編號 全民健康保險醫療費用支付標準 第二部西醫 第ㄧ章基本診療 第ㄧ節門診診察費 診療項目 所 院 院 心 數 註 01015C 急診診察費 v v 478 修訂註 註 :1. 急診定義及適用範圍如附表 , 註 4 2. 本項支付點數含護理費 點 3. 夜間 ( 晚上十時至

Transcription

1 編號 全民健康保險醫療費用支付標準 第二部西醫 第ㄧ章基本診療 第ㄧ節門診診察費 診療項目 所 院 院 心 數 註 01015C 急診診察費 v v 478 修訂註 註 :1. 急診定義及適用範圍如附表 , 註 4 2. 本項支付點數含護理費 點 3. 夜間 ( 晚上十時至隔日早上六時 ) 加成 50% 例假日( 週六之中午十二時起 至週日二十四時止 國定假日零時至 二十四時 ) 加成 20%, 同時符合夜間 及例假日者, 則僅加成 50% 4. 山地離島及符合行政院衛生署公告之 緊急醫療資源不足地區急救責任醫院 加成 30%, 若同時符合夜間 例假日 者, 依表定點數加成 80% 5. 兒童加成項目 01021C 精神科急診診察費 v v v v 505 修訂註 註 :1. 精神科急診定義及範圍如附表 本項支付點數含護理費 點 3. 夜間 ( 晚上十時至隔日早上六時 ) 加成 50% 例假日( 週六之中午十二時起至週日二十四時止 國定假日零時至二十四時 ) 加成 20%, 同時符合夜間及例假日者, 則僅加成 50% 4. 山地離島及符合行政院衛生署公告之緊急醫療資源不足地區急救責任醫院加成 30%, 若同時符合夜間 例假日者, 依表定點數加成 80% 5. 兒童加成項目 3, 註 4 基 層 院 地 區 醫 區 域 醫 醫 學 中 支 付 點 備 1

2 第六節 調劑 通則 : 三 醫院牙科門診申報本節門診藥事服務費用, 應按調劑人員及處方類別, 限申報 05203C 05204D 05224C 05225D 05207C 05208D 05211C 及 05212D 等項, 惟 05219B 05220A 及 05221A 如符合相關規定, 亦得申報 ( 修訂通則 3) 編號診療項目 05219B 放射性藥品處方之藥事服務費 ( 天 ) 註 : 凡設置核子醫學部或核醫科, 使用放射性同位素 ( 如口服 I-131 以及其他身體各部位之檢查所需之放射線製劑均屬之 ), 且調劑藥師具有放射性物質操作執照, 於核醫科特殊配製環境內調配, 及申報全民健康保險醫療費用支付標準第二部第二章第一節第二十項核子醫學檢查一 造影 所列項目 ( 排除 26009B 甲狀腺刺激素詴驗 26049B 核子斷層檢查術 26074C 碘 -131 癌症追蹤檢查 - 施打 Thyrogen 三項 ) 時, 得申報本項 05221A 化學腫瘤藥品處方之藥事服務費 ( 天 ) 註 : 在層流工作檯內操作或調配之化學腫瘤藥品 係指所有細胞毒(cytoxic) 藥品針劑 非單一劑量包裝之口服細胞毒藥品及生物毒藥品類等 者得申報本項, 惟不包括藥廠製造之一般口服或外用化學腫瘤等, 無需在層流工作檯調配之成品製劑者 特約藥局 基層院所地醫自藥員區師調事調醫親劑人劑院 區域醫院 醫學中心 v v v v v 支付點數 備註 190 增列 註 307 增列 註 2

3 第二章特定診療 Specific Diagnosisand Treatment 第二節放射線診療 X-RAY 編號 診療項目 基層院所 地區醫院 區域醫院 醫學中心 支付點數 備 註 經皮冠狀動脈擴張術 修訂註 Percutaneous coronary dilatation 4 適應 33076B - 一條血管 one vessel v v v 症 33077B - 二條血管 two vessels v v v B - 三條血管 three vessels v v v 註 :1. 應有血管造影設備並報經保險人同意後實施 2. 包括選擇性血管造影 (Including selective angiography) 3. 包括材料費 4. 適應症如下 : (1) 心絞痛或其他冠狀動脈心臟病症狀經藥物 治療後效果不佳者 (2) 血管狹窄 70%( 含 ) 以上者 (3) 狹窄部份為血管近端 左前降枝 左迴旋枝 或右冠狀動脈 (4) 左冠狀動脈主幹狹窄 50%( 含 ) 以上者 (5) 血管經 PCI 後 Restenosis 超過 50%( 含 ) 者 5. 同次住院實施經皮冠狀動脈擴張術不論同時或分段做 診斷性心導管檢查, 僅能申報經皮冠狀動脈擴張術及一次心導管 (18020B 或 18021B), 而不得申報冠狀動脈造影 (18022B) 冠狀動脈血管內超音波 (18043B) 3

4 第四節復健治療 Rehabilitation Therapy 通則:一 本節各項治療費用限醫療機構開業執照診療科別登記設有復健科者申報 ; 未設復健科之醫療院所, 如具其他與復健相關之專科醫師與復健治療專業人員及設備並有能力實施者, 得向保險人提出申請, 經核可後依基層院所類別申報 二 第四項語言治療項目限聘有受過該類專業訓練之相關醫師之院所始可實施並申報費用 三 申報費用應同時詳細註明 治療內容代碼, 並附復健治療紀錄表 四 本節各復健項目除 (43010C~43025C 43033C~43038C) 及 (44501B~44503B) 外, 皆為兒童加成項目, 意指病人年齡未滿二歲所實施之診療項目點數, 依表定點數加計百分之三十 ; 年齡在二 ( 含 ) 歲至六歲者依表定點數加計百分之二十 ( 新增通則四 ) 4

5 第五節精神醫療治療費 Psychiatric Treatment Fee (45001 ~45102) 通則 : 一 除有特殊規定者外, 所訂支付點數均包括治療費及材料費在內 二 本節各精神醫療治療項目除 (45087C~45089C 45013C 45090C 45091C 45046C 45085B 45092B 45093B 45098C 45099C) 外, 皆為兒童加成項目, 意指病人年齡未滿二歲所實施之診療項目點數, 依表定點數加計百分之三十 ; 年齡在二 ( 含 ) 歲至六歲者依表定點數加計百分之二十 ( 新增通則二 ) 5

6 第六節治療處置 Therapeutic Treatment 編號 診療項目 基層院所 地區醫院 區域醫院 醫學中心 支付點數 備 註 深部複雜創傷處理 Debridement 修訂註 C - 傷口長 5 公分以下者 <5cm v v v v C - 傷口長 5-10 公分者 5-10cm v v v v C - 傷口長 10 公分以上者 10cm v v v v 3630 註 :1. 指創傷深及肌肉 神經 肌腱 骨膜時之處理 2. 含縫合 接紮 擴創處理 3. 申報費用時, 請註明處置日期和部位, 並附處置前後彩色照片或繪圖說明 4. 會陰部位擴創術按 48006C 申報 6

