All VAs need to be coded to determine the direct and underlying cause of death according to the ICD10 classification.  Physicians need specific training in coding VAs, and this training needs to be repeated every few years.  (Sample VA Coding Manual).  Some sites use staff physicians for coding, however these are usually too busy to keep up with the numbers of VAs in need of coding.  Furthermore, their intimate knowledge of the population and the interventions may bias their coding.  An option is to use retired physicians off-site, usually in the capital, who will do this on a fee for VA basis.  Usually each VA is coded independently by two physicians.  When the resulting two codes are discordant, the VA is coded by a third VA. When there are two concordant codes, the cause is entered in the database. If there are three discordant codes, the cause is uncertain. For some analyses, the three causes are used with appropriate weighting.

A major challenge is tracking the status of the two to three coding forms and ensuring that all codes are completed and entered into the database in a timely manner.  Logging forms is critical to keep this process running smoothly.