Chapter XI K00-K93 Digestive System Disease of Stomach · Chapter XI K00-K93 Digestive System นพ.บิัก์ เจิญิล์ ก่มงานัลยกรรม

Chapter XI K00-K93 Digestive System

นพ.บก เจญล

กมงานลยกรรม รพ.สวรรประชาก นครสวรร

1

Disease of Stomach

2

Dyspepsia

Chronic or recurrent pain or discomfort centered in the upper

abdomen when eating

One or more the following symptoms (ROME III)

Postprandial fullness

Early satiety

Epigastric pain

Epigastric burning

Functional dyspepsia [Non-ulcer dyspepsia]

Peptic ulcer disease

Gastroesophageal reflux disease

dys “bad” or “difficult” & pepsis “digestion” = indigestion

3

Dyspepsia

Summary Diagnosis ICD-10

Dyspepsia

Heartburn

Indigestion

Regurgitation

Functional dyspepsia

K30

R12

R11

R11

F45.3

Subjective Diagnosis

4

Gastritis

Diagnosis view

: Endoscopic diagnosis

: Pathologic diagnosis

: with underlying condition

CAG

CSG

AEGAHG

Objective Diagnosis

5

Gastritis

Acute gastritis

- Acute infectious gastritis: including H.pylori

- Acute erosive gastritis: NSAID, alcohol, chemical ingestion

- Acute hemorrhagic gastritis: ischemia

Chronic gastritis

- Helicobactor pylori type

- Chronic atrophic gastritis: type A, type B

- Chemical: bile reflux, NSAID

- Granulomatous gastritis: Crohn’s disease, sarcoidosis, vasculitides

- Allergic gastritis: Eosinophilic gastritis

- Specific infection: HIV, TB, syphilis, cytomegalovirus, histoplasmosis

Objective Diagnosis

6

Gastritis


Acute erosive gastritis

Acute hemorrhagic gastritis

K29.0

K29.0

Alcoholic gastritis

Allergic gastritis

Giant hypertrophic gastritis [Menetrier’s disease]

Granulomatous gastritis

K29.2

K29.6

K29.6

K29.6

Eosinophilc gastritis

Lymphocytic gastritis

K52.8

K29.6

Gastritis K29.7

Objective Diagnosis

7

Gastritis


Chronic gastritis

Chronic atrophic gastritis

Chronic superficial gastritis

Intestinal metaplasia

K29.5

K29.4

K29.3

K29.5

Curling ulcer

Cushing ulcer

K25.0

K25.0

Viral gastritis

Tuberculous gastritis

Helicobacter pylori gastritis

A08.4

A18.8 + K93.8

K29.- + B96.8

Objective Diagnosis

8

Peptic Ulcer

An ulcer is defined as disruption of the mucosal integrity in a

region that touches gastric acid and pepsin, so ‘peptic ulcer’

refers to an ulcer in the lower esophagus, stomach or

duodenum, in jejunum after surgical anastomosis to stomach or

rarely in there ileum adjacent to Meckel’s diverticulum leading to

local defect or excavation due to active inflammation.

Acute: associated with superficial erosion and minimal

inflammation

Chronic: one of long duration eroding through the muscular

wall with the formation of fibrous tissue

9

Peptic Ulcer

acute chronic

10

Peptic Ulcer

Gastric ulcer

Duodenal ulcer

Gastrojejunal ulcer / Marginal ulcer / Stomal ulcer

Jejunal ulcer

Dyspepsia

!

