CCSD code E2140 – Stomach pull-up reconstruction after pharyngolaryngectomy

Key takeaways

CCSD code E2140 covers reconstruction using a stomach pull-up after pharyngolaryngectomy. It is a surgical ENT code, not an anesthesia code.

The pharyngolaryngectomy is billed as its own line, and E2140 sits beside it for the reconstruction.

The CCSD lists E2150, E2100, E2300 and E2320 as unacceptable combinations with E2140.

The surgeon’s operative note must name the stomach pull-up and tie it to the resection done in the same operation.

Pre-authorization should list both the resection and the reconstruction before the operation date.

CCSD code E2140: What it covers

CCSD code E2140 is the procedure code for reconstruction using stomach pull up following pharyngolaryngectomy. The CCSD schedule places it in Chapter 5, Ear, nose and throat.

Within that chapter, it sits under Section 5.7.0 Larynx and Trachea. UK private medical insurers (PMIs) pay specialist fees against this schedule. Our index of CCSD codes lists the other procedures it covers.

The code describes one step of a larger operation. First, the surgeon removes the larynx and pharynx. Then the swallowing passage is rebuilt using the stomach, and E2140 bills that rebuild. The resection itself goes on the claim under its own code.

What a stomach pull-up involves

A stomach pull-up, also called a gastric pull-up or gastric transposition, replaces the removed throat segment with the patient’s own stomach.

The surgeon frees the stomach from its abdominal attachments while keeping its blood supply intact. The stomach is then drawn up through the chest and joined to the remaining pharynx in the neck. Surgeons usually choose this method when the esophagus is removed along with the larynx and pharynx.

Because the operation spans the neck, chest and abdomen, two surgical teams often share it. In that case, each surgeon should record which part they performed.

What E2140 includes and leaves out

Scope decides which lines go on the claim, so check it before you code. The diagram below sorts each line onto the surgeon’s claim, another invoice, or off the claim entirely.

Included in E2140

• Mobilizing the stomach and bringing it up to the neck
• Joining the stomach to the remaining pharynx
• Rebuilding the swallowing passage after pharyngolaryngectomy

Outside E2140

• The pharyngolaryngectomy itself, which takes its own CCSD code
• Reconstruction with a free jejunal graft, which is E2150 instead
• Repair of pharynx (E2100), pharyngeal myotomy (E2300) and open operation on pharyngeal pouch (E2320), all listed as unacceptable combinations
• Anesthesia, which the anesthetist bills against the surgical procedure
• Hospital facility charges, which the hospital invoices directly

How an E2140 claim moves

An E2140 claim always travels with the resection line. Here is the path it takes from booking to payment.

1. Pre-authorization. The practice asks the insurer to authorize the resection and the reconstruction together.
2. Operation and note. The surgeon records the resection, the stomach pull-up and who did each part.
3. Coding. The biller enters the pharyngolaryngectomy code and E2140 as separate lines.
4. Anesthetist’s invoice. The anesthetist bills on their own invoice, against the surgical procedure.
5. Submission. Invoices go electronically through Healthcode, with the authorization reference and policy number.
6. Payment or query. The insurer checks the codes against the authorization, then pays or raises a query.

Healthcode is the main electronic billing route to UK insurers. A claim that reaches it with both lines and a matching authorization has the fewest reasons to stall.

Worked example: One operation, two lines

Picture a patient with cancer of the postcricoid region, coded C13.0. The surgeon removes the larynx, pharynx and esophagus, then rebuilds the passage with a stomach pull-up.

The finished claim looks like this:

• Line 1: The pharyngolaryngectomy code that matches the extent recorded in the note.
• Line 2: E2140 for the stomach pull-up.
• Diagnosis: C13.0, taken from the operative note.
• Anesthetist: A separate invoice against the surgical procedure.

Now suppose a second team mobilized the stomach through the abdomen. Each surgeon’s note then names their own part. Before you submit, ask the insurer how it wants the shared work invoiced.

Neighboring codes to keep apart

The CCSD lists four codes as unacceptable combinations with E2140. Each looks plausible on a long throat operation, so check them before you submit.

Always confirm descriptors in the schedule edition in force on the date of surgery. Insurers check the claim against that edition.

What the operative note must show

The surgeon’s operative note carries the claim. Insurer reviewers compare it with the descriptor, so it should use the same words.

• The resection, named as a pharyngolaryngectomy, with its extent
• Whether the esophagus was removed as well
• The reconstruction method, stated as a stomach pull-up
• The level where the stomach was joined to the pharynx
• Which surgeon performed each part, if two teams operated
• The indication and diagnosis behind the resection
• The date and the operating surgeon’s name

Write the note so a reviewer who never met the patient can match each claim line to a paragraph.

Pre-authorization: Approve both lines

UK insurers generally expect pre-authorization before planned inpatient surgery. For E2140, the authorization needs to cover the reconstruction as well as the resection.

Rules differ by insurer and policy, so check each one directly.

• Bupa: Confirm the codes in the Bupa code search, then request authorization before admission. Our guide to Bupa CCSD codes explains how Bupa applies the schedule.
• AXA Health: Request authorization with both CCSD codes and the planned admission date.
• Aviva: Check the code against the Aviva fee schedule and authorize before treatment.
• Vitality: Get authorization before treatment, quoting both codes.

Ask for the authorization reference in writing. If it names only the resection, ask the insurer to add E2140 before the operation date.

Why E2140 claims get denied

E2140 claims usually stall on the lines around the code. The table pairs each common problem with its fix.

Before-you-submit checklist

Run through these checks before the invoice leaves the practice.

• The pharyngolaryngectomy code and E2140 appear as separate lines.
• E2150, E2100, E2300 and E2320 are not on the same claim.
• The authorization reference covers both lines.
• The operative note names the stomach pull-up and the resection.
• The anesthetist’s invoice uses the surgical procedure, not E2140 as an anesthesia code.
• The descriptor matches the schedule edition in force on the date of surgery.

How Pabau sends E2140 claims through Healthcode

Keying a two-line surgical claim by hand means retyping codes, references and policy numbers for every insurer. Each retyped line is another chance for E2140 to go out without its resection code.

In Pabau, the practice software we build, billers send claims through the Healthcode integration. Its claims management software puts E2140 and the resection code on one invoice and sends it electronically. The operative note sits in the same patient record, ready if the insurer raises a query.

Send CCSD claims through Healthcode

Pabau lets UK private practices put CCSD codes on invoices and submit claims through the Healthcode integration. Operative notes and invoices stay in one patient record.

Book a demo

Conclusion

E2140 is a reconstruction code that only makes sense next to the resection it follows. Treat the two as a pair at every step, from authorization to submission. Then the claim has little left to trip on.

The effort is front-loaded. Checking the authorization and the operative note takes minutes before surgery. Fixing a rejected claim means reopening the note, the authorization and the invoice after the fact.

Book a demo to see how Pabau sends CCSD claims through Healthcode for your private practice.

Continue your research

Need the full picture of Bupa’s code set? Bupa CCSD codes explains how Bupa applies the schedule, its billing rules, and how to use its provider portal.

Billing another procedure on the pharynx? CCSD code E2300 covers pharyngeal myotomy, one of the codes that can never share a claim with E2140.

Coding the diagnosis behind the resection? ICD-10 code C13.0 covers malignant neoplasm of the postcricoid region, a common reason for pharyngolaryngectomy.

Looking up other ENT procedure codes? CCSD codes indexes the schedule’s procedures, with a billing guide for each code.

Frequently asked questions