JPH07104883B2 - Dental insurance claim office calculator - Google Patents

Description

TECHNICAL FIELD The present invention relates to a dental insurance claim office computer, and more particularly to a method of calculating medical items.

(B) Conventional technology Insurance claim calculators that issue counters and monthly medical bills are widely used in general hospitals such as internal medicine and surgery. Sanyo Giho Vol.11 No.1 (1979 edition) ".

In such a computer, the operator in the counter work specifies the day and date when the medical examination was performed and the patient, and
The doctor has to input the medical care code indicating the medical care item given to the patient and the number of times. In response to this, the computer adds the medical care data of the medical care item to the inputted medical care code and the number of times, and then stores the data in the storage area of the medical care data of the day in the patient data file of the patient. .

In this way, the medical treatment points of the medical treatment items performed on that day are calculated and recorded for each medical treatment day.

By the way, in the case of dentistry, it is necessary to also describe the "site" that was treated in the medical treatment fee statement. Therefore, in the conventional window work, the treated site, the medical care code, and the number of times of medical care are input.

For example, if the unit of a part is a medical item for one tooth, and the medical items are given to three teeth, the positions (parts) of these three teeth are
I entered the code of the medical care item and the number of times as 3.

(C) Problems to be Solved by the Invention In the conventional dental insurance claim calculator, as described above, the operator has to input the medical treatment site, the medical treatment code, and the number of times, so that the operation is performed. Was troublesome.

Also, in dentistry, the insurance score differs depending on the type of tooth such as anterior teeth, premolars, molars and the number of root canals (the number of tooth roots). Items with different insurance points are treated as different medical care items, and different medical care codes are assigned to each.

However, the medical record entered by the doctor only describes the dental formula in which the tooth numbers representing the treated teeth are lined up, along with the medical treatment name, and whether it is an anterior or posterior tooth or the number of root canals Some information is not listed.

Therefore, the operator looks at the tooth formula written in the chart to determine the type of tooth to be treated and the number of root canal teeth,
Based on this, the corresponding medical care code and the number of times of medical care must be input while performing the thinking work of deciding the medical care code, and the burden was very heavy.

(D) Means for Solving the Problems The present invention provides a method for treating a plurality of medical care items having the same medical care content and having different insurance points depending on factors such as the number of root canals and the types of teeth. A storage unit that pre-stores region representative data indicating a region or a number of teeth that can be a target of calculation for each of the plurality of medical care items, and a region indicating the representative code and a region where medical treatment is performed. With respect to the input means for inputting data and the plurality of medical care items represented by the input representative code, the site definition data is read from the storage means, and the read site definition data is collated with the input site data. Then, the calculation means for calculating the number of times that can be calculated for each of the plurality of medical care items, and the calculated number of times are displayed as the number of times of calculation for each of the plurality of medical care items. The above-mentioned problem is solved by providing a display means for doing so.

(E) Action In the present invention, the number of times is automatically calculated and displayed as long as the site data indicating the treated site and the representative code representing the medical care content are input, and the operator is troubled to think. Also, it is released from the troublesome number of inputs.

(F) Example Before explaining examples of the present invention, first, a tooth formula will be described. The tooth formula indicates a tooth part, and
As shown in the figure, it consists of vertical and horizontal straight lines and numbers. The vertical and horizontal straight lines indicate a boundary that divides the mouth (oral cavity) into upper, lower, left and right, and the numbers indicate tooth numbers sequentially given from the front teeth to the back teeth. Therefore, when the dental examination as shown in FIG. 18 is shown as the treated site, the tooth of the upper right jaw No. 4 is
This means that the patient examined the 7th lower left jaw.

Now, FIG. 1 is a block diagram showing a configuration of an embodiment of a dental insurance claim office computer according to the present invention, in which (1) is provided with various keys such as a tooth type key, an input key, a character key and a numeric key. Keyboard, (2) CRT display as display device, (3) external storage device such as magnetic disk comprising patient data file (4) and medical care code file (5), (6) data memory, (7) ) Is a processing target buffer, (8) is a definite buffer, (9) is an arithmetic processing unit,
(10) is a control unit.

In the present invention, as in the conventional case, even if the medical care contents are the same,
Different medical care codes are assigned to a plurality of medical care items A, B, C, ... whose insurance points are different depending on factors such as the number of root canals and the types of teeth, but these plural medical care items A, B, A representative code representing C, ... Is newly defined. Then, in the representative code portion (11) of the medical care code file (5), the representative code and the medical care code contained therein are stored as representative data in association with each other as shown in FIG. I also remember the name.

