Laser sheath removal of pacing leads

NICE interventional procedures guidance [IPG63] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laser sheath removal of pacing leads.

  • Description

    This procedure is used to remove pacemaker leads that have been in place for more than a few months.

    A pacemaker is a device inserted to maintain the rhythm of the heart. During insertion, one or more leads are passed through the veins into the right side of the heart with their other ends are attached to the pacemaker, which is usually placed under the skin of the chest.

    Pacemaker leads may need to be removed or changed if they malfunction or become infected. If the leads have been in place for more than a few months, they can become tightly attached by scar tissue to the heart and the veins they pass through, making removal difficult and risky.

    Laser assisted removal of pacing leads is claimed to be quicker and less risky than other methods. It involves passing a double layered sheath over the pacing lead, starting with the end that lies outside the body. The inner layer of the sheath is fibreoptic and can transmit a laser beam. The outer layer is more rigid. The double sheath is passed slowly down over the lead while the laser destroys the scar tissue as the sheath advances. Near the heart wall, the more rigid outer sheath is advanced to provide countertraction for removal of the pacing lead.

    The procedure is generally carried out under X-ray control. It may take several hours.

  • OPCS4.6 Code(s)

    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 organ NOC

    Y53.1 Approach to organ under radiological control (if used)


    K61.4 Removal of cardiac pacemaker system NEC

    Y08.4 Laser destruction of lesion of organ NOC

    Y53.1 Approach to organ under radiological control (if used)

    Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control, if the method of image control is unspecified Y53.9 Unspecified approach to organ under image control is assigned.

    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.

    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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