OPCS-4.6 codes agreed with the NHS Classifications Service 26/09/2012

Transcription

1 OPCS-4.6 codes agreed with the NHS Classifications Service 26/09/2012 IPGNo IPName BLOOD AND IMMUNE SYSTEM 251 Liposuction f chronic lymphoedema S62.2 Liposuction of subcutaneous tissue NEC site code In addition one of the following ICD-10 codes is assigned: I97.2 Postmastectomy lymphoedema syndrome I89.0 Lymphoedema, not elsewhere classified Q82.0 Hereditary lymphoedema. BLOOD AND IMMUNE SYSTEM CENTRAL NERVOUS SYSTEM 252 Laser-assisted cerebral vascular anastomosis without tempary arterial occlusion One of the following OPCS-4 codes is selected as appropriate: L29.2 Intracranial bypass to carotid artery NEC L29.6 High flow interposition extracranial to intracranial bypass from external carotid artery to middle cerebral artery L29.7 Bypass of carotid artery by anastomosis of superficial tempal artery to middle cerebral artery L34.2 Anastomosis of cerebral artery Plus the following code: Y08.8 Other specified laser therapy to gan NOC Note: It is not possible to classify without tempary arterial occlusion using OPCS-4. BLOOD AND IMMUNE SYSTEM DIGESTIVE SYSTEM 265 Stent insertion f bleeding oesophageal varices One of the following OPCS-4 codes is selected as appropriate: G21.5 Insertion of stent into oesophagus NEC G15.4 Fibreoptic endoscopic insertion of tubal prosthesis into oesophagus G15.6 Fibreoptic endoscopic insertion of expanding metal stent into oesophagus NEC G15.7 Fibreoptic endoscopic insertion of expanding covered metal stent into oesophagus CANCER 147 Endoscopic axillary node retrieval f breast cancer T85.2 Block dissection of axillary lymph nodes Y76.3 Endoscopic approach to other body cavity T86.2 Sampling of axillary lymph nodes Y76.3 Endoscopic approach to other body cavity T87.3 Excision biopsy of axillary lymph node Includes: Excision biopsy of supraclavicular lymph node NEC Y76.3 Endoscopic approach to other body cavity In addition an ICD-10 code from categy C50.- Malignant neoplasm of breast C79.8 Secondary malignant neoplasm of other specified sites is assigned.

2 89 Interstitial laser Research only therapy f breast cancer 235 Intravesical microwave hyperthermia with intravesical chemotherapy f superficial bladder cancer Research only B40.1 Interstitial laser destruction of lesion of breast In addition an ICD-10 code from categy C50.- Malignant neoplasm of breast C79.8 Secondary malignant neoplasm of other specified sites is assigned. This type of heated chemotherapy cannot currently be specifically captured using OPCS-4. At present this is captured using the following codes: M49.4 Introduction of a therapeutic substance into bladder X70-X71 Procurement of drugs f chemotherapy f neoplasm Bands 1-10 (depending on the cytotoxic drug used) X72 Delivery of chemotherapy f neoplasm (the delivery code is f outpatients and day cases only) Y53.2 Approach to gan under ultrasonic control (if used). In addition an ICD-10 code from categy C67. - Malignant neoplasm of bladder is assigned. 369 Cryotherapy f the treatment of liver metastases Open cryotherapy to liver metastases: J03.2 Destruction of lesion of liver NEC Y13.2 Cryotherapy to lesion of gan NOC Percutaneous cryotherapy to liver metastases: J12.8 Other specified other therapeutic percutaneous operations on liver Y13.2 Cryotherapy to lesion of gan NOC Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct would be recded. 253 Laparoscopic mobilisation of omentum f breast reconstruction B39.4 Reconstruction of breast using pedicled omental flap T36.5 Creation of omental flap Y75.2 Laparoscopic approach to abdominal cavity NEC B39.5 Reconstruction of breast using free omental flap T36.5 Creation of omental flap Y75.2 Laparoscopic approach to abdominal cavity NEC Note: In addition an appropriate code f the breast cancer surgery, and axillary node clearance, if perfmed,, is assigned if the reconstruction and the breast cancer surgery, and axillary clearance, are perfmed during the same procedure. 268 Brachytherapy as the sole method of adjuvant radiotherapy f breast cancer after local excision Research only X65.3 Delivery of a fraction of interstitial radiotherapy Y35.4 Introduction of radioactive substance into gan f brachytherapy NOC Z15.- Breast Z94.- Laterality of operation In addition an ICD-10 code from categy C50.- Malignant neoplasm of breast C79.8 Secondary malignant neoplasm of other specified sites is assigned.

