吉林省医保定点医院上传ICD-10编码现状研究  

Study on the Status of Uploading ICD-10 Encoding of Medicare Designated Hospitals in Jilin Province

作　　者：徐长妍[1] 刘玉霞[2] 王建国[1] 刘鸿声[3] 刘宏亮[3] 

机构地区：[1]吉林大学第一医院,长春市130021 [2]吉林大学中日联谊医院,长春市130033 [3]吉林省社会医疗保险管理局,长春市130022

出　　处：《中国病案》2017年第8期11-13,共3页Chinese Medical Record

基　　金：吉林省科技发展计划项目(编号:20140418099FG)

摘　　要：目的了解吉林省医保定点医院上传ICD-10编码现状,针对存在的问题提出相应的对策,为吉林省社会医疗保险管理局提供参考。方法随机抽取6家省医保定点医院上传的1877例患者,选派专业编码员逐一审核病案的主要诊断和ICD-10编码,与定点医院上传给省医保局的编码对照,总结定点医院上传编码的现状。结果在1877份病案中,有1396份病案主要诊断选择正确,正确率74.37%,但在上传给省医保局时仅670份病案的编码上传正确,正确率35.70%,有38.68%的病案主要诊断选择正确但上传编码错误。6家医院主要诊断选择正确率与ICD编码上传正确率的差异有统计学意义(P<0.001),且均体现出主要诊断选择的正确率明显高于编码上传的正确率,其中A医院的主要诊断上传正确率与ICD编码上传正确率的差值最大,F医院差值最小。结论建议省医保局加强对定点医院上传编码工作的监管力度,指导医院不断完善上传编码工作的流程和质量,与定点医院共同努力,发挥ICD分类在吉林省医保付费改革中的作用,更好地为参保人员提供高质量的服务。Objective To understand the status of uploading ICD-10 encoding of medicare designated hospitals,to puts forward the corresponding countermeasures to the existing problems and provide reference for Social Medical Insurance Administration Bureau of Jilin Province. Methods 1877 patients uploaded by 6 provincial medicare designated hospitals to the Social Medical Insurance Administration Bureau of Jilin Province were randomly selected.The professional encoders were employed to examine the main diagnosis and ICD-10 encoding contrast to the encoding uploaded by medicare designated hospitals to the Social Medical Insurance Administration Bureau of Jilin Province and the status of uploading encoding of medicare designated hospitals were summarized. Results In the 1877 cases of medical records, the main diagnosis of 1396 cases was correct, the correct rate was 74.37%.However, when the records were uploaded to the Social Medical Insurance Administration Bureau of Jilin Province,the encoding uploaded of only 670 cases of medical records was correct, the correct rate was 35.70%. 38.68% of the cases were diagnosed correctly but the encoding uploaded were wrong. There were significant differences between the correct rates of the main diagnosis selection and the ICD encoding upload in 6 hospitals（P〈0.001）,and the correct rates of main diagnosis selection were significantly higher than those of encoding upload, the difference between the correct rates of main diagnosis selection were significantly higher than those of encoding upload in A hospital was the maximum, that in F hospital was the minimum. Conclusions It is recommended for the Social Medical Insurance Administration Bureau of Jilin Province to strengthen supervision of jobs of uploading encoding of the designated hospitals, to guide the hospitals to improve the process and quality of uploading encoding constantly, to work together with the designated hospital to play the role of ICD classification in the reform of medical insurance payment in Jilin Province and

关 键 词：医保定点医院 即时结算 ICD-10编码 

分 类 号：R197.323[医药卫生—卫生事业管理]