Transcript Document 7225651

DRG & coding guidelines
MDC1、4、5、6、7、10、11
台北榮總 醫務企管部
病歷組
魏秀美
於台灣地區醫院協會2006-10-09 & 16
DRG個數
MDC
名
稱
DRG
第一版 第二版 第三版
1
神經系統之疾病與疾患
00101~035
36
87
87
4
呼吸系統之疾病與疾患
07501~10206
47501~47502
29
82
82
5
循環系統之疾病與疾患
10401~14503
47801~47903
44
95
95
6
消化系統之疾病與疾患
14601~18402
18801~19010
40
99
99
7
肝膽系統及胰臟之疾病
與疾患
191~208
20
26
26
10
內分泌、營養及新陳代
謝之疾病與疾患
28501~30102
17
35
35
11
腎及尿道之疾病與疾患
30201~33302
32
42
44
DRG Validation
 Case-Mix
Index
 Complication/Comorbidity DRG percentage
 High-Risk DRGs
 Highest-Volume DRGs
 Problematic Diagnosis or procedure
 Variations in Length of stay and in charges
資料來源：Lou Ann Schreffenberger.(2002) Effective
Management Coding Services. AHIMA
序號
1
2
3
4
5
6
7
8
9
10
MDC
DRG
Description
1
14
Specifiec cerebrovascular disorders except TIA
1
15
TIA & precerebral occlusions
4
79
Respiratory infections & inflammations age＞17 w CC
4
89
Simple pneumonia & pleurisy age＞17 w CC
4
79
Respiratory infections & inflammations age＞17 w CC
4
87
Pulmonary edema & respiratory failure
4
87
Pulmonary edema & respiratory failure
4
88
Chronic obstructive pulmonary disease
4
88
Chronic obstructive pulmonary disease
4
96
Bronchitis & asthma age＞17 w CC
5
110
Major cardiovascular procedures w CC
5
478
Other vascular procedures w CC
5
130
Peripheral vascular disorders w CC
5
128
Deep vein thrombophlebitis
5
132
Atherosclerosis w CC
5
140
Angina pectoris
5
138
Cardiac arrhythmia & conduction disorders w CC
5
141
Syncope & collapse w CC
5
140
Angina pectoris
5
143
Chest pain
序號
11
12
13
14
15
16
17
18
19
20
MDC
DRG
Description
6
174
G.I. hemorrhage w CC
6
182
Esophagitis, gastroent & misc digest disorders age＞17 w CC
6
182
Esophagitis, gastroent & misc digest disorders age＞17 w CC
5
143
Chest pain
6
188
Other digestive system diagnosis age ＞17 w CC
6
180
GI obstruction w CC
8
239
Pathological factures & musculoskeletal & conn tissue malignancy
8
243
Medical back problems
9
271
Skin ulcers
9
277
Cellulitis age ＞17 w CC
10
296
Nutritional & Misc metabolic disorders age＞17 w CC
6
182
Esophagitis, gastroent & misc digest disorders age＞17 w CC
11
316
Renal failure
11
331
Other kidney & urinary tract diagnoses age＞17 w CC
11
316
Renal failure
10
296
Nutritional & Misc metabolic disorders age＞17 w CC
18
416
Septicemia age＞17
11
320
Kidney & urinary tract infections age＞17 w CC
4
475
Respiratory system diagnosis with ventilator support
5
127
Heart failure & chock
Excludes

