鼻咽癌放疗后鼻咽颅底坏死手术治疗编码分析  

Coding Analysis of Surgical Treatment of Nasopharyngeal Skull Base Necrosis after Radiotherapy for Nasopharyngeal Carcinoma

作　　者：钟婷婷 陆田田 陆丹艳[1] Zhong Tingting;Lu Tiantian;Lu Danyan(Guangxi Guigang People’s Hospital,Guigang 537100,Guangxi Zhuang Autonomous Region,China;不详)

机构地区：[1]广西贵港市人民医院,广西壮族自治区贵港市537100

出　　处：《中国病案》2022年第9期36-38,共3页Chinese Medical Record

摘　　要：通过对鼻咽癌放疗后鼻咽颅底坏死手术治疗病案的ICD-10和ICD-9-CM-3编码以及编码思路进行分析,提高鼻咽癌放疗后鼻咽颅底坏死手术治疗病案编码的准确性。鼻咽癌放疗后鼻咽颅底坏死手术治疗病案合并肿瘤局部残留或复发时主要诊断编码为C11;为放疗后软组织坏死时,主要诊断编码为J02.9;为放疗后软组织坏死合并骨坏死时主要诊断编码为M87.3。手术编码则主要分为坏死病灶清除和颅底重建2个步骤分析,切除的坏死病灶仅涉及鼻咽颅底软组织时,主要手术编码为29.39;切除范围达坏死骨质时,手术既要编码29.39,也要编码01.25,主要手术则需根据与主要诊断相对应原则选择;颅底重建手术则应根据所采用的不同软组织覆盖物进行编码。医师与编码员的共同努力可提高鼻咽癌放疗后鼻咽颅底坏死手术治疗病案编码准确性。This study aims to improve the coding accuracy of surgical case of nasopharyngeal skull base necrosis after radiotherapy for nasopharyngeal carcinoma.ICD-10 and ICD-9-CM-3 codes and coding ideas of surgical cases of nasopharyngeal skull base necrosis after radiotherapy for nasopharyngeal carcinoma were analyzed to explore the rational coding.The main diagnostic code for the cases of nasopharyngeal base necrosis after radiotherapy with local tumor residual or recurrence is C11.The main diagnostic code for soft tissue necrosis after radiotherapy is J02.9.The main diagnostic code of soft tissue necrosis complicated with osteonecrosis after radiotherapy is M87.3.The surgical code was mainly divided into two steps:necrotic lesion removal and skull base reconstruction.When the necrotic lesion is only involved in nasopharyngeal skull base soft tissue,the main surgical code is 29.39.When the excision includes bone necrosis,both 29.39 and 01.25 codes should be used.Major operations should be selected according to the principle corresponding to the main diagnosis.Skull base reconstruction should be coded based on the different soft tissue coverings being used.The improvement of coding accuracy of surgical case of nasopharyngeal base necrosis after radiotherapy for nasopharyngeal carcinoma requires the joint efforts of both doctors and coders.

关 键 词：鼻咽癌 手术治疗 颅底坏死 颅底重建 ICD编码 

分 类 号：R739.63[医药卫生—肿瘤] R197.323[医药卫生—临床医学]