CCSD code E1310 – Antral puncture and washout

Key takeaways

CCSD Code E1310 covers antral puncture and washout on one or both sides under a single code.

Bilateral washout is billed as one E1310, so the operative note has to document both sides clearly.

The CCSD lists antrostomy, FESS and frontal balloon sinuplasty codes as unacceptable combinations with E1310.

Pre-authorization rules vary by insurer and should be confirmed before the procedure date.

Pabau, the practice management platform we build, supports insurance billing and claims management for UK private practices.

CCSD Code E1310: Definition and official descriptor

CCSD Code E1310 is the Clinical Coding and Schedule Development (CCSD) procedure code for antral puncture and washout, including bilateral.

It is used on UK private medical insurance (PMI) claims. The code sits in the ENT chapter of the CCSD schedule. It is recognized by the major UK insurers, including Bupa, AXA Health, Aviva and Vitality Health.

The official descriptor captures three clinical scenarios under a single code:

• Unilateral antral puncture with saline washout
• Bilateral antral puncture with saline washout (both maxillary sinuses in one session)
• Antral puncture as a diagnostic procedure without therapeutic washout

Because bilateral and unilateral procedures share one code, the operative note has to show what was performed. The CCSD schedule has no separate bilateral modifier for E1310, unlike some CPT codes. Insurers rely on the procedure documentation to judge the clinical scope of the claim.

The code does not cover functional endoscopic sinus surgery (FESS), intranasal antrostomy or nasal polypectomy, which each have their own CCSD codes. The CCSD lists FESS and antrostomy codes, such as E1432 and E1330, as unacceptable combinations with E1310, so they cannot be billed together with it. Whether a same-session polypectomy can sit alongside E1310 should be confirmed against the CCSD combination list. The matrix below sets out each pairing this guide covers.

What is antral puncture and washout?

Antral puncture and washout is a minimally invasive ENT procedure. A trocar and cannula reach the maxillary sinus through the inferior meatus of the nasal cavity. Once the antrum is entered, saline irrigation flushes purulent or mucopurulent secretions from the sinus. This relieves pressure and allows bacteriological sampling where needed.

The procedural steps, in brief:

1. Patient positioned with head elevated, and topical or local anesthetic applied to the inferior meatus
2. Trocar introduced through the inferior meatus into the maxillary antrum
3. Cannula exchanged for the trocar, and sinus contents aspirated for culture if required
4. Saline or antiseptic solution irrigated through the cannula until returns are clear
5. Cannula removed, with nasal packing placed only if hemostasis requires it

For bilateral antral washout, steps 1 through 5 are repeated on the other side in the same operative session. The procedure is usually performed under local anesthetic in an outpatient or day-case setting. Some patients receive a general anesthetic instead, such as children, people with significant needle phobia, or cases needing concurrent nasal procedures.

Clinical indications for antral washout

Antral washout is indicated when maxillary sinusitis persists or recurs despite adequate medical management. In UK private ENT practice, the most common referral triggers are:

• Acute maxillary sinusitis not responding to treatment
• Chronic maxillary sinusitis with repeated courses of antibiotics failing to resolve symptoms
• Diagnostic washout where imaging alone cannot characterize sinus contents
• Post-dental extraction sinusitis with oroantral communication
• Maxillary sinus opacification on CT or MRI requiring bacteriological sampling

Washout is generally not first-line. Most insurers expect evidence of prior medical treatment before authorizing it, so the referral letter and admission documentation should record the treatment history clearly. Where an oroantral communication needs closing with a local flap, that repair is a separate procedure with its own code, E1350.

Unilateral vs bilateral: How E1310 billing works

Because CCSD Code E1310 covers both unilateral and bilateral antral washout, the number of sides changes the documentation, not the code. Bilateral is included in the single E1310 fee unless the insurer’s own schedule states otherwise. Fee treatment of bilateral cases is set by each insurer, so confirm it with them. The table below summarizes the billing approach:

Fee schedules are set by each insurer and updated periodically. Check the current Aviva fee schedule and your other insurer portals for how they pay E1310 under your recognition terms. For Bupa, the guide to the Bupa fee schedule explains how its reimbursement is structured. The claim itself needs no pound figure, only an accurate description of the procedure so the insurer can apply the right fee.

Anesthesia and facility considerations

Antral washout under local anesthetic (LA) is an outpatient procedure, and the surgical fee (E1310) does not include the anesthetist or facility charge. Under general anesthetic (GA), the anesthetist codes their time separately with the relevant CCSD anesthetic codes. The hospital or day-case unit bills the facility fee independently.

Keep anesthetic costs out of the E1310 surgical claim. Bundling them creates an over-claim that most insurer audit processes will flag. The CCSD Technical Guide sets out the unbundling rules. They govern which concurrent charges may be claimed alongside a procedure code and which count as part of the base fee.