3 296 Endoscopic Research only mastectomy and endoscopic wide local excision f breast cancer The OPCS-4 codes f endoscopic wide local excision are as follows: B28.2 Partial excision of breast NEC Includes: Wedge excision of breast NEC Wide excision of breast NEC Y76.3 Endoscopic approach to other body cavity The OPCS-4 codes f endoscopic mastectomy are as follows: B27.- Total excision of breast (fourth character dependent on the description of the mastectomy) Y76.3 Endoscopic approach to other body cavity Note: The codes within B27. - do not include any associate lymph node removal and these are classified with an additional code from categies T85-T87. In addition an ICD-10 code from categy C50.- Malignant neoplasm of breast C79.8 Secondary malignant neoplasm of other specified sites is assigned. 308 Image guided radiofrequency excision bioppsy of breast lesions (BLES/Intact) 424 Focal therapy using high-intensity focused ultrasound f localised prostate cancer 402 Percutaneous cryotherapy f renal cancer B28.3 Excision of lesion of breast NEC Y06.7 Radiofrequency excision of lesion of gan NOC Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. M71.1 High intensity focused ultrasound of prostate Plus Y53.2 Approach to gan under ultrasonic control And/ Y53.7 Approach to gan under magnetic resonance imaging control In addition the ICD-10 code C61.X Malignant neoplasm of prostate would be recded. M13.8 Other specified percutaneous puncture of kidney Y13.2 Cryotherapy to lesion of gan NOC Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. In addition ICD-10 codes C64.X Malignant neoplasm of kidney, except renal pelvis, C65.X Malignant neoplasm of renal pelvis C79.0 Secondary malignant neoplasm of kidney and renal pelvis are assigned f renal malignancies D30.0 Benign neoplasm of kidney D30.1 Benign neoplasm of renal pelvis f benign neoplasms of the kidney. 423 Focal therapy using cryoablation f localised prostate cancer M70.8 Other specified other operations on outlet of male bladder Y13.2 Cryotherapy to lesion of gan NOC Y53.2 Approach to gan under ultrasonic control Z42.2 Prostate In addition the ICD-10 code C61.X Malignant neoplasm of prostate would be recded.

4 Irreversible electropation (IRE) f the treatment of primary liver cancer Research only OPCS Codes and guidance: J12.8 Other specified other therapeutic percutaneous operations on liver Y13.8 Other specified other destruction of lesion of gan NOC Y53.- Approach to gan under image control CANCER DIGESTIVE SYSTEM 56 Complete cyteduction f pseudomyxoma peritonei (Sugarbaker technique) This procedure cannot be expressed in the OPCS-4 classification by a single code. The current guidance would be to code each gan removed as per nmal coding rules, and to combine this with the ICD-10 diagnosis code C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum. F the intraperitoneal chemotherapy the following OPCS-4 codes are assigned: T48.2 Introduction of cytotoxic substance into peritoneal cavity plus a code from categies X70-X71 Procurement of drugs f chemotherapy f neoplasm in Bands 1-10 dependent on the regimen prescribed. 2 Radiofrequency ablation of hepatocellular carcinoma J12.4 Percutaneous radiofrequency ablation of lesion of liver Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C22.0 Liver cell carcinoma C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct would be recded. 298 Ex-vivo hepatic resection and reimplantation f liver cancer A code from one of the following OPCS-4 categies is selected: J02.- Partial excision of liver Y05.4 Ex vivo resection of gan NOC J03.- Extirpation of lesion of liver Y05.4 Ex vivo resection of gan NOC In addition the ICD-10 code C22.9 Malignant neoplasm of liver, unspecified C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct would be recded. 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 categise procedures f analysis and it is not always possible to identify a procedure uniquely. 129 Computed tomographic colonography (virtual colonoscopy) U17.5 Computed tomography of colon Y97.- Radiology with contrast Y98.1 Radiology of one body area ( < twenty minutes) Note: A code from categy Y97.- Radiology with contrast is only assigned if contrast is used

5 93 Selective internal radiation therapy f colectal metastases in the liver J12.3 Selective internal radiotherapy with microspheres to lesion of liver X65.3 Delivery of a fraction of interstitial radiotherapy Y36.4 Introduction of non-removable radioactive substance into gan f brachytherapy NOC Y53.4 Approach to gan under fluoscopic control In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver would be recded. 92 Radiofrequency ablation f the treatment of colectal metastases in the liver J12.4 Percutaneous radiofrequency ablation of lesion of liver Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct and a code from categy C18.- Malignant neoplasm of colon would be recded. 134 Photodynamic therapy f bile duct cancer J41.4 Endoscopic retrograde photodynamic laser therapy of lesion of bile duct J48.4 Percutaneous photodynamic therapy of lesion of bile duct In addition a code from categy Y53.- Approach to gan under image control is assigned when image control has been used. Note: The code assignment depends on whether the procedure is carried out with the use of an endoscope (J41.4) percutaneously (J48.4). In addition the ICD-10 code C24.0 Malignant neoplasm of extrahepatic bile duct C78.8 Secondary malignant neoplasm of other and unspecified digestive gans is assigned. 135 Laparoscopic liver resection J02.3 Resection of segment of liver Includes: Resection of segments of liver Resection of section of liver Y75.2 Laparoscopic approach to abdominal cavity NEC Y75.4 Hand assisted minimal access approach to abdominal cavity Or J02.4 Wedge excision of liver Y75.2 Laparoscopic approach to abdominal cavity NEC Y75.4 Hand assisted minimal access approach to abdominal cavity 189 Thacoscopically assisted oesophagectomy The codes are dependent upon the extent of the excision; the procedure is classified using codes from one of the following two categies and fourth character detail will be required: G02.- Total excision of oesophagus Y74.4 Thacoscopic video-assisted approach to thacic cavity G03.- Partial excision of oesophagus Y74.4 Thacoscopic video-assisted approach to thacic cavity

