I. Revisi'on, July 1, 1963

Transcription

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2 . Revs'on, July 1, 1963 No changes n Appendx (X-Code for Specal mparments) and Appendx 11 (Modfcatons of the nternatonal Classfcaton) have been made snce July 1, Medcal coders wll contnue to use those portons of the Medcal Codng Manual and Short ndex as ssued under that date when the entre Manual and Short ndex was rewrtten. For fscal year July 1, June 30, 1964, the Short ndex 'and all pages of the Manual, except Appendx and Appendx 111, have been rewrtten and brought up to date, and are attached hereto. The attached pages contan all changes and addtons made n and prevous years whch are stll n effect, plus revsons made necessary by changes n the form and content of the current questonnare (Form NHS-HS-1, FY 1964). Persons new to medcal codng must be gven a copy of the Manual as revsed July 1, 1961, and also a set of the attached pages. Appendx and Appendx 11 of the July 1, 1961 revson, added to the attached pages, consttute the Medcal Codng Manual and Short ndex effectve for.the year July 1, 1963-June 30, The basc rules for determnng the dagnostc and operatve codes and for codng njures, accdents, and hosptalzatons are the same as they were last year. Many of the attached pages have been rewrtten merely to make the nstructons consstent wth the column number changes n Table of the current questonnare. Others of these pages are the same as, or only slghtly dfferent from, the way they were as of July 1, 1962, but are ressued for the sake of convenence and to complete the package of pages revsed after July 1, Earler Revsons The frst Medcal Codng Manual (July 1, 1957) was completely re-wrtten for the year begnnng July 1, 1958: (a) to acheve a more satsfactory form; and (b) to concde wth the adopton of the Seventh Revson of the nternatonal Classfcaton of Dseases. The transton from the Sxth to the Seventh Revsons of nternatonal, however, presented few codng problems for the Health ntervew Survey (HS). Certan detal, used by HS n the frst year, was elmnated. For example: allergc manfestatons other than hay fever or asthma, were collected under category 245; psychogenc symptoms were restrcted to those only of heart, skn, dgestve and gento-urnary systems; 4th dgts for eplepsy, cataract, and herna, used n the frst y-earj were dscontnued; pneumona types were restrcted to "vrus" or atypcal, and "all other"; arthrts types n were coded to 725 only. On July 1, 1959, certan pages only of the 1958 Manual were revsed and ssued to users wth nstructons to substtute such pages for the prevous pages applcable to a gven nstructon. Methods of codng njures were revsed somewhat; dstncton was made between school-loss days and work-loss days; certan dseases on the check lsted were coded as chronc only f the date of onset was more than 3 months ago. 1.

3 No revsons were ssued for the year July 1, 1960-June 30, The revson of July 1, 1961 dffered lttle, n essentals, from the prevous ssues. No basc code numbers were changed, but the content of varous categores was altered as shown n Appendx and Appendx 111. The provsons of the document called "Supplement ", dated December 1, 1959, were ncorporated n the July 1, 1961 revson or became nvald. Edtng responsbltes of medcalcoderswere stressed. nstructons for codng strokes and ther effects, and for determnng the actvty of rheumatc fever, were revsed. "Troubles", n general, were preferred over symptoms. Certan types of posonng were clarfed. Certan classes of mparments were modfed. Consderable detal was added to assst coders and supervsors n judgng problem cases, partcularly n the areas of symptoms, ll-defned troubles, and mparments. As of July 1, 1962, Appendx 1 (2-dgt Classfcaton of Operatons) was clarfed n regard to the content of certan categores, and more terms were added to the Short ndex of Operatons. Secton 1 (Outlne of Steps n Medcal Codng) was expanded consderably to nclude nstructons needed by medcal coders for all phases of ther workcodng to the document sensng cards, to the questonnare only, or comparng the codes of the questonnare wth' those of the cards. 1

4 . TABLE OF CONTENTS Preface (wth Hstory of Prevous Revsons) Page. j A. B. C. D. E. F. SECTON. NTRODUCTON AND ORENTATON GUDES Bref Descrpton of the Health ntervew Survey... mportance of the Medcal Codng... Codes Used (descrbed brefly).... The Short ndex (descrbed brefly)... Abbrevatons and References... Tranng Prelmnary to Codng ,. :-1 ' 1 j 1 :. A. B. C. SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG General Descrpton of Medcal Codng... Use of Colored Fencls... Basc Steps... Step 1: General Checkng... a. number of questonnares... b. column number of person... c. queston number... d. "dummy" codes and cards... e. "nadequacy" codes... f. data changed n the feld... Step 2: Step 3: Step 4: Step 5: Step 6: of the Questonnare) c. Codes for Cols 16-19, 21-24, and of the Hosptal Card... Recordng Dsablty and All Other tems n Table.. a. Edtng Responsbltes wth Respect to "Days" B ' , g. Table A--see also Secton V... Codng Whether Acute or Chronc; Condtons to be Deleted--see also Sectons 11 and V Assgnng Dagnostc Codes and Where to Enter Them, Tables and Recordng Addtonal Facts About njures and ' Accdents--= Secton V... Codng Hosptalzatons (see also,sectons V11 and X) e A-12 C a. Specal Checkng... 12A, 12B b. Codes for Cols of the Hosptal Card-(Col () 12c 12c 13-18B 13 b. Condton Days n Past 2 Weeks, Table c. ntervewer Error-for Col. 36 of the Card d. Person-days of Dsablty n Past 2 Weeks... 15,16 e. Date of Onset f. Chronc or Not g. h.. j. Condton Bed-Days n Past 12 Months... Person Bed-Days n Past 12 Months... Lmtaton of Actvty (Cols. (n)-(p) of Questonnare) ntervewer Error-for Col 63 of the Card A 18B 11

