基于DIP的高费用偏差病例ICD编码缺陷对病种分组影响分析  

Analysis of the Influence of ICD Coding Defects on High-Cost Biased Cases for Disease Grouping based on DIP

作　　者：谭华珍 邓活清 徐詠恩 周爱莲[1] 徐子蕴 罗丽敏 龚启英[1] 于磊[1] Tan Huazhen;Deng Huoqing;Xu Yong'en(Huadu District People's Hospital of Guangzhou,Guangdong,510800,China;不详)

机构地区：[1]广州市花都区人民医院,广东广州510800

出　　处：《中国医院管理》2024年第7期55-58,共4页Chinese Hospital Management

基　　金：广州市花都区医疗卫生一般科研专项项目(22-HDWS-004);广州市卫生健康科技项目(20221A011116)。

摘　　要：目的分析按病种分值付费(Diagnosis-Intervention Packet,DIP)高费用偏差病例ICD编码缺陷对DIP病种分组的影响。方法收集某三级甲等综合医院2019—2021年342例DIP高费用偏差病例的病案首页数据和费用结算数据。对病例首页ICD编码进行质控,将病例错误ICD编码修正后,重新进行DIP分组,利用Wilcoxon配对符号秩和检验,分析编码修正前后病种入组和分值变化。结果DIP高费用偏差病例ICD编码缺陷率为19.30%,主要诊断ICD编码缺陷率为9.36%,诊断ICD编码缺陷以肿瘤、呼吸系统、循环系统疾病为主,累计构成比为57.53%;手术操作ICD编码缺陷率为7.93%。在66例ICD编码缺陷病例中,35例修正编码后重新进行DIP分组,DIP分组发生变化,DIP分值中位数ICD编码从修正前的1022分上升至修正后的1089分,差异有统计学意义(Z=-2.71,P=0.03)。结论DIP高费用偏差病例的ICD编码缺陷率高,肿瘤、呼吸系统、循环系统诊断ICD编码缺陷较为突出,修正缺陷编码后重新进行DIP分组,DIP分值提高。医院应制定针对性措施,提高ICD编码质量,为DIP病种分组提供关键支撑,助力医院精细化管理和高质量发展。Objective To analyze the effect of ICD coding defects on disease grouping of Diagnosis-Intervention Packet(DIP)high-cost biased cases.Methods Data from the home page of medical record and the cost settlement of 342 DIP high-cost biased cases in a tertiary grade A general hospital from 2019 to 2021 were collected.The quality control of ICD codes of DIP high-cost biased cases was performed.After the incorrect ICD codes were corrected,the cases were grouped again by DIP.The changes of disease grouping and score before and after the coding correction were analyzed by paired Wilcoxon signed-rank test.Results The defect rate of ICD coding with DIP high-cost biased cases was 19.30%,the defect rate of ICD coding for main diagnosis was 9.36%.The ratio of coding defects of tumor,respiratory system and cardiovascular disease accumulates to 57.53%.The defect rate of coding for operation was 7.93%.Among the 66 cases with ICD coding defects,35 cases with revised codes were regrouped,and the classification and score of DIP disease were changed.The DIP median score increased from 1022 to 1089,which was statistically significant(Z=-2.71,P=0.03).Conclusion The DIP high-cost biased cases had a high rate of ICD coding defects.The defect rate of ICD coding in the diagnosis of tumor,respiratory system and circulatory system was prominent.The hospital should make specific measures to improve the quality of ICD coding,provide the key support for the DIP disease grouping,and promote the hospital fine management and highquality development.

关 键 词：按病种分值付费 高费用偏差病例 ICD编码 病种分组 

分 类 号：R197.323.2[医药卫生—卫生事业管理]