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¥ Neoplasm ¥ Neonatal ¥ External cause of injury ; -- 'LVHDVHVRIWKHUHVSLUDWRU\V\VWHP
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¥ Endocrine & ¥ Code for special ;,, // 'LVHDVHVRIWKHVNLQDQGVXEFXWDQHRXVWLVVXH
;,,, 00 'LVHDVHVRIWKHPXVFXORVNHOHWDOV\VWHPDQG
Nutritional & purposes FRQQHFWLYHWLVVXH
Metabolic ;,9 11 'LVHDVHVRIWKHJHQLWRXULQDU\V\VWHP
;9 22 3UHJQDQF\FKLOGELUWKDQGWKHSXHUSHULXP
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¥ Developmental ;9,, 44 &RQJHQLWDOPDOIRUPDWLRQVGHIRUPDWLRQVDQG
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00.01 Therapeutic ultrasound of vessels of head and neck
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99.99 Other miscellanous procedures
15 16
//?./?>/ //?./?>/
48.5 Abdominoperitoneal resection of rectum
Includes: with synchronous colostomy
Combined abdominoendorectal resection
Complete proctectomy
Code also any synchronous anastomosis other than end - to - end
(45.90, 45.92 - 45.95)
Excludes: Duhamel abdominoperineal pull-through (48.65)
that as part pf pelvic exenteration (68.8)
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48.50 Abdominoperineal resection of the rectum, not elsewhere specified

. .
48.51 Laparoscopic abdominoperineal resection of the rectum

48.53 Open abdominoperineal resection of the rectum
48.59 Other abdominoperineal resection of the rectum
Excludes: abdominoperineal resection of the rectum (48.50)
laparoscopic abdominoperineal resection of the rectum (48.51)
17 18
//?./?>/ >/./>/?>/
31 Other operations on larynx and trachea
Non-OR procedure 31.0 Injection of larynx ¥ ./>>/?>/?N/?/ÿ/>/N>ÿ>.ÿ>/>>/>>/O.ÿ
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but effect ThaiDRG
31.2 Permanent tracheotomy
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31.21 Mediastinal tracheostomy

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OR procedure
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31.29 Other permanent tracheostomy

Excludes: that with laryngectomy (30.3-30.4)
31.3 Other incision of larynx or trachea ¥ ./>/?>/N?./? >/?O?N?//>.O?O>//N/.>>//>/?O
Excludes: that for assistance in breathing (31.1-31.29)
31.4 Diagnostic procedures on larynx and trachea
31.41 Tracheoscopy through artificial stoma /?>/?N?ÿ/?ÿ/-./?/ÿ O/>.?/?ÿ?>//>>?.//?
Excludes: that with biopsy (31.43-31.44)
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O/>>>/>N/.>/.?//?>/?/?>/ Non-OR procedure affects ThaiDRG
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¥ >///./>.>>//>>. (description) >.>N?N// (finding) O/>?O/
/>./>N/?./>/?/?>/ O/>///?/>/N>.>/>O/ÿ/ N÷.ÿ/.?? />/? ¥ Continuous mechanical ventilation
N?.?>?N/N/O/>?N//?>/OO?> N/ÿ.>/>/Oÿ/ÿ>/>/ÿ>/?>/ÿ>?//?/ ¥ Cardiac diagnostic procedure
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¥ Skin and subcutaneous tissue procedure
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O.ÿ/?>/>/ÿ>//ÿ> (progress note) N./?ÿ//?/.>N?N//O/>/>./>N/?. ¥ Endoscopy
?N.??/>/?/?>/ //?//?///?NNÿ>Nÿ?>/?/?>/?O ¥ Tracheostomy
21 22
Non-OR procedure for Diagnostic support /?>/?NN/ÿ?N÷ÿ/?>

¥ Blood component transfusion ¥ IV fluid, Antibiotics, Electrolytes infusion
¥ Diagnostic procedure: Biopsy ¥ Gram stain, Culture
¥ CPR, Cardioversion ¥ EKG
¥ Special investigation: Echocardiography, U/S, CT scan, MRI, Scan ¥ Plain film
¥ Chemotherapy ¥ NG tube insertion, FoleyÕs catheterization
¥ Radiotherapy ¥ Neubulizer, Oxygen canula, Oxygen mask
23 24
N/ÿNÿ?/?>/N/
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Diagnostic Related Groups [DRGS]
N÷/>>/Oÿ/>ÿ/?ÿ÷/. (patient classification system) N>>?ÿ÷/./>.>N?./? (acute
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Thai Diagnosis Related Group ÿ//?/?NOÿO>/?/ DRGs

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ICD-10 WHO 2010 ICD-10-TM 2010 ICD-9-CM 2010 PDx [Principal Diagnosis]
N///??NO/ÿ>//?/> ./>N/?N/?/ÿ>.N.O.ÿ?ÿ/?/>?Nÿ//? Tabular List & Alphabetical Index
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?N/N/?NO.ÿ./> ¥
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Aggregate mean charge
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¥ General summary discharge ¥ N>N/>.>/N//>N?.: ?>ÿ//?/>/>.>/???NN>>O (//?/N/O/
¥ History ?N.>?N.>/>/?>Nÿ) O/>?>ÿ//?/O/ÿ?ÿ/ //>NO
¥ Physical examination
¥ Inform consent ¥ N>N/>.>//?. ICD: O/ÿ//?. ICD-10 O/> ICD-9-CM ?ÿ/
¥ Progress note >/?N>>N//>N?.?N/>./>/.?N/O
¥ Operative note N/?.NÿN//?/>//>N 4x100N//
¥ Anesthetic record
¥ Consultation form
N/ÿ?N 1 O.ÿ?ÿ/?/> (Recoder)
¥ Labor record N/ÿ?N 2 ?//N//>N?. (Reviewer)
¥ Rehabilitation record N/ÿ?N 3 ?ÿO/ÿ//?.N/ /?>/ (Coder)
¥ Nurse note N/ÿ?N 4 >N/.>> (Data entry)
¥ /?NN: OPD card, Clinical summary, Laboratory report, Pathology report, Radiological report
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/>/.??/>/?>N//>N?./O.ÿ />NO.??/>/?>N//>N?./O.ÿ
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Principal diagnosis PDx DIAGNOSIS ICD CODING
by CODER &&&&&&&&&&&&&&&&&&.
? !1? !1@ /> @@0 2556
22. DISCHARGE STATUS
1. COMPLETE RECOVERED 6. NORMAL CHILD DISCHARGE WITH MOTHER

23. DISCHARGE TYPE
1. WITH APPROVAL 5. OTHER

MINISTRY OF PUBLIC HEALTH HOSPITAL MINISTRY OF PUBLIC HEALTH HOSPITAL
THAILAND IN PATIENT SUMMARY 18 (2) PRE ADMISSION COMORBIDITY (S) MAIN CONDITION (/?NO1/?.N?0/) THAILAND IN PATIENT SUMMARY 2. IMPROVED 7. NORMAL CHILD DISCHARGE SEPERATELY 2. AGAINST ADVICE 8. DEAD, AUTOPSY
1. ADMISSION NUMBER 2. PERSONAL IDENTIFICATION NUMBER OR PASSPORT NUMBER 3. HOSPITAL NUMBER 1. ADMISSION NUMBER 2. PERSONAL IDENTIFICATION NUMBER OR PASSPORT NUMBER 3. HOSPITAL NUMBER 3. NOT IMPROVED 9. DEAD 3. ESCAPE 9. DEAD, NO AUTOPSY
4. DELIVERED 4. BY TRANSFER
4. PATIENT NAME 5. PATIENT ADDRESS
Comorbidity COMORBIDITY (S) 4. PATIENT NAME 5. PATIENT ADDRESS 5. UNDELIVERED
?N/. @0@ @/!?N.NN/ &&&&&&&&&&&&&&
6. SEX
1.MALE 2.FEMALE
7. MARITAL STATUS 8.ETHNIC GROUP 9.OCCUPATION
(3) COMPLICATION (S) (POST ADMISSION COMORBIDITY)

SDx 6. SEX
1.MALE 2.FEMALE
7. MARITAL STATUS 8.ETHNIC GROUP 9.OCCUPATION
ATTENDING APPROVED
DIAGNOSIS
10.DATE OF BIRTH 11. AGE AT ADMISSION ____YEARS. FOR INFANT ____ MONTHS ____ DAYS 12. BIRTHWEIGHT (INFANT ONLY) GRAMS 10.DATE OF BIRTH 11. AGE AT ADMISSION ____YEARS. FOR INFANT ____ MONTHS ____ DAYS 12. BIRTHWEIGHT (INFANT ONLY) GRAMS
13.WARD 14.DEPARTMENT 15. DATE OF DATE MONTH YEAR TIME 16.LENGTH OF STAY
_________DAYS
13.WARD 14.DEPARTMENT 15. DATE OF DATE MONTH YEAR TIME 16.LENGTH OF STAY
_________DAYS
PHYSICIAN &&&&&&&&&&&&&&&&&&. BY &&&&&&&&&&&&&&&&&&&
01 MEDICINE
02 SURGERY
03 OBS.
04 GYN
05 PED
06 ENT
07 EYE
08 ORTHOPEDICS
09 PSYCHIATRY
10 RADIOLOGY
11 DENTAL
12 OTHER &&&&&&&&&&.
ADMISSION
DISCHARGE
17. TOTAL LEAVE DAYS
_________DAYS Complication COMPLICATION (S) 01 MEDICINE
02 SURGERY
03 OBS.
04 GYN
05 PED
06 ENT
07 EYE
08 ORTHOPEDICS
09 PSYCHIATRY
10 RADIOLOGY
11 DENTAL
12 OTHER &&&&&&&&&&.
ADMISSION
DISCHARGE
17. TOTAL LEAVE DAYS
_________DAYS
SIGNATURE SIGNATURE
(1) PRINCIPAL DIAGNOSIS ? !?NON?0N1N?0/N!N@?O (1) PRINCIPAL DIAGNOSIS ? !?NON?0N1N?0/N!N@?O
18 (2) PRE ADMISSION COMORBIDITY (S)

DIAGNOSIS ICD CODING
by CODER &&&&&&&&&&&&&&&&&&.
MAIN CONDITION (/?NO1/?.N?0/)
(4) OTHER DIAGNOSIS
ODx OTHER (S) 18 (2) PRE ADMISSION COMORBIDITY (S)
DIAGNOSIS ICD CODING
by CODER &&&&&&&&&&&&&&&&&&.
MAIN CONDITION (/?NO1/?.N?0/)
Attending physician Approved by
COMORBIDITY (S) Other diagnosis COMORBIDITY (S)
Extern/MD MD
(5) EXTERNAL CAUSE (S) OF INJURY
(3) COMPLICATION (S) (POST ADMISSION COMORBIDITY)
Ext EXTERNAL CAUSE (S) (3) COMPLICATION (S) (POST ADMISSION COMORBIDITY)
DIAGNOSIS
DIAGNOSIS
(4) OTHER DIAGNOSIS
COMPLICATION (S)
External cause (4) OTHER DIAGNOSIS
COMPLICATION (S)
OTHER (S) OTHER (S)

OPERATING ROOM PROCEDURES DATE TIME IN TIME OUT
(5) EXTERNAL CAUSE (S) OF INJURY EXTERNAL CAUSE (S) 19
1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&.
(5) EXTERNAL CAUSE (S) OF INJURY EXTERNAL CAUSE (S)
>//>//?//>/./>N//>N?. O.ÿ.>/>//>/?N attending //?/ approved ÿ>O
ÿ>/>NONÿ /??N./>N.?ÿ?NN/ÿ/?O/>>/>//>>?N//// />/NÿN?.?N attending
OPERATING ROOM PROCEDURES DATE TIME IN TIME OUT 2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&. OPERATING ROOM PROCEDURES DATE TIME IN TIME OUT
Procedure Proc
OPERATION
19 19
1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&. 1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&.
2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&. 3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&. 2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&.
OPERATION
OPERATION
3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&. 3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&. &&&&& &&&&&&.
20
4. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&.
IMPORTANT NON OPERATING ROOM PROCEDURES
1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&& &&&&&&.
PROCEDURES ICD CODING
by CODER &&&&&&&&&&&&&&&&&&&&
4. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&. &&&&&
&&&&&&.
20
4. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&.
1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&& &&&&&&.
by CODER &&&&&&&&&&&&&&&&&&&&
O/>ÿ//?O.ÿ/>//?// (approved) >>?//ÿ>N÷O./>>//?/>.>>/?N./?/ÿ />
2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
SPECIAL INVESTIGATIONS
MAIN
(/?NO1/?.N?0/)
OTHER (S)
20
1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& by CODER &&&&&&&&&&&&&&&&&&&&
MAIN
2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
MAIN
(/?NO1/?.N?0/)
OTHER (S)
N/ÿ/?>//>//?//>?//ÿ>N//>N?.?/ÿ>/N/ÿ/?>/./>>//?/>.>>/ ///?O>/./>N/
2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
//?//?>/N÷//?.//?/>/./>ÿ/.>./O/ÿ?//ÿ>N/ÿ/?>/./>>//?/>.>>/ ?O?O>/N/ÿ/?./>
21 21
1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& (/?NO1/?.N?0/) 2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
OTHER (S)
>//?/>.>>/O/ÿ?//ÿ>.>.>>///?//ÿ/./>>/N/ÿ/>.ÿ>N>ÿ>.ÿ>/?/>O/?O?O
22. DISCHARGE STATUS 23. DISCHARGE TYPE 22. DISCHARGE STATUS 23. DISCHARGE TYPE
1. COMPLETE RECOVERED
2. IMPROVED
6. NORMAL CHILD DISCHARGE WITH MOTHER
7. NORMAL CHILD DISCHARGE SEPERATELY
1. WITH APPROVAL
2. AGAINST ADVICE
5. OTHER
8. DEAD, AUTOPSY
21 1. COMPLETE RECOVERED
2. IMPROVED
6. NORMAL CHILD DISCHARGE WITH MOTHER
7. NORMAL CHILD DISCHARGE SEPERATELY
1. WITH APPROVAL
2. AGAINST ADVICE
5. OTHER
8. DEAD, AUTOPSY
3. NOT IMPROVED 9. DEAD 3. ESCAPE 9. DEAD, NO AUTOPSY 1. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 3. NOT IMPROVED 9. DEAD 3. ESCAPE 9. DEAD, NO AUTOPSY
4. DELIVERED 4. BY TRANSFER 4. DELIVERED 4. BY TRANSFER
5. UNDELIVERED 5. UNDELIVERED
?N/. @0@ @/!?N.NN/ &&&&&&&&&&&&&& 2. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& ?N/. @0@ @/!?N.NN/ &&&&&&&&&&&&&&
ATTENDING APPROVED ATTENDING APPROVED
PHYSICIAN &&&&&&&&&&&&&&&&&&. BY &&&&&&&&&&&&&&&&&&& 3. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& PHYSICIAN &&&&&&&&&&&&&&&&&&. BY &&&&&&&&&&&&&&&&&&&
SIGNATURE SIGNATURE SIGNATURE SIGNATURE
22. DISCHARGE STATUS 23. DISCHARGE TYPE
41 42
?N/. @0@ @/!?N.NN/
Admission note / Progress note / Order sheet >//>>?.//? [Principal Diagnosis, PDx]
O?>>/?/>/?>O/>///ÿ>>. (admission note) ÿ/Oÿÿ//?/?N?>N.O.ÿ O/?>/>//?N Nÿ ¥ /?NÿN?.>//>>?.N?./Nÿ>?O O.ÿÿ/?>?/>>?.N/N?.?/>>?.N?./
?.>/>O.ÿ .>>/ ?>/?>ÿ//?/OO.ÿ >ÿ//?>//>/??N.O.ÿ />N/ÿ/?>//>//?//N/ÿ
ÿ//?/?/ÿ>/N/ÿ.>/>/Oÿ/ÿ>/>/>/>///./N//>N?. ¥ ?N/?/N .>.>O>//?/>N?N/O/ÿNÿ?/>>?..>ÿ>. (final diagnosis) >NN÷?/>>?.
O?>/>/ÿ>//ÿ> (progress note) Oÿÿ//?/?N?>N.O.ÿ//?//>/??N.O.ÿ>>?//ÿ>N÷ÿ//?/?N ?N/>N/?.?N?N.>
/?/>/ÿ>N?N/?/O/>.>/>//ÿ>/>O>///./N//>N?.Nÿ ¥ ÿ/N÷N/?NN>>OO?/?ÿ÷/.ÿ//?N/ÿON/.>>/ O/ÿN/?NN>>O.>.//?>
O?>>/.?N>//?/> (doctorÕs order) Oÿ?.?N>//?/>.>>//O.ÿNÿ>?O O/??N?.>/>O.ÿ //?/ ?O/ÿ.>ON/?//?.>///?/ÿ>Oÿÿ>.O>//?/>/>/ÿ>
>/?>.>>/?N/??.?N (/..) ÿ//?>//>/??N.O.ÿ>/?O?N.?N>//?/>.>>/ />N/ÿ/?>//>/
/?//N/ÿ ÿ//?/?/ÿ>/N/ÿ.>/>/Oÿ/ÿ>/>/>/>///./N//>N?.Nÿ ¥ />?ÿ÷/./?//>.N/?OOÿÿ//?N/ÿ/?/>ON/.>>/ O/ÿN/?/N/?NN÷.>N/>?O/ÿ
ÿ//?>//?/>O/?O?O ÿ>/?/>//>O/O/>.??O/ÿN?.?O/ÿN/?/N/?NOÿ
If it is Not Signs, it was Not Done. /?.>/O>//?/>.??N.>
43 44
>//>>?.//? [Principal Diagnosis, PDx] />>/ />>/O.
¥ ?ÿ÷/.?NN /ÿ.>/>//>>?.N/O/ÿOÿ?Nÿ O/ÿ>.>O.>>//?/>O/ÿ/ ¥ O.ÿ.>/>/?>/>>///?//>>/O.//?//>ÿ//>>/?N.???N.>N÷>//>>?.
# />.>>/NO÷/.N/ //?Nÿ
# N.?.?/>N..?/>>?.N/N/ÿNÿ ¥ O.ÿN/ÿ//?>/>>///?//>>/O./N/?N/>/>>?..>ÿ>.O/ÿ/ Nÿ
# ?.ÿÿ/N/?/>?N/ÿ/./>>//?N fever, jaundice, dehydration, hypoalbuminemia, hypoglycemia,
.>/>/?>/>>/ (symptom) //?//>>/O. (sign) //?//>ÿ//>>/?N.???N.> hyperglycemia, ascites, pleural effusion [.N/ÿ /?ÿ//N>N/N>/]
N÷>//>>?.//?
45 46
>//>>?.//? [Principal Diagnosis, PDx] >//>>?.//? [Principal Diagnosis, PDx]

>.N./>.> 60 ÷ />N/.>>/ÿ/./>>//>.?/>.ÿ>. />.ON/?N/.// />? ?ÿ÷/./ÿ/???O O.ÿ/ÿ/>N>/>>?./ÿ> acute abdomen /?N/ÿ/?/>O
O?>/ON/?/O//? 80 mg/dL //.>/> metabolic acidosis O.ÿO/ÿ>/ N/.>>/ O.ÿ?N//?ÿ÷/./>>?./ÿ> peritonitis .?/.O.ÿÿ>?N÷ÿ/ÿ/
/?/>.>/>?OO/>O/ÿ.>/>/O?>/ON/?/ N/N>//?ÿ÷/.NÿOÿ DM type 2, perforated chronic duodenal ulcer ?ÿ>? simple suture with omental
hypertension, dyslipidemia O.ÿ./>>//>>?.//?N÷ DM2, metformin graft
induced acidosis >//>>?.//?N÷>//>>?..>ÿ>.
>//>>?.//?/?NÿN?.>//>>?.N?./
>//>>?.?N> PDx: Acute abdomen
>//>>?.?N> PDx: DM type 2 with metformin induced acidosis
>//>>?.?N> PDx: Peritonitis
PDx: Metformin induced metabolic acidosis
>//>>?.?N? SDx: Diabetes mellitus type 2 >//>>?.?N?
PDx: Perforated chronic duodenal ulcer
Ext: Metformin Proc: Simple suture duodenal ulcer
47 48
?ÿ÷/./>ÿ/.Nÿ N/ // O.ÿ/?N/ÿ/ON/.>>/ />>?./ÿ> Streptococcal >.N.?//>>>N>ÿ>/ N/ÿ/?ÿ.>?/ ///>/?N//>N? ÿ>N÷
pneumoniae pneumonia of right lobe O/ÿ>//?/>ÿ/..>ÿ>N?O/ 3 /?ÿ//>/?Nÿ.? ÿ/ÿ/ ruptured spleen ? splenectomy /?/// CT brain left
/>/.?N /N>>N?O/ON/?/ S.pneumoniae O.ÿ?>/>>?./ÿ> sepsis due frontal cerebral contusion O/> film pelvis fracture pelvic rami /?/>ÿ/.
to S.pneumoniae .ÿ>.Nÿ>//?/>O ICU ?ÿ÷/.N.?.?/>O/??N 7 external fixation
>//>>?.//?/?NÿN?.>//>>?.N?./
>//>>?.//?ÿ/N÷.>N/>/N/ >//>>?.//?N÷N/?N.???N.>
PDx: Sepsis >//>>?.//?N÷N/?Nÿ/Oÿ/?.>/.?.>
>//>>?.?N>
SDx: Lobar pneumonia PDx: Car accident with ruptured spleen with
PDx: S.pneumoniae pneumonia >//>>?.?N> cerebral contusion with fracture pelvic rami
>//>>?.?N?
Proc: S.pneumoniae septicemia Proc: Splenectomy, CT brain
49 50

