The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on percutaneous laser revascularistion for refractory angina pectoris. Full guidance has also been published on laser transmyocardial revascularistion for refractory angina pectoris.


Patients with refractory angina pectoris have chest pain (because of insufficient oxygen delivery to their heart muscle) that cannot be controlled by optimal medical or surgical management. Percutaneous laser revascularisation involves insertion of a catheter into major vessels of the groin, which is advanced to the heart, to drill holes on the heart muscle using a laser beam. The aim is to enable blood flow from the heart chambers into the heart muscle, to relieve myocardial ischaemia and reduce chest pain.

Coding recommendations

K23.4 Revascularisation of wall of heart

Includes: Revascularisation of heart

Y08.5 Laser modification of organ NOC

Y53.4 Approach to organ under fluoroscopic 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.

Note: U20.1 Transthoracic echocardiography, U20.2 Transoesophageal echocardiography, U20.3 Intravascular echocardiography or U20.4 Epicardial echocardiography is also assigned when echocardiography is used during the procedure.

In addition a code from the ICD-10 category I20.- Angina pectoris would be recorded.

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.

  • National Institute for Health and Care Excellence (NICE)