Analysis of Coding Quality of Death Certificates and Autopsy Rates in Chemnitz: 2010-2013

Background Postmortem examination as the last service of physicians has been increasingly criticized recently. The aim of this project was to study the influence of place of death, type of postmortem physician, age and sex of the deceased person on the completeness and quality of ICD-10 coding of death certificates issued by physicians in Chemnitz, Germany. Methods We reviewed 15 612 death certificates and 353 autopsy reports of the health office of Chemnitz for the years 2010-2013. We extracted age and sex of the deceased, causes of death as based on the primary postmortem examination and after autopsy if applicable, type of death (natural or unnatural cause of death), and complications as discovered at the second postmortem examination before cremation. In addition, we documented the place of death and type of physician carrying out the postmortem examination. Furthermore, we corrected the inappropriate or missing ICD-10 codes followed by agreement analysis. The analysis was in agreement with the rules of the German Institute of Medical Documentation and Information. Results The autopsy rate was 2.3 %. The underlying condition was not documented in 34.1 % of the cases. The agreement between quality-controlled ICD-10 coding of the cause of death and the original ICD-10 coding ( three-digit codes) was high (96.5 %). High age at death, death not occurring in hospitals, and postmortem examination not carried out in hospitals were associated with a higher probability of ICD-10 miscoding. The observed agreement of 3-digit ICD-10 coded underlying condition after primary postmortem examination and after autopsy was 26.3 %. The underlying cause of death contained garbage codes in 24.2 %, that is, codes that are inappropriate for cause of death statistics. Conclusions Physicians have to be sensitized to the need for appropriate documentation of causes of death. Autopsy very frequently resulted in a change of the assessment of the underlying cause of death and therefore remains an important quality control measure for certification on the cause of death. ICD-10 coding of causes of death is not a primary task of physicians and physicians should not be required by law to carry out this task.