>.N.?//>>>N>ÿ>/ N/ÿ/?ÿ.>?/ ///>/?N//>N? ÿ>N÷ ?ÿ/>/ÿ/ÿ/.ÿ>/>/>/?>///?N/ÿ/>N> O.ÿN/ÿOÿO/ÿ>N÷N.ÿ>N
ÿ/ÿ/ ruptured spleen ? splenectomy /?/// CT brain left /?N.//?/N/ÿ /?N/ÿ?/>>/ON/.>>/ 1 ? />>////N/?N/.N />.O/?
frontal cerebral contusion O/> film pelvis fracture pelvic rami /?/>ÿ/. />ÿ>O ?ÿ÷/.//?ÿ>O/>O.ÿ/>>O/ÿ/?N..?N/ÿ.>/>//>>?.Nÿ/ÿ>/>>/
external fixation /ÿ/N>>.>N/>//?///?/N/O
>//>>?.//?/>N÷/>>///>>/O.Nÿ
PDx: Ruptured spleen
SDx: Cerebral contusion, Fracture pelvis >//>>?.?N> PDx: R/O appendicitis
>//>>?.?N?
Proc: Splenectomy, CT brain, External fixation pelvis >//>>?.?N? PDx: Right lower abdominal pain
Ext: //>>>ÿ>/ N/ÿ//Oÿ?.ÿ/?NN/ÿ.>/ .?/?/ÿ/>/? ÿ//>N./ //?///?./? ?N/?/?ÿN>>N/.>>/ON/.>>//>N O/>N/ÿ
.>/>/Oÿ/ÿ>/>N?N/>/./>N///?//?>/Nÿ N/>>/>?O/ÿN>/>/Nÿ>O/>N/?N/Nÿ Nÿ R/O, UP, B24
51 52
>//>>?.// [Secondary Diagnosis, SDx] >//>>?.// [Secondary Diagnosis, SDx]
¥ >//>>?.// >///?ON//ÿ// (comorbidity) O/>N/O/ (complication) ¥ N/ÿ.>/>/?/>///N/?/ //÷..>/> />/N>>N?O/ //?/>///>N.//?N
?NN/ÿOÿ?/>>?.N//O.ÿ?N?O//?/>//?//ÿ///?/>ON//>N?. />?/>/N÷
¥ N÷N/?N/?/>//>O//>/?N>?O/ÿ?ÿ÷/./?/>/N.?N.?/>.?>O //?//?>/////?/
>//>>?.OO?>./>>//?/> >O/ÿ/ÿ>>/ÿ>/?>////?N?NN?N./ÿ///?//?
/?/>N>N/>O />//ÿ>>//?/>?/ON/.>>//?O?O
>//?/>÷/>?OO/ÿ?÷/>?ÿ÷/.O>/ .N/ÿ/>.>/>///>.>>/>.>
¥ >/./>>//>>?.// ÿ//??/>>?.N/?N?>/.ÿ>N÷/>./?/ÿ/?///O.ÿ //?/N//ÿ/>.>N..>>O.ÿ
?ÿ?O///?//ÿ///?/>N÷//?>/?///.?ÿO.ÿ//>N.ÿ/O/N//>N?. [Problem
list, Provisional diagnosis, Progress note, Operative note, Clinical summary, If it is No Written, it was Not Done.
Refer-out note] N/ÿOÿN?.>//>>?./O.ÿ?N?>N÷>//>>?.OO?>
./>>//?/> (discharge summary) Nÿ>?O
53 54
>//>>?./?N [Other Diagnosis, ODx] .>N/>.>./ [External Cause, Ext]

¥ N÷N///?/.>/>?NN /ÿNÿ>ÿ>.???/>//>//>>?.//? >//>>?.// /ÿ>/?/ ¥ N÷/N>/>NO//?//NNÿ/?.>/>/ >NNÿ>>/?/>/?>?ÿ÷/. N?N/O/ÿ/>
N÷N/?N/?/>//>O/N/ÿ/>/?N>?O/ÿ?ÿ÷/./?/>/N.?N.?/>/>>O //?/N/ÿÿ/Oÿ /ÿ>>NO/>/.ÿ>N/ N÷/>?>N/> ??/ÿ>./ÿ>>. ÿ>?/>. N÷ÿ N?N/O/ÿNÿÿ//?/
/?.>/O>//?/>N>N/>O/>//ÿ>>//?/>ON/.>>//?O?O />Oÿ÷/?>/>NO?N/>N÷.>N/>O/ÿ.?N.?./>>N.ÿ//?./?//
¥ O.ÿÿ//>>/N>/>NO/?ÿ÷/.>/>. N/>>Oÿ/>N/>/>/./?/ÿ/
¥ N/ÿ?O/ÿÿ/N>N/>///>N./ N//>N?. O/ÿ/ÿ>N/ÿOÿN÷ÿ//?/O>/?/>ÿ//>>?.N//ÿ//
¥ N/ÿÿ/N>N/.>//?/N/.?ÿ ¥ .>/>/?>N÷.>/>N.Nÿ /N>/>NO + />./>N/?.>/>NO
¥ N/ÿÿ/?>//?/>N>N/N>/
/>./>N/?.>/>NO = .>?NN>N/> + >///>N>N/>
55 56
?/>>?.?// (Ambiguous Diagnosis) ?/>>?.?// (Ambiguous Diagnosis)
¥ O.ÿN/ÿ//Oÿ??///>>?.N/ ??//?/?N/?.?N/N/O Ò//?//>/Ó ¥ Multiple injuries, Head injury, Soft tissue injury
/>///>/N/Nÿ?//> ¥ Blunt abdomen, Blunt chest trauma, Penetrating injury
¥ ICD-10 /?//?.?// (ambiguous code) //>.//?.>N//O/>O/ÿOÿ?/>N. ¥ Car accident, Motorcycle accident, Traffic accident
ÿ/.?>?N/?/>ÿ//?/>>/O.ÿ/ÿ>./?.
¥ Lacerated wound, Gunshot wound, Stab wound
¥ O.ÿ//>.ÿ>/>N?.??//N.N/ÿ?OO ?ÿO/ÿ//?.//O/ÿÿ//?/O.ÿ/ÿ>??//
/>?O/ÿN>//?.?// O/>?O/ÿ>.>/ÿ//?/N////?/N?/ÿ>/>/> ¥ Diabetic foot, DM foot, Infected DM foot
[Multiple injuries T07] [Injury, Car accident, MCA, Traffic accident T14.9]
[Laceration, Stab wound, Gunshot wound, Penetrating injury T14.1]
[Blunt abdomen S39.9] [Chest injury S29.9] [DM foot E14.9]
57 58
//?>?N.?.>>/./>>//?/> [Document Supported] //?>?NN/ÿ.>/>/?/>.?.>>/./>>//?/>

¥ ?/>>?.N//O.ÿ?N/>ON/.>/ÿ>N /N//>N?.?ÿ÷/.O ¥ >/?O.?N.> //?/O.?N>//?/> O/ÿ/>N>/ÿ>?ÿ÷/.N÷N/O
¥ />.>/>///>/?.? /?//>>/ÿ //?/>///>N./N./?.?O.ÿ //?/O.ÿ ¥ .?/?/ÿ/>/? ÿ//>N./ //?./? ?NOÿO/>N÷?N/?/?ÿN>>.>.ON/.>>/O
?ÿN?N./> Nÿ />////?N/?/O?N/ÿ>N.O.ÿN//?/O N/.>>//>N
¥ />.>/>///>.>>/>.>N..>>O.ÿ
¥ />///N/?/ ÷..>/> />>/> N.//> >/N>>N?O/ />///>/ÿ/>?>>/
?N>>/?NN ?NO.ÿNÿO//N÷?/>>?.N/
59 60
O/>>/./>N//>N?.
61 62
SIRS [Systemic Inflammatory Response Syndrome] Sepsis, Septicemia

>//>>?./>/ÿ/.Nÿÿ/N?O/.ÿ>ÿ/. 2 ÿ/ >//>>?./>/ÿ/.Nÿÿ/N?O
1. />/.?/>>..?/ÿ> 38 /.>N/N?.. //?/N?/ÿ> 36 /.>N/N?.. 1. /?Nÿ>//>>?./ SIRS
2. ?/N/O//ÿ> 90 /?O/>? 2. /?>/>N?O/?N//?./>O//?./>/>N //?/>/>N?O/>//>
3. />.ON/O//ÿ> 24 /?O/>? //?//? PaCO2 N?/ÿ> 32 />//>N//// 3. /?N?O/N/O/N>>N?O//N/?/ [Hemoculture] .N/ÿ?ÿ÷/.?N/?/>/>>/
4. />/>N/ON/?/>//>/ÿ> 12,000 N//ÿ///3 //?/N?/ÿ> 4,000 N//ÿ///3 //?/ .?/>>ÿ/?/>N>>N?O/ON/?/N/ÿ>O O.ÿÿ/?>>/N?O/N/N÷/>./?/ÿ/?//
/? band form />/ÿ>/ÿ/./> 10 4. /?>/O/ÿ.>>?/>O/>.>N//>?NN//>>.//.ÿ>ÿ/. 5-7 /?O/ÿ/?>O //?/N.?.?/>
SIRS N÷/>ÿ//>>/?NN>>N/>N?O/O/>N/ÿOÿN/>N?O/ >N>/?.>N/>?N?N />/>>/.?/>>ÿ/??Nÿ/. NÿOÿ ?OO N>//>?N/>/N/ÿNÿ N/ON/?/>/

??O>N/ÿÿ/?> SIRS N÷>//>>?.OO?>./>>//?/> ON/?/N? //?>/?/ÿ>/ N/.ÿ
63 64
Sepsis, Septicemia Severe Sepsis [Multiorgan Dysfunction]
¥ /??N/>>?.O//?/ÿ> sepsis OÿNÿ//N÷>//?Nÿ/?.>>?/>N 1-2 /? >//>>?./>/ÿ/.Nÿÿ/N?O/.ÿ>ÿ/. 2 ÿ/
.>/>/?/ÿ>./?Nÿ O/ÿ./>>//?/>N÷ Fever [R50.9] 1. />/?/OO/>///N/?/: Ps <90 mmHg, MAP <70 mmHg
¥ /??NN÷>/>N?O/?N//?./>ÿ>N Nÿ pneumonia, acute cholecystitis, acute 2. />N: Urine <0.5 ml/kg/hr after adequate fluid resuscitation
pyelonephritis O/ÿ?>>/>N?O/?N/>O//ÿ>N?O/?ON÷>//>>?.//? O/> 3. />/: PaO2/FiO2 <250
?>.>/>>N?O/ON/?/N÷>//>>?.// 4. />N/?/: Platelet <80,000/mm3, <50% from the last three days
¥ /?N>>N?O/ON/?/N/ÿ>O O/ÿ>//N?O/N/OO//ÿ>N?O/ Nÿ ÷..>/> N.//> 5. />/-ÿ>: pH <7.30, bicarbonate <15 mmol/L, lactate >1.5 UNL
ON/ÿÿ//>>?..>/>>N?O/ON/?/ /??N/?>/?>///?./>O/ÿ/N/// (organ failure) ?NN÷N>/Nÿ>//>>?.
¥ N/ÿÿ/?>?/>>?./ÿ> SIRS N÷>//>>?.// /Oÿ/>//?./> .>/>/?>N÷>//>>?.//Nÿ
65 66
Septic Shock Septic Shock in SCG 2011 & 2017

Sepsis + Persistent Hypoperfusion or Lacticaemia
>//>>?./>/ÿ/.Nÿÿ/N?O O ม⇣.>/> Sepsis ร⏤//กǣม⇣.>/>ช૤/幈Nดᓤร⏣.>/鸳Nพợ./Oล◤/O/>ตᗤ/Nดᓤร⏣.> vasopressors
1. /?Nÿ>//>>?./ SIRS //?/ Septicemia น᧣ตᗤ>N N繈/ช૤/.ร⏣/>/>ดᓣ/>/ดᓣN/ห⯣N幈. [MAP] Oห⯤ส⫣ว⟤> 65 ม⇣/ล◣N////
2. /?/?/>>/>>/ Shock O />ย⋣ย⋣>/ว⟣น᧣ฉৣ.N.>///

- Hypotension: Ps <90 mmHg or <40 mmHg of baseline after fluid - Lactate ส⫣ว⟤> 2 ม⇣/ล◣N//ตᗤ/ล◣/ /ร⏣/
resuscitation at least 1 hour, need vasopressor to maintain Ps >90 mmHg - Lactate ส⫣ว⟤> 18 ม⇣/ล◣ร⏣/ตᗤ/Nซ௣ล◣/
or MAP >70 mmHg N繈/NดᓤOห⯤.>/鸳/ย⋤>Nพợ./Oล◤/
- Poor tissue perfusion: conscious change, urine <0.5 ml/kg/hr or <400

ml/d, delayed capillary filling time, metabolic acidosis
3. /?>/O/ÿ.>>?/>O/>.>N//>?NN//>>.//.ÿ>ÿ/. 5-7 /?O/ÿ/?>O //?/N.?.?/>
.>/>/?>N÷>//>>?.//? /?N/ÿ/>//?/N/ÿO//ÿ>N?O/
67 68
鹉ปᯤ/.ม⇣Nขˤส⫣ />/Ṉ //อⷣ/ภ⃣ม⇣ 39oC ชૣ/ 100 ṉตᗤ/>ท៣ 鹉ปᯤ/.N/ตᗣOขˤ />ดᓤ/.Nขˤส⫣ />/Ṉ //อⷣ/ภ⃣ม⇣ 38.5oC
/>.O 26 ṉตᗤ/>ท៣ />/ดᓣN/ห⯣ 120/70 /./.// // ชૣ/ 100 ṉตᗤ/>ท៣ />.O 26 ṉตᗤ/>ท៣ />/ดᓣN/ห⯣ 120/70
Fever, Fever of Unknown Origin ปᯣ..>/>Nม⇤Nล◣/>/จࣣ//> N>>N繉/Oปᯣ..>/>O/>ONล◣/ /./.// NจࣤṈ/ท៤/ //Nล◣/Nม⇤Nล◣/>/ 15,000 N/ล◤ตᗤ/
No DeÞnite Source of Infection 湉 E.coli ม⇣/ล◣ล◣/ [neutrophil 90%, lymphocyte 10%] N>>鸳ช૤/ท៤/Nม⇤
Nล◣/>/ 1,500 N/ล◤ตᗤ/ม⇣/ล◣ล◣/ /N>>N繉/Nล◣/O/>鸳Oช૤/ท៤/
# /ณᏣ幈ว⟣น᧣ฉৣ.O/ร⏣ว⟤> Sepsis OตᗤN繈/NดᓤOห⯤.>ตᗤ>จࣣ/ชૣNNพợ. 1-2 ว⟣ E.coli
DRG 18502 RW 1.0096 DRG 18501 RW 2.2341
Nขˤ//O/>จࣣ/น᧤>.ล◣บ᫤>N.Nม⇤ม⇣O/ล◤ตᗣN繉/幈Nปᯤ.>N/ตᗣ/Nขˤ
Oห⯤บ᫣ท៣>/ว⟣น᧣ฉৣ.ว⟤> Fever /ร⏣/ Fever of unknown origin PDx E.coli septicemia A41.5
PDx: Fever Acute pyelonephritis N10

# Nม⇤ตᗤ/.ร⏣ SIRS Nปᯤ>/ว⟣น᧣ฉৣ.// SDx: - SDx PDx Spontaneous bacterial peritonitis (E.coli infection) K65.0
B96.2
E.coli septicemia A41.5
SDx Cirrhosis K74.6
PDx Acute pyelonephritis [E.coli infection] N10 Ascites R18
B96.2
SDx Paracentesis 54.91
E.coli septicemia A41.5 Op
DRG 11541 RW 0.6186 DRG 11541 RW 1.6079 DRG 06603 RW 1.5448 DRG 06600 RW 0.9094
ÒO/ล◤ตᗣN繉/Ó ตᗤ/Nปᯤ>/ว⟣น᧣ฉৣ./ล◣ Ò N繉/กǤ/N/Ó O/> ÒN繉/ONล◣/Ó ม⇣/ห⯣.幈Oตᗤ>กǣ
69 70
鹉ปᯤ/.N/ตᗣOขˤ />ดᓤ/.Nขˤส⫣ />/Ṉ //อⷣ/ภ⃣ม⇣ 38.5oC 鹉ปᯤ/.N/ beta-thalassemia N.ตᗣม⇤>/ />ดᓤ/.Nขˤส⫣ 2 ว⟣ // 鹉ปᯤ/./>ดᓤ/.Nขˤส⫣/>/Ṉ 3 ว⟣ Nม⇤ม⇣/>/ผ᳣ตᗣ繈 Nม⇤ม⇣N/ 鹉ปᯤ/./>ดᓤ/.Nขˤส⫣/>/Ṉ 3 ว⟣ //อⷣ/ภ⃣ม⇣ 38.5oC ชૣ/ 130
ชૣ/ 100 ṉตᗤ/>ท៣ />.O 26 ṉตᗤ/>ท៣ />/ดᓣN/ห⯣ 120/70 อⷣ/ภ⃣ม⇣ 39oC ชૣ/ 85 ṉตᗤ/>ท៣ />.O 20 ṉตᗤ/>ท៣ />/ดᓣ />จࣣตᗣ/ //อⷣ/ภ⃣ม⇣ 38.5oC ชૣ/ 130 ṉตᗤ/>ท៣ />.O 24 ṉตᗤ/>ท៣ />.O 24 ṉตᗤ/>ท៣ />/ดᓣN/ห⯣ 80/50 /././/
/./.// NจࣤṈ/ท៤/ //Nล◣/Nม⇤Nล◣/>/ 15,000 N/ล◤ตᗤ/ N/ห⯣ 110/70 /./.// Nม⇤O/ล◤ตᗣN繉/ชૣN ว⟣น᧣ฉৣ.O/ร⏣ว⟤> ṉตᗤ/>ท៣ />/ดᓣN/ห⯣ 100/60 /./.// CBC: Hb 14, Hct 45, Nจࣤ幈/ล◣ดᓤ>/> CBC: Hb 14, Hct 45, WBC 15,000 [N85% L15%],
ม⇣/ล◣ล◣/ [neutrophil 90%, lymphocyte 10%] N>>鸳ช૤/ท៤/// Sepsis Oห⯤.>ฏ࿣ชૣ/>>///Nล◣/ดᓣ ว⟣蹈湉Nขˤ// />>/ wbc 15,000 [N85% L15%], platelet 230,000 /N>>N繉/>Nล◣/Nม⇤湉 platelet 55,000; UA: WBC 100-200 Oห⯤.>/鸳 500 ม⇣/ล◣ล◣/ />/ดᓣ
Nม⇤Nล◣/>/ 1,500 N/ล◤ตᗤ/ม⇣/ล◣ล◣/ /N>>N繉/鸳Oช૤/ท៤/ ตᗣ จࣣจࣣ/น᧤>.Oอⷣ 2 ว⟣ตᗤ//> ร⏣/>ดᓤ/..>ฏ࿣ชૣ/> 3 ว⟣ />>/ดᓣ湉O/>จࣣ/น᧤>.Oว⟣幈 4 N/ห⯣Nปᯤ 90/60 /./.// ร⏣/>ดᓤ/..>ฏ࿣ชૣ/> Oว⟣幈 2 ปᯣ..>/>
E.coli N>>N繉/Nล◣/Nม⇤湉 //น᧤/.ว⟤> 100 ม⇣/ล◣ล◣/O 8 Ṉ/N/ />>/ดᓣ湉Oว⟣幈 4 /N>>
N繉/>Nล◣/O/>ปᯣ..>/>Nม⇤湉 O/>จࣣ/น᧤>.Oว⟣幈 7
PDx Spontaneous bacterial peritonitis (E.coli infection) K65.0 PDx Fever R50.9 PDx Fever with chill R50.8 PDx Acute pyelonephritis N10
B96.2 Postsplenectomy status D73.0 Severe sepsis R65.1

Cirrhosis K74.6 Acute renal failure N17.9
SDx Ascites R18 SDx SDx SDx
Paracentesis 54.91 B-thalassemmia D56.1

