国家医保信息业务编码标准研究与应用

A Review of National Medical Insurance Information Service Coding Standards

医保信息业务编码是医保标准化体系的重要内容,也是国家标准化战略的组成部分。本文旨在介绍业务编码的编制过程中,课题组如何通过坚持“四个统一”、摸清标准底数、坚持实用优先、凝聚专家共识等方式,逐步建立医保疾病诊断与手术、药品、医疗服务项目、医用耗材等15项核心编码标准,并在后续过程中搭建动态维护平台,推进全国范围内的编码贯标工作,从而实现全国医保数据全覆盖、编码全转换、系统全贯通,使业务编码真正成为全国医保信息业务的“通用语言”。

Medical insurance information coding is an important part of medical insurance standardization system,and also a part of national standardization strategy.This article aims to introduce during the coding process,how to adhere to the'four unification',finding out standard base,emphasis the priority of practicality,condense experts'consensus and so on,to gradually establish 15 core coding standards including disease diagnosis and surgery,drugs,medical services,medical consumables etc.,and in the subsequent process to construct a dynamic maintenance platform,to promote the nationwide implementation of coding standards,to achieve full coverage of national medical insurance data,full conversion of codes,and full connection of the system,so that business code truly become the"universal language"of national medical insurance information business.