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Coding causes of death to statistical categories

Basic roadmap for improving mortality coding practices

1. Develop a national committee made up of mortality coding stakeholders such as ministry of health and other health institute officials, national statistics office staff, hospital managers and local WHO representatives.

2. Assess pre-service and in-service ICD-10 training in the country by reviewing COD certification training. Specifically

  • assess the requirement for training on certification of COD and ICD-10 coding for both preservice and in-service clinicians (including medical officers, medical recorders, assistant medical officers and clinical officers)
  • assess the scope and coverage of any existing COD certification and ICD-10 coding training for continuous education requirements for in-service clinicians
  • assess current COD and ICD-10 coding content in clinicians’ training curriculum and provide appropriate recommendations that will ensure clinicians have sufficient COD and ICD skills.

3. Assess ICD trainers, output of coders, and organisational set-up of the production of mortality statistics. Specifically, assess

  • who trains coders – ICD trainers should have extensive knowledge of medical certification, determination of UCOD by using the explicit ICD coding rules, and principles and application of multiple cause coding procedures. It is crucial that, in addition to these requirements, ICD trainers should possess adequate training skills as well as be able to simplify ICD rules, ICD terminologies and determination of UCOD
  • the number of trained coders, deployment in the country and retention – the assessment should examine whether the number of coders trained annually will meet the country’s target number of coders to be trained. It should also examine, the evenness of deployment and distribution of the coders in the country, and annual rate of retention of coders
  • organisations using or handling COD statistics – the assessment should focus on the organisations/institutions (ministry of health, statistics department, ministry of home affairs, and so on) that are responsible for coding. It should look at the organisational efficiency and effectiveness of ICD coding, the degree of centralisation/decentralisation of coding and the distribution, availability and skill levels of coders. This includes exploring the time taken from death to ICD coding, and the time take to produce mortality statistics and put them to use.

4. Based on analysis of issues identified in Steps 2 and 3, identify problems and set priorities. Prepare an action plan that sets out specific activities, responsibilities, resources and expected outcomes.

5. If training is identified as a problem area, conduct a training needs assessment for mortality coding. If necessary, increase training opportunities and standardise training curricula and education. Identify the components to be taught; use the core curriculum recommended by the WHO-FIC (Family of International Classifications) and International Federation of Health Information Management Associations (IFHIMA) joint collaboration as a guide.

6. If quality or a backlog of coding are identified as problem areas, investigate the feasibility of adopting automated coding or of introducing the manual use of the Mortality Medical Data System Automated Classification of Medical Entities (MMDS ACME) decision tables for identifying underlying causes of death. If mortality coding is decentralised to hospitals, investigate any potential efficiency gains in having it performed centrally.

7. Monitor progress by conducting regular coding-quality assessments.

Learn more

The Mortality Medical Data System (MMDS) decision tables were originally developed by the Centres for Disease Control and Prevention (CDC) in 1967 to automated the entry, classification, and retrieval of COD information reported on medical certificates of cause of death in the United States. They are used to help determine the correct UCOD and to assign valid COD codes. The decision tables are available to download for free from:

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