Op ODx Op Op
DRG 06603 RW 1.5448 DRG 06600 RW 0.9094 DRG 18580 RW 0.3864 DRG 18581 RW 0.9165 DRG 18580 RW 0.3864 DRG 18580 RW 0.5155 DRG 11544 RW 3.7446 DRG 11540 RW 0.6181
บ᫣ท៣N繉/กǤ/N/O/>O/ล◤ตᗣN繉/Oห⯤ชૣN />.>N//>>/ร⏣/>Nม⇤/Nฑᇤว⟣น᧣ฉৣ..>/> sepsis />.>N//>>/ร⏣/>Nม⇤/Nฑᇤว⟣น᧣ฉৣ..>/> sepsis />/Nฑᇤว⟣น᧣ฉৣ..>/> severe sepsis O/> acute renal failure
DRG 18580 RW 0.3864 R50.9 DRG 18580 RW 0.5155
71 72
鹉ปᯤ/.ม⇣Nขˤส⫣/>/Ṉ 3 ว⟣ ซ௣/ล◣繈 อⷣ/ภ⃣ม⇣ 38.5oC ชૣ/ 130 鹉ปᯤ/./>ดᓤ/.Nขˤส⫣/>/Ṉ 3 ว⟣ Nม⇤ม⇣/>/ผ᳣ตᗣ繈 //
SEPSIS
ṉตᗤ/>ท៣ />.O 24 ṉตᗤ/>ท៣ />/ดᓣN/ห⯣ 70/40 /./.// อⷣ/ภ⃣ม⇣ 38.5oC ชૣ/ 130 ṉตᗤ/>ท៣ />.O 24 ṉ>ท៣ />/ดᓣ
Development
CBC: Hb 14, Hct 45, WBC 15,000 [N85% L15%], platelet 55,000; UA: N/ห⯣ 70/40 /./.// CBC: Hb 14, Hct 45, WBC 15,000 [N85% L15%],
WBC 100-200 Oห⯤.>/鸳 1,000 ม⇣/ล◣ล◣/ O 1 Ṉ/N/ />/ดᓣN/ห⯣ platelet 55,000 Oห⯤.>/鸳 1,000 ม⇣/ล◣ล◣/O 1 Ṉ/N/ />/ดᓣN/ห⯣
80/50 /./.// ตᗤ/Oห⯤ levophed N繈//คӣ//>/ดᓣN/ห⯣ ร⏤// 80/50 /./.// ตᗤ/Oห⯤ levophed N繈//คӣ//>/ดᓣN/ห⯣ ร⏤//กǣ O Sepsis-1 The first definition of the septic syndrome had
กǣ.>ฏ࿣ชૣ/> ว⟣幈 2 ปᯣ..>/>//น᧤/.ว⟤> 100 ม⇣/ล◣ล◣/O 8 .>ฏ࿣ชૣ/> /N>>N繉/>Nล◣/Nม⇤湉 O/>จࣣ/น᧤>.Oว⟣幈 8 been published by SCCM/ACCP in 1992 introduced the
Ṉ/N/ />>/ดᓣ湉Oว⟣幈 4 /N>>N繉/>Nล◣/O/>ปᯣ..>/>Nม⇤湉 term SIRS (Systemic Inflammatory Response Syndrome)
O/>จࣣ/น᧤>.Oว⟣幈 8 # Sepsis [SIRS response to infection]
# Severe sepsis [sepsis with organ dysfunction]
PDx Acute pyelonephritis N10 PDx Septic shock R57.2
# Septic shock [sepsis induced arterial hypotension
despite adequate fluid resuscitation]
Septic shock R57.2
Severe sepsis R65.1 O Sepsis-2 was consensus by SCCM/ESICM/ACCP/SIS in
SDx Acute renal failure N17.9 SDx
2001, and mentioned SOFA (Sequential Organ Failure
Assessment) as a potential definition of infection
associated persistent arterial dysfunction
Op Op
O Sepsis-3 has been published in 2016 by ESICM/SCCM,
Singer M, Balk RA, Deutschman CS, et al. The Third International Consensus Definitions for Sepsis
and Septic Shock (Sepsis-3). JAMA. 2016;315(8):1810Ð1655.
DRG 11544 RW 3.7446 DRG 11540 RW 0.6181 DRG 18500 RW 0.5482 DRG 18500 RW 0.7880
confirmed that SOFA had a higher predictive validity than
/>/Nฑᇤว⟣น᧣ฉৣ..>/> septic shock O/> acute renal failure Nม⇤O/ล◤ตᗣN繉/ SIRS, and abandoned of SIRS and severe sepsis
.>/>/.ร⏣ Severe sepsis ร⏤//กǣ Septic shock Nดᓤ ม⇣.>/> SIRS O/> Septic shock >/Nฑᇤว⟣น᧣ฉৣ. ESICM; the European Society of Intensive Care Medicine: SCCM; the Society of Critical Care Medicine ACCP;
the American College of Chest Physicians: SIS; the Surgical Infection Society
73 74
SEPSIS-3 SEPSIS-3
New DeÞnitions SOFA score [Predictive Mortality Score]
O Sepsis O Sepsis
System / 0 1 2 3 4
Score
Respiratio <200 with <100 with
# Hospital mortality >10% [>2 points in SOFA or n >400 <400 <300 respiratory respiratory
A life-threatening organ dysfunction due to a PaO2/FiO2 support support
dysregulated host response to infection Quick SOFA (qSOFA) Coagulatio
n >150,000 <150,000 <100,000 <50,000 <20,000
Platelets
Increase of 2 points or more in SOFA score # qSOFA ÔHATÕ Liver
Bilirubin <1.2 1.2-1.9 2.0-5.9 6.0-11.9 >12.0
O Septic shock
§ Hypotension; SBP <100 mmHg (mg/dL)
MAP >70 MAP <70 Dopamine Dopamine Dopamine
Cardiovas
§ Altered mental status; any GCS <15 cular mmHg mmHg <5
Dobutamin
5.1-1.5
Epinephrin
>1.5
Epinephrin
A subset of sepsis where underlying circulatory and § Tachypnea; RR >22 /minute e (any e <0.1 e >0.1
cellular/metabolic abnormalities are profound enough CNS
to substantially increase mortality O Septic shock GCS score 15 13-14 10-12 6-9 <6
Renal
Need for vasopressors to obtain a MAP >65 mmHg # hospital mortality >40% Creatinine <1.2 1.2-1.9 2.0-3.4 3.5-4.9 >5.0
(mg/dL) <500 <200
and an increase the lactate concentration >2 mmol/L Urine
(18 mg/dL), despite adequate fluid resuscitation < 9 points; MR <33%
9-11 points; MR 40-50%
the term ÒSevere SepsisÓ is no longer in use >11 points; MR >95%
75 76
SEPSIS-2 vs SEPSIS-3
SEPSIS-2 vs SEPSIS-3
Mapping on DeÞnition Mapping on Severity
DeÞnition Sepsis-2 (2001) Sepsis-3 (2016) Simple infection Sepsis Severe sepsis Septic shock
Sepsis suspected infection + suspected infection + Sepsis-2 >2 SIRS criteria: Sepsis with Sepsis with
SIRS rise in SOFA score by >2 - Fever/Hypothermia - Organ failure Refractory hypotension
- Tachycardia - or Hypotension Dear Sepsis-3, IÕm sorry to say that I donÕt like you.
- Tachypnea - or Hypoperfusion
- Leukocytosis/
Leukopenia
Severe Sepsis sepsis +
hypotension, hypoxia, elevated
lactate or other lab markers of end - Simple infection Sepsis Septic shock
organ dysfunction
Sepsis-3 Infection and organ Sepsis with
sepsis + sepsis + failure (may include - Hypotension
Septic Shock - hypotension - Hyperlactatemia
hypotension after adequate fluid vasopressors + - hyperlactatemia or - Vasopressors
resuscitation lactate >2 - vasopressors)
77 78
Resistance to Antibiotics Resistance to Antibiotics

Severity of Infections Severity of Infections
U82 Resistance to betalactam antibiotics U83 Resistance to other antibiotics U84 Resistance to other antimicrobial drugs
Use additional code (B95-B98), if desired, to identified Use additional code (B95-B98), if desired, to identified Use additional code (B95-B98), if desired, to identified agents
agents resistance to betalactam antibiotic treatment. agents resistance to other antibiotic treatment. resistance to antimicrobial drugs.
U82.0 Resistance to penicillin U83.0 Resistance to vancomycin Excludes: Resistance to antibiotics (U82-U83)
Resistance to: U83.1 Resistance to other vancomycin related antibiotics U84.0 Resistance to antiparasitic drugs(s)
¥ amoxicillin
U83.2 Resistance to quinolones Resistance to quinine and related compounds
¥ ampicillin
U83.7 Resistance to other multiple antibiotics U84.1 Resistance to antifungal drug(s)
U82.1 Resistance to methicillin U83.8 Resistance to other single specified antibiotics
Resistance to: U84.2 Resistance to antiviral drug(s)
¥ cloxacillin
U83.9 Resistance to unspecified antibiotics U84.7 Resistance to tuberculostatic drug(s)
¥ flucloxacillin
Resistance to antibiotics NOS Excludes: Resistance to antibiotics (U82-U83)
¥ oxacillin
U84.8 Resistance to other antimicrobial drug
U82.2 Extended spectrum betalactamase (ESBL) resistance
U82.8 Resistance to other betalactam antibiotics
U82.9 Resistance to betalactam antibiotics, unspecified
MDR = U83.7 multidrugs resistant

XDR = U83.7 extensively drugs resistant
79 80
Febrile Convulsions Febrile Convulsions
Aetilogy must be Principal diagnosis No evidence of intracranial infection or other CNS pathology
Nดᓤ/>ย⋣ 1 ปᯣ/>ดᓤ/.Nขˤส⫣O/>ชૣ // acute tonsillitis
O Nขˤส⫣ว⟤> 38.4 /.>N/Nซ௣.. O ชૣ>Nขˤส⫣Nปᯤ/>>/幈บ᫤幉ถᛣ/>/ร⏣O//N/ตᗣN繉/ R56 Convulsions, not elsewhere classified
# ถᛤ>/>N/ตᗣN繉/幈Nปᯤ.>N/ตᗣ
PDx Acute tonsillitis J03.9
# Nม⇤ม⇣>/ตᗣN繉/O/>/>.> Excludes: Convulsions and seizure (in):
¥ dissociative ( F44.5 )
# Nม⇤ม⇣/>/ผ᳣ตᗣ/Nล◣/Oร⏤Oร⏤>>. : Oห⯤บ᫣ท៣N/ตᗣN繉/Nปᯤ>/ว⟣น᧣ฉৣ./ล◣ O/> ¥ epilepsy ( G40-G41 )
¥ newborn ( P90 )
SDx Febrile convulsions R56.0
# Nม⇤ม⇣/>ว⟣ตᗣชૣN.Nม⇤ม⇣Nขˤร⏤//ดᓤ/./>กǤ/ : Oห⯤บ᫣ท៣ febrile convulsions Nปᯤ>/ว⟣น᧣ฉৣ.// R56.0 Febrile convulsions

DRG 03530 RW 0.2591 DRG 03520 RW 0.3228
Nดᓤ/>ย⋣ 1 ปᯣ/>ท៤/Nส⫣.O/>Nขˤส⫣ Nกǣ/>>/ชૣ/>/ว⟤>ร⏣/>
# /ณᏣ//Nม⇤N/ตᗣN繉/幈Nปᯤ.>N/ตᗣ/Nขˤ
O ม⇣ONดᓤ/>ย⋣ 6 Nดᓣ/ถᛣ 3 ปᯣ
: Oห⯤บ᫣ท៣ febrile convulsions Nปᯤ>/ว⟣น᧣ฉৣ./ล◣
PDx Infectious diarrhoea A09.0
PDx: Infections SDx Febrile convulsions R56.0

SDx: Febrile convulsions DRG 06570 RW 0.2298 DRG 06581 RW 0.3596
PDx: Infections Nดᓤ/>ย⋣ 1 ปᯣ/>ดᓤ/.Nขˤส⫣O/>ชૣ ส⫤Nร⏣/>ตᗤ/幈 /.จࣣ/ว⟣
SDx: Febrile convulsions PDx: Febrile convulsions PDx Febrile convulsions R56.0
PDx: Febrile convulsions SDx: -
SDx
SDx: -
DRG 01620 RW 0.2622 DRG 01620 RW 0.3235
81 82
Diarrhea, Gastroenteritis, Enteritis, Colitis Viral Gastritis, Viral Gastroenteritis, Viral Colitis
¥ ÿ>/?/?/>>/>>/>/>N?O/ Nÿ /?Nÿ ÿ>.N///N÷O? ÿ>.N÷/? O/ÿ?> ¥ N/ÿÿ/.?.?/>>?.ÿ/.>/.ÿ//ÿ/// (endoscopy)
N÷ infectious diarrhea
¥ /?/>>/?NO.>>/>N?O/N//?.?N Nÿ Nÿ ?/O ÿ//O?N//?/N /ÿ//?/>>/
¥ ÿ>//N/ON/?/>/O/>>/> O/ÿ?>N÷ bacterial diarrhea ÿ/N> /Oÿÿ/ //?/ÿ//? //N/?//>/>N/ON/?/>/N?/ÿ>> /ÿ//
¥ ÿ>///?/>N>>/N?O///?/N>>N?O/>O O/ÿ?>>/N?O/?N// Nÿ ?/?.>/> lymphocytosis
cholera, shigellosis, salmonella, amebic dysentery
¥ />/?///.?.?>///N?O/N//?. Nÿ immunoassay, polymerase chain
¥ ÿ>//.>N/>/?N?N?NN/ÿOÿ>/>N?O/ O/ÿ?>/>./>N/?. Nÿ drug-induced reaction O/ÿ?>>//// Nÿ Rotar viral enteritis
colitis, non-infectious diarrhea, antibiotic associated diarrhea
¥ ÿ>//N/ÿ.>N/> O/ÿ?>N÷ acute diarrhea
83 84
Viral Gastritis, Viral Gastroenteritis, Viral Colitis Hypovolaemic Shock
SCG 2017 / NHSO 2019
¥ ?ÿ÷/.ÿ/N.?./>/?/>>/ÿ>N /ÿ//ÿ/.?N?//ÿ>N÷/>>//N/ Nÿ Dehydration, O ม⇣/>>//ช૤/
Postural hypotension, Prerenal azotemia, Hypokalemia, Hyponatremia, - MAP <60 mmHg /ร⏣/ Ps <90 mmHg /ร⏣/// >40 mmHg
Metabolic acidosis N/ÿÿ/./>/>>/N//ÿ>?ON÷>//>>?. - Poor tissue perfusion O/ว⟣./>ตᗤ>N
O ม⇣/>ว⟣ตᗣ>/Nส⫣.鸳/ร⏣/Nล◣/ /ร⏣/Nดᓤร⏣.>/鸳Nม⇤Nพợ./
¥ .>/>/?>N//.>/>?N/?/>//>O/N÷>//>>?.Nÿ
O ม⇣/>>/O./.>/>>.>/鸳 Nช૤ >Oห⯤ ผ᳣//น᧣N幈./
7 Severe hypokalaemia [K+ <2.5 mEq/L] />ย⋣ย⋣ดᓤ/. CVP <15 cmH2O
7 Severe hyponatremia [Na+ <125 mEq/L]
O ม⇣>//./ตᗤ/>/Oห⯤.>/鸳Oร⏣/>幈N//>>./
7 Acute renal failure O/>.>N//>อⷣṉ Nช૤ 2-3 ล◣/ON//>湈ถᛣ 2 Ṉ/N/
7 Hypovolemic shock ONดᓤ พợ>/>>/Nฑᇤ鸳/น᧣ตᗣ/
85 86
Non-Infectious Diarrhoea Antibiotic-Associated Diarrhoea

More Value in DRG-6 Pseudomembranous enterocolitis / Clostridium difÞcile enterocolitis
Acute Diarrhoea Chronic Diarrhoea

Infectious diarrhoea Secretory diarrhoea O ท៤/Nดᓣ幈NกǣO鹉ปᯤ/.幈Nดᓤร⏣.>ฏ࿣ชૣ/>ตᗣตᗤ/กǣNปᯤ
Enteritis Medication N//>>Nกǣว⟤> 2 ส⫣>ห⯤湉N N./>.>N/ตᗣ繈Nม⇤
Food-poisoning (infectious origin) Bowel resection
Intra-abdominal infection Bile acid malabsorption O /ณᏣว⟣น᧣ฉৣ.Nปᯤ Pseudomembranous Enterocolitis
Osmotic diarrhoea ตᗤ/ย⋣ย⋣ว⟣น᧣ฉৣ.ดᓤ/.
Medication - ส⫤/ล◤/ล◣Nส⫤O/ญ෤ Pseudomembranous enterocolitis
Carbohydrate malabsorption - //อⷣ>/> Clostridium difficile toxin
Celiac disease ÔVolcanoÕ or ÔMushroomÕ shaped exudate of Þbrin mucin and neutrophils
- N>>N繉/>อⷣ>/>N繉/ Clostridium difficile
Non-infectious diarrhoea Motility-related diarrhoea
Drug-induced Irritable bowel syndrome # Oห⯤/>บ᫣繈/.>ฏ࿣ชૣ/>幈Nปᯤ.>N/ตᗣ
Diet Hyperthyroidism
Poisoning Summary Diagnosis ICD-10
Inflammatory diarrhoea
Carcinoid syndrome Antibiotic-associated diarrhoea K52.1 + Y
Inflammatory bowel disease Pseudomembranous enterocolitis A04.7
Enterocolitis due to Clostridium difficile A04.7
87 88
Chemotherapy-Induced Diarrhoea Allergy, Dietetic Gastroenteritis
Must be ruled out the other caused of diarrhoea CowÕs milk protein diarrhoea / Eosinophilic gastroenteritis / Osmotic diarrhoea
O ท៤/Nดᓣ幈Nกǣ>>/ร⏣/>N//>Nร⏤ NกǣNดᓤṉ>.ร⏣ส⫣ O ท៤/Nดᓣ幈Nกǣ>.>/>繈 Nช૤ OพỤ.>//>/>/ >/อⷣN.

Nม⇣บ᫣บ᫣ N/ตᗣN繉/ /ร⏣/ graft-versus-host disease Summary Diagnosis ICD-10 />Nดᓣ/>/>/ Nดᓤร⏣/>/>/幈ม⇣/>/Nขˤ/ขˤส⫣
Chemotherapy-induced diarrhoea K52.1 + Y43.- # Allergic gastroenteritis
'ตᗣ//ย⋤>.>Nม⇣幈ท៣Oห⯤Nกǣ.>/>ท៤/Nส⫣.
5-fluorouracil, irinotecan, target therapies [cetuximab, ม⇣/>>//ภ⃣ม⇣OพỤO/>繈ดᓤ/. Nช૤ 繈O //
erlotinib, ipilimumab, gefitinib, lapatinib, sorafenib] # CowÕs milk protein allergy diarrhoea
Grade Description ONดᓤ幈N幉.ดᓤ/./ว⟣/Nปᯤส⫤/O/ญ෤
1 increase of <4 stool/day over baseline; mild increase in ostomy output compared with baseline # Enteral feeding diarrhoea [osmotic diarrhoea]
increase of 4-6 stool/day over baseline; moderate increase in ostomy output compared with
2
baseline Nกǣ>Nดᓤร⏣/>/>/幈ม⇣/>/Nขˤ/ขˤส⫣
increase of >7 stool/day over baseline; incontinence; hospitalisation indicated; severe in ostomy
3 output compared with baseline; limiting self-care activities of daily living # Eosinophilic gastroenteritis
.>/>อⷣN.N繉/ร⏣幈// eosinophil Oน᧣/>
4 life-threatening consequences; urgent intervention indicated
5 death
Nดᓣ/>/>/ [>20 eosinophils/HPF]
89 90
Diarrhoea / Enteritis
Diarrhoea / Gastroenteritis / Enteritis DRG-5 vs. DRG-6
Infectious caused vs Non-infectious caused PDx DRG- 0 1 2 3 4
5
A05.9, A09.0, A09.9 0657 0.2238 0.4100 0.6544 1.0796 1.2392
Summary Diagnosis ICD-10 Summary Diagnosis ICD-10
Diarrhoea A09.9 Chemotherapy-induced diarrhoea K52.1 Infectious diarrhoea 0658 0.2225 0.2884 0.5234 0.9271 1.6191
Gastroenteritis A09.9 Allergic gastroenteritis K52.2 K52.2, K52.3, K52.8, K52.9 0657 0.2238 0.4100 0.6544 1.0796 1.2392
Enteritis A09.9 CowÕs milk protein allergy diarrhoea K52.2 Non-infective diarrhoea 0658 0.2225 0.2884 0.5234 0.9271 1.6191
Loose stool R19.5 Eosinophilic gastroenteritis K52.8 0660 0.4408 0.5224 0.6029 1.0603 2.6699
K52.0, K52.1
Mucous stool R19.5 Eosinophilic enteritis K52.8 Radiation/Toxic enteritis 0675 0.2553 0.4462 0.4780 0.7358 1.4475
Acute gastroenteritis A09.9
Eosinophilic colitis K52.8
Acute enteritis A09.9 PDx DRG- 0 1 2 3 4
Enteral feeding diarrhoea K52.8 6
Acute diarrhoea A09.9 Radiation-induced gastroenteritis K52.0 A05.9, A09.0, A09.9 0657 0.3229 0.6814 1.4248 2.9895 6.7354
Infectious diarrhoea A09.0 Radiation-induced enteritis K52.0 Infectious diarrhoea 0658 0.2660 0.3596 0.6496 1.7770 5.4732
Acute watery diarrhoea A09.0 Non-infective diarrhoea K52.9 0676 0.4144 1.0422 2.5058 - -
K52.2, K52.3, K52.8, K52.9
Acute bloody diarrhoea A09.0 Neonatal non-infective diarrhoea P78.3 Non-infective diarrhoea 0658 0.2660 0.3596 0.6496 1.7770 5.4732
Dysentery A09.0 Functional diarrhoea K59.1
K52.0, K52.1 0660 0.9094 2.8756 4.2573 6.3356
Radiation/Toxic enteritis 0675 0.2203 0.7687 1.4952 2.8595
DRG 0658 for age <10 years; DRG 0675 for transferred case
91 92
Neoplasm
//?>/?>/>>?.N?N./?N?O//
¥ ÷/>/?ÿ÷/./>/?>//?/>/>/?O
¥ ?O/ÿ//?./>?NN>N?O// (anatomical site)
¥ /?N÷/>N/O N÷>//?/>/>N/O/.?/>//?//>N/O>>..?/>
//?>/>/>//>>?.N//>N/O
¥ ///>.>>/>.> N//ÿ/>.> //?N/?N. ./>>//>>?./ÿ> Mass, Tumor
¥ ///>/ÿ/>?>>/N?N./?/>N/O Nÿ alpha-fetoprotein
¥ ///>/?.?
¥ />/?>>//?/>N//>N/O
93 94
Mass, Tumor Malignant, Cancer