5 SECTON 11. CLASSES OF CHRONC AND ACUTE CONDTONS A. "Chronc". Defned B. Condtons Always Chronc Regardless of Date of Onset C. Check Lst Condtons, Chronc only f 3 mas D. "Acute", Defned E. Checkng for Bed-days, after Col (aa) F. Dagnostc Codes Dfferng f Acute, Chronc, or Unspecfed SECTON V. GENERAL CODNG PRNCPLES AND PROBLEMS A. The Objectve... B. Expressons ndcatng Doubt... C, 1 ltovercodng", "Undercodng... C, 2 "Arrested", "nactve", "Corrected" Condtons n (d-1) or (.2). Table D. "Symptoms',.. Card C Codng "Symptoms", and tttroublestt, and Ther Causes... G.) 1. "Symptoms" due to certan causes Multple symptoms, unknown cause, same lne "Troubles,.. knds, and causes Examples n codng rrsymptoms" and "troubles" H. Nervous or Mental Trouble Nervous or mental condtons n (a-1) due to varous causes Physcal condtons n (d-1) due to "nerves" Multple mental condtons. same person ' 4. Descrptons of 'hervous" and mental cases, wth codes l'removal" and other Operatons, Table ; and Post-operatve States J. Asthma and Other Allerges K. Cysts L. ttdscfl Condtons M. "Gland" Condtons N. "Gro~hs He&t Condtons, ll-defned, or Due to' Varous Causes P. "Non~cton &. "Senstv." R. Pregnancy wth Hypertenson and Other Toxemas S. Spellng Problems U. When to Use 795.0, or 795.5, Table T. Typhod and Other Carrer States SECTON V. "COMBNNG" AM) "MERGNG" A. "Combnng ~ n ea-l... r Knds of condtons that combne References, n Appendx Examples of condtons that may combne B. "Mergng V

6 SECTON V. BLNMESS, OrlTHER XMPARMENTS, AND THER CAUSES A. General Notes... B. Vsual mparments 1. Date of onset Blndness (XOO), defned Vsual mparments n XOl, XO2, X Wth cause stated Selectng the etology code Eye dseases n (d-1) Examples, chronc vsual mparments and eye dseases... C. Hearng mparments Degrees of hearng mparment Date of onset Wth cause stated D. Speech mparments (ncludng Voce Defects).... E. mparments, Specal Sense, NEC... F. Specal Learnng Dsabl-ky, and Mental Defcency... G. Absence of Extremtes, and Certan Other Stes (revsed)... H. Paralyss, Complete or Partal (wth Revsed nstructons for Codng "Strokes") Date of onset...~ Multple stes and types, 3 mos+, n X40-X Problem termnology (spastc, spasms, palsy, etc).... Non-Paralytc. Orthopedc mparment, NEC (wth Revsed nclusons) (due to Strokes) etc...m J. Deformty, Lmbs, Back, Trunk (wth Revsed nclusons) (due to Strokes) (Scars) etc...' K. mparment, NM: (wth Revsed nclusons)... L. Multple mparments, Same person...^... M. Multple Etologes, Per Tparment N. When to Code the Cause Separately a. When =to Code to X~ode... SECTON V. NJURES, ACCDENTS, AND THER EFFECTS A. njures and Ther Effects, General (njuqy Defned) (Date of Onset) (Table A).... B. Recordng Other Facts About njures and Accdents..... C,D Loss of Eye, Lmb, Nose, Ear, any Onset, Due to njury... E. Other njures, -3 mos.o. F. njures, 3 mos+, Present Effect Known... G. Sprans, Strans, 3 mas+... H. Dslocatons, 3 mas+.... Other njures, 3 mos+, No Effect Specfed... J. Multple njures and Multple Accdents... K. Brth or Delvery njury L. Exqples Codable to or nvolvng "njury"... Page ,46 46, , ,50! ,53 1! ,56 56, ,61 61, , , v!

7 SECTON V. CONDTONS R3LA!El TO CHlllBEARNG page A. Pregnancy B. Abortons, Delveres, and Brths C. Complcatons Followng Delve D. Codng Col (aa), Table SECTON M. HOSPTALZATON AND SURGERY, TABU3 1 A. Table 11, General B. Codng the Dagnoss, Col (h)... 71,72 Date of-onset, unknown, Table nadequate dagnostc terms, Table njures, Table... C. Codng Operatons, Col ()... 72A,73 1. What to nclude A 2. Usng the ndex of Operatons--see 'also Appendx D. Multple,Dagnoses; Multple Operatons... 73,74 E. Applyng 1-Dgt Code, Col () F. Examples, Codng n Table APPENDX. X-CODE FOR SPECAL MPARvENTS A. Development of the X-Code B. Characterstcs of Specal mparments C. mparments by CD Codes and by X-Codes D. "Late Effects" Codes of CDt..., E. "Late Effects" Not ncluded n X-Code F. ll-defned "Late Effects" G. Lsts of 1-Dgt Etology'Codes H. Lst of Specal mparments, By m e and Ste XOO-X05 mparment of Vson X06-XO9 mparment of Hearng XlO-Xl9 mparment of Speech, ntellgence, Specal Sense X20-X39 Absence, Loss, Extremtes and Certan Other Stes X40-X69 Paralyss, Complete or Partal X70-X79 Non-Paralytc Orthopedc hparment NEC X80-X89 Specfed Deformty of Lmbs, Trunk, Back X9O-X99 Defect, Abnormalty, Specal mparment NEC APPENDX DGT TYPE OF OPERATON CODE Operatons : On organs of Endocrne System (01-09)... On Parts of Nervous System Except Eye, Ear (10-14).... On Eye, Ear, Mastod (20-26)... On Cardovascular System (30-32)... On Lgmph System, Spleen, Bone Marrow (49)... On Respratory System, and Chest NEC (50-59) On Dgestve System, and Abdomnal Regons NEC (60-69, 6X)... On Gentournary System (70-79, 7X)... On Skn, Musculoskeletal System, and ''Regons" NEC (80189, 8X).... Surgcal and Operatve Procedures for Delvery (93,95)... Operaton, type unknown, ste unknown or ll-defned (XX) ! V