How to document antral puncture and washout for insurance claims

The operative note is the main evidence an insurer uses to validate an E1310 claim. Weak documentation is a common reason for delayed payment or a query. A compliant operative note for E1310 should record:

1. Side(s) operated: state left, right or bilateral explicitly. “Antral washout performed” without a side creates ambiguity that slows payment.
2. Access route and technique: confirm the inferior meatus approach, trocar and cannula, and saline irrigation. Generic terms such as “sinus washout done” are insufficient.
3. Findings at the time of procedure: describe the secretions (purulent, mucopurulent, clear), the volume aspirated, and whether a bacteriological specimen was sent.
4. Anesthetic method: state LA or GA. If GA, confirm the anesthetist is billing separately, so the scope of the E1310 claim is clear.
5. Clinical indication: reference the diagnosis that drove the procedure (e.g. “chronic maxillary sinusitis bilateral, CT confirmed opacification, failed two courses of antibiotics”).

The Royal College of Surgeons of England recommends completing operative notes on the day of surgery. They should be legible and include the operating surgeon’s name and GMC number. For PMI claims, a co-signed or dictated note in the patient record gives a clear audit trail if the insurer queries the claim later.

A structured operative note template with the five items above as required fields stops a note from being signed with one missing. That keeps the field an insurer would query from going out blank.

Common billing errors to avoid with E1310

Billing errors on E1310 follow a predictable pattern. These are the ones that come up most often on ENT claims for this code:

• Submitting two E1310 codes for a bilateral procedure. The descriptor already includes bilateral, so a second code is an overbill. Insurers reject it.
• Claiming bilateral without documenting both sides. A note that reads “bilateral antral washout” but describes only one side in the technique section will be queried.
• Missing pre-authorization. Pre-authorization requirements vary by insurer and by policy tier, so confirm authorization before the procedure date. Performing E1310 without required pre-auth does not always mean refusal, but it substantially raises query risk.
• Bundling theater or anesthetic costs into the surgical fee. E1310 is the surgeon’s fee only. Include only what the surgeon performed.
• Adding a code the CCSD bars. Antrostomy (E1330), FESS and frontal balloon sinuplasty (E1360) codes cannot be billed with E1310. A same-session polypectomy or septoplasty carries its own code, so check the CCSD combination list before billing it alongside E1310.
• Late note submission. Some insurers impose documentation timelines. A note produced weeks after the procedure raises audit concerns when queried, so complete and submit it on the day.

Claims management software that ties coding to the clinical note cuts transcription errors and prompts for missing details before a claim goes out. Practices that check claims at the point of entry catch these errors before an insurer query does.

Related CCSD codes near E1310

E1310 sits in the nasal and sinus section of the CCSD ENT chapter. Knowing the adjacent codes prevents accidental substitution and shows which same-session codes the CCSD bars from being billed with E1310. See also Bupa CCSD procedure codes for insurer-specific fee lookups.

Image-guided FESS has its own billing guide under E1260, and the full set of CCSD codes covers the rest of the ENT chapter. Confirm current descriptors and fee levels against the live CCSD schedule and insurer portals, as the schedule is updated periodically.

Bupa fee data for adjacent codes can be confirmed in the Bupa code search tool. The Healix fee schedule is another publicly accessible fee reference.

How Pabau keeps E1310 notes and claims together

In many private ENT practices, the operative note lives in one system and the insurer claim is keyed into a portal by hand. The side, the technique and the code get typed twice, and each retyping is a chance for the claim and the note to disagree.

Pabau supports insurance billing and claims management in the UK, including claims sent through Healthcode to insurers such as Bupa and AXA Health. The operative note, the invoice and the claim sit in the same patient record, so the claim is built from what the surgeon documented.

The result is fewer queries about a missing side or a mismatched code, and less time chasing payment after a washout list.

Keep ENT notes and insurance claims together

Pabau supports insurance billing and claims management for UK private practices, with operative notes, invoices and claims in the same patient record.

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Conclusion

E1310 is rarely the wrong code to choose for an antral washout. Claims on it go wrong later, at the note and the code line. A note that never names the side gets queried. A second E1310, or a same-session antrostomy or FESS code, gets rejected.

So write the note on the day of surgery and record side, technique and findings. Then check every same-session code against the CCSD combination list before you bill. Do that, and the claim goes in once without a query to answer later.

Book a demo to see how Pabau keeps operative notes and insurance claims in one patient record for UK private ENT practices.

Continue your research

Need a framework for CCSD billing compliance? Bupa procedure codes and fee schedule walks through how Bupa structures CCSD reimbursement for private practitioners.

Want to reduce claim rejection rates? Claims management software covers how Pabau handles insurance billing and claims for private practices.

Billing bilateral sinus surgery instead? CCSD code E1432 explains how bilateral FESS is coded and documented.

Working on an open maxillary approach? CCSD code E1220 covers billing for the Caldwell-Luc procedure.

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