CCSD Code C3910: Excision/Biopsy of Conjunctival Lesion

Key Takeaways

CCSD Code C3910 covers Excision/Biopsy of Conjunctival Lesion and is classified as Minor complexity by Freedom Health Insurance, with a specialist fee of £150.00 (effective 01/01/2026).

Allianz Care reimburses £210 for CCSD Code C3910 (effective December 2024), the highest verified rate among published UK insurer fee schedules.

Pre-authorisation is required by most UK insurers before billing C3910; submitting without it is one of the most common reasons claims are rejected.

Three adjacent CCSD codes (C3920, C3950, C4010) cover related conjunctival procedures and should not be billed alongside C3910 for the same surgical episode.

Accurate operative notes, histopathology documentation, and a confirmed ICD-10 diagnosis code are the minimum documentation requirements for a clean C3910 claim.

Private ophthalmology practices in the UK deal with insurer fee schedules that change annually, pre-authorisation rules that differ by policy, and coding decisions that directly affect whether a claim is paid in full or queried. When submitting claims for conjunctival procedures, selecting the wrong code or leaving out a documentation requirement can hold up payment for weeks. CCSD procedure codes provide the standardised framework that UK private insurers use to identify and price each procedure, and getting them right from the first submission matters.

This guide covers everything UK private ophthalmology providers need to know about CCSD Code C3910: the procedure it describes, verified fee rates from published insurer schedules, documentation requirements, related codes, and the steps that reduce claim rejection risk. Reimbursement figures cited here are drawn from publicly available insurer fee schedules; always verify against your current contracted rate before submitting.

CCSD Code C3910: Excision and Biopsy of Conjunctival Lesion

CCSD Code C3910 describes the surgical removal or biopsy of a lesion on the conjunctiva, the thin transparent membrane covering the white of the eye and the inner surface of the eyelids. The procedure may be performed for diagnostic purposes, to obtain tissue for histopathological analysis, or therapeutically to remove a lesion causing symptoms or posing oncological risk.

The Clinical Coding and Schedule Development Group (CCSD) maintains the CCSD Schedule, which is the standard procedural coding framework used across the UK private healthcare sector. CCSD Code C3910 sits within Chapter 4 of the procedural schedule, which covers eye and orbital contents procedures.

Clinical Indications for CCSD Code C3910

Conjunctival lesions warranting excision or biopsy under CCSD Code C3910 include a range of pathologies: suspected conjunctival squamous cell carcinoma, conjunctival melanoma, benign epibulbar dermoids, persistent pingueculae causing mechanical symptoms, and pyogenic granulomas. Pterygium excision, though sometimes performed on the conjunctiva, typically has its own dedicated coding pathway and should not default to C3910 without review of the clinical indication.

The code applies whether the lesion is excised completely or only biopsied for pathology. When excision and biopsy occur as two distinct surgical steps in the same operative episode, most insurer guidelines treat them as a single C3910 claim. Review the CCSD Technical Guide (updated October 2025) for bundling rules that apply within Chapter 4.

Complexity Classification

Freedom Health Insurance classifies CCSD Code C3910 as Minor complexity within its Freedom Elite Schedule of Fees. This classification affects both the specialist fee tier and, in some cases, the anaesthetist fee structure. Other insurers may apply their own complexity grading; always check your insurer-specific schedule before assuming a Minor classification applies across all payers.

CCSD Code C3910 Fee Schedules Across UK Insurers

Fee rates for CCSD Code C3910 vary across UK private medical insurers. The figures below are drawn from publicly available or provider-accessible fee schedules; rates are subject to change and individual contracted rates may differ. Practices with fee-approved specialist status should refer to their contracted schedule for the applicable rate.

Allianz Care’s published specialist fee of £210 (effective December 2024) is the highest verified rate for CCSD Code C3910 among publicly available schedules. Freedom Health Insurance’s Freedom Elite schedule lists the specialist fee at £150.00 and the anaesthetist fee at £194.00 as of 1 January 2026. Note: the published anaesthetist fee exceeding the specialist fee is atypical for a Minor-classified procedure often performed under local anaesthetic; verify these figures directly with Freedom Health before invoicing. For Bupa, AXA Health, The Exeter, Vitality Health, WPA, H3 Insurance, and Cigna, specific C3910 rates are accessible only through their provider portals or direct contact with the insurer. Practices billing these insurers should log in to the relevant portal or contact provider relations to confirm current rates.