6 200 Photo-dynamic therapy f early oesophageal cancer 206 Palliative photodynamic therapy f advanced oesophageal cancer 201 Preoperative high dose rate brachytherapy f rectal cancers G14.7 Fibreoptic endoscopic photodynamic therapy of lesion of oesophagus In addition an ICD-10 code from categy C15. - Malignant neoplasm of oesophagus C78.8 Secondary malignant neoplasm of other and unspecified digestive gans is assigned. G14.7 Fibreoptic endoscopic photodynamic therapy of lesion of oesophagus In addition a code from the ICD-10 categy C15.- Malignant neoplasm of oesophagus C78.8 Secondary malignant neoplasm of other and unspecified digestive gans would be recded. X65.2 Delivery of a fraction of intracavitary radiotherapy Note: Use a subsidiary code to identify introduction of radioactive material (Y35, Y36) Y35.8 Other specified introduction of removable radioactive material into gan NOC Z29.1 Rectum In addition the ICD-10 code C20.X Malignant neoplasm of rectum C78.5 Secondary malignant neoplasm of large intestine and rectum is assigned 211 Radiofrequency-as sisted liver resection A code from the following categy is assigned: J02.- Partial excision of liver plus Y11.4 Radiofrequency controlled thermal destruction of gan NOC Includes: Radiofrequency ablation of gan NOC Y53.2 Approach to gan under ultrasonic control (if used) 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 categise procedures f analysis and it is not always possible to identify a procedure uniquely. In addition the ICD-10 code C22.9 Malignant neoplasm of liver, unspecified C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct would be recded. 220 Microwave ablation f the treatment of metastases in the liver Open procedure: J03.2 Destruction of lesion of liver NEC Y13.7 Microwave destruction of lesion of gan NOC Percutaneous procedure: J12.7 Percutaneous microwave ablation of lesion of liver Laparoscopic procedure: J08.3 Endoscopic microwave ablation of lesion of liver using laparoscope Note: A code from categy Y53.- Approach to gan under image control may also be assigned to these procedures if image control has been used. Codes in categy Y53.- are used as secondary codes. If the method of image control is unspecified, Y53.9 Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver is assigned.

7 269 Laparoscopic gastrectomy f cancer A code is selected from one of the following OPCS-4 categies: G27.- Total excision of stomach G28.- Partial excision of stomach plus Y75.2 Laparoscopic approach to abdominal cavity NEC In addition an ICD-10 code from categy C16.- Malignant neoplasm of stomach C78.8 Secondary malignant neoplasm of other and unspecified digestive gans is assigned. 327 Radiofrequency ablation f colectal liver metastases J12.4 Percutaneous radiofrequency thermal abalation of lesion of liver plus Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver would be recded. 401 Selective internal radiation therapy f non-resectable colectal metastases in the liver J12.3 Selective internal radiotherapy with microspheres to lesion of liver X65.3 Delivery of a fraction of interstitial radiotherapy Y36.4 Introduction of non-removable radioactive substance into gan f brachytherapy NOC Y53.4 Approach to gan under fluoscopic control In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct and a code from categy C18.- malignant neoplasm of colon would be recded. 331 Cyteduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy f peritoneal carcinomatosis 406 Microwave ablation f the treatment of liver metastases This procedure cannot be expressed in the OPCS-4 classification by a single code. The current guidance would be to code each gan removed as per nmal coding rules, and to combine this with the ICD-10 diagnosis code C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum. The appropriate code f the primary malignant neoplasm is also recded, if this is not stated unspecified then a code from categy C80.- Malignant neoplasm, without specification of site is recded. Heated chemotherapy cannot currently be specifically captured using OPCS-4. At present this is captured using the following codes: T48.2 Introduction of cytotoxic substance into peritoneal cavity plus a code from categies X70-X71 Procurement of drugs f chemotherapy f neoplasm in Bands 1-10 dependent on the regimen prescribed. Open procedure: J03.2 Destruction of lesion of liver NEC Y13.7 Microwave destruction of lesion of gan NOC Percutaneous procedure: J12.7 Percutaneous microwave ablation of lesion of liver Laparoscopic procedure: J08.3 Endoscopic microwave ablation of lesion of liver using laparoscope Note: A code from categy Y53.- Approach to gan under image control may also be assigned to these procedures if image control has been used. Codes in categy Y53.- are used as secondary codes. If the method of image control is unspecified, Y53.9 Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct is assigned.

8 CANCER DIGESTIVE SYSTEM ENDOCRINE, NUTRITIONAL AND METABOLIC 57 Laparoscopic live don simple nephrectomy 214 Microwave ablation f hepatocellular carcinoma X45.1 Donation of kidney Y75.2 Laparoscopic approach to abdominal cavity NEC Open procedure: J03.2 Destruction of lesion of liver NEC Y13.7 Microwave destruction of lesion of gan NOC Percutaneous procedure: J12.7 Percutaneous microwave ablation of lesion of liver Laparoscopic procedure: J08.3 Endoscopic microwave ablation of lesion of liver using laparoscope Note: A code from categy Y53.- Approach to gan under image control may also be assigned to these procedures if image control has been used. Codes in categy Y53.- are used as secondary codes. If the method of image control is unspecified, Y53.9 Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C22.0 Liver cell carcinoma C78.7 Secondary malignant neoplasm of liver would be recded. CANCER GYNAECOLOGY, PREGNANCY AND BIRTH 160 High dose rate brachytherapy f carcinoma of the cervix X65.2 Delivery of a fraction of intracavitary radiotherapy Y35.4 Introduction of radioactive substance into gan f brachytherapy NOC Z45.1 Cervix uteri In addition an ICD-10 code from categy C53.- Malignant neoplasm of cervix uteri is assigned. 180 Percutaneous laser therapy f fetal tumours R04.7 Percutaneous laser ablation of lesion of fetus A code from categy Y95.- Gestational age must be assigned in a subsidiary position where this infmation is available. Y53.2 Approach to gan under ultrasonic control Code from Chapter Z to identify site of tumour