8 '. 8' 8, Neoplasms /. Allergc, -. APPENDX 111. MODFCATONS OF THE NTERNATONAL CLASSFCATON (1955 REVSON), AM) SPECAL NSTRUCTONS, USED FOR THE HEALm NTERVEW SURVEY Explanatory Notes nfectve and Parastc Dseases ( ) ( ) Endocrne System, Metabolc, Nutrtonal, and Blood Dseases ( ) Mental, Psychoneurotc, Personalty, and ll-defned ffnervous'f Dsorders ( ) Dseases of Central Nervous System (ncludng ffstrokes'') ( ) Dseases of Nerves and Perpheral Gangla ( ) Certan Eye and Ear Condtons ( ) Rheumatc Fever and Chronc Rheumatc Heart Dsease ( ) Dseases of Heart n , '1 Hypertenson wth Heart and Certan Other Condtons ( ) t1 Dseases of Arteres, Vens, and Other Crculatory Dseases ( ) Dseases of the Respratory System ( ) Dseases of the Dgestve System ( ) : Dseases of the Gentournary System ( )... Delveres and Complcatons of Pregnancy, Chldbrth, and the Puerpertum ( ) Dseases 'of the Skn and Cellular Tssue ( ) Arthrts and Rheumatsm ( ) ' Structural or Mechancal Defects of Musculoskeletal System ( ') Congental Malformatons ( Certan Dseases of Early nfancy ( ) Symptoms, Senlty, and ll-defned Condtons ( ) Accdents, Posonngs, and Volence (Nature of njury) ( ) SHORT NDEX OF DSEASES, MPAMNTS, NJURES, AND OPERATONS v11....,

9 SECTON. NTRODUCTON AND ORENTATON GUDES 1 ' :. j, A. The Health -- ntervew Survey,, of the Natonal Health Survey The Health ntervew phase of the Natonal Health Survey, begun July 1, 1957, s a contnung survey based on household ntervews conducted by the Bureau of the Census. The survey s made on a sample bass. Approxmately 42,000 ntervews wll be conducted over the course of a year, wth households located n every one of the 50 States, and the Dstrct of Columba. Data collected n the Health ntervew Survey wll provde a statstcal pcture of llness and dsablty n the populaton of the naton, as well as nformaton on related subjects such as tme lost from work or school because of llness and medcal care receved by persons who are ll. One of our naton's greatest resources s a healthy populaton. The health of the naton may be evaluated n economc terms, such as the loss of ndvdual ncome or the reducton of total natonal economc producton because of llness or njury. t may be evaluated n terms other than economc, such as the extent of occurrence of partcular knds of llness. Snce the overall health of the naton s of vtal mportance, t s necessary to be able to measure our health assets and labltes n terms of the entre populaton. The Congress of the Unted States, realzng the necessty for natonal health statstcs, authorzed a contnung Natonal Health Survey (Publc Law 652 of the 84th Congress) whch was sgned nto law by the Presdent n The Health ntervew Survey, wth other branches of the Natonal Health Survey, s sponsored by the Unted States Publc Health Servce, whch s a part of the Department of Health, Educaton and Welfare. The Publc Health Servce has asked the Bureau of the Census to conduct the ntervewng because of the Bureau's functon as an objectve fact-fndng agency and because of ts broad experence n conductng surveys. The Bureau also performs most of the clercal operatons necessary for processng the data. The fndngs of the survey are analyzed and publshed by the Publc Health Servce, n the Natonal Center for Health Statstcs. * ' 1- B. mportance of the Medcal Codng Medcal coders play a very mportant part n the success of the Natonal Health Survey. They must translate nto numercal symbols all of the nformaton on the questonnares about dseases, njures, accdents, delveres, and operatons. Mstakes n med,cal codng can serously affect the accuracy of data whch wll be furnshed to people who wll base ther decsons and plans on ths materal.

10 2 SECTON. ORTENTATON GUDES C. Codes Used 1. Dagnostc 2. Operatons 3. Accdents D. The Short ndex The 4-dgt dagnostc code for the condton causeng the sckness or dsablty s derved from the nternatonal Classfcaton of Dseases, (1955 revson) and a supplementary classfcaton called the X-Code for Specal mparments. The X-Code s lste d and descrbed n detal n Appendx of ths Manual. Operatons are coded accordng to the 2-dgt Ty-pe of Operaton Code, lsted n Appendx 11. njures, and ther effects, requre certan other codes, n addton to the dagnostc code. These are descrbed further n Secton V. The Short ndex, developed by the Publc Health Servce, has been planned to smplfy the job of locatng the correct medcal codes. t contans the names of the more common dseases, symptoms, and njures of the nternatonal Classfcaton, and all types of mparments and operatons lsted n Appendxes and 11. t ncludes a number of popular or lay terms not ndexed by nternatonal. Even more mportantly, t contans most of the terms affected by the consderable number of modfcatons of the nternatonal shown n Appendx 111 of ths Manual. The astersk after a code n the Short ndex ndcates that some change has been made n that category, as lsted n Appendx 11 of ths Manual, and/or that the term s ncluded n the Short ndex but not n Volumn 1 of nternatonal, or s modfed n the Short ndex n a manner that dffers from that shown n Volumn 11. The astersk, however, s not appled to the numercal code when t s entered by the coder on the questonnare or other recordng form. The Short ndex MUST be consulted frst n order to assgn a dagnostc code. f the term to be coded s not lsted n the Short ndex, the coder wll then look for t n Volumn. f the term does not appear there, the case should be referred to the supervsor.

11 , SECTON. ORENTATON GUDES 3,! E. Abbrevatons To save space n the Manual hereafter, and n the and References Short ndex, abbrevatons are used freely Organza- HS tons NHS PHS WHO 2. Certan CD classf - N-Code catons E- Code and references Y-Code to them X-Code VOl. VOl xoo-x99 3. Certan Col parts of Cols the ques- Table tonnare and booklet Table 1 Table A Card A Card B Card C Health ntervew Survey Natonal Health Survey Publc Health Servce World Health Organzaton nternatonal Classfcaton of Dseases Nature of njury Classfcaton of CD External Cause of njury Classfcaton of CD; not used for NHS Supplementary Classfcatons of CD; not used for MS X-Code for Specal mparments (XOO-X99) Tabular lst of CD Alphabetcal ndex of CD Used n varous dscussons to ndcate the span of numbers of CD from 001 through 779, consttutng the man body of'the classfcaton for dseases. The span of numbers for certan symptoms. The span of numbers for njures. The span of numbers for specal mparments. Varous other spans of numbers are used for smaller groups, such as (hypertensve dseases), (allergc dsorders) etc., etc. Column Columns Contans facts about dagnoses, medcal care, dsablty, dates frst notced, etc. Where hosptal admssons are recorded. Contans facts about where, how, and when an accdent happened. The lst of chronc dseases read to the respondent. The lst of selected mparments. The lst of "symptoms" for whch the ntervewer asks the cause. 4. Tme of Onset onset of -3 mos a cond- 3 mos+ ton -2 wks -12 mos 12 mos+ When a condton'started Wthn past 3 months 3 months ago or longer Wthn past 2 weeks; "last week or the week before Wthn past year 1year ago or longer