: Gastrointestinal ulcer องจยจากการตรวจเศษเาน

: Peptic ulcer ไใในการจยโรคในจน

: Dyspepsia ใจยจากอาการ [แทน peptic ulcer]

11

Peptic Ulcer

Gastric ulcer

Duodenal ulcer

Gastrojejunal ulcer / Marginal ulcer / Stomal ulcer

Jejunal ulcer

Dyspepsia

12

Gastric Ulcer


Gastric ulcer K25.9

Acute gastric ulcer

Acute gastric ulcer with bleeding

Acute gastric ulcer with perforation

Acute gastric ulcer with bleeding and perforation

K25.3

K25.0

K25.1

K25.2

Chronic gastric ulcer

Chronic gastric ulcer with bleeding

Chronic gastric ulcer with perforation

Chronic gastric ulcer with bleeding and perforation

K25.7

K25.4*

K25.5*

K25.6*

* included Unspecified Gastric Ulcer

13

Duodenal Ulcer


Duodenal ulcer K26.9

Acute duodenal ulcer

Acute duodenal ulcer with bleeding

Acute duodenal ulcer with perforation

Acute duodenal ulcer with bleeding and perforation

K26.3

K26.0

K26.1

K26.2

Chronic duodenal ulcer

Chronic duodenal ulcer with bleeding

Chronic duodenal ulcer with perforation

Chronic duodenal ulcer with bleeding and perforation

K26.7

K26.4*

K26.5*

K26.6*

* included Unspecified Duodenal Ulcer

14

Barry J Marshall & J Robin Warren at Perth, first discover

in the stomachs of gastritis and gastric ulcer at 1982

Diagnosis of H.pylori infection

Non-endoscopic tests

: Blood antibody

: Urea breath test

: Stool antigen

Endoscopic tests

: Biopsy urease test “CLO-test”

: Histology

: Culture

Helicobacter pyloriB98.0 H.pylori infection

15

Helicobacter pylori diseases classified to other chapters

B98.0 Helicobacter pylori [H.pylori] as the cause of diseases classified

to other chapters-B98.1 Vibrio vulnificus as the cause of diseases classified to other

-

16

Gastrointestinal Bleeding

Hematemesis

อาเยนเนเอดแดงสด หอเอดำเาๆ [coffee-ground]

Hematochezia

ายเนเอดแดงสด

Melena

จจาระำเนน เหยว และกนเหน [เอดออก 60 ลตร]

Stool occult blood

Rectal bleeding

17


Summary Diagnosis ICD-10 Neonate

Hematemesis

Hematochezia

Melena

Stool occult blood

Upper gastrointestinal bleeding

Coffee ground [NG lavage]

Coffee ground emesis

Lower gastrointestinal bleeding

Gastrointestinal bleeding

Rectal bleeding

K92.0

K92.1

K92.1

R19.5

K92.2

K92.2

K92.0

K92.2

K92.2

K62.5

P54.0

P54.1

P54.1

-

P54.3

P54.3

P54.0

P54.3

P54.3

P54.2

18


กรตรวจพบรอยโรค เน erosion, ulcer, varix

สามารถจยาเนสาเหของเอดออกไ โดยไำเนอง

พบาเอดออกในขณะน (acute bleeding)

แพทควรระา lesion with bleeding หอ hemorrhage

ใรสองตรวจสอบรสการจยา ำเนองเมรส

ของ gastrointestinal bleeding เมเมหอไ [บางรสการจยไครอบคมวย เน K72.6 Mallory-Weiss tear]

19

FORREST classification

Clinical Diagnosis Endoscopic Finding

Acute bleeding

Forrest Ia

Forrest Ia

!

Arterial spurting bleeding

Oozing bleeding

Recent bleeding

Forrest IIa

Forrest IIb

Forrest IIc

!

Ulcer with non-bleeding visible vessel

Ulcer with adherent clot on surface

Ulcer with hematin-covered lesion

Lesions without active bleeding

Forrest III

!

