肾内科易混淆疾病ICD-10编码分析

Discussion on ICD-10 Coding of Easily Confused Diseases in Nephrology

肾内科的诊断包括肾功能诊断、临床诊断、病理诊断等,并且很多疾病的名称相似,给编码工作带来了一定的困难。病理诊断易混淆的有:脂性肾病和脂蛋白肾病,分别编码于N04.0和N28.9;膜性肾病和膜增生性肾小球肾炎(Ⅰ、Ⅲ型),分别编码于N00-N07伴有第四位数.2和N00-N07伴有第四位数.5,膜增生性肾小球肾炎Ⅱ型编码于N00-N07伴有第四位数.6;局灶节段性肾小球硬化和高血压性小动脉肾硬化,分别编码于N00-N07伴有第四位数.1和I12.9。功能诊断易混淆的有:急性肾损伤和急性肾脏病,其分别代表了肾功能不全的不同阶段,根据损伤的部位统一编码于N17.-。临床诊断易混淆的有:缺血性肾病和肾缺血,分别编码于N17.0和N28.0;继发性甲状旁腺功能亢进和肾源性继发性甲状旁腺功能亢进,分别于编码E21.1和N25.8。遇到相似的疾病名称时,编码员应主动辨析,多检索、多讨论,提高编码准确性。

The diagnosis of nephrology includes renal function diagnosis,clinical diagnosis,pathological diagnosis,etc.,and the names of many diseases are similar,bringing certain difficulties to the work of coders.The easily confused pathological diagnoses are:lipid nephropathy and lipoprotein glomerulopathy,coded in N04.0 and N28.9 respectively;Membranous nephropathy and membranoproliferative glomerulonephritis(types Ⅰ and Ⅲ),coded in N00-N07 with the fourth digit.2 and N00-N07 with the fourth digit.5,respectively.Type Ⅱmembranoproliferative glomerulonephritis is coded in N00-N07 with a fourth character.6;Focal segmental glomerulosclerosis and hypertensive arteriolar nephrosclerosis,coded in N00-N07 with a fourth character.1 and112.9 respectively.The easily confused functional diagnoses are acute kidney injury and acute kidney disease,which represent different stages of renal insufficiency respectively,and are uniformly coded in N17.-,according to the location of the injury.The easily confused clinical diagnoses are ischemic renal disease and renal ischemia,coded in N17.0 and N28.0 respectively;Secondary hyperparathyroidism and nephrogenic secondary hyperparathyroidism are coded E21.1 and N25.8 respectively.When encountering similar disease names,the coder should take the initiative to differentiate,search and discuss more to improve the accuracy of coding.