ICD-10北京临床版的设计与实现

通过对疾病分类系统结构的修改,建立临床版模型,并以此为框架,在汇总、整理北京地区实际在用临床诊断名称及编码的基础上,制定标准编码,开发完成国际疾病分类第十次修订本(ICD-10)北京临床版.这个规范标准在北京地区二级以上医院成功应用两年,成功支持北京地区诊断相关组(DRGs)应用,能够支持传统疾病分类工作,可提高编码精度,满足了新的更高的信息处理要求.     

ICD-10-PCS手术分类系统及临床应用策略探讨

随着医疗技术水平的进步,手术新设备、新技术不断推陈出新,ICD-9-CM-3手术分类系统难以满足加码要求。ICD-10-PCS是ICD-9-CM-3的升级版,其兼容性强,临床应用价值相对更高。通过分析ICD-10-PCS手术分类系统组成、编码结构及编码原则,探讨编码列表汉化和结构化编码系统应用策略,为ICD-10-PCS的推广使用提供借鉴,以促进DRG和DIP准确入组,为临床数据应用和分析奠定基础。     

基于语义相似度的ICD-10编码归一化探讨

ICD-10编码模式属于临床病案编码的基准性技术。近些年来,相关学者在国际ICD-10 4位编码的基础上,与医院自身的编码需求相结合,进行了编码扩展上的研究。但是由于不同医院之间所应用到的编码体系不相同,故导致当前在ICD-10编码的过程中,出现了基于编码医疗数据的共享、共认造成了限制的问题发生。因此,笔者围绕ICD-10,综述了语义相似度的ICD-10编码归一化内容。     

疾病编码的规范应用对DRGs的影响

目的评价规范填写国际疾病编码对实现DRGs的重要影响。方法随机抽取了100份出院病历的疾病编码和手术操作编码进行研究,分别使用ICD-10编码(北京协和医院版)及ICD-9-CM手术操作编码进行重新编码,比较原始编码和新编码的差异程度。结果诊断编码和手术操作编码不准确率均30%。结论规范填写ICD-10编码(北京协和医院版)及ICD-9-CM手术操作编码对实现DRGs合理分组付费具有重大意义。     

运输事故ICD-10编码快速查询方法探讨

目的探索运输事故ICD-10编码快速、准确的查询方法,避免模糊查询方法的弊端和经常导致的编码选择错误,提高编码查询效率和编码准确率。方法根据ICD-10中运输事故分类轴心建立二维查询列表,编码人员根据事故的性质浏览查询列表查寻事故外因的ICD-10编码。结果按照编码原则,运输事故(V01-V99)节的内容类目表和四位数亚目共分为8个查询列表。表中多数事故的亚目显示到类目水平,部分事故显示到亚目水平。水上运输和航空、航天运输事故着重对事故性质进行描述,也只显示到类目。经在全市各县(市、区)医疗、疾控机构推广应用,证明该方法便捷、实用,可以显著提高运输事故ICD-10编码的查询效率。熟悉编码的人员可以通过浏览提高查询速度,对编码比较生疏的人员可用于替代模糊查询方法,避免或减少编码错误。结论该查询方法在业界具有推广价值。     

基于ICD-11的诊断相关分组研究

目的 自2022年起诊断相关分组(DRG)的基础数据标准ICD-10将逐渐被ICD-11取代,本文研究ICD-11对DRG的支持情况,有利于分组方案建设,并为疾病编码工作提供指导.方法 建立ICD-10临床版对应ICD-11的3种映射表,替换CN-DRG诊断代码定义,形成3种新的分组器,分别替换病案首页中的ICD-10...     

ICD-10与ICD-11的异同分析

目的:了解ICD-10及ICD-11,分析两者使用及发展情况,探寻从ICD-10到ICD-11过渡使用的方法。方法:利用现有的资源,对ICD-10及ICD-11的概念、结构及编码规则进行阐述,并通过具体疾病在ICD-10及ICD-11中的分类情况,对比分析两者存在的异同。结果:概念上,两者同属于WHO的主要出版物,是国际疾病分类方法的不同修订版本;结构上,ICD-11对ICD-10有所延续、删除,最大变化是框架做了调整,极大扩展了编码和应用范围;编码规则上,ICD-11在ICD-10的基础上,编码的表现形式呈现了很大不同。结论:随着医学的发展及管理需求的变化,ICD-10由于其结构等的局限性已经不能满足分类的需求,研究使用ICD-11是疾病分类面临的重要课题。     

人禽流感的ICD-10编码探讨

1981年至今,人类已确认可感染人的禽流感病毒有H7N7、H5N1、H9N2、H7N2、H7N3、H5N2、H10N7、H7N9八种,其临床表现和病死率相差悬殊,而ICD-10(2008年第2版)提供的人禽流感编码只有类目J09,随着威胁人类的高病死率人禽流感的出现,建议适当增加亚目对人禽流感疾病进行分类,以利于死亡和疾病数据进行系统记录、分析、解释和比较。     