An excludes note under a code indicate that the terms
excluded from the code are to be coded elsewhere. In
some cases the codes for the excluded terms should not
be used in conjunction with the code from which it is
excluded. An example of this is a congenital condition
excluded from an acquired form of the same condition. The
congenital and acquired codes should not be used together.
In other cases, the excluded terms may be used
together with an excluded code. An example of this is
when fractures of different bones are coded to different
codes. Both codes may be used together if both types of
fractures are present.
ICD-9-CM Official Guidelines For Coding and Reporting
Cerebrovascular disease, CVA
 Cerebrovascular
disease 430~438
Includes： with mention of hypertension
(conditions classifiable to 401~405)
Use additional code, if desired, to identify
presence of hypertension
ICD-9-CM 2001 Tabular list
CVA-Hemorrhage
Spontaneous
Non-trauma
Trauma
Craniotomy
with remove
of hematoma
SAH
SDH
EDH
ICH
430
432.1
432.0
431
852.0x 852.2x 852.4x 853.0x
01.31
01.31
01.24
01.39
Craniotomy
Trauma
& Non-trauma
Comorbidity & Complication
Age
DRG
中文敘述
00101 顱骨切開術，創傷除外，年
齡大於等於18歲
00102
with/without CC
00201 顱骨切開術，含有創傷，年
齡大於等於18歲
00202
with/without CC
00301 顱骨切開術，年齡 0~17歲
with/without CC
00302
英文敘述
RW
Craniotomy except for
trauma age≥18 with/without
CC
4.7070
Craniotomy for trauma
age≥18 with/without CC
4.5134
3.6370
3.0508
Craniotomy age 0~17
with/without CC
4.6270
3.4874
CVA-Occlusion-1
Occlusion of cerebral arteries
Cerebral
thrombosis
Cerebral
embolism
Unspecified
434.0x
434.1x
434.9x
Occlusion and stenosis of precerebral arteries
Basilar
Carotid Vertebral Multiple and
artery
artery
artery
bilateral
433.0x
433.1x
433.2
433.3x
CVA-Occlusion-2
Transient cerebral ischemia
Reversible
Vertebro- ischemic
Basilar Vertebral basilar
neurologica
artery artery
artery, VBI l disease
(insufficiency) (defect),
RIND
Transient
ischemic
attack,
TIA
435.0
435.9
435.1
435.3
435.8
Infarction / Hemiplegia / Aphasia
 Code
430~437 use of additional codes to
identify any sequelse.
 Acute cerebral artery occlusion with
infarction with sequelse of hemiplegia and
aphasia 434.91+342.90+784.3
Coding clinic, 4Q,1998, p.87
 A history
of cerebral artery occlusion with
infarction with residuals hemiplegia and
aphasia is coded 438.20+438.11
Coding clinic, 4Q,1998, p.39~40
Embolic hemorrhagic infarct
 Embolic
hemorrhagic infarct of the temporal
lobe is coded 434.11, The hemorrhage is
considered a component of the occlusion so
code 431, Intracerebral hemorrhage is not
used as an additional code.
Coding clinic, 3Q,1997, p.11
Brain stem stroke
 Brain
stem stroke is coded 434.91
Coding clinic, 4Q,2004, p.77~78
 Lacunar
infarction
 An acute lacunar infarction is coded 434.91
Coding clinic, 2Q,1996, p.5
Ischemic stroke
 Ischemic
stroke
 Stroke (ischemic) and CVA with cerebral
infarction是相等的，其疾病分類代碼皆為
434.91。
Coding Clinic, ICD-9-CM Addendum, 2004, p.22&50
依2005-11-22疾病分類委員會會議決議
History of a CVA
 When
there is a history of a CVA and no
residuals are present V12.59
 When there is a history of a CVA and there
are residuals are present 438.xx
Coding clinic, 4Q,1998, p.88~89
Coding clinic, 4Q,1997, p.37
Late effect of CVA-1
 Code
438.xx was expanded with the use of
fourth and fifth digits so that new sequela
from a current stroke and residuals from a
previous stroke can both coded.
Coding clinic, 2Q,2002, p.35
Coding clinic, 4Q,1998, p.39~40
Coding clinic, 4Q,1997, p.35~37
Late effect of CVA-2
 Category
438 is unlike other late effect
codes in that it is used as the principal
diagnosis and the residual effect is a
secondary diagnosis.
 Contractures of the right and left wrist due to
a previous stroke is coded 438.89 and
718.43
Coding clinic, 4Q,1998, p.39~40
Late effect of CVA-3
 Old
CVA with vascular dementia 290.40
 290.4x Arteriosclerotic dementia 項下說明
Multi-infarction dementia or psychosis ，故
只編290.4x
協會 Q & A,編號998
 Post
stroke epilepsy 438.89+ 345.90
Post stroke seizure 438.89+780.39
協會 Q & A,編號1265
Late effect of CVA-4
With cognitive deficits
438.0
 With aphasia 438.11
 With dysphasia
(dysarthria) 438.12
 With hemiplegia /
hemiparesis 438.2x
 With monoplegia of
upper limb 438.3x

With monoplegia of
upper limb 438.4x
 Other paralytic
syndrome 438.5x

Use additional code
quadriplegia 344.00~344.09
With apraxia 438.81
 With dysphagia 438.82
 Old CVA 438.9

