The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on photodynamic therapy for bile duct cancer in July 2005. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.
The guidance was considered for reassessment in July 2008 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.
If cancer develops in the biliary tract, it may prevent bile flowing from the liver to the intestine. Early cancers are often asymptomatic but as the disease advances patients may experience symptoms such as jaundice, itchy skin, abdominal discomfort, loss of appetite, weight loss and fever.
Treatment options depend largely on the stage, size, position and type of the cancer. Bile duct cancer is not usually diagnosed before the symptoms of biliary obstruction occur, by which time the cancer may be too advanced for curative surgical resection. The standard options for palliative treatment include surgical bypass of the bile duct or the insertion of a stent using surgical, endoscopic or percutaneous techniques.
Photodynamic therapy (PDT) produces localised tissue necrosis by applying a photosensitising agent and then exposing the area to laser light of an appropriate wavelength. A photosensitising agent is used that preferentially accumulates in the tumour tissue rather than normal tissue.
Photodynamic therapy is usually administered in conjunction with a biliary stenting procedure. The photosensitising agent is injected intravenously and photoactivation is performed approximately 48 hours later. This is done by inserting a laser through a catheter situated close to the tumour or by placing the laser directly across the tumour. Patients remain in the dark for about 3 days after injection and are then gradually readapted to light.
J41.4 Endoscopic retrograde photodynamic laser therapy of lesion of bile duct
J48.4 Percutaneous photodynamic therapy of lesion of bile duct
In addition a code from category Y53.- Approach to organ under image control is assigned when image control has been used.
Note: The code assignment depends on whether the procedure is carried out with the use of an endoscope (J41.4) or percutaneously (J48.4).
In addition the ICD-10 code C24.0 Malignant neoplasm of extrahepatic bile duct or C78.8 Secondary malignant neoplasm of other and unspecified digestive organs is assigned.
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding