2021年10月27日星期三

Discussion on rules of ICD-10 merge coding

1、 Combined coding in ICD coding

1. Description of merge code

In the actual merging coding process, in most cases, two groups of codes are merged, and three or more groups of codes are merged into one code. Therefore, merge coding can be abstracted as:

2. Merge codes during coding

ICD-10 is divided into three volumes. The second volume gives the specific use rules and coding errors of ICD-10 coding. Volume I and Volume III are used together to complete the index query of a diagnosis and obtain the coding by extracting the leading words and multi-level search words in the diagnosis. Then, reverse check Volume I of ICD-10, check whether there are some "see you again" and "not included" in the current code, and complete the coding process of the current diagnosis.

In this case, the coder shall judge whether there is a diagnosis that needs to be combined based on experience. If so, the combined coding shall be adopted to finally complete the complete ICD coding process. The ICD coding process is roughly shown in Figure 1.

The coding process proposed above is based on manual judgment to complete the merging coding. In computer-aided ICD coding, the relationship between ICD-10 codes can also be trained according to a large number of confirmed merging coding examples, so as to judge whether merging coding is required by retrieving ICD-10 codes. Its workflow is shown in Figure 2.

2、 Type of merge code

1. Combination of two groups of codes

When there are some diagnostic combinations in clinical discharge diagnosis, the combined code shall be given according to the combined diagnosis instead of separate coding. The combined coding of the two sets of codes is a relatively common situation in clinical application. Therefore, in multiple standard diagnostic libraries in China, the diagnostic combination of multiple cases that often appear in groups is directly defined as a diagnosis in the extension code, as shown in Table 1. Most of these diagnostic names contain keywords "companion", "merger", and "concurrency".

2. Combination of multiple codes

In clinical practice, we found that the combined coding not only appears in the combined coding of two diagnoses, but also when three or more diagnoses appear at the same time, they should be combined into one diagnosis for coding. See Table 2 for the cases.

Of course, there are a few cases where the diagnosis of more than three groups needs to be combined with coding, such as renal hypertension i12.9, hypertensive heart disease i11.9, congestive heart failure i50.0, acute renal failure n17.8, and combined coding: hypertensive heart disease, kidney disease with heart failure and renal failure i13.2.

3. Other situations of merging codes

In observing the example of ICD-10 diagnostic coding, we found several other cases similar to combined coding. For example, when using ICD-10 for disease coding, after indexing the disease coding, we need to check Volume I of ICD-10 to confirm whether there are "see you again" and "not included", so as to code some diagnoses. Then, two situations are encountered at the same time, so it is necessary to compile the two situations into one of them, as shown in the first group of situations in Table 3. Or one situation is generated by another, and the two situations are also compiled into one of them, as shown in group II and III in Table 3. The shape is as follows:

For another example, as mentioned earlier, in the standard library issued by China's medical departments, because the extension code is a subdivision and supplement to the sub item code, when revising the standard library, many diagnostic combinations with obvious merging conditions are newly defined as one diagnosis, but when clinicians make a diagnosis, they may still be given separately as multiple diagnoses, which we also regard as "merging code" A form of statistics is shown in Table 3.

3、 Case analysis

The patient, a 42 year old male, complained of renal insufficiency and urinary protein for 3 months. Three months ago, due to cervical spondylosis, dizziness and headache, blood drawing examination showed that renal function showed ua495mmol / L, cr151.0mmol/l, urinary ammonia nitrogen 6.86mmol/l and cysc1.60mg/l. There is no frequency of urination, urination and pain, no edema and swelling of the lower limbs, no hematuria and foam urine, urine volume is normal, no nocturnal urine is increased, no skin itching and dryness, and no attention has been paid to it. The renal function showed UA533mmol/L, Cr191.0mmol/L, Urea6.96mmol/L, CysC1.66mg/L. Urine routine showed protein + + +, occult blood + +. To be hospitalized for chronic nephritis. Pathological diagnosis: mesangial proliferative IgA nephropathy with partial glomerular crescent formation and sclerosis, equivalent to Lee grade: grade v.

Main diagnosis: chronic nephritis n03.5, n03.7 and n03.8 (correction: combined as n02.5 and n02.7)

Other diagnosis: mesangial proliferative nephritis with crescent formation and sclerosis

IgA nephropathy leev grade

Chronic renal failure ckd3 n18.8

Code search and analysis: in such cases, clinicians have different diagnostic and coding requirements according to their habits. Inexperienced coders can't figure out whether to code chronic nephritis in N03 - or IgA nephropathy in N02 -. Some make n03.8 chronic nephritis with special cases, some make n03.5 membranous proliferative glomerulonephritis, some make n03.7 chronic nephritis (diffuse) crescent glomerulonephritis, and some make n02.5 mesangial proliferative IgA nephropathy.

According to the relevant data, IgA nephropathy is a common glomerular disease, which is a high incidence area in China. The main clinical manifestation of this disease is paroxysmal hematuria. The types of cases are diverse, including small lesions, focal stage lesions, mesangial capillary lesions, etc. fluorescence immunoassay shows that there are diffuse granular or lumpy IgA deposits in the glomerular mesangial area.

The classification axis of glomerular diseases is the clinical classification of glomerular diseases, and the sub objective classification axis is the case classification of glomerular diseases. According to volume 3, the search indication should be N02 -. Volume 3: glomerulonephritis immunoglobulin A - see renal lesions, immunoglobulin A, - Crescent (diffuse) nec - coded in N00 ~ N07 with the fourth digit. 7, Check Volume 1 is crescentic IgA nephropathy n02.7; Re examination: nephropathy (degeneration) - immunoglobulin A - with glomerular damage - membranous proliferative (diffuse) n02.5.

The patient, a 63 year old male, complained of hypertension for 40 years and maintained peritoneal dialysis for 5 months. 40 years ago, the patient found no inducement to increase blood pressure. He took oral antihypertensive drugs regularly for a long time, and the blood pressure was controlled at 140 ~ 160 / 80-90mmhg. One year ago, he found that the blood creatinine increased. He was hospitalized in our hospital for antihypertensive, kidney protection and other symptomatic treatment, and the blood creatinine increased gradually. He maintained peritoneal dialysis and peritoneal dialysis 4 times / day before May. The outpatient department plans to be admitted to the hospital for "chronic renal failure, uremia period" and live in the Department of nephrology.

Main diagnosis: benign renal arteriosclerosis nephropathy i12.9 (correction: renal and heart failure, hypertension, hypertensive heart disease diagnosis combined with one code i13.2.)

Other diagnoses: chronic renal failure uremic stage (ckd5 stage) n18.0

Renal anemia d64.8

Secondary hyperparathyroidism n25.8

Maintenance peritoneal dialysis z49.2

Grade 3 very high risk group of hypertension I10

Hypertensive heart disease i11.0

Cardiac function class III

Right renal cyst n28.1

Therefore, coders should learn to judge, summarize and summarize by themselves. During coding, they should pay attention to the causal relationship between diagnoses. For discharged patients with causal relationship diagnosis, they should comprehensively analyze the whole group diagnosis and code the combined diagnosis of the whole group. Therefore, the five diagnoses written by the clinician of this case can be combined into one code. Therefore, for the diagnosis of interrelated diseases, according to the principle of combined coding, if there is joint coding and doctors diagnose separately, the coder should combine them.

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