Interpreting and coding causal relationships for quality and safety using ICD-11

Table 1 List of terms implying a causal relationship from the ICD-11 Reference Guide

Terms implying a clear causal relationship	Terms where the causal relationship is unclear	Terms not implying causal relationship
as (a) complication of, complicated by, complicating, complication(s) of as a cause of, cause of, caused, caused by, causing as a result of, resulted in, resulting in, with resultant, with resulting because of due to from induced, induced by leading to, led to related to, precipitated by producing secondary to likely related to^a possibly secondary to, probably secondary to^a may be the reason for^a	associated with accompanied by incidental to	after also and during with arising in or during consistent with followed by, following incurred after/during/in/when occurred after/during/in/when/while postoperatively, postoperative, occurred post-op^b

^aCoding judgment call. However, the clinician is making a causal inference with this term
^bTerms like “postoperative,” “post-op,” “postprocedural,” etc. are a special situation because these have historically been considered and in some coding systems are considered to be indicative of a causal link. However, conditions such as urinary tract infection, pneumonia, and atrial fibrillation may temporally arise after surgery, without necessarily being caused by surgery. For this reason, in such cases it is necessary to look for more explicit causal connections in establishing inferences about causation using ICD-11

ISSN: 1472-6947