12 4 SECTON. OFCENTATON GUDES E. Abbrevatons-- - Con. 5. Age of CD classfes certan dseases accordng to age of the person person: -4 wks nfants under 4 weeks of age 4 wks+ Persons 4 weeks of age or older -1 yr nfants under 1year of age 1 Yr+ Persons 1year or older -65 PS Persons under 65 years of age 65 yrs+ Persons 65 or over 6. Other NOS Not otherwse specfed, or so statedabbreva- n reference to a medcal term. tons n NEC Not elsewhere classfed n a partcu- Manual and lar lstng or some other place n the Short n- varous classfcatons - n reference dex to a medcal term. APP - Appendx ORTH MP OP Orthopedc mparment of the lesser knds n X70-X79 - not paralyss and not deformty; "see ORTH MP," n the Short ndex, s a referral to the lstng un- der Orthopedc mparment NEC. Operaton: "see - OP NEC" s a referral, n the Short ndex, to the lstng under Operaton, NEC. F. Tranng Pre- Persons new to medcal codng should be gven an exlmnary to tensve prevew of the man classes of dseases and Codng njures of ed, n Vol., and must be thoroughly prepared to recognze all departures from CD as shown n Appendx 11 of ths Manual. WHETHER THE CODER S EXPERENCED OR NEXPERENCED, THE M- PORTANCE OF KNOWNG WHAT S N APPENDJX 11 CANNOT BE (XEREMPHASZED.

13 SECTON. OFCENTATON OES 5 F. Tranng F-relmnary to Codng--Con. ' 7! 1. CD 3-dgt categores Revew the lstng on pp. 3-25, and 32-38, of Vol.. Ths wll gve some dea of the large number of condtons that are possble wth ther techncal medcal names, and haw they are grouped as to type or the system of the body. The E-Codes and Y-Codes of CD are not used by NHS.. 2. Comparng the Tabular Lst, VOl., wth Appendx 11 ' 1! 1 The Tabular Lst begns on p. 43 of Vol.. Note the explanatons on p. 44. Read the explanatory notes for Appendx 111. Next, compare each category lsted n Appendx 11 wth that category as lsted n Vol., Tabular Lst, begnnng wth 002 and contnung through to 999, notng statements begnnng "For NHS"..; these tell n what way the NHS method dffers, or call attenton to some provson that s especally mportant for NHS. Ths frst readng s also ntended to acquant the new coder wth more detaled knds of dagnoses, both n the techncal language of VoL. and the more common knds of terms dscussed,n Appendx T. Note partcularly, and memorze, or wrte out on a card, the followng 4th dgt subdvsons used by NHS but -not by CD, as shown n the "new code" column of- Append-x 111:, These separate ll-def ned "trouble or dsease of thyrod, E, stomach, ntestne, lver, gallbladder, and kdney from better defned condtons,n the same CD category. For example, CD classfes "thyrod dsease or trouble" n the same category wth "cyst of thyrod;" "thyrod trouble" s lsted n the Short ndex as 254.0; "cyst'of thy- rod" s not n the Short ndex; Vol.. 1 s consulted, and the number there s 254; f the coder uses 254x for "cyst of thyrod", she s n error; for NHS ths number should be 254.1, snce t s not classfable to% NHS \ ' '.

14 6 SECTON. ORDNTATON GUDES F. Tranng Prelmnary to Codng--Con. 3. VOl. 1 Although most of the terms reported wll be found n the Short ndex, there wll be need at tmes to consult Vol. 11. Read the ntroducton to Vol. 11, but omt all references to "late effects" because the NHS method of codng late effects s dfferent from the CD method; references to the E-Code and Y-Code may be read but nether of these codes are used by NHS. The astersk and dagger, as used n Vol. 11, should be understood, but these devces are ntended to pont up prmary causes and secondary condtons and do not apply n NHS codng. Attenton s called to the specal use of parantheses, a form that appears also n the Short ndex. Note that condtons combnng wth other condtons, nto one code, appear frst n a lstng under the word -wth. Ths form s also used n the Short ndex.. Tne paragraphs followng "Neoplasms", p. x, wll be helpful, as the Short ndex refers the coder to Vol. 1 for all stes and types of tumors. The NHS rules for codng ne.oplasms are n Appendx 11 ( ). n usng Vol. 1 or the Short ndex, watch for ndented terms under the word multple, for here wll be lsted codes that may be used when two or more stes (parts of the body) are affected by the same dsease or njury, but a sngle code may be used; ths should be looked for n all lstngs, but partcularly under Fracture; Wound, Open; and other types of njury. 4. Appendx 1 a 5. Appendx 6. Summary For NHS, operatons n Table 1 are coded accordng to a classfcaton of operatons lsted n Appendx 11. Study Appendx 1 to become acquanted wth the terms used and the parts and. structures ncluded n the var-! ous systems of the body. A few operatve terms appear n Vol. 11, but they may be gnored; look always n the Short ndex., -! Appendx (X-Code for Specal mparments) should be read and dscussed durng the orentaton perod. A general knowledge of the range of condtons to be coded, of the form of Vols. and 11, and of the other classfcatons to be used, should be helpful n understandng the 1 more specfc codng nstructons to be found elsewhere n the Manual.

