CCSD code E5702 – Thoracotomy lung volume reduction

Key takeaways

E5702 is the CCSD code for open thoracotomy lung volume reduction on one side, used for UK private insurer billing.

Bilateral open surgery is E5700, while thoracoscopic (VATS) lung volume reduction is E5592 for one side and E5593 for both.

The CCSD schedule lists E5702 as an unacceptable combination with exploratory thoracotomy, T0320, so the access incision is never claimed separately.

CCSD sets the codes, not the fees, so check each insurer’s own fee schedule and get pre-authorisation before surgery.

Practice software such as Pabau keeps the authorisation reference, operative note and Healthcode claim together, so the claim matches the approved procedure.

CCSD Code E5702: definition and official descriptor

CCSD Code E5702 is the UK private healthcare code for open lung volume reduction surgery on one lung. The official descriptor reads: Thoracotomy lung volume reduction – unilateral. The code was added to the schedule on 20 January 2010.

The CCSD Group (Clinical Coding and Schedule Development) maintains the schedule for UK private medical insurers, including Bupa, AXA Health, Aviva, Vitality and WPA. CCSD defines the codes and their rules but sets no fees. Each insurer applies its own fee schedule to the code.

E5702 sits in Chapter 8 (Thorax and intra-thoracic organs). Two words in the descriptor decide whether it is the right code: thoracotomy, meaning open surgery, and unilateral, meaning one lung. For the wider coding rules, see the guide to CCSD codes.

Related CCSD codes: E5702 vs E5700, E5592 and E5593

The CCSD schedule codes lung volume reduction on two axes: the surgical approach and the number of sides treated. That gives four codes in total.

When both lungs are treated in the same operation through open surgery, the claim uses E5700, not two lines of E5702. When the operative note describes port incisions and a thoracoscope, the case belongs under E5592 or E5593. A planned VATS case converted to open surgery should be coded from what the operative note records, as the grid below sets out.

The schedule also lists E5702 as an unacceptable combination with T0320, exploratory thoracotomy. The thoracotomy is the access route for E5702, so it is never billed as a second procedure. If both sides are treated in separate admissions, confirm the coding with the insurer before the second operation.

What the procedure involves: open lung volume reduction

Lung volume reduction surgery removes the most damaged, over-inflated areas of an emphysematous lung. The remaining tissue can then expand, and the diaphragm can return to a more effective position. Under E5702, the surgeon reaches one lung through a thoracotomy incision rather than through thoracoscopic ports.

The operative note should record each step that supports the code:

1. Thoracotomy incision, confirming open access rather than VATS
2. Target areas, usually the upper-lobe segments with the worst destruction on CT and perfusion scanning
3. Stapled resection of the target tissue, often with buttressing material on the staple line
4. Air-leak check and haemostasis before closure
5. Chest closure, with the side operated on stated plainly

An operative note that describes port placement instead of a thoracotomy does not support E5702. Insurers compare the note with the claim on audit, so the approach and side need to be stated in words.

Indications and patient selection

In the UK, the NICE guideline on COPD (NG115) sets out who should be referred for a lung volume reduction assessment. Most surgical thresholds come from the National Emphysema Treatment Trial (NETT). Fishman et al. published its results in the New England Journal of Medicine in 2003.

Insurers judge each pre-authorisation request against their own clinical criteria, which can differ from these thresholds. Send the full lung function report rather than a summary letter, because reviewers check the raw values.

ICD-10 diagnosis codes to pair with E5702

UK private claims carry an ICD-10 diagnosis code from the WHO classification, the edition the NHS uses. It is not the US ICD-10-CM set. For E5702, the primary diagnosis comes from the emphysema category, J43. Check descriptors in the WHO ICD-10 browser before submission.

Use J43.1 or J43.2 wherever the CT report names the pattern of emphysema. An unspecified code on a high-cost elective claim invites the insurer to ask for the clinical records.

Documentation requirements for E5702 claims

Insurers can ask for any of these records before or after they pay an E5702 claim. Keeping them together in the patient record means the file is complete when the claim goes out.

• Pre-authorisation reference from the insurer, confirmed before the admission date
• Full lung function report with FEV1, TLC, RV and gas transfer values
• CT chest report describing the distribution of emphysema
• Multidisciplinary team outcome recording the patient as a surgical candidate
• Pulmonary rehabilitation record and the 6-minute walk result
• Signed operative note stating the thoracotomy approach, the side, and the areas resected
• Anaesthetic record carrying the same authorisation reference
• Discharge summary, which insurers sometimes request on high-value claims

Building the work-up as a digital form means each item is captured in a fixed field.

