肝外胆管癌手术编码探讨  

Study on Operations and Procedures Coding for Extrahepatic Cholangiocarcinoma

作　　者：许毅从[1] 蔡浩雷[1] 蔡栋[1] Xu Yicong;Cai Haolei;Cai Dong(Medical Records Room,Department of Medical Administration,Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,Zhejiang Province,China;不详)

机构地区：[1]浙江大学医学院附属第二医院,浙江省杭州市310009

出　　处：《中国病案》2023年第7期52-55,共4页Chinese Medical Record

基　　金：浙江省医院可持续发展正大天晴研究项目[2019ZHA-ZDTQ101]。

摘　　要：肝外胆管癌根据发病部位分为肝门部胆管癌、中段胆管癌和下段胆管癌。由于肿瘤纵向累及胆管范围的不同,肝外胆管癌手术方式也不相同。手术方式的复杂性和多样性,使得肝外胆管癌手术操作编码较难掌握。依据国际疾病分类手术与操作第九版临床修订本(ICD-9-CM-3),肝门部胆管癌BismuthⅠ型和部分BismuthⅡ型以及中段胆管癌一般行肝外胆管局部切除术,需根据实际切除范围分类于51.63和51.69;肝门部胆管癌BismuthⅢ型、BismuthⅣ型和部分BismuthⅡ型可联合肝部分切除术,分类于50.22和50.3;下段胆管癌可行胰十二指肠切除术(Whipple手术),分类于52.7;有转移的肝外胆管癌可行胃空肠吻合术(旁路),分类于44.3。在实际工作中,编码员需要仔细阅读病案,明确胆管癌分型以及手术切除范围和消化道重建方式,正确另编码非端对端吻合术,并掌握省略编码原则,确保各种肝外胆管癌手术方式的正确编码。Extrahepatic cholangiocarcinoma can be divided into three parts according to the site of origin:hilar cholangiocarcinoma,middle bile duct cancer,and distal bile duct cancer.Due to the different extent of longitudinal involvement of the bile duct,the surgical methods for extrahepatic cholangiocarcinoma are also different.The complexity and diversity of surgical operations make it difficult to master the operations coding of extrahepatic cholangiocarcinoma.Based on the International Classification of Diseases,Clinical Modification of 9th Revision,Operations and Procedures(ICD-9-CM-3),Hilar cholangiocarcinoma(Bismuth typeⅠand part of Bismuth typeⅡ)and middle bile duct cancer generally undergo local excision of the extrahepatic bile duct,which is classified under 51.63 and 51.69 according to the resection scope.Hilar cholangiocarcinoma of Bismuth typeⅢ,Bismuth typeⅣ,and partial Bismuth typeⅡcan be combined with partial hepatectomy,which is classified to 50.22 and 50.3.Pancreaticoduodenectomy was feasible for distal bile duct cancer,which is classified as 52.7.Extrahepatic cholangiocarcinoma with metastases can undergo gastrojejunostomy(bypass),which is classified as 44.3.In practical work,coders need to carefully read medical records,identify the type of cholangiocarcinoma,clarify the scope of surgical resection and the way of digestive tract reconstruction,correctly code the non-end-to-end anastomosis,and master the principle of omitting coding,which can help to achieve correct codes of various surgical methods for extrahepatic cholangiocarcinoma.

关 键 词：肝外胆管癌 手术编码 ICD-9-CM-3 

分 类 号：R197.323[医药卫生—卫生事业管理]