Codificação de uma neobexiga

"Estou com dúvidas relativamente à codificação do procedimento de construção de uma bexiga a partir do íleo.
Codifiquei o bypass dos ureteres ao íleo ficando este ligado à pele, ou seja a confeção de uretero-ileostomia de tipo Bricker, da seguinte forma: 0T184ZC  Bypass Bilateral Ureters to Ileocutaneous, Percutaneous Endoscopic Approach
Mas não sei como codificar a construção da bexiga."


(Responde Fernando Lopes)

 
 
O procedimento de construção de uma neobexiga a partir de outra estrutura enquadra-se na root operation Replacement:
 
Replacement
Definition: Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Explanation: The body part may have been taken out or replaced, or may be taken out, physically eradicated, or rendered nonfunctional during the Replacement procedure. A Removal procedure is coded for taking out the device used in a previous replacement procedure
Includes/Examples: Total hip replacement, bone graft, free skin graft
 
O Coding Clinic apresenta um exemplo de construção da bexiga, numa técnica diferente da de Bricker, mas que não deixa de ser elucidativa:
 
Question:
A patient underwent a simple cystectomy with creation of an Indiana pouch. During the procedure, dissection of the bladder was carried out. The ascending colon and ileum were divided and sutured creating a pouch, and the bowel was reanastomosed.
The right ureter was tunneled through the bowel creating an ureterocolonic anastomosis, and a urinary diversion stent was passed into the patient’s right kidney. Through a separate incision, the left ureter was placed into the pouch and an additional
urinary diversion stent was passed into the patient’s left renal pelvis. Prior to complete closure of the pouch a suprapubic catheter was placed and the bilateral ureteral stents were withdrawn from the lumen of the pouch. The remainder of the pouch was
closed and a catheterizable stoma was created at the abdominal wall. What are the appropriate ICD-10-PCS code assignments for creation of an Indiana pouch and stoma following a cystectomy?
Answer:
Assign the following ICD-10-PCS codes:
0TRB07Z Replacement of bladder with autologous tissue substitute, open approach, for the creation of the Indiana pouch
0T180ZC Bypass bilateral ureters to ileocutaneous, open approach, for the attachment of the ureters to the Indiana pouch
The insertion of ureteral stents is considered inherent in the total procedure, and therefore not reported separately.
 
(Creation of Indiana Pouch: Coding Clinic, Third Quarter 2017, p. 21)
 
 
Fernando Lopes