CCSD code E5591 – Bilateral VATS bullectomy ± pleurodesis

Key takeaways

CCSD code E5591 covers bilateral VATS bullectomy, with or without pleurodesis, in Chapter 8 of the CCSD schedule.

It’s a surgical code, billed once per operation by the thoracic surgeon, not per session or per side.

Pleurodesis done in the same operation sits inside the descriptor, so it doesn’t get its own line.

E5590 is the one-sided version, and E5592 and E5593 cover VATS lung volume reduction instead.

The CCSD schedule bars E5591 from the same claim as six codes, including E5590 and open bullectomy E5703.

CCSD code E5591 covers both lungs in one line

CCSD code E5591 is the code for a bilateral bullectomy done by video-assisted thoracoscopic surgery (VATS). The official descriptor reads: Video-assisted thoracoscopic surgery (VATS) assisted bullectomy – bilateral +/- pleurodesis.

In plain terms, a thoracic surgeon removes bullae from both lungs through small chest incisions. Bullae are enlarged air spaces in damaged lung tissue. They can rupture and cause a pneumothorax, or grow large enough to squeeze healthy lung. The surgeon works with a camera and long instruments, so the chest isn’t opened.

Often, the surgeon also performs pleurodesis. This makes the two layers of the pleura stick together, so the lung is less likely to collapse again. The “+/-” in the descriptor means E5591 applies whether or not pleurodesis was done.

E5591 sits in Chapter 8 of the CCSD schedule, Thorax and intra-thoracic organs, under section 8.7, Video Assisted Thoracic Surgery (VATS). Our CCSD billing guides cover other codes in the schedule.

CCSD stands for Clinical Coding and Schedule Development. UK private medical insurers, including Bupa, AXA Health, Aviva and Vitality, pay surgeons against CCSD codes. Each insurer still sets its own fee, and our guide to Bupa CCSD codes shows how one insurer’s fee bands work.

The wording changed in August 2024. Before then, the schedule listed E5591 simply as “VATS bullectomy – bilateral”. Older fee lists and templates may still show that short name.

Five neighboring codes look like E5591 on a busy list

The VATS section groups bullectomy and lung volume reduction side by side. The open-chest versions sit nearby too. Each code differs by side, technique or approach, so pick it from the operative note.

Bullectomy and lung volume reduction are easy to mix up in a note. A bullectomy removes distinct air spaces. Lung volume reduction removes areas of emphysematous lung, so it takes E5592 or E5593. The grid below sets out all six codes by procedure and by side.

What E5591 includes, and what it can’t share a claim with

One E5591 line covers the whole operation. That means:

• Thoracoscopic bullectomy on the left and right lungs.
• Pleurodesis on either side, if the surgeon performs it.
• The surgeon’s fee only, since the anesthetist and the hospital bill separately.

The CCSD schedule also lists unacceptable combinations. These codes can’t appear on the same claim as E5591 for the same operation:

• E5432, VATS lobectomy.
• E5442, VATS assisted wedge resection of lung.
• E5590, VATS assisted bullectomy on one side.
• E5592 and E5593, VATS assisted lung volume reduction.
• E5703, thoracotomy bullectomy on both sides.

The E5591 record also cross-references E5932, VATS lung biopsy, and T1240, insertion of a chest drain. Check the coding rules for both in the schedule before you add either one to the claim.

The operative note decides whether the code holds up

Insurers check the claim against the note. So the note should describe the operation in the descriptor’s own terms. A complete E5591 note records:

• The indication, such as recurrent pneumothorax or giant bullae.
• Both sides treated, with left and right named.
• The thoracoscopic approach, and any conversion to an open operation.
• The bullae removed on each side.
• Whether pleurodesis was done, and the method used.
• Any lung resection beyond the bullae, which may point to another code.

Then add the pre-authorization reference, the date of surgery and the consultant’s details to the claim file. Keep the signed consent form with the patient record as well.

Walk a bilateral case from consultation to payment

UK private medical insurers generally ask members to get pre-authorization before planned surgery. For an elective operation like this one, assume you need it. Here is the usual path for an insured case.

1. Consultation. The thoracic surgeon confirms surgery on both sides and gives the patient the code E5591.
2. Pre-authorization. The patient quotes the code to their insurer and receives an authorization number.
3. Surgery and note. The surgeon records each side, the approach and any pleurodesis.
4. Coding. Your billing team matches the note to E5591, or to another code if the operation changed.
5. Submission. The claim goes to the insurer with the authorization number, often electronically through Healthcode.
6. Follow-up. Answer any insurer query with the note. If the insurer pays less than invoiced, check your fee agreement before billing the patient.

Take a worked example. A patient has bullous disease in both lungs and recurrent pneumothoraces. The surgeon removes the bullae on both sides by VATS and adds pleurodesis. Your team bills one E5591 line, with no separate pleurodesis line and no E5590.

Now change one detail. Suppose the surgeon converts to a thoracotomy partway through. The claim then goes out as E5703, and the authorization needs updating before you bill.

Check these points before the claim goes out

Run through this list for every E5591 claim before it leaves the practice:

• The authorization number is on the claim and matches the date of surgery.
• The claim carries one E5591 line, not one per side.
• The note names both sides and confirms a thoracoscopic approach.
• No code from the unacceptable combinations list sits on the same claim.
• Pleurodesis appears in the note only, not as an extra claim line.
• The fee matches your agreement with that insurer, not another payer’s rate.
• The anesthetist and the hospital send their own bills, separate from yours.

Five mistakes that get a bilateral claim queried

Each of these errors puts an E5591 claim out of step with the note or the schedule:

How Pabau keeps bullectomy claims tied to the operative note

In many surgical practices, a claim gets typed twice. The details go into the practice system first, then into Healthcode, with the authorization number copied from an email.

Pabau connects to Healthcode, so the claim builds from the patient record instead. With claims management in Pabau, the CCSD code, membership number and authorization reference carry across. Your team doesn’t rekey them for each insurer.

You can then follow each claim’s status and payment in one place. When an insurer queries a bilateral claim, the operative note sits in the same record.

Send clean E5591 claims to Healthcode

Pabau builds CCSD claims like E5591 from the patient record, with the authorization number attached. You can then track every claim’s status in one place.

Book a demo

Conclusion

E5591 is a narrow code, which makes it straightforward to bill well. It fits one situation: bullae removed from both lungs by VATS in a single operation.

So let the operative note settle the code. When the note names both sides, the approach and any pleurodesis, the claim and the authorization line up without a query. If the note is vague on any of the three, ask the surgeon before you code.

Book a demo to see how Pabau carries an E5591 claim from the operative note to Healthcode.

Continue your research

Billing other Bupa procedures? Bupa CCSD codes guide explains how the schedule is organized and how Bupa fee bands work.

Coding other VATS work on both sides? CCSD code A7561 covers VATS sympathectomy and how to bill it.

Looking for a different CCSD code? CCSD billing guides list our code-by-code guides for UK private practice.

Want fewer queried claims? Pabau claims management sends CCSD claims to insurers from the patient record.

Billing another bilateral operation? CCSD code E1432 shows how one line covers sinus surgery on both sides.

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