Tools Series Practical guides for health information systems professionals

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1 Practical guide Introducing the International Statistical Classification of Diseases in countries: Guidelines for implementing cause-of-death certification, morbidity and mortality coding Tools Series Practical guides for health information systems professionals Strengthening health systems in Asia and the Pacific through better evidence and practice For the PDF version of this publication and other related documents, visit

2 The University of Queensland 2013 ISBN Published by the Health Information Systems Knowledge Hub School of Population Health, The University of Queensland Public Health Building, Herston Rd Herston Qld 4006, Australia Please contact us for additional copies of this publication, or send us feedback: Tel: Fax: Edited by Econnect Communication. Designed by Biotext, Canberra, Australia

3 Introducing the International Statistical Classification of Diseases in countries: Guidelines for implementing cause-of-death certification, morbidity and mortality coding Health Information Systems Knowledge Hub

4 Acknowledgments The authors would like to thank the Health Information Systems Knowledge Hub team for their support in preparing this capacity building tool. Expert guidance was provided by Dr Nandalal Wijesekera, Dr Saman Gamage, Dr Rasika Rampatige, Dr Lene Mikkelsen and Sue Walker. ii

5 Contents Acronyms and abbreviations...3 Preface...4 What is the International Classification of Diseases, or ICD?...5 Certifying the cause of death...7 Who certifies the cause of death?...8 Notification, registration and certification of a death understanding the terms...8 What is the medical death certificate used for?...9 Morbidity coding...9 What is morbidity coding?...9 Who codes morbidity?...9 Mortality coding...10 What is mortality coding?...10 Who codes mortality?...10 Establishing ICD coding in countries or regions practical guidance...11 Coding audits and refresher training for coders...14 Appendix 1: Establishing a medical record department/office in a hospital...17 Appendix 2: Training doctors in medical record documentation, especially in writing final diagnoses...19 Appendix 3: Training doctors in cause-of-death certification...20 Appendix 4: Training clinical coders...22 Training in medical terminology...22 Guidelines for implementing certification and coding 1

6 Training in ICD-10 morbidity coding...24 Training in ICD-10 mortality coding...26 Appendix 5: Training materials for ICD-10 morbidity and mortality coding...30 References

7 Acronyms and abbreviations HIS HIS Hub ICD ICD-10 IT MMDS MRA MRO UQ WHO WHO-FIC health information system/s Health Information Systems Knowledge Hub International Classification of Diseases International Classification of Diseases, 10th revision information technology Medical Mortality Data System Medical Record Assistant Medical Record Officer University of Queensland World Health Organization WHO Family of International Classifications Guidelines for implementing certification and coding 3

8 Preface The International Classification of Diseases (ICD) was developed by the World Health Organization as the global standard for the correct certification by doctors of the underlying cause of death which is recorded on the International Form of Medical Certificate of Cause of Death. Once a death has been correctly certified by a doctor, the ICD specifies rules and procedures for coding the death according to a single underlying cause. The ICD also specifies rules and procedures for coding morbidity. Using the ICD rules and procedures ensures that data can be compared between hospitals, provinces, states and countries. Although the ICD is widely adopted, a number of countries are yet to introduce it, use the International Form of Medical Certificate of Cause of Death, and begin coding their morbidity and mortality data according to the ICD s guidelines and recommendations. These basic guidelines are a tool for countries and regions that have not yet introduced correct cause-of-death certification according to the ICD, or established ICD morbidity and mortality coding practices for their data, and therefore cannot compare the health situation of their population to that of other countries. The tool is organised for easy reference and explains in a stepwise way how to go about establishing ICD certification and coding practices in a country or region. 4

