Understanding Cause of Death Certification and Coding Workshop

Introduction to cause of death data - Certification, coding and data quality Data analysis and Report writing workshop for Civil Registration and Vital Statistics data

Overview of session 1. What is CoD certification and coding 2. Coding Resources 3. Underlying cause of death (UCoD) 4. ICD coding practices to find the UCoD 5. CoD Data Quality Review

1. Introduction to CoD certification and coding what is it? For each individual death in our data set.... ...it is the process of finding and allocating a specific code for each condition on an individual death certificate.... ...and applying rules to these codes to find the Underlying Cause of Death for each person... ...it enables all deaths to be standardised to the same output (the code), and then these can be used in tabulations and other indicators (and policy)

2. Coding Resources Three main resources are required The medical certificate cause of death The ICD classification Decision tables (or Iris auto-coding software) Let s look at each individually...

2. Coding Resources - Medical Certificate of Cause of Death

2. Coding Resources - Medical Certificate of Cause of Death Acute Renal Failure 12 days Diabetic Nephropathy 1 yr Diabetes (type 2) 5 yrs Femoral neck fracture, femoral fracture repair, Post operative haematoma

2. Coding Resources - ICD 10 - International Classification of Disease Standard diagnostic tool for classifying types of morbidity and mortality The resource we use to find a specific codes to each condition on the death certificate E.g. instead of heart attack we have I219 for diabetes we have E149 Over 10,000 codes Provides rules and principles for selecting codes (e.g., UCoD)

2. Coding Resources - Decision Tables https://www.cdc.gov/nchs/data/dvs/2c2009.pdf

3. Underlying Cause of Death (UCoD) The WHO defines the UCOD as the disease or injury which initiated the train of morbid events leading directly to death... External causes head injury vs car accident Is based on the concept of where in the causal sequence you would intervene to prevent that happening to someone else The UCoD is used to tabulate our CoD statistics There are rules for coders around how to select the underlying cause of death

4. ICD 10 Coding Rules used to find the UCoD Information here comes from ICD 10, Volume 2, Instruction Manual, and is available online for free... http://apps.who.int/classifications/icd10/browse/Content/statichtml/ICD10Volume2_ en_2016.pdf

4. ICD 10 Coding Rules used to find the UCoD Basic concept 1: Finding the causal sequence & avoiding end stage conditions The term sequence refers to a chain or series of medical events in which each step is a complication of, or is caused by, the previous step To find the UCoD, the coder is looking for a plausible sequence starting on the top line and working backwards to the last condition mentioned in part 1 of the death certificate At the same time, we want to avoid selecting an end-stage condition when we have other conditions on the certificate which lead to that end stage condition...

Finding the causal sequence & avoiding end stage conditions eg 2 Renal Failure (N19) 12 days Ischemic Heart Disease (I259) 5 yrs

4. ICD 10 Coding Rules used to find the UCoD Basic concept 2: Dealing with more than one sequence Basic concept 3: Addressing obvious cause Basic concept 4: Ill-defined conditions and conditions unlikely to cause death

1d. Data quality review CoD data - Ill-defined codes Ill-defined codes are important to pay closer attention to as they can influence our overall output... How prevalent are ill-defined codes as the UCoD in your data set? Is it possible to go back to the source data and confirm that no better cause of death is available? Page 213, ICD-10 Volume 2 Instruction Manual available online

Ill-defined conditions and conditions unlikely to cause death eg 1 Old age (R54) Ischemic Heart Disease (I259)

4. ICD 10 Coding Rules - External Causes When reporting external causes of death the certifier must also describe the circumstances of the incident or accident that led to death. Coding is based on HOW the injury / event occurred as this is what you need to know for prevention ie fractured skull DUE TO Motor vehicle accident Intent is critical from a coding perspective

5. Data quality review CoD data Before we tabulate data, we want to ensure the quality is as good as it can be... We ve used the ICD to code deaths, but the accuracy and quality of causes of death data can be affected by issues relating to: 1. Certification issues 2. Demographic inconsistencies 3. Coding errors (esp. Ill-defined codes) We need to run this 3 point-filter over our data to check its accuracy Let s look at each one in turn...

5. Data quality review - CoD - certification issues Events and issues which influence the certifier which can impact coding Info quality and availability Training and knowledge Attitudes towards certification Ease of diagnosis of certain diseases Diseases associated with stigma These can t necessarily be fixed by the coder but need to be considered, and if possible, understood and discussed in reports...

5. Data quality review CoD data - demographic inconsistencies Need to do data quality checks at the individual record level. Consider Sex issues, such as: - Males who died giving birth - Females who died of prostate cancer - Males who died of cervical or breast cancer Age issues, such as: - Adults dying from congenital causes - Children dying from type 2 diabetes - Children or young adults dying from dementia - Inconsistent records may need to be changed based on other information found on the certificate or record...

5. Data quality review - CoD data - coding issues Remember our coding rules and basic concepts? We need to make sure that these have been followed... Causal sequence & end stage condition? Check. First mentioned sequence? Check. Obvious cause? Check. Ill-defined code and those unlikely to cause death not UCoD if other things on cert? Decision tables used to aid coding (if possible)? Check

5. Data quality review - Final checklist for CoD records Remember - we want to check our cause of death data at the individual record level... Have we considered possible certification issues for the record? Is there a valid ICD 10 code recorded for each condition? Is there a valid UCoD assigned to each record? Have we checked for demographic inconsistencies? A final sense check does the record look and feel accurate given our current level of knowledge and experience? Others??? May depend upon your country s situation...