Abstract：Objective To summarize the methods and ideas of accurate coding for premature rupture of membranes, so as to improve the coding accuracy of premature rupture of membranes.Methods I retrieved medical records with ICD-10 code O42 as the main diagnosis in the obstetrics department of a hospital from Jan. 1st, 2021 to June 30th, 2021. According to the international classification code of diseases (ICD-10) rules and combined with relevant clinical medical knowledge, the accuracy of the classification code of premature rupture of membranes on the first page of each medical records was reviewed and analyzed one by one, and the error types and factors leading to errors were statistically analyzed.Results There were coding errors in 38 medical records, with an error rate of 33.63%. The main reasons of the errors were shown as follows: carelessness and lacking knowledge of clinical and coding rules of the coders; poor mastery of the main principles of obstetrics diagnosis and inaccurate writing of medical records of clinicians.Conclusion It is necessary to improve coding accuracy by strengthening the construction of the coding team, controlling coding quality as well as training coders and clinicians.
饶毅. 2021年1—6月某院产科胎膜早破ICD-10编码案例分析[J]. 中国医院统计, 2022, 29(3): 179-182.
Rao Yi. Case analysis on ICD-10 coding for premature rupture of obstetric membranes in a hospital from January to June 2021. journal1, 2022, 29(3): 179-182.