15 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG 7 A. General Descrpton of Medcal Codng Ths Manual deals wth the codng of data on the Questonnare concernng dseases, njures, accdents, mparments, delveres, hosptalzatons, surgery, medcal care, and days of dsablty, as shown n Tables, 11, and A and footnotes thereto. Codng of ths knd s called "medcal. codng", and s done by clerks who have been gven the specal prelmnary tranng. Medcal coders also watch for and record certan ntervewer errors and omssons whch affect the completeness and accuracy of the health nformat on. The medcal coders translate the medcal data nto codes whch are to be transcrbed to document sensng cards. There are 4 types of such cards, as follows, but the medcal coders are concerned only wth 3 and 4: 1. Household Card 3. Condton Card 2. Person Card 4. Hosptalzaton Card Processng after the preparaton of these cards s beyond the scope of ths Manual. Medcal Coders are desgnated' as follows, accordng to the specfc dutes each usually performs : a. Medcal Coder to Card (MCC) b. Medcal Coder to Questonnare (MCQ) c. Comparson of Dagnostc Codes Clerk (Comp. DCC) Effectve July 1, 1962, ths Manual wll descrbe the procedures,requred of each class of medcal coder. n prevous years, nstructons n ths Manual were drected manly to the MCQ, wth detaled nstructons for fllng the cards and for verfyng beng lsted elsewhere. The MCQ makes all of her entres on the Questonnare and does not handle the cards. The MCC makes certan entres on the. questonnare and flls the ovals of the cards also f.a person has one or more codable condtons, and/ or one or'more hosptal admssons. For each card needed, the MCC flls the oval n Col. 1, leaves Cols blank, and wrtes n, n the extreme rght margn, the PSU, Sepent, and Seral number shown n tems 7, 8a, 9 on the face of the questonnare.! The Comp. DCC's man functon s to check and verfy all tems pertanng to the medcal codng, comparng the codng on the questonnare wth that entered on the cards. Codng dfferences and errors that can be resolved readly are corrected by the coders. Problem cases are referred to the supervsor, and f necessary to the NHS nosologst. When a dagnostc code on the questonnare dffers from that on a card ths fact s recorded by the Comp.DCC on NHS Form 715. Form 715 s a report of dagnostc codng dfferences, per work unt; the supervsor examnes each case lsted, and decdes what the correct code should be.

16 0 SECTON 11. OW'LNE OF STEPS N MEDCAL CODNG B. Use of The E C uses a specal black pencl for fllng the ovals on Colored the cards. When entres are to be made by any of the med- Pencls cal coders on the questonnare, a green, purple, or red pencl s used, as follows:. a. A preen pencl s used: (1)to lne out entre lnes of condtons n table that are to be deleted and not coded n any way; and (2) to call attenton to certan errors made by the ntervewers. b. A purple pencl s used by the EQ only, for one purpose only. f an ntervewer error, of the type n the Census-ssued "Lst of Error Codes for llness, njury, and Hosptalzaton &tres," s noted by the MCQ, the EQ selects the proper code for t and enters t, n purple pencl on the questonnare, accordng to Census. Bureau nstructon. When, later, the Comp. DCC sees such an entry on the questonnare, she checks t for accuracy and enters t, n black pencl, n the proper ovals, as applcable, n ether cols. 37,38 of a Condton Card or Cols. 14,15 of a Hosptal Card. f no error code of ths type,s applcable, XX s used on the card. The code for an error of ths type s referred to also as an "nadequacy" code. Note: The MCC has no part n the applcaton of ths "nadequacy" code. When the columns headed "nadequacy or Dummy Codew are to be flled for ''mssed" conc. A -red pencl s used to make all other entres on the dtons, proceed as n C, d, below. questonnare, ncludng lnng out condtons that are to- be merged wth other condtons.. C. Basc Steps The medcal coder, of any class, should frst examne care- Step 1: f'ully all parts of the questonnare. For edtng hosptalza- General tons, and "days", see Steps 5 and 6.. Checkng a. Check tem 1on the face of the questonnare; f more than one questonnare s ndcated there, but one, or more, of these s mssng, report ths to the super- vsor.

17 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG 9 C. Basc Steps Step 1: General Checkng--Con. b. Check the column number of the perso:. The questonnare has space for 6 household members, one column for each, numbered 1, 2, etc. f one of these persons has been deleted by the ntervewer from the household, the Col numbers of the other persons on any o s questonnare are not to be changed. f a second or thrd ques- tonnare s necessary because of the number of people n the household, the Col numbers of the persons on a second questonnare must always begn wth 7, 8, etc., and on a thrd, 13, 14, etc. f the ntervewer has not changed the Col numbers on a second or thrd questonnare of a set, renumber n preen pencl. f a person has a condton n table or 11, see that the correct number for hm s n Col (a) of table or 11. t s most mportant that the number n Col (a) be dentfed wth the rght person and the rght condton. f the ntervewer has entered a wrong person number n Col (a), (or left Col (a) blank) edt Col (a) n green pencl. Ths wll prevent absurd stuatons such as an entry for a delvery n table or 11, wth "3" n Col (a) when "3" s a male 5 years old! The MCC wll also fll the proper ovals n Cols 11 and 12 of the card for the correct column number of the person. c. Check the queston number: t s mportant to know from what questonnare tem the dagnoss was derved. Edt Col (b) of table or 1 to see that t contans the rght queston number that produced the dagnoss--usually f the ntervewer has entered a wrong number, correct t n green pencl. f the condtons was reported only when specal supplementary tems were asked--such as of the current questonnare--delete the condton entrely n red pencl and do not code t n any way. f the condton was volunteered by the respondent and dd not come from any queston, or f t came from some routne queston other than 8-17, wrte "XX" n red n Col (b) of tables or 11. f the condtons was frst reported from questons 15-17, but was correctly carred back to table by the ntervewer, see that the queston number n Col (b) of table s the same as the number shown n Col (b) of table 11. The MCC wll transcrbe the correct queston number from Col (b) of table to Cols 13, 14 of the Condton Card. Effectve July 1, 1963, the Hosptal Card contans Col 13 for the queston number from Col (b) of table 11. The MCC wll fll the approprate oval accordng to whether ths codable hosptalzed condton n table 1 was derved from questons 15-17, or some other queston.

