2021年11月11日星期四

Zhou Jie | DRG app 1 foot: ICD code

E medical columnist: Zhu Jie

Senior product director of medical Du Yun

Begonia has no fragrance

Bees have many thorns

The red building has no end

These are the three regrets of life mentioned by Zhang Ailing.

As Zhang Ailing said, "Begonia has no fragrance and towel gourd is prickly." it seems that the perfect scheme will cover the big hole intertwined with love and hate. The large hole of DRG is on ICD.

When it comes to ICD, the mainland medical management system was introduced at the beginning of the new century. We have no historical burden when overtaking in corners. When the United States is also ICD-9, we directly apply ICD-10 as the diagnostic classification coding standard of the home page of discharged patients' medical records, becoming a famous "ICD".

Everything is going well. Since 2009, CMS of the United States announced that it would postpone the upgrade period of diagnostic codes sent by hospitals for medical insurance data by two years. From 2011 to 2013. We watched the fire from a distance. Unexpectedly, the code upgrade will cause such a big storm to the hit industry opposite. Unexpectedly, with the advance of this target time, the dust settled in October 2015, and the system upgrade of icd-10-cm was completed nationwide. This has been 19 years since the unified use of ICD10 code was proposed in the EDI specification of HIPAA act in 1996.

In contrast, domestic ICD coding has never aroused such high interest. For many years, ICD coding work is only related to ward tasks. If the health committee does not use this data item for statistics, do you look at the coding quality? I'm afraid no one is too committed to it.

More serious hospitals have constructed the corresponding relationship between clinical diagnosis and ICD code commonly used by departments in the information system, but the effect should be seen from the perspective of cognition. At present, most his / EMR systems deal with ICD by making a comparison table from commonly used clinical diagnostic names to ICD diagnostic codes. After the doctor enters the clinical commercial diagnosis, the ICD code can be automatically displayed.

To be honest, if such a "response table" is formulated, the United States will not have to work hard for 19 years. How can there be such a good thing? The positioning of ICD is a classification code defined for statistical convenience, but the purpose of clinical diagnostic terms is to explain the disease name, location, onset stage and severity of specific patients. The two words have different structures and can't correspond one by one. Moreover, clinical diagnostic language itself does not have a stable form, and develops with the development of clinical medicine.

Therefore, the emergence of "ICD dilemma" with Chinese characteristics has the side that clinicians do not know, understand and despise ICD codes. In the Katakana recorded on the medical record, Ward's code supervisor collected various data and completed the ICD code as a supplement to the brain. The correctness of the final code cannot be further confirmed.

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