Coding causes of death to statistical categories
Poor certification practices
Coders are often wrongly blamed for the poor quality of some COD data. In fact, the problem is more often related to poor death certification rather than poor coding. The accuracy of coding is closely linked to the quality of certification. Mortality coding can also be complex and demands a certain amount of subjective judgement – for example, when there is no direct match between what is written on the death certificate and the ICD coding list. This results in coders having to use their own judgement about the code to use for a particular diagnosis. Slight differences in wording or in COD semantics may also lead to the assigning of incorrect codes, particularly if the coder is inexperienced and/or poorly trained.
The comprehensiveness of the entries of causes of death in the death certificate depends on the quality (completeness and accuracy) of medical information entered in the case notes of the deceased. The information includes age and sex of the deceased as well as symptom duration of the conditions, information on relevant clinical examinations during illness, and laboratory as well as imaging procedures performed during the illness. Examination of medical records shows that these details are often grossly underreported or misreported, which compromises the quality of determination of causes of death during certification.
To verify and select the correct UCOD, coders should have access to all the information on the original death certificate, and not simply be provided with the COD reported by the certifier.