Polyneuritis / Polyneuropathy
 Acute
inflammatory demyelinating
polyneuritis,AIDP 357.0
 Chronic inflammatory demyelinating
polyneuritis,CIDP 357.8
Coding clinic, 2Q,1998, p.12
 Sensorimotor
polyneuropathy 356.9
協會 Q & A,編號414、697、977
Brain tumor
 C-P
angle meningioma 225.2+M9530/0
 Craniotomy with removal of tumor 01.51
 Pineal
germinoma 194.4+M9064/3
 Craniotomy with removal of tumor 07.53
Hydrocephalus
 Congenital
hydrocephalus：741.0x、742.3、
771.2
 Acquired hydrocephalus
Non-communicating type
Obstructive hydrocephalus 331.4
Ventricular- Peritoneal (V-P) shunt 02.34
Communicating type
Normal pressure hydrocephalus (NPH) 331.3
Subarachnoid-peritoneal shunt 03.71
V-P shunt complication
V-P shunt obstruction (breakdown、
displacement、malfunction、dysfunction)
996.2
 V-P shunt occlusion (thrombus) 996.75
 V-P shunt infection 996.63

Removal V-P shunt 02.43
Revision VP Shunt at ventricular site 02.42
at peritoneal site 54.95 V-A Shunt 02.32
協會 Q & A,編號312
Removal of V-P shunt
 Admission
for removal V-P shunt V53.01
 Removal of V-P shunt 02.43
 V-P
shunt insertion and removal of old shunt
 Replacement of V-P shunt
 Revision of V-P shunt
 02.42
頭部外傷第五碼之使用-1
醫師鑑別頭部外傷及顱骨骨折的第五位碼意識喪失
時間，為患者發生意外至該院出院前的意識狀況
(Consciousness)判斷
 其第五位碼為表現患者的意識狀況，其涵義如下：
 “0”沒有明示意識狀況Unspecified state of
consciousness
 “1”合併沒有意識喪失With no loss of
consciousness
 “2”暫時性(1小時以內)意識喪失 With brief(less than
one hour) loss of consciousness
 “3”中等時間的(1~24小時)意識喪失 With
moderate(1~24 hours) loss of consciousness

頭部外傷第五碼之使用-2




“4”長時間的(超過24小時)意識喪失；但能回復到以前意
識階段 With prolonged (more than 24 hours) loss of
consciousness and return to pre-existing conscious
level
“5”長時間的(超過24小時)意識喪失；但不能回復到以前
意識階段。如：死亡(含Hopeless)或植物人 With
prolonged (more than 24 hours) loss of consciousness
without return to pre-existing conscious level
“6”有意識喪失；但未明示時間長短 With loss of
consciousness of unspecified duration
“9”合併有腦震盪 With concussion, unspecified
依2005-11-22疾病分類委員會會議決議
Head injury-1
 Head
injury with brain concussion 850.x
 Head injury 959.01，當HI有更進一步描述情
況為代碼850-854時，不編Head injury。
Coding Clinic, 2Q,1992,p5~6
協會 Q & A,編號57
ICD-9-CM 2001 Tabular list
Head injury-2
 Contusion
ICH with SAH 851.8x+852.0x
協會 Q & A,編號64
 R't
temporal-parietal fracture with SAH
801.2x+800.2x
協會 Q & A,編號340
Head injury-3
 Head
injury with subarachnoid hemorrhage
with loss of consciousness of unspecified
duration 852.06
 MDC 01 DRG 02702
 Head
injury with contusion of scalp 959.01+
920
 MDC 21 DRG 445
Coma
Trauma and coma
time > 1hr or < 1hr
Comorbidity & Complication
Age
DRG
中文敘述
02701
創傷性木殭及昏迷，昏迷超過1小時
with/without CC
02702
02801
02802
英文敘述
Traumatic stupor and coma,
coma > 1 hr with/without CC
1.3304
創傷性木殭及昏迷，昏迷少於1小時， Traumatic stupor and coma,
年齡大於等於18歲，有合併症或併
coma < 1 hr age≥18 with CC
發症
0.8462
02803
02901
02902
03002
0.6558
0.9438
0.4872
創傷性木殭及昏迷，昏迷少於1小時， Traumatic stupor and coma,
年齡大於等於18歲，無合併症或併
coma < 1 hr age≥18 without CC
發症
02903
03001
RW
0.4195
0.4935
0.3558
創傷性木殭及昏迷，昏迷少於1小時， Traumatic stupor and coma,
年齡0~17歲 with/without CC
coma < 1 hr age 0~17
with/without CC
0.7165
0.3546
03003
0.6838
03004
0.3662
03005
0.9606
03006
0.3183
Concussion
是否有書寫Concussion
Comorbidity
& Complication
Age
DRG
031
032
中文敘述
英文敘述
腦震盪，年齡大於等於18 Concussion age≥18
歲，有合併症或併發症
with CC
腦震盪，年齡大於等於18 Concussion age≥18
歲，有合併症或併發症
without CC
03301 腦震盪，年齡0~17歲
with/without CC
03302
Concussion age 0~17
with/without CC
RW
0.3917
0.2681
0.3613
0.2292
S/P Craniectomy
 Skull
bone defect due to trauma SAH S/P
Craniectomy with removal of hematoma.
Admission for osteoplasty
 738.19+907.0+02.06+E-Code
協會 Q & A,編號756
Coding Clinic, 1Q,2006,p6~7
Spinal cord injury-1
 Fracture
of vertebral column 805.xx
MDC 8 DRG 24301~24302
 Fracture
of vertebral column with spinal cord
injury 806.xx
MDC 1 DRG 00901~00902
 Spinal
cord injury 952.xx
MDC 1 DRG 00903~00904
Spinal cord injury-2
 Spinal
cord injury of T8 level 952.15
 C4
spinal cord injury with quadriparesis
952.04
 Spinal
cord injury, lumbar 952.2
Spinal cord injury-3
 L2
burst fracture with cauda equina
syndrome
 依Table List 806項下說明Includes含injury to：
cauda equina 之情形，故建議編806.4
協會 Q & A,編號280
ICD-9-CM 2001 Tabular list
Spinal cord injury-late effect-1
V57.xx care involving use of rehabilitation
procedure, is assigned as the principal diagnosis.
 When the patient is admitted for the purpose of
rehabilitation following previous illness or injury,
with the fourth digit indicating the focus of
treatment, An additional code is assigned for the
residual condition requiring rehabilitation.
 No code for the original injury or illness that led to
the disability is assigned.