Further, for each medical care item, as shown in FIG. 3, a medical care code, a name, a score, and part check data which is data relating to a part required for automatic calculation are used as medical care item data as a medical care code file. It is stored in the medical care code section (12) of (5). The site check data consists of site unit identification data that shows the unit of calculation for the calculation of 1 oral cavity, 1/3 jaw, the number of root canals, etc., and site definition data that defines factors such as the number of root canals and tooth types for the site. As will be described later, the site unit identification data is used to select the type of calculation to be performed in automatic calculation, and the site definition data is used together with the data in the actual calculation process. Specifically, the part definition data is represented by a tooth formula, the number of teeth, and the like.

Here, the definition about the part of each factor is the number of root canals, 1/3 jaw,
The types of teeth will be taken as examples and shown in FIGS. 4 (a) to 4 (c). However, the 1/3 jaw is the range (site) where the upper or lower jaw is divided into the anterior and left and right molars, but if it is within this range, if the total number of teeth is 3 or more, it is 1 It is treated as a / 3 jaw unit, and if it has 1 to 2 teeth, 1/3 jaw (1 to 2 teeth)
Treated as.

Next, the contents of the medical care code file (5) will be described in detail by taking specific medical care contents as an example. First, the relationship between the medical care contents and the insurance points will be shown below.

(I) Root canal patch Single tooth 10 points 2 roots 15 points 3 roots 20 points (ii) Extraction surgery 1 tooth front tooth 140 points Molar 240 points (iii) Periodontal tissue detailed examination Total number of teeth per oral cavity Up to 20 teeth 180 points 21 to 24 teeth 300 points 25 teeth or more 400 points (iv) Tartar removal 1/3 jaw 55 points to the first 1/3 jaw 1/3 when 1/3 jaw is exceeded at the same time 40 points each time 3 jaws are added 40 points in the case of 1-2 teeth Regarding the medical treatment of (i) to (iv) described above, in the present embodiment, the medical treatment code file (5) is respectively shown in FIGS. Data is stored as shown in the figure. The classification of the site unit identification data is shown in FIG.

(I) Root canal patch (Fig. 5) There are three clinical items according to the number of root canals, and the site definition data for each clinical item is a tooth formula that defines a single root, two roots, and three roots, respectively. I remember.

(Ii) Tooth extraction surgery (Fig. 6) There are two medical care items according to the type of tooth, and as the part definition data of each medical care item, the dental formula defining the anterior tooth and the dental formula defining the posterior tooth are stored. is doing.

(Iii) Periodontal tissue detailed examination (Fig. 7) There are three medical care items according to the total number of teeth, and as the site definition data of each medical care item, the number of teeth that defines the range of the total number of teeth is I remember.

(Iv) Tartar removal (Fig. 8) There are three medical care items. As site definition data, tartar removal (1/3 jaw first) is "1" indicating the first 1/3 jaw, tartar removal (1 "/ 3 jaws" indicates 1/3 jaw beyond the first 1/3 jaw, and "2" indicating tartar removal (1 to 2 teeth), 1 to 2 teeth beyond the first 1/3 jaw. "3" shown is stored.

Since the range of 1/3 jaw cannot be easily expressed by the tooth formula or the number of teeth as in (i) to (iii), numerical values such as “1” to “3” are used as the site definition data. Remember, 1 /
The data defining the three jaw range is separately stored in the data memory (6).

Next, with the flowchart of FIG. 10 and the display example of FIG. 11,
The overall processing flow of this embodiment will be described with reference to the explanatory view of FIG. Note that FIG. 11 is an example of a root canal patch.

In the window work, first, enter the patient code and date from the keyboard (1), then press the tooth type key to display the cross line on the display screen of the CRT display (2) and then enter the tooth number. As a result, the dental formula indicating the part used for medical examination is input. Then, after that, a representative code indicating the content of medical treatment is input (Fig. 11 (a)).

Then, as shown in FIG. 12 (a), the inputted dental formula is stored in the confirmation buffer (8), and a plurality of medical care item data included in the inputted representative code is converted into the medical care code file (5). ) Is read from the medical care code portion (12) of the processing buffer (7).

Next, the site unit identification data in the read medical care item data is determined, and the arithmetic processing unit (9) is determined according to the content.
Then, the corresponding arithmetic processing is performed, and the number of times that can be calculated for each medical care item is calculated. This calculation process is executed based on the inputted tooth formula and part definition data, as will be described later.

When the number of times that can be calculated is calculated, as shown in Fig. 11 (b), these times are displayed as the number of times of calculation along with the corresponding medical care code, medical care item name and score on the screen of the CRT display (2). To be done.