Non-neoplasm Neoplasm ¥ ÿ///?>.?.>>//>>?./ÿ>N÷/>N/O/>/.?ÿO?NO?N/>N/N//>N?.
Nÿ ///>.>>/>.> />///>/ÿ/>?>>/ //?////>/?.?/>.>
Hematoma Benign
¥ /??N?ÿ÷/.Nÿ/?>//>>?./ÿ>N÷/>N/O>/ÿ/./>>//?NO/ÿ//>/?>//?/>ÿ/
Hyperplasia .>/>/Oÿ/?.?/.ÿ?///?/?>>/?/>/?>/O.ÿ?N//>./>N/?. >
Infection Malignant, Cancer ?O/ÿ >//?/>?N?ÿ÷/.Nÿ/? N÷//?>.?.>>//>>?.
- Abscess - Carcinoma ¥ ÿ>/?N/ÿN?N//?/>/>N/O>/.?/> O/ÿ?>/>N/O/.?/>N÷>//>>?.//?
- Granuloma - Sarcoma
¥ ÿ>/?N/ÿN?N//?/>/>N/O>>>..?/> O/ÿ?>/>N/O>>..?/>N÷>//>>?.//? /??N
/>/ÿ>/>N/O?ON/>N/ÿ?N//?./>O O/ÿ?>/>N/O/.?/>N÷>//>>?.// Oÿÿ>N/ÿ
/> O/ÿ?>N÷ unknown primary cancer
95 96
Malignant, Cancer Metastasis
¥ O/ÿ/>>/ÿ>?ÿ÷/./>/?/>/>N/O/?O?Oÿ/./>?O Nÿ N/??? /?.?/?/> /?/>O/>? /?/??ÿ÷/.?N/?/>N/O>>..?/>N?N/>//?/>N//>N/O /?/>?>>/>?/?O
/>/ N.?>N÷>//>>?.// [admit for chemotherapy] ¥ ÿ>/>N/O/.?/>.?N/ÿ/>.N>?/?ÿ÷/. O/ÿ?>/>N/O/.?/>N÷>//>>?.//? O/>
¥ O/ÿ./>N//>N/ON÷>//>>?.//?>/?O?N?ÿ÷/.Nÿ>/>/?/>N?N./?N//>N/O/ÿ> ?>/>N/O>>..?/>N÷>//>>?.//
>//?/>/>N/O>.>O.> >O/ÿ/ÿ>ÿ//>N/O>??//NO/ÿ/O>/ ¥ ÿ>/?N/ÿN?N//?/>/>N/O>>..?/>O/>/>N/O/.?/>/>.N/??//NO/ÿ/ O/ÿ?>/>N/O
¥ /??N/??ÿ÷/.N/ÿN?N//?/>N/O/ÿ/>N//>N/O O/ÿ?>N//>N/ON÷>//>>?. >>..?/>N÷>//>>?.//? O/>?>/>N/O/.?/>//?//>/?>>/N.N÷N//>N/O
//?>/?O O/>?>N/O/ÿ/?ON÷>//>>?.// (personal history of malignat of.... ) N÷>//>>?.//
¥ /??N/??ÿ÷/.N/ÿN?N//?/>N/O/ÿ/?NN>>>//?/>N//>N/O O/ÿ?>N/
O/ÿ/?ON÷>//>>?.//? O/>?>N//>N/ON÷>//>>?.//
97 98
Malignant, Cancer Complication Associated With Carcinoma

¥ /??N/?N/ÿN?N/O/ÿ>//?/>N//>N/O//?/N/O/ÿ/>N//>N/O //?/O/ÿ>//?/> From Malignant From Treatment
O/>?/>/ ÿ//?///>.>>/>.> //?//?>/?>/O.ÿ?N/>>> - Anemia in malignant - Febrile neutropenia
/>./>N/?. ?O/ÿ >//?/> />.>N//>/>/NO÷/.?Nÿ>/> N?N/.?.?/ÿ>N÷ - Paraneoplastic syndrome - Toxic gastroenteritis
N//>N/O?N.? active /.?ÿ [?/ÿ> Òunderlying CA....Ó N/ÿN?./?N>/>>/ÿ>?ÿ÷/./>. - Bleeding from malignancy - Radiation proctitis
?ON÷N//>N/O?Nÿ/O/ÿ>//?/>] - Obstruction from malignancy - Radiation cystitis
¥ /??N/?N/ÿN?N/O/ÿ>//?/>N//>N/ON./ [N/??? /?.?/?/>] />N/ÿ/?//?> - Ruptured tumor - Postgastrectomy syndrome
ON//>N?.?N.?.?>/N÷N//>N/O >///./N//>N?.>./>/N÷/>ÿ/ - etc. - etc.
neoplasms of uncertain or unknow behavior [D37-D48] Nÿ colonic PDx: Malignancy PDx: Complication of treatment
neoplasm [D37.4], breast neoplasm [D48.6] SDx: Complication SDx: Malignancy or Personal history
of malignancy
99 100
Anemia in Malignant Chemotherapy-Induced Anemia
>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
1. />N/O.?N÷/.?ÿ (active cancer) 1. />N/O.?N÷/.?ÿ (active cancer) ?NN>>O//?>/O/ÿ.>N/???
2. /?///N/?/.?.?: normal MCV, normochromic normocytic rbc 2. N/ON/?/ON?/.ÿ>N?./ N.?NN/ON/?/>/O/>N/ON/?/N/ÿN?
3. /??>>//>>?./O.ÿ/ÿ> Anemia in malignant 3. />.>N//>N>?NN//>>./ (/?N>>O//?.>.//?O/ÿ.>N/?//>./?O)
4. /?>//?/>ÿ/.>/O/ÿN/?/ //?//?>///N>N/N>/ 4. /??>>//>>?./O.ÿ/ÿ> Chemotherapy-induced anemia
5. /?>//?/>ÿ/.>/O/ÿN/?/
N/ÿ.>/>/?> Anemia in malignant N÷>//>>?.//?
O/ÿ?> Chemotherapy-induced anemia N÷>//>>?.//?
/??NN/ON/?/N?>> O/ÿ?>/ÿ> Chemotherapy-induced aplastic anemia
101 102
Chemotherapy-Induced Febrile Neutropenia Radiotherapy

Febrile neutropenia [FN] N÷.>/>?NN/ON/?/>/>>/N/÷/ (ANC, absolute //?./?>/ÿ>/?.?/?/>OÿN÷ 3 />ÿ/
neutrophil count) N?/ÿ> 500 N//ÿÿ//>//>/>/ //?/N?/ÿ> 1,000 N//ÿÿ//>//>/>/ 1. Teletherapy N÷/?.?/?/>?Nÿ?N>/?.?/.?ÿ/ÿ>>?O?N/?/> Nÿ Co-60, Linac
O/>/?O/Nÿ/>///?O 48 ?N/N/ /ÿ//?/?Nÿ (>38oC >/ÿ> 1 ?N/N/) 2. Brachytherapy N÷/?.?/?/>?Nÿ?N>/.?ÿ>>//?//.?ÿ.>.O/>N/?N>/?/>
ON/>?> /? 3 /?/> NÿOÿ [/?Oÿ?.ÿ//ÿ> BCT] OÿN÷ 3 > ?/
Intracavity implantation Nÿ CA cervix
1. FN ?NN/ÿ>/>N?O/ Interstitial implantation Nÿ CA prostate
2. FN ?N/?O//ÿ>N?O/ Mould Nÿ Keloid
3. FN ?N/?/>>//>/>N?O/ON/?/ 3. Systemic therapy N÷/?.?/?/>N.>/? //?/>//?/>> Nÿ I-131, P-32
O/ÿ?> Chemotherapy-induced neutropenia N÷>//>>?.//? N>>/>./?.? Nÿ conventional RT, 3D-RT, IM-RT, IG-RT >N/ÿ/?//?./?>/N>>
103 104
Anemia
Age/Gender group Hb threshold (g/dL) Hct (%)
Men (>15 years old) 13.0 39
Woman, non-pregnant (15 years old) 12.0 36
Woman, pregnant 11.0 33
Teens (12-14 years old) 12.0 36
Children (5-11 years old) 11.5 34
Children (6-59 months old) 11.0 33
105 106
Thalassemia Thalassemia
>//>>?./>/ÿ/.Nÿÿ/N?O ¥ O/ÿ./>>//>>?.>/>/ thalassemia ?N.>/>/?O>.ÿ/.>////
1. /?.>/>N/?/>> microcytic anemia [MCV <80 fL] hemoglobin typing
2. /?N/ON/?/O>>O hypochromic, anisocytosis, poikilocytosis, ¥ Alpha thalassemia trait //?/ Beta thalassemia trait //?/ heterozygous
polychromasia (//?/ reticulocyte .?) hemoglobin E N/ÿ?//ÿ>N÷N/ >O/ÿ/ÿ>>/?>/>.?N/?/>?.?N/N/>N?/ÿ>>
3. />/?/>>/>/>>/>/?.?N/?.: thalassemic facies, hepatosplenomegaly N?.N/Oÿ/.>NN/ÿÿ/Nÿ/?>//?/>N>N/N>/ >N/ÿÿ/?>N÷>//>>?. .N/ÿO
>.>/>?Nÿ/O/ÿN/?/
4. />/?/// serum ferritin >//?/.?
5. />/?/// hemoglobin typing .?.>>//>>?.
>//>>?./?OO/ ÿ//?/// hemoglobin typing
107 108
Iron Deficiency Anemia from (Chronic) Blood Loss Acute Posthemorrhagic Anemia
>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
1. /?/>/?>>/N.?.N/?/N/?O//?: hypermenorrhea, stool occult blood 1. /?/>/?>>/N.?.N/?/N?./?: hematemesis, melena, epistaxis, hemoptysis
2. /?N/ON/?/O>>O hypochromic microcytic, MCV <80 fL 2. /?N/ON/?/O?N> [MCV >80 fL]
3. />/?///.?.>>//>>?.: low serum iron, high total iron binding 3. /??>/>>?./ÿ> acute posthemorrhagic anemia //?/
capacity, low bone marrow iron storage anemia from acute blood loss
4. /??>/>>?./ÿ> iron deficiency anemia 4. /?>//?/>N.>/O/ÿN/?/
5. /?>//?/>N.>/O/ÿN//OO
109 110
Anemia in Chronic Disease ?ÿ÷/.?N//N//ÿNÿ/N? .?>?> /?//.O??N>.N/ÿ>ÿ>. N/N/.ÿ//>/N//ÿ

ÿ/ÿ/ subcapsular hematoma of spleen with hemoperitoneum N>>N/?/
>//>>?./>/ÿ/.Nÿÿ/N?O >>/ Hct //> 40% N÷ 35%
1. /?N/N/?O//??N?O/ÿ>/./ÿ>N/?///: chronic kidney disease [stage 3-5] N/
ÿ//N/ÿÿ/ [hypothyroid N/ÿ/// DM] N/>N?O/N/?O//? [TB, AIDS, Liver disease]
PDx Splenic injury S36.00
2. /?.>/>?N/Oÿ/. [Hb ÿ/./ÿ>> 1-3 g/dL .N/ÿ CKD] N÷ normochromic
//?/ hypochromic O/> MCV > [/>N?NÿN/Oÿ/. OÿN/ÿÿ/./ÿ> 70 fL] SDx Acute post-hemorrhagic anemia D62
3. /??>/>>?./ÿ> anemia in chronic disease CT abdomen 88.01
Proc
4. /?>//?/>N.>/O/ÿN/?/ //?/ erythropoietin //?//?>////>>?.N>N/N>/ PRC transfusion 99.04
Ext 幈//N/ร⏤NคӤ踳N/ V28.40
111 112
Diabetes Mellitus
}
.2 With renal complications
The following fourth-character subdivisions are for use with categories Diabetic nephropathy ( N08.3* )
E10-E14: Intracapillary glomerulonephrosis ( N08.3* )
Kimmelstiel-Wilson syndrome ( N08.3* )
.0 With coma .3 With ophthalmic complications
Diabetic: Diabetic:
á coma with or without ketoacidosis á cataract ( H28.0* )
á retinopathy ( H36.0* )
á hyperosmolar coma
.4 With neurological complications
á hypoglycaemic coma Diabetic:
Hyperglycaemic coma NOS á amyotrophy ( G73.0* )
á autonomic neuropathy ( G99.0* )
á mononeuropathy ( G59.0* )
.1 With ketoacidosis á polyneuropathy ( G63.2* )
Diabetic: á autonomic ( G99.0* )
á acidosis .5 With peripheral circulatory complications
}
á ketoacidosis without mention of coma
Diabetic:
á gangrene
á peripheral angiopathy ( I79.2* )
á ulcer
.6 With other specified complications
ÿ//>>>/N>//>>/?O Diabetic arthropathy ( M14.2* )

á neuropathic ( M14.6* )
.7 With multiple complications
113 114
Diabetes Mellitus with Acute Complication Diabetes Mellitus with Renal Complication
DM with Coma DM with Ketoacidosis
>//>>?./>/ÿ/.Nÿÿ/N?O
>/ />.?/>.ÿ>. .?. //.> /?NN.ÿ />N?. />.O///> /?.>? 1. /?///÷..>/> protein +2 >ON N.N/ÿ/?.>Nÿ?O/ÿ>N÷N/N>/?N
- Hyperosmolar coma - Ketonemia 2. /??N//÷..>/>N/ÿN/?//?/ +1 O/ÿ.?.?ÿ/. micro-albumin/creatinine
- Hypoglycemic coma - Ketonuria [>2+] ratio />/ÿ> 30 mg/g ÿ///.?.? 2 /O?
DM type 2 with hyperpsmolar coma DM type 1 with ketoacidosis 3. /??ÿ÷/.Nÿ>//?//?.ÿÿ/ /??>/>.>N//>?NN÷N/?O O/>/?///÷..>/>O//ÿ
DM type 1 with hypoglycaemic coma /.ÿ>ÿ/. 1 /?O ?N protein +1 >ON N.N/ÿ/?.>Nÿ?O/ÿ>N÷N/N>/?N
DM type 2 with coma
Diabetes mellitus type 2 with nephropathy + Proteinuria
/>//ÿ>>//?/>/?.>/> hyperglycemia //?/ hypoglycaemia N/ÿÿ/./>N÷>//>>?.
115 116
Diabetes Mellitus with Ophthalmic Complication Diabetes Mellitus with Neurological Complication
DM with Diabetic Cataract DM with Retinopathy
>//>>?./>/ÿ/.Nÿÿ/N?O
- Bilateral white punctate or snowflake; - Retinal images: NPDR, PDR, macular
anterior and posterior subcapsular edema
1. /?/>/?>>/>./?//>.Nÿ> //?//O.//ÿ/?NNÿ>
- Visual acuity - Blood sugar in lens extraction visit
2. /?///.?.?/>/>>/ monofilament //?/ pin-prick sensation //?/
proprioception
Diabetes Cataract ÉNotÉ DM + Cataract
117 118
Diabetes Mellitus with Circulatory Complication Diabetic Gangrene, Diabetic Ulcer

>//>>?./>/ÿ/.Nÿÿ/N?O (ÿ/Oÿ//>N) ¥ O/N/?O//?O?ÿ÷/.N>//>?N/? neurological and/or peripheral circulatory complication
1. /?>///?/?N dorsalis pedis/posterior tibial pulse N>//?//?N/ÿNÿ /ÿ//? ¥ ÿ//?///.?.?/>/>>//>/>.>//?////N/?//O>
/?/?/>/ arterial insufficiency Nÿ claudication, discoloration, atrophic /?N/ÿ/?///.?.?/>/>> O/ÿ./>//.N/?N//N÷>//>>?.
skin, brittle nails, dependence rubor
Nÿ Ulcer at foot, Cellulitis at foot
2. /?///.?.?ÿ/. Doppler U/S //?/ ABI <0.9 //?/ CTA //?/ MRA
Diabetic foot N/ÿOÿ?/>>?.?N?ÿ/ N/>>>?///?.N÷ E14.9
119 120
Electrolytes Imbalance Electrolytes Imbalance
>//>>?./>/ÿ/.Nÿÿ/N?O ¥ Hyponatremia ÿ//?/>ÿ/..>//>/>.>///N/?/??N/?/>/Nÿ/ÿ?OOÿ NSS
1. /?/>/ÿ/>?>>/?N/>/Nÿ?N?/ >ON //?//?/>> sodium tablet/sachet
2. /?>//?/> //?/ //O?.>.O 24 ?N/N/.?/>/>>O/??NN/ÿNÿ/?/> ¥ Hyponatremia ?N/ÿ//? diarrhea N/ÿÿ/./>N÷>//>>?. .N/ÿ severe
hyponatremia (<125 mEq/L)
3. /??>/O.ÿON//>N?.
Electrolytes Hypo- Hyper- ¥ Hypokalemia ÿ//?/>ÿ/..>//>/>.?N/? potassium >///N/?///?//?/>>
Sodium <135 mEq/L >145 mEq/L
Potassium <3.5 mEq/L >5.5 mEq/L ¥ Hypokalemia ?N/ÿ//? diarrhea N/ÿÿ/./>N÷>//>>?. .N/ÿ severe
Calcium <8 mg/dL >11 mg/dL hypokalemia (<2.5 mEq/L)
Magnesium <1.5 mg/dL >2.5 mg/dL
Phosphate <2.5 mg/dL >4.5 mg/dL
121 122
Electrolytes Imbalance Acidosis

¥ Hyperkalemia N?ON/N/>.N/?O//? //?/ hypoaldosteronism ?//ÿ>N÷/>>/ ¥ ÿ/N/ÿOÿ/>>//N///?/.>/> shock, sepsis, diarrhea, lactic acidosis, diabetic
/N/ N/ÿÿ/./>N÷>//>>?. .N/ÿN÷.>/>>>/ÿ/?/> Nÿ arrhythmia ketoacidosis, renal failure, renal tubular acidosis, salicylate poisoning,
[tall T wave] sleep apnea, etc
ON/>?> N/ÿÿ/./>>//>>?./ÿ> acidosis N/>>?//ÿ>N÷/>>//N///?/.>/>
123 124
Adrenal Insufficiency Adrenal Insufficiency
AddisonÕs Disease Ñ Addisonian Crisis [Adrenal Crisis] Chronic Adrenal InsufÞciency vs. Acute Adrenal InsufÞciency [Adrenal Crisis]
O Chronic Adrenal Insufficiency ÔAddisonÕs diseaseÕ O Acute Adrenal Insufficiency ÔAddisonian crisisÕ O Chronic Adrenal Insufficiency Nม⇤ม⇣/>>/N>> [อⷤ/Nล◣.
# Fatigue, Lassitude, Maliase, Weakness, Anorexia # Unexplained hypotension Nม⇤ม⇣O/ ซ௣ 繈Nส⫤ />Nจࣣ. /ท៤/ ถᛤ>.N/// /ขˤ/
# Postural dizziness, Syncope, Hypotension # Abdominal pain, Nausea, Vomiting, Diarrhoea /ล◤>/N繉/] 湈NดᓤO.>/>繈N
# Nausea, Vomiting, Abdominal pain, Diarrhoea # Hypoglycaemia
O Acute Adrenal Insufficiency Nปᯤ.>/>ฉৣNฉৣคӣ>/ชૣว⟣幈
# Decrease of libido, Amenorrhoea, Weight loss # Hyponatraemia, Hyperkalaemia, Metabolic ตᗤ/OกǤN/ย⋤>Nร⏤ดᓤ/ ม⇣/>/ดᓣN/ห⯣踳O/>Nม⇤/./
# Myalgia, Arthralgias acidosis
ตᗤ/.>/>蹉/>/ดᓣN/ห⯣
# Hyperpigmentation [pressure points, axilla, palmar # Hypercalcaemia
crease, perineum, oral mucosa] - 鹉ปᯤ/.ม⇣ม⇣.>/> chronic adrenal insufficiency /鹈Nดᓣ/
# Thinning of axillary and pubic hair N繈/ม⇣.>/>/>/Nจࣤปᯤ/.>ท៣Oห⯤/>>/กǣNร⏣
# Vitiligo
# Electrolytes imbalance
125 126
Adrenal Insufficiency Adrenal Insufficiency

ConÞrmed Diagnosis E27.4 ÔDCL=0 in DRGs version 6Õ
20
O Basal cortisol secretion N>>Nล◣/// cortisol N//> 6:00-8:00 . #/ณᏣNปᯤ.>/>ร⏤/Nฉৣ.ล◣ Summary Diagnosis ICD-10
: <5 ug/dL Oห⯤ว⟣น᧣ฉৣ.Nปᯤ adrenal insufficiency Nดᓤ

10 Oห⯤บ᫣ท៣ว⟣น᧣ฉৣ.ว⟤> acute adrenal insufficiency
Adrenal insufficiency E27.4
Acute adrenal insufficiency E27.2
/ร⏣/ adrenal crisis
: <10 ug/dL ร⏤//กǣม⇣/>>/>ล◣น᧣ Oห⯤ว⟣น᧣ฉৣ.Nปᯤ adrenal insufficiency Nดᓤ 5 Chronic adrenal insufficiency E27.4
Adrenal crisis E27.2
: >20 ug/dL .>/>/O.N/幉//NNดᓤ #/ณᏣม⇣.>N/ตᗣ Oห⯤บ᫣ท៣ว⟣น᧣ฉৣ.>/.>N/ตᗣ Adrenal infarction E27.4
: Steroid-induced adrenal insufficiency Adrenal haemorrhage E27.4
O Random cortisol secretion N>>Nล◣///>幈ม⇣.>/> stress : Adrenal insufficiency due to adrenalectomy Adrenal insufficiency due to adrenalectomy E89.6
: <13 ug:dL Oห⯤ว⟣น᧣ฉৣ.Nปᯤ adrenal insufficiency Nดᓤ : Adrenal infarction Drug-induced adrenal insufficiency E27.3
Cryptococcal adrenalitis B45.8 + E35.1
: >20 ug/dL .>/>/O.N/幉//NNดᓤ : Adrenal haemorrhage
Meningococcal adrenalitis A39.1 + E35.1
: Tuberculous adrenalitis Tuberculous adrenalitis A18.7 + E35.1
: Meningococcal adrenalitis
127 128
Oÿ//>N...> Acute Alcoholic Intoxication
Oÿ/./...> />>
Oÿ/.>/...O/ÿ//ÿ>?>//> >//>>?./>/ÿ/.Nÿÿ/N?O
Oÿ/.?N...Nÿ>ÿ>>N/ÿ/?ÿ?/
1. /?/>/?>?N/.>/>
Oÿ//ÿ>...N/>/?/?N/ÿ/?//>/>
Oÿ//.../?. >N?>>? 2. /?>/N/?N.O//>?/>//?ÿ.>?/ N>ÿ÷> >//?/?ÿ />//ÿ //?/.>///
Oÿ/NO.../?N?/?//?/> N.?NN/ÿN>>N//?N
Oÿ/O...N//>N/Oÿ>Nÿ>//? 3. /?/>>/?>O>//>.>N//> O/>/>.N÷>NÿN/
Oÿ/Nÿ>...N//?N/O/>?N÷?N
Oÿ/.>....>O. >NNN/ÿN////
4. /?>//?/>?NN//>>./
.....//Nÿ>
ÿ/N/ÿN>>>/>NO?N.// //?/ Hypoglycemic coma
129 130
Alcohol Dependence, Alcoholism Alcohol Withdrawal

