冠心病编码思路

Line of Thinking in Coding of Coronary Heart Disease

本文从概念、定义和ICD-10编码规则入手,对冠心病的临床分型和ICD-10分类之间的关系进行了分析对比,对冠心病的编码思路进行了探讨。在我国,冠心病临床分为心绞痛、心肌梗死(心梗)、冠心病猝死、无症状性心肌缺血和缺血性心肌病5型。心绞痛编码于I20.-。心肌梗死≤4周者编码于I21.-,>4周者编码于I25.8,陈旧性者编码于I25.2;但4周内复发的急性心肌梗死编码于I22.-。心梗的并发症近期发生者编码于I23.-;较晚或缓慢发生者编码于I24或I25的相应亚目;对于非心梗所特有者,则应编缺血性心脏病一节以外的码。冠心病猝死的主要编码为I24.8,I46只能作为附加编码,但因急性心梗早期并发症而突然死亡者不属于冠心病猝死。无症状性心肌缺血要根据三种不同亚型来编码。缺血性心肌病要将I25.5作为主要编码,心力衰竭或心律失常作为附加编码。至于近年来较普遍出现的急性冠脉综合征应按其具体类型编码,即不稳定型心绞痛编I20.0,非ST段抬高型心梗编I21.4或I22.8,ST段抬高型心梗编I21.0-I21.3或I22.0-I22.8;只有具体类型不明时方可编I24.8。

Based on the concepts, definitions, and coding rules of ICD-IO, this article analyzed and compared the relationship between clinical types and ICD-IO classifications of coronary heart diseases, and discussed the thinking line in coding of coronary heart disease. Coronary heart disease is divided into five groups： angina pectoris, myocardial infarction, sudden coronary death, silent myocardial ischemia and ischemic cardiomyopathy. Angina pectoris should be coded to 120.-. Myocardial infarction： 121.- when ≤4 weeks, I25.8 when 〉4 weeks, I25.2 for old one and 122.- if recurred in 4 weeks. Myocardial infarction＇ s complications： I23.- for those occurred recently; if occurred later or slowly, classified to relevant subcategories in I24 or I25 ; for those not specific to myocardial infarction, coded elsewhere other than block of Ischemic Heart Diseases. For sudden coronary death, primary code should be 124.8, 146 can only be assigned as additional code. But the death occurred suddenly from complications in early stage of acute myocardial infarction is not considered as sudden coronary death. Silent myocardial ischemia should be coded according to three different subgroups. For ischemic cardiomyopathy, I25.5 should be assigned as primary code, whereas the code of heart failure or arrhythmias be additional. As to the acute coronary syndrome, emerged recently, the code should be assigned according to its specific type, i.e., unstable angina pector is coded to 120.0, non-ST elevation myocardial infarction is coded to 121.4 or 122.8, ST elevation myocardial infarction is coded to I21.0-I21.3 or I22.0-I22.8; only when the specific types were unknown could the code I24.8.