2021年11月11日星期四

Zhu Jie | the first pit of DRG application: ICD coding

E medical columnist: Zhu Jie

Senior product director of Yidu cloud

Begonia without fragrance

Shad is spiny

Red Mansions without tails

These are the three regrets in life that Zhang Ailing said

As Ms. Zhang Ailing said, "Begonia has no fragrance and shad has many thorns". The seemingly perfect scheme must hide the pit intertwined with love and hate. The pit of DRG is in ICD.

Speaking of ICD, it has been introduced into the mainland's medical management system since the beginning of the new century, and because we overtake at a curve without historical burden, when the United States was still ICD-9, we directly applied ICD-10 as the diagnostic classification coding standard on the front page of discharged patients' medical records, and released the local clinical expanded version, namely the famous "ICD-10 National Standard Version" GB / t14396-2001.

Everything went smoothly, so that since 2009, CMS in the United States announced that the upgrade period of diagnostic code for hospitals to send medical insurance data was postponed for two years (from 2011 to 2013). We were surprised that a code upgrade could set off such a storm in the opposite hit industry. Unexpectedly, the target time was pushed again and again until October 2015. The system upgrade of icd-10-cm was completed nationwide. It has been 19 years since the unified use of ICD10 coding was proposed in the EDI specification of HIPAA act in 1996.

Relatively speaking, ICD coding has never attracted so much attention in China. For many years, ICD coding seems to be only the task of the Department of the medical record room. If the health and Family Planning Commission didn't use this data item for statistics, would it come down to see the coding quality? Probably no one would put too much energy into this matter.

Some serious hospitals have made the corresponding relationship between common clinical diagnosis and ICD code in the information system, but the effect is different. At present, the treatment of ICD in most his / EMR systems is to establish a comparison table from commonly used clinical diagnosis names to ICD diagnosis codes, so that when doctors input commonly used clinical diagnosis, the system will automatically bring out an ICD code.

Frankly speaking, if such a "correspondence table" can be established, the United States will not have to toss about for 19 years. How can there be such a good thing? The positioning of ICD is a classification code defined to facilitate statistics, and the purpose of clinical diagnosis vocabulary is to describe the disease name, location, onset stage, critical degree and so on. The two word lists have different structures, so it is impossible to achieve one-to-one correspondence, not to mention that the clinical diagnosis vocabulary itself does not have a stable form, and constantly evolves with the progress of clinical medicine.

Therefore, a "ICD dilemma" with Chinese characteristics has emerged. On the one hand, clinicians do not understand, understand and despise ICD codes; On the other hand, the coder in the medical record room pieced together a set of data from a few words in the medical record, and completed the ICD coding all by brain compensation. The final coding accuracy can not be verified.

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