skin and soft tissue infection · skin and soft tissue infection skin and soft tissue infection...

นพ.บริรักษ์ เจริญศิลป์ กลุ่มงานศัลยกรรม รพ.สวรรค์ประชารักษ์ นครสวรรค์

Chapter XII L00-L99 Skin and Subcutaneous Tissue

บันทึกการวินิจฉัยรอยโรคท่ีรุนแรงสุด หรือ เนื้อเยื่อชั้นลึกสุด

ระบุตำแหน่งทางกายวิภาคของรอยโรค หรือ ชนิดเนื้อเยื่อเฉพาะ

ระบุสาเหตุของการอักเสบติดเชื้อ

ระบุเชื้อก่อโรค

Skin and Soft Tissue Infection

Skin and Soft Tissue Infection

Epidermis: Erysipelas, Impetigo, Folliculitis, Ectyma, Carbuncle

Dermis: Cellulitis

Subcutaneous fat: Necrotizing fasciitis

Muscle: Pyomyositis

Cellulitis

Summary Diagnosis ICD-10Erysipelas A46

Cellulitis

following immunization

at drainage site

at auricle/external auditory canal

at penis

at other sites

!T88.0

T81.4

H60.1

N48.2

L03.-

Lymphangitis I89.1

Gas gangrene, Clostridial cellulitis A48.0

Necrotizing fasciitis M72.6-

Cellulitis

Version for 2010 497

L03 Cellulitis Includes: acute lymphangitis Excludes: cellulitis of:

· anal and rectal regions ( K61.- ) · external auditory canal ( H60.1 ) · external genital organs: · female ( N76.4 ) · male ( N48.2 , N49.- ) · eyelid ( H00.0 ) · lacrimal apparatus ( H04.3 ) · mouth ( K12.2 ) · nose ( J34.0 ) eosinophilic cellulitis [Wells] ( L98.3 ) febrile neutrophilic dermatosis [Sweet] ( L98.2 ) lymphangitis (chronic)(subacute) ( I89.1 )

L03.0 Cellulitis of finger and toe Infection of nail

Onychia Paronychia Perionychia

L03.1 Cellulitis of other parts of limb Axilla

Hip Shoulder

L03.2 Cellulitis of face L03.3 Cellulitis of trunk Abdominal wall

Back [any part] Chest wall Groin Perineum Umbilicus

Excludes: omphalitis of newborn ( P38 ) L03.8 Cellulitis of other sites Head [any part, except face]

Scalp L03.9 Cellulitis, unspecified


L03 Cellulitis Includes: acute lymphangitis Excludes: cellulitis of:

· anal and rectal regions ( K61.- ) · external auditory canal ( H60.1 ) · external genital organs: · female ( N76.4 ) · male ( N48.2 , N49.- ) · eyelid ( H00.0 ) · lacrimal apparatus ( H04.3 ) · mouth ( K12.2 ) · nose ( J34.0 ) eosinophilic cellulitis [Wells] ( L98.3 ) febrile neutrophilic dermatosis [Sweet] ( L98.2 ) lymphangitis (chronic)(subacute) ( I89.1 )

L03.0 Cellulitis of finger and toe Infection of nail

Onychia Paronychia Perionychia

L03.1 Cellulitis of other parts of limb Axilla

Hip Shoulder

L03.2 Cellulitis of face L03.3 Cellulitis of trunk Abdominal wall

Back [any part] Chest wall Groin Perineum Umbilicus

Excludes: omphalitis of newborn ( P38 ) L03.8 Cellulitis of other sites Head [any part, except face]

Scalp L03.9 Cellulitis, unspecified

Abscess

Summary Diagnosis ICD-10Abscess at

eyelid

nose, nasal septum

auricle, external auditory canal

preauricular sinus

other sites

furuncle, carbuncle]

!H00.0

J34.0

H60.0

Q18.1

L02.-

Breast abscess

Breast abscess in puerperium / Postpartum breast abscess

N61

O91.0

Anorectal abscess

Pilonidal abscess

K61.-

L05.0

Abscess

Summary Diagnosis ICD-10Bartholin’s abscess

Bartholin’s abscess in pregnancy

Bartholin’s abscess in puerperium

N75.1

O23.5

O86.1

Abscess at surgical wound, stitch abscess T81.0

Hiadradenitis suppurativa

Sebaceous cyse abscess

Epidermal inclusion cyst abscess

L73.2

L73.2

L72.0

Wound / Ulcer / Gangrene


L95 Vasculitis limited to skin, not elsewhere classified Excludes: angioma serpiginosum ( L81.7 )

