2021年10月28日星期四

For malignant tumor claims, ICD-10 coding can not be ignored

When valuing disease insurance clauses, we often see such a word - ICD-10. What exactly does this word mean? Why can't I understand the explanation of the insurance salesman, and why are the insurance terms so stipulated?

ICD-10 looks very complex. In fact, it is a worldwide coding rule, which is internationally used. As long as doctors all over the world see the ICD-10 code on the diagnosis book, they will know what disease this person has. They don't have to find a translator to "chew words". It takes a lot of time and may not be accurate.

International Classification of diseases (ICD) is a universal disease diagnosis coding system regularly maintained and released by the World Health Organization, which is widely used by countries all over the world.

for instance. Mr. Liu was in danger abroad. The local doctor diagnosed him with malignant tumor and transferred him back to China for treatment. However, to what extent, if domestic doctors can't understand German, they have to find German medical experts to translate and confirm the diagnosis for many times. As time dragged on, Mr. Liu's condition deteriorated, and the doctor-patient relationship began to become tense

What if it is coded with ICD-10?

Benign tumor d10-d36

Dynamic not sure or unknown d37-d48

Tumor in situ d00-d09

Malignant tumor, stated or assumed to be primary c00-c76

Malignant tumor, stated or assumed to be secondary c80-c97

Malignant, whether the primary site or secondary site is uncertain c77-c79

Even an unprofessional doctor can easily judge what disease Mr. Liu has.

This provision in the insurance clause obviously facilitates the claim adjuster to judge whether the condition is serious enough to settle the claim, and facilitates the communication between claim settlement and medicine.

The definition of malignant tumor by serious illness insurance clearly states that clinical diagnosis belongs to the category of malignant tumor in the international statistical classification of diseases and related health problems (ICD-10) of the World Health Organization. If the category of malignant tumor specified in ICD-10 code is not reached, insurance consumers will not be able to obtain compensation.

Another real-time ICD-10 news. During this year's new crown, China formulated the new crown ICD-10 code, which greatly accelerated the global medical big data war.

At the 2017 China US smart medical big data summit, associate professor Weng Chunhua of Columbia University mentioned that a large number of medical data are incorrect, incomplete and unavailable due to the inaccurate use of ICD code. She cited an example: New York Presbyterian Hospital is a famous hospital with electronic medical records of 4.5 million patients. "In one study, we needed to look for patients with hypertension. As a result, we found that there was no ICD9 / 10 data on hypertension in all case records. The doctor said that because everyone had hypertension, he was too lazy to put the information in the case, and the information would be put in the case only when the patient had other diseases." because of the lack of ICD9 / 10 data, a large number of medical records could not be transformed into effective data, For medical big data research.

Some people say that ICD coding is the key to the big data war!

Can you still underestimate the ICD-10 code now?

I believe after reading this article, you already know that the practical significance of disease classification and coding is very great, and this is also an important part of the final compensation basis of insurance companies, which can not be ignored.

Know more about insurance so that there is no fuzzy area in your claim settlement.

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