diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java
index 908517e2..f5530839 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationAdviceAppServiceImpl.java
@@ -1058,9 +1058,20 @@ public class DoctorStationAdviceAppServiceImpl implements IDoctorStationAdviceAp
             iServiceRequestService.remove(
                     new LambdaQueryWrapper<ServiceRequest>().eq(ServiceRequest::getParentId,
                             adviceSaveDto.getRequestId()));// 删除诊疗套餐对应的子项
-            // 删除费用项
-            iChargeItemService.deleteByServiceTableAndId(CommonConstants.TableName.WOR_SERVICE_REQUEST,
-                    adviceSaveDto.getRequestId());
+            // 🔧 Bug Fix #219: 删除费用项前查询确认
+            Long requestId = adviceSaveDto.getRequestId();
+            String serviceTable = CommonConstants.TableName.WOR_SERVICE_REQUEST;
+            // 先查询费用项是否存在
+            List<ChargeItem> existingChargeItems = iChargeItemService.getChargeItemInfoByReqId(Arrays.asList(requestId));
+            if (existingChargeItems == null || existingChargeItems.isEmpty()) {
+                log.warn("BugFix#219: 删除诊疗医嘱时未找到费用项, requestId={}, serviceTable={}", requestId, serviceTable);
+            } else {
+                log.info("BugFix#219: 找到 {} 个费用项, 准备删除, requestId={}, serviceTable={}", 
+                    existingChargeItems.size(), requestId, serviceTable);
+                // 删除费用项
+                iChargeItemService.deleteByServiceTableAndId(serviceTable, requestId);
+                log.info("BugFix#219: 费用项删除完成, requestId={}", requestId);
+            }
         }
 
         for (AdviceSaveDto adviceSaveDto : insertOrUpdateList) {