Henoch(-Schönlein) purpura ( D69.0 ) hypersensitivity angiitis ( M31.0 ) panniculitis (of): · NOS ( M79.3 ) · lupus ( L93.2 ) · neck and back ( M54.0 ) · relapsing [Weber-Christian] ( M35.6 )

polyarteritis nodosa ( M30.0 ) rheumatoid vasculitis ( M05.2 ) serum sickness ( T80.6 ) urticaria ( L50.- ) Wegener's granulomatosis ( M31.3 )

L95.0 Livedoid vasculitis Atrophie blanche (en plaque) L95.1 Erythema elevatum diutinum L95.8 Other vasculitis limited to skin L95.9 Vasculitis limited to skin, unspecified L97 Ulcer of lower limb, not elsewhere classified Excludes: decubitus [pressure] ulcer and pressure area ( L89.- )

gangrene ( R02 ) skin infections ( L00-L08 ) specific infections classified to A00-B99 varicose ulcer ( I83.0 , I83.2 )

L98 Other disorders of skin and subcutaneous tissue, not elsewhere classified L98.0 Pyogenic granuloma L98.1 Factitial dermatitis Neurotic excoriation L98.2 Febrile neutrophilic dermatosis [Sweet] L98.3 Eosinophilic cellulitis [Wells]

520 WHO’s ICD-10

L98.4 Chronic ulcer of skin, not elsewhere classified Chronic ulcer of skin NOS

Tropical ulcer NOS Ulcer of skin NOS

Excludes: decubitus [pressure] ulcer and pressure area ( L89.- ) gangrene ( R02 ) skin infections (L00-L08 ) specific infections classified to A00-B99 ulcer of lower limb NEC ( L97 ) varicose ulcer ( I83.0 , I83.2 )

L98.5 Mucinosis of skin Focal mucinosis

Lichen myxoedematosus Excludes: focal oral mucinosis ( K13.7 )

myxoedema ( E03.9 ) L98.6 Other infiltrative disorders of skin and subcutaneous tissue Excludes: hyalinosis cutis et mucosae ( E78.8 ) L98.8 Other specified disorders of skin and subcutaneous tissue L98.9 Disorder of skin and subcutaneous tissue, unspecified L99* Other disorders of skin and subcutaneous tissue in diseases classified elsewhere L99.0* Amyloidosis of skin ( E85.-† ) Lichen amyloidosis

Macular amyloid L99.8* Other specified disorders of skin and subcutaneous tissue in

diseases classified elsewhere Syphilitic:

· alopecia ( A51.3† ) · leukoderma ( A51.3† , A52.7† )



T79.0 Air embolism (traumatic) Excludes: air embolism complicating:

· abortion or ectopic or molar pregnancy ( O00-O07 , O08.2 )· pregnancy, childbirth and the puerperium ( O88.0 )

T79.1 Fat embolism (traumatic) Excludes: fat embolism complicating:

· abortion or ectopic or molar pregnancy ( O00-O07 , O08.2 )· pregnancy, childbirth and the puerperium ( O88.8 )

T79.2 Traumatic secondary and recurrent haemorrhage

T79.3 Post-traumatic wound infection, not elsewhere classified Use additional code (B95-B97), if desired, to identify infectious agent. T79.4 Traumatic shock Shock (immediate)(delayed) following injury Excludes: shock:

· anaesthetic ( T88.2 ) · anaphylactic: · NOS ( T78.2 ) · due to: · adverse food reaction ( T78.0 ) · correct medicinal substance properly administered ( T88.6 ) · serum ( T80.5 ) · complicating abortion or ectopic or molar pregnancy ( O00-O07 , O08.3 ) · electric ( T75.4 ) · lightning ( T75.0 ) · nontraumatic NEC ( R57.- ) · obstetric ( O75.1 ) · postoperative ( T81.1 )

T79.5 Traumatic anuria Crush syndrome

Renal failure following crushing

T79.6 Traumatic ischaemia of muscle Compartment syndrome

Volkmann's ischaemic contracture Excludes: anterior tibial syndrome ( M76.8 )

888 WHO’s ICD-10

T81.3 Disruption of operation wound, not elsewhere classified Dehiscence

Rupture } of operation wound

Excludes: disruption of: · caesarean-section wound ( O90.0 ) · perineal obstetric wound ( O90.1 )

T81.4 Infection following a procedure, not elsewhere classified Abscess:

· intra-abdominal · stitch · subphrenic · wound Sepsis

postprocedural

Use additional code, if desired, to identify other manifestations of infection, such as sepsis or abscess.