Ulcer with clean base

20

Endoscopic Findings

21

Peptic Ulcer Coding

The following fourth-character subdivisions are for use with categories

K25-K28:

.0 Acute with haemorrhage

.1 Acute with perforation

.2 Acute with both haemorrhage and perforation

.3 Acute without haemorrhage or perforation

.4 Chronic or unspecified with haemorrhage

.5 Chronic or unspecified with perforation

.6 Chronic or unspecified with both haemorrhage and perforation

.7 Chronic without haemorrhage or perforation

.9 Unspecified as acute or chronic, without haemorrhage or

perforation

K25 Gastric ulcer

22

- Endoscopic injection therapy: saline, adrenaline

- Endoscopic clipping

- Endoscopic coagulation: heater probe, gold probe, APC

44.43 Endoscopic control gastric and duodenal bleeding

Endoscopic Stop Bleeding

23

Peptic Ulcer Perforation

24

44.41 Simple closure of gastric ulcer perforation

44.42 Simple closure of duodenal ulcer perforation

!

ไองใรสตถการ Omental graft, Peritoneal toilet

!

!

!

Peptic Ulcer Perforation

25

Peptic Ulcer Obstruction

จยจากอาการ [pyloric obstruction]

: Splashing sound

จยจากการตรวจเมเม [pyloric or duodenal obstruction]

: สามารถระสาเหของภาวะ

ในกสาเหเนการจยหก

: ไสามารถระสาเหของภาวะ

ในกำแหงดนเนการจยหก

‘Gastric Outlet Obstruction’

26

Gastric Outlet Obstruction

27

Gastric Outlet Obstruction


Pyloric obstruction

Duodenal obstruction

K31.1

K31.5 Acute distension of stomach

K31.1 Adult hypertrophic pyloric stenosis

Pyloric stenosis NOS

Excludes: congenital or infantile pyloric stenosis ( Q40.0 )

K31.2 Hourglass stricture and stenosis of stomach

Excludes: congenital hourglass stomach ( Q40.2 )

hourglass contraction of stomach ( K31.8 )

K31.3 Pylorospasm, not elsewhere classified

xcludes: pylorospasm:

xcludes: congenital diverticulum of stomach ( Q40.2 )

K31.5 Obstruction of duodenum

Constriction

Stenosis

Stricture } of duodenum

Duodenal ileus (chronic)

Excludes: congenital stenosis of duodenum ( Q41.0 )

K31.6 Fistula of stomach and duodenum

clinical diagnosis ‘unknown etiology'

28

Esophageal Varices

29

Bleeding Esophageal Varices

เกณการจย สปสช.2559

: ประอาเยนเนเอดหอายำ

: การนกจยของแพท Bleeding esophageal varices

- พบ active bleeding

- ไพบ recent/active bleeding หอ

- เอดออกภายใน 10 นหงำหาย

- องการกษาโรค [SB-tube, Somatostatin, Vasopressin]

กรทราบสาเห องนกเนโรคหก

ใรส I98.2* หอ I98.3*

30

Esophageal Varices


Bleeding esophageal varices

Bleeding esophageal varices due to cirrhosis

Bleeding esophageal varices due to alcoholic cirrhosis

Bleeding esophageal varices due to hepatitis cirrhosis

I85.0

K74.6 + I98.3

K70.3 + I98.3

B15-B19 + I98.3

Esophageal varices I85.9· lesions of pinta [carate] ( A67.2† )

I98.2* Oesophageal varices without bleeding in diseases classified

elsewhere

Oesophageal varices in:

· liver disorders ( K70-K71† , K74.-† )

· schistosomiasis ( B65.-† )

I98.3* Oesophageal varices with bleeding in diseases classified

elsewhere-

Oesophageal varices in:

· liver disorders ( K70-K71† , K74.-† )

· schistosomiasis ( B65.-† )