Spinal cord injury-late effect-2
 Hemiparesis
due to old spinal cord injury
342.90+907.2
Coding Handbook 2005,P.130
 Neurogenic
 344.6x
 596.54
bladder
Neurogenic bladder-1
 344.6x
 A pattern
of symptoms caused by nerve root
compression usually felt in the bladder,
sacrum and perineal areas; the pain
radiates down the buttocks, back of thigh,
calf of leg, into the foot with pricking, burning
sensations; causes paralysis.
ICD-9-CM 2001 Tabular list; St.Anthony’s
Neurogenic bladder-2
 596.54
 Unspecified
dysfunctional bladder due to a
lesion of the central or peripherial nervous
system; complications may include
incontinence, residual urine retention.
urinary infection, stone formation and renal
failure.
 ICD-9-CM 2001 Tabular list; St.Anthony’s
Spinal surgery complication
S/P spinal surgery 造成 CSF Leakage
997.09＋349.81
 Debridement 03.4

協會 Q & A,編號1122
 Cerebrospinal
fluid (CSF) rhinorrhea 349.81
 CSF otorrhea 388.61
結核菌感染 (Tuberculosis )
010~018
 結核病編碼之第五位碼是用來描述結核病之
診斷依據（生化、細菌之檢驗報告）
“0”-不確定檢查方式(Unspecified )
 “1”-未做細菌及組織學檢查(examination not done)
 “2”-不知有無做細菌及組織學檢查(examination unknown)
 “3”-痰液含結核菌(bacilli found in sputum)
 “4”-細胞培養有發現結核菌(bacilli found by culture)
 “5”-組織學檢查發現有結核菌 (histologically)-biopsy
 “6”-細菌或組織學檢查未發現有結核菌，但其他檢驗確定
(other)-X-ray或PCR
註：診斷依據：”3”優於”4”優於”5”優於”6”

