The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on corneal implants for keratoconus.


Keratoconus is a disease of the cornea which affects the shape of the eyeball and causes refractive errors, some of which cannot be corrected by spectacles or contact lenses. The insertion of clear plastic implants into the cornea is an interventional procedure aiming to restore eyesight in patients with this condition.

Coding recommendations

C46.4 Insertion of prosthesis into cornea

Excludes: Insertion of therapeutic contact lens (C51.5)

In addition ICD-10 code H18.6 Keratoconus or Q13.4 Other congenital corneal malformations or a combination of Dagger(†) and Asterisk(*) codes Q90.-† Down’s syndrome and H19.8A Other disorders of sclera and cornea in diseases classified elsewhere would be assigned. In the ICD-10 4th Edition † and * codes must appear together, sequencing depends on which is the main condition treated or investigated during the consultant episode, if this is not clear the † code is assigned before the * code.

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, and specifically any special arrangements relating to the introduction of new interventional procedures. 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. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

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. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

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.