7 第七節手術 第五項循環器 Cardiovascular System 編號 一 心臟及心包膜 ( ) 診療項目 68035B 心臟植入 Heart implantation 註 : 施行診療項目 68034B 68035B 之規定如下 : 1. 施行手術之醫院及醫師條件如下 : (1) 醫院條件 : A. 須為 中華民國心臟醫學會 及 中華民國胸 腔及心臟血管外科學會 所認定之專科醫師訓 練醫院 B. 應有專任具臨床藥理 病理 移植免疫 感染 症及血液學專長之醫師 (2) 醫師條件 : 手術主持醫師須有主持開心手術五百例以上之經 驗 2. 適應症 : (1) 心臟衰竭且 Maximal VO2<10ml /kg/min 者 (2) 心臟衰竭達紐約心臟功能第四度, 且 Maximal VO2<14ml/kg/min 者 (3) 心臟衰竭核醫檢查 LVEF<20%, 經六個月以上藥物 ( 包括 ACE inhibitors, Digoxin. Diuretics 等 ) 治療 仍無法改善者如有重度二尖瓣閉鎖不全, 經核醫 檢查 LVEF<25% 者 (4) 嚴重心肌缺血, 核醫檢查 LVEF<20%, 經核醫心肌 灌注掃描及心導管等檢查, 證實無法以傳統冠狀 動脈繞道手術治療者 (5) 紐約心臟功能第四度, 持續使用 Dopamine 或 Dobutamine>5g/kg/min 七天以上, 經核醫檢查 LVEF<25% 或心臟指數 Cardiac index<2.0l/min/m 2 者 (6) 心臟衰竭已使用 ECMO VAD 等心臟輔助器且無 法斷離者 (7) 復發有症狀的心室性不整, 無法以公認有效的方 基層院所 地區醫院 區域醫院 醫學中心 支付點數 備註 v v v 文字 修正 7

8 基 地 區 醫 支 備註 編號 診療項目 層院 區醫 域醫 學中 付點 所 院 院 心 數 法治療者 (8) 其他末期心臟衰竭, 無法以傳統手術方法矯正者 3. 禁忌症 : (1) 年齡 65 歲以上 ( 年齡超過者需專案申請核准 ) (2) 有明顯感染者 (3) 愛滋病帶原者 (4) 肺結核經證實者 (5) 惡性腫瘤患者 (6) 心智不正常或無法長期配合藥物治療者 (7) 少年型或胰導素依賴型糖尿病患者 (8)ABO 血型與捐贈者不相容者 (9) 嚴重肺高血壓, 經治療仍大於 6 Wood Unit 者, 不 得做正位心臟移植 ( 異位心臟移植者不得大於 12 Wood Unit) (10) 肝硬化或 GPT 在正常兩倍以上, 且有凝血異常者 (11) 中度以上腎功能不全者 (Creatinine > 30mg/dl 或 Ccr<20ml/min)( 需同時故腎臟移植之末期腎衰竭 洗腎病人, 不在此限 ) (12) 嚴重的慢性阻塞性肺病患者 (FEVI<50% of predicted 或 FEVI/FVC<40% of predicted) (13) 活動性消化性潰瘍患者 (14) 嚴重的腻血管或周邊血管病變, 使日常生活無法 自理, 且無法接受重建手術者 (15) 免疫系統不全或其他全身性疾病, 雖經治療仍預 後不良者 (16) 藥癮患者 4. 需採行此一手術之病患 醫療院所皆應於事前提報保 險人, 由保險人邀集相關專家事先審查 5. 不得加計急診加成 6. 心臟捐贈者若為非保險對象, 其捐贈者摘取所需之檢 驗費 手術費 麻醉費 手術材料費由保險人給付, 而 ICU 費用及藥品費則僅給付施行摘取手術當日之費 用 8

9 編號 診療項目 68051B 心室輔助裝置植入 Ventricular Assist System implantation 註 : 1. 適應症 : (1) 心臟衰竭且 Maximal VO2<10ml /kg/min 者 (2) 心臟衰竭達紐約心臟功能第四度, 且 Maximal VO2<14ml/kg/min 者 (3) 心臟衰竭核醫檢查 LVEF<20%, 經六個月以上 藥物 ( 包括 ACE inhibitors, Digoxin. Diuretics 等 ) 治療仍無法改善者如有重度二尖瓣閉鎖不 全, 經核醫檢查 LVEF<25% 者 (4) 嚴重心肌缺血, 核醫檢查 LVEF<20%, 經核醫 心肌灌注掃描及心導管等檢查, 證實無法以傳 統冠狀動脈繞道手術治療者 (5) 紐約心臟功能第四度, 持續使用 Dopamine 或 Dobutamine>5g/kg/min 七天以上, 經核醫檢查 LVEF<25% 或心臟指數 Cardiac index<2.0l/min/m 2 者 (6) 心臟衰竭已使用 ECMO 等心臟輔助器且無法 斷離者 (7) 復發有症狀的心室性不整, 無法以公認有效的 方法治療者 (8) 其他末期心臟衰竭, 無法以傳統手術方法矯正 者 2. 需採行此一手術病患 醫療院所皆應事前專案向保險人申請 基層院所 地區醫院 區域醫院 醫學中心 支付點數 備註 v v v 文字 修正 9

10 第七項消化器 Digestive System 編號 十二 其他腹部手術 ( ) 診療項目 75813B 臍尿管或瘻管切除術與部分膀胱切除術 Excision of Urachal duct or fistula with partial cystectomy 基層院所 地區醫院 區域醫院 醫學中心 支付點數 備 註 v v v 9373 修訂英 文名稱 第十項神經外科 Neurosurgery ( ) 編號 診療項目 83079B 高頻熱凝療法 Radiofrequency coagulation 1. 申請人檢附資料應符合之要件 : (1) 病歷應記載清楚 詳實及病史完整 須有理學檢查 術前術後 Image-guided OP note 疼痛量表等相關資料, 以佐證實施之必要性 (2) 需為中重度 慢性疼痛且經藥物 復健治療等保守療法 3 個月後未改善 (3) 單一部位首次實施前需至少施行一次影像輔助診斷性阻斷 (image-guided diagnostic block),2 週後倘症狀未緩解, 才可施行 RF, 需檢附影像副本以資佐證 2. 適應症 : (1) 需為脊椎小關節症候群 (Facet Joint Syndrome) 引起的疼痛者 (2) 三叉神經痛 惡性腫瘤引起神經疼痛者 (3)Neuropathic pain, 如 postherpetic neuropathic pain 等 (4) 脊椎手術後疼痛症候群 (Failed Back Surgery Syndrome,FBSS) 慢性脊椎疼痛 (Chronic spinal pain) 後背根神經節 其他周邊神經痛等 3. 治療次數與限制 : (1) 同區域重複治療以間隔 6 個月以上為原則, 並應附施予高頻熱凝療法後之衛教紀錄與疼痛量表, 個案病情如需於 3-6 個月內同區域重複施行者, 應另檢附精神科醫師或心理治療師或疼痛科醫師之治療評估紀錄 (2) 一次施行一個區域, 共分五個區域 : 腰薦椎 胸椎 頸椎 頭部 周邊神經等五大部位 同一手術野內同時施行多點處置, 視為單一處置申報 基層院所 地區醫院 區域醫院 醫學中心 支付點數 備 註 v v v 5360 增列適 應症 10

11 第三部牙醫 附表 牙醫相對合理門診點數給付原則 一 實施範圍定義 : ( 一 ) 醫療費用 1. 申報之總醫療費用點數 ( 含部分負擔 ) 2. 下列項目費用, 不列入計算 : (1) 案件分類為 等專款專用之詴辦計畫項目 (2) 加成之點數 (3) 牙齒預防保健案件 ( 案件分類為 A3) ( 刪除兒童 ) (4) 支付標準適用地區以上醫院之表別 (A B 表 ) 項目 (5) 初診診察費差額 (370 點 ) (6) 感染控制診察費差額 (30 點 ) (7) 職災代辦案件 ( 案件分類為 B6) (8) 特殊治療項目代號為 G9 山地離島醫療給付效益計畫服務 (9) 山地離島診察費差額 (20 點 ) (10) 牙醫急診診察費差額 (248 點 ) 11

