基于DRGs支付方式下误入高倍率病案的诊断与手术操作填写和编码缺陷分析

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中图分类号：R197.323文献标识码：A

DOI:10.3969/j.issn.1006-1959.2025.18.007 文章编号：1006-1959(2025)18-0033-04

Diagnosisand Surgical Operation Fillingand CodingDefect Analysis ofMistakenly inHigh-rate CasesBased onDRGsPaymentMethod

LI Xiandi

(MedicalRecordStatistcsRoomofundeHospitalAflatedtoinanUnvesityoshan2835,Guangdong,ina)

Abstract:ObjectieToalyeteigateasesasedonGsayentinurgerydepartmentofospitalinFoshandtopete reasonsfrmistakenlyinatessdropoproenteasustodospialooicehtsgtfate caseserecoldfrtscirgdastrialoi theseletfrrileodesilsdeetfi andsurgicaloeratioflngndcinginhefirstpafteedalreodshcheecoddndasifdwiExcel2OulsOf the84 high-ratecases,26medicalrecordsweremistakenlycompiledbycoders,themaindiagnosiserorsaccounted for 46.15% in 12 case,the main operation accounted for 34.62% in 9 cases,the main diagnosis and main operation accounted for 11.54% in 3 cases,the other diagnoses or other operations accounted for 7.69 % in2 cases.Among the 26 casesof wrong medical records,15cases were mistakenly compiled by doctors,the main diagnosis accounted for 20.00% in2 cases,the main operation accounted for 60.00% in9 cases,the main diagnosis and main operation accounted for 13.33% in2 cases,the other diagnosis or other operation accounted for 6.67 % in1 case.Conclusion The main reason for mistakenly inhighratecassisetreodingndflingofemaindagosisdtemainoeratioreacurateTeospialsoudstre writingqualityofdaosisndsurgcaloatondteualitofCDodngtseteoticsioofedicalodsdvdte economic loss caused by entering the high-rate cases group,

Keywords:DRGs;High-rate cases;Diagnosis and surgery operation; Coding defect

《国务院办公厅关于进一步深化基本医疗保险支付方式改革的指导意见》（国办发[2017]55号）明确提出“2017年起，进一步加强医保基金预算管理，全面推行以按病种付费为主的多元复合医保支付方式，国家选择部分地区开展按DRGs付费试点。（剩余7573字）