The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic repair of abdominal aortic aneurysm in August 2007. 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 August 2010 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.

Description

A midline minilaparotomy incision is made for insertion of one of the surgeon's hands for hand assisted laparoscopic surgery (HALS). Three or more small skin incisions are made for insertion of a laparoscope and instruments. Clamps are applied above and below the aneurysm and its sac is opened. Thrombus is removed and patent lumbar arteries are sutured from the inside of the aneurysm. A prosthetic vascular graft is anastomosed to the proximal and distal ends of the aorta. The aneurysm wall and the posterior parietal peritoneum are closed to cover the graft.

Coding recommendations

A code from categories L18.- or L19.- would be selected depending if the procedure is an emergency (an emergency is defined as using unscheduled operating theatre time) or not (or not known) and with the fourth character dependent on the specific site of the aorta that is replaced:

L18.- Emergency replacement of aneurysmal segment of aorta

Includes: Emergency replacement of aneurysmal segment of aorta using prosthesis

Y75.4 Hand assisted minimal access approach to abdominal cavity or Y75.2 Laparoscopic approach to abdominal cavity NEC (see Note)

or

L19.- Other replacement of aneurysmal segment of aorta

Includes: Replacement of aneurysmal segment of aorta using prosthesis NEC

Y75.4 Hand assisted minimal access approach to abdominal cavity or Y75.2 Laparoscopic approach to abdominal cavity NEC (see Note)

Note: : Laparoscopic repair of abdominal aortic aneurysm can be done by hand-assisted laparoscopic surgery (HALS) coded by the addition of  Y75.4 Hand assisted minimal access approach to abdominal cavity or by the technically more demanding totally laparoscopic surgery (TLS ) coded by the addition of Y75.2 Laparoscopic approach to abdominal cavity NEC.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.