人工骨植骨术ICD-9-CM-3编码的探讨
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摘要
骨缺损修复常常需植骨治疗,临床中人工骨作为理想的骨修复材料,常以伴随的方式出现在骨科治疗手术中。现有编码将人工骨植骨术纳入骨移植术(78.0)或重组骨形态形成蛋白置入(84.52)。通过分析比较相关编码,编码难点是若将人工骨植入纳入78.0骨移植术类目,需要另编码表明骨切除来源;若纳入84.52重组骨形态形成蛋白置入,人工骨组成材料和骨形成发生蛋白存在差异,编码欠妥。结合现有的医学资料,临床医师沟通的内容,手术中人工骨材料、分类及作用等方面内容,人工骨置入是骨空隙填补物的一种,在手术中起填补作用,纳入骨空隙填补物置入(84.55),表述查找合理编码过程,以期与同行交流,提高疾病诊断编码质量。
Bone defect repairing often requires bone grafting treatment. As an ideal bone repair material in clinical, artificial bone often appears in the orthopedic surgery in an accompanying manner. In this paper, the existing differences of the artificial bone were found between the operation code and clinical surgery. Artificial bone surgery was coded in bone transplantation(78.0) according to the ICD-9-CM-3, while some scholars thought that it should be included in recombinant bone morphogenetic protein into(84.52). If it was coded in the 78.0 bone grafting category, additional coding was required to indicate the source of bone resection. Besides, there were differences between artificial bone composition material and bone formation protein. The code may be not proper if it was coded in 84.52 recombinant bone formation protein. According to the existing medical data, combined with the content of the communication from clinicians and artificial bone materials, classification and function, this paper thought that its function was same as the bone gap filling and it should be coded in bone gap filling into(84.55).Through analysis and comparison of relevant codes, the coding difficulties were proposed, and the process of finding reasonable codes was described in order to communicate with peers and improve the quality of diagnostic codes.
Bone defect repairing often requires bone grafting treatment. As an ideal bone repair material in clinical, artificial bone often appears in the orthopedic surgery in an accompanying manner. In this paper, the existing differences of the artificial bone were found between the operation code and clinical surgery. Artificial bone surgery was coded in bone transplantation(78.0) according to the ICD-9-CM-3, while some scholars thought that it should be included in recombinant bone morphogenetic protein into(84.52). If it was coded in the 78.0 bone grafting category, additional coding was required to indicate the source of bone resection. Besides, there were differences between artificial bone composition material and bone formation protein. The code may be not proper if it was coded in 84.52 recombinant bone formation protein. According to the existing medical data, combined with the content of the communication from clinicians and artificial bone materials, classification and function, this paper thought that its function was same as the bone gap filling and it should be coded in bone gap filling into(84.55).Through analysis and comparison of relevant codes, the coding difficulties were proposed, and the process of finding reasonable codes was described in order to communicate with peers and improve the quality of diagnostic codes.
引文
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[12]Wang L,Huang Y,Pan K,et al.Osteogenic responses to different concentrations/ratios of BMP-2 and bFGF in bone formation[J].Ann Biomed Eng,2010,38(1):77-87.
[13]Bai Y,Li P,Yin G,Huang Z,et al.BMP-2,VEGF and b FGF synergistically promote the osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells[J].Biotechnol Lett,2013,35(3):301-308.
[14]Puvanesarajah V,Shapiro JR,Sponseller PD.Sandwish allografts for long-bone nonunions in patients with osteogenesis imperfecta:a retrospective study[J].J Bone Joint Surg Am,2015,97(4):318-325.
[2]辛雷,苏佳灿,人工骨修复材料的现状与展望[J].创伤外科杂志,2011,13(3):272-275.
[3]Wu J,Ding Y,Bi Y,et al.Staphylococcus aureus induces TGF-β1 and bFGF expression through the activation of AP-1 and NF-κB transcription factors in bovine mammary gland fibroblasts[J].Microb Pathog,2016,(95):7-14.
[4]Ndukwe KC,Aregbesola SB,Ikem IC,et al.Reconstruction of mandibular defects using nonvascularized autogenous bone graft in nigerians[J].Niger J Surg,2014,20(2):87-91.
[5]Valentini P,Abensur D.sinus floor elevation for implant placement with demineralized freeze-dried bone and bovine bone(Bio-Oss):a clinical study of 20 patients[J].Int JPeriodomtics Restorative Dent,2009,17(3):232-241.
[6]潘京诗.自体骨、同种异体骨、多孔磷酸三钙及异种骨治疗股骨干粉碎性骨折的疗效比较[D].江苏:苏州大学,2009:33-35.
[7]曾吉阳.骨移植材料BMP/b FGF/XACB的异位成骨实验研究[D].贵州:贵州医科大学,2017:34-37.
[8]周萌萌,刘宏,郭偲.复合人工修复材料功能性应用进展[J].中国药师,2017,20(5):899-903.
[9]刘爱民,编译.国际疾病分类第九版临床修订本ICD-9-CM-3 2011版[M],北京:人民军医出版社,2014.
[10]Chen B,Lin H,Wang J,et al.Homogeneous osteogenesis and bone regeneration by demineralized bone matrix loading with collagen-targeting bone morphogenetic protein-2[J].Biomaterials.2007,28(6):1027-1035.
[11]Heisterbach PE,Todorov A,Flückiger R,et al.Effect of BMP-12,TGF-β1 and autologous conditioned serum on growth factor expression in Achilles tendon healing[J].Knee Surg Sports Traumatol Arthrosc,2012,20(10):1907-1914.
[12]Wang L,Huang Y,Pan K,et al.Osteogenic responses to different concentrations/ratios of BMP-2 and bFGF in bone formation[J].Ann Biomed Eng,2010,38(1):77-87.
[13]Bai Y,Li P,Yin G,Huang Z,et al.BMP-2,VEGF and b FGF synergistically promote the osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells[J].Biotechnol Lett,2013,35(3):301-308.
[14]Puvanesarajah V,Shapiro JR,Sponseller PD.Sandwish allografts for long-bone nonunions in patients with osteogenesis imperfecta:a retrospective study[J].J Bone Joint Surg Am,2015,97(4):318-325.
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