I98.8* Other specified disorders of circulatory system in diseases

classified elsewhere

31

Disease of Appendix

32

Appendicitis

Abscess of appendix

K35.2 Acute appendicitis with generalized peritonitis-

Appendicitis (acute) with generalized (diffuse) peritonitis

following rupture or perforation

K35.3 Acute appendicitis with localized peritonitis-

Acute appendicitis with localized peritonitis with or without

rupture or perforation

Acute appendicitis with peritoneal abscess

K35.8 Acute appendicitis, other and unspecified-

Acute appendicitis without mention of localized or generalized

peritonitis

K35.9 Acute appendicitis, unspecified

Acute appendicitis with peritonitis, localized or NOS

33

Appendicitis

กรการาดไง

Acute appendicitis with localized peritonitis

: ตรวจพบ rebound tenderness/guarding องอยขวา

: ไาจะเน ruptured/accidental ruptured

Acute appendicitis with generalized peritonitis

: ตรวจพบ rebound tenderness/guarding งสองง

: กเน ruptured วมบหนองกระจายวงององ

กรไการาดไง

สถานภาพำหาย องไใ improved-approval

ยกเน หกฐานนนการจย หอ อามอการาด

34

Appendicitis

กรการาดไง


: ตรวจพบ rebound tenderness/guarding องอยขวา

: ไาจะเน ruptured/accidental ruptured

Acute appendicitis with generalized peritonitis

: ตรวจพบ rebound tenderness/guarding งสองง

: กเน ruptured วมบหนองกระจายวงององ

กรไการาดไง

สถานภาพำหาย องไใ improved-approval

ยกเน หกฐานนนการจย หอ อามอการาด

35

Appendicitis


Appendicitis

Acute appendicitis


Acute inflammatory appendicitis

Appendiceal abscess

K37

K35.8

K35.3

!

!

!

!

K35.3

Ruptured appendicitis with generalized peritonitis

Peritonitis due to ruptured peritonitis

K35.2

K35.2

Chronic appendicitis K36

Acute suppurative appendicitis

Acute gangrenous appendicitis

Ruptured appendicitis

36

Appendectomy

QRGTCVKQPU"QP"VJG"FKIGUVKXG"U[UVGO"*64/76+

- New code ""® Revised code fl 4th digit re

-

Gzenwfgu<"gpfqueqrke"kpugtvkqp"qh"eqnqpke"uvgpv"*680:8+"

//ugg"

Gzenwfgu<"fkcipquvke"rtqegfwtgu"qp"kpvguvkpg *67033/6704;+fkncvkqp"qh"gpvgtquvqo{"uvqoc"*;8046+"kpvguvkpcn"kpvwdcvkqp"*;802:+"tgoqxcn"qh<"kpvtcnwokpcn"hqtgkip"dqf{"htqo"nctig"kpvguvkpg"ykvjqwv"kpekukqp"

*;:026+"kpvtcnwokpcn"hqtgkip"dqf{"htqo"uocnn"kpvguvkpg"ykvjqwv"

kpekukqp"*;:025+"vwdg"htqo"nctig"kpvguvkpg"*;9075+"vwdg"htqo"uocnn"kpvguvkpg"*;9074+"

tgrncegogpv"qh<"nctig"kpvguvkpg"vwdg"qt"gpvgtquvqo{"fgxkeg"*;9026+"uocnn"kpvguvkpg"vwdg"qt"gpvgtquvqo{"fgxkeg"*;9025+"

(99.77)

4 7 .0 A p p e n d ecto m y

Gzenwfgu<"kpekfgpvcn"crrgpfgevqo{."uq"fguetkdgf"ncrctqueqrke"*69033+"qvjgt"*6903;+"

4 7 .0 1 La p a r o sc o p ic a p p e n d ec to m y

4 7 .0 9 O t h e r a p p e n d ec to m y

KEF/;/EO"VCDWNCT"NKUV"QH"RTQEGFWTGU"*H[32+"

4 7 .1 Inci d e n t a l ap p e n d ecto m y

4 7 .1 1 La p a r o sc o p ic i n c i d e n t a l a p p e n d ec t o m y

4 7 .1 9 O t h e r i n c i d e n t a l a p p e n d ec t o m y

4 7 .2 D r a in a g e of a p p e n d ice a l a b scess

Gzenwfgu<"vjcv"ykvj"crrgpfgevqo{"*6902+"