12 第九部 全民健康保險住院診斷關聯群 (Taiwan Diagnosis Related Groups,Tw-DRGs) 第一章 Tw-DRGs 支付通則一 名詞定義 ( 九 ) 前述各 DRG 之 RW 醫療服務點數上限臨界點 醫療服務點數下限臨界點 幾何平均住院日, 由保險人公告之 SPR 由保險人每年年底公告, 依前一年醫療服務點數計算之結果, 並於次年適用 六 各案件依全民健康保險住院診斷關聯群分類表認定 Tw-DRG 後, 依下列原則計算 Tw-DRG 支付點數 : ( 三 ) 實際醫療服務點數高於點數上限臨界點者, 計算方式如下 : 1. 年齡小於 18 歲之先天性疾病個案, 超過上限臨界點之實際醫療服務點數全數支付 先天性疾病個案係指主診斷為 740.XX~759.XX( 不包括 ) 非本項第 1 點個案, 按第 ( 二 ) 項原則計算之金額, 加上超過上限臨界點部分之 80% 支付, 即 Tw-DRG 支付定額 +( 實際醫療服務點數 - 醫療服務點數上限臨界點 )*80%; 實際醫療服點數高於點數上限臨界點, 且 TW-DRG 支付定額高於上限臨界點但低於實際醫療服務點數之個案, 上限臨界點以 TW-DRG 支付定額計算 ; 實際醫療服點數高於點數上限臨界點, 惟 TW-DRG 支付定額高於實際醫療服務點數之個案, 不得計算超過上限臨界點支付數 ( 六 ) 下列項目得另行核實申報不含於 DRG 支付點數, 其點數亦不得計入本通則六所稱實際醫療服務點數計算 1. 生產 DRG 之權重僅計算當次產婦及一人次新生兒費用, 新生兒如為雙胞胎以上得另計一人次新生兒費 ( 多胞胎類推 ) 2. 同次住院期間之安胎費用不併入生產相關 DRG, 俟所屬 MDC 導入時按其適當 DRG 申報及支付 12

13 3. 植入 IABP(Intra-aortic balloon pump, 主動脈內氣球幫浦 ) 之特殊材料 4. 次診斷為癌症及性態未明腫瘤之個案核實申報之化療 放療費用, 應符合下列三項要件 : (1) 次診斷為癌症 (140.XX-176.XX 179.XX-208.XX) 或性態未明腫瘤 (235.XX 236.XX 237.XX 238.XX) (2) 處置碼包括化療 (99.25) 或放療 (92.2X) (3) 核實申報項目 : 化療之核實申報項目為支付標準代碼為 37005B 37025B 37031B~37041B, 或個案使用之化療藥品 放療之核實申報項目為支付標準代碼為 36001B~36015B 36018B~36021C 37006B~37019B 37026B 37030B 5. 使用呼吸器之個案核實申報之呼吸器費用, 應符合下列二項要件 : (1) 處置碼包含使用呼吸器 (96.7X ) (2) 核實申報項目為支付標準代碼為 57001B 57002B 57023B) 6. 施行洗腎之個案核實申報之洗腎費用, 應符合下列二項要件 : (1) 處置碼包含洗腎 (39.95) (2) 核實申報項目為支付標準代碼為 58001C ( 八 ) 使用新增全新功能類別特殊材料之個案, 除依前述 ( 一 ) 至 ( 三 ) ( 六 ) 項計算 DRG 支付點數及另行核實申報點數外, 依 DRG 支付制度下新增全新功能類別特殊材料因應方案 ( 附表 9.4) 規定加計額外點數 13

14 八 各 MDC 導入時程如下 : 時程 DRG 或 MDC 第 1 年 (99 年 ) 164 項 DRG( 附表 ) 第 2 年 (100 年 ) ( 暫定 ) 第 3 年 (101 年 ) ( 暫定 ) 第 4 年 (102 年 ) ( 暫定 )PRE 第 5 年 (103 年 ) ( 暫定 )

15 附表 第 1 年導入之 164 項 DRG 項目表 MDC DRG MDC DRG MDC DRG MDC DRG MDC DRG MDC DRG

16 附表 9.1 TW-DRGs 分類表 PRE MDC HEART TRANSPLANT LIVER TRANSPLANT BONE MARROW TRANSPLANT TRACHEOSTOMY LUNG TRANSPLANT PANCREATIC TRANSPLANT DRG512 胰臟移植 PANCREATIC TRANSPLANT OPERATING ROOM PROCEDURES 5280 Pancreatic transplant, not otherwise specified 5281 Reimplantation of pancreatic tissue 5282 Homotransplant of pancreas 5283 Heterotransplant of pancreas MDC5 DRG10701 循環系統之疾病與疾患 DISEASES AND DISORDERS OF THE CIRCULATORY SYSTEM 多條血管冠狀動脈繞道手術, 伴有心導管 MULTIPLE VESSELS CORONARY BYPASS WITH CARDIAC CATHETERIZATION OPERATING ROOM PROCEDURES 3612 Aortocoronary bypass of two coronary arteries 3613 Aortocoronary bypass of threecoronary arteries 3614 Aortocoronary bypass of four or more coronary arteries 3616 Double internal mammary-coronary artery bypass OR OPERATING ROOM PROCEDURES 3611 Aortocoronary bypass of one coronary artery AND 3615 Single internal mammary-coronary artery bypass 3617 Abdominal-coronary artery bypass 3619 Other bypass anastomosis for heart revascularization AND NON-OPERATING ROOM PROCEDURES 3721 Right heart cardiac catheterization 3722 Left heart cardiac catheterization 16

17 3723 Combined right and left heart cardiac catheterization 8852 Angiocardiography of right heart structures 8853 Angiocardiography of left heart structures 8854 Combined right and left heart angiocardiography 8855 Coronary arteriography using a single catheter 8856 Coronary arteriography using two catheters 8857 Other and unspecified coronary arteriography 8858 Negative-contrast cardiac roentgenography DRG10901 多條血管冠狀動脈繞道手術, 無心導管 MULTIPLE VESSELS CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION OPERATING ROOM PROCEDURES 3612 Aortocoronary bypass of two coronary arteries 3613 Aortocoronary bypass of threecoronary arteries 3614 Aortocoronary bypass of four or more coronary arteries 3616 Double internal mammary-coronary artery bypass OR OPERATING ROOM PROCEDURES 3611 Aortocoronary bypass of one coronary artery AND 3615 Single internal mammary-coronary artery bypass 3617 Abdominal-coronary artery bypass 3619 Other bypass anastomosis for heart revascularization DRG11201 多條血管及其他經皮心臟血管手術 MULTIPLE VESSELS AND OTHRE PERCUTANEOUS CARDIOVASCULAR PROCEDURES OPERATING ROOM PROCEDURES 3596 Percutaneous valvuloplasty 3605 Multiple vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy performed during the same operation, with or without mention of thrombolytic agent 3609 Other removal of coronary artery obstruction OR OPERATING ROOM PROCEDURES 3601 Single vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy without mention of thrombolytic agent AND 17

18 3601 Single vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy without mention of thrombolytic agent DRG11203 經導管心臟病灶或組織剝除術 CATHETER ABLATION OF LESION OR TISSUES OPERATING ROOM PROCEDURES 3734 Catheter ablation of lesion or tissues of hear DRG11204 其他經皮心臟血管手術 OTHER PERCUTANEOUS CARDIOVASCULAR PROCEDURES NON-OPERATING ROOM PROCEDURES 3726 Cardiac electrophysiologic stimulation and recording studies 3727 Cardiac mapping MDC6 DRG16401 DRG16501 消化系統之疾病與疾患複雜診斷之腹腔鏡闌尾切除術, 有合併症或併發症 LAPAROSCOPIC APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC 複雜診斷之腹腔鏡闌尾切除術, 無合併症或併發症 LAPAROSCOPIC APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC PRINCIPAL DIAGNOSIS 5400 Acute appendicitis, with generalized peritonitis 5401 Acute appendictis, with peritoneal abscess AND OPERATING ROOM PROCEDURES 4701 Laparoscopic appendectomy DRG16402 DRG16502 複雜診斷之闌尾切除術, 有合併症或併發症 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC 複雜診斷之闌尾切除術, 無合併症或併發症 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC PRINCIPAL DIAGNOSIS 5400 Acute appendicitis, with generalized peritonitis 5401 Acute appendictis, with peritoneal abscess AND OPERATING ROOM PROCEDURES 4709 Other appendectomy 472 Drainage of appendiceal abscess 18