>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
1. /?/>/?>?N/.>/>/>> 1. /?/>/?>?N/.>/>Oÿ//>.>N//>?Nÿ>/>N/ÿN> 1 N?/
2. /?/>//>N/>/>//>O//>/N..>/> Nÿ CAGE, AUDIT //?//??>>/ 2. /?/>>///?>//>//?//.>.>/> 12-72 ?N/N/ .ÿ//>N/ÿN> 1 .?>/ÿ N./?
/>N/>N.>O.ÿ /.ÿ>ÿ/. 2 />>/ÿ/N?O />/> ?/.?N />?// /ÿ/N/?. >/>N/N/ÿ// O
3. /?>//?/>?NN//>>./ Nÿ vitamin B1, benzodiazepine .?N /.?//>> ?? /?/.?N ONÿN/O/ /?NN.ÿ/>N?. N/N/ÿ>. />//ÿO///
>/N./ÿ> N?N//>/>/ /N/ÿ//? N/?N/// N÷ÿ
¥ /?N/ÿ/?//?>/>/Nÿ O/ÿ?>>//>>?./ÿ> alcohol use 3. /?>//?/>?NN//>>./ Nÿ vitamin B1, benzodiazepine
¥ /?O/ÿ?O>?N?N/N/>?N/.>/> O/ÿ?>>//>>?./ÿ> alcohol abuse counselling
¥ /?/?>/??N?N/N/>?N/.>/> O/ÿ?>>//>>?./ÿ> alcohol rehabilitation />/?/>>/?/ÿ//ÿ/.Nÿ >N/ÿÿ/./>N÷>//>>?.
131 132
Alcohol Withdrawal with Delirium
>//>>?./>/ÿ/.Nÿÿ/N?O
1. /?/>/?>?N/.>/>Oÿ//>.>N//>?Nÿ>/>N/ÿN> 1 N?/
2. /?/>>///?>//>//?//.>.>/> 12-72 ?N/N/ .ÿ//>N/ÿN> 1 .?>/ÿ N./?
/.ÿ>ÿ/. 2 />>/ÿ/N?O />/> ?/.?N />?// /ÿ/N/?. >/>N/N/ÿ// O
.?N /.?//>> ?? /?/.?N ONÿN/O/ /?NN.ÿ/>N?. N/N/ÿ>. />//ÿO///
>/N./ÿ> N?N//>/>/ /N/ÿ//? N/?N/// N÷ÿ
3. /?/>>/.?.N?./? O/>/?>/.?N.?.>//?/?ÿN?N./?N//> .>?N >/
4. /?>//?/>?NN//>>./ Nÿ vitamin B1, benzodiazepine
/>/?/>>/?/ÿ//ÿ/.Nÿ >N/ÿÿ/./>N÷>//>>?.
133 134
Ischemic Heart Disease / Coronary Artery Disease Acute Coronary Syndrome

Ischemic heart disease [IHD] Unstable Angina NSTEMI STEMI
//>.> N//?/O>N/?/ ?N/>>?.Nÿÿ/./>>/NO/ÿ>/ Myocardial ischemia Myocardial injury Myocardial infarction
Coronary artery disease [CAD] - ST depression or - ST depression or - ST elevation [>2 leads] or
- T inversion - T inversion - new LBBB or
//>.> N////N/?/NN/>/??? ?Nÿ//?///.?.?/>>?.N.// - normal cardiac marker - elevated cardiac marker - new Q wave
- elevated cardiac marker
I20.0 I21.4 I21.0 - I21.3
135 136
Acute Coronary Syndrome Myocardial Infarction
¥ O>//N/.>>//>/?O .>/>/./>>//>>?.NÿN?./>>?.N?./ N.N/?/ //?>/./>/>>?.
N/?N/>O/?N.> 1. //.//ÿ>N÷ STEMI //?/ NSTEMI
¥ /??N?ÿ÷/./>ÿ/./>>/NO/ÿ>/ Oÿ//N/ÿ/>/>> O/ÿ./>>//>>?. 2. /?N÷ STEMI
N÷ precordial chest pain ¥ />>?O/ÿ//ÿ>/N?O//?/O?N>.
¥ /??NN>O?.>.O 4 .?>/ÿ O/ÿ?>/ÿ> recurrent MI
3. /?/?>///.?.?/ÿ>N>>///N/?/NN/>/??? O/ÿ?> coronary
artery disease N>N/N>/
137 138
Myocardial Infarction Ischemic Cardiomyopathy

>//>>?.O/ÿ>>/>//?>ÿ/N?O
1. /?>/?>//?/O//
2. /?////?/Oÿ/./?NN.?. low ejection fraction
3. /?///.?.?/ÿ>/?N////N/?/NN/>/??: CAG, CTA, Perfusion scan
4. /??/>>?./ÿ> Ischemic cardiomyopathy
Lateral Inferior Anterior Septal N/ÿÿ/./>>//>>?. Coronary artery disease /ÿ//ÿ/.
Left Main Left Anterior
Left Circumßex Right Coronary
Coronary Descending .>/>/./>>//>>?. Congestive heart failure /ÿ//ÿ/.Nÿ ÿ>/?/>>/>/>>
139 140
Cardiac Arrest Cardiac Arrest During Admission
>//>>?.O/ÿ>>/>//?>ÿ/N?O ¥ ÿ>? CPR .?N/O O/ÿ./>>//>>?.N÷ cardiac arrest with successful CPR
1. Cardiac arrest N>>Oÿ///?//>//ÿ>>//N/.>>//?O?O ¥ ÿ>? CPR N/ÿ.?N/O
# /?/>.>N/>//?/O/.>Nÿ?N Nÿ heart block, dysarrhythmia,
2. Cardiopulmonary resuscitation /?O?O.?N/O//?/N/ÿ
myocardial infarction O/ÿ./>.>N/>?/ÿ>/N÷>//>>?. N.N/ÿÿ/./>
3. Cardia arrest N>>.>N/>O //?/N/ÿ.>N/> cardiac arrest N÷>//>>?.
# /??ÿ÷/./?N/?NN÷.>N/>?N?O/ÿN.?.?/> Nÿ />N/O N/.ÿ >N?O/ON/?/ O/ÿ./>
.>N/>?/ÿ>/N÷>//>>?. N.N/ÿÿ/./> cardiac arrest N÷>//>>?.

# /?N/ÿNÿ/>>?.O>N>N/>>/ÿOÿ/ Oÿ>/ÿ>N>>/?/O/.>Nÿ O/ÿ
./>/>>?.N÷ sudden cardiac death
141 142
Cardiac Arrest Before Admission Atrial Fibrillation, Atrial Flutter

¥ ÿ>/>.>N/> O/ÿ./>.>N/>?N?O/ÿN> cardiac arrest N÷>//>>?.//? >//>>?./>/ÿ/.Nÿÿ/N?O
¥ ÿ>N/ÿ/>.>N/>O/>/?/>>/>.// O/ÿ./> anoxic encephalopathy N÷>/ 1. /?/>/?>>//>>?. atrial fibrillation
/>>?.//? N.N/ÿÿ/./> cardiac arrest with sucessful CPR N÷>//>>?.// 2. /?>///?/NÿN/ÿ./N?N.// N/ÿ/?/?O?N?N
¥ ÿ>N/ÿ/>.>N/>O/>N/?N/ÿ/.÷÷??O/ÿ/N.?.?/> O/ÿ./> cardiac arrest N÷>/ 3. /?////?NN÷>/?/ONÿ>Nÿ? AF: P wave N/ÿ?N RR interval N/ÿ./N?N.//
/>>?.//? I48.0 Paroxysmal atrial fibrillation
¥ ÿ>N/ÿ/>.>N/>O/>N/?N/ÿ/.÷÷??O/ÿ/N/ÿN.?.?/> /?/>/?N÷ÿ/?O/ÿ/N?N/ I48.1 Persistent atrial fibrillation
I48.2 Chronic atrial fibrillation
O/ÿ./>.>/> />>///?//>>/O.?N?O/ÿ/N?N/N÷>//>>?.//? N.N/ÿÿ/./> I48.3 Typical atrial fibrillation [Type 1 atrial flutter]
cardiac arrest N÷>//>>?.// I48.4
I48.9
Atypical atrial fibrillation [Type II atrial flutter]
Atrial fibrillation and atrial flutter
143 144
Atrial Fibrillation, AF Heart Failure
¥ First diagnosed AF N÷ AF ?N/>>?.N÷/?OO/
¥ Paroxysmal AF N÷ AF ?NN>>OO/>/?N÷ sinus rhythm NÿN/ .ÿ/O/ÿ/?Nÿ
.>.O 24 ?N/N/ Oÿ/>N÷>Nÿ> 7 /?
¥ Persistent AF N÷ AF ?NN>>Oÿ/N?N/>N> 7 /? //?/N/ÿ.>/>//?/>NÿN÷
>NÿN/ ÿ//>.?.>//?/>ÿ/.>//??//> (cardioversion)
¥ Long standing persistent AF N÷ AF ?NN÷ÿ/N?N//>>/ÿ> 1 ÷ N.O.ÿO/>
?ÿ÷/.?.>O.>.>//?/>O/ÿ/?/>Nÿ>
¥ Permanent AF N÷ AF ?NN/ÿ.>/>//?/>O/ÿ/?N÷>Nÿÿ/./>?>/ÿ>N //?/
O.ÿO/>?ÿ÷/.?.>O/ÿ>>N/ÿ.>.>//?/>O/ÿ/?/>NÿN÷>
145 146
Right Ventricular Failure, Congestive Heart Failure Left Ventricular Failure

>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
1. /?/?/>/>>/ RVF: ///N/?/??N/N÷ ?N /ÿ>/N ÿ//> O?/?N>N/ 1. /?/?/>/>>/ LVF: //N/?N/. //>N/ÿNÿ ?N>O/>// N/ ÷N.?./
>//>ÿ/ >> [crackle, wheezing] //?/.>ÿ>./?.?/ pulmonary congestion
2. /??>?/>>?./ÿ> Right ventricular failure //?/ Congestive heart failure 2. /??>?/>>?./ÿ> Left ventricular failure //?/ Acute cardiogenic
//?/ Biventricular failure pulmonary oedema
3. /?>/?O//?/>.>/>/?/O/ÿ/N///?NN//>>./ 3. /?>/?O//?/>.>/>/?/O/ÿ/N///?NN//>>./
147 148
Heart Failure CPR / Cardioversion
¥ /??NO.ÿN/ÿ?>>//>>?.?N/>>/>./>N/?. O/ÿ//?.N÷ I50.9 99.60 Cardiopulmonary resuscitation, not otherwise specified
99.62 Other electric countershock of heart
¥ /??N/?.>/> pulmonary edema ?NN/ÿ/?.>N/>>/?/O //?/ Acute non- Cardioversion:
NOS
cardiogenic pulmonary edema >Nÿ//?.N÷ J81 OÿN>>/?/O>ÿ//>> external
.>N/>O/ÿ?N?/ Acute cardiogenic pulmonary edema >Nÿ//?.N÷ I50.1 Conversion to sinus rhythm
Defibrillation
¥ N?N/>/?/O/ÿ/N///N÷.>/>N/ >//>>?..>/>?O>ÿ//?/>>/O/>/>>/O. External electrode stimulation
99.63 Closed chest cardiac massage
/.>/>?O O/ÿ//?N/?N./>>?.O/>ÿ/?ÿ÷/.?NN/ÿ/?/>>/>/>> ÿ/N?O Cardiac massage NOS
# ?ÿ÷/.?NNÿ/?.>ÿ/N?N/ //?/.>/>/?/O/>.N/?O//? Manual external cardiac massage
# ?ÿ÷/.?N////?/Oÿ/./?NN.?.>> Nÿ EF <50%, LVEDP .?
149 150
CPR / Cardioversion
¥ /??/?>/?O./O/>/N?./? [CPR with cardioversion] O/ÿ./>>//?/>
N÷ cardioverion //?/ defibrillation N?./.ÿ>N?./
¥ /??/?>/?O./ÿ>ÿ/N//>? .>/>/./>>//?/>NÿN÷.//?>/
151 152
Cerebral Infarction Stroke Syndrome vs Cerebral Infarction
>//>>?./>/ÿ/.Nÿÿ/N?O .>/>/Oÿ/>>/>/>>/ÿ//?////?.?/.//N?N//>>?O/ÿ/.>>..>
1. /?/>>/O/>/>>/O.Nÿ>Nÿ?N////N/?/.//?//?//>? ¥ Middle cerebral artery syndrome: /?/?/>/>N?O/>>/>N??Nÿ>/ÿ>/
2. /?///.//ÿ/. CT scan //?/ MRI N./>/?/N÷>Nÿ ///.N/ ÿ>N÷ÿ>ÿ>.>/? aphasia /ÿ//ÿ/. O/ÿ/O//>/ÿ>>
¥ Anterior cerebral artery syndrome: /?>/ÿ/O//> N.O>//?//ÿ/O/
ÿ>N/ÿ/?>/.ÿ// CT scan //?/ MRI .>/>/./>>//?/>NÿN?. Stroke N>>ÿO
¥ Posterior cerebral artery syndrome: /? homonymous hemianopsia /ÿ//?
macular sparing ÿ>/ÿ>/
ÿ>/? hemorrhagic transformation >./>>//?/>/ÿ> Intracerebral hemorrhage Nÿ Right homonymous hemianopsia with macular sparing
Oÿ/N/?N//?>/?O//?/>.>/>?O (/.ÿ>ÿ/.ÿ//?>/// CT scan O?) from Left posterior cerebral artery syndrome
153 154
Stroke Syndrome vs Cerebral Infarction Cerebral Infarction

Obstruction of an artery leading to or in the brain
.>/>/Oÿ/>>/>/>>/ÿ//?////?.?/.//N?N//>>?O/ÿ/.>>..>
Thrombotic stroke [58%]
¥ Cerebellar stroke syndrome: /?/>>/N>N (cerebellar ataxia) blood clot within blood vessel of the
brain and neck
I63 Cerebral infarction
I63.0 Cerebral infarction due to thrombosis of precerebral arteries
¥ Lacunar syndrome: N÷O////N/?/.// />>//?N/ÿ/>O/ />/?/>>/ : Large artery thrombosis 20%
: Small vessel disease 35%
I63.1
I63.2
Cerebral infarction due to embolism of precerebral arteries
Cerebral infarction due to unspecified occlusion or stenosis
N>> Nÿ pure motor, pure sensory, ataxia hemiparesis (Lacunar infarction)
: Hypercoagulable disorder
of precerebral arteries
I63.3 Cerebral infarction due to thrombosis of cerebral arteries

¥ Brain stem stroke syndrome: /?/>>/ cranial palsies, dysconjugate eye, I63.4 Cerebral infarction due to embolism of cerebral arteries
Embolic stroke [16%] I63.5 Cerebral infarction due to unspecified occlusion or stenosis
nystagmus, alternating hemiplegia, alternating hemisensory loss (/>>/ blood clot or other material carried to
of cerebral arteries
>/>.>?NO/ÿ>./?ÿ>?/??/) N÷/>/>>////N/?/ vertebral the brain from another part of the body I63.6 Cerebral infarction due to cerebral venous thrombosis
//?/ basilar : Atrial Þbrillation (Cardiac emboli)

: Myocardial infarction
I63.8
I63.9
Other cerebral infarction
Cerebral infarction, unspecified
: Bacterial endocarditis
155 156
Cerebral Infarction Cerebral Artery

Focal necrosis due to complete and prolonged ischaemia of brain Cerebral Artery Stroke Syndrome
Standard Coding Guidelines 2017 /น᧤> 193-194

# ///>บ᫣/>./>Nอⷣ.ว⟤>Nปᯤ cerebral embolism /ร⏣/ G46* Vascular syndromes of brain in cerebrovascular
thrombosis [.>/>/Oช૤/>ว⟣ตᗣ>/Nจࣤปᯤ/.Nปᯤขˤ/ม⇣/] diseases ( I60-I67? )
G46.0* Middle cerebral artery syndrome ( I66.0? )
# >/ว⟣น᧣ฉৣ.ว⟤>N////Nล◣/.//Nกǣ幈///Nล◣/O G46.1* Anterior cerebral artery syndrome ( I66.1? )
Oช૤/>>/>ล◣น᧣ ร⏤//กǣ///.>ร⏣ส⫣ CT scan G46.2* Posterior cerebral artery syndrome ( I66.2? )
G46.3* Brain stem stroke syndrome ( I60-I67? )
N繈//>บ᫣ตᗣO/น᧤ G46.4* Cerebellar stroke syndrome ( I60-I67? )
G46.5* Pure motor lacunar syndrome ( I60-I67? )
# //Oห⯤/ห⯣.蹈/ G46.-* Vascular syndrome of brain in G46.6* Pure sensory lacunar syndrome ( I60-I67? )
cerebrovascular disease Nปᯤ/ห⯣.>/ว⟣น᧣ฉৣ.ร⏤// N繈/ G46.7* Other lacunar syndrome ( I60-I67? )
/>บ᫣///Nล◣/幈ม⇣.>ธᣣ..> G46.8* Other vascular syndromes of brain in cerebrovascular
diseases ( I60-I67? )
157 158
鹉ปᯤ/./>ดᓤ/.อⷤ/O/>ขˤ>/> Nม⇤พợ // eye deviate to the left, 鹉ปᯤ/./>ดᓤ/.อⷤ/O/>ขˤ>/> Nม⇤พợ // eye deviate to the left, 鹉ปᯤ/./>ดᓤ/.อⷤ/O/>ขˤ>/> Nม⇤พợ // eye deviate to the left, 鹉ปᯤ/./>ดᓤ/.อⷤ/O/>ขˤ>/> Nม⇤พợ // eye deviate to the left,
right lower extremity grade III N/N/ย⋤//พợ/N/ร⏤.// hypodense right lower extremity grade III N/N/ย⋤//พợ/N/ร⏤.// hypodense right lower extremity grade III N/N/ย⋤//พợ/N/ร⏤.// hypodense right lower extremity grade III N/N/ย⋤//พợ/N/ร⏤.// hypodense
lesion at left ACA region N/Nดᓣ/ DM type 2, HT ม⇣ปᯣ/> Hypokalaemia lesion at left ACA region N/Nดᓣ/ DM type 2, HT ม⇣ปᯣ/> Hypokalemia lesion at left ACA region N/Nดᓣ/ DM type 2, HT ม⇣ปᯣ/> Hypokalaemia lesion at left ACA region N/Nดᓣ/ DM type 2, HT ม⇣ปᯣ/> Hypokalemia
DRG 01570 RW 0.6099 DRG 01570 RW 0.6054 DRG 01550 RW 1.0563 DRG 01550 RW 1.1574 DRG 01550 RW 1.0563 DRG 01550 RW 1.1574 DRG 01550 RW 1.0563 DRG 01551 RW 2.1899
PDx Stroke I64 PDx Cerebral infarction I63.9 PDx Cerebral infarction I639 PDx Cerebral infarction from ACA thrombosis I63.3
Diabetes mellitus type 2 E11.9 Diabetes mellitus type 2 E11.9
Hypertension I10 Diabetes mellitus type 2 E11.9 Hypertension I10 Anterior cerebral artery stroke syndrome G46.1
SDx SDx
Hypokalaemia E87.6 Hypertension I10 Hypokalaemia E87.6 Diabetes mellitus type 2 E11.9
SDx Hypokalaemia E87.6 SDx Hypertension I10
CT brain 87.03 CT brain 87.03 Hypokalaemia E87.6
Op Op
CT brain 87.03 CT brain 87.03

Op Op
I64 Stroke, not specified as hemorrhage or infarction I63.9 Cerebral infarction, unspecified I63.3 Cerebral infarction due to thrombosis of cerebral I63.3 Cerebral infarction due to thrombosis of cerebral
Cerebrovascular accident NOS arteries arteries
G46.1* Anterior cerebral artery syndrome
159 160
Old CVA
¥ /?/>/?>/ Cerebrovascular accident O/>///ÿ>>./>/>>>/>
/>.>//N//?//.?ÿ O/ÿ./>>//?/>/ÿ> Sequelae of cerebrovascular accident
N./>>/>./>N/?.?N/> Nÿ Sequelae of intracerebral hemorrhage /ÿ//?
/>/>>>/>/>.>
¥ /?N/ÿ/>/>>>/>/>.> O/ÿ./>>//?/>/ÿ> Personal history of
cerebrovascular accident
161 162
Pneumonia Pneumonia
ClassiÞcation
>//>>?./>/ÿ/.Nÿÿ/N?O Morphology Aetiology System Organism
1. /?/?/>>/>>>/>/>N?O/>N>/>.O.ÿ//ÿ> [3/5: fever (>38.3oC), Lobar pneumonia Hypostatic pneumonia Community-acquired Bacterial pneumonia
Bronchopneumonia Aspiration pneumonia pneumonia Viral pneumonia
cough with/without productive sputum, dyspnea, pleuritic chest pain, Interstitial pneumonia Chemical pneumonia Hospital-acquired pneumonia Mycotic pneumonia
consolidation or crackles] Eosinophilic pneumonia Healthcare-Associated Mycoplama pneumonia
Opportunistic pneumonia pneumonia Parasitic pneumonia
2. /?/>>/ON?./? (ÿ/./ÿ> 2 .?>/ÿ) BOOP Ventilator-Associated
pneumonia
3. /?///.>ÿ>./?.?/ new pulmonary infiltration
/?///.>ÿ>./?.?//?OO/>
¥ ÿ//??/>>?./O.ÿ/ÿ>N÷ Pneumonia O/>/?/>>/>>/N/?N?N
¥ ///.>ÿ>./?.?//?Oÿ/N /?/>/>>
163 164
Pneumonia Pneumonia
Morphology, Diagnosis of CXR Morphology, Diagnosis of CXR
O Bronchopneumonia O Hypostatic pneumonia
//?N.?NN>N÷/.ÿ//N //N ///// />>.?N/N //?N.?NN>>N.//>?NO/////O/>>// O?NN/ÿ.>/>/N/Nÿ/.ÿ>/?
//?/N>>/?ONÿ />.>>.> Nÿ ?ÿ.?/>.> />N?.
O Lobar pneumonia
//?N.?NN>?N/?O/?/ />N÷//>./? Bronchopneumonia Bronchopneumonia
O Interstitial pneumonia
//?N./?>// O/>/?>//>>./>//?N.
N?N///N/?//.//N ///////?/N?O/N.?N//>//ÿ>
/////>N/O Lobar pneumonia Interstitial pneumonia
Bronchopneumonia Lobar pneumonia Interstitial pneumonia Hypostatic pneumonia
165 166
Recording of Pneumonia Pneumonia

