Guidance

Appendix D: High-risk procedures

Appendix D: High-risk procedures

The OPCS‑4 codes for intradural operations on the brain and spinal cord are shown below.

Neurosurgery

This list may not be comprehensive.

All purposeful intradural brain and spinal cord surgery are regarded as high-risk and this guidance applies wherever there is contact with or possible contamination by brain or spinal cord tissue.

Extradural surgery, even in the presence of a cerebrospinal fluid leak, is not high risk and this guidance does not apply.

  • A01 Major excision of tissue of brain

  • A02 Excision of lesion of tissue of brain

  • A03 Stereotactic ablation of tissue of brain

  • A04 Open biopsy of lesion of tissue of brain

  • A05 Drainage of lesion of tissue of brain

  • A07 Other open operations on tissue of brain

  • A08 Other biopsy of lesion of tissue of brain

  • A09 Neurostimulation of brain

  • A10 Other operations on tissue of brain

  • A12 Creation of connection from ventricle of brain

  • A13 Attention to component of connection from ventricle of brain

  • A14 Other operation on connection from ventricle of brain

  • A16 Other open operations on ventricle of brain

  • A20 Other operations on ventricle of brain

  • A22 Operations on subarachnoid space of brain

  • A24 Graft to cranial nerve

  • A25 Intracranial transection of cranial nerve

  • A26 Other intracranial destruction of cranial nerve

  • A29 Excision of lesion of cranial nerve

  • A30 Repair of cranial nerve

  • A31 Intracranial stereotactic release of cranial nerve

  • A32 Other decompression of cranial nerve

  • A33 Neurostimulation of cranial nerve

  • A34 Exploration of cranial nerve

  • A36 Other operations on cranial nerve

  • A38 Extirpation of lesion of meninges of brain

  • A39 Repair of dura

  • A42 Other operations on meninges of brain

  • B01 Excision of pituitary gland

  • B02 Destruction of pituitary gland

  • B04 Other operations on pituitary gland

  • B06 Operations on the pineal gland

  • L33 Operations on aneurysm of cerebral artery

  • L34 Other open operations on cerebral artery

  • A44.1 Chordectomy of spinal cord

  • A44.2 Extirpation of lesion of spinal cord NEC

  • A44.3 Excision of lesion of intradural intramedullary spinal cord

  • A44.5 Excision of lesion of intradural extramedullary spinal cord

  • A44.8 Other specified partial extirpation of spinal cord

  • A44.9 Unspecified partial extirpation of spinal cord

  • A45.1 Stereotactic chordotomy of spinal cord

  • A45.2 Open chordotomy of spinal cord NEC

  • A45.3 Myelotomy of spinal cord

  • A45.4 Open biopsy of lesion of spinal cord

  • A45.5 Removal of foreign body from spinal cord

  • A45.6 Open aspiration of lesion of spinal cord

  • A45.8 Other specified other open operations on spinal cord

  • A47.1 Needle destruction of substantia gelatinosa of cervical spinal cord

  • A47.2 Radiofrequency controlled thermal destruction of spinothalamic tract

  • A47.3 Percutaneous chordotomy of spinal cord

  • A47.8 Other specified other destruction of spinal cord

  • A48.1 Biopsy of lesion of spinal cord NEC

  • A48.2 Aspiration of lesion of spinal cord

  • A48.3 Insertion of neurostimulator adjacent to spinal cord

  • A48.4 Attention to neurostimulator adjacent to spinal cord NEC

  • A48.6 Removal of neurostimulator adjacent to spinal cord

  • A48.7 Insertion of neurostimulator electrodes into the spinal cord

  • A48.8 Other specified other operations on spinal cord

  • A49.1 Freeing of spinal tether NEC

  • A49.2 Closure of spinal myelomeningocele

  • A49.3 Closure of spinal meningocele

  • A49.4 Complex freeing of spinal tether

  • A49.8 Other specified repair of spina bifida

  • A49.9 Unspecified repair of spina bifida

  • A51.1 Extirpation of lesion of meninges of spinal cord

  • A51.2 Freeing of adhesions of meninges of spinal cord

  • A51.3 Biopsy of lesion of meninges of spinal cord

  • A51.8 Other specified other operations on meninges of spinal cord

  • A51.9 Unspecified other operations on meninges of spinal cord

  • A53.1 Cerebrospinal syringostomy

  • A53.3 Creation of syringoperitoneal shunt

  • A57.1 Extirpation of lesion of spinal nerve root

  • A57.6 Reimplantation of spinal nerves into spinal cord

Posterior eye surgical procedures that are regarded as high-risk posterior segment eye surgery

Orbit (C01 to C08)

  • C01 Excision of eye

  • C03 Insertion of prosthesis of eye

  • C04 Attention to prosthesis of eye

These orbital operations are only included if the surgery or implant is likely to come into contact with the optic nerve or retinal tissue (for example, evisceration of the eye and intra-orbital implant).

Operations on optic nerve (A29.1 to A36.4)

  • A29.1 Excision of lesion of optic nerve

  • A30.1 Repair of optic nerve

  • A32.1 Decompression of optic nerve

  • A34.1 Exploration of optic nerve

  • A36.4 Radial Optic Neurotomy

Sclera and iris (C52 to C65)

C54 Buckling operations for attachment of retina

Retina, other parts of eye and anaesthetics (C79 to C90)

  • C79 Operations on vitreous body, only when this involves potential contact with the posterior hyaloid face. For example:

    • Code C7910 for vitrectomy via anterior approach and code C7923 for intravitreal injections are specifically excluded because they are unlikely to come into contact with the posterior hyaloid face.

    • Code C7920 and code C7922, which potentially could come into contact with the hyaloid face, are included.

  • C80 Operations on retinal membrane

  • C81 Photocoagulation of retina for detachment, only when the retina is handled directly

  • C82 Destruction of lesion of retina, only when the retina is handled directly

    • Code C82.4 for insertion of radiotherapy plaques is specifically excluded.

  • C83 Translocation of retina

  • C84 Other operations on retina

  • C85 Fixation of retina

  • C86 Other operations on eye

  • C88 Destruction of subretinal lesion

  • C89 Operations on posterior segment of eye

ISBN: 978-1-4731-3605-2