Excludes: infection due to: · infusion, transfusion and therapeutic injection ( T80.2 ) · prosthetic devices, implants and grafts ( T82.6-T82.7 , T83.5-T83.6 , T84.5-T84.7 , T85.7 ) obstetric surgical wound infection ( O86.0 )

T81.5 Foreign body accidentally left in body cavity or operation wound following a procedure

Adhesions Obstruction Perforation due to foreign body accidentally left in

operation wound or body cavity

Excludes: obstruction or perforation due to prosthetic devices and implants intentionally left in body ( T82.0-T82.5 , T83.0-T83.4 , T84.0-T84.4 , T85.0-T85.6 )

T81.6 Acute reaction to foreign substance accidentally left during a procedure

Peritonitis: · aseptic · chemical



T87 Complications peculiar to reattachment and amputation T87.0 Complications of reattached (part of) upper extremity

T87.1 Complications of reattached (part of) lower extremity

T87.2 Complications of other reattached body part

T87.3 Neuroma of amputation stump

T87.4 Infection of amputation stump

T87.5 Necrosis of amputation stump

T87.6 Other and unspecified complications of amputation stump Amputation stump:

· contracture (flexion)(of next proximal joint) · haematoma · oedema

Excludes: phantom limb syndrome ( G54.6-G54.7 ) T88 Other complications of surgical and medical care, not elsewhere classified Excludes: accidental puncture or laceration during a procedure

( T81.2 ) complications following: · infusion, transfusion and therapeutic injection ( T80.- ) · procedure NEC ( T81.- ) specified complications classified elsewhere, such as: · complications of: · anaesthesia in: · labour and delivery ( O74.- ) · pregnancy ( O29.- ) · puerperium ( O89.- ) · devices, implants and grafts ( T82-T85 ) · obstetric surgery and procedures ( O75.4 ) · dermatitis due to drugs and medicaments ( L23.3 , L24.4 , L25.1 , L27.0-L27.1 ) · poisoning and toxic effects of drugs and chemicals ( T36-T65 )


412 WHO’s ICD-10

I83 Varicose veins of lower extremities Excludes: complicating:

· pregnancy ( O22.0 ) · puerperium ( O87.8 )

I83.0 Varicose veins of lower extremities with ulcer Any condition in I83.9 with ulcer or specified as ulcerated

Varicose ulcer (lower extremity, any part) I83.1 Varicose veins of lower extremities with inflammation Any condition in I83.9 with inflammation or specified as

inflamed Stasis dermatitis NOS I83.2 Varicose veins of lower extremities with both ulcer and

inflammation Any condition in I83.9 with both ulcer and inflammation I83.9 Varicose veins of lower extremities without ulcer or

inflammation Phlebectasia

Varicose veins Varix } of lower extremity [any part] or of

unspecified site

I84 Haemorrhoids Includes: piles

varicose veins of anus and rectum Excludes: complicating:

· childbirth and the puerperium ( O87.2 ) · pregnancy ( O22.4 )

I84.0 Internal thrombosed haemorrhoids I84.1 Internal haemorrhoids with other complications Internal haemorrhoids:

· bleeding · prolapsed · strangulated · ulcerated

I84.2 Internal haemorrhoids without complication Internal haemorrhoids NOS I84.3 External thrombosed haemorrhoids Perianal thrombosis

Perianal haematoma (nontraumatic)

516 WHO’s ICD-10

L87.8 Other transepidermal elimination disorders L87.9 Transepidermal elimination disorder, unspecified

L88 Pyoderma gangrenosum Dermatitis gangrenosa

Phagedenic pyoderma

L89 Decubitus ulcer and pressure area Bedsore

Plaster ulcer Note: For multiple sites of differing stages assign only one

code indicating the highest stage. Excludes: decubitus (trophic) ulcer of cervix (uteri) ( N86 ) L89.0 Stage I decubitus ulcer and pressure area� Decubitus [pressure] ulcer limited to erythema only Note: The ulcer appears as a defined area of persistent redness

(erythema) in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues, without skin loss.