Documentation to support
pneumonia
 A diagnosis
of pneumonia must be
determined by a physician.
 A coder should not determine the type of
pneumonia based on laboratory findings and
other information in the medical record
without seeking clarification from the
physician.
ICD-9-CM Code classified to
DRG 79
 Pneumonia
due to Staphylococcus 482.x
 Gram-negative pneumonia 482.83
 Gram-positive pneumonia 482.9
 Legionnaires’ disease 482.84
 Pneumonia due to other specified bacteria
482.89
 Aspiration pneumonia 507.0
ICD-9-CM Code classified to
DRG 89
 Virus
pneumonia 480.9
 Lobar pneumonia 481
 Pneumonia due to Streptococcus 482.3x
 Mycoplasma pneumonia 483.0
 Bronchopneumonia 485
 Pneumonia 486
DRG79 Respiratory infections & inflammations age＞17 w CC
DRG89 Simple pneumonia & pleurisy age＞17 w CC
Yes
Pneumonia
07901
1.1169
89
1.0118
07905
0.6937
Complication Yes
and/or
No
Comorbidity
Age>17
08001
0.9106
No
90
0.5293
08005
0.5166
Aspiration
pneumonia
Complication Yes
and/or
Comorbidity No
09101
0.5128
09102
0.4002
08101
0.8628
08109
0
Pneumonia-1
 Gram-negative
pneumonia 482.83
Coding clinic, 3rd quarter 1988, p.11
 Gram-positive
pneumonia 482.9
Coding clinic, 2nd quarter 1998, p.6
 Pneumonia
due to more than one organism
and the organisms are identified, each type
of pneumonia should be coded
Coding clinic, 4th quarter 1993, p.39
Pneumonia-2
 Lobar
pneumonia and pneumonia of the
right lower lobe are not the same.
 Pneumonia of right lower lobe without
specification is coded to 486
 Lobar pneumonia is a synonym for
pneumococcal pneumonia, code 481
Coding clinic, March-April 1985, p.6
Pneumonia-3
 Staphylococcus
aureus pneumonia 482.41
Coding clinic, 4th quarter 1998, p.40
 Staphylococcus
pneumoniae pneumonia
481
Coding clinic, 1st quarter 1988, p.13
 Cryptococcus
pneumonia 117.5+484.7
Aspiration pneumonia
 Aspiration
pneumonia with growth of
Staphylococcus aureus requires two codes.
Coding clinic, 3rd quarter 1991, p.16
ARDS
Adult (Acute) Respiratory Distress Syndrome
 Acute
pulmonary edema associated with
ARDS is noncardiogenic.
 ARDS due to conditions not classifiable to
code 518.5 is coded to 518.82 other
pulmonary insufficiency.
 ARDS following shock, surgery or trauma is
coded to 518.5
Coding clinic, 3rd quarter 1988, p.7~9
Noncardiac
acute pulmonary edema
Postoperative pulmonary edema with adult
respiratory distress syndrome is coded 518.5
 Postoperative pulmonary edema due to fluid
overload is coded 518.4 and 276.6
 Acute pulmonary edema due to smoke inhalation
from a fire is coded 506.1 plus the appropriate Ecode

Coding clinic, 3rd quarter 1988, p.3~4
Acute bronchitis/ COPD/ asthma
 Acute
bronchitis with COPD 491.21
Coding clinic, volume10, number 5,1993, p.5
 Acute
bronchitis and chronic obstructive
asthma 466.0+ 493.2x
Coding clinic, 4th quarter 1993, p.41
Ventilation
 DRG
4750x Mechanical ventilation Focus
MDC 4 diagnoses。
 其他MDC診斷或手術中，使用Ventilation，
不會落入DRG 47501~47502。
 Mechanical ventilation請註明Consecutive
duration。
 排除 Non-invasive positive pressure（Ex：
CPAP、Bi-PAP、IPPB…..）
Acute myocardial ischemia/ AMI
 If
an acute myocardial ischemia has
occurred without an infarction, code 411.8x
Code 411.81 If an occlusion or thrombosis is
present, otherwise code 411.89
Coding clinic, 3rd quarter 1991, p.18
Coronary artery disease (CAD) /
CABG
P’t had CAD, a CABG was performed in the past,
and the chart does not document the location of
the CAD ( i.e.,-native vessel vs. graft), use codes
414.00+V45.81
 Only information is known p’t has a history of
CABG, use code V45.81 and do not code CAD