19 4799 Other operations on appendix DRG16601 DRG16701 單純性腹腔鏡闌尾切除術, 有合併症或併發症 LAPAROSCOPIC APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC 單純性腹腔鏡闌尾切除術, 無合併症或併發症 LAPAROSCOPIC APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC OPERATING ROOM PROCEDURES 4701 Laparoscopic appendectomy DRG16602 DRG16702 單純性闌尾切除術, 有合併症或併發症 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC 單純性闌尾切除術, 無合併症或併發症 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC OPERATING ROOM PROCEDURES 4709 Other appendectomy 472 Drainage of appendiceal abscess 4799 Other operations on appendix MDC7 DRG191 DRG192 肝 膽系統或胰臟之疾病與疾患 DISEASES AND DISORDERS OF THE HEPATOBILIARY SYSTEM AND PANCREAS 胰 肝及其吻合性手術, 有合併症或併發症 PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC 胰 肝及其吻合性手術, 無合併症或併發症 PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC OPERATING ROOM PROCEDURES 391 Intra-abdominal venous shunt 500 Hepatotomy 5021 Marsupialization of lesion of liver 5022 Partial hepatectomy 5029 Other destruction of lesion of liver 503 Lobectomy of liver 504 Total hepatectomy 5061 Closure of laceration of liver 5069 Other repair of liver 5143 Insertion of choledochohepatic tube for decompression 19

20 5182 Pancreatic sphincterotomy 5183 Pancreatic sphincteroplasty 5201 Drainage of pancreatic cyst by catheter 5209 Other pancreatotomy 5222 Other excision or destruction of lesion or tissue of pancreas or pancreatic duct 523 Marsupialization of pancreatic cyst 524 Internal drainage of pancreatic cyst 5251 Proximal pancreatectomy 5252 Distal pancreatectomy 5253 Radical subtotal pancreatectomy 5259 Other partial pancreatectomy 526 Total pancreatectomy 527 Radical pancreaticoduodenectomy 5292 Cannulation of pancreatic duct 5295 Other repair of pancreas 5296 Anastomosis of pancreas 5299 Other operations on pancreas 5494 Creation of peritoneovascular shunt DRG49301 DRG49401 腹腔鏡膽囊切除術, 有內視鏡手術, 無總膽管探查, 有合併症或併發症 LAPAROSCOPIC CHOLECYSTECTOMY, WITH ENDOSCOPIC OPERATIONS, WITHOUT COMMON DUCT EXPLORATION WITH CC 腹腔鏡膽囊切除術, 有內視鏡手術, 無總膽管探查, 無合併症或併發症 LAPAROSCOPIC CHOLECYSTECTOMY, WITH ENDOSCOPIC OPERATIONS, WITHOUT COMMON DUCT EXPLORATION WITHOUT CC OPERATING ROOM PROCEDURES 5123 Laparoscopic cholecystectomy WITH OPERATING ROOM PROCEDURES 5184 Endoscopic dilation of ampulla and biliary duct 5185 Endoscopic sphincterotomy and papillotomy 5186 Endoscopic insertion of nasobiliary drainage tube 5187 Endoscopic insertion of stent(tube) into bile duct 5188 Endoscopic removal of stone(s) from biliary tract DRG49302 腹腔鏡膽囊切除術, 無內視鏡手術, 無總膽管探查, 有合併症或併發症 20

21 DRG49402 LAPAROSCOPIC CHOLECYSTECTOMY, WITHOUT ENDOSCOPIC OPERATIONS, WITHOUT COMMON DUCT EXPLORATION WITH CC 腹腔鏡膽囊切除術, 無內視鏡手術, 無總膽管探查, 無合併症或併發症 LAPAROSCOPIC CHOLECYSTECTOMY, WITHOUT ENDOSCOPIC OPERATIONS, WITHOUT COMMON DUCT EXPLORATION WITHOUT CC OPERATING ROOM PROCEDURES 5123 Laparoscopic cholecystectomy 5124 Laparoscopic partial cholecystectomy MDC8 DRG21002 DRG21102 DRG21203 DRG21204 骨骼 肌肉系統及結締組織之疾病與疾患 DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 主或次診斷為感染之髖及股骨手術, 下肢關節除外, 年齡大於等於 18 歲, 有合併症或併發 症 HIP AND FEMUR PROCEDURES WITH PDX OR SDX OF INFECTION, EXCEPT MAJOR JOINT,AGE 18 WITH CC 主或次診斷為感染之髖及股骨手術, 下肢關節除外, 年齡大於等於 18 歲, 無合併症或併發 症 HIP AND FEMUR PROCEDURES WITH PDX OR SDX OF INFECTION, EXCEPT MAJOR JOINT,AGE 18 WITHOUT CC 主或次診斷為感染之髖及股骨手術, 下肢關節除外, 年齡 0-17 歲, 有合併症或併發症 HIP AND FEMUR PROCEDURES WITH PDX OR SDX OF INFECTION, EXCEPT MAJOR JOINT, AGE 0-17 WITH CC 主或次診斷為感染之髖及股骨手術, 下肢關節除外, 年齡 0-17 歲, 無合併症或併發症 HIP AND FEMUR PROCEDURES WITH PDX OR SDX OF INFECTION, EXCEPT MAJOR JOINT,AGE 0-17 WITHOUT CC PRINCIPAL OR SECONDARY DIAGNOSIS Acute osteomyelitis shoulder region Acute osteomyelitis upper arm Acute osteomyelitis forearm Acute osteomyelitis hand Acute osteomyelitis pelvic region and thigh Acute osteomyelitis lower leg Acute osteomyelitis ankle and foot Acute osteomyelitis other specified sites Acute osteomyelitis multiple sites Chronic osteomyelitis unspecified site Chronic osteomyelitis shoulder region Chronic osteomyelitis upper arm 21

22 73013 Chronic osteomyelitis forearm Chronic osteomyelitis hand Chronic osteomyelitis pelvic region and thigh Chronic osteomyelitis lower leg Chronic osteomyelitis ankle and foot Chronic osteomyelitis other specified sites Chronic osteomyelitis multiple sites Unspecified osteomyelitis unspecified site Unspecified osteomyelitis shoulder region Unspecified osteomyelitis upper arm Unspecified osteomyelitis forearm Unspecified osteomyelitis hand Unspecified osteomyelitis pelvic region and thigh Unspecified osteomyelitis lower leg Unspecified osteomyelitis ankle and foot Unspecified osteomyelitis other specified sites Unspecified osteomyelitis multiple sites Malunion of fracture Nonunion of fracture Unequal leg length (acquired) 9964 Mechanical complication of internal orthopedic device implant and graft Infection and inflammatory reaction due to internal joint prosthesis Infection and inflammatory reaction due to other internal orthopedic device implant and graft Other complications due to internal joint prosthesis Other complications due to other internal orthopedic device implant and graft Complications of reattached unspecified extremity Complications of reattached forearm Complications of reattached hand Complications of reattached finger(s) Complications of reattached upper extremity other and unspecified Complications of reattached foot and toe(s) Complications of reattached lower extremity other and unspecified Complications of reattached other specified body part AND OPERATING ROOM PROCEDURES 7705 Sequestrectomy, femur 7725 Wedge osteotomy, femur 7735 Other division of bone, femur 22

