Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

10 July 2012

DEPARTMENT CIRCULAR
No. 2012- 0!281
TO ICD-10 COORDINATORS/TRAINORS, CHIEF OF
HOSPITALS, MUNICIPAL HEALTH OFFICERS,
MEDICAL RECORDS OFFICERS, STATISTICIANS,
HOSPITAL/CLINICAL CODERS, PHILHEALTH
EVALUATORS/STAFF, NSO STAFF AND ALL
CONCERNED

SUBJECT Cause of Death Flyer- Death Certificate in line with ICD-10

(A quick reference guide)

Mortality data provide a valuable measure for assessing nation's health status.
Certification of death is one of the first steps in getting mortality data. Proper completion of the
cause of death certificate is crucial to ensure accurate and reliable mortality data based on ICD-
10 coding. A properly completed cause-of-death certificate provides the description of the order,
type and association of events that have resulted in death.

In view thereof, attached is the Cause of Death flyer extracted from the 2010 WHO
Cause of Death flyer which provides a quick reference guide to physicians in completing the
cause of death certificate properly.

For information and guidance of all concerned.

By the authority of the Secretary of Health:

ENRIQUE A. G, MD, PHSAE, FPSMID, CESO III

Assistant Secretar
Head, Support to Service Delivery Technical Cluster II

2/F Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz,l003 Manila •
Trunk Line 651-7800 locallllllll07/l125/1132; Direct Line: 711-9502, 711-9503; 912-5244
Fax: 743-1829 • URL: http://www.doh.gov.ph; e-mail: osec@doh.gov.ph
 . ~

Frequently used ill-defined terms

Republic of the Philippines
Accident Specify circumstances DEPARTMENT OF HEALTH
Specify intent, as 'car accident', or 'assault';
Specify place of occurrence
Alcohol, drugs Specify use: long term or single, addiction
Complication of surgery Specify disease: disease that caused surgery
Cause of Death
Dementia Specify cause: Alzheimer', infarction, old age, on the
other
Hepatitis Specify course, etiology: acute or chronic, Death Certificate
alcoholic In line with ICD-10
If viral: specify Type (A,B,C ... )
Infarction Specify site: heart, brain., ...
-Quick reference guide-
Specify cause: arteriosclerotic, thrombotic,
embolic ...
Infection Specify: primary or secondary, causative
organism
Cause of death information serves
If primary: specify bacterial or viral - epidemiology and prevention
If secondary: specify primary infection - managing health care
Leukemia Specify: acute, subacute, chronic lymphatic, - comparing health in different populations
myeloid, monocytic
Pneumonia Specify: primary, aspiration, cause, causative Certification of death is one of the first steps in getting an overview
organism of the health and people.
If due to immobility: specify the cause of the
immobility
Pulmonary embolism Specify cause: cause of embolism The diseases or conditions recorded on a death certificate represent
If post surgical or immobility: specify the best medical opinion.
disease that caused surgery or immobility
Renal Failure Specify: acute, chronic or terminal, underlying A properly completed cause-of-death certificate represent the best
cause of insufficiency, like arteriosclerosis, or medical opinion.
infection
If due to immobility: specify the cause of the
immobility A properly completed cause-of-death certificate provides a
Thrombosis Specify: arterial or venous description of the order, type and association of events that have
Specify: the blood vessel resulted in the death.
If post-surgical or immobility: specify disease
that caused surgery or immobility
The diagnoses reported on the certificate are coded with the
Tumor Specify: behavior, location, metastases
Urinary tract infection Specify: site in the urinary tract, causative International Classification of Diseases, 10th edition. This coded data
organism, underlying cause of infection is analyzed and used both nationally and internationally no matter
If due to immobility: specify the cause of the what language was used to complete the certification.
immobility

Extracted from the 2010 WHO Cause of Death Flyer (The "Example" modified based on the
format of the Cause of Death Certification in the Philippines)
 # •

Part n·- is used· for ~onditicms which have no direct connection with the
events leading to death but whose presence contributed to death
Cause of Death on the certificate - step by step
Cause of Death on the certificate - how to fill in?
Start at line I (a) , with the immediate (direct) cause, then go back in time
Death certificates may look different in most countries.
But the section on the cause of death is identical world wide. That section has to preceding conditions until you get to the one that started the sequence
been designed by WHO, based on a century of experience. It has two parts, of events. You will get very close to the time the patient was healthy.
called Part I and Part II, and a section to record the time interval between the onset
of each condition and the date of death. Now, you should have reported the underlying or originating cause on
the lowest used line and a sequence of events leads from the underlying
Part I - is used for diseases or conditions that form part of the sequence of cause up to the immediate (direct) cause in the first line I (a).
events leading directly to death.
Finally, record the time interval between the onset of each condition
The immediate (direct) cause of death is entered on the first line, I (a). entered on the certificate and the date of death. Where the time or date of
There must always be an entry on line I (a). onset is not known you should record a best estimate. Enter the unit of
The entry on line l(a) may be the only condition reported in Part I time (minutes, hours, days, weeks, months, years).
of the certificate.
Example
Where there are two or more conditions that form part of the sequence Interval between
of events leading directly to death . Each event in the sequence should be onset and death
recorded on a separate line.
In any case you must record the disease, injury or external cause that Immediate cause: (a) Cerebral hemorrhage I 4 hours
resulted in the death. Do not record the mode of dying, such as cardiac (b) Metastasis of the brain I 4 months
Antecedent cause:
arrest, respiratory failure or heart failure.
"Unknown" cause of death should be recorded in cases where thorough Underlying cause: (c) Squamous cell carcinoma I 5 years
testing or autopsy examination cannot determine a cause of death. of the breast
"Unknown" is better than any speculation on the possible cause of death.
Always fully spell out all terms. Abbreviations can be interpreted in II Other significant conditions
different ways. Terms such as "suspected" or "possible" are ignored in contributing to the death, Arterial Hypertension I 3 years
evaluation of the entries . For example" suspected Diabetes" will be Diabetes mellitus 10 years
interpreted as "Diabetes". The four lines may not provide enough space for
the chain of events. Do not waste space with unnecessary words. • Write clearly and do not use abbreviations.
Some clinical terms are very vague. For example , "tumor" does not • Be sure the information is complete.
specify behavior (see also last page of this flyer). • Do not speculate on the cause of death; rather record "cause
unknown"
Duration - is the time interval between the onset of each condition that is • Do not fill in laboratory results or statements like "found by wife".
entered on the certificate (not the time of diagnosis of the condition), and (others may be separate fields on the form for this kind of information)
the date of death. The duration information is useful in coding certain • One condition per line should be sufficient
diseases and also provides a useful check on the reported sequence of
conditions.
Extracted from the 2010 WHO Cause of Death Flyer (The "Example" modified based on the
format of the Cause of Death Certification in the Philippines)