More speciÞc, More value
ล◣ดᓣ>/บ᫣ท៣ว⟣น᧣ฉৣ. N.//>幈N//>>./O>/O// [adequate sputum]

¥ /??N/.>ÿ>./?.?//?/?/>N>> O/ÿ?>/>>?.N÷ Bronchopneumonia
# />บ᫣N繉/กǤ/N/ [organism] # ม⇣Nม⇤Nล◣/>/น᧣น᧣/Nฟΰ//>ว⟤> 25 N/ล◤ตᗤ/ LPF //?/ Lobar pneumonia
# />บ᫣/N>/NกǣN/ [aetiology] # ม⇣N/ล◤N繈/บ᫣ squamous cell น᧤/.ว⟤> 10 N/ล◤ตᗤ/ LPF ¥ /?/>>?./ÿ> Bacterial pneumonia ÿ//?///N.//>.ÿ//.?O//O?N/?.
# />บ᫣ล◣/>//อⷣN. [morphology] # ม⇣N/ล◤N繈/บ᫣/ alveoli /ร⏣/ macrophage ร⏤//ดᓤ/. N.N.//>?N//ÿ/N/ON/?/>/O/>O?N/?./>? moderate >ON
¥ /??NN>>N.//>N?O/ O.ÿÿ/?>/ÿ>N?O/ON÷N?O/ÿ/N/ N.>>/>>>/
?N>N/O/>>//./ÿ/.>>?/>?NOÿ/?/>
¥ /??N/?.>N/>?N O/ÿ?>.>N/>O/ÿ?N Nÿ Aspiration pneumonia, Lipid
Culture Gram stain CXR pneumonia (oil aspiration), Pneumonitis due to aspiration of blood
167 168
Pneumonia Pneumonia
J15.0 Pneumonia due to Klebsiella pneumoniae J18.0 Bronchopneumonia, unspecified
J15.1 Pneumonia due to Pseudomonas J18.1 Lobar pneumonia, unspecified N/ÿ/>N?O/ÿ/N/
J15.2 Pneumonia due to staphylococcus J18.9 Pneumonia, unspecified
J15.3 Pneumonia due to streptococcus, group B />?N/N?O/ÿ/N/ J69.0 Pneumonitis due to food and vomit
J15.6 Pneumonia due to Escherichia coli J69.1 Pneumonitis due to oil and essences />.>N/>?N
J15.7 Pneumonia due to Mycoplasma pneumoniae J69.8 Pneumonitis due to other solids and liquids
J16.0 Chlamydial pneumonia
J15.9 Bacterial pneumonia, unspecified

/>>N?O/ÿ/N/
169 170
Bronchitis Chronic Obstructive Pulmonary Disease [COPD]

>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
1. /?/>/?>N/Nÿ? /?N.//> />/?Nÿ N.?N///ÿ>>./>÷Nÿ crepitation 1. /?/>>/N//?N.//> //N/?N/.>//?/?>. N./?/>>/N÷N?///?/N÷÷
O/>/?>/?N/> (exacerbation) N÷/>.>
2. .>ÿ>./?.?///> //?//? bronchovascular marking N>N/>O
2. /?>////ÿ>>.÷Nÿ wheezing ////?/?/> barrel chest /?>/Oÿ
¥ O.ÿÿ//>>/ÿ>N÷ Acute bronchitis //?/ Chronic bronchitis O/ÿ?N accessory muscles ÿ/./>.O
# ONO/>.>ÿ/./ÿ> 15 ÷ Bronchitis >//>.> J20.9 Acute brochitis 3. /?///.>ÿ>./?.?/// emphysema O/>///?/ chronic bronchitis
# O?N/>.>?OOÿ 15 ÷>ON Bronchitis >//>.> J40 (Chronic) bronchitis //?////.///.>// FEV1/FVC <70%
¥ /??NN>>N.//>N?O/ O/ÿ/>>?N/N?O/ÿ/N/ÿ/. ¥ ?ÿ÷/.Nÿ> ÿ//?>/?O//?/>ÿ/N?N/ //?//?///.?.?
¥ ?ÿ÷/.O//ÿ ///?///.///.>/
171 172
J181 Lobar pneumonia
J9609 Acute respiratory failure
E119 Diabetes mellitus type2
Pneumonia vs. Acute Bronchitis E876 Hypokalemia
L899 Pressure sore
N179 Acute renal failure
Thai DRG version 6.2.1
Level 0452 0459 311 Tracheostomy
9672 Ventilator >96 hr PDx SDx1 SDx2 SDx3 SDx4 SDx Proc1 Proc2 Proc3
0 0.5661 0.4004 PRC transfusion
J181 J9609 E119 E876 L899 N179 311 9672 9904
1 0.9877 0.6018
J181 & 311 & 9672 in DC 0010 Tracheostomy w mech vent 96+ hr
2 1.8974 1.0835
3 3.1233 1.8052 DCL PCL
J181 J9609 E119 E876 L899 N179 J181 N179 E119
4 5.1197 4.4052
2 0 2 0 0 1 2 1 1
0452 = PDx: Pneumonia; 0459 = PDx: Acute bronchitis
J181 E119 N179 E876 J9609 L899 J181 N179 E119
2 1 1 0 0 0 2 x0.82o 1 x0.821 1 x0.822
J181 N179 E119 SUM PCL

DCL of Pneumonia CC Exclusion lists 2.0000 0.8200 0.6724 3.4924 3
DC PDx J18.9 J18.1 J15.9 J15.1 J69.0 J20.9 J181 N179 E119
0452 Pneumonia 1 1 1 3 2 0 2 1 1
0455 COPD 2 2 2 4 3 - DC 0010 w PCL 3-9 = DRG 00101

DRG 00101 RW = 25.6231
COPD w Lower respiratory tract infection = J440; DCL=2
173 174
J189 Pneumonia
J9609 Acute respiratory failure
E119 Diabetes mellitus type2
E876 Hypokalemia
L899 Pressure sore
N179 Acute renal failure
Thai DRG version 6.2.1 Acute Respiratory Failure
311 Tracheostomy
9672 Ventilator >96 hr PDx SDx1 SDx2 SDx3 SDx4 SDx Proc1 Proc2 Proc3
PRC transfusion
J189 J9609 E119 E876 L899 N179
J181 & 311 & 9672 in DC 0010 Tracheostomy w mech vent 96+ hr
311 9672 9904
>//>>?./>/ÿ/.Nÿÿ/N?O
DCL PCL 1. /?/>>/.// Nÿ >/ N/?..?//> /.?//> //.> ? N?.//>N//>/÷>
J189
1
J9609
0
E119
2
E876
0
L899
0
N179
1
N179
1
J189
1
E119
1
/>./?//>.Nÿ>
J189
1
E119
1
N179
1
E876
0
J9609
0
L899
0
N179
1 x0.82o
J189
1 x0.821
E119
1 x0.822
2. /?///.?.>: PaO2 <55 mmHg, PaCO2 >45 mmHg, O2 sat <90%
J181 N179 E119 SUM PCL 3. /?>//?/>ÿ/. invasive ventilator //?/ artificial airway with mechanical
ventilator support //?/ Ambu bag />//ÿ>.ÿÿ/
CC Exclusion lists 1.0000 0.8200 0.6724 2.4924 2
N179 J189 E119

1 1 1
DC 0010 w PCL 3-9 = DRG 00100

DRG 00100 RW = 22.4104
/??N/?.ÿÿ/?ÿ÷/.?NO.ÿÿ//>.OO/>OÿN/?N/ÿ/./>.O/>ÿ/
¥ ÿ//?>/.>.>//.ÿ>N/?N/ÿ/./>.OOÿN/ÿ.?N/OON//>/>.>N//> 2-3 /?
175 176
Pleural Effusion Ventilator Time
>//>>?./>/ÿ/.Nÿÿ/N?O Include
1. /?/>>///N/?N/. NO/ÿ>/N//>/>.ONÿ> ¥ via Endotracheal tube or Tracheostomy
¥ with Ventilator
2. ///ÿ>>.N>>> vocal resonance // ÿ///??Nÿ>/ÿ>/
3. .?.?/>>?.ÿ/..>ÿ>./?.?/// //?/N>>N.?N//>ÿ//O? Exclude
¥ Nasal canula
/?/?.>N/>/ÿ////?>.?.> ?>/>./>N/?.O/ÿ?N Nÿ ¥ Face mask
¥ Tuberculous pleural effusion, Tuberculous pleuritis - TB Rx ¥ IPPB
¥ Malignant pleural effusion - cytology/pathology ¥ NIPPV
¥ Pleural effusion in SLE - SLE Rx ¥ BiPAP, CPAP
¥ Iron lung
177 178
Ventilator Time Ventilator Time

duration would end at the time of the transfer (discharge). duration would end at the time of the transfer (discharge).
Note: Endotracheal Intubation Note: Endotracheal Intubation
96.70 Continuous invasive mechanical ventilation of unspecified duration 96.70 Continuous invasive mechanical ventilation of unspecified duration
To calculate the number of hours (duration) of continuous mechanical For patients who begin on (endotracheal) intubation and subsequently
ventilation during a hospitalization, begin the count from the start of the
Invasive mechanical ventilation NOS have a tracheostomy performed for mechanical ventilation, the duration Invasive mechanical ventilation NOS
(endotracheal) intubation. The duration ends with (endotracheal) 96.71 Continuous invasive mechanical ventilation for less than 96 begins with the (endotracheal) intubation and ends when the mechanical 96.71 Continuous invasive mechanical ventilation for less than 96
extubation. ventilation is turned off (after the weaning period).
consecutive hours consecutive hours
96.72 Continuous invasive mechanical ventilation for 96 consecutive 96.72 Continuous invasive mechanical ventilation for 96 consecutive
/ณᏣ幈Oส⫤ท៤//>.O//>.ṉ hours or more /ณᏣ幈N>>/O.>./ล◣ hours or more
Oห⯤Nล◣/น᧣ṉ幈>幈ส⫣Nพợ.ṉNดᓣ./ Oห⯤น᧣ถᛣ/N繈/ช૤/./>.O
be
or
or
m
or
or
Discharge
Discharge
ilat
. tu
ion
sto
tila
ilat
t
on
on
tila
ing
ing
c
at
heo
Ven
Admit
ati
ati
Ven
t
Tra
Ven
Ven
ub
an
an
ub
ub
c
Ext
Off
Off
Off
Tra
We
We
On
On
Int
Int
T2 T3 T4 T5 TD T0 T1 T2 TT T3 T4 T5 TD
Hours of Mechanical Ventilation = T5-T1 Hours of Mechanical Ventilation = T4-T1
179 180
Ventilator Time
duration would end at the time of the transfer (discharge).
Note: Tracheostomy
En
96.70 Continuous invasive mechanical ventilation of unspecified duration
To calculate the number of hours of continuous mechanical ventilation Invasive mechanical ventilation NOS
during a hospitalization, begin counting the duration when mechanical
ventilation is started. The duration ends when the mechanical ventilator 96.71 Continuous invasive mechanical ventilation for less than 96
is turned off (after the weaning period). consecutive hours
96.72 Continuous invasive mechanical ventilation for 96 consecutive
/ณᏣ幈N>>/ hours or more
Oห⯤น᧣ช૤/幈Oช૤N繈/ช૤/./>.O
be
y
or
om
tor
Discharge
. tu
ilat
tila
ost
ing
c
t
Admit
Tra
Ven
Ven
che
an
Off
We
Off
Tra
On
T0 TT T2 T3 T4 T5 TD
Hours of Mechanical Ventilation = T4-T2
181 182
q
q
Acute Appendicitis Acute Appendicitis

>//>>?./>/ÿ/.Nÿÿ/N?O ¥ Acute appendicitis with localized peritonitis: NOÿ/ÿ/.ÿ>/>ÿ>N?./
1. /?/>>/>/>>?NNÿ>Nÿ?N/: //>ÿ/ /ÿ//?N?N//>/>/ /?NN.ÿ ÿ/.ÿ>. N.?NN.ÿ>N>O//?/N/ÿONÿ
N/?Nÿ/ÿ/.ÿ>/> ¥ Acute appendicitis with generalized peritonitis: NOÿ/?O./ÿ> /ÿ//?
2. /?>//?/>N.ÿ>N/?N.?NN//>>./ ?>ÿ>?>//>>.///?N/ÿ/ÿ/ N.ÿ>N/?>O
/?N/ÿNÿ/?>/ÿ>?N.ÿ>N />N//O/>.?N/?ÿ//ÿ>/ÿ/>/ÿ>? ¥ /??NN/ÿNÿ>Nÿ/>>?. Acute appendicitis O/ÿ./>>//?/>N÷ right lower
¥ ÿ//?////?N?NN?N/?/Nÿ/ÿ>N÷N.ÿ>N/?N./> Nÿ CT, US quadrant pain [R10.3] //?/ acute abdomen [R10.0]
¥ ÿ/N/ÿ??/ÿ>.ÿ/..>> improved/approval
/?Nÿ/?>/ÿ>?N.ÿ>N
¥ ÿ//>>/>//>O//N/N.ÿ>N/?N.O/ÿ?ÿ/
183 184
Gastritis, Duodenitis Gastrointestinal Bleeding
¥ ÿ/Nÿ/?>////>>?.ÿ/./ÿ/.ÿ/ (endoscopy) >/>. />N/ÿ/?///.?.? ¥ //?N/?N../>?/>>?.?N?// NÿOÿ GI-bleeding, GI-hemorrhage, UGIH, LGIH
O/ÿ./>>//>>?.N÷ abdominal pain [R10.4] //?/ epigastric pain [R10.1] >N?O///////>.> Gastrointestinal haemorrhage, unspecified [K92.2]
¥ />/?/>>//?N?NN>>N>> Nÿ N/?///O>N>/>/>/ O/ÿ./>>//>>?.>/ ¥ /??N/??O hematemesis O/> melena />/N?./? O/ÿ?>N?.>//>>?.N?./
/>./>N/?.?N Nÿ hematemesis, melena ?/ hematemesis N?N/>/?/>//>O//ÿ>
¥ />/>>?.N÷ chronic gastritis ÿ//?///>.>>/>.> N.OÿN÷ 2 > ¥ /??N///>>/> occult blood >N/ÿ?//ÿ>N÷/>>//N/?///O>N>
NÿOÿ chronic superficial gastritis O/> chronic atrophic gastritis />/>/
¥ //?N/?N.>//>>?./ÿ> severe gastritis, mild gastritis >N//>.> gastritis [K29.7] /.ÿ>/?/.>/>O/ÿ//N/ Nÿ acute post-hemorrhagic anemia //?/ anemia
///>>?.N÷ acute hemorrhagic gastritis, acute gastritis ?N/?/>/?N>>/ÿ> from acute blood loss, hypovolemic shock O/>/?/?>/?NN?N./ÿ/ Nÿ PRC
transfusion
185 186
Oesophageal Varices Cirrhosis

¥ ///N/?///////>/>/ N?/?O///?.>N/>/>>.>/>?OO ??OO/ÿ./> ¥ Alcoholic cirrhosis .>/>/Oÿÿ//?/>/>/?>?N/>>/ÿ>?N/.>/>N÷/>?O/>ÿ/N?N/
>//>>?.N÷?N?./? N?N/O/ÿ//?.?N?ÿ/ Nÿ N÷N//>>
7 Alcoholic cirrhosis with oesophageal varices ¥ N/ÿÿ/?>/>>/O/>/>>/O./N/?ON÷>//>>?. //>.///>.>/> ascites,
7 Hepatitis B viral cirrhosis with bleeding oesophageal varices thrombocytopenia, coagulopathy .N/ÿ>/?>//?/>?NN>>ÿ/.>/>?/ÿ>/
¥ /??N/?N/?///O>N>/>/>/ .>/>/./>Nÿ/ÿ>/?.>N/>>///N/?// O/ÿ/ÿ> [paracentesis/platelet/FFP/vitamin K]
>N/ÿN/?///>.ÿ//ÿ/// />/?>/?O//?/>.>/>?O?NN//>>./ [.N/ÿ/? ¥ /??N/?.>/> coagulopathy ?NO/ÿ>//?/>ÿ/. FFP/vitamin K O/ÿ?>/>>?.N÷
.>N/>/?N?N?N] [SB-intubation/sandostatin/vasopressin] acquired coagulopathy //?/ coagulopathy from cirrhosis
>/./>>//>>?.?NN/ÿ?ÿ/ />N÷/O/ÿ/>ÿ//>>?.N//ÿ///>N/?N/ [RW //]
187 188
Urinary Tract Infection
>//>>?./>/ÿ/.Nÿÿ/N?O
1. /??/>>?./O.ÿON//>N?.
2. /?///.?.?/ÿ>/?>/>N?O/ /.ÿ>O/.ÿ>/>Nÿ/N?O
¥ //N/ON/?/>/O÷..>/>
7 (÷÷) N.>. N>/ÿ> 5 N//ÿ/HPF - N./> N>/ÿ> 10 N//ÿ/HPF
¥ //O?N/?.O÷..>/>
7 (N/ÿ÷) ?/N?O/?OOÿ 1 N//ÿ/HPF
7 (÷÷) ?/N?O//>/> moderate //?/ 3+ >ON
7 (N>>N?O/) ?/N?O/?OOÿ 105 colonies/mL
189 190
Urinary Tract Infection Urinary Tract Infection in Pediatrics

Acute Pyelonephritis >//>>?./>/ÿ/.Nÿÿ/N?O
- /?///.?.?>/>N?O/>N>÷..>/> (ÿ/Oÿ//>N) 1. /??/>>?./O.ÿON//>N?.
- /?Nÿ.? />/.?N [/>/.?/>/ÿ>>..?/ÿ> 38.0oC //?/N?/ÿ> 36.0oC] N.N/ÿ/?Nÿ> 2. /?///.?.?/ÿ>/?>/>N?O/ /.ÿ>O/.ÿ>/>Nÿ/N?O
.>N/>/?N 7 N/ON/?/>/ ?/N> 5 N//ÿ/HPF
- />/?NN.ÿ/>N?. //?/NO?N//? (costovertebral angle) 7 O?N/?. ?OOÿ 1 N//ÿ/HPF
7 Nitrite and/or leucocyte esterase
Acute Cystitis
- /?///.?.?>/>N?O/>N>÷..>/> (ÿ/Oÿ//>N) NON/O?N/>.>ÿ/./ÿ> 3 ÷ //?/NO?N.?/O/ÿ÷..>/>N/ÿNÿ ÿ/N>>N?O/?NNÿ>
- /?÷..>/>O.? ÷..>/>ÿ/.Oÿ/>/>N/ÿ/> >/NO÷..>/>ÿ/./>? urethral catheterisation //?/ suprapubic aspiration
- />//>N/N/?//?/N/ÿ>
191 192
Prerenal Azotemia Acute Renal Failure
>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O ÿ/Oÿ//>N
1. /?>/?>/N///.ÿ>//N/O/ O/>?>O/.ÿ>//N/O/.>.O 1-2 /?N/?N/OÿN 1. /?>/N>N/>O/ creatinine
.>N/>Nÿ 7 N>N//>/ÿ>ÿ>?O> 0.3 mg/dL .>.O 48 ?N/N/
2. /?///.?.? 7 N>N//.ÿ>ÿ/. 1.5 Nÿ>/ÿ>?O> 0.3 mg/dL .>.O 7 /?
7 BUN:creatinine ratio />/ÿ>//?/Nÿ>? 20:1
2. /?÷..>/>//ÿ/./ÿ> 0.5 ml/hr >/ÿ> 6 ?N/N/
7 Urine specificity gravity />/ÿ> 1.018
/?/?.>N/>/N/>.O/ÿ./>N÷>//>>?.
N/ÿÿ/?> acute renal failure N>N/N>/
/?//?/>>?./ÿ> Acute Kidney Injury
Prerenal azotemia, Congenital renal failure, Drug-induced renal failure, Hemolytic-uremic
O/ÿ//.//ÿ>N÷ Prerenal azotemia //?/ Acute renal failure syndrome, Hepatorenal syndrome, Puerperal renal failure, Postprocedure renal failure,
Post-renal obstruction
193 194
Acute Renal Failure Chronic Kidney Disease

Acute tubular necrosis >//>>?./>/ÿ/.Nÿÿ/N?O
- >/?>/N//>ÿ/?N÷N//>/.ÿ>ÿ/. 1 .?>/ÿ 1. /?.>/>N>>>>ÿ/?N> 3 N?/ (/?/>>////N>>//?/N/ÿONÿ)
- /?/?/>>// volume overload, uremia, electrolyte imbalance 7 ///?/?/>O÷..>/>: albumin excretion rate >30 mg in 24 hr
- .ÿ/O/ÿ>/?>/N>/?/>?>O.>.O 1-2 .?>/ÿ //?/ albumin/creatinine >30 mg/g
7 //N/ON/?/OO÷..>/>
Acute cortical necrosis
7 /?/>/>>/N/?/O/ÿ?NN>>ÿ/N>>
- >/?>/N//>ÿ/?N÷N//>>N> 2 .?>/ÿ
- /?N/>./>.N÷N/N/>.N/?O//? 2. /?/>/>>>/?.?/>.>/N
3. /?/>/>>>N/./ÿ>//?/.>>..>/N
Acute papillary necrosis 4. /?>/ÿ>?/?ÿ>.N
- //N?O/N.?N//N///>O÷..>/>
195 196
Chronic Kidney Disease Acute on top Chronic Kidney Disease
>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
5. /?/?/>//Nÿ/./ÿ> <60 ml/min/m2 >ÿ/N> 3 N?/ (N/?.>/>>>//?/ 1. /?Nÿ>//>>?./ acute renal failure
N/ÿONÿ)
2. /?Nÿ>//>>?./ chronic kidney disease
>/./>>//>>?. anemia in chronic disease [D63.8]
/??ÿ÷/.N÷ end stage renal disease //?/ chronic kidney disease stage 5
>ÿ/N÷ chronic kidney disease stage 3-5 Nÿ>?O
N/ÿÿ/./> acute renal disease N÷>//>>?.
N/ÿÿ/./>/>>//N/NN/?O//?N÷>//>>?.
.N/ÿ Fluid overload, Uremic encephalopathy, Hyperkalemia (?N?O/ÿN>>/
N/?N.O///?NN÷>/?/O
197 198
Recording & Coding of Delivered Patient