23 7785 Other partial ostectomy, femur 7795 Total ostectomy, femur 7805 Bone graft, femur 7815 Application of external fixation device, femur 7825 Limb shortening procedures, femur 7835 Limb lengthening procedures, femur 7845 Other repair or plastic operations on bone, femur 7855 Internal fixation of bone without fracture reduction, femur 7875 Osteoclasis, femur 7895 Insertion of bone growth stimulator, femur 7915 Closed reduction of fracture with internal fixation, femur 7925 Open reduction of fracture without internal fixation, femur 7935 Open reduction of fracture with internal fixation, femur 7945 Closed reduction of separated epiphysis, femur 7955 Open reduction of separated epiphysis, femur 7965 Debridement of open fracture site, femur 7985 Open reduction of dislocation of hip 7995 Unspecified operation on bone injury, femur 8005 Arthrotomy for removal of prosthesis, hip 8015 Other arthrotomy, hip 8045 Division of joint capsule, ligament, or cartilage, hip 8075 Synovectomy, hip 8095 Other excision of joint, hip 8121 Arthrodesis of hip 8140 Repair of hip, not elsewhere classified 8312 Adductor tenotomy of hip DRG21003 閉鎖性骨折及其他骨骼肌肉系統及結締組織之疾病與疾患, 髖及股骨手術, 下肢關節除 外, 年齡大於等於 18 歲, 有合併症或併發症 CLOSE FRACTURE AND OTHER DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE, HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT,AGE 18 WITH CC DRG21103 閉鎖性骨折及其他骨骼肌肉系統及結締組織之疾病與疾患, 髖及股骨手術, 下肢關節除 外, 年齡大於等於 18 歲, 無合併症或併發症 CLOSE FRACTURE AND OTHER DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE, HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT,AGE 18 WITHOUT CC 23

24 DRG21205 DRG21206 閉鎖性骨折及其他骨骼肌肉系統及結締組織之疾病與疾患, 髖及股骨手術, 下肢關節除外, 年齡 0-17 歲, 有合併症或併發症 CLOSE FRACTURE AND OTHER DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT, AGE 0-17 WITH CC 閉鎖性骨折及其他骨骼肌肉系統及結締組織之疾病與疾患, 髖及股骨手術, 下肢關節除外, 年齡 0-17 歲, 無合併症或併發症 CLOSE FRACTURE AND OTHER DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT,AGE 0-17 WITHOUT CC PRINCIPAL DIAGNOSIS OF CLOSE FRACTUERE( 如附表 ) OR OTHER DISEASES AND DISORDERS OF THE MUSCULOSKELETAL AND OPERATING ROOM PROCEDURES 7705 Sequestrectomy, femur 7725 Wedge osteotomy, femur 7735 Other division of bone, femur 7785 Other partial ostectomy, femur 7795 Total ostectomy, femur 7805 Bone graft, femur 7815 Application of external fixation device, femur 7825 Limb shortening procedures, femur 7835 Limb lengthening procedures, femur 7845 Other repair or plastic operations on bone, femur 7855 Internal fixation of bone without fracture reduction, femur 7875 Osteoclasis, femur 7895 Insertion of bone growth stimulator, femur 7915 Closed reduction of fracture with internal fixation, femur 7925 Open reduction of fracture without internal fixation, femur 7935 Open reduction of fracture with internal fixation, femur 7945 Closed reduction of separated epiphysis, femur 7955 Open reduction of separated epiphysis, femur 7965 Debridement of open fracture site, femur 7985 Open reduction of dislocation of hip 7995 Unspecified operation on bone injury, femur 8005 Arthrotomy for removal of prosthesis, hip 8015 Other arthrotomy, hip 8045 Division of joint capsule, ligament, or cartilage, hip 8075 Synovectomy, hip 24

25 8095 Other excision of joint, hip 8121 Arthrodesis of hip 8140 Repair of hip, not elsewhere classified 8312 Adductor tenotomy of hip MDC10 DRG292 DRG293 內分泌 營養及新陳代謝之疾病與疾患 其他內分泌 營養及新陳代謝手術, 有合併症或併發症 OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC OPERATING ROOM. PROCEDURES WITH CC 其他內分泌 營養及新陳代謝手術, 無合併症或併發症 OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC OPERATING ROOM. PROCEDURES WITHOUT CC OPERATING ROOM PROCEDURES 0115 Biopsy of skull 0716 Biopsy of thymus 0780 Thymectomy, not otherwise specified 0781 Partial excision of thymus 0782 Total excision of thymus 0791 Exploration of thymus field 0792 Incision of thymus 0793 Repair of thymus 0794 Transplantation of thymus 0799 Other operations on thymus 0820 Removal of lesion of eyelid, not otherwise specified 0838 Correction of lid retraction 0870 Reconstruction of eyelid, not otherwise specified 1264 Trabeculectomy ab externo 1272 Cyclocryotherapy 1279 Other glaucoma procedures 1311 Intracapsular extraction of lens by temporal inferior route 1319 Other intracapsular extraction of lens 1359 Other extracapsular extraction of lens 1449 Other scleral buckling 1454 Repair of retinal detachment with laser photocoagulation 146 Removal of surgically implanted material from posterior segment of eye 1472 Other removal of vitreous 1474 Other mechanical vitrectomy 1699 Other operations on eyeball 25

26 3426 Open biopsy of mediastinum 343 Excision or destruction of lesion or tissue of mediastinum 344 Excision or destruction of lesion of chest wall 3800 Incision of vessel, unspecified site 3802 Incision of vessel, other vessels of head and neck 3803 Incision of vessel, upper limb vessels 3808 Incision of vessel, lower limb arteries 3812 Endarterectomy, other vessels of head and neck 3813 Endarterectomy, upper limb vessels 3818 Endarterectomy, lower limb arteries 3821 Biopsy of blood vessel 3829 Other diagnostic procedures on blood vessels 3830 Resection of vessel with anastomosis, unspecified site 3833 Resection of vessel with anastomosis, upper limb vessels 3838 Resection of vessel with anastomosis, lower limb arteries 3843 Resection of vessel with replacement, upper limb vessels 3848 Resection of vessel with replacement, lower limb arteries 3855 Ligation and stripping of varicose veins, other thoracic vessels 3860 Other excision of vessels, unspecified site 3863 Other excision of vessels, upper limb vessels 3868 Other excision of vessels, lower limb arteries 3883 Other surgical occlusion of vessels, upper limb vessels 3888 Other surgical occlusion of vessels, lower limb arteries 3925 Aorta-iliac-femoral bypass 3927 Arteriovenostomy for renal dialysis 3929 Other (peripheral) vascular shunt or bypass 3931 Suture of artery 3941 Control of hemorrhage following vascular surgery 3942 Revision of arteriovenous shunt for renal dialysis 3949 Other revision of vascular procedure 3950 Angioplasty or atherectomy of non-coronary vessel 3956 Repair of blood vessel with tissue patch graft 3957 Repair of blood vessel with synthetic patch graft 3958 Repair of blood vessel with unspecified type of patch graft 3959 Other repair of vessel 3991 Freeing of vessel 3993 Insertion of vessel-to-vessel cannula 3998 Control of hemorrhage, not otherwise specified 4011 Biopsy of lymphatic structure 26

