面向家庭医学住院医师的糖尿病编码培训

J Am Osteopath Assoc. 2015 Jul;115(7):426-31. doi: 10.7556/jaoa.2015.088.

CONTEXT

Although physicians regularly use numeric coding systems such as the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to describe patient encounters, coding errors are common. One of the most complicated diagnoses to code is diabetes mellitus. The ICD-9-CM currently has 39 separate codes for diabetes mellitus; this number will be expanded to more than 50 with the introduction of ICD-10-CM in October 2015.

OBJECTIVE

To assess the effect of a 1-hour focused presentation on ICD-9-CM codes on diabetes mellitus coding.

METHODS

A 1-hour focused lecture on the correct use of diabetes mellitus codes for patient visits was presented to family practice residents at Doctors Hospital Family Practice in Columbus, Ohio. To assess resident knowledge of the topic, a pretest and posttest were given to residents before and after the lecture, respectively. Medical records of all patients with diabetes mellitus who were cared for at the hospital 6 weeks before and 6 weeks after the lecture were reviewed and compared for the use of diabetes mellitus ICD-9 codes.

RESULTS

Eighteen residents attended the lecture and completed the pretest and posttest. The mean (SD) percentage of correct answers was 72.8% (17.1%) for the pretest and 84.4% (14.6%) for the posttest, for an improvement of 11.6 percentage points (P≤.035). The percentage of total available codes used did not substantially change from before to after the lecture, but the use of the generic ICD-9-CM code for diabetes mellitus type II controlled (250.00) declined (58 of 176 [33%] to 102 of 393 [26%]) and the use of other codes increased, indicating a greater variety in codes used after the focused lecture.

CONCLUSION

After a focused lecture on diabetes mellitus coding, resident coding knowledge improved. Review of medical record data did not reveal an overall change in the number of diabetic codes used after the lecture but did reveal a greater variety in the codes used.

背景

尽管医生经常使用国际疾病分类第九版临床修订本（ICD - 9 - CM）等数字编码系统来描述患者就诊情况，但编码错误很常见。糖尿病是最难编码的诊断之一。ICD - 9 - CM目前有39个单独的糖尿病编码；随着2015年10月ICD - 10 - CM的引入，这个数字将扩大到50多个。

目的

评估一场关于ICD - 9 - CM糖尿病编码的1小时专题讲座的效果。

方法

在俄亥俄州哥伦布市医生医院家庭医疗科，为家庭医疗住院医师举办了一场关于患者就诊时糖尿病编码正确用法的1小时专题讲座。为评估住院医师对该主题的知识掌握情况，在讲座前后分别对住院医师进行了预测试和后测试。回顾并比较了讲座前6周和讲座后6周在该医院接受治疗的所有糖尿病患者的病历中糖尿病ICD - 9编码的使用情况。

结果

18名住院医师参加了讲座并完成了预测试和后测试。预测试正确答案的平均（标准差）百分比为72.8%（17.1%），后测试为84.4%（14.6%），提高了11.6个百分点（P≤0.035）。讲座前后使用的可用编码总数的百分比没有显著变化，但II型受控糖尿病的通用ICD - 9 - CM编码（250.00）的使用有所下降（176例中的58例[33%]降至393例中的102例[26%]），其他编码的使用增加，表明专题讲座后使用的编码种类更多。