Gzenwfgu<"fkcipquvke"rtqegfwtgu"qp"crrgpfkz *67043/6704;+

Gzenwfgu<"kpekukqp"qh"rgtktgevcn"vkuuwg"*6:0:3+"

Gzenwfgu<" vjcv"ykvj"dkqru{ *6:046+

Gzenwfgu<"vjcv"ykvj"dkqru{ *6:046+

Gzenwfgu<"hngzkdng"ukioqkfqueqr{ *67046+

Gzenwfgu<"fkikvcn"gzcokpcvkqp"qh"tgevwo *:;056+nqygt"IK"ugtkgu"*:9086+"oketqueqrke"gzcokpcvkqp"qh"urgekogp"htqo"tgevwo"*;20;3/;20;;+"

37

Appendectomy

Summary Procedure ICD-9-CM

Appendectomy

Open appendectomy

Laparoscopic appendectomy

Exploratory laparotomy to appendectomy

47.09

47.09

47.01

47.09

Drainage of appendices abscess

Open drainage of abscess with appendectomy

Laparoscopic drainage of abscess with appendectomy

47.2

47.09

47.01

Incidental open appendectomy

Incidental laparoscopic appendectomy

47.19

47.11

38

าด Exploratory laparotomy พบ ruptured appendicitis หนองกระจายวององ ำไบวม หงดไง างองวยำเกอนอนเบดององวย

retention suture แไเบดนวหง หงาดน 4 เบดแผลาด ไภาวะแทรกอน ำหายในน 10

Op

Peritonitis K65.9

Peritonitis due to ruptured appendicitis K35.2

Ruptured appendicitis K35.8

Ruptured appendicitis with generalized peritonitis K35.2

Intraabominal abscess K65.0

Ruptured appendicitis with intraabdominal abscess K35.3

Appendiceal abscess K35.3

Appencitis K37

39

าด Exploratory laparotomy พบ ruptured appendicitis หนองกระจายวององ ำไบวม หงดไง างองวยำเกอนอนเบดององวย

retention suture แไเบดนวหง หงาดน 4 เบดแผลาด ไภาวะแทรกอน ำหายในน 10

Op

Exploratory laparotomy 54.11

Appendectomy 47.09

Exploratory laparotomy to appendectomy 47.09

Peritoneal toilet 54.25

Retention suture -

Delayed primary closure 86.59

Resuture of abdominal wall 54.61

Suture of skin of abdomen 86.59

40

Hernia

41

Groin Hernia

Indirect inguinal hernia (IIH)

Direct inguinal hernia (DIH)

Femoral hernia (FH)

ภาวะแทรกอน

: Incarcerated hernia เนไเอนไสามารถนวนไหลออก

มากบเาไปในององ

: Strangulated hernia เนไเอนำใการขาดเอดไปเยง

ของวนไหลออกมาและเดเา (gangrene) ตามมาไ

: Bowel obstruction เนไเอนำใการดนของำไ

Strangulation…..IS…..Gangrene…..in Practice

42

K40 Inguinal hernia Includes: bubonocele

inguinal hernia:

· NOS

· direct

· double

· indirect

· oblique

scrotal hernia

K40.0 Bilateral inguinal hernia, with obstruction, without gangrene

K40.1 Bilateral inguinal hernia, with gangrene

K40.2 Bilateral inguinal hernia, without obstruction or gangrene

Bilateral inguinal hernia NOS K40.3 Unilateral or unspecified inguinal hernia, with obstruction,

without gangrene

Inguinal hernia (unilateral):

· causing obstruction

· incarcerated

· irreducible

· strangulated

without gangrene

K40.4 Unilateral or unspecified inguinal hernia, with gangrene

Inguinal hernia NOS with gangrene

K40.9 Unilateral or unspecified inguinal hernia, without obstruction

or gangrene

Inguinal hernia (unilateral) NOS

K41 Femoral hernia

Groin Hernia

43

Groin Hernia

Inguinal hernia (unilateral) NOS

K41 Femoral hernia K41.0 Bilateral femoral hernia, with obstruction, without gangrene