9 338 Laparoscopic radical hysterectomy f early stage cervical cancer One of the following OPCS-4 codes is selected: Q07.1 Abdominal hysterocolpectomy and excision of periuterine tissue Q07.2 Abdominal hysterectomy and excision of periuterine tissue NEC The following code is assigned directly after one of the above codes: Y75.2 Laparoscopic approach to abdominal cavity NEC F the removal of the lymph nodes one, a combination, of the following codes is assigned depending on which lymph nodes are removed and if excision block dissection is perfmed: T85.4 Block dissection of para-atic lymph nodes T85.6 Block dissection of pelvic lymph nodes T87.5 Excision biopsy of para-atic lymph node T87.8 Other specified excision biopsy of lymph node The following code is assigned directly after each of the above codes: Y75.2 Laparoscopic approach to abdominal cavity NEC In addition an ICD-10 code from categy C53.- Malignant neoplasm of cervix uteri is assigned. CANCER MOUTH AND DENTAL 259 Interstitial photodynamic therapy f malignant parotid tumours F45.5 Destruction of lesion of salivary gland Y13.6 Photodynamic therapy of lesion of gan NOC Z26.1 Parotid gland In addition ICD-10 code C07. X Malignant neoplasm of parotid gland C79.8 Secondary malignant neoplasm of other specified sites is assigned. CANCER MUSCULOSKELETAL 179 Percutaneous cementoplasty f palliative treatment of bony malignancies W35.1 Introduction of therapeutic substance into bone W35.5 Therapeutic percutaneous puncture of bone Y53.4 Approach to gan under fluoscopic control In addition one of the ICD-10 codes from categies C40.- Malignant neoplasm of bone and articular cartilage of limbs C41.- Malignant neoplasm of bone and articular cartilage of other and unspecified sites code C79.5 Secondary malignant neoplasm of bone and bone marrow would be recded. CANCER RESPIRATORY 87 Photodynamic therapy f advanced bronchial carcinoma E48.7 Fibreoptic endoscopic photodynamic therapy of lesion of lower respiraty tract Z24.5 Bronchus In addition an ICD-10 code from categy C34.- Malignant neoplasm of bronchus and lung C78.0 Secondary malignant neoplasm of lung is assigned.

10 137 Photodynamic therapy f localised inoperable endobronchial cancer 142 Cryosurgery f malignant endobronchial obstruction E48.7 Fibreoptic endoscopic photodynamic therapy of lesion of lower respiraty tract Chapter Z code f site in lower respiraty tract In addition an ICD-10 code from categy C34.- Malignant neoplasm of bronchus and lung C78.0 Secondary malignant neoplasm of lung is assigned. The code selection depends on whether a rigid bronchoscope is utilised (E50.3) not (E48.3): E48.3 Fibreoptic endoscopic destruction of lesion of lower respiraty tract NEC Y13.2 Cryotherapy to lesion of gan NOC Chapter Z code to indicate site treated E50.3 Endoscopic destruction of lesion of lower respiraty tract using rigid bronchoscope NEC Y13.2 Cryotherapy to lesion of gan NOC Chapter Z code to indicate site treated In addition an ICD-10 code from categy C34.- Malignant neoplasm of bronchus and lung is assigned. 185 Percutaneous radiofrequency ablation f primary and secondary lung cancers E59.5 Percutaneous radiofrequency ablation of lesion of lung Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. In addition, an ICD-10 code from categy C34.- Malignant neoplasm of bronchus and lung C78.0 Secondary malignant neoplasm of lung would be recded. CANCER SKIN 155 Photodynamic therapy f non-melanoma skin tumours (including premalignant and primary non-metastatic skin lesions) A code from categy S07.- Photodynamic therapy of skin below is assigned: S07.1 Photodynamic therapy of skin of whole body S07.8 Other specified photodynamic therapy of skin S07. 9 Unspecified photodynamic therapy of skin Plus a Chapter Z code to identify the body site treated. CANCER UROGENITAL 119 Cryotherapy f recurrent prostate cancer M70.8 Other specified other operations on outlet of male bladder Y13.2 Cryotherapy to lesion of gan NOC Z42.2 Prostate In addition the ICD-10 code C61.X Malignant neoplasm of prostate C79.8 Secondary malignant neoplasm of other specified sites would be recded.