Therefore, when the operator confirms the displayed number of times of calculation and then presses the input key, as shown in FIG. 11C, only the medical care items for which the number of times of calculation is one or more are displayed on the display screen. It is displayed again in the form of (point) × (number of times) to inform the operator that the input regarding this medical care item has been completed. At the same time, inside the device, Fig. 12 (b)
As shown in (4), for the displayed medical care item, the number of calculations is added to the medical care item data and stored in the confirmation buffer (8), and the contents of the processing target buffer (7) are cleared. It is also possible to correct the displayed number of calculations by using the numeric keys before pressing the input key.

In this way, when the end key is pressed after the calculation is completed, the tooth formula stored in the confirmation buffer (8), the medical care item data excluding the part check data, and the number of calculations are displayed.
The patient data is stored in the patient data file (4) in the patient-specific place as the patient data of that date.

The overall processing flow of this embodiment has been described above. Next, the calculation processing for calculating the number of times that can be calculated will be described in detail.

Hereinafter, description will be made according to the classification of the site unit identification data.

(A) 01: number of root canals As shown in the flowchart of FIG. 13, the input tooth formula of the confirmation buffer (8) is compared with the tooth formula as the part definition data read in the processing target buffer (7). , The number of coincident teeth is the number of times N of calculation of each medical care item, as shown in FIG.

For example, if the input tooth formula is Then, when the input representative code is “Tu”, it is calculated as follows.

Root canal patch (1) 10 × 5 Root canal patch (2) 15 × 1 Root canal patch (3) 20 × 3 (b) 02: Tooth / teeth type Also in this case, refer to the flowchart of FIG. This is the same as the processing shown, for example, Then, when the input representative code is “Ts 12”, it is calculated as follows.

Extraction surgery (anterior teeth) 140 × 1 Extraction surgery (molars) 240 × 1 (c) 03: 1 oral cavity / total number of teeth As shown in the flowchart of FIG. It is determined whether or not the total number of teeth N is included in the number-of-teeth range NL to NH as the part definition data of the medical care item, and the number of times of only the medical care item included is set to "1".

For example, if the input tooth formula is When the input representative code is “Ts15”, it is calculated as follows: Periodontal tissue precision inspection (up to 20 teeth) 180 x Periodontal tissue precision inspection (21 to 24 teeth) 300 × Periodontal tissue precision inspection (25 teeth ~) 400 × 1 (d) 04: 1/3 jaw As shown in the flowchart of FIG. 15, the contents of the data memory (6) are compared with the input tooth formula, and the input tooth formula is compared.
Calculate the number of 1/3 jaw first, 1/3 or more jaw, 1 to 2 teeth, then determine the content of the site definition data in the medical care item data, and calculate the calculated number of times for each corresponding medical care item. It is the number of calculations.

For example, if the input tooth formula is Then, when the input representative code is “Tsu 18”, it is calculated as follows.

Tartar removal (1/3 jaw first) 55 × 1 Tartar removal (over 1/3 jaw) 40 × 1 Tartar removal (1 to 2 teeth) 40 × 2 In the embodiment described above, the site unit identification data is “ In the case of "01" and "02", the dental formula is stored as the site definition data in each medical care item data. However, as in the case where the site unit identification data is "04", the data memory (6)
It is also possible to store such a tooth formula and store only the numerical data for distinguishing the number of root canals and the types of teeth in each medical care item data.

The calculations shown in STEP-2 in FIG. 14 and STEP-1 in FIG. 15 can be executed if the dental formula indicating the medical treatment site is input, so that the representative after or after the dental formula input. This calculation may be performed after the code is input, and the necessary calculation result may be selectively used after the determination of the site unit identification data.

Further, although the site unit identification data is stored in each medical care item data as shown in FIG. 3, it may be stored in the representative data shown in FIG. 2 instead.

By the way, in the present embodiment, when the patient data file (4) already contains the patient data of the date to be input, as shown in FIG. 10, this patient data is read to the confirmation buffer (8), The configuration is displayed on the display screen, and calculation of medical care items can be added to the read dental formula. Further, not only the input method using the representative code but also the method of inputting the medical care code and the number of times as in the conventional method are possible, and these input data can also be input to the confirmation buffer (8) by pressing the input key. ).

In this way, when the representative code is input for the same tooth formula while the medical care item data is already stored in the confirmation buffer (8), the input representative code is related to the input representative code in the same manner as described above. Medical care item data is medical care code part (12)
Is read out to the processing target buffer (7), and the counts that can be calculated are calculated in the same manner for each read medical care item.