18 10 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG C. Basc Steps--Con. Step 1--Con. d. "Dummy" Codes and Cards" These refer to "mssed" condtons--.e. condtons that the ntervewer should have entered n tables or 11, but whch are mssng n those tables. All medcal coders must watch for omssons of ths knd. The MCC makes cards for these mssed condtons but flls only Col 1, the rght margn, and certan other columns as shown below. These "dummy" cards are excluded from HS total counts of condtons and hosptalzatons; ther purpose s to record ntervewer omssons of ths nature. ' 1. Condtons mssng from table : f questons 8-14 show a condton that has not been carred through table, but should have been, the MCQ and the MCC place a green check besde that condton and determne a 4-dgt dagnostc coae for t: The MCQ wrtes ths code n green on the questonnare besde the green check. The MCC enters ths n Cols of a Condton Card, and enters "00" n Cols 37, 38, flls also Cols 11-14, and flls the "DK" oval n Col. 15. f table 1 shows a stay for an mparment or a condton on Card A, or a stay for any llness n the past 2 weeks,.but- ths condton s mssng n table, both the MCQ and the MCC wll place a green check after ths dagnoss n table 11. The MCC enters ths mssed dagnoss n Cols of a Condton Card, enters "OX" n Cols 37, 38, and flls also Cols The queston number must be the queston number shown n table 11, and the "yes" oval n Col 15 s.to be flled. or "OX" n Cols Thus, a dummy Condton Card wth t'oo" 37, 38 represents a condton mssng from table. f "OX" s used, ths means a hosptalzed condton was not brought back to table but should have been. -Note: Do -not make a dummy card, or charge error, f a Card A condton or an mparment s codable n table 11, but had no nghts n past 12 months, and was not carred back to table by ntervewer. However, f such a condton--codable n table --= carred back to table, or t was already n table from questons 8-14, code t n table, f t s codable n table...!

19 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG 11 ~ ~~~~ ~ s. Basc Steps--Con. Step l--con.--d. "Dummy Codes and Cards--Con. 2. Condtons mssng from table 11: Watch for entres n questons 15-17, or other places, that.ndcate that the person was hosptalzed one or more tmes but table. 1 does not have an entry for ths. Look through the questonnare for a footnote or notaton that may explan why these hosptal stays are not ncluded n.table 11.. f some explanaton s found,. refer to supervsor who wll furnsh you wth data for completng table 11. f no explanaton can be found, and the case s to be treated as a "mssedr' hosptalzaton, both the MCQ and the MCC wll place a green check besde the tem n 15-17, or elsewhere, that ndcates a mssed hosptal stay. The MCC wll make a dummy hosptal card, enterng "00" n Cols 14,15, and the approprate queston number n Col See also Step 5, for specal checkng for hosptalzatons. e. nadequacy Codes: See B,b, of ths Secton. f a condton or a hosptal stay s codable, and s not a "mssed" condton, the MCC flls the columns of the card that- are applcable, and gnores the column headed "nadequacy -or Dummy Code". f. Data changed n the feld: f the ntervewer has made a wrong entry, and-has changed t n the feld, code the nformaton as changed. g. Table A: Note whether table A has been flled. Secton V. Step 2: Codng Whether Acute or Chronc; Condtons to be Deleted a. Judge whether a condton n table s acute or chronc accordng to nst_ructons n Secton 11 of ths Manual. Enter n Col (ah) of table the followng: 1, f chronc; 2, f acute. The MCC wll also fll the proper oval n Col 42. b. Watch for condtons that can be lned out and not coded n'any way, but be sure all specfcatons are met. 1. Acute condtons n table wth nether medcal care nor cut-down of actvty: f Col (c) s "no", and both Col (e) and Col (f-1) are checked, lne the condton out n green pencl. Effectve July 1, 1962, f Col (c) s blank, DK, or NA, do & lne out the condton. When fllng Col 15 of the Condton Card (for whether or not a doctor was seen) the MCC wll fll the 'Pftoval f Col (c) of the questonnare. s blank, or the "DK" oval n Col (c) s DK or NA. 2. Certan chronc condtons n table, corrected by surgery pror to the past year, may be deleted, provded there s no present effect, and no present actvty restrcton or lmtaton n the past 2 weeks or n the past year, and wth blank n Col (p). -See Secton V for further detals. 3. Watch for acute-type condtons, n table, such as "swallowed poson", or."pneumona", wth no days of cut-down n past 2 weeks, whch have been brought back by the ntervewer from table 1 to table, -, error wth the queston number n table seen to be Condtons of ths type, and others not related to chronc condtons on cards A or B, wth no days of dsablty n the past 2 weeks, may be deleted n table ; but consult supervsor frst. 4. Condtons pcked up from specal supplementary tems such as questons 18-23: delete. See also Cy Step 1,c, of ths Secton. 5. Stays n.table 1 for -w ell newborn babes: lne out n red pencl. Do & delete stays for prematurty or any abnormalty.

20 12 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG C. Basc Steps--Con. Step 3: Assgnng Dagnostc Codes and Where to Enter Them Medcal coders judge how many separate codable condtons a person has, and what the dagnostc code for each should be, accordng to detaled nstructons n later sectons of ths Manual. a. Number of dgts per dagnoss: Each dagnostc code must have 4 dgts. f a code has only 3 dgts--for example, anema 293--use "X" for the 4th dgt, and enter 29% for the dagnoss. b. Total number of dagnoses, per person, table : Medcal coders determne, after deletng and sometmes combnng certan condtons, how many condtons a person has. The MCQ makes no.entry for number of condtons. However, ths s an mportant step for the MCC, n preparng the Condton Card, f a person has no condtons n table, no Condton Card s made. f the person has one or more condtons, Cols 39 and 40 of the card must be flled. Col 39 s for the total number of condtons a person has, and Col 40 tells whether the condton s the frst or only, or s the second, thrd, fourth, etc. of multple condtons for ths person. f the total number s 9 or more, fll the "9+" oval. c. Where to enter the dagnostc codes: The MCC enters the dagnostc code for a condton n table n Cols of a Condton Card; and the dagnostc code for a hosptal stay n Cols of a Hosptal Card. Tne MCQ wrtes her dagnostc codes on the questonnare as follows: n table : f the dagnostc statement n a lne requres only one code, enter t n Col (a-1) above the ntervewers statement; f t requres a second code, enter t n C O ~(d-2); f a thrd, n C O ~ (d-3). When there are-multple codes per lne they are usually all acute or all chronc. n rare cases when one s chronc, and others are acute, make use of the frst unused lnes of table, to enter there the codes for the acutes duplcatng the data for Cols (a), (b), (c), and (e) through (k-31, but enterng "2", acute, n Col (aa) of the new lne, and leavng Cols (k-4) (1)- (p) blank. n table 11: The MCQ enters the dagnostc code for the hosptal stay n Col (h). Only one dagnoss per hosptal stay s coded and only one Hosptal Card per hosptal stay s made. Step 4: Recordng Addtonal Facts about njures and Accdents: -See Secton V.

