慢性阻塞性肺疾病介入治疗手术编码探讨

Discussion on Surgical Coding of Interventional Therapy for Chronic Obstructive Pulmonary Disease

慢性阻塞性肺疾病目前的介入治疗手术为支气管镜肺减容术。常见的支气管镜肺减容术为支气管镜腔内活瓣技术、肺减容线圈术、人工支气管旁路术、生物凝胶支气管封堵术、经支气管镜热蒸汽消融术、液氮计量冷冻喷雾、靶向肺去神经术。根据作用原理、作用部位、置入物质或装置类型不同其对应的手术编码不同。其中支气管镜腔内活瓣技术需区分单叶还是多叶,编码为33.71/33.73,如同时进行了肺气道流量评估,还需同时编码33.72;肺减容线圈术、人工支气管旁路术、生物凝胶支气管封堵术的手术编码均为33.79,但需注意扩展码的选择;经支气管镜热蒸汽消融术、液氮计量冷冻喷雾和靶向肺去神经术实质上都是一种消融术,但作用原理不同编码不同。经支气管镜热蒸汽消融术属于热消融术,液氮计量冷冻喷雾属于冷冻消融术,都是对肺组织的消融,手术编码为32.26;靶向肺去神经术是通过射频消融方式对神经进行破坏,手术编码为04.2。编码员应充分了解各种支气管镜肺减容术的术式及作用原理,并与编码内涵相结合,必要时与临床医师沟通,提高编码质量,保证编码的准确性。

The current interventional treatment for chronic obstructive pulmonary disease is bronchoscopic lung volume reduction.Common bronchoscopic lung volume reduction procedures include endobronchoscopic flap technique,lung volume reduction coil,artificial bronchial bypass,biogel bronchoplasty,transbronchoscopic hot steam ablation,liquid nitrogen dosing freezer spray,and targeted lung denervation.The corresponding surgical code is different according to the principle of action,the site of action,the type of implanted substance or device.The endobronchoscopic valve technique needs to distinguish between single lobe and multiple lobe,and the code is 33.71/33.73.If pulmonary airway flow assessment is performed at the same time,the code is 33.72.The surgical codes of Lung volume reduction coil,artificial bronchial bypass and biogel bronchial closure were 33.79,but attention should be paid to the selection of extension codes.Transbronchoscopic hot steam ablation,liquid nitrogen metered freezing spray and targeted lung denervation are all essentially one type of ablation,but the principle of action is different and the code is different.Transbronchoscopic hot steam ablation belongs to thermal ablation,liquid nitrogen metered freezing spray belongs to cryoablation,both of which are the ablation of lung tissue.The operation code is 32.26.Targeted lung denervation is the destruction of nerves by radiofrequency ablation,code 04.2.Coders should fully understand the various bronchoscopic lung volume reduction procedures and their working principles,and combine with the coding connotation,and communicate with clinicians when necessary to improve the coding quality and ensure the accuracy of the coding.