Cryotherapy for malignant endobronchial obstruction

NICE interventional procedures guidance [IPG142] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on cryotherapy for malignant endobronchial obstruction.

  • Description

    Lung cancer is often at an advanced stage by the time it is diagnosed and survival rates are low. Patients can develop endobronchial lesions that obstruct the major airways, causing symptoms such as dyspnoea, cough, haemoptysis and postobstructive pneumonia. The obstruction may lead to gradual asphyxiation.

    The aim of treatment in patients with malignant endobronchial obstruction is mainly palliative. Current treatment options include a variety of endobronchial therapies such as resection, brachytherapy, laser ablation, photodynamic therapy and stenting. External beam radiotherapy and chemotherapy may also be used for palliative treatment.

    Cryosurgery uses extreme cold to destroy tissue. General anaesthesia is usually used and a cryoprobe is inserted through a bronchoscope to reach the tumour. The selection of probe diameter depends on the size and position of the tumour. After a period of freezing, the tumour is allowed to thaw until the probe separates from the tissue. The freeze/thaw cycle may be repeated two to three times in the same place. The probe is then moved to an adjacent area and the process repeated until the whole tumour has been treated. Any resulting necrotic tumour material is then removed with forceps or the cryoprobe. Further necrotic-appearing material may be coughed out 24 to 48 hours later. The procedure can be repeated if necessary.

  • OPCS4.6 Code(s)

    The code selection depends on whether a rigid bronchoscope is utilised (E50.3) or not (E48.3):

    E48.3 Fibreoptic endoscopic destruction of lesion of lower respiratory tract NEC 

    Y13.2 Cryotherapy to lesion of organ NOC

    Chapter ‘Z’ code to indicate site treated

    or

    E50.3 Endoscopic destruction of lesion of lower respiratory tract using rigid bronchoscope NEC

    Y13.2 Cryotherapy to lesion of organ NOC

    Chapter ‘Z’ code to indicate site treated

     

    In addition an ICD-10 code from category C34.- Malignant neoplasm of bronchus and lung 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

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