JPH07104884B2 - 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 window work, after designating the date of the day when the medical examination was performed and the patient,
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 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.

Therefore, the applicant assigns a representative code representative of these medical care items to 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, and performs medical treatment. Enter the region and this representative code, calculate the number of times that can be calculated for each of a plurality of medical care items represented by the representative code, and display the calculated number of times as the number of calculations for each of the plurality of medical care items. I considered an automatic calculation method.

However, depending on the combination of the two medical care items, there are those that can be calculated together for the same site on the same medical day and those that are not allowed to be calculated together.

For example, “myelination” and “electric root canal length measurement test (EMR)” can be calculated together. These can be calculated by applying both medical treatments to the same site, in this case, the same tooth, on the same day.

On the other hand, "myelination" and "root canal patch" are examples that cannot be calculated together. This is because if a certain tooth is subjected to demyelination treatment, naturally, root canal patch treatment is also accompanied, so that the score is included in the demyelination procedure, and the root canal patch is calculated separately. It must not be. In this way, there are some combinations that should not be calculated together.

Therefore, when the representative code is entered and the medical items that cannot be calculated together for the same site on the same medical day have already been calculated on the same day, as described above, simply calculate the calculated number of times. Even if displayed as, it does not mean that an appropriate automatic calculation was performed.

(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. An input unit that determines a representative code and inputs the site data indicating the site where medical treatment is performed and the representative code, and the plurality of medical treatments represented by the representative code based on the input site data and the representative code. A medical means for calculating the number of times that can be calculated for each item and a display means for displaying the number of times for calculating each of the plurality of medical care items are provided, and medical care items that cannot be calculated together for the same part on the same medical day are grouped together. The part group information to be divided is stored in association with each medical care item, and when the representative code is input, the medical care item already calculated on the day and the input representative code are stored. Compared with the site group information of a plurality of medical care items represented by more, when the site group information is the same, for the medical care item having the same definition information regarding the site, it has already been calculated from the number of times calculated by the calculating means. By subtracting the number of times of calculation and displaying the result of the subtraction as the number of times of calculation on the display means,
The above problems are solved.

(E) Action In the present invention, when a medical care item that cannot be calculated together for the same site on the same medical day is already calculated, it is detected by comparing the site group information, and this number is subtracted from the calculated number of times. Then, the result is displayed as the number of calculations of the input medical care item.

(F) Example Before explaining the example of the present invention, first, a tooth formula will be described. The tooth formula indicates a tooth portion, 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, if a tooth formula as shown in FIG. 20 is shown as the treated site, it is the tooth of the upper right jaw No. 4,
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.

Also, for each medical care item, as shown in FIG. 3, the medical care code, the name, the number of points, and the part attribute data consisting of the part check data and the part check group data which are the data related to the part required for automatic calculation. Is stored in the medical care code section (12) of the medical care code file (5) as medical care item data. 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 refers to the range (region) where the upper or lower jaw is divided into the anterior teeth and the left and right molars, but if it is within this range, if there are three or more teeth It is treated as a 1/3 jaw unit, and if it has 1 or 2 teeth, 1/3 jaw (1 or 2 teeth)
Treated as.

On the other hand, the part check group data is information for grouping the medical care items that are prohibited to be calculated together for the same part on the same medical day.

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 root 10 points 2 roots 15 points 3 roots 20 points (ii) Extraction surgery 1 tooth front tooth 140 points Molar tooth 240 points (iii) Periodontal tissue precision inspection Total number of teeth per oral cavity Up to 20 teeth 180 points 21-24 teeth 300 points 25 teeth or more 400 points (IV) Tartar removal 1/3 jaws to the first 1/3 jaws 55 points 1 / when performing over 1/3 jaws simultaneously 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 medical items according to the number of root canals, and the site definition data for each medical 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 the part definition data of each medical care item is a dental formula defining an anterior tooth and a dental formula defining a molar, respectively. I remember.

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

(Iv) Tartar removal (Fig. 8) There are three medical treatment items. As site definition data, tartar removal (1/3 jaw first) indicates "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 treated site 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 below. 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 in 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 Then, 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 x Periodontal tissue precision inspection (25 teeth ~) 400 x 1 (d) 04: 1/3 jaw Fig. 15 As shown in the flow chart of, the contents of the data memory (6) are compared with the input tooth formula, and
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 treatment item data.

Further, the calculations shown in STEP-2 of FIG. 14 and STEP-1 of 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 is 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.

