The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Off-pump coronary artery bypass grafting.

It replaces the previous guidance on Off-pump coronary artery bypass (OPCAB) (NICE interventional procedures guidance 35, January 2004).  


Coronary artery disease (also called coronary heart disease or ischaemic heart disease) happens when the build-up of a fatty substance narrows or blocks the arteries restricting supply of blood to the heart muscle, which may cause chest pain (angina) or a heart attack.

Coronary artery bypass grafting aims to improve the flow of blood to the heart muscle. The surgeon uses a healthy blood vessel, usually taken from the chest or the leg, and attaches it on the heart muscle so that blood can get round (‘bypass’) the affected part of the coronary artery.

Coding recommendations

An OPCS-4 code from categories 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

Note: Regarding categories K40-K44:

• 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)

Note: It is not possible to capture the fact that the coronary artery bypass grafting was performed off-pump (OPCAB) using OPCS-4 codes. However on-pump surgery using cardiopulmonary bypass is coded using Y73.1 Cardiopulmonary bypass whenever it is stated to have been carried out.

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.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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