Pre-authorisation: what UK insurers require before approving E5702

UK private medical insurers expect pre-authorisation for elective major thoracic surgery such as E5702. A claim sent without a valid authorisation reference is very likely to be rejected. Each insurer publishes its own process, so check the current provider guidance before every request. For Bupa cases, the Bupa CCSD codes guide shows how to look up the code before you ask for approval.

Most requests need the same core evidence:

• The specialist referral and a summary of symptoms despite optimal medical treatment
• Lung function results and the CT report confirming hyperinflation and emphysema distribution
• The multidisciplinary team recommendation
• The planned procedure code, E5702, with the side and the open approach stated
• The ICD-10 diagnosis code, usually from J43

Some policies exclude or limit cover for certain conditions or procedures. Confirm the patient’s cover with the insurer at the same time as the authorisation.

Billing E5702 alongside other CCSD codes

CCSD has no two-character modifiers of the kind used in US billing. Laterality and approach are written into the code itself, which is why E5702, E5700, E5592 and E5593 exist as separate codes.

• Anaesthetist: the anaesthetist submits a separate claim with their own CCSD codes. It should carry the same authorisation reference and diagnosis code.
• Assistant surgeon: where an assistant is present, insurers handle the fee under their own rules. Check the insurer’s guidance before submitting it.
• Exploratory thoracotomy: T0320 is an unacceptable combination with E5702 and is not added to the claim.
• Other procedures in the same session: check the CCSD schedule’s unacceptable combinations for each extra code before you add it.

Common reasons E5702 claims are denied

Lung volume reduction is a high-cost elective operation, so insurers review E5702 claims closely. Most denials trace back to a mismatch between the claim and the records.

How to submit an E5702 claim via Healthcode

Healthcode is the main electronic clearing house for UK private healthcare claims. Most CCSD claims to the large UK insurers pass through it.

1. Create the invoice. Enter E5702 as the procedure code and apply the fee for the patient’s insurer and policy.
2. Add the diagnosis code. Enter the J43 code that matches the CT and lung function reports.
3. Enter the authorisation reference. Use the number the insurer issued for E5702, not one issued for a different code.
4. Record the procedure date and consultant details. The consultant’s insurer provider number must match the insurer’s records.
5. Attach supporting documents if the insurer asks. Some insurers take attachments through Healthcode, while others want a separate submission.
6. Track the claim. Watch the acknowledgement and status, and correct any rejection quickly.

How Pabau keeps E5702 claims complete before submission

An E5702 claim relies on three records agreeing: the authorisation, the operative note and the claim. When those live in email, insurer portals and spreadsheets, a claim can leave with the wrong code or no reference.

Pabau, the practice management platform we build, keeps those records in one patient file. Its claims management software pulls patient, insurer, policy and authorisation details into each claim. Validation checks flag a missing membership number or authorisation code before the claim is sent.

UK practices submit claims through the Healthcode integration without leaving Pabau. Operative-note templates built in Pabau’s forms prompt the surgeon to record the approach and the side, so the note supports E5702.

Submit complete lung volume reduction claims with Pabau

Pabau keeps authorisation references, operative notes and claim status together, so E5702 claims leave the practice coded to the right approach and side.

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Conclusion

E5702 is the right code only when one lung is reduced through an open thoracotomy. Read the operative note for the approach and the side before anything else on the claim. Both sides in one open operation is E5700, and a thoracoscopic case is E5592 or E5593.

The work that protects the claim happens before surgery. An authorisation for the exact code, and a call to the insurer when the plan changes, take minutes. A denied lung volume reduction claim can take weeks to resolve.

Book a demo to see how Pabau keeps authorisation references, operative notes and claim status together for every CCSD claim your practice submits.

Continue your research

Coding another thoracic procedure under CCSD? CCSD codes collects every CCSD billing guide in one place, chapter by chapter.

Billing the thoracoscopic version on both sides? CCSD code E5593 covers bilateral VATS lung volume reduction and how to claim it.

Treating a pneumothorax through a thoracotomy? CCSD code E5705 explains open pleurectomy and pleurodesis claims.

Submitting to Bupa? Bupa CCSD codes walks through the code lookup for Bupa procedure submissions.

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