving chemical weapons

    • Gases, fumes and chemicals

    • Hydrogen cyanide

    • Phosgene

    • Sarin


    Selected part of 113 cause list l.jpg

    Current

    Accidents (unintentional injuries) (V01-X59, Y85-Y86)

    Transport accidents (V01-V99, Y85)

    “ “ “

    Intentional self-harm (suicide) (X60-X84, Y87.0)

    Intentional self-harm (suicide) by

    discharge of firearms (X72-X74)

    Intentional self-harm (suicide) by other

    and unspecified means and their

    sequelae (X60-X71, X75-X85, Y87.0)

    Assault (homicide) (X85-Y09, Y87.1)

    Assault (homicide) by discharge of

    firearms ( X93-X95)

    Assault (homicide) by other and

    unspecified means and their

    sequelae (X85-X92, X96-Y09, Y87.1)

    Legal intervention (Y35, Y89.0)

    Plus terrorism codes

    Accidents (unintentional injuries) (V01-X59, Y85-Y86)

    Transport accidents (V01-V99, Y85)

    “ “ “

    Intentional self-harm (suicide) (X60-X84, Y87.0, *U03)

    Intentional self-harm (suicide) by

    discharge of firearms (X72-X74)

    Intentional self-harm (suicide) by other and unspecified means and their

    sequelae (X60-X71, X75-X85, Y87.0, *U03)

    Assault (homicide)(X85-Y09, Y87.1, *U01-*U02)

    Assault (homicide) by discharge of

    firearms (X93-X95)

    Assault (homicide) by other and

    unspecified means and their sequelae(X85-

    X92, X96-Y09, Y87.1, *U01-*U02)

    Legal intervention (Y35, Y89.0)

    Selected part of 113-cause list


    Implementation mortality l.jpg
    Implementation-Mortality

    • Through the Division of Vital Statistics

    • To State vital statistics offices for immediate implementation through an addendum to its vital statistics instruction manuals

    • Beginning with September 11 deaths

    • NCHS will recode those deaths that have not been classified using new codes

    • Amended tabulation lists will appear in NCHS reports for 2001 data year


    Guidelines for morbidity l.jpg
    Guidelines for Morbidity

    • Place terrorism codes for morbidity within the framework of ICD-9-CM.

    • Unlike the placement of the mortality codes, which are in a new chapter (“U”), the codes for morbidity are within the existing chapter for External Causes of Morbidity.


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    Guidelines for Morbidity

    • Use the new ICD-9-CM codes

      E979.0-E979.9 and E999.0-E999.1 for nonfatal injuries resulting from terrorism.

    • For statistical purposes these codes will be tabulated within the category for assault, expanding the current category from E960-E969 to include E979 and E999.

    • At this time, NCHS is not recommending a parallel category for self-inflicted injury.


    Terrorism codes icd 9 cm e979 e999 l.jpg
    Terrorism Codes ICD-9 CM E979, E999

    • E979.0 Terrorism involving explosion of marine weapons

    • E979.1 Terrorism involving destruction of aircraft

    • E979.2 Terrorism involving other explosions and fragments

    • E979.3 Terrorism involving fires, conflagration, and hot substances

    • E979.4 Terrorism involving firearms

    • E979.5 Terrorism involving nuclear weapons

    • E979.6 Terrorism involving biological weapons

    • E979.7 Terrorism involving chemical weapons

    • E979.8 Terrorism involving other means

    • E979.9 Terrorism, secondary effects

    • E999 Late effect of injury due to war operations and terrorism

      • E999.0 Late effect of injury due to war operations

      • E999.1 Late effect of injury due to terrorism


    Implementation morbidity l.jpg
    Implementation-Morbidity

    • Through its Data Policy and Standards Staff

    • Notice to be published in the Federal Register to announce the availability of the new codes to the health care community.

    • Codes become effective Oct.1, 2002

    • Dissemination to the American Hospital Association, the American Health Information Management Association, State health information professional organizations, book publishers, and data system vendors.


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    Complete documentation can be found:

    NCHS web site

    Disease Classification

    http://www.cdc.gov/nchs/about/otheract/icd9/terrorism_code.htm


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