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 atherectomy as an adjunct to balloon angioplasty (with or without stenting) for peripheral arterial disease.

Description

Blood vessels (arteries) in the legs can become blocked by the build-up of fatty deposits on the inner surface. This can cause leg pain when walking or at rest and, in advanced cases, foot ulcers and gangrene.

For this procedure, a laser attached to a flexible plastic tube (a catheter) is inserted into a blood vessel in the leg and moved to the site of the blockage to burn away the deposits. A balloon is then inserted and inflated to widen the artery at the site of the blockage. An expandable mesh tube (stent) may also be inserted to keep the artery open.

Coding recommendations

Percutaneous laser atherectomy with balloon angioplasty without stent:

L71.7 Percutaneous transluminal atherectomy

Y08.4 Laser destruction of lesion of organ NOC

L66.5 Percutaneous transluminal balloon angioplasty of artery

Y53.- Approach to organ under image control

Site code for the artery

Percutaneous laser atherectomy with balloon angioplasty and insertion of stent:

L71.7 Percutaneous transluminal atherectomy

Y08.4 Laser destruction of lesion of organ NOC

Plus one of the following 3 codes:

L63.5 Percutaneous transluminal insertion of stent into femoral artery

L54.4 Percutaneous transluminal insertion of stent into iliac artery

L66.7 Percutaneous transluminal placement of peripheral stent in artery

Plus a code from one of the following categories:

L76.- Endovascular placement of stent or

L89.- Other endovascular placement of stent

Plus

Y53.- Approach to organ under image control

Site code for the artery

Note: Current coding rules state that when angioplasty and stent procedures are performed concurrently, and individual codes are available for the angioplasty and stent, only the code for the stent insertion is required. This is because the angioplasty is implicit within the code for stent insertion.

 

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.

  • National Institute for Health and Care Excellence (NICE)