21 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG 12A condtons are gven n Sectons V11 and X of ths Manual. are other procedures necessary for codng table 11. Followng :\ t : L. - a. Specal Checkrq: Effectve July 1, 1962, all medcal coders are nstructed to check carefully all entres n questons 15-17, and n Cols (c) - (g) of table 11. f "yes" has been checked n questons 15 and/or 16, verfy that there s an entry for that person n table 1 for each tme mentoned. f queston 17(c) s "yes", and the date n questdon 17(d) s snce the date stamped n queston 15, there should be lnes of table 1 flled for mother and nfant. (Note: The'hosptal experence for the mother s coded; brths of well newborn nfants are -not coded, but f the nfant s premature or stays for any abnormalty, such.stays coded. ) f col. (d) of table 1 has an entry of "none.," the ntervewer should have deleted ths hosptalzaton by drawng a lne through ths entry n table 11. f she has faled to do so, and cols.(e) and (f) have no entry of nghts, draw a lne through ths entry and do not fll the hosptal card for ths hosptalzaton. f "none" s entered n col.(d) but cols.(e) and/or (f) have entres, refer to.your supervsor. Cols (c) through (dshould be checked carefully and all nconsstences., should be referred to the supervsor. Ths nconsstency check should nclude,) ~ such tems as: (1) Verfyng that some part of the hosptal stay occured between the date stamped n queston 15 and the week of ntervew. (2) Check that the date of admsson s not after the date of Sunday pror to the week of nkervew.' (3) Check that the date of admsson s consstent.wth the entres n Cols (d) and (e): (a) f the date of admsson s wthn the 12 month perod pror to week of ntervew, Cols (d) and (e) should have the same entres. (b) f the date of admsson s pror to the past 12 months the entry n Col (d) should be greater than Col (e). j 1- (4) Verfy that entres n Col (f) (nghts n the past 2 weeks) are consstent wth Col (c) date of entry and Col (d) number of nghts n hosptal and be sure the entry n Col (f) s not larger :- j than the entres n Cols (d) and (e)..'

22 12B SECTON 11. OUTLE OF STEPS N MEDCAL CODNG C. Basc Steps--Con. Step 5: Hosptalzatons--Con. Checkng Cols (c) - (a)--con. (5) Verfy the correctness of the entry n Col (g) by the entres n Cols (c) and (a). (Use a calendar. ) (a) f col (g) s checked '!No, ' the number of nghts n Col (a) added to the date of admsson n Col (e) may be, equal to but cannot exceed the date of Sunday pror to the week of ntervew. (b) f Col (g) s checked "Yes," the number of nghts n Col (a) added to the date of admsson n C O ~(c) must exceed the date of Sunday pror to the week of ntervew by 1nght. The followng examples relate to a date of Tntervew of July 23, 1963; Sunday pror to week of ntervew was July 21, 1963; date stamped n Q.15 s June 1. Col c Col d e f g Comments Month Day Year July N o L/ July Yes 2/ Both of these examples show proper entres whch could be transcrbed wthout referrng to supervsor. (6) f ''Yes'' s entered n Col (g) Col (f) should have an entry of nghts.

23 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG 12c C. Basc Steps--Con. Step 5--Con. b. Codes for Cols of the Hosptal Card-(Col ()of the questonnare): Examne Col ()of the questonnare. Was the dagnoss surgcally treated, and f so what was the name of the operaton? At the left of Col (),the MCQ enters one of the followng codes: X = Operaton, for the coded dagnoss 0 = Operaton, but not for the coded dagnoss 1 = Operaton, but unknown f for the coded dagnoss 2 = No operaton done, or uknown f operaton was done. 5e'MCC enters ths code n Col 29 of a Hosptal Card. f one or more operatons were performed, code each as nstructed n Sectons V11 or X. The MCQ enters these,, separated by dashes f multple, at the rght of Col (). 5e MCC used Cols of the Hosptal Card,. accordng to whether one or more operatons were done. f no operatons were performed, Cols wll be blank, and the code n Col 29 wll be "2 t. c. Codes for Cols 16-19, 21-24, and of the Hosptal Card: Ths nformaton s recorded by the MCC only. Date of entry: Check Col (c). Transc-rbe month, day, and year n f any entry s "blank" or "DK", refer to supervsor. Also refer any date pror to January 1, Nghts n Hosptal: Transcrbe the number of nghts n Col (a) to Cols of the card. f months or years are entered on the questonnare, convert to nghts on a 30-day month or 365-day'~ar bass. f entry n Col (a) s b.lank' or "DK", refer to supervsor. Hosptal dentfcaton: Ths s a 4-dgt code to be entered n -Cols The frst 2 dgts ndcate "Type of Servce", and the 3rd and 4th ndcate "Ownershp". For example, "0212" s the code for a psychatrc state hosptal. For detaled nstructons for codng Cols see transcrpton nstructons ssued by Census. d. Surgcal nsurance:!ths nformaton s entered by the ntervewer n Cols (j) - (n), of table 1 of the current questonnare, for completed hosptalzatons ( "no" n Col (g) AND delvery or operaton shown n Col (h) or Col ()). The entres n Col (j) - (n) wll be transcrbed by the MCC to Col 36 of the Hosptal Card n terms of a 1-dgt code whch wll ndcate whether persons who were surgcally treated had some part of the surgeon's bll pad for by nsurance. For detaled nstructons, -see transcrpton nstructons.