K41.1 Bilateral femoral hernia, with gangrene

K41.2 Bilateral femoral hernia, without obstruction or gangrene

Bilateral femoral hernia NOS

K41.3 Unilateral or unspecified femoral hernia, with obstruction,

without gangrene

Femoral hernia (unilateral):

· causing obstruction

· incarcerated

· irreducible

· strangulated

without gangrene

K41.4 Unilateral or unspecified femoral hernia, with gangrene

K41.9 Unilateral or unspecified femoral hernia, without

obstruction or gangrene

Femoral hernia (unilateral) NOS

K42 Umbilical hernia

Strangulation…..IS…..Gangrene…..in Practice

Strangulation…..NOT…..Gangrene…..in ICD-10

44

Groin Hernia

Clinical Diagnosis ICD-10 Diagnosis

Hernia

Reducible hernia

Sliding hernia

Pantaloon hernia

Recurrent hernia

Hernia

Incarcerated hernia

Irreducible hernia

Hernia with obstruction

Obstructed hernia Hernia with obstruction

Strangulated hernia Hernia with obstruction

Hernia with gangrene Hernia with gangrene

Hernia with obstruction with gangrene

45

Groin Hernia

Summary DiagnosisICD-10

Unilateral Bilateral

Inguinal hernia

Indirect inguinal hernia

Direct inguinal henia

Femoral hernia

Hernia

K40.9

K40.9

K40.9

K41.9

K46.9

K40.2

K40.2

K40.2

K41.2

K46.9

Incarcerated inguinal hernia

Obstructed inguinal henia

Incarcerated femoral hernia

Obstructed femoral hernia

K40.3

K40.3

K41.3

K41.3

K40.0

K40.0

K41.0

K41.0

46

Groin Hernia



Incarcerated indirect inguinal hernia

Incarcerated direct inguinal hernia

Obstructed indirect inguinal henia

Obstructed direct inguinal hernia

Incarcerated femoral hernia

Obstructed femoral hernia

K40.3

K40.3

K40.3

K40.3

K41.3

K41.3

K40.0

K40.0

K40.0

K40.0

K41.0

K41.0

47

Groin Hernia



Strangulated indirect inguinal hernia

Strangulated direct inguinal hernia

Strangulated femoral hernia

K40.3

K40.3

K41.3

K40.0

K40.0

K41.0

Indirect inguinal hernia with gangrene

Direct inguinal hernia with gangrene

Femoral hernia with gangrene

K40.4

K40.4

K41.4

K40.1

K40.1

K41.1

Strangulation…..NOT…..Gangrene…..in ICD-10

48

Repair of Hernia

Herniotomy and Herniorrhaphy or Hernioplasty

Non-mesh repair vs Mesh repair

Open repair vs Laparoscopic repair

49

Repair of Hernia

Open and Non-mesh repair

: Herniotomy

: Bassini herniorrhaphy

: McVay herniorrhaphy

: Shouldice herniorrhaphy

: Halsted herniorrhaphy

: Furguson herniorrphaphy

50

Repair of Hernia

Open and Mesh repair

: Lichtenstein hernioplasty

: Plug and patch hernioplasty

51

Repair of Hernia

Laparoscopic repair [all mesh repair]

- Total extraperitoneal technique (TEP)

- Transabdominal preperitoneal approach (TAPP)

TEP

TAPP

TAPP

52

Repair of Groin Hernia


Gzenwfgu<"ocpwcn"tgfwevkqp"qh"jgtpkc"*;8049+"

5 3 .0 O t h e r u n i l a t e r a l r e p a i r o f i n g u in a l h e r n ia ®

Gzenwfgu<"ncrctqueqrke"wpkncvgtcn"tgrckt"qh"kpiwkpcn"jgtpkc"*39033/39035+"

