The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Off-pump coronary artery bypass grafting.

It replaces the previous guidance on Off-pump coronary artery bypass (OPCAB) (Interventional Procedures Guidance no. 35, January 2004).  

  • Description

    Coronary artery disease (also called coronary heart disease or ischaemic heart disease) happens when the build-up of a fatty substance narrows or blocks the arteries restricting supply of blood to the heart muscle, which may cause chest pain (angina) or a heart attack.

    Coronary artery bypass grafting aims to improve the flow of blood to the heart muscle. The surgeon uses a healthy blood vessel, usually taken from the chest or the leg, and attaches it on the heart muscle so that blood can get round (‘bypass’) the affected part of the coronary artery.

  • OPCS4.6 Code(s)

    An OPCS-4 code from categories K40-K44 is selected for the Coronary Artery Bypass Grafting:

    K40.- Saphenous vein graft replacement of coronary artery

    K41.- Other autograft replacement of coronary artery

    K42.- Allograft replacement of coronary artery

    K43.- Prosthetic replacement of coronary artery

    K44.- Other replacement of coronary artery

    Includes: Coronary artery bypass graft NEC

    Note: Regarding categories K40-K44:

    • A supplementary code must be used for concurrent repair of valve of heart (K25-K29).

    • A supplementary code must be used for concurrent excision of lesion of ventricle of heart (K23.1) or  repair of defect of interventricular septum (K11)

    • These categories must be used as supplementary codes in the case of concurrent connection of thoracic artery to coronary artery (K45)

    Note: It is not possible to capture the fact that the coronary artery bypass grafting was performed off-pump (OPCAB) using OPCS-4 codes. However on-pump surgery using cardiopulmonary bypass is coded using Y73.1 Cardiopulmonary bypass whenever it is stated to have been carried out.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.



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