The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Insertion of endobronchial nitinol coils to improve lung function in emphysema, in March 2015.


Emphysema is a chronic lung disease, which is usually related to smoking but may also be inherited. It is one of a group of diseases referred to as chronic obstructive pulmonary disease (COPD). Common symptoms of emphysema are dyspnoea, coughing, fatigue and weight loss.

Current treatment options include pulmonary rehabilitation (advice on smoking cessation, patient and carer education, exercise training and breathing retraining) and use of inhaled or oral bronchodilators and glucocorticoids. Some patients benefit from oxygen treatment. In advanced disease, lung volume reduction surgery (thoracoscopic or open), insertion of one-way endobronchial valves or lung transplantation may be needed.

Coding recommendations

The OPCS-4 codes for insertion of endobronchial nitinol coils to improve lung function in emphysema are:

E48.8 Other specified therapeutic fibreoptic endoscopic operations on lower respiratory tract

Y36.2 Introduction of therapeutic implant into organ NOC

Y53.4 Approach to organ under fluoroscopic control

Z24.6 Lung

In addition a code from the ICD-10 category J43 Emphysema would be recorded.

The Clinical Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis ant it is not always possible to identify a procedure uniquely.

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)