住院病案首页ICD编码质量对分值付费的影响

The Role of ICD Coding Quality of Medical record Front Page in Score Payment under Medical Reform

目的在分值付费结算改革中,利用住院病案首页质量控制系统对国际疾病分类(ICD)编码进行质量控制,以达到获得准确的医保结算总额为目的。方法研究某院2017年1月-2018年6月,肝癌栓塞治疗术、乳腺癌根治术和血液恶性肿瘤椎管内化疗的出院病例。将该3个DRGs组质控编码前的病例纳入对照组,质控编码后的DRGs组病例纳入试验组,比较2组病例进入不同DRGs组的分值差异。结果对比质控后两组数据分值的平均值,P>0.05,差异无统计学意义;对3个病种的总分值进行比较,试验组比对照组增加了30863分,增长了3.05%;血液恶性肿瘤椎管内化疗增加8例的费用超过200%,其分值减少1281分,下降29.19%。结论做好病案首页ICD编码的质控,确保编码的准确性,医疗机构将获得与实际病种相对应的病种分值,保证其得到准确的医保结算总额。

Objectives In the environment of the payment and settlement reform, the quality control system of the medical record front page was used to control the quality of the ICD code on the front page of the medical record, so as to achieve the accurate total medical insurance settlement. Methods From January 2017 to June2018, the discharged cases of embolization of liver cancer, radical mastectomy and intraspinal injection of chemotherapeutic drugs in blood malignant tumor were studied.The patients in the DRG group before the quality control coding were included in the control group, and the quality control coded DRG group was included in the test group, and the scores of the two groups entering the different DRG groups were compared. Results Compared with the average score value of the two groups after quality control, P>0.05, the difference was not statistically significant.Comparing the total scores of the three diseases, the test group increased by 30863 points compared with the control group, an increase of 3.05%.Intraspinal injection of chemotherapy drugs for hematological malignancies increased the cost of 8 cases by more than 200%, and the score decreased by 1281 points, down29.19%. Conclusions To do a good job in quality control of ICD coding on the front page of medical records to ensure the accuracy of the coding, and medical institutions would get the corresponding disease type scores corresponding to the actual diseases, so as to ensure the accurate total medical insurance settlement.significant.Comparing the total scores of the three diseases,the test group increased by 30863 points compared with the control group,an increase of 3.05%.Intraspinal injection of chemotherapy drugs for hematological malignancies increased the cost of 8 cases by more than 200%,and the score decreased by 1281 points,down29.19%.Conclusions To do a good job in quality control of ICD coding on the front page of medical records to ensure the accuracy of the coding,and medical institutions would get the corresponding disease type scores corresponding to the actual diseases,so as to ensure the accurate total medical insurance settlement.