11 118 High-intensity focused ultrasound f prostate cancer 132 Low dose rate brachytherapy f localised prostate cancer M71.1 High intensity focused ultrasound of prostate In addition the ICD-10 code C61.X Malignant neoplasm of prostate C79.8 Secondary malignant neoplasm of other specified sites would be recded. M70.6 Radioactive seed implantation into prostate Note: Use an additional code to specify radiotherapy delivery (X65) X65.3 Delivery of a fraction of interstitial radiotherapy Note: Use a subsidiary code to identify introduction of radioactive material (Y35, Y36) Y36.3 Radioactive seed implantation NOC In addition the ICD-10 code C61.X Malignant neoplasm of prostate C79.8 Secondary malignant neoplasm of other specified sites is assigned 145 Cryotherapy as a primary treatment f prostate cancer M70.8 Other specified other operations on outlet of male bladder Y13.2 Cryotherapy to lesion of gan NOC Y53.- Approach to gan under image control Z42.2 Prostate Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. In addition the ICD-10 code C61.X Malignant neoplasm of prostate is assigned. 158 Laparoscopic retroperitoneal lymph node dissection f testicular cancer 174 High dose rate brachytherapy f prostate cancer T85.8 Other specified block dissection of lymph nodes Y75.2 Laparoscopic approach to abdominal cavity NEC In addition an ICD-10 code from categy C62.- Malignant neoplasm of testis is assigned. M71.2 Implantation of radioactive substance into prostate Note: Use an additional code to specify radiotherapy delivery (X65) X65.3 Delivery of a fraction of interstitial radiotherapy Note: Use a subsidiary code to identify introduction of radioactive material (Y35, Y36) Y35.4 Introduction of radioactive substance into gan f brachytherapy NOC Note: An external beam radiotherapy code X65.4 Delivery of a fraction of external beam radiotherapy NEC plus a code from categy Y91. - External beam radiotherapy is assigned on the appropriate episode when this occurs. In addition the ICD-10 code C61.X Malignant neoplasm of prostate C79.8 Secondary malignant neoplasm of other specified sites is assigned

12 193 Laparoscopic radical prostatectomy One of the following OPCS-4 codes is selected: M61.1 Total excision of prostate and capsule of prostate M61.8 Other specified open excision of prostate plus Y75.2 Laparoscopic approach to abdominal cavity Y76.5 Robotic assisted minimal access approach to other body cavity Note: The codes M61.1 and M61.8 do not include any associated lymph node removal and these are classified with an additional code from categies T85-T87. In addition the ICD-10 code C61.X Malignant neoplasm of prostate would be recded. 277 Electrically-stimula ted intravesical chemotherapy f superficial bladder cancer Research only This would be recded using the codes f intravesical chemotherapy as there is no current way to identify electrically-stimulated using OPCS-4 codes. Intravesical instillation of chemotherapy is coded by using M49.4 Introduction of therapeutic substance into bladder, followed by the appropriate combination of chemotherapy codes from categies X70-X73 depending on which chemotherapy regimen is administered. In addition an ICD-10 code from categy C67.- Malignant neoplasm of bladder C79.1 Secondary malignant neoplasm of bladder and other and unspecified urinary gans is assigned. 287 Laparoscopic cystectomy In OPCS-4 categy M34.- Total excision of bladder is used to classify a range of excisions of the bladder: the code selected will be dependent upon what is documented in the patient s clinical recd. M34.1 Cystoprostatectomy M34.2 Cystourethrectomy M34.3 Cystectomy NEC M34.4 Simple cystectomy M34.8 Other specified total excision of bladder M34.9 Unspecified total excision of bladder The codes above would then be supplemented with an additional code to denote the laparoscopic approach. There are a range of codes within Y75. - Minimal access to abdominal cavity that can be used: Y75.1 Laparoscopic assisted approach to abdominal cavity Y75.2 Laparoscopic approach to abdominal cavity NEC Y75.3 Robotic minimal access approach to abdominal cavity Y75.4 Hand assisted minimal access approach to abdominal cavity Y75.5 Laparoscopic ultrasonic approach to abdominal cavity Y75.8 Other specified minimal access to abdominal cavity Y75.9 Unspecified minimal access abdominal cavity Note: If concurrent construction of ileal conduit is carried out, a further additional code is required. CARDIOVASCULAR

13 127 Endovascular stent-graft placement in thacic atic aneurysms and dissections An OPCS-4 code is selected from the following to capture the dissection aneurysm in the ata: L27.3 Endovascular insertion of stent graft f thacic atic aneurysm L27.4 Endovascular insertion of stent graft f atic dissection in any position A supplementary code from categy O20.- Endovascular placement of stent graft is assigned to indicate the number and type of stent grafts. Y53.- Approach to gan under image control Y78.- Arteriotomy approach to gan under image control Note: Codes within categies Y53.- and Y78.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. 191 Carotid artery stent placement f carotid stenosis L31.4 Percutaneous transluminal insertion of stent into carotid artery Note: Use a supplementary code f placement of stent (L76, L89, O20) A code from categy L76.- Endovascular placement of stent L89.- Other endovascular placement of stent O20.- Endovascular placement of stent graft is added to specify the type and number of stents used. Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. 40 Non-surgical reduction of myocardial septum K16.6 Percutaneous transluminal chemical mediated septal ablation Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. 63 Laser sheath removal of pacing leads This procedure applies to the removal of transvenous pacing systems. K60.4 Removal of intravenous cardiac pacemaker system Y08.4 Laser destruction of lesion of gan NOC Y53.1 Approach to gan under radiological control (if used) Or K61.4 Removal of cardiac pacemaker system NEC Y08.4 Laser destruction of lesion of gan NOC Y53.1 Approach to gan under radiological control (if used) Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of image control, if the method of image control is unspecified Y53.9 Unspecified approach to gan under image control is assigned. 177 Sht-term circulaty suppt with left ventricular assist devices as a bridge to cardiac transplantation recovery K54.1 Open implantation of ventricular assist device F removal of the ventricular assist device: K54.2 Open removal of ventricular assist device

