Assigning appropriate primary cause of death and indication for medical procedures.

The most appropriate primary cause of death in a patient who had multiple medical conditions is that medical condition which initiated the chain of events that led to the other medical conditions that resulted in death. In clinical practice, there are deceased patients who had several medical conditions that could lead to death (primary causes of death) without biological plausibility that any of the medical conditions initiated the chain of events that resulted in the other medical conditions. To assign the single most appropriate primary cause of death to such a deceased patient is challenging. Under such circumstances, the International classification of diseases and related health problems, tenth revision (ICD-10) guidelines recommend that the medical practitioner certifying the death should decide on the primary cause to be assigned. The ICD-10 also acknowledges that the recommendation is arbitrary. Similar difficulty is also encountered when a single indication is being assigned to a patient for a medical procedure when there are multiple indications for such a procedure. The ICD-10 and its clinical modification (ICD-10-CM) which provides the guidelines for assigning indication for a medical procedure use criteria that are insufficient. In the present article, comprehensive, easy and objective clinicopathological criteria on how to assign the single most appropriate primary cause of death or indication for a medical procedure are recommended. The new criteria (referred to NJ model II) may be used to improve the ICD-10.