 Coding clinic, 3rd quarter 1997, p.15~16

CAD no mention of having had CABG, use code
414.01
 Coding clinic, 3rd quarter 1997, p.5
Angina/Coronary artery disease
(CAD)
 Angina
is a symptom, when the cause is
known, the cause would be the principle
diagnosis.
 If the cause of the angina is unknown, then
the angina would be principle diagnosis.
Coding clinic, 2nd quarter 1997, p.13
Coding clinic, 2nd quarter 1994, p.15
Coding clinic, volume10,number 5,1993, p.19
Coding clinic, 4th quarter 1993, p.43~44
Unstable angina/ AMI/ cardiac catheter
 Unstable
angina and has an AMI during
cardiac catheterization and the physician
states the AMI was due to the procedure.
Principal diagnosis is unstable angina 411.1,
additional codes for complication of the
procedure 997.1 and the AMI 410.xx
Coding clinic, 4th quarter 1993, p.39~40
Hypertensive cardiomyopathy
 Hypertensive
cardiomyopathy is coded
402.9x hypertensive heart disease and
425.8 cardiomyopathy in other disease
classified elsewhere.
Coding clinic, 2nd quarter 1993, p.9
Acute and chronic heart failure
 Acute
and chronic heart failure is coded
428.9, but be sure this is not congestive
heart failure 428.0
Coding clinic, Nov-Dec 1985, p.14
Pleural effusion/ CHF
 Pleural
effusion associated with CHF,
treatment of the underlying CHF, the pleural
effusion not be coded.
 Pleural effusion can be coded as an
additional diagnosis, such thoracentesis or
chest tube drainage is performed.
Coding clinic, 3rd quarter 1991, p.19~20
Respiratory failure/ CHF
 When
a patient is admitted in respiratory
failure due to/associated with CHF, the CHF
is the principal diagnosis.
Coding clinic, 2nd quarter 1991, p.3~4
Hypertension/ CHF
 Category
402.xx hypertensive heart disease,
10/1/02 had the narrative description ” with
or w/o CHF or HF”. An additional code is
required to specify the type of heart failure.
Coding clinic, 4th quarter 2002, p.50~52
診斷:Aortic vale stenosis & mitral valve stensois
Coronary artery disease
處置:AVR + MVR + CABG x 2 + CAG
DRG 10401-11.5716
主診斷 次診斷 主處置 次處置 次處置
變項因素
Cath
CC
DRG
RW
35.22
35.24
36.12
Y
─
107
12.8983
396.0
35.22
35.24
─
Y
Y
N
10402
10403
11.8093
11.7843
396.0
35.22
─
─
Y
─
10404
9.9450
35.22
35.24
36.12
N
─
10501
12.0395
10502
10503
11.4070
9.8179
10504
8.9593
396.0
396.0
414.0x
414.0x
396.0
35.22
35.24
─
N
Y
N
396.0
35.22
─
─
N
─
Yes
CABG
Yes
Complication
and/or
Comorbidity
No
PTCA
Yes
No
Cardiac
Cath
No
Yes
CAD
OR
Procedure
PTCA
10602
13.3027
107
12.8983
109
11.9077
112
3.8424
Cardiac
Cath
No
10601
14.9495
PDX or SDX
Complex
Diagnosis
Yes
No
124
1.4234
125
1.0778
Diagnosis
Complication
and/or
Comorbidity
Yes
No
132
0.6677
133
0.4400
DRG 112
 PTCA無論是1條（36.01、36.02）或2條
（36.05）或是否有做CAG，皆落入 DRG
112。
 Percutaneous balloon valvuloplasty 35.96
 Catheter ablation 37.34
 Electrophysiologic study, EPS 37.26
DRG 116
 不論是否自費或報健保費用（0112A~0112D
），只要有Stent，即落入 DRG 116。
 除了Stent外，Pacemaker 亦屬於此DRG。
 若因裝置物機械性併發症(pacemaker
exhaustion)而被更換時編碼996.01。
 當病人住院僅移除(removal)、置換
(replacement)或再設定(reprogramming)心臟
節律器，或當節律器裝置物被更換，只是因
它已接近預期的壽命時，則可編碼V53.31。
Hypertension
診斷
MDC
DRG
RW
Hypertension
5
13402
0.3654
Hypertensive
heart disease
5
13402
0. 3654
H/T , ESRD
11
31604
0.5405
Hypertensive
heart and renal
disease
5
12702
0.5582
Renal stone
due to H/T
11
32402
0.3926
Pain due to malignancy
 If
the pain is due to a malignancy, the
malignancy is the principal diagnosis.
Coding clinic, 2nd quarter 2002, p.42
Coding clinic, 2nd quarter 1990, p.10
Postoperative pain
 A complication
of the procedure code is not
used for postoperative pain when the site of
the pain is known.
Coding clinic, volume10,number 5,1993, p.8 and p.15
Bilateral hernia inguinal
 Left
direct inguinal hernia and right recurrent
direct inguinal hernia應分開編碼或合併編碼？
 550之第五位碼”3” 意指雙側疝氣併有單側
或雙側復發，故此個案編碼為550.93
Coding clinic, Nov-Dec 1985, p.12
協會 Q & A,編號515
Percutaneous embolization
 Transcatheter
or percutaneous embolization
is coded 99.29 injection or infusion of other
therapeutic or prophylactic substance.
 The procedure usually involves an artery.
Contrast is injected via the catheter for
performance of an angiogram.
Coding clinic, 1st quarter 2001, p.19~20
Coding clinic, 1st quarter 2000, p.18~19
Coding clinic, 2nd quarter 1996, p.6
肝炎 Hepatitis-1
 Hepatitis,
type A
 Hepatitis, type B
 Hepatitis, type C
 Hepatitis, type D
 Hepatitis, type E
 Hepatitis, type G

