The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Single incision laparoscopic cholecystectomy, in December 2014.

This document replaces the previous guidance on single incision laparoscopic cholecystectomy (NICE interventional procedure guidance 346, September 2009)

Description

Single-incision laparoscopic cholecystectomy (SILC) aims to remove the gallbladder through a single incision, which is usually made near the umbilicus. The claimed benefits of this procedure over standard laparoscopic cholecystectomy include less pain, shorter recovery time, fewer wound complications and improved cosmesis.

SILC is done with the patient under general anaesthesia. There are 2 surgical approaches. One uses a single umbilical skin incision with skin flaps to insert ports through multiple fascial punctures. The other uses a specifically designed device that allows multiple instruments to be passed through a single port placed in or near the umbilicus. A pneumoperitoneum is established and the gallbladder is retracted with a laparoscopic instrument ('grasper') or by a transabdominal suture. The hilum of the gallbladder is dissected using endoscopic instruments. The cystic artery and cystic duct are clipped and divided, and the gallbladder is separated from the liver. At least 1 additional port in the epigastrium may be needed if a cholangiogram is performed or if the common bile duct is explored. The gallbladder is removed through the umbilical incision.

Coding recommendations

Single port incision surgery for laparoscopic cholecystectomy is coded in the same way as multiple port incision laparoscopic cholecystectomy.

A code from category J18.- Excision of gall bladder below plus Y75.2 Laparoscopic approach to abdominal cavity NEC is assigned as appropriate:

J18.1 Total cholecystectomy and excision of surrounding tissue

J18.2 Total cholecystectomy and exploration of common bile duct

Includes: Cholecystectomy and exploration of common bile duct NEC

J18.3 Total cholecystectomy NEC

Includes: Cholecystectomy NEC

J18.4 Partial cholecystectomy and exploration of common bile duct

J18.5 Partial cholecystectomy NEC

J18.8 Other specified excision of gall bladder

J18.9 Unspecified excision of gall bladder

For example the OPCS-4 codes for single port incision surgery for laparoscopic cholecystectomy that is not further specified are:

J18.3 Total cholecystectomy NEC

Includes: Cholecystectomy NEC

Y75.2 Laparoscopic approach to abdominal cavity NEC

If both a laparoscopic cholecystectomy and an operative cholangiography are performed at the same time, then both procedures need to be coded. The OPCS-4 codes assigned are:

J18.- Excision of gall bladder

A fourth character is assigned as appropriate

Y75.2 Laparoscopic approach to abdominal cavity NEC

J37.2 Operative cholangiography through cystic duct.

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.

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