27 4019 Other diagnostic procedures on lymphatic structures 4021 Excision of deep cervical lymph node 4029 Simple excision of other lymphatic structure 403 Regional lymph node excision 4040 Radical neck dissection, not otherwise specified 4041 Radical neck dissection, unilateral 4042 Radical neck dissection, bilateral 4052 Radical excision of periaortic lymph nodes 4053 Radical excision of iliac lymph nodes 430 Gastrotomy 4342 Local excision of other lesion or tissue of stomach 437 Partial gastrectomy with anastomosis to jejunum 4492 Intraoperative manipulation of stomach 4541 Excision of lesion or tissue of large intestine 4562 Other partial resection of small intestine 4575 Left hemicolectomy 4593 Other small-to-large intestinal anastomosis 4594 Large-to-large intestinal anastomosis 5012 Open biopsy of liver 5212 Open biopsy of pancreas 5219 Other diagnostic procedures on pancreas 5222 Other excision or destruction of lesion or tissue of pancreas or pancreatic duct 5251 Proximal pancreatectomy 5252 Distal pancreatectomy 5253 Radical subtotal pancreatectomy 5259 Other partial pancreatectomy 5411 Exploratory laparotomy 543 Excision or destruction of lesion or tissue of abdominal wall or umbilicus 544 Excision or destruction of peritoneal tissue 627 Insertion of testicular prosthesis 6522 Wedge resection of ovary 6524 Laparoscopic wedge resection of ovary 7727 Wedge osteotomy, tibia and fibula 7738 Other division of bone, tarsals and metatarsals 7740 Biopsy of bone, unspecified site 7741 Biopsy of bone, scapula, clavicle, and thorax [ribs and sternum] 7742 Biopsy of bone, humerus 7743 Biopsy of bone, radius and ulna 7744 Biopsy of bone, carpals and metacarpals 27

28 7745 Biopsy of bone, femur 7746 Biopsy of bone, patella 7747 Biopsy of bone, tibia and fibula 7748 Biopsy of bone, tarsals and metatarsals 7749 Biopsy of bone, other site 7761 Local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] 7768 Local excision of lesion or tissue of bone, tarsals and metatarsals 7769 Local excision of lesion or tissue of bone, other site 7788 Other partial ostectomy, tarsals and metatarsals 7789 Other partial ostectomy, other site 7865 Removal of internal fixation device, femur 7935 Open reduction of fracture with internal fixation, femur 8010 Other arthrotomy, unspecified site 8012 Other arthrotomy, elbow 8016 Other arthrotomy, knee 8026 Arthroscopy, knee 806 Excision of semilunar cartilage of knee 8082 Other local excision or destruction of lesion of joint, elbow 8088 Other local excision or destruction of lesion of joint, foot and toe 8098 Other excision of joint, foot and toe 8111 Ankle fusion 8123 Arthrodesis of shoulder 8152 Partial hip replacement 8153 Revision of hip replacement 8221 Excision of lesion of tendon sheath of hand 8233 Other tenonectomy of hand 8313 Other tenotomy 8331 Excision of lesion of tendon sheath 8339 Excision of lesion of other soft tissue 8365 Other suture of muscle or fascia 8375 Tendon transfer or transplantation 8379 Other muscle transposition 8512 Open biopsy of breast 8521 Local excision of lesion of breast 8606 Insertion of totally implantable infusion pump 9227 Implantation or insertion of radioactive elements OR NON-OPERATING ROOM PROCEDURES 28

29 9230 Stereotactic radiosurgery, not otherwise specified 9231 Single source photon radiosugery 9232 Multi-source photon radiosugery 9233 Particulate radiosugery 9239 Stereotactic radiosurgery, not elsewhere classified MDC13 DRG35805 DRG35905 女性生殖系統之疾病與疾患 DISEASES AND DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM 其他腹腔鏡子宮及其附屬器官手術, 有合併症或併發症 OTHER LAPAROSCOPIC PROCEDURES FOR UTERINE AND ADNEXA WITH CC 其他腹腔鏡子宮及其附屬器官手術, 無合併症或併發症 OTHER LAPAROSCOPIC PROCEDURES FOR UTERINE AND ADNEXA WITHOUT CC PRINCIPAL DIAGNOSIS Tuberculous oophoritis and salpingitis, unspecified Tuberculous oophoritis and salpingitis, bacteriological or histological examination not done Tuberculosis oophoritis and salpingitis, bacteriological or histological examination unknown(at present) Tuberculosis oophoritis and salpingitis, tubercle bacilli found (in sputum) by microscopy Tuberculosis oophoritis and salpingitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture Tuberculosis oophoritis and salpingitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically Tuberculosis oophoritis and salpingitis, tubercle bacilli not found by bacteriological or histological examination but tuberculosis confirmed by other methods inoculation of animals Tuberculosis of other female genital organs, unspecified Tuberculosis of other female genital organs, bacteriological or histological examination not done Tuberculosis of other female genital organs, bacteriological or histological examination unknown (at present) Tuberculosis of other female genital organs, tubercle bacilli found (in sputum )by microscopy Tuberculosis of other female genital organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically 29

30 01676 Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological or histological examination but tuberculosis confirmed by other methods inoculation of animals Genital herpes, unspecified Herpetic vulvovaginitis Herpetic ulceration of vulva Other genital herpes 0910 Genital syphilis (primary) 0980 Acute gonococcal infections of lower genitourinary tract Acute gonococcal infections of upper genitourinary tract, site unspecified Gonococcal cervicitis (acute) Gonococcal endometritis (acute) Gonococcal salpingitis, specified as acute Other gonococcal infections (acute) of upper genitourinary tract 0982 Chronic gonococcal infection of lower genitourinary tract Gonococcal cervicitis, chronic Gonococcal endometritis, chronic Gonococcal salpingitis, chronic Other gonococcal infection of upper genitourinary tract, chronic 0990 Chancroid 0991 Lymphogranuloma venereum 0992 Granuloma inguinale Other unspecified nongonococcal urethritis Chlamydia trachomatic nongonococcal urethritis Other specified organism nongonococcal urethritis Other venereal disease due to Chlamydia trachomatis, unspecified site Lower genitourinary sites venereal disease due to Chlamydia trachomatis Unspecified genitourinary site venereal disease due to Chlamydia trachomatis Other specified site venereal disease due to Chlamydia trachomatis 0998 Other specified venereal diseases 0999 Venereal disease, unspecified 1121 Candidiasis of vulva and vagina 1122 Candidiasis of other urogenital sites Urogenital trichomoniasis, unspecified Trichomonal vulvovaginitis Trichomonal urethritis Other urogenital trichomoniasis 2180 Submucous leiomyoma of uterus 2181 Intramural leiomyoma of uterus 30

31 2182 Subserous leiomyoma of uterus 2189 Leiomyoma of uterus, unspecified 2190 Benign neoplasm of cervix uteri 2191 Benign neoplasm of corpus uteri 2198 Benign neoplasm of other specified parts of uterus 2199 Benign neoplasm of uterus, part unspecified 220 Benign neoplasm of ovary 2210 Benign neoplasm of fallopian tube and uterine ligaments 2211 Benign neoplasm of vagina 2212 Benign neoplasm of vulva 2218 Benign neoplasm f other specified sites of female genital organs 2219 Benign neoplasm of female genital organ, site unspecified 2331 Carcinoma in situ of cervix uteri 2332 Carcinoma in situ of other and unspecified parts of uterus 2333 Carcinoma in situ of other and unspecified female genital organs 2560 Hyperestrogenism 2561 Other ovarian hyperfunction 2562 Postablative ovarian failure 2563 Other ovarian failure 2564 Polycystic ovaries 2568 Other ovarian dysfunction 2569 Unspecified ovarian dysfunction Psychogenic vaginismus Psychogenic dysmenorrhea 4565 Pelvic varices 4566 Vulval varices 6140 Acute salpingitis and oophoritis 6141 Chronic salpingitis and oophoritis 6142 Salpingitis and oophoritis, not specified as acute, subacute or chronic 6143 Acute parametritis and pelvic cellulitis 6144 Chronic or unspecified parametritis and pelvic cellulitis 6145 Acute or unspecified pelvic peritonitis, female 6146 Pelvic peritoneal adhesions, female(postoperative)(postinfection) 6147 Other chronic pelvic peritonitis, female 6148 Other specified inflammatory disease of female pelvic organs and tissues 6149 Unspecified inflammatory disease of female pelvic organs and tissues 6150 Acute inflammatory diseases of uterus, except cervix 6151 Chronic inflammatory diseases of uterus, except cervix 6159 Unspecified inflammatory disease of uterus 31

