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在ICD-10第三卷中采用主导词“丙”查到单克隆丙种球蛋白病的编码是D47.2;意义未明的单克隆丙种球蛋白病的编码是D89.2。回顾某院收治的1例意义未明的单克隆丙种球蛋白病(MGUS)患者的临床表现、骨髓病理改变和治疗,并复习相关文献,分析意义未明的单克隆丙种球蛋白病的临床特征与其它类型丙球蛋白病的区别,特别是与单克隆丙种球蛋白病的区别,单克隆丙种球蛋白血症是一组由B细胞克隆性增殖所致的疾病,其共同特点为分泌具有相同结构的免疫球蛋白分子或其片段,即M蛋白。MGUS的诊断标准包括:(1)血清中M-蛋白浓度<3g.dl~(-1);(2)骨髓中浆细胞<10%;(3)尿中极少或无M-蛋白;(4)扁骨中没有溶骨性损害;(5)无相应的贫血、高钙血症或肾功能不全~([3])。仔细阅读病案,按照国际疾病分类原则进行准确的ICD-10编码。提示意义未明的单克隆丙种球蛋白病与单克隆丙种球蛋白病要分开编码,需要在使用的字典库中扩充编码D89.2未确定意义的单克隆丙球蛋白病,这样可避免编码员在电脑系统查找中,在没有在卷三查找的情况下,把D89.2未确定意义的单克隆丙球蛋白病,错编码成D47.2单克隆丙种球蛋白病。编码员阅读病案,提高医学知识和国际疾病分类专业技能,是准确进行编码的关键。
The code for the detection of monoclonal gammopathy in the ICD-10 Volume III using the predictor “C” is D47.2; the coding of unidentified monoclonal gammopathy is D89.2. To review the clinical manifestations, pathological changes and treatment of one patient with unidentified monoclonal gammopathy (MGUS) in a hospital and to review the relevant literature to analyze the clinical features of monoclonal gammopathies with unknown significance and other The difference between type globulinopathy, in particular with monoclonal gammopathies, is that monoclonal gammopathies are a group of diseases caused by the clonal proliferation of B cells that share the common feature of secreting proteins that have the same structure Immunoglobulin molecule or fragment thereof, ie M protein. MGUS diagnostic criteria include: (1) serum M-protein concentration <3g.dl -1; (2) bone marrow plasma cells <10%; (3) little or no M-protein in urine; ( 4) no osteolytic lesions in the flat bones; (5) no corresponding anemia, hypercalcemia or renal insufficiency ~ ([3]). Carefully read the medical records, in accordance with the principles of international classification of diseases ICD-10 accurate coding. Promising monoclonal gammopathies of unknown significance are coded separately from monoclonal gammopathies and require the use of dictionaries that augment the undefined significance of monoclonal gammopathy by D89.2, In the computer system search, monoclonal C globulin disease of undetermined significance of D89.2 was mistakenly coded as D47.2 monoclonal gammopathy in the absence of volume three searches. Encoders read medical records, improve medical knowledge and international disease classification expertise, is the key to accurate coding.