Castleman病ICD-10的编码问题浅析

Analysis of the coding problem of ICD-10 in Castleman's Disease

目的分析Castleman病的病因、病理、影像特征与临床分型,探讨Castleman病ICD-10的正确编码。方法使用PDCA分析法对2017—2023年中山大学肿瘤防治中心住院病历中编码为D47.7、I89.808和R59的病案共394本进行筛选,逐本重新核查,与病理、影像及临床医生沟通,确定为Castleman病的有109本,根据ICD-10编码原则探讨Castleman病正确编码。结果单中心Castleman病(编码为189.808)为54本,多中心Castleman病(编码为D47.7)为44本,淋巴结反应性增生(R59.901)为11本,Castleman病编码正确率为61.48%,错误率为38.52%。结论提高Castleman病的编码正确率,需要编码员熟悉Castleman病的临床分型、病理特征,熟练掌握ICD-10的编码原则,病案编码员必须认真阅读每一份病历,尤其是对罕见病的编码要更认真、细心,积极主动地与临床医生和病理科医生沟通,不断学习积累相关医学知识,及时学习各系统最新肿瘤分类知识。

Objective To explore the correct encoding of ICD-10 in Castleman's disease by analyzing the etiol-ogy,pathology,imaging features,and clinical classification of the disease.Methods A total of 394 inpatient medical re-cords with codes D47.7,I89.808,and R59 from the Cancer Prevention and Treatment Center of Sun Yat-sen University Cancer Center from 2017 to 2023 were screened using the PDCA analysis method.Each case was rechecked and commu-nicated with pathology,imaging,and clinical doctors,and 109 cases were determined as Castleman's disease.The correct coding of Castleman's disease was explored based on the ICD-10 coding principle.Results There were 54 cases of monocentric Castleman's disease(code:189.808),44 cases of polycentric Castleman's disease(code:D47.7),and 11 cas-es of lymph node reactive hyperplasia(code:R59.901).The accuracy rate and error rate of Castleman's disease were 61.48%and 38.52%.Conclusion To improve the coding accuracy,it is necessary for coders to be familiar with the clin-ical classification and pathological characteristics of Castleman's disease,and master the coding principles of ICD-10.Medical record coders must read every medical record carefully(especially for the coding of rare diseases),actively com-municate with clinicians and pathologists,and continue to learn and accumulate relevant medical knowledge and the lat-est tumor classification knowledge of various systems.