CCSD code C0122 – Eye removal with orbital implant

Key takeaways

C0122 covers enucleation or evisceration of the eyeball when an orbital implant goes in during the same operation.

The same operation without an implant bills as C0120, and an implant added at a later operation moves to the socket reconstruction codes.

Insurers check the operative note against the descriptor, so the note should name the procedure, the side, and the implant.

Confirm pre-authorization and the consultant’s recognition with the insurer before surgery, since both are common reasons for a query.

The anesthetist claims against the same CCSD code with a separate fee line, not under a different chapter.

CCSD code C0122 bills eye removal and an implant in one operation

CCSD code C0122 is the UK private billing code for enucleation/evisceration of eyeball (with implant).

It applies when the surgeon removes the eye, or only its contents, and places an orbital implant in the same sitting. You’ll find it in chapter 4 of the schedule, Eye and orbital contents, under section 4.1 Globe and orbit.

CCSD stands for Clinical Coding and Schedule Development. The CCSD Group, whose members include Aviva, AXA Health, Bupa and Vitality, maintains the codes and their descriptors on ccsd.org.uk. C0122 is one of many CCSD codes used on private claims, and each insurer sets its own fee against it.

NHS hospitals record the same surgery in OPCS-4, which is a different classification. A private claim needs the CCSD code instead, so a consultant who operates in both sectors keeps the two references apart.

Enucleation or evisceration, the implant is what makes it C0122

Both operations fall under the same code, so choosing one over the other doesn’t change what you bill. The note still has to say which one happened, though, because the insurer’s reviewer reads it against the descriptor.

• Enucleation: the whole eyeball comes out. The surgeon cuts the optic nerve and detaches the eye muscles from the globe.
• Evisceration: only the contents of the eye come out. The white outer shell, the sclera, stays in place with its muscles attached.
• The orbital implant: a sphere placed in the socket to replace the lost volume. It gives the artificial eye a base to sit on later.

Here’s how that plays out. A patient has a blind, painful eye after years of glaucoma. The surgeon eviscerates the eye and places an implant in the same session, so the case is C0122. Had the surgeon left the socket empty and planned the implant for later, the first operation would bill as C0120.

The artificial eye itself isn’t part of C0122. An ocularist usually fits it once the socket has healed, and that work sits outside the surgical fee.

Neighboring codes decide most C0122 queries

Section 4.1 groups C0122 with a handful of close neighbors. Two questions separate them: how much tissue came out, and when the implant went in.

The descriptors below come from Freedom Health Insurance’s chapter 4 schedule, which lists the CCSD wording for each code.

In practice, two errors come up again and again. The first is billing C0122 when the note never mentions an implant. The second is using it for a secondary implant into an empty socket, which belongs with the socket reconstruction entries instead.

The operative note has to show the implant went in

Insurers audit a C0122 claim by comparing the note with the descriptor. So the note should read like the descriptor, plus the clinical detail a reviewer needs to agree with it.

Before the claim goes out, check that the note records these six points:

1. Procedure: enucleation or evisceration, named plainly rather than as “eye surgery”.
2. Side: right or left eye.
3. Implant: its type and size, recorded as placed during this operation.
4. Indication: the diagnosis behind the removal, matching the ICD-10 code on the claim.
5. Date, setting and surgeon: when and where it happened, and which consultant operated.
6. Authorization: the insurer’s pre-authorization reference, where one was issued.

A structured template makes this far easier to get right. Give the implant its own field on the form, and the surgeon fills it in every time instead of relying on memory.

Before you submit a C0122 claim, run this checklist

Most queries on an eye removal claim trace back to a detail someone could have checked at booking. A quick pass through this list catches them while there’s still time to fix them.

• Pre-authorization is confirmed, and the reference is on the claim.
• The consultant is recognized by the patient’s insurer.
• The membership number and date of birth match the insurer’s records.
• The code matches the note, C0122 with an implant and C0120 without.
• The diagnosis code supports removing the eye, such as a choroidal melanoma or a degenerated, blind eye.

Each insurer publishes its own fee and authorization rules for the code. The table shows where to look them up.

Bupa’s rules differ from the other insurers in places. If Bupa covers a large share of your patients, our guide to Bupa CCSD codes covers those differences.

From there, claims usually go through Healthcode, the UK clearinghouse for private medical claims, which checks each one and routes it to the insurer.

Common C0122 mistakes, and how to fix each one

When a claim does come back, the reason is usually one of these four. Each has a simple fix.

• The anesthetist bills a different code. Insurer schedules list an anesthetist fee against the procedure code itself. So the anesthetist claims C0122 as well, on their own fee line.
• A separate implant code goes on the same claim. The implant is already inside the C0122 descriptor. Adding a socket reconstruction code for the same session will usually be queried as unbundling.
• The resubmission adds nothing new. If the insurer queried the note, attach it and point to the line that names the implant. Sending the same claim again tends to get the same answer.
• The membership number is out of date. Patients switch policies more often than you’d think. Confirm the number when you book the surgery, not after it.

How claims management software keeps C0122 claims clean

In many practices, the operative note lives in one system, the invoice in another, and the claim in a third. Each hand-off is a chance for the implant detail or the authorization number to fall off the claim.

Practice management software like Pabau keeps those steps on one patient record. Its claims management software sends CCSD-coded claims to Healthcode straight from that record, with checks before submission. You can then follow each claim’s status and reconcile the payment in the same place.

The result is fewer queried claims, and less time spent chasing a missing reference after the patient has gone home.

Submit cleaner CCSD claims from one record

Pabau keeps the operative note, the invoice and the Healthcode claim on one patient record. That way, each C0122 submission carries the detail insurers check.

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Conclusion

C0122 is a narrow code. It fits only when the eye, or its contents, comes out and an implant goes in during the same operation. Treat the implant as the fact the whole claim rests on, and make sure the note says so plainly.

Get that right, confirm authorization before the surgery date, and most C0122 claims go through without a query. The cost is a few minutes of checks at booking, which is far less than the time a resubmission takes.

Want your notes, invoices and Healthcode claims on one record? Book a demo and we’ll walk you through a private surgical claim from start to finish.

Continue your research

Billing across several private insurers? Bupa CCSD codes explains how Bupa applies the schedule, and where its rules differ from other insurers.

Coding eye trauma that didn’t need removal? CCSD code C6410 covers repair of a prolapsed iris and what the claim needs.

Removing a foreign body instead? CCSD code C6450 walks through removal of a foreign body from the iris.

Also billing cataract surgery? CCSD code C7110 covers extracapsular cataract extraction without an implant.

Frequently asked questions