中醫疾病辨證編碼之研究

目前中醫健保之申報及給付均以國際分類表碼(A-code)爲依據，然而中西醫病名不同，診治的模式亦不同，勉強使用西醫病名的分類表碼來申報，容易有誤診誤報，病名與處方不合的情形發生，而審查醫師依書面申報資料，又無法判定其病症與處方是否合理，造成審查困擾、醫療資源的浪費和許多不必要的紛爭。有鑑矜此，應有必要建立一套符合中醫診病模式的疾病分類編碼系統，以因應健保申報及審查的實際需要。本項研究以A-code爲基礎，在現行的西醫病名編碼後面，附以中醫辨證編碼：第一碼代表病因、第二碼代表藏府、第三碼代表病症所在的層次或部位、第四碼代表病機與證候。最常見或主要的選項均以阿拉伯數字編碼，而0代表「無或其他」，較少見或次要的選項以大寫英文字母編碼，而Z代表「複雜」，兼具多種證型者，亦可同時申報數個B-code。

關鍵字

中醫疾病編碼； B-code ；國際分類表碼； A-code

並列摘要

The current system of reimbursement in national health insurance for Chinese medicine in Taiwan is done according to the ”A-code” system, which depends on Western medicine for diagnosis classifications. Because Chinese medicine uses a system of diagnosis that differs significantly from that of Western medicine, adopting the ”A-code” system often causes many technical problems in insurance reimbursement. Therefore, we propose a new coding system (the ”B-code” system), which would serve the management of national health insurance in Taiwan better. The ”B-code” system adds another four digits (which should properly identify the TCM diagnosis) to our current ”A-code” system. The first digit for TCM diagnosis indicates etiology, the second digit indicates the diseased viscera, the third digit marks the phase and/or the extent of the disease, and the fourth digit describes the mechanism and pattern of disease. The major categories are coded in numbers, with ”0” representing ”none” or ”others”. The minor categories are coded in English alphabets, with ”Z” representing ”complex”. For diseases that are more complex in nature, several sets of ”B-code” numbers can be applied simultaneously.

並列關鍵字

A-Code ； ICD-9 ； B-code ； traditional Chinese medicine

國際替代計量

中醫疾病辨證編碼之研究

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