14 41 Partial left ventriculectomy (the Batista procedure) K23.5 Partial left ventriculectomy In cases where the procedure is perfmed with the aid of cardiopulmonary bypass OPCS-4 code Y73.1 Cardiopulmonary bypass is assigned in addition. OPCS-4 codes K25.5 Mitral valve repair NEC and K34.1 Annuloplasty of mitral valve may also be assigned when these procedures have also been perfmed. 90 Intralesional photocoagulation of subcutaneous congenital vascular disders 76 Balloon dilatation with without stenting f pulmonary artery non-valvar right ventricular outflow tract obstruction in children S09.1 Laser destruction of lesion of skin of head neck S09.2 Laser destruction of lesion of skin NEC In addition an ICD-10 code would be included to reflect the appropriate diagnosis, f example: Q27.3 Peripheral arteriovenous malfmation. With stent L13.6 Percutaneous transluminal insertion of stent into pulmonary artery + L76,L89 to identify type and number of stents + Y53.- Approach to gan under image control Without stent L13.4 Percutaneous transluminal cutting balloon angioplasty of pulmonary artery L13.5 Percutaneous transluminal balloon angioplasty of artery NEC + Y53.- Approach to gan under image control Note: Current coding rules state that when angioplasty and stent procedures are perfmed concurrently, and individual codes are available f the angioplasty and stent, only the code f the stent insertion is required. This is because the angioplasty is implicit within the code f stent insertion. Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to gan under image control is assigned. 59 Subfascial endoscopic perfat vein surgery F endoscopic subfascial ligation surgery of perfating veins: L83.2 Subfascial ligation of perfating vein of leg Y76.3 Endoscopic approach to other body cavity F perfating veins that are clipped and divided with endoscopic scisss, the following OPCS-4 codes are appropriate: L83.8 Other specified other operations f venous insufficiency Y76.3 Endoscopic approach to other body cavity Y07.2 Clipping of gan NOC 8 Radiofrequency ablation of varicose veins 67 Balloon dilatation of pulmonary valve stenosis L88.2 Radiofrequency ablation of varicose vein of leg K35.5 Percutaneous transluminal valvuloplasty Includes: Percutaneous transluminal balloon valvuloplasty Y53.- Approach to gan under image control Z32.4 Pulmonary valve Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned.

15 78 Balloon valvuloplasty f atic valve stenosis in adults and children 74 Balloon angioplasty with without stenting f coarctation recoarctation of ata in adults and children K35.5 Percutaneous transluminal valvuloplasty Includes: Percutanous transluminal balloon valvuloplasty Y53.- Approach to gan under image control Z32.2 Atic valve Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. Without stenting: L26.1 Percutaneous transluminal balloon angioplasty of ata Y53.- Approach to gan under image control With stenting: L26.5 Percutaneous transluminal insertion of stent into ata A supplementary code from L76.- Endovascular placement of stent L89.- Other endovascular placement of stent would be added to identify the type and number of stents Y53.- Approach to gan under image control Note: Current coding rules state that when angioplasty and stent procedures are perfmed concurrently, and individual codes are available f the angioplasty and stent, only the code f the stent insertion is required. This is because the angioplasty is implicit within the code f stent insertion. Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to gan under image control is assigned. In addition ICD-10 code Q25.1 Coarctation of ata is assigned. 96 Endovascular closure of atrial septal defect 95 Radiofrequency valvotomy f pulmonary atresia K13.3 Percutaneous transluminal repair of defect of interatrial septum using prosthesis Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. K35.4 Percutaneous transluminal pulmonary valvotomy Includes: Percutaneous transluminal balloon valvotomy of pulmonary valve Y11.4 Radiofrequency controlled thermal destruction of gan NOC Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. 79 Stent placement f vena caval obstruction L79.3 Insertion of stent into vena cava NEC Note: Use a supplementary code f placement of stent (L76, L89, O20) A code from categy L76.- Endovascular placement of stent L89.- Other endovascular placement of stent O20.- Endovascular placement of stent graft is added to specify the type and number of stents used. and Y53.1 Approach to gan under radiological control

16 75 Balloon angioplasty of pulmonary vein stenosis in infants With stenting L80.4 Percutaneous transluminal insertion of stent into pulmonary vein a supplementary code from L76 L89 would be added to identify type and number of stents + Y53.- Approach to gan under image control without stenting L80.2 Percutaneous transluminal balloon angioplasty of pulmonary vein L80.3 Percutaneous transluminal cutting balloon angioplasty of pulmonary vein + Y53.- Approach to gan under image control Note: Current coding rules state that when angioplasty and stent procedures are perfmed concurrently, and individual codes are available f the angioplasty and stent, only the code f the stent insertion is required. This is because the angioplasty is implicit within the code f stent insertion. Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to gan under image control is assigned. 77 Balloon dilatation of systemic to pulmonary arterial shunts in children 86 Endovascular atrial septostomy L05.4 Percutaneous transluminal balloon dilation of interposition tube prosthesis between pulmonary artery and ata Y53.1 Approach to gan under radiological control K16.1 Percutaneous transluminal balloon atrial septostomy Y53.- Approach to gan under image control K16.2 Percutaneous transluminal atrial septostomy NEC Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. 97 Endovascular closure of patent ductus arteriosus L03.1 Percutaneous transluminal prosthetic occlusion of patent ductus arteriosus Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. 60 Thrombin injections f pseudoaneurysms 37 Transilluminated powered phlebectomy f varicose veins L97.7 Thrombin injection f pseudoaneurysm Y53.2 Approach to gan under ultrasonic control L87.7 Transilluminated powered phlebectomy of varicose vein of leg Excludes: Combined operations on varicose vein of leg (L84)