L89.1 Stage II decubitus ulcer� Decubitus [pressure] ulcer with:

•abrasion •blister •partial thickness skin loss involving epidermis and/or dermis •skin loss NOS

L89.2 Stage III decubitus ulcer� Decubitus [pressure] ulcer with full thickness skin loss

involving damage or necrosis of subcutaneous tissue extending to underlying fascia

L89.3 Stage IV decubitus ulcer� Decubitus [pressure] ulcer with necrosis of muscle, bone or

supporting structures (ie tendon or joint capsule) L89.9 Decubitus ulcer and pressure area, unspecified� Decubitus [pressure] ulcer without mention of stage

L90 Atrophic disorders of skin L90.0 Lichen sclerosus et atrophicus Excludes: lichen sclerosus of external genital organs:

· female (N90.4) · male (N48.0)



I69.2 Sequelae of other nontraumatic intracranial haemorrhage

I69.3 Sequelae of cerebral infarction I69.4 Sequelae of stroke, not specified as haemorrhage or infarction

I69.8 Sequelae of other and unspecified cerebrovascular diseases

Diseases of arteries, arterioles and capillaries (I70-I79) I70 Atherosclerosis Includes: arteriolosclerosis

arteriosclerosis arteriosclerotic vascular disease atheroma degeneration: · arterial · arteriovascular · vascular endarteritis deformans or obliterans senile: · arteritis · endarteritis

The following supplementary classification to indicate the presence or absence of gangrene is provided for optional use. 0 without gangrene� 1 with gangrene�

Excludes: cerebral ( I67.2 ) coronary ( I25.1 ) mesenteric ( K55.1 ) pulmonary ( I27.0 )

I70.0 Atherosclerosis of aorta I70.1 Atherosclerosis of renal artery Goldblatt's kidney Excludes: atherosclerosis of renal arterioles ( I12.- ) I70.2 Atherosclerosis of arteries of extremities Atherosclerotic gangrene

Mönckeberg's (medial) sclerosis I70.8 Atherosclerosis of other arteries I70.9 Generalized and unspecified atherosclerosis


746 WHO’s ICD-10

R00.1 Bradycardia, unspecified Bradycardia:

· sinoatrial · sinus · vagal Slow heart beat

Use additional external cause code (Chapter XX), if desired, to identify drug, if drug-induced.

R00.2 Palpitations Awareness of heart beat

R00.8 Other and unspecified abnormalities of heart beat

R01 Cardiac murmurs and other cardiac sounds Excludes: those originating in the perinatal period ( P29.8 ) R01.0 Benign and innocent cardiac murmurs Functional cardiac murmur

R01.1 Cardiac murmur, unspecified Cardiac bruit NOS

R01.2 Other cardiac sounds Cardiac dullness, increased or decreased

Precordial friction R02 Gangrene, not elsewhere classified Excludes: gangrene in:

· atherosclerosis ( I70.2 ) · diabetes mellitus ( E10-E14 with common fourth character .5) · other peripheral vascular diseases ( I73.- ) gangrene of certain specified sites - see Alphabetical Index gas gangrene ( A48.0 ) pyoderma gangrenosum ( L88 )


