Research on the coding system of medical consumables based on medical insurance classification coding
基于医保分类编码的医用耗材编码体系研究

摘要

目的 构建符合医保标准化需求的医用耗材编码体系，解决现行编码混乱、数据孤岛等问题，支撑医保支付改革与耗材精细化管理。方法 采用文献研究、实证分析与跨系统数据验证相结合的方法，基于医保业务场景设计“分类分层+属性关联”编码模型，通过某三甲医院试点与省级医保平台数据互通测试验证效果。结果 试点医院编码统一率从41%提升至92%，医保结算效率提高59%，年节约采购成本1200万元；跨区域数据互通实现耗材使用异常预警，违规率下降65%。结论 该编码体系显著提升编码标准化水平与医保管理效能，需进一步推动全产业链协同与智能化维护，为“三医联动”提供支撑。

Abstract

Objective To construct a medical consumables coding system that meets the requirements of medical insurance standardization, solve the current problems such as chaotic coding and data silos, and support the reform of medical insurance payment and the refined management of consumables.
Methods Adopted a combination of literature research, empirical analysis and cross-system data verification. Based on the medical insurance business scenarios, a coding model of "classification and stratification + attribute association" was designed. The effect was verified through the test of data intercommunication between a pilot project in a tertiary hospital and the provincial medical insurance platform.
Results The unified coding rate of the pilot hospitals increased from 41% to 92%, the efficiency of medical insurance settlement improved by 59%, and the annual procurement cost was saved by 12 million yuan. Cross-regional data intercommunication has enabled abnormal early warning of consumable usage, reducing the violation rate by 65%.
Conclusion   This coding system significantly enhances the standardization level of coding and the efficiency of medical insurance management. It is necessary to further promote the collaboration of the entire industrial chain and intelligent maintenance to provide support for the "three medical linkages".