Coding causes of death to statistical categories
Inadequate number of coders, qualifications and training
Mortality coding is a highly specialised task that requires thorough understanding of the ICD-10 rules for determining the UCOD and for assigning codes. Many countries do not have sufficient numbers of specialist ICD coders, and working conditions are not attractive. Many low and middle-income countries have very few or no professional coders (nosologists). While statistical clerks and health information officers can be trained to become competent coders, some cases will be highly complex to code and all countries should aim to develop a cadre of highly experienced professional coders.
The level of knowledge and understanding of the coder is a key determinant of the accuracy of the resulting data. In many settings, however, coders receive only basic on-the-job training, which is insufficient for quickly and efficiently developing the coding skills required. Although on-the-job training is important, formal training courses based on standardised curricula are essential for ensuring the consistency of training and hence the consistency of coding.
In many countries where clinical coding is not a recognised profession, poor recognition of the skills required and lack of career-development paths have resulted in high levels of coder turnover, negatively impacting the quality of coding. The establishment of career paths, and the improved recognition and formal qualification of coders are important elements in maintaining coding standards.
In some countries, physicians who certify the COD also code the data. However, this is not a good use of their time and skills. More commonly, coding should be carried out by specially trained administrative clerks and statisticians. This approach is preferable as it leads to the development of a specialised group of coders with in-depth knowledge of ICD rules and procedures.
Walker S (2006). Capturing health information – a coding perspective. Bulletin of the World Health Organization.