Balloon dilatation with or without stenting for pulmonary artery or non-valvar right ventricular outflow tract obstruction in children

NICE interventional procedures guidance [IPG76] 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 Northern Ireland on balloon dilatation with or without stenting for pulmonary artery or non-valvar right ventricular outflow tract obstruction in children.

  • Description

    The right ventricular outflow tract includes the pulmonary valve and the tissue above and below it. Narrowing (stenosis) of this region may involve the area below the valve (subvalvar), the valve itself (valvar) or the area above the valve (supravalvar). Balloon angioplasty of valvar right ventricular outflow tract narrowing (pulmonary valve stenosis) is covered in a separate overview.

    Congenital subvalvar and supravalvar right ventricular outflow tract stenosis usually occurs with other cardiac defects such as ventricular septal defect or tetralogy of Fallot. Postoperative right ventricular outflow tract obstruction may occur after surgery to create a conduit between the right ventricle and pulmonary artery in children with congenital anomalies.

    Narrowing may also occur beyond the right ventricular outflow tract, in one of the pulmonary arteries, or in their branches. This may also be congenital or occur following surgery for congenital defects.

    Balloon dilatation is a minimally invasive transvenous procedure to dilate the obstruction during cardiac catheterisation. Stenting involves the insertion of a small tube within the narrow region following balloon angioplasty. Standard treatment of right ventricular outflow tract or pulmonary artery obstruction involves open chest surgery.

  • OPCS4.6 Code(s)

    With stenting:

    L13.6 Percutaneous transluminal insertion of stent into pulmonary artery

    A supplementary code from L76.- Endovascular placement of stent or  L89.- Other endovascular placement of stent would be added to identify the type and number of stents

    Y53.- Approach to organ under image control

    Without stenting:

    L13.4 Percutaneous transluminal cutting balloon angioplasty of pulmonary artery

    Y53.- Approach to organ under image control

    or

    L13.5 Percutaneous transluminal balloon angioplasty of pulmonary artery NEC

    Y53.- Approach to organ under image control

    Note: Current coding rules state that when angioplasty and stent procedures are performed concurrently, and individual codes are available for the angioplasty and stent, only the code for the stent insertion is required. This is because the angioplasty is implicit within the code for stent insertion.

    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 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.  www.connectingforhealth.co.uk/clinicalcoding

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