Summary Diagnosis ICD-10Infected wound

Surgical wound

Surgical wound

Amputated stump

Pressure sore

Traumatic wound

!T81.4

T85.7

T87.4

L89.-

T79.3

Ulcer

Arterial ulcer

Venous ulcer

Unknown caused

!I70.20

I83.0 / I83.2

L97

L98.4


Summary Diagnosis ICD-10Gangrene

Diabetic angiopathy, Diabetic gangrene

Atherosclerosis

Unknown caused

!E11.5

I70.21

R02

Lymphangitis

Lymphangitis Lymphadenitis

Lymphadenitis

Lymphangitis Lymphadenitis

Lymphangitis LymphadenitisSummary Diagnosis ICD-10

Lymphangitis

Acute lymphangitis

Chronic lymphangitis

I89.1

L03.-

I89.1

Lymphadenitis

Acute lymphadenitis

Chronic lymphadenitis

Mesenteric lymphadenitis

Tuberculous lymphadenitis

Mesenteric tuberculous lymphadenitis

O91.2

L04.-

I88.1

I88.0

A18.2

A18.3 + K93.0

Phlebitis

Summary Diagnosis ICD-10

Phlebitis

Phlebitis of upper extremity

Phlebitis of lower extremity

Superficial phlebitis of lower extremity

Phlebitis of femoral vein

Deep vein thrombosis

Deep vein thrombosis of femoral vein

I80.9

I80.8

I80.3

I80.0

I80.1

I80.2

I80.1

Lymphadenopathy

766 WHO’s ICD-10

R57.0 Cardiogenic shock

R57.1 Hypovolaemic shock

R57.2 Septic shock�

R57.8 Other shock Endotoxic shock

R57.9 Shock, unspecified Failure of peripheral circulation NOS

R58 Haemorrhage, not elsewhere classified Haemorrhage NOS

R59 Enlarged lymph nodes Includes: swollen glands Excludes: lymphadenitis:

· NOS ( I88.9 ) · acute ( L04.- ) · chronic ( I88.1 ) · mesenteric (acute)(chronic) ( I88.0 )

R59.0 Localized enlarged lymph nodes

R59.1 Generalized enlarged lymph nodes Lymphadenopathy NOS Excludes: HIV disease resulting in (persistent) generalized

lymphadenopathy ( B23.1 )

R59.9 Enlarged lymph nodes, unspecified

R60 Oedema, not elsewhere classified Excludes: ascites ( R18 )

hydrops fetalis NOS ( P83.2 ) hydrothorax ( J94.8 ) oedema (of): · angioneurotic ( T78.3 ) · cerebral ( G93.6 ) · due to birth injury ( P11.0 ) · gestational ( O12.0 )

Lymphadenopathy คือ ต่อมน้ำเหลืองขนาดโตกว่า 1 เซนติเมตร

เป็นเวลานานกว่า 2 สัปดาห์ [epitrochear >0.5 cm, inguinal >1.5 cm]

Generalized lymphadenopathy

: ต่อมน้ำเหลืองโตในบริเวณต่างกัน ตั้งแต่สองตำแหน่งขึ้นไป

Localized lymphadenopathy

: ต่อมนำ้เหลืองโตในบริเวณเดียวกัน

ให้ระบุสาเหตุของต่อมน้ำเหลืองโตเป็นการวินิจฉัย

Lymphadenopathy

Persistent generalized lymphadenopathy [PGL] due to HIV

เป็นต่อมน้ำเหลืองตั้งแต่สองตำแหน่งขึ้นไป [ไม่รวมที่ขาหนีบ]

และต่อมน้ำเหลืองทั้งสองตำแหน่งต้องเชื่อมต่อกัน (draining chain)

ต่อมน้ำเหลืองต้องโตกว่า 1 เซนติเมตร และโตอยู่นานกว่า 1 เดือน

เมื่อตัดชิ้นเนื้อไปตรวจจะไม่ใช่จากการติดเชื้อหรือเป็นมะเร็งของ

ต่อมน้ำเหลือง

พบในระยะที่ 3 ของการติดเชื้อเอสไอวี

Lymphadenopathy

Congenital toxoplasmosis

เกิดในทารก มีการติดเชื้อของอวัยวะทั่วร่างกาย เช่น pneumonia,

myocarditis, hepatitis, chorioretinitis, hydrocephalus

Toxoplasma lymphadenitis

ผู้ป่วยจะมีไข้ ต่อมน้ำเหลืองโต โดยเฉพาะที่คอและหลังหู รวมถึง

มีการติดเชื้อของอวัยวะอื่นร่วมด้วย

ยืนยันวินิจฉัยโดยตรวจพบเชื้อ toxoplasma gondii หรือการตรวจ

หาปฏิกิริยาภูมิต้านทานต่อเชื้อ เช่น ELISA, indirect hemagglutination test, complement fixation, IgM antibodies

Lymphadenopathy Lymphadenopathy

Summary Diagnosis ICD-10Lymphadenopathy

Generalized lymphadenopathy

Localized lymphadenopathy

R57.1

R57.1

R57.0

Persistent generalized lymphadenopathy in HIV disease

Toxoplasma lymphadenitis

Congenital toxoplasmosis

B23.1

B58.8

P37.1

Debridement vs Excisional D’

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228 1 .1 OR procedure 012 Non OR procedure but affects ThaiDRG

