急，谁能告诉我美国为啥要用icd-10-cm.与ICD-10区别在哪。

jekyllhy

急，谁能告诉我美国为啥要用icd-10-cm.与ICD-10区别在哪。

jekyllhy

ICD is an abbreviation of international statistical classification of disease and related health problem. And ICD-10-cm is the clinical modification of ICD-10. who knows why american use icd-10-cm to certificate morbidity data while use icd-10 to certificate mortality data.

dongxi

授之以渔　
http://www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm

jekyllhy

i have seen all this materials, but ...

dongxi

ICD 核心分类为3 位代码,基本满足世界卫生组织死亡统计报表的需要.ICD-10-CM 包含更详细的代码。
ICD-10-CM。它是和ICD-10 完全兼容的,但是它还包含额外的分层详述。另外，ICD-10-CM 包含关于
医疗过程的第三卷。

jekyllhy

能否谈谈关于医疗过程的第三卷大概情况。谢谢。

dongxi

6. Principal procedures for
admitted patients
Introduction
The National Health Data Dictionary defines the principal procedure as the most significant
procedure that was performed for treatment of the principal diagnosis. A procedure is one
that is surgical in nature, carries a procedural risk, carries an anaesthetic risk, requires
specialised training, or requires special facilities or equipment only available in an acute
setting. The procedures encompassed in the ICD-9-CM classification include surgical
procedures and also non-surgical investigative and therapeutic procedures such as X-rays and
chemotherapy.
Procedures are not undertaken for all hospital admissions so only a proportion of the
separation records includes principal procedure data. For example, fewer than 40% of the
reports for separations with principal diagnoses within the Mental disorders and Infectious and
parasitic diseases chapters included principal procedures in 1995–96.
The tables and figures in this chapter use the information on the principal procedure reported
for the separations using ICD-9-CM codes. The tables include the numerical codes and
abbreviated descriptions of the categories. Full descriptions are available in the Australian
edition of ICD-9-CM, implemented in July 1995 (National Coding Centre 1995).
Information in this chapter is presented using three methods of grouping records based on the
ICD-9-CM principal procedure code. Tables and figures using the first two methods
incorporate all separations, while those using the third do not:
• ICD-9-CM chapters—these 16 groups provide information aggregated at the ICD-9-CM
chapter level (Figures 6.1 and 6.2)"
• ICD-9-CM procedure groups—these groupings were chosen to provide more detailed
information than ICD-9-CM chapter headings, but still at a manageable level (Tables 6.1
to 6.10). Note that these groups vary slightly from those used in previous Hospital
Utilisation and Costs Study reports (for example, Cook 1996)"
• 3-digit ICD-9-CM codes that accounted for the highest numbers of separations in the
public and private sectors—this method provides information at a level enabling analysis
of more specific procedures rather than groups of procedures (Tables 6.11 to 6.18 and
Tables D3 and D4 on the diskette). Information in the National Hospital Morbidity
Database includes even finer detail (that is, at the 4-digit code level as detailed in
ICD-9-CM).
Tables are presented with summary national separation, patient day and length of stay
statistics for public and private hospitals. In addition, the data are presented by State and
Territory and by age group and sex. Separations for which procedures other than the principal
procedure were reported have been analysed by principal procedure only.

ironstone

简单说一下：
ICD本来是WHO应用在死亡统计的疾病分类编码，主要用于对比全球不同国家的卫生状况，统一的统计分类编码才能够使得这种统计具有统计学上对比的意义，但其后来发现医疗方面的其他统计也需要统一的编码，而ICD也可以用于满足这方面的统计要求，所以就逐渐扩大了ICD所覆盖的范围，每10年进行一次修订。但由于其基础是为了满足WHO的疾病的分类统计而进行的编码，所以在分类上的粗细上并不能够满足临床上的分类统计应用。比如某一种疾病ICD可能仅分到这个疾病的细类，而在临床统计的时候可能还需要统计到该疾病的细类的分型，甚至随着临床研究的发展有可以要统计到疾病的分子分型，而ICD是不会考虑到这么细的，因此到这么细，对于发展中的国家的卫生统计是没有意义的。所以为了满足临床的需要，美国医学会在ICD的基础上对ICD进行更细的划分，舍弃了一些临床上不必要的东西，但总体上还是遵循ICD的编码原则的，从而形成了ICD－9－cm，用于满足其临床统计的应用。
在国内不少HIS以及医院将ICD当作疾病诊断字典或者当作疾病命名字典来用，其实是一种误解。

