肝胆胰肿瘤外科DRG入组错误案例分析

Case study of DRG enrollment error in hepatobiliary and pancreatic tumor surgery

分析肝胆胰肿瘤外科ICD编码原则和DRG分组特点,讨论肝胆胰肿瘤外科5个由于ICD编码错误而导致DRG入组错误的案例,分别为将胰腺穿刺活检(52.1100x001)错编为超声内镜下胰腺细针穿刺活组织检查(52.1101)、将胰腺恶性肿瘤(C25.900x001)错编为恶性肿瘤维持性化学治疗(Z51.103)并漏编静脉注射化疗药物(99.2503)主要操作、错误将结肠恶性肿瘤(C18.900)替代肝继发恶性肿瘤(C78.700x011)当主要诊断、将肝段切除术(50.2202)错编为肝病损切除术(50.2908)、在胰腺癌根治术中将胆囊切除术(51.2200)作为主要手术,经质控后调整为正确的主要诊断和主要手术编码,并进一步分析质控前后相应病例DRG入组及基准点数的变化。阐明肝胆胰肿瘤外科ICD编码的准确性对于DRG入组的影响并针对病案首页数据质量的提高给出对策。

This study analyzed the ICD coding principles and DRG grouping characteristics of hepatobiliary and pancreatic tumor surgery, and listed and discussed five cases of DRG enrollment errors due to ICD coding errors in hepatobiliary and pancreatic tumor surgery: misclassification of pancreatic puncture Biopsy(52.1100x001) as ultrasound endoscopic pancreatic fine needle puncture biopsy(52.1101), misclassification of pancreatic malignant tumor(C25.900x001) as maintenance chemotherapy for malignant tumor(Z51.103) and missing the main operation of intravenous chemotherapy drugs(99.2503), incorrect replacement of colonic malignancies(C18.900)for secondary hepatic malignancy(C78.700x011) as the main diagnosis, and misclassification of liver segment resection(50.2202) as resection of liver lesions(50.2908). Cholecystectomy(51.2200) was used as the main surgery in radical pancreatic cancer resection, which was adjusted to the correct main diagnosis and main surgical code after quality control, and further analyzed the changes in the DRG enrollment and reference points of the corresponding cases before and after quality control. This study clarified the influence of the accuracy of ICD coding in hepatobiliary and pancreatic tumor surgery on DRG enrollment and provided countermeasures for improving the quality of data on the first page of medical records.