Furthermore, when some medical items have already been calculated in the confirmation buffer (8) for the same site on the same day, the site check group data is also compared.

As described above, the part check group data is information for grouping medical items prohibited to be calculated together for the same part on the same medical day on the same medical day, and a specific example is shown in FIG. It shows in.

Explaining the contents of this processing, as shown in FIG. 16 (b), regarding the medical care items of the processing target buffer (7) and the confirmation buffer (8), the site check group data are compared, and a new calculation is going to be performed. Search whether the medical care items of the same site check group as the medical care items have already been calculated, and if there are medical care items of the same group, further compare the site check data of those medical care items,
In the case of the same, the already calculated number of times is subtracted from the calculated number of times, and the subtraction result is displayed as the number of times of calculation of the medical care item to be input.

For example, "demyelination" is divided into three medical treatment items, ie, myelination (1), myelination (2), and myelination (3), according to the number of root canals, similar to the "root canal patch", and these site checks are performed. The data are the same as those of the root canal patch (1), the root canal patch (2), and the root canal patch (3), respectively.

Here, with respect to the dental formula shown in FIG.
Has already been calculated once. There, for example, the 19th
If you enter a new tooth formula including the above-mentioned tooth formula as shown in Fig. (B) and enter the representative code "tsu 10," as shown in Fig. 18, the extraction of the pulp and the root canal patch will be performed. Since the site check group data for each medical care item is the same, as shown in Fig. 19 (b), for the root canal patch (2), the number of times "2" calculated from the input tooth formula is changed to the pulp extraction (2). The already-calculated number “1” is subtracted, and the subtraction result “1” is displayed as the number of calculations. On the other hand, root canal patch (1) and root canal patch (3)
For, the calculated numbers “4” and “2” are displayed as they are as the number of calculations.

Therefore, the extraction of the pulp and the root canal patch will not be calculated together for the same site.

In this way, more appropriate automatic calculation is realized by using the part check group data.

If the site check groups are the same, the site unit identification data is usually the same, so STEP-4 in FIG.
In the comparison in (1), it is only necessary to compare the part definition data among the part check data.

(G) Effect of the Invention According to the present invention, since the input operation is simplified and the troublesome thinking work of the operator is unnecessary, not only the operator's burden is reduced, but also by using the group data. Therefore, erroneous calculation is prevented, and more appropriate automatic calculation becomes possible.

[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, FIG. 17 and FIG. 19 are diagrams showing a display example in this embodiment, FIG. 12 is a diagram showing stored contents of a processing target buffer and a commit buffer, and FIG. 13 to FIG. FIG. 16 is a flow chart showing the details of various arithmetic processes, FIG. 16 is a flow chart for explaining the details of the process of the present embodiment, FIG. 18 is a diagram showing a specific example of a part check group, and FIG. 20 is a tooth formula. It is a figure for explaining. (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 front page (72) Inventor Ryuichi Kato 180 Sakata, Oizumi-cho, Gunma-gun Ojizumi-cho, East Kyosanyo Electric Co., Ltd. (72) Etsumi Daimaru 180 Sakata, Oita-gun, Oizumi-gun, Gunma Prefecture Within Kyosanyo Electric Co., Ltd. (72) Inventor Kino Okura 180 Sakata, Ojiizumi-gun, Gunma Prefecture Osamu, East Kyosanyo Electric Co., Ltd. (72) Shuji Ueno 180 Sakata, Oita-gun, Oizumi-gun, Gunma Prefecture Inside Kyosanyo Electric Co., Ltd. (72) Inventor Koji Tsukamoto 180 Sakata, Oizumi-cho, Gunma-gun Osamu-gun, East Kyosanyo 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 the types of teeth, a representative code representative of the plurality of medical care items is set and medical treatment is performed. The input means for inputting the part data indicating the part and the representative code, and the number of times that can be calculated for each of the plurality of medical care items represented by the representative code is calculated based on the input part data and the representative code. A calculation means and a display means for displaying the number of times of calculation of each of the plurality of medical care items are provided, and part group information for grouping medical care items that cannot be calculated together for the same part on the same medical treatment day is provided for each medical care item. When the representative code is input, the medical care items already calculated on the day of the day and a plurality of medical care items represented by the input representative code are stored. The region group information is compared, and when the region group information is the same, the number of times already calculated is subtracted from the number of times calculated by the calculating means for the medical care items having the same definition information regarding the site, and the subtraction is performed. A dental insurance claim office computer, wherein the result is displayed as the number of calculations on the display means.