5 3 .0 0 U n i l a t e r a l r e p a i r o f i n g u i n a l h e r n i a , n o t o t h e r w is e s p ec i f i e d Inguinal herniorrhaphy NOS

5 3 .0 1 O t h e r a n d o p e n r e p a i r o f d i r ec t i n g u i n a l h e r n i a ®

Direct and indirect inguinal hernia

5 3 .0 2 O t h e r a n d o p e n r e p a i r o f i n d i r ec t i n g u i n a l h e r n i a ®

5 3 .0 3 O t h e r a n d o p e n r e p a i r o f d i r ec t i n g u i n a l h e r n i a w i t h g r a f t o r

p r o s t h es i s ®

5 3 .0 4 O t h e r a n d o p e n r e p a i r o f i n d i r ec t i n g u i n a l h e r n i a w i t h g r a f t o r

p r o s t h es i s ®

5 3 .0 5 Re p a i r o f i n g u i n a l h e r n i a w i t h g r a f t o r p r o s t h es i s , n o t o t h e r w is e s p ec i f i e d

®

Gzenwfgu<"ncrctqueqrke"dkncvgtcn"tgrckt"qh"kpiwkpcn"jgtpkc"*39043" 39046+"




5 3 .1 O t h e r b i l a t e r a l r e p a i r o f in g u in a l h e rn ia ®


5 3 .1 0 Bi l a t e r a l r e p a i r o f i n g u i n a l h e r n i a , n o t o t h e r w is e s p ec i f i e d

5 3 .1 1 O t h e r a n d o p e n b i l a t e r a l r e p a i r o f d i r ec t i n g u i n a l h e r n i a ®

5 3 .1 2 O t h e r a n d o p e n b i l a t e r a l r e p a i r o f i n d i r ec t i n g u i n a l h e r n i a ®

5 3 .1 3 O t h e r a n d o p e n b i l a t e r a l r e p a i r o f i n g u i n a l h e r n i a , o n e d i r e c t a n d

o n e i n d i r ec t ®

5 3 .1 4 O t h e r a n d o p e n b i l a t e r a l r e p a i r o f d i r ec t i n g u i n a l h e r n i a w i t h g r a f t

o r p r o s t h es i s ®

5 3 .1 5 O t h e r a n d o p e n b i l a t e r a l r e p a i r o f i n d i r ec t i n g u i n a l h e r n i a w i t h

g r a f t o r p r o s t h es i s ®

5 3 .1 6 O t h e r a n d o p e n b i l a t e r a l r e p a i r o f i n g u i n a l h e r n i a , o n e d i r e c t a n d

o n e i n d i r ec t , w i t h g r a f t o r p r o s t h es i s ®

5 3 .1 7 Bi l a t e r a l i n g u i n a l h e r n i a r e p a i r w i t h g r a f t o r p r o s t h es i s , n o t o t h e r w is e s p ec i f i e d

53

Repair of Groin HerniaQVJGT"OKUEGNNCPGQWU"FKCIPQUVKE"CPF"VJGTCRGWVKE"RTQEGFWTGU"*39+

1 7 .1 La p a rosco p ic u n i l a t e r a l r e p a i r o f i n g u in a l h e r n ia

Gzenwfgu<"qvjgt"cpf"qrgp"wpkncvgtcn"tgrckt"qh"jgtpkc"*75022" 75027+"

1 7 .1 1 La p a r o sc o p ic r e p a i r o f d i r ec t i n g u i n a l h e r n i a w i t h g r a f t o r

p r o s t h es i s- Laparoscopic repair of direct and indirect inguinal hernia with graft or

prosthesis

1 7 .1 2 La p a r o sc o p ic r e p a i r o f i n d i r ec t i n g u i n a l h e r n i a w i t h g r a f t o r

p r o s t h es i s-

1 7 .1 3 L a p a r o sc o p ic r e p a i r o f i n g u i n a l h e r n i a w i t h g r a f t o r p r o s t h es i s , n o t

o t h e r w is e s p ec i f i e d-

1 7 .2 La p a rosco p ic b i l a t e r a l r e p a i r o f i n g u in a l h e r n ia

