The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Carotid artery stent placement for symptomatic extracranial carotid stenosis.

It replaces the previous guidance on carotid artery stent placement for carotid stenosis (NICE interventional procedures guidance 191, September 2006).  

NICE has also published guidance on carotid artery stent placement for asymptomatic extracranial carotid stenosis (NICE interventional procedures guidance 388, April 2011).

Description

The main arteries in the neck (the carotid arteries) can become narrowed by fatty deposits. Blood clots can form on these fatty deposits and fragments can detach and lodge in thinner arteries that supply blood to parts of the brain, causing a transient ischaemic attack (TIA, sometimes called a ‘mini stroke’) or a stroke.

In this procedure a metal mesh called a stent is used to widen the narrowed carotid artery. This procedure does not involve making a cut in the neck. Instead a fine wire is inserted into an artery in the leg and passed up into the carotid artery, and the stent is then moved into place along the wire. Some stenting also includes protective devices, to help to prevent any fragments loosened by the stent insertion from reaching smaller arteries and causing a stroke.

Coding recommendations

L31.4 Percutaneous transluminal insertion of stent into carotid artery

Note: Use a supplementary code for placement of stent (L76, L89, O20)

A code from  category L76.- Endovascular placement of stent or L89.- Other endovascular placement of stent or O20.- Endovascular placement of stent graft is added to specify the type and number of stents used.  Please note that the .8 and .9 codes from extended category L89 must not be used.

Y53.- Approach to organ under image control

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.

In addition the ICD-10 codes I65.2 Occlusion and stenosis of carotid artery or I65.3 Occlusion and stenosis of multiple and bilateral precerebral arteries would be recorded. It is not possible to specify that the carotid stenosis is symptomatic.

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.

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