基于DRGs理论谈规范应用疾病编码的必要性

目的说明规范国际疾病编码标准性是实现DRGs的重要前提。方法任意抽取了185份出院病历作为研究对象,分别使用本土化的ICD-10国际编码(广东省疾病编码库)和《疾病分类与代码(GB/T 14396-2012版)》,以下简称"国标库")及ICD-9-CM手术操作编码诊断和操作编码的一致程度作统计对比。结果主要诊断和主要手术操作的编码不一致性均大于50%。结论规范ICD-10国际疾病编码和ICD-9-CM手术操作编码标准对于实现DRGs合理分组具有重大意义。     

浅谈艾森门格综合征的编码体会

我国实行国际疾病分类(ICD-10)非常重要:①便于国内与国际交流;②医疗、科研与教学病案资料的检索;③医院管理信息的提取;④医院等级评审;⑤临床路径应用;⑥临床重点学科申报;⑦医保管理、医疗付款等方面。所以编码人员必须根据临床诊断结合ICD-10编码原则,正确编码。笔者从ICD-10第二版索引中发现,以艾森门格尔命名的疾病编码有两个,分别分类到第九章循环系统疾病与第十七章先天性畸形、变形和染色体异常两章。两者的区别与编码选择使编码者感到困惑,因此,查阅了一些有关资料,对此疾病的编码进行探讨。     

International Classification of Diseases, 10th Revision: it's coming, ready or not

The current diagnostic and inpatient procedure coding system, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), has been used in the United States since 1979. The coding system has become insufficient because of many medical and technological improvements that have occurred since then. On September 20, 2013, the US health care system will assign the final ICD-9-CM code. The new system, International Classification of Diseases, 10th Revision, Clinical Modification, Procedure Classification System, will become effective on October 1, 2013, including more codes and other differences. Although October 2013 is the implementation deadline, facilities should start preparing for the change at this time. A thorough understanding of the new official guidelines is key to a successful transition from ICD-9-CM to International Classification of Diseases, 10th Revision, Clinical Modification, Procedure Classification System. As we are embracing 1 of the greatest health care changes in 30 years, specific considerations are offered for initiating implementation and ensuring a smooth transition.     

An assessment of the incidence of maternal mortality in the United States.

Recent studies in several states have found that the incidence of maternal mortality is higher than traditional vital statistics reports indicate. Since no comprehensive national study has been done to evaluate the completeness of maternal mortality ascertainment through the national vital statistics reporting system, the Centers for Disease Control (CDC) undertook such a study with the assistance of the National Center for Health Statistics and state health departments. The state health departments provided CDC with death certificates for all pregnancy-related deaths occurring during 1974-78. We reviewed and classified these certificates using both International Classification of Diseases, Adapted, Eighth Revision (ICDA-8) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) maternal death codes. We found that the actual incidence of maternal mortality for 1974-78 was approximately 20 per cent and 30 per cent greater than that published in national vital statistics reports using ICDA-8 and ICD-9-CM, respectively.     

Development of the ICD-10 procedure coding system (ICD-10-PCS)

The International Classification of Diseases 10th Revision Procedure Classification System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision. The development of ICD-10-PCS was funded by the U.S. Health Care Financing Administration. ICD-10-PCS has a multi-axial seven character alphanumerical code structure, which provides a unique code for all substantially different procedures and which allows new procedures to be easily incorporated as new codes. ICD-10-PCS was under development for over five years and the initial draft was formally tested and evaluated by an independent contractor. The final version of the ICD-10-PCS was released in the spring of 1998. The design, development and testing of ICD-10-PCS are discussed.     

Converting ICD-9 to ICD-10

Implementing the International Classification of Diseases, Ninth Revision (ICD-9) to International Classification of Diseases, Tenth Revision (ICD-10) conversion on October 1, 2015, in the United States has been a long-term goal. While most countries in the world converted more than 10 years ago, the United States was still using ICD-9. Many countries in the world have a single-payer healthcare system, while there are thousands of different healthcare organizations (providers and payers) that presently exist in the United States. With so many different software platforms for healthcare providers and payers, the conversion had become that much more complicated and capital intensive for all healthcare organizations in the country. A few of the present delay reasons to the ICD-10 conversion in past years were the concurrent timelines for meeting meaningful use requirements for the electronic health record, testing with external payers and upgrades from vendors which added complexities and extra costs. The authors examine the reasoning behind the conversion as well as the delays, before making the conversion on October 1, 2015, and review the question regarding whether the government's decision to push the date back a year would have been helpful.     

Coding and reimbursement of primary care biopsy and destruction procedures.

Current medical practice requires physicians to accurately report services provided to patients. Billing for destruction of benign and malignant lesions and for surgical, needle, and endoscopic biopsy procedures involves the selection of specific 1992 Current Procedural Terminology (CPT) codes. Payment for these procedures by third-party payers often requires the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding for neoplastic lesions. This review explains the proper codes to use in identifying common biopsy and destruction procedures performed by primary care physicians. The Health Care Financing Administration's relative value units and one state's published Medicaid payment rates are included for each procedure code. Instructions for selecting site-specific biopsy and destruction codes are provided.     