9 What is the International Classification of Diseases, or ICD? The International Classification of Diseases (ICD) was developed by the World Health Organization (WHO) as the global standard for the correct certification by doctors of the underlying cause of death. It has been used to describe diagnoses and procedures for many years and WHO has been publishing revisions and updates to the ICD since The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (referred to as ICD-10 ) is the latest revision of the standard. It classifies thousands of diseases and groups similar diseases together in a meaningful way. It is published by the WHO and maintained by the Education and Implementation Committee of the WHO Family of International Classifications (WHO-FIC) Network a number of collaborating centres designated by WHO. The process of translating diseases, health-related problems and procedural concepts from text to alphabetic/numeric codes for storage, retrieval and analysis is known as clinical coding (WHO 2004). Using ICD- 10 for coding hospital discharge (morbidity) data and death certificate (mortality) data ensures data can be compared between hospitals, provinces, states and countries, and at different points in time (National Centre for Classification in Health 1997). Coded data are used for public health planning, research, and epidemiological studies at the population level, and for hospital management and funding purposes. The data can be used to: understand the case-mix of hospitals allocate resources to health areas of greatest need assess the efficacy of public health interventions pinpoint and access specific information inform clinical practice support clinical and managerial decision-making. Guidelines for implementing certification and coding 5

10 6 Health data that are coded to the ICD-10 standard are the basic building blocks used for assessing health system performance, analysing the burden of disease, and producing summary measures of population health. WHO and its regional offices, through the Classifications, Terminologies and Standards program, encourage use of the ICD for both morbidity and mortality coding (WHO 1993).

11 Certifying the cause of death The quality of morbidity and mortality statistics depends on how well doctors diagnose the diseases and conditions which patients were treated for and which sometimes led to a person s death. Quality is also influenced by how well the treatment given is documented in medical records and whether the discharge records and death declaration forms are correctly filled in and coded. As part of introducing ICD, it is also important to introduce the WHO International Form of Medical Certificate of Cause of Death (Figure 1) which is designed to help doctors correctly report the causes and conditions that led to a person s death. INTERNATIONAL FORM OF MEDICAL CERTIFICATE OF CAUSE OF DEATH I Disease or condition directly leading to death* Cause of death (a) due to (or as a consequence of) Approximate interval between onset and death Antecedent causes Morbid conditions, if any, giving rise to the above cause, stating the underlying condition last (b) due to (or as a consequence of) (c) due to (or as a consequence of) II Other significant conditions contributing to the death, but not related to the disease or condition causing it * This does not mean the mode of dying, e.g. heart failure, respiratory failure. It means the disease, injury or complication that caused death. (d) Figure 1 The International Form of Medical Certificate of Cause of Death Guidelines for implementing certification and coding 7

12 Who certifies the cause of death? For a death to be considered medically certified, a physician must complete the death certificate and judge what causes led to death. This can only be done by a medically trained person who fully understands the clinical sequence of conditions and, therefore, can determine the single underlying cause of death which initiated the fatal sequence. If a person dies in a hospital or medical facility, the attending doctor should complete the certificate. If a person dies at home, the best option is for the family doctor, or the doctor who last attended to the person, to complete the certificate. Notification, registration and certification of a death understanding the terms When a person dies, the meaning of the different steps that need to be followed and documents that need to be issued can cause confusion. When introducing ICD in a country, it is important to distinguish between death notification, death registration, death certification and medical certification, and make sure that the appropriate forms are available for each process. Notification occurs when an appropriate authority (such as the village chief, the police or a health worker) issues a form confirming that a death has taken place. This form is often needed for the burial to take place or for formally registering the death. Registration occurs when someone formally registers the death at the civil registration office. If the death has not been registered, a legally valid death certificate cannot be issued. Certification occurs when the civil registrar issues the legal death certificate, which is needed for inheritance and insurance purposes. Medical certification occurs when a doctor completes the death certificate/declaration which states the cause of death. In countries where cause of death is collected by the registration office and has to be stated on the official death certificate, this certificate is used for the formal registration. 8

13 What is the medical death certificate used for? The medical death certificate/declaration written by the hospital or the family doctor must state the causes that led to death and must be written in a way that a coder can read the writing and select the underlying cause. Mortality statistics are based on the underlying cause of death, not the last or immediate cause of death. As such, the underlying cause is what drives preventive public health interventions. Therefore, it is extremely important that doctors are trained in accurately determining the underlying cause and filling in the death certificate correctly (see Appendix 3 for information about training on cause-of-death certification). In countries that are introducing ICD, doctors will need training in these tasks. The training should also be included in the country s medical curriculum so that all future doctors will be trained. Morbidity coding What is morbidity coding? Morbidity coding is the coding of diagnoses written in a medical record or other source document at the end of an episode of care, to the ICD-10 standard. It is mostly done using commercial software which assigns the ICD codes for the diseases and procedures documented in the medical records. Much more information than the final diagnosis is usually coded, and many different types of reports are automatically produced by the system for management and for statistical purposes. Who codes morbidity? In general, the person who does morbidity coding is a designated clinical coder. However, the designation of the clinical coder can vary from country to country. Examples of possible designations are Medical Record Officer (MRO), Medical Record Assistant (MRA), Medical Record Attendant, Statistical Clerk and Coding Clerk. Clinical coders are trained to translate clinical documentation into codes. They may code the final diagnoses written by a physician in a medical Guidelines for implementing certification and coding 9

