Mortality Forum 2012-10-02 Q1 Update 1

[mortality-forum]

Mortality Forum 2012-10-02 Q1 Update 1

From Jan Karduan, The Netherlands:

Dear Forum Members,

Please give me your opinion on the following:

The question came form a certificate : female, more than 90 years
old,
(1a) cardiac arrest [no time ]
(1b) atrium fibrillation [1 yr]
(1c) chronic myocarditis due to diphteria [80 years]


I checked that cardiac problems are a common complication of
diphteria, so the causal chain seems to be intact. But I have a
problem in designating an underlying cause (UCD) that happened 80
years ago. How long can one be in the act of dying? I know that we
sometimes take UCD that is 20 or even 40 years old (and I am not
happy
with that) but 80 years is too much for me. That means that you still
have a full life in front of you. Even if this life is with a chronic
disease, you are living, not dying.

Should there be an upper limit to the interval for which a condition
can be selected as UCD? Vol II does not say so explicitly, but as we
will have more and more diseases for which a genetic variation can be
found as cause, more and more people are going to die as soon as they
are born.

Best regards,
Jan Kardaun

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2012-10-29

[Comments from Dr. Torres, Mexico]

The same happens with congenital anomalies or diseases acquired during
perinatal period or infancy. The UCD will be the chronic myocarditis
due to diphtheria, even after 80years, if it was true and this female
had a good clinical record, but I doubt it. I don't know cases with
many years of survival after a chronic myocarditis due to diphtheria,
because the mortality rate is very high. The woman could have healed
after diphtheria. Maybe it is a mistake of the certifier and it will
be interesting ask him about this rare case.

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[Comments from Humberto Rocha, Mexican Collaborating Centre (CEMECE)]

Female, more than 90 years old

(1a) cardiac arrest [no time ] I46.9
(1b) atrium fibrillation [1 yr] I48
(1c) chronic myocarditis due to diphteria [80 years] A36.8

Procedure:

GP: Yes A36.8
R3: No Originating antecedent cause is A36.8
RA-RE: No
RF: Yes B94.8 Sequelae of other infectious and parasitic disease. The
sequelae include... Sequelae also include chronic conditions reported
as due to, or residual conditions present one year or more after onset
of, conditions classifiable to categories A00-B89.

Underlying cause of death is B94.8

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[Comments from Dr. Ruy Laurenti]

Dear all from the mortality forum.

In the case from Jan Karduan, if we accept that diphtheria was the UC
it is clear that this disease is not currently present; thus the UC in
this case is a late effect and the code is B94.8 (In the Index: Late
effect—see Sequelae)

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[Comments from Patricia Wood, Canada]

There seem to be two parts to this discussion; the clinical
possibilities of chronic myocarditis caused by diphtheria occurring 80
years prior to death and the ICD-10 coding of such a cause of death.
From the coding point of view, I agree with Humberto Rocha and Dr.
Laurenti that the cause of death must be assigned to the Sequelae code
B94.8 Sequelae of infectious and parasitic disease. Dr. Torres'
comments however suggest that this sequence of events is not likely to
be valid with an 80 year interval. Jan, is it possible for this to be
double-checked with the certifier?