32 6160 Cervicitis and endocervicitis Vaginitis and vulvovaginitis, unspecified 6162 Cyst of bartholin's gland 6163 Abscess of bartholin's gland 6164 Other abscess of vulva Ulceration of vulva, unspecified 6168 Other specified inflammatory diseases of cervix, vagina, and vulva 6169 Unspecified inflammatory disease of cervix, vagina, and vulva 6170 Endometriosis of uterus 6171 Endometriosis of ovary 6172 Endometriosis of fallopian tube 6173 Endometriosis of pelvic peritoneum 6174 Endometriosis of rectovaginal septum and vagina 6178 Endometriosis of other specified sites 6179 Endometriosis, site unspecified 6180 Prolapse of vaginal walls, without mention of uterine prolapse 6181 Uterine prolapse without mention of vaginal wall prolapse 6182 Uterovaginal prolapse, incomplete 6183 Uterovaginal prolapse, complete 6184 Uterovaginal prolapse, unspecified 6185 Prolapse of vaginal vault after hysterectomy 6186 Vaginal enterocele, congenital or acquired 6187 Old laceration of muscles of pelvic floor 6188 Other specified genital prolapse 6189 Unspecified genital prolapse 6190 Urinary-genital tract fistula, female 6192 Genital tract-skin fistula, female 6198 Other specified fistulas involving female genital tract 6199 Unspecified fistula involving female genital tract 6200 Follicular cyst of ovary 6201 Corpus luteum cyst or hematoma 6202 Other and unspecified ovarian cyst 6203 Acquired atrophy of ovary and fallopian tube 6204 Prolapse or hernia of ovary and fallopian tube 6205 Torsion of ovary, ovarian pedicle or fallopian tube 6206 Broad ligament laceration syndrome 6207 Hematoma of broad ligament 6208 Other noninflammatory disorders of ovary, fallopian tube, and broad ligament 6209 Unspecified noninflammatory disorder of ovary, fallopian tube, and broad 32

33 ligament 6210 Polyp of corpus uteri 6211 Chronic subinvolution of uterus 6212 Hypertrophy of uterus 6213 Endometrial cystic hyperplasia 6214 Hematometra 6215 Intrauterine synechiae 6216 Malposition of uterus 6217 Chronic inversion of uterus 6218 Other specified disorders of uterus, not elsewhere classified 6219 Unspecified disorders of uterus 6220 Erosion and ectropion of cervix 6221 Dysplasia of cervix (uteri) 6222 Leukoplakia of cervix (uteri) 6223 Old laceration of cervix 6224 Stricture and stenosis of cervix 6225 Incompetence of cervix 6226 Hypertrophic elongation of cervix 6227 Mucous polyp of cervix 6228 Other specified noninflammatory disorders of cervix 6229 Unspecified noninflammatory disorder of cervix 6230 Dysplasia of vagina 6231 Leukoplakia of vagina 6232 Stricture or atresia of vagina 6233 Tight hymenal ring 6234 Old vaginal laceration 6235 Leukorrhea, not specified as infective 6236 Vaginal hematoma 6237 Polyp of vagina 6238 Other specified noninflammatory disorders of vagina 6239 Unspecified noninflammatory disorder of vagina 6240 Dystrophy of vulva 6241 Atrophy of vulva 6242 Hypertrophy of clitoris 6243 Hypertrophy of labia 6244 Old laceration or scarring of vulva 6245 Hematoma of vulva 6246 Polyp of labia and vulva 6248 Other specified noninflammatory disorders of vulva and perineum 33

34 6249 Unspecified noninflammatory disorder of vulva and perineum 6250 Dyspareunia 6251 Vaginismus 6252 Mittelschmerz 6253 Dysmenorrhea 6254 Premenstrual tension syndromes 6255 Pelvic congestion syndrome 6256 Stress incontinence, female 6258 Other specified symptoms associated with femal genital organs 6259 Unspecified symptom associated with femal genital organs 6260 Absence of menstruation 6261 Scanty or infrequent menstruation 6262 Excessive or frequent menstruation 6263 Puberty bleeding 6264 Irregular menstrual cycle 6265 Ovulation bleeding 6266 Metrorrhagia 6267 Postcoital bleeding 6268 Other disorders of menstruation and other abnormal bleeding from female genital tract 6269 Unspecified disorder of menstruation and other abnormal bleeding from female genital tract 6270 Premenopausal menorrhagia 6271 Postmenopausal bleeding 6272 Menopausal or female climacteric states 6273 Postmenopausal atrophic vaginitis 6274 States associated with artificial menopause 6278 Other specified menopausal and postmenopausal disorders 6279 Unspecified menopausal and postmenopausal disorder 6280 Infertility, female, associated with anovulation 6282 Infertility, female, of tubal origin 6283 Infertility, female, of uterine origin 6284 Infertility, female, of cervical or vaginal origin 6288 Infertility, female, of other specified origin 6289 Infertility, female, of unspecified origin 6290 Hematocele, female, not elsewhere classified 6291 Hydrocele, canal of Nuck 6298 Other specified disorders of female genital organs 6299 Unspecified disorder of female genital organs 34

35 6981 Pruritus of genital organs 7520 Anomalies of ovaries Unspecified anomaly of fallopian tubes and broad ligaments Embryonic cyst of fallopian tubes and broad ligaments Other anomalies of fallopian tubes and broad ligaments 7522 Doubling of uterus 7523 Other anomalies of uterus Unspecified anomaly of cervix, vagina, and external female genitalia Embryonic cyst of cervix, vagina, and external female genitalia Imperforate hymen Other anomalies of cervix, vagina, and external female genitalia 7527 Indeterminate sex and pseudohermaphroditism 7528 Other specified anomalies of genital organs 7529 Unspecified anomaly of genital organs 7586 Gonadal dysgenesis Other conditions due to sex chromosome anomalies Other conditions due to chromosome anomalies 7950 Nonspecific abnormal Papanicolaou smear of cervix 8674 Injury to uterus,without mention of open wound into cavity 8675 Injury to uterus,with open wound into cavity 8676 Injury to other specified pelvic organs,without mention of open wound into cavity 8677 Injury to other specified pelvic organs,with open wound into cavity 8678 Injury to unspecified pelvic organ,without mention of open wound into cavity 8679 Injury to unspecified pelvic organ,with open wound into cavity 8784 Open wound of vulva, without mention of complication, including traumatic amputation 8785 Open wound of vulva, complicated, including traumatic amputation 8786 Open wound of vagina, without mention of complication, including traumatic amputation 8787 Open wound of vagina, complicated, including traumatic amputation 8788 Open wound of other and unspecified parts of genital organs, without mention of complication, including traumatic amputation 8789 Open wound of other and unspecified parts of genital organs, complicated, including traumatic amputation 9082 Late effect of internal injury to other internal organs 9224 Contusion of genital organs 9260 Crushing injury of external genitalia 9391 Foreign body in uterus, any part 9392 Foreign body in vulva and vagina 35

