复杂角膜移植手术ICD-9-CM-3编码探讨

Discussion on ICD-9-CM-3 Surgical Coding for Complex Keratoplasty

随着角膜移植理念和医学技术的不断发展,角膜移植手术体系更加多样化,其ICD-9-CM-3编码难度也随之增加。某院角膜移植有6种常见术式:角膜移植NOS(11.60)、其他板层角膜成形术(11.62)、其他穿透性角膜成形术(11.64)、其他角膜移植(11.69)、胬肉切除术伴角膜移植术(11.32)和人工角膜(11.73)。角膜移植手术的材料来源以及不包括等提示可能会导致多编、漏编和错编等问题。通过回顾分析6例角膜移植患者病例,探讨复杂角膜移植术编码规则,以期提高角膜移植相关手术编码准确性和统一性。角膜病损切除术技术含量高,影响预后,因此不可省略编码。飞秒激光辅助属于计算机辅助外科,作为附加编码可更完整地表达手术操作过程。复杂角膜移植术编码需综合考虑术式内涵、移植范围和材料来源,根据实际手术情况进行判断并准确编码。

With the continuous development of the concept and medical technology of corneal transplantation,the surgical system of corneal transplantation has become more diverse,and the difficulty of ICD-9-CM-3 coding has also increased.There are 6 common operations of keratoplasty in a hospital:corneal transplantation,not otherwise specified(11.60),other lamellar keratoplasty(11.62),other penetrating keratoplasty(11.64),other corneal transplant(11.69),excision of pterygium with corneal graft(11.32)and keratoprosthesis(11.73).Keratoplasty operation materials and the note and excluded of corneal transplantation codes may lead to error of excess code,missing code and incorrect code.The purpose of this study is to discuss the coding rules of complex keratoplasty by reviewing six keratoplasty medical cases,so as to enhance the coding accuracy and uniformity of keratoplasty.The technique of corneal lesion resection is advanced and affects the prognosis.Therefore,the coding should not be omitted.Femtosecond laser assistance belongs to computer-assisted surgery and is an additional code which can express the operation process more completely.The coding of complex keratoplasty should consider the connotation of operation,the scope of transplantation and the source of materials,and make judgment and accurate coding according to the actual operation situation.