14 record or a discharge record, or from other source documentation. There are a number of other sources of clinical information that can be coded using the ICD. For information about training for clinical coders, see Appendix 4. It is important to note that while it is the doctor who documents the diagnoses, it is the coder who translates the clinical documentation into code(s). The responsibility for accurate documentation rests with the treating clinician and the responsibility for accurate codes rest with the coder. Mortality coding What is mortality coding? From the medical death certificate, the mortality coder extracts the underlying cause of death and assigns it an ICD code. If the information on the death certificate is incorrect or not legible, the coder cannot code the cause of death and is likely to assign one of the ill-defined codes. In most countries, mortality is still coded manually, sometimes with the aid of a tool to help the coder select the correct underlying cause of death. Who codes mortality? In general, the person who does mortality coding is a designated clinical coder. However, the designation of the clinical coder can vary from country to country. Examples of possible designations are Medical Record Officer (MRO), Medical Record Assistant (MRA), Medical Record Attendant, Statistical Clerk and Coding Clerk. The responsibility for documenting the cause(s) of death rests with the treating clinician, a medical examiner, coroner or other designated official. It is up to the coder to interpret this information and select the correct code for the underlying cause only. For information about training for clinical coders, see Appendix 4. 10

15 Establishing ICD coding in countries or regions practical guidance Introducing ICD to a health system requires careful planning. A strategic plan for progressively implementing ICD across the whole country should be prepared. While plans will vary by country according to the availability of financial and human resources, a number of basic steps are likely to be the same everywhere. These are outlined in Figure 3 and further details can be found in the five appendixes. The first step in the process is to identify an office responsible for developing the strategic plan; this is often the Directorate of Health Information Systems (HIS) or similar in the ministry or department of health. To develop the strategic plan, the office will need the support of health administrators, experts in ICD morbidity and mortality coding, health information specialists, IT specialists, medical record managers, finance managers and doctors. It is also highly recommended that key personnel, or a small group of responsible and involved officers, be sent on a study tour to a country which has a functional system of ICD coding. Such observational experience would help them to understand how the parts of the system function and interact. ICD is usually first introduced in a major hospital and the experience learned from a pilot phase would provide valuable lessons for the progressive introduction to the entire health system. In countries where medical record departments already function in hospitals, the planning process should include an assessment of how well they are functioning and of the quality of their documentation. If either of these is not satisfactory, improvement measures must be included as a step in the implementation plan. In countries where medical record departments are not common, they need to be established using best practice guidelines (see Appendix 1 for information about establishing medical record departments /offices in hospitals). During the planning process, it is also necessary to identify the relevant training needs of the doctors working in the hospital(s) and plan to meet these needs. Guidance on training for medical record documentation and death certification is given in appendixes 2 and 3 respectively. Guidelines for implementing certification and coding 11

16 Once the strategic planning and pilot phase is completed, suitable candidates need to be recruited for training as clinical coders and mortality coders. Candidates with a sound knowledge of medical terminology are preferred but may not be available. The training of the newly recruited clinical coders / medical record officers should consist of three distinct parts: 1. Medical terminology 2. ICD -10 morbidity coding 3. ICD -10 mortality coding Until a core cadre of national trainers can be built, the new coders should either be sent to an established and recognised ICD training centre where coder training courses are conducted, or trained in country by bringing in a couple of experts. There are several training centres around the world, which have been recognised as World Health Organization collaborating centres. The list of collaborating centres can be found at: who.int/classifications/network/collaborating/en/. The National Institute of Health Sciences in Kalutara, Sri Lanka, is one such institution. It has been conducting ICD coder training since Experienced trainers for in-country training can be requested from the WHO collaborating centres. Box 1 lists the kind of training materials required for basic coder training. 12

