CCSD code 25100 – Coeliac plexus, splanchnic and hypogastric diagnostic block

Key takeaways

CCSD Code 25100 covers diagnostic coeliac plexus, splanchnic nerve, and hypogastric blocks that use local anaesthetic to test a patient’s pain response.

Neurolytic blocks using alcohol, phenol, or radiofrequency are billed under a separate CCSD code, and mixing up the two is the most common denial trigger.

Image guidance is bundled into the 25100 fee, so the claim carries one line and no separate guidance code.

Procedure notes must record diagnostic intent, the guidance modality, the agent and volume injected, and the post-block pain assessment.

Claims management software like Pabau checks membership numbers and authorisation codes before Healthcode submission, then tracks each claim’s status.

What is CCSD Code 25100?

CCSD Code 25100 is the Clinical Coding and Schedule Development code for a diagnostic coeliac plexus block, splanchnic nerve block, or hypogastric block. The CCSD Group publishes and updates the procedure schedule used by UK private medical insurers, including Bupa, AXA Health, Aviva, Vitality, WPA, and Cigna.

Three anatomically distinct procedures share the code because they answer the same diagnostic question. Does the patient’s visceral or pelvic pain respond to sympathetic nerve interruption before anyone commits to a therapeutic or neurolytic intervention?

The word “diagnostic” in the descriptor limits the code to prognostic or test blocks. A block performed with chemical neurolysis (alcohol or phenol), or intended as a definitive treatment, is billed under a different CCSD code. Submitting a therapeutic block under 25100, or a diagnostic block under the neurolytic code, is the most frequent coding error in this procedure class.

The three procedures the code covers

All three procedures grouped under CCSD Code 25100 target ganglia or nerve trunks in the sympathetic nervous system that relay visceral pain signals. Each has its own anatomical target and clinical indication. What they share is diagnostic intent. Local anaesthetic temporarily interrupts the pain pathway, so the clinician can assess how the patient responds.

Pain specialists and anaesthetists should confirm in the procedure note which of the three blocks was performed and which anatomy was targeted. Insurers may query a claim that carries only the code number, with no matching procedure description in the notes.

Diagnostic vs therapeutic blocks: Where 25100 stops

The most consequential distinction in this procedure class is whether the block is diagnostic or therapeutic. CCSD Code 25100 covers diagnostic blocks only. Neurolytic blocks on the same structures use alcohol, phenol, or radiofrequency as a definitive treatment. They fall under a separate CCSD code, with different clinical criteria, documentation requirements, and insurer coverage rules.

Document the agent name, concentration, and volume in every procedure note. A note that records only “nerve block performed” gives the insurer no way to confirm diagnostic or neurolytic intent. That usually leads to a request for further information, or an outright rejection.

How the procedure is performed and what must be documented

Each procedural step maps to something the billing note must capture. In an insurer audit, the procedure note is the primary evidence that the correct code was applied. Below is the typical clinical sequence for a diagnostic coeliac plexus or splanchnic nerve block under image guidance.

1. Patient positioning and consent: The patient is placed prone. Written informed consent confirming the diagnostic (not therapeutic) purpose of the injection must be obtained and retained in the record.
2. Image guidance setup: Fluoroscopy, CT, or ultrasound guidance is established. The modality used must be named in the procedure note. Guidance is bundled into the 25100 fee, so no separate image guidance code is appended.
3. Needle placement: One or two needles are advanced to the target structure under continuous image guidance. The anatomical approach (e.g. anterocrural, retrocrural, transaortic, or paravertebral for splanchnic) is documented.
4. Contrast injection: A small volume of contrast medium is injected to confirm needle tip position and exclude intravascular placement. Spread pattern is noted.
5. Local anaesthetic injection: The diagnostic agent (name, concentration, volume in mL) is injected. For a coeliac plexus block, volumes typically range from 10 to 20 mL per side, though specific protocol should follow institutional or RCoA guidance.
6. Post-procedure assessment: Pain scores are recorded before and after the block. Vital signs, sensory changes, and any adverse effects are documented. The degree and duration of pain relief recorded here directly supports the diagnostic justification on the claim.

