难治性癫痫手术编码探讨

Discussion on Surgical Coding for Refractory Epilepsy

难治性癫痫常见手术包括致痫灶切除术、神经通路阻断术以及神经调控术,在致痫灶切除手术中常应用立体定向脑电图技术,通过临时将电极植入颅内对致痫灶进行评估与定位,手术编码为02.93,去除颅内电极,手术编码为01.22,再对致痫灶进行切除,根据致痫灶的不同范围其手术编码通常包括01.59脑病损切除术、01.52大脑半球切除术、01.53脑叶切除术。神经通路阻断手术常指胼胝体切开术01.32。神经调控术主要包括迷走神经刺激术、脑深部刺激术和反应性神经刺激术,VNS首先电极缠绕在迷走神经干上,手术编码为04.92,然后将脉冲发生器与电极进行连接后埋置于皮下,手术编码为86.96。DBS首先将电极植入颅内,手术编码为02.93,然后通过导线连接到位于胸壁皮下的脉冲发生器,根据脉冲发生器植入具体情况编码为(86.94-86.98)。RNS首先将电极植入颅内,手术编码为02.93,后将脉冲发生器与颅内电极连接后固定于颅骨,手术编码为01.20。

Common surgeries for refractory epilepsy include resection of epileptogenic lesions,nerve pathway blockade,and neuromodulation.SEEG technique is often used in resection of epileptogenic lesions.The purpose is to evaluate and locate epileptogenic foci by temporary electrode implantation.The surgical code is 02.93.The surgery code for the removal of intracranial electrodes is 01.22.According to the different ranges of the lesion,the surgical code of the lesion usually includes 01.59 cerebral lesion resection,01.52 hemisphetomy,and 01.53 lobectomy.Neuroural pathway-blocking surgery often refers to callolotomy with a surgical code of 01.32.Neuromodulation techniques mainly include VNS,DBS,and RNS.VNS first electrode winding on the vagal trunk has the surgical code of 04.92.Then the pulse generator is connected to the electrode and is buried subcutaneously,and the surgical code is 86.96.The DBS first implanted the electrode,and the operation code is 02.93.It is then connected to the pulse generator located under the skin of the chest wall through wires and is coded(86.94-86.98)according to the specific circumstances of pulse generator implantation.RNS first implants the electrodes into the skull,and the operation code is 02.93.Then it connects the pulse generator to the intracranial electrodes and fixes them on the skull,and the operation code is 01.20.