jekyllhy

这是我查了一些资料写的一些小文章：
A comparison of ICD-10 and ICD-10-CM
Introduction:
The purpose of this essay is to compare the ICD-10-CM system with ICD-10 system, subjectively discuss its strengths and weaknesses.
Background:
The ICD-10 is the foundation for ICD-10-CM and continues to be the classification employed in cause-of-death coding in the United States. The ICD-10 is a revision of ICD-9, and expanded some codes from ICD-9-CM. ICD-10 differs from ICD-9 in a number of respects:
1) ICD-10 is far more detailed than ICD-9" about 8,000 categories compared with 4,000 categories. The expansion was mainly to provide more clinical detail for morbidity applications"
2) ICD-10 uses 4-digit alphanumeric codes compared with 4-digit numeric codes in ICD-9"
3) Three additional chapters have been added and some chapters rearranged"
4) cause-of-death titles have been changed, and conditions have been regrouped"
5) Some coding rules have been changed.
6) Finally, ICD-10 is published in three volumes compared with two volumes in ICD-9.
The ICD-10-CM is a clinical modification of ICD-10. The term clinical is used to emphasize the modification’s intent: to serve as a useful tool in the area of classification of morbidity data for indexing of medical records, medical care review, and ambulatory and other medical care programs, as well as for basic health statistics. To describe the clinical picture of the patient the codes must be more precise than those needed only for statistical groupings and trend analysis.
Why we need a clinical mortification of ICD-10?
There are some weaknesses of ICD such as not specific enough for all data user needs. So some modification should be made as below:
1) Expand distinctions for ambulatory and managed care encounters
The explosive growth of ambulatory surgery was one of the major developments in the recent decades of turbulent changes in the U.S. health care system. Extrapolating the overall surgical trend from either the inpatient or ambulatory data would have been misleading. It will likely become increasingly important to include information about ambulatory and managed care encounters.
2) Expand to include new concepts
3) Expand to include emerging diseases and more recent medical knowledge.
4) Incorporate changes made to ICD-9-CM since ICD-10 implementation

The major modifications of ICD-10-CM
1) Addition of sixth character and/or seventh character
Compared with the ICD-10 system with 4 alphanumeric codes, the ICD-10-CM codes have been expanded to six or seven characters.
Example: S32.0 Fracture of lumbar vertebra
        S32.00 Fracture of unspecified lumbar vertebra
    S32.001 Stable burst fracture of unspecified lumbar vertebra
The following 7th character extensions are to be added to each code for this category: A fracture not identified as opened or closed should be coded to closed
a: initial encounter for closed fracture
b: initial encounter for open fracture d subsequent encounter for fracture with routine healing
g: subsequent encounter for fracture with delayed healing
j: subsequent encounter for fracture with nonunion
q: sequela
The ICD-10-CM is far more detailed in order to capture the finer level of detail on medical records compared to the less detailed diagnostic information reported from ICD-10.
2) Addition of laterality
Sometimes the detail medical information is needed for reimbursement. The health insurance companies are interested in gaining the information about laterality.
3) Created combination diagnosis / symptoms codes
In October 1997, the official ICD-9-CM contained 12,562 diagnosis codes (categories).
Effective October 1998, the number will rise to 12,628 diagnosis codes. The draft version of ICD-10-CM as posted on the Internet, however, contained approximately 60,000 codes.  The enormous increase in numbers of categories (codes) appears to be primarily the result of an increase in the use of “combination coding.” One type of combination coding is to subdivide a disease or injury category by adding digits, in this case usually 4th and 5th digits, which describe the site of its manifestation.
4) Added trimesters to OB codes
Pregnancy is divided up into three three-month periods called trimesters. There are specific events that occur during these three trimesters. If there are complications, they tend to be confined to one of these trimesters. However, pregnancy is a continuous process from the moment of conception to birth. So the information of trimesters is added to OB codes to provide the detailed information.
5) Revised diabetes mellitus codes
The new classification system identifies four types of diabetes mellitus: type 1, type 2, "other specific types" and gestational diabetes. Arabic numerals are specifically used in the new system to minimize the occasional confusion of type "II" as the number "11." Each of the types of diabetes mellitus identified extends across a clinical continuum of hyperglycemia and insulin requirements. The changes recommended by the expert committee for the diagnosis of diabetes mellitus should prove beneficial to patients. So the diabetes categories have been fully revised to reflect the recent revisions to the classification of DM issued by the American Diabetes Association.
6) Expanded codes (e.g., injury, diabetes)
Detail for open wounds added at 5th digit.
The challenges of ICD-10-CM
The ICD-10-CM meets some challenges:
1) This is the pre-release draft of ICD-10-CM and implementation of this version takes time.
2) Concerns about privacy may favor use of systems with less detail as being more acceptable when the full detail of the medical record is not necessary.
Conclusion:
It is important to keep in mind that ICD-10 is well known and used by many countries, but it is not as robust as the draft ICD-10-CM. ICD-10-CM far exceeds its predecessors in the number of concepts and codes provided. The disease classification has been expanded to include health-related conditions and to provide greater specificity at the sixth digit level and with a seventh digit extension. With slight modification, it might become a suitable replacement of ICD-10 in the area of classification of morbidity data.

jekyllhy

谢谢楼上两位给我的解答。