Minimum documentation for a valid claim

• Named procedure (coeliac plexus, splanchnic nerve, or hypogastric block) and confirmation it was diagnostic
• Clinical indication and the diagnostic question being answered
• Image guidance modality used (fluoroscopy, CT, or ultrasound)
• Agent injected: name, concentration, and volume
• Needle approach and confirmed anatomical placement
• Pre- and post-procedure pain scores or assessment
• Any complications and their management
• Clinician name and GMC number

Billing image guidance alongside CCSD Code 25100

Image guidance is standard practice for sympathetic nerve blocks at these anatomical depths and is almost universally used in UK private practice. It is never billed separately under CCSD Code 25100.

The official schedule descriptor reads “Coeliac plexus block, splanchnic nerve block, hypogastric block – diagnostic +/- image guidance”. That “+/- image guidance” wording means one bundled fee applies whether or not fluoroscopy, CT, or ultrasound guidance was used.

There is no separate add-on code for image guidance in this procedure family. The bundling is written into the schedule itself, so it holds for every insurer that uses CCSD.

The same “+/- image guidance” wording appears across other CCSD pain-block codes, such as 25022, 25030, A5743 to A5766, and A7300. Where guidance is mandatory, CCSD writes it into the descriptor instead, using wording like “under image guidance” or “under X-ray control”.

Insurers that use CCSD can set different fee amounts for 25100, but none of them unbundle the guidance from it. In practice, that means:

• Submit 25100 once for the block, with no additional guidance code.
• Expect the same fee whether the block was performed with or without imaging.
• Check each insurer’s fee schedule for the amount it pays for 25100, not for a guidance add-on.
• Name the guidance modality in the procedure note so the clinical record is complete.

Any guidance code submitted alongside 25100 is an unbundled line and will be declined by Bupa, AXA Health, and other CCSD insurers. Documenting the modality still matters for clinical governance and audit, even though it does not change the code or the fee.

Bilateral and multiple-level blocks: Coding considerations

Some diagnostic protocols involve bilateral needle placement in one session. Examples include bilateral anterocrural coeliac plexus blocks and bilateral splanchnic nerve blocks. Whether 25100 can be billed once per side on the same date is governed by the current CCSD technical guide and each insurer’s policy. Check both before claiming bilaterally.

Where bilateral billing is supported, the procedure note must state that bilateral injection was performed. It should document needle placement and agent injection for each side separately, and confirm that each side was guided independently. A note describing only one side’s technique, submitted with two 25100 codes, will typically be queried or reduced to a single unit.

Multiple procedures on the same date raise a similar question. A coeliac plexus block and a hypogastric block in one session target anatomically distinct structures and answer distinct diagnostic questions. Check the CCSD schedule and the insurer’s multiple-procedure policy to see whether both can be billed as separate 25100 lines.

Most UK insurers apply a percentage reduction to the lesser procedure when several interventional pain procedures are performed in one session.

Related CCSD codes and when to use them instead

CCSD Code 25100 sits within a family of interventional pain codes covering sympathetic nervous system procedures. Using the wrong code from this family is among the most common billing errors in pain management practices. Two facts from the procedure note settle the choice, as the diagram below shows. The table after it maps the key neighbouring codes and when each applies.

Code numbers in this class can change between annual editions of the schedule. Check the neurolytic, lumbar sympathetic, and stellate ganglion codes against the current edition before you submit. For other procedures billed under the same schedule, browse Pabau’s library of CCSD codes.

Pre-authorisation requirements for CCSD Code 25100

Most UK private medical insurers require pre-authorisation for interventional pain procedures in this category. Pre-authorisation (also called prior approval or pre-auth) confirms that the insurer will fund the procedure before it is performed. A claim submitted without a required pre-authorisation is typically declined, however accurate the coding.

Build the pre-auth request into the booking process for every elective pain intervention, so it is settled before the appointment.

Pre-authorisation requirements can change with each insurer’s annual policy update. The table above reflects general practice for interventional pain procedures, so check each insurer’s current provider guide before the patient attends. For Bupa specifically, the Bupa CCSD coding guide covers submission conventions across Bupa-recognised procedures.

Common reasons CCSD Code 25100 claims are denied

Denial patterns for CCSD Code 25100 follow predictable categories. Most can be prevented through correct code selection, complete documentation, and timely pre-authorisation. Auditing each claim at the point of coding catches these errors before a rejection arrives.

