Analysis of the ICD-10 Coding of Intra-abdominal Abscess

Abstract

Objective. To assign the correct ICD-10 code to an intra-abdominal abscess, based on its etiology and position. Methods. The medical records of a hospital from April 1, 2009 to March 31, 2013, of patients having a discharge diagnosis of intra-abdominal abscess, were retrospectively analyzed according to the etiology and location. An intra-abdominal abscess is encoded based on the classification requirements of the International Statistical Classification of Diseases and Related Health Problems (second version of ICD-10). Results. Out of 57 medical records of patients diagnosed as having an intra-abdominal abscess, there are 7 medical records showing a primary intra-abdominal abscess, accounting for 12.28%; there are 50 medical records showing a secondary intra-abdominal abscess, accounting for 87.72%. Conclusion. The name ‘intra-abdominal abscess’ is a diagnostic name commonly used by clinicians. Coders must read the medical record information and clearly know the cause of the condition and the abscessed parts of an intra-abdominal abscess, to guarantee the accuracy of the intra-abdominal abscess code.