先天性静脉畸形骨肥大综合征ICD-1O编码

先天性静脉畸形骨肥大综合征为一种复杂且罕见的先天性肢体发育畸形性疾病,该疾病以其血管畸形、骨肥大和软组织增生三联征为主要表现.本文通过其发病机理和临床表现,分析病例内容,探讨该疾病的ICD-10编码.按照国际疾病的分类和查找方法,甄选和变通主导词进行查询.分别以综合征、异常、畸形为主导词进行编码的查找,未获得准确编码;以音译词克利佩尔-特脑纳-韦伯综合征为主导词,得到其编码Q87.2,核对卷一,确认编码.通过对疾病编码的讨论分析,总结了罕见疾病的编码思路.编码人员除了坚持学习和巩固编码原则外,还应深入研究疾病诊断的内涵,通过查阅文献寻找切实依据,并与临床医师互相交流,才能编码科学、准确.

The ICD-10 Coding of Klippel-Trenaunay Syndrome

Klippel-Trenaunay syndrome is a kind of rare congenital malformation syndrome with three features included vascular malformation, hypertrophy bone and hyperplasia of soft tissues. Through analyzing the pathogenesis, clinical manifestation and the content of medical cases, we investigated the ICD-10 coding of the disease, and conducted inquiry by selecting and changing main words according to the classification and searching methods of international diseases. To perform searching process with the main words of syndrome, abnormal and malformation, but no accurate coding was obtained, then take the transliterated words of Klippel-Trenaunay syndrome as the main words, the coding of Q87.2 was obtained and finally check and affirm the coding. Through the discussion and analysis of the coding, we summarized the coding methods of orphan diseases. The coders should not only keep learning and reviewing the coding rules, but also research the connotation of diseases diagnosis deeply, find practical evidence through reading literatures and communication with clinical doctors, thus could we got accurate and scientific coding.