24 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG 13 C. Basc Steps--Con. Step 6: Recordng Dsablty and All Other tems n table : Effectve July 1, 1962, and revsed as of July 1, 1963, ths step s expanded consderably n order to nclude procedures to be followed by the MCC as well as the MCQ. a. Edtng Responsbltes wth Respect to "Days". All medcal coders must nspect, and edt f necessary, each retaned lne n table for consstency wth respect to days of dsablty of any knd. f a condton s n table, and also n table 11, any hosptal days, n the past 2 weeks should be reflected n the number of days n the past 2 weeks n table ; and f the condton s chronc, n the number of bed-days n Cols (1)and (m) of table. f Col (m) of table has bed-days n the past 2 weeks, then Col (h) should have bed-days; f the number n (m) s larger than that n (h), change (h) to agree wth (m). f after ths adjustment, the bed-days n (h) are greater than the days of "cut-down" n (g), change (g) to agree wth (h). However, f (h) s equal to or larger than (m), do not change. (m). f (m) has less days than (h), leave (m) as s, and do not change (h). f (1)shows 365 bed-days n the year, Cols (f) and (fl2) should say yes, and (g) and (h) should have 14.. f you judge that a condton should be coded as chronc, but the ntervewer has stopped at Col (aa), contrary to her nstructons, adjust for the blanks beyond (aa) n reen pencl, enterng n (1)and (m) the number of days shown n (ht=se red pencl to make these adjustments f the condton was checked as havng ts onset -3 mos, and the ntervewer could not have recognzed the condton as one whch would be coded chronc. f you judge that a condton should be coded as acute, but the nter vewer has carred t beyond Col (aa), strke out the entres beyond Col (aa) n red pencl,. but use the data to edt, f necessary, the! bed-days n the past 2 weeks. All lnes of table must be n order wth respect to deleton, "mergng", and consstency before condton-days, person days, or any other facts, can be recorded.!

25 14 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG C. Basc Steps--Con. Step 6--Con. b. Condton Days n Past 2 Weeks, table : Cols (e) - (j) of the Questonnare show whether or not any codable condton, acute or chronc, caused days of dsablty n the past 2 weeks. Both the MCQ and the MCC must know how to edt and nterpret ths data. The MCC edts, and must also determne the proper entres to be transcrbed to Cols of every Condton Card she makes (excludng "dummy cards"). Cols 30,31 of the card are for days of ttcut-downtt--from (g) of the questonnare. Cols 32,33 are for days n bed--from (h). Cols 34,35 are headed "Tme Lost"--derved fron () (j). "C-ut-down" days and beddays refer to persons of any age. However, the ntervewer s not supposed to ask about loss of "tme" f the person s a chld under 6, and Cols ()and (j) could both be blank for ths reason. Col () represents days lost from school for persons 6-16; Col (j) s for days, lost from work for persons 17 and over. f ()s flled, (j) should be blank and vce versa. f t s known that a person 6-16 works n addton to gong to school, record only hs school-loss; and f a person 17+ goes to school n addton to workng, record only hs workloss. NOTE: Coders need not refer to the actual age of the person except n the followng stuatons: 1. f. ()and (j) both are blank, but there are known or "DK" days of "cut-down" n (g), check age; f under 6, transcrbe Col 34 as '%lder 6 yrs." f the person s over 6, enter tloo" n Cols 34, f ()and (j) both are flled, but could apply n one of them, check age; f the person s 6-16, transcrbe to Cols 34,35 only the entry n ();f 17+, transcrbe only the entry n (j). n rare cases when -all of the Cols (g) follows: - (j) are blank, proceed as ~ookat cols (f-1) and (f-2): f (f-1)s checked, transcrbe ttoo" n Cols 30, 31 and leave COlS blank. - f (f-2) s checked, transcrbe "DK" n Cols 30, 31, and "OO", ''00" n Cols 32, 33 and 34, 35. f blank n (f-1) and (f-2), transcrbe "00" n Cols 30, 31, and leave Cols blank. -! 0 f Cols (f-1) and (f-2) are DK, nspect cols (e) and (f): f Col (e) s checked, transcrbe "00" n Cols 30, 31, and leave Cols blank. f Col (f) s checked--(.e. there was cut'-down) transcrbe "DK" n Cols 30, 31, and "OO", "00" n Cols 32, 33, and 34, 35. f blank n (e) and (f), transcrbe "00" n Cols 30, 31, and leave Cols blank.

26 SECTON 11. OUTLNE OF STEPS N MEDCAL CODNG 15 ' C. Basc Steps--Con. Step 6--Con.. ' 1 :, ' 7 1. b! b. Condton Days n Past 2 Weeks table --Con. When these "days" n past 2 weeks'are n order, and any are applcable for Cols 30-35, they can be-01-14, but must never exceed 14; f 14+;transcrbe as 14. Wth the exceptons noted above, transcrbe "DK" as "DK", and "none" or blank as "00". c. 'ntervewer Error - for Col 36 of the Card: (for MCC only): ' f the ntervewer has omtted or handled mproperly any part of Cols (e)-(j) of the questonnare, transcrbe as "V". f the ntervewer faled to correct Cols (e - j) on the bass of an entry n table 11, transcrbe as error f "DK" or covered by footnote. f Col (h) s adjusted from Col (m). "V". Do not charge as Do not charge as error f 1 lne of condtons requres 2 or more dagnostc codes (and cards) ths error code, f applcable, must be entered on each card. d. Person-days of dsablty n past.2 weeks: -, "Person-days" n past 2 weeks refer to the sum total. of the days of dsablty n the past 2 weeks caused by all of one person's condtons, acute or chronc. f a person has only one condton, the M!Q makes no entry on the questonnare about days. But f a person has 2 or more codable condtons, acute or chronc, the MCQ wll compute the number of days, as shown below, and wll enter them n Col (d-4) of the last lne of multpe lnes for a person. The MCC records the number of person-days of dsablty n the past ' 2 weeks n Cols of the frst of one or more Condton Cards she flls for each person, but leaves Cols blank on the others of multples for ths person. Cols 23, 24 (the frst 2 dgts) are for person-days of ttcut-downtt, computed from Col (g); Cols 25, 26 (the next 2 dgts) are for person-days n bed, from Col (h); Cols 27, 28 (the last 2 dgts) are for person-days of the tme lost, computed from Col ()-OR (j). Person-days of dsablty n past 2 weeks cannot be assgned untl all separate codable condtons have been judged and edted wth respect to dsablty n the past 2 weeks - n accordance wth rules n Step 6,a and b. The followng procedures are based on the assumpton that the MCQ has noted these nstructons, and that the MCC has already flled out each Condton Card by the nstructons.n Step 6,a and b.