CCSD code E5410 – Pneumonectomy billing and coding

Key takeaways

CCSD code E5410 covers pneumonectomy, the removal of a whole lung, in the UK private-healthcare schedule that insurers such as Bupa and AXA Health use.

A robotic-assisted pneumonectomy is coded E5411, and a carinal resection with or without pneumonectomy is coded E4400.

A lobectomy, including segmental resection, is E5430, so the operative note and pathology report must show that the whole lung was removed.

The CCSD schedule bars E5410 on the same claim as pleural drain insertion (T1240), because the chest drain is part of the operation.

Get preauthorization from the patient’s insurer before surgery, and quote the authorization number on the claim you send through Healthcode.

CCSD code E5410: Definition and official descriptor

CCSD code E5410 is the UK private-healthcare procedure code for pneumonectomy, the surgical removal of an entire lung.

Its official descriptor is a single word: “Pneumonectomy”. The CCSD (Clinical Coding and Schedule Development) Group maintains the schedule that UK private medical insurers use to identify procedures on claims.

E5410 sits in chapter 8 of the schedule, thorax and intra-thoracic organs, in the bronchi, lungs and pleura section. It was added to the schedule on 20 January 2010. The code carries no laterality, so the operative note records whether the right or left lung was removed.

E5410 covers an open or thoracoscopic pneumonectomy. A robotic-assisted pneumonectomy has had its own code, E5411, since CCSD added it in 2024.

What does a pneumonectomy involve?

A pneumonectomy removes one whole lung, usually through a thoracotomy and sometimes by video-assisted thoracoscopic surgery (VATS). The patient is under general anesthesia, with only the other lung ventilated. The surgeon divides the main pulmonary artery, the pulmonary veins and the main bronchus, then removes the lung in one piece.

The bronchial stump is closed with staples or sutures. Many surgeons cover it with a flap of pleura, pericardium or muscle to lower the risk of a bronchopleural fistula.

Four variants matter for coding:

• Standard pneumonectomy: Removal of the whole right or left lung, coded E5410.
• Completion pneumonectomy: Removal of the lung left after an earlier lobectomy on the same side. The operative note should state that all remaining lung tissue was removed.
• Robotic-assisted pneumonectomy: The same resection done with a surgical robot, coded E5411 instead of E5410.
• Carinal pneumonectomy: The resection takes in the carina and the airway is rejoined. It is coded E4400, carinal resection with or without pneumonectomy, rather than E5410.

Clinical indications and ICD-10 codes that support E5410

A pneumonectomy is done when disease affects one lung and a smaller resection can’t remove it. Lung cancer involving the main bronchus or more than one lobe is the most common reason. UK insurers expect a WHO ICD-10 diagnosis code with the claim, and the WHO ICD-10 browser shows the full C34 hierarchy.

The diagnosis on the claim has to match the pre-operative workup and the pathology report. A pleural effusion with no documented lung disease, for example, won’t support a whole-lung resection. Check the fourth character before you submit.

What E5410 includes, and what it can’t be billed with

E5410 covers the whole operation, from opening the chest to closing it. Don’t bill these steps as separate procedures on the same claim:

• Thoracotomy or VATS access and closure
• Dissection and division of the pulmonary artery, pulmonary veins and main bronchus
• Closure and reinforcement of the bronchial stump
• Hemostasis and pleural lavage

The CCSD schedule lists T1240, insertion of tube drain into pleural cavity, as an unacceptable combination with E5410. The chest drain placed at the end of the operation is part of the pneumonectomy. T1240 therefore can’t appear on the same claim for the same operation.

Other procedures at the same sitting, such as a diagnostic bronchoscopy or a staging mediastinoscopy, may be billable separately. Check each one against the E5410 unacceptable-combinations list in the CCSD schedule first. The CCSD Technical Guide explains how the schedule treats bundled and combined procedures.

E5410 vs E5411, E5430, E4400 and E4600: Choosing the right code

The neighboring lung resection codes differ by how much lung is removed and whether the airway is rebuilt. Insurers check the operative note and the pathology report against the code you bill. Our pages on E4400 and E4600 cover the two airway reconstruction codes in more depth.

Read the operative note against four questions, in order, and the first “yes” settles the code.

A completion pneumonectomy removes the lung left after an earlier lobectomy on the same side. The E5410 descriptor is simply “Pneumonectomy”, and OPCS-4 records the same operation as E54.1, total pneumonectomy. The operative note should state that all remaining lung tissue on that side was removed. For how the rest of the schedule is organized, see our CCSD code library.

Documentation requirements for an E5410 claim

Insurers reviewing an E5410 claim look for a clear record from diagnosis to final pathology. Clinical records kept in one structured file from the first consultation make that evidence easy to produce when an insurer asks for it.

Five documents support a pneumonectomy claim:

1. Tissue diagnosis: A biopsy, bronchoscopy or endobronchial ultrasound (EBUS) result that confirms the disease.
2. Imaging: A contrast CT of the chest and, for cancer, a PET-CT for staging. The findings should match the ICD-10 code on the claim.
3. MDT decision: The record of the multidisciplinary team meeting that recommended pneumonectomy.
4. Operative note: The approach, the side, each structure divided, how the stump was closed, and confirmation that the whole lung was removed. A generic template that never states the extent of resection won’t support E5410.
5. Pathology report: Confirmation that the whole lung, or the whole remaining lung, was received.