17 128 Totally endoscopic robotically assisted conary artery bypass grafting An OPCS-4 code from K40-K44 is selected f the Conary Artery Bypass Grafting: K40.- Saphenous vein graft replacement of conary artery K41.- Other autograft replacement of conary artery K42.- Allograft replacement of conary artery K43.- Prosthetic replacement of conary artery K44.- Other replacement of conary artery Includes: Conary artery bypass graft NEC In addition the following code is assigned directly following the primary procedure code: Y74.3 Robotic minimal access approach to thacic cavity Note: Regarding categies K40-K44: A supplementary code must be used f concurrent repair of valve of heart (K25-K29). A supplementary code must be used f concurrent excision of lesion of ventricle of heart (K23.1) repair of defect of interventricular septum (K11) These categies must be used as supplementary codes in the case of concurrent connection of thacic artery to conary artery (K45) 52 Endovenous laser treatment of the long saphenous vein 98 Intraoperative fluescence angiography in conary artery bypass grafting Other recommendation (e.g nmal + special) 121 Radiofrequency ablation f atrial fibrillation in association with other cardiac surgery L88.1 Percutaneous transluminal laser ablation of long saphenous vein Y53.2 Approach to gan under ultrasonic control Note: L88.3 Percutaneous transluminal laser ablation of varicose vein of leg NEC can be assigned if this is on a different vein and not the long saphenous vein. Y53.8 Other specified approach to gan under image control Y37.1 Introduction of photodynamic substance into gan NOC Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of image control: the code f the CABG is assigned in the primary position. OPCS-4 code Y37.1 indicates that indocyanine green (ICG) dye has been administered. One of the following codes would be assigned: K52.1 Open ablation of atrioventricular node K52.8 Other specified open operations on conducting system of heart The following code would be assigned in addition to one of the above codes: Y11.4 Radiofrequency controlled thermal destruction of gan NOC If code K52.8 is chosen, the site code Z33.6 Atrium of heart is assigned following Y11.4. Note: Codes are f patients undergoing concomitant open-heart surgery. In addition ICD-10 code I48.X Atrial fibrillation and flutter would be recded. 294 Percutaneous (non-thacoscopi c) epicardial catheter radiofrequency ablation f atrial fibrillation K64.1 Percutaneous radiofrequency ablation of epicardium Y53.4 Approach to gan under fluoscopic control In addition the ICD-10 code I48.X Atrial fibrillation and flutter would be recded.

18 122 Microwave ablation f atrial fibrillation in association with other cardiac surgery One of the following codes would be assigned: K52.1 Open ablation of atrioventricular node K52.8 Other specified open operations on conducting system of heart The following code would be assigned in addition to one of the above codes: Y11.6 Microwave destruction of gan NOC If code K52.8 is chosen, the site code Z33.6 Atrium of heart is assigned following Y11.6. Note: Codes are f patients undergoing concomitant open-heart surgery. In addition ICD-10 code I48.X Atrial fibrillation and flutter would be recded. 123 Cryoablation f atrial fibrillation in association with other cardiac surgery One of the following codes would be assigned: K52.1 Open ablation of atrioventricular node K52.8 Other specified open operations on conducting system of heart The following code would be assigned in addition to one of the above codes: Y11.2 Cryotherapy to gan NOC If code K52.8 is chosen, the site code Z33.6 Atrium of heart is assigned following Y11.2. Note: Codes are f patients undergoing concomitant open-heart surgery. In addition ICD-10 code I48.X Atrial fibrillation and flutter would be recded. 168 Percutaneous radiofrequency catheter ablation f atrial fibrillation One of the following codes is assigned depending on the area of ablation: K57.4 Percutaneous transluminal ablation of accessy pathway K62.1 Percutaneous transluminal ablation of pulmonary vein to left atrium conducting system K62.2 Percutaneous transluminal ablation of atrial wall f atrial flutter K62.3 Percutaneous transluminal ablation of conducting system of heart f atrial flutter NEC In addition to one of the above codes, the following code is assigned in addition: Y11.4 Radiofrequency controlled thermal destruction of gan NOC Note: The OPCS-4 code Y53.4 Approach to gan under fluoscopic control is assigned in addition if fluoscopic guidance is used. If codes K57.4 K62.3 are chosen, the site code Z33.6 Atrium of heart is assigned following Y11.4, following Y53.4 if fluoscopic control is used. In addition the ICD-10 code I48.X Atrial fibrillation and flutter would be recded.