/??>/?>>//>>?.//?N?N/O/ÿ//?.Nÿ/.ÿ>N//>>./
¥ /???N 1 ÿ/ÿ?O/>/?//N..?>.>./ÿ/?>/ (indications)
¥ /???N 2 N///?/.>/>O/ÿ//>///O/>/?O [ÿ/-/>//ÿ>-//?]
¥ /???N 3 />?>/// (mode of delivery)
¥ /???N 4 //>/// (outcome of delivery)
O00-O99 (except O80-O84) + O80-O84 + Z37 + Procedure code [72-75]
Mode of Delivery .>/>/?>N÷>//>>?.//?Nÿ N/?N/N/ÿ/?/???N 1 O/> 2
199 200
Premature Rupture Of Membranes [PROM] Preterm Labour - Preterm Delivery
O/ÿ?>/>.>N//>?N>O?/N?O>N//>N/>N/NO//.ÿO>//>>?.>/?O Preterm labour >/NO//.ÿÿ/?/// - N÷Nÿ?ONO//.ÿN/ O/>???
O/ÿNO//.ÿ
O42 Premature rupture of membranes Preterm delivery N÷>///ÿ/?/// ÿ//>.>//.ÿ/ 37 .?>/ÿNO/
O42.0 Premature rupture of membranes, onset of labour within 24 hours
O42.1 Premature rupture of membranes, onset of labour after 24 hours >/./>>//?/>?N./?/ÿ
Excludes: with labour delayed by therapy - Preterm labour without delivery
O42.2 Premature rupture of membranes, labour delayed by therapy - Preterm labour with preterm delivery
O42.9 Premature rupture of membranes, unspecified - Preterm labour spontaneous labour with term delivery
- Preterm delivery without spontaneous labour
201 202
Preterm Labour - Preterm Delivery Obstructed Labour

Preterm labour without delivery [O60.0] .>/>/./>N÷>//>>?.//?NÿN/?N//>/>NO//.ÿO/ÿ/Nÿ>?O
N/>N/NO//.ÿÿ//>.>//.ÿ/ 37 .?>/ÿNO/O/>?/ÿ>.N.N/ÿ//
///>>.>N/>/>///>?/ÿ//ÿ/.N.//
Preterm labour with preterm delivery [O60.1]
/??N>///>?>/>/>>/.ÿ/?/>/
N/>N/NO//.ÿÿ//>.>//.ÿ/ 37 .?>/ÿO/>//ÿ//>.>//.ÿ/ 37 .?>/ÿNO/
O/ÿ./>N÷ Obstructed labour due to malposition/malpresentation [O64.-]
Preterm spontaneous labour with term delivery [O60.2]
/??N>///>?>/>/>>//>ÿN>/>//>/>
N/>N/NO//.ÿÿ//>.>//.ÿ/ 37 .?>/ÿO/>//N/?N//>.>//.ÿ/ 37 .?>/ÿNO/
O/ÿ./>N÷ Obstructed labour due to pelvic abnormality [O65.-]
Preterm delivery without spontaneous labour [O60.3]
//ÿ//>.>//.ÿ 37 .?>/ÿNO/N./>NÿN/>N/NO//.ÿN/ />???O/ÿNO//.ÿ /??N/>.>N/>?N/>?O/ÿN>>///>?ÿ/>/NO//.ÿ//
//?/ÿ>//ÿ/N/>N/NO//.ÿ O/ÿ./>N÷ Maternal care for caused [O32.-, O33.- O34.-]
203 204
Perineal Laceration / Perineal Tear [O70.-] Postpartum Hemorrhage, Puerperal Bleeding [O72.-]
.>/>/./>N÷>//>>?.NÿN/?N/>/?>?ON>>OO/>.?NN/ÿNÿ?÷N.O O/ÿ./>.>N/>/>/N.?.N/?/ Nÿ coagulopathy, retained placenta, uterine
//?/>/?>N>N>N/N>/>>/?÷N.O atony N?N/O/ÿNÿ//?.?N/?/>/N>>N>>
O/ÿ/>>?ON?O/N.?N/?N?> N?N/O/ÿÿ>.ÿ/>/O/ÿ//?.>//>>?. /??N.>/> hypovolemic shock O/ÿ./>>//>>?.N÷ obstetric shock
205 206
Postpartum Hemorrhage, Puerperal Bleeding [O72.-] Birth Before Arrival [BBA]

>//>>?./>/ÿ/.Nÿÿ/N?O /?>///ÿ//>>.>.>>/
N/ÿ/?.>/>O/ÿ/O/>N/ÿNÿ?/?>/NN?./?>///
1. /??>>/.?N.?.N/?///?//
7 >///>ÿ///: N> 500 />//>/>/
O/ÿ./>>//?/>N÷ Care after immediately delivery [Z39.0]
7 >/ÿ>//: N> 1,000 />//>/>/ /?>///ÿ//>>.>.>>/
2. /??>?/>>?./ÿ> postpartum hemorrhage //?/ puerperal bleeding /?>/?/?>/?NN?N./ÿ/?>/// Nÿ ?.>..>?/ ?/// N.OO/
O/ÿ./>>//?/>N÷ Spontaneous delivery [O80.0] + Single live birth [Z37.0]
/?N/ÿ/>/Nÿ?/ÿ>/ ÿ//>/?>/N.?.N/?//.ÿ>ÿ/N?N//>/>>/>>/
N.?.N/?/ Nÿ />/?N//>// .>/>/./>>//>>?.N÷ delayed postpartum /??.ÿÿ//>>.>.>>//?N ?ÿ÷/.N/ÿ/?.>/>O/ÿ/
hemorrhage N.N/ÿ///>>/////>?/>/Nÿ/ÿ/N/?/ O/ÿ./>>//?/>N÷ Care after immediately delivery [Z39.0] //?/
O/ÿ./>>//?/>N÷ Admit for newborn care [Z76.3]
207 208
Recording & Coding of Neonate
/??>/?>>//>>?.//?N?N/O/ÿ//?.Nÿ/.ÿ>N//>>./
¥ /???N 1 Low Birth Weight / Prematurity
¥ /???N 2 Birth Asphyxia
¥ /???N 3 Complication of Delivery
¥ /???N 4 Congenital Anomalies
¥ Affected by Maternal Factors N÷>//>>?.//Nÿ>?O
¥ Liveborn [Z38.-] N>>/>.?N//O/ÿ/./>>/
209 210
Low Birth Weight / Prematurity Slow Fetal Growth and Malnutrition

>///ÿ/?/ //>.> //ÿ//>.>//.ÿ/ 37 .?>/ÿNO/ >N.ÿ/O/ÿ Oÿ.?//?>/?N/?O?/?O///ÿ/./ÿ>N//ÿNN/ÿ?N 10 /O?/?O///
O?/?O///ÿ/./ÿ> 2,500 /?/ N/?N/N?.?/>.>//.ÿ?O [P05.-]
Extremely low birth weight <,1000 g P07.0
Light for gestational age BW <10th; Length - normal P05.0
Low birth weight 1,000-2,499 g P07.1
Small for gestational age BW & Length <10th P05.1
Extremely prematurity <28 weeks P07.2
Preterm infant 28-36 weeks P07.3 BW & Length - normal
Fetal manutrition P05.2
Old man
ÿ>/>?O/>.>//.ÿO/>O?/?O/// O/ÿOÿO?/?O///N÷>//>>?.//? Fetal growth retardation BW & Length - normal P05.9
?ÿO/ÿ//?.N/ÿÿ/O/ÿ//?. P07.2 //?/ P07.3 N÷>//>>?.//
211 212
Birth Weight Gestational Age Weight Height Summary Diagnosis
(grams) (weeks) Birth Weight Gestational Age
(grams) (weeks) Weight Summary Diagnosis
<1000 <37 any any Extremely low birth weight

>4500# >37 any Exceptionally large baby
<37 normal normal Low birth weight
Large for gestational age
<10th%tile normal Light for gestational age >4000# >37 >90th%tile Heavy for gestational age
Large for dates
1000-2499
<10th%tile <10th%tile Small for gestational age
>37 Post-term
<4000 >42 any
Fetal malnutrition Postmaturity
normal normal
Fetal growth retardation
# Exclude: Infant of maternal diabetes
Preterm ÉÉ SCG
>2500 <37 any any
Singleton É. NSHO
213 214
Neonatal Respiratory Distress Syndrome Congenital Pneumonia

>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
1. N÷ preterm .N/ÿ infant of diabetic mother 1. /?/>>//>.ON/O/ // (/>.ON/O//ÿ> 60 /?Oÿ/>?) //?//>.O/?>
2. /?/>>//>.O/?>: flare nose, tachypnea (>60/min), grunting, retraction
2. /?/>>/N>.>.O 48 ?N/N///?//
3. /?.>ÿ>./?.?/.?.>: hypoaeration, ground glass appearance //?/
white out lung, reticula-nodular pattern, air bronchogram 3. /?///.>/?.?/?NNÿ>Nÿ?//?N.
4. /?>//?/>ÿ/.N/?N/ÿ/./>.O>N>/ÿ>/>N/? .N/ÿ />.?NNÿ/?>//?/>ÿ/. 4. /?>//?/>.>/>//?N.?NN//>>./
surfactant
5. />/?///N/?/N÷ hypoxia, hypercarbia, metabolic acidosis //?/ 5. />/?÷?.N.?N./>//ÿ>>/?O//.ÿO/>>/// Nÿ PROM, maternal infection
respiratory alkalosis /??NN>.>.//?ÿ/N//>?/ÿ>/ ?N÷ nosocomial pneumonia
/?N/ÿ/?///.>ÿ>./?.?/.?.? O/ÿ/>>?.N÷ neonatal respiratory distress
215 216
Neonatal Sepsis Prophylactic Antibiotics
>//>>?./>/ÿ/.Nÿÿ/N?O /?>/O////?/>/N.?N.ÿ/>/>N?O/.? Nÿ />/>/?>O?/N?Oÿ/N/>N/NO
1. /?/>>/>/>>Nÿ>Nÿ?.>/>>N?O/ON/?/ /?N?N./ÿ/? 3 />ÿ/N?O //.ÿ O.ÿO/ÿ.>>?/>N?N/÷/?>/>N?O/ //?/ prophylactic antibiotics
7 GI: >N/ÿ? ÿ//? .?// //?/ O/ÿ/N//?/
N/?N/ÿ//?/O>/?O//?/>N/ÿ/Nÿ/ neonatal sepsis
7 Respiratory: />.ON/O/ (60 /?Oÿ/>?) // //?//.>/>.O
>//>>?.//?: prophylactic antibiotics
7 CNS: >/ hypo/hyperthermia
>//>>?.//: singleton born in hospital
2. /?///>/ÿ/>?>>/ ?ÿ/N?O
7 WBC >15,000 //?/ <5,000 cells/mL //?/ band/nuetrophil >0.2
7 /?>/N>>N?O//N/?/ [N/ÿ?N÷ÿ/N>>>ON?O/]
3. /?>//?/>ÿ/..>>?/>>///N/?/?/.ÿ>ÿ/. 5 /? //?/N.?.?/> //?/.ÿÿ/
217 218
Pathologic Jaundice Pathologic Jaundice

>//>>?./>/ÿ/.Nÿÿ/N?O /?N÷ pathologic jaundice O/ÿ?>.>N/>/?ÿ>N÷>//>>>?.>/?O
1. N/ÿN//?/O/?O///
2. /// total bilirubin : G6PD deficiency [P58.8 + D55.0]
: Term >12 mg/dL : Preterm >15 mg/dL : ABO isoimmunization [P55.1]
>////?/?N/?ÿ> total bilirubin N/ÿN> 12 mg/dL />Nÿ/?>//?/>ÿ/. : Minor blood group incompatible [P55.8]
phototherapy N/ÿÿ/./>>//>>?. N..>/>/./>/?>/Nÿ
: Breast milk inhibitor [P59.3]
>///ÿ/?/?N/?ÿ> total bilirubin N/ÿN> 15 mg/dL />O.ÿ>>/>
O/ÿ>//?/>ÿ/. phototherapy //?/ blood exchange O/ÿ./>>//>>?.N÷ />N/ÿ.>/>//>>.>N/>?NOÿ/Nÿ >O/ÿ//?.N÷ P59.9
neonatal jaundice of prematurity
219 220
Shock
>//>>?./>/ÿ/.Nÿÿ/N?O
1. /?/>/?N//>N? ÿ/Oÿ//>Nÿ/N?O
7 Mean arterial pressure <60 mmHg
7 Ps <90 mmHg
7 Ps ///ÿ>N>/ 40 mmHg
2. /?/>>// poor tissue perfusion O//?./>ÿ>N Nÿ >/ N/?N/OO /?/Nÿ>N.O

/?/ONÿN/O/ />.ON/O/ ÷..>/>//ÿ/. capillary refill time .>/>O //?/ .>/>
metabolic acidosis
O/ÿ./>.>/>O/N÷>//>>?.// N?N/>.>/>O/N÷/>>/?N/>>/>//>O//N/Nÿ>?O
.N/ÿ//N/ÿ.>N/>/.>/>O/ Nÿ septic shock
221 222
Cardiogenic Shock Hypovolemic Shock

>//>>?./>/ÿ/.Nÿÿ/N?O >//>>?./>/ÿ/.Nÿÿ/N?O
1. /?/?/>>/>>/O/ (/?O./ÿ/) 1. /?/?/>>/>>/O/ (/?O./ÿ/)
2. /?//?>/N//?/O?NN÷ÿN/> N/ÿ/ÿ>>N÷N.?N//>ÿ//?/O />O/?/O /ÿ>/N?O//?/O 2. /?/>/?>/.>N/>?N?N Nÿ volume loss, blood loss, poor intake
/>N÷>/?/O
3. /?>//./ÿ/>//?/>ÿ/.>/O/ÿ.>/O?O/>/>O/>/>.>N//>?NN//>>./ Nÿ
3. />/? central venous pressure >15 cmH2O //?//?>//?>///N/?/? IVC O/ÿ.>/O? 2 />/ ON//>/>N>./?N/N/ [NO>>/> 15-20 ml/kg/hr]
4. />/? cardiac index <2.2 L/min/m2 O/> PCWP >18 mmHg 4. />/?/>>//>/>O? (dehydration)
5. />.?.?ÿ/. CVP <15 cmH2O
223 224
Septic Shock Specific Shock
>//>>?./>/ÿ/.Nÿÿ/N?O - Anaphylactic shock due to food [T78.0]
- Anaphylactic shock due to serum [T80.5]
1. /?/?/>>/>>/O/ (/?O./ÿ/) - Anaphylactic shock due to drug [T88.6]
2. /?/?/>>/>>/ SIRS //?/ sepsis - Anaphylactic shock [T78.2]
- Shock from anesthesia [T88.2]
3. /?>/O/ÿ.>>?/>O/>.>N//>?NN//>>.//.ÿ>ÿ/. 5-7 /?O/ÿ/?>O //?/N.?.?/> - Shock from/following abortion/ectopic pregnancy/molar pregnancy [O00-O07, O08.3]
- Electrical shock [T75.4]
- Ligtning shock [T75.0]
- Postoperative shock [T81.1]
- Psychic shock [F43.0]
- Traumatic shock [T79.4]
- Toxic shock syndrome [A48.3]
225 226
Coding of Trauma Coding of Trauma

//?.>//>>?.?O>/?O/ÿ>>./>.> O/>>/>/>NO //?.>//>>?.?O>/?O/ÿ>>./>.> O/>>/>/>NO
Head S00-S09 Superficial injury: abrasion, contusion, superficial foreign bodies, nonvenomous insect bite
Neck S10-S19 Open wound: animal bite, laceration, puncture wound, penetrating foreign bodies
Shoulder & Upper arm S40-S49
Thorax S20-S29 Fracture: closed fracture, open fracture
Elbow & Forearm S50-S59
Abdomen & Lower back S30-S39 Dislocation, Sprain/Strain of joint/ligament
Wrist & Hand S60-S69
Injury to nerves and spinal cord Injury to blood vessels
Hip &Thigh S70-S79 Injury to muscle and tendon Traumatic amputation

Multiple body regions T00-T07
Knee & Lower leg S80-S89 Injury to internal organ
Ankle & Foot S90-S99 Crushing injury Other and unspecified injuries
227 228
66 ,QMXULHVWRWKHHOERZDQGIRUHDUP 66 ,QMXULHVWRWKHHOERZDQGIRUHDUP
66 ,QMXULHVWRWKHZULVWDQGKDQG 66 ,QMXULHVWRWKHZULVWDQGKDQG
66 ,QMXULHVWRWKHKLSDQGWKLJK 66 ,QMXULHVWRWKHKLSDQGWKLJK
66 ,QMXULHVWRWKHNQHHDQGORZHUOHJ 66 ,QMXULHVWRWKHNQHHDQGORZHUOHJ
66 ,QMXULHVWRWKHDQNOHDQGIRRW 66 ,QMXULHVWRWKHDQNOHDQGIRRW
77 ,QMXULHVLQYROYLQJPXOWLSOHERG\UHJLRQV 77 ,QMXULHVLQYROYLQJPXOWLSOHERG\UHJLRQV
77
Nature of Injury
,QMXULHVWRXQVSHFLILHGSDUWVRIWUXQNOLPERUERG\UHJLRQ 77
Nature of Injury
,QMXULHVWRXQVSHFLILHGSDUWVRIWUXQNOLPERUERG\UHJLRQ
77 (IIHFWVRIIRUHLJQERG\HQWHULQJWKURXJKQDWXUDORULILFH 77 (IIHFWVRIIRUHLJQERG\HQWHULQJWKURXJKQDWXUDORULILFH
77 %XUQVDQGFRUURVLRQV 77 %XUQVDQGFRUURVLRQV
77 %XUQVDQGFRUURVLRQVRIH[WHUQDOERG\VXUIDFHVSHFLILHG 77 %XUQVDQGFRUURVLRQVRIH[WHUQDOERG\VXUIDFHVSHFLILHG
E\VLWH E\VLWH
77 %XUQVDQGFRUURVLRQVFRQILQHGWRH\HDQGLQWHUQDORUJDQV 77 %XUQVDQGFRUURVLRQVFRQILQHGWRH\HDQGLQWHUQDORUJDQV
77 %XUQVDQGFRUURVLRQVRIPXOWLSOHDQGXQVSHFLILHGERG\ 77 %XUQVDQGFRUURVLRQVRIPXOWLSOHDQGXQVSHFLILHGERG\
UHJLRQV UHJLRQV
77 )URVWELWH 77 )URVWELWH
77 3RLVRQLQJE\GUXJVPHGLFDPHQWVDQGELRORJLFDOVXEVWDQFHV 77 3RLVRQLQJE\GUXJVPHGLFDPHQWVDQGELRORJLFDOVXEVWDQFHV
77 7R[LFHIIHFWVRIVXEVWDQFHVFKLHIO\QRQPHGLFLQDODVWRVRXUFH 77 7R[LFHIIHFWVRIVXEVWDQFHVFKLHIO\QRQPHGLFLQDODVWRVRXUFH
77 2WKHUDQGXQVSHFLILHGHIIHFWVRIH[WHUQDOFDXVHV 77 2WKHUDQGXQVSHFLILHGHIIHFWVRIH[WHUQDOFDXVHV
YHUVLRQIRU 229 YHUVLRQIRU 230
Complications and Sequelae Summary for Injury

7 &HUWDLQHDUO\FRPSOLFDWLRQVRIWUDXPD
# N÷ Current injury //?/ Old injury
77 &RPSOLFDWLRQVRIVXUJLFDODQGPHGLFDOFDUHQRWHOVHZKHUH
FODVVLILHG # N÷>/>NO>O [type of injury]
77 6HTXHODHRILQMXULHVRISRLVRQLQJDQGRIRWKHUFRQVHTXHQFHVRI
H[WHUQDOFDXVHV
# N÷>/>NO?N.ÿ/O//ÿ>>. [body region]
7KHFKDSWHUXVHVWKH6VHFWLRQIRUFRGLQJGLIIHUHQWW\SHVRILQMXULHVUHODWHGWR # N÷>/>NO?N/?.>N/>N>>//?/N/ÿ [nature of injury]
VLQJOH ERG\ UHJLRQV DQG WKH 7VHFWLRQ WR FRYHU LQMXULHV WR PXOWLSOH RU # N÷>//>/>>/N?N/>>/>NO//?/N/ÿ [sequelae of injury]
XQVSHFLILHGERG\UHJLRQVDVZHOODVSRLVRQLQJDQGFHUWDLQRWKHUFRQVHTXHQFHV
RIH[WHUQDOFDXVHV
:KHUH PXOWLSOH VLWHV RI LQMXU\ DUH VSHFLILHG LQ WKH WLWOHV WKH ZRUG ZLWK ÿ//>>.>N/>.>./>/?O (.>?NN>N/> >////>//ÿ>N>N/>)
LQGLFDWHV LQYROYHPHQW RI ERWK VLWHV DQG WKH ZRUG DQG LQGLFDWHV
LQYROYHPHQWRIHLWKHURUERWKVLWHV
7KH SULQFLSOH RI PXOWLSOH FRGLQJ231
RI LQMXULHV VKRXOG EH IROORZHG ZKHUHYHU 232
SRVVLEOH &RPELQDWLRQ FDWHJRULHV IRU PXOWLSOH LQMXULHV DUH SURYLGHG IRU XVH
ZKHQWKHUHLVLQVXIILFLHQWGHWDLODVWRWKHQDWXUHRIWKHLQGLYLGXDOFRQGLWLRQV
RU IRU SULPDU\ WDEXODWLRQ SXUSRVHV ZKHQ LW LV PRUH FRQYHQLHQW WR UHFRUG D
Current Injury vs Old Injury Snake Bite / Insect Bite
# Current injury N÷/N.///>?>N/>?NN>>O.>.O 1 ÷ ¥ /?>/ [venomous bite]
# Old injury N÷/N.///>?>N/>?N>/ÿ> 1 ÷ [?N/ÿNÿ] >//>>?.//?: >/.?/ÿ/O///?>/
# Sequelae N÷/>/ÿ//>/>?>N/> N/ÿ??N//>?NN> >//>>?.//: />N>N/N>/ //>/?N/?/>//>O/O/>/?>/?O///?/Oÿ/?.>/O
>/?O//>>O
# Degeneration //?/ From overuse N/ÿ/?/>/?>/>?>N/>
¥ N/ÿ/?>/ [non-venomous bite]
>//>>?.//?: /?/>/?O/ÿ///.N/ [animal - laceration, insect -
abrasion
>//>>?.//: .>N/>>/>NO
233 234
Anaphylactic Shock / Anaphylaxis Poisoning / Adverse Effect

