Establish and application of intelligent management system for ICD coding of diseases and procedures
10.3969/j.issn.1671-332X.2025.03.028
- VernacularTitle:疾病和手术操作ICD编码智能管理系统的构建与应用
- Author:
Yun LI
1
;
Yongfeng LIU
1
;
Ke YANG
1
;
Wenzhong HOU
1
;
Qi ZHANG
1
Author Information
1. 复旦大学附属华山医院 上海 200040
- Publication Type:Journal Article
- Keywords:
International classification of disease;
Diagnosis;
Procedure;
Intelligent management system;
Mapping;
Label
- From:
Modern Hospital
2025;25(3):438-441
- CountryChina
- Language:Chinese
-
Abstract:
Objective To establish an intelligent ICD coding management system to solve the current difficulties in hos-pital ICD coding management,reduce the error rate of information uploading,and improve the accuracy of coding.Methods An ICD coding management system was constructed,with the national clinical version of ICD coding as the main index system.The mapping relationship between the main index coding and the medical insurance version of ICD coding,as well as the hospital ver-sion of ICD coding,was established to achieve real-time maintenance and adjustment.In accordance with the requirements of na-tional public hospital performance evaluation and hospital level assessment,we will establish the ICD coding"label"function and knowledge base for evaluation indicators,embed them into electronic medical record system(EMR),and implement intelligent prompting functions for clinicians to facilitate systematic statistical analysis of data.Results After the establishment of the sys-tem,the error rate of mapping and uploading information such as disease diagnosis and procedures coding decreased significantly(1.2‰ vs 0.3‰,P＜0.05).The accuracy of the main discharge diagnosis and procedures coding has significantly improved(82％vs 91％,P＜0.05;78％vs 88％,P＜0.05).The satisfaction of clinicians and coders increased significantly(65％vs 82％,P＜0.05;79％vs 88％,P＜0.05).Conclusion This system can reduce the error rate of mapping and uploading infor-mation,improve the accuracy and completeness of coding,enhance the management level of ICD coding,and promote the high-quality development of medical care.
