减重代谢疾病与手术编码探讨

Discussion on Metabolic and Bariatric Surgery Coding

减重代谢外科与其他外科领域比较是一门新颖的亚专科,糖尿病外科治疗的全球联合声明指出减重代谢外科治疗的适应证,根据手术适应证确定减重外科病例的主要诊断,并根据其最新临床指南探讨减重代谢手术各种术式的正确编码,以解决减重代谢病例进入医保病种结算的各种困惑。减重代谢外科的主要诊断是肥胖症(疾病编码E66.0、E66.2、E66.8和E66.9)或2型糖尿病(疾病编码E11.0、E11.1、E11.2、E11.3、E11.4、E11.5、E11.6、E11.7和E11.9);3种标准术式是腹腔镜胃袖状切除术(手术编码43.82)、腹腔镜Roux-en-Y胃旁路术(手术编码44.38)、胆胰分流并十二指肠转位术(手术编码43.89+45.91)。编码工作应涵盖学习最新临床指南,结合病例的术前讨论、术前小结,手术实施的具体术式,才能找到准确ICD编码。

Metaboilic and bariatric surgery is a new one in surgical field.To resolve the issues about disease and operation classification of metabolic and bariatric surgery(MBS)according to the global announcement on diabetes surgical therapy.The principles and specific coding of disease and operation classification of MBS were investigated according to its clinical guidelines and pratical operation methods.The indication of MBS is obesity which code should be E66.0,E66.2,E66.8 and E66.9,or type 2 diabetes mellitus(T2DM)which code is E11.0,E11.1,E11.2,E11.3,E11.4,E11.5,E11.6,E11.7 and E11.9.Three standard operation is laparoscopic sleeve gastrectomy(LSG)which code is 43.82,laparoscopic Roux-en-Y gastric bypass(LRYGB)which code is 44.38,and biliopancreatic diversion with duodenal switch(BPD-DS)which code is 43.89&45.91.It’s suitable for setting micro-trauma operation matching obesity and T2DM case in carrying out case payment.The coding of MBS should follow the newest clinical statement,read thoroughly across the whole medical record and consult medical clinics on specific case.