17 Box 1 Training materials needed for training coders 1. ICD-10 volumes 1, 2 and 3 (see Figure 2) are available for download from WHO at: Volume 1 Tabular list Volume 2 Instruction manual Volume 3 Alphabetical index 2. Medical Mortality Data System (MMDS) decision tables (National Centre for Health Statistics 2013), are available for download at: 3. ICD-10 workbooks and answer books are available on request from Sue Walker, Director of the National Centre for Health Information Research and Training, Queensland University of Technology: s.walker@qut.edu.au 4. Medical terminology books Once the first batch of trainers has been trained, they can work as coders in the pilot project hospital where ICD morbidity and mortality coding is first being introduced. An external expert can be engaged for periodic supervision in the beginning. Guidelines for implementing certification and coding 13

18 Figure 2 ICD-10 is published in three volumes entitled: International statistical classification of diseases and related health problems: Tenth revision. Coding audits and refresher training for coders When the coding quality of the pilot hospital is satisfactory and the system is running at the expected level, ICD coding is ready to be introduced to the other hospitals in a systematic manner. Depending on their skills and ICD knowledge, some of the coders in the core group could become local trainers for the introduction of ICD in other hospitals and regions. Good quality coding is important. Following the successful establishment of ICD coding in a country, the quality of ICD-10 coding should be periodically monitored and evaluated. This is achieved by conducting regular coding audits by both internal and external experts in the field of ICD. Periodic refresher training should be offered to the coders, as needed, so that they may update their knowledge. Coders should also be given in-service refresher training at least every two years to keep their knowledge on new developments up to date. To maintain good coding staff and avoid constantly having to train new coders, it is advisable to give coders professional recognition and career paths. Coding is a challenging task and doing it well requires significant investment in education and training. Coders should be recognised for 14

19 the skills that they have acquired and the importance of their role in producing high quality data and health statistics that can be reliably used for management and resource planning. Guidelines for implementing certification and coding 15

20 Decide to introduce ICD Recruit officers as clinical coders / medical record officers Identify key persons to develop a strategic plan Acquire training materials Identify actions to be included in the plan Train newly recruited clinical coders / medical record officers in medical terminology; ICD-10 morbidity coding; ICD-10 mortality coding Establish a medical record department / review existing facilities and practice Introduce ICD-compliant patient charts and morbidity diagnosis Introduce ICDcompliant death certificates and processes Assess training needs of doctors in documenting medical records and certifying death Conduct regular coding audits of morbidity and mortality coding in hospitals Train doctors accordingly Conduct periodic refresher training for coders Figure 3 The basic steps to establish ICD coding in a country

21 Appendix 1: Establishing a medical record department/office in a hospital The medical record department/office is the area designated to the officers who are working with medical records. The medical records are securely stored in this area. There are many methods of storing medical records in a medical record department. Which method to choose depends on local circumstances, including availability of resources. It is best to locate the clinical coders in the same department/office, although in some countries morbidity coding is done on the wards, in the finance office, at the ministry of health and elsewhere. Figure 4 Examples of medical record departments In a hospital, the medical record department/office should be located centrally in the patient admission area an appropriate and secure location which also allows medical records to be rapidly retrieved when a patient arrives at the hospital. Medical records are legal documents and, therefore, need to be stored securely to prevent unauthorised access. Only the healthcare professionals who are directly involved in care of the patient should have access to medical records. Ideally, the medical record department should have enough space for staff to do their work and for medical records (both active and inactive) to be stored. It should also have enough resources to be able to deliver its services. Guidelines for implementing certification and coding 17

22 18 Further guidance on planning a medical record department can be found in Education Module 8 - Planning a Health Record Department, published by the International Federation of Health Information Management Associations and available for download at:

