澳洲与美国发展与推动ICD-10临床修订版工作坊.ppt

對健康保險支付制度的影響 Source : /apps/media/press/release.asp?Counter=1836 * DRG分類解決方向: 1.增加合併症/併發症嚴重度分組 2007年10月1日公告,合併症/併發症再細分成三組 (1) without complication/comobidity (2) with complication/comobidity (3) major complication/comobidity DRG組數增加至999項 2.以ICD-10分類取代ICD-9做為疾病分類基礎 ICD-10-CM 第十版臨床修訂分類與申報 The ICD-10 coded data will permit a better assessment of patient severity, the intensity and complexity of services provided to patients, and the resources utilized in caring for patients. ICD-10-CM 對於保險申報誤報浮報的預防與偵測 It may help reduce the opportunities for fraud and improve fraud detection capabilities. The report of the anti-fraud study conducted by the Office of the National Coordinator for Health Information Technology (ONC) is available at 第十版臨床修訂版適用於醫院所有診斷編碼 ICD-10-CM will replace ICD-9-CM diagnosis codes and will be used for reporting all diagnoses. Providers in all healthcare settings currently utilize ICD-9-CM diagnosis codes to report various conditions, diseases or symptoms as required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and in the future these same providers will utilize ICD-10-CM diagnosis codes for reporting, payment, research, and other purposes. ICD-10-PCS第十版處置編碼系統 第十版處置分類編碼系統不影響門診醫師保險給付申報 ICD-10-PCS will not be used in physician offices. ICD-10-PCS will be used only for inpatient billing by hospitals. Physicians - Current Procedural Terminology (CPT) - Healthcare Common Procedure Coding System (HCPCS) 世界各國運用情形 HCFA-DRGs (499 Fallgruppen, 1983) 老人保險, C.C vs Non-C.C AP-DRGs (641 Fallgruppen, 1988) New York針對非Medicare被保險人,增加兒童及青少年部份 R-DRGs (1198 Fallgruppen, 1991) 將嚴重度區分更細, Non-C.C, Moderate-C.C, Major-C.C, Catastrophic-C.C APR-DRGs (1530 Fallgruppen, 1993) 嚴重度區分為Minor, Moderate, Major, Extreme四類 最後分成382個base DRG, 1530個APR-DRGs IAP-DRGs (1046 Fallgruppen 1999 ) WHO以ICD-10為分類基礎之DRG 美國 Mapping 版本對照 電腦軟體公司已發展處理轉換使用第十版臨床修訂疾病分類與處置分類的相關軟體 ICD-9-CM and ICD-10-CM ICD-9-CM and ICD-10-PCS G