Coding causes of death to statistical categories
Centralised mortality coding
In some countries, mortality coding is carried out centrally, often in the ministry of health or national statistics office. In other countries, statistical clerks apply codes in the hospital where the death occurred.
The centralised coding of COD facilitates the consistent application of common standards and procedures. It also makes it easier to conduct quality assessment and to maintain workforce training standards. In addition, few hospitals have enough deaths to justify a specialised mortality coder, and coding is usually undertaken by morbidity coders who are not necessarily familiar with all the special coding rules for mortality. Small countries tend to prefer centralised systems for these reasons.
However, larger countries with federal systems often prefer facility-based coding. Hospital coding makes it easier to access original patient medical records where there is any doubt about the certification. Within hospitals, coders may also have access to the certifier for further clarification, allowing for an informed opinion to be obtained from the certifier, rather than relying upon mortality coding rules, which are more arbitrary.
A general principle is that coding should take place at a level that has a sufficient number of deaths for the coders to be able to maintain their skills.