以内镜治疗编码为例分析病案首页质量对医保支付的影响

Effect of the quality of the first page medical records on medicare payment by taking endoscopic therapy code as an example

目的研究病案首页编码质量对医保DRG入组的影响。方法以内镜治疗操作编码为例,收集某医院2020年1月1日至12月31日经过消化道内镜治疗的740例患者数据,对病案首页进行核查并修正,比较修正前后的医保DRG入组情况,采用卡方检验比较修正前后的医保支付差异。结果740份病案中55份编码错误,错误率7.39%。修正后医保支付平均点数由75.56增加到77.47。修正前后的DRG分组情况差异有统计学意义(χ^(2)=2013.04,P<0.05)。结论在内镜治疗消化道病变的病例中,主要操作选择错误对DRG分组的影响比主要诊断选择错误的影响大,编码错误会影响医保DRG入组,并且影响医保支付金额。提升病案首页编码质量,使医疗行为能够客观真实表达,有助于医保支付改革精准运行。

Objective To study the effect of the quality of the first page of medical records on the enrollment of medicare of DRGs.Methods With the operation code of endoscopic treatment as an example,the data of 740 patients who underwent gastrointestinal endoscopic treatment in a hospital from January 1 to December 31,2020 were collected.The first page of medical records was checked and revised to compare the inclusion of medicare of DRG before and after the revision,and the chi-square test was used to compare the difference in medical insurance payment before and after the revision.Results Fifty-five out of 740 medical records were wrong in coding,with an error rate of 7.39%.After the revision,the average number of points paid by medicare payments increased from 75.56 to 77.47.There was statistically significant difference in DRG before and after the revision(χ^(2)=2013.04,P<0.05).Conclusion In the cases of endoscopic treatment of digestive tract lesions,the influence of main operation code selection errors on DRG is bigger than the influence of main diagnostic errors,and coding errors could affect the inclusion of medicare payments of DRG and the amount of medicare payments.Improving the coding quality of the first page of medical records for the medical behavior to be objectively and truly expressed,is helpful for the accurate operation of medicare payment reform.