2021年11月10日星期三

Comprehensive analysis of common operation code problems in the medical insurance settlement list of DRG / dip.

1、 The application for the development environment of the national medical security disease diagnosis related group (chs-drg) is based on the settlement list data of the medical security fund, the classification and code of medical security diseases (ICD-10) of the national medical insurance version, and the classification and code of medical security surgery and operation icd-9-cm-3. In addition, when grouping DRG, patients were classified according to discharge diagnosis (ICD-10), surgical operation (icd-9-cm-3), complications, complications, respiratory tract use time, age and other related medical factors. The main operation and operation codes are the key information directly used in DRG group and an important basis for distinguishing ADRG, as shown in the figure below.

Diagnosis intervention packet (DIP) refers to disease diagnosis (ICD) in all sample data in combination with cases with the same disease diagnosis level and similar clinical process, taking the one-time treatment process of the disease as the research unit.

The operation and operation name of icd-9-cm-3 generally consists of (SCOPE) location, operation, method, disease nature, etc. Each component of the surgical operation name may affect the integrity and accuracy of the code. If you pay little attention, code errors will occur. Through the actual situation, let's take a look at the impact of each of the above factors on the actual coding.

(1) Effect of anatomical site comparison code

As the core component of surgical language, it must be clearly pointed out. Otherwise, it is difficult to classify or roughly classify.

Example: lung cancer resection

Analysis: This is a typical improper operation name. The scope of resection and surgical method are not clear. It can be divided into electrical pneumonectomy, lobectomy or lung injury resection. The code is as follows:

Lung disease injury resection 32.29-open, 32.2003-thoracoscopy

Pneumonectomy 32.39-open, 32.30-thoracoscopy

Lobectomy 32.49-open, 32.41-thoracoscopy

Total pneumonectomy with mediastinal lymph node dissection 32.59-open, 32.50-thoracoscopy

The correct code of icd-9-cm-3 can be correctly confirmed only when the surgical site and surgical method are clear. (special note: in the classification of surgical operation, the left and right parts of the same organ are classified into the same classification. In addition, if the indicated parts are too detailed and the specific parts are not recorded in icd-9-cm-3 index, they can be treated by expanding methods such as disease classification.).

(2) The impact of surgery on the code

The operation method is also the central component of the operation name, which is more important than the position. Without the operation method, it can not be classified. Surgery is also a writing component that doctors can't forget, but there are often problems that they can't express correctly. The difficulty of different surgical methods directly affects the grouping of DRG / dip.

Example 1: eyelid repair

Suture of eyelid margin 085200

Eyelid marginal plate related eyelid reconstruction 08.7100

Eyelid reconstruction with full-thickness correlation of eyelid margin 08.7300

Solution: repair is often an ambiguous operation, not only suture, but also repair. Therefore, the repair of eyelid should be divided into simple suture, repair and reconstruction. Especially with regard to reconstruction, it is pointed out that eyelids, boards or full layers should be distinguished.

(c) The impact of surgical methods on the code

Generally speaking, it is not necessary to point out the way of surgical operation, but there are requirements in some cases.

Case 2) cervical fusion includes anterior approach, posterior approach, anterolateral approach and posterolateral approach

Anterior cervical fusion 81.020001

Posterior cervical fusion 81.0300001

Anterolateral cervical fusion 81.020002

Posterolateral cervical fusion 81.0300x002

(IV) influence of disease essence on code

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