¥ O/ÿ/>>.>N/>?N?O/ÿN>/>>/ÿ/ ¥ Poisoning, Toxic effect, Intoxication, Overdose
- Anaphylactic shock due to medication: T88.6 - OÿN>>>?.?NO.ÿ
- Anaphylactic shock due to serum: T80.5 - Oÿ.>//?/.>/?N?/>/>N/ //?/N/ÿ/>O//ÿ?N/>
- Anaphylactic shock due to adverse food reaction T78.0 - Oÿ/ÿ//?O///.//ÿ
¥ /?N/ÿ/>>.>N/> O/ÿ//?.>//>>?.N÷ T78.2 - N/ÿNÿOÿN?N/>//?/> [/.>> ?/ÿ>.?/N/ ?/>.>]
¥ Adverse effect, Allergic reaction, Side effect, Cumulative toxicity, Interaction
- OÿN?N/>//?/>.>.Oÿ?.?NO.ÿ [> > O/>O//ÿ?N/>]
ÿ//>>?N/.>?N?O/ÿN>>///?//ÿ>N?.
235 236
7 6KRFNGXHWRDQDHVWKHVLD
6KRFNGXHWRDQDHVWKHVLDLQZKLFKWKHFRUUHFWVXEVWDQFHZDV
SURSHUO\DGPLQLVWHUHG
FRPSOLFDWLRQVRIDQDHVWKHVLD LQ
āIURPRYHUGRVHRUZURQJVXEVWDQFHJLYHQ 77
āODERXUDQGGHOLYHU\ 2
āSUHJQDQF\ 2
āSXHUSHULXP 2
SRVWRSHUDWLYHVKRFN126 7
Adverse Effect
7 0DOLJQDQWK\SHUWKHUPLDGXHWRDQDHVWKHVLD Adverse Effect of Anticoagulants
7 )DLOHGRUGLIILFXOWLQWXEDWLRQ
¥ ÿ//>>/>/>>?NN>>OO/>?N/.>?N?O/ÿN>/ÿ>N?. Nÿ ibuprofen-

7 2WKHUFRPSOLFDWLRQVRIDQDHVWKHVLD ¥ ?ÿ÷/.> anticoagulants >/?.?NO.ÿ /?N/?/?N>N//O/>// prolonged
+\SRWKHUPLDIROORZLQJDQDHVWKHVLD
induced gastritis, alloprunol-induced generalized drug reuption
7 $QDSK\ODFWLFVKRFNGXHWRDGYHUVHHIIHFWRIFRUUHFWGUXJRU
coagulogram O/ÿ./>>//>>?.N÷ Epistaxis due to anticoagulants [D68.3]
PHGLFDPHQWSURSHUO\DGPLQLVWHUHG
¥ />N/ÿ/>>/>/>>?NN> >ODQDSK\ODFWLFVKRFNGXHWRVHUXP
>Nÿ//?.>//>>?.N÷ 7
T88.7?O// ¥ ?ÿ÷/.> anticoagulants >/?.?NO.ÿ // prolonged coagulogram >
7 8QVSHFLILHGDGYHUVHHIIHFWRIGUXJRUPHGLFDPHQW /?N/ÿ.?N>/>>/O/>/?>.>O/ÿN//>>./ O/ÿ./>>//>>?.N÷ Coagulopathy
$GYHUVHHIIHFWRI
$OOHUJLFUHDFWLRQWR FRUUHFWGUXJRUPHGLFDPHQWSURSHUO\ due to anticoagulants [D68.4]
+\SHUVHQVLWLYLW\WR DGPLQLVWHUHG
,GLRV\QFUDF\WR ¥ ?ÿ÷/.> anticoagulants >/?.?NO.ÿ /?N/ÿ/N/.>>/ÿ/.÷/>/?N O/ÿ/ÿ>
'UXJ
āK\SHUVHQVLWLYLW\126 >/? prolonged coagulogram OÿN/ÿNÿ?O/N>N/N>/ [therapeutic range] N/ÿ?N÷
āUHDFWLRQ126
Excludes: VSHFLILHGDGYHUVHHIIHFWVRIGUXJVDQG
ÿ/./>N÷>//>>?. //?/./>>//>>?.N÷ Anticoagulants use [Z72.1]
PHGLFDPHQWV $5777
:+2¶V,&'
237 238
Wound Infection
¥ /?N÷>/>N?O//O/?NN>>>/>NON./ O/ÿ./>>//>>?.N÷
Post-traumatic wound infection [/.ÿ>/?/?>.>N/>.>./]
¥ /?N÷>/>N?O//O/?NN>N//>//? N/////N/?/ N/N>//> //?/
O/? O/ÿ./>>//>>?.N÷N/N>>N//ÿ>?O ??//.ÿ>ÿ/N?O
O Diabetes mellitus type 2 with peripheral artery disease [E11.5]
O Varicose veins with stasis ulcer [I83.2]
O Pyoderma [L08.0]
O Decubitus ulcer/Infected pressure sore [L89.-]
O Gangrene [R02]
239 240
Wound Infection Wound Infection
¥ /?N÷>/>N?O//O/?NN>//?/?>/ O/ÿ./>>//>>?.N÷N/N>>N//ÿ>?O ¥ /?>/>N?O/?NN>>>/>NO/?>//>/>/>?ON÷ Necrotizing fasciitis
??//.ÿ>ÿ/N?O //?/ Osteomyelitis O/ÿ./>>//>>?.N÷N/?N// N.N/ÿÿ/./> Post-
O Infected pin site [T84.6] traumatic wound infection N÷>//>>?.N>N/N>/
O Infected amputated stump [T87.4] ¥ /?/?>//>>?N/N?O/N/?NNÿ>>/N>>N?O/ .>/>/./>N÷>//>>?.//
O Infected traumatic wound [T79.3]
ÿ//>>.>N/>.>./>/?O (.>?NN>N/> >////>//ÿ>N>N/>)
241 242
,QIHFWLRQVRIWKHVNLQDQGVXEFXWDQHRXVWLVVXH
//
8VHDGGLWLRQDOFRGH %% LIGHVLUHGWRLGHQWLI\LQIHFWLRXVDJHQW
Excludes: KRUGHROXP +
Necrotizing Fasciitis
LQIHFWLYHGHUPDWLWLV /
ORFDOLQIHFWLRQVRIVNLQFODVVLILHGLQ&KDSWHU,VXFKDV
āHU\VLSHODV $ >//>>?./>/ÿ/.Nÿÿ/N?O
āHU\VLSHORLG $
āKHUSHVYLUDO>KHUSHVVLPSOH[@LQIHFWLRQ %
āDQRJHQLWDO $
1. /?>///.>./?/>>O//ÿ> //O >ÿ/O?.?O/O? (hemorrhagic bleb)
āPROOXVFXPFRQWDJLRVXP %
āP\FRVHV %%
>//?Nÿ>>. (necrotic skin) /ÿ//?/>>//
āSHGLFXORVLVDFDULDVLVDQGRWKHULQIHVWDWLRQV %%
āYLUDOZDUWV % 2. /?>//?/>ÿ/. excisional debridement ?N/??>.>N//O/>/?>/?NNÿ>
SDQQLFXOLWLV RI
ā126 0 Nÿ?/?>/?O //?/.ÿÿ/N/?/>?N/?N //?/>N.>//?/> //?/N.?.?/>
āOXSXV /
āQHFNDQGEDFN 0
āUHODSVLQJ>:HEHU&KULVWLDQ@ 0 3. /??>/>//>>?./ÿ> necrotizing fasciitis
SHUOqFKH GXHWR
ā126 . /??NN/ÿ/?//.N/?NNÿ>? necrotizing fasciitis .>/>/Oÿ////?N.?.>>//>>?.ONÿ Nÿ
āFDQGLGLDVLV %
āULERIODYLQGHILFLHQF\ (
ultrasound, CT scan //?/ MRI
S\RJHQLFJUDQXORPD /
]RVWHU % /??NN/ÿ/?>//?/>ÿ/. excisional debridement ?ÿ//./N//>N?.>/>>?.N÷ cellulitis

/ 6WDSK\ORFRFFDOVFDOGHGVNLQV\QGURPH
243 244
3HPSKLJXVQHRQDWRUXP
5LWWHU VGLVHDVH
WR[LFHSLGHUPDOQHFURO\VLV>/\HOO@ /

Excisional Debridement Excisional Debridement
5 Elements Complete Excisional Debridement Note
/?>//>/ÿ/.Nÿÿ/N?O
Complete documentation for excisions debridement requires Þve elements
1. /?/>./>N/?..>>..>/ÿ> /?N?O/>.?N?N÷ÿ/?N/>>// 1. Description of the procedure as ÒexcisionalÓ
N/ÿOÿ>/?>?N/N/ 2. Description of the instrument used to cut or excise the tissue (e.g.
scissors, scalpel, curette)
2. /?/>./>N/?.//?>//ÿ> /?>/?N/>>N?O/N.?N////> 3. Description of the tissue removed (e.g. necrotic, devitalised or non-viable)
N/ÿOÿ>/?>?N//?>/ 4. Appearance of the tissue removed (e.g. down to fresh bleeding tissue, 7 cm x 10
cm)
3. /??>/?>//ÿ> excisional debridement 5. Depth of the debridement (e.g. to skin, fascia, subcutaneous tissue, muscle or bone)
If any of these elements are missing, documentation does not meet the
/??NN/ÿ/?O.>/ÿ/ ?ÿ//./N//>N?.>/>>?.N÷ debridement criteria for excisional debridement.
245 246
Summary Procedure ICD-9-CM Summary Procedure ICD-9-CM

Debridement of skin and subcutaneous tissue 86.28 Debridement of [if suture or repair, not coding]
Excisional debridement of skin and subcutaneous tissue 86.22 abdominal wall 54.3
Debridement or Excisional debridement of brain 01.59
open fracture of bone [not skull] 79.6- cerebral meninges 01.51
infected bone [not skull] 77.6- fascia 83.44
open fracture of skull 02.02 flap 86.75
infected skull 01.25 nail, nail fold 86.27
muscle 83.45
muscle of hand 82.36
spinal meninges 03.4
tendon 83.39
247 248
Refer Back 2 Tactics for Safety to Audit
/?÷/>//?N÷ medical case Nÿ pneumonia />O/ÿ?.>>?/>ÿ/N?N/ ?>?/>>?.
O/ÿN//.>/>?/ÿ>/N÷>//>>?.//?
N/?N/>//>>?.?OOÿNÿ////>N./N>N/N>/
/?÷/>//?N÷ surgical case Hypomagnesemia, Anemia from acute blood, E.coli infection
ÿ>.ÿ/>?÷÷//?ÿ>? O/ÿ./>>//?/>N÷ convalescence of operation
ÿ>.ÿ/>N?N/>/?O/N>>N/?N/ O/ÿ./>>//?/>N÷ follow-up care of problem ?>/>>/ />>/O.
ÿ>.ÿ/>N?N/?O/.>/>O/ÿ/>>/ÿ>? O/ÿ./>>//?/>N÷÷/>?NN>>O
N/?N/>//>>?.?OOÿNÿ/////ÿ>>.
Drowsiness, Crepitation both lungs, Cold & moist skin, Necrosis of skin
249 250

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Diagnosis Related Group

InPatient Care Discharge Summary Coding DRG Reimbursement

Document Summary Code Quality

/>?>/?/>ÿ// ICD-10 ,,,

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48.50 Abdominoperineal resection of the rectum, not elsewhere specified

48.51 Laparoscopic abdominoperineal resection of the rectum

31.21 Mediastinal tracheostomy

31.29 Other permanent tracheostomy

Non-OR procedure for Diagnostic support /?>/?NN/ÿ?N÷ÿ/?>

Thai Diagnosis Related Group ÿ//?/?NOÿO>/?/ DRGs

Mean charge per DRG

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FRYHU 2.LQGG$OO3DJHV $0

O./>>//?/>.>>/ [Summary Discharge] O./>>//?/>.>>/ [Summary Discharge]

(1) PRINCIPAL DIAGNOSIS ? !?NON?0N1N?0/N!N@?O

1. COMPLETE RECOVERED 6. NORMAL CHILD DISCHARGE WITH MOTHER

1. WITH APPROVAL 5. OTHER

(3) COMPLICATION (S) (POST ADMISSION COMORBIDITY)

18 (2) PRE ADMISSION COMORBIDITY (S)

OTHER (S) OTHER (S)

22. DISCHARGE STATUS 23. DISCHARGE TYPE

>//>>?.//? [Principal Diagnosis, PDx] >//>>?.//? [Principal Diagnosis, PDx]

>//>>?.//? [Principal Diagnosis, PDx] >//>>?.//? [Principal Diagnosis, PDx]

>//>>?./?N [Other Diagnosis, ODx] .>N/>.>./ [External Cause, Ext]

//?>?N.?.>>/./>>//?/> [Document Supported] //?>?NN/ÿ.>/>/?/>.?.>>/./>>//?/>

SIRS [Systemic Inflammatory Response Syndrome] Sepsis, Septicemia

SIRS N÷/>ÿ//>>/?NN>>N/>N?O/O/>N/ÿOÿN/>N?O/ >N>/?.>N/>?N?N />/>>/.?/>>ÿ/??Nÿ/. NÿOÿ ?OO N>//>?N/>/N/ÿNÿ N/ON/?/>/

Septic Shock Septic Shock in SCG 2011 & 2017

2. /?/?/>>/>>/ Shock O />ย⋣ย⋣>/ว⟣น᧣ฉৣ.N.>///

- Poor tissue perfusion: conscious change, urine <0.5 ml/kg/hr or <400

PDx: Fever Acute pyelonephritis N10

ÒO/ล◤ตᗣN繉/Ó ตᗤ/Nปᯤ>/ว⟣น᧣ฉৣ./ล◣ Ò N繉/กǤ/N/Ó O/> ÒN繉/ONล◣/Ó ม⇣/ห⯣.幈Oตᗤ>กǣ

B96.2 Postsplenectomy status D73.0 Severe sepsis R65.1

Paracentesis 54.91 B-thalassemmia D56.1

Resistance to Antibiotics Resistance to Antibiotics

MDR = U83.7 multidrugs resistant

# Nม⇤ม⇣/>/ผ᳣ตᗣ/Nล◣/Oร⏤Oร⏤>>. : Oห⯤บ᫣ท៣N/ตᗣN繉/Nปᯤ>/ว⟣น᧣ฉৣ./ล◣ O/> ¥ epilepsy ( G40-G41 )

# Nม⇤ม⇣/>ว⟣ตᗣชૣN.Nม⇤ม⇣Nขˤร⏤//ดᓤ/./>กǤ/ : Oห⯤บ᫣ท៣ febrile convulsions Nปᯤ>/ว⟣น᧣ฉৣ.// R56.0 Febrile convulsions

PDx: Infections SDx Febrile convulsions R56.0

Non-Infectious Diarrhoea Antibiotic-Associated Diarrhoea

Acute Diarrhoea Chronic Diarrhoea

O ท៤/Nดᓣ幈Nกǣ>>/ร⏣/>N//>Nร⏤ NกǣNดᓤṉ>.ร⏣ส⫣ O ท៤/Nดᓣ幈Nกǣ>.>/>繈 Nช૤ OพỤ.>//>/>/ >/อⷣN.

Tabular List & Alphabetical Index

Mass, Tumor Malignant, Cancer

Malignant, Cancer Complication Associated With Carcinoma

Chemotherapy-Induced Febrile Neutropenia Radiotherapy

Men (>15 years old) 13.0 39

Woman, non-pregnant (15 years old) 12.0 36

Woman, pregnant 11.0 33

Teens (12-14 years old) 12.0 36

Children (5-11 years old) 11.5 34

Children (6-59 months old) 11.0 33

Anemia in Chronic Disease ?ÿ÷/.?N//N//ÿNÿ/N? .?>?> /?//.O??N>.N/ÿ>ÿ>. N/N/.ÿ//>/N//ÿ

Ext 幈//N/ร⏤NคӤ踳N/ V28.40

/>/ดᓣNน᧣>N/.

# N/.>>/ศ⣣ย⋤ (A) Nม⇤น᧤/.ว⟤> 1.6

ตᗣ//ย⋤> ปᯣ/>/> ^_`^N/.>>/ม⇣///// adjRW Nปᯤ # N/.>>/Ṉ/N>Nล◤ (M1) Nม⇤น᧤/.ว⟤> 1.0

83,234.4062 >>/Oห⯤ร⏣>/鹉ปᯤ/.O 41,702 />.

CMI = 83,234.4062 / 41,702 # N/.>>/ชૣ/ (F1-F3) Nม⇤น᧤/.ว⟤> 0.6 0.941 0.869

= 1.9959 # N/.>>/ชૣ/ (O) Nม⇤น᧤/.ว⟤> 1.2 0.0

/>?>/?/>ÿ// ICD-10 ,,,

>/Oÿ>//?. ICD-10 /?>/

Non-OR procedure for Diagnostic support /?>/?NN/ÿ?N÷ÿ/?>

Thai Diagnosis Related Group ÿ//?/?NOÿO>/?/ DRGs

//?>/./>N///? N//ÿ// O/>N//?NN ?/>/ÿ>/>

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'Ę+%1 < Đ ¡

FRYHU 2.LQGG$OO3DJHV $0

O./>>//?/>.>>/ [Summary Discharge] O./>>//?/>.>>/ [Summary Discharge]

(1) PRINCIPAL DIAGNOSIS ? !?NON?0N1N?0/N!N@?O

>//>>?.//? [Principal Diagnosis, PDx] >//>>?.//? [Principal Diagnosis, PDx]

>//>>?.//? [Principal Diagnosis, PDx] >//>>?.//? [Principal Diagnosis, PDx]

>//>>?./?N [Other Diagnosis, ODx] .>N/>.>./ [External Cause, Ext]

//?>?N.?.>>/./>>//?/> [Document Supported] //?>?NN/ÿ.>/>/?/>.?.>>/./>>//?/>

SIRS N÷/>ÿ//>>/?NN>>N/>N?O/O/>N/ÿOÿN/>N?O/ >N>/?.>N/>?N?N />/>>/.?/>>ÿ/??Nÿ/. NÿOÿ ?OO N>//>?N/>/N/ÿNÿ N/ON/?/>/

2. /?/?/>>/>>/ Shock O />ย⋣ย⋣>/ว⟣น᧣ฉৣ.N.>///

ÒO/ล◤ตᗣN繉/Ó ตᗤ/Nปᯤ>/ว⟣น᧣ฉৣ./ล◣ Ò N繉/กǤ/N/Ó O/> ÒN繉/ONล◣/Ó ม⇣/ห⯣.幈Oตᗤ>กǣ

# Nม⇤ม⇣/>/ผ᳣ตᗣ/Nล◣/Oร⏤Oร⏤>>. : Oห⯤บ᫣ท៣N/ตᗣN繉/Nปᯤ>/ว⟣น᧣ฉৣ./ล◣ O/> ¥ epilepsy ( G40-G41 )

# Nม⇤ม⇣/>ว⟣ตᗣชૣN.Nม⇤ม⇣Nขˤร⏤//ดᓤ/./>กǤ/ : Oห⯤บ᫣ท៣ febrile convulsions Nปᯤ>/ว⟣น᧣ฉৣ.// R56.0 Febrile convulsions

O ท៤/Nดᓣ幈Nกǣ>>/ร⏣/>N//>Nร⏤ NกǣNดᓤṉ>.ร⏣ส⫣ O ท៤/Nดᓣ幈Nกǣ>.>/>繈 Nช૤ OพỤ.>//>/>/ >/อⷣN.

Anemia in Chronic Disease ?ÿ÷/.?N//N//ÿNÿ/N? .?>?> /?//.O??N>.N/ÿ>ÿ>. N/N/.ÿ//>/N//ÿ

Ext 幈//N/ร⏤NคӤ踳N/ V28.40

ÿ//>>>/N>//>>/?O Diabetic arthropathy ( M14.2* )

Diabetic foot N/ÿOÿ?/>>?.?N?ÿ/ N/>>>?///?.N÷ E14.9

ON/>?> N/ÿÿ/./>>//>>?./ÿ> acidosis N/>>?//ÿ>N÷/>>//N///?/.>/>

: <5 ug/dL Oห⯤ว⟣น᧣ฉৣ.Nปᯤ adrenal insufficiency Nดᓤ

.>N/>?/ÿ>/N÷>//>>?. N.N/ÿÿ/./> cardiac arrest N÷>//>>?.

./>/>>?.N÷ sudden cardiac death

ล◣ดᓣ>/บ᫣ท៣ว⟣น᧣ฉৣ. N.//>幈N//>>./O>/O// [adequate sputum]

Mode of Delivery .>/>/?>N÷>//>>?.//?Nÿ N/?N/N/ÿ/?/???N 1 O/> 2

2. /?/>>// poor tissue perfusion O//?./>ÿ>N Nÿ >/ N/?N/OO /?/Nÿ>N.O

YHUVLRQIRU 229 YHUVLRQIRU 230

¥ ÿ//>>/>/>>?NN>>OO/>?N/.>?N?O/ÿN>/ÿ>N?. Nÿ ibuprofen-

ÿ//>>.>N/>.>./>/?O (.>?NN>N/> >////>//ÿ>N>N/>)