Note that AXA Health’s fee schedule is based on work undertaken by the CCSD and applies only to fee-approved specialists. Non-fee-approved specialists negotiate fees directly with AXA Health. If you are moving from NHS to private practice, understanding these distinctions early avoids billing disputes later. Pabau’s claims management software helps private practices track outstanding claims and insurer-specific payment terms across multiple payers.

Documentation Requirements for CCSD Code C3910

Claim rejections for CCSD Code C3910 almost always trace back to incomplete documentation rather than incorrect code selection. UK private insurers review supporting clinical records before settling surgical claims, and missing or vague documentation is the fastest route to a query letter or non-payment.

Minimum Documentation for CCSD Code C3910 Claims

• Pre-operative consultation note: Record the clinical indication for the procedure, including a description of the conjunctival lesion, its location, size, and suspected diagnosis. A vague entry such as “lesion noted” is insufficient.
• Pre-authorisation reference number: Most insurers require pre-authorisation before performing elective conjunctival surgery. The authorisation reference must appear on the claim form. Absent authorisation is a primary rejection trigger.
• Operative note: Document the procedure technique, whether excision was complete or partial, the instruments used, and whether the specimen was sent for histopathology. The note should confirm the procedure maps to CCSD Code C3910 and not to a related code such as C3920 (cauterisation) or C3950 (radiotherapy).
• Histopathology report: When tissue was submitted for analysis, include or reference the pathology report. Insurers may request this to confirm the procedure was clinically necessary.
• ICD-10 diagnosis code: Pair C3910 with an appropriate ICD-10 code, such as C69.0 (malignant neoplasm of conjunctiva), D31.0 (benign neoplasm of conjunctiva), or H11.0 (pterygium) as applicable. The diagnosis code must be consistent with the clinical note.
• GDPR-compliant consent: Patient consent must be documented in the clinical record before submitting to insurers. Under UK GDPR, sharing clinical records with insurers requires appropriate lawful basis and, typically, explicit patient consent. See the Information Commissioner’s Office guidance if your consent workflow is not clearly defined.

Practices using digital clinical forms can pre-populate consent, operative note templates, and post-operative records, reducing the risk of missing fields at the point of claim submission. Pabau’s GDPR compliance framework supports UK private practices in managing patient data shared with insurers.

CCSD Code C3910 vs Related Conjunctival Procedure Codes

Three adjacent codes in the CCSD ophthalmology chapter describe conjunctival procedures that are often considered alongside CCSD Code C3910. Selecting the correct code depends on the clinical intervention performed, not the diagnosis. Billing the wrong adjacent code when C3910 is the correct choice is a common source of insurer queries.

C3920 covers cauterisation and cryotherapy to a conjunctival lesion without surgical excision. If a lesion is ablated rather than cut out, C3920 applies, not CCSD Code C3910. C3950 is specific to radiotherapy delivery and should only be coded when formal brachytherapy or external beam treatment was administered. C4010, the mucosal graft code, may be billed in addition to CCSD Code C3910 when a graft was required to reconstruct the conjunctiva after wide excision, but pre-authorisation for both codes is advisable before performing this combination.

Billing C3920 and CCSD Code C3910 together for the same lesion in the same session is generally not supported unless the operative note clearly documents two distinct interventions on separate lesions. Unbundling rules within the Bupa CCSD codes framework and equivalent insurer guidelines typically prevent separate payment for overlapping interventions. Consult the Allianz Care UK Recognition Fee Schedule for specific guidance on simultaneous billing of adjacent conjunctival codes.

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How to Submit a CCSD Code C3910 Claim Without Errors

A clean C3910 claim reaches the insurer with the correct code, the right supporting documentation, and a valid pre-authorisation reference. Practices that submit claims electronically via Healthcode reduce turnaround time compared to paper submissions and benefit from automated format validation before the claim reaches the insurer.