36 9474 Burn of vagina and uterus Mechanical complication due to intrauterine contraceptive device V253 Menstrual extraction V5042 Prophylactic ovary removal V557 Attention to artificial vagina WITH OPERATING ROOM PROCEDURES 6501 Laparoscopic oophorotomy 6513 Laparoscopic biopsy of ovary 6514 Other laparoscopic diagnostic procedures on ovaries 6523 Laparoscopic marsupialization of ovarian cyst 6524 Laparoscopic wedge resection of ovary 6525 Other laparoscopic local excision or destruction of ovary 6531 Laparoscopic unilateral oophorectomy 6541 Laparoscopic unilateral salpingo-oophorectomy 6553 Laparoscopic removal of both ovaries at same operative episode 6554 Laparoscopic removal of remaining ovary 6563 Laparoscopic removal of both ovaries and tubes at same operative episode 6564 Laparoscopic removal of remaining ovary and tube 6574 Laparoscopic simple suture of ovary 6575 Laparoscopic reimplantation of ovary 6576 Laparoscopic salpingo-oophoroplasty 6581 Laparoscopic lysis of adhesions of ovary and fallopian tube OR OPERATING ROOM PROCEDURES Unilateral Laparoscopic salpingectomy Bilateral Laparoscopic salpingectomy Laparoscopic myomectomy Laparoscopic excision or destruction of lesion of fallopian tube Laparoscopic other partial salpingectomy Laparoscopic other repair of fallopian tube Laparoscopic lysis of peritoneal adhesions and unilateral salpingectomy Laparoscopic lysis of peritoneal adhesions and bilateral salpingectomy Laparoscopic lysis of peritoneal adhesions and myomectomy Laparoscopic lysis of peritoneal adhesions and excision or destruction of lesion of fallopian tube Laparoscopic lysis of peritoneal adhesions and other partial salpingectomy Laparoscopic lysis of peritoneal adhesions and other repair of fallopian tube 36

37 附表 診斷碼編碼限制 限年齡 0~17 歲申報之診斷碼 (I) 2591 Precocious sexual development and puberty, not elsewhere classified Other or mixed emotional disturbances of childhood or adolescence 3139 Unspecified emotional disturbance of childhood or adolescence Reye's syndrome Seborrheic infantile dermatitis 7511 Atresia and stenosis of small intestine Failure of thrive Delayed milestones 7980 Sudden infant death syndrome Child abuse, unspecified Child emotional/psychological abuse Child neglect (nutritional) Child sexual abuse Child physical abuse Shaken infant syndrome Other child abuse and neglect V200 Health supervision of foundling V201 Health supervision of other healthy infant or child receiving care V202 Health supervision of routine infant or child health check 限年齡 14 歲以上申 2900 Senile dementia, uncomplicated 報之診斷碼 (K) Presenile dementia uncomplicated Presenile dementia with delirium Presenile dementia with delusional features Presenile dementia with depressive features 37

38 29020 Senile dementia with delusional features Senile dementia with depressive features 2903 Senile dementia with delirium Arteriosclerotic dementia uncomplicated Arteriosclerotic dementia with delirium Arteriosclerotic dementia with delusional features Arteriosclerotic dementia with depressive features 2909 Unspecified senile psychotic condition Senile cataract, unspecified Pseudoexfoliation of lens capsule Incipient senile cataract Anterior subcapsular polar senile cataract Posterior subcapsular polar senile cataract Cortical senile cataract Nuclear sclerosis Total or mature cataract Hypermature cataract Other and combined forms of senile cataract Senile entropion Senile ectropion 4110 Postmyocardial infarction syndrome 4111 Intermediate coronary syndrome Other acute and subacute forms of ischemic heart disease 412 Old myocardial infarction 4130 Angina decubitus 4131 Prinzmetal angina 4139 Other and unspecified angina pectoris Coronary atherosclerosis of unspecified type vessel, native or graft Coronary atherosclerosis of native coronary artery Coronary atherosclerosis of autologous vein bypass graft Coronary atherosclerosis of nonautolgous biological bypass graft Coronary atherosclerosis of artery bypass graft Coronary atherosclerosis Acquired cardiac septal defect Other certain sequelae of myocardial infarction, 38

39 not elsewhere classified 4358 Other specified transient cerebral ischemias 4400 Atherosclerosis of aorta 4401 Atherosclerosis of renal artery Atherosclerosis of the extremities, unspecified Atherosclerosis of the extremities with intermittent claudication Atherosclerosis of the extremities with rest pain Atherosclerosis of the extremities with ulceration Other atherosclerosis of native arteries of the extremities Atherosclerosis of unspecified bypass graft of the extremities Atherosclerosis of autologous vein bypass graft of the extremities Atherosclerosis of nonautologous biological bypass graft of the extremities 4408 Atherosclerosis of other specified arteries 4409 Generalized and unspecified atherosclerosis Dissection of aorta, unspecified site Dissection of aorta, thoracic Dissection of aorta, abdominal Dissection of aorta, thoracoabdominal 4411 Thoracic aneurysm, ruptured 4413 Abdominal aneurysm, ruptured 4414 Abdominal aneurysm without mention of rupture 4415 Aortic aneurysm of unspecified site, ruptured 4416 Thoracoabdominal aneurysm, ruptured 4417 Thoracoabdominal aneurysm, without mention of rupture 4419 Aortic aneurysm of unspecified site without mention of rupture 4420 Aneurysm of artery of upper extremity 4421 Aneurysm of renal artery 4422 Aneurysm of iliac artery 4423 Aneurysm of artery of lower extremity Aneurysm of subclavian artery Aneurysm of splenic artery Aneurysm of other visceral artery 39

40 44289 Aneurysm of other specified artery 4429 Aneurysm of unspecified site 4540 Varicose veins of lower extremities with ulcer 4541 Varicose veins of lower extremities with inflammation 4542 Varicose veins of lower extremities with ulcer and inflammation 4549 Varicose veins of lower extremities without mention of ulcer or inflammation 4570 Postmastectomy lymphedema syndrome 496 Chronic airways obstruction, not elsewhere classified 500 Coal workers' pneumoconiosis 501 Asbestosis 5710 Alcoholic fatty liver 5711 Acute alcoholic hepatitis 5712 Alcoholic cirrhosis of liver 5713 Alcoholic liver damage, unspecified 6000 Hypertrophy (benign) of prostate 6001 Nodular prostate 6002 Benign localized hyperplasia of prostate 6003 Cyst of prostate 6009 Hyperplasia of prostate, unspecified 6010 Acute prostatitis 6011 Chronic prostatitis 6012 Abscess of prostate 6013 Prostatocystitis 6014 Prostatitis in diseases classified elsewhere 6018 Other specified inflammatory diseases of prostate 6019 Prostatitis, unspecified 6020 Calculus of prostate 6021 Congestion or hemorrhage of prostate 6022 Atrophy of prostate 6028 Other specified disorders of prostate 6029 Unspecified disorder of prostate 6060 Azoospermia 6061 Oligospermia 6068 Infertity due to extratesticular causes 6069 Male infertility, unspecified 40

41 60784 Impotence of organic origin 6101 Diffuse cystic mastopathy 7220 Displacement of cervical intervertebral disc without myelopathy Displacement of thoracic intervertebral disc without myelopathy 7222 Displacement of intervertebral disc, site unspecified, without myelopathy Schmorl's nodes, unspecified region Schmorl's nodes, thoracic region Schmorl's nodes, lumbar region Other Schmorl's nodes 7224 Degeneration of cervical intervertebral disc Degeneration of thoracic or thoracolumbar intervertebral disc Degeneration of lumbar or lumbosacral intervertebral disc 7226 Degeneration of intervertebral disc, site unspecified Intervertebral disc disorder with myelopathy, unspecified region Cervical intervertebral disc disorder with myelopathy Thoracic intervertebral disc disorder with myelopathy Lumbar intervertebral disc disorder with myelopathy Postlaminectomy syndrome, unspecified region Postlaminectomy syndrome, cervical region Postlaminectomy syndrome, thoracic region Postlaminectomy syndrome, lumbar region Unspecified disc disorder Cervical intervertebral disc disorder Thoracic intervertebral disc disorder Lumbar intervertebral disc disorder Spinal stenosis, unspecified region Spinal stenosis, thoracic region Spinal stenosis, lumbar region Other spinal stenosis 41