Monitoring anthrax vaccine safety in US military service members on active duty: surveillance of 1998 hospitalizations in temporal association with anthrax immunization

We compared 1998 hospitalizations in active-duty US military personnel for possible temporal association with anthrax immunization. Immunization, demographic, and hospitalization data were analyzed using Cox proportional hazards modeling for hospitalization within 42 days of vaccination. Discharge diagnoses were aggregated into 14 International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) categories. Approximately 11% of subjects received one or more doses of vaccine during 1998; those immunized were more likely to be younger and male. Lower hospitalization rates were observed across doses and diagnostic categories among the immunized. Adjusted risk ratios for hospitalization by diagnostic category suggest that immunized service members were at equal or lesser risk for hospitalization than the non-immunized.     

System for Rapid Assessment of Pneumonia and Influenza-Related Mortality—Ohio, 2009–2010

Rapid mortality surveillance is critical for state emergency preparedness. To enhance timeliness during the 2009–2010 influenza A H1N1 pandemic, the Ohio Department of Health activated a drop-down menu within Ohio’s Electronic Death Registration System for reporting of pneumonia- or influenza-related deaths approximately 5 days postmortem. We used International Classification of Diseases—Tenth Revision (ICD-10) codes, available 2–3 months postmortem as the standard, and assessed their agreement with drop-down-menu codes for pneumonia- or influenza-related deaths. Among 56 660 Ohio deaths during September 2009–March 2010, agreement was 97.9% for pneumonia (κ = 0.85) and 99.9% for influenza (κ = 0.79). Sensitivity was 80.2% for pneumonia and 73.9% for influenza. Drop-down menu coding enhanced timeliness while maintaining high agreement with ICD-10 codes.     

Failure of ICD-9-CM codes to identify patients with comorbid chronic kidney disease in diabetes

OBJECTIVE: To determine prevalence of chronic kidney disease (CKD) in patients with diabetes, and accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify such patients. DATA SOURCES/STUDY SETTING: Secondary data from 1999 to 2000. We linked all inpatient and outpatient administrative and clinical records of U.S. veterans with diabetes dually enrolled in Medicare and the Veterans Administration (VA) health care systems. STUDY DESIGN: We used a cross-sectional, observational design to determine the sensitivity and specificity of renal-related ICD-9-CM diagnosis codes in identifying individuals with chronic kidney disease. DATA COLLECTION/EXTRACTION METHODS: We estimated glomerular filtration rate (eGFR) from serum creatinine and defined CKD as Stage 3, 4, or 5 CKD by eGFR criterion according to the Kidney Disease Outcomes Quality Initiative guidelines. Renal-related ICD-9-CM codes were grouped by algorithm. PRINCIPAL FINDINGS: Prevalence of CKD was 31.6 percent in the veteran sample with diabetes. Depending on the detail of the algorithm, only 20.2 to 42.4 percent of individuals with CKD received a renal-related diagnosis code in either VA or Medicare records over 1 year. Specificity of renal codes for CKD ranged from 93.2 to 99.4 percent. Patients hospitalized in VA facilities were slightly more likely to be correctly coded for CKD than patients hospitalized in facilities reimbursed by Medicare (OR 5.4 versus 4.1, p=.0330) CONCLUSIONS: CKD is a common comorbidity for patients with diabetes in the VA system. Diagnosis codes in administrative records from Medicare and VA systems are insensitive, but specific markers for patients with CKD.     

ICD-9-CM coding of emergency department visits for food and insect sting allergy

PURPOSE: Little is known about the role of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identification of specific allergic reactions in the emergency department (ED). METHODS: Investigators in 10 EDs reviewed 1395 charts of consecutive patients presenting with food allergy (ICD-9-CM codes 693.1 and 995.60 to 995.69) and insect sting allergy (code 989.5). They also reviewed charts of patients with "unspecified" allergic reactions (codes 995.0 [other anaphylactic shock] and 995.3 [allergy, unspecified]) to identify additional patients with food or insect sting allergy. RESULTS: Of 406 patients with food allergy, 216 patients (53%) were coded as food allergy, whereas the remaining 190 patients (47%) were not. Of 394 patients with insect sting allergy, 341 (87%) were coded as insect sting allergy, whereas 53 patients (13%) were not. Characteristics of ICD-9-CM-identified compared with chart-review-identified patients differed for both food and insect sting allergy. ICD-9-CM-identified patients with food allergy were less likely to experience anaphylaxis. CONCLUSIONS: Almost half the patients with food allergy would have been missed by using food-specific ICD-9-CM codes alone, whereas only 13% of patients with insect sting allergy would have been missed. Furthermore, characteristics of these allergy patients would have been biased by studying only patients identified by using the allergen-specific ICD-9-CM codes.