19 184 High intensity focused ultrasound ablation f atrial fibrillation as an associated procedure with other cardiac surgery One of the following codes would be assigned: K52.1 Open ablation of atrioventricular node K52.8 Other specified open operations on conducting system of heart The following code would be assigned in addition to one of the above codes: Y11.5 Ultrasonic destruction of gan NOC If code K52.8 is chosen, the site code Z33.6 Atrium of heart is assigned following Y11.5. Note: Codes are f patients undergoing concomitant open-heart surgery. In addition ICD-10 code I48.X Atrial fibrillation and flutter would be recded. 219 Lower limb deep vein valve reconstruction f chronic deep venous incompetence 229 Laparoscopic repair of abdominal atic aneurysm L82.8 Other specified repair of valve of vein A code from Chapter Z can be added to identify the site of the vein Note: Y07.1 Ligation of gan NOC can be added (above the site code) if external banding is carried out A code from categies L18.- L19.- would be selected depending if the procedure is an emergency (an emergency is defined as using unscheduled operating theatre time) not ( not known) and with the fourth character dependent on the specific site of the ata that is replaced: L18.- Emergency replacement of aneurysmal segment of ata Includes: Emergency replacement of aneurysmal segment of ata using prosthesis Y75.4 Hand assisted minimal access approach to abdominal cavity Y75.2 Laparoscopic approach to abdominal cavity NEC (see Note) L19.- Other replacement of aneurysmal segment of ata Includes: Replacement of aneurysmal segment of ata using prosthesis NEC Y75.4 Hand assisted minimal access approach to abdominal cavity Y75.2 Laparoscopic approach to abdominal cavity NEC (see Note) Note: : Laparoscopic repair of abdominal atic aneurysm can be done by hand-assisted laparoscopic surgery (HALS) coded by the addition of Y75.4 Hand assisted minimal access approach to abdominal cavity by the technically me demanding totally laparoscopic surgery (TLS ) coded by the addition of Y75.2 Laparoscopic approach to abdominal cavity NEC. 237 Percutaneous pulmonary valve implantation f right ventricular outflow tract dysfunction 245 Thacoscopically assisted mitral valve surgery K35.7 Percutaneous transluminal pulmonary valve replacement Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. A code from Y74. - Minimal access to thacic cavity would be used as a supplementary code following a code from Chapter K f the primary mitral valve surgery carried out.

20 250 Arterio venous extracpeal membrane carbon dioxide removal 254 Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) f mediastinal masses 309 Percutaneous mitral valve leaflet repair f mitral regurgitation Other recommendation (e.g nmal + special) X58.8 Other specified artificial suppt f body system E63.2 Endobronchial ultrasound examination of mediastinum Note: Use a supplementary code f concurrent biopsy of mediastinal lymph node (T87.4) T87.4 Excision biopsy of mediastinal lymph node K35.8 Other specified percutaneous transluminal operations on valve of heart Y07.2 Clipping of cavity of gan NOC (if clips are used) Y53.4 Approach to gan under fluoscopic control Z32.1 Mitral valve Note: U20.2Transoesophageal echocardiography is also assigned when transoesophageal echocardiography (TOE) is used during the procedure. Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. 266 Transcatheter atic valve implantation f atic stenosis Transluminal approach: K26.2 Xenograft replacement of atic valve Y79.- Approach to gan through artery Y53.- Approach to gan under image control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. Transapical / transventricular approach: K26.2 Xenograft replacement of atic valve Y49.4 Transapical approach to heart 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 categise procedures f analysis and it is not always possible to identify a procedure uniquely. 302 Percutaneous laser revascularistion f refracty angina pectis Do not use K23.4 Revascularisation of wall of heart Includes: Revascularisation of heart Y08.5 Laser modification of gan NOC Y53.4 Approach to gan under fluoscopic control Note: Codes within categy Y53.- are used as secondary codes to classify interventions that are percutaneous and require some fm of Unspecified approach to gan under image control is assigned. Note: U2.1 Transthacic echocardiography, U20.2 Transoesophageal echocardiography, U20.3 Intravascular echocardiography U20.4 Epicardial echocardiography is also assigned when echocardiography is used during the procedure. In addition a code from categy I20.- Angina pectis is assigned.

21 295 Percutaneous Other (non-thacoscopi recommendation c) epicardial (e.g nmal + catheter special) radiofrequency ablation f ventricular tachycardia 310 Placement of pectus bar f pectus excavatum (also known as MIRPE the Nuss procedure) 286 Thacoscopic epicardial radiofrequency ablation f atrial fibrillation 352 Percutaneous Research only mitral valve annuloplasty 336 Transcatheter endovascular closure of perimembranous ventricular septal defect 314 Ultrasound-guided foam sclerotherapy f varicose veins K64.1 Percutaneous radiofrequency ablation of epicardium Y53.4 Approach to gan under fluoscopic control In addition the ICD-10 code I47.2 Ventricular tachycardia would be recded. T02.1 Crection of pectus defmity of chest wall Includes: Crection of pectus carinatum Crection of pectus excavatum Y74.1 Thacoscopically assisted approach to thacic cavity (if used) Y02.2 Insertion of prosthesis into gan NOC K52.8 Other specified open operations on conducting system of heart Y74.2 Thacoscopic approach to thacic cavity NEC Y11.4 Radiofrequency controlled thermal destruction of gan NOC Z33.6 Atrium of heart In addition ICD-10 code I48.X Atrial fibrillation and flutter would be recded. K35.8 Other specified therapeutic transluminal operations on valve of heart Y02.2 Insertion of prosthesis into gan NOC Y53.4 Approach to gan under fluoscopic control Z32.1 Mitral valve U20.2 Transoesophageal echocardiography (if carried out) K13.1 Percutaneous transluminal repair of defect of interventricular septum using prosthesis Y53.4 Approach to gan under fluoscopic control L86.2 Ultrasound guided foam sclerotherapy f varicose vein of leg