The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on totally endoscopic robotically assisted coronary artery bypass grafting in June 2005. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in June 2008 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


The development of endoscopic surgical techniques with robotic assistance has enabled this technology to be used for coronary artery bypass grafting, known as totally endoscopic coronary artery bypass surgery (TECAB) . Following deflation of the lung, small-port incisions are made at three intercostal spaces through which one robotic arm carrying the endoscope and two arms with surgical implement attachments are introduced. Grafts are harvested from suitable donor sites, and anastomosis is achieved across the diseased coronary artery in one or more vessels.

TECAB treatment of the beating heart is carried out using a stabilisation device, consisting of two branches like those used in the MIDCAB procedure, that hold the site for anastomosis steady while the heart continues to beat and removes the need for cardiopulmonary bypass. The stabilisation device requires an additional chest incision to be made when it is used.

Coding recommendations

An OPCS-4 code from 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

In addition the following code is assigned directly following the primary procedure code: Y74.3 Robotic minimal access approach to thoracic cavity.

 Note: Regarding categories K40-

  • 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).