23 Appendix 2: Training doctors in medical record documentation, especially in writing final diagnoses The responsibility for entering the final diagnosis in the designated place of the medical record, at the end of an episode of care, lies with the hospital doctors/clinicians. They should be trained to correctly and accurately document the final diagnosis / main condition. This training should cover the WHO definition of final diagnosis / main condition and the guidelines for documenting diagnosis, and should emphasise, for example, that the use of abbreviations is not permitted. Proper clinical documentation forms the basis of both an accurate discharge diagnosis and the cause-of-death diagnosis. When making the diagnosis, all the information available in the clinical record should be taken into account. If clinical records are not properly maintained, they form a poor basis on which to make a reliable diagnosis. Resources exist to support the education of doctors and other clinical staff about clinical documentation. One example is the handbook developed by the Health Information Systems Knowledge Hub (HIS Hub), Documenting medical records: A handbook for doctors, (HIS Hub 2013). The handbook is part of a face-to-face training package that includes the training curriculum and presentation slides, and is available free of charge. Guidelines for implementing certification and coding 19

24 Appendix 3: Training doctors in cause-ofdeath certification Medical doctors are responsible for certifying the cause of death and reporting it on the death declaration form. They should be trained to correctly and accurately document/certify the cause(s) of death in a death certificate, with a special emphasis on reporting the underlying cause of death, which is crucial for public health policy. The training should make sure that doctors fully understand the WHO definition of underlying cause of death and the guidelines for correctly certifying death, and should emphasise that documenting the mode of dying such as respiratory failure, cardio-respiratory failure, septicaemia and sepsis without indicating its cause, is not meaningful and is discouraged. Training resources The Handbook for doctors on cause-of-death certification (HIS Hub 2012) is part of a face-to-face training package that includes the training curriculum. The Education and Implementation Committee of the WHO Family of International Classifications Network recommends a core curriculum for training certifiers, which is available for download from their website: WHO ICD online self-training tool WHO has developed an interactive self-training tool to improve people s ICD coding and their understanding and use of ICD-10. It offers specific paths for different users, including a fast track for managers and an in-depth training path for coders. The tool also has a module on causeof-death certification to promote and support the use of approved deathcertification practices by doctors. 20

25 The tool can be found at: icd10training/ A useful two-page quick-reference guide on cause-of-death certification is also part of the self-training tool, and can be found at: who.int/classifications/apps/icd/icd10training/icd-10%20death%20 Certificate/html/ICD-10_Resources/causeofdeathflyer.pdf Please note that the first page of the quick-reference guide is deliberately shown upside down so that the document prints correctly. Guidelines for implementing certification and coding 21

26 Appendix 4: Training clinical coders Training in medical terminology Most trainee coders are unlikely to have previous knowledge of medical science or medical terminology, so they should first be trained in medical terminology. They need sound knowledge of medical terms if they are to understand the language used in ICD, much of which is very formal and not often used by doctors in recording clinical notes. The coder needs to be able to interpret the documentation and locate the appropriate ICD codes to use. Without this background knowledge, they will find it hard to understand the diagnoses and causes of death which they need to code. The following self-paced textbooks on medical terminology are recommended: Mastering medical terminology and the companion Mastering medical terminology workbook By Sue Walker, BAppSc (MRA), GradDip (Public Health), MHlthSc; Maryann Wood, BBus (Health Admin), MHlthSc; and Jenny Nicol, BBus (Health Admin), MPH More information and order details: Book: jsp?isbn= Workbook: Medical terminology: The language of health care By Marjorie Canfield Willis, CMA-AC The language of medicine By Davi-Ellen Chabner, BA, MAT More information and order details: 22

27 Coders should also be provided with reference books, including a comprehensive medical or nursing dictionary, an anatomy textbook and/or posters/diagrams of human anatomy. Two weeks is the recommended time duration needed for medical terminology training, though it could be longer if more in-depth training is warranted. The training should include the following modules: 1. Building a medical vocabulary 2. Basic term components 3. Basic prefixes, suffixes and combining forms 4. Using basic prefixes, suffixes and combining forms to build medical terms 5. Common rules for properly forming, pronouncing and spelling medical terms 6. Terminology used in individual body systems 7. Integumentary system 8. Musculoskeletal system 9. Cardiovascular system 10. Blood lymphatic and immune system 11. Respiratory system 12. Nervous system 13. Endocrine system 14. Gastrointestinal system 15. Urinary system 16. Male reproductive system 17. Female reproductive system 18. The senses 19. Pregnancy, childbirth and the neonate Guidelines for implementing certification and coding 23

