The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Irreversible electroporation for the treatment of liver metastases.
Electroporation is a tissue ablative procedure that uses an electric field to open pores in the cell membrane. Irreversible electroporation is the stage at which the electric field has been applied with sufficient amplitude and duration to cause permanent damage to the cell membrane and thus cell death.
Under general anaesthesia and with imaging guidance, needle-electrodes are passed directly through the skin into the target tumour. Up to six single use disposable needles are placed at a fixed distance apart in the target lesion. A series of very short electrical field pulses are delivered over several minutes to ablate the tumour and a small surrounding tissue margin.
Percutaneous approach with image guidance:
J12.8 Other specified other therapeutic percutaneous operations on liver
Y12.3 Electrochemotherapy to lesion of organ NOC
Y53.- Approach to organ under image control
In addition ICD-10 code C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct is assigned.
The NHS Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.