常见急性白血病的WHO分类与ICD编码

Analysis of WHO Classification and ICD coding of Acute Leukemia

急性白血病是临床上常见的血液系统恶性肿瘤,相关的临床诊断标准和形态学分类发展迅速,分类繁多,在进行编码工作时,需注意以下要点:编码员要掌握急性白血病的最新临床分类,例如FAB分类将急性白血病分为急性淋巴细胞白血病和急性髓细胞白血病两大类,第四版WHO造血与淋巴组织肿瘤分类将淋巴造血系统肿瘤分为髓系肿瘤、淋巴组织肿瘤、肥大细胞病、组织细胞和树突状细胞肿瘤几个大类;此外,要了解疾病含义,毛细胞白血病变异型是一种成熟B细胞肿瘤,类似毛细胞白血病,但其临床、形态、免疫学表现并不完全符合毛细胞白血病特征,生物学上与毛细胞白血病无关;白血病在国际疾病分类中属于无法区分部位的肿瘤,它们的部位编码直接在形态学后面给出,这与一般的恶性肿瘤编码查找步骤不同;还要熟悉肿瘤形态学的变化,能够区分不同码段的形态学编码,前B细胞急性淋巴细胞白血病(C91.000x006,M98360/3)和前体B细胞淋巴细胞白血病(C91.304,M98331/3),从疾病名称的字面意义上看应是同一种疾病,但了解它们的疾病编码和形态学编码后就可以找到两者之间的区别。除了以上几点注意事项,编码员还要认真阅读病案,尤其是相关检查、检验结果,有疑问时需与临床医师进行沟通;可借助信息化手段,形成院内的疾病诊断名称集合,再通过与ICD编码进行对照,提高编码工作的效率与质量。

Acute leukemia is a common clinical hematological malignancy.Relevant clinical diagnostic criteria and morphological classifications are developing rapidly,and there are many classifications.Therefore,it is necessary to pay attention to the following points during coding work.Firstly,coders should master the latest clinical classification of acute leukemia.For example,The FAB classification divides acute leukemia into two categories:acute lymphoblastic leukemia and acute myeloid leukemia.The fourth edition of the WHO classification of hematopoietic and lymphoid tissue tumors divided lymphatic hematopoietic system tumors into myeloid tumors,lymphoid tissue tumors,mast cell diseases,histiocytes and dendritic cell tumors.In addition,it is necessary to understand the meaning of the diseases.For example,the hairy cell leukemia variant is a mature B-cell tumor,similar to hairy cell leukemia.But its clinical,morphological,and immunological manifestations are not completely consistent with the characteristics of hairy cell leukemia and are biologically unrelated to hairy cell leukemia.Besides Leukemia is an indistinguishable tumor in the International Classification of Diseases.Their site code is given directly after the morphology,which is different from the code search steps of general malignant tumors.It is also necessary to be familiar with the changes in tumor morphology and be able to distinguish morphological codes in different segments,such as pre-B-cell acute lymphoblastic leukemia(C91.000x006,M98360/3)and precursor B-cell lymphocytic leukemia(C91.304,M98331/3),which might be the same disease in the literal sense,but the difference between the two can be found after understanding their disease codes and morphological codes.In addition to the above points,the coders should carefully read the medical record,especially the relevant examination and test results,and communicate with the clinician when in doubt.Finally,with the help of information technology,a collection of disease diagnosis names in the hospital can be formed.Then the efficiency and quality of coding work can be improved by comparing it with ICD codes.