ulcera duodenal com hemorragia

(Responde Fernando Lopes)


A hemostase de úlcera duodenal sangrante, com injeção de adrenalina e aplicação endoscópica de clips enquadra-se na Root Operation Control e a codificação aplicável será:
 
0W3P8ZZ Control Bleeding in Gastrointestinal Tract, Via Natural or Artificial Opening Endoscopic
 
A aplicação de clips (uma forma de 'ligature') está incluída na codificação do procedimento de controlo de hemorragia:
"Guideline B6.1b
Materials such as sutures, ligatures, radiological markers and temporary post-operative wound drains are considered integral to the performance of a procedure and are not coded as devices."
 
Outras Instruções aplicáveis:
"Control of bleeding of a cut or eroded body part is coded to the body part where the bleeding was controlled, rather than to a vascular system body part. In this case, the bleeding from the duodenal ulcer was controlled via an endoscopic approach, with clips placed on vessels eroded by the ulcers." (Coding Clinic 4Q 2016 p.100)
 
"substances injected during an operative procedure are not coded separately" (Coding Clinic 2Q 2015 p.11)
 
A injeção seria codificada se não houvesse mais nenhum procedimento:
"Normally injections are not coded in the inpatient setting, and substances injected during an operative procedure are not coded separately. However, since the only therapeutic part of the procedure is the injection, the injection procedure can be used to indicate that the procedure was more than just a diagnostic endoscopy" (Coding Clinic 3Q 2015, p.25)
 
De notar, ainda, que a root operation Control se aplicava, antes de 2017, apenas às hemorragias pós-operatórias, o que excluía as espontâneas como as digestivas. Isto explica porque se encontram instruções (agora desatualizadas) para codificar o controlo de hemorragias digestivas como Occlusion de vasos em vez de Control.