28 Training in ICD-10 morbidity coding Following the medical terminology training, the trainee clinical coders should be given thorough training in ICD-10 morbidity coding. The recommended time duration for this training is two weeks. The officers who are trained only in morbidity coding are usually stationed in hospitals and will be responsible for coding of diagnoses written by the clinicians in medical records. Objectives The main objective is to provide standardised and professional training to all coders and thereby make available high quality, timely and reliable data to decision-makers, healthcare planners and the other users of hospital information. The training should also: teach and improve the skills of medical record personnel in morbidity coding provide reliable information for the hospital management system allow routine surveillance of diseases by improving quality of morbidity statistics. Outcomes At the end of the training, participants should be able to: understand and use basic ICD-10 coding conventions interpret and apply WHO rules for morbidity coding accurately assign codes for principal (main) and other diagnoses appreciate the concept of multiple coding for morbidity data collections appreciate inputs to quality coding and apply strategies for improving coded data. 24

29 Methodology The standard international curricula for morbidity coding education developed by the Education and Implementation Committee of the WHO- FIC network should be used. The ICD-10 morbidity coding skills training course is offered as a 10-day intensive block. Face-to-face instructions are given in a classroom situation which provides optimal learning conditions. Training materials used include both electronic (e.g. internet, multimedia projectors, laptop computers) and paper-based resources, and participants should receive paper workbooks and answer books on ICD-10. The program s teaching mix is diverse and stimulating and includes: lectures / lecture discussions practical exercises an end-of-course assessment to evaluate participants progress (recommended). At the end of the training, it is recommended that the participants sit a standard coding examination. Participants who pass the examination should be awarded a certificate of successful completion in ICD-10 morbidity coding. Guidelines for implementing certification and coding 25

30 Model course outline The course is presented in six sections: 1. Course orientation and course outline 2. ICD-10 introduction; why code?; coded data uses; ICD-10 structure and conventions 3. Using ICD-10 volume 2, WHO morbidity coding rules, WHO short tabulation lists 4. How to code with ICD-10, chapter by chapter (lectures, training software and work books, group exercises) 5. Student presentations about morbidity coding in participants hospitals; coding issues and problems open forum; future coding activity plans 6. Data extraction exercises using medical records. The 26 modules are listed on the WHO-FIC website ( classifications/apps/icd/icd10training/) which also describes the structure and principles of ICD and the contents of the three volumes. The modules essentially cover each of the 20 chapters of the ICD and conclude with an explanation of how ICD is updated. Training in ICD-10 mortality coding The officers recruited to work as mortality coders should be formally trained in mortality coding and not be expected to learn on the job. The recommended minimum duration for mortality training is one week. Before the training, the officers should have completed the training on medical terminology and ICD morbidity coding, as described above, as these are prerequisites for understanding the concepts of mortality coding. Unlike morbidity coders, mortality coders are usually stationed in a central location in the country or region. Often the mortality coding unit is located in the national statistical office, the central civil registration office or the ministry of health. The mortality coders will be responsible 26

31 for coding the information written in all death certificates received from hospitals, general practitioners and coroners in the country. Objectives The main objective of the training is to enable coders to correctly identify and code the underlying cause of death according to ICD-10 rules and guidelines, and thereby make available high quality, timely and reliable data to decision-makers, healthcare planners and the other users of mortality and cause-of-death information. The training should also: improve the skills of coding personnel in mortality coding understand the application of mortality coding rules and rules of reselection of the underlying cause of death using MMDS decision tables produce reliable statistics on causes of death which can accurately help describe the mortality pattern and health status of the population. Outcomes At the conclusion of this program, course participants should be able to: understand the concept of underlying cause of death interpret and apply WHO rules for mortality coding accurately select the underlying cause of death appreciate the concept of multiple causes of death coding for mortality data collections appreciate inputs to quality coding and apply strategies for improving coded data Methodology The standard international curricula for mortality coding education, developed by the Education and Implementation Committee of the WHO- FIC Network should be used. The ICD-10 mortality coding skills training course is offered as a five-day intensive block. Face-to-face instructions are conducted in a classroom situation which provides optimal learning Guidelines for implementing certification and coding 27

