The Interventional Procedures Advisory Committee (IPAC) originally considered this procedure as one procedure, entitled coil embolisation for intracranial aneurysms. However, as a result of comments received during the initial consultation in June 2003, IPAC decided to consider the procedure separately for ruptured intracranial aneurysms and for unruptured intracranial aneurysms.
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on coil embolisation of ruptured intracranial aneurysms.
To be alerted to developments regarding the use of the procedure to treat unruptured intracranial aneurysms please refer to NICE interventional procedure guidance 105.
This procedure is used to treat intracranial aneurysms. Rupture of intracranial aneurysms has a poor prognosis and can be fatal.
Standard treatment for ruptured intracranial aneurysm involves open surgery to clip the aneurysms inside the skull. Endovascular techniques techniques involve approaching the aneurysm from inside the diseased blood vessel, avoiding the need for open surgery.
A thin tube, containing the coil device on a guidewire, is inserted into a large artery, usually in the groin, and passed up into the skull under X-ray control. The coil is placed inside the aneurysm and detached from the guidewire. Multiple coils can be placed the aneurysm through the same tube until the aneurysm is densely packed.
The technique is mainly carried out on ruptured aneurysms but may also be used to treat unruptured aneurysms.
The OPCS-4 codes are dependent on the size of the aneurysm:
O01.1 Percutaneous transluminal coil embolisation of small aneurysm of artery
O01.2 Percutaneous transluminal coil embolisation of medium aneurysm of artery
O01.3 Percutaneous transluminal coil embolisation of large aneurysm of artery
O01.4 Percutaneous transluminal coil embolisation of giant aneurysm of artery
If the size of the aneurysm is other specified (.8), or unspecified (.9), then one of the following codes is assigned:
O01.8 Other specified transluminal coil embolisation of aneurysm of artery
O01.9 Unspecified transluminal coil embolisation of aneurysm of artery
Note: For balloon assisted coil embolisation a code from category O02.- Transluminal balloon assisted coil embolisation of aneurysm of artery is assigned instead of the above.
In addition to the primary procedure code above, two extra codes are both required:
Y53.- Approach to organ under image control
Z35.- Cerebral artery
Note: 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.