CCSD code D1910 – Middle ear polypectomy

Key takeaways

CCSD code D1910 covers polypectomy of the middle ear cavity, not the external auditory canal.

ICD-10 code H74.4 (Polyp of middle ear) is the primary diagnosis pairing, with H66.1 or H66.3 added when chronic otitis media drives the polyp.

UK private medical insurers, including Bupa, AXA Health, Aviva, VitalityHealth and WPA, set their own pre-authorization rules, so confirm approval before every D1910 case.

Pabau’s claims management software keeps the insurer, the operation note and the Healthcode claim on one patient record, which cuts re-keying errors.

What CCSD code D1910 covers

CCSD code D1910 is the procedure code used to reimburse a middle ear polypectomy. Its official descriptor in the Clinical Coding & Schedule Development (CCSD) schedule is “Middle ear polypectomy.”

The CCSD Group maintains the schedule, and its founding members are Aviva, AXA Health, Bupa and VitalityHealth. WPA and other insurers recognize CCSD codes too. For one insurer’s rules, see the guide to Bupa CCSD codes. To check a neighboring procedure fast, browse our CCSD code guides.

The anatomical qualifier is critical. D1910 applies only to polyp removal from the middle ear cavity, which sits medial to the tympanic membrane. Polyps in the external auditory canal are billed under D0810 instead.

The schedule files D1910 in Chapter 5, Ear, nose and throat, under Middle ear and mastoid, as a minor procedure. ENT surgeons and their billing teams use it whenever a polyp in the middle ear needs surgical excision. That holds whether the polyp is primary or secondary to a chronic infection.

Key facts about D1910

• Code number: D1910
• Official descriptor: Middle ear polypectomy
• Schedule: CCSD, used by UK private medical insurers
• Chapter: 5 Ear, nose and throat
• Category: Middle ear and mastoid
• Complexity: Minor
• Anatomical site: Middle ear cavity (medial to the tympanic membrane)
• Excluded site: External auditory canal polyps (billed under D0810)

The procedure: What happens during a middle ear polypectomy

A middle ear polypectomy removes a soft tissue growth from the middle ear under direct visualization. It is performed under local or general anesthesia, depending on the patient’s age and the extent of disease.

In most cases, the surgeon reaches the middle ear through the ear canal. A microscope or rigid endoscope shows the tympanic membrane and the middle ear space beyond it. Where the anatomy is complex or the polyp is large, the surgeon may make an incision behind the ear instead.

Once the polyp is identified, the surgeon excises it with microsurgical instruments and controls any bleeding. Packing or a dressing goes in before closing. The operation note has to place the polyp in the middle ear, and the documentation section below lists what it must record.

Common clinical indications driving this procedure

• Chronic suppurative otitis media (CSOM) with secondary aural polyp formation
• Granulation polyp arising from a perforated tympanic membrane
• Bleeding or recurrently bleeding middle ear polyp
• Polyp masking a suspected cholesteatoma requiring histological confirmation
• Polyp causing conductive hearing loss that has not responded to medical management

ICD-10 codes to pair with CCSD code D1910

UK insurers check the diagnosis on every surgical claim against the documented clinical findings. For D1910, the ICD-10 code must describe a middle ear condition, not an external ear condition. An external ear polyp code on a middle ear polypectomy claim is one of the most common triggers for a mismatch denial.

The WHO ICD-10 browser provides the authoritative classification for these codes. The table below lists the accepted pairings and the clinical scenario each covers.

Check the full descriptor and any coding notes in the WHO browser before you submit. Confirm that the code maps to the middle ear, because unspecified ear polyp codes often point to the external canal. Insurer auditors will challenge that mismatch.

Neighboring codes: How D1910 differs from related procedures

Several ear codes sit close to D1910 in the CCSD schedule. Billing one when the operation note supports another is a common source of both undercoding and inappropriate claims. The table below separates the most frequently confused procedures, from a D1530 myringotomy to an external canal excision.

The chart below puts both coding decisions in order: where the polyp sat, then what else the surgeon did in the same session.

Pre-authorization requirements from UK private medical insurers

The major UK private medical insurers all use the CCSD schedule as the basis for procedure reimbursement. Each one sets its own fee for D1910 and its own pre-authorization (pre-auth) rules. There is no blanket rule, so the same claim can pay differently across insurers.

The table below lists where each insurer publishes its fees. Use the insurer’s own portal for current figures, because fee schedules change and third-party summaries lag behind.

Some insurers require pre-auth for all elective surgery, while others apply it only above a cost threshold. Operating without pre-auth when the policy requires it is the simplest denial trigger in UK private billing. It is also rarely recoverable afterward.

Before operating on any insured patient under D1910, confirm the following:

• Whether the patient’s policy requires pre-auth for middle ear surgery
• The insurer’s pre-auth reference number, recorded on the patient’s file before surgery
• Whether the approval names D1910, or a different ear code you may need to justify
• The approved consultant or facility, where the insurer restricts the treating surgeon

Insurers typically ask for the following when they review a D1910 request:

• Clinical notes documenting the presenting complaint and duration of symptoms
• Otoscopic examination findings confirming the presence of a middle ear polyp
• ICD-10 diagnosis code(s) with the specific middle ear site
• The CCSD procedure code (D1910) and a brief clinical reason for surgery
• Booking details: facility name, date and surgeon name
• Confirmation that conservative management has been tried, where applicable

Build a pre-auth check into the booking workflow for every middle ear surgery referral. An emergency case may be reviewed afterward, but the insurer will want written clinical justification for the urgency.