• Wrong code: therapeutic vs diagnostic. Billing a neurolytic block under 25100, or a diagnostic block under the neurolytic code, is the highest-frequency coding error. Always document agent type in the procedure note to make the intent explicit.
• Missing pre-authorisation. Claims submitted without a valid pre-auth reference number from the insurer are declined at adjudication regardless of other documentation. If pre-auth was not obtained before the procedure, most insurers offer an appeal window but do not guarantee retrospective approval.
• Inadequate procedure note. Notes that omit the agent name and volume, the image guidance modality, or the post-procedure assessment give the insurer grounds to request further information. Claims placed on hold for information requests frequently exceed insurers’ payment timescales.
• Image guidance billed as an unbundled add-on. The CCSD schedule bundles guidance into the single 25100 fee. A separate guidance code will be denied and may trigger a review of the entire claim.
• Bilateral billing without explicit documentation. Two units of 25100 submitted without a procedure note that separately documents bilateral needle placement and injection will be reduced to a single unit.
• Insurer policy exclusion. Some insurer products exclude certain interventional pain procedures or limit the number of diagnostic blocks per calendar year. Verify coverage eligibility before booking the procedure.

When a CCSD Code 25100 claim is denied, the appeal should attach the complete procedure note and the pre-authorisation confirmation, if one was obtained. Add a short clinical letter from the treating clinician explaining why the diagnostic block was indicated at that point in the patient’s pathway. Most insurers run a formal appeal process with a 30-day resolution window.

How to submit a CCSD Code 25100 claim

Submitting a CCSD Code 25100 claim to a UK private insurer follows a consistent workflow across most payers. The seven steps below outline the standard submission pathway.

1. Confirm diagnostic indication and patient eligibility. Verify that the patient’s policy covers interventional pain procedures and that the clinical indication aligns with the insurer’s stated criteria for sympathetic nerve block coverage.
2. Obtain pre-authorisation. Contact the insurer’s provider portal or phone line before the procedure date. Record the authorisation reference number and keep it with the claim record. Some insurers issue authorisation numbers electronically via Healthcode.
3. Perform the procedure and complete the procedure note. Document all elements listed in the documentation section above before closing the clinical record. Late additions to procedure notes can be queried during audit.
4. Assign the correct CCSD code. Confirm that CCSD Code 25100 applies, with diagnostic intent and a local anaesthetic agent. Image guidance is bundled into 25100 and is never billed separately, so no guidance code is added.
5. Prepare the invoice. Include the CCSD code, the procedure date, the clinician’s recognition number (for the treating insurer), the pre-authorisation reference, and the insurer’s member/policy number. Most insurers require the invoice on their standard format.
6. Submit via Healthcode or the insurer portal. Healthcode is the primary electronic submission route for UK private practice CCSD claims. Attach the procedure note summary if the insurer or your practice requires it as supporting documentation.
7. Track and follow up. Monitor submission status and respond to any information requests within the insurer’s stated window, typically 14 to 30 days, so the claim does not lapse.

How Pabau catches CCSD claim errors before submission

Many pain practices still type membership numbers and pre-authorisation references into each claim by hand. One transposed digit sends a correctly coded 25100 claim back from the insurer, and the fee waits while someone fixes it.

Pabau’s claims management software checks the membership number and authorisation code on each claim before it goes to Healthcode. After submission, each claim’s status is tracked in Pabau, so your team can see where every 25100 claim stands.

Fewer claims bounce back for missing details. When an insurer does ask for more information, your team can reply inside its response window, before the claim lapses.

Send cleaner CCSD claims from your pain practice

Pabau checks membership numbers and authorisation codes before each Healthcode submission, then tracks every claim’s status in one place.

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Conclusion

Treat the agent in the procedure note as the coding decision. Local anaesthetic only, a test purpose, and a recorded post-block pain score point to 25100. Alcohol, phenol, or radiofrequency move the claim to the neurolytic code.

From there, two habits remove the most avoidable rejections. Get the pre-authorisation reference before the procedure date, and submit 25100 as a single line with no guidance add-on. Both cost a few minutes at booking, which is far cheaper than an appeal after a denial.

Book a demo to see how Pabau checks membership numbers and authorisation codes before your CCSD claims reach Healthcode.

Continue your research

Need Bupa’s submission conventions in one place? Bupa CCSD codes covers the Bupa procedure code schedule and how claims are submitted against it.

Billing a block at the nerve root instead? CCSD code 25120 is the billing guide for dorsal root ganglion blocks.

Moving from a test block to radiofrequency treatment? CCSD code 25130 is the billing guide for dorsal root ganglion radiofrequency blocks.

Billing a paravertebral block instead? CCSD code 25010 is the billing guide for paravertebral blocks.

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