CCSD Code C3910 Billing Workflow: Step by Step

1. Verify patient cover and obtain pre-authorisation. Contact the insurer or use their provider portal to confirm the patient’s policy covers conjunctival surgery and to obtain a pre-authorisation reference. Note that coverage for CCSD Code C3910 may depend on policy type and whether the procedure is classified as day-case or inpatient.
2. Document the clinical indication before the procedure date. The consultation note must record lesion characteristics, the suspected diagnosis, and the clinical rationale for excision or biopsy. This note is the foundation of the claim.
3. Confirm code selection at the point of procedure. Review the procedure performed against the CCSD Chapter 4 codes. If only cauterisation was performed, C3920 applies. If tissue was surgically removed or biopsied, CCSD Code C3910 is the correct code.
4. Complete the operative note immediately after surgery. A same-day operative note reduces the risk of missing detail. Include procedure technique, laterality (left eye, right eye, or bilateral), and histopathology submission details.
5. Pair with the correct ICD-10 diagnosis code. The diagnosis code must match the clinical indication documented in the consultation note. Mismatches between the procedure code and diagnosis code are a common reason for manual review.
6. Submit via Healthcode or the insurer’s preferred channel. Most UK private insurers accept electronic submissions through CCSD-coded billing platforms. Include the pre-authorisation reference, the treating specialist’s name and recognition number, and the procedure date.
7. Track the claim status and respond promptly to queries. Unresolved insurer queries age into formal rejections if not answered within the insurer’s specified window. A claims tracking system prevents submissions from being forgotten after they leave the practice.

Practices managing multiple insurer relationships benefit from dedicated claims management software that logs submission dates, outstanding queries, and payment confirmations in one place. Manual spreadsheet tracking is adequate for low-volume practices but creates gaps in follow-up as case volumes grow.

Common CCSD Code C3910 Claim Rejection Reasons

• No pre-authorisation reference: The single most frequent rejection trigger. Some policies allow retrospective authorisation for emergency procedures, but elective conjunctival surgery rarely qualifies.
• Code mismatch: Billing C3920 (cauterisation) when excision was performed, or vice versa. The operative note must clearly support whichever code is submitted.
• Missing or vague diagnosis code: Submitting a claim without a specific ICD-10 code, or pairing C3910 with an unrelated diagnosis, prompts manual review and delays payment.
• Concurrent code bundling errors: Claiming CCSD Code C3910 alongside C3920 or another conjunctival procedure for the same lesion in the same session without clinical justification for separate billing.
• Specialist not recognised by the insurer: Claims submitted by a specialist without fee-approved or recognised status with the specific insurer are assessed differently and may require separate negotiation. Practices new to private work should confirm recognition status before performing insured procedures.
• Anaesthetist fee not separately authorised: Freedom Health Insurance lists an anaesthetist fee of £194.00 for CCSD Code C3910, which unusually exceeds the £150.00 specialist fee. Verify this figure directly with Freedom Health, as it is atypical for a Minor procedure. Some policies require the anaesthetist to obtain their own pre-authorisation reference rather than relying on the surgeon’s authorisation.

Insurer-Specific Considerations When Billing CCSD Code C3910

No two UK insurer fee schedules are identical, and CCSD Code C3910 is no exception. Fee-approved status, policy type, and whether the patient is covered under a corporate or individual plan all affect how a claim is assessed. Below are the key differences across the main UK private insurers relevant to ophthalmology billing.

Bupa

Bupa operates its own fee schedule, which is accessible through the Bupa CCSD codes portal for recognised specialists. Bupa-recognised consultants receive published fee rates; non-recognised specialists must negotiate independently. Pre-authorisation for surgical procedures including conjunctival excision is mandatory. Claims submitted without a Bupa authorisation reference are rejected automatically. For a full overview of how Bupa applies CCSD codes, see Pabau’s dedicated Bupa procedure codes and fee schedule guide.

