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Chapter XII Infection of Skin

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Chapter XII Infection of Skin Infection of Skin Cellulitis Chapter XII Necrotizing fasciitis Wound infection Epidermis L00-L99 Skin and Dermatitis Ulcer Subcutaneous Tissue Dermis Gangrene Erysipelas นพ.บรรกษ เจรญศลป พญ.รงใจ เจรญศลป Hypodermis Pressure sore Cellulitis กลมงานศลยกรรม แพทยโสต ศอ นาสก รพ.สวรรคประชารกษ รพ.ปรนซปากนโพ Lymphadenopathy Fascia นครสวรรค นครสวรรค Necrotizing fasciitis Muscle Myositis 1 2 Tabular List & Alphabetical Index Skin & Soft Tissue Infection Skin & Soft Tissue Infection Clinical Practice vs ICD-10 Aetiology >> Lesion > Site Summary Diagnosis ICD-10 Summary Diagnosis ICD-10 ลดบการบนทกวนจฉย Erysipelas A46 Abscess ‣ บนทกการวนจฉยรอยโรคทรนแรงสด หรอเนอเยอชนลกสด Cellulitis at eyelid [hordeolum] H00.0 following immunization T88.0 at nose, nasal septum J34.0 ระบตแหนงทางกายวภาคของรอยโรค หรอชนดเนอเยอเฉพาะ ‣ at drainage site T81.4 at auricle, external auditory canal H60.0 ‣ ระบสาเหตของการอกเสบตดเชอ at auricle/external auditory canal H60.1 at preauricular sinus Q18.1 at penis N48.2 at other sites [defined anatomical site, include L02.- ‣ ระบเชอกอโรค ๏ Epidermis: Erysipelas, Impetigo, Folliculitis, Ectyma, Carbuncle at other sites [defined anatomical site] L03.- folliculitis, furuncle, carbuncle] Lymphangitis I89.1 Breast abscess N61 Dermis: Cellulitis, Abscess ๏ Gas gangrene A48.0 Breast abscess in puerperium O91.0 Postpartum breast abscess O91.0 ๏ Subcutaneous fat: Necrotizing fasciitis Clostridial cellulitis A48.0 Anorectal abscess [perianal, intersphincteric, K61.- Necrotizing fasciitis [defined anatomical site] M72.6- ๏ Muscle: Pyomyositis ischiorectal] Pilonidal abscess L05.0 3 4 Tabular List & Alphabetical Index Wound / Ulcer / Gangrene Tabular List & Alphabetical Index Skin & Soft Tissue Infection Ambiguous Diagnosis in Clinical practice Aetiology >> Lesion > Site T79.3 Post-traumatic wound infection, not elsewhere classified Use additional code (B95-B97), if desired, to identify infectious agent Summary Diagnosis ICD-10 การบนทกวนจฉย ใหพจารณาสาเหตของการเกดแผล T81.4 Infection following a procedure, not elsewhere classified Bartholin’s abscess N75.1 ‣ เกดทแผลผาตด [surgical wound] Abscess: Bartholin’s abscess in pregnancy O23.5 • postprocedural intra-abdominal Bartholin’s abscess in puerperium O86.1 ‣ เปนแผลกดทบ [pressure sore, decubitus ulcer] • postprocedural stitch Abscess at surgical wound T81.0 • postprocedural subphrenic Stitch abscess T81.0 ‣ เกดจากการบาดเจบ [post-traumatic wound] • postprocedural wound Hiadradenitis suppurativa L73.2 ‣ ภาวะแทรกซอนจากโรคระบบอน [vascular, diabetes] Sepsis Sebaceous cyst abscess L73.2 T87.4 Infection of amputation stump เปนแผลไฟไหม นรอนลวก [burns] Epidermal inclusion cyst abscess L72.0 ‣ 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 5 6 Wound / Ulcer / Gangrene Tabular List & Alphabetical Index Wound / Ulcer / Gangrene Tabular List & Alphabetical Index Ambiguous Diagnosis in Clinical practice Ambiguous Diagnosis in Clinical practice L98.4 Chronic ulcer of skin, not elsewhere classified I83.0 Varicose vein of lower extremities with ulcer Chronic ulcer of skin NOS Any condition in I83.9 with ulcer or specified as ulcerated Tropical ulcer NOS Varicose ulcer (lower extremity, any part) Ulcer of skin NOS I83.1 Varicose vein of lower extremities with inflammation Excludes: decubitus [pressure] ulcer and pressure area ( L89.