2021年10月27日星期三

ICD-10 uniform code rules

1、 Unified code of ICD code

1. Description of integration code

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

2. Merge codes during coding

ICD-10 is divided into three volumes. The second volume lists the specific use rules of ICD-10 code and the code errors that are easy to occur. Volume 1 and volume 3 are used together to extract leading words and multi-level search words from diagnosis, complete index search and coding of diagnosis. Then check Volume I of ICD-10 to determine whether the current code has "other", "exclusion" and other parts, so as to complete the code process of current diagnosis.

Because inpatients suffer from multiple diseases at the same time, and there is hospital causality between diseases, in this case, the code hospital will judge whether there is a diagnosis that needs to be combined according to experience. If so, the combined code will be used to finally complete the whole ICD coding process. The ICD coding process is roughly shown in Figure 1.

The coding process shown here is a process of completing coding according to manual judgment, but computer-aided ICD coding trains the relationship between ICD-10 codes based on multiple confirmed coding examples, so as to generate the workflow of ICD, as shown in Figure 2.

2、 Unified code type

1.2 combination code

In case of diagnosis combination in clinical discharge diagnosis, the combined code shall be submitted according to the combined diagnosis rather than a separate code. The combination of two sets of codes is common in clinical application. Therefore, a variety of diagnostic combinations often grouped in most standard diagnostic libraries in China are directly defined as one diagnosis in the extended code. (David Asher, northern exposure) see Table 1. Most of these diagnostic names contain keywords such as accompany, merge and merge.

2. Merge multiple code sets

Clinical practice shows that the combined code is not only the combined code of two diagnoses, but also can be combined into one diagnosis for coding if more than three diagnoses occur at the same time. See Table 2 for details.

Of course, there are also renal hypertension i12.9, hypertensive heart disease i11.9, congestive heart failure i50.0, acute renal failure n17.8 and combined code. Hypertensive heart disease nephropathy with heart failure i13.2.

3. Other situations of unified code

Looking at the example of ICD-10 diagnostic code, we found some other situations similar to the merged code. For example, when ICD-10 is used to generate a disease code, because after the index is established in the disease code, the ICD-10 volume is searched to determine whether there are "other references", "not included", etc. if other codes are generated for a diagnosis, two situations will occur at the same time. For example, the first group in Table 3. Alternatively, according to other situations (such as the second and third situations in Table 3), the two situations can be compiled into one situation. (David Asher, northern exposure) is shaped as follows:

In addition, as mentioned above, in the standard library released by China's medical departments, the extension code is a subdivision and supplement to the sub object code. Therefore, when revising the standard library, the combined diagnosis combination is obviously redefined as a diagnosis, but when clinicians make a diagnosis, please refer to table 3.

3、 Case study

The patient was a 42 year old male with major renal failure and urinary protein for 3 months. Before March, cervical spondylosis vertigo, headache and blood sampling examination showed that renal function ua495mmol / L, cr151.0mmol/l, ammonia nitrogen 6.86mol/l and cysc1.60mg/l. Usually frequent urination, urination, urination, facial edema, lower body edema, gross hematuria, foam excretion, normal urine volume, nocturnal urine did not increase, skin pruritus, dryness and so on were not taken seriously. The renal function test showed that ua533mmol / L, cr191.0mmol/l, urea 6.96mmmol/l and cysc1.66mg/l showed protein and hidden blood. Plan to enter chronic nephritis hospitalization. Pathological diagnosis: consistent with mesangial proliferative IgA nephropathy and the formation and sclerosis of some glomerular crescents. Lee grade: grade v.

Main diagnosis of homepage: chronic nephritis n03.5, n03.7, n03.8 (modified: n02.5, n02.7).

Other diagnoses: mesangial proliferative nephritis with crescent formation and sclerosis

Leev grade of IgA nephropathy

Chronic renal failure ckd3 stage n18.8

Code retrieval and analysis: in this case, clinicians habitually write different diagnostic and code requirements. Inexperienced coders do not know whether chronic nephritis is coded as N03 - or IgA nephropathy is coded as N02 -. Some n03.8 chronic nephritis is accompanied by some cases, some n03.5 membranous proliferative glomerulonephritis, some n03.7 chronic nephritis (diffuse) crescent glomerulonephritis, and some n02.5 mesangial proliferative IgA nephropathy.

By consulting relevant data, IgA nephropathy is a common glomerular disease, which belongs to a high incidence area in China. The main clinical symptom of this disease is paroxysmal hematuria. Case diversity, small lesions, focal stage lesions, mesangial capillary lesions, etc. fluorescence immunoassay can see granular and massive IgA deposition scattered in the glomerular mesangial region.

It is pointed out that the classification axis of glomerular diseases is the clinical classification of glomerular diseases, and the secondary classification axis is the case classification of glomeruli. Volume 3 is N02 -. Volume 3 investigation shows that glomerulonephritis immunoglobulin A nephropathy, immunoglobulin A, - Crescent (diffuse) nec - Codes N00 ~ N07, position 4. 7, control circle 1 reviews crescent IgA nephropathy n: nephropathy (change)

A 63 year old male patient with hypertension for 40 years underwent maintenance peritoneal dialysis for 5 months. 40 years ago, the patient found that there was no inducement and his blood pressure increased. He was treated with oral antihypertensive drugs regularly for a long time. His blood pressure was controlled at 140 ~ 160 / 80-90 MHG. A year ago, he found that his blood root increased and was hospitalized for treatment of serious diseases such as antihypertensive and renal protection. The clinic will be hospitalized for "chronic renal insufficiency and uremia" and admitted to the nephrology department.

Page 1 main diagnosis: benign renal arteriosclerotic nephropathy i12.9 (modified: kidney, heart failure, hypertension, hypertensive heart disease diagnosis combined code i13.2.)

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

Renal anemia d64.8

Secondary hyperparathyroidism n25.8

Maintenance abdominal membrane dialysis z49.2

Grade 3 high risk group of hypertension I10

Hypertensive heart disease i11.0

Cardiac function level III

Right renal cyst n28.1

Therefore, coders should learn to draw conclusions and generalize by themselves. When coding, they should pay attention to the causal relationship between diagnoses. For discharged patients diagnosed with causal relationship, they should comprehensively analyze the whole diagnosis set and the whole diagnosis set. Break the merge code of the merge. 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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