CCSD code D2610 – Endolymphatic sac operation

Key takeaways

CCSD code D2610 covers operation(s) on the endolymphatic sac, a hearing-preserving inner ear procedure used mainly for Ménière’s disease.

Bupa’s February 2026 schedule places D2610 in the MAJOR 5 band, with a listed fee of £650.

Labyrinthectomy is coded separately as D2620 or D2630, and both sit in Bupa’s higher MAJOR+ band.

Insurers look for a confirmed Ménière’s diagnosis, hearing tests and failed medical treatment before they authorize surgery.

The mastoidectomy is the access route to the sac, so it does not go on the claim as a second code.

What CCSD code D2610 covers, and where it sits in the schedule

CCSD code D2610 covers operation(s) on the endolymphatic sac. In practice, that means endolymphatic sac decompression, or decompression with a shunt. Surgeons use it mainly to control vertigo from Ménière’s disease.

The code comes from the CCSD schedule, published by the Clinical Coding & Schedule Development group. UK private medical insurers use that schedule to process specialist claims. The CCSD codes reference explains how its chapters fit together.

D2610 sits in Chapter 5, Ear, nose and throat, under the inner ear section. Its neighbors there include cochlear implants, acoustic neuroma excision and two labyrinthectomy codes.

• Code: D2610
• Descriptor: Operation(s) on endolymphatic sac
• Chapter: 5 Ear, nose and throat
• Section: Inner ear
• Bupa band: MAJOR 5 (February 2026 schedule)
• Bupa fee: £650

Bands and fees belong to each insurer, not to CCSD. Bupa’s figures appear here because Bupa publishes them. AXA Health, Aviva and Vitality each set their own, so check the relevant schedule before you quote a patient.

Inside the operation: Relieving pressure in the inner ear

Ménière’s disease causes attacks of spinning vertigo, fluctuating hearing loss, tinnitus and a feeling of pressure in the ear. It is linked to endolymphatic hydrops, a build-up of fluid inside the inner ear.

The endolymphatic sac is thought to help absorb that fluid. It lies against the dura on the back of the temporal bone, behind the inner ear. Sac surgery aims to relieve the pressure while keeping hearing and balance function intact.

A typical operation runs through five steps:

1. Incision. The surgeon makes a cut behind the ear to reach the mastoid bone.
2. Mastoidectomy. The mastoid air cells are drilled away to expose the inner ear structures.
3. Sac exposure. Bone is removed over the sac, between the sigmoid sinus and the posterior semicircular canal.
4. Decompression or shunt. The sac is left free to expand, or opened and drained with a shunt into the mastoid.
5. Closure. The wound is closed in layers.

The whole sequence bills as one D2610 claim. Insurers treat the mastoidectomy as the route to the sac. Adding the simple mastoidectomy code D1040 to the same claim will usually be queried as unbundling.

Who qualifies for sac surgery, and why reviewers ask more questions

Sac surgery is a second-line treatment. ENT surgeons usually offer it once vertigo attacks continue despite medical management. The NHS guidance on Ménière’s disease describes inner ear surgery as a rare step for symptoms that are hard to manage.

First-line care typically includes:

• Salt reduction and other lifestyle changes
• Betahistine or diuretics, depending on the surgeon’s approach
• Vestibular rehabilitation for balance between attacks
• Intratympanic steroid injections in some cases

The evidence behind sac surgery is still debated. A Cochrane review of surgery for Ménière’s disease found two small trials, with 59 patients between them. It judged the evidence insufficient to show a benefit.

Many surgeons still offer the operation, because it preserves hearing where destructive options do not. For billing, that debate has one practical effect. A clinical reviewer may ask for more proof of medical necessity than usual.

Before you request authorization, make sure the record shows:

• A Ménière’s diagnosis, coded H81.0 in ICD-10
• Audiograms showing the hearing pattern in the affected ear
• How often the vertigo attacks happen, and how severe they are
• Each medical treatment tried, with dates and outcomes
• MRI results ruling out a vestibular schwannoma, where the insurer asks for them

D2610, D2620 or D2630? Hearing preservation decides

D2610 is the hearing-preserving option in the inner ear section. The labyrinthectomy codes beside it remove the balance organ, and with it any remaining hearing on that side.

