Hello! I hope the following answer can be helpful to you: What are the key points in the process of entering the DRG grouping of the medical insurance settlement list? 1. Determine whether to be grouped in advance based on the discharge diagnosis (1) Organ transplantation or ventilator use for more than 96 hours will be classified into MDCA (preliminary grouping of diseases and related operations); analyze the reasons why DRG cannot be included in the medical insurance settlement list. What are the key points to enter the DRG group? ? 1. The total cost of DRG enrollment failure caused by non-coding reasons is 0 (doctor’s order to leave the hospital), there is injury, no external reasons, and the coded main operation is not filled in. The main diagnosis is inconsistent with the surgical operation. 2. The DRG enrollment failure caused by coding reasons, the main diagnosis and In the first five "other diagnoses", there are situations where the medical record codes are not recognized: there are a large number of "non-specific" and "unspecified" disease codes, and there are a large number of pathology codes. Other cases of underpayment of medical insurance funds caused by DRG enrollment issues 1. Abnormal cost cases - high-rate cases are cases with a rate 2.5 times higher than the DRG benchmark value. One type is when the patient has operational complications during hospitalization. The treatment of complications resulted in high medical consumption (medical insurance will not compensate in this case because the hospitalization condition is 4 and can be avoided); there is also the deliberate high number and low number mentioned above, artificially causing a high rate of cases. , in an attempt to induce medical insurance to pay on a project-by-project basis. High-rate cases will cause the hospital to bear an additional 1.5 times the benchmark expenses, resulting in losses for the hospital. Solution: Check whether the information on the home page of the medical record is filled in (2) Newborns younger than 29 days old are classified into MDCP (Neonatal and other perinatal neonatal diseases); (3) HIV is classified into MDCY (HIV infectious diseases and related diseases) Operation); (4) Multiple severe traumas are classified into MDCZ (Multiple Severe Traumas); (5) The remaining cases are classified into different MDCs according to the main diagnosis. Among them, reproductive system diagnosis also distinguishes gender, males are classified into MDCM, and females are classified into MDCN, each MDC has a major diagnostic table for reference. 2. According to the main diagnosis and main surgeries and operations in the settlement list, they are divided into each ADRG group (1) those with operating room surgeries or operations are divided into the corresponding surgery and operation groups; (2) those without operating room surgeries or operations are classified into the main diagnosis They will be assigned to the relevant internal medicine group; (3) When the main diagnosis and the main surgery and operation do not match in the grouping table, they will be assigned to the QY group of the corresponding MDC. 3. Compare all other diagnoses in the settlement list with the MCC/CC table. If the comparison is successful, search for the corresponding MCC/CC exclusion table and divide it into each DRG group (1) If the main diagnosis is in the corresponding exclusion table , then the other diagnosis is not MCC or CC; (2) If the main diagnosis is not in the exclusion list, MCC will be classified into the group with serious complications or comorbidities; if there is only CC, it will be classified into the group with general complications or comorbidities group; (3) If neither is present, it is divided into without complications or comorbidities.