疾病编码主体的探讨

ICD是一门科学性、技术性、专业性很强的疾病分类方法,具有自身的系统性、复杂性及标准化的操作规程。疾病编码主体必须是专业的编码员,临床医师的责任是准确、完整、规范地书写诊断。保证高质量的编码,应让编码员与临床医师各司其职,各有侧重,并建立有效的沟通机制。

Discussion of Disease Coding Subject

ICD is very scientific, technical and professional method for disease classification, which has its own systematic,complex and standardized operation specification. The subject of disease coding must be a professional coder and the responsibility of a clinician is to write accurate, complete, and standardized diagnosis. To guarantee high-quality coding, the coders and the clinicians should perform their own functions and have their own focuses. And the effective com- munication mechanism should be established.