070.1
070.30
070.51
070.31
070.53
070.59
非A、非B型肝炎(Non-A non-B type, hepatitis)
 因肝炎分類型態目前已十分詳細，區分為C型、D型、
E型等，故臨床診斷名稱已無Non-A non-B type,
hepatitis之診斷敘述。
肝炎 Hepatitis-2
 Viral
hepatitis (病毒性肝炎) 070.9
 Fulminant hepatitis (猛爆性肝炎) 070.9
 Viral hepatitis, type B 070.30
 Chronic viral hepatitis, type B 070.32
 Chronic viral hepatitis, type B with acute
exacerbation 070.32
肝炎 Hepatitis-3
 Chronic
hepatitis B with AE 070.32
 急慢性的情況，因為兩個次要字都出現在相
同的行首空格層級，此時兩個代碼皆須編碼。
當只有一個字詞被列出當成次要字，其他在
括弧內為非必要修飾詞，則僅編列出次要字
詞之分類碼。
Coding Handbook with Answers
協會 Q & A,編號173
Liver cirrhosis related

Liver cirrhosis due to PHG (portal hypertension
gastropathy) 572.3+ 537.89
協會 Q & A,編號266
Liver cirrhosis with esophageal varices with
bleeding 571.5+456.20
 LC 引起的 cardiac varices with bleeding 456.8
+578.9
Gastric injection sclerosing therapy 44.43

協會 Q & A,編號162
協會 Q & A,編號1062
AHA, 2002,2Q,P4
Ileus
 Adhesion
ileus 560.81
協會 Q & A,編號34
 Ileus
with bowel obstruction 560.1
協會 Q & A,編號435、927
Gastroenteritis

Eosinophilic gastroenteritis 558.9 +288.3
協會 Q & A,編號271

AGE suspect diverticulitis 558.9+562.11
協會 Q & A,編號963

Infectious diarrhea (salmonella group 2) 003.0
協會 Q & A,編號1293

Infection diarrhea suspected acute gastroenteritis
009.0
協會 Q & A,編號612
Duodenal disorder
 Gastric
polyp 211.1+M8210/0
 Duodenal polyp 537.89
協會 Q & A,編號550、1114
 Duodenal
ulcer或Gastric ulcer病歷上未註明
acute or chronic該如何編碼？
532.90; 531.90
協會 Q & A,編號37
Colostomy or enterostomy infection/
septicemia
 Septicemia
due to an infection of a
colostomy or enterostomy is coded 569.61
and 038.x
Coding clinic, 4th quarter 1998, p.44
Appendectomy
 複雜診斷
(Complicated principal diagnosis)
DRG 164~165
Acute appendicitis, with generalized peritonitis
Acute appendictis, with peritoneal abscess
Malignant neoplasm of appendix 除外
 單純性診斷
DRG 166~167
MDC 7 肝膽系統之疾病與疾患
574.00+574.30
診斷:Acute cholecystitis & GB sone
CBD stone
處置:Cholecystectomy + Choledocholithotomy
主診斷
574.60
574.60
次診斷
主處置
次處置
DRG
RW
7
51.22
51.22
MDC
198
51.41
1.7005
7
196
2.9129
注意: 合併碼使用及有無做總膽管探查手術
糖尿病(Diabetes mellitus)
型態
Type II or
unspecified type
type I


not sateted as
uncontrolled
uncontrolled
0
2
1
3
當醫師診斷DM為poor control或Uncontrol時，其第
五位碼為“2”或“3”。
接受胰島素治療的糖尿病患，不一定屬於胰島素依
賴型， 故第五位碼不能逕自編為“1”
Diabetes mellitus
診斷名稱
DM foot (ulcer)
Coding MDC DRG
250.80 10 29401
707.10
DM foot (gangrene) 250.70
5 13001
785.4
DM with
250.40 11
332
nephropathy
585
(ESRD)
BDR
250.50
2
47
362.01
RW
0.7531
1.2558
0.6617
0.4457
Lobectomy V.S subtotal thyroidectomy
Right thyroid lobectomy and left subtotal
thyroidectomy 06.2
 Thyroidectomy → subtotal → with complete
removal of remaining lobe 06.2
 06.2 complete removal of one lobe of thyroid
(with removal of isthmus or portion of other
lobe)