8 6 .2 E xcis io n o r d es t r uct io n o f l e s io n o r t iss u e o f s k in a n d s u bcu t a n e ou s t iss u e 8 6 .2 1 E x c i s i o n o f p i l o n i d a l c ys t o r s i n u s

Marsupialization of cyst

([FOXGHV��LQFLVLRQ�RI�SLORQLGDO�F\VW�RU�VLQXV ��

8 6 .2 2 E x c i s i o n a l d e b r i d e m e n t o f w o u n d , i n f ec t i o n , o r b u r n Removal by excision of:

devitalized tissue necrosis slough

([FOXGHV��GHEULGHPHQW�RI��DEGRPLQDO�ZDOO��ZRXQG��ERQH��PXVFOH��

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8 6 .2 3 Re m o v a l o f n a i l , n a i l b e d , o r n a i l f o l d

8 6 .2 4 C h e m o s u r g e r y o f s k i n Chemical peel of skin

8 6 .2 5 D e r m a b r as i o n That with laser

([FOXGHV��GHUPDEUDVLRQ�RI�ZRXQG�WR�UHPRYH�HPEHGGHG�GHEULV ��

8 6 .2 6 Li g a t i o n o f d e r m a l a p p e n d a g e

([FOXGHV��H[FLVLRQ�RI�SUHDXULFXOD�DSSHQGDJH ��

8 6 .2 7 D e b r i d e m e n t o f n a i l , n a i l b e d , o r n a i l f o l d Removal of:

necrosis slough

([FOXGHV��UHPRYDO�RI�QDLO��QDLO�EHG��RU�QDLO�IROG ��

8 6 .2 8 N o n e x c i s i o n a l d e b r i d e m e n t o f w o u n d , i n f ec t i o n o r b u r n Debridement NOS Maggot therapy Removal of devitalized tissue, necrosis and slough by such methods as:

brushing irrigation (under pressure) scrubbing washing

Water scalpel (jet)


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228 1 .1 OR procedure 012 Non OR procedure but affects ThaiDRG

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Marsupialization of cyst

([FOXGHV��LQFLVLRQ�RI�SLORQLGDO�F\VW�RU�VLQXV ��

8 6 .2 2 E x c i s i o n a l d e b r i d e m e n t o f w o u n d , i n f ec t i o n , o r b u r n Removal by excision of:

devitalized tissue necrosis slough

([FOXGHV��GHEULGHPHQW�RI��DEGRPLQDO�ZDOO��ZRXQG��ERQH��PXVFOH��

RI�KDQG��QDLO��EHG��IROG��QRQH[FLVLRQDO�GHEULGHPHQW�RI�ZRXQG��LQIHFWLRQ��RU�EXUQ�

��RSHQ�IUDFWXUH�VLWH��SHGLFOH�RU�IODS�JUDIW��

8 6 .2 3 Re m o v a l o f n a i l , n a i l b e d , o r n a i l f o l d

8 6 .2 4 C h e m o s u r g e r y o f s k i n Chemical peel of skin

8 6 .2 5 D e r m a b r as i o n That with laser

([FOXGHV��GHUPDEUDVLRQ�RI�ZRXQG�WR�UHPRYH�HPEHGGHG�GHEULV ��

8 6 .2 6 Li g a t i o n o f d e r m a l a p p e n d a g e

([FOXGHV��H[FLVLRQ�RI�SUHDXULFXOD�DSSHQGDJH ��

8 6 .2 7 D e b r i d e m e n t o f n a i l , n a i l b e d , o r n a i l f o l d Removal of:

necrosis slough

([FOXGHV��UHPRYDO�RI�QDLO��QDLO�EHG��RU�QDLO�IROG ��

8 6 .2 8 N o n e x c i s i o n a l d e b r i d e m e n t o f w o u n d , i n f ec t i o n o r b u r n Debridement NOS Maggot therapy Removal of devitalized tissue, necrosis and slough by such methods as:

brushing irrigation (under pressure) scrubbing washing

Water scalpel (jet)

บันทึกรายงานการทำหัตถการ

: รายละเอียดพยาธิสภาพว่า มีเนื้อตายที่จำเป็นต้องตัดเลาะออก

ไม่ใช่ บันทึกชื่อการวินิจฉัยโรค

: รายละเอียดของหัตถการว่า มีการตัดเลาะเนื้อเยื่อออกจริง

ไม่ใช่ บันทึกชื่อหัตถการ

: บันทึกหัตถการว่า Excisional debridement

หากไม่ครบตามเกณฑ์ทั้งสามข้อ ให้ถือว่าเป็น Debridement

กรณีเป็นเนื้อเยื่อที่มีความจำเพาะ ให้ระบุชนิดของเนื้อเยื่อนั้น

Excisional Debridement Debridement vs Excisional D’

