From Devindra Awmee, New Zealand:

Hi All

I appreciate participation from the forum members to advise how we
should code the underlying cause of death for this person. The death
certificate is in its original format as written by the doctor.

Sepsis, days

Pseudomonas and staph aureus infection with surgical wound dehiscence
poor immune functioning

Acute Renal Failure, weeks

L1 decompression and L5 neurolysis surgery, months, for spinal
stenosis

Please note all conditions written above were in part 1 of the
medical
certificate of cause of death.

Thanks

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2012-10-06

[Comments from Jan Kardaun, the Netherlands]

Dear All,

I was a bit puzzled by the certificate presented.

I think there is not so much choice, other than to accept the spinal
stenosis as UCD, but it seems to me that the certificate is not
mentioning important information.

First of all, the period between surgery and renal failure is too
long, to be a simple post-op complication, and secondly the mentioning
of poor immune status both suggest that there is some other condition/
disease that is not mentioned. As the age is not mentioned, not an
interval after the spinal stenosis, we do not know whether it is
"degenerative" stenosis, or congenital, or from external causes. In
the presence of limited information, assuming that everything is a
complication of the surgery is indeed the best guess.

Regards,

Jan Kardaun / Netherlands

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[Comments from Ruy Laurenti]

Dear all

The case was discussed by our Center staff.  Now we received the
answer from Colin and we agreed with the UCD(M48.0) but for us the
code for sepsis is T81.4(sepsis post procedural) and not A41.9.Poor
immune functioning is D84.9 and not D89.9

Ruy Laurenti

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[Comments from Humberto Rocha, Mexico Collaborating Centre (CEMECE))

Dear colleagues

Part I
a) Sepsis, days   A41.9
b) Pseudomonas and staph aureus infection with surgical wound
dehiscence poor immune functioning A49.8, A49.0, T81.3, D89.9
c) Acute Renal Failure, weeks   N17.9
d)L1 decompression and L5 neurolysis surgery, months, for spinal
stenosis  M48.0

Procedure:
GP: No, R1: Yes, M48.0     A41.9 (due to) A49.8 (due to) N17.9 (due
to) M48.0
R3: No
RA: No
RB: Yes (B) M48.0 is in Appendix 7.1 List of conditions unlikely to
cause death.  (It is not for the cervical region)  Then, the adverse
reaction to treatment of the trivial condition is select, T81.4
(Infection following a procedure, not elsewhere classified)

4.2.13 External causes
The codes for external causes (V01-Y89) should be used as the primary
codes, and then the underlying cause of death is Y62.0

Humberto Rocha, Mexican Collaborating Centre (CEMECE)

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Comments from Patricia Wood, Canada

I agree with Humberto that this certificate requires an application of
Modification Rule B (Trivial Causes) as the condition necessitating
the surgery, spinal stenosis (M480), is on the list of trivial
conditions unlikely to cause death.  However, I think I would select
Y838 as the underlying cause code as I don’t infer any misadventure to
the patient at the time of surgery, but rather an abnormal reaction or
later complication to the surgery performed.

Underlying cause of death: Y83.8

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2012-10-02:

[Comments from Colin Fischbacher/Janice Hogg Scotland]

As all the conditions following the surgery are obvious complications
of the operation we would make the Spinal Stenosis the underlying
cause of death as this was the reason for the surgery.

We would code the certificate as follows:

Sepsis - A419
Pseudomonas and staph aureus infection - T814 (with optional codes
A498
and A490 to show the types of infection)
Wound dehiscence - T813
Poor immune functioning - D899
Acute renal failure - N179
L1 decompression and L5 neurolysis surgery - Y838
Spinal stenosis - M480

Underlying Cause of death - M480