胆脂瘤ICD编码分析

Analysis of ICD Coding for Cholesteatoma

针对胆脂瘤编码目前存在的手术分型混乱、颅内胆脂瘤病理诊断多样等问题,结合案例分析进行编码解析,总结胆脂瘤疾病与手术编码鉴别要点。中耳胆脂瘤(H71)手术编码根据病灶侵及听骨范围判断,单纯鼓膜修补为Ⅰ型为19.4,将人工听骨靠于砧骨或锤骨为Ⅱ型为19.52,移植物靠于镫骨为Ⅲ型为19.53;乳突根治术根据外耳道后壁是否完整判断是开放式20.42还是完壁式20.42,根据切除范围和是否重建(保留)中耳生理功能判断是传统式乳突根治术20.42还是改良式乳突根治术20.49。外耳道胆脂瘤(H60.4)切除编码于外耳道病损切除18.29,侵犯鼓膜以内部位时附加相应术式19.4-19.55,20.42-20.49。颅内表皮样囊肿、珍珠瘤编码于颅内胆脂瘤G93.8。编码时需明确胆脂瘤病灶范围和手术切除范围,进一步判断相应术式类型,完整准确编码。

Focusing on the existing problems of cholesteatoma coding, such as the confusion over surgical classification and the diversity of pathological diagnosis of intracranial cholesteatoma, this paper use coding analysis on case studies to summarize the key points of distinguishing surgical coding of cholesteatoma diseases.Surgeries on middle ear cholesteatoma(H71) are categorized based on the lesion area of auditory ossicle.Myringoplasty is type Ⅰ(19.4). Leaning a synthetic ossicular prosthesis against incus or malleus is categorized as type II(19.52). Leaning a graft against stapes is categorized as type Ⅲ(19.53). Radical mastoidectomy is categorized into canal-wall-down(20.42) and canal-wall-up(20.42) based on the completeness of the posterior wall of external auditory canal and is classified as traditional(20.42) and modified(20.49) based on resection range and whether the physiological function of middle ear is restored(preserved). Resection of external auditory canal cholesteatoma(H60.4) is encoded in the resection of lesions within external auditory canal(18.29), and corresponding surgical procedures are added for intratympanic membrane lesions(19.4-19.55, 20.42-20.49).Intracranial epidermoid cyst and pearl tumor are encoded in intracranial cholesteatoma(G93.8). It is necessary to clarify the range of both cholesteatoma lesion and surgical resection during coding, further determine the corresponding surgical type and accurately complete the coding procedure.