Overview of Mortality Coding and its usage in MEDICAL CERTIFICATION OF CAUSE OF DEATH BY SHIV KUMAR

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Overview of Mortality Coding and its usage
inMEDICAL CERTIFICATION OF CAUSE OF DEATH
BYSHIV KUMARDRG(MCCD) OFFICE OF THE RGI
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Background

• 1961 Conference on Improvement of Vital
  Statistics endorsed the gradual introduction of
  scheme on Medical Certification of Cause of Death
  only in limited areas with support by legal
  sanction (as subsequently provided in the
  Registration of Birth and Death Act of 1969).

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Introduction of MCCD

• MEDICAL CERTIFICATION OF CAUSE OF DEATH (MCCD)
  under Civil Registration System was initiated by
  the office of the RGI during the Third Five Year
  Plan. It was operational in many states in the
  beginning of 70s.
• It provides data on deaths by age and sex in
  respect of 18 major groups, 66 categories and 197
  sub-categories of causes (includes few single
  causes) as per National list based on ICD-9 till
  1998.
• National list based on ICD-10 is comprised of 20
  Major Groups, 69 categories and 194
  sub-categories of causes is prepared by ORGI and
  been adopted since 1999.

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Legal Provisions

• Medical Certification of Cause of Death under
  Civil Registration System has got statutory
  backing under sections 10(2) and 10(3) of the
  Registration of Births Deaths Act, 1969.
• The Act also incorporates a clause about the
  confidentiality of the information on cause of
  death, forbidding to disclose this in any extract
  provided from the registration records.
• Under Section 23(3) of the RBD Act, any Medical
  Practitioner who neglects or refuses to issue a
  certificate under section 10(3) and any person
  who neglects or refuses to deliver such
  certificate shall be punishable with fine, which
  may extend to fifty rupees.

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Cause of death

• A cause of death is disease, abnormality, injury
  or poisoning that contributed directly or
  indirectly to death.
• Underlying cause of death
• The disease or injury which initiated the train
  of events leading directly to death
• or
• The circumstances of the accident or violence
  which produced the fatal injury.

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Form of medical certificate

• Sixth Decennial International Conference held in
  April 1948 at Paris endorsed the
• Selection of Underlying cause of death as main
  cause of death for tabulation of mortality data
  and
• Tabulation list of mortality morbidity
• The standard format of the certificate is
  incorporated in the rules made by the State
  Government.
• The format of the certificate proper (medical
  part) conforms to the standard prescribed by
  (WHO)

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International Format
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Revised Form of Medical Certificate in the
revamped system of civil registration w.e.f
1.1.2000

• Form 4 for hospital deaths
• 1. Name of the Hospital
• 2. Name of the deceased
• 3. Sex( Male/Female)
• 4. Age at death
• 5. Cause of Death
• 1(a) Immediate cause of death
• 1(b) Antecedent cause of death
• 1(c) Underlying cause of death
• 6. Internal between onset and deaths
• 7. Manner of death
• (1. Natural, 2. Accident 3. Suicide,
• 4. Homicide, 5. Pending investigation)
• 8. How did the injury occur?
• 9. Whether death related to pregnancy?

• Form 4A for Non-hospital deaths
• 1. Name of the deceased
• 2. Sex( Male/Female)
• 3. Age at death
• 4. Cause of Death
• 1(a) Immediate cause of death
• 1(b) Antecedent cause of death
• 1(c) Underlying cause of death
• 5. Internal between onset and deaths
• 6. Whether death related to pregnancy?
•  

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Implementation of MCCD

• Implemented in all States/Uts except
• Newly created States Uttranchal and Jharkhand
• Union Territories of Dadra Nagar Haveli and
  Daman Diu

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Coverage of MCCD

• RECOMMENDATIONS OF 1980 WORKSHOP ON MCCD
• First phase The scheme was to cover teaching
  hospitals at State Headquarter towns to gain
  experience of problems that may arise in
  introducing the scheme
•  
• Second phase Specialized hospitals and district
  and sub-divisional hospitals
•  
• Third phase Private hospitals, other public
  hospitals and Primary Health Centres (PHCs) and
  
•  
• Final phase Private physicians practicing
  modern medicine.

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Coverage of hospitals in 1998
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_at_ Operational in urban hospitals.
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Medically certified deaths during 1999

• 22 States/Uts reported data on medically
  certified deaths during 1999
• About 15.4 of the total registered deaths.
• About 41.3 of urban registered deaths.
• More than 50 of the urban registered deaths In
  Arunachal Pradesh, Goa, Maharashtra, Manipur,
  Meghalaya, Orissa, Tamil Nadu, A N Islands,
  Delhi and Pondicherry
• More than 100 Urban registered deaths In
  Arunachal Pradesh, Goa and Manipur due to
  inclusion the rural deaths.
• More than 50 of total registered deaths In
  Arunachal Pradesh, Goa, Manipur, Delhi and
  Pondicherry.

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Mortality coding

• Coding It is the assignment of a code for a
  diagnostic statement, related health conditions,
  or cause of death as identified by the health
  care.
• Classification of diseases It can be defined as
  a system of categories to which morbid entities
  are assigned according to established criteria.
• International Classification of Diseases (ICD) is
  used for coding cause of mortality.

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Purpose applicability of ICD

• ICD permits the systematic recording, analysis,
  interpretation and comparison of mortality and
  morbidity data collected in different countries
  or areas and at different times.
• It translates diagnoses of diseases and other
  health problems from words into an
  numeric/alphanumeric code, which permits easy
  storage, retrieval and analysis of the data.

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Simple situation
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Complicated situation
A lady aged 23 years was admitted to a hospital.
She had H/O suicidal burn- because of pouring of
kerosene and burnt herself. O/E patient had 78
burn (superficial deep). She developed
septicemia and died after 3 days of admission.

• Manner of death
• Natural, 2. Accident, 3 .
  Suicide, 4. Homicide,
• 5. Pending investigation

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Special Tabulation Lists for Mortality and
Morbidity

• ICD-10 provides four special tabulation lists for
  mortality and one list for morbidity
• List 1-General mortality-condensed list
• (103 causes)
• List 2-General mortality-selected list (80
  causes)
• List 3- Infant and child mortality-condensed list
  
• (67 causes)
• List 4- Infant and child mortality-selected list
• (51 causes) and
• Tabulation list for morbidity (298 causes)

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• The ICD-10 tabulation lists are not being adopted
  as such instead national list based on ICD is
  used for tabulation of mortality.
• In National list major group, category and
  sub-category terms are used in place of Chapter,
  Block and three/four character category.
• National list based on ICD-9 has been used up to
  the year 1998.
• National list based on ICD-10 has been adopted
  from the year 1999 onwards.

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Characteristics of National list based on ICD-9
and ICD-10
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Leading Causes of Deaths during 1991 to 1999
All India
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Level and Coverage of causes of deaths in India
and United States
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Usefulness of MCCD

• MCCD provides cause-specific mortality profiles
  and is a key indicator for analyzing the health
  trends of the population in a scientific manner.
• The information is of considerable use to public
  health planners, administrators, medical
  professionals and research workers.
• The information is made use of in the assessment
  of the effectiveness of public health programme.
• It is feedback for better health planning and
  management as well as for deciding priorities of
  health and medical research programme.

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