AXA Health

AXA Health’s schedule is built on the CCSD framework and applies to fee-approved specialists only. Rates for specific codes including CCSD Code C3910 are viewable through the AXA Health specialist procedure codes portal following login. AXA Health distinguishes between inpatient and day-case settings when calculating fees; confirm which setting applies before submitting a C3910 claim.

Allianz Care

Allianz Care publishes one of the most accessible fee schedules in UK private healthcare. The specialist fee for CCSD Code C3910 is £210 and the anaesthetist fee is £165, effective from 2 December 2024, as listed in the Allianz Care UK Recognition Fee Schedule. Claims should be submitted electronically, with all supporting documentation attached. Allianz Care’s provider resources portal provides guidance on invoice formatting and submission channels.

Freedom Health Insurance

Freedom Health Insurance’s Freedom Elite Schedule of Fees, effective 1 January 2026, lists CCSD Code C3910 at £150.00 for the specialist and £194.00 for the anaesthetist. The anaesthetist fee exceeding the specialist fee is unusual for a Minor conjunctival procedure typically performed under local anaesthetic – confirm these figures directly with Freedom Health before invoicing, as they may have been transposed in the published schedule. The Minor complexity classification applies. Freedom Health requires pre-authorisation before elective procedures and has specific documentation requirements for day-case eye surgery. Contact Freedom Health’s provider team to confirm whether histopathology costs are covered separately under the patient’s policy.

WPA and The Exeter

Both WPA and The Exeter use CCSD-based fee schedules. WPA medical fees are available through their provider portal and are negotiated individually with specialists in some cases. The Exeter publishes a fee schedule listing maximum benefit amounts payable for CCSD-coded procedures. For both insurers, the maximum benefit figure represents the ceiling of what the policy pays, not a guaranteed payment; actual reimbursement depends on the patient’s plan level and excess.

Billing CCSD Code C3910 in Private Ophthalmology Practice

Private ophthalmology practices billing CCSD Code C3910 need more than accurate code selection. The administrative workflow surrounding each claim, from patient registration to post-payment reconciliation, determines whether the practice receives consistent, on-time reimbursement or manages a backlog of queries and resubmissions.

The transition to private ophthalmic practice brings freedom to set consultation structure and referral pathways, but it also requires the practice to own the entire billing cycle. NHS-trained surgeons moving to private work often underestimate the documentation burden insurers place on elective surgical claims such as C3910.

Using practice management software that supports CCSD coding, pre-authorisation tracking, and electronic submission through Healthcode reduces the manual work involved in managing a C3910 billing pipeline. Pabau’s compliance management tools help private ophthalmology practices maintain the documentation standards required by UK insurers, including the records retention requirements under UK GDPR.

Reviewed against current CCSD Chapter 4 ophthalmology coding guidance and published insurer fee schedules (Allianz Care effective December 2024; Freedom Health Insurance effective January 2026).

Expert Picks

Billing other CCSD ophthalmology procedures for UK insurers? Bupa CCSD Codes: Complete Guide for UK Clinics covers the full Bupa coding framework, pre-authorisation workflow, and common claim errors for private ophthalmic and other specialist practices.

Need to understand how CCSD codes work across all UK private insurers? Pabau’s Procedure Codes Hub provides billing guides for CCSD, CPT, and HCPCS codes covering usage, documentation requirements, and reimbursement guidance.

Managing private practice compliance across GDPR and insurer requirements? GDPR Checklist for UK Clinics outlines the data protection obligations relevant to sharing clinical records with insurers and processing patient billing data.

Want to reduce claim rejection rates across all CCSD codes? Pabau’s Claims Management Software tracks submission status, insurer queries, and payment confirmations for multi-payer private practices.

Conclusion

CCSD Code C3910 is straightforward to apply when the procedure matches its description: surgical excision or biopsy of a conjunctival lesion. The complexity lies in the surrounding workflow. Pre-authorisation, accurate diagnosis coding, and complete operative documentation are what separate a clean first-submission claim from one that spends weeks in an insurer’s query queue.

Pabau’s claims management and compliance tools are built for UK private practices managing CCSD billing across multiple insurers. To see how Pabau handles pre-authorisation tracking, CCSD code submission, and documentation workflows for ophthalmology and other specialties, book a demo.

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