Documentation requirements to support a CCSD code D1910 claim

A complete clinical record is the foundation of a clean claim. UK insurers audit ENT surgical claims, and thin operation notes are the fastest route to a query or denial. The note for a middle ear polypectomy needs anatomical and procedural detail that cannot be rebuilt after the fact.

Using digital forms for clinical documentation captures every required field before the surgeon leaves the operating room. That lowers the risk of incomplete notes surfacing weeks later during a claims audit.

Required documentation elements for a defensible D1910 claim:

• Pre-operative record: otoscopic findings describing the polyp at its middle ear location, duration of symptoms, and failed prior treatment (where applicable)
• Operation note: the middle ear cavity or a specific structure (mesotympanum, epitympanum) as the site, plus the approach, visualization method, excision technique and bleeding control
• Specimen handling: if tissue was sent for histology, record the specimen label and destination; if not, document the clinical reason
• Intraoperative findings: status of the tympanic membrane (intact or perforated), presence or absence of cholesteatoma, granulation tissue, or middle ear effusion
• Post-operative plan: follow-up interval, hearing test scheduling, antibiotic or topical treatment prescribed

How to submit a claim for CCSD code D1910 via Healthcode

Healthcode is the main electronic billing platform for UK private practice, and most major insurers receive claims through it. Practice software that connects to Healthcode removes manual re-entry and the transcription errors that come with it. Pabau’s claims management software sends the claim to Healthcode straight from the invoice.

Claim submission steps for CCSD code D1910:

1. Verify the patient’s policy: Confirm the membership number, the insurer and whether the policy covers middle ear surgery before the appointment.
2. Obtain pre-authorization where required: Contact the insurer’s pre-auth team before surgery and record the reference number in the patient’s notes.
3. Complete the operation note: Record the date, treating surgeon, indication, the polyp’s middle ear site and the excision method.
4. Create the invoice: Enter D1910, the treating consultant’s details, the procedure date and the agreed fee. Include the pre-auth reference number where applicable.
5. Submit via Healthcode: Send the claim electronically through Healthcode or connected practice software. Check that its status moves from submitted to accepted.
6. Monitor and follow up: If the insurer queries or rejects the claim, it returns a reason code. Answer promptly, because a slow response delays payment.

Billing CCSD code D1910 with concurrent procedures

Middle ear polypectomy is often performed alongside tympanoplasty, myringotomy or mastoidectomy in the same session. The CCSD schedule sets codes and descriptors, not fees. Each insurer applies its own multiple-procedure rules to decide how much of each fee it pays.

On the claim, a combined approach tympanoplasty is D1440 and a simple mastoidectomy is D1040. Both are Major procedures.

Check those rules on the insurer’s provider portal before you bill two codes together. Some insurers treat polyp removal as part of a larger middle ear operation, so it may not be payable separately.

Sequence the codes with care. The principal procedure, usually the tympanoplasty or mastoidectomy, goes on the first line of the claim, with D1910 as the secondary procedure. A reversed order rarely changes the fee, but it can send the claim to manual review.

Common D1910 denial reasons and how to resolve them

D1910 denials from UK insurers cluster around a few predictable causes. Knowing which type of denial you face tells you the right way to resolve it.

Review your denial patterns every quarter. Recurring ICD-10 mismatches for this code usually mean someone codes the claim without reading the operation note. A billing compliance review between the note and the claim submission breaks that pattern.

How Pabau supports CCSD code D1910 billing

In many private ENT practices, the operation note lives in one system, the invoice in another and claim status in a spreadsheet. Each hand-off is a chance to key the wrong diagnosis or lose a pre-auth reference.

Pabau keeps that work on one patient record. Add the patient’s insurer and policy to the client card, and invoices go to the right insurer at its own price list. When the invoice is ready, Pabau pre-fills the claim and sends it to Healthcode, or by email for insurers that aren’t on Healthcode.

Every claim then moves through clear stages: Pending, Submitted, Processing, Paid or Error. Your billing team can filter by insurer and chase a queried D1910 claim before it ages past the resubmission deadline.

Manage ENT claims and pre-authorization in one place

Pabau links each D1910 invoice to the patient’s insurer, pre-auth reference and operation note, then sends the claim to Healthcode. Your team tracks every claim to payment from one dashboard.

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Conclusion

Most D1910 denials trace back to the paperwork around the code. The usual culprits are a missing pre-authorization and a diagnosis that points to the wrong part of the ear.

Those checks cost minutes before surgery and weeks once a claim is queried. Confirm the insurer’s pre-auth, code the diagnosis from the operation note rather than the referral letter, and send the note with every claim.

Book a demo to see how Pabau sends D1910 claims to Healthcode with the operation note and insurer details already attached.

Continue your research

Coding other middle ear and mastoid surgery? CCSD code D1060 covers billing for revision mastoidectomy.

Clearing the middle ear before or after surgery? CCSD code D1520 explains how to bill suction clearance of the middle ear.

Frequently asked questions