- ) Any condition in I83.9 with inflammation or specified as inflamed gangrene ( R02 ) Stasis dermatitis NOS skin infections ( L00-L08 ) I83.2 Varicose vein of lower extremities with both ulcer and inflammation specific infectious classified to A00-B99 Any condition in I83.9 with both ulcer and inflammation ulcer of lower limb NEC ( L97 ) varicose ulcer ( I83.0-I83.2 ) L89 Decubitus ulcer and pressure area L97 Ulcer of lower limb, not elsewhere classified Note: For multiple sites of differing stages assign only one code indicating the highest stage. Excludes: decubitus [pressure] ulcer and pressure area ( L89.- ) Includes: bedsore gangrene ( R02 ) plaster ulcer skin infections ( L00-L08 ) specific infectious classified to A00-B99 varicose ulcer ( I83.0-I83.2 ) 7 8 Wound / Ulcer / Gangrene Tabular List & Alphabetical Index Wound / Ulcer / Gangrene Tabular List & Alphabetical Index Ambiguous Diagnosis in Clinical practice Ambiguous Diagnosis in Clinical practice I70 Atherosclerosis R20 Gangrene, not elsewhere classified Includes: arteriolosclerosis Excludes: gangrene in: arteriosclerosis • atherosclerosis ( I70.2 ) arteriosclerotic vascular disease • diabetes mellitus ( E10-E14 with common fourth character .5 ) atheroma • other peripheral vascular disease ( I73.- ) degeneration: I70.2 Atherosclerosis of arteries of extremities gangrene of certain specified sites - see Alphabetical Index • arterial Atherosclerotic gangrene gas gangrene ( A48.0 ) • arteriovascular Monckeberg’s (medial) sclerosis pyoderma gangrenosum ( L88 ) • vascular endarteritis deformans or obliterans senile: • arteritis • end arteritis The following supplementary classification to indicate the presence or absence of gangrene is provided for optional use with appropriate subcategories in I70 0 without gangrene 1 with gangrene 9 10 Tabular List & Alphabetical Index Skin & Soft Tissue Infection Necrotizing Fasciitis Aetiology >> Lesion > Site Excisional Debridement Summary Diagnosis ICD-10 Summary Diagnosis ICD-10 Infected wound Infected wound Surgical wound [general] T81.4 Surgical wound [general] T81.4 Surgical wound [orthopedics implant] T85.7 Surgical wound [orthopedics implant] T85.7 Amputated stump T87.4 Amputated stump T87.4 Pressure sore [at least on stage 3] L89.- Pressure sore [at least on stage 3] L89.- Traumatic wound ** T79.3 Traumatic wound ** T79.3 Ulcer Arterial ulcer I70.20 Venous ulcer I83.0 Venous ulcer and inflammation I83.2 Unknown caused: at lower limb L97 other site L98.4 11 12 ผปวยถกเปลอกหอยเชอรบาดขาซายขณะจบปลาในบงไปขาย ผปวยถกเปลอกหอยเชอรบาดขาซายขณะจบปลาในบงไปขาย Necrotizing Fasciitis 4 วนตอมา บวมแดงทงขา มตมนสแดงคล กดเจบ นผปวย 4 วนตอมา บวมแดงทงขา มกดเจบ ใหการรกษาดวย cefazolin Label site of infection เขาหองผาตด รายงานผาตดพบ necrosis of skin with cloudy เปนเวลา 5 วน อาการดขน จหนายในวนท 6 สถานภาพ fluid in subfascial plane ไดตดเลาะผวหนงทเนาตายออก จหนายดขน เกณฑการวนจฉย สปสช. 2562 ขนาด 8x10 เซนตเมตร ‣ มลกษณะรอยโรคทเขาไดกบโรค PDx Necrotizing