The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic bipolar radiofrequency ablation for the treatment of malignant biliary obstructions from cholangiocarcinoma or pancreatic adenocarcinoma.

Description

Unresectable malignant bile or pancreatic duct obstructions caused by cholangiocarcinoma or pancreatic cancer block the drainage of bile ducts that carry digestive juices from the gall bladder and pancreas to the small intestine. This causes bloating, abdominal pain and nausea. These patients are often managed by placing stents via an endoscope which help to keep the bile duct open and drain properly. However, many of these stents will eventually become blocked and need replacing which may be difficult. Endoscopic radiofrequency destruction which uses heat energy is a new method to clear the duct obstructions prior to stent insertion and for clearance of obstructed stents.

Coding recommendations

J41.8 Other specified other therapeutic endoscopic retrograde operations on bile duct

Y13.4 Radiofrequency controlled thermal destruction of lesion of organ NOC

Z30.3 Common bile duct or

Z30.4 Bile duct NEC or

Z30.8 Specified biliary tract NECor

Z30.9 Biliary tract NEC

When perfomed on pancreatic duct:

J42.8 Other specified therapeutic endoscopic retrograde operations on pancreatic duct

Y13.4 Radiofrequency controlled thermal destruction of lesion of organ NOC

Z31.2 Pancreatic duct

If a stent is inserted during the procedure this would also be coded by assigning a code from category Y14 Placement of stent in organ NOC after code Y13.4.

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)