Summary Procedure ICD-9-CMDebridement

Excisional debridement

88.28

86.22

Debridement or Excisional debridement of

open fracture of

infected

open fracture of skull

infected skull

!79.6-

77.6-

02.02

01.25

Debridement of [if suture or repair, not coding]

muscle

muscle at hand

tendon or fascia

!83.45

82.36

83.39


Summary Procedure ICD-9-CMDebridement or Excisional debridement of

abdominal wall

brain

nail, nail fold

flap

!54.3

01.59

86.27

86.75

คำวินิจฉัยอื่น bed sore, decubitus ulcer

ความรุนแรงของแผล

: ระยะที่ 1 รอยแดงที่กดไม่จางลง รอยช้ำในผิวสีคล้ำ

: ระยะที่ 2 ถลอก ตุ่มพอง

: ระยะที่ 3 ผิวหนังตาย หลุดลอก

: ระยะที่ 4 ลึกถึงกล้ามเนื้อ เอ็น ปลอกหุ้มข้อ ข้อ กระดูก

Pressure sore = Infected pressure sore

Pressure Sore

Pressure Sore

516 WHO’s ICD-10

L87.8 Other transepidermal elimination disorders L87.9 Transepidermal elimination disorder, unspecified

L88 Pyoderma gangrenosum Dermatitis gangrenosa

Phagedenic pyoderma

L89 Decubitus ulcer and pressure area Bedsore

Plaster ulcer Note: For multiple sites of differing stages assign only one

code indicating the highest stage. Excludes: decubitus (trophic) ulcer of cervix (uteri) ( N86 ) L89.0 Stage I decubitus ulcer and pressure area� Decubitus [pressure] ulcer limited to erythema only Note: The ulcer appears as a defined area of persistent redness

(erythema) in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues, without skin loss.

L89.1 Stage II decubitus ulcer� Decubitus [pressure] ulcer with:

•abrasion •blister •partial thickness skin loss involving epidermis and/or dermis •skin loss NOS

L89.2 Stage III decubitus ulcer� Decubitus [pressure] ulcer with full thickness skin loss

involving damage or necrosis of subcutaneous tissue extending to underlying fascia

L89.3 Stage IV decubitus ulcer� Decubitus [pressure] ulcer with necrosis of muscle, bone or

supporting structures (ie tendon or joint capsule) L89.9 Decubitus ulcer and pressure area, unspecified� Decubitus [pressure] ulcer without mention of stage

L90 Atrophic disorders of skin L90.0 Lichen sclerosus et atrophicus Excludes: lichen sclerosus of external genital organs:

· female (N90.4) · male (N48.0)

ระยะที่ 1 รอยแดงที่ไม่จางลง รอยช้ำในผิวคล้ำ ระยะที่ 2 ถลอก ตุ่มพอง [ผิวหนังบางส่วนหลุดลอก] ระยะที่ 3 ผิวหนังตาย หลุดลอก [รวมชั้น fascia] ระยะที่ 4 กล้ามเนื้อ เอ็น ปลอกหุ้มข้อ ข้อ กระดูก

Pressure Sore

Summary Diagnosis ICD-10Pressure sore

Pressure sore stage I

Pressure sore stage II

Pressure sore stage III

Pressure sore stage IV

L89.9

L89.0

L89.1

L89.2

L89.3

ผู้ป่วยเป็นอัมพาตครึ่งซีกซ้าย มาด้วยแผลเรื้อรังที่ก้นกบ มีหนองไหลกลิ่นเหม็น นานกว่า 2 เดือน ตรวจพบแผลลึกถึงกระดูก

แพทย์วินิจฉัยว่า chronic osteomyelitis

PDx Chronic osteomyelitis at sacrum M86.65

SDxOld CVA Z86.7

PDx Decubitus ulcer stage IV L89.3

SDxSequelae of CVA Flaccid left hemiplegia

I69.2 G81.0

skin and soft tissue infection · skin and soft tissue infection skin and soft tissue infection...

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