fasciitis at left leg M72.66 PDx Cellulitis at left leg L03.1 • บวมแดง ปวด ถาไมครบเกณฑการวนจฉย Op Excisional debridement 86.22 Op • ตมพองนสแดง [haemorrhagic bleb] ใหสรปการวนจฉยเปน Cellulitis • ผวหนงมเนอตาย [necrotic skin] EC หอยเชอรบาดขณะจบปลาไปขาย W49.82 EC หอยเชอรบาดขณะจบปลาไปขาย W49.82 ‣ อาจตรวจพบนขงใตชนพงผด [subfascial fluid] M72.66 Necrotizing fasciitis at leg L03.1 Cellulitis of other parts of limb ‣ มการรกษาดวยวธ excisional debridement หรอ refer หรอ dead W49.82 Exposure to other and unspecified inanimate at W49.82 Exposure to other and unspecified inanimate at M72.6- lake while working for income lake while working for income 86.22 Excisional debridement of wound, infection, or burn DRG 08310 RW 1.8671 [N w ED] DRG 09560 RW 0.6930 [C] DRG 09050 RW 1.9848 [C w ED] DRG 08611 RW 0.9788 [N] 13 14 Tabular List & Alphabetical Index ผปวย old CVA มาดวยแผลเรอรงทกนกบ มหนองไหลกลน ผปวยอมพาตครงซกซาย มาดวยแผลเรอรงทกนกบ มหนอง Pressure Sore / Decubitus Ulcer เหมน นานกวา 2 เดอน ตรวจพบแผลลกถงกระดก แพทย ไหลกลนเหมน นานกวา 2 เดอน ตรวจพบแผลลกถงกระดก Label staging วนจฉยวา chronic osteomyelitis แพทยวนจฉยวา pressure sore stage 4 ‣ ระบความลกของแผลของแผลทรนแรงทสด L89.0-L89.3 • ระยะท 1 รอยแดงทกดไมจางลง รอยชใน ผวสคล PDx Chronic osteomyelitis at sacrum M86.65 PDx Decubitus ulcer stage IV L89.3 • 2 ระยะท ถลอก ตมพอง Old CVA Z86.7 Sequelae of CVA I69.4 SDx SDx • ระยะท 3 ผวหนงตาย หลดลอก Flaccid left hemiplegia G81.0 • ระยะท 4 ลกถงกลามเนอ เอน ปลอกหมขอ ขอ กระดก EC EC กรณมผลเพาะเชอของแผล ใหระบเชอกอโรคเปนการวนจฉยรอง ‣ M86.65 Other chronic osteomyelitis at buttock L89.3 Decubitus ulcer and pressure area stage IV Z86.7 Personal history of diseases of the circulatory I69.4 Sequelae of stroke, not specified as haemorrhage or system infarction Infected pressure sore = Pressure sore Condition classifiable to I00-I99 G81.0 Flaccid hemiplegia DRG 08530 RW 1.3653 DRG 09500 RW 1.4164 DRG 08311 RW 4.4277 [D] DRG 09050 RW 1.9848 [D] 15 16 Tabular List & Alphabetical Index Lymphatic Disorders Lymphatic & Venous Disorders Aetiology >> Lesion > Site Summary Diagnosis ICD-10 Summary Diagnosis ICD-10 Lymphadenitis ๏ Lymphangitis I89.1 Phlebitis I80.9 Acute lymphangitis L03.- ๏ Lymphangitis Phlebitis of upper extremity I80.8 Chronic lymphangitis I89.1 Phlebitis of lower extremity I80.3 ๏ Lymphadenopathy Lymphadenitis O91.2 Superficial phlebitis of lower extremity I80.0 Acute lymphadenitis L04.- Phlebitis of femoral vein I80.1 Chronic lymphadenitis I88.1 Deep vein thrombosis I80.2 Mesenteric lymphadenitis I88.0 Deep vein thrombosis of femoral vein I80.1 Tuberculous lymphadenitis A18.2 Mesenteric tuberculous lymphadenitis A18.3 + K93.0 17 18 Lymphadenopahty Tabular List & Alphabetical Index Lymphadenopathy Palpable node in ICD-10 Ambiguous Diagnosis in Clinical practice R59 Enlarged lymph nodes Includes: swollen glands Excludes: lymphadenitis: ✦ Lymphadenopathy คอ ตอมนเหลองขนาดโตกวา 1 เซนตเมตร • NOS ( I88.9 ) เปนเวลานานกวา 2 สปดาห [epitrochear >0.5 cm, inguinal >1.5 cm] • acute ( L04.- ) • chronic ( I88.1 ) ๏ Generalised lymphadenopathy • mesenteric (acute)(chronic) ( I88.0 ) R59.0 Localized enlarged lymph node : ตอมนเหลองโตในบรเวณตางกน ตงแตสองตแหนงขนไป R59.1 Generalized
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