Gzenwfgu<"qvjgt"cpf"qrgp"dkncvgtcn"tgrckt"qh"jgtpkc"*75032" "75039+"

1 7 .2 1 L a p a r o sc o p ic b i l a t e r a l r e p a i r o f d i r ec t i n g u i n a l h e r n i a w i t h g r a f t

o r p r o s t h es i s-

1 7 .2 2 La p a r o sc o p ic b i l a t e r a l r e p a i r o f i n d i r ec t i n g u i n a l h e r n i a w i t h

g r a f t o r p r o s t h es i s-

1 7 .2 3 La p a r o sc o p ic b i l a t e r a l r e p a i r o f i n g u i n a l h e r n i a , o n e d i r ec t a n d

o n e i n d i r ec t , w i t h g r a f t o r p r o s t h es i s-

1 7 .2 4 La p a r o sc o p ic b i l a t e r a l r e p a i r o f i n g u i n a l h e r n i a w i t h g r a f t o r

p r o s t h es i s , n o t o t h e r w is e s p ec i f i e d-

Gzenwfgu<"qvjgt"cpf"qrgp"rctvkcn"gzekukqp"qh"nctig"kpvguvkpg"*67093/"6709;+"

--

--

--

-

Gzenwfgu<"eqorwvgt"cuukuvgf"uwtigt{"*22053/22057."2205;+"

54

Repair of Groin Hernia


146 1 .1 OR procedure 012 Non OR procedure but affects ThaiDRG




5 3 .2 Un i l a t e r a l r e p a i r o f f e m ora l h e r n ia

5 3 .2 1 U n i l a t e r a l r e p a i r o f f e m o r a l h e r n i a w i t h g r a f t o r p r o s t h es i s

5 3 .2 9 O t h e r u n i l a t e r a l f e m o r a l h e r n i o r r h a p h y

5 3 .3 Bi l a t e r a l r e p a i r o f f e m or a l h e r n ia

5 3 .3 1 Bi l a t e r a l r e p a i r o f f e m o r a l h e r n i a w i t h g r a f t o r p r o s t h es i s

5 3 .3 9 O t h e r b i l a t e r a l f e m o r a l h e r n i o r r h a p h y

การนกการจยไเอนขาหบ

1. ระชดของไเอน

2. ระางของไเอน

3. ระภาวะแทรกอนของไเอน

การนกและใรสตถการอมไเอนขาหบ

1. ระางำตถการ

2. ระาใแนสเยมวมวยหอไ

3. ระเทคคของการำตถการ

55

Groin Hernia

Summary ProcedureICD-9-CM


Herniotomy 53.02 53.12

Herniorrhaphy 53.00 53.10

Indirect herniorrhaphy

Direct herniorrhaphy

Femoral hernorrhaphy

53.02

53.01

53.29

53.12

53.11

53.39

Bassini herniorrhaphy

McVay herniorrhaphy

Shouldice herniorrhaphy

Furguson herniorrhaphy

?

?

?

?

?

?

?

?

56

Groin Hernia



Hernioplasty 53.05 53.17

Indirect hernioplasty

Direct hernioplasty

Femoral hernoplasty

53.04

53.03

53.21

53.15

53.14

53.31

Indirect herniorrhaphy with mesh graft

Direct herniorrhaphy with mesh graft

Femoral herniorrhaphy with mesh graft

53.04

53.03

53.21

53.15

53.14

53.31

Lichtenstein hernioplasty

Plug and patch hernioplasty

?

?

?

?

57

Groin Hernia



Laparoscopic hernioplasty 17.13 17.24

Laparoscopic indirect hernioplasty

Laparoscopic direct hernioplasty

17.12

17.11

17.22

17.21

58

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