GOVERNMENT OF INDIA OFICE OF THE MEDICAL SUPERINTENDENT SAFDARJANG HOSPTIAL, NEW DELHI MEDICAL RECORD DEPARTMENT AND TRAINING CENTRE FOR MEDICAL RECORDS SAFDARJANG HOSPITAL, NEW DELHI WORKSHOP OF ICD – 10 FROM CITIES OF DELHI AND ROHTAK (21-23 JULY, 2004)

SUBJECT: CBHI – WORKSHOP OF KEY TRAINERS ON ICD – 10 FROM CITIES OF DELHI & ROHTAK PRESENT ACTION PLAN FOR IMPLEMENTING ICD – 10 IN THIS HOSPITAL A.PRESENT STATUS OF MEDICAL CODING IN MRD&TC OF S.J. HOSPITAL B.DIAGNOSTIC INDEXING C.TRAINING IN MEDICAL CODING IN ICD-10 IN THE TRAINING CENTRE FOR MEDICAL RECORDS OF THIS HOSPITAL BY VIJAY KUMAR HARNAL, MEDICAL RCORD OFFICER, (MRD&TC), MEDICAL RECORD DEPARTMENT AND TRAINING CENTRE FOR MEDICAL RECORDS, SAFDARJUNG HOSPITAL, NEW DELHI

A. PRESENT STATUS OF MEDICAL CODING IN MRD&TC OF S.J. HOSPITAL 1.THE MEDICAL CODING OF DISEASES IS DONE ON THE CASE SHEET, AS AND WHEN DISCHARGED CASE SHEETS ARE RECEIVED FROM THE WRDS. 2.IT IS DONE BY CODING BOOKS OF WHO I.E. ICD – 10 TH REVISIONS SINCE 1996, BEFORE IT, IT WAS DONE BY THE ICD-9 TH REVISION 3.IT IS DONE BY THE TRAINED MEDICAL RECORD TECHNICIANS OF THIS HOSPITAL 4.MULTIPLE CODING IS DONE I.E. CODE NUMBERS TO ALL THE PRIMARY AND SECONDARY DISEASES ARE GIVEN ON THE CASE SHEETS. 5.OPERATIONS OR SURGICAL PROCEDURES CODING IS ALSO DONE ON THE CASE SHEET WITH RED INK 6.AS YOU MAY BE AWARE CODE NUMBERS FOR OPERATION ARE NOT PUBLISHED IN ICD – 10 TH REVISION. THE CODE NUMBER FOR OPRATION ARE GIVEN AS PER INCD-9 TH REVISION

B. DIAGNOSTIC INDEXING 1.PREVIOUSLY WE HAVE BEEN DOING DIAGNOSTIC INDEXING MANUALLY ON THE DIAGNOSTIC INDEX CARDS FOR RETRIEVAL OF MORBIDITY AND MORTALITY DATA. 2.SAMPLE OF DIAGNOSTIC INDEX CARD IS AS UNDER FOR CODING: G 04.9 (G 04 IS FOR ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS..9 IS FOR UNSPEC9IFIED FOR ITS FURTHER DETAILS) CODE NO. G MRD NO AGE RESULT MONTH OF DAYS OF ASSOCI- UNIT OTHER SEX M F DISCHARGE STAY ATED DISEASE DISEASES Exp NEAURO (IHD) AT PRESENT WE ARE DOING DIANOSITC INDEXING IN THE COMPUTERS

C. TRAINING OF MEDICAL CODING ON ICD – 10 TH REVISION 1.THE MEDICAL RECORD DEPARMENT OF THIS HOSPITAL IS DOING CODING OF DISEASE AS PER ICD-10 TH REVISION SINCE BEING A TRAINING CENTRE FOR MEDICAL RECORDS THE MRO/MRT TRAINEES ARE ALSO TRAINED N THE MRD&TC, 3.ABOUT 19 MRO & 87 MRT TRAINEES OF VARIOUS STATES OF INDIA, VIZ DELHI, U.P., HARYANA, RAJASTHAN, MANIPUR, ASSAM, J7K HAVE BEEN TRAINED IN THIS MRTC SO FAR IN USE OF INCD-10 CODING. 4.THE RESPONSE FO RMRTC TRAINING IS VERY LOW DUE TO VARIOUS REASONS VIZ: -LACK OF MRO/MRT POSTS IN MEDICAL RECORD DEPAREMENTS IN HOSPTIALS. - LACK OF WELL ORGANISED MEDICAL RECORD DEPARTMENTS IN IN THE HOSPTIALS - IT SHOULD BE MADE MENDATORY TO HAVE A TRAINED MRO/MRT IN HOSPITALS BY THE DGHS IN ALL OVER INDIA -SOME HOSPITALS ARE MANNED WITH STATISTICIANS/MINISTERIAL STAFF IN PLACE OF MRO/MRT -LACK OF RECOGNITION TO MEDICAL RECORD DEPARTMENTS AND TRAINED MEDICAL RECORD PERSONNEL

5. THE ICD-10 MEDICAL CODING CAN BE IMPROVED IN INDIA BY DEVELOPING MEDICAL RECORDS OF HOSPITALS OF INDIA BY - - A STUDY SHOULD BE MADE TO IDENTIFY THE STATUS OF MEDICAL RECORDS OF VARIOUS HOSPITALS OF ALL THE STATES OF INDIA. - EXISTENCE OF MEDICAL RECORD DEPARTMENT. - SUGGEST SUFFICIENT NUMBER OF TRAINED MRO/MRT STAFF. -TO MAKE IT ESSENTIAL TO HAVE A TRAINED MEDICAL RECORD STAFF. - FOR TRAINED MEDICAL RECORD STAFF -FOR TRAINING LIN MEDICAL CODING OF INC-10 IN VARIOUS HOSPITALS IN INDIA THE HOSPITALS SHOULD GET THEIR STAFF TRAINED IN MRTC OF SAFDARJANG 7 PONDICHERY IN MRO/MRT TRAINING, BEING CONDUCTED IN THESE TRAINING CENTRES THROUGH THE OFFICE OF DIRECTOR, CBHI (DGHS), ROOM NO. 401, A WING, NIRMAN BHAVAN, NEW DELHI. -MEDICAL CODING IS ONE OF THE ULTIMATE SUBJECT IN BOTH THE ABOVE COURSES. -MEDICAL CODING CAN NOT BE DONE WITHOUT THE TRAINED MRO/MRT PERSONNELS.

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