Sacral nerve stimulation for faecal incontinence (IPG99)
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on sacral nerve stimulation for faecal incontinence.
It replaces the previous guidance on sacral nerve stimulation for faecal incontinence (Interventional Procedures Guidance no. 5, October 2004) after reviewing the results a systematic review, requested in the original guidance.
Faecal incontinence occurs when a patient loses control over the passing of faeces from the rectum to the outside of the body. Faecal incontinence may result from degeneration of the anal sphincter, spinal injury or other neurologic disorders.
Faecal incontinence is associated with a high level of physical and social disability. If left untreated, the patient may end up wearing pads to control the condition. Faecal incontinence is the second leading cause of admission to long-term care facilities in the United States.
In patients with a weak but structurally intact sphincter it may be possible to alter sphincter and proximal bowel behaviour using the surrounding nerves and muscles. Sacral nerve stimulation is a treatment option for these patients. It involves low-level electrical stimulation applied via electrodes through the sacral foramina to the sacral nerve supply of the lower bowel and sphincters. Shortly after surgery continuous stimulation begins. The patient interrupts the pulse for defaecation and voiding, using an external magnet.
Depending on the details of the procedure performed, one of the following OPCS-4 codes is utilised:
A70.1 Implantation of neurostimulator into peripheral nerve
A70.2 Maintenance of neurostimulator in peripheral nerve
A70.3 Removal of neurostimulator from peripheral nerve
A70.4 Insertion of neurostimulator electrodes into peripheral nerve
In addition to one of the above OPCS-4 codes the following site code would be assigned:
Z11.2 Sacral nerve.
Note: OPCS-4 code Y70.5 Temporary operations would be assigned in addition to A70.4 Insertion of neurostimulator electrodes into peripheral nerve if temporary electrodes are inserted to test whether the intervention is likely to be effective, but the pulse generator device is not implanted under the skin.
In addition, the ICD-10 code R15.X Faecal incontinence is assigned.
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding
- IPG99 Sacral nerve stimulation for faecal incontinence: guidance (web format)
- IPG99 Sacral nerve stimulation for faecal incontinence: guidance
- IPG99 Sacral nerve stimulation for faecal incontinence: understanding NICE guidance
- Interventional procedure consultation document - sacral nerve stimulation for faecal incontinence (second consultation)
- Systematic review of the efficacy and safety of sacral nerve stimulation for faecal incontinence
This page was last updated: 12 April 2011
- Web format
- Full Guidance (PDF)
- IPG99 Symbylu'r nerf sacrol ar gyfer baeddu: deall canllawiau NICE (fformat MS Word)
Information for the public
Implementation tools and resources
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The summary of the key recommendations in the guidance written for patients, carers and those with little medical knowledge and may be used in local patient information leaflets.
Quick Reference Guide
The quick reference guide presents recommendations for health professionals
The published NICE clinical guidance, contains the recommendations for health professionals and NHS bodies.
The published full clinical guidance for specialists with background, evidence, recommendations and methods used.