Ophthalmopathy
Grave’s ophthalmopathy 242.00+376.21
 376.2x Endocrine exophthalmos
Code first underlying thyroid disorder
(242.0x~242.9x)
Urinary tract infection-1
 UTI與APN
590.10
 UTI與Acute cystitis 595.0
協會 Q & A,編號41、1139、1169
 Urethritis與UTI
597.80
協會 Q & A,編號834
Urinary tract infection-2
 Urinary
tract infection due to E-coli
（大腸桿菌所致之泌尿道感染） 599.0+041.4
 Urinary tract infection due to Candidiasis
（念珠菌所致之泌尿道感染） 112.2
 Urosepsis (尿敗血症) 599.0
 Bacteremia (菌血症) 790.7
 Pyuria (膿尿症) 791.9
Urinary tract infection-3
 Urinary
tract infection due to candidiasis
 599.0+112.9 (未使用合併碼)
 MDC 11 DRG 321
性別是影響因素
 112.2
 男：MDC
12 DRG 35001~35002
 女：MDC 13 DRG 36801~36802
Urinary tract infection (UTI)/
septicemia
 Septicemia
due to a pseudomonas UTI is
coded 038.43 as the principal diagnosis and
599.0 as the secondary diagnosis. Code
041.7 pseudomonas infection, does not
have to be coded as it is already identified
by the code for septicemia.
Coding clinic, 4th quarter 1988, p.10
MDC 11 Diseases and disorders
of kidney and urinary tract
DRG
Yes
32301
ESWL
Yes
No
Urinary stones
Complication
and / or
Comorbidity
Yes
No
32302
32401
ESWL
No
Vesical stone 594.1
Vesicolithotripsy 57.0
DRG 32402
32402
Percutaneous nephrostomy (PCN)
 Percutaneous
nephrostomy (PCN) 55.03
 Percutaneous nephrostomy with
fragmentation 55.04
 Hydronephrosis
 PCN
55.03
 DRG 304~305
591
DM VS ESRD VS Hypertension
 DM
with nephropathy with ESRD
 Hypertension
 Hemodiaysis
 250.40+403.91+39.95
DRG 331~332
 403.91+250.40+39.95
DRG 31601~31602
Renal insufficiency
 CRI
(Chronic renal insufficiency) 593.9
 ARI (Acute renal insufficiency) 593.9
協會 Q & A,編號44
 DM
with chronic renal insufficiency 250.40
＋ 593.9
協會 Q & A,編號789
 Chronic
renal failure with acute exacerbation
584.9+ 585
協會 Q & A,編號110、464
Abnormal findings
 Abnormal
findings (laboratory, X-ray,
pathologic, and other diagnostic results) are
not coded and reported unless the physician
indicates their clinical significance.
Coding clinic, 2nd quarter 2002, p.17 and p67
Coding clinic, 2nd quarter 1990, p.15~16
Aftercare with history of malignancy
Bladder Ca 患者接受過TURBT手術，此次住院做膀
胱鏡檢查以評估是否有復發情形，膀胱鏡檢查結果
顯示正常並無癌症復發。
 V67.09＋V10.51＋57.32
 MDC 23 DRG 465

Bladder Ca患者身體不適來院接受檢查，醫師懷疑
癌症復發，但經檢查結果顯示並無復發或轉移現象。
 V71.1 ＋V10.51
 MDC 17 DRG 41102

Aftercare without history of malignancy
 Bilateral
femoral shaft fracture S/P ORIF
Left tibia with fibular fracture S/P ORIF
 V58.49、821.01、823.82
MDC 23 DRG 466
 821.01、823.82
MDC 8 DRG 235
Removal of port-A catheter
 Removal
of port-A catheter
 V58.81+V10.xx+86.05
MDC 23 DRG 465
 V58.81+86.05
MDC 23 DRG 466
 Complication
996.62 or 996.74+86.05
MDC 5 DRG 14501
工具書不同，會出現不同的代碼
 使用工具書(
ICD-9-CM &ICD-O-3)不同，會
出現不同的代碼。
 Myelodysplastic syndrome & Polycythemia
vera
 ICD-9-CM 238.7 & 238.4
MDC 17 DRG40301~40402
 ICD-O-3
Lymphoma 202.9x
心得分享
前題—知己知彼、百戰百勝
了解自己醫院的有限財務資源及各類環境的限制，不同的
個案，不同的編碼，應以不同的手段及方法，解決不同的
問題。
決策—互為輔助、相得益彰
讓疾病分類與費用申報結合形成完整明確之統計資訊，透
過經驗的累積、介入時機與模式，讓有限之醫療資源做最
合宜之運用。
電話: 02-28712121#3851
E-mail:[email protected]