However, before the representative code is input, if the medical care items that already exist on the day have been calculated for the same site, the calculated number of times is not simply displayed as the number of times of calculation.

That is, as shown in FIG. 16, by comparing the medical care codes of the medical care items of the processing target buffer (7) and the confirmation buffer (8), the same medical care item as the new medical care item to be calculated, Search whether it has already been calculated, and if it has already been calculated, subtract the number of times from the calculated number and display the result of this subtraction as the number of times the medical care item to be entered is calculated. There is.

For example, it is assumed that the root canal patch (1) has already been calculated twice for the dental formula shown in FIG. Enter a new tooth formula including the above-mentioned tooth formula, for example, as shown in Fig. 17 (b), and enter the representative code "tsu 10", and as shown in the figure, the root canal patch will be applied. Regarding (1), the already calculated number "2" is subtracted from the number "3" calculated from the input tooth formula, and the subtraction result "1" is displayed as the number of calculations. On the other hand, for the root canal patch (2), the calculated number “2” is directly displayed as the number of calculations. The subsequent operation is as already described.

In this way, when the medical care item to be input has already been calculated, the number of times is subtracted and an appropriate number of times is automatically calculated.

(G) Effect of the Invention According to the present invention, even if the number of times is not input, the number of times is automatically calculated and displayed only by inputting the representative code and the medical treatment site, so the input operation is simplified, The input work time becomes extremely short. Further, since the representative code input eliminates the troublesome thinking work of the operator, the burden on the operator is remarkably reduced, and the insurance claim work can be performed even by an operator unskilled in dental medical office work.

[Brief description of drawings]

FIG. 1 is a block diagram showing a configuration of an embodiment of a dental insurance claim office computer according to the present invention, FIG. 2 is a diagram showing a data structure of a representative code part of a medical care code file, and FIG. 3 is medical care of a medical care code file. Diagram showing the data structure of the code part,
FIG. 4 is a diagram showing a definition regarding a site of factors such as the number of root canals,
5 to 8 are diagrams showing a specific example of the medical care code file, FIG. 9 is a diagram showing classification contents of the site unit identification data, and FIG. 10 is a flow of the overall processing of this embodiment. Flow charts, FIG. 11 and FIG. 17 are diagrams showing a display example in the present embodiment, FIG. 12 is a diagram showing stored contents of a buffer to be processed and a confirmation buffer, and various arithmetic operations are shown in FIG. 13 to FIG. FIG. 16 is a flow chart showing the processing contents, FIG. 16 is a flow chart for explaining the processing contents of the present embodiment in more detail, and FIG. 18 is a view for explaining the tooth formula. (1) …… Keyboard, (2) …… CRT display,
(4) ... Patient data file, (5) ... Medical care code file, (7) ... Process target buffer, (8) ... Confirmation buffer, (9) ... Arithmetic processing unit.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Kaneo Okura, Ina No. 180 Sakata, Oizumi-cho, Gunma-gun, Oita-gun, Toyo Kyoyo Electric Co., Ltd. (72) Ryuichi Kato 180, Sakata, Oizumi-cho, Oura-gun, Gunma Kyosanyo Electric Co., Ltd. (72) Inventor Koji Tsukamoto 180 Sakata, Odaizumi-cho, Gunma-gun, Osamu, East Kyosanyo Electric Co., Ltd. (72) Inventor Shuji Ueno 180 Sakata, Oizumi-cho, Gunma-gun, Tokyo Sanyo Denki Co., Ltd. (72) Inventor Etsuru Daimaru 180 Sakata, Oizumi-cho, Ora-gun, Gunma Tokyo Sanyo Electric Co., Ltd. (56) Reference JP-A-60-68463 (JP, A) JP-A-60 -198670 (JP, A) JP 59-188770 (JP, A)

Claims (1)

[Claims] 1. For a plurality of medical care items having the same medical care content and having different insurance points depending on factors such as the number of root canals and types of teeth, a representative code representative of the plurality of medical care items is determined and Storage means for storing in advance the site definition data indicating the site or the number of teeth that can be the target of calculation for each medical treatment item, the input means for inputting the representative code and the site data indicating the treated site, and the input For the plurality of medical care items represented by the representative code, the site definition data is read from the storage unit, the read site definition data is collated with the input site data, and each of the plurality of medical care items is read. It is characterized by comprising a calculating means for calculating the number of times that can be calculated and a display means for displaying the calculated number of times as the number of times of calculating each of the plurality of medical care items. Dental insurance claims office computer to be.