意义未明单克隆丙种球蛋白病的ICD-10编码分析

ICD-10 Coding Analysis of Monoclonal Gammopathy of Undetermined Significance(MGUS)

在ICD-10第三卷中采用主导词"丙"查到单克隆丙种球蛋白病的编码是D47.2;意义未明的单克隆丙种球蛋白病的编码是D89.2。回顾某院收治的1例意义未明的单克隆丙种球蛋白病(MGUS)患者的临床表现、骨髓病理改变和治疗,并复习相关文献,分析意义未明的单克隆丙种球蛋白病的临床特征与其它类型丙球蛋白病的区别,特别是与单克隆丙种球蛋白病的区别,单克隆丙种球蛋白血症是一组由B细胞克隆性增殖所致的疾病,其共同特点为分泌具有相同结构的免疫球蛋白分子或其片段,即M蛋白。MGUS的诊断标准包括:(1)血清中M-蛋白浓度<3g.dl^(-1);(2)骨髓中浆细胞<10%;(3)尿中极少或无M-蛋白;(4)扁骨中没有溶骨性损害;(5)无相应的贫血、高钙血症或肾功能不全^([3])。仔细阅读病案,按照国际疾病分类原则进行准确的ICD-10编码。提示意义未明的单克隆丙种球蛋白病与单克隆丙种球蛋白病要分开编码,需要在使用的字典库中扩充编码D89.2未确定意义的单克隆丙球蛋白病,这样可避免编码员在电脑系统查找中,在没有在卷三查找的情况下,把D89.2未确定意义的单克隆丙球蛋白病,错编码成D47.2单克隆丙种球蛋白病。编码员阅读病案,提高医学知识和国际疾病分类专业技能,是准确进行编码的关键。

In the 3rd volume of ICD-10, the code of monoclonal gammopathy was D47.2 and the one for MGUS is D89.2. We made a review of the symptoms, pathological changes of the bone marrow and the treatment of a case of MGUS admitted to our hospital. Analysis of the feature differences between MGUS and other gammopathies was conducted, especially the difference between MGUS and monoclonal gammopathy. Research on papers and cases related to MGUS were also finished to realize a more accurate coding of MGUS according to rules of ICD-10. It was our conclusion that the coding of MGUS and monoclonal gammopathy should be separated and the code of MGUS as D89. 2 in the ICD-10 code dictionary library should he expanded. In this way, encoders may not take D47.2 （monoclonal gammopathy） as D89.2 （MGUS） when searching in computers without the reference of the 3rd volume of ICD-10. It was essential for encoders to make research on past cases, expand medical knowledge, and increase skills on ICD.