阻塞性睡眠呼吸暂停低通气综合症手术治疗相关编码解析  

Analysis of Coding Related to Surgical Treatment of Obstructive Sleep Apnea Hypopnea Syndrome

作　　者：罗积洪 李兰 Luo Jihong;Li Lan(Medical Record Department of Jinhua Traditional Chinese Medicine Hospital,Jinhua 321000,Zhehjiang Province,China;不详)

机构地区：[1]金华市中医医院病案室,浙江省金华市321000 [2]金华市金东区疾病预防中心,浙江省金华市321000

出　　处：《中国病案》2022年第4期40-41,112,共3页Chinese Medical Record

摘　　要：鼾症患者通过对悬雍垂,扁桃体,腺样体,咽,软腭等的切除治疗,达到改善患者睡眠时打鼾的效果,同时避免其他临床并发症的发生。在ICD-9-CM-3中涉及的手术编码主要有:悬雍垂、软腭手术编码分类在27.69细目中,扁桃体、腺样体手术编码分类在28类目当中,咽部手术分类在29.4当中。鼾症患者手术编码较为复杂,编码过程中常出现编码错误问题(未合并编码,漏编,多编)。本文章通过对鼾症患者不同方式的手术治疗,结合案例及ICD的编码规则,分析总结不同的治疗方式对应的ICD编码:有扁桃体等离子切除术28.2x03;扁桃体切除伴腺样体切除术28.3x01;悬雍垂腭咽成形术[改良H-UPPP手术]27.6906:即切除肥厚悬雍垂的同时最大限度地缩短两侧切口软腭,保留了软腭的功能;悬雍垂-软腭-咽成形术27.6900x007:即通过低温等离子消融除去部分腭咽弓及软腭、悬雍垂,扩大咽腔,缝合腭舌弓系腭咽弓;腭咽成形术27.6902;软腭成形术27.6904等。Through the resection of uvula,tonsil,adenoid,pharynx and soft palate,snoring patients can improve the effect of snoring during sleep and avoid other clinical complications.The surgical codes involved in ICD-9-CM-3 are as follows:uvula and soft palate in 27.69,tonsil and adenoid in 28,and pharynx in 29.4.The surgical coding of snoring patients is more complex,and there are often coding errors in the coding process(no combined coding,missing coding,multi-coding).In this paper,through different surgical treatment of snoring patients,combined with cases and ICD coding rules,the corresponding ICD codes of different treatment methods were analyzed and summarized:plasma tonsillectomy 28.2x03;tonsillectomy with adenoidectomy 28.3x01.Uvulopalatopharyngoplasty [modified H-UPPP operation] 27.6906:removal of hypertrophic uvula while maximally shortening bilateral incisions of the soft palate,retaining the soft palate function;uvula-soft palate-pharyngoplasty 27.6900x007:removal of part of the palatopharyngeal arch,soft palate and uvula by low temperature plasma ablation,expansion of pharyngeal cavity,suture of palatoglossal arch to palatopharyngeal arch;palatopharyngoplasty 27.6902;soft palatoplasty 27.6904,etc.

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 UPPP H-UPPP ICD-9-CM-3 ICD-10 

分 类 号：R766.9[医药卫生—耳鼻咽喉科] R197.323[医药卫生—临床医学]