CCSD code E5705 – Open pleurectomy or pleurodesis for pneumothorax

Key takeaways

CCSD code E5705 covers an open thoracotomy with pleurectomy or pleurodesis, with or without ligation of bullae, to treat a pneumothorax.

The code sits in section 8.5.0 of the schedule, Bronchi/Lungs/Pleura, with a MAJOR+ 3 complexity band.

Check the schedule’s unacceptable combinations before you add a second code, such as a VATS pleurodesis or chest drain code.

Pre-authorize the admission, then keep the operative note, consent and imaging on file before the claim goes in.

Before you submit, confirm that the code, the authorization number and the operative note all describe the same open operation.

CCSD code E5705 covers open surgery to stop a pneumothorax recurring

CCSD code E5705 is the code for a thoracotomy with pleurectomy or pleurodesis, with or without ligation of bullae, for pneumothorax. The surgeon opens the chest, then either strips the parietal pleura or treats the pleural surfaces so the lung stays stuck to the chest wall.

Surgery like this usually follows a pneumothorax that keeps coming back, or an air leak that won’t settle with a chest drain. Ligating bullae deals with the blisters on the lung surface that tend to cause the leak. Because the descriptor includes that step, it doesn’t need a code of its own.

E5705 belongs to the Clinical Coding and Schedule Development (CCSD) schedule that UK private medical insurers use for procedures. Insurers such as Bupa, AXA Health, Aviva and Vitality share the codes, but each one sets its own fee. Our Bupa fee schedule guide shows how one insurer groups its fees.

Every part of the E5705 descriptor sets a condition

The CCSD schedule describes E5705 as “Thoracotomy pleurectomy/pleurodesis +/- ligation of bullae for pneumothorax.” The code was added on January 20, 2010. Each part of that wording shapes what the operative note has to show.

• Thoracotomy: the approach is an open incision through the chest wall. A keyhole operation done by video-assisted thoracoscopic surgery (VATS) takes a different code.
• Pleurectomy/pleurodesis: either removing the parietal pleura or creating adhesions between the pleural layers qualifies. The slash means one of the two is enough.
• +/- ligation of bullae: tying off or stapling bullae is optional. Its presence or absence doesn’t change the code.
• For pneumothorax: the indication is part of the descriptor. Pleurodesis done for another reason, such as a malignant effusion, doesn’t fit E5705.

You can browse neighboring thoracic codes in our CCSD codes by chapter index. For an open lung biopsy instead, the code is E5532. The complexity band places E5705 among the larger chest operations, and many insurers use bands like this to group fees.

Codes the schedule won’t let you bill alongside E5705

The CCSD schedule lists unacceptable combinations for E5705. These codes describe the same operation, a different route to it, or a step already included in it. Billing one of them on the same claim can get the line rejected.

The list also blocks the robotic bullectomy codes E5707 and E5708, plus needle biopsy of the lung and of the pleura. Check the schedule entry before you add any second thoracic code, because the combination rules change over time.

When a VATS operation turns into an open one

Say a surgeon books a VATS pleurectomy for a recurrent pneumothorax, then converts to an open thoracotomy partway through. Coding generally follows the operation that was finished, not the one that was booked. So E5705 may fit if the pleurectomy or pleurodesis was completed through the open incision.

Don’t assume it, though. Confirm the coding with the insurer, or check the CCSD coding principles for E5705, before you submit. Either way, the operative note should record the conversion and the reason for it.

The pre-authorization will usually name T1030, the VATS code. Ask the insurer to update it before the claim goes in, because a claim that doesn’t match the authorized code tends to stall.

How an E5705 claim moves from booking to payment

An E5705 claim passes through five stages, and each one has its own way of going wrong. The common thread is simple. Every stage has to describe the same open operation, as the path below shows.

