1. 11-17 October 2014 Barcelona, Spain WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2014 Authors: Puigdefàbregas Anna 1, Freitas Adriana 1, Gispert Rosa 1, Molina Purificació 1, Gibert Alfred 1, Zaragoza Sílvia 1, Tresserras Ricard 2. 1 Mortality Registry, Department of health, Catalonia, 2 DGRPRS, Department of health, Catalonia The experience of Catalonia in coding mortality data with Iris automatic coding system

2. Routine review of 5% of death certificates coded by Iris to find “problematic” underlying causes List of ICD10 codes to review Why some codes are checked and manually recoded? Results of the quality control review 11-17 October 2014 Barcelona, Spain WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2014

3.  Ambiguous expressions to which is specially difficult to assign ICD10 codes 1 expression2 codes  Habits of certification (immediate cause, sequence and time interval)  Manually Multiple Cause code errors (ICD10 updates, medical procedures, …)  Low accuracy of the ICD10 code for frequently used expressions (.8,.9) n expressions1 code Why some codes are checked and manually recoded? 11-17 October 2014 Barcelona, Spain WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2014

4. ICD 10 Chapter ReviewedChanged Codes / Expressions (Examples) NN I- Infectious 25074 A09 II- Neoplasms 4631 III- Blood 229 Anemia IV- Endocrine 5322 Malnutrition V- Mental 8952 Mental disorder VI- Nervous 43958 VII- VIII- Eye/Ear 60 IX- Circulatory 25237 X- Respiratory 1131388 J98 XI- Digestive 8822 XII- Skin 10523 XIII- Musculoskeletal 17630 XIV- Genitourinary 57189 N18 XV- Pregnancy 20 XVI- Perinatal 152 XVII- Congenital 14226 XVIII-Ill defined 19029 XX-External 935164 TOTAL 45121056 Chapter distribution of cases reviewed, Catalonia 2013 (60,726 DC) 11-17 October 2014 Barcelona, Spain WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2014

5. Conclusion 11-17 October 2014 Barcelona, Spain WHO - FAMILY OF INTERNATIONAL CLASSIFICATIONS NETWORK ANNUAL MEETING 2014  Mortality Register of Catalonia has difficulty to assign appropriate ICD10 Multiple Cause code to few equivocal expressions  It is necessary to allocate proper Multiple Cause codes to reach an appropriate automatic selection of the UC of death  The implementation of Iris provides significant advantages to causes of death coding: Increases internal consistency, improves the comparability of mortality statistics and reduces the time spent in coding