32 conditions. Training materials usually include electronic (e.g. internet, multimedia projectors, laptop computers) and paper-based resources such as workbooks and answer books on ICD-10. Countries that do not have resources such as electronic media should use alternative teaching methods such as overhead projectors with transparency papers, and whiteboards and pens. The program s teaching mix is planned to be diverse and stimulating and includes: lectures / lecture discussions practical exercises an end-of-course assessment to evaluate participants progress (recommended). At the end of the training, it is recommended that the participants sit a standard coding examination. Participants who pass the examination should be awarded a certificate of successful completion in ICD-10 mortality coding. Model course outline The course is presented in six sections: 1. Course orientation and course outline 2. Using ICD-10 volume 2; WHO mortality coding rules 3. Using MMDS decision tables 4. Selecting the underlying cause of death, chapter by chapter (lectures, training software and work books, group exercises) 5. Student presentations about mortality coding in participants country or regions; coding issues and problems open forum; future coding activity plans 6. Data extraction exercises using death certificates. 28

33 The23 modules are listed on the website of the International Federation of Health Information Management Associations ( org/learning.aspx) which includes an overview of mortality coding, an explanation of the concept of the underlying cause of death, and how to use the MMDS decision tables to arrive at the correct cause. The other modules describe each of the 20 chapters of the ICD. Guidelines for implementing certification and coding 29

34 Appendix 5: Training materials for ICD-10 morbidity and mortality coding Trainee coders will need the following training materials: 1. ICD-10 volumes 1, 2 and 3, available for download from WHO at: Volume 1 Tabular list Volume 2 Instruction manual Volume 3 Alphabetical index 2. Medical Mortality Data System (MMDS) decision tables (National Centre for Health Statistics 2013), available for download at: 3. ICD-10 workbooks and answer books, available on request from Sue Walker, Director of the National Centre for Health Information Research and Training, Queensland University of Technology: s.walker@qut.edu.au 4. Medical terminology books 30

35 References Chabner, D 2013, The language of medicine, 10th edn, Elsevier, St. Louis, Missouri. HIS Hub 2012, Handbook for doctors on cause-of-death certification, Health Information Systems Knowledge Hub, School of Population Health, The University of Queensland, Herston, Brisbane, available at: uq.edu.au/hishub/docs/handbook/hishub-handbook-for-doctors.pdf, accessed 8 August , Documenting medical records: A handbook for doctors, Health Information Systems Knowledge Hub, School of Population Health, The University of Queensland, Herston, Brisbane, available at: uq.edu.au/hishub/docs/handbook/mr%20handbook_17april.pdf, accessed 8 August International Federation of Health Information Management Associations 2012, Education module 8: Planning a health record department, IFHIMA, available at: accessed 8 August 2013 National Centre for Health Statistics 2013, Medical mortality data system (MMDS) decision tables, Available at: instruction_manuals.htm, accessed 10 May National Centre for Classification in Health 1997, ICD-10 Student work book: An interactive training course for ICD-10, National Centre for Classification in Health (Brisbane), School of Public Health, Queensland University of Technology, Kelvin Grove, Brisbane, Australia. Walker, S 2012, Mastering medical terminology, Elsevier, Sydney, Australia Willis, MC 2005, Medical terminology: The language of health care, Lippincott Williams & Wilkins, Philadelphia PA. World Health Organization 2004, International statistical classification of diseases and related health problems, 10th revision, vol. 2, 2nd edn, WHO, Geneva, available at: Guidelines for implementing certification and coding 31

36 2010, Cause of death on the death certificate in line with ICD-10: Quick reference guide, available at: apps/icd/icd10training/icd-10%20death%20certificate/html/icd-10_ Resources/causeofdeathflyer.pdf, viewed 8 August , Core curriculum for training certifiers [online], WHO-FIC Network, Education and Implementation Committee, WHO, Geneva, available at: htm, accessed 16 June n.d., ICD-10 Interactive Self-learning tool, WHO, Geneva, available at: accessed 8 August

37 Guidelines for implementing certification and coding 33

38 A strategic partnerships initiative funded by the Australian Agency for International Development HUMAN RESOURCES FOR HEALTH KNOWLEDGE HUB The Nossal Institute for Global Health