The records that back up an E5705 claim

Insurers can ask for clinical records to confirm that the operation billed matches the operation performed. For E5705, these records carry the claim:

• Operative note: the thoracotomy approach, whether pleurectomy, pleurodesis or both were done, and any bullae ligated or stapled.
• Indication: the pneumothorax history that justified surgery, such as recurrence, a persistent air leak or a lung that failed to re-expand.
• Imaging: the chest X-ray or CT report that confirms the pneumothorax and any bullae.
• Consent form: signed consent that names the open procedure and its main risks.
• Anesthetic record: the anesthetist’s record of the general anesthetic. Anesthetists often claim separately, so confirm the arrangement with each insurer.
• Histology: the pathology report, if pleura or bullae were sent for analysis.

A structured operative note template makes these details hard to leave out. Set the approach and the procedure as required fields, and the note can’t be signed off without them.

Pre-authorize the admission before surgery is booked

E5705 is an inpatient operation, so the insurer will expect pre-authorization before the patient is admitted. The patient usually calls the insurer, and the insurer issues an authorization number for the planned procedure and hospital.

Give the insurer the code, the diagnosis, the hospital, the planned date and the consultant’s name. Then add the authorization number to the patient record so it travels with the claim. If the operation date moves, check that the authorization still covers it.

An emergency admission can’t always wait for pre-authorization. In that case, the patient or the hospital should tell the insurer as soon as possible. Check each insurer’s stated window for retrospective notification, because a late call can put the claim at risk.

Bupa publishes its procedure codes and fee details on the Bupa code search. Our Bupa CCSD codes guide explains how its schedule is organized.

Why E5705 claims get rejected, and the fix for each

Rejections on E5705 usually trace back to a mismatch between the claim, the authorization and the operative note. The table pairs the common causes with the fix.

How to challenge a rejected claim

1. Read the rejection reason: match it to the table above before you edit the claim.
2. Fix the claim itself: correct the code, the combination or the authorization number, then resubmit.
3. Send the evidence: attach the operative note, the imaging report and the authorization if the insurer disputes the operation.
4. Ask for a review: use the insurer’s appeal process, and check each insurer’s stated window for appeals.
5. Escalate if needed: the Financial Ombudsman Service handles unresolved disputes between patients and insurers.

Run this check before you submit an E5705 claim

A short check before submission catches most of the rejection reasons above. Tick each line against the patient record:

• The operative note names an open thoracotomy, not a VATS approach.
• It records a pleurectomy, a pleurodesis or both.
• The indication is pneumothorax, with the history that justified surgery.
• The authorization number is on the claim, and it names E5705.
• No blocked code, such as T1240 or T0320, sits on the same claim.
• Imaging, consent and any histology are on file.
• The claim goes in within the insurer’s stated window.

How Pabau keeps E5705 claims moving to Healthcode

Surgical claims often get typed out by hand after discharge, from notes held in several places. Each retyped field is a chance for the code, the authorization number or the date to drift from the record.

Pabau, the practice management platform we build, raises the invoice against the patient’s insurer. It works from the same record that holds the booking and the operative note. Its claims management software then sends the CCSD claim to Healthcode.

Once the claim is out, you can track its status in Pabau. Your team sees which E5705 claims are paid and which need a follow-up call, all in one list.

Send CCSD claims to Healthcode from the patient record

Pabau raises the insurer invoice from the record, submits CCSD claims like E5705 through Healthcode, and tracks each claim’s status in one place.

Book a demo

Conclusion

E5705 is a narrow code. It needs an open thoracotomy, a pleurectomy or pleurodesis, and a pneumothorax as the reason. When the operative note, the authorization and the claim agree on those three points, the claim has little to trip on.

So treat the operative note as the source and make the rest follow it. If a VATS case converts, or a drain code creeps onto the claim, fix it before submission rather than after a rejection. To see how Pabau keeps the invoice and claim tied to one patient record, book a demo.

Continue your research

Billing another open chest operation? CCSD code E5532 covers thoracotomy with lung biopsy and how it is billed.

Working on pleural procedures after surgery? CCSD code Y3811 explains how complex pleural catheter removal is coded.

Looking for neighboring codes by chapter? CCSD codes by chapter lists the schedule section by section.

Want every Bupa code in one place? Bupa CCSD procedure codes sets out the full schedule and how it is organized.

Comparing fees across procedures? Bupa procedure codes fee schedule shows how chapter groupings shape what each code pays.

Frequently asked questions