Surgeons usually reserve labyrinthectomy for an ear with little useful hearing left. That is why the operation note must name the procedure performed. “Ménière’s surgery” on its own leaves the coder guessing.

Bands and fees come from Bupa’s CCSD schedule, February 2026 edition. The Bupa CCSD codes guide covers how Bupa applies them.

One more neighbor matters during the workup. If the MRI shows a vestibular schwannoma, the operation moves to the acoustic neuroma codes, such as A2952.

Before you pick a line, read the operation note against the panel below. Each wording points to one code, one band and one fee.

How a D2610 claim moves from referral to payment

Sac surgery is planned, so the claim can be built in the right order. Here is the sequence a clean claim follows.

1. The ENT surgeon confirms Ménière’s disease and records the failed medical treatment in the consultation letter.
2. The practice requests pre-authorization, quoting D2610 and the H81.0 diagnosis.
3. The insurer issues an authorization reference for the planned date.
4. The surgeon operates, and the operation note names the sac procedure performed.
5. The anesthesiologist submits a separate claim against the same episode and reference.
6. The practice submits D2610, usually through Healthcode, and matches the remittance when it arrives.

Planned surgery leaves little excuse for operating before the reference arrives. If the date moves, ask the insurer to update the authorization before the operation.

Before you submit: A six-point check

• The operation note says decompression or shunt, not labyrinthectomy
• No separate mastoidectomy code sits on the same claim
• The diagnosis code is H81.0, matching the referral letter
• The authorization reference matches this episode and this ear
• The fee claimed matches the insurer’s current schedule, not last year’s
• The anesthesiologist’s claim quotes the same date and reference

Common mistakes that send D2610 claims back

Queried D2610 claims tend to trace back to one of five errors. Each one has a simple fix.

• Dental code confusion. The US dental code set also uses D2610, for a porcelain inlay. Billing systems that hold several code sets can pull the wrong descriptor. Fix: confirm the claim uses the CCSD schedule.
• Mastoidectomy added as a second line. The insurer reads it as unbundling. Fix: claim D2610 alone for the sac operation.
• Wrong inner ear code. A labyrinthectomy billed as D2610, or the reverse, invites a query either way. Fix: code from the operation note, not the booking.
• Thin medical-necessity history. The reviewer cannot see what was tried first. Fix: attach the consultation letter listing each treatment and its outcome.
• Outdated fee. A rate copied from an old schedule gets short-paid or returned. Fix: check the insurer’s current schedule before submission.

How Pabau gets a D2610 claim to the insurer in one pass

Planned ENT surgery leaves a long paper trail. The referral, audiograms, authorization and operation note often live in different places.

Pabau, the practice management platform we build, keeps them on one patient record. Its claims management software pre-fills the claim from that record. It also checks required fields, such as membership and authorization numbers, before the claim can be sent.

Pabau then submits the CCSD claim to the insurer through Healthcode. When the insurer pays, the remittance is matched against the claim. A short payment on D2610 shows up straight away, rather than at month end.

Send D2610 claims without rekeying them

Pabau pre-fills CCSD claims from the patient record, checks the required fields and submits them to UK insurers through Healthcode. ENT billing teams spend less time chasing queried claims.

Book a demo

Conclusion

D2610 is a mid-band code on paper, yet it draws more scrutiny than its £650 fee suggests. The evidence for sac surgery is debated, and higher-paying labyrinthectomy codes sit one line below it.

The claims that pay first time share one trait. The record proves medical treatment failed before anyone booked the operation, and the operation note names the sac procedure.

Put that proof in the consultation letter, not in an appeal. Book a demo to see how Pabau keeps the referral, authorization and D2610 claim on one record.

Continue your research

Need the wider Bupa view of the CCSD schedule? Bupa CCSD codes covers the full Bupa schedule with billing rules and payer-specific guidance.

Has the MRI found a vestibular schwannoma instead? CCSD code A2952 explains how acoustic neuroma excision is coded and claimed.

Checking what a procedure is worth under Bupa? Bupa procedure codes and fee schedule explains how the fee schedule is structured and where to verify a current rate.

Coding another Chapter 5 ENT procedure? CCSD code E4100 sets out the billing rules for inserting a voice prosthesis.

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