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

Description

Pelviureteric junction obstruction is a condition caused by a narrowing of the funnel-shaped part of the kidney (known as the renal pelvis) where urine collects before being carried to the bladder by tubes called ureters. The obstruction may cause episodes of loin pain and/or nausea and vomiting, urinary infections and kidney stones. In some patients the condition could also affect the normal function of the kidney.

This procedure (endopyelotomy) aims to widen the renal pelvis by inserting small instruments either up through the urinary tract or down through the skin and into the kidney. The instruments are used to remove the tissue that is causing the obstruction by cutting or burning it away or by applying laser.

Coding recommendations

The primary OPCS-4 code for this procedure is dependent on the route of access used:

For an endoscopic approach via the ureter, the primary code is:

M10.8 Other specified other therapeutic endoscopic operations on kidney

In addition, one of the following codes is assigned depending on the type of cutting device used:

Y08.6 Laser incision of organ NOC

Y13.1 Cauterisation of lesion of organ NOC

Y30.1 Incision of lesion of organ NOC

For a percutaneous approach in the flank, the primary codes are:

M13.8 Other specified percutaneous puncture of kidney

Y53.- Approach to organ under image control

In addition, one of the following codes is assigned depending on the type of cutting device used:

Y08.6 Laser incision of organ NOC

Y13.1 Cauterisation of lesion of organ NOC

Y30.1 Incision of lesion of organ NOC

If a stent is inserted during the procedure a code from category Y14.- Placement of stent in organ NOC can be assigned to specify the type of stent inserted.

In addition the ICD-10 code N13.8 Other obstructive and reflux uropathy is assigned.

Your responsibility

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.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)