住院病案首页ICD编码质控前后的差异性及分值变化

Differences and Score Changes Before and After Quality Control of ICD Codes on the First Page of Hospitalized Medical Records

目的分析住院病案首页ICD编码质量控制前后差异性和分值变化,探讨获得准确医保结算总额的方法。方法选择我院2019年2月~2020年5月肝癌介入治疗、乳腺癌局部扩大切除术和化疗药物灌注的出院病例,将上述3个疾病诊断相关分组(DGRs)质控前的病例纳入对照组,质控后的DRGs病例纳入研究组,比较两组分值均值、病种分值、化疗药物灌注的病种分值差异及总分值变化情况。结果对照组肝癌介入治疗、乳腺癌局部扩大切除术和化疗药物灌注的分值分别为(562.42±20.36)、(998.15±20.26)、(279.23±11.02),研究组上述DGRs分组分值分别为(562.12±20.36)、(988.62±21.03)、(278.98±12.62),两组的DGRs分组分值均值比较,差异无统计学意义(P>0.05);对照组总分值为234940分,研究组质控后的合计分值为444248分,研究组比对照组的总分值增加了9.47%;研究组化疗药物灌注10例病例的治疗费用均超过200%,其分值减少1582分,下降27.80%。结论对病案首页ICD编码进行质控,可保证编码准确,以获得准确的医保结算总额。

Objective To analyze the differences and score changes before and after the quality control of ICD coding on the first page of inpatient medical records,and to explore the method of obtaining accurate medical insurance settlement.Methods We selected discharged patients from our hospital from February 2019 to May 2020 who received interventional therapy for liver cancer,expanded local resection of breast cancer,and chemotherapy drug infusion,and included the above three disease diagnosis-related groups(DGRs)before quality control into the control group,the DRGs cases after quality control were included in the study group,and the mean value of the two components,the score of the disease type,the difference of the score of the disease type of chemotherapy drug infusion and the change of the total score were compared.Results The scores of interventional therapy for liver cancer,local extended resection of breast cancer and chemotherapy drug infusion in the control group were(562.42±20.36),(998.15±20.26),(279.23±11.02),and the above DGRs in the study group were(562.12±20.36),(988.62±21.03),(278.98±12.62),there was no significant difference in the mean value of DGRs between the two groups(P>0.05);the total score of the control group was 234940 points,and the quality of the study group the total score after control was 444248 points,which was an increase of 9.47%in the study group compared with the total score of the control group;the treatment cost of the 10 cases of chemotherapy drug infusion in the study group exceeded 200%,and the score decreased by 1582 points,a 27.80%decrease.Conclusion The quality control of the ICD code on the first page of the medical record could ensure the accuracy of the code and obtain an accurate total medical insurance settlement.