The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on direct skeletal fixation of limb or digit prostheses using intraosseous transcutaneous implants.


If a leg, arm, finger or thumb has had to be amputated, or is missing at birth, an artificial substitute (known as a prosthetic limb or prosthesis) may be fitted. Prosthetic limbs usually have a socket and are held in place either by suction or by being strapped to the stump of the missing limb. In this procedure, a metal implant is inserted through the skin and into the centre of the bone of the stump. A prosthetic limb is then attached to the metal implant. The aim is to produce a more comfortable and securely attached prosthetic limb.

Coding recommendations

The precise code assignment for this procedure will be dependent on the limb or digit into which the implant is introduced.  Only the insertion of the implant into the medullary cavity of the residual bone can be classified in OPCS-4, the attachment of the prosthetic limb cannot. This procedure would be coded on a case by case basis.

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.