Digital forms can standardize the operative note, so the surgeon records the side, the approach and the extent of resection for each case.

Preauthorization: What UK insurers require before E5410

UK private medical insurers such as Bupa, AXA Health, Aviva and Vitality expect preauthorization before a planned pneumonectomy. Without an authorization number, the insurer can refuse the claim even when the code and the surgery were correct.

The patient usually contacts the insurer first, and the insurer may then ask the specialist’s team for clinical details. A typical request includes:

• The diagnosis, with its ICD-10 code and a short clinical summary
• Staging for cancer (TNM) or the extent of disease for benign conditions
• The MDT recommendation
• The planned CCSD code, E5410, plus any other procedure codes for the same operation
• The hospital, the planned admission date and the expected length of stay

Record the authorization number against the episode and quote it on each invoice. If the planned operation changes, for example to a carinal resection, ask the insurer to update the authorization before you bill a different code.

Who sets the fee for E5410?

CCSD doesn’t set fees. The CCSD Group maintains the codes and descriptors, and each insurer publishes its own fee schedule against them. The amount paid for E5410 therefore depends on the patient’s insurer and policy. Our Bupa CCSD code guide shows how one insurer applies the schedule.

Three points apply to most pneumonectomy claims:

• Shortfalls: If the surgeon’s fee is above the insurer’s schedule, the patient pays the difference. Tell the patient in writing before surgery.
• Anesthetist fees: The anesthetist invoices the insurer separately, and insurer schedules list a separate anesthetist fee for the procedure.
• Hospital charges: The hospital bills the insurer on its own account for theater time, critical care and the inpatient stay.

Submitting an E5410 claim through Healthcode

Healthcode is the main electronic billing platform for UK private medical claims, and most UK insurers accept claims through it. A clean E5410 claim carries:

• The patient’s insurer and membership number
• The authorization number from preauthorization
• CCSD code E5410, with the descriptor “Pneumonectomy”
• The ICD-10 diagnosis code
• The date of surgery and the specialist’s insurer provider number

Check the claim against the E5410 unacceptable-combinations list before it leaves the practice. A claim that pairs E5410 with a pleural drain code is likely to come back rejected.

Common reasons E5410 claims are denied

An E5410 claim is high in value, so insurers check it closely. Plan for these denial reasons:

Logging denials in claims tracking software shows whether E5410 rejections cluster around one insurer, one documentation step or one coding error. Fixing that root cause saves appealing each claim on its own.

CCSD code E5410 vs OPCS-4 code E54.1

NHS hospitals record a pneumonectomy with the OPCS-4 code E54.1, total pneumonectomy. UK private insurers use CCSD code E5410 on claims instead. A private hospital may record both for the same patient, so check that the invoice to the insurer carries the CCSD code.

How Pabau keeps E5410 claims complete from note to payment

For a pneumonectomy claim, the billing team often chases three items by hand: the authorization number, a finished operative note and the right resection code. One missing item can hold up the whole claim.

Pabau keeps the authorization code on the patient’s case, with its dates and sessions. Nobody has to search old emails for it after the operation, and Pabau warns the team when a code is missing.

In the UK, Pabau submits private medical insurance claims through Healthcode and Bupa. Which insurers a practice can reach depends on Healthcode’s own payer list. Claim validation checks for missing or invalid details before submission. If a claim comes back rejected, Pabau shows the reason so the team can correct it and resubmit.

Send cleaner pneumonectomy claims through Healthcode

Pabau records preauthorization numbers, checks claims before they go to Healthcode and flags rejections. Your thoracic billing team spends less time on resubmissions.

Book a demo

Conclusion

Code E5410 only when the operative note and the pathology report prove that a whole lung was removed. Use E5411 for a robotic-assisted operation, E4400 when the carina was resected and E5430 for a lobectomy.

The code is only one part of a paid claim. The authorization number has to be in place before surgery. The claim also has to leave out codes the schedule bars with E5410, such as the pleural drain.

Building those checks into booking and documentation means fewer appeals later. Book a demo to see how Pabau keeps preauthorization numbers on file and sends thoracic surgery claims through Healthcode.

Continue your research

Need a broader CCSD billing reference? Bupa CCSD code guide covers the CCSD schedule structure, code conventions, and insurer-specific submission requirements for private healthcare.

Billing a smaller lung resection? CCSD code E5442: VATS wedge resection of lung explains when a wedge resection is coded instead of a lobectomy or pneumonectomy.

Coding other open thoracic surgery? CCSD code E5704: Thoracotomy bullectomy covers the descriptor, documentation and claim checks for that operation.

Looking to reduce claim denials across your practice? Pabau claims management tracks submission status, flags incomplete documentation, and surfaces denial patterns before they become write-offs.

Removing chest wall with the lung? CCSD code E5480: Lung resection with chest wall resection covers the code for a lung resection that also takes part of the chest wall.

Frequently asked questions