The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on ultrasound-guided catheterisation of the epidural space.


The epidural space is surrounding the spinal cord, inside the spinal column. Epidural space catheterisation through the middle or lower back is usually performed as part of anaesthetic techniques, in order to inject analgesic drugs. A needle is inserted into the interspinous ligament and advanced very slowly until there is no longer any resistance to the injection of air or saline, indicating that the tip of the needle is in the epidural space. However, there are at times technical difficulties in achieving this. Ultrasound imaging may be used to help identify the epidural space.

Coding recommendations

The following codes are applied for ultrasound guided catheterisation of the epidural space, except for catheterisation of the epidural space for pain management during delivery and surgery. 

A54.8 Other specified therapeutic spinal puncture

Y53.2 Approach to organ under ultrasonic control

Z06.3 Lumbar spinal cord

Note; If the epidural is performed for pain control in labour then Y81.- Spinal anaesthetic is applied in a secondary position., There is no national standard to record administration of anaesthetic during a procedure, therefore these codes would not be used in this scenario.

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.