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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


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    1. Classification of death and injury due to terrorism Lois A. Fingerhut & NCHS Colleagues…. May, 2002 National Center for Health Statistics, CDC

    2. 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

    3. 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

    4. 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)

    5. 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.

    6. 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.”

    7. 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.

    8. 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.

    9. 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

    10. New terrorism codes… • *U02 Sequelae of terrorism • *U03 Terrorism • *U03.0 Terrorism involving explosions and fragments • *U03.9 Terrorism by other and unspecified means

    11. Illustration of inclusion terms • *U01.7 Terrorism involving chemical weapons • Gases, fumes and chemicals • Hydrogen cyanide • Phosgene • Sarin

    12. 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

    13. 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

    14. 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.

    15. 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.

    16. 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

    17. 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.

    18. Complete documentation can be found: